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Current Patterns of Care in Breast Cancer: Use of Adjuvant Trastuzumab

Current Patterns of Care in Breast Cancer: Use of Adjuvant Trastuzumab. Neil Love, MD September 17, 2005. Recent Trends in Adjuvant Systemic Therapy of Early Breast Cancer. Chemotherapy Taxanes Dose-dense chemotherapy Use of computer models like Adjuvant! Onco type DX™ assay

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Current Patterns of Care in Breast Cancer: Use of Adjuvant Trastuzumab

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  1. Current Patterns of Care in Breast Cancer:Use of Adjuvant Trastuzumab Neil Love, MD September 17, 2005

  2. Recent Trends in Adjuvant Systemic Therapy of Early Breast Cancer • Chemotherapy • Taxanes • Dose-dense chemotherapy • Use of computer models like Adjuvant! • Oncotype DX™ assay • Endocrine therapy • Aromatase inhibitors • Biologic therapy • Trastuzumab

  3. Trastuzumab in the Adjuvant Setting • 1.2-centimeter, Grade II tumor • ER-negative, HER2-positive • 3 positive nodes Would you utilize adjuvant trastuzumab off protocol? Source: Breast Cancer UpdatePatterns of Care Study; Vol2(1): February 2005.

  4. Clinical Use of Adjuvant Trastuzumab Would you recommend adjuvant trastuzumab to a 65-year-old woman with an ER-negative, HER2-positive tumor with 10 positive nodes? Source: Breast Cancer UpdatePatterns of Care Study; Vol2(1): February 2005.

  5. Use of Adjuvant Trastuzumab Have you ever utilized adjuvant trastuzumab in a nonprotocol setting? Source: Breast Cancer UpdatePatterns of Care Study; Vol2(1): February 2005.

  6. Breast Cancer Survivors’ Perspectives on Adjuvant Trastuzumab • Case scenario: 40-year-old woman with ER/PR/HER2-positive IDC and 6 positive nodes Source: Love NL et at. San Antonio Breast Cancer Symposium, 2003. Abstract 142.

  7. Current Patterns of Care: Case A — 1.2-cm IDC, ER/PR/HER2-positive, 3 positive nodes Source: Breast Cancer UpdatePatterns of Care Study; Vol2(2): August 2005.

  8. Current Patterns of Care: Case B — ER/PR-negative, HER2-positive, Grade II IDC:Would You Recommend Trastuzumab? Source: Breast Cancer UpdatePatterns of Care Study; Vol2(2): August 2005.

  9. Current Patterns of Care: Case C — a 55 yo with a 2.4-cm, Grade II, ER/PR-negative, HER2-positive IDCWould you start delayed trastuzumab? Source: Breast Cancer UpdatePatterns of Care Study; Vol2(2): August 2005.

  10. Sources of Information about ASCO Adjuvant Trastuzumab Trials Source: Breast Cancer UpdatePatterns of Care Study; Vol2(2): August 2005.

  11. Case of Dr Barbara Fallon New Britton, Connecticut • 42 yo woman: ER/PR-negative, HER2-positive IDC, 5 positive nodes • Enrolled on NSABP-B-31 — randomized to AC g T • Patient is now 28 months since start of adjuvant chemotherapy • Should trastuzumab be administered at this time? • If she presented today, what would you recommend?

  12. Case of Dr Gary Steinecker Oak Lawn, Illinois • 76 yo woman: 3.5-cm, ER/PR-negative, HER2-positive, node-negative IDC (2/2005) • CALGB 49909: randomized to A/C gpaclitaxel gtrastuzumab • Significant toxicity with chemotherapy (colitis) • Post AC MUGA: drop from 66% to 50% — not eligible for trastuzumab as per protocol • Repeat MUGA : EF 71%; 2D Echo: EF 45% • Should trastuzumab be administered at this time? • If she presented today, what would you recommend?

  13. Use of Media to Assist with Informed Consent: NCI SBIR Grant R43CA103264-01A1 Sandra Franco, MD Cynthia Frankel, RN Richard Margolese, MD Ms L, a participant in NSABP-B-35 Ms F, a participant in NSABP-B-38 Ms R, a participant in NSABP-B-38 Ms M, a participant in NSABP-B-31

  14. 12:00 PM Dr Wolmark: Introduction 12:05 PM Dr Love: Current patterns of care in the community 12:15 PM Dr Romond: Combined analysis: NSABP-B-31/NCCTG-N9831 12:35 PM Dr Slamon: BCIRG 006: Background, design, initial results 12:55 PM Dr Leyland-Jones: First results of the HERA trial 1:15 PM Dr Kaufman: NCCTG-N9831: Sequential versus concurrent trastuzumab and chemotherapy 1:35 PM Dr Geyer: NSABP-B-31 cardiac toxicity data 2:00 PM Close Agenda

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