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Metastatic Breast Cancer: One Size Does Not Fit All

Metastatic Breast Cancer: One Size Does Not Fit All. Clifford Hudis, M.D. Chief, Breast Cancer Medicine Service MSKCC. Breast cancer is predictable but not absolutely. Invasive Ductal Carcinoma. Message Pathways Inside Cancer Cells.

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Metastatic Breast Cancer: One Size Does Not Fit All

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  1. Metastatic Breast Cancer: One Size Does Not Fit All Clifford Hudis, M.D.Chief, Breast Cancer Medicine Service MSKCC

  2. Breast cancer is predictable but not absolutely.

  3. Invasive Ductal Carcinoma

  4. Message Pathways Inside Cancer Cells

  5. We define invasive breast cancer on the basis of 2 genes: ER and HER2

  6. ER Negative

  7. HER2 Positive

  8. HER2/neu FISH Test

  9. Outcomes are widely variable.

  10. We have to consider the genome of the tumor AND the patient.

  11. Apoptosis genes (n=641) Cytoskeleton genes (n=641)

  12. Five Kinds Of Breast Cancer? HER-2+/ER- Luminal B Luminal A Basal-like Normal Sorlie T et al, PNAS 2001

  13. Molecular profiles are: Variable by population studied Poorly adapted for clinical use Biology as yet not well characterized Relationship to conventional chemotherapy response not well characterized Ability to correctly identify molecular targets not yet proven Challenges

  14. Unsupervised Cluster Analysis of 99 primary breast carcinomas from MSKCC tumor bank

  15. IHC for differentially expressed genes in ER(-) Class A Class A Class A Class B Class B ALCAM p<0.0001 ALCAM p=0.023 A B SPDEF SPDEF p<0.0001 p<0.0001 A B AR p<0.0001 AR p=0.04 A B

  16. Your doctor makes an educated guess about the pace of the disease and treats accordingly. You and your doctor regularly assess the benefits of specific treatments and adjust accordingly Real World - Now

  17. Your doctor tests your cancer AND your normal cells. You and your doctor rationally select therapy predicted to control or cure the disease. Real World - Future

  18. Breast Cancer Medicine Service, MSKCC: 2005

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