1 / 74

Post San Antonio & Post EBCC Chemotherapie Aafke H. Honkoop

Post San Antonio & Post EBCC Chemotherapie Aafke H. Honkoop. San Antonio BCS & EBCC. Presentaties Neoadjuvante chemotherapie (2) Adjuvante chemotherapie (4) Gemetastaseerde ziekte (2) Posters Neoadjuvante chemotherapie Adjuvante chemotherapie Nieuwe middelen

elina
Download Presentation

Post San Antonio & Post EBCC Chemotherapie Aafke H. Honkoop

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Post San Antonio &Post EBCCChemotherapie Aafke H. Honkoop

  2. San Antonio BCS & EBCC • Presentaties Neoadjuvante chemotherapie (2) Adjuvante chemotherapie (4) Gemetastaseerde ziekte (2) • Posters Neoadjuvante chemotherapie Adjuvante chemotherapie Nieuwe middelen Gemetastaseerde ziekte

  3. Neoadjuvante chemotherapie • Comparison of TAC versus NX in patients non-responding to 2 cycles of neoadjuvant TAC- first results of the phase III GEPARTRIO study by the German Breast Group • Primary endocrine therapy versus chemotherapy in postmenopausal ER-positive patients Semiglazov, et al

  4. Comparison of Dox/Doce/Cyclo (TAC) versus Vino/Cape ) (NX) in patients non-responding to 2 cycles of neoadjuvant TAC GEPARTRIO

  5. GEPARTRIO • Doseringen: TAC: 75/50/500 mg/m2 NX : 25 d1,8/2500 d1-14 • Eindpunten studie Echografische response Pathologische response

  6. GEPARTRIO

  7. GEPARTRIO, conclusies • 2/3 heeft uiteindelijk nog response op TAC • TAC meer toxiciteit (hematologisch als ook niet-hematologisch) • NX goed alternatief voor TAC

  8. Neoadjuvante endocriene therapie versus chemotherapie • T2N1, T3N1-0, T4NOMO (geen IBC) • ER+, postmenopausale patienten • AI versus Doxorubicine/Paclitaxel 60/200, q 3wkn • Eindpunten: Klinische response Echografische response Pathologische response mammasparende operatie Semiglazov, et al

  9. Neoadjuvante endocriene therapie versus chemotherapie

  10. Neoadjuvante endocriene therapie versus chemotherapie CONCLUSIES • Effectiviteit endocriene therapie gelijk aan chemotherapie • Endocriene therapie minder toxisch

  11. Adjuvante chemotherapie GEICAM 9906; 6xFEC versus 4xFEC -8xP q1wk 4xTC versus 4xAC , Jones et al. Houston INT C9741 Dose Dense INT E1199, 4xAC- P1, P3, D1 of D3

  12. Doce/Cyclo (TC) versus Dox/Cyclo (AC) in early breast cancer • N=1016, N0 en N+ • 4 x AC versus 4 x TC • Chemotherapie voor Radiotherapie • Tam na chemotherapie, indien ER+ • Eindpunten: DFS (primair) OS en Toxiciteit (secundair) Jones et al, Texas

  13. TC versus AC

  14. TC versus AC

  15. TC versus AC

  16. TC versus AC conclusies • TC betere DFS • TC minder toxiciteit • TC nieuwe standaard

  17. Five year follow-up of INT C9741: dose-dense is safe and effective

  18. INT C9741

  19. INT C9741

  20. INT C9741

  21. INT C9741

  22. INT C9741

  23. INT C9741

  24. INT C9741 conclusies • Dose Dense is superior • Geen verschil sequentieel versus gelijktijdig • Data stabiel t.o.v. 3 jaar geleden • Toxiciteit van DD acceptabel • Groter voordeel van DD bij ER-

  25. Phase III study of AC followed by P or D Q 1wk or Q 3wk in N+ and N0 high risk Patients: INT E1199

  26. INT E1199 • Eindpunten : DFS en OS • Vergelijking : P versus D Q1 versus Q3 P3 als standaard versus andere armen (subset ER- P3 versus andere armen) • Median follow-up: 46.5 mnd • N=4988

  27. INT E1199

  28. INT E1199

  29. INT E1199

  30. INT E1199

  31. INT E1199 conclusies • Docetaxel en Paclitaxel even effectief • Q1 wk gelijk aan Q3 wk • Trend voor een betere DFS P1 tov P3 (meer uitgesproken bij ER-) • D1 meer gr3/4 tox; 39% versus 24%

  32. GEICAM 99066xFEC versus 4xFEC- 8xP in N+ BC

  33. GEICAM 9906 • Eindpunten: DFS en OS • Vergelijking: 6xFEC90 4xFEC90 - 8xP 100 q1wk • Median follow-up: 47 mnd • N=1248

  34. GEICAM 9906

  35. GEICAM 9906

  36. Geicam 9906

  37. Geicam 9906 conclusies • Toxiciteit van beide schema’s acceptabel • FEC - P meer myalgie • FEC meer neutropenie • Adjuvant FEC - P effectiever in alle subgroepen tav DFS • Geen verschil in OS

  38. Gemetastaseerd mammacarcinoom • Meta-analyse eerste lijn Taxanen (Piccart) Hoge dosis chemotherapie (Rodenhuis)

  39. INCORPORATION OF TAXANES IN FIRST LINE CHEMOTHERAPY FOR ADVANCED BREAST CANCER : A META-ANALYSIS Presenter : Martine J. Piccart-Gebhart, MD, PhD Statisticians : Tomasz Burzykowski, PhD, Marc Buyse, ScD Clinical Fellows : Gul Atalay, Daniela Rosa Financial support : EORTC Breast Cancer Group

  40. In2002 • N = 12 trials with inconsistent results • Doxorubicin (8), Epirubicin (4) • Docetaxel (6), Paclitaxel (6) • Survival gain in only one trial (Jassem et al) • Greater toxicity and cost with the anthracycline + taxane regimens • Febrile neutropenia 8 – 21% (paclitaxel + A) 23 – 33% (docetaxel + A) • Cross-over rates 24 – 57%

  41. Individual patient data were collected (not merely summary statistics from the literature): • All relevant trials were included, whether published or not • Reporting biases were avoided • Data were extensively checked (and resulted in the exclusion of one trial) • The power of the analyses was maximized • Subgroup analyses (by visceral disease / ER status) could be performed

  42. Progression-free survival hazard ratios

  43. Overall survival hazard ratios

  44. Single agent doxorubicine (at 75 mg/m2) was better than single agent taxane in terms of response rate and PFS in one of 3 trials • Taxanes in combination with anthracyclines provide greater chances of "response" remain the treatment of choice when a "response" is desirable • The impact of taxanes on progression-free survival appears to be marginal and their impact on survival has not been shown by this meta-analysis of trials conducted in the "empirical" era of oncology • More attention needs to be paid to cross-over • Strong considerations should be given to trials run in better defined “molecular” sub-populations

  45. High-Dose Chemotherapyin Breast Cancer A ‘Critical Review’, or: Is it dead ? Rodenhuis

  46. High-dose Therapy in Breast Cancer: • in stage IV patients (phase II) Strong rationale derived from model systems • High objective response rates • Excellent DFS rate in high-risk primary breast cancer (phase II)

  47. 861 Stage IV Patients Randomized6 studies, 6 different HD regimens

  48. High-Dose Chemotherapy with PBPC-Tx in Advanced Breast Cancer • High-dose chemotherapy cannot eradicate macroscopic disease • It may (sometimes) eradicate micrometastases (when any macrometastatic disease is either resected or irradiated • ( ? but could this also be achieved by conventionally dosed chemotherapy ? )

  49. High-Dose Chemotherapy with PBPC-Tx in High-Risk Breast Cancer • Over5500 patients treated in 14 (reported) randomized studies • Many studies (allunderpowered, most too early for OS analysis) show trend for RFS benefit for dose-intensive arm

More Related