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Carcinoma mammario metastatico CASO CLINICO n.2

Carcinoma mammario metastatico CASO CLINICO n.2. Stefania Gori Oncologia Medica- Perugia. Caso clinico n.2. Agosto 2009: Donna di anni 37 anni, premenopausa, operata altrove di quadrantectomia mammaria Sx + dissezione ascellare per ca. duttale infiltrante

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Carcinoma mammario metastatico CASO CLINICO n.2

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  1. Carcinoma mammario metastaticoCASO CLINICO n.2 Stefania Gori Oncologia Medica- Perugia

  2. Caso clinico n.2 Agosto 2009: Donna di anni 37 anni, premenopausa, operata altrove di quadrantectomia mammaria Sx + dissezione ascellare per ca. duttale infiltrante pT2 pN3(20LN+/24) M0; STADIO IIIC • G3 • ER=0%, PgR=0% • Ki67=60% • HER2= 3+ IHC Settembre 2001: Programma terapeutico (altrove): CT adiuvante (FECTaxano) seguita da RT Aveva ricevuto 1° ciclo di F600E90C600

  3. Caso clinico n.2 Vengono richiesti: RM encefalo con gadolinio: negativa PET /TC total body (9 ottobre 2009): metastasi LN mediastinici metastasi ossee: - sterno e collo femore dx IV STADIO

  4. Trattamenti Ottobre 2009 IV stadio RT femore dx + Zometa Trastuzumab Paclitaxel Febbraio 2010 RC Zometa+ trastuzumab

  5. Trattamenti Ottobre 2009 IV stadio RT femore dx + Zometa Trastuzumab Paclitaxel Febbraio 2010 RC Zometa+ trastuzumab Nov 2010 PD SNC LN Osso

  6. Novembre 2010:RM encefalo T1 con gadolinio

  7. 1- Metastasi cerebrali di 6 e 13 mm di diametro (centro semiovale e corteccia frontale dx) asintomatiche, in pt con progressione extracranica asintomatica (ossea e linfonodale).Quale sequenza di trattamento? A- Trattamento locale terapia sistemica B- Terapia sistemica  trattamento locale

  8. Dicembre 2010 RT stereotassica su entrambe le lesioni (dose di riferimento:18 Gy)

  9. Systemic therapy in brain metastases from HER2+ BC: when? Extracranial disease and .. 1-3 brain lesions Multiple (>3) brain lesions Local treatment WBRT Systemic therapy Systemic therapy Systemic therapy WBRT The choice of systemic therapy must be tailored on the following factors: Performance Status and previous agents received

  10. Lapatinib+Capecitabine (all pts pretreated with CT) RETROSPECTIVE STUDIES PHASE II PROSPECTIVE STUDIES * Optional extension phase after cerebral progression

  11. Brain metastases in HER2+ breast cancer Causesofdeath

  12. Systemic therapy in brain metastases from HER2+ BC: when? Extracranial disease and .. 1-3 brain lesions Multiple (>3) brain lesions Local treatment WBRT Systemic therapy Systemic therapy Systemic therapy WBRT The choice of systemic therapy must be tailored on the following factors: Performance Status and previous agents received

  13. 2- Quale terapia sistemica? A- Trastuzumab-based therapy B- Lapatinib +capecitabine C- Chemotherapy only

  14. Brain metastases in HER2-positive Trastuzumab-pretreated MBC SYSTEMIC THERAPY OPTIONS- Sept 2011 • Trastuzumab-based therapy (?) retrospective data Newly diagnosed brain metastasesand no PD at extracranial sites • Lapatinib + capecitabine phase II trial- Bachelot ASCO 20111 retrospective study 2 Newly diagnosed brain metastases and PD at extracranial sites • Lapatinib + capecitabine phase II trial- Bachelot ASCO 20111 retrospective study 2 • Lapatinib + capecitabine • phase II trials 3,4; retrospective studies Brain progression after RT 1.Bachelot T, ASCO 2011 #505; 2.Metro G, Gori S, Ann Oncol 2011; 3.Lin NU, Clin Cancer Res 2009;4.Lin NU, J Neurooncol 2011 online

  15. Trattamenti Dic 2010: RT stereotassica cerebrale Lapatinib+ capecitabina Nov 2011 RC Ottobre 2009 IV stadio RT femore dx Zometa Trastuzumab+ Paclitaxel Febbraio 2010 RC Zometa+ trastuzumab Nov 2010 PD SNC LN Osso Marzo 2011 RC PET/TC RM encefalo PET/TC RM encefalo

  16. Novembre 2011

  17. Grazie!

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