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Femara

What to use in treatment of breast cancer. Nolvadex. Arimidex. Femara. fulvestrant. Aromasin. and why ?????????????. Breast cancer: -in the Netherlands 10.000 new cases/year incidence has doubled since 1940, now 1000/10 6 women/year -30 % of all cancers in women

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Femara

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  1. What to use in treatment of breast cancer Nolvadex Arimidex Femara fulvestrant Aromasin and why ?????????????

  2. Breast cancer: • -in the Netherlands 10.000 new cases/year • incidence has doubled since 1940, now 1000/106 women/year • -30 % of all cancers in women • life time risk is 8-12% • -in 50% of women with primary tumors occult metastases occur • death rate: 40% in node-negative • 70% in node-positive • nearly 100% in metastatic disease • hereditary 5-10%, involvement BRCA-1, BRCA-2 and CHEK-2 • in men: incidence 1% of that of women.

  3. Hormonale behandeling bij borstkanker Remmers van de ER werking: Anti-oestrogenen borst bot endometrium endotheel SERM: tamoxifen – + + – selective ER modulatorraloxifen – + – – SERD (selective ER downregulator)= full-anti-oestrogenen: ICI 182.780 (Faslodex=Fulvestrant) doet ER afbreken. Remmers van de oestrogeen aanmaak: Aromatase remmers Nonsteroidale: Anastrazole (Arimidex) en Letrozole (Femara) Steroidale : Exemestane(Aromasin)

  4. Ligands and anti-estrogens

  5. Endocrine treatment options of breast cancer After Robertson et al, EJC, 41, 346, 2005.

  6. tumor progressie veroorzaakt door genetische chaos 100 ER- 70 recurrences tamoxifen Fulvestrant, Aromatase inhibitors ER+ treatment effect of anti-estrogen treatment on recurrence in breast cancer

  7. cofactor ER-DES ER- raloxifene agonist antagonist

  8. FRET Fluorescence Resonance Energy Transfer

  9. Profile of anti-estrogen sensitivity by FRET insensitive resistant sensitive

  10. PKAMAPK treatment tamoxifen fulvestrant raloxifene ICI 163.384 or resveratrol Hypothetical scheme of anti-estrogenic treatment of breast cancer ER positive tumor truly positive tumor, ER dependent : or not chemotherapy Individual treatment based on modification of the Estrogen Receptor

  11. Acknowledgements FRET Kees Jalink Microarray Arno Floore Arno Velds Laura van ‘t Veer CLSM Lauran Oomen Lenny Brocks FACS Anita Pfauth Frank van Diepen Monoclonal Antibody Upstate Biotechnology Inc. Anti-estrogens Michel Renoir, Geneva Claude Labrie, Quebec Organon GSK Tumor Biology Alexander Griekspoor Wilbert Zwart Lennert Janssen Astrid Balkenende Desiree Verwoerd Els Groeneveld Jacques Neefjes Rob Michalides Clinic Sabine Linn Pathology Hans Peterse Elly Mesman Ellen Riem Statistics Harm van Tinteren

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