Meme kanserinde neoadjuvan hormonoterapi - m. altınbaş
1. MEME KANSERİNDE NEOADJUVAN HORMON TEDAVİSİ PROF DR MUSTAFA ALTINBAŞ Dışkapı Yıldırım Beyazıt EAH Tıbbi Onkoloji Kliniği ANKARA 2011
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12. NEOADJUVAN HT Dixon JM, et al. Neoadjuvant endocrine therapy of breast cancer: a surgical perspective. Eur J Cancer 38: 2214-2221, 2002. %80 2 10 12 Eksemestan %89 2 19 24 Anastrozol %93 2 24 36 Letrozol %63 15 41 65 Tamoksifen MEME KORUMA ORANI NEOADJUVAN SONRASI CERRAHİ MASTEKTOMİ (BAŞLANGIÇTA) HASTA SAYISI İLAÇ
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18. Neoadj LETROZOL vs TAMOKSİFEN Kıyaslaması ( PO24 Çalışması ) 32 45 -Kısmi yanıt 4 10 -Tam yanıt <0.001 36 55 Klinik cevap (palpasyon ile) 1. HEDEF p değeri TAMOKSİFEN n=170 % LETROZOL n=154 % ETKİNLİK
19. Neoadj LETROZOL vs TAMOKSİFEN Kıyaslaması ( PO24 Çalışması ) Eiermann et al. Ann Oncol 12:1527 -1532, 2001 . 2 32 -Kısmi yanıt 1 3 -Tam yanıt <0.042 25 35 USG ile cevap 2. HEDEF p değeri TAMOKSİFEN n=170 % LETROZOL n=154 % ETKİNLİK
20. Neoadj LETROZOL vs TAMOKSİFEN Kıyaslaması ( PO24 Çalışması ) Eiermann W, et al. Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomised double-blind multicentre study. Ann Oncol 12: 1527-1532, 2001. 16 30 -Kısmi yanıt 0.022 35 45 MKC 0 4 -Tam yanıt <0.001 16 34 Mamografi ile cevap 2. HEDEF p değeri TAMOKSİFEN n=170 % LETROZOL n=154 % ETKİNLİK
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24. Neoadj HT Faz III Çalışmalar Chia YH,et al. British J Cancer 103:759-764, 2010. %39.5 A vs %35.4 T p >0.05 %37 A vs %39 AT vs %36 T p >0.05 %55 L vs %36 T P<0.001 Cevap oRR %43.0 A vs %30.8 T p >0.05 %44 A vs %24 AT vs %31 T p >0.05 %45 L vs %35 T P=0.022 MKC 3 ay 12 hafta 4 ay Süre İnop 96 MKC uygun MKC uygun değil %14 inop Hasta özelliği 451 330 337 Sayı (n) PROACT Çalışması IMPACT Çalışması Letrozol 024 Çalışması
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26. Preop Letrozol vs Anastrozol Murray et al. Breast Cancer Res Treat. 2008. 14 gün (n=105) (n=101) Letrozol 2.5 mg /gün Bi y omarker : ER, PR, Ki 67, HER - 2 CE R RAHİ R A N D O M I Z E Anastrozol 1 mg /gün
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33. Postmenopozal HR pozitif meme ca. oRR MKC Tmx, Anastrozol, Letrozol Tmx + Anastrozol Aİ > Tmx Kullanılacaksa Aİ tercih edilmelidir Neoadj Endokrin Tedavi NCCN KLAVUZU Postmenopozal HR pozitif meme ca. oRR MKC Tmx, Anastrozol, Letrozol Tmx + Anastrozol Aİ > Tmx Kullanılacaksa Aİ tercih edilmelidir
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Editor's Notes
Neoadjuvant Study P024: Design A total of 337 patients were enrolled in this randomized, double-blind, multicenter study of neoadjuvant letrozole (n=162) vs tamoxifen (n=175) for 4 months prior to surgery. Of these patients, 154 who received letrozole and 170 who received tamoxifen were evaluated for efficacy in an ITT analysis. For the safety analysis, 157 patients on letrozole and 170 on tamoxifen were included. Clinical staging mandate was that tumors be T2 (>2 cm but ≤ 5 cm) to T4c (>5 cm).
Preoperative Letrozole vs Anastrozole in ER+ Tumors: Effects on Biomarkers Biologic changes that occur within primary hormone receptor–positive breast cancers within 14 days after initiation of neoadjuvant endocrine therapy may predict for efficacy. This study was conducted to determine if 14-day changes could serve as a surrogate marker of comparative drug efficacy. 1 Letrozole and anastrozole were compared for effects on several biomarkers. A crossover study had shown that letrozole was more potent than anastrozole in suppressing total-body aromatization and estrogen synthesis in postmenopausal women with breast cancer. 2 Postmenopausal women with ER-positive operable breast cancer (3 with bilateral tumors) were randomized to receive letrozole 2.5 mg/d (n=105) or anastrozole 1 mg/d (n=101) for 14 days. Paired tumor biopsies were obtained prior to treatment (day 0) and on day 14 (N=209). They were confirmed as invasive breast cancer and were analyzed by IHC for expression levels of the following: ER and PgR (by Allred score) HER2 (2+ and 3+ considered positive for overexpression) Proliferating cells, using Ki67 antibody (percent of cells stained) 1. Murray et al. Breast Cancer Res Treat. 2008. E-pub ahead of print. 2. Geisler et al. J Clin Oncol. 2002;20:751.
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