SlideShare uma empresa Scribd logo
1 de 42
What’s New in Treatment and
Clinical Trials for Advanced Triple-
Negative Breast Cancer
Nancy Lin, MD
Susan F. Smith Center for Women’s Cancers
Dana-Farber Cancer Institute
October 17, 2015
Outline
• Definitions: What is TNBC?
• Treatment: How do we treat TNBC?
• New Directions: What are some exciting
approaches being tested in clinical trials?
• Clinical Trials: Which, why, how, when?
• There are three main subtypes of
breast cancer
• Within these, there are other ways
to further sub-divide breast cancers
• Oncologists use the breast cancer
subtype to guide the kinds of
treatments to recommend
• Clinical trials often will focus on
specific subtypes
Breast Cancer Subtypes
Breast Cancer Subtypes
Breast Cancer Subtypes
ER-positive
HER2-positive
Triple-negative
TALK to your doctor if you are not sure what type of breast cancer you have
“Triple Negative” Breast Cancer (TNBC)
• Defined as negative for estrogen, progesterone, and HER2 receptors
• Represents about 15% of all breast cancer
• More likely to present in younger women and in women of African
ancestry
• May be associated with an inherited mutation in BRCA1
– But--most patients with triple negative breast cancer do not carry a
hereditary BRCA1 mutation
– Other hereditary mutations: PALB2, RAD51c, BARD1
– National guidelines recommend consideration of genetic testing in women
younger than age 60 with TNBC, regardless of family history
Hormonal
therapy
Hormonal
therapy
Chemotherapy Chemotherapy
Chemotherapy Chemotherapy Chemotherapy
Herceptin +
perjeta +
chemotherapy
TDM1
Lapatinib +
Capecitabine
Herceptin +
chemotherapy
Herceptin +
chemotherapy
Hormone receptor
positive
Triple-negative
HER2-Positive
*Note, these are just examples. Each patient is different and treatment is tailored accordingly.
How Do We Treat
Metastatic Breast Cancer?
Chemotherapy for Metastatic Breast Cancer
Many active and tolerable chemotherapy choices
• Order of chemotherapy does not appear to
influence survival
• Choose chemotherapy based on:
– Activity level seen in clinical trials
– Amount of active cancer/need for rapid response
– Prior treatments
– Route of administration (pills versus IV)
– Side effect profile
– Other health problems
• Blood counts, neuropathy, diabetes, heart problems, liver
function
Choice of Chemotherapy in Metastatic TNBC
Drug Route Hair loss Diarrhea Neuropathy PPE Allergic
reactions
Paclitaxel
(Taxol)
IV weekly
2 or 3 wks in a row
Then off 1 wk
Yes No Yes No Possible
Capecitabine
(Xeloda)
Oral twice daily
2 wks in a row
Then off 1 wk
No Yes No Yes No
Eribulin
(Halaven)
IV weekly
2 wks in a row
Then off 1 wk
Sometimes No Yes No No
Choice of Chemotherapy in Metastatic TNBC:
One example
•Was a taxane given previously for early-stage disease? If yes, how long ago?
•What chemotherapies have been given for metastatic cancer previously?
•Able to take and absorb pills?
•How is the liver function?
•On coumadin (warfarin)?
•Problems with blood sugar control?
Is all TNBC the same?
ER-negative, PR-negative
HER2-negative
HER2+ Estrogen
receptor +
Triple
Negative
GENES
TUMORS
Breast cancer is a family of different cancers
Triple
Negative
GENES
TUMORS
Breast cancer is family of different cancers
Heterogeneity of TNBC
TNBC is not just one disease—
Different subtypes likely have different “Achilles’ heels”
VEGF
EGFR
PTEN
loss
BRCA1-
Basal-like
AR
Immune
infiltrate
Many Approaches Under Evaluation for TNBC
in Clinical Trials!
Pathway/Drug type Drugs in development
DNA repair PARP inhibitors (olaparib, rucaparib, veliparib), platinum
agents (cisplatin, carboplatin)
PI3K/Akt/mTOR PI3K inhibitors (buparlisib, taselisib, GDC0941,
AZD8186, many others); Akt inhibitors (GDC0068,
others), mTOR inhibitors (everolius, others)
Androgen (testosterone)
signaling
Anti-androgens (bicalutamide, enzalutamide),
Immune CTLA4 blockade (ipilumumab), PD1/PD-L1 blockade
(nivolumab, pembrolizumab, MPDL3280A),
Antibody-drug conjugates IMMU-132, SGN-LIV1A, PF06647263, CDX-011
Cell cycle Dinaciclib
Chk1 GDC0575
Bromodomain TEN-101, GSK525762
Heat shock (stress) Ganetespib, others
Angiogenesis Ramucirumab, cedirinib
Targeting DNA repair
PARP Inhibitors
•Tumors of BRCA 1/2+
patients lose 2
important ways to
repair DNA when
treated with a PARP
inhibitor
•Multiple trials testing
PARP vs chemo in
BRCA 1/2 carriers
•Trials combining PARP
with other drugs in
BRCA 1/2 non-carriers
Olaparib in BRCA 1/2 Carriers with
Metastatic Breast Cancer
Tutt et al, 2010
Ongoing Olaparib Trial*
Inherited BRCA 1
or
BRCA2 mutation
Up to 2 previous
types
of chemotherapy
for MBC
Olaparib
Choice of standard chemotherapy
-Capecitabine (Xeloda)
-Vinorelbine (Navelbine)
-Eribulin (Halaven)
*Other PARP inhibitors being evaluated in a similar fashion
Targeting the PI3K/Akt/mTOR pathway
Polyak and Filho, Cancer Cell, 2012
Targeting the PI3Kinase Pathway
Modulating the immune system
22
Kyi, FEBS Letters 2014
aKaplan-Meier estimate.
Analysis cut-off date: November 10, 2014.
0 8 16 24 32 40 48 56
Time, weeks
Responder
Nonresponder
CR
PR
SD
PD
PD after CR, PR, or SD
Last dose
Treatment ongoing
Best overall response
A Phase Ib Study of Pembrolizumab (MK-3475,anti-PD-1 Ab)
in Patients With Advanced Triple-Negative Breast Cancer.
Nanda et al.
Immunotherapy trials available at DFCI
FIRST LINE TNBC
Protocol # Short Title Eligibility
15-241 Ph3 Abraxane +/- Atezolizumab (PDL1 Ab) Measurable Disease
No prior treatment for metastatic dz
15-307 Ph1/2 Eribulin + Pembrolizumab
SECOND LINE and BEYOND TNBC
15-240 Phase 2 Pembrolizumab Monotherapy 2L+ Measurable disease
Biopsy required
Prior A + T required
15-307 Ph 1/2 Eribulin + Pembrolizumab
11-314 Atezolizumab (PDL1) monotherapy for PDL1+
TNBC
Requires tumor prescreening
Any line of therapy
Targeting the Androgen Receptor
Androgen Receptor Function: The Basics
Testosterone
Androgen
Receptor
Androgen Receptor Function: The Basics
Testosterone
Androgen
Receptor
DNA
Targeting AR in the Clinic
• Bicalutamide
– TBCRC 011 study
– No objective responses…but 21% had stable disease >
6 months
• Enzalutamide
– Study MDV 3100-11
– 20% of patients had stable disease > 6 months
– “PredictAR” gene signature sorted patients (with 0-1
prior treatments) to those with average disease
control 2 months vs 10 months
Antibody-Drug Conjugates
Antibody Drug Conjugates in TNBC
30
1. Monoclonal antibody specific
for a tumor antigen with
little/no expression on normal
cells
2. Linker that is stable in
circulation but releases the
cytotoxic agent in target cells
3. Potent cytotoxic agent designed
to induce target cell death
when internalized and released
IMMU-132
• Target: Trop2 (EGP-1)
– Oncogene associated with increased aggressiveness
and metastasis.
– Prognostic marker in several cancer types
• Linker: pH sensitive linker (CL2A)
• Cytotoxic: SN-38 (Irinotecan active metabolite)
– 7.6 drug molecules/IgG
31
Phase I/II Trial of Sacituzumab
Govitecan (IMMU-132), an anti-Trop-
2-SN-38 antibody-drug conjugate, in
refractory/relapsed metastatic triple-
negative breast cancer
Aditya Bardia1, Linda T. Vahdat2, Jennifer R. Diamond3, Alexander N. Starodub4, Rebecca
Moroose5, Steven Isakoff 1, Allyson J. Ocean2, Jordan D. Berlin6, Wells A. Messersmith3, Sajeve
S. Thomas5, Francois Wilhelm7, William A. Wegener8, Pius P. Maliakal7, Robert M. Sharkey7,
David M. Goldenberg7, Ingrid A. Mayer6
1Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; 2Weill Cornell Medical
College, New York, NY; 3Vanderbilt-Ingram Cancer Center, Nashville, TN; 3University of Colorado Cancer
Center, Aurora, CO;4Indiana University Health Center for Cancer Care, Goshen, IN; 5UF Health Cancer Center,
Orlando, FL; 6Vanderbilt-Ingram Cancer Center, Nashville, TN; 7Immunomedics, Inc., Morris Plains, NJ.
32
255-022
111-029
255-008
255-025
252-004
255-028
111-018
255-018
252-009
255-005
252-014
254-012
255-019
252-007
111-006
111-030
254-019
252-001
181-004
255-021
255-027
111-013
254-016
255-011
252-010
255-023
204-005
255-029
254-017
255-024
254-009
255-026
252-003
111-002
254-021
255-015
255-004
255-010
111-033
204-009
-1 0 0
-8 0
-6 0
-4 0
-2 0
0
2 0
4 0
6 0
8 0
1 0 0
BestResponse
(%changeintargetlesionfrombaseline)
CR = 2
PR = 13
SD = 22
PD = 12
22 pts continuing
Prior chemotherapies = 4 (median; range=1-11)
TNBC Best Response (N = 49 assessable patients)
• 58 patients enrolled; 4 have not had their first assessment; 4 excluded
because ≤2 doses given; 1 excluded with starting dose of 18 mg/kg
• Doses (mg/kg) given (N = 49): 8 (N = 13), 10 (N = 34), 12 (N = 2)33
Objective response = 15/49 = 31%
Disease control = 37/49 = 76%
Clinical benefit ratio [CR+PR+(SD ≥4 mo)] = 63%*
*29/46; 3 pts with SD <4 mo are continuing treatment
9 pts with PD because of progression of
non-target lesion or new lesion are not
shown in graph
15 May 2015
CDX-011 (glembatumumab vedotin)
• Target: GPNMB
• Cytotoxic- monomethyl-aurostatin E (MMAE)
• EMERGE study – Ph2 CDX-011 vs Investigator Choice
• 122 pts enrolled (TNBC/ER+), median 6 prior
regimens
34
Phase 2 EMERGE study
CDX-011 vs Investigator’s choice of rx
35
Common treatment related AE’s: rash, fatigue, nausea, neutropenia, alopecia
*Median number of lines of cytotoxic rx for MBC=4
*
Yardley et al JCO 33:1609, 2015
METRIC study
Glembatumumab Vedotin
1.88 mg/kg IV Day 1 of 21-
day cycles
Capecitabine 1250 mg/m2
BID Days 1-14 of 21-day
cycles
2:1 randomization
Primary Endpoint
• Progression free survival by independent review
N=300
 Metastatic TNBC
overexpressing gpNMB
 0-2 prior chemo for MBC
 Prior Taxane and
anthracycline
ClinicalTrials.gov Identifier: NCT01997333
Other Antibody Drug Conjugates in
Development for TNBC
• SGN-LIV1A
– Target: LIV-1, transmembrane protein in
65% TNBC
– Ph1 in breast ca ongoing
• PF-06647263
– Target: EFNA4
– Phase 1 in breast cancer ongoing
37
How Can We Do Better?
Participate in Trials!
• “One reason I chose to participate in a clinical trial
was to help women with triple-negative breast
cancer. It is thanks to women who have enrolled in
clinical trials that we have the treatments that give
us hope.”
– Natalia (LBBC, Guide to Understanding TNBC)
Clinical Trials: FAQs
• When should I consider a clinical trial?
– Clinical trials may be an option for you as early as the first treatment you receive for
metastatic breast cancer, but may also be an option further into the course of your
disease.
– If you are interested in trials, getting connected early to a treatment team who can help
identify potential trials for you is key.
• Will I have to pay more to be on a trial?
– All normal procedures are billed to insurance; anything beyond normal care is paid for
by the trial. There should be no “upcharge” for being in a trial
• Is being on a trial busy?
– Each trial is different and has a different schedule
• Will I know what medicine I am getting? I don’t want a placebo.
– In most trials, both patient and provider know exactly what treatment is being given.
– Some larger trials use randomization and placebos, and in some cases neither patient
nor provider know identity of study drug.
– But in almost every trial with placebo, at minimum a patient receives best standard of
care.
How to learn about trials?
OR……
How to learn about trials?
• Know what subtype of breast cancer you have
• Learn about your family history and consider BRCA
testing
• Talk to your doctor and/or nurse
• Consider on-line resources
• Consider receiving care and/or consultation in a center
with a focus on clinical trials
Advanced TNBC: Conclusions
• TNBC is unique compared to other types of breast cancer
• Not all TNBC is the same
• Chemotherapy works for TNBC, and there are a number of standard
options
• No single best target has been identified so far; however, TNBC is an area
of very active research; many exciting new agents and approaches in the
pipeline
• Speak to your provider about entering a trial!
• Future progress depends on.....Making every woman count!

Mais conteúdo relacionado

Mais procurados

Hitting the Target in HER2-Positive Metastatic Colorectal Cancer
Hitting the Target in HER2-Positive Metastatic Colorectal CancerHitting the Target in HER2-Positive Metastatic Colorectal Cancer
Hitting the Target in HER2-Positive Metastatic Colorectal Canceri3 Health
 
Proteasome inhibitors in treatment of multiple myeloma
Proteasome inhibitors in treatment of multiple myelomaProteasome inhibitors in treatment of multiple myeloma
Proteasome inhibitors in treatment of multiple myelomaAlok Gupta
 
Clinical Trials for Metastatic HER2-positive Breast Cancer
Clinical Trials for Metastatic HER2-positive Breast CancerClinical Trials for Metastatic HER2-positive Breast Cancer
Clinical Trials for Metastatic HER2-positive Breast CancerDana-Farber Cancer Institute
 
Management of metastatic colorectal cancer
Management of metastatic colorectal cancerManagement of metastatic colorectal cancer
Management of metastatic colorectal cancerMohamed Abdulla
 
Triple Negative Breast Cancer
Triple Negative Breast CancerTriple Negative Breast Cancer
Triple Negative Breast CancerMohamed Abdulla
 
Targeted cancer therapy
Targeted cancer therapy Targeted cancer therapy
Targeted cancer therapy amarjeet singh
 
NEW AGE ADC IN LUNG CANCER 2022.pptx
NEW AGE ADC IN LUNG CANCER 2022.pptxNEW AGE ADC IN LUNG CANCER 2022.pptx
NEW AGE ADC IN LUNG CANCER 2022.pptxmadurai
 
Clinical Trials for Metastatic Triple-Negative Breast Cancer
Clinical Trials for Metastatic Triple-Negative Breast CancerClinical Trials for Metastatic Triple-Negative Breast Cancer
Clinical Trials for Metastatic Triple-Negative Breast CancerDana-Farber Cancer Institute
 
chemotherapy for gastric cancer.pptx
chemotherapy for gastric cancer.pptxchemotherapy for gastric cancer.pptx
chemotherapy for gastric cancer.pptxSujan Shrestha
 
What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...
What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...
What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...Canadian Cancer Survivor Network
 
Role of olaparib in breast and ovarian cancers
Role of olaparib in breast and ovarian cancersRole of olaparib in breast and ovarian cancers
Role of olaparib in breast and ovarian cancersSabeena Choudhary
 
Targeted therapy anticancer drugs
Targeted therapy anticancer drugsTargeted therapy anticancer drugs
Targeted therapy anticancer drugsAbarna Ravi
 
Immunotherapy advances in lung cancer
Immunotherapy advances in lung cancerImmunotherapy advances in lung cancer
Immunotherapy advances in lung cancerAlok Gupta
 
landmark trials in ca rectum.pptx
landmark trials in ca rectum.pptxlandmark trials in ca rectum.pptx
landmark trials in ca rectum.pptxmasoom parwez
 
Introduction to Targeted Therapies in Oncology
Introduction to Targeted Therapies in OncologyIntroduction to Targeted Therapies in Oncology
Introduction to Targeted Therapies in OncologyMohamed Abdulla
 
Right vs Left Sidedness in Colon Cancer.pptx
Right vs Left Sidedness in Colon Cancer.pptxRight vs Left Sidedness in Colon Cancer.pptx
Right vs Left Sidedness in Colon Cancer.pptxDrMalcolmBrigden1
 

Mais procurados (20)

Hitting the Target in HER2-Positive Metastatic Colorectal Cancer
Hitting the Target in HER2-Positive Metastatic Colorectal CancerHitting the Target in HER2-Positive Metastatic Colorectal Cancer
Hitting the Target in HER2-Positive Metastatic Colorectal Cancer
 
Proteasome inhibitors in treatment of multiple myeloma
Proteasome inhibitors in treatment of multiple myelomaProteasome inhibitors in treatment of multiple myeloma
Proteasome inhibitors in treatment of multiple myeloma
 
Cleopatra trial
Cleopatra trialCleopatra trial
Cleopatra trial
 
Clinical Trials for Metastatic HER2-positive Breast Cancer
Clinical Trials for Metastatic HER2-positive Breast CancerClinical Trials for Metastatic HER2-positive Breast Cancer
Clinical Trials for Metastatic HER2-positive Breast Cancer
 
Management of metastatic colorectal cancer
Management of metastatic colorectal cancerManagement of metastatic colorectal cancer
Management of metastatic colorectal cancer
 
MANAGEMENT OF EARLY OPERABLE HER2+ BREAST CANCER.pptx
MANAGEMENT OF EARLY OPERABLE HER2+ BREAST CANCER.pptxMANAGEMENT OF EARLY OPERABLE HER2+ BREAST CANCER.pptx
MANAGEMENT OF EARLY OPERABLE HER2+ BREAST CANCER.pptx
 
Triple Negative Breast Cancer
Triple Negative Breast CancerTriple Negative Breast Cancer
Triple Negative Breast Cancer
 
Targeting Advanced Triple-Negative Breast Cancer
Targeting Advanced Triple-Negative Breast CancerTargeting Advanced Triple-Negative Breast Cancer
Targeting Advanced Triple-Negative Breast Cancer
 
Targeted cancer therapy
Targeted cancer therapy Targeted cancer therapy
Targeted cancer therapy
 
NEW AGE ADC IN LUNG CANCER 2022.pptx
NEW AGE ADC IN LUNG CANCER 2022.pptxNEW AGE ADC IN LUNG CANCER 2022.pptx
NEW AGE ADC IN LUNG CANCER 2022.pptx
 
Clinical Trials for Metastatic Triple-Negative Breast Cancer
Clinical Trials for Metastatic Triple-Negative Breast CancerClinical Trials for Metastatic Triple-Negative Breast Cancer
Clinical Trials for Metastatic Triple-Negative Breast Cancer
 
chemotherapy for gastric cancer.pptx
chemotherapy for gastric cancer.pptxchemotherapy for gastric cancer.pptx
chemotherapy for gastric cancer.pptx
 
What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...
What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...
What is New for the Prostate Cancer Patient with Non-Metastatic Castration Re...
 
MANAGEMENT OF LUMINAL BREAST CANCER.pptx
MANAGEMENT OF LUMINAL BREAST CANCER.pptxMANAGEMENT OF LUMINAL BREAST CANCER.pptx
MANAGEMENT OF LUMINAL BREAST CANCER.pptx
 
Role of olaparib in breast and ovarian cancers
Role of olaparib in breast and ovarian cancersRole of olaparib in breast and ovarian cancers
Role of olaparib in breast and ovarian cancers
 
Targeted therapy anticancer drugs
Targeted therapy anticancer drugsTargeted therapy anticancer drugs
Targeted therapy anticancer drugs
 
Immunotherapy advances in lung cancer
Immunotherapy advances in lung cancerImmunotherapy advances in lung cancer
Immunotherapy advances in lung cancer
 
landmark trials in ca rectum.pptx
landmark trials in ca rectum.pptxlandmark trials in ca rectum.pptx
landmark trials in ca rectum.pptx
 
Introduction to Targeted Therapies in Oncology
Introduction to Targeted Therapies in OncologyIntroduction to Targeted Therapies in Oncology
Introduction to Targeted Therapies in Oncology
 
Right vs Left Sidedness in Colon Cancer.pptx
Right vs Left Sidedness in Colon Cancer.pptxRight vs Left Sidedness in Colon Cancer.pptx
Right vs Left Sidedness in Colon Cancer.pptx
 

Destaque

triple negative breast cancer
triple negative breast cancertriple negative breast cancer
triple negative breast cancerLuis Toache
 
Should triple negative breast cancer (tnbc) subtype
Should triple negative breast cancer (tnbc) subtypeShould triple negative breast cancer (tnbc) subtype
Should triple negative breast cancer (tnbc) subtypeEreny Samwel
 
What’s New in Biology, Treatment and Clinical Trials for Metastatic Triple-N...
What’s New in Biology, Treatment  and Clinical Trials for Metastatic Triple-N...What’s New in Biology, Treatment  and Clinical Trials for Metastatic Triple-N...
What’s New in Biology, Treatment and Clinical Trials for Metastatic Triple-N...Dana-Farber Cancer Institute
 
What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...
What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...
What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...Dana-Farber Cancer Institute
 
Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...
Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...
Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...Dana-Farber Cancer Institute
 
Gene expression profiling in breast carcinoma
Gene expression profiling in breast carcinomaGene expression profiling in breast carcinoma
Gene expression profiling in breast carcinomaghoshparthanrs
 
Adjuvant chemotherapy of breast cancer
Adjuvant chemotherapy of breast cancerAdjuvant chemotherapy of breast cancer
Adjuvant chemotherapy of breast cancerGita Bhat
 
Treatment of her2 positive breast cancer
Treatment of her2 positive breast cancerTreatment of her2 positive breast cancer
Treatment of her2 positive breast cancerManar Malik
 
Breast Cancer Highlights: ASCO 2015
Breast Cancer Highlights: ASCO 2015Breast Cancer Highlights: ASCO 2015
Breast Cancer Highlights: ASCO 2015spa718
 
ASCO 2016 Breast Cancer Review
ASCO 2016 Breast Cancer ReviewASCO 2016 Breast Cancer Review
ASCO 2016 Breast Cancer ReviewOSUCCC - James
 
Breast Cancer.ppt
Breast Cancer.pptBreast Cancer.ppt
Breast Cancer.pptShama
 
Screen breast cancer gigerenzer (bmj. 2014)
Screen breast cancer  gigerenzer (bmj. 2014)Screen breast cancer  gigerenzer (bmj. 2014)
Screen breast cancer gigerenzer (bmj. 2014)Miguel Pizzanelli
 
Women’s autonomy confronted with massive screening
Women’s autonomy confronted with massive screeningWomen’s autonomy confronted with massive screening
Women’s autonomy confronted with massive screeningMiguel Pizzanelli
 
Prostate cancer radiotherapy
Prostate cancer radiotherapyProstate cancer radiotherapy
Prostate cancer radiotherapymohamed alhefny
 
Screening y metodos diagnosticos emi y guille
Screening y metodos diagnosticos emi y guilleScreening y metodos diagnosticos emi y guille
Screening y metodos diagnosticos emi y guilleGINECOLOGIAHIGASM
 

Destaque (20)

triple negative breast cancer
triple negative breast cancertriple negative breast cancer
triple negative breast cancer
 
Should triple negative breast cancer (tnbc) subtype
Should triple negative breast cancer (tnbc) subtypeShould triple negative breast cancer (tnbc) subtype
Should triple negative breast cancer (tnbc) subtype
 
What’s New in Biology, Treatment and Clinical Trials for Metastatic Triple-N...
What’s New in Biology, Treatment  and Clinical Trials for Metastatic Triple-N...What’s New in Biology, Treatment  and Clinical Trials for Metastatic Triple-N...
What’s New in Biology, Treatment and Clinical Trials for Metastatic Triple-N...
 
What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...
What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...
What's New in Metastatic Research and Clinical Trials: ER Positive and Triple...
 
Fifth Annual Metastatic Breast Cancer Forum
Fifth Annual Metastatic Breast Cancer ForumFifth Annual Metastatic Breast Cancer Forum
Fifth Annual Metastatic Breast Cancer Forum
 
Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...
Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...
Making Progress in the Treatment of Estrogen Receptor Positive Metastatic Bre...
 
Gene expression profiling in breast carcinoma
Gene expression profiling in breast carcinomaGene expression profiling in breast carcinoma
Gene expression profiling in breast carcinoma
 
Adjuvant chemotherapy of breast cancer
Adjuvant chemotherapy of breast cancerAdjuvant chemotherapy of breast cancer
Adjuvant chemotherapy of breast cancer
 
Treatment of her2 positive breast cancer
Treatment of her2 positive breast cancerTreatment of her2 positive breast cancer
Treatment of her2 positive breast cancer
 
Metastatic Breast Cancer Research and Treatment
Metastatic Breast Cancer Research and TreatmentMetastatic Breast Cancer Research and Treatment
Metastatic Breast Cancer Research and Treatment
 
Breast Cancer Highlights: ASCO 2015
Breast Cancer Highlights: ASCO 2015Breast Cancer Highlights: ASCO 2015
Breast Cancer Highlights: ASCO 2015
 
ASCO 2016 Breast Cancer Review
ASCO 2016 Breast Cancer ReviewASCO 2016 Breast Cancer Review
ASCO 2016 Breast Cancer Review
 
What's New in Treatment of ER+ Breast Cancer?
What's New in Treatment of ER+ Breast Cancer?What's New in Treatment of ER+ Breast Cancer?
What's New in Treatment of ER+ Breast Cancer?
 
Breast Cancer.ppt
Breast Cancer.pptBreast Cancer.ppt
Breast Cancer.ppt
 
Tnbc ca mammae
Tnbc ca mammaeTnbc ca mammae
Tnbc ca mammae
 
Screen breast cancer gigerenzer (bmj. 2014)
Screen breast cancer  gigerenzer (bmj. 2014)Screen breast cancer  gigerenzer (bmj. 2014)
Screen breast cancer gigerenzer (bmj. 2014)
 
Women’s autonomy confronted with massive screening
Women’s autonomy confronted with massive screeningWomen’s autonomy confronted with massive screening
Women’s autonomy confronted with massive screening
 
Prostate cancer radiotherapy
Prostate cancer radiotherapyProstate cancer radiotherapy
Prostate cancer radiotherapy
 
Screening y metodos diagnosticos emi y guille
Screening y metodos diagnosticos emi y guilleScreening y metodos diagnosticos emi y guille
Screening y metodos diagnosticos emi y guille
 
Screening ca mama 2011
Screening ca mama 2011Screening ca mama 2011
Screening ca mama 2011
 

Semelhante a What's New in Treatment and Clinical Trials for Advanced Triple-Negative Breast Cancer

Dr arun Triple Negative Breast cancer Presentation
Dr arun Triple Negative Breast cancer PresentationDr arun Triple Negative Breast cancer Presentation
Dr arun Triple Negative Breast cancer PresentationArun Shahi MD,MPH
 
8 jason westin
8 jason westin8 jason westin
8 jason westinspa718
 
Endocrine_therapy.ppt
Endocrine_therapy.pptEndocrine_therapy.ppt
Endocrine_therapy.pptDoQuyenPhan1
 
Pembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaPembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaRanjita Pallavi
 
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015bkling
 
Immunotherapy for Metastatic Triple Negative Breast Cancer
Immunotherapy for Metastatic Triple Negative Breast CancerImmunotherapy for Metastatic Triple Negative Breast Cancer
Immunotherapy for Metastatic Triple Negative Breast Cancerbkling
 
MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...
MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...
MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...European School of Oncology
 
MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...
MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...
MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...European School of Oncology
 
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...Pharma Intelligence
 
CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...
CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...
CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...mutahir2
 
Research Update on MBC
Research Update on MBCResearch Update on MBC
Research Update on MBCbkling
 
Palbociclib in Metastatic Breast Cancer
Palbociclib in Metastatic Breast CancerPalbociclib in Metastatic Breast Cancer
Palbociclib in Metastatic Breast CancerVibhay Pareek
 
GOG 240 Bevacizumab in carcinoma cervix
GOG 240 Bevacizumab in carcinoma cervixGOG 240 Bevacizumab in carcinoma cervix
GOG 240 Bevacizumab in carcinoma cervixSagar Raut
 
Chemo hormonal and targeted therapy in ca breast
Chemo hormonal and targeted therapy in ca breast Chemo hormonal and targeted therapy in ca breast
Chemo hormonal and targeted therapy in ca breast Rahul Sankar
 
6 frederick
6 frederick6 frederick
6 frederickspa718
 
Breast Cancer Trials And Tribulations Revised Oct 09
Breast Cancer Trials And Tribulations Revised Oct 09Breast Cancer Trials And Tribulations Revised Oct 09
Breast Cancer Trials And Tribulations Revised Oct 09fondas vakalis
 
7 neelapu
7 neelapu7 neelapu
7 neelapuspa718
 

Semelhante a What's New in Treatment and Clinical Trials for Advanced Triple-Negative Breast Cancer (20)

Dr arun Triple Negative Breast cancer Presentation
Dr arun Triple Negative Breast cancer PresentationDr arun Triple Negative Breast cancer Presentation
Dr arun Triple Negative Breast cancer Presentation
 
Update in tnbc
Update in tnbcUpdate in tnbc
Update in tnbc
 
8 jason westin
8 jason westin8 jason westin
8 jason westin
 
Endocrine_therapy.ppt
Endocrine_therapy.pptEndocrine_therapy.ppt
Endocrine_therapy.ppt
 
Pembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaPembrolizumab in advanced melanoma
Pembrolizumab in advanced melanoma
 
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015
 
Immunotherapy for Metastatic Triple Negative Breast Cancer
Immunotherapy for Metastatic Triple Negative Breast CancerImmunotherapy for Metastatic Triple Negative Breast Cancer
Immunotherapy for Metastatic Triple Negative Breast Cancer
 
MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...
MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...
MCO 2011 - Slide 9 - G. Curigliano - Joint medics and nurses spotlight sessio...
 
MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...
MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...
MON 2011 - Slide 7 - G. Curigliano - Joint medics and nurses spotlight sessio...
 
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...
Analyzing ASCO 2016: Developments, takeaways, and implications from the confe...
 
JC_ppt 2.pptx
JC_ppt 2.pptxJC_ppt 2.pptx
JC_ppt 2.pptx
 
CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...
CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...
CORALLEEN phase 2 trial: Neoadjuvant Ribociclib plus Letrozole in Early Stage...
 
Research Update on MBC
Research Update on MBCResearch Update on MBC
Research Update on MBC
 
Palbociclib in Metastatic Breast Cancer
Palbociclib in Metastatic Breast CancerPalbociclib in Metastatic Breast Cancer
Palbociclib in Metastatic Breast Cancer
 
GOG 240 Bevacizumab in carcinoma cervix
GOG 240 Bevacizumab in carcinoma cervixGOG 240 Bevacizumab in carcinoma cervix
GOG 240 Bevacizumab in carcinoma cervix
 
Chemo hormonal and targeted therapy in ca breast
Chemo hormonal and targeted therapy in ca breast Chemo hormonal and targeted therapy in ca breast
Chemo hormonal and targeted therapy in ca breast
 
6 frederick
6 frederick6 frederick
6 frederick
 
On the Cusp of the Era of Immuno-Oncology in Triple-Negative Breast Cancer: R...
On the Cusp of the Era of Immuno-Oncology in Triple-Negative Breast Cancer: R...On the Cusp of the Era of Immuno-Oncology in Triple-Negative Breast Cancer: R...
On the Cusp of the Era of Immuno-Oncology in Triple-Negative Breast Cancer: R...
 
Breast Cancer Trials And Tribulations Revised Oct 09
Breast Cancer Trials And Tribulations Revised Oct 09Breast Cancer Trials And Tribulations Revised Oct 09
Breast Cancer Trials And Tribulations Revised Oct 09
 
7 neelapu
7 neelapu7 neelapu
7 neelapu
 

Mais de Dana-Farber Cancer Institute

Personal Finance Tips for Young Adults with Cancer
Personal Finance Tips for Young Adults with Cancer Personal Finance Tips for Young Adults with Cancer
Personal Finance Tips for Young Adults with Cancer Dana-Farber Cancer Institute
 
How are Adult and Childhood Leukemia Alike and Different?
How are Adult and Childhood Leukemia Alike and Different?How are Adult and Childhood Leukemia Alike and Different?
How are Adult and Childhood Leukemia Alike and Different?Dana-Farber Cancer Institute
 
Research in the Program for Young Women with Breast Cancer: Past, Present and...
Research in the Program for Young Women with Breast Cancer: Past, Present and...Research in the Program for Young Women with Breast Cancer: Past, Present and...
Research in the Program for Young Women with Breast Cancer: Past, Present and...Dana-Farber Cancer Institute
 
Surgery for Inflammatory Breast Cancer: How and Why
Surgery for Inflammatory Breast Cancer: How and WhySurgery for Inflammatory Breast Cancer: How and Why
Surgery for Inflammatory Breast Cancer: How and WhyDana-Farber Cancer Institute
 
Primary Systemic Therapy for Inflammatory Breast Cancer
Primary Systemic Therapy for Inflammatory Breast CancerPrimary Systemic Therapy for Inflammatory Breast Cancer
Primary Systemic Therapy for Inflammatory Breast CancerDana-Farber Cancer Institute
 
7 Ways Integrative Therapies Can Help Cancer Patients
7 Ways Integrative Therapies Can Help Cancer Patients7 Ways Integrative Therapies Can Help Cancer Patients
7 Ways Integrative Therapies Can Help Cancer PatientsDana-Farber Cancer Institute
 

Mais de Dana-Farber Cancer Institute (20)

Exercise Tips for Cancer Patients
Exercise Tips for Cancer Patients Exercise Tips for Cancer Patients
Exercise Tips for Cancer Patients
 
Personal Finance Tips for Young Adults with Cancer
Personal Finance Tips for Young Adults with Cancer Personal Finance Tips for Young Adults with Cancer
Personal Finance Tips for Young Adults with Cancer
 
5 Things to Know About Glioblastomas
5 Things to Know About Glioblastomas5 Things to Know About Glioblastomas
5 Things to Know About Glioblastomas
 
How are Adult and Childhood Leukemia Alike and Different?
How are Adult and Childhood Leukemia Alike and Different?How are Adult and Childhood Leukemia Alike and Different?
How are Adult and Childhood Leukemia Alike and Different?
 
Research in the Program for Young Women with Breast Cancer: Past, Present and...
Research in the Program for Young Women with Breast Cancer: Past, Present and...Research in the Program for Young Women with Breast Cancer: Past, Present and...
Research in the Program for Young Women with Breast Cancer: Past, Present and...
 
Healthy Living After A Breast Cancer Diagnosis
Healthy Living After A Breast Cancer DiagnosisHealthy Living After A Breast Cancer Diagnosis
Healthy Living After A Breast Cancer Diagnosis
 
Signs and Symptoms of Prostate Cancer
Signs and Symptoms of Prostate CancerSigns and Symptoms of Prostate Cancer
Signs and Symptoms of Prostate Cancer
 
6 Common Types of Pediatric Brain Tumors
6 Common Types of Pediatric Brain Tumors6 Common Types of Pediatric Brain Tumors
6 Common Types of Pediatric Brain Tumors
 
Soft Tissue Sarcomas: Symptoms and Risk Factors
Soft Tissue Sarcomas: Symptoms and Risk FactorsSoft Tissue Sarcomas: Symptoms and Risk Factors
Soft Tissue Sarcomas: Symptoms and Risk Factors
 
10 Tips for Easing Chemo-Related Fatigue
10 Tips for Easing Chemo-Related Fatigue10 Tips for Easing Chemo-Related Fatigue
10 Tips for Easing Chemo-Related Fatigue
 
Surgery for Inflammatory Breast Cancer: How and Why
Surgery for Inflammatory Breast Cancer: How and WhySurgery for Inflammatory Breast Cancer: How and Why
Surgery for Inflammatory Breast Cancer: How and Why
 
Radiation Therapy for Inflammatory Breast Cancer
Radiation Therapy for Inflammatory Breast CancerRadiation Therapy for Inflammatory Breast Cancer
Radiation Therapy for Inflammatory Breast Cancer
 
Primary Systemic Therapy for Inflammatory Breast Cancer
Primary Systemic Therapy for Inflammatory Breast CancerPrimary Systemic Therapy for Inflammatory Breast Cancer
Primary Systemic Therapy for Inflammatory Breast Cancer
 
What Cancers Should Men Be Screened For?
What Cancers Should Men Be Screened For?What Cancers Should Men Be Screened For?
What Cancers Should Men Be Screened For?
 
Five Common Types of Brain Tumors
Five Common Types of Brain TumorsFive Common Types of Brain Tumors
Five Common Types of Brain Tumors
 
Signs and Symptoms of Multiple Myeloma
Signs and Symptoms of Multiple MyelomaSigns and Symptoms of Multiple Myeloma
Signs and Symptoms of Multiple Myeloma
 
7 Ways Integrative Therapies Can Help Cancer Patients
7 Ways Integrative Therapies Can Help Cancer Patients7 Ways Integrative Therapies Can Help Cancer Patients
7 Ways Integrative Therapies Can Help Cancer Patients
 
Five Things You Need to Know About Colon Cancer
Five Things You Need to Know About Colon CancerFive Things You Need to Know About Colon Cancer
Five Things You Need to Know About Colon Cancer
 
What You Should Know About Cervical Cancer
What You Should Know About Cervical CancerWhat You Should Know About Cervical Cancer
What You Should Know About Cervical Cancer
 
Making A New Treatment Decision
Making A New Treatment DecisionMaking A New Treatment Decision
Making A New Treatment Decision
 

Último

power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 

Último (20)

How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 

What's New in Treatment and Clinical Trials for Advanced Triple-Negative Breast Cancer

  • 1. What’s New in Treatment and Clinical Trials for Advanced Triple- Negative Breast Cancer Nancy Lin, MD Susan F. Smith Center for Women’s Cancers Dana-Farber Cancer Institute October 17, 2015
  • 2. Outline • Definitions: What is TNBC? • Treatment: How do we treat TNBC? • New Directions: What are some exciting approaches being tested in clinical trials? • Clinical Trials: Which, why, how, when?
  • 3. • There are three main subtypes of breast cancer • Within these, there are other ways to further sub-divide breast cancers • Oncologists use the breast cancer subtype to guide the kinds of treatments to recommend • Clinical trials often will focus on specific subtypes Breast Cancer Subtypes
  • 4. Breast Cancer Subtypes Breast Cancer Subtypes ER-positive HER2-positive Triple-negative TALK to your doctor if you are not sure what type of breast cancer you have
  • 5. “Triple Negative” Breast Cancer (TNBC) • Defined as negative for estrogen, progesterone, and HER2 receptors • Represents about 15% of all breast cancer • More likely to present in younger women and in women of African ancestry • May be associated with an inherited mutation in BRCA1 – But--most patients with triple negative breast cancer do not carry a hereditary BRCA1 mutation – Other hereditary mutations: PALB2, RAD51c, BARD1 – National guidelines recommend consideration of genetic testing in women younger than age 60 with TNBC, regardless of family history
  • 6. Hormonal therapy Hormonal therapy Chemotherapy Chemotherapy Chemotherapy Chemotherapy Chemotherapy Herceptin + perjeta + chemotherapy TDM1 Lapatinib + Capecitabine Herceptin + chemotherapy Herceptin + chemotherapy Hormone receptor positive Triple-negative HER2-Positive *Note, these are just examples. Each patient is different and treatment is tailored accordingly. How Do We Treat Metastatic Breast Cancer?
  • 7. Chemotherapy for Metastatic Breast Cancer Many active and tolerable chemotherapy choices
  • 8. • Order of chemotherapy does not appear to influence survival • Choose chemotherapy based on: – Activity level seen in clinical trials – Amount of active cancer/need for rapid response – Prior treatments – Route of administration (pills versus IV) – Side effect profile – Other health problems • Blood counts, neuropathy, diabetes, heart problems, liver function Choice of Chemotherapy in Metastatic TNBC
  • 9. Drug Route Hair loss Diarrhea Neuropathy PPE Allergic reactions Paclitaxel (Taxol) IV weekly 2 or 3 wks in a row Then off 1 wk Yes No Yes No Possible Capecitabine (Xeloda) Oral twice daily 2 wks in a row Then off 1 wk No Yes No Yes No Eribulin (Halaven) IV weekly 2 wks in a row Then off 1 wk Sometimes No Yes No No Choice of Chemotherapy in Metastatic TNBC: One example •Was a taxane given previously for early-stage disease? If yes, how long ago? •What chemotherapies have been given for metastatic cancer previously? •Able to take and absorb pills? •How is the liver function? •On coumadin (warfarin)? •Problems with blood sugar control?
  • 10. Is all TNBC the same? ER-negative, PR-negative HER2-negative
  • 11. HER2+ Estrogen receptor + Triple Negative GENES TUMORS Breast cancer is a family of different cancers
  • 12. Triple Negative GENES TUMORS Breast cancer is family of different cancers
  • 13. Heterogeneity of TNBC TNBC is not just one disease— Different subtypes likely have different “Achilles’ heels” VEGF EGFR PTEN loss BRCA1- Basal-like AR Immune infiltrate
  • 14. Many Approaches Under Evaluation for TNBC in Clinical Trials! Pathway/Drug type Drugs in development DNA repair PARP inhibitors (olaparib, rucaparib, veliparib), platinum agents (cisplatin, carboplatin) PI3K/Akt/mTOR PI3K inhibitors (buparlisib, taselisib, GDC0941, AZD8186, many others); Akt inhibitors (GDC0068, others), mTOR inhibitors (everolius, others) Androgen (testosterone) signaling Anti-androgens (bicalutamide, enzalutamide), Immune CTLA4 blockade (ipilumumab), PD1/PD-L1 blockade (nivolumab, pembrolizumab, MPDL3280A), Antibody-drug conjugates IMMU-132, SGN-LIV1A, PF06647263, CDX-011 Cell cycle Dinaciclib Chk1 GDC0575 Bromodomain TEN-101, GSK525762 Heat shock (stress) Ganetespib, others Angiogenesis Ramucirumab, cedirinib
  • 16. PARP Inhibitors •Tumors of BRCA 1/2+ patients lose 2 important ways to repair DNA when treated with a PARP inhibitor •Multiple trials testing PARP vs chemo in BRCA 1/2 carriers •Trials combining PARP with other drugs in BRCA 1/2 non-carriers
  • 17. Olaparib in BRCA 1/2 Carriers with Metastatic Breast Cancer Tutt et al, 2010
  • 18. Ongoing Olaparib Trial* Inherited BRCA 1 or BRCA2 mutation Up to 2 previous types of chemotherapy for MBC Olaparib Choice of standard chemotherapy -Capecitabine (Xeloda) -Vinorelbine (Navelbine) -Eribulin (Halaven) *Other PARP inhibitors being evaluated in a similar fashion
  • 20. Polyak and Filho, Cancer Cell, 2012 Targeting the PI3Kinase Pathway
  • 23. aKaplan-Meier estimate. Analysis cut-off date: November 10, 2014. 0 8 16 24 32 40 48 56 Time, weeks Responder Nonresponder CR PR SD PD PD after CR, PR, or SD Last dose Treatment ongoing Best overall response A Phase Ib Study of Pembrolizumab (MK-3475,anti-PD-1 Ab) in Patients With Advanced Triple-Negative Breast Cancer. Nanda et al.
  • 24. Immunotherapy trials available at DFCI FIRST LINE TNBC Protocol # Short Title Eligibility 15-241 Ph3 Abraxane +/- Atezolizumab (PDL1 Ab) Measurable Disease No prior treatment for metastatic dz 15-307 Ph1/2 Eribulin + Pembrolizumab SECOND LINE and BEYOND TNBC 15-240 Phase 2 Pembrolizumab Monotherapy 2L+ Measurable disease Biopsy required Prior A + T required 15-307 Ph 1/2 Eribulin + Pembrolizumab 11-314 Atezolizumab (PDL1) monotherapy for PDL1+ TNBC Requires tumor prescreening Any line of therapy
  • 26. Androgen Receptor Function: The Basics Testosterone Androgen Receptor
  • 27. Androgen Receptor Function: The Basics Testosterone Androgen Receptor DNA
  • 28. Targeting AR in the Clinic • Bicalutamide – TBCRC 011 study – No objective responses…but 21% had stable disease > 6 months • Enzalutamide – Study MDV 3100-11 – 20% of patients had stable disease > 6 months – “PredictAR” gene signature sorted patients (with 0-1 prior treatments) to those with average disease control 2 months vs 10 months
  • 30. Antibody Drug Conjugates in TNBC 30 1. Monoclonal antibody specific for a tumor antigen with little/no expression on normal cells 2. Linker that is stable in circulation but releases the cytotoxic agent in target cells 3. Potent cytotoxic agent designed to induce target cell death when internalized and released
  • 31. IMMU-132 • Target: Trop2 (EGP-1) – Oncogene associated with increased aggressiveness and metastasis. – Prognostic marker in several cancer types • Linker: pH sensitive linker (CL2A) • Cytotoxic: SN-38 (Irinotecan active metabolite) – 7.6 drug molecules/IgG 31
  • 32. Phase I/II Trial of Sacituzumab Govitecan (IMMU-132), an anti-Trop- 2-SN-38 antibody-drug conjugate, in refractory/relapsed metastatic triple- negative breast cancer Aditya Bardia1, Linda T. Vahdat2, Jennifer R. Diamond3, Alexander N. Starodub4, Rebecca Moroose5, Steven Isakoff 1, Allyson J. Ocean2, Jordan D. Berlin6, Wells A. Messersmith3, Sajeve S. Thomas5, Francois Wilhelm7, William A. Wegener8, Pius P. Maliakal7, Robert M. Sharkey7, David M. Goldenberg7, Ingrid A. Mayer6 1Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; 2Weill Cornell Medical College, New York, NY; 3Vanderbilt-Ingram Cancer Center, Nashville, TN; 3University of Colorado Cancer Center, Aurora, CO;4Indiana University Health Center for Cancer Care, Goshen, IN; 5UF Health Cancer Center, Orlando, FL; 6Vanderbilt-Ingram Cancer Center, Nashville, TN; 7Immunomedics, Inc., Morris Plains, NJ. 32
  • 33. 255-022 111-029 255-008 255-025 252-004 255-028 111-018 255-018 252-009 255-005 252-014 254-012 255-019 252-007 111-006 111-030 254-019 252-001 181-004 255-021 255-027 111-013 254-016 255-011 252-010 255-023 204-005 255-029 254-017 255-024 254-009 255-026 252-003 111-002 254-021 255-015 255-004 255-010 111-033 204-009 -1 0 0 -8 0 -6 0 -4 0 -2 0 0 2 0 4 0 6 0 8 0 1 0 0 BestResponse (%changeintargetlesionfrombaseline) CR = 2 PR = 13 SD = 22 PD = 12 22 pts continuing Prior chemotherapies = 4 (median; range=1-11) TNBC Best Response (N = 49 assessable patients) • 58 patients enrolled; 4 have not had their first assessment; 4 excluded because ≤2 doses given; 1 excluded with starting dose of 18 mg/kg • Doses (mg/kg) given (N = 49): 8 (N = 13), 10 (N = 34), 12 (N = 2)33 Objective response = 15/49 = 31% Disease control = 37/49 = 76% Clinical benefit ratio [CR+PR+(SD ≥4 mo)] = 63%* *29/46; 3 pts with SD <4 mo are continuing treatment 9 pts with PD because of progression of non-target lesion or new lesion are not shown in graph 15 May 2015
  • 34. CDX-011 (glembatumumab vedotin) • Target: GPNMB • Cytotoxic- monomethyl-aurostatin E (MMAE) • EMERGE study – Ph2 CDX-011 vs Investigator Choice • 122 pts enrolled (TNBC/ER+), median 6 prior regimens 34
  • 35. Phase 2 EMERGE study CDX-011 vs Investigator’s choice of rx 35 Common treatment related AE’s: rash, fatigue, nausea, neutropenia, alopecia *Median number of lines of cytotoxic rx for MBC=4 * Yardley et al JCO 33:1609, 2015
  • 36. METRIC study Glembatumumab Vedotin 1.88 mg/kg IV Day 1 of 21- day cycles Capecitabine 1250 mg/m2 BID Days 1-14 of 21-day cycles 2:1 randomization Primary Endpoint • Progression free survival by independent review N=300  Metastatic TNBC overexpressing gpNMB  0-2 prior chemo for MBC  Prior Taxane and anthracycline ClinicalTrials.gov Identifier: NCT01997333
  • 37. Other Antibody Drug Conjugates in Development for TNBC • SGN-LIV1A – Target: LIV-1, transmembrane protein in 65% TNBC – Ph1 in breast ca ongoing • PF-06647263 – Target: EFNA4 – Phase 1 in breast cancer ongoing 37
  • 38. How Can We Do Better? Participate in Trials! • “One reason I chose to participate in a clinical trial was to help women with triple-negative breast cancer. It is thanks to women who have enrolled in clinical trials that we have the treatments that give us hope.” – Natalia (LBBC, Guide to Understanding TNBC)
  • 39. Clinical Trials: FAQs • When should I consider a clinical trial? – Clinical trials may be an option for you as early as the first treatment you receive for metastatic breast cancer, but may also be an option further into the course of your disease. – If you are interested in trials, getting connected early to a treatment team who can help identify potential trials for you is key. • Will I have to pay more to be on a trial? – All normal procedures are billed to insurance; anything beyond normal care is paid for by the trial. There should be no “upcharge” for being in a trial • Is being on a trial busy? – Each trial is different and has a different schedule • Will I know what medicine I am getting? I don’t want a placebo. – In most trials, both patient and provider know exactly what treatment is being given. – Some larger trials use randomization and placebos, and in some cases neither patient nor provider know identity of study drug. – But in almost every trial with placebo, at minimum a patient receives best standard of care.
  • 40. How to learn about trials? OR……
  • 41. How to learn about trials? • Know what subtype of breast cancer you have • Learn about your family history and consider BRCA testing • Talk to your doctor and/or nurse • Consider on-line resources • Consider receiving care and/or consultation in a center with a focus on clinical trials
  • 42. Advanced TNBC: Conclusions • TNBC is unique compared to other types of breast cancer • Not all TNBC is the same • Chemotherapy works for TNBC, and there are a number of standard options • No single best target has been identified so far; however, TNBC is an area of very active research; many exciting new agents and approaches in the pipeline • Speak to your provider about entering a trial! • Future progress depends on.....Making every woman count!