01 Leonard Treatment decisions.333333ppt

treatment

1. Key factors for treatment
decision making
Bob Leonard
South West Wales Cancer Institute
Swansea, UK

2. Major drivers
Tumour biology
Patient characteristics
Prior therapy

3. Biology drives treatment choices
in metastatic breast cancer (MBC)
Local Metastatic
NegativePositive
ER / PgR HER2
NegativePositive
Bone / soft tissueVisceral

4. HER2/ER status
Tested?
Problems with rapid access to
result if not previously tested?

5. Patient characteristics
influence treatment decisions
Age
Performance
status
Patient history
Patient
preference
Comorbidities
e.g. diabetes, impaired
cardiac function
Sites
Pace of
relapse
Previous
therapy
Fitness
Cardiac
function
Renal/hepatic
function

6. Prior therapy drives
treatment decisions

7. Prior therapy: adjuvant setting
Anthracyclines
–dose: cumulative risk of CHF, decreased LVEF
–which anthracycline was used?
–tolerability; hair loss
Taxoids
–which taxoid was used?
Time to relapse
–Sledge data (AT versus A T): relapse 2 years
significant independent negative prognostic factor¹
Hormonal therapy
–relapse whilst on hormonal therapy?
¹Sledge GW, et al. J Clin Oncol 2003;21:588–92
CHF = congestive heart failure
LVEF = left ventricular ejection fraction

8. After relapse
Anthracyclines again?
–toxicity and cardiac damage
Taxoids
–myelotoxic, clinical toxicity
Drug resistance
–especially early relapse

9. Oral Xeloda:
the keystone of MBC treatment
Unique tumour specific mechanism of action via
higher intratumoural thymidine phosphorylase
In previously treated BC
–consistently high single-agent activity
–in combination with Taxotere, only cytotoxic agent
to extend survival in MBC
–favourable safety with no cumulative toxicity;
minimal myelosuppression and alopecia
Provides convenient oral therapy that patients prefer
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Liu G, et al. J Clin Oncol 1997;15:425–32