powerpoint presentation...2009, self-examination breast mass diagnosis of a invasive ductal...
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![Page 1: PowerPoint Presentation...2009, self-examination breast mass Diagnosis of a invasive ductal carcinoma grade III, 13mm RH+, HER2-. (5N+R+/22N) Treatment strategy: –Conservative surgery](https://reader030.vdocuments.mx/reader030/viewer/2022040111/5e2c7d14c3215e5452096529/html5/thumbnails/1.jpg)
ESMO Preceptorship Programme
Challenges of treating advanced HER2+
Bianca Cheaib
Institut Gustave Roussy, Villejuif - FRANCE
Breast cancer brain metastasis – Lugano – 12/10/2019
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ESMO PRECEPTORSHIP PROGRAMME
DISCLOSURE OF INTEREST
None
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ESMO PRECEPTORSHIP PROGRAMME
CLINICAL CASE
49 year old female, Caucasian, medical secretary
non smoker.
No allergies
No significant personal medical history.
No family history of cancer.
No medication
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ESMO PRECEPTORSHIP PROGRAMME
History
2009, self-examination ➔ breast mass
Diagnosis of a invasive ductal carcinoma grade III, 13mm RH+, HER2-. (5N+R+/22N)
Treatment strategy:
– Conservative surgery - lumpectomy and axillary lymph node dissection November 2009
– Adjuvant chemotherapy (4FEC-4Taxotere)
– Radiotherapy (breast et boost, internal mammary chain and supraclavicular).
– Endocrine therapy by Tamoxifene 5 years.
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ESMO PRECEPTORSHIP PROGRAMME
August 2011:
Following an epileptic seizure, discovery by CT scan multiple brain metastasis (5 lesions, 14 to 25mm).
Treatment strategy:– Whole brain irradiation - 30Gy in 10
fractions;
– 1st line chemotherapy: CARBOPLATINE/TAXOL/BEVACIZUMAB followed by maintenance treatment with BEVACIZUMAB and endocrine therapy.
Recovery of the initial surgery paraffin blocks!!!
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ESMO PRECEPTORSHIP PROGRAMME
January 2012
Discovery of HER2 expression on the initial tumour
Following the discovery of HER2 expression:
➔Stop CARBOPLATINE & AVASTIN
➔Introduction of HERCEPTIN/TAXOL until march
2012 followed by maintenance therapy by Herceptin +
Femara.
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ESMO PRECEPTORSHIP PROGRAMME
December 2013
On the follow-up
examination, discovery
on a new occipital lesion
Treatment strategy:
– Stereotaxic irradiation
11Gy in 3 fractions.
– 2nd line therapy with
HERCEPTIN (4mg/Kgc) /
TYVERB (1000mg)
T1
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ESMO PRECEPTORSHIP PROGRAMME
March 2019
Follow-up examination discovery on the MRI: – Increased contrast enhancement
of the right paramedian portion of the corpus callosum
No neurological symptoms
Neurological examination correct
PET/CT : Negative
Blood tests within limits
T1 F2
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ESMO PRECEPTORSHIP PROGRAMME
Suspicion of brain metastasis progression
or Radio necrosis??
Complementary exam:
Choline PET/MRI:
– Confirms the reactivation and evolution of the lesion.
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ESMO PRECEPTORSHIP PROGRAMME
PET MRI
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ESMO PRECEPTORSHIP PROGRAMME
Discussion: Treatment options
Radiotherapy ? Surgery?
– 30 Gy in 5 fractions
Continuation of the HERCEPTIN/TYVERB ? Or
Change in treatment ? If change in treatment what
options??
– Continue treatment
Last follow up in august 2019➔ good response,
continue the systemic treatment.
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ESMO Preceptorship Programme