Aromatase inhibitors act by lowering estrogen in the circulation and in tumor cells in post-...
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Transcript of Aromatase inhibitors act by lowering estrogen in the circulation and in tumor cells in post-...
Aromatase Aromatase inhibitors act by inhibitors act by lowering estrogen lowering estrogen in the circulation in the circulation and in tumor cells and in tumor cells in post-in post-menopausal menopausal womenwomen
Adverse Effects Adverse Effects Associated with Associated with Anastrozole and Anastrozole and
Tamoxifen in TrialsTamoxifen in Trials
Leuprolide (LupronLeuprolide (Lupron®®))
GnRH analogGnRH analog continuous GnRH analog turns off the continuous GnRH analog turns off the
production of gonadotropins (LH,FSH) and production of gonadotropins (LH,FSH) and decreases testosterone synthesis by 90-95%decreases testosterone synthesis by 90-95%
slow release implantable devices (Durosslow release implantable devices (Duros®®) lasts ) lasts 12 mos.12 mos.
used to treat advanced prostate cancerused to treat advanced prostate cancer cancer can escape and become androgen cancer can escape and become androgen
independent after 18-36 mos.independent after 18-36 mos.
Concerns related to the Concerns related to the success of chemotherapy success of chemotherapy in curing primary cancerin curing primary cancer
Quality of life: fertilityQuality of life: fertility
Increased risk: secondary cancerIncreased risk: secondary cancer
Combination Therapy Examples: Combination Therapy Examples: Hodgkin’s DiseaseHodgkin’s Disease
• MOPPMOPP– mechlorethamine, vincristine, procarbazine, mechlorethamine, vincristine, procarbazine,
prednisoneprednisone
• ABVDABVD– doxorubicin, bleomycin, vinblastine, doxorubicin, bleomycin, vinblastine,
dacarbazinedacarbazine
• Stanford VStanford V * Mechlorethamine by vein once every 4 weeks* Mechlorethamine by vein once every 4 weeks * Doxorubicin (Adriamycin) by vein every odd * Doxorubicin (Adriamycin) by vein every odd
weekweek * Vinblastine (Velban) by vein every odd week* Vinblastine (Velban) by vein every odd week * Vincristine (Oncovin) by vein every even week* Vincristine (Oncovin) by vein every even week * Bleomycin (Blenoxane) by vein every even week* Bleomycin (Blenoxane) by vein every even week * Etoposide by vein 2 days in a row weeks 3, 7, 11* Etoposide by vein 2 days in a row weeks 3, 7, 11 * Prednisone by mouth every other day* Prednisone by mouth every other day
high risk of high risk of secondary cancers, secondary cancers, infertilityinfertility
lower risk: lower risk: contraindicated if contraindicated if heart or lung heart or lung diseasedisease
complex but may be complex but may be better than ABVDbetter than ABVD
78 non-lymph node positive78 non-lymph node positivesporadic Breast CA tumors sporadic Breast CA tumors were chosenwere chosen
70 genes that were best discriminators
black=disease free at 5 yrblack=disease free at 5 yr
white = metastases
Tumors
Future of Gene Array Analysis in Future of Gene Array Analysis in ChemotherapyChemotherapy
1. establish a prognosis directly from gene 1. establish a prognosis directly from gene expressionexpressiondata on primary tumor sample--determine data on primary tumor sample--determine whether adjuvant therapy is warranted?whether adjuvant therapy is warranted?
2. expression analysis may predict which tumors 2. expression analysis may predict which tumors will respond to which drugswill respond to which drugs