Dr. Moore Presentation

2. SHARE and WEILL CORNELL BREAST CENTER
Metastatic breast cancer:
Update 2012
Anne Moore, MD
Linda Vahdat, MD
Christine

3. Metastatic breast cancer
• Spread of breast cancer outside of the breast
and axillary lymph nodes
– About 20-30 % of women treated for stage 1, 2 or
3 breast cancer will later develop metastatic
cancer
– Breast cancer can start as metastatic cancer

4. Metastatic breast cancer
• Now considered “a chronic disease”
• Have a strategic plan

5. The woman with metastatic disease
• Tools:
– Surgery
– Radiation therapy
– Zometa for bone strengthening

6. The woman with metastatic disease
• Tools:
– Chemotherapy
– Hormonal therapy for ER/PR positive
– Her-2 directed therapy for HER 2 positive
– Anti-angiogenesis approach
– Clinical trials
• New drugs, new approaches
• Vaccines
• What about diet, supplements, vitamins, immune
boosters?

7. [TITLE]

8. [TITLE]

9. Does the ER/PR/HER 2 change between
the primary cancer and the metastasis?
• Estrogen receptor- 126 patients
– Was positive and now negative-14%
– Was negative and now positive-8%
• HER 2- 121 patients
– Was positive and now negative-17%
– Was negative and now positive- 0%
Luis, DFCI. ASCO education session 2012

10. [TITLE]
Luis, ASCO education session, 2012

11. How do we stop cancer cells from dividing?
DNA

12. How do we stop cancer cells from dividing?
Chemotherapy directly attacks the DNA: Cells cant divide.

13. BUT DNA can repair itself so we need to
outsmart cell division in other ways
DNA

14. TARGETED TREATMENT:
INACTIVATE THE ESTROGEN RECEPTOR Estrogen
Estrogen receptor

15. TARGETED TREATMENT: INACTIVATE THE ESTROGEN RECEPTOR
Take away estrogen
Use a “fake” estrogen:
Tamoxifen
Destroy the estrogen
receptor:
Faslodex

16. BUT the cells can bypass the estrogen receptor blockade and start
to divide again so we need to outsmart estrogen dependent cell
division in other ways

17. Estrogen activates the estrogen receptor and cells
proliferate through activation of the mTOR pathway

18. mTOR blockade blocks estrogen receptor activation
Block mTOR
EVEROLIMUS IS AN MTOR INHIBITOR

19. BOLERO 2: ASCO UPDATE

20. RESULTS
• CLINICAL BENEFIT RATE-Those women who had a complete
response, a partial response or stable disease for more than 6
months
– 26.4% for exemestane
– 51.3% for exemestane and everolimus

21. Characteristics of these women with
metastatic ER+ breast cancer
• Average age: 61
• Disease free interval before first recurrence: 5
year
• All had received anastrazole or letrozole- 84% had
shown a response.
• 53% had received >3 treatments for metastatic
disease including chemotherapy
• The women were in good shape

22. Women receiving both pills,
Exemestane (Aromasin) and Everolimus (Afinitor)
had more side effects
• mouth sores
• Infections
• Rash
• Pneumonitis
• high blood sugar

23. Will we use everolimus with hormone
therapy?
Pt. recurs on or after adjuvant letrozole:
Tamoxifen
Fulvestrant
Then: ?exemestane alone or with everolimus
as an alternative to chemotherapy
This trial is exciting because it opens a new pathway
for drug development in breast cancer

24. HER-2 POSITIVE METASTATIC BREAST CANCER

25. Lapatinib (Tykerb) (a pill) targets the Her2
receptor
X
X
X

26. PERTUZUMAB HAS JUST BEEN APPROVED FOR HER 2 +
METASTATIC BREAST CANCER

27. Pertuzumab
• Approved for first line metastatic breast
cancer treatment with herceptin and
docetaxel (taxotere)
• Very weak by itself but boosts herceptin effect
even for women who have had herceptin
already

30. Herceptin linked to a strong chemotherapy drug
[TITLE]

34. [TITLE]

35. [TITLE]

36. [TITLE]

37. The Future is Promising for Metastatic Breast Cancer