last update in breast cancer hormone therapy.

1. Hormone therapy in early breast cancer Farshad seyednejad ,M.D Radiation oncologist Tabriz medical science university Jan2009

2. Early Breast Cancer The Good News Majority cured with optimal therapy

5. Hypothalamus Gonadotropins (FSH + LH) Ovary Estrogens Progesterone Prolactin Growth Hormone Pituitary gland Postmenopausal and Premenopausal Adrenal gland Progesterone Androgens Estrogens Corticosteroids Premenopausal Adrenocorticotropic hormone (ACTH) Estrogen Production in Premenopausal and Postmenopausal

8. Node negative AND all of the following features: Low risk T ≤2 cm & Grade 1, & Absence of peritumoral vascular invasion, & HER2/neu gene neither overexpressed nor amplified, & Age≥ 35 Node negative & at least one of the following features: Intermediate risk T >2 cm, OR Grade 2-3, OR Presence of peritumoral vascular invasion, OR HER2/neu gene overexpressed or amplified, OR Age <35 years Node positive (1-3 involved nodes) & HER2/neu gene neither overexpressed nor amplified Node positive (1-3 involved nodes) AND HER2/neu gene overexpressed or amplified High risk Node positive (4 or more involved nodes)

11. Endocrine nonresponsive Endocrine response uncertain Endocrine responsive Risk category Not applicable ET or Nil ET or Nil Low risk CT CT -> ET ET alone, or CT -> ET Intermediate risk CT CT -> ET CT -> ET High risk

18. Role of Aromatase in Estrogen Biosynthesis and Tumor Growth Aromatase Aromatase Adrenal gland Peripheral tissues Postmenopausal women Tumor = Estrogen = Androstenedione Receptor

19. The Role of Aromatase in Estrogen Biosynthesis and Tumor Growth Aromatase Aromatase Adrenal gland Peripheral tissues Postmenopausal women Tumor = Estrogen = Androstenedione Receptor AI AI

24. MA.17: Trial Design Adjuvant Letrozole (Femara ® ) vs Placebo in Postmenopausal Women With Primary Breast Cancer Completing 5 Years of Tamoxifen Primary end point: DFS Secondary end points: OS/safety/QOL *n=2575 (efficacy); 2154 (safety) in the FEMARA arm. † n=2582 (efficacy); 2145 (safety) in the placebo arm. Goss et al. N Engl J Med . 2003;349:TBD. Randomization (Disease-free) Tamoxifen Placebo qd † FEMARA (Letrozole) 2.5 mg qd* 5 years early adjuvant 5 years extended adjuvant