Breast Cancer - Patients' Therapies - Essay Example

Its invasive ductal carcinoma; which you are probably familiar is the most common histology for invasive carcinoma in the breast. Nuclear grade 2; meaning it is moderately differentiated; ER 85 % PR 80% HER2 by amino histo-chemistry is 0 HER2 by FISH is normal KEY 67 is 20 %. So all other staging studied were negative for metastases; which is good. So based on the information what are the treatment options for this patient? Just to summarize, this patient is T2 and 0, 0. The staging criteria were most recently updated in 2010.

She is ER PR positive HER2 normal; moderate growth fraction - that is KEY 67 as a measurement of tumor proliferation. She has a moderate grade, of course, nuclear grade 3 would be poorly differentiated and 1 would be well differentiated. She has several good prognostic features, for instance not having any positive lymph nodes her hormone receptor status, and not having KEY 67 or nuclear grade 3. So for this patient are there any other tests that we would like to have to make decisions regarding her systemic adjuvant therapy?

Luckily for us, there are several very helpful prognostic tools; which I will go through in detail. The first is adjuvant online, you may have heard of it. It is not only for breast cancer but I believe for colorectal as well. You all have access to this, www.adjuvantonline.com. It just requires you to sign up for a free password. It is a validated decision-making tool for adjuvant therapy both for chemotherapy and endocrine therapy. Then we have instead of a population database we have two tests that actually take a piece of the tumor and send it off for testing.

So these are these OncaType DX screens for 21 gene profiles, it is appropriate for patients who are lymph node-negative, hormone receptor-positive, and HER 2 negative. So it is in a population where we have trouble deciding whether this patient needs chemotherapy or not and because of their biology they may benefit very little from chemotherapy. Mammocrant is another gene assay, it screens for 70 genes, it has not caught on quite as quickly as Oncotype DX, OncaTypeDX has already been included and the NCCN guidelines for breast cancer management; Mammacrant hasn’t - primarily because originally it required fresh frozen tissue which is a little bit more challenging to get orchestrated and sent off; however more recently it has been available in paraffin embedded tissue – which makes it much more user friendly after a surgical procedure.

It classifies patients into either good or poor prognostic classification. So, both of these tests, Oncotype DX and Mammacrant have ongoing trials. So those will be very helpful. Talking about first Adjuvantonline, this is a decision tool for adjuvant therapy, based on data that has been incorporated into a tool - it is estimated the risk of cancer-related mortality or relapse. You can flip back and forth without systemic adjuvant therapy. Basically all the information like their age, hormone receptor status their grade, tumor size, lymph node status, and then gives you an estimate for chances for recurrence and the risk of death.

Then it estimates the risk reduction with adjuvant therapy. So if they are hormone receptor-positive, you can estimate the risk reduction of either tamoxifen Romo pass inhibitors if they are post-menopausal. Then you can decide which therapy to use or chemotherapy to use.