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1. Introduction
2. Major clinical issues in the personalized treatment
3. The efficacy barrier: tamoxifen
4. The efficacy barrier: tamoxifen and anastrozole
5. Advances in targeting have improved the treatment
6. Tumor based expression arrays
7. Prognostic expression arrays
8. The fisrt pharmacogenetic principle
9. Principals for valuable predictive biomarkers
10. The COBRA
11. Anti-estrogen therapy for breast cancer
12. Case report
13. The ELPH trial
14. Aromatase inhibitor side effects in the ELPh trial
15. Drop out rates from aromatase inhibitors
16. The problem with aromatase inhibitors in Asia
17. Breast cancer around the world
18. Oxford overview
19. Classic understanding of tamoxifen pharmacology
20. Tamoxifen metabolism
21. Endoxifen and 4-OH-tamoxifen (1)
22. Endoxifen and 4-OH-tamoxifen (2)
23. Paroxetine and CYP2D6 genotype
24. Predicting efficacy by serum concentrations
25. CYP2D6 variant genotype and CYP2D6 inhibitors
26. CYP2D6 inhibition and endoxifen concentrations
27. Relapse free survival
28. CYP2D6 inhibitor data inclusion
29. Databank data
30. Stratifying patients according to genotype
31. Japanese women carrying the CYP2D6 *10 allele
32. Unanswered questions
33. Clinical consequences
34. Pharmacodynamic pharmacogenomics
35. Women with hot flashes do better
36. Multiple targets to inhibit angiogenesis
37. Bevacizumab in breast cancer
38. PFS, ORR and OS
39. No subgroup that could be determined to do well
40. Financial consequences of FDA decisions
41. VEGF -2578 AA and -1154 AA tagSNPs (1)
42. VEGF -2578 AA and -1154 AA tagSNPs (2)
43. VEGF genetic variability
44. Summary
45. Thank you

Topics Covered

• Major clinical issues in the personalized treatment of breast cancer
• The efficacy barrier: tamoxifen and anastrozole
• Advances in targeting that have improved the treatment of breast cancer
• Tumor-based expression arrays
• Prognostic expression arrays remain valuable beyond tumor grade and stage
• Pharmacogenetic principles
• Principles for valuable predictive biomarkers
• COBRA
• Anti-estrogen therapy for breast cancer
• The ELPH trial
• Aromatase inhibitor side effects in the ELPH trial
• The problem with aromatase inhibitors in Asia
• Breast cancer around the world
• Classic understanding of tamoxifen pharmacology
• Tamoxifen metabolism
• Endoxifen
• Serum concentrations of tamoxifen and metabolites predict efficacy
• CYP2D6
• Relapse-free survival was worse in poor metabolizers
• Clinical consequences
• Pharmacodynamic pharmacogenomics
• Multiple targets to inhibit angiogenesis
• Bevacizumab in breast cancer: E2100 trial
• Financial consequences of FDA decisions

Links

Series:

• Cancer Therapy

Categories:

• Cancer
• Clinical Practice
• Pharmaceutical Sciences

Therapeutic Areas:

• Oncology

Talk Citation

Flockhart, D. (2009, January 6). Germline pharmacogenomics as a tool to individualize therapy in breast cancer [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved April 15, 2025, from https://doi.org/10.69645/HMKQ7315.
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Publication History

• Published on January 6, 2009
• Archived on February 25, 2021

Financial Disclosures

• Dr. David Flockhart has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.