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Printable Handouts
Navigable Slide Index
- Introduction
- Clinical practice
- Systemic therapy for breast cancer
- Treatment for ER+, Her2+ localized breast cancer
- Oncotype Dx®
- Oncotype Dx®: the genes
- Oncotype Dx®: chemotherapy benefit
- Oncotype Dx® in practice
- Goal of precision medicine
- Individualizing chemotherapy doses
- Tumor vs. patient genome
- Targeting the tumor genome
- Patient critetia for tumor genetic tests
- Evolution of NSCLC treatment
- NSCLC somatic mutations
- Mutation landscape changes over time
- Evolution of cancer treatment: immunotherapy
- Progression of immunotherapy
- History of immunotherapy
- CTLA-4 and PD-1 pathways
- Mutation load and immunotherapy
- Talimogene laherparepvec (T-VEC)
- Evolution of cancer treatment: summary
- Melanoma case: MM
- Management in 2000s: HR
- Management in 2016: HR
- Final considerations for cancer pharmacotherapies
Topics Covered
- Translation of tumor genetics into clinical treatment
- Immunotherapy mechanism of action and pharmacotherapy
- Examples of treatment study cases
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Walko, C.M. (2017, May 29). Key considerations for cancer pharmacotherapy 2 [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 8, 2024, from https://doi.org/10.69645/VFJM4434.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Christine M. Walko has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Key considerations for cancer pharmacotherapy 2
Published on May 29, 2017
28 min
Other Talks in the Series: Cancer Therapies in the Personalized Medicine Era
Transcript
Please wait while the transcript is being prepared...
0:05
Now that we've introduced you to a variety
of the different agents
that we see in clinical practice,
how does this actually translate
into a treatment plan
for a patient?
0:16
Let's take the example of breast cancer
and look at the different modalities
and sequencing of therapy that we can utilize.
So we have traditional cytotoxic chemotherapy
that is still a big part of the treatment
of breast cancer.
We commonly will use taxanes
like paclitaxel and docetaxel,
and anthracyclines like doxorubicin.
We have a subset of breast cancers
that are estrogen
or progesterone receptor positive
and so we didn't talk too much
about hormonal therapy here
but in breast cancer and prostate cancer
and a few others,
we do use hormonal therapy a lot.
Tamoxifen
is a selective estrogen receptor modulator
and the aromatase inhibitors anastrozole,
letrozole, exemestane,
all inhibit estrogen in different ways.
And then we also have our targeted therapy
that I started to introduce.
So again HER2 is expressed on
about 20% to 30% of breast cancers,
and we can target it
with a monoclonal antibody trastuzumab.
Pertuzumab is another monoclonal antibody
that actually works to prevent
the dimerization of HER2
with a family member that will cause
an activating pathway.
And then we also have lapatinib
which is a tyrosine kinase inhibitor
that binds on the inside of the cell
directed towards HER2 as well.
1:31
And so, an example treatment regimen
for an estrogen receptor positive,
HER2 positive patient with localized breast cancer
may look something like this,
where the patient gets either a lumpectomy
that will remove the breast cancer
from the breast or a mastectomy
followed by adjuvant chemotherapy.
So again, this is given
after the definitive therapy which is surgery
so doxorubicin
and cyclophosphamide
is typically given for four cycles,
this can be given in a dose-dense manner
where it's given every two weeks
with growth factor support
as I talked about before,
or it can be given every three weeks.
Following that,
patients commonly get a different drug
called paclitaxel
with a targeted therapy
because the tumor is HER2 positive,
so paclitaxel is given in combination
with a monoclonal antibody to target HER2.
And then after that is completed,
radiation may be given depending on the surgery
and the stage of the disease,
tamoxifen because the patient
is estrogen receptor positive,
will be given daily for five to ten years,
and then trastuzumab our targeted therapy
against HER2
is also continued out for a year.
So you can see that these treatment regimens
can combine a lot of the modalities
we just talked about between surgery,
radiation, traditional chemotherapy,
and targeted therapy,
and can also last for quite a long time
but this is part of the reason
why we have been so successful at curing
a lot of localized breast cancer as well.