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Nice St Paul Breast Cancer Guidelines : 2013 5 topics : - Axillary nodal exploration - Tumor Proliferation - Treatment resistance - Neoadjuvant treatments - T1ab tumors
Breast Cancer Guidelines and Axillary nodal
exploration
Emmanuel BARRANGER, Jean-Marc CLASSE, Marie Mélanie DAUPLAT, Gilles HOUVENAEGHEL, Alain TOLEDANO
1. Must we perform an addi3onal axillary clearance in case of isolated tumor cells in the sen3nel nodes?.
1 - Yes
2 - No
3 – Too few data
4 – Abstain
6%
63%
27%
4%
2 - In case of conserva3ve surgery, followed by a RT and a systemic medical treatment, must we perform an axillary clearance in case of 1 or 2 micrometasta3c sen3nel nodes?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
25%
48%
21%
6%
3. In case of conserva3ve surgery, followed by a RT indica3on and a systemic medical treatment, must we perform an axillary clearance in case of 1 or 2 macrometasta3c sen3nel nodes?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
63%
8%
22%
6%
7. Can we assess axillary lymph node involvement with sen3nel nodes technique aEer NACT (Neoadjuvant chemotherapy) in case of, clinical and ultrasonographic N0 tumor?
1 - Yes
2 – No
3 – Too few data
4 – Abstain
27%
46%
19%
8%
10. Must we recommend an axillary radiotherapy in case of pN1 micrometastases without an additional axillary clearance?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
50%
20%
13%
17%
Breast Cancer Guidelines and tumor
Prolifération
Fabrice ANDRE, Suzette DELALOGE, Jean-Marc GUINEBRETIERE, Thierry PETIT, Jean-Yves PIERGA, Daniel ZARCA
Préambule
Among the tests assessing proliferation we can consider the following ones (IMPAKT group.
! Oncotype Dx™, Mammaprint®, PCR-GG®, PAM50™, TBCI™ et Endopredict®
n Plus an individual marker of the proliferation ! Ki67
2. Are some of these genomic signatures useful for an adjuvant chemotherapy decision in HER2 posi3ve BC, ≥ pT1c, N+ ou N- ?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
2%
94%
0%
4%
3. Are some of these genomic signatures useful for an adjuvant chemotherapy decision in a ≥ pT1c, HR+, HER2-‐, > 3pN+?
1 - Yes
2 - No
3 – Too Few data
4 – Abstain
19%
75%
0%
6%
4. Are some of these genomic signatures useful for an adjuvant chemotherapy decision in a ≥ pT1c, HR+, HER2-‐, 1-‐3 pN+?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
55%
29%
10%
6%
5. Are some of these genomic signatures useful for an adjuvant chemotherapy indica3on in case of T1/T2, G3, N-‐, HR+, HER2 -‐?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
50%
30%
8%
12%
6. Are some of these genomic signatures useful for an adjuvant chemotherapy indica3on in case of ≥ T1c, G2, N-‐, HR+, HER2-‐ tumor?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
85%
4%
0%
10%
7. Are some of these genomic signatures useful for an adjuvant chemotherapy indica3on in case of ≥ T1c, G1, N-‐, HR+, HER2-‐ tumor?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
39%
49%
4%
8%
8 - For HR+ tumor, for which you have agreed to perform a test , which one(s) seem(s) useful for you to make you opt for an adjuvant chemotherapy?
1 - Oncotype Dx™
2 - Mammaprint®
3 - PCR-GG®
4 - PAM50™
5 - Endopredict®
6 - TBCI™
7 - Ki67
8 – any
78%
24%
12%
12%
27%
2%
90% 0%
Multiple choice Admitted
9 - Is Ki67 sufficent for an adjuvant chemotherapy indication in case of HR+, HER- breast cancer as defined previously?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
29%
45%
20%
6%
Breast Cancer Guidelines and Treatment resistance
Monica ARNEDOS, David AZRIA, Thomas BACHELOT, Mario CAMPONE, Anne VINCENT-SALOMON
1 – In optimal condition, must a single metastasis be systematiquely biopsied?
1 - Yes
2 - No
3 – Too Few Data
4 – Abstain
87%
13%
0%
0%
2 - Beside a single metastasis, are there any setting where a biopsy must be performed systematically?
1 - Yes
2 - No
3 – Too Few Data
4 – Abstain
67%
10%
4%
18%
3 - Can we define the specific evolution criteria and modalities required to opt for the best 1st line metastatic treatment?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
73%
2%
2%
23%
4- If so, which parameter should be considered ?
1 – Free Interval time
2 – Type of adjuvant systemic treatment
3 – Metastatic relapse location
4 – Sub-molecular classes.
5 – Menopausal status
6 – Other
91%
84%
70%
84%
72%
40%
Multiple choice Multiple choice admitted
5 – Can we define a primary resistance to hormonal treatment for an HR+ tumor treated in adjuvant setting?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
53%
23%
11%
13%
6- If so, which of the following parameters should be considered:
Multiple choice admitted
1 – Early relapse : during the first 2 years of adjuvant Hormonotherapy (HT).
2 – Relapse during the adjuvant hormonotherapy
3 – Free Interval time after completion of adjuvant HT
4 – Sub molecular classes.
5 - Other
80%
56%
20%
36%
16%
7– Can we define a secondary resistance to a first line anti hormonal treatment for a metastatic HR+ tumor ?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
89%
4%
0%
6%
8- If so, which of the following parameters should be considered :
Choix multiple possible
1 – Duration of disease control due to the antihormonal treatment for < than 3 months 2 - Duration of disease control due to the antihormonal treatment for < than 6 months 3 Duration of disease control due to the antihormonal treatment for < than 12 months 4 – Sub molecular classes
5 - Other
47%
50%
18%
18%
8%
9- Must we consider metastatic site as well as therapeutic response to opt for the best therapeutic strategy ie, chemotherapy or hormonotherapy?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
58%
23%
6%
13%
10- Must a breast cancer metastasis progressing with a non steroidal hormonotherapy, could (should) receive Everolimus + the non steroidal HT in 2nd line treatment?.
1 - Yes
2 - No
3 – Too few data
4 - Abstain
29%
27%
20%
24%
11- What do you advocate in case of a patient HER2 + who is progressing while treated with trastuzumab for a 1rst line?.
1 – To continue with trastuzumab
2 – To substitute trastuzumab for Lapatinib
3 – To combine trastuzumab and Lapatinib
4 - other
45%
8%
38%
10%
12 - In case of an metastatic HER2 + breast cancer patient progressing with trastuzumab, do the metastatic site have an influence on future therapeutic strategies (CNS vs other)?.
1 - Yes
2 - No
3 – Too few data
4 – Abstain
65%
13%
9%
13%
BreastCancer Guidelines and
Neoadjuvant treatment
Luc CEUGNART, Francette ETTORE, Anthony GONÇALVES, Christophe HENNEQUIN, Rémy SALMON
1- Are the following parametters necessarry and sufficient for NAT decision : hystological type, mitotic index, HR status, HER2 status, Ki 67 ?
1 - Yes
2 - Non
3 – Too few data
4 - Abstain
54%
36%
6%
4%
2. When NAT is considered, is an initial surgical consultation essential to assess and explain the surgical options to the patients
1 - Yes
2 - No
3 – Too few data
4 – Abstain
96%
2%
2%
0%
3. Must we propose a systematic, morphologic and functional breast MRI at the begining of NAT, whether conservative surgery is considered
1 - Yes
2 – No
3 – Too few data
4 – Abstain
54%
31%
13%
2%
4. Must we perform a systematic a whole body work up including, TEP TDM at the beginning of NAT?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
27%
60%
10%
2%
5. Must we set up an intratumoral clip at the beginning of any conservative NACT?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
92%
6%
0%
2%
6. Can we consider that some submolecular subtype breast cancer are sufficent to apply a neo adjuvant strategy; a part from the classical indication for conservative surgery or for carcinologic purposes. (T4D) ?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
35%
39%
26%
0%
7 – Must we contraindicate a NACT for a postmenopausal HR+; lobular BC; with a low proliferation?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
77%
19%
2%
2%
8. Can we propose a NA hormonotherapy for conserva3ve purposes for some HR+ menopausal pa3ents with a low prolifera3on?.
1 - Yes
2 - No
3 – Too few data
4 – Abstain
60%
9%
20%
11%
9 - In NA setting, regarding the selection of the agents and/or the administration of the products, must the CT medication differ from that of adjuvant setting?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
11%
70%
13%
7%
10 Must we include another an3HER2 agent in combina3on with trastuzumab in NA se[ng for HER2+ breast cancer ?.
1 - Yes
2 - No
3 – Too few data
4 – Abstain
15%
32%
51%
2%
11. Are the indication and the modalities of post operative RT the same with and without NAT ?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
59%
20%
14%
7%
12 - In case of histological partial response, after a complete NACT protocole, must we consider an adjuvant cytotoxic treatment different from the initial NACT. ?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
14%
30%
53%
2%
Breast Cancer Guideline and Management of pT1a,b pN0
Yazid BELKACEMI, David COEFFIC, Paul COTTU, Florence DALENC, William JACOT, Magali LACROIX
1 - Must we consider that prognostic and predictive tumor markers of pT1ab breast cancers have the same value than for bulkier tumor?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
83%
12%
5%
0%
2 - For all invasive pT1ab N0 breast cancers cases, can we recommand not to perform any workup?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
78%
17%
5%
0%
3 - Can we define the BC optimal features allowing us to prevent RT in the management of pT1ab N0 breast cancer undergoing a conservative surgery?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
14%
55%
25%
7%
4- Must we perform a systematic boost on the tumoral bed of pT1ab breast cancer undergoing a conservative surgery with a normal fractionated RT ?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
27%
49%
5%
20%
5 - Can we define the optimal tumoral feature of some pT1ab breast cancers with a RT indication, allowing to use specific irradiation techniques of the mammary gland ie, hypofractionated irradiation partial irradiation, Intra Operative radiotherapy (IORT)
1 - Yes
2 - No
3 – Too few data
4 – Abstain
43%
10%
30%
18%
6- Must we propose a chemotherapy for all Triple negative pT1a pN0 invasive ductal carcinoma
1 - Oui
2 - Non
3 - Données insuffisantes
4 - Je m'abstiens
19%
59%
19%
3%
7- Must we propose a chemotherapy for all Triple negative pT1b pN0 invasive ductal carcinoma
1 - Yes
2 - No
3 – Too few data
4 – Abstain
46%
20%
22%
12%
8 - Must we perform an adjuvant treatment combining chemotherapy and Trastuzumab for all T1a, pN0, HR+, HER2 + breast cancer?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
37%
39%
17%
7%
9 – Must we perform an adjuvant treatment combining chemotherapy and Trastuzumab for all pT1b, pN0, HR+, HER2 + breast cancer?
1 - Yes
2 - No
3 – Too few data
4 - Abstain
66%
5%
24%
5%
10- Must we perform an adjuvant treatment combining chemotherapy and Trastuzumab for all pT1a, pN0, HR negative, HER2 + breast cancer?
1 - Oui
2 - Non
3 - Données insuffisantes
4 - Je m'abstiens
45%
14%
34%
7%
11- Must we perform an adjuvant treatment combining chemotherapy and Trastuzumab for all pT1b, pN0, HR negative, HER2 + breast cancer?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
88%
0%
10%
2%
12- Can we perform an adjuvant treatment combining an antihormonal treatment only with trastuzumab for some pT1ab, pN0, HR+, HER2+?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
19%
26%
43%
12%
13- Can adjuvant treatment be avoided for some pT1a pN0, HR +, HER2 negative breast cancers?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
78%
20%
0%
2%
14- Can adjuvant treatment be avoided for some pT1b pN0, HR +, HER2 negative breast cancers?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
50%
40%
5%
5%
15- For T1a, HR +, HER2 negative, can we define the tumoral features able to indicate an adjuvant chemotherapy?
1 - Yes
2 - No
3 – too few data
4 – Abstain
34%
27%
37%
2%
16- For T1b, HR +, HER2 negative, can we define the tumoral features able to indicate an adjuvant chemotherapy?
1 - Yes
2 - No
3 – Too few data
4 – Abstain
45%
13%
33%
10%
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