Rational for breast conference-European Breast Cancer Conference (EBCC 12) : EORTC

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Rational for breast conference

Rational for breast conference

Paolo Veronesi Istituto Europeo di Oncologia, Italy started the surgical session with a presentation based on standards and controversies in SN, making a quick historical explanation from the initial surgical approach to the axilla with the AD for all patients with BC, passing on the SNB, to the current management. In the adjuvant setting, however, the larger benefit from trastuzumab in Rqtional compared to HRpos disease has not been observed and all the intrinsic subtypes did benefit similarly from Rational for breast conference. They are also the best way for doctors to learn better methods to Rational for breast conference cancer. Thai Gynecologic Cancer Society. Information Program. Breast Cancer Conference provide a platform for sharing of information about the breast cancer treatment techniques and newly developed techniques Rational for breast conference the same as well as provide platform about the recent researches on breast cancer. Stock peg indicators ofcryoablation is being studied to see whether it could be the subtitle for lumpectomy in small cancers. It will also provide insight to the novel inventions and techniques. Every cancer triggers cknference immune response that constitutes an important first-line protection against cancer progression.

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Track 8: Breast Cancer Nursing. Cancer Relief Society Nepal Early detection is always better and can be done through Rational for breast conference methods. Track Mammography. Lump in the breast are not cancer but they are benign which means they will not spread out, but are abnormal growths. Canada Breast Cancer Statistics 26, women were diagnosed with breast cancer. Taking healthy food, avoiding alcohol and smoking may be an important precaution Rational for breast conference developing cancer. Related Videos. Genetic changes in growth factor can lead to abnormalities. Trust me; a visit here will guarantee you the best hospitality in the world. In these cases, treatment can relieve your symptoms and help you live longer. Rational for breast conference describes an accumulation of abnormal cells in the breast which isn't cancer, but it can be a forerunner to the development of breast cancer. Breast cancer, like other forms of fod, can result from multiple environmental and hereditary risk factors like individual person's development, exposure to microbes, medical interventions, and Jude bald exposures to nutrients, energy and toxicants, chemicals from industrial, agricultural processes and from consumer products. As a result of being confined to the ducts, DCIS has a very good prognosis. The Rationla Conference of State Legislatures addresses the health benefits of breastfeeding in an article published June 11, [2] which states in part that: "Both mothers and children benefit from breast milk.

An exclusive, annual biopharma summit providing insights into the research and development of cutting edge treatments for Breast Cancer and a networking forum for precision medicine leaders in this space.

  • The schedule at a glance and daily schedule will be posted this month.
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The venue was excellent. It has been a high quality meeting. September 17, Other attendees echoed this. Well done! October 18, Excellent all round, delighted to have had the opportunity to be part of it.

October 22, The cross-pollination of ideas will promote better patient care and lead to new opportunities for innovative research. Smith , USA. November 17, I also liked the debates on cutting edge topics which are thought provoking and sometimes practice changing. I brought a wealth of new insights and inspirations back home in my daily and scientific work. I feel very privileged to have been given the opportunity to present our study at such a highly professional multidisciplinary forum.

November 15, You helped make the congress a success. Watch the MIBC video for congress highlights. Congress Book Click on the picture above to view the full scientific program and abstracts. In Partnership With. Opportunity to attend workshops featuring local experts.

Who Should Attend? Congress Chairpersons. Registration How to register, terms and conditions. Accommodation Book accommodation at the official congress hotel. Abstracts Guidelines for abstract submission. General Information Important information about the congress. Industry Support and exhibition opportunities.

Oslo is also in the process of being certified as a Sustainable Destination, a seal of approval given to destinations that work systematically to reduce the negative impact of tourism. Invasive cancer has the potential to also spread to other parts of the body. The first breast cancer line described was BT, established in The schedule at a glance and daily schedule will be posted this month. It helped to shrink cancerous cells before surgery and prevent recurrence after surgery and treat cancer that is metastasized or has spread to other parts of the body. Berlin is the capital and the largest city of Germany as well as one of its 16 constituent states. If you are reporting on the symposium, whether remotely or on site, you will find everything you need here.

Rational for breast conference

Rational for breast conference

Rational for breast conference

Rational for breast conference

Rational for breast conference

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11th European Breast Cancer Conference (EBCC)

Consuelo Morigi. Improved imaging and increased screening uptake have led to detect smaller cancers. These factors have highlighted two possible scenarios to omit surgery: for patients with small low-grade ductal carcinoma in situ DCIS and for those who have received NACT and had a clinical and radiological complete response.

The Umberto Veronesi Memorial Award went to Lesley Fallowfield Brighton and Sussex Medical School, UK for her important research and activity in the field of the development of patient outcome, of better communication skills and quality of life for women.

In her lecture, she remarked on the importance of improving BC personalised treatments, especially through co-operation between scientists, always considering the whole woman and not just her breast disease.

This award was given by Paolo Veronesi, after a moving introduction which culminated with the following words of Professor Umberto Veronesi:. Keywords: 16th St Gallen Consensus Conference , early breast cancer, neoadjuvant, adjuvant, therapies, consensus. Correspondence to: Consuelo Morigi. Email: consuelo. Publication costs for this article were supported by the e cancer Global Foundation.

Currently, SN biopsy SNB after NACT in patients with initially positive nodes is accurate and reliable but requires patient selection and optimal surgical techniques [ 4 — 7 ].

Something totally new appears to be the possibility of prophylactic irradiation of the contralateral breast for BRCA mutation carriers [ 14 ]. In pre-menopausal high-risk patients who have received chemotherapy, aromatase inhibitor AI and ovarian function suppression OFS are effective in reducing distant relapse at 8 years [ 17 ]. Extension of endocrine therapy ET beyond 5 years with an AI in postmenopausal women modestly affects recurrences; for some of these patients at high risk but with low compliance, intermittent administration of AI might be feasible with an improved quality of life [ 18 ].

In triple negative breast cancer TNBC , the role of platinum is still unclear. The role of TILs in residual disease may further improve risk stratification [ 31 ]. Christos Sotiriou Institut Jules Bordet, Belgium focussed on the genomic risk stratification of early relapse.

Gene expression profile GEP assays e. Regarding risk assessment of late recurrence from ERpos BC, Ivana Sestak Wolfson Institute of Preventive Medicine, UK reported that clinico-pathological parameters, especially nodal status and tumour size, are important for prediction of late recurrences. In some patients, extended ET can reduce recurrences but given the side effects of ET to define optimal patient selection for extended treatment is crucial.

Many web-based risk calculators incorporating clinico-pathological and epidemiological parameters providing information on the risk of late recurrence have been developed, for example, the CTS5 calculator. Even if GEP have been developed to predict early recurrence, some of them have shown clinical validity for late recurrence too e. Molecular tests could have the clinical utility to better decide which patients should receive chemotherapy or not, patients who can avoid ET with the rationale of not reducing quality of life unnecessarily [ 35 ], women at high risk even when optimally treated who are eligible for new expensive drugs and predict which patients will present outlier toxicity in order to substitute conventional treatments with new drugs.

Regarding new tools for risk stratification, it should be taken into consideration that some genomic alteration could predict the outcome of BC patients—for instance, it has been reported in several studies that 8p11 amplification identifies a group of patients with poor outcome, in contrast, mutations on MAP3KA have been associated with better outcome [ 36 ]. Detection of circulating tumour DNA ctDNA after NACT and surgery could be associated with the worst prognosis [ 37 ], this tool could be important because we can detect micro metastases before to give local therapies.

Testing pharmacodynamic of the drug in vivo [ 38 ] can also be relevant. Intratumour heterogeneity genetic distance, lethal sub-clones in the primary tumour and genome instability and genome evolution are going to give us information about the risk of relapse. Interestingly, there also appears to be a possible application for artificial intelligence and machine learning in this field of prediction [ 39 ].

Aleix Prat Hospital Clinic of Barcelona, Spain reported in his presentation on the heterogeneity in treatment response in patients with HER2pos BC and the importance of combinations of clinical and biomarker data with well-designed trials in order to successfully escalate or de-escalate therapy.

Tumour microenvironment is also important, in particular, TILs in the stroma is a consistent biomarker of better outcome [ 42 ]. TILs seem to be interesting also as an on-treatment biomarker, in fact, there is a correlation between increasing TILs during therapy and pCR [ 43 ].

Since the progression of ERpos BC is related to increased somatic mutation rates, immunotherapy approaches should be aggressively pursued. The current research challenges are the translations of biomarkers to early BC e. GeparNuevo , integration of PD-L1 as a new marker for neoadjuvant and adjuvant clinical trials and selection of patients for additional therapeutic strategies.

Research priorities are the identification and the evaluation of biomarkers that could allow the best treatment for the patient [ 50 — 54 ].

TrEatment could provide the opportunity to prospectively validate a biomarker-driven strategy for treatment of ERpos postmenopausal women. Emerging molecular tools offer the potential to tailor treatment according to biology. Numerous efforts have evaluated the role of biomarkers in discriminating high from low-risk DCIS. The expression of 23 genes involved in cell cycle progression CCP score, Myriad Genetics may provide prognostic and predictive markers to identify patients who can derive the greatest benefits from low dose of tamoxifen in terms of recurrences.

The first special lecture of the second day of the congress was held by Sharon H Giordano MD Anderson Cancer Center, USA , who spoke about the necessity to extrapolate data from clinical trials to applying them in real life.

It is very important to carefully select the study design, statistical techniques and also be aware of the limitations of trial data. The second lecture was given by Ann H Partridge Dana-Farber Cancer Institute, USA and she spoke on the clinical benefit of treatments for women with BC, especially if these treatments convey current understanding of evidence and guidelines.

It is important to consider individual patient preferences in order to determine the optimal treatment approach for every woman with BC: we should take care of the human being, not the disease.

Currently, emerging clinical biomarkers may predict the response to these drugs e. In contrast, the quantity of TILs in metastatic lesions is extremely low, indicating why advanced BC patients did not have high response rates to immune checkpoint PD- L 1 inhibitors.

Combinations of immunotherapy with chemotherapy have been investigated in the advanced setting e. Further studies are necessary but target immune pathway in BC appears promising.

It should be considered that surrogate endpoints do not consistently correlate with long term endpoints [ 59 ]. What can we expect from the latest drugs approved for aBC and evaluated for eBC? Regarding mammalian target of rapamycin inhibitor mTORi —moderate PFS benefit was demonstrated, OS not statistically significant maybe also because the trials were not powered , with toxicity now better managed with the use of steroid mouth wash for stomatitis—they probably do not have a future role in eBC.

This is likely to be the same for PI3Ki, currently only one of which has showed a moderate PFS benefit and all of these drugs showed too much toxicity. The role of Histone deacetylase inhibitor HDACi still remains uncertain: chidamide has a moderate PFS benefit but some toxicity and we are still waiting to hear about entinostat. Regarding checkpoint inhibitors, we cannot conclude based on aBC trials the benefit for eBC because aBC and eBC are totally different in the immune setting.

For other patients, MGS scores may have a role in prognostication and prognosis models. Future studies may establish MGS to guide the choice of drug therapies with benefits for patients and also for health care systems avoiding unnecessary and costly treatments. These groups of BC are relatively uncommon and heterogenous by gene expression profiling. Low HR expression is associated with higher KI67, higher grade and less progesterone receptor PR positivity, higher recurrence score and higher chemo-sensitivity.

Regarding treatment recommendations, chemotherapy should be given following guidelines for TNBC [ 60 ]. It is important to consider the intra- and inter-tumoural heterogeneity and the fact that there is no correlation between IHC and gene expression profiling. In the adjuvant setting, however, the larger benefit from trastuzumab in HRneg compared to HRpos disease has not been observed and all the intrinsic subtypes did benefit similarly from trastuzumab.

Some studies demonstrated major sensitivity to carboplatin [ 61 ] but in others, it is less evident GeparSixto.

Additional prospective studies stratified by BRCA1 and BRCA2 mutation status are needed to better understand the effect of carboplatin in polychemotherapy regimens. Paolo Veronesi Istituto Europeo di Oncologia, Italy started the surgical session with a presentation based on standards and controversies in SN, making a quick historical explanation from the initial surgical approach to the axilla with the AD for all patients with BC, passing on the SNB, to the current management.

Bahadir Gulluoglu Marmara University School of Medicine, Turkey focussed his presentation on the impact of older age on local treatment decisions. Systematic analyses showed that both ET alone and surgical approach plus adjuvant ET provided similar OS rates, but without surgery, there is a higher local recurrence LR rate [ 64 ].

The surgical option remains the standard in physiologically fit elderly patients with all subtypes of BC, but in fragile HRpos BC patients with limited life expectancy, it may be possible to consider primary ET, with AI being preferable over tamoxifen [ 65 ].

Controversy also remains regarding the utility of whole breast irradiation WBI. WBI reduces LR rate but does not improve OS, and therefore it can be omitted in unfit patients or in fit patients with clinical low-risk BC [ 66 , 67 ]. SNB can possibly be omitted in unfit patients and in fit patients with clinical low risk or in those in which SN information will not change surgical management [ 68 , 69 ].

In this group of patients, a possible contralateral prophylactic mastectomy CPM should be a shared decision between women and their physicians. CPM has not shown any survival benefit, the annual risk of contralateral BC second primary is only 0. The resection of the whole residual microcalcification is still necessary after NACT [ 78 ]. Currently, omitting surgery after NACT is still not possible, but there are many ongoing trials that will perhaps lead to a change in this approach.

The optimal time after last NACT and surgery is 21 days: surgery within 21 days was associated with an improved OS [ 79 ]. Nowadays, there are many trials evaluating the omission of RT in patients at low biological risk based on biomarker assessment e. These trials will help to quantify the risk of LR and select patients for whom RT may be omitted. There are also trials evaluating the elimination of regional nodal radiotherapy in patients with limited node-positive disease and low biological risk e.

Current data support PBI use for selected low-risk patients but longer-term safety data are essential for definitive evaluation. The use of hypofractionated-PMRT currently remains unclear.

Patients with breast reconstruction are at increased risk of late fibrosis and adverse cosmetic outcome after RT but there are no current guidelines for target volume definition after reconstruction. John H Maduro University Medical Centre Groningen, The Netherlands spoke about the potential role of proton irradiation compared to conventional photon irradiation.

Protons are charged particles able to deliver the dose to a specified depth where they stop, with a reduction of cardiac and pulmonary toxicity [ 82 ]. Nowadays, however, even if there has been a clear increase in proton facilities in recent years, the availability remains scarce and the costs high. The goals of adjuvant therapy are: eradicate micrometastatic disease, improve OS, and delay recurrence resulting in a better overall quality of life.

The goals of neoadjuvant therapy are: eradicate micrometastatic disease, improve OS, decrease extent of surgery, provide prognostic information, select candidates for additional treatment, test de-escalation trials and strategies and conduct tissue-intensive trials. Adjuvant chemotherapy with upfront surgery should be preferred, dependent on the anatomic extent of disease and when it is impossible to follow disease during NACT.

It is time for a new approach for clinical trials in the neoadjuvant setting which can lead to individualization therapy and improved outcomes COMPASS trial. This group of BCs has generally favourable prognosis, but sometimes some of them have a poor prognosis. In the future, we could benefit from the clinical use of circulating tumour cells CTC to assess prognosis [ 85 , 86 ].

Circulating tumour DNA ctDNA methylation in serum and plasma has been shown to be effective for diagnostic or prognostic biomarkers detection in different tumour types and in the future will be useful in clinic. There is emerging evidence that metabolomic profiling may have the ability to further stratify risk within existing genomic assay determined risk categories [ 88 , 89 ]. According to the data, the use of adjuvant tamoxifen T for 5 years in these women determines substantial reductions in recurrence with an important improvement of OS.

In choosing the duration of ET, the following should be considered: baseline tumour risk, age, tolerance to ET, and fertility. The current treatment options include T, AI or a sequence of these. Individual trials and meta-analysis suggest that AI treatment, such as either initial or sequential therapy, reduces recurrence risk compared to 5 years of T alone and it appears to be better, especially for women with higher risk tumours and lobular carcinomas BIG , ABCSG 8.

It is important to consider that ET also have side effects which can be reduced by switching a type of ET with another one or, for example, regarding arthralgia, using omega-3 fatty or acupuncture [ 90 , 91 ]. The aim for better therapeutic management is to identify patients with intermediate-high risk of recurrences that could potentially benefit from the extension of ET, genomic signature has been shown to be prognostic in term of the risk of recurrences [ 92 ].

Robert Coleman Weston Park Hospital, UK focussed on the clinical benefit of bisphosphonates, which should be part of routine treatment in the adjuvant setting in postmenopausal women with early BC at significant risk for disease recurrence.

Benefits appeared similar across different bisphosphonates tested suggesting a class effect.

Rational for breast conference

Rational for breast conference

Rational for breast conference