Focus on Triple Negative Breast Cancer (TNBC), covering both early-stage and metastatic TNBC.
Introduction slide will cover in detail about metastatic TNBC (referred to as Metat).
Classification
Mention of Rayman Classification, which involves potential drugs believed to be effective.
Overview of TNBC, its characteristics and how it varies based on location and spread.
Staging Criteria
Stage 1 - 3
Stage 1: Tumor size less than 1mm.
Stage 2: Tumor size between 2cm – 5cm; no significant lymph node involvement.
Stage 3: Tumor size more than 5cm, involving close areas with extensive lymph node involvement.
Stage 4
Stage 4: Advanced spread involving vital organs and nodes.
Treatment Considerations
Preoperative Recommendations
NeoAdjuvant Chemotherapy is advised for inoperable cases like phyllodes tumor, large tumor size, or presence of nodal involvement.
Decision based on various factors whether to proceed with surgery or chemotherapy first.
Surgical Decisions Post Neoadjuvant Therapy
Types of surgeries considered are mastectomy or lumpectomy based on response.
Potential consideration for additional systemic therapy or radiation.
Sentinel Lymph Node Biopsy
Decision-making between sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND).
Criteria for SLNB: clean nodes in imaging or fewer than 2 suspicious nodes.
ALND recommended if SLNB is positive or inadequate for clearance.
Chemotherapy Regimens
Historical Perspective
Evolution of chemotherapy regimens: CMF, AC, FAC, etc.
AC and EC regimens, adding on drugs like Taxanes, Paclitaxel, and Docetaxel.
Modern Approach
Use of regimens like TC (Docetaxel and Cyclophosphamide) versus more traditional combinations.
Benefits and drawbacks comparisons for various chemo combinations.
Immunotherapy and Targeted Therapy
Exploration of adding drugs like Pembrolizumab and others.
Trial outcomes: positive vs. negative impacts.
Keynote trials with Pembrolizumab showed improved outcomes.
Residual Disease Management
Management post-neoadjuvant treatment if residual disease remains.
Trials like CAPE and olaparib for 1-year demonstrated positive outcomes in reducing recurrence.
New Therapeutic Trials and Approaches
Integration of novel agents in trials for TNBC to improve outcomes.
Focus on Drugs such as Veliparib, Pembrolizumab (Keynote 522), and their impact on Pathological Complete Response (PCR).
Conclusion
Summary reiterating the advances in systemic treatments, their efficacy, and the importance of personalized treatment approaches based on individual response and genetic profiles.