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Malattia triplo negativa

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(1)

Il tempo guadagnato, a cosa dare valore?

La malattia triple negative

Antonella Lai

(2)
(3)

Outline

1. Introduction

2. Metastatic breast cancer

3. Goals of neoadjuvant therapy; pCR as an endpoint in TNBC

4. How to improve pCR in TNBC

• Optimizing taxanes in TNBC

• DNA damaging agents

• Immunotherapy

5. Is there a role for adjuvant therapy in TNBC in the future?

6. Take home messages

(4)

Triple negative breast cancer

(5)

TNBC is histologically heterogeneous

(6)

Outline

1. Introduction

2. Metastatic breast cancer

3. Goals of neoadjuvant therapy; pCR as an endpoint in TNBC

4. How to improve pCR in TNBC

• Optimizing taxanes in TNBC

• DNA damaging agents

• Immunotherapy

5. Is there a role for adjuvant therapy in TNBC in the future?

6. Take home messages

(7)

Metastatic TNBC: still a very poor outcome

(8)

Decision tree?

(9)
(10)

Goals of the treatment in ABC

(11)

Early treatment of TNBC is the BEST CHANCE

of cure!!!!

(12)

Outline

1. Introduction

2. Metastatic breast cancer

3. Goals of neoadjuvant therapy; pCR as an endpoint in TNBC

4. How to improve pCR in TNBC

• Optimizing taxanes in TNBC

• DNA damaging agents

• Immunotherapy

5. Is there a role for adjuvant therapy in TNBC in the future?

6. Take home messages

(13)

Goals of neoadjuvant therapy in breast cancer

• Make tumours more operable, increase the rate of breast conserving surgeries

• Probably, to improve prognosis of certain disease subtypes (i.e HER 2 +)

• Allow patient to start treatment earlier

• Have a better idea of prognosis based on response to neadj treatment

• Improve DFS and OS using pathological response rate for selection of

subsequent treatment in individual patients

(14)

Goals of neoadjuvant therapy in breast cancer

• Make tumours more operable, increase the rate of breast conserving surgeries

• Probably, to improve prognosis of certain disease subtypes (i.e HER 2 +)

• Allow patient to start treatment earlier

• Have a better idea of prognosis based on response to neadj treatment

• Improve DFS and OS using pathological response rate for selection of

subsequent treatment in individual patients

(15)
(16)

pCR as a surrogate endpoint for long term

outcomes

(17)

Stromal TILs and survival outcome in residual TNBC

Following neoadjuvant chemotherapy

(18)

Outline

1. Introduction

2. Metastatic breast cancer

3. Goals of neoadjuvant therapy; pCR as an endpoint in TNBC

4. How to improve pCR in TNBC

• Optimizing taxanes in TNBC

• DNA damaging agents

• Immunotherapy

5. Is there a role for adjuvant therapy in TNBC in the future?

6. Take home messages

(19)

Nab-Paclitaxel in TNBC: GeparSepto

(20)
(21)
(22)

Nab paclitaxel in TNBC: ETNA

(23)
(24)
(25)
(26)
(27)
(28)
(29)
(30)
(31)
(32)
(33)
(34)
(35)
(36)

pCR and EFS

(37)
(38)
(39)

Post neoadjuvant treatment approach

(40)

Adjuvant chemotherapy after pCR

(41)
(42)
(43)

Take home messages

(44)

• PARP inhibitors

available in metastatic setting (OlimpiaD) promising in NADJ

Olimpia

• Selection of patients

high risk patients/ biology of tumors post-neoadjuvant studies

earlier surrogate marker for pCR?

(45)

Grazie per

l’attenzione

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