Aromatase inhibitors act by lowering estrogen in the circulation and in tumor cells in postmenopausa

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• Aromatase inhibitors act by lowering estrogen in
  the circulation and in tumor cells in
  post-menopausal women

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Aromatase Inhibitors in Breast Cancer
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Clinical Trials with Aromatase Inhibitors
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Adverse Effects Associated with Anastrozole and
Tamoxifen in Trials
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Leuprolide (Lupron)

• GnRH analog
• continuous GnRH analog turns off the production
  of gonadotropins (LH,FSH) and decreases
  testosterone synthesis by 90-95
• slow release implantable devices (Duros) lasts
  12 mos.
• used to treat advanced prostate cancer
• cancer can escape and become androgen independent
  after 18-36 mos.

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Concerns related to the success of chemotherapy
in curing primary cancer

• Quality of life fertility
• Increased risk secondary cancer

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Late Complications of Cancer Chemotherapy
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Testis Histology
after Chemo
Normal
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Risk of Secondary Cancer after Chemotherapy
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Combination Therapy Examples Hodgkins Disease

• MOPP
• mechlorethamine, vincristine, procarbazine,
  prednisone
• ABVD
• doxorubicin, bleomycin, vinblastine, dacarbazine
• Stanford V
• Mechlorethamine by vein once every 4 weeks
• Doxorubicin (Adriamycin) by vein every odd
  week
• Vinblastine (Velban) by vein every odd week
• Vincristine (Oncovin) by vein every even
  week
• Bleomycin (Blenoxane) by vein every even
  week
• Etoposide by vein 2 days in a row weeks 3,
  7, 11
• Prednisone by mouth every other day

• high risk of secondary cancers, infertility
• lower risk contraindicated if heart or lung
  disease
• complex but may be better than ABVD

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DNA Microarray Analysis and Cancer Diagnosis
how does it work?
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blackdisease free at 5 yr
78 non-lymph node positive sporadic Breast CA
tumors were chosen
Tumors
white metastases
70 genes that were best discriminators
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Future of Gene Array Analysis in Chemotherapy

• 1. establish a prognosis directly from gene
  expression
• data on primary tumor sample--determine whether
  adjuvant therapy is warranted?
• 2. expression analysis may predict which tumors
  will respond to which drugs