Metastatic Breast Cancer: One Size Does Not Fit All

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Metastatic Breast Cancer One Size Does Not Fit
All
Clifford Hudis, M.D.Chief, Breast Cancer
Medicine Service MSKCC
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• Breast cancer is predictable but not
  absolutely.

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Invasive Ductal Carcinoma
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Message Pathways Inside Cancer Cells
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• We define invasive breast cancer on the basis of
  2 genes ER and HER2

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ER Negative
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HER2 Positive
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HER2/neu FISH Test
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• Outcomes are widely variable.

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• We have to consider the genome of the tumor
  AND the patient.

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(No Transcript)
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Apoptosis genes (n641)
Cytoskeleton genes (n641)
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Five Kinds Of Breast Cancer?
HER-2/ER-
Luminal A
Luminal B
Normal
Basal-like
Sorlie T et al, PNAS 2001
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Challenges

• Molecular profiles are
• Variable by population studied
• Poorly adapted for clinical use
• Biology as yet not well characterized
• Relationship to conventional chemotherapy
  response not well characterized
• Ability to correctly identify molecular targets
  not yet proven

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Unsupervised Cluster Analysis of 99 primary
breast carcinomas from MSKCC tumor bank
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IHC for differentially expressed genes in ER(-)
Class A
Class A
Class A
Class B
Class B
ALCAM
plt0.0001
ALCAM p0.023
A
B
SPDEF
SPDEF plt0.0001
plt0.0001
B
A
AR
plt0.0001
AR p0.04
B
A
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Real World - Now

• Your doctor makes an educated guess about the
  pace of the disease and treats accordingly.
• You and your doctor regularly assess the benefits
  of specific treatments and adjust accordingly

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Real World - Future

• Your doctor tests your cancer AND your normal
  cells.
• You and your doctor rationally select therapy
  predicted to control or cure the disease.

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Breast Cancer Medicine Service, MSKCC 2005