The Tenth Kyoto Breast Cancer Consensus Conference ... · JuJudgdgment ment ofof s senensisibibility lity toto hohormrmononalal ththeraperapyy Gene expression profile 5 4 2 21 Ki67

Theme“Presurgical Treatment of Luminal-

type Breast Cancer”

The Tenth Kyoto Breast Cancer Consensus Conference

Questionnaire Result

Sat. 22 January 2011

Kyoto Breast Cancer Consensus Conference 2011/1/22

CorporatedCorporated institutions for the questionnaire (32 institutions for the questionnaire (32 institutes, no particular order)institutes, no particular order)

Kyoto KatsuraHospital

Shiga University of medical science

Hyogo prefectualTsukaguchi hospital

Shiga medical center for adults

Kohka public hospital

Kan norimichi clinic Otsu red cross hospital

Kyoto min-iren chuohospital

Himeji medical center

Osaka red cross hospital

Japan red cross Wakayama medical center

Obama municipal hospital

Hiroshima university hospital

Kodama surgery

Kitano hospitalKyoto medical center

Kishiwada city hospital

Yamato takadamunicipal hospital

West Kobe medical center

Tenriyorozu hospital

Hikone municipal hospital

Fukui red cross hospital

The Baptist hospital

Prefectural Amagasaki hospital

Nagahama city hospital

Takatsuki red cross hospital

Ako city hospitalKansai electric power hospital

Kurashiki central hospital

Social insurance Shiga hospital

Shinko hospital Kyoto university


Chemotherapy indication of Chemotherapy indication of LuminalLuminal--type breast cancertype breast cancerER levelER level

26

6

PgR levelPgR level

12

19

1

Weigh heavily

Consider

Not Consider

Not measuring

Assessment Assessment methodmethod

27

3

%%

Allred


Chemotherapy indication of Chemotherapy indication of LuminalLuminal--type breast cancertype breast cancer

HER2 levelHER2 level

17

6

9

1810

13

Histological gradeHistological grade

1613

0 3

Nuclear gradeNuclear grade

Weigh heavily

Consider

Not consider

Not measuring



weigh heavily

Consider

Not consider

Not measuring

10

19

3Tumor sizeTumor size

20

12

lymph node involvementlymph node involvement

20

12

Number of involved Number of involved lymph nodeslymph nodes 6

16

10

Level of involved Level of involved lymph nodeslymph nodes



Vascular invasionVascular invasion

8

23

01 1

21

10

Ki67Ki67 11

90

12

Weigh heavily

Consider

Not consider

Not measuring

6

25

1

AgeAge

Histological typeHistological type


OncotypeOncotype DxDx・・MammaPrintMammaPrint

5

27

Using Oncotype Dx

Not using it


Timing of chemotherapyTiming of chemotherapy

9

320

Before surgeryAfter surgeryOn each case


Evaluation of chemotherapeutic Evaluation of chemotherapeutic effects during and after NACeffects during and after NAC

31581719Use3421151Attach particular

importance

Ki67PETCTMRIUSMMG


When hormone receptors become When hormone receptors become negative after prenegative after pre--operative operative chemotherapy, do you give hormonal chemotherapy, do you give hormonal therapy after surgery?therapy after surgery?

20

9

2

GiveNot giveGive when ER before the treatment is high


Do you give preoperative Do you give preoperative hormonal therapy?hormonal therapy?

11

3

18For post-menopausal patientsGive regardless of menopausal statusNot give


The purpose of preoperative The purpose of preoperative hormonal therapy is…hormonal therapy is…

2381To decide the duration of hormonal therapy

15161To obtain pCR

13190To know the change of biomarker (ER, Ki67 etc)

51512Judging the necessity of chemotherapy

4216Tailoring of hormonal therapy

8204Prediction of prognosis

41117To know sensitivity to hormonal therapy

11318Increase in breast conserving rate

Not a purpose

Could well be a purpose

Important purpose


Indication of preoperative Indication of preoperative hormonal therapyhormonal therapy

349Menopausal status

574Low sensitivity to chemotherapy

169Hormonal therapy sensitivity

475Lymph node involvement

1411Tumor size

Not considerConsiderWeigh heavily


Judgment of sensibility to hormonal Judgment of sensibility to hormonal therapytherapy

21245Gene expression profile112136Ki67

7178Age1913histological type

119102vascular invasion2363Level of involved lymph nodes17114Number of involved lymph nodes1688lymph node involvement1796Tumor size

411134Nuclear grade411116Histological grade

14126HER2 level (0, 1+, 2+)51215HER2 (whether positive or

negative)

11120PgR level

131ER level

Not measuringNot considerConsiderWeigh heavily


Evaluation of preoperative hormonal Evaluation of preoperative hormonal therapytherapy

453117Use

23114Attach particular importance

Ki67PETCTMRIUSMMG

2

elasticity



The Tenth Kyoto Breast Cancer Consensus Conference

Theme“Preoperative Treatment of Luminal-type

Breast Cancer”

27%

19%

6%

48% Should be implemented principallyWhen more than 4 then should be implemented principally

Regardless of lymph node meta, it should be decided on propensities of tumor

Not just number of meta but other factors should be taken into account andshould be collectively judged

For hormone receptor positive For hormone receptor positive breast cancer with nodal breast cancer with nodal involvement (>2mm), chemotherapy involvement (>2mm), chemotherapy should be implementedshould be implemented


Chemotherapy should be implemented Chemotherapy should be implemented for hormone receptor positive breast for hormone receptor positive breast cancer with the sizes as stated below, cancer with the sizes as stated below,

13%

9%

15%

63%

More than 2cmMore than 3cmMore than 5cmTumour size is irrelevant


For judging the necessity of For judging the necessity of chemotherapy for hormone receptor chemotherapy for hormone receptor positive breast cancer, PgR is…positive breast cancer, PgR is…

6%

64%

30%

Heavily weighedConsideredNot considered


For judging the necessity of For judging the necessity of chemotherapy for hormone receptor chemotherapy for hormone receptor positive breast cancer, HER2 level (0, 1+, positive breast cancer, HER2 level (0, 1+, 2+) is…2+) is…

0%

49%51%

Heavily weighedConsideredNot considered


Which proliferation marker should Which proliferation marker should be considered for the indication of be considered for the indication of chemotherapychemotherapy

17%

13%

61%

9%

Mitotic index is weighed heavilyKi67 is weighed heavilyJudging collectively Mitotic index, Ki67Proliferation is not taken into consideration


33%

29%

31%

7%

~15%20%30%More than 30%


9%

17%

74%

UsefulNot usefulAbstention


62%

38%

0%

If possible, would like to do it in all casesShould be done with consideration of risk of recurrenceThere is no need to implement at this moment


15%

11%

74%

0%

Useful for prediction of prognosisUseful for prediction of effect of treatment Useful for prediction of prognosis/ prediction of effect of treatmentNot useful


4%

87%

9%

IImportant

Should be considered

Not consider


83%

0%

13%

4%

GiveNot giveDepend on hormone receptor levelbefore chemotherapy

Others

If the hormone receptor became negative (0%) after preoperative chemotherapy, would you give hormonal therapy after surgery?


33%

21%

41%

5%

For postmenopausal patients

Give regardless of menopausal status

Not give, but would like to

Would not like to give


To know the sensitivity of hormonal To know the sensitivity of hormonal treatment can be the purpose of treatment can be the purpose of preoperative hormonal therapy?preoperative hormonal therapy?

84%

2%

14%

Can be purposeCan’t be purposeCan’t say either


Preoperative hormonal therapy should Preoperative hormonal therapy should be given only for the highly hormone be given only for the highly hormone sensitive breast cancer?sensitive breast cancer?

46%

32%

22%

I think soI don’t think soabstention


37%

5%

58%

I think soI don’t think soabstention


47%

40%

10%3%

Size reduction is necessary

SUV decrease by FDG-PET or decrease of Ki67

Change of solidity of tumour

Others


For the evaluation of treatment For the evaluation of treatment effect, are you interested in effect, are you interested in Volumetry?Volumetry?

96%

0% 4% 0%

InterestedNot interestedMore info is necessaryOthers


Are you interested in clinical trial Are you interested in clinical trial using Volumetry?using Volumetry?

87%

11%

2%

Interested

Not interested

Abstention


Documents

The Tenth Kyoto Breast Cancer Consensus Conference ... · JuJudgdgment ment ofof s senensisibibility lity toto hohormrmononalal ththeraperapyy Gene expression profile 5 4 2 21 Ki67