August is exciting: "2022 Breast Tumor Elite Practice and Exchange Project - Jiangsu Station" is enthusiastically coming!

The "2022 Breast Tumor Elite Practice and Exchange Project" is an offline + online linkage project sponsored by the China Medical Education Association, which not only improves the standardization of clinical breast cancer treatment in the industry, but also promotes the in-depth communication
between the majority of young and middle-aged breast cancer doctors.
The conference was held on August 13 in Nanjing, Jiangsu Province, and it was an honor to invite the chairmen: Professor Sun Weili (Jiangsu Cancer Hospital), Professor Zhang Yanan (Zhongda Hospital Affiliated to Southeast University), Professor Liu Jianxia (The First Affiliated Hospital of Soochow University), Professor Zhou Jun (Lianyungang First People's Hospital).

The speakers were Dr.
Siying Zhou (The First Affiliated Hospital of Soochow University), Dr.
Haohao Wu (Yancheng First People's Hospital), Dr.
Ma Xiao (Zhongda Hospital Affiliated to Southeast University), Dr.
Zhu Mingao (The Second Affiliated Hospital of Soochow University) and Dr.
Bao Zhaokang (Suzhou Municipal Hospital).

Conference Chair: Prof.
Weili Sun (Jiangsu Cancer Hospital)

Conference Chair: Prof.
Yanan Zhang (CUHK Hospital, Southeast University)

Chair: Prof.
Jianxia Liu (The First Affiliated Hospital of Soochow University)

Chairman: Professor Zhou Jun (Lianyungang First People's Hospital)

Case 1 Sharing: Dr.
Siying Zhou (The First Affiliated Hospital of Soochow University)

Patient He, 39 years old, invasive carcinoma of the right breast, cT2N1M0, stage III.
A, Luminal B, PR(5%+,2+), Her2(-), underwent surgery on April 24, 2018, postoperative pathology suggested lymphatic metastasis, postoperative chemotherapy + radiotherapy + endocrine therapy (OFS+AI, 2019.
02-2019.
10), multiple bone metastases
were found throughout the body in October 2019.
The patient developed recurrent metastasis within 2 years of postoperative adjuvant endocrine therapy, which was judged to be primary endocrine resistance
.
Guidelines recommend consideration of endocrine therapy
for HR+, treatment strategies for primary endocrine resistance during adjuvant endocrine therapy after HER2-breast cancer surgery.
The patient's postoperative endocrine therapy adopted the OFS+AI protocol, following the endocrine therapy guidelines for postmenopausal patients, with fulvestrant recommended for level I and fulvestrant + CDK4/6
for level II after AI treatment failure.
Florvestrant has a good synergistic effect with CDK4/6i and fully inhibits tumor cell proliferation
.
Since December 2019, the patient treatment plan has been formulated as fulvestrant 500mg + CDK4/6 inhibitor 125mg qd po + OFS (goserelin 3.
6mg Q4W subcutaneous injection); Zolephosphate injection 4 mg IVGTT Q4W
.
The efficacy was rated as SD.

As of July 2022, PFS reached 32+
.

Comments:

The idea of making PPT is clear, and the questions raised are also representative; Throughout the whole speech process, the speaker was very expressive, the response was calm and fluent, and the patient diagnosis and treatment was standardized
.

Speaker: Dr.
Siying Zhou (The First Affiliated Hospital of Soochow University)

Case 2 Sharing: Dr.
Wu Haohao (Yancheng First People's Hospital)

The patient, 39 years old, found left-sided breast cancer, multiple lymph node metastases in the left clavicle area and chest, liver metastases, lung metastases, and multiple bone metastases
on June 2021.
Pathological suggestion: left breast invasive ductal carcinoma grade III, ER95%+, PR-, HER2++, FISH(-), Ki6735%+
.
On June 18, the postoperative pathology was left breast cancer, cT4N1M1, stage
IV.
After surgery, letrozole, abecilib, and goserelin were given, and the patient was re-examined to suggest PR, and regular treatment
with abecicil, letrozole, goserelin and denosumab continued.
The patient's reexamination suggested PD, and from 2022-04-30, he was treated with fulvestrant combined with everolimus, and goserelin and denosumab were treated
regularly.
Patient review suggests PR, and the original plan is under
maintenance therapy.

Comments:

The speaker's speech was smooth and infectious, with complete PPT content, comprehensive case data and rich pictures, which fully reflected the speaker's clear thinking
.
This is a complex case, and questions are raised about the diagnosis and treatment process of the case, and the speaker answers them one by one, which fully reflects the speaker's standardized diagnosis and treatment ideas
for the case.

Speaker: Dr.
Wu Haohao (Yancheng First People's Hospital)

Case 3 Sharing: Dr.
Ma Xiao (Breast Center, Zhongda Hospital, Southeast University)

Patient, 41 years old, right breast mass found on July 2009 DR, surgery on 31 July 2009, postoperative pathology as invasive ductal carcinoma, PR+++, HER2(2+), postoperative chemoradiotherapy + endocrine therapy (Torremiphene, 5 years).

Lymphatic metastases and bone metastases
were found on February 12, 2018.
According to the guidelines, endocrine therapy
can be preferred for patients with advanced breast cancer with HR+, HER2- MBC and visceral metastases.
As a result, OFS+fulvestrant + zolephosphate
began to be used in February 2018.
After three months of treatment, the condition was stable
.
Until October 2019, when the disease progressed, the second-line treatment decision was changed to fulvestrant + CDK4/6 inhibitor, and the examination in January 2020 showed lymph node narrowing, stable condition, and PFS for 32 months
.

Comments:

The speaker's speech was passionate, infectious and expressive, and his voice was loud, which fully reflected the speaker's confidence
.
Whether it is the presentation skills or the idea of case analysis, it is well founded
.
The speakers responded fluently, accurately and logically to the questions raised by the commentators
.

Speaker: Dr.
Ma Xiao (Breast Center, Zhongda Hospital, Southeast University)

Case 4 Sharing: Dr.
Zhu Mingao (The Second Affiliated Hospital of Soochow University)

This is a 72-year-old case of HR+ advanced breast cancer, operated on January 21, 2015, invasive catheter (T2), right axillary lymph node (1/9) with metastasis, immunopathology: ER(+, 50%), PR(-), Her-2(2+) not tested by FISH, Ki67(+, 30%)
.
After surgery, EC*4-T*4 chemotherapy was given, and oral tamoxifen endocrine therapy
was given without radiotherapy.
2016-12-30CT showed lung metastases
.
From January 11 to May 19, 2017, trastuzumab + vinorelbine, IV degree myelosuppression developed, and the efficacy PR
was evaluated in April 2017.
In June, he changed to exemetan oral + trastuzumab treatment, and one year later, he was treated with exemetan monotherapy
.
On April 19, 2019, lung and liver metastasis, considering the progression
of the disease.
Efficacy evaluation PR.

The reasons for this were analyzed, and the previous steroidal AI treatment developed drug resistance and led to treatment failure
.
2019-10-18 to 2021-10-26 Trastuzumab 330mg targeted therapy combined with fulvestrant endocrine therapy
.
During this period, the liver lesions were regularly assessed, the lung lesions continued to show no progression, no metastases in the skull, and no metastases
in the bone.

Comments:

The speaker's speech was smooth and organized, the PPT production case was complete and comprehensive, relevant questions were asked to the speaker, and the speaker answered calmly, reasonably
.

Speaker: Dr.
Zhu Mingao (The Second Affiliated Hospital of Soochow University)

Case 5 Sharing: Dr.
Bao Zhaokang (Suzhou Municipal Hospital (East District))

HR-positive advanced breast cancer patient, 53 years old, left breast invasive ductal carcinoma, left axillary lymph node (5/16) see cancer metastasis, ER(+), PR(-), HER2(2+), FISH(-)
.
Surgery was performed
in May 2003.
Postoperatively, TEC chemotherapy + radiotherapy + tamoxifen endocrine therapy (5 years)
was given.
In July 2013, the disease progressed and the right axillary lymph node metastasized
.
The effect of chemotherapy in patients with advanced breast cancer is not ideal, and the side effects of chemotherapy drugs seriously affect the quality of life of patients and even lead to interruption
of the treatment course.
A number of studies have shown that fulvestrant combined with CDK4/6 inhibitors have a significant
effect on the first-line treatment of HR+MBC.
However, CDK4/6 inhibitors had not yet appeared in drug therapy that year, so chemotherapy was still the first choice for advanced first-line
therapy.
Therefore, the NX chemotherapy regimen + radiotherapy + AI maintenance therapy
was maintained for this case.
Until September 2021, the disease progressed again and the right supraclavicular lymph node metastasized
.
Genetic testing found that ESR1 mutations can lead to secondary drug resistance to AI, and studies have shown that patients with ESR1 mutations are more effective than exemestane
when used with fulvestrant.
The MONARCH-2 study also demonstrated that abeccilil combined with fulvestrant significantly prolonged PFS in ITT populations, significantly increased ORR in endocrine resistant patients, significantly prolonged OS in ITT populations, and showed PFS benefits
in both wild and mutant ESR1 populations.
CSCO 2022 guidelines recommend that HR+HER2-MBC treatment options can choose HR+HER2-MBC treatment for second-line treatment, and CT in July 22 showed no obvious enlarged lymph nodes
on the right supraclavicular and neck.

Comments:

This case fully demonstrated the advantages of precision treatment, and the speaker used a strong basis to reflect the speaker's treatment plan treatment standard
.

Speaker: Dr.
Bao Zhaokang (Suzhou Municipal Hospital (East District))

Dr.
Ma Xiao from the Breast Center of Zhongda Hospital Affiliated to Southeast University will also participate in the next stage of sharing to bring you more excellent clinical experience sharing
.

Through this activity, it is hoped that experts from all over the country can fully understand and recognize more clinical experience
in the effective treatment of advanced breast cancer in the process of specific case analysis.
In the sharing process of multiple speakers, different real cases were shown, whether it is for first-line treatment or second-line treatment, young and middle-aged doctors have further expanded their cognition, which will also open a broader path
for the treatment of advanced breast cancer patients.

Group photo of all experts