Doctors' benevolence, excellence: "2022 Breast Cancer Elite Practice and Exchange Project - Weihai Station" ended successfully

On August 13, the "2022 Breast Cancer Elite Practice and Exchange Project - Weihai Station" was successfully launched offline and online live broadcast, aiming to further improve the standardized diagnosis and treatment level of the industry, so as to improve the prognosis of breast cancer patients and promote the learning and exchange of young and
middle-aged medical workers 。 At the beginning of the conference, Professor Yu Zhigang (Second Hospital of Shandong University) and Executive Chairman Professor Wang Jian (Weihai Maternal and Child Health Hospital) delivered opening speeches and introduced the commentators of the conference, including: Professor Bi Tieqiang (Weihai Municipal Hospital), Professor Cao Fangli (Qilu Hospital of Shandong University), Professor Jiang Rui (Cancer Center of Shandong Provincial Hospital), Professor Qin Chunxin (Weihai Municipal Hospital) and Professor Wang Fei (Second Hospital of Shandong University).

。 The five speakers include: Dr.
Ni Gaofeng (Yantai Yantaishan Hospital), Dr.
Wu Jingwen (Qilu Hospital of Shandong University), Dr.
Mao Yan (Affiliated Hospital of Qingdao University), Dr.
Zhou Fei (Second Hospital of Shandong University) and Dr.
Yang Xiaodan (Yantai Laiyang Central Hospital).

Professor Yu Zhigang (The Second Hospital of Shandong University)

Professor Wang Jian (Weihai Maternal and Child Health Care Hospital)

Case 1 Sharing: Dr.
Ni Gaofeng (Yantai Yantaishan Hospital)

The patient, 37 years old, presented in
2013 for "2 years of discovery of a right breast mass".
2013.
12.
26 surgery, postoperative pathology suggests pT1N3M0 (stage III.
c), Luminal type A, ER(3+), PR(3+), Ki67 10%, HER2 (1+).

Postoperative TAC chemotherapy + radiation therapy + endocrine therapy (Torremiphene 60mg qd).

2016.
9.
16 Multiple bone metastases, disease progression
.
From September 2016 until March 2021, the patient's condition progressed multiple times, so on 9 March 2021, in accordance with guideline level I recommendations, the use of fulvestrant for endocrine therapy
was changed.
Through the diagnosis and treatment of this case, it can be seen that the use of AI endocrine therapy can still effectively control tumor progression in patients with HR-positive metastatic breast cancer who have failed TAM-assisted endocrine therapy.
After the AI rescue treatment failed, fulvestrant was used as a rescue treatment to obtain long-term disease control
.

Big coffee likes:

The speaker affirmed the diagnosis and treatment plan and effect of the case, raised relevant questions about the speaker's diagnosis and treatment process, and gave targeted answers, which was organized and logical, reflecting the standardization of diagnosis and treatment
.

Case 2 Sharing: Dr.
Wu Jingwen (Qilu Hospital, Shandong University)

This is a patient with HR(+), Her-2(-) metastatic breast cancer, 60 years old, 2004.
04 surgery, postoperative pathology: (left breast) invasive ductal carcinoma grade I-II (S: 5*3cm), ER(+++), PR(+++), CerbB-2(+), P53(++), VEGF(+).

Postoperative chemotherapy 7 cycles + endocrine therapy (tamoxifen 2 years, exemestatan 7 years).

2017.
10.
22Disease progression, bone metastasis
.
According to guideline recommendations, the advanced first-line endocrine therapy strategy for hormone receptor-positive postmenopausal patients is fulvestrant
.
Studies have shown that fulvestrant is more effective
than AI in postmenopausal HR+MBC patients who have not previously received endocrine therapy.
However, patients insist on letrozole
.
In July 2018, the disease progressed with metastasis of the left clavicle and no metastasis of
internal organs.
After 5 m of endocrine therapy with letrozole, tumor indicators increased
again.
According to the guidelines, the strategy after AI failure of endocrine therapy for advanced breast cancer in HR+ postmenopausal patients is recommended as level I recommended fulvestrant
.
We have been using fulvestrant
since July 2018.

Big coffee likes:

The speaker's voice is loud, smooth, expressive and infectious
.
The PPT is rich in content and complete in case data, reflecting the speaker's ideas
on case diagnosis and treatment.

Case 3 Sharing: Dr.
Mao Yan (Breast Disease Diagnosis and Treatment Center, The Affiliated Hospital of Qingdao University)

The patient, 43 years old, was diagnosed with breast malignancy (left, cT2N1M1), stage IV, Luminal type B, bone secondary malignancy, PR(-), Her-2(1+))
in 2018.
The consensus of guidelines is that endocrine therapy is the preferred treatment
for HR+MBC.
The results of the FALCON study showed that fulvestrant was more effective
than AI in postmenopausal HR(+) MBC patients who had not previously received endocrine therapy.
Late endocrine therapy for HR+ postmenopausal patients, and for patients without endocrine therapy, the level I strategy is endocrine therapy
.
After discussion of MDT, it was decided to use OFS+AI or OFS+fulvestrant + zoledronic acid treatment, but the patient finally chose oral torremiphene + zoledronic acid + lumbar spine radiotherapy
due to his own reasons.
2019-11-25Progression
.
Physical examination found that left breast cancer with left axillary lymph node metastasis, multiple bone metastases and liver metastases
throughout the body.
It is inferred that first-line PFS for 18 months is secondary endocrine resistance
.
The results of PALOMA-3 studies demonstrated that fulvestrant combined with Palbociclib in patients sensitive to prior endocrine therapy significantly improved OS.

The MONARCH 2 study also demonstrated significant improvement in PFS
after progression of fulvestrant in combination with Abemaciclib after prior endocrine therapy.
The MONALEESA-3 study showed that fulvestrant combined with ribociclib significantly improved PFS
.
Therefore, OFS+AI or OFS+fulvestus + CDK4/6+zoledronic acid are used
.
Efficacy was assessed as PR.

Big coffee likes:

The speaker's speech process was eloquent, which was infectious to case analysis, and fully reflected the speaker's medical benevolence! The case history and pathological data of PPT are complete, the diagnosis and treatment ideas are clear, and the treatment plan is interlinked, which is in line with the guidelines and specifications
.

Case 4 Sharing: Dr.
Fei Zhou (The Second Hospital of Shandong University)

The patient, 58 years old, was admitted to hospital on 04.
01.
2016 and had invasive ductal carcinoma of the right breast (cT2N0M0 stage IIA Luminal type B)
on 2016-01-05 puncture biopsy.
From January 10, 2016 to March 14, 2016, he was given 4 cycles of neoadjuvant chemotherapy with a 4-cycle TE regimen with an imaging evaluation of SD.

April surgery, 2016.
04.
14-2016.
05.
20 radiotherapy + endocrine therapy (letrozole, June 2016-July 2019), DFS for 42 months
.
2019-07-10The disease progressed, and bone metastases
were found.
The URGE study demonstrated that fulvestrant 500 mg was better than 250 mg and fulvestrant was superior to anastrozole
in patients with postmenopausal HR+ advanced breast cancer treated with endocrine therapy.
From July 2019 Fulvestrant 500mg IM once a month, followed by a dose of 500mg 2 weeks after the first dose
.
The efficacy was evaluated as SD and PFS for 36 months
.
Through the diagnosis and treatment of this case, it can be seen that for hormone receptor-positive advanced breast cancer rescue endocrine therapy that has failed AI treatment, fulvestrant + CDK4/6 inhibitors
are preferred.

Big coffee likes:

The speaker carried out standardized diagnosis and treatment of the case, and through the production of the entire PPT, it can be seen that his diagnosis and treatment ideas are clear, reasonable, and accurately answered the questions raised, reflecting the speaker's familiarity with the pathology of the case history and profound clinical foundation
.

Case 5 Sharing: Dr.
Yang Xiaodan (Yantai Laiyang Central Hospital)

The patient, 77 years old, was found to have left femoral metastasis for 11 months after breast cancer surgery, and on November 13, 2017, he presented with "6 months after the discovery of left breast mass"
.
Surgery on November 17, 2017, PR+, HER2-, ki67+40%.

No chemotherapy and radiotherapy, postoperative endocrine therapy (anastrozole 1mg QD PO).

Left femur metastasis in
September 2020.
According to the guideline level I recommendations, use fulvestrant 500mg im every 4 weeks + abecilil 150mg orally twice daily
.
The subsequent 28-day administration continued to this day, and the patient's left lower limb pain was significantly reduced
.
CT of the hip joint showed no significant enlargement
of the left femoral metastases.
After 8 months, the mass continued to shrink, and the efficacy was evaluated as partially remitting (PR).

Big coffee likes:

Through case analysis, it can be seen that the speaker has a thorough understanding of the guidelines and research basis, reflecting the speaker's standardized diagnosis and treatment level
for advanced breast cancer.
In the face of the questions asked, they can calmly answer, reflecting the speaker's confidence
.

This conference was best delivered by Dr.
Yan Mao from the Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qingdao University
.
At the end of the meeting, Professor Yu, chairman of the conference, concluded that the case analysis of this conference is very exciting, showing the strong and solid academic skills of young doctors, and the wonderful comments of the expert jury also highlight the diagnosis and treatment level
in the field of breast cancer in China.

(Group photo)