Treatment of metastatic breast cancer ppt,std testing nyc results,complementary and alternative medicine magazine - Easy Way

admin 15.01.2014

As a busy clinician, balancing work life and home life and personal time generally means that something gives.
Lung cancer symptoms and signs up to one-fourth of all people with lung cancer may have no symptoms when the cancer is diagnosed.. Bone cancer begins in a person's bones but may spread to other parts of the body, called metastasis. Whether one of the several different modalities used for treating localized prostate cancer offers survival benefits over the others remains controversial.. Whether modalities treating localized prostate cancer offers survival benefits remains controversial..
Continuous advances understanding diagnosis, staging, treatment metastatic advanced prostate cancer. If uterine cancer diagnosed, doctor learn extent (stage) disease choose treatment. Copyright © 2013 Caroldoey, All trademarks are the property of the respective trademark owners. As we enter the era of personalized medicine, tests that can inform on molecular mechanisms of cancer, and on breast cancer in particular, are in high demand.
Body imaging (CT scan, x-rays, and magnetic resonance imaging [MRI] scans), more so than PET, has traditionally been used to detect the location of tumors and can assess the size and shape of malignant primary and metastatic disease. Determination of the hormone receptor status of primary breast tumors to stratify patients to appropriate therapy is standard clinical practice, but metastatic disease from breast cancer may be difficult to biopsy (eg, disease in the bones or brain), and the accuracy of biopsy may be confounded by tumor heterogeneity.
While FDG-PET is a valuable tool for detecting distant breast cancer, it can also be used to predict and assess response to therapy. Besides FDG, there are also several radionuclides under investigation for use as diagnostic tools to aid in treatment selection and assessment of chemotherapy response.
24 (HealthDay News) -- The American Society of Clinical Oncology has issued updated guidelines for the use of bone-modifying agents (BMAs) in treating breast cancer patients with bone metastases to include a new drug, denosumab, and provide new advice regarding a potentially serious complication of treatment, osteonecrosis of the jaw (ONJ); an overview of the guideline update was published online Feb. However, molecular imaging can also provide additional information on tumor biochemistry and molecular biology. Thus, an assay to determine the functional ER status of residual disease and monitor treatment response would be a valuable tool that could aid in therapeutic decision making.


FDG-PET was used to assess metabolic response in a subset of the 455 patients enrolled, and studies were obtained at baseline, at 2 and 6 weeks post initiation of the targeted agent, and prior to the addition of weekly paclitaxel. The goal of the study is to evaluate the ability of FLT-PET to noninvasively measure tumor proliferation.
Outcomes included SRE, time to SRE, adverse events, and pain.The investigators recommended BMA therapy for breast cancer patients with bone metastases, and did not find sufficient evidence to recommend any one particular BMA.
Measurement of tumor ER status could also be useful in determining effectiveness of novel ER-blocking therapies.
Among these, FES is emerging as a promising predictive biomarker that can help select candidates for endocrine therapy and monitor treatment response.
Eleven patients had undergone both imaging studies and definitive surgery at the time of the presentation. Recommended treatments include denosumab (120 mg subcutaneously), intravenous (IV) pamidronate (90 mg), or IV zoledronic acid (4 mg) every three to four weeks. There are several ways to obtain information on these biomarkers, including invasive testing (biopsy), which can be challenging depending on the location. These nuclides can be coupled with radiopharmaceuticals that target specific molecular characteristics of tumors. Positive predictive value (PPV) of response at 2 weeks vs 6 weeks was 78.5%, and negative predictive value (NPV) was 90%. Dental examination and appropriate preventive dentistry is recommended before initiation of BMA therapy as part of the advice to prevent ONJ. However, not all tumors that express targets identified by tissue assay will respond to directed therapy. At present, there are no standard tools that examine tumor heterogeneity or determine who will respond to targeted therapy, although genomic profiling may be useful with the latter.
When used for imaging, the amount of radiopharmaceutical administered is small (10-6 Ci to 10-9 Ci) and without pharmacologic effect.
Preliminary evidence suggests that FES PET is 100% specific and more sensitive than conventional imaging (CT and bone scan) for patients with metastatic disease who initially had an ER-positive breast cancer.[18] Clinical trials to better understand the role of FES imaging in metastatic breast cancer are currently under development. In total, 35.1% of subjects in this imaging cohort achieved a pathologic complete response (pCR).


Pain management by current standards for cancer bone pain is recommended with the onset of pain.
Positron emission tomography (PET) imaging using various tracers may be useful for both purposes. Thus, PET can assess molecular changes associated with disease, without modifying the underlying processes.[7] Based upon the observation that cancers have elevated rates of glucose consumption compared with normal tissues, PET was first introduced into clinical practice using a glucose analog with fluorine-18 substituted for the normal hydroxyl group at the 2' position (18F-fluoro-deoxyglucose [18F-FDG]).
Subjects who achieved a pCR had greater SUVmax reduction at both time points than those who did not have a pCR.[19] This study was the first prospective multicenter trial to examine the utility of FDG-PET as a pharmacodynamic biomarker in conjunction with HER2-directed therapy (and biological therapy) administered alone in patients with locally advanced breast cancer. Use of biochemical markers to monitor BMA is not recommended."The Update Committee stresses the importance of communicating risks and benefits of and the rationale expected for using bone-modifying agents, including clarifying potential outcomes," the authors write.
They can be used as a noninvasive method for detecting tumor, obtaining information about the biology of the tumor, and predicting which tumors will respond to targeted therapies. Fluorine-18 is a radioactive isotope and emits positrons, allowing three-dimensional imaging and quantification of regional 18F concentration. FDG-PET is also being incorporated as an integral biomarker in future studies of chemotherapy and targeted therapy in the neoadjuvant setting.
Here, we will review how radiolabeled glucose and estrogen analogs can be used in breast cancer patients. PET imaging is often used in conjunction with CT, where the CT is used for the purposes of anatomic localization and attenuation correction. We focus this review on the application of positron emission tomography (PET) imaging to ER-positive metastatic breast cancer as an example of how imaging can guide breast cancer treatment. 18F-FDG measures regional FDG uptake, largely in the form of trapped FDG-6-phosphate in images taken an hour after injection, and is thus a quantitative indicator of the cellular glycolytic rate. Here we will discuss the reliability of radiotracer imaging to detect breast cancer (focusing on metastatic disease), predict response to therapy in the neoadjuvant and metastatic settings, and assess response to breast cancer–directed therapy.




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