Soft Heart: "2022 Breast Cancer Elite Practice and Exchange Project - Hebei Station" was successfully held!

In order to promote the in-depth and extensive exchanges between young and middle-aged breast cancer doctors in the industry, the "2022 Breast Tumor Elite Practice and Exchange Project - Hebei Station" sponsored by the Chinese Medical Education Association was held in Qinhuangdao City on August 13, the conference took the form of offline + online live broadcast, invited Professor Xiao Chunhua (Tianjin Cancer Hospital) as the chairman of the conference, and invited Professor Han Meng (Qinhuangdao First Hospital) as the executive chairman, commentators include: Professor Wang Yingman (Affiliated Hospital of North China University of Science and Technology), Prof.
Zhang Wei (Cangzhou Central Hospital), Prof.
Song Cuiping (Qinhuangdao No.
4 Hospital) and Prof.
Huang Ruixue (Qinhuangdao Maternal and Child Health Hospital).

The speakers were Dr.
Lv Linlin (Affiliated Hospital of Hebei University of Engineering), Dr.
Liu Jiani (Qinhuangdao First Hospital), Dr.
Chen Jingjing (Tangshan People's Hospital) and Dr.
Wang Bing (Panjin Central Hospital).

Executive Chairman: Professor Han Meng (Qinhuangdao First Hospital)

Guest: Professor Wang Yingman (Affiliated Hospital of North China University of Science and Technology)

Guest: Professor Zhang Wei (Cangzhou Central Hospital)

Guest: Professor Song Cuiping (The Fourth Hospital of Qinhuangdao

Commentator: Professor Huang Ruixue (Qinhuangdao Maternal and Child Health Care Hospital)

Case 1 Sharing: Dr.
Lv Linlin (Cancer Center, Affiliated Hospital of Hebei University of Engineering)

This is a relatively young patient with HR+ advanced breast cancer, invasive ductal carcinoma of the left breast, pT1N0M0, stage I.
A, 34 years old, left breast cancer surgery in March 2018, liver metastasis found in early January 2022, chemotherapy from March 9, 2018 to June 22, 2018, tamoxifen until 2022.
1, DFS for 3 years and 6 months
.
2022.
1.
5-2022.
2.
17 The use of white violet + capecitabine is rated as SD.

According to guideline recommendations, for patients who are hormone receptor-positive and have metastases from internal organs, after TAM therapy failure, the class I regimen can choose fulvestrant + CDK4/6 inhibitor.

2022.
3.
9-So far, with fulvestrant + abeclib + goserellin, the efficacy is rated as PR, and CA153, ALT, and AST are reduced
.

Comments:

The speaker's speech is smooth, confident, and the on-site performance is infectious, which fully reflects the characteristics of the speaker; PPT production is complete, and the case diagnosis and treatment process is standardized; In the question-and-answer session, the speaker answered fluently, reasonably, and
logically.

Speaker: Dr.
Lv Linlin (Cancer Center, Affiliated Hospital of Hebei University of Engineering)

Case 2 Sharing: Dr.
Liu Jiani (Qinhuangdao First Hospital)

The case was relatively young, only 34 years old, with regular menstruation, and surgically removed the right breast mass on March 14, 2018, and the postoperative pathology showed invasive ductal carcinoma, pT2N3M0 (stage III.
C) luminal type B, low expression
of Her-2.
TAC regimen chemotherapy was given in April, goserelin 3.
6 mg subcutaneously + tamoxifen 20 mg orally was given in July, and tamoxifen was replaced with letrozole orally
in October.
Liver metastases
were detected on 23 June 2021 by enhanced liver magnetic (T2W1).
The reason may be due to patient resistance to previous endocrine therapy
.
The 2021 version of the CSCO BC diagnosis and treatment guidelines recommends that for patients with HR+ advanced breast cancer who fail non-steroidal AI treatment, fulvestrant + CDK4/6 inhibitors
can be preferred.
On June 30, 2021, chemotherapy + goserelin was given subcutaneous injection, and the efficacy was rated as PD.

From September 29, fluvestrant + CDK4/6 inhibitors were given, and on December 24, liver enhanced nuclear magnetic (T2W1) showed that the number of multiple metastases in the liver was reduced and shrunk
compared with the previous one.
It can be seen that the use of fulvestrant + CDK4/6 inhibitors for patients with HR+ advanced breast cancer who fail non-steroidal AI treatment can inhibit the growth
of cancer cells to a certain extent.

Comments:

The speaker's speech is fluent, smooth and expressive, reflecting the speaker's confidence; PPT is beautifully produced and the case data is complete; The speaker made a unique analysis of the diagnosis and treatment plan of the whole case, reflecting his unique thinking ability; In the process of asking questions, accurate and targeted answers reflect the logic and standardization of its diagnosis and treatment plan
.

Speaker: Dr.
Liu Jiani (Qinhuangdao First Hospital)

Case 3 Sharing: Dr.
Chen Jingjing (Tangshan People's Hospital)

The patient, 34 years old, was diagnosed with left breast cancer on pathological examination on 1 December 2015, cT2N3M0, stage III.
c, Luminal type B (HER-2 negative), pre-emptive neoadjuvant chemotherapy, first cycle 2015-12-09, a total of four cycles
.
2016-04-20Surgery, endocrine therapy after surgery, first use goserelin acetate + tamoxifen, 3 months later changed to imported anastrozole oral
.
Until March 25, 2019, it was discovered that the right axillary lymph node metastasized
after surgery for left breast cancer.
ASCO guidelines specify that patients with HR+ metastatic breast cancer should be recommended for initiation therapy
in patients with HR+ metastatic breast cancer, except for patients with immediate life-threatening disease or rapid visceral metastases during adjuvant endocrine therapy.
ESMO guidelines state that endocrine therapy is preferred for hormone receptor-positive disease, even in cases with visceral disease2 (recommended level 1A [strongly recommended, can be unconditionally applied to most patients in most conditions])
unless accompanied by visceral crisis or proven endocrine resistance.
NCCN guidelines recommend that women with ER and/or PR-positive tumors with recurrent or metastatic tumors are suitable for initiating endocrine therapy
.
The phase III FALCON study demonstrated superior efficacy
of first-line fulvestrant over anastrozole in postmenopausal patients with HR+/HER2-mBC who did not receive ET.
2019-04-08Laparoscopic bilateral oophorectomy under general anesthesia, postoperative use of fulvestrant, 2019-08-12Review the normal level of breast tumor markers, the condition is stable, the treatment is effective, and continue the maintenance treatment
of fulvestrant.
On May 26, 2020, an increase in tumor markers was found, and endocrine resistance was suspected
.
According to the guideline recommendation, 2020-07-30 was changed to exemetaan combined with cedamide orally, and tumor markers decreased
after medication.

Comments:

The speaker gave wonderful speeches, calm and confident, expressive, logical, reasonable, and very infectious; In terms of diagnosis and treatment plan, standardization, the speaker is very familiar with every diagnosis and treatment link of the case, which fully reflects the sense of
responsibility as a doctor.

Speaker: Dr.
Chen Jingjing (Tangshan People's Hospital)

Case 4 Sharing: Dr.
Wang Bing (Panjin Central Hospital)

Dr.
Wang shared a case of HR+ advanced breast cancer, a 73-year-old patient who underwent surgery in March 2008 and showed postoperative pathology that (right breast) invasive ductal carcinoma, ER(+), PR(-), C-erB2(+).

After surgery, NE*3 + TP*3 adjuvant chemotherapy + letrozole endocrine therapy was given until June 2011
.
In March 2016, CT showed bone metastasis, and ibandronate + exemetatam endocrine therapy + oxycodone hydrochloride sustained-release tablet 40mg treatment was given, and the efficacy was rated as SD.

In October 2019, the patient developed aggravated shoulder and back pain, low back pain, and lower limb pain and decreased temperature perception, and was treated with intensity-modulated radiotherapy, and continued to take oral exementane + oxycodone hydrochloride extended-release tablets 80mg, and the efficacy was rated as PD in October 2020, and the bone metastasis increased and increased
.
So, the treatment regimen was changed: fulvestrant + HDAC inhibitor (cedamide).

In May 2021, the patient developed multiple metastases of the skull and received cranial radiotherapy + fulvestrant + cedamide + oxycodone extended-release tablets 80mg
.
Cedabonamide was discontinued in August and treated with a monotherapy of fulvestrant
.
From the whole treatment process of this case, it can be seen that it may be difficult to inhibit cancer metastasis in postmenopausal patients with HR+ advanced breast cancer who choose steroidal AI therapy, and at this time, the treatment plan can be changed and the combination of fulvestrant and targeted regimen
can be selected.

Comments:

The speaker's speech style is unique, and the production of PPT is organized and rich in basis, which fully reflects the logic of the speaker's diagnosis and treatment
.
In the face of questions from many professors, the questions were answered
in detail.

Speaker: Dr.
Wang Bing (Panjin Central Hospital)

After the multi-angle evaluation of experts and the voting of the audience, Dr.
Liu Jiani from the First Hospital of Qinhuangdao City was selected as the best speaker of this conference, and she will also participate in the next stage of sharing to bring you more excellent clinical experience sharing
.

It is the original intention
of all doctors to help patients control their condition, reduce and control side effects, and help patients maintain a good quality of life.
Through such case sharing and exchange, the purpose of learning can be achieved, which is conducive to promoting the in-depth and extensive exchange of clinical experience between young and middle-aged doctors, thereby improving the diagnosis and treatment level of young and middle-aged doctors, and then bringing hope
for treatment for more patients.