Living Beyond Breast CancerLiver and Lung Metastases Workshop

April 29, 2012

Paul B. Gilman, MD Lankenau Medical Center

RecurrenceRecurrence

LocalLocalRegionalRegionalDistantDistant

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Distant MetastasisDistant Metastasis

Soft-tissueSoft-tissueBoneBoneVisceralVisceral

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Visceral MetastasisVisceral Metastasis

LiverLiverLungLung

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Presentation of Liver/Lung Presentation of Liver/Lung MetastasesMetastases

SymptomaticSymptomatic Incidental finding on physical examIncidental finding on physical exam Incidental finding on imagingIncidental finding on imagingLaboratory studiesLaboratory studies

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Liver MetastasisLiver MetastasisSymptomsSymptoms

Nausea, anorexia, weight lossNausea, anorexia, weight lossPainPainJaundiceJaundiceFeverFever

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Liver Metastasis Liver Metastasis Laboratory EvaluationLaboratory Evaluation

Liver function testsLiver function testsBlood countsBlood countsCoagulation testsCoagulation testsTumor markersTumor markers

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Liver Metastasis Liver Metastasis Imaging EvaluationImaging Evaluation

UltrasoundUltrasoundCT ScanCT ScanMRIMRIPET-CTPET-CT

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Lung MetastasisLung MetastasisSymptomsSymptoms

DyspneaDyspneaCough, hemoptysisCough, hemoptysisPainPain

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Lung MetastasisLung MetastasisLaboratory EvaluationsLaboratory Evaluations

Sputum analysisSputum analysisTumor markersTumor markersPulmonary Function TestingPulmonary Function Testing

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Lung MetastasisLung MetastasisImaging EvaluationsImaging Evaluations

Chest x-rayChest x-rayCT ScanCT ScanPET-CTPET-CT

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DiagnosisDiagnosis

ClinicalClinicalLaboratoryLaboratoryRadiologicRadiologicPathologicPathologic

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BiopsyBiopsyTissue DiagnosisTissue Diagnosis

Needle BiopsyNeedle Biopsy• FNAFNA• CoreCore

Surgical BiopsySurgical Biopsy Endoscopic (ultrasound)Endoscopic (ultrasound) US-guidedUS-guided CT-guidedCT-guided

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Biopsy AnalysisBiopsy Analysis

Tissue of originTissue of originHormone receptorsHormone receptorsHER-2HER-2Biomarkers (investigational)Biomarkers (investigational)

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Treatment GoalsTreatment Goals

Palliation (Symptoms, QOL)Palliation (Symptoms, QOL) Organ FunctionOrgan Function Improved Survival (chronic disease)Improved Survival (chronic disease)

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Treatment ObjectivesTreatment Objectives

Response vs. Stable (clinical benefits)Response vs. Stable (clinical benefits) Disease Free Survival vs. Overall SurvivalDisease Free Survival vs. Overall Survival ToxicityToxicity

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Treatment ApproachesTreatment Approaches

Lines of Therapy (First-line, etc.)Lines of Therapy (First-line, etc.) SequentialSequential CombinationCombination ““Maintenance”Maintenance” InvestigationalInvestigational

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TreatmentTreatment LocalLocal

• Ablation (cryo, radiofrequency)Ablation (cryo, radiofrequency)• Radiation (external beam, brachytherapy)Radiation (external beam, brachytherapy)• Surgery Surgery

SystemicSystemic• Hormonal therapyHormonal therapy• ChemotherapyChemotherapy• Targeted TherapiesTargeted Therapies

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Clinical TrialsClinical Trials

ResponseResponse Time to ProgressionTime to Progression Progression-Free SurvivalProgression-Free Survival Overall SurvivalOverall Survival Quality of LifeQuality of Life

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