ทดสอบโรคผิวหนังภูมิแพ้ Management

Principles of Therapy

Preoperative Therapy Options

• Chemotherapy
• All chemotherapy administration before surgery is preferred
  
  
• Modalities used in adjuvant therapy may also be used eg endocrine and targeted therapy
• Purpose is to reduce tumor size which allows complete removal of the tumor with less extensive surgery
• Can convert inoperable tumors to viably operable tumors 
• Can predict how the cancer cells respond to chemotherapeutic drugs
• Considered in women with large clinical stage IIA, IIB, and T3N1M0 tumors who meet the criteria for breast-conserving therapy except for tumor size and those who wish to undergo breast-conserving therapy
• Indications: Tumor size >2 cm (T2, T3), cancer does not involve the surrounding skin or chest wall, LN enlarged but movable
• Endocrine therapy
• May be considered in patients with strongly hormone receptor-positive tumors
• Effectively reduces residual disease and enables breast-conserving surgery in patients with low rates of local-regional recurrence postop
• Tamoxifen (with or without ovarian function suppression for premenopausal women) or aromatase inhibitor (preferred for postmenopausal women; administered with ovarian suppression to premenopausal women) may be given in hormone receptor-positive disease
• HER2-targeted therapy
• Should be considered for HER2-positive patients with clinical node-positive tumors or tumors measuring ≥2 cm (cT2) at presentation
• Systemic therapy with Trastuzumab + Pertuzumab-based therapy is the recommended treatment option for patients with HER2-positive breast cancer who are candidates for neoadjuvant therapy
• Patients with HER2-positive tumors should be treated with preoperative chemotherapy incorporating Trastuzumab with or without Pertuzumab for at least 9 weeks
• Pertuzumab-containing regimen may be considered preoperatively in patients with HER2-positive early breast cancer tumors ≥cT2 or ≥cN1
• Immunotherapy