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Programma

Het programma van het 18e Bossche Mamma Congres vindt volledig digitaal plaats op dinsdag 15 juni 2021. In tegenstelling tot voorgaande edities betreft dit een ééndaags congres. Hieronder treft u een opzet van het programma. Er zijn meerdere plenaire sessies opgenomen, een abstractsessie voor jonge onderzoekers en een “keynote-lecture’’.

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Meer achtergrond informatie over de sprekers leest u hier.

 

dinsdag 15 jun

Voorlopig programma

08:50

Opening

Young investigator session

Moderator: Jacqueline van Laarhoven, surgical resident, Jeroen Bosch Hospital

09:00

O.01 Subtype discordance rates and initial systemic treatment choices in patients with advanced breast cancer in 2007-2018: a study of the SONABRE Registry

Marissa Meegdes, Phd Student, MUMC+

Background
The growing knowledge on the occurrence of conversion of the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) during the disease course of breast cancer emphasises the importance to obtain a biopsy of a metastatic site before treatment decisions are made (1, 2).

Methods
All 2854 patients diagnosed with advanced breast cancer from 2007-2018 in seven hospitals were selected from the Southeast Netherlands Advanced Breast cancer (SONABRE) registry to assess the biopsy rate at initial diagnosis of metastatic disease. Subtype discordance rates were determined for patients with a known subtype of the primary tumour and initial metastatic site. Next, multivariate logistic regression analyses were performed to identify factors influencing biopsy rate and discordance. Finally, initial systemic treatment choices per concordant and discordant subtypes were evaluated.

Results
The overall biopsy rate is 60%. Factors associated with obtaining a biopsy are the period of diagnosis since 2010, an unknown subtype of primary tumour, a metastatic site of soft or visceral tissue, and a metastatic-free interval (MFI) beyond three months. The overall discordance rate is 18% (Figure 1). Receptor subtype discordance is found to be associated with the HR+/HER2+ subtype of primary tumour (vs. HR+/HER2- subtype, OR=8.47; 95% CI:5.10-14.09), and a MFI of 3-24 months (vs. MFI <3 months, OR=2.52; 95% CI:1.15-5.52). None of the given adjuvant therapies were associated with a higher risk for subtype discordance. Following loss or gain of a receptor status a different pattern for the use of endocrine and HER2-targeted therapies are seen.

Conclusion
The findings of this study highlight the importance of obtaining biopsy of metastatic disease, especially in the HR+/HER2+ subtype and in patients with a MFI of 3-24 months, as the possibility of subtype discordance has implications for treatment options.

References
1)Schrijver et al, 2018, JNCI, DOI:10.1093/jnci/djx273
2)Dutch Breast Cancer Guideline,NABON2012.

09:15

O.02 Trends of care in axillary treatment of sentinel node positive cT1-4 breast cancer patients

Eline Verreck, MSc Student Medicine, Utrecht University

Objectives
To evaluate patterns of care in axillary treatment of Dutch patients – who were diagnosed with stage I-IV primary invasive breast cancer, underwent amputation and were found positive by sentinel lymph node biopsy (SLNB) – in the years following the publication of the American College for Surgeons Oncology Group (ACOSOG)-Z0011 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trials.

Methods
Data from females diagnosed between January 1st 2009 and December 31st 2018 were obtained from the Netherlands Cancer Registry (NKR). Trends in completion axillary lymph node dissection (cALND), administration of adjunctive radiotherapy and, inversely, of omission of any kind of axillary treatment, were revealed by descriptive analyses on SNL positive patients.

Results
Of 28,070 cT1-4 breast cancer patients undergoing amputation with SLNB from 2009 up until 2018, 10,706 were diagnosed as SLN positive. In the latter, the frequency of subsequent cALND went down significantly from 78% in 2009 to 10% in 2018 (P < 0.001), while adjunctive radiotherapy increased from 4% to 49% (P < 0.001). Omission of any additional local treatment increased from 18% to 41% (P < 0.001). In N1 patients cALND decreased from 57% to 13% (P < 0.001) and was mostly replaced by radiotherapy, increasing from 2% to 70% (P < 0.001). In N1mi and N0i+ patients, cALND decreased to less than 1% of cases in 2018, while radiotherapy increased from 4% to 40% and 8% to 13% (P < 0.001), respectively.

Conclusion
In SLN positive breast cancer patients undergoing breast amputation, cALND had become rare 10 years following the AMAROS and Z0011 trial results. While radiotherapy mostly replaced cALND in the vast majority of N1 patients, less than half of N1mi and only a tenth of N0i+ patients received radiotherapy as the only adjunctive axillary treatment by the end of 2018.

09:30

Concurrent treatment with endocrine- and chemotherapy

Chaja Jacobs, medical oncologist in training, Amsterdam UMC

Hormoontherapie is de meest gebruikte modaliteit bij de behandeling van vroege borstkanker. In theorie zou deze behandeling al op de dag van diagnose kunnen worden geïnitieerd, maar in de praktijk wordt deze vaak uitgesteld tot na het voltooien van operatie, chemotherapie en/of radiotherapie. Wij hebben een literatuuronderzoek verricht om de beschikbare gegevens hieromtrent samen te vatten. Hieruit blijkt dat gelijktijdige toediening van hormonale en chemotherapie minstens gelijkwaardig is ten opzichte van sequentiële toediening en er mogelijk zelfs voordeel van gelijktijdige behandeling kan zijn. In het bijzonder bij het gelijktijdig toedienen van aromataseremmers en chemotherapie worden veelbelovende resultaten ten aanzien van klinische respons bereikt. Wij vinden daarom dat gelijktijdige chemo-hormonale therapi kan worden overwogen als standaard behandelstrategie bij hormoongevoelige borstkanker.

09:45

Break

Inflammatory breast cancer

Moderator: Maud Bessems, surgical oncologist, Jeroen Bosch Hospital

10:00

Imaging

Ritse Mann, radiation oncologist, Radboudumc

10:20

Pathology

Jelle Wesseling, pathologist, NKI-AvL

10:40

Treatment of inflammatory breast cancer

Caroline Schröder, medical oncologist, UMC Groningen

Developments in neoadjuvant treatment

Moderator: Koop Bosscha, surgical oncologist, Jeroen Bosch Hospital

11:00

The role of imaging

Marc Lobbes, radiation oncologist, MUMC+

Bij de beoordeling van therapieresponse tijdens neoadjuvant systemische behandeling is beeldvorming essentieel. Om de response op therapie te beoordelen, werd initieel voornamelijk gebruik gemaakt van mammografie en echografie. Uit studies is naar voren gekomen dat MRI op dit moment de meest robuuste methode is om deze response te beoordelen. In deze presentatie zal kort uitgelegd worden hoe deze beoordeling plaatsvindt, maar wordt er ook gekeken naar de mogelijkheden in de toekomst, o.a. met meer geavanceerde MRI-technieken en de toepassing van kunstmatige intelligentie, maar ook met contrast-versterkte mammografie.  

11:15

NET: the future

Anna Weiss, assistant professor of surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, USA

She will be presenting “The role of neo-adjuvant endocrine therapy in breast cancer”. She has a special interest in surgical management of the axilla after neoadjuvant endocrine therapy, so this presentation will briefly touch on the well-established data supporting endocrine therapy to downsize breast tumors but will then focus on the axillary management controversies.

11:35

What after the MICRA?

Marie-Jeanne Vrancken Peeters, surgical oncologist, NKI-AvL

12:00

Break

Keynote-lecture

Moderatoren: Sabine Siesling, clinical epidemiologist, IKNL and University Twente and Koop Bosscha, surgical oncologist, Jeroen Bosch Hospital

12:15

The Corona-pandemic: lessons from the USA

Jill Dietz, president of the American Society of Breast Surgeons, director of Breast Center Operations, University Hospitals Case Medical Center , University Hospital, Cleveland Medical Center, Cleveland, OH USA

13:00

Lunch

Immunotherapy in breast cancer treatment

Moderator: Jolien Tol, medical oncologist, Jeroen Bosch Hospital

14:00

Basics of immunotherapy

John Martens, basic researcher, Erasmus MC

Prof. Martens will introduce the field of tumor immunology with a focus on breast cancer.

14:15

Immunotherapy in metastatic triple negative breast cancer

Birgit Vriens, medical oncologist,, Catherina Hospital

14:35

The future of immunotherapy in breast cancer

Sherene Loi, professor of medical oncology, University of Melbourne, Melbourne, Australia

During the last decades, breast cancer survival increased impressively as a consequence of extensive adjuvant treatment. Consequently attention shifted from only survival to a combined endpoint including both survival as well as quality of life. This attention shift resulted in the question: “How can we limit overtreatment?”. All research I perform(ed) in Maastricht suits this qualification.

gnantConcerning axillary treatment, the ultimate goal is treatment equally safe though with less lifelong morbidity. Therefore I am interested in noninvasive nodal staging study with (PET) MRI, which has the potential to offer the same knowledge as the sentinel node/axillary lymph node dissection without operating.

My goal is also supported by the BOOG-studies, RISAS- en MINIMAX-study. These (RCT/cohort) studies investigate the value of axillary treatment in clinical node negative and positive patients in standard and neoadjuvant setting. European PIs (incl me) on similar studies concerning axillary de-escalation collaborate in EUBreast. The aim is to connect PIs and collaborate on axillary de-escalation studies aiming to empower outcome and improve implementation.

The study om the role of microbiome composition in systemic cancer treatment suits the same theme: “How to improve response and decrease side effects by manipulation of the gut microbiome in breast and colorectal patients?”.

14:50

Q&A session

15:00

Immuun checkpoint blockade bij TNBC: nu & straks in Nederland

Marleen Kok, medical oncologist,, NKI-AvL

Reflectie van huidige en aanstaande indicaties immuun checkpoint blockade bij TNBC voor de Nederlandse praktijk.

15:15

Break

How to treat the axilla?

Moderators: Luc Scheijmans, radiation-oncologist, Tolbrug, Tilburg/’s-Hertogenbosch and Marjolein Smidt, surgical oncologist, MUMC+

15:25

What can we expect?

Janine Simons, radiation oncology resident, Erasmus MC

15:40

The changing role of RT

Duncan Wheatley, Director of Research and Innovation Cornwall, Royal Hospitals Cornwall, UK

16:00

Dutch reflections

Marjolein Smidt, surgical oncologist, MUMC+

16:15

Break

Highlights in systemic/endocrine therapy

Moderator: Jolien Tol, medical oncologist, Jeroen Bosch Hospital

16:30

Biphosphonates: the past and the future

Michael Gnant, professor of Surgery, Medical University of Vienna, Austria

Traditionally, bone-targeted agents (BTAs), such as bisphosphonates and Receptor activator of nuclear factor kappa-Β (RANK) ligand inhibitors, were used in patients with bone metastases from breast (and other) cancer, because they reduce morbidity, pain, quality of life (QoL) and skeletal-related events (SREs). More recently, bisphosphonates and denosumab have been used in early breast cancer – for the prevention and treatment of detrimental bone health side effects of adjuvant endocrine therapy, but also outcome improvements have been show. Large clinical trials (e.g. ABCSG-12, AZURE, ZO/Z-FAST, HOBOE, ABCSG-18, D-CARE) have been performed, however results were controversial in some aspects. What appears to be clear (from an Oxford meta-analysis) is that adjuvant bisphosphonates improve outcomes in postmenopausal women with luminal breast cancer, and that denosumab very effectively prevents fractures in patients on AI therapy (ABCSG-18).

16:50

Role of PIK3CA-inhibitors

Agnes Jager, medical oncologist Erasmus MC

17:05

Neo-adjuvant treatment of HER2+ breast cancer: where will the TRAIN bring us?

Gabe Sonke, medical oncologist, NKI-AvL

Response rates to neo-adjuvant treatment and long-term outcome in patients with HER2+ breast cancer have dramatically improved since the introduction of anti-HER2 targeting agents. The Dutch TRAIN studies have contributed to optimizing efficacy and toxicity in this patient group. Benefiting from a strong collaboration with the Dutch breast cancer research group (BOOG) and participation of many Dutch hospitals, the TRAIN studies will continue to improve individualized treatment regimens.

17:20

Closing remarks