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Pharmacy and Therapeutics Committee Approvals

Pharmacy Focus

Highlights of the June meeting of the Pharmacy and Therapeutics Committee are summarized in the PDF link below.

P and T Approvals - June 2016 (PDF)  

Mark Your Calendar

Grand Rounds

Click here to view a schedule of all upcoming grand rounds.

Education Schedule

Click the PDF link below to see the Department of Surgery's education schedule.

Education Schedule - July 2016 (PDF)

Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

Share Your News

Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

Advances in the Treatment of Early Invasive Breast Cancer

By Alice Chung, MD, and Armando Giuliano, MD

Of the over 700 newly diagnosed breast cancer cases seen at Cedars-Sinai each year, approximately 500 women have early stage invasive breast cancer. While the five-year overall survival rates for Stage 1 and 2 breast cancer exceed 90 percent, there still remain challenges in the surgical treatment of this disease. As patients are achieving longer survival rates, the importance of quality of life has increased and surgeons are faced with trying to balance performing adequate oncologic surgery while maximizing quality of life and minimizing morbidity. This article discusses several examples of how the Saul and Joyce Brandman Breast Center - A Project of Women's Guild and the Samuel Oschin Comprehensive Cancer Institute are at the forefront of evaluating less invasive procedures to achieve these endpoints.

Breast cancer patients over the age of 70 present unique challenges in treatment, as physicians aim to optimize therapy while accounting for life expectancy, comorbidities and effects of treatment on function. Omission of sentinel node biopsy in this patient population may spare unnecessary morbidity without affecting outcome for women in whom the decision to treat with adjuvant systemic therapy is based upon factors such as age, comorbidities and tumor biology. The group previously demonstrated that omission of sentinel node biopsy in women age 70 and older with early invasive cancer was associated with very low recurrence and breast cancer mortality rates. This preliminary data led to the opening of a prospective clinical trial at Cedars-Sinai investigating the safety and efficacy of omitting sentinel node biopsy in women age 70 and older with clinical T1-2N0 ER+ invasive breast cancer. This trial is a single arm Phase 2 trial that includes women age 70 or older with clinical T1-2N0, ER+ invasive breast cancer planning to undergo breast conserving surgery and hormonal therapy. Recurrence, survival and quality-of-life outcomes will be evaluated over time with the hypothesis that these women can safely avoid axillary surgery without compromising survival.

With advancements in preoperative breast imaging and increasing use of breast MRI, the incidence of diagnosing multiple ipsilateral tumors is rising. Traditionally mastectomy has been the standard of care for patients with multifocal or multicentric breast cancer, although there is a paucity of scientific evidence that supports performing mastectomies in these patients. Breast conserving surgery is associated with improved quality of life and has been shown to be cost effective. The multicenter ACOSOG Z11102 is a study open to accrual at Cedars-Sinai that will prospectively evaluate whether breast conservation is a safe surgical approach for patients with multiple ipsilateral breast cancer. It is a single-arm trial with a primary objective of assessing the local recurrence rate. Secondary objectives include evaluating the rate of conversion to mastectomy due to persistently positive margins, inability to satisfy radiation dose constraints due to volume of boost, or poor cosmesis. Patients are eligibile if they are women older than 40 years old who have two or three foci of biopsy proven breast cancer on preoperative imaging. Foci must include at least one focus of invasive breast carcinoma with another focus of either invasive breast carcinoma or ductal carcinoma in situ. The aim is to provide scientific evidence that breast conservation may be an appropriate surgical option for select women with multicentric breast cancer.

Radiation therapy is typically recommended with breast conserving surgery and standard treatment involves five days of treatment per week for up to six to seven weeks. Traditional radiation therapy for breast cancer may expose healthy organs such as the lung and heart to unnecessary radiation. Intraoperative radiotherapy is a new technology that allows delivery of a single concentrated dose of radiation therapy to the tumor bed intraoperatively (during the lumpectomy procedure) while preserving surrounding healthy tissue, including the lung and heart. This helps to reduce side effects as well as treatment time. Early randomized studies of Intraoperative radiotherapy have shown similar survival rates between patients who received standard external beam radiation and those who received Intraoperative radiotherapy. This technology will be available at Cedars-Sinai soon for the appropriately selected patient and may lead to greater patient satisfaction and reduced costs of treatment.

Treatment options for patients with early breast cancer continue to evolve. The advancements described demonstrate how Cedars-Sinai is leading the pathway to improving quality of life while maintaining excellent survival outcomes.