1. Living Beyond Breast Cancer Liver and Lung Metastases Workshop April 29, 2012 Paul B. Gilman, MDLankenau Medical Center

2. Recurrence  Local  Regional  Distant LBBC/04.29.2012

3. Distant Metastasis  Soft-tissue  Bone  Visceral LBBC/04.29.2012

4. Visceral Metastasis  Liver  Lung LBBC/04.29.2012

5. Presentation of Liver/Lung Metastases  Symptomatic  Incidental finding on physical exam  Incidental finding on imaging  Laboratory studies LBBC/04.29.2012

6. Liver Metastasis Symptoms  Nausea, anorexia, weight loss  Pain  Jaundice  Fever LBBC/04.29.2012

7. Liver Metastasis Laboratory Evaluation  Liver function tests  Blood counts  Coagulation tests  Tumor markers LBBC/04.29.2012

8. Liver Metastasis Imaging Evaluation  Ultrasound  CT Scan  MRI  PET-CT LBBC/04.29.2012

9. Lung Metastasis Symptoms  Dyspnea  Cough, hemoptysis  Pain LBBC/04.29.2012

10. Lung Metastasis Laboratory Evaluations  Sputum analysis  Tumor markers  Pulmonary Function Testing LBBC/04.29.2012

11. Lung Metastasis Imaging Evaluations  Chest x-ray  CT Scan  PET-CT LBBC/04.29.2012

12. Diagnosis  Clinical  Laboratory  Radiologic  Pathologic LBBC/04.29.2012

13. Biopsy Tissue Diagnosis  Needle Biopsy FNAFNA CoreCore  Surgical Biopsy  Endoscopic (ultrasound)  US-guided  CT-guided LBBC/04.29.2012

14. Biopsy Analysis  Tissue of origin  Hormone receptors  HER-2  Biomarkers (investigational) LBBC/04.29.2012

15. Treatment Goals  Palliation (Symptoms, QOL)  Organ Function  Improved Survival (chronic disease) LBBC/04.29.2012

16. Treatment Objectives  Response vs. Stable (clinical benefits)  Disease Free Survival vs. Overall Survival  Toxicity LBBC/04.29.2012

17. Treatment Approaches  Lines of Therapy (First-line, etc.)  Sequential  Combination  “Maintenance”  Investigational LBBC/04.29.2012

18. Treatment  Local Ablation (cryo, radiofrequency)Ablation (cryo, radiofrequency) Radiation (external beam, brachytherapy)Radiation (external beam, brachytherapy) SurgerySurgery  Systemic Hormonal therapyHormonal therapy ChemotherapyChemotherapy Targeted TherapiesTargeted Therapies LBBC/04.29.2012

19. Clinical Trials  Response  Time to Progression  Progression-Free Survival  Overall Survival  Quality of Life LBBC/04.29.2012