1.  Aromatase inhibitors act by lowering estrogen in the circulation and in tumor cells in post- menopausal women

2. Aromatase Inhibitors in Breast Cancer

3. Clinical Trials with Aromatase Inhibitors

4. Adverse Effects Associated with Anastrozole and Tamoxifen in Trials

5. Leuprolide (Lupron ® )  GnRH analog  continuous GnRH analog turns off the production of gonadotropins (LH,FSH) and decreases testosterone synthesis by 90-95%  slow release implantable devices (Duros ® ) lasts 12 mos.  used to treat advanced prostate cancer  cancer can escape and become androgen independent after 18-36 mos.

6. Concerns related to the success of chemotherapy in curing primary cancer Quality of life: fertility Increased risk: secondary cancer

7. Late Complications of Cancer Chemotherapy

8. Normal after Chemo Testis Histology

9. Risk of Secondary Cancer after Chemotherapy

10. Combination Therapy Examples: Hodgkin’s Disease MOPPMOPP –mechlorethamine, vincristine, procarbazine, prednisone ABVDABVD –doxorubicin, bleomycin, vinblastine, dacarbazine Stanford VStanford V * Mechlorethamine by vein once every 4 weeks * Mechlorethamine by vein once every 4 weeks * Doxorubicin (Adriamycin) by vein every odd week * Doxorubicin (Adriamycin) by vein every odd week * Vinblastine (Velban) by vein every odd week * Vinblastine (Velban) by vein every odd week * Vincristine (Oncovin) by vein every even week * Vincristine (Oncovin) by vein every even week * Bleomycin (Blenoxane) by vein every even week * Bleomycin (Blenoxane) by vein every even week * Etoposide by vein 2 days in a row weeks 3, 7, 11 * Etoposide by vein 2 days in a row weeks 3, 7, 11 * Prednisone by mouth every other day * Prednisone by mouth every other day high risk of secondary cancers, infertility lower risk: contraindicated if heart or lung disease complex but may be better than ABVD

11. DNA Microarray Analysis and Cancer Diagnosis: how does it work?

12. 78 non-lymph node positive sporadic Breast CA tumors were chosen 70 genes that were best discriminators black=disease free at 5 yr white = metastases Tumors

13. Future of Gene Array Analysis in Chemotherapy 1. establish a prognosis directly from gene expression data on primary tumor sample--determine whether adjuvant therapy is warranted? 2. expression analysis may predict which tumors will respond to which drugs