PracticeUpdate: Haematology & Oncology

BREAST 17

EXPERT OPINION NESRINE TURKI MEJRI Current challenges in breast cancer management in developing countries Interview by Sumanta Kumar Pal MD relapse in Tunisia versus the rest of the world. Now, give me a sense of what your data shows.

I don’t think that our healthcare system can go along with that. We have low income countries limited resources and several economic issues. We are trying to negotiate with the health system, the Tunisian Society of Medical Oncology elaborated guidelines, local guidelines, and you can convince the authorities to consider those guidelines in discussing, negotiating reimbursement of new drugs. This is a step, but there are a lot of steps to do and access to several types of therapies in the metastatic setting is not really established in my country in Tunisia.

Dr Pal: We’re really honoured to have here today Dr Mejri. She is a world- renowned breast cancer expert, and we’re thrilled to have her here today to comment on some of her own findings related to patterns of metastasis. Before we jump into your data, Dr Mejri, I wanted to ask you what are some of the typical patterns of relapse for patients with breast cancer? Dr Mejri: Early breast cancer in Tunisia is the most common presentation. Around 80 percent of patients are diagnosed with early breast cancer such other parts in the world, and after adjuvant therapy, curative treatment, we observe around 23% of relapses. This number improved what we see in the last decade. What we see the series from the ‘90s, it was like 35 percent, and this is, of course, due to the improvement of management of breast cancer all over the world and also in Tunisia, so it’s 23% mainly HR-positive disease and visceral metastasis. Dr Pal: You here are presenting some very interesting work I think that pertains to some of the differences that we might see in patterns of

our hospital and other institutions to collect blood and samples from patients in order to focus on this BRCA mutation spectrum, and they think that maybe in a few years we will have real accurate results. Dr Pal: We talked about some of the patterns of disease, but one question that we always have is what is the level of access to the various treatments? In the US and in Europe, I think we’re quite familiar with which drugs are available and which aren’t, but in Tunisia, how do you feel your level of access is to various novel therapies for breast cancer? Dr Mejri: When we look to the early breast cancer population, I think that we’re doing pretty good. I mean we have oncology expertise. We have access to several diagnostic and imaging procedures. Most of the drugs are available. Radiation therapy, it’s available. I think we are following in more than 90% of the case’s international guidelines, but when we look to metastatic breast cancer patients, the situation is different. There’s a big challenge in providing drugs. We receive all the drugs that come on the market. In this ESMO meeting,

Dr Mejri: Incidents of breast cancer in Tunisia is increasing, and we have around 25 to 30 hundred new cases per year. What is particular in Tunisian patients is, first of all, age. Middle-age, the diagnosis is around 50 years old, which is 10 years younger than what we see in Europe and in the US. Also, medium tumour size diagnosis is pretty high, locally advanced disease frequently observed. Medium tumour size is 4 cm. We need to work on that to improve outcome of our patients. Also, we have particularly higher inflammatory breast cancer cases. It’s the most aggressive presenta- tion of breast cancer. We have an incidence of 5–7%, and when we look to Europe or US it’s 1–2%, but regarding pathology proportions, HR-positive disease, triple negative, HER2-positive disease, I don’t think that there are differences between us and western countries. BRCA mutations, we don’t really have an idea. We don’t know the prevalence, we don’t know the spectrum of mutations, but we have a work in

Dr Pal and Dr Nesrine Turki Mejri, MD, discuss breast cancer at ESMO 2016.

Dr Pal is an internationally recognised leader

in the area of genitourinary cancers. He is the Co-Director of the City of Hope Kidney Cancer Program in California and is the head of the kidney and bladder cancer disease team at the institution.

Dr Mejri is a Medical Oncology Assistant at the University Hospital Abderrahmen Mami, Ariana (SOMA), Tunisia. Watch the full interview at PracticeUpdate.com

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References: 1. Pharmaceutical Benefits Scheme. Available from www.pbs.gov.au, accessed July 2016. 2. Dummer R et al. Ann Oncol 2015; 26 (Suppl 5): 126–32. 3. Kakavand H et al. Pathology 2016;48(2):194–202. Novartis Pharmaceuticals Australia Pty Ltd, ABN 18 004 244 160, 54 Waterloo Road, Macquarie Park, NSW 2113. Phone (02) 9805 3555. Item No.: MEL0168. Date of preparation: September 2016.