Vernon Harvey
Associate Professor Vernon Harvey has been a consultant Medical Oncologist at Auckland Hospital since 1984 and in private practice since 1992. He is a Clinical Associate Professor in the Department of Oncology at the University of Auckland Medical School. He trained in medicine at Guy’s Hospital, London and undertook his postgraduate oncology training in Auckland and at St Bartholomew’s Hospital in London. Vernon’s primary interest is the management of patients with breast cancer. He is a keen supporter of clinical trials and the Principal Investigator of a large number of clinical trials in early and advanced breast cancer and drug development. He is an active member of several breast cancer co-operative trial groups, including the ANZ Breast Cancer Trials Group (ANZBCTG), the International Breast Cancer Study Group (IBCSG), Breast International Group (BIG), the Breast Cancer International Research Group (BCIRG) and the Early Breast Cancer Trialist’s Group (EBCTG). He is Chairman and Scientific Director of the Auckland Breast Cancer Study Group. He was made an Officer of the New Zealand Order of Merit (ONZM) for services to Medicine, particularly Oncology Research in the 2010 New Years Honours. Vernon has involved in several NZ governmental committees related to cancer and is a member of the Cancer Treatment Subcommittee of PHARMAC, the government agency responsible for public funding of medicines within the NZ Health Service.
Breast Cancer Symposium - Oncology Treatments Pre-conference Workshop (Repeated)  Thursday, 12 June 2014 Start 2:00pm Duration: 120mins Room 1 Start 4:30pm Duration: 120mins Room 1 Systemic Therapy of Breast Cancer Systemic treatment options for breast cancer are chemotherapy, endocrine therapy and biological therapy, used individually or in combination, either concurrently or sequentially. Therapy may be for palliation in metastatic breast cancer or to enhance the chance of cure in locoregional disease. In metastatic breast cancer, the aim is to control the disease, increasing duration of survival while maintaining quality of life. For hormone sensitive breast cancer (ER and/or PR+), this usually means initially hormone therapy (tamoxifen or aromatase inhibitor), followed by chemotherapy when endocrine resistance inevitably occurs, with trastuzumab (Herceptin), in addition for HER2 positive tumours. In metastatic disease hormone treatment is usually given for as long as it is effective (average duration 9-12 months, but with huge variation). Chemotherapy is mainly given in courses of 4-6 months, followed by a rest until further disease progression and usually single drugs used sequentially for effect with minimal toxicity. Trastuzumab is given initially with chemotherapy, but then continues alone, until disease progression. In early breast cancer, therapy is usually given after surgery (adjuvant therapy), but sometimes before for larger tumours (neoadjuvant), to increase the chance of cure. Therapy will usually involve endocrine therapy for hormone sensitive tumours, chemotherapy for those at higher risk of relapse and trastuzumab in addition to chemotherapy for HER+ tumours. In general hormone treatment is given for at least 5 years, chemotherapy for 3-6 months and trastuzumab for 12 months, though the optimal duration of trastuzumab is unknown and trials of shorter duration are in progress. The possible benefit of therapy must be balanced against potential toxicity. To determine the benefit it is necessary first to estimate the risk of relapse/mortality without additional treatment, based on conventional factors (tumour size, grade and nodal involvement), although genetic profiles will likely soon replace these. Secondly one needs to know likely tumour sensitivity to available treatment based on tumour factors (histological type, ER/PR receptors and HER2 positivity) and patient factors (age, menopausal status and comorbidities). Computer programmes (eg ‘adjuvantonline.com’) can help to synthesise these data, but are likely to be replaced by molecular profiles (Mammaprint, OncotypeDX etc) in the next year or two. With these data one can discuss with the patient predicted outcome without added therapy, the possible difference that various therapies can make and integrate these with the patients’ wishes to decide a treatment plan. At the present time chemotherapy type and duration is fairly standard with fewer drugs over shorter duration (eg TC for 4 cycles) for lower risk patients and more drugs over slightly longer duration (eg FEC/AC-T over 6-8 cycles) for higher risk patients. Endocrine therapy involves tamoxifen for premenopausal women and tamoxifen or aromatase inhibitor for postmenopausal women with the latter preferred for higher risk patients. It is traditionally given for 5 years, though recent research suggests an additional benefit for tamoxifen given for 10 years. The international standard duration of trastuzumab is 12 months, but the optimal duration is unknown and trials of shorter therapy are continuing. For the future there are several newer drugs (eg mTOR inhibitors), capable of reversing endocrine resistance, under investigation and several new AntiHER2 drugs being developed. It is likely that progress will involve developing therapy targeted at specific genetic abnormalities given to those patients shown to possess the genetic change.