Susan Dent

Overview:

Medical Oncologist with a focus on breast cancer
Associate Director of Breast Cancer Clinical Research
Co-Director Duke Cardio-Oncology Program

Positions:

Instructor in the Department of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

McMaster University

Internal Medicine

Royal College of Physicians (UK)

Medical Oncology

Royal College of Physicians (UK)

Grants:

CardiovAscular Risk profile and Treatment patterns in ER+HER2 - Advanced Breast Cancer: A retrospective cohort study (CAREB)

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

CO41012

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.
Authors
Armenian, SH; Lacchetti, C; Barac, A; Carver, J; Constine, LS; Denduluri, N; Dent, S; Douglas, PS; Durand, J-B; Ewer, M; Fabian, C; Hudson, M; Jessup, M; Jones, LW; Ky, B; Mayer, EL; Moslehi, J; Oeffinger, K; Ray, K; Ruddy, K; Lenihan, D
MLA Citation
Armenian, Saro H., et al. “Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline..” J Clin Oncol, vol. 35, no. 8, Mar. 2017, pp. 893–911. Pubmed, doi:10.1200/JCO.2016.70.5400.
URI
https://scholars.duke.edu/individual/pub1161876
PMID
27918725
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
35
Published Date
Start Page
893
End Page
911
DOI
10.1200/JCO.2016.70.5400

Cardio-Oncology Training: A Proposal From the International Cardioncology Society and Canadian Cardiac Oncology Network for a New Multidisciplinary Specialty.

There is an increasing awareness and clinical interest in cardiac safety during cancer therapy as well as in optimally addressing cardiac issues in cancer survivors. Although there is an emerging expertise in this area, known as cardio-oncology, there is a lack of organization in the essential components of contemporary training. This proposal, an international consensus statement organized by the International Cardioncology Society and the Canadian Cardiac Oncology Network, attempts to marshal the important ongoing efforts for training the next generation of cardio-oncologists. The necessary elements are outlined, including the expectations for exposure necessary to develop adequate training. There should also be a commitment to local, regional, and international education and research in cardio-oncology as a requirement for advancement in the field.
Authors
Lenihan, DJ; Hartlage, G; DeCara, J; Blaes, A; Finet, JE; Lyon, AR; Cornell, RF; Moslehi, J; Oliveira, GH; Murtagh, G; Fisch, M; Zeevi, G; Iakobishvili, Z; Witteles, R; Patel, A; Harrison, E; Fradley, M; Curigliano, G; Lenneman, CG; Magalhaes, A; Krone, R; Porter, C; Parasher, S; Dent, S; Douglas, P; Carver, J
MLA Citation
Lenihan, Daniel J., et al. “Cardio-Oncology Training: A Proposal From the International Cardioncology Society and Canadian Cardiac Oncology Network for a New Multidisciplinary Specialty..” J Card Fail, vol. 22, no. 6, June 2016, pp. 465–71. Pubmed, doi:10.1016/j.cardfail.2016.03.012.
URI
https://scholars.duke.edu/individual/pub1135401
PMID
27038642
Source
pubmed
Published In
Journal of Cardiac Failure
Volume
22
Published Date
Start Page
465
End Page
471
DOI
10.1016/j.cardfail.2016.03.012

Locoregional therapy of locally advanced breast cancer: A clinical practice guideline

© 2015 Multimed Inc. Questions 1. In female patients with locally advanced breast cancer (LABC) and good response to neoadjuvant chemotherapy (NACT), including endocrine therapy, what is the role of breast-conserving surgery (BCS) compared with mastectomy? 2. In female patients with LABC, a. is radiotherapy (RT) indicated for those who have undergone mastectomy? b. does locoregional RT, compared with breast or chest wall RT alone, result in a higher survival rate and lower recurrence rates? c. is RT indicated for those achieving a pathologic complete response (PCR) to NACT? 3. In female patients with LABC who receive NACT, is the most appropriate axillary staging procedure sentinel lymph node biopsy (SLNB) or axillary dissection? Is SLNB indicated before NACT rather than at the time of surgery? 4. How should female patients with LABC that does not respond to initial NACT be treated? Methods This guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care (PEBC) and the Breast Cancer Disease Site Group (DSG). A systematic review was prepared based on literature searches conducted using the medline and embase databases for the period 1996 to December 11, 2013. Guidelines were located from that search and from the Web sites of major guideline organizations. The working group drafted recommendations based on the systemic review. The systematic review and recommendations were then circulated to the Breast Cancer DSG and the PEBC RepoRT Approval Panel for internal review; the revised document underwent external review. The full three-paRT evidence series can be found on the Cancer Care Ontario Web site. Recommendations • For most patients with LABC, modified radical mastectomy should be considered the standard of care. For some patients with noninflammatory LABC, BCS can be considered on a case-by-case basis when the surgeon deems that the disease can be fully resected and the patient expresses a strong preference for breast preservation. • For patients with LABC, RT after mastectomy is recommended. • It is recommended that, after BCS or mastectomy, patients with LABC receive locoregional RT encompassing the breast or chest wall and local node-bearing areas. • It is recommended that postoperative RT remain the standard of care for patients with LABC who achieve PCR to NACT. • It is recommended that axillary dissection remain the standard of care for axillary staging in LABC, with the judicious use of SLNB in patients who are advised of the limitations of the current data. • Although SLNB either before or after NACT is technically feasible, the data are insufficient to make any recommendation about the optimal timing of SLNB with respect to NACT. Limited data suggest higher sentinel lymph node identification rates and lower false negative identification rates when SLNB is conducted before NACT; however, those data must be balanced against the requirement for two operations if SLNB is not performed at the time of resection of the main tumour. • It is recommended that patients receiving neoadjuvant anthracycline–taxane-based therapy (or other sequential regimens) whose tumours do not respond to the initial agent or agents, or who experience disease progression, be expedited to the next agent or agents of the regimen. • For patients who, in the opinion of the treating physician, fail to respond or progress on firstline NACT, several therapeutic options can be considered, including second-line chemotherapy, hormonal therapy (if appropriate), RT, or immediate surgery (if technically feasible). Treatment should be individualized through discussion at a multidisciplinary case conference, considering tumour characteristics, patient factors and preferences, and risk of adverse effects. • It is recommended that prospective randomized clinical trials be designed for patients with LABC who fail to respond to NACT so that more definitive treatment recommendations can be developed.
Authors
Brackstone, M; Fletcher, GG; Dayes, IS; Madarnas, Y; Sen Gupta, SK; Verma, S; Eisen, A; Gandhi, S; Holloway, C; Trudeau, M; Bedard, P; McCready, D; Semple, J; George, R; Meyers, B; Dhesy-Thind, B; Elavathil, L; Perera, F; Vandenberg, T; Gupta, R; Hamm, C; Freedman, O; Mates, M; Clemons, M; Dent, S
MLA Citation
Brackstone, M., et al. “Locoregional therapy of locally advanced breast cancer: A clinical practice guideline.” Current Oncology, vol. 22, Mar. 2015, pp. S54–66. Scopus, doi:10.3747/co.22.2316.
URI
https://scholars.duke.edu/individual/pub1386596
Source
scopus
Published In
Current Oncology (Toronto, Ont.)
Volume
22
Published Date
Start Page
S54
End Page
S66
DOI
10.3747/co.22.2316

Optimal systemic therapy for early breast cancer in women: a clinical practice guideline.

The Breast Cancer Disease Site Group of Cancer Care Ontario identified the need for new guidelines for the adjuvant systemic therapy of early-stage breast cancer. The specific question to be addressed was "What is the optimal adjuvant systemic therapy for female patients with early-stage operable breast cancer, when patient and disease factors are considered?" A systematic review was prepared based on literature searches conducted using the medline and embase databases for the period January 2008 to March 5, 2012, and updated to May 12, 2014. Guidelines were located from that search, from the Standards and Guidelines Evidence directory of cancer guidelines, and from the Web sites of major guideline organizations. The literature located was subdivided into the broad categories of chemotherapy, hormonal therapy, and therapy targeted to her2 (human epidermal growth factor receptor 2). Although several of the systemic therapies discussed in this guideline can be considered in the neoadjuvant setting, the review focused on trials with rates of disease-free and overall survival as endpoints and thus excluded several trials that used pathologic complete response as a primary endpoint. Based on the systematic review, the working group drafted recommendations on the use of chemotherapy, hormonal therapy, and targeted therapy; based on their professional experience, they also drafted recommendations on patient and disease characteristics and recurrence risk. The literature review and draft recommendations were circulated to a consensus panel of medical oncologists who had expertise in breast cancer and who represented the regions of Ontario. Items without initial consensus were discussed at an in-person consensus meeting held in Toronto, November 23, 2012. The final recommendations are those for which consensus was reached before or at the meeting. Some of the key evidence was revised after the updated literature search. Evidence reviews for systemic chemotherapy, endocrine therapy, and targeted therapy for her2-positive disease are reported in separate articles in this supplement. The full three-part 1-21 evidence-based series, including complete details of the development and consensus processes, can be found on the Cancer Care Ontario Web site at https://www.cancercare.on.ca/toolbox/qualityguidelines/diseasesite/breast-ebs.
Authors
Eisen, A; Fletcher, GG; Gandhi, S; Mates, M; Freedman, OC; Dent, SF; Trudeau, ME; members of the Early Breast Cancer Systemic Therapy Consensus Panel,
MLA Citation
Eisen, A., et al. “Optimal systemic therapy for early breast cancer in women: a clinical practice guideline..” Curr Oncol, vol. 22, no. Suppl 1, Mar. 2015, pp. S67–81. Pubmed, doi:10.3747/co.22.2320.
URI
https://scholars.duke.edu/individual/pub1298102
PMID
25848340
Source
pubmed
Published In
Current Oncology (Toronto, Ont.)
Volume
22
Published Date
Start Page
S67
End Page
S81
DOI
10.3747/co.22.2320

Systemic targeted therapy for her2-positive early female breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline.

BACKGROUND: This systematic review addresses the question "What is the optimal targeted therapy for female patients with early-stage human epidermal growth factor receptor 2 (her2)-positive breast cancer?" METHODS: The medline and embase databases were searched for the period January 2008 to May 2014. The Standards and Guidelines Evidence directory of cancer guidelines and the Web sites of major guideline organizations were also searched. RESULTS: Sixty publications relevant to the targeted therapy portion of the systematic review were identified. In four major trials (hera, National Surgical Adjuvant Breast and Bowel Project B-31, North Central Cancer Treatment Group N9831, and Breast Cancer International Research Group 006), adjuvant trastuzumab for 1 year was superior in disease-free survival (dfs) and overall survival (os) to no trastuzumab; trastuzumab showed no benefit in one trial (pacs 04). A shorter duration of trastuzumab (less than 1 year compared with 1 year) was evaluated, with mixed results for dfs: one trial showed superiority (finher), one trial could not demonstrate noninferiority (phare), another trial showed equivalent results (E 2198), and one trial is still ongoing (persephone). Longer trastuzumab duration (hera: 2 years vs. 1 year) showed no improvement in dfs or os and a higher rate of cardiac events. Newer her2-targeted agents (lapatinib, pertuzumab, T-DM1, neratinib) have been or are still being evaluated in both adjuvant and neoadjuvant trials, either by direct comparison with trastuzumab alone or combined with trastuzumab. In the neoadjuvant setting (neoaltto, GeparQuinto, Neosphere), trastuzumab alone or in combination with another anti-her2 agent (lapatinib, pertuzumab) was compared with either lapatinib or pertuzumab alone and showed superior or equivalent rates of pathologic complete response. In the adjuvant setting, lapatinib alone or in combination with trastuzumab, compared with trastuzumab alone (altto) or with placebo (teach), was not superior in dfs. The results of the completed aphinity trial, evaluating the role of dual her2 blockade with trastuzumab and pertuzumab, are highly anticipated. Ongoing trials are evaluating trastuzumab as a single agent without adjuvant chemotherapy (respect) and in patients with low her2 expression (National Surgical Adjuvant Breast and Bowel Project B-47). CONCLUSIONS: Taking into consideration disease characteristics and patient preference, 1 year of trastuzumab should be offered to all patients with her2-positive breast cancer who are receiving adjuvant chemotherapy. Cardiac function should be regularly assessed in this patient population.
Authors
Mates, M; Fletcher, GG; Freedman, OC; Eisen, A; Gandhi, S; Trudeau, ME; Dent, SF
MLA Citation
Mates, M., et al. “Systemic targeted therapy for her2-positive early female breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline..” Curr Oncol, vol. 22, no. Suppl 1, Mar. 2015, pp. S114–22. Pubmed, doi:10.3747/co.22.2322.
URI
https://scholars.duke.edu/individual/pub1346281
PMID
25848335
Source
pubmed
Published In
Current Oncology (Toronto, Ont.)
Volume
22
Published Date
Start Page
S114
End Page
S122
DOI
10.3747/co.22.2322