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Characterization of bone only metastasis patients with respect to tumor subtypes. NPJ Breast Cancer 2018; 4:2. [PMID: 29387785 PMCID: PMC5785511 DOI: 10.1038/s41523-018-0054-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/12/2017] [Accepted: 01/03/2018] [Indexed: 11/09/2022] Open
Abstract
Metastatic breast cancer (MBC) patients with bone only metastasis (BOM) are a unique population with limited characterization. We identified patients followed at MD Anderson Cancer Center from 01/01/1997 to 12/31/2015 for at least 6 months with a BOM diagnosis as first site of metastasis. Tumor subtype (TS) was assessed by initial breast biopsy immunohistochemistry using hormonal receptor (HR) and HER2 status, with four subtypes identified: HR+/HER2−, HR+/HER2+, HR−/HER2−, HR−/HER2+. HR+ was defined as estrogen receptor or progesterone receptor ≥1%. We identified 1445 patients with BOM, 1048 with TS data available. Among these patients, the majority were HR+/HER2− (78%). Median time from breast cancer diagnosis to first bone metastasis was 2.3 years (95% CI 2.1, 2.5) and varied significantly by TS, with longer time to distant disease in HR+/HER2− patients relative to all other TS (p < .0001). Median overall survival (OS) from breast cancer diagnosis was 8.7 years (95% CI 8.0, 9.7) and varied significantly by TS with poorer OS for HR−/HER2− and HR-/HER2+ patients relative to HR+/HER2− TS (p < .0001). The 442 patients with de novo BOM disease, defined as bone metastasis diagnosis within 4 months of breast cancer diagnosis, had significantly shorter OS (p < .0001). Overall, several higher risk BOM subsets were identified in this analysis, most notably HR−/HER2+ and HR−/HER2− TS and de novo BOM patients. Not all cases of breast cancer with bone-only metastases should be treated the same. Amanda Parkes and colleagues from The University of Texas MD Anderson Cancer Center
in Houston, USA, examined the tumor subtype of over 1000 women with metastatic breast cancer that had spread to the bone. The majority—78%—tested positive for a hormone receptor (estrogen or progesterone) but negative for the HER2 receptor. The median time from diagnosis to identification of the first bone metastasis was 2.3 years and the median survival time post-diagnosis was 8.7 years, although this varied significantly by tumor subtype. Women negative for a hormone receptor or who developed bone metastases within 4 months of breast cancer diagnosis had the worst outcomes. The findings show the need to consider tumor subtype for this patient population.
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Nzeangung BA, Biwole ME, Kadia BM, Bechem NN, Dimala CA, Sone AM. Evolutionary aspects of non-metastatic breast cancer after primary treatment in a sub-Saharan African setting: a 16-year retrospective review at the Douala general hospital, Cameroon. BMC Cancer 2018; 18:32. [PMID: 29304834 PMCID: PMC5755006 DOI: 10.1186/s12885-017-3984-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer has a high case fatality rate in sub-Saharan Africa, and this is chiefly because of late detection and inadequate treatment resources. Progressive renovations in diagnostic and management modalities of non-metastatic breast cancer (NMBC) have been noted in the region but there is paucity of data describing the clinical progress of patients with NMBC. This study sought to determine the rates of local relapse, distant metastasis and sequelae and the time span from initial treatment to the occurrence of these adverse events among patients with NMBC. METHODS This was a retrospective review of medical records of patients with histologically confirmed NMBC at the department of radiation therapy and oncology of the Douala General Hospital in Cameroon from the January 1997 to December 2012 period. Clinicopathological and treatment characteristics as well as occurrences of adverse events were studied. RESULTS A total of 260 cases were reviewed of which 224/260 (86.2%) had invasive ductal carcinoma. Surgery was performed on 258/260 cases (99.2%) with 187/258 (72.5%) being modified radical mastectomies. Various treatment combinations were used in up to 228/260 patients (87.5%) while surgery alone was the treatment in the remaining 32 cases (12.5%). Metastasis occurred in 142/260 cases (54.6%) of which 68/142 (26.2%) were local relapses and 74/142 (28.5%) were distant metastases. Among the cases of distant metastasis, 9.2% were bone, 8.5% lungs, 6.9% nodal, and 5.4% brain. Metastasis to multiple organs was noted in 4.7% of these cases. The median periods of occurrence of local relapse and distant metastases were 13 and 12 months respectively. Sequelae occurred in 26/260 cases (10%) and were noted after an average of 30 months. The main sequelae were lymphoedema (6.5%) and lung fibrosis (1.5%). At the end of the period under review, 118/260 patients (45.4%) were alive and disease-free with a median follow up time of 24 months. CONCLUSIONS Adverse events were frequent among patients who received primary treatment for NMBC. Available cancer therapeutic modalities ought to be supplemented with efficient strategies of follow-up and monitoring so as to optimize the care provided to these patients and improve on their survival.
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Affiliation(s)
| | - Martin Essomba Biwole
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Benjamin Momo Kadia
- Foumbot District Hospital, Foumbot, Cameroon. .,Grace Community Health and Development Association, Kumba, Cameroon. .,Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | | | - Christian Akem Dimala
- Health and Human Development (2HD) Research Network, Douala, Cameroon.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Orthopaedics, Southend University Hospital, Essex, UK
| | - Albert Mouelle Sone
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Kantamneni H, Zevon M, Donzanti MJ, Zhao X, Sheng Y, Barkund SR, McCabe LH, Banach-Petrosky W, Higgins LM, Ganesan S, Riman RE, Roth CM, Tan MC, Pierce MC, Ganapathy V, Moghe PV. Surveillance nanotechnology for multi-organ cancer metastases. Nat Biomed Eng 2017. [PMID: 29531851 PMCID: PMC5844578 DOI: 10.1038/s41551-017-0167-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The identification and molecular profiling of early metastases remains a major challenge in cancer diagnostics and therapy. Most in vivo imaging methods fail to detect small cancerous lesions, a problem that is compounded by the distinct physical and biological barriers associated with different metastatic niches. Here, we show that intravenously injected rare-earth-doped albumin-encapsulated nanoparticles emitting short-wave infrared light (SWIR) can detect targeted metastatic lesions in vivo, allowing for the longitudinal tracking of multi-organ metastases. In a murine model of basal human breast cancer, the nanoprobes enabled whole-body SWIR detection of adrenal gland microlesions and bone lesions that were undetectable via contrast-enhanced magnetic resonance imaging (CE-MRI) as early as, respectively, three weeks and five weeks post-inoculation. Whole-body SWIR imaging of nanoprobes functionalized to differentially target distinct metastatic sites and administered to a biomimetic murine model of human breast cancer resolved multi-organ metastases that showed varied molecular profiles at the lungs, adrenal glands and bones. Real-time surveillance of lesions in multiple organs should facilitate pre-therapy and post-therapy monitoring in preclinical settings.
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Affiliation(s)
- Harini Kantamneni
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Margot Zevon
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Michael J Donzanti
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Xinyu Zhao
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Yang Sheng
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Shravani R Barkund
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Lucas H McCabe
- Department of Computer Science, Rutgers University, Piscataway, NJ, USA
| | | | - Laura M Higgins
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Richard E Riman
- Department of Materials Science and Engineering, Rutgers University, Piscataway, NJ, USA
| | - Charles M Roth
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
| | - Mei-Chee Tan
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Mark C Pierce
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
| | - Vidya Ganapathy
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
| | - Prabhas V Moghe
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ, USA. .,Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
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Park S, Yoon JK, Jin Lee S, Kang SY, Yim H, An YS. Prognostic utility of FDG PET/CT and bone scintigraphy in breast cancer patients with bone-only metastasis. Medicine (Baltimore) 2017; 96:e8985. [PMID: 29390293 PMCID: PMC5815705 DOI: 10.1097/md.0000000000008985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We performed this retrospective clinical study to examine the prognostic power of bone scintigraphy (BS) and F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in terms of overall survival (OS) of breast cancer with bone-only metastasis.We retrospectively evaluated 100 female invasive ductal breast cancer patients (mean age 48.1 years) with bone-only metastasis. Twenty-five patients had human epidermal growth factor receptor 2 (HER2)-positive tumors, 65 were estrogen receptor (ER) and/or progesterone receptor (PR)-positive, HER2-negative tumors, and 10 were triple negative tumors. The patients were treated properly with various treatments, including chemotherapy, radiotherapy, hormone, and bisphosphonate therapy, based on their clinical status. All patients underwent BS and FDG PET/CT at baseline and 1 year after treatment. The baseline and follow images were visually compared, and the patients were grouped as responders or nonresponders based on their images. OS was compared between the groups.The mean OS after the diagnosis of bone-only metastasis was 57.6 months. Fifty-one patients (51%) died within 5 years after diagnosis of metastasis. No difference in survival was evident between responders and nonresponders based on BS imaging data (P = .090). The response status based on PET imaging data waste only significant independent prognostic factor on multivariate analysis (P = .001). Survival was lower in nonresponders than in responders based on PET imaging (32.7% vs 66.4%; P < .001).Our findings suggest that the response status according to FDG PET imaging can be used to predict OS in breast cancer patients with bone-only metastasis.
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Affiliation(s)
- Soyeon Park
- Department of Nuclear Medicine and Molecular Imaging
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging
| | - Su Jin Lee
- Department of Nuclear Medicine and Molecular Imaging
| | | | - Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging
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Dalasanur Nagaprashantha L, Adhikari R, Singhal J, Chikara S, Awasthi S, Horne D, Singhal SS. Translational opportunities for broad-spectrum natural phytochemicals and targeted agent combinations in breast cancer. Int J Cancer 2017; 142:658-670. [PMID: 28975625 DOI: 10.1002/ijc.31085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
Breast cancer (BC) prevention and therapy in the context of life-style risk factors and biological drivers is a major focus of developmental therapeutics in oncology. Obesity, alcohol, chronic estrogen signaling and smoking have distinct BC precipitating and facilitating effects that may act alone or in combination. A spectrum of signaling events including enhanced oxidative stress and changes in estrogen-receptor (ER)-dependent and -independent signaling drive the progression of BC. Breast tumors modulate ERα/ERβ ratio, upregulate proliferative pathways driven by ERα and HER2 with a parallel loss and/or downregulation of tumor suppressors such as TP53 and PTEN which together impact the efficacy of therapeutic strategies and frequently lead to emergence of drug resistance. Natural phytochemicals modulate oxidative stress, leptin, integrin, HER2, MAPK, ERK, Wnt/β-catenin and NFκB signaling along with regulating ERα and ERβ, thereby presenting unique opportunities for both primary and combinatorial interventions in BC. In this regard, this article focuses on critical analyses of the evidence from multiple studies on the efficacy of natural phytochemicals in BC. In addition, areas in which the combinations of such effective natural phytochemicals with approved and/or developing anticancer agents can be translationally beneficial are discussed to derive evidence-based inference for addressing challenges in BC control and therapy.
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Affiliation(s)
| | | | - Jyotsana Singhal
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
| | - Shireen Chikara
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
| | - Sanjay Awasthi
- Texas Tech University Health Sciences Center, Lubbock, TX
| | - David Horne
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
| | - Sharad S Singhal
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
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van Kampen R, Ramaekers B, Lobbezoo D, de Boer M, Dercksen M, van den Berkmortel F, Smilde T, van de Wouw A, Peters F, van Riel J, Peters N, Tjan-Heijnen V, Joore M. Real-world and trial-based cost-effectiveness analysis of bevacizumab in HER2-negative metastatic breast cancer patients: a study of the Southeast Netherlands Breast Cancer Consortium. Eur J Cancer 2017; 79:238-246. [DOI: 10.1016/j.ejca.2017.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/15/2016] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
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Follow-up bone scan in breast cancer patients: what is the appropriate interpretation of purely rib uptake? Nucl Med Commun 2017; 37:1318-1324. [PMID: 27636120 DOI: 10.1097/mnm.0000000000000597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Although rib uptake is frequently detected in follow-up bone scans of breast cancer patients, few studies have assessed its clinical significance. PATIENTS AND METHODS Among 1208 breast cancer patients who underwent a bone scan between 2011 and 2014, 157 patients presented with newly detected rib uptake at follow-up. Patients who had underlying bone metastases (n=8) or had simultaneous new uptake in sites other than the rib (n=13) were excluded. The patients enrolled finally were those who had purely rib uptakes. The location, intensity, and final diagnosis of the uptake were evaluated by nuclear medicine physicians. RESULTS A total of 275 new instances of rib uptake were detected in follow-up bone scans of 136 patients. These were more frequently located on the ipsilateral side of the breast cancer (61.1%) and the anterior arc (65.1%), and they presented as moderate to intense (93.1%) uptakes. Among these, 265 lesions in 130 patients turned out to be benign fractures (96.4%), whereas only 10 lesions in six patients were metastases. The proportion of metastases was significantly higher if the uptake was linear or if the patient had recurrence. It was marginally higher if the uptake was located in the posterior arc. The proportion of metastases within the radiation field was significantly lower in patients with a history of irradiation. CONCLUSION Newly detected purely rib uptake on a follow-up bone scan in patients who have been treated for breast cancer is mostly because of fractures and rarely signals metastasis. However, if the patient has disease recurrence, metastasis should strongly be suspected, particularly when uptake is linear or located in the posterior arc.
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58
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Longitudinal Computed Tomography Monitoring of Pelvic Bones in Patients With Breast Cancer Using Automated Bone Subtraction Software. Invest Radiol 2017; 52:288-294. [DOI: 10.1097/rli.0000000000000343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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59
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Pulido C, Vendrell I, Ferreira AR, Casimiro S, Mansinho A, Alho I, Costa L. Bone metastasis risk factors in breast cancer. Ecancermedicalscience 2017; 11:715. [PMID: 28194227 PMCID: PMC5295847 DOI: 10.3332/ecancer.2017.715] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 12/25/2022] Open
Abstract
Bone is the single most frequent site for bone metastasis in breast cancer patients. Patients with bone-only metastasis have a fairly good prognosis when compared with patients with visceral disease. Nevertheless, cancer-induced bone disease carries an important risk of developing skeletal related events that impact quality of life (QoL). It is therefore particularly important to stratify patients according to their risk of developing bone metastasis. In this context, several risk factors have been studied, including demographic, clinicopathological, genetic, and metabolic factors. Most of them show conflicting or non-definitive associations and are not validated for clinical use. Nonetheless, tumour intrinsic subtype is widely accepted as a major risk factor for bone metastasis development and luminal breast cancer carries an increased risk for bone disease. Other factors such as gene signatures, expression of specific cytokines (such as bone sialoprotein and bone morphogenetic protein 7) or components of the extracellular matrix (like bone crosslinked C-telopeptide) might also influence the development of bone metastasis. Knowledge of risk factors related with bone disease is of paramount importance as it might be a prediction tool for triggering the use of targeted agents and allow for better patient selection for future clinical trials.
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Affiliation(s)
- Catarina Pulido
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; These authors contributed equally to this work
| | - Inês Vendrell
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; These authors contributed equally to this work
| | - Arlindo R Ferreira
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sandra Casimiro
- Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - André Mansinho
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Irina Alho
- Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luís Costa
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Luis Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Physical activity and survival in breast cancer: What were missing? Eur J Cancer 2016; 71:121-122. [PMID: 27939844 DOI: 10.1016/j.ejca.2016.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
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Ouldamer L, Bendifallah S, Chas M, Boivin L, Bedouet L, Body G, Ballester M, Daraï E. Intrinsic and extrinsic flaws of the nomogram predicting bone-only metastasis in women with early breast cancer: An external validation study. Eur J Cancer 2016; 69:102-109. [PMID: 27821312 DOI: 10.1016/j.ejca.2016.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The recently developed MDACC nomogram purports to predict the risk of bone-only metastasis in women with early breast carcinoma based on five clinical and pathological characteristics. We set out to externally validate and assess its robustness using a tertiary breast cancer centre database. METHODS All consecutive women treated for early breast cancer in our centre between January 1989 and December 2013 and who had all the nomogram variables documented were eligible for analysis. RESULTS We identified 1255 eligible women for external validation analysis. The median follow-up was 54 months (range: 1-312) and time to initial metastasis 20 months (range: 1-80). The correspondence between the actual bone-only metastasis and the nomogram predictions implied poor calibration of the nomogram in the validation cohort, be it in the whole cohort or when stratified by breast cancer subtype. CONCLUSION This external validation study of the MDACC nomogram showed limitations in its generalizability to a new and independent European patient population.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France.
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Marie Chas
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Laura Boivin
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Lea Bedouet
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Gilles Body
- Department of Gynaecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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Elefteriou F. Role of sympathetic nerves in the establishment of metastatic breast cancer cells in bone. J Bone Oncol 2016; 5:132-134. [PMID: 27761374 PMCID: PMC5063226 DOI: 10.1016/j.jbo.2016.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 01/11/2023] Open
Abstract
The bone marrow microenvironment is characterized by its multicellular nature, and perhaps less obviously by the high mobility of multiple transient and stationary cell lineages present in this environment. The trafficking of hematopoietic and mesenchymal cells between the bone marrow and blood compartments is regulated by a number of bone marrow-derived factors. It is suspected that transformed metastatic cells “hijack” these processes to engraft into the skeleton and eventually cause the skeletal complications associated with metastatic disease. In this short review, experimental and association data supporting the contribution of a less recognized cell type of the bone marrow – the nerves of the sympathetic nervous system – to early events of the breast cancer bone metastatic process, are summarized.
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Affiliation(s)
- Florent Elefteriou
- Baylor College of Medicine, Center for Skeletal Medicine and Biology, Dept. of Molecular and Human Genetics and Orthopedic Surgery, One Baylor Plaza, ABBR-R716, Houston, TX 77030, United States
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Nishimukai A, Higuchi T, Ozawa H, Yanai A, Miyagawa Y, Murase K, Imamura M, Takatsuka Y, Miyoshi Y. Different patterns of change in bone turnover markers during treatment with bone-modifying agents for breast cancer patients with bone metastases. Breast Cancer 2016; 24:245-253. [DOI: 10.1007/s12282-016-0695-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/24/2016] [Indexed: 11/24/2022]
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Jacob L, Hadji P, Kostev K. Age-related differences in persistence with bisphosphonates in women with metastatic breast cancer. J Bone Oncol 2016; 5:63-6. [PMID: 27335773 PMCID: PMC4908184 DOI: 10.1016/j.jbo.2016.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022] Open
Abstract
Aims To investigate age-related persistence with bisphosphonates (BIS) in women with breast cancer (BC) and bone metastases. Methods We included a dataset of 1541 patients diagnosed with BC and bone metastases and initially treated with BIS between 1994 and 2013. The primary outcome measure was the age-related rate of BIS discontinuation within 12 months after treatment initiation. Therapy discontinuation was defined as a period of at least 90 days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance coverage (private/statutory), type of care (gynecological/general), region (West/East Germany), depression, chemotherapy, hormone therapy, pain medication, antidepressants, and the number of co-medications were included as covariates. Results The mean ages in the group of women <70 and that of women ≥70 years of age were 55.7 (SD: 9.8) and 76.7 (SD: 5.1) years respectively. Within 12 months after treatment initiation, 44.3% of women <70 and 34.8% of women ≥70 had terminated treatment (p-value<0.001). Patients aged ≥70 were at a lower risk of treatment discontinuation than patients <70 (HR=0.78, 95% CI: 0.67–0.91). Furthermore, treatment in gynecological practices, chemotherapy, hormone therapy, pain medication, and number of co-medications decreased the risk of discontinuation. By contrast, residing in West Germany and private health insurance coverage increased discontinuation risk. Conclusions Women with metastatic BC aged ≥70 are at a lower risk of BIS treatment discontinuation than younger women.
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Affiliation(s)
- L Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - P Hadji
- Nordwest Hospital Frankfurt, Germany
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Cook GJR, Azad GK, Goh V. Imaging Bone Metastases in Breast Cancer: Staging and Response Assessment. J Nucl Med 2016; 57 Suppl 1:27S-33S. [PMID: 26834098 DOI: 10.2967/jnumed.115.157867] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Bone metastases are common in patients with advanced breast cancer. Given the significant associated morbidity, the introduction of new, effective systemic therapies, and the improvement in survival time, early detection and response assessment of skeletal metastases have become even more important. Although planar bone scanning has recognized limitations, in particular, poor specificity in staging and response assessment, it continues to be the main method in current clinical practice for staging of the skeleton in patients at risk of bone metastases. However, the accuracy of bone scanning can be improved with the addition of SPECT/CT. There have been reported improvements in sensitivity and specificity for staging of the skeleton with either bone-specific PET/CT tracers, such as (18)F-NaF, or tumor-specific tracers, such as (18)F-FDG, although these methods are less widely available and more costly. There is a paucity of data on the use of (18)F-NaF PET/CT for response assessment in breast cancer, but there is increasing evidence that (18)F-FDG PET/CT may improve on current methods in this regard. At the same time, interest and experience in using whole-body morphologic MRI augmented with diffusion-weighted imaging for both staging and response assessment in the skeleton have been increasing. However, data on comparisons of these methods with PET methods to determine the best technique for current clinical practice or for clinical trials are insufficient. There are early data supporting the use (18)F-FDG PET/MRI to assess malignant disease in the skeleton, with the possibility of taking advantage of the synergies offered by combining morphologic, physiologic, and metabolic imaging.
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Affiliation(s)
- Gary J R Cook
- Cancer Imaging Department, Division of Imaging Sciences and Biomedical Engineering, Kings College London, London, England
| | - Gurdip K Azad
- Cancer Imaging Department, Division of Imaging Sciences and Biomedical Engineering, Kings College London, London, England
| | - Vicky Goh
- Cancer Imaging Department, Division of Imaging Sciences and Biomedical Engineering, Kings College London, London, England
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Fontanella C, Fanotto V, Rihawi K, Aprile G, Puglisi F. Skeletal metastases from breast cancer: pathogenesis of bone tropism and treatment strategy. Clin Exp Metastasis 2015; 32:819-33. [PMID: 26343511 DOI: 10.1007/s10585-015-9743-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/03/2015] [Indexed: 12/17/2022]
Abstract
Breast cancer (BC) is the most common female cancer worldwide with approximately 10 % of new cases metastatic at diagnosis and 20-50 % of patients with early BC who will eventually develop metastatic disease. Bone is the most frequent site of colonisation and the development of skeletal metastases depends on a complex multistep process, from dissemination and survival of malignant cells into circulation to the actual homing and metastases formation inside bone. Disseminated tumor cells (DTCs) can be detected in bone marrow in approximately 30 % of BC patients, likely reflecting the presence of minimal residual disease that would eventually account for subsequent metastatic disease. Patients with bone marrow DTCs have poorer overall survival compared with patients without them. Although bone-only metastatic disease seems to have a rather indolent behavior compared to visceral disease, bone metastases can cause severe and debilitating effects, including pain, spinal cord compression, hypercalcemia and pathologic fractures. Delivering an appropriate treatment is therefore paramount and ideally it should require interdisciplinary care. Multiple options are currently available, from bisphosphonates to new drugs targeting RANK ligand and radiotherapy. In this review we describe the mechanisms underlying bone colonization and provide an update on existing systemic and locoregional treatments for bone metastases.
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Affiliation(s)
- Caterina Fontanella
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy.
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Valentina Fanotto
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Karim Rihawi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Fabio Puglisi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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67
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Contemporary approaches for imaging skeletal metastasis. Bone Res 2015; 3:15024. [PMID: 26273541 PMCID: PMC4502405 DOI: 10.1038/boneres.2015.24] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/23/2015] [Indexed: 01/13/2023] Open
Abstract
The skeleton is a common site of cancer metastasis. Notably high incidences of bone lesions are found for breast, prostate, and renal carcinoma. Malignant bone tumors result in significant patient morbidity. Identification of these lesions is a critical step to accurately stratify patients, guide treatment course, monitor disease progression, and evaluate response to therapy. Diagnosis of cancer in the skeleton typically relies on indirect bone-targeted radiotracer uptake at sites of active bone remodeling. In this manuscript, we discuss established and emerging tools and techniques for detection of bone lesions, quantification of skeletal tumor burden, and current clinical challenges.
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68
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Brockton NT, Gill SJ, Laborge SL, Paterson AHG, Cook LS, Vogel HJ, Shemanko CS, Hanley DA, Magliocco AM, Friedenreich CM. The Breast Cancer to Bone (B2B) Metastases Research Program: a multi-disciplinary investigation of bone metastases from breast cancer. BMC Cancer 2015; 15:512. [PMID: 26156521 PMCID: PMC4496930 DOI: 10.1186/s12885-015-1528-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
Background Bone is the most common site of breast cancer distant metastasis, affecting 50–70 % of patients who develop metastatic disease. Despite decades of informative research, the effective prevention, prediction and treatment of these lesions remains elusive. The Breast Cancer to Bone (B2B) Metastases Research Program consists of a prospective cohort of incident breast cancer patients and four sub-projects that are investigating priority areas in breast cancer bone metastases. These include the impact of lifestyle factors and inflammation on risk of bone metastases, the gene expression features of the primary tumour, the potential role for metabolomics in early detection of bone metastatic disease and the signalling pathways that drive the metastatic lesions in the bone. Methods/Design The B2B Research Program is enrolling a prospective cohort of 600 newly diagnosed, incident, stage I-IIIc breast cancer survivors in Alberta, Canada over a five year period. At baseline, pre-treatment/surgery blood samples are collected and detailed epidemiologic data is collected by in-person interview and self-administered questionnaires. Additional self-administered questionnaires and blood samples are completed at specified follow-up intervals (24, 48 and 72 months). Vital status is obtained prior to each follow-up through record linkages with the Alberta Cancer Registry. Recurrences are identified through medical chart abstractions. Each of the four projects applies specific methods and analyses to assess the impact of serum vitamin D and cytokine concentrations, tumour transcript and protein expression, serum metabolomic profiles and in vitro cell signalling on breast cancer bone metastases. Discussion The B2B Research Program will address key issues in breast cancer bone metastases including the association between lifestyle factors (particularly a comprehensive assessment of vitamin D status) inflammation and bone metastases, the significance or primary tumour gene expression in tissue tropism, the potential of metabolomic profiles for risk assessment and early detection and the signalling pathways controlling the metastatic tumour microenvironment. There is substantial synergy between the four projects and it is hoped that this integrated program of research will advance our understanding of key aspects of bone metastases from breast cancer to improve the prevention, prediction, detection, and treatment of these lesions.
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Affiliation(s)
- Nigel T Brockton
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stephanie J Gill
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie L Laborge
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada
| | - Alexander H G Paterson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Medical Oncology, Tom Baker Cancer Centre, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Linda S Cook
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada.,Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Hans J Vogel
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Carrie S Shemanko
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Hanley
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Pahouja G, Wesolowski R, Reinbolt R, Tozbikian G, Berger M, Mangini N, Lustberg MB. Stabilization of bone marrow infiltration by metastatic breast cancer with continuous doxorubicin. ACTA ACUST UNITED AC 2015; 3:28-32. [PMID: 25914871 PMCID: PMC4408922 DOI: 10.1016/j.ctrc.2014.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Complete bone marrow infiltration with profound pancytopenia is very uncommon in breast cancer. Bone marrow metastasis can frequently occur following development of metastatic breast cancer. However, bone marrow failure as the herald of this disease is not typically seen. Very limited data exists as to the safest and most efficacious manner to treat patients with profound pancytopenia due to metastatic solid tumor involvement. In this case, the patient’s thrombocytopenia was particularly worrisome, requiring daily platelet transfusions. There was also concern that cytotoxic chemotherapy would exacerbate the patient’s thrombocytopenia and increase bleeding risk. The patient’s dramatic response to chemotherapy with full platelet recovery is also highly unusual. For our patient, continuous doxorubicin successfully “unpacked” the bone marrow despite a low baseline platelet level, and without increasing the need for more frequent platelet transfusion or risk of catastrophic bleeding. Given the rarity of this presentation, it is currently unknown if the majority of similar patients experience near full recovery of hematopoietic function after initiation of appropriate systemic treatment for metastatic disease.
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Affiliation(s)
- Gaurav Pahouja
- Northeast Ohio Medical University, College of Medicine, Rootstown, OH 44272, USA
| | - Robert Wesolowski
- Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA
| | - Raquel Reinbolt
- Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA
| | - Gary Tozbikian
- Department of Pathology, Wexner Medical Center at The Ohio State University, USA
| | - Michael Berger
- Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA
| | - Neha Mangini
- Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA
| | - Maryam B. Lustberg
- Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA
- Correspondence to: Assistant Professor of Internal Medicine, B405 Starling Loving Hall, 20 West 10th Avenue, Columbus, Ohio, USA. (M.B. Lustberg)
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Haraldsen A, Bluhme H, Røhl L, Pedersen EM, Jensen AB, Hansen EB, Nellemann H, Rasmussen F, Morsing A. Single photon emission computed tomography (SPECT) and SPECT/low-dose computerized tomography did not increase sensitivity or specificity compared to planar bone scintigraphy for detection of bone metastases in advanced breast cancer. Clin Physiol Funct Imaging 2014; 36:40-6. [DOI: 10.1111/cpf.12191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ate Haraldsen
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Henrik Bluhme
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Lisbeth Røhl
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Erik Morre Pedersen
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Anders Bonde Jensen
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Eva Boysen Hansen
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Hanne Nellemann
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Finn Rasmussen
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - Anni Morsing
- Nuclear medicine Department & PET Center; Department of Radiology; Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
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71
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Alunni-Fabbroni M, Müller V, Fehm T, Janni W, Rack B. Monitoring in metastatic breast cancer: is imaging outdated in the era of circulating tumor cells? ACTA ACUST UNITED AC 2014; 9:16-21. [PMID: 24803882 DOI: 10.1159/000360438] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In clinical practice imaging technologies such as computed tomography (CT), positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) are well-established methods for monitoring metastatic breast cancer (MBC) patients and for assessing therapeutic efficacy. However, several weeks of treatment are required before these technologies can offer any reliable information on effective disease regression, and, in the meanwhile, the patients are exposed to potentially unnecessary therapy. Circulating tumor cells (CTCs) have been shown to be powerful prognostic and predictive markers and provide clinicians with valuable information. However, in one clinical trial, an early change of chemotherapy based on CTC detection did not result in improved survival. Currently, CTC detection outside clinical trials should be limited to selected clinical situations, i.e. increased treatment toxicity or as risk estimation.
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Affiliation(s)
| | - Volkmar Müller
- Clinic for Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Germany
| | - Tanja Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolfgang Janni
- Clinic for Gynecology and Obstetrics, University Hospital Ulm, Germany
| | - Brigitte Rack
- Clinic for Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Germany
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Kwast ABG, Voogd AC, Menke-Pluijmers MBE, Linn SC, Sonke GS, Kiemeney LA, Siesling S. Prognostic factors for survival in metastatic breast cancer by hormone receptor status. Breast Cancer Res Treat 2014; 145:503-11. [PMID: 24771049 DOI: 10.1007/s10549-014-2964-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 12/30/2022]
Abstract
Hormone receptor (HR) status is an important prognostic factor for patients with metastatic breast cancer (MBC) and is also correlated with other prognostic factors, such as initial lymph node status, HER2-Neu status and age. The prognostic value of these other factors, however, is unknown when stratified by HR positive versus HR negative patients. The aim of this study was to evaluate prognostic factors for MBC survival in relation to HR status. Dutch women diagnosed with breast cancer in 2003-2006 treated with curative intent who developed MBC within 5 years of follow-up were selected from the Netherlands cancer registry (N = 2,001). Independent prognostic factors for survival after metastatic occurrence were determined by multivariable Cox survival analyses stratified by HR status. Interactions between HR status and prognostic factors were determined. Median survival for MBC patients with HR negative (HR-) tumours was 8 months, compared to 19 months for HR positive (HR+) patients. The prognostic value of lymph node status, HER2-Neu status, adjuvant endocrine treatment and first-line palliative chemotherapy was dependent on HR status. Initial lymph node status was independently associated with survival in HR- patients, but not in HR+ patients. HER2-Neu positive status was associated with better survival in both HR+ and HR- patients, although the association was stronger in HR- patients. Similarly, patients treated with first-line palliative chemotherapy fared better, especially HR- patients. HR+ patients had worse survival if they had received adjuvant endocrine treatment. This study shows that the prognostic value of various factors depends on HR status in MBC. This information may help physicians to determine individual prognostic profiles and therapeutic strategies for MBC patients.
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Affiliation(s)
- A B G Kwast
- Department of Research, Comprehensive Cancer Centre the Netherlands, PO Box 19079, 3501 DB, Utrecht, The Netherlands,
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Foroni C, Milan M, Strina C, Cappelletti M, Fumarola C, Bonelli M, Bertoni R, Ferrero G, Maldotti M, Takano E, Andreis D, Venturini S, Brugnoli G, Petronini PG, Zanoni V, Pritzker L, Pritzker K, Parissenti A, Santini D, Fox SB, Bottini A, Generali D. Pure anti-tumor effect of zoledronic acid in naïve bone-only metastatic and locally advanced breast cancer: proof from the “biological window therapy”. Breast Cancer Res Treat 2014; 144:113-21. [DOI: 10.1007/s10549-014-2840-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/11/2014] [Indexed: 12/14/2022]
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van den Hurk C, van de Poll-Franse L, Breed W, Coebergh J, Nortier J. Scalp cooling to prevent alopecia after chemotherapy can be considered safe in patients with breast cancer. Breast 2013; 22:1001-4. [DOI: 10.1016/j.breast.2013.07.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/01/2013] [Accepted: 07/16/2013] [Indexed: 12/11/2022] Open
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Ahn SG, Lee HM, Cho SH, Lee SA, Hwang SH, Jeong J, Lee HD. Prognostic factors for patients with bone-only metastasis in breast cancer. Yonsei Med J 2013; 54:1168-77. [PMID: 23918566 PMCID: PMC3743183 DOI: 10.3349/ymj.2013.54.5.1168] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Bone is the most frequent site of metastasis among breast cancer patients. We investigated prognostic factors affecting survival following bone-only metastasis in breast cancer patients. MATERIALS AND METHODS The medical records of breast cancer patients who were treated and followed at Gangnam Severance Hospital retrospectively reviewed to identify patients with bone-only metastasis. RESULTS The median time from the diagnosis of bone-only metastasis to the last follow-up or death was 55.2 [95% confidence interval (CI), 38.6-71.9] months. The Kaplan-Meier overall survival estimate at 10 years for all patients was 34.9%. In the multivariate Cox regression model, bisphosphonate treatment [hazard ratio=0.18; 95% CI, 0.07-0.43], estrogen receptor positivity (hazard ratio=0.51; 95% CI, 0.28-0.94), and solitary bone metastasis (hazard ratio=0.32; 95% CI, 0.14-0.72) were significantly associated with longer overall survival in the bone-only recurrence group. Among the treatment modalities, only bisphosphonate treatment was identified as a significant prognostic factor. CONCLUSION Identifying the factors influencing breast cancer mortality after bone-only metastasis will help clarify the clinical course and improve the treatment outcome for patients with breast cancer and bone-only metastasis. Bisphosphonates, as a significant prognostic factor, warrant further investigation.
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Affiliation(s)
- Sung Gwe Ahn
- Department of Surgery, Yonsei University Medical College, Seoul, Korea
| | - Hak Min Lee
- Department of Surgery, Yonsei University Medical College, Seoul, Korea
| | - Sang-Hoon Cho
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seung Ah Lee
- Department of Surgery, Yonsei University Medical College, Seoul, Korea
| | - Seung Hyun Hwang
- Department of Surgery, Yonsei University Medical College, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Yonsei University Medical College, Seoul, Korea
| | - Hy-De Lee
- Department of Surgery, Yonsei University Medical College, Seoul, Korea
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Dystrophic Cutaneous Calcification and Metaplastic Bone Formation due to Long Term Bisphosphonate Use in Breast Cancer. Case Rep Oncol Med 2013; 2013:871917. [PMID: 23956898 PMCID: PMC3728502 DOI: 10.1155/2013/871917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/01/2013] [Indexed: 12/03/2022] Open
Abstract
Bisphosphonates are widely used in the treatment of breast cancer with bone metastases. We report a case of a female with breast cancer presented with a rash around a previous mastectomy site and a discharge lesion on her right chest wall in August 2010. Biopsy of the lesion showed dystrophic calcification and metaplastic bone formation. The patient's history revealed a long term use of zoledronic acid for the treatment of breast cancer with bone metastasis. We stopped the treatment since we believed that the cutaneous dystrophic calcification could be associated with her long term bisphosphonate therapy. Adverse cutaneous events with bisphosphonates are very rare, and dystrophic calcification has not been reported previously. The dystrophic calcification and metaplastic bone formation in this patient are thought to be due to long term bisphosphonate usage.
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77
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Glendenning J, Cook G. Imaging Breast Cancer Bone Metastases: Current Status and Future Directions. Semin Nucl Med 2013; 43:317-23. [DOI: 10.1053/j.semnuclmed.2013.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aromatase inhibitors in the treatment of elderly women with metastatic breast cancer. Breast 2013; 22:142-149. [PMID: 23321585 DOI: 10.1016/j.breast.2012.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 10/26/2012] [Accepted: 12/17/2012] [Indexed: 11/22/2022] Open
Abstract
The proportion of elderly women in the population is rising, and in tandem, the incidence of breast cancer rises with age. Because of health and tolerability concerns, as well as life expectancy, physicians may be reluctant to advise a standard treatment regimen for elderly patients with metastatic breast cancer. To elucidate this issue, we performed a literature review of clinical studies that included women with metastatic breast cancer who were over the age of 65. Our results show that although little clinical evidence exists, what is available suggests that standard treatment is tolerated and beneficial for patients meeting certain criteria. A geriatric assessment may identify specific patient groups (independent, dependent, or frail) and thereby guide treatment. Treatment recommendations for elderly patients with metastatic breast cancer are sparse, although first-line endocrine treatment, usually aromatase inhibitors or tamoxifen, is recommended for hormone-sensitive disease. In general, the evidence from clinical studies suggests that aromatase inhibitors are more effective than either tamoxifen or megestrol acetate as first- or second-line treatment in postmenopausal women with metastatic breast cancer. Ultimately, quality of life, treatment effects, and comorbidities are important aspects in this population and may guide treatment choice. To provide evidence-based treatment guidance, future clinical trials should include more patients over the age of 65 years.
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Capulli M, Angelucci A, Driouch K, Garcia T, Clement-Lacroix P, Martella F, Ventura L, Bologna M, Flamini S, Moreschini O, Lidereau R, Ricevuto E, Muraca M, Teti A, Rucci N. Increased expression of a set of genes enriched in oxygen binding function discloses a predisposition of breast cancer bone metastases to generate metastasis spread in multiple organs. J Bone Miner Res 2012; 27:2387-98. [PMID: 22714395 DOI: 10.1002/jbmr.1686] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bone is the preferential site of distant metastasis in breast carcinoma (BrCa). Patients with metastasis restricted to bone (BO) usually show a longer overall survival compared to patients who rapidly develop multiple metastases also involving liver and lung. Hence, molecular predisposition to generate bone and visceral metastases (BV) represents a clear indication of poor clinical outcome. We performed microarray analysis with two different chip platforms, Affymetrix and Agilent, on bone metastasis samples from BO and BV patients. The unsupervised hierarchical clustering of the resulting transcriptomes correlated with the clinical progression, segregating the BO from the BV profiles. Matching the twofold significantly regulated genes from Affymetrix and Agilent chips resulted in a 15-gene signature with 13 upregulated and two downregulated genes in BV versus BO bone metastasis samples. In order to validate the resulting signature, we isolated different MDA-MB-231 clonal subpopulations that metastasize only in the bone (MDA-BO) or in bone and visceral tissues (MDA-BV). Six of the signature genes were also significantly upregulated in MDA-BV compared to MDA-BO clones. A group of upregulated genes, including Hemoglobin B (HBB), were involved in oxygen metabolism, and in vitro functional analysis of HBB revealed that its expression in the MDA subpopulations was associated with a reduced production of hydrogen peroxide. Expression of HBB was detected in primary BrCa tissue but not in normal breast epithelial cells. Metastatic lymph nodes were frequently more positive for HBB compared to the corresponding primary tumors, whereas BO metastases had a lower expression than BV metastases, suggesting a positive correlation between HBB and ability of bone metastasis to rapidly spread to other organs. We propose that HBB, along with other genes involved in oxygen metabolism, confers a more aggressive metastatic phenotype in BrCa cells disseminated to bone.
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Affiliation(s)
- Mattia Capulli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Ding X, Fan Y, Ma F, Li Q, Wang J, Zhang P, Yuan P, Xu B. Prolonged administration of bisphosphonates is well-tolerated and effective for skeletal-related events in Chinese breast cancer patients with bone metastasis. Breast 2012; 21:544-9. [DOI: 10.1016/j.breast.2012.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/19/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
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Niikura N, Liu J, Hayashi N, Palla SL, Tokuda Y, Hortobagyi GN, Ueno NT, Theriault RL. Retrospective analysis of antitumor effects of zoledronic acid in breast cancer patients with bone-only metastases. Cancer 2011; 118:2039-47. [PMID: 22139648 DOI: 10.1002/cncr.26512] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 06/26/2011] [Accepted: 08/04/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bisphosphonates have been used successfully in the treatment of hypercalcemia and to reduce skeletal complications of bone metastasis, but have not been shown to prevent bone metastasis or to prolong survival time in metastatic breast cancer patients. The aim of this study was to determine whether the progression-free survival (PFS) and overall survival (OS) of patients with bone-only breast cancer metastasis differed based on whether patients received zoledronic acid, pamidronate, or no bisphosphonate upon diagnosis of their metastases. PATIENTS AND METHODS We retrospectively identified 314 patients diagnosed with bone-only metastasis at the time of initial staging or who developed bone metastasis as the first recurrence site during follow-up from January 1, 1997 to December 31, 2008, at The MD Anderson Cancer Center. Univariate and multivariate Cox hazards models were used to assess the effects of each treatment on PFS and OS. RESULTS Patients who had more than 1 bone metastasis and Eastern Cooperative Oncology Group (ECOG) performance status of 2 and 3 were more likely to receive zoledronic acid in this analysis. Compared with no bisphosphonate use, the use of zoledronic acid was not significantly associated with longer PFS (hazard ratio [HR] = 0.72, P = .058 in univariate analysis, and HR = 0.80, P = .235 in multivariate analysis) nor with longer OS (HR = 1.04, P = .863 in univariate analysis and HR = 1.34, P = .192 in multivariate analysis). CONCLUSION Our study demonstrates that for patients with bone-only metastases, zoledronic acid did not prolong PFS or OS. In patients with bone-only metastasis, we could not demonstrate antitumor effects of zoledronic acid.
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Affiliation(s)
- Naoki Niikura
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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82
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Planchat E, Durando X, Abrial C, Thivat E, Mouret-Reynier MA, Ferrière JP, Pomel C, Kwiatkowski F, Chollet P, Nabholtz JM. Prognostic Value of Initial Tumor Parameters After Metastatic Relapse. Cancer Invest 2011; 29:635-43. [DOI: 10.3109/07357907.2011.621911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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83
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Félix J, Andreozzi V, Soares M, Borrego P, Gervásio H, Moreira A, Costa L, Marcelo F, Peralta F, Furtado I, Pina F, Albuquerque C, Santos A, Passos-Coelho JL. Hospital resource utilization and treatment cost of skeletal-related events in patients with metastatic breast or prostate cancer: estimation for the Portuguese National Health System. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:499-505. [PMID: 21669375 DOI: 10.1016/j.jval.2010.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 11/18/2010] [Accepted: 11/30/2010] [Indexed: 05/13/2023]
Abstract
BACKGROUND Skeletal-related events (SREs) occur frequently in patients with bone metastases as a result of breast (BC) and prostate (PC) cancers. They increase both morbidity and mortality and lead to extensive health-care resource utilization. METHODS Health care resource utilization by BC/PC patients with at least one SRE during the preceding 12 months was assessed through retrospective chart review. SRE-treatment costs were estimated using the Portuguese Ministry of Health cost database and analyzed using generalized linear models. RESULTS This study included 152 patients from nine hospitals. The mean (SD) annual SRE-treatment cost per patient was €5963 (€3646) and €5711 (€4347), for BC (n=121) and PC (n=31) patients, respectively. Mean cost per single episode ranged between €1485 (radiotherapy) and €13,203 (spinal cord compression). Early onset of bone metastasis (P = 0.03) and diagnosis of bone metastases at or after the occurrence of the first SRE (P < 0.001) were associated with higher SRE-treatment costs. CONCLUSION These results reveal the high hospital SRE-treatment costs, highlighting the need for early diagnosis and treatment, and identify key factors determining the economic value of therapies for patients with skeletal metastases.
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Affiliation(s)
- J Félix
- Exigo Consultores, Alhos Vedros, Portugal.
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84
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Pockett RD, Castellano D, McEwan P, Oglesby A, Barber BL, Chung K. The hospital burden of disease associated with bone metastases and skeletal-related events in patients with breast cancer, lung cancer, or prostate cancer in Spain. Eur J Cancer Care (Engl) 2011; 19:755-60. [PMID: 19708928 PMCID: PMC3035821 DOI: 10.1111/j.1365-2354.2009.01135.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
POCKETT R.D., CASTELLANO D., MCEWAN P., OGLESBY A., BARBER B.L. & CHUNG K. (2010) European Journal of Cancer Care19, 755–760 The hospital burden of disease associated with bone metastases and skeletal-related events in patients with breast cancer, lung cancer, or prostate cancer in Spain Metastatic bone disease (MBD) is the most common cause of cancer pain and of serious skeletal-related events (SREs) reducing quality of life. Management of MBD involves a multimodal approach aimed at delaying the first SRE and reducing subsequent SREs. The objective of the study was to characterise the hospital burden of disease associated with MBD and SREs following breast, lung and prostate cancer in Spain. Patients admitted into a participating hospital, between 1 January 2003 and 31 December 2003, with one of the required cancers were identified and selected for inclusion into the study. The index admission to hospital, incidence of patients admitted and hospital length of stay were analysed. There were 28 162 patients identified with breast, lung and prostate cancer. The 3 year incidence rates of hospital admission due to MBD were 95 per 1000 for breast cancer, 156 per 1000 for lung cancer and 163 per 1000 for prostate cancer. For patients admitted following an SRE, the incidence rates were 211 per 1000 for breast cancer, 260 per 1000 for lung cancer and 150 per 1000 for prostate cancer. This study has shown that cancer patients consume progressively more hospital resources as MBD and subsequent SREs develop.
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Affiliation(s)
- R D Pockett
- Cardiff Research Consortium, the MediCentre, Cardiff, UK.
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85
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Urakawa H, Nishida Y, Wasa J, Arai E, Zhuo L, Kimata K, Kozawa E, Futamura N, Ishiguro N. Inhibition of hyaluronan synthesis in breast cancer cells by 4-methylumbelliferone suppresses tumorigenicity in vitro and metastatic lesions of bone in vivo. Int J Cancer 2011; 130:454-66. [PMID: 21387290 DOI: 10.1002/ijc.26014] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/01/2011] [Accepted: 02/11/2011] [Indexed: 01/26/2023]
Abstract
Hyaluronan (HA) has been shown to play crucial roles in the tumorigenicity of malignant tumors. Previous studies demonstrated that inhibition of HA suppressed the tumorigenicity of various malignant tumors including breast cancer. 4-methylumbelliferone (MU) has been reported to inhibit HA synthesis in several cell types. However, few studies have focused on the effects of HA inhibition in breast cancer cells by MU, nor the effects on bone metastasis. We hypothesized that MU would suppress the progression of bone metastasis via inhibition of HA synthesis. Here, we investigated the effects of MU on HA expression in MDA-MB-231 breast cancer cell line in addition to their tumorigenicity in vitro and in vivo. HAS2 mRNA expression was downregulated after 6 and 24 hr treatment with MU. Quantitative analysis of HA revealed that MU significantly inhibited the intracellular and cell surface HA. MU significantly inhibited cell growth and induced apoptosis as determined by cell proliferation and TUNEL assays, respectively. Phosphorylation of Akt was suppressed after 12 and 24 hr treatment with MU. MU treatment also inhibited cell motility as well as cell invasiveness. MU also inhibited cell growth and motility in murine fibroblast cell line NIH3T3. In vivo, administration of MU inhibited the expansion of osteolytic lesions on soft X-rays in mouse breast cancer xenograft models. HA accumulation in bone metastatic lesions was perturbed peripherally. These data suggest that MU might be a therapeutic candidate for bone metastasis of breast cancer via suppression of HA synthesis and accumulation.
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Affiliation(s)
- Hiroshi Urakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Showa, Nagoya, Aichi, Japan
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86
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Unfavourable pattern of metastases in M0 breast cancer patients during 1978-2008: a population-based analysis of the Munich Cancer Registry. Breast Cancer Res Treat 2011; 128:795-805. [PMID: 21311969 DOI: 10.1007/s10549-011-1372-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
Abstract
Little is known about time trends in metastases in the patients treated in routine health care facilities without metastases at diagnosis (M0) and about survival after these metastases. Data on 33,771 M0 patients with primary breast cancer diagnosed between 1978 and 2003 were obtained from the Munich Cancer Registry. Survival analyses were restricted to the patients with metastases within 5 years of the initial diagnosis. The incident number of the patients approximately doubled each period and 5-year overall survival increased from 77% in the first to 82% percent in the last period. 5490 (16%) M0 patients developed metastases within 5 years after the initial diagnosis. The hazard of developing metastases was lowest in the most recent period compared to the first period (HR = 0.50, P < 0.001). The hazard of dying after metastases was equal for patients diagnosed between 1978-1984 and 1995-2003 (HR 1.08, P = 0.3). The percentage of the patients that developed bone metastases decreased each time period, but the percentage primary liver and CNS metastases increased. Exclusion of site of metastases in the multivariate analysis led to a 20% (P = 0.02) higher hazard of dying following metastases in the last versus the first period. In the period 1978-2008, unfavourable changes in the pattern of metastases were exhibited and no improvement was observed in survival of the patients after occurrence of metastases. An explanation might be the increased use of adjuvant systemic treatment, which has less effect on the highly lethal liver and CNS metastases than on bone metastases. The increased use also appeared to contribute to the overall prevention of metastases in breast cancer and therefore to improve overall survival.
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87
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Niikura N, Liu J, Hayashi N, Palla SL, Tokuda Y, Hortobagyi GN, Ueno NT, Theriault RL. Treatment outcome and prognostic factors for patients with bone-only metastases of breast cancer: a single-institution retrospective analysis. Oncologist 2011; 16:155-64. [PMID: 21266401 PMCID: PMC3228079 DOI: 10.1634/theoncologist.2010-0350] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Limited information is available about the optimal management and clinical outcome of bone-only metastases in breast cancer patients. The objective of this study was to define prognostic factors for patients with bone-only metastases. Our second objective was to compare progression-free survival (PFS) and overall survival (OS) between patients with hormone receptor (HR)(+) tumors and bone-only metastases who received combinatory therapy (chemotherapy followed by endocrine therapy, or endocrine therapy combined with molecular targeted therapy) and those treated with endocrine or chemotherapy alone. PATIENTS AND METHODS We retrospectively identified 351 breast cancer patients diagnosed with bone-only metastasis in 1997-2008 at our institution. RESULTS Patients with metastasis detected at the time of their primary breast cancer diagnosis (rather than at recurrence), a single metastasis, or asymptomatic bone disease had a longer PFS interval, and patients with a performance status of 0-1, a single metastasis, or asymptomatic bone disease had a longer OS time. Among patients with HR(+) human epidermal growth factor receptor (HER)-2(-) disease, combinatory therapy was associated with longer PFS and OS times than with endocrine therapy. In multivariate analyses, combinatory therapy was not associated with longer PFS or OS times than with endocrine therapy. Among patients with HER-2(+) disease, trastuzumab led to a longer PFS interval but no difference in the OS time. CONCLUSION Our results indicate that, for HR(+) disease, a prospective trial of chemotherapy followed by endocrine therapy is warranted to determine whether it prolongs survival more than endocrine therapy alone in patients with bone-only metastases.
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Affiliation(s)
- Naoki Niikura
- Departments of Breast Medical Oncology and
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Jun Liu
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Shana L. Palla
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yutaka Tokuda
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
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88
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Goldstein RH, Reagan MR, Anderson K, Kaplan DL, Rosenblatt M. Human bone marrow-derived MSCs can home to orthotopic breast cancer tumors and promote bone metastasis. Cancer Res 2011; 70:10044-50. [PMID: 21159629 DOI: 10.1158/0008-5472.can-10-1254] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
American women have a nearly 25% lifetime risk of developing breast cancer, with 20% to 40% of these patients developing life-threatening metastases. More than 70% of patients presenting with metastases have skeletal involvement, which signals progression to an incurable stage. Tumor-stroma cell interactions are only superficially understood, specifically regarding the ability of stromal cells to affect metastasis. In vivo models show that exogenously supplied human bone marrow-derived stem cells (hBMSC) migrate to breast cancer tumors, but no reports have shown endogenous hBMSC migration from the bone to primary tumors. Here, we present a model of in vivo hBMSC migration from a physiologic human bone environment to human breast tumors. Furthermore, hBMSCs alter tumor growth and bone metastasis frequency. These may home to certain breast tumors based on tumor-derived TGF-β1. Moreover, at the primary tumor level, interleukin 17B (IL-17B)/IL-17BR signaling may mediate interactions between hBMSCs and breast cancer cells.
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Affiliation(s)
- Robert H Goldstein
- Program in Genetics, Sackler School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
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89
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The lysyl oxidase inhibitor, beta-aminopropionitrile, diminishes the metastatic colonization potential of circulating breast cancer cells. PLoS One 2009; 4:e5620. [PMID: 19440335 PMCID: PMC2680032 DOI: 10.1371/journal.pone.0005620] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 04/14/2009] [Indexed: 12/27/2022] Open
Abstract
Lysyl oxidase (LOX), an extracellular matrix remodeling enzyme, appears to have a role in promoting breast cancer cell motility and invasiveness. In addition, increased LOX expression has been correlated with decreases in both metastases-free, and overall survival in breast cancer patients. With this background, we studied the ability of β-aminopropionitrile (BAPN), an irreversible inhibitor of LOX, to regulate the metastatic colonization potential of the human breast cancer cell line, MDA-MB-231. BAPN was administered daily to mice starting either 1 day prior, on the same day as, or 7 days after intracardiac injection of luciferase expressing MDA-MB-231-Luc2 cells. Development of metastases was monitored by in vivo bioluminescence imaging, and tumor-induced osteolysis was assessed by micro-computed tomography (μCT). We found that BAPN administration was able to reduce the frequency of metastases. Thus, when BAPN treatment was initiated the day before, or on the same day as the intra-cardiac injection of tumor cells, the number of metastases was decreased by 44%, and 27%, and whole-body photon emission rates (reflective of total tumor burden) were diminished by 78%, and 45%, respectively. In contrast, BAPN had no effect on the growth of established metastases. Our findings suggest that LOX activity is required during extravasation and/or initial tissue colonization by circulating MDA-MB-231 cells, lending support to the idea that LOX inhibition might be useful in metastasis prevention.
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90
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Metastasis of breast cancer to a uterine leiomyoma. Breast Cancer 2009; 16:157-61. [DOI: 10.1007/s12282-008-0069-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 07/22/2008] [Indexed: 11/30/2022]
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91
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Renal safety of zoledronic acid administration beyond 24 months in breast cancer patients with bone metastases. Med Oncol 2008; 25:356-9. [DOI: 10.1007/s12032-008-9045-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 12/17/2007] [Indexed: 12/01/2022]
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92
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Liposomal pegylated doxorubicin plus vinorelbine combination as first-line chemotherapy for metastatic breast cancer in elderly women ≥65 years of age. Cancer Chemother Pharmacol 2007; 62:285-92. [DOI: 10.1007/s00280-007-0605-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
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93
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Gennari R, Audisio RA. Breast cancer in elderly women. Optimizing the treatment. Breast Cancer Res Treat 2007; 110:199-209. [PMID: 17851758 DOI: 10.1007/s10549-007-9723-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
The elderly population is on the rise. Breast cancer is the most common cancer in western women and its incidence increases with age. Despite the epidemiological burden of this condition, there is a lack of knowledge regarding the management of older patients, as treatment planning is mainly based on personal preferences rather than hard data. Older women are often offered sub-optimal treatment when compared to their younger counterpart at any particular stage. This is due to various reasons, including the lack of scientific evidence from well-conducted clinical trials. Reluctance to prescribe systemic treatments may be explained by the complexity of cost-benefit evaluations in such patients. It is also an ethical dilemma to decide how aggressive one should be when it comes to treat cancer in the elderly in view of the higher rate of cognitive impairment and specific patients' expectations. This paper reviews the currently available evidence and attempts presenting and discussing chemoprevention of breast cancer, risk and benefit of hormone replacement therapy and the various treatment options for older women with breast cancer.
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94
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Lipton A, Cook RJ, Major P, Smith MR, Coleman RE. Zoledronic Acid and Survival in Breast Cancer Patients with Bone Metastases and Elevated Markers of Osteoclast Activity. Oncologist 2007; 12:1035-43. [PMID: 17914073 DOI: 10.1634/theoncologist.12-9-1035] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Most breast cancer patients with bone metastases will receive bisphosphonate treatment. This post hoc analysis investigated whether early normalization of urinary N-telopeptide of type I collagen (NTX) levels during bisphosphonate therapy correlates with a long-term reduction in skeletal-related event (SRE) risk and mortality in patients with breast cancer. METHODS This was a retrospective subset analysis of a phase III randomized trial comparing i.v. zoledronic acid with pamidronate treatment in patients with bone metastases from breast cancer or multiple myeloma. Patients with breast cancer who had NTX assessments at baseline and at months 1 and 3 (n = 342) were classified as normal (NTX < 64 nmol/mmol creatinine) or elevated (NTX > or = 64 nmol/mmol creatinine). The relative risk for an SRE or death was estimated with Cox regression models. RESULTS Among the 328 evaluable patients treated with zoledronic acid, 196 patients (59.7%) had elevated baseline NTX, with 149 of those patients (76.0%) having normalized NTX levels and 31 patients (15.8%) having persistently elevated NTX levels at 3 months. The normalized NTX group had significantly lower risks for a first SRE, a first fracture or surgery to bone, or death than the group that had persistently elevated NTX levels. CONCLUSIONS These results suggest that early normalization of elevated baseline NTX while receiving zoledronic acid is associated with longer event-free and overall survival times compared with persistently elevated NTX. Further analyses in cancer patients with elevated marker levels are warranted to confirm the implications of these findings.
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Affiliation(s)
- Allan Lipton
- Milton S. Hershey Medical Center, Penn State Cancer Institute, 500 University Drive, Hershey, Pennsylvania 17033, USA.
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95
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Vulto JCM, Louwman WJ, Poortmans PMP, Lybeert LM, Rutten HJT, Coebergh JWW. A population based study of radiotherapy in a cohort of patients with breast cancer diagnosed between 1996 and 2000. Eur J Cancer 2007; 43:1976-82. [PMID: 17618112 DOI: 10.1016/j.ejca.2007.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 05/16/2007] [Accepted: 05/25/2007] [Indexed: 11/30/2022]
Abstract
We studied the use of radiotherapy (RT) (especially secondary RT) in a cohort of 6561 patients in southern Netherlands with invasive breast cancer diagnosed between 1996 and 2000 (median follow-up: 66 months, range 0-107 months). Radiation within 6 months of diagnosis was considered primary RT (PRT). RT given 6 months or later after diagnosis or after PRT was considered secondary RT (SRT). Of all patients, 67% received RT, 3554 only PRT, 323 only SRT and 503 both. The cumulative use of SRT at 100 months was 17%. The 826 patients receiving SRT underwent 1846 courses 0-105 months (median 36) after diagnosis; the retreat rate was 35%. Elderly patients received SRT significantly less often (OR(age50-69)=0.7, 95%CI=0.6-0.8, OR(age> or 70)=0.4, 95%CI=0.3-0.5). The following factors increased the chance for SRT: patients from the eastern region (OR=1.3, 95%CI=1.1-1.6); patients who received PRT (OR=1.3, 95%CI=1.0-1.5) and patients who underwent mastectomy including axillary node dissection as well as unresected patients (OR=1.9, 95%CI=1.5-2.4, OR=2.6, 95%CI=1.7-3.9, respectively). Thirteen percent of all patients with breast cancer received SRT, with a large variation in age and between the 2 RT departments in the region.
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Affiliation(s)
- J C M Vulto
- Dr. Bernard Verbeeten Institute, PO Box 90120, 5000 LA Tilburg, The Netherlands.
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