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Kim R, Kawai A, Wakisaka M, Sawada S, Shimoyama M, Yasuda N, Kin T, Arihiro K. Outpatient breast-conserving surgery for breast cancer: Use of local and intravenous anesthesia and/or sedation may reduce recurrence and improve survival. Ann Med Surg (Lond) 2020; 60:365-371. [PMID: 33224492 PMCID: PMC7666315 DOI: 10.1016/j.amsu.2020.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 01/13/2023] Open
Abstract
The use of general anesthesia (GA) with inhalational anesthetics for breast cancer surgery may be associated with breast cancer recurrence and increased mortality due to the immunosuppressive effects of these drugs. Less-immunosuppressive anesthetic techniques may reduce breast cancer recurrence. We evaluated the feasibility, safety, and efficacy of outpatient breast-conserving surgery (BCS) for breast cancer in a breast clinic in terms of the anesthetic technique used, complications occurring, recurrence, and survival. Methods: The sample comprised 456 consecutive patients with stage 0–III breast cancer who underwent BCS/axillary lymph node (ALN) management using local and intravenous anesthesia and/or sedation between May 2008 and January 2020. Most patients received adjuvant chemotherapy and/or endocrine therapy and radiotherapy after surgery. Patient outcomes were evaluated retrospectively. Results: All patients recovered and were discharged after resting for 3–4 h postoperatively. No procedure-related severe complication or death occurred. Sixty-four complications (14.0%) were observed: 14 wound infections, 17 hematomas, and 33 axillary lymphoceles. The median follow-up period was 2259 days (range, 9–4190 days), during which disease recurrence was observed in 25 (5.4%) patients. The overall survival and breast cancer–specific survival rates were 92.3% and 94.7%, respectively. Conclusions: Outpatient surgery for breast cancer involving BCS and ALN management under local and intravenous anesthesia and/or sedation can be performed safely, without serious complication or death. Less-immunosuppressive anesthetic techniques with spontaneous breathing may reduce the recurrence of breast cancer and improve survival relative to GA. Outpatient surgery for breast cancer involving breast-conserving surgery (BCS) and axillary lymph node (ALN) management under local and intravenous anesthesia and/or sedation can be performed safely. Less-immunosuppressive anesthetic techniques with spontaneous breathing may reduce the recurrence of breast cancer and improve survival compared with general anesthesia.
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Affiliation(s)
- Ryungsa Kim
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima, 730-0051, Japan
| | - Ami Kawai
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima, 730-0051, Japan
| | - Megumi Wakisaka
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima, 730-0051, Japan
| | - Sayaka Sawada
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima, 730-0051, Japan
| | - Mika Shimoyama
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima, 730-0051, Japan
| | - Naomi Yasuda
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima, 730-0051, Japan
| | - Takanori Kin
- Department of Breast Surgery, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, 2-3, 1-Chome Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Mosayebi A, Mojaradi B, Bonyadi Naeini A, Khodadad Hosseini SH. Modeling and comparing data mining algorithms for prediction of recurrence of breast cancer. PLoS One 2020; 15:e0237658. [PMID: 33057328 PMCID: PMC7561198 DOI: 10.1371/journal.pone.0237658] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is the most common invasive cancer and the second leading cause of cancer death in women. and regrettably, this rate is increasing every year. One of the aspects of all cancers, including breast cancer, is the recurrence of the disease, which causes painful consequences to the patients. Moreover, the practical application of data mining in the field of breast cancer can help to provide some necessary information and knowledge required by physicians for accurate prediction of breast cancer recurrence and better decision-making. The main objective of this study is to compare different data mining algorithms to select the most accurate model for predicting breast cancer recurrence. This study is cross-sectional and data gathering of this research performed from June 2018 to June 2019 from the official statistics of Ministry of Health and Medical Education and the Iran Cancer Research Center for patients with breast cancer who had been followed for a minimum of 5 years from February 2014 to April 2019, including 5471 independent records. After initial pre-processing in dataset and variables, seven new and conventional data mining algorithms have been applied that each one represents one kind of data mining approach. Results show that the C5.0 algorithm possibly could be a helpful tool for the prediction of breast cancer recurrence at the stage of distant recurrence and nonrecurrence, especially in the first to third years. also, LN involvement rate, Her2 value, Tumor size, free or closed tumor margin were found to be the most important features in our dataset to predict breast cancer recurrence.
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Affiliation(s)
- Alireza Mosayebi
- Department of Management and Business Engineering, School of Progress Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Barat Mojaradi
- Department of Geomatics, School of Civil Engineering, Iran University of Science and Technology, Tehran, Iran
- * E-mail:
| | - Ali Bonyadi Naeini
- Department of Management and Business Engineering, School of Progress Engineering, Iran University of Science and Technology, Tehran, Iran
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Zaleskis G, Garberytė S, Pavliukevičienė B, Valinčius G, Characiejus D, Mauricas M, Kraśko JA, Žilionytė K, Žvirblė M, Pašukonienė V. Doxorubicin uptake in ascitic lymphoma model: resistance or curability is governed by tumor cell density and prolonged drug retention. J Cancer 2020; 11:6497-6506. [PMID: 33046971 PMCID: PMC7545667 DOI: 10.7150/jca.46066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023] Open
Abstract
Background/Aims: Chemotherapy resistance of malignancies is a universal phenomenon which unfavorably affects therapeutic results. Genetic adaptations as well as epigenetic factors can play an important role in the development of multidrug resistance. Cytotoxic drug content in plasma of cancer patients is known to variate up to one hundred-fold regardless of the same dose injected per m2 body surface. The relationship between plasma concentrations, tissue uptake, and chemotherapy response is not completely understood. The main objective of this study was to investigate how the identical dose of Doxorubicin (Dox) can result in a different therapeutic response pattern depending on tumor size. Study Design: The study was performed on ascitic EL4 lymphoma in an exponential growth phase focusing on the rapidly changing tumor susceptibility to the Dox treatment. Well distinguishable tumor response patterns (curability, remission-relapse, resistance) were selected to unveil Dox intratumoral uptake and drug tissue persistence. Intratumoral Dox content within peritoneal cavity (PerC) in conjunction with systemic toxicity and plasma pharmacokinetics, were monitored at several time points following Dox injection in tumor bearing mice (TBM) with differing patterns of response. Results: Following intraperitoneal (i.p.) transplantation of 5x104 EL4 lymphoma cells rapid exponential proliferation with ascites volume and animal mass increase resulted in median survival of 14.5 days. The increase in tumor cell mass in PerC between day 3 and day 9 was 112.5-fold (0.2±0.03 mg vs 22.5±0.31 mg respectively). However, tumors at this time interval (day 3 to day 9 post-transplantation) were relatively small and constituted less than 0.05% of animal weight. An identical dose of Dox (15 mg/kg) injected intravenously (i.v.) on Day 3 lead to a cure whereas a TBM injected on day 9 exhibited resistance with a median survival time no different from the untreated TBM control. Injection of Dox resulted in noticeable differences of cellular uptake in PerC between all three groups of TBM ("cure", relapse", "resistance"). Larger tumors were consistently taking up less Dox 60 min after the 15 mg/kg i.v. bolus injection. Higher initial uptake resulted also in longer retention of drug in PerC cells. The area under the concentration curve in PerC cells AUC0-10d was 8.2±0.57 µg/g x h, 4.6±0.27 µg/g x h and 1.6±0.02 µg/g x h in "cure", "relapse" and "resistance" TBM respectively (p<0.05 "relapse" vs "cure" and p<0.001 "resistance" vs "cure"). No differences in plasma Dox pharmacokinetics or systemic hematological effects were observed in TBM following a single i.v. Dox push. Hematologic nadir was tested on day 2 and subsequent hematologic recovery was evaluated on day 10 following Dox administration. Hematologic recovery on day 10 coincided with complete drug efflux from PerC and rising tumor cell numbers in PerC of "relapse" TBM. Myelosuppression and hematological recovery patterns were identical in all surviving animal groups regardless of the tumor size on the day of Dox injection. Conclusions: Within a few days of exponential tumor growth, an identical dose of Dox produced dramatically different responses in the TBM with increasing resistance. Systemic toxicity and plasma pharmacokinetics were indistinguishable between all TBM groups. Initial uptake in tumor cells was found to be consistently lower in larger tumors. Drug uptake in tumor cells was regulated locally - a phenomenon known as inoculum effect in vitro. The duration of drug retention in cells was directly related to initial cellular uptake. The magnitude of Dox cellular retention could potentially play a role in determining tumor remission and relapse.
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Affiliation(s)
- Gintaras Zaleskis
- Laboratory of Immunology, National Cancer Institute, Vilnius, Lithuania
| | - Sima Garberytė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Gintaras Valinčius
- Institute of Biochemistry, Life Sciences Centre, Vilnius University, Vilnius, Lithuania
| | - Dainius Characiejus
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Mykolas Mauricas
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | | | - Margarita Žvirblė
- Laboratory of Immunology, National Cancer Institute, Vilnius, Lithuania
| | - Vita Pašukonienė
- Laboratory of Immunology, National Cancer Institute, Vilnius, Lithuania
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Buscemi J, Oswald LB, Baik SH, Buitrago D, Iacobelli F, Phillips SM, Perez-Tamayo A, Guitelman J, Penedo FJ, Yanez B. My health smartphone intervention decreases daily fat sources among Latina breast cancer survivors. J Behav Med 2020; 43:732-742. [PMID: 31970652 PMCID: PMC7374026 DOI: 10.1007/s10865-020-00136-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/17/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer is the most common cancer among Latina women, and Latina women are at higher risk for breast cancer mortality than white women. Lifestyle factors, such as consuming a nutritious diet and engaging in regular physical activity, promote health and are protective against heart disease, type 2 diabetes, and breast cancer recurrence. Previous studies have developed and tested interventions for Latina breast cancer survivors to improve diet and increase physical activity, however, no studies to date have developed a smartphone delivered intervention. The purpose of the current study was to compare two Smartphone delivered interventions, My Health, which focused on diet and physical activity, and My Guide, which focused on psychosocial functioning, on dietary and physical activity outcomes, post-intervention, and at a 2-week follow-up assessment. Overall, participants receiving the My Health intervention reported a greater reduction in daily fat sources than the My Guide group over time. However, daily sources of fat did not differ between conditions. Walking, measured by estimated weekly metabolic equivalents, increased across time points in both groups. These preliminary findings suggest that eHealth interventions aimed at improving lifestyle factors may favorably impact nutritional intake and physical activity. Future research should utilize more comprehensive and objective measures of diet and physical activity, and incorporate more behavioral lifestyle components into the intervention in larger samples with a longer follow-up period.
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Affiliation(s)
- Joanna Buscemi
- Department of Psychology, DePaul University, 2219 N Kenmore Ave, Chicago, IL, 60614, USA.
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Judy Guitelman
- ALAS-WINGS, Latina Association for Breast Cancer, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Zhang LY, Zhang YQ, Zeng YZ, Zhu JL, Chen H, Wei XL, Liu LJ. TRPC1 inhibits the proliferation and migration of estrogen receptor-positive Breast cancer and gives a better prognosis by inhibiting the PI3K/AKT pathway. Breast Cancer Res Treat 2020; 182:21-33. [PMID: 32415497 DOI: 10.1007/s10549-020-05673-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/06/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Previous studies have indicated that transient receptor potential (TRP) channels can influence cancer development. The TRPC subfamily consists of seven subtypes, TRPC1 - TRPC7. Interestingly, the expression levels of TRPC1 have been shown to be totally different in different breast cancer cell lines. Nevertheless, the underlying mechanism remains unknown. In this study, we explore the significance of TRPC1 expression in breast cancer. METHODS Immunohistochemical TRPC1 staining was performed in 278 samples. TRPC1 expression in different breast tissues were examined. Then, the influence of TRPC1 on migration, invasion and proliferation was explored. We analyzed the protein of TRPC1 by Western blot to prove which pathway may be involved in. Finally, we use online database to predict the prognosis of TRPC1 in breast cancer. RESULTS Through immunohistochemistry and in vitro experiments, we found that the expression level of TRPC1 was higher in breast cancer cells as compared with that in normal breast epithelial cells. Moreover, the expression level of TRPC1 was different between estrogen receptor-positive (ER +) and -negative (ER -) breast cancer. It was shown that TRPC1 inhibited MCF7 cell proliferation, migration, and invasion in vitro. Western blotting revealed that TRPC1 inhibited the PI3K/AKT pathway and epithelium-mesenchymal transformation, leading to subsequent inhibition of cell proliferation and metastasis. In luminal A and luminal B patients, those with high TRPC1 expression had a better prognosis. On the contrary, in basal-like and triple-negative breast cancer (TNBC) subtypes, patients with high-TRPC1 expression had a worse prognosis. CONCLUSIONS We confirmed that TRPC1 was high expression in breast cancer. Overexpression of TRPC1 inhibits proliferation and migration of ER + breast cancer and gives a better prognosis by inhibiting PI3K/AKT pathway activation. TRPC1 may be an independent prognostic predictor in breast cancer patients.
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Affiliation(s)
- Li-Ying Zhang
- Department of Pathology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou, 515031, People's Republic of China
| | - Yong-Qu Zhang
- Department of Breast Center, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, shantou, 515031, People's Republic of China
- Department of Breast-Thyroid-Surgery, Xiang'an Hospital of Xiamen University, 2000 Xiang'an East Road, Xiamen, 361101, People's Republic of China
| | - Yun-Zhu Zeng
- Department of Pathology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou, 515031, People's Republic of China
| | - Jian-Ling Zhu
- Department of Pathology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou, 515031, People's Republic of China
| | - Huan Chen
- Department of Pathology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou, 515031, People's Republic of China
| | - Xiao-Long Wei
- Department of Pathology, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou, 515031, People's Republic of China.
| | - Li-Juan Liu
- Outpatient Department of Breast Center, Cancer Hospital of Shantou University Medical College, No. 7 Raoping Road, Shantou, 515031, People's Republic of China.
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Shiferaw WS, Aynalem YA, Akalu TY, Demelew TM. Incidence and Predictors of Recurrence among Breast Cancer Patients in Black Lion Specialized Hospital Adult Oncology Unit, Addis Ababa, Ethiopia: Retrospective Follow-up Study with Survival Analysis. J Cancer Prev 2020; 25:111-118. [PMID: 32647652 PMCID: PMC7337003 DOI: 10.15430/jcp.2020.25.2.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 12/17/2022] Open
Abstract
Currently, breast cancer is becoming a major public health problem for developing countries. In Ethiopia, breast cancer is the most prevalent cancer among women, and constitutes a major public health concern. Hence, this study was aimed to determine the incidence and predictor of recurrence among breast cancer clients at Black Lion Specialized Hospital, Ethiopia, in 2018. We analyzed 513 patients out of 835 women breast cancer patients treated at Black Lion Specialized Hospital. Recurrent-free survival was determined using the Kaplan-Meier method, with comparisons between groups through the log-rank test. The Cox proportional hazards model was used to identify predictors of recurrence among breast cancer clients. The incidence rate of recurrence among breast cancer was 6.5% per (95% CI = 6.49-12.47) follow-up. The median recurrent-free survival time was 60.33 months (95% CI = 54.46-62.30). Predictors of recurrence were negative estrogen receptor (hazard ratio [HR] = 1.8, 95% CI = 1.53-7.62), high histologic grade (HR = 2.8, 95% CI = 1.14-10.31), positive lymph node status (HR = 2.6, 95% CI = 1.14-10.31), clinical staging III (HR = 2.5, 95% CI = 1.26-9.42), and involved deep surgical margin (HR = 3.6, 95% CI = 2.14-8.61). This research showed that incidence of recurrence was high. Advanced clinical stage, positive nodal status, high histologic grade, negative estrogen receptor, and involved deep surgical margin were associated with higher recurrence rates. In contrast, hormonal therapy has a great role in decreasing the development of recurrence.
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Wu T, Hsu FC, Pierce JP. Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses Among Breast Cancer Survivors: A Prospective Cohort Study. J Clin Med 2020; 9:jcm9061817. [PMID: 32545214 PMCID: PMC7355548 DOI: 10.3390/jcm9061817] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Current dietary guidelines do not consider cancer survivors’ and past smokers’ low capacity to regulate their acid–base balance. People with a low capacity to regulate their acid–base balance are more susceptible to acid-producing diets. We studied a cohort of 2950 early stage breast cancer survivors who provided dietary information at baseline and during follow-up. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). We assessed past smoking intensity by pack-years of smoking. After an average of 7.3 years of follow-up, there were 295 total deaths, 249 breast cancer-specific deaths, and 490 cases of recurrent breast cancer. Increased intakes of dietary acid load and pack-years of smoking were each independently and jointly associated with increased total mortality and breast cancer-specific mortality; tests for trends and overall associations were statistically significant for NEAP and marginally significant for PRAL. Compared to women in the lowest tertile of NEAP and pack-year of smoking = 0, women in the highest tertile of NEAP and pack-years of smoking >15 had the greatest increased risk of total mortality (HR = 3.23, 95%CI 1.99–5.26). Further, dietary acid scores were associated with increased breast cancer recurrence among women with pack-years of smoking >0 but not in those with pack-years of smoking = 0 (p values for interactions <0.05). Our study provides valuable evidence for adding dietary acid load scores to dietary guidelines for breast cancer survivors and developing specific guidelines for past smokers among these survivors.
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Affiliation(s)
- Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92093, USA;
- Correspondence:
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - John P. Pierce
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92093, USA;
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Bhattacharyya GS, Doval DC, Desai CJ, Chaturvedi H, Sharma S, Somashekhar S. Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective. JCO Glob Oncol 2020; 6:789-798. [PMID: 32511068 PMCID: PMC7328098 DOI: 10.1200/go.20.00033] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The prevalence and mortality of breast cancer is increasing in Asian countries, including India. With advances in medical technology leading to better detection and characterization of the disease, it has been possible to classify breast cancer into various subtypes using markers, which helps predict the risk of distant recurrence, response to therapy, and prognosis using a combination of molecular and clinical parameters. Breast cancer and its therapy, mainly surgery, systemic therapy (anticancer chemotherapy, hormonal therapy, targeted therapy, and immunotherapy), and radiation therapy, are associated with significant adverse influences on physical and mental health, quality of life, and the economic status of the patient and her family. The fear of recurrence and its devastating effects often leads to overtreatment, with a toxic cost to the patient financially and physically in cases in which this is not required. This article discusses some aspects of a breast cancer diagnosis and its impact on the various facets of the life of the patient and her family. It further elucidates the role of prognostic factors, the currently available biomarkers and prognostic signatures, and the importance of ethnically validating biomarkers and prognostic signatures.
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Affiliation(s)
| | - Dinesh C. Doval
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Chirag J. Desai
- Vedanta Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | | | - Sanjay Sharma
- Asian Cancer Institute, Somaiya Ayurvihar, Mumbai, Maharashtra, India
| | - S.P. Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
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Pasin O, Dirican A, Ankarali H, Disci R, Karanlik H. Assessment of death risk of breast cancer patients with joint frailty models. Saudi Med J 2020; 41:491-498. [PMID: 32373916 PMCID: PMC7253835 DOI: 10.15537/smj.2020.5.25065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: To investigate the effects of risk factors on recurrence and death in breast cancer patients, taking into account the dependence between recurrence and death as well as the heterogeneity among individuals. The other aim of this study was to make predictions of death risks with a dynamic model that includes patient’s history and different horizons. Methods: The data of 465 patients who had undergone surgery at the Istanbul University Oncology Institute, Istanbul, Turkey, between 2009 and 2016 were used. For data analysis in this retrospective study, the authors applied the joint frailty model, and the predictions were obtained using dynamic prediction methods that consider the patient’s history. The Brier score was used to evaluate the accuracy of the estimations. Results: A positive relationship was found between recurrence and death, and heterogeneity was found among patients (p<0.001, p=1.008, p=2.945). The effects of Cerb-B2, tumor type, remaining lymph nodes, neoadjuvant chemotherapy, and surgery type were statistically significant for death and recurrence (p<0.05, relative risk [death, recurrence] = [2.5, 11.86], [2.065, 2.798], [1.852, 3.113], [4.211, 9.366], [1.521,1.991]). The Brier score values used in the evaluation of the predictions obtained by the dynamic prediction methods were found to be below 0.30. Conclusion: The use of joint frailty models is recommended for the detection of heterogeneity effects and dependence between recurrence and death. Through models in survival analysis, researchers can obtain more accurate parameter estimates. A significant variance of frailty indicates different death risks for the same characteristics.
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Affiliation(s)
- Ozge Pasin
- Department of Biostatistics, Faculty of Medicine, Istanbul University, Istanbul, Turkey. E-mail.
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Larouzee E, Allegre L, Boudy AS, Ilenko A, Selleret L, Zilberman S, Owen C, Gligorov J, Richard S, Thomassin-Naggara I, Chabbert-Buffet N, Darai E, Bendifallah S. Predicting the likelihood of recurrence of pregnancy-associated breast cancer: Nomogram based on analysis of the French cancer network: Cancer Associé à La Grossesse. J Gynecol Obstet Hum Reprod 2020; 50:101766. [PMID: 32325267 DOI: 10.1016/j.jogoh.2020.101766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Pregnancy associated breast cancer (PABC) are defined as breast cancer diagnosed during pregnancy and during the year following delivery. The prediction of poor prognosis events (PPE) such as recurrence is a major medical challenge of management for women with PABC. The aim of this study was to build a nomogram based on selected clinical and histological variables to predict recurrence. STUDY DESIGN This retrospective study included 96 patients with PABC from January 2002 to January 2018. A multivariate Cox analysis of selected risk factors was performed and a nomogram to predict recurrence was built. The nomogram was internally validated. RESULTS The overall recurrence rate was 22% (21/95) and the 3-years recurrence rate was 13% (12/95). Age at diagnosis, histological type, immuno-histological class, tumor stage (TNM), node stage (TNM) were associated with PPE in univariate analysis, and were included in the final Cox model to develop the nomogram. The predictive model had a concordance index of 0.83 (95% Confidence Interval (CI), 0.81-0.85) and 0.78 (95% CI, 0.76-0.80) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. CONCLUSION Our results support the use of the present nomogram based on 5 clinical and pathological characteristics to predict PPE in PABC with a high concordance. External validation is required to recommend this nomogram in routine practice.
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Affiliation(s)
- Elise Larouzee
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - Lucie Allegre
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Anna Ilenko
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Sonia Zilberman
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Clémentine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France
| | - Joseph Gligorov
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Sandrine Richard
- Centre CALG (Cancer Associé à La Grossesse), France; Department of Oncology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France; UMRS-938 Sorbonne University, Paris, France
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Heterogeneity of Circulating Tumor Cells in Breast Cancer: Identifying Metastatic Seeds. Int J Mol Sci 2020; 21:ijms21051696. [PMID: 32121639 PMCID: PMC7084665 DOI: 10.3390/ijms21051696] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
Metastasis being the main cause of breast cancer (BC) mortality represents the complex and multistage process. The entrance of tumor cells into the blood vessels and the appearance of circulating tumor cells (CTCs) seeding and colonizing distant tissues and organs are one of the key stages in the metastatic cascade. Like the primary tumor, CTCs are extremely heterogeneous and presented by clusters and individual cells which consist of phenotypically and genetically distinct subpopulations. However, among this diversity, only a small number of CTCs is able to survive in the bloodstream and to form metastases. The identification of the metastasis-initiating CTCs is believed to be a critical issue in developing therapeutic strategies against metastatic disease. In this review, we summarize the available literature addressing morphological, phenotypic and genetic heterogeneity of CTCs and the molecular makeup of specific subpopulations associated with BC metastasis. Special attention is paid to the need for in vitro and in vivo studies to confirm the tumorigenic and metastatic potential of metastasis-associating CTCs. Finally, we consider treatment approaches that could be effective to eradicate metastatic CTCs and to prevent metastasis.
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Ouyang J, Sun L, Zeng Z, Zeng C, Zeng F, Wu S. Nanoaggregate Probe for Breast Cancer Metastasis through Multispectral Optoacoustic Tomography and Aggregation‐Induced NIR‐I/II Fluorescence Imaging. Angew Chem Int Ed Engl 2019; 59:10111-10121. [DOI: 10.1002/anie.201913149] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Juan Ouyang
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Lihe Sun
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Zhuo Zeng
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Cheng Zeng
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Fang Zeng
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Shuizhu Wu
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
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63
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Ouyang J, Sun L, Zeng Z, Zeng C, Zeng F, Wu S. Nanoaggregate Probe for Breast Cancer Metastasis through Multispectral Optoacoustic Tomography and Aggregation‐Induced NIR‐I/II Fluorescence Imaging. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201913149] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Juan Ouyang
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Lihe Sun
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Zhuo Zeng
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Cheng Zeng
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Fang Zeng
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
| | - Shuizhu Wu
- State Key Laboratory of Luminescent Materials and DevicesGuangdong Provincial Key Laboratory of Luminescence from Molecular AggregatesCollege of Materials Science and EngineeringSouth China University of Technology Wushan Road 381 Guangzhou 510640 China
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Groza M, Zimta AA, Irimie A, Achimas-Cadariu P, Cenariu D, Stanta G, Berindan-Neagoe I. Recent advancements in the study of breast cancer exosomes as mediators of intratumoral communication. J Cell Physiol 2019; 235:691-705. [PMID: 31328284 DOI: 10.1002/jcp.29096] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/25/2019] [Indexed: 12/24/2022]
Abstract
Breast cancer is a heterogeneous disease, with a morbidity rate of 27.8% and a mortality rate of 15% among women population worldwide. Understanding how this cancer develops and the mechanisms behind tumor progression and chemoresistance is of utmost importance. Exosomes mediate communication in a population of heterogeneous tumoral cells. They have a cargo composed of oncogenes and oncomiRs which change the transcriptomic scenario of their targeted cells and activate numerous tumor-promoting signaling pathways. Exosomes secreted by breast cancer cells lead to enhanced cell proliferation, replicative immortality, angiogenesis, invasion, migration, and chemoresistance. Studying exosomes from this perspective offers more in depth understanding of breast malignancy and may aid in the future development of early diagnostic, prognostic and therapeutic options. We present the latest findings in this area and offer practical solutions which may further stimulate the much-needed research of exosome in breast cancer.
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Affiliation(s)
- Monica Groza
- Department of Medical Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
| | - Alina-Andreea Zimta
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - Alexandru Irimie
- 11th Department of Oncological Surgery and Gynecological Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.,Department of Surgery, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
| | - Patriciu Achimas-Cadariu
- 11th Department of Oncological Surgery and Gynecological Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.,Department of Surgery, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
| | - Diana Cenariu
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - Giorgio Stanta
- DSM, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Ioana Berindan-Neagoe
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu-Hatieganu, Cluj-Napoca, Romania.,Research Center for Functional Genomics, Biomedicine and Translational Medicine, uliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Functional Genomics and Experimental Pathology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
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65
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Cytotoxic, Anti-Migration, and Anti-Invasion Activities on Breast Cancer Cells of Angucycline Glycosides Isolated from a Marine-Derived Streptomyces sp. Mar Drugs 2019; 17:md17050277. [PMID: 31075906 PMCID: PMC6562490 DOI: 10.3390/md17050277] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
Four angucycline glycosides were previously characterized from marine-derived Streptomyces sp. OC1610.4. Further investigation of this strain cultured on different fermentation media from that used previously resulted in the isolation of two new angucycline glycosides, vineomycins E and F (1–2), and five known homologues, grincamycin L (3), vineomycinone B2 (4), fridamycin D (5), moromycin B (7), and saquayamycin B1 (8). Vineomycin F (2) contains an unusual ring-cleavage deoxy sugar. All the angucycline glycosides isolated from Streptomyces sp. OC1610.4 were evaluated for their cytotoxic activity against breast cancer cells MCF-7, MDA-MB-231, and BT-474. Moromycin B (7), saquayamycin B1 (8), and saquayamycin B (9) displayed potent anti-proliferation against the tested cell lines, with IC50 values ranging from 0.16 to 0.67 μM. Saquayamycin B (9) inhibited the migration and invasion of MDA-MB-231 cells in a dose-dependent manner, as detected by Transwell and wound-healing assays.
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66
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Influence of ductal carcinoma in situ on the outcome of invasive breast cancer. A prospective cohort study. Int J Surg 2019; 63:98-106. [DOI: 10.1016/j.ijsu.2019.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/22/2018] [Accepted: 01/25/2019] [Indexed: 11/19/2022]
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67
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Stergiou N, Nagel J, Pektor S, Heimes AS, Jäkel J, Brenner W, Schmidt M, Miederer M, Kunz H, Roesch F, Schmitt E. Evaluation of a novel monoclonal antibody against tumor-associated MUC1 for diagnosis and prognosis of breast cancer. Int J Med Sci 2019; 16:1188-1198. [PMID: 31588183 PMCID: PMC6775261 DOI: 10.7150/ijms.35452] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/09/2019] [Indexed: 12/25/2022] Open
Abstract
There is still a great unmet medical need concerning diagnosis and treatment of breast cancer which could be addressed by utilizing specific molecular targets. Tumor-associated MUC1 is expressed on over 90 % of all breast cancer entities and differs strongly from its physiological form on epithelial cells, therefore presenting a unique target for breast cancer diagnosis and antibody-mediated immune therapy. Utilizing an anti-tumor vaccine based on a synthetically prepared glycopeptide, we generated a monoclonal antibody (mAb) GGSK-1/30, selectively recognizing human tumor-associated MUC1. This antibody targets exclusively tumor-associated MUC1 in the absence of any binding to MUC1 on healthy epithelial cells thus enabling the generation of breast tumor-specific radiolabeled immune therapeutic tools. Methods: MAb GGSK-1/30 was used for immunohistochemical analysis of human breast cancer tissue. Its desferrioxamine (Df')-conjugate was synthesized and labelled with 89Zr. [89Zr]Zr-Df'-GGSK-1/30 was evaluated as a potential PET tracer. Binding and pharmacokinetic properties of [89Zr]Zr-Df'-GGSK-1/30 were analyzed in vitro using human and murine cell lines that express tumor-associated MUC1. Self-generated primary murine breast cancer cells expressing human tumor-associated MUC1 were transplanted subcutaneously in wild type and human MUC1-transgenic mice. The pharmacology of [89Zr]Zr-Df'-GGSK-1/30 was investigated using breast tumor-bearing mice in vivo by PET/MRT imaging as well as by ex vivo organ biodistribution analysis. Results: The mAb GGSK-1/30 stained specifically human breast tumor tissue and can be possibly used to predict the severity of disease progression based on the expression of the tumor-associated MUC1. For in vivo imaging, the Df'-conjugated mAb was radiolabeled with a radiochemical yield of 60 %, a radiochemical purity of 95 % and an apparent specific activity of 6.1 GBq/µmol. After 7 d, stabilities of 84 % in human serum and of 93 % in saline were observed. In vitro cell studies showed strong binding to human tumor-associated MUC1 expressing breast cancer cells. The breast tumor-bearing mice showed an in vivo tumor uptake of >50 %ID/g and clearly visible specific enrichment of the radioconjugate via PET/MRT. Principal conclusions: Tumor-associated MUC1 is a very important biomarker for breast cancer next to the traditional markers estrogen receptor (ER), progesterone receptor (PR) and HER/2-neu. The mAb GGSK-1/30 can be used for the diagnosis of over 90% of breast cancers, including triple negative breast cancer based on biopsy staining. Its radioimmunoconjugate represents a promising PET-tracer for breast cancer imaging selectively targeting breast cancer cells.
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Affiliation(s)
| | - Johannes Nagel
- Institute for Nuclear chemistry, Johannes-Gutenberg University
| | - Stefanie Pektor
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center
| | - Anne-Sophie Heimes
- Department of Obstetrics and Women's Health, University Medical Center, Johannes Gutenberg-University, Germany
| | - Jörg Jäkel
- Department of Pathology, University Medical Center
| | - Walburgis Brenner
- Department of Obstetrics and Women's Health, University Medical Center, Johannes Gutenberg-University, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Women's Health, University Medical Center, Johannes Gutenberg-University, Germany
| | - Matthias Miederer
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center
| | - Horst Kunz
- Institute for Organic Chemistry, Johannes-Gutenberg University
| | - Frank Roesch
- Institute for Nuclear chemistry, Johannes-Gutenberg University
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Nowsheen S, Duma N, Ruddy KJ. Preventing Today's Survivors of Breast Cancer From Becoming Tomorrow's Cardiac Patients. J Oncol Pract 2018; 14:213-214. [PMID: 29641946 DOI: 10.1200/jop.18.00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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