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von Minckwitz G, Blohmer JU, Costa SD, Denkert C, Eidtmann H, Eiermann W, Gerber B, Hanusch C, Hilfrich J, Huober J, Jackisch C, Kaufmann M, Kümmel S, Paepke S, Schneeweiss A, Untch M, Zahm DM, Mehta K, Loibl S. Response-guided neoadjuvant chemotherapy for breast cancer. J Clin Oncol 2013; 31:3623-30. [PMID: 24002511 DOI: 10.1200/jco.2012.45.0940] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE We investigated disease-free survival (DFS) and overall survival (OS) after response-guided neoadjuvant chemotherapy in patients with early breast cancer. PATIENTS AND METHODS We treated 2,072 patients with two cycles of docetaxel, doxorubicin, and cyclophosphamide (TAC) and randomly assigned early responders to four (n = 704) or six (n = 686) additional TAC cycles, and early nonresponders to four cycles of TAC (n = 321) or vinorelbine and capecitabine (NX; n = 301) before surgery. RESULTS DFS was longer in early responders receiving TAC × 8 than in those receiving TAC × 6 (hazard ratio [HR], 0.78; 95% CI, 0.62 to 0.97; P = .026), and in early nonresponders receiving TAC-NX than in those receiving TAC × 6 (HR, 0.59; 95% CI, 0.49 to 0.82; P = .001). Exploratory analysis showed that DFS after response-guided chemotherapy (TAC × 8 or TAC-NX) was significantly longer (HR, 0.71; 95% CI, 0.60 to 0.85; P < .003), as was OS (HR, 0.79; 95% CI, 0.63 to 0.99; P = .048), than on conventional chemotherapy (TAC × 6). DFS was longer after response-guided chemotherapy in all hormone receptor-positive tumors (luminal A HR = 0.55, luminal B [human epidermal growth factor receptor 2 (HER2) negative] HR = 0.40, and luminal B [HER2 positive] HR = 0.56), but not in hormone receptor-negative tumors (HER2 positive [nonluminal] HR = 1.01 and triple negative HR = 0.87). Pathologic complete response did not predict these survival effects. pCR predicted an improved DFS in triple-negative (HR = 6.67), HER2-positive (nonluminal; HR 5.24), or luminal B (HER2-negative) tumors (HR = 3.74). CONCLUSION This exploratory analysis suggests that response-guided neoadjuvant chemotherapy might improve survival and is most effective in hormone receptor-positive tumors. If confirmed, the response-guided approach could provide a clinically meaningful advantage for the neoadjuvant over the adjuvant approach in early breast cancer.
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Affiliation(s)
- Gunter von Minckwitz
- Gunter von Minckwitz, Keyur Mehta, and Sibylle Loibl, Headquarters, German Breast Group, Neu-Isenburg; Jens Uwe Blohmer, St Gertrauden Krankenhaus, Berlin); Serban Dan Costa, Universitäts-Frauenklinik, Magdeburg; Carsten Denkert, Institute for Pathology, Charite, Berlin; Holger Eidtmann, Universitäts-Frauenklink, Kiel; Wolfgang Eiermann and Claus Hanusch, Klinikum zum Roten Kreuz, Munich; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Jörn Hilfrich, Henrietten-Stiftung, Hanover; Jens Huober, Universitäts-Frauenklinik Tübingen, Frauenklinik; Christian Jakisch and Sibylle Loibl, Städtische Kliniken, Offenbach; Gunter von Minckwitz, Universitäts-Frauenklinik, Frankfurt; Sherko Kümmel, Klinikum Essen Mitte, Essen; Stefan Paepke, Universitäts-Frauenklinik rechts der Isar, Munich; Andreas Schneeweiss, National Center for Tumor Diseases, University of Heidelberg; Michael Untch, Helios-Klinikum, Berlin-Buch; Dirk Michael Zahm, Brustzentrum Stiftung Rehabilitation Heidelberg (SRH) Waldkliniken, Gera, Germany; Jens Huober, Kantonsspital, St Gallen, Switzerland
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Adjuvant docetaxel and cyclophosphamide plus trastuzumab in patients with HER2-amplified early stage breast cancer: a single-group, open-label, phase 2 study. Lancet Oncol 2013; 14:1121-1128. [PMID: 24007746 DOI: 10.1016/s1470-2045(13)70384-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous results suggest that docetaxel plus cyclophosphamide improves disease-free survival (DFS) and overall survival compared with doxorubicin plus cyclophosphamide in early stage breast cancer. We assessed the addition of 1 year of trastuzumab to a non-anthracycline regimen, docetaxel plus cyclophosphamide, in patients with HER2-amplified early stage breast cancer and examined whether this regimen was equally effective in patients with TOP2A-amplified and TOP2A-non-amplified disease. METHODS This was an open-label, single-group, phase 2 study. Eligible patients were aged 18-75 years; had Eastern Cooperative Oncology Group performance status of 1 or less; HER2-amplified early stage breast cancer; operable, histologically confirmed, invasive carcinoma of the breast; adequate tumour specimen available for FISH analysis of TOP2A status; and adequate haematological, renal, hepatic, and cardiac function. Patients received four 21-day cycles of intravenous docetaxel 75 mg/m(2), plus intravenous cyclophosphamide 600 mg/m(2), plus intravenous trastuzumab 4 mg/kg (loading dose) on day 1 and 2 mg/kg on days 1, 8, and 15 during chemotherapy, followed by trastuzumab 6 mg/kg every three weeks for the remainder of 1 year. The primary endpoint was 2-year DFS in TOP2A-amplified and TOP2A-non-amplified patients; the primary analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00493649. FINDINGS 493 patients were enrolled between June 15, 2007, and Aug 5, 2009. After a median follow-up of 36·1 months (IQR 35·5-36·7), 2-year DFS was 97·8% (95% CI 94·2-99·2) and 2-year overall survival was 99·5% (95% CI 96·2-99·9) for the 190 patients with TOP2A-amplified disease; 2-year DFS was 97·9% (95% CI 94·9-99·1) and 2-year overall survival was 98·8% (95% CI 96·2-99·6) for the 248 patients with TOP2A-non-amplified disease; 55 patients were not assessable for TOP2A status. In the 486 patients who received at least one dose of study drug, the most common adverse events of any grade were fatigue (284 patients, 58·4%), neutropenia (250, 51·4%), and nausea (217, 44·7%). The most common grade 3-4 toxic effects were neutropenia (229, 47·1%), febrile neutropenia (30, 6·2%), fatigue (21, 4·3%), and diarrhoea (16, 3·3%). Cardiac dysfunction occurred in 29 (6·0%) patients (12 [2·5%] grade 1, 15 [3·1%] grade 2, and two [0·4%] grade 3). 23 patients had at least one study-related serious adverse event. 16 patients stopped trastuzumab because of cardiac dysfunction. INTERPRETATION A short, four-cycle regimen of docetaxel and cyclophosphamide combined with trastuzumab could be an option for adjuvant treatment of women with lower risk HER2-amplified early breast cancer, irrespective of TOP2A status. FUNDING Sanofi.
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Swain SM, Tang G, Geyer CE, Rastogi P, Atkins JN, Donnellan PP, Fehrenbacher L, Azar CA, Robidoux A, Polikoff JA, Brufsky AM, Biggs DD, Levine EA, Zapas JL, Provencher L, Northfelt DW, Paik S, Costantino JP, Mamounas EP, Wolmark N. Definitive results of a phase III adjuvant trial comparing three chemotherapy regimens in women with operable, node-positive breast cancer: the NSABP B-38 trial. J Clin Oncol 2013; 31:3197-204. [PMID: 23940225 DOI: 10.1200/jco.2012.48.1275] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Anthracycline- and taxane-based three-drug chemotherapy regimens have proven benefit as adjuvant therapy for early-stage breast cancer. This trial (NSABP B-38; Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Positive Breast Cancer) asked whether the incorporation of a fourth drug could improve outcomes relative to two standard regimens and provided a direct comparison of those two regimens. PATIENTS AND METHODS We randomly assigned 4,894 women with node-positive early-stage breast cancer to six cycles of docetaxel, doxorubicin, and cyclophosphamide (TAC), four cycles of dose-dense (DD) doxorubicin and cyclophosphamide followed by four cycles of DD paclitaxel (P; DD AC→P), or DD AC→P with four cycles of gemcitabine (G) added to the DD paclitaxel (DD AC→PG). Primary granulocyte colony-stimulating factor support was required; erythropoiesis-stimulating agents (ESAs) were used at the investigator's discretion. RESULTS There were no significant differences in 5-year disease-free survival (DFS) between DD AC→PG and DD AC→P (80.6% v 82.2%; HR, 1.07; P = .41), between DD AC→PG and TAC (80.6% v 80.1%; HR, 0.93; P = .39), in 5-year overall survival (OS) between DD AC→PG and DD AC→P (90.8% v 89.1%; HR, 0.85; P = .13), between DD AC→PG and TAC (90.8% v 89.6%; HR, 0.86; P = .17), or between DD AC→P versus TAC for DFS (HR, 0.87; P = .07) and OS (HR, 1.01; P = .96). Grade 3 to 4 toxicities for TAC, DD AC→P, and DD AC→PG, respectively, were febrile neutropenia (9%, 3%, 3%; P < .001), sensory neuropathy (< 1%, 7%, 6%; P < .001), and diarrhea (7%, 2%, 2%; P < .001). Exploratory analyses for ESAs showed no association with DFS events (HR, 1.02; P = .95). CONCLUSION Adding G to DD AC→P did not improve outcomes. No significant differences in efficacy were identified between DD AC→P and TAC, although toxicity profiles differed.
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Affiliation(s)
- Sandra M Swain
- Sandra M. Swain, Gong Tang, Charles E. Geyer Jr, Priya Rastogi, James N. Atkins, Paul P. Donnellan, Louis Fehrenbacher, Catherine A. Azar, André Robidoux, Jonathan A. Polikoff, Adam M. Brufsky, David D. Biggs, Edward A. Levine, John L. Zapas, Louise Provencher, Soonmyung Paik, Joseph P. Costantino, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project (NSABP); Norman Wolmark, Allegheny General Hospital, Allegheny Health Network; Gong Tang and Joseph P. Costantino, NSABP Biostatistical Center and University of Pittsburgh Graduate School of Public Health; Priya Rastogi, University of Pittsburgh Cancer Institute; Adam M. Brufsky, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra M. Swain, MedStar Washington Hospital Center, Washington, DC; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; James N. Atkins, Southeast Cancer Control Consortium-Community Clinical Oncology Program, Goldsboro; Edward A. Levine, Wake Forest University, Winston-Salem, NC; Paul P. Donnellan, University Hospital, Galway, and the All-Ireland Cooperative Oncology Research Group, Dublin, Ireland; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo; Jonathan A. Polikoff, Kaiser Permanente Southern California, San Diego, CA; Catherine A. Azar, Kaiser Permanente, Denver, CO; André Robidoux, Centre hopitalier de l'Université de Montréal (CHUM), Montréal; Louise Provencher, CHU de Québec, Hôpital du Saint-Sacrement, Québec City, QC, Canada; David D. Biggs, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE; John L. Zapas, Medstar Franklin Square Medical Center, Baltimore, MD; Donald W. Northfelt, Mayo Clinic Arizona, Scottsdale, AZ; and Eleftherios P. Mamounas, MD Anderson Cancer Center, Orlando, FL
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Kader YA, El-Nahas T, Sakr A. Adjuvant chemotherapy for luminal A breast cancer: a prospective study comparing two popular chemotherapy regimens. Onco Targets Ther 2013; 6:1073-7. [PMID: 23966793 PMCID: PMC3745289 DOI: 10.2147/ott.s48397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Based on the variable benefit of taxanes in the adjuvant setting of early breast cancer in certain tumor phenotypes, especially in human epidermal growth factor receptor (HER)2-positive and triple-negative disease, and with the observation of a lesser benefit in luminal A, this research article aimed at exploring the value of docetaxel in patients with an estrogen receptor-positive, HER2-negative disease phenotype, who might not derive the same benefits as those with other phenotypes. Patients and methods This was a randomized prospective study comparing disease-free survival (DFS) and safety profile of sequential adjuvant three cycles Fluorouracil, Epirubicin, Cyclophosphamide followed by three cycles Docetaxel (FEC-D) versus six cycles classic Fluorouracil, Epirubicin, Cyclophosphamide (FEC)-100 in 60 Egyptian women who presented to Dar Al Fouad Hospital during the period June 2007 to July 2008 with (pT1-2 pN0-3 M0). The primary end point was DFS in a follow-up period of 4 years. The secondary end point was toxicity profile. Results Four-year DFS rates were comparable in both arms: 73.3% ± 8.1% in the FEC-D arm versus 76.5% ± 7.8% in the FEC-100 arm (P = 0.83). N3 and grade III subgroups achieved the worst DFS in both subgroups (P = 0.001 and P = 0.214, respectively). The rate of nausea and vomiting was higher in the FEC-100 arm (P = 0.49), while grade III–IV neutropenia and febrile neutropenia incidence was similar between both arms. Conclusion Sequential adjuvant chemotherapy with FEC followed by docetaxel achieved comparable DFS results to FEC alone in luminal A phenotype subgroups of breast cancer.
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Schönherr A, Aivazova-Fuchs V, Annecke K, Jückstock J, Hepp P, Andergassen U, Augustin D, Simon W, Wischnik A, Mohrmann S, Salmen J, Zwingers T, Kiechle M, Harbeck N, Friese K, Janni W, Rack B. Toxicity Analysis in the ADEBAR Trial: Sequential Anthracycline-Taxane Therapy Compared with FEC120 for the Adjuvant Treatment of High-Risk Breast Cancer. ACTA ACUST UNITED AC 2013; 7:289-95. [PMID: 23904831 DOI: 10.1159/000341384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Data from meta-analyses have shown taxane-containing therapies to be superior to anthracycline-based treatments for high-risk breast cancer. PATIENTS AND METHODS The ADEBAR trial was a multicenter phase III trial in which patients with lymph node-positive breast cancer were prospectively randomized for either sequential anthracycline-taxane or FEC120 therapy. Patients received 4× epirubicin (90 mg/m(2)) and cyclophosphamide (600 mg/m(2)) every 3 weeks (q3w), followed by 4× docetaxel (100 mg/m(2)) q3w (EC-Doc arm), or 6× epirubicin (60 mg/m(2)) and 5-fluorouracil (500 mg/m(2)) on days 1 and 8 and cyclophosphamide (75 mg/m(2)) on days 1-14, q4w (FEC arm). We compared both arms with respect to toxicity and feasibility. RESULTS Hematological toxicity was found significantly more often in the FEC arm. Febrile neutropenia was seen in 11.3% of patients in the FEC arm and in 8.4% of patients in the EC-Doc arm (p = 0.027). Non-hematological side effects of grade 3/4 were rarely seen in either arm. Therapy was terminated due to toxicity in 3.7% of the patients in the EC-Doc arm and in 8.0% of the patients in the FEC arm (p = 0.0009). CONCLUSION The sequential anthracycline-taxane regimen is a well-tolerated and feasible alternative to FEC120 therapy.
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206
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Munzone E, Curigliano G, Colleoni M. Tailoring adjuvant treatments for the individual patient with luminal breast cancer. Hematol Oncol Clin North Am 2013; 27:703-14, vii-viii. [PMID: 23915740 DOI: 10.1016/j.hoc.2013.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Estrogen Receptor-positive/HER-2 negative breast cancers represent a heterogeneous group of tumors. Luminal A and B tumor subtypes can be identified through immunohistochemical assessment of estrogen and progesterone receptor, Ki-67 and HER-2 status. Patients with high levels of expression of steroid hormone receptors and low proliferation (Luminal A) are commonly cured with endocrine therapy alone. Patients with doubtful endocrine responsiveness or with high proliferation index (Luminal B/Her-negative) require the addition of chemotherapy to the best endocrine therapy. Controversies still exist on the identification of those patients who do not benefit from chemotherapy. Tailored adjuvant treatments should be considered in the therapeutic algorithm of patients with luminal tumors.
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Affiliation(s)
- Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy.
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207
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Yardley DA. nab-Paclitaxel mechanisms of action and delivery. J Control Release 2013; 170:365-72. [PMID: 23770008 DOI: 10.1016/j.jconrel.2013.05.041] [Citation(s) in RCA: 303] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 12/14/2022]
Abstract
Taxanes are a key chemotherapy component for several malignancies, including metastatic breast cancer (MBC), ovarian cancer, and advanced non-small cell lung cancer (NSCLC). Despite the clinical benefit achieved with solvent-based (sb) taxanes, these agents can be associated with significant and severe toxicities. Albumin-bound paclitaxel (Abraxane; nab®-Paclitaxel), a novel solvent-free taxane, has demonstrated higher response rates and improved tolerability when compared with solvent-based formulations in patients with advanced MBC and NSCLC. The technology used to create nab-paclitaxel utilizes albumin to deliver paclitaxel, resulting in an advantageous pharmacokinetic (PK) profile. This review discusses the proposed mechanism of delivery of nab-paclitaxel, including an examination into a hypothesized greater ability to leverage albumin-based transport relative to sb-paclitaxel. An advantageous PK profile and the more efficient use of albumin-based transport may contribute to the preclinical finding that nab-paclitaxel achieves a 33% higher tumor uptake relative to sb-paclitaxel. Another possible contributing factor to the tumor accumulation of nab-paclitaxel is the binding of albumin to secreted protein acidic and rich in cysteine (SPARC), although the data supporting this relationship between SPARC and nab-paclitaxel remain largely correlative at this point. Recent data also suggest that nab-paclitaxel may enhance tumor accumulation of gemcitabine in pancreatic cancer treated with both agents. Additionally, a possible mechanistic synergy between nab-paclitaxel and capecitabine has been cited as the rationale to combine the two agents for MBC treatment. Thus, nab-paclitaxel appears to interact with tumors in a number of interesting, but not fully understood, ways. Continued preclinical and clinical research across a range of tumor types is warranted to answer the questions that remain on the mechanisms of delivery and antitumor activity of nab-paclitaxel.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN 37203, USA.
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Kreienberg R, Albert US, Follmann M, Kopp IB, Kühn T, Wöckel A. Interdisciplinary GoR level III Guidelines for the Diagnosis, Therapy and Follow-up Care of Breast Cancer: Short version - AWMF Registry No.: 032-045OL AWMF-Register-Nummer: 032-045OL - Kurzversion 3.0, Juli 2012. Geburtshilfe Frauenheilkd 2013; 73:556-583. [PMID: 24771925 PMCID: PMC3963234 DOI: 10.1055/s-0032-1328689] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - U.-S. Albert
- Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik
für Gynäkologie, Gynäkologische Endokrinologie und Onkologie,
Marburg
| | - M. Follmann
- Deutsche Krebsgesellschaft e. V., Bereich Leitlinien,
Berlin
| | - I. B. Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, c/o
Philipps-Universität, Marburg
| | - T. Kühn
- Klinikum Esslingen, Klinik für Frauenheilkunde und Geburtshilfe,
Esslingen
| | - A. Wöckel
- Universitätsklinikum Ulm, Klinik für Frauenheilkunde und Geburtshilfe,
Ulm
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209
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If there is no overall survival benefit in metastatic breast cancer: Does it imply lack of efficacy? Taxanes as an example. Cancer Treat Rev 2013; 39:189-98. [DOI: 10.1016/j.ctrv.2012.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 11/20/2022]
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BRCA1 regulates microtubule dynamics and taxane-induced apoptotic cell signaling. Oncogene 2013; 33:1418-28. [PMID: 23524581 DOI: 10.1038/onc.2013.85] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/10/2013] [Accepted: 01/28/2013] [Indexed: 01/01/2023]
Abstract
The taxanes are effective microtubule-stabilizing chemotherapy drugs used in the treatment of various solid tumors. However, the emergence of drug resistance hampers their clinical efficacy. The molecular basis of clinical taxane resistance remains poorly understood. Breast cancer 1, early onset gene, BRCA1, is a tumor-suppressor gene, whose expression has been correlated with taxane sensitivity in many solid tumors including non-small cell lung cancer. However, the molecular mechanism underlying the relationship between BRCA1 (B1) expression and taxane activity remains unclear. To this end, we created a stable B1 knockdown A549 cell line (B1-KD) to investigate B1's role in microtubule biology and response to taxane treatment. We show that B1-KD rendered A549 cells resistant to paclitaxel (PTX), phenocopying clinical studies showing that low B1 expression correlated with taxane resistance. As previously reported, we show that loss of B1 enhanced centrosomal γ-tubulin localization and microtubule nucleation. Interestingly, we found that the B1-KD cells exhibited increased microtubule dynamics as compared with parental A549 cells, as assessed by live-cell confocal microscopy using enhanced green fluorescent protein-tagged α-tubulin or EB1 protein. In addition, we showed that loss of B1 impairs the ability of PTX to induce microtubule polymerization using immunofluorescence microscopy and a cell-based tubulin polymerization assay. Furthermore, B1-KD cells exhibited significantly lower intracellular binding of a fluorescently labeled PTX to microtubules. Recent studies have shown that PTX-stabilized microtubules serves as a scaffold for pro-caspase-8 binding and induction of apoptosis downstream of induced-proximity activation of caspase-8. Here we show that loss of B1 reduces the association of pro-caspase-8 with microtubules and subsequently leads to impaired PTX-induced activation of apoptosis. Taken together, our data show that B1 regulates indirectly endogenous microtubule dynamics and stability while its loss leads to microtubules that are more dynamic and less susceptible to PTX-induced stabilization conferring taxane resistance.
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Hertz DL, Roy S, Motsinger-Reif AA, Drobish A, Clark LS, McLeod HL, Carey LA, Dees EC. CYP2C8*3 increases risk of neuropathy in breast cancer patients treated with paclitaxel. Ann Oncol 2013; 24:1472-8. [PMID: 23413280 DOI: 10.1093/annonc/mdt018] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Paclitaxel-induced neuropathy is an adverse event that often leads to therapeutic disruption and patient discomfort. We attempted to replicate a previously reported association between increased neuropathy risk and CYP2C8*3 genotype. PATIENTS AND METHODS Demographic, treatment, and toxicity data were collected for paclitaxel-treated breast cancer patients who were genotyped for the CYP2C8*3 K399R (rs10509681) variant. A log-rank test was used in the primary analysis of European-American patients. An additional independent replication was then attempted in a cohort of African-American patients, followed by modeling of the entire patient cohort with relevant covariates. RESULTS In the primary analysis of 209 European patients, there was an increased risk of paclitaxel-induced neuropathy related to CYP2C8*3 status [HR (per allele) = 1.93 (95% CI: 1.05-3.55), overall log-rank P = 0.006]. The association was replicated in direction and magnitude of effect in 107 African-American patients (P = 0.043). In the Cox model using the entire mixed-race cohort (n = 411), each CYP2C8*3 allele approximately doubled the patient's risk of grade 2+ neuropathy (P = 0.004), and non-Europeans were at higher neuropathy risk than Europeans of similar genotype (P = 0.030). CONCLUSIONS The increased risk of paclitaxel-induced neuropathy in patients who carry the CYP2C8*3 variant was replicated in two racially distinct patient cohorts.
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Affiliation(s)
- D L Hertz
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, UNC Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Hernandez-Aya LF, Gonzalez-Angulo AM. Adjuvant systemic therapies in breast cancer. Surg Clin North Am 2013; 93:473-91. [PMID: 23464697 DOI: 10.1016/j.suc.2012.12.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although some women with early breast cancer (BC) may be cured with loco-regional treatment alone, up to 20% of patients with early-stage BC will ultimately experience treatment failure and recurrence. A substantial portion of the success in improving clinical outcomes of patients with BC is related to the standardized use of adjuvant therapies. The identification of tumor subtypes with prognostic value has contributed to the idea of tailoring treatments using biologic predictive factors to identify the patients who will most likely respond to therapy and minimize the exposure of "nonresponders" to the side effects of the treatment.
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Affiliation(s)
- Leonel F Hernandez-Aya
- Division of Hematology/Oncology, Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI, USA
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Kirkwood JM, Tarhini A, Sparano JA, Patel P, Schiller JH, Vergo MT, Benson Iii AB, Tawbi H. Comparative clinical benefits of systemic adjuvant therapy for paradigm solid tumors. Cancer Treat Rev 2013; 39:27-43. [PMID: 22520262 PMCID: PMC8555872 DOI: 10.1016/j.ctrv.2012.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/16/2012] [Accepted: 03/18/2012] [Indexed: 01/15/2023]
Abstract
Adjuvant therapy employing cytotoxic chemotherapy, molecularly targeted agents, immunologic, and hormonal agents has shown a significant impact upon a variety of solid tumors. The principles that guide adjuvant therapy differ among various tumor types and specific modalities, but generally indicate a greater impact of therapy in the postsurgical setting of micrometastatic disease, for which adjuvant therapy is commonly pursued, vs. the setting of gross unresectable disease. This review of adjuvant therapies in current use for five major solid tumors highlights the rationale for current effective adjuvant therapy, and draws comparisons between the adjuvant regimens that have found application in solid tumors.
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Affiliation(s)
- John M Kirkwood
- University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213-1862, USA.
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Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University). Med Oncol 2013; 30:457. [PMID: 23322524 DOI: 10.1007/s12032-013-0457-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
Abstract
This trial compared 6 cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) with a sequential regimen of 3 cycles of FEC followed by 3 cycles of docetaxel (FEC-D) as adjuvant treatment for women with node-positive or/and T3 or T4 breast cancer. Between January 2006 and January 2010, 657 patients with operable breast cancer were randomly assigned to either FEC every 21 days for 6 cycles, or 3 cycles of FEC followed by 3 cycles of docetaxel, both given every 21 days. Radiotherapy was mandatory for all patients who had undergone breast conserving surgery. Radiation to the chest wall, supraclavicular area, was recommended following mastectomy. Hormone-receptor-positive patients received tamoxifen for 5 years after chemotherapy. The primary end point was 5-year disease-free survival (DFS). Median follow-up was 61 months. Five-year DFS rates were 74 % with FEC and 78 % with FEC-D (P = 0.013). Multivariate analysis adjusted for prognostic factors showed a 17 % reduction in the relative risk of relapse with FEC-D. Five-year overall survival rates were 85 % with FEC and 89.4 % with FEC-D, demonstrating a 27 % reduction in the relative risk of death (P = 0.014). The incidence of grade 3-4 neutropenia, the need for hematopoietic growth factor, and incidence of nausea/vomiting were higher with FEC. Docetaxel was associated with more febrile neutropenia, stomatitis, edema, and nail disorders. Though rare overall, there were fewer cardiac events after FEC-D, attributable mainly to the lower anthracycline cumulative dose. Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive or/and T3 or T4 breast cancer patients. Although the magnitude of the benefit observed with FEC-D, differences in the toxicity profiles of FEC and FEC-D may influence the choice of treatment for patients.
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215
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Oakman C, Francis PA, Crown J, Quinaux E, Buyse M, De Azambuja E, Margeli Vila M, Andersson M, Nordenskjöld B, Jakesz R, Thürlimann B, Gutiérrez J, Harvey V, Punzalan L, Dell'orto P, Larsimont D, Steinberg I, Gelber RD, Piccart-Gebhart M, Viale G, Di Leo A. Overall survival benefit for sequential doxorubicin-docetaxel compared with concurrent doxorubicin and docetaxel in node-positive breast cancer--8-year results of the Breast International Group 02-98 phase III trial. Ann Oncol 2013; 24:1203-11. [PMID: 23293111 DOI: 10.1093/annonc/mds627] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background In women with node-positive breast cancer, the Breast International Group (BIG) 02-98 tested the incorporation of docetaxel (Taxotere) into doxorubicin (Adriamycin)-based chemotherapy, and compared sequential and concurrent docetaxel. At 5 years, there was a trend for improved disease-free survival (DFS) with docetaxel. We present results at 8-year median follow-up and exploratory analyses within biologically defined subtypes. Methods Patients were randomly assigned to one of four treatments: (i) sequential control: doxorubicin (A) (75 mg/m(2)) × 4 →classical cyclophosphamide, methotrexate, 5-fluorouracil (CMF); (ii) concurrent control: doxorubicin, cyclophosphamide (AC)(60/600 mg/m(2)) × 4 →CMF; (iii) sequential docetaxel: A (75 mg/m(2)) × 3 → docetaxel (T) (100 mg/m(2)) × 3 → CMF and (iv) concurrent docetaxel: AT(50/75 mg/m(2)) × 4 →CMF. The primary comparison evaluated docetaxel efficacy regardless of the schedule. Exploratory analyses were undertaken within biologically defined subtypes. Results Two thousand eight hundred and eighty-seven patients were enrolled. After 93.4 months of median follow-up, there were 916 DFS events. For the primary comparison, there was no significant improvement in DFS from docetaxel [hazard ratio (HR) = 0.91, 95% confidence interval (CI) = 0.80-1.05, P = 0.187]. In secondary comparisons, sequential docetaxel significantly improved DFS compared with sequential control (HR = 0.81, 95% CI = 0.67-0.99, P = 0.036), and significantly improved DFS (HR = 0.84, 95% CI = 0.72-0.99, P = 0.035) and overall survival (OS) (HR = 0.79, 95% CI = 0.65-0.98, P = 0.028) compared with concurrent doxorubicin-docetaxel. Luminal-A disease had the best prognosis. HRs favored addition of sequential docetaxel in all subtypes, except luminal-A; but this observation was not statistically supported because of limited numbers. Conclusion With further follow-up, the sequential docetaxel schedule resulted in significantly better OS than concurrent doxorubicin-docetaxel, and continued to show better DFS than sequential doxorubicin-based control.
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Affiliation(s)
- C Oakman
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
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216
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Seror V, Marino P, Bertucci F, Mancini J, Extra JM, Ferrero JM, Bachelot T, Viens P, Julian-Reynier C. Breast Cancer Patients' Views on the Use of Genomic Testing to Guide Decisions about Their Postoperative Chemotherapy. Public Health Genomics 2013; 16:110-7. [DOI: 10.1159/000349920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
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217
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Martin M. Docetaxel, doxorubicin and cyclophosphamide (the TAC regimen): an effective adjuvant treatment for operable breast cancer. ACTA ACUST UNITED AC 2012; 2:527-37. [PMID: 19803960 DOI: 10.2217/17455057.2.4.527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The introduction of taxanes in the armamentarium against breast cancer in the 1990s has been one of the landmarks in the treatment of this disease. Docetaxel in particular is considered one of the most active cytotoxic agents in metastatic breast cancer and has also been tested as adjuvant postsurgical therapy in earlier stages. A regimen including docetaxel, doxorubicin and cyclophosphamide (the TAC regimen) was the first combination that demonstrated the efficacy of docetaxel in the adjuvant setting. This combination has been approved by regulatory agencies for adjuvant therapy of node-positive breast cancer and is presently used worldwide. TAC is more toxic than the traditional anthracycline-containing combinations, but many of its side effects can be ameliorated with colony-stimulating growth factor support.
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Affiliation(s)
- Miguel Martin
- Servicio de Oncologia Medica, Hospital, Universitario San Carlos, 28040 Madrid, Spain.
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218
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Borson R, Harker G, Reeves J, Beck T, Hager S, Horvath W, Jones M, Tillinghast G, Arrowsmith E, Harrer G, Kudrik FJ, Malamud SC, Bromund J, Zeigler H, Tai DF, Kornberg LJ, Obasaju C, Orlando M, Yardley DA. Phase II Study of Gemcitabine and Bevacizumab As First-Line Treatment in Taxane-Pretreated, HER2-Negative, Locally Recurrent or Metastatic Breast Cancer. Clin Breast Cancer 2012; 12:322-30. [DOI: 10.1016/j.clbc.2012.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/26/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
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KAWAJIRI HIDEMI, TAKASHIMA TSUTOMU, ONODA NAOYOSHI, KASHIWAGI SHINICHIRO, NODA SATORU, ISHIKAWA TETSUROU, WAKASA KENICHI, HIRAKAWA KOSEI. Efficacy and feasibility of neoadjuvant chemotherapy with FEC 100 followed by weekly paclitaxel for operable breast cancer. Oncol Lett 2012; 4:612-616. [PMID: 23205071 PMCID: PMC3506652 DOI: 10.3892/ol.2012.801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/04/2012] [Indexed: 11/06/2022] Open
Abstract
Sequential administration of anthracyclin and taxane for neoadjuvant chemotherapy (NAC) is the standard treatment for operable breast cancer. The pathological complete response (pCR) is a significant predictor of overall survival (OS), regardless of treatment. In this study, the pCR rate was retrospectively examined and compared with the treatment efficacy and the characteristics of pCR patients were analyzed. A total of 54 female patients with operable breast cancer, treated with FEC 100 followed by weekly paclitaxel between December 2005 and May 2009 at the Osaka City University Hospital, Osaka, Japan, were retrospectively reviewed. A total of 21 patients (39%) achieved pCR. The overall response rate was 91%. Only one patient had progressive disease. The pCR rate was significantly higher in those patients with estrogen receptor (ER)- and progesterone receptor (PR)-negative tumors and in those patients who completed the treatment course. An NAC regimen incorporating FEC 100 followed by weekly paclitaxel is effective for treating operable breast cancer.
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Affiliation(s)
| | | | | | | | | | | | - KENICHI WAKASA
- Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585,
Japan
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220
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Phua CE, Bustam AZ, Yusof MM, Saad M, Yip CH, Taib NA, Ng CH, Teh YC. Risk of Treatment Related Death and Febrile Neutropaenia with Taxane-Based Adjuvant Chemotherapy for Breast Cancer in a Middle Income Country Outside a Clinical Trial Setting. Asian Pac J Cancer Prev 2012; 13:4623-6. [DOI: 10.7314/apjcp.2012.13.9.4623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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221
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Bae S, Yeung Y, Ng S, Craike M, Livingston PM, Chirgwin J. Is chemotherapy dose intensity adequate in breast cancer management in the Australian healthcare setting: a retrospective analysis. Asia Pac J Clin Oncol 2012; 10:e54-62. [PMID: 22989364 DOI: 10.1111/j.1743-7563.2012.01591.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 11/28/2022]
Abstract
AIM To determine the adequacy of chemotherapy received dose intensity (RDI) in breast cancer treatment in a general population and to identify factors that influence RDI. METHODS A retrospective analysis of breast cancer patients who commenced a course of i.v. chemotherapy in 2008 was undertaken. Data were collected on patient and tumor characteristics, chemotherapy regimen, dose (including delays, reductions and the reasons for these), granulocyte colony-stimulating factor (G-CSF) use and febrile neutropenia incidence. RDI was calculated using the planned and actual dose received and time taken. A level of ≥85% RDI was considered acceptable for treatment given with curative intent. RESULTS In all, 131 patients (aged 28 to 77 years) received chemotherapy in adjuvant (n = 76, 58%), neoadjuvant (n = 11, 8%) and metastatic settings (n = 44, 34%). RDI did not reach 85% for 12% adjuvant, 36% neoadjuvant and 34% metastatic cases (χ(2) = 10.55, P = 0.005). Overall, 43% of patients received G-CSF. CONCLUSION Acceptable chemotherapy RDI was delivered for most patients in the adjuvant setting but not in the neoadjuvant setting. G-CSF treatment contributed to the optimization of dose intensity in the adjuvant setting only. Dose intensity in the metastatic setting was considered satisfactory where quality of life is the primary focus. Other factors can be modified to improve RDI.
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Affiliation(s)
- Susie Bae
- Department of Medical Oncology, Eastern Health
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222
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Wang K, Deng QT, Liao N, Zhang GC, Liu YH, Xu FP, Zu J, Li XR, Wu YL. Tau expression correlated with breast cancer sensitivity to taxanes-based neoadjuvant chemotherapy. Tumour Biol 2012; 34:33-8. [PMID: 22976542 DOI: 10.1007/s13277-012-0507-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/28/2012] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to investigate the correlation between tau expression in primary breast cancer and sensitivity to taxanes during neoadjuvant chemotherapy in patients with breast cancer. We used immunohistochemistry to examine tau expression in breast cancer biopsies from 113 primary breast cancer patients and evaluated the correlation between tau expression and taxane sensitivity. Twenty-eight (24.78 %, 28/113) patients were positive for tau expression. After taxanes-based neoadjuvant chemotherapy, 40 patients achieved pathological complete response (pCR) (35.4 %). Among the 40 patients with pCR, five (12.5 %) were positive for tau expression. In univariate analysis, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2 (HER2), and tau were found to be significantly predictive of a pCR (P = 0.001, 0.030, 0.002, and 0.025, respectively). Tau, ER, and HER2 status were significant for pCR on multivariate analysis (P = 0.025, 0.005, and 0.043, respectively). Tau expression was positively related to ER (P = 0.007) and progestin receptor (P = 0.008). In conclusion, tau protein expression correlated with breast cancer sensitivity to taxanes-based neoadjuvant chemotherapy; patients negative for tau expression were more likely to achieve pCR.
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Affiliation(s)
- Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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223
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Lord SJ, Marinovich ML, Patterson JA, Wilcken N, Kiely BE, Gebski V, Crossing S, Roder DM, Gattellari M, Houssami N. Incidence of metastatic breast cancer in an Australian population-based cohort of women with non-metastatic breast cancer at diagnosis. Med J Aust 2012; 196:688-92. [PMID: 22708766 DOI: 10.5694/mja12.10026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the incidence of metastatic breast cancer (MBC) in Australian women with an initial diagnosis of non-metastatic breast cancer. DESIGN, SETTING AND PARTICIPANTS A population-based cohort study of all women with non-metastatic breast cancer registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002 who received care in a NSW hospital. MAIN OUTCOME MEASURES 5-year cumulative incidence of MBC; prognostic factors for MBC. RESULTS MBC was recorded within 5 years in 218 of 4137 women with localised node-negative disease (5-year cumulative incidence, 5.3%; 95% CI, 4.6%-6.0%); and 455 of 2507 women with regional disease (5-year cumulative incidence, 18.1%; 95% CI, 16.7%-19.7%). The hazard rate for developing MBC was highest in the second year after the initial diagnosis of breast cancer. Determinants of increased risk of MBC were regional disease at diagnosis, age less than 50 years and living in an area of lower socio-economic status. CONCLUSIONS Our Australian population-based estimates are valuable when communicating average MBC risks to patients and planning clinical services and trials. Women with node-negative disease have a low risk of developing MBC, consistent with outcomes of adjuvant clinical trials. Regional disease at diagnosis remains an important prognostic factor.
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Affiliation(s)
- Sarah J Lord
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW.
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224
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Schneider BP, Zhao F, Wang M, Stearns V, Martino S, Jones V, Perez EA, Saphner T, Wolff AC, Sledge GW, Wood WC, Davidson NE, Sparano JA. Neuropathy is not associated with clinical outcomes in patients receiving adjuvant taxane-containing therapy for operable breast cancer. J Clin Oncol 2012; 30:3051-7. [PMID: 22851566 DOI: 10.1200/jco.2011.39.8446] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Neuropathy is a common and potentially disabling complication of adjuvant taxane therapy. Recent studies have identified candidate single nucleotide polymorphisms associated with taxane-induced neuropathy. Therefore, we sought to determine whether neuropathy was associated with breast cancer recurrence in a clinical trial population who received adjuvant taxane therapy. PATIENTS AND METHODS Trial E1199 included 4,554 eligible women with operable breast cancer who received up to four cycles of doxorubicin and cyclophosphamide every 3 weeks followed by paclitaxel 175 mg/m(2) every 3 weeks for four cycles (P3), paclitaxel 80 mg/m(2) weekly for 12 cycles (P1), docetaxel 100 mg/m(2) every 3 weeks for four cycles (D3), or docetaxel 35 mg/m(2) weekly for 12 cycles (D1). A Cox proportional hazards model was used to determine the relationship between neuropathy and disease-free survival (DFS), overall survival (OS), and recurrence-free survival (RFS) by treating neuropathy status as a time dependent covariate and using a landmark analysis. RESULTS Of 4,554 patients who received at least one taxane dose, grade 2 to 4 neuropathy developed in 18%, 22%, 15%, and 13% of patients in the P3, P1, D3, and D1 arms, respectively. In a model that included age, race, obesity, menopausal status, tumor size, nodal status, treatment arm, neuropathy, and hyperglycemia, no significant relationship was found between neuropathy and DFS, OS, or RFS. CONCLUSION There was no association between taxane-induced neuropathy and outcome.
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Affiliation(s)
- Bryan P Schneider
- Eastern Cooperative Oncology Group, 535 Barnhill Dr, Indiana Cancer Pavilion, Indianapolis, IN 46202, USA.
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225
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Shulman LN, Cirrincione CT, Berry DA, Becker HP, Perez EA, O'Regan R, Martino S, Atkins JN, Mayer E, Schneider CJ, Kimmick G, Norton L, Muss H, Winer EP, Hudis C. Six cycles of doxorubicin and cyclophosphamide or Paclitaxel are not superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes: Cancer and Leukemia Group B 40101. J Clin Oncol 2012; 30:4071-6. [PMID: 22826271 DOI: 10.1200/jco.2011.40.6405] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The ideal duration of adjuvant chemotherapy for patients with lower risk primary breast cancer is not known. Cancer and Leukemia Group B trial 40101 was conducted using a phase III factorial design to define whether six cycles of a chemotherapy regimen are superior to four cycles. We also sought to determine whether paclitaxel (T) is as efficacious as doxorubicin/cyclophosphamide (AC), but with reduced toxicity. PATIENTS AND METHODS Between 2002 and 2008, the study enrolled women with operable breast cancer and zero to three positive nodes. Patients were randomly assigned to either four or six cycles of either AC or T. Study stratifiers were estrogen receptor/progesterone receptor (ER/PgR), human epidermal growth factor receptor 2 (HER2), and menopausal status. After 2003, all treatment was administered in dose-dense fashion. The primary efficacy end point was relapse-free survival (RFS). RESULTS A total of 3,171 patients were enrolled; 94% were node-negative and 6% had one to three positive nodes. At a median follow-up of 5.3 years, the 4-year RFS was 90.9% and 91.8% for six and four cycles, respectively. The adjusted hazard ratio (HR) of six to four cycles regarding RFS was 1.03 (95% CI, 0.84 to 1.28; P=.77). The 4-year OS was 95.3% and 96.3% for six and four cycles, respectively, with an HR of six to four cycles of 1.12 (95% CI, 0.84 to 1.49; P=.44). There was no interaction between treatment duration and chemotherapy regimen, ER/PgR, or HER2 status on RFS or OS. CONCLUSION For women with resected primary breast cancer and zero to three positive nodes, we found no evidence that extending chemotherapy regimens of AC or single-agent T from four to six cycles improves clinical outcome.
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226
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Febrile neutropenia incidence and hematological toxicity with the FEC100-docetaxel regimen in the treatment of early-stage breast cancer. Bull Cancer 2012; 99:75-80. [DOI: 10.1684/bdc.2012.1607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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227
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Mortality, leukemic risk, and cardiovascular toxicity of adjuvant anthracycline and taxane chemotherapy in breast cancer: a meta-analysis. Breast Cancer Res Treat 2012; 135:335-46. [PMID: 22689092 DOI: 10.1007/s10549-012-2121-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
Abstract
The contribution of adjuvant taxanes (T) in cardiovascular toxicity, leukemic risk, and non-cancer-related deaths is unknown when they are added to anthracycline (A)-based chemotherapy for breast cancer. We performed a meta-analysis of published randomized controlled trials (RCTs) to determine the risk of cardiovascular toxicity, leukemia, neurotoxicity, and non-breast cancer-related mortality associated with T added to adjuvant A in breast cancer. PubMed was searched to identify relevant studies. Eligible studies included prospective RCTs in which approved T in combination with A (A + T) were compared with A alone as adjuvant chemotherapy for breast cancer. Summary incidence rates, relative risks (RRs), and 95 % confidence intervals were calculated by means of fixed- or random-effects models. A total of 27,039 patients from 15 RCTs were included. Compared with A alone, A + T was associated with a statistically similar risk of toxicity. Compared with control arms, A + T schedules with less cumulative dose of anthracyclines than control arms were associated with lower severe cardiotoxicity (RR = 0.41, [95% CI 0.26-0.66], P = 0.0002), venous thromboembolic events (RR 0.45, [95% CI 0.26-0.79], P = 0.006), and leukemic risk (RR 0.39; [95%CI 0.18-0.87] P = 0.02), but with an increased risk of non-breast cancer-related mortality (RR = 1.79, [95% CI 1.06-3.04] P = 0.03). In particular, this risk of death is greater when >3 cycles of A precede T in sequential schedules (RR 2.24, [1.2-4.21] P = 0.01). This meta-analysis suggests that A + T-based adjuvant chemotherapy is as toxic as A alone with no significant difference in non-breast cancer-related mortality. However, sequential A + T schedules are associated with less toxicity, but a significant increase in non-breast cancer-related mortality compared with control arms with a greater dose of A.
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228
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Giordano SH, Lin YL, Kuo YF, Hortobagyi GN, Goodwin JS. Decline in the use of anthracyclines for breast cancer. J Clin Oncol 2012; 30:2232-9. [PMID: 22614988 DOI: 10.1200/jco.2011.40.1273] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the patterns of use of anthracycline- and taxane-based chemotherapy for breast cancer treatment. METHODS Claims from a 5% national Medicare sample and from a nationally representative claims database (Marketscan) from 1998 to 2009 were used. Patients with International Classification of Diseases (ICD), ninth revision, codes indicating breast cancer, ICD and Common Procedural Terminology codes indicating breast surgery, and claims for chemotherapy between 3 months before and 12 months after surgery comprised the study cohort. Chemotherapy was classified as anthracycline-based or taxane-based, and the percentages of use were calculated. Piecewise regression models were used to identify the inflection points in the rates of chemotherapy use. The effect of patient characteristics on receiving different types of chemotherapy was estimated by multivariable logistic regression models. RESULTS A total of 4,458 patients were included in the Medicare cohort and 30,422 in the private insurance cohort. After 2005, a sharp increase in the use of taxane-based chemotherapy and a decline in anthracycline-based chemotherapy was seen. By 2008 in the Medicare cohort, 51% of patients received taxane-based and 32% received anthracycline-based chemotherapy. By the end of 2008, the majority of patients younger than 65 years were also receiving taxane-based chemotherapy. Patients younger than 35 years were less likely to be treated with a taxane-based regimen, whereas patients who underwent 21-gene recurrence score testing and those treated with trastuzumab were more likely to receive taxane-based chemotherapy. CONCLUSION The use of anthracycline-based chemotherapy has declined, and the majority of patients with breast cancer are instead receiving taxane-based chemotherapy. The potential impact on patient outcomes is unknown.
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Affiliation(s)
- Sharon H Giordano
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1354, Houston, TX 77030, USA.
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229
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A multicenter phase II study of TSU-68, a novel oral multiple tyrosine kinase inhibitor, in patients with metastatic breast cancer progressing despite prior treatment with an anthracycline-containing regimen and taxane. Int J Clin Oncol 2012; 18:590-7. [PMID: 22585426 DOI: 10.1007/s10147-012-0421-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/19/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE TSU-68 is a novel multiple tyrosine kinase inhibitor that inhibits vascular endothelial growth factor receptor-2, platelet-derived growth factor receptor and fibroblast growth factor receptor. TSU-68 demonstrated a strong anti-tumor effect against established human breast cancer xenografts in nude mice without apparent toxicity. We conducted a phase II study to evaluate the efficacy and safety of TSU-68 monotherapy in patients with metastatic breast cancer progressing despite prior treatment with an anthracycline-containing regimen and taxane. METHODS TSU-68 was administered daily at a dose of 400 mg twice a day after meals in 20 patients. The primary endpoint was objective overall response rate according to the Response Evaluation Criteria in Solid Tumors guideline version 1.0. Secondary endpoints included clinical benefit rate (complete response, partial response and stable disease lasting for at least 24 weeks), exploratory assessments of change in mRNA levels of biological markers associated with angiogenesis in tumor tissue at the end of Cycle 1, and safety of TSU-68. RESULTS Twenty patients were enrolled into the study from October 2002 through April 2003. TSU-68 monotherapy produced objective overall response in none of the patients; however, clinical benefit was seen in 5 % of the patients. The mRNA levels of CD31, Flt-1 and Flk-1/KDR showed a decreasing trend in all 4 patients who provided additional written informed consent for collection of tumor tissue. However, no significant difference was observed in the change in mRNA level due to the small sample size. The most common adverse drug reaction (ADR) was tumor pain (60 %); hematological ADRs rarely occurred, and they were mild in severity. Only one patient experienced grade 2 rash and no patient experienced hypertension. No patients experienced a grade 4 ADR and no episode of death related to the study treatment occurred in the 20 patients. CONCLUSIONS TSU-68 monotherapy produced clinical benefit in only 5 % of the patients and did not produce objective overall response; however, the treatment was well tolerated. Further evaluation of the efficacy of TSU-68 will be worthwhile because the mRNA levels of CD31, Flt-1 and Flk-1/KDR decreased in 4 patients.
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Tendulkar RD, Rehman S, Shukla ME, Reddy CA, Moore H, Budd GT, Dietz J, Crowe JP, Macklis R. Impact of postmastectomy radiation on locoregional recurrence in breast cancer patients with 1-3 positive lymph nodes treated with modern systemic therapy. Int J Radiat Oncol Biol Phys 2012; 83:e577-81. [PMID: 22560546 DOI: 10.1016/j.ijrobp.2012.01.076] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 12/10/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Postmastectomy radiation therapy (PMRT) remains controversial for patients with 1-3 positive lymph nodes (LN+). METHODS AND MATERIALS We conducted a retrospective review of all 369 breast cancer patients with 1-3 LN+ who underwent mastectomy without neoadjuvant systemic therapy between 2000 and 2007 at Cleveland Clinic. RESULTS We identified 271 patients with 1-3 LN+ who did not receive PMRT and 98 who did receive PMRT. The median follow-up time was 5.2 years, and the median number of LN dissected was 11. Of those not treated with PMRT, 79% received adjuvant chemotherapy (of whom 70% received a taxane), 79% received hormonal therapy, and 5% had no systemic therapy. Of the Her2/neu amplified tumors, 42% received trastuzumab. The 5-year rate of locoregional recurrence (LRR) was 8.9% without PMRT vs 0% with PMRT (P=.004). For patients who did not receive PMRT, univariate analysis showed 6 risk factors significantly (P<.05) correlated with LRR: estrogen receptor/progesterone receptor negative (hazard ratio [HR] 2.6), lymphovascular invasion (HR 2.4), 2-3 LN+ (HR 2.6), nodal ratio >25% (HR 2.7), extracapsular extension (ECE) (HR 3.7), and Bloom-Richardson grade III (HR 3.1). The 5-year LRR rate was 3.4% (95% confidence interval [CI], 0.1%-6.8%] for patients with 0-1 risk factor vs 14.6% [95% CI, 8.4%-20.9%] for patients with ≥2 risk factors (P=.0006), respectively. On multivariate analysis, ECE (HR 4.3, P=.0006) and grade III (HR 3.6, P=.004) remained significant risk factors for LRR. The 5-year LRR was 4.1% in patients with neither grade III nor ECE, 8.1% with either grade III or ECE, and 50.4% in patients with both grade III and ECE (P<.0001); the corresponding 5-year distant metastasis-free survival rates were 91.8%, 85.4%, and 59.1% (P=.0004), respectively. CONCLUSIONS PMRT offers excellent control for patients with 1-3 LN+, with no locoregional failures to date. Patients with 1-3 LN+ who have grade III disease and/or ECE should be strongly considered for PMRT.
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Affiliation(s)
- Rahul D Tendulkar
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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231
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Fernández-Cuesta L, Oakman C, Falagan-Lotsch P, Smoth KS, Quinaux E, Buyse M, Dolci MS, Azambuja ED, Hainaut P, Dell'Orto P, Larsimont D, Francis PA, Crown J, Piccart-Gebhart M, Viale G, Leo AD, Olivier M. Prognostic and predictive value of TP53 mutations in node-positive breast cancer patients treated with anthracycline- or anthracycline/taxane-based adjuvant therapy: results from the BIG 02-98 phase III trial. Breast Cancer Res 2012; 14:R70. [PMID: 22551440 PMCID: PMC3446332 DOI: 10.1186/bcr3179] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 04/05/2012] [Accepted: 05/02/2012] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Pre-clinical data suggest p53-dependent anthracycline-induced apoptosis and p53-independent taxane activity. However, dedicated clinical research has not defined a predictive role for TP53 gene mutations. The aim of the current study was to retrospectively explore the prognosis and predictive values of TP53 somatic mutations in the BIG 02-98 randomized phase III trial in which women with node-positive breast cancer were treated with adjuvant doxorubicin-based chemotherapy with or without docetaxel. METHODS The prognostic and predictive values of TP53 were analyzed in tumor samples by gene sequencing within exons 5 to 8. Patients were classified according to p53 protein status predicted from TP53 gene sequence, as wild-type (no TP53 variation or TP53 variations which are predicted not to modify p53 protein sequence) or mutant (p53 nonsynonymous mutations). Mutations were subcategorized according to missense or truncating mutations. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Cox-regression analysis was used to identify independent predictors of outcome. RESULTS TP53 gene status was determined for 18% (520 of 2887) of the women enrolled in BIG 02-98. TP53 gene variations were found in 17% (90 of 520). Nonsynonymous p53 mutations, found in 16.3% (85 of 520), were associated with older age, ductal morphology, higher grade and hormone-receptor negativity. Of the nonsynonymous mutations, 12.3% (64 of 520) were missense and 3.6% were truncating (19 of 520). Only truncating mutations showed significant independent prognostic value, with an increased recurrence risk compared to patients with non-modified p53 protein (hazard ratio = 3.21, 95% confidence interval = 1.740 to 5.935, P = 0.0002). p53 status had no significant predictive value for response to docetaxel. CONCLUSIONS p53 truncating mutations were uncommon but associated with poor prognosis. No significant predictive role for p53 status was detected. TRIAL REGISTRATION ClinicalTrials.gov NCT00174655.
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Affiliation(s)
- Lynnette Fernández-Cuesta
- Molecular Carcinogenesis Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 8, France
| | - Catherine Oakman
- 'Sandro Pitigliani' Medical Oncology Unit, Hospital of Prato, Istituto Toscano Tumori, Piazza dell'Ospedale 2, 59100 Prato, Italy
| | - Priscila Falagan-Lotsch
- Molecular Carcinogenesis Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 8, France
| | - Ke-seay Smoth
- Molecular Carcinogenesis Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 8, France
| | - Emmanuel Quinaux
- International Drug Development Institute, Avenue Provinciale 30, 1340 Louvain-La-Neuve, Belgium
| | - Marc Buyse
- International Drug Development Institute, Avenue Provinciale 30, 1340 Louvain-La-Neuve, Belgium
| | - M Stella Dolci
- Breast European Adjuvant Studies Team, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 121, 1000 Brussels, Belgium
| | - Evandro De Azambuja
- Breast European Adjuvant Studies Team, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 121, 1000 Brussels, Belgium
| | - Pierre Hainaut
- Molecular Carcinogenesis Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 8, France
| | - Patrizia Dell'Orto
- University of Milan School of Medicine and European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Denis Larsimont
- Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 121, 1000 Brussels, Belgium
| | - Prudence A Francis
- Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria 3002, Australia; Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, NSW 2310, Australia; International Breast Cancer Study Group, Effingerstrasse 40, 3008 Bern, Switzerland
| | - John Crown
- Irish Clinical Oncology Research Group, 60 Fitzwilliam Square, Dublin, 2, Ireland
| | - Martine Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 121 Boulevard de Waterloo, 1000 Brussels, Belgium
| | - Giuseppe Viale
- University of Milan School of Medicine and European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Angelo Di Leo
- 'Sandro Pitigliani' Medical Oncology Unit, Hospital of Prato, Istituto Toscano Tumori, Piazza dell'Ospedale 2, 59100 Prato, Italy
| | - Magali Olivier
- Molecular Carcinogenesis Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 8, France
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Zhang J, Li G, Li Z, Yu X, Zheng Y, Jin K, Wang H, Gong Y, Sun X, Teng X, Cao J, Teng L. Estrogen-independent effects of ER-α36 in ER-negative breast cancer. Steroids 2012; 77:666-73. [PMID: 22402113 DOI: 10.1016/j.steroids.2012.02.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/31/2012] [Accepted: 02/19/2012] [Indexed: 11/28/2022]
Abstract
Estrogen receptor-alpha 36 (ER-α36) is a variant of ER-α that has been found to be expressed in conventional ER (ER-α66)-negative breast cancer cell lines and human breast cancer samples. In this study, we found that, using immunohistochemical study, ER-α36 expression was significantly higher in ER-negative tumors than in ER-positive tumors although the expression was not associated with other clinicopathological characteristics. We then constructed an ER-α36-specific microRNA hairpin vector and established stable ER-α36 knockdown cells, and found that the knockdown cells were more sensitive to paclitaxel; the c-Jun N-terminal kinase pathway appeared to be involved in the mechanism. Downregulation of ER-α36 also resulted in decreased migration and invasion. These changes were estrogen independent. Our findings indicated that target ER-α36 may be a strategy for treating ER-negative breast cancers.
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Affiliation(s)
- Jing Zhang
- Department of Surgical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
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Zhu D, Zha X, Hu M, Tao A, Zhou H, Zhou X, Sun Y. High expression of TIMP-1 in human breast cancer tissues is a predictive of resistance to paclitaxel-based chemotherapy. Med Oncol 2012; 29:3207-15. [DOI: 10.1007/s12032-012-0239-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/10/2012] [Indexed: 11/28/2022]
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234
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Abe H, Mori T, Kawai Y, Cho H, Kubota Y, Umeda T, Kurumi Y, Tani T. Feasibility and toxicity of docetaxel before or after fluorouracil, epirubicin and cyclophosphamide as adjuvant chemotherapy for early breast cancer. Int J Clin Oncol 2012; 18:487-91. [DOI: 10.1007/s10147-012-0407-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
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235
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Joerger M, Thürlimann B, Savidan A, Frick H, Bouchardy C, Konzelmann I, Probst-Hensch N, Ess S. A Population-Based Study on the Implementation of Treatment Recommendations for Chemotherapy in Early Breast Cancer. Clin Breast Cancer 2012; 12:102-9. [DOI: 10.1016/j.clbc.2011.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/30/2011] [Accepted: 10/14/2011] [Indexed: 10/14/2022]
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236
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Shajahan AN, Dobbin ZC, Hickman FE, Dakshanamurthy S, Clarke R. Tyrosine-phosphorylated caveolin-1 (Tyr-14) increases sensitivity to paclitaxel by inhibiting BCL2 and BCLxL proteins via c-Jun N-terminal kinase (JNK). J Biol Chem 2012; 287:17682-17692. [PMID: 22433870 DOI: 10.1074/jbc.m111.304022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Paclitaxel, an anti-microtubule agent, is an effective chemotherapeutic drug in breast cancer. Nonetheless, resistance to paclitaxel remains a major clinical challenge. The need to better understand the resistant phenotype and to find biomarkers that could predict tumor response to paclitaxel is evident. In estrogen receptor α-positive (ER(+)) breast cancer cells, phosphorylation of caveolin-1 (CAV1) on Tyr-14 facilitates mitochondrial apoptosis by increasing BCL2 phosphorylation in response to low dose paclitaxel (10 nM). However, two variants of CAV1 exist: the full-length form, CAV1α (wild-type CAV1 or wtCAV1), and a truncated form, CAV1β. Only wtCAV1 has the Tyr-14 region at the N terminus. The precise cellular functions of CAV1 variants are unknown. We now show that CAV1 variants play distinct roles in paclitaxel-mediated cell death/survival. CAV1β expression is increased in paclitaxel-resistant cells when compared with sensitive cells. Expression of CAV1β in sensitive cells significantly reduces their responsiveness to paclitaxel. These activities reflect an essential role for Tyr-14 phosphorylation because wtCAV1 expression, but not a phosphorylation-deficient mutant (Y14F), inactivates BCL2 and BCLxL through activation of c-Jun N-terminal kinase (JNK). MCF-7 cells that express Y14F are resistant to paclitaxel and are resensitized by co-treatment with ABT-737, a BH3-mimetic small molecule inhibitor. Using structural homology modeling, we propose that phosphorylation on Tyr-14 enables a favorable conformation for proteins to bind to the CAV1 scaffolding domain. Thus, we highlight novel roles for CAV1 variants in cell death; wtCAV1 promotes cell death, whereas CAV1β promotes cell survival by preventing inactivation of BCL2 and BCLxL via JNK in paclitaxel-mediated apoptosis.
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Affiliation(s)
- Ayesha N Shajahan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D. C. 20057.
| | - Zachary C Dobbin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D. C. 20057
| | - F Edward Hickman
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D. C. 20057
| | - Sivanesan Dakshanamurthy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D. C. 20057
| | - Robert Clarke
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D. C. 20057
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Increased efficacy of a dose-dense regimen of neoadjuvant chemotherapy in breast carcinoma: a retrospective analysis. Med Oncol 2012; 29:2577-85. [PMID: 22392196 DOI: 10.1007/s12032-012-0195-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 02/16/2012] [Indexed: 12/31/2022]
Abstract
Neoadjuvant chemotherapy is being increasingly used in the treatment of breast carcinoma. We performed a single-center retrospective analysis of the results of neoadjuvant therapy in 376 breast carcinoma patients treated with three different regimens combining doxorubicin and paclitaxel (AT), dose-dense doxorubicin and cyclophosphamide with sequential weekly paclitaxel (DD AC-P), or the combination of trastuzumab with chemotherapy (DD AC-PT). The expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (HER)-2 was determined immunohistochemically. Pathological response was determined in 318 patients. Pathological complete response (pCR) was observed in 18% of patients. The pCR rate was significantly higher in patients treated with DD regimen (22 vs. 13%) and younger than 55 years (23 vs. 13%). The pCR rate was higher in patients with triple negative (TN) tumors (43%) and tumors over-expressing HER-2 (HER-2+; 28%) compared to patients with ER- or PR-positive tumors not expressing HER-2 (ER/PR+HER-2-; 6%). In patients with TN tumors pCR rate was significantly higher after treatment with DD AC-P compared to AT (61 vs. 22%, p=0.005). pCR was associated with significantly improved relapse-free survival (RFS) and overall survival (OS), but when analysis was performed based on tumor phenotype, the difference was significant only in patients with TN tumors. In multivariate analysis, pCR, stage, and ER expression were significant predictors of RFS, while pCR, stage, ER and DD regimen were significant predictors of OS. In conclusion, present data indicate superiority of a DD regimen in obtaining pCR in patients with breast carcinoma treated with neoadjuvant chemotherapy. The difference in efficacy is due mostly to markedly higher pCR rate in patients with TN tumors.
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238
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Bear HD, Tang G, Rastogi P, Geyer CE, Robidoux A, Atkins JN, Baez-Diaz L, Brufsky AM, Mehta RS, Fehrenbacher L, Young JA, Senecal FM, Gaur R, Margolese RG, Adams PT, Gross HM, Costantino JP, Swain SM, Mamounas EP, Wolmark N. Bevacizumab added to neoadjuvant chemotherapy for breast cancer. N Engl J Med 2012; 366:310-20. [PMID: 22276821 PMCID: PMC3401076 DOI: 10.1056/nejmoa1111097] [Citation(s) in RCA: 370] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bevacizumab and the antimetabolites capecitabine and gemcitabine have been shown to improve outcomes when added to taxanes in patients with metastatic breast cancer. The primary aims of this trial were to determine whether the addition of capecitabine or gemcitabine to neoadjuvant chemotherapy with docetaxel, followed by doxorubicin plus cyclophosphamide, would increase the rates of pathological complete response in the breast in women with operable, human epidermal growth factor receptor 2 (HER2)-negative breast cancer and whether adding bevacizumab to these chemotherapy regimens would increase the rates of pathological complete response. METHODS We randomly assigned 1206 patients to receive neoadjuvant therapy consisting of docetaxel (100 mg per square meter of body-surface area on day 1), docetaxel (75 mg per square meter on day 1) plus capecitabine (825 mg per square meter twice a day on days 1 to 14), or docetaxel (75 mg per square meter on day 1) plus gemcitabine (1000 mg per square meter on days 1 and 8) for four cycles, with all regimens followed by treatment with doxorubicin-cyclophosphamide for four cycles. Patients were also randomly assigned to receive or not to receive bevacizumab (15 mg per kilogram of body weight) for the first six cycles of chemotherapy. RESULTS The addition of capecitabine or gemcitabine to docetaxel therapy, as compared with docetaxel therapy alone, did not significantly increase the rate of pathological complete response (29.7% and 31.8%, respectively, vs. 32.7%; P=0.69). Both capecitabine and gemcitabine were associated with increased toxic effects--specifically, the hand-foot syndrome, mucositis, and neutropenia. The addition of bevacizumab significantly increased the rate of pathological complete response (28.2% without bevacizumab vs. 34.5% with bevacizumab, P=0.02). The effect of bevacizumab on the rate of pathological complete response was not the same in the hormone-receptor-positive and hormone-receptor-negative subgroups. The addition of bevacizumab increased the rates of hypertension, left ventricular systolic dysfunction, the hand-foot syndrome, and mucositis. CONCLUSIONS The addition of bevacizumab to neoadjuvant chemotherapy significantly increased the rate of pathological complete response, which was the primary end point of this study. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00408408.).
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Affiliation(s)
- Harry D Bear
- Medical College of Virginia School of Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298-0011, USA.
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Khasraw M, Bell R, Dang C. Epirubicin: is it like doxorubicin in breast cancer? A clinical review. Breast 2012; 21:142-9. [PMID: 22260846 DOI: 10.1016/j.breast.2011.12.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 12/01/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022] Open
Abstract
Anthracyclines are among the most effective chemotherapy treatments available for various types of cancer. The anthracyclines commonly used in treatment of breast cancer are either epirubicin or doxorubicin. Epirubicin is an epimer of doxorubicin with important role in the chemotherapy treatment of both early and metastatic breast cancer. The efficacy of epirubicin is similar to doxorubicin while epirubicin has a different toxicity profile particularly in regard to cardiotoxicity. Epirubicin has been incorporated into most of the anthracycline containing chemotherapy combinations in well-conducted clinical trials involving large numbers of patients. It has also been investigated in studies involving the administration of epirubicin in dose-dense chemotherapy schedules. Short term follow up of dose-dense clinical trials demonstrated safety comparable to that of doxorubicin. This review summarizes published clinical trials investigating epirubicin in the treatment of early and advanced breast cancer.
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Affiliation(s)
- Mustafa Khasraw
- Andrew Love Cancer Center, Geelong Hospital, and School of Medicine of Deakin University, Geelong VIC 3220, Australia.
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240
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Postoperative dose-dense sequential versus concomitant administration of epirubicin and paclitaxel in patients with node-positive breast cancer: 5-year results of the Hellenic Cooperative Oncology Group HE 10/00 phase III Trial. Breast Cancer Res Treat 2011; 132:609-19. [PMID: 22187126 DOI: 10.1007/s10549-011-1913-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
To explore the impact of dose intensity (DI) in the adjuvant setting of breast cancer, a randomized phase III trial was conducted comparing postoperative dose-dense sequential chemotherapy with epirubicin, paclitaxel, and cyclophosphamide, methotrexate and fluorouracil (CMF)in high-risk breast cancer patients. From Oct 2000 to June 2005, 1,121 node-positive patients were randomized to dose-dense sequential epirubicin 110 mg/m(2) and paclitaxel (Taxol, Bristol Myers-Squibb, Princeton, NJ) 250 mg/m(2) (group A), or concurrent epirubicin 83 mg/m(2) and paclitaxel 187 mg/m(2) (group B), both followed by three cycles of "intensified" combination chemotherapy with CMF. By protocol design total cumulative dose and duration of treatment were identical in both groups. Dose intensity of epirubicin and paclitaxel was double in the dose-dense arm. Prophylactic treatment with granulocyte colony-stimulating factor was given with the dose-dense treatments. Disease-free survival (DFS) was the primary endpoint. At a median follow-up of 76 months, 253 patients (23%) had documented disease relapse (123 vs. 130 in groups A and B, respectively) and 208 deaths (101, group A and 107, group B) had been observed. The 5-year DFS rate of 74 and 74% and OS rate of 86 and 85% were observed for group A and group B, respectively. No differences were found in DFS or OS between the two treatment groups (P = 0.78 and P = 0.45 for DFS and OS, respectively). Safety analysis results showing that both regimens were well tolerated and safe have been previously published (Fountzilas et al. Ann Oncol 2008). No DFS or OS benefit from the dose-dense sequential epirubicin and paclitaxel was detected when compared to the concurrent administration of the same drugs. No additional safety issues were raised with long-term follow-up.
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Sucheston LE, Zhao H, Yao S, Zirpoli G, Liu S, Barlow WE, Moore HCF, Thomas Budd G, Hershman DL, Davis W, Ciupak GL, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Livingston RB, Albain KS, Hayes DF, Ambrosone CB. Genetic predictors of taxane-induced neurotoxicity in a SWOG phase III intergroup adjuvant breast cancer treatment trial (S0221). Breast Cancer Res Treat 2011; 130:993-1002. [PMID: 21766209 PMCID: PMC3532924 DOI: 10.1007/s10549-011-1671-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 06/29/2011] [Indexed: 12/16/2022]
Abstract
Taxanes have resulted in improved survival for breast cancer patients, but often cause neurological toxicities. Identification of biomarkers related to toxicities could be important for dictating treatment regimen. We evaluated single nucleotide polymorphisms (SNPs) in the Fanconi Anemia (FA)/BRCA pathway in relation to grade 3/4 neurotoxicities in patients (n = 888) from SWOG0221, a phase III adjuvant trial for breast cancer of 4 dose/schedules of cyclophosphamide (C), doxorubicin (A), and paclitaxel (T). In a separate cohort, we measured the correlation of significant FANCD2 SNPs with corresponding gene expression. For FANCD2, permutation testing revealed that 4 (out of 20) SNPs were significantly associated with an almost two-fold increased risk of toxicity. Two FANCD2 haplotypes were also associated with neurological toxicity, with odds ratios (OR) in the overall population of 1.8 (95% confidence interval (CI) 1.3, 2.5) and 1.7 (95% CI, 1.2, 2.4). Although numbers were small, an African-American-specific haplotype was associated with an almost 3-fold increase in risk of neurologic toxicity (OR = 2.84, 95% CI = 1.2, 6.9). Expression analyses revealed that significant FANCD2 SNPs were associated with FANCD2 expression levels (P = 0.03). There were no associations between SNPs in BRCA1 and neurotoxicities. In this trial of CA+T for breast cancer, SNPs in FANCD2, but not in BRCA1, were associated with a 70-80% increase in the odds of grade 3/4 neurological toxicities and increased expression of the gene. If replicated, women with these genotypes should be closely monitored for toxicities and could be targeted for preventive measures or alternative therapeutic approaches.
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Affiliation(s)
- Lara E Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Paclitaxel-induced peripheral neuropathy in patients receiving adjuvant chemotherapy for breast cancer. Int J Clin Oncol 2011; 18:132-8. [PMID: 22105895 DOI: 10.1007/s10147-011-0352-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 11/08/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND The long-term outcomes and risk factors of paclitaxel-induced peripheral neuropathy (PIPN) have not yet been fully elucidated. METHODS We identified 219 breast cancer patients who received paclitaxel as adjuvant chemotherapy between 2002 and 2009. We retrospectively analyzed the incidence, time to onset, duration, and risk factors for PIPN by chart review. RESULTS Of the 219 patients, 212 developed PIPN (97%) during a median follow-up time of 57 months (range 5.3-95.5). Median time to PIPN onset was 21 days (range 11-101) for the entire patient population: 35 days (range 14-77) for weekly administration and 21 days (range 11-101) for tri-weekly administration. PIPN caused termination of paclitaxel treatment in 7 patients (4%). Median duration of PIPN was 727 days (range 14-2621 days). PIPN persisted in 64 and 41% of patients at 1 and 3 years after initiating paclitaxel, respectively. Age ≥60 years and severity of PIPN were significantly associated with PIPN duration. CONCLUSIONS PIPN persists longer in older patients and in those who experience severe neuropathy. Further studies to identify the risk factors for PIPN are warranted.
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Ginés J, Sabater E, Martorell C, Grau M, Monroy M, Casado MA. Efficacy of taxanes as adjuvant treatment of breast cancer: a review and meta-analysis of randomised clinical trials. Clin Transl Oncol 2011; 13:485-98. [PMID: 21775276 DOI: 10.1007/s12094-011-0686-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the magnitude of benefit obtained by taxanes as adjuvant treatment of breast cancer and to assess the best method for their administration. MATERIAL AND METHODS We performed a systematic search of phase III randomised clinical trials that included patients with non-metastatic breast cancer in whom comparisons were chemotherapy (CT) containing a taxane (docetaxel or paclitaxel) vs. CT without taxanes (first-generation trials), or CT with taxane in both treatment arms (second-generation trials), administered after surgery. The parameters of efficacy evaluated were disease-free survival (DFS) and overall survival (OS). The data obtained in the first-generation trials (number of relapses and deaths) were submitted to a meta-analysis. The odds ratio (OR) combined with DerSimonian and Laird (OR DL) and 95% confidence interval (95% CI) were calculated. Further, an analysis was performed of those trials that included only patients with nodal involvement (N+). In both cases, the results were also analysed as a function of the taxane used, and with indirect comparisons between the two. The second-generation trials were analysed to assess the optimum method of administration. RESULTS A total of 17 trials were selected for the meta-analysis (30,672 patients). The OR DL was 0.82 (95%CI: 0.76-0.88) for DFS and 0.83 (95% CI: 0.75-0.91) for OS. In N+ patients the results were 0.80 (95% CI: 0.74-0.86) and 0.79 (95% CI: 0.69-0.89), respectively. Docetaxel and paclitaxel significantly increased the DFS and OS. In our indirect comparison, the benefit of docetaxel on OS was significantly superior to that obtained with paclitaxel in N+ patients (OR: 0.79; 95% CI: 0.63-0.98). CONCLUSIONS The administration of adjuvant CT-based taxanes reduces the risk of relapse and death. This reduction is superior in clinical trials that included only N+ patients. With the available evidence, it would appear that the best method of administering paclitaxel is weekly and for docetaxel tri-weekly.
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Affiliation(s)
- Jordi Ginés
- Servicio de Farmacia, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, Spain.
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Romero A, Martín M, Oliva B, de la Torre J, Furio V, de la Hoya M, García-Sáenz JA, Moreno A, Román JM, Diaz-Rubio E, Caldés T. Glutathione S-transferase P1 c.313A > G polymorphism could be useful in the prediction of doxorubicin response in breast cancer patients. Ann Oncol 2011; 23:1750-6. [PMID: 22052985 DOI: 10.1093/annonc/mdr483] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identification of predicting factors for anthracyclines-based chemotherapy remains a clinical challenge. Glutathione S-transferase (GSTs) enzymes detoxify chemotherapy drugs and their metabolites. Several polymorphisms in GST genes result in reduced or no activity of the enzymes. Specifically, GSTM1 and GSTT1 genes are polymorphically deleted, the polymorphism GSTP1 c.313A>G (rs1695) determines the amino acid substitution Ile105Val, where the Val-containing enzyme has reduced activity. Also, GSTA1*B allele has reduced levels of GSTA1 enzyme. Several polymorphisms in GSTs have been associated with differences in survival for cancer patients treated with chemotherapy. PATIENTS AND METHODS We genotyped a total of five polymorphisms in GSTM1, GSTT1, GSTP1 and GSTA1 genes in 159 patients with locally advanced breast cancer, treated with single-agent doxorubicin or docetaxel (Taxotere). Gene expression microarrays were performed in 67 breast tumor samples. We correlate this data with treatment outcome. RESULTS In multivariate analysis, patients homozygous GG for GSTP1 c.313A>G SNP had a lower risk of chemoresistance when treated with doxorubicin (odds ratio 0.106; confidence interval 0.012-0.898; P=0.040). No association was found in the docetaxel arm. Also, we found that GSTP1 expression varied significantly among breast cancer molecular subtypes. CONCLUSIONS GSTP1 may constitute another tool contributing to individualized anthracycline-based therapy.
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Affiliation(s)
- A Romero
- Medical Oncology Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Abstract
The rapid pace of discoveries in tumor biology, imaging technology, and human genetics hold promise for an era of personalized oncology care. The successful development of a handful of new targeted agents has generated much hope and hype about the delivery of safer and more effective new treatments for cancer. The design and conduct of clinical trials has not yet adjusted to a new era of personalized oncology and so we are more in transition to that era than in it. With the development of treatments for breast cancer as a model, we review the approaches to clinical trials and the development of novel therapeutics in the prior era of population oncology, the current transitional era, and the future era of personalized oncology.
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Affiliation(s)
- Michael L. Maitland
- Section of Hematology/Oncology, Associate Director, Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago
| | - Richard L. Schilsky
- Corresponding author: , MC 2115, 5841 S. Maryland Ave., Chicago, IL 60637, U of C Phone: (773) 834-3914, U of C Fax: (773) 834-3915, Assistant: Michelle Scheuer ()
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Qin YY, Li H, Guo XJ, Ye XF, Wei X, Zhou YH, Zhang XJ, Wang C, Qian W, Lu J, He J. Adjuvant chemotherapy, with or without taxanes, in early or operable breast cancer: a meta-analysis of 19 randomized trials with 30698 patients. PLoS One 2011; 6:e26946. [PMID: 22069477 PMCID: PMC3206064 DOI: 10.1371/journal.pone.0026946] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/06/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Taxanes have been extensively used as adjuvant chemotherapy for the treatment of early or operable breast cancer, particularly in high risk, node-negative breast cancer. Previous studies, however, have reported inconsistent findings regarding their clinical efficacy and safety. We investigated disease-free survival (DFS), overall survival (OS), and drug-related toxicities of taxanes by a systematic review and meta-analysis. METHODOLOGY AND PRINCIPAL FINDINGS We systematically searched PubMed, EMBASE, the Cochrane Center Register of Controlled Trials, proceedings of major meetings, and reference lists of articles for studies conducted between January 1980 and April 2011. Randomized controlled trials (RCTs) comparing chemotherapy with and without taxanes in the treatment of patients with early-stage or operable breast cancer were eligible for inclusion in our analysis. The primary endpoint was DFS. Nineteen RCTs including 30698 patients were identified, including 8426 recurrence events and 3803 deaths. Taxanes administration yielded a 17% reduction of hazard ratio (HR) for DFS (HR = 0.83, 95% CI 0.79-0.88, p<0.001) and a 17% reduction of HR for OS (HR = 0.83, 95% CI 0.77-0.90, p<0.001). For high risk, node-negative breast cancer, the pooled HR also favoured the taxane-based treatment arm over the taxane-free treatment arm (HR = 0.82, 95% CI 0.77-0.87, p = 0.022). A significantly increased rate of neutropenia, febrile neutropenia, fatigue, diarrhea, stomatitis, and oedema was observed in the taxane-based treatment arm. CONCLUSIONS/SIGNIFICANCE Adjuvant chemotherapy with taxanes could reduce the risk of cancer recurrence and death in patients with early or operable breast cancer, although the drug-related toxicities should be balanced. Furthermore, we also demonstrated that patients with high risk, node-negative breast cancer also benefited from taxanes therapy, a result that was not observed in previous studies.
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Affiliation(s)
- Ying-Yi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
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Jacquemier J, Boher JM, Roche H, Esterni B, Serin D, Kerbrat P, Andre F, Finetti P, Charafe-Jauffret E, Martin AL, Campone M, Viens P, Birnbaum D, Penault-Llorca F, Bertucci F. Protein expression, survival and docetaxel benefit in node-positive breast cancer treated with adjuvant chemotherapy in the FNCLCC-PACS 01 randomized trial. Breast Cancer Res 2011; 13:R109. [PMID: 22044691 PMCID: PMC3326551 DOI: 10.1186/bcr3051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 09/15/2011] [Accepted: 11/01/2011] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The PACS01 trial has demonstrated that a docetaxel addition to adjuvant anthracycline-based chemotherapy improves disease-free survival (DFS) and overall survival of node-positive early breast cancer (EBC). We searched for prognostic and predictive markers for docetaxel's benefit. METHODS Tumor samples from 1,099 recruited women were analyzed for the expression of 34 selected proteins using immunohistochemistry. The prognostic and predictive values of each marker and four molecular subtypes (luminal A, luminal B, HER2-overexpressing, and triple-negative) were tested. RESULTS Progesterone receptor-negativity (HR = 0.66; 95% CI 0.47 to 0.92, P = 0.013), and Ki67-positivity (HR = 1.53; 95% CI 1.12 to 2.08, P = 0.007) were independent adverse prognostic factors. Out of the 34 proteins, only Ki67-positivity was associated with DFS improvement with docetaxel addition (adjusted HR = 0.51, 95% CI 0.33 to 0.79 for Ki67-positive versus HR = 1.10, 95% CI 0.75 to 1.61 for Ki67-negative tumors, P for interaction = 0.012). Molecular subtyping predicted the docetaxel benefit, but without providing additional information to Ki67 status. The luminal A subtype did not benefit from docetaxel (HR = 1.16, 95% CI 0.73 to 1.84); the reduction in the relapse risk was 53% (HR = 0.47, 95% CI 0.22 to 1.01), 34% (HR = 0.66, 95% CI 0.37 to 1.19), and 12% (HR = 0.88, 95% CI 0.49 to 1.57) in the luminal B, HER2-overexpressing, and triple-negative subtypes, respectively. CONCLUSIONS In patients with node-positive EBC receiving adjuvant anthracycline-based chemotherapy, the most powerful predictor of docetaxel benefit is Ki67-positivity.
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Affiliation(s)
- Jocelyne Jacquemier
- Department of Molecular Oncology, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille, UMR891 Inserm, 232, Bd Ste-Marguerite, Marseille, 13009, France
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Eckhoff L, Nielsen M, Moeller S, Knoop A. TAXTOX - a retrospective study regarding the side effects of docetaxel given as part of the adjuvant treatment to patients with primary breast cancer in Denmark from 2007 to 2009. Acta Oncol 2011; 50:1075-82. [PMID: 21824038 DOI: 10.3109/0284186x.2011.602111] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In 2007 docetaxel was introduced as part of the adjuvant setting offered to high risk breast cancer patients in Denmark. Meta-analyses had shown that taxane-containing chemotherapy reduced the relative risk of relapse and death by 20-30%, apparently with moderate side effects. The treatment was given as three cycles of cyclophosphamide (600 mg/m(2)) and epirubicin (90 mg/m(2)) followed by three cycles of docetaxel (100 mg/m(2)). Because of an apparent high incidence of side effects, especially febrile neutropenia (FN) and non-hematologic side effects, the DBCG (The Danish Breast Cancer Cooperative Group) initiated a retrospective study of adverse reactions to the newly introduced regime and all patients were offered primary prophylaxis with growth factors (G-CSF) pr 1/1-2008. MATERIAL AND METHODS Two medical doctors examined available journals and nurse charts from the 13 oncology departments in Denmark, and graded all side effects according to NCI CTC version 2.0. To be enrolled, the patients should have received three cycles of EC and at least one cycle of docetaxel. The side effects were investigated before and after routine use of G-CSF. RESULTS One thousand one hundred and forty-three patients entered the study. In 2007 (before G-CSF) the incidence of FN was 25% and 90.6% of the patients completed the planned treatment. In 2008 (after the introduction of G-CSF) the incidence of FN was 10% and 94.5% completed the treatment. The incidence of non-hematological adverse events, in 2007 and 2008 combined, was for neuropathy 35%, mucositis 75%, muscle and joint pain 53%, skin rash 25% and fatigue 43% (all grades). CONCLUSION The introduction of G-CSF was justified because of the high incidence of FN. However, it could not have been predicted after reviewing the published literature. The incidence of non-hematological adverse events had been reported in some, but not all adjuvant taxanes studies. In the future, focus should be more on the side effects, especially when introducing new toxic systemic regimes.
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Affiliation(s)
- Lise Eckhoff
- Department of Oncology, Odense University Hospital, Denmark.
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Coombes RC, Bliss JM, Espie M, Erdkamp F, Wals J, Tres A, Marty M, Coleman RE, Tubiana-Mathieu N, den Boer MO, Wardley A, Kilburn LS, Cooper D, Thomas MW, Reise JA, Wilkinson K, Hupperets P. Randomized, Phase III Trial of Sequential Epirubicin and Docetaxel Versus Epirubicin Alone in Postmenopausal Patients With Node-Positive Breast Cancer. J Clin Oncol 2011; 29:3247-54. [DOI: 10.1200/jco.2010.32.7254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Docetaxel Epirubicin Adjuvant (DEVA) trial evaluated the efficacy and toxicity of incorporating docetaxel after epirubicin to create a sequential anthracycline-taxane regimen in early breast cancer. Patients and Methods After complete tumor excision, postmenopausal women with node-positive early breast cancer were randomly assigned to either epirubicin 50 mg/m2 on days 1 and 8 every 4 weeks for six cycles (EPI × 6) or three cycles of epirubicin 50 mg/m2 on days 1 and 8 every 4 weeks followed by three cycles of docetaxel 100 mg/m2 on day 1 every 3 weeks (EPI-DOC). A subset of patients also participated in a quality of life (QOL) study. The primary end point was disease-free survival (DFS). Results From 1997 to 2005, 803 patients entered DEVA (EPI × 6, n = 397; EPI-DOC, n = 406). At a median follow-up of 64.7 months (interquartile range, 45.2 to 84.4 months), 198 DFS events had been reported (EPI × 6, n = 114; EPI-DOC, n = 84). The 5-year DFS rates were 72.7% (95% CI, 68.0% to 77.3%) for epirubicin alone and 79.5% (95% CI, 75.2% to 83.8%) for epirubicin followed by docetaxel; evidence of improvement in DFS was observed with EPI-DOC (hazard ratio [HR], 0.68; 95% CI, 0.52 to 0.91; P = .008). One hundred twenty-seven patients have died (EPI × 6, n = 75; EPI-DOC, n = 52); a reduction in deaths was observed with EPI-DOC (HR, 0.66; 95% CI, 0.46 to 0.94; P = .02). The 5-year overall survival rates were 81.8% (95% CI, 77.7% to 85.9%) for epirubicin and 88.9% (95% CI, 85.5% to 92.2%) for epirubicin followed by docetaxel. Assessment of toxicity and QOL showed that EPI-DOC was associated with greater toxicity but with no difference in QOL between arms during follow-up. Conclusion These results suggest, within a relatively small trial, that substitution of docetaxel for epirubicin for the last three cycles of chemotherapy results in improved outcome in postmenopausal women with node-positive, early breast cancer compared with six cycles of epirubicin monotherapy.
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Affiliation(s)
- R. Charles Coombes
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Judith M. Bliss
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Marc Espie
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Frans Erdkamp
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Jacob Wals
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Alejandro Tres
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Michel Marty
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Robert E. Coleman
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Nicole Tubiana-Mathieu
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Marinus O. den Boer
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Andrew Wardley
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Lucy S. Kilburn
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Derek Cooper
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Marina W.K. Thomas
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Justine A. Reise
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Katie Wilkinson
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
| | - Pierre Hupperets
- R. Charles Coombes, Marina W.K. Thomas, Justine A. Reise, Katie Wilkinson, Imperial College London; Derek Cooper, King's College London, London; Judith M. Bliss, Lucy S. Kilburn, The Institute of Cancer Research, Sutton; Robert E. Coleman, Weston Park Hospital, Sheffield; Andrew Wardley, Christie Hospital, Manchester, United Kingdom; Marc Espie, Michel Marty, Hôpital Saint-Louis, Paris; Nicole Tubiana-Mathieu, Centre Hospitalier Universitaire de Limoges, Limoges, France; Frans Erdkamp, Orbis Medisch
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18F-fluorodeoxyglucose positron emission tomography optimizes neoadjuvant chemotherapy for primary breast cancer to achieve pathological complete response. Int J Clin Oncol 2011; 17:276-82. [PMID: 21830087 DOI: 10.1007/s10147-011-0287-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND To assess the usefulness of positron emission tomography combined with computed tomography using (18)F-fluorodeoxyglucose (FDG PET/CT) for optimizing chemotherapy during neoadjuvant chemotherapy for primary breast cancer. METHODS One hundred and eight patients (110 tumors) with breast cancer (≥2 cm, stages II and III) received neoadjuvant chemotherapy consisting of an anthracycline-based regimen and taxane. The maximal value of the baseline standardized uptake value (SUV) and the change in SUV after four cycles of an anthracycline-based regimen relative to baseline SUV were assessed for predicting pathological complete response (pCR) after sequential taxane. RESULTS Tumors with pCR had significantly higher baseline SUV (9.3 ± 3.7 SD) compared to those with non-pCR (7.2 ± 3.8 SD) (p = 0.02), but there was a considerable overlap between two groups. On PET scan after four cycles of chemotherapy, thirty-three patients (33.7%) with a 72.1% or greater reduction in SUV were considered as responders and the performance in predicting pCR had a sensitivity of 88.9% and specificity of 78.7%. CONCLUSION The baseline SUV could not be a useful indicator for predicting pCR due to the wide range in sensitivity. On the other hand, a relative change in SUV after completion of an anthracycline-based regimen could be useful for predicting pCR.
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