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Fialho MFP, Brum ES, Becker G, Oliveira SM. TRPV4 Activation and its Intracellular Modulation Mediated by Kinin Receptors Contribute to Painful Symptoms Induced by Anastrozole. Mol Neurobiol 2024; 61:1627-1642. [PMID: 37740866 DOI: 10.1007/s12035-023-03654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Anastrozole, an aromatase inhibitor, induces painful musculoskeletal symptoms, which affect patients' quality of life and lead to therapy discontinuation. Efforts have been made to understand the mechanisms involved in these painful symptoms to manage them better. In this context, we explored the role of the Transient Receptor Potential Vanilloid 4 (TRPV4), a potential transducer of several nociceptive mechanisms, in anastrozole-induced musculoskeletal pain in mice. Besides, we evaluated the possible sensibilization of TRPV4 by signalling pathways downstream, PLC, PKC and PKCε from kinin B2 (B2R) and B1 (B1R) receptors activation in anastrozole-induced pain. Anastrozole caused mechanical allodynia and muscle strength loss in mice. HC067047, TRPV4 antagonist, reduced the anastrozole-induced mechanical allodynia and muscle strength loss. In animals previously treated with anastrozole, the local administration of sub-nociceptive doses of the TRPV4 (4α-PDD or hypotonic solution), B2R (Bradykinin) or B1R (DABk) agonists enhanced the anastrozole-induced pain behaviours. The sensitizing effects induced by local injection of the TRPV4, B2R and B1R agonists in animals previously treated with anastrozole were reduced by pre-treatment with TRPV4 antagonist. Furthermore, inhibition of PLC, PKC or PKCε attenuated the mechanical allodynia and muscle strength loss induced by TRPV4, B2R and B1R agonists. The generation of painful conditions caused by anastrozole depends on direct TRPV4 activation or indirect, e.g., PLC, PKC and PKCε pathways downstream from B2R and B1R activation. Thus, the TRPV4 channels act as sensors of extracellular and intracellular changes, making them potential therapeutic targets for alleviating pain related to aromatase inhibitors use, such as anastrozole.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Gabriela Becker
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Biochemistry and Molecular Biology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria, RS, 97105-900, Brazil.
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Brusco I, Becker G, Palma TV, Pillat MM, Scussel R, Steiner BT, Sampaio TB, Ardisson-Araújo DMP, de Andrade CM, Oliveira MS, Machado-De-Avila RA, Oliveira SM. Kinin B 1 and B 2 receptors mediate cancer pain associated with both the tumor and oncology therapy using aromatase inhibitors. Sci Rep 2023; 13:4418. [PMID: 36932156 PMCID: PMC10023805 DOI: 10.1038/s41598-023-31535-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Pain caused by the tumor or aromatase inhibitors (AIs) is a disabling symptom in breast cancer survivors. Their mechanisms are unclear, but pro-algesic and inflammatory mediators seem to be involved. Kinins are endogenous algogenic mediators associated with various painful conditions via B1 and B2 receptor activation, including chemotherapy-induced pain and breast cancer proliferation. We investigate the involvement of the kinin B1 and B2 receptors in metastatic breast tumor (4T1 breast cancer cells)-caused pain and in aromatase inhibitors (anastrozole or letrozole) therapy-associated pain. A protocol associating the tumor and antineoplastic therapy was also performed. Kinin receptors' role was investigated via pharmacological antagonism, receptors protein expression, and kinin levels. Mechanical and cold allodynia and muscle strength were evaluated. AIs and breast tumor increased kinin receptors expression, and tumor also increased kinin levels. AIs caused mechanical allodynia and reduced the muscle strength of mice. Kinin B1 (DALBk) and B2 (Icatibant) receptor antagonists attenuated these effects and reduced breast tumor-induced mechanical and cold allodynia. AIs or paclitaxel enhanced breast tumor-induced mechanical hypersensitivity, while DALBk and Icatibant prevented this increase. Antagonists did not interfere with paclitaxel's cytotoxic action in vitro. Thus, kinin B1 or B2 receptors can be a potential target for treating the pain caused by metastatic breast tumor and their antineoplastic therapy.
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Affiliation(s)
- Indiara Brusco
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil.
| | - Gabriela Becker
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Tais Vidal Palma
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Micheli Mainardi Pillat
- Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Rahisa Scussel
- Graduate Program in Health Sciences, University of Extreme South Catarinense, Criciuma, SC, Brazil
| | - Bethina Trevisol Steiner
- Graduate Program in Health Sciences, University of Extreme South Catarinense, Criciuma, SC, Brazil
| | - Tuane Bazanella Sampaio
- Graduate Program in Pharmacology, Department of Physiology and Pharmacology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Daniel Mendes Pereira Ardisson-Araújo
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
- Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Cinthia Melazzo de Andrade
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Mauro Schneider Oliveira
- Graduate Program in Pharmacology, Department of Physiology and Pharmacology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil.
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Rižner TL, Romano A. Targeting the formation of estrogens for treatment of hormone dependent diseases-current status. Front Pharmacol 2023; 14:1155558. [PMID: 37188267 PMCID: PMC10175629 DOI: 10.3389/fphar.2023.1155558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Local formation and action of estrogens have crucial roles in hormone dependent cancers and benign diseases like endometriosis. Drugs that are currently used for the treatment of these diseases act at the receptor and at the pre-receptor levels, targeting the local formation of estrogens. Since 1980s the local formation of estrogens has been targeted by inhibitors of aromatase that catalyses their formation from androgens. Steroidal and non-steroidal inhibitors have successfully been used to treat postmenopausal breast cancer and have also been evaluated in clinical studies in patients with endometrial, ovarian cancers and endometriosis. Over the past decade also inhibitors of sulfatase that catalyses the hydrolysis of inactive estrogen-sulfates entered clinical trials for treatment of breast, endometrial cancers and endometriosis, with clinical effects observed primarily in breast cancer. More recently, inhibitors of 17beta-hydroxysteroid dehydrogenase 1, an enzyme responsible for formation of the most potent estrogen, estradiol, have shown promising results in preclinical studies and have already entered clinical evaluation for endometriosis. This review aims to provide an overview of the current status of the use of hormonal drugs for the major hormone-dependent diseases. Further, it aims to explain the mechanisms behind the -sometimes- observed weak effects and low therapeutic efficacy of these drugs and the possibilities and the advantages of combined treatments targeting several enzymes in the local estrogen formation, or drugs acting with different therapeutic mechanisms.
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Affiliation(s)
- Tea Lanišnik Rižner
- Laboratory for Molecular Basis of Hormone-Dependent Diseases and Biomarkers, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Tea Lanišnik Rižner, ; Andrea Romano,
| | - Andrea Romano
- GROW Department of Gynaecology, Faculty of Health, Medicine and Life Sciences (FHML)/GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- *Correspondence: Tea Lanišnik Rižner, ; Andrea Romano,
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Translation and validation of the EORTC QLQ-BR45 among Ethiopian breast cancer patients. Sci Rep 2022; 12:605. [PMID: 35906247 PMCID: PMC9338022 DOI: 10.1038/s41598-021-02511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/15/2021] [Indexed: 12/09/2022] Open
Abstract
This study aimed to examine the validity and reliability of the EORTC QLQ-BR45 questionnaire among breast cancer patients in Ethiopia. This study included 248 breast cancer patients who completed the QLQ-BR45 and QLQ-C30 questionnaires. The internal reliability, test–retest reliability, and the content, concurrent, convergent, divergent, and clinical validity of the tool were examined. The statistical analyses included Cronbach’s α coefficient, Pearson’s correlation coefficient, standardised root mean square residual (SRMR), comparative fit index (CFI), t-test, and root mean square error of approximation (RMSEA). All items were marked as relevant, and item-level content validity index (I-CVI) scores ranged from 0.83 to 1. The S-CVI/Ave was calculated by dividing the sum of I-CVI values by the total number of items, which was found to be 0.94. The average CVR value was 0.76. The Cronbach’s α coefficient was 0.80 for all domains. All subscales met the minimal standards of reliability except the arm symptom scale (0.66). The test–retest reliability coefficient was 0.77 for all domains. Seven out of the 12 hypothesised scales showed positive correlations (r > 0.40) between the QLQ-BR45 and QLQ-C30 scales. Multitrait scaling analysis showed that the item-scale correlations exceeded the 0.40 criterion for item-convergent validity for 11 of the 12 hypothesised scales. The correlation coefficients between an item and its own subscale were significantly higher than with other subscales. The EORTC QLQ-BR45 had good reliability and validity, and it can be used to measure the quality of life of breast cancer patients in Ethiopia.
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Rubovszky G, Kocsis J, Boér K, Chilingirova N, Dank M, Kahán Z, Kaidarova D, Kövér E, Krakovská BV, Máhr K, Mriňáková B, Pikó B, Božović-Spasojević I, Horváth Z. Systemic Treatment of Breast Cancer. 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610383. [PMID: 35898593 PMCID: PMC9311257 DOI: 10.3389/pore.2022.1610383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified based on the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The professional guideline primarily reflects the resolutions and recommendations of the current ESMO, NCCN and ABC5, as well as that of the St. Gallen Consensus Conference statements. The recommendations cover classical prognostic factors and certain multigene tests, which play an important role in therapeutic decision-making. From a didactic point of view, the text first addresses early and then locally advanced breast cancer, followed by locoregionally recurrent and metastatic breast cancer. Within these, we discuss each group according to the available therapeutic options. At the end of the recommendations, we summarize the criteria for treatment in certain rare clinical situations.
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Affiliation(s)
- Gábor Rubovszky
- Department of Clinical Pharmacology, National Institute of Oncology, Chest and Abdominal Tumours Chemotherapy “B”, Budapest, Hungary,*Correspondence: Gábor Rubovszky,
| | - Judit Kocsis
- Center of Oncoradiology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Katalin Boér
- Department of Oncology, Szent Margit Hospital, Budapest, Hungary
| | - Nataliya Chilingirova
- Clinic Center of Excellence, Heart and Brain Hospital, Science and Research Institute, Medical University-Pleven, Pleven, Bulgaria
| | - Magdolna Dank
- Oncology Centre, Semmelweis University, Budapest, Hungary
| | | | | | - Erika Kövér
- Institute of Oncotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Bibiana Vertáková Krakovská
- 1st Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia,Medical Oncology Department, St. Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Károly Máhr
- Department of Oncology, Szent Rafael Hospital of Zala County, Zalaegerszeg, Hungary
| | - Bela Mriňáková
- 1st Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia,Medical Oncology Department, St. Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Béla Pikó
- County Oncology Centre, Pándy Kálmán Hospital of Békés County Council, Gyula, Hungary
| | | | - Zsolt Horváth
- Center of Oncoradiology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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Mohammed Alwan A, Tavakol Afshari J, Afzaljavan F. Significance of the Estrogen Hormone and Single Nucleotide Polymorphisms in the Progression of Breast Cancer among Female. ARCHIVES OF RAZI INSTITUTE 2022; 77:943-958. [PMID: 36618302 PMCID: PMC9759246 DOI: 10.22092/ari.2022.357629.2077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/16/2022] [Indexed: 01/10/2023]
Abstract
Breast cancer is one of the most frequent types of malignancies among women and is internationally recognized as the main reason for cancer-caused mortality. Most breast tumors are heterogeneous and genetically complicated due to the involvement of several genes. Therefore, it is clinically important to study genetic variants that increase the risk of breast cancer. It is identified that the presence of polymorphisms in genes encoding regulatory hormones is linked to a higher risk of breast cancer. Additionally, circulating estrogen levels are connected to aromatase (CYP19A1) genes, which is a recognized risk factor for breast cancer progression. In this paper, the authors present a review study on the effect of estrogen and its Single Nucleotide Polymorphisms (SNPs) in the occurrence of breast cancer. This review mainly aimed to find out the connection between CYP19A1 gene variations and the risk of breast cancer, as well as its clinical characteristics and prognosis. Due to the highly special activity of the CYP19A1 enzyme in steroid production, suppression of the targeted CYP19A1 is a focused medication for breast cancer patients, which has only minor adverse effects. Numerous clinical trials over the last decade have shown that Aromatase inhibitors (AIs) not only outperform tamoxifen in terms of effectiveness but also have a lower adverse effect profile. The AI is now widely accepted as a routine therapy option for postmenopausal females with Estrogen receptor-positive (ER+) breast cancer. Furthermore, not only dysregulation of gene expression in different genes related to distinguished pathways, such as estrogen metabolism, is essential in the progression of breast cancer but also particular SNPs can play an essential role in particular genes, such as CYP19A1. Different studies have demonstrated that these SNPs can be located in different sites of these genes, which are collected in this review. In a nutshell, more specific clinical trials are required to demonstrate the precise meditative role of anti-estrogen drugs in the treatment of ER+ breast cancer patients. Furthermore, more genotype analyses are needed to confirm the role of SNPs in the progression of breast cancer.
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Affiliation(s)
- A Mohammed Alwan
- Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
Department of Pathological Analysis Techniques, Advanced Research Center, Al-Kut University College, Kut, Iraq
| | - J Tavakol Afshari
- Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - F Afzaljavan
- Molecular Medicine Department, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
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Kaur R, Chaudhary G, Kaur A, Singh P, Longowal GD, Sapkale GP, Arora S. PROTACs: A Hope for Breast Cancer Patients? Anticancer Agents Med Chem 2021; 22:406-417. [PMID: 33687888 DOI: 10.2174/1871520621666210308100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/04/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast Cancer (BC) is the most widely recognized disease in women. A massive number of women are diagnosed with breast cancer and many lost their lives every year. Cancer is the subsequent driving reason for dying, giving rise to it one of the current medication's most prominent difficulties. OBJECTIVES The main objective of the study is to examine and explore novel therapy (PROTAC) and its effectiveness against breast cancer. METHODS The literature search was done across Medline, Cochrane, ScienceDirect, Wiley Online, Google Scholar, PubMed, Bentham Sciences from 2001 to 2020. The articles were collected; screened, segregated, and selected papers were included for writing the review article. RESULTS AND CONCLUSION A novel innovation emerged around two decades ago that has great potential to not only overcome the limitations but also can provide future direction for the treatment of many diseases which has presently not many therapeutic options available and regarded as incurable with traditional techniques; that innovation is called PROTAC (Proteolysis Targeting Chimera) and able to efficaciously ubiquitinate and debase cancer encouraging proteins by noncovalent interaction. PROTACs are constituted of two active regions isolated by a linker and equipped for eliminating explicit undesirable protein. It is empowering greater sensitivity to "drug-resistant targets" as well as a more prominent opportunity to influence non-enzymatic function. PROTACs have been demonstrated to show better target selectivity contrasted with traditional small-molecule inhibitors. So far, the most investigation into PROTACs possesses particularly concentrated on applications to cancer treatment including breast cancer, the treatment of different ailments may profit from this blossoming innovation.
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Affiliation(s)
- Rajwinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Gaurav Chaudhary
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Amritpal Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Pargat Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | | | - Gayatri P Sapkale
- Fortis Flt. Lt. Rajan Dhall Hospital, Aruna Asaf Ali Marg, Pocket 1, Sector B, Vasant Kunj, New Delhi-110070. India
| | - Sandeep Arora
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
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Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management. Front Endocrinol (Lausanne) 2021; 12:713700. [PMID: 34385978 PMCID: PMC8353230 DOI: 10.3389/fendo.2021.713700] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/31/2022] Open
Abstract
Aromatase inhibitors (AIs) are a key component in the chemoprevention and treatment of hormone receptor-positive (HR+) breast cancer. While the addition of AI therapy has improved cancer-related outcomes in the management of HR+ breast cancer, AIs are associated with musculoskeletal adverse effects known as the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) that limit its tolerability and use. AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence. The pathophysiology of AIMSS is not fully understood though has been proposed to be related to estrogen deprivation within the musculoskeletal and nervous systems. This review aims to characterize the prevalence, risk factors, and clinical features of AIMSS, and explore the syndrome's underlying mechanisms and management strategies.
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Affiliation(s)
- Tara Hyder
- University of Pittsburgh Physicians, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Marino
- Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Sasha Ahmad
- Department of Sciences, Sewickley Academy, Pittsburgh, PA, United States
| | - Azadeh Nasrazadani
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
| | - Adam M Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
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Schneeweiss A, Bauerfeind I, Fehm T, Janni W, Thomssen C, Witzel I, Wöckel A, Müller V. Therapy Algorithms for the Diagnosis and Treatment of Patients with Early and Advanced Breast Cancer. Breast Care (Basel) 2020; 15:608-618. [PMID: 33447235 DOI: 10.1159/000511925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background In order to offer optimal treatment approaches based on available evidence, the Commission Breast of the Working Group Gynecologic Oncology (AGO) of the German Cancer Society developed therapy algorithms for eight complex treatment situations in primary and advanced breast cancer. Summary Therapy algorithms for the following complex treatment situations are outlined in this paper: (neo)adjuvant therapy of human epidermal growth factor receptor 2 (HER2)-positive breast cancer; axillary surgery and neoadjuvant chemotherapy; adjuvant endocrine therapy in premenopausal patients; adjuvant endocrine therapy in postmenopausal patients; hormone receptor (HR)-positive/HER2-negative metastatic breast cancer: strategies; HR-positive/HER2-negative metastatic breast cancer: endocrine-based first-line treatment; HER2-positive metastatic breast cancer: first to third-line; metastatic triple-negative breast cancer. Key Messages The therapy options shown in these algorithms are based on the current AGO recommendations updated in January 2020 but cannot represent all evidence-based treatment options. Prior therapies, performance status, comorbidities, patient preference, etc. must be taken into account for the actual treatment choice. Therefore, in individual cases, other evidence-based treatment options not listed here may also be appropriate and justified.
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Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital, Düsseldorf, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynecology and Obstetrics, University Hospital, Halle, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital, Würzburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Elliott MJ, Ennis M, Pritchard KI, Townsley C, Warr D, Elser C, Amir E, Bedard PL, Rao L, Stambolic V, Sridhar S, Goodwin PJ, Cescon DW. Association between BMI, vitamin D, and estrogen levels in postmenopausal women using adjuvant letrozole: a prospective study. NPJ Breast Cancer 2020; 6:22. [PMID: 32566743 PMCID: PMC7293309 DOI: 10.1038/s41523-020-0166-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Studies have suggested that women with elevated BMI or 25-OH vitamin D levels may derive less benefit from AIs versus tamoxifen. We prospectively investigated whether high BMI or 25-OH vitamin D levels were associated with higher estrogen levels in post-menopausal women receiving standard adjuvant letrozole (2.5 mg/day). Furthermore, we evaluated whether an increased dose of letrozole resulted in lower serum estrogens in women with BMI > 25 kg/m2. Correlation between entry BMI and day 29 serum biomarkers (estrogens, 25-OH vitamin D, insulin, CRP, leptin) was assessed in all patients. On day 29, participants with BMI > 25 kg/m2 switched to letrozole 5 mg/day for 4-weeks and blood was drawn upon completion of the study. The change in serum estrogen levels was assessed in these patients (BMI > 25 kg/m2). 112 patients completed days 1-28. The Pearson correlations of estradiol and estrone with BMI or serum 25-OH vitamin D levels were near zero (-0.04 to 0.07, p = 0.48-0.69). Similar results were obtained for correlation with markers of obesity (insulin, CRP, and leptin) with estradiol and estrone (-0.15 to 0.12; p = 0.11-0.82). Thirty-one patients (BMI > 25 kg/m2) completed the interventional component; Increasing the dose of letrozole did not further reduce estradiol or estrone levels (change 0.1 and 0.4 pmol/L respectively; p = 0.74 and 0.36). There was no observed association between markers of obesity (BMI, insulin, leptin, and CRP), serum 25-OH vitamin D levels and estradiol or estrone levels. Additionally, an increased dose of letrozole did not further reduce estradiol or estrone levels compared to the standard dose.
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Affiliation(s)
- Mitchell J. Elliott
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Kathleen I. Pritchard
- University of Toronto, Toronto, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Canada
| | | | - Dave Warr
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Christine Elser
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Canada
| | - Eitan Amir
- University of Toronto, Toronto, Canada
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Canada
| | - Philippe L. Bedard
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Lakshmi Rao
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Canada
| | - Vuk Stambolic
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Srikala Sridhar
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Pamela J. Goodwin
- Princess Margaret Cancer Centre, Toronto, Canada
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Canada
- Lunenfeld Tanenbaum Research Institute, Mt. Sinai Hospital, Toronto, Canada
| | - David W. Cescon
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
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Shimoi T, Nagai SE, Yoshinami T, Takahashi M, Arioka H, Ishihara M, Kikawa Y, Koizumi K, Kondo N, Sagara Y, Takada M, Takano T, Tsurutani J, Naito Y, Nakamura R, Hattori M, Hara F, Hayashi N, Mizuno T, Miyashita M, Yamashita N, Yamanaka T, Saji S, Iwata H, Toyama T. The Japanese Breast Cancer Society Clinical Practice Guidelines for systemic treatment of breast cancer, 2018 edition. Breast Cancer 2020; 27:322-331. [PMID: 32240526 PMCID: PMC8062371 DOI: 10.1007/s12282-020-01085-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/26/2020] [Indexed: 11/06/2022]
Abstract
Purpose We present the English version of The Japanese Breast Cancer Society (JBCS) Clinical Practice Guidelines for systemic treatment of breast cancer, 2018 edition. Methods The JBCS formed a task force to update the JBCS Clinical Practice Guidelines, 2015 edition, according to Minds Handbook for Clinical Practice Guideline Development 2014. First, we set multiple outcomes for each clinical question (CQ). Next, quantitative or qualitative systematic review was conducted for each of the multiple outcomes, and the strength of recommendation for the CQ was taken into consideration during meetings, with the aim of finding a balance between benefit and harm. Finalized recommendations from each session were confirmed through discussion and voting at the recommendation decision meeting. Results The recommendations, the strength of recommendation and the strength of evidence were determined based on systemic literature reviews and the meta-analyses for each CQ. Conclusion The JBCS updated the Clinical Practice Guidelines for systemic treatment of breast cancer. Electronic supplementary material The online version of this article (10.1007/s12282-020-01085-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tatsunori Shimoi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji,, Chuo-ku, Tokyo, 104-0045, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Shigenori E Nagai
- Department of Breast Oncology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Tetsuhiro Yoshinami
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, 2-2-E 10 Yamadaoka, Suita, Osaka, 565-0871, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Masato Takahashi
- Department of Breast Surgery, NHO Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Hitoshi Arioka
- Department of Medical Oncology, Yokohama Rosai Hospital, 3211 Kozukue, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Mikiya Ishihara
- Department of Medical Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Kei Koizumi
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Hakuaikai Social Cooperation, Sagara Hospital, 3-31 Matsubara-cho, Kagoshima, 892-0098, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Junji Tsurutani
- Department of Medical Oncology, Advanced Cancer Translational Research Institute, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Yoichi Naito
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Rikiya Nakamura
- Department of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Chiba, 280-8717, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Fimikata Hara
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Toshiro Mizuno
- Department of Medical Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Nami Yamashita
- Department of Surgery and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Takashi Yamanaka
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Ashahi-ku, Yokohama, 241-8515, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. .,The Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer Panel Membership, Tokyo, Japan.
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12
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Optimizing expectations about endocrine treatment for breast cancer: Results of the randomized controlled psy-breast trial. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2695. [DOI: 10.32872/cpe.v2i1.2695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background
Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients’ expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
Method
In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Results
Both interventions were well accepted and feasible. Patients’ necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Conclusion
Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.
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13
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First-line endocrine therapy for postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer: a systematic review and meta-analysis. Breast Cancer 2020; 27:340-346. [PMID: 32043218 PMCID: PMC7196086 DOI: 10.1007/s12282-020-01054-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/22/2020] [Indexed: 12/24/2022]
Abstract
Background In establishing the 2018 Breast Cancer Practice Guidelines of the Japan Breast Cancer Society, we explored the optimal first-line endocrine therapy for advanced postmenopausal hormone receptor-positive breast cancer. Methods We performed a systematic review of relevant reports from randomized-controlled studies published prior to November 2016 found using medical journal search engines. The main outcomes which we evaluated were progression-free survival (PFS), objective response rate (ORR), disease control rate (CBR), and toxicity. Results Four controlled trials comparing aromatase inhibitors (AI) and cyclin-dependent kinase (CDK)4/6 inhibitor combination therapy to AI monotherapy, and two controlled trials comparing anastrozole to fulvestrant 500 mg were analyzed. AI/CDK4/6 inhibitor combination therapy significantly improved PFS (Risk Ratio: 0.67, 95%CI 0.60–0.73), increased ORR (Risk Difference: 0.11, 95% CI 0.07–0.16), and increased CBR (Risk Difference: 0.11, 95% CI 0.07–0.15), compared with AI monotherapy. Patients who received this combination therapy had a higher grade ≥ 3 adverse event rate more than those who received AI monotherapy (Risk Difference: 43%, 95%CI: 0.39–0.47). Fulvestrant 500 mg alone significantly improved PFS (risk ratio: 0.85, 95%CI 0.72–0.98), but ORR and CBR were similar to those of anastrozole alone. Conclusion In the first-line treatment for advanced postmenopausal hormone receptor-positive breast cancer, a combination therapy of CDK4/6 inhibitors and AI showed significant improvement of PFS, ORR, and CBR but with significant increased toxicities compared with AI alone. Fulvestrant 500 mg monotherapy significantly prolonged PFS compared with AI monotherapy. We must wait for the results of the studies with longer follow-up period.
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14
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Abstract
Links between autoimmune rheumatic diseases and cancer continue to be elucidated. In this review, we explore this complex, bidirectional relationship. First, the increased risk of cancer across the breadth of the autoimmune rheumatic diseases is described. The magnitude of risk and types of tumors seen can differ by the type of autoimmune disease, timing of disease course, and even clinical and laboratory features within a particular autoimmune disease, suggesting that targeted cancer screening strategies can be considered. Multiple mechanisms linking autoimmune rheumatic diseases and cancer are discussed, including the development of autoimmunity in the context of naturally occurring anti-tumor immune responses and malignancy arising in the context of inflammation and damage from autoimmunity. Immunosuppression for rheumatic disease can increase risk for certain types of cancers. Finally, immune checkpoint inhibitors, a type of cancer immunotherapy, which cause a variety of inflammatory syndromes of importance to rheumatologists, are reviewed.
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Affiliation(s)
- Laura C Cappelli
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Arthritis Center, Baltimore, MD, 21224, USA.
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
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15
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Caswell-Jin JL, Plevritis SK, Tian L, Cadham CJ, Xu C, Stout NK, Sledge GW, Mandelblatt JS, Kurian AW. Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr 2018; 2:pky062. [PMID: 30627694 PMCID: PMC6305243 DOI: 10.1093/jncics/pky062] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/22/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022] Open
Abstract
Background Metastatic breast cancer (MBC) treatment has changed substantially over time, but we do not know whether survival post-metastasis has improved at the population level. Methods We searched for studies of MBC patients that reported survival after metastasis in at least two time periods between 1970 and the present. We used meta-regression models to test for survival improvement over time in four disease groups: recurrent, recurrent estrogen (ER)-positive, recurrent ER-negative, and de novo stage IV. We performed sensitivity analyses based on bias in some studies that could lead earlier cohorts to include more aggressive cancers. Results There were 15 studies of recurrent MBC (N = 18 678 patients; 3073 ER-positive and 1239 ER-negative); meta-regression showed no survival improvement among patients recurring between 1980 and 1990, but median survival increased from 21 (95% confidence interval [CI] = 18 to 25) months to 38 (95% CI = 31 to 47) months from 1990 to 2010. For ER-positive MBC patients, median survival increased during 1990–2010 from 32 (95% CI = 23 to 43) to 57 (95% CI = 37 to 87) months, and for ER-negative MBC patients from 14 (95% CI = 11 to 19) to 33 (95% CI = 21 to 51) months. Among eight studies (N = 35 831) of de novo stage IV MBC, median survival increased during 1990–2010 from 20 (95% CI = 16 to 24) to 31 (95% CI = 24 to 39) months. Results did not change in sensitivity analyses. Conclusion By bridging studies over time, we demonstrated improvements in survival for recurrent and de novo stage IV MBC overall and across ER-defined subtypes since 1990. These results can inform patient-doctor discussions about MBC prognosis and therapy.
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Affiliation(s)
| | - Sylvia K Plevritis
- Department of Biomedical Data Science, Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Christopher J Cadham
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Washington, DC
| | - Cong Xu
- Department of Biomedical Data Science, Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Natasha K Stout
- Department of Population Health, Harvard Pilgrim Health Care, Boston, MA
| | - George W Sledge
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Washington, DC
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
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16
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Gul A, Leyland-Jones B, Dey N, De P. A combination of the PI3K pathway inhibitor plus cell cycle pathway inhibitor to combat endocrine resistance in hormone receptor-positive breast cancer: a genomic algorithm-based treatment approach. Am J Cancer Res 2018; 8:2359-2376. [PMID: 30662797 PMCID: PMC6325472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023] Open
Abstract
Cyclin-dependent kinase 4 (CDK4) and CDK6 together with D-type cyclins (D1, D2 and D3) to promote cell cycle entry and progression through G1 by inactivating retinoblastoma protein (RB) by inhibiting an INK4 family of CDK inhibitors (CDKN2A/B). Selective cyclin-dependent kinase inhibitors are game changers in the clinical management of hormone receptor-positive/HER2-negative advanced breast cancers. There are currently three CDK4/6 inhibitors that have been approved by the US Food and Drug administration: palbociclib, ribociclib, and abemaciclib. Although, the bulk of the data supporting the use of selective CDK4/6 inhibitors is currently in breast cancer patients with other tumor types are expected to benefit as well from this class of agents, which can counter proliferative signaling pathways and arrest cell cycle in early G1 phase. Areas of active interest include identifying predictive biomarkers for CDK4/6 inhibitors, deciding whether to continue CDK4/6 inhibitor after disease progression, creating novel treatment combinations and expanding the use of CDK4/6 inhibitors beyond hormone receptor-positive/HER2-negative advanced breast cancer. Right now, CCND1 amplification and CDKN2A/B loss have not sorted out biomarkers useful for the purpose. One of the most important clinical questions is how to use a CDK4/6 inhibitor with other targeted therapies. Here we provide a rationale that oncologists can use to sequence the CDK4/6 inhibitors along with the PI3K-AKT-mTOR pathway-specific inhibitor(s); future data will better guide this approach. In this review we have tried to (a) describe the specific cellular signals initiated following alterations in the cell cycle pathway genes and the PI3K pathway genes, (b) interrogate how these alterations/co-alterations influence the action of PI3K and cell cycle pathway-targeted drugs in different clinical trials and (c) understand the role of co-alterations towards the development of cell cycle inhibitors induced drug-resistance in ER+ breast cancers.
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Affiliation(s)
- Anita Gul
- VA Medical CenterSioux Falls, SD, USA
- Department of Internal Medicine, SSOM, University of South DakotaSD, USA
| | - Brain Leyland-Jones
- Department of Molecular and Experimental Medicine, Avera Cancer InstituteSioux Falls, SD, USA
| | - Nandini Dey
- Department of Molecular and Experimental Medicine, Avera Cancer InstituteSioux Falls, SD, USA
- Department of Internal Medicine, SSOM, University of South DakotaSD, USA
| | - Pradip De
- Department of Molecular and Experimental Medicine, Avera Cancer InstituteSioux Falls, SD, USA
- Department of Internal Medicine, SSOM, University of South DakotaSD, USA
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17
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Xia D, Wang H, Wang R, Liu C, Xu J. High-dose fulvestrant as third-line endocrine therapy for breast cancer metastasis to the left kidney: A case report and literature review. Medicine (Baltimore) 2018; 97:e11115. [PMID: 29901634 PMCID: PMC6023661 DOI: 10.1097/md.0000000000011115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Endocrine therapy plays an important role in the treatment of patients with hormone receptor-positive breast cancer. Renal metastasis of breast cancer is rare in clinical practice. PATIENT CONCERNS We present here a 54-year-old woman with breast cancer after first line chemotherapy and second line endocrinotherapy (i.e., toremifene & exemestane) failure. DIAGNOSES The patient was rarely diagnosed breast cancer metastasis to the kidney and a positive hormone status (ER and PR) but was negative for human epidermal factor receptor 2 (HER2). INTERVENTIONS The patient was treated with a high dose of fulvestrant (SERD; 500 mg) by intramuscular injection once per month. OUTCOMES The patient's condition significantly improved as measured by a decrease in the renal and pulmonary masses; symptoms including dry cough and blood phlegm also improved. LESSONS Endocrinotherapy with high-dose fulvestrant may provide benefits for patients with HR+/HER2- advanced breast cancer with renal metastasis after SERMs failure.
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18
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Abbasalizadeh F, Sahhaf F, Sadeghi-Shabestari P, Mirza-Aghazadeh-Attari M, Naghavi-Behzad M. Comparison Between Effect of Letrozole Plus Misoprostol and Misoprostol Alone in Terminating Non-Viable First Trimester Pregnancies: A Single Blind Randomized Trial. J Family Reprod Health 2018; 12:27-33. [PMID: 30647756 PMCID: PMC6329994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective: To evaluate the effect of letrozole plus misoprostol to terminate non-viable pregnancies in first trimester compared with the use of misoprostol alone. Materials and methods: In a single-blind clinical trial, 128 women over 18 years old referred to Educational-Medical centers of Tabriz University of Medical Science (Tabriz, Iran), for abortion in first trimester of non-viable pregnancies, were randomly selected in two intervention and control groups using Rand list (version 1.2) software. To complete abortion both groups received 600 mcg of misoprostolorally. The intervention group received letrozole 10 mg daily for 3 days before receiving misoprostolorally. Complete abortion rate and the side effects of both groups were recorded. Results: Mean pregnancy age based on LMP in intervention group and control group were 7.74 ± 0.95 and 8.52 ± 1.29 weeks respectively. Complete abortion rate in the intervention group was 93.7%, and in control group was 68.7% which was significantly higher in intervention group (p = 0.001). Abdominal pain in the intervention group is also significantly lower than that of the control group (p = 0.013). Intervention group also had significantly lower duration of bleeding rather than control group (p = 0.006). Conclusion: Based on the findings of this study, letrozole pretreatment with misoprostol for first-trimester medical abortion can increase complete abortion rate significantly without increasing side effects compared to use of misoprostol alone.
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Affiliation(s)
- Fatemeh Abbasalizadeh
- Department of Gynecology and Obstetrics, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farnaz Sahhaf
- Department of Gynecology and Obstetrics, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Paria Sadeghi-Shabestari
- Department of Gynecology and Obstetrics, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Mirza-Aghazadeh-Attari
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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19
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Abstract
Precision medicine in oncology focuses on identifying which therapies are most effective for each patient based on genetic characterization of the cancer. Traditional chemotherapy is cytotoxic and destroys all cells that are rapidly dividing. The foundation of precision medicine is targeted therapies and selecting patients who will benefit most from these therapies. One of the newest aspects of precision medicine is liquid biopsy. A liquid biopsy includes analysis of circulating tumor cells, cell-free nucleic acid, or exosomes obtained from a peripheral blood draw. These can be studied individually or in combination and collected serially, providing real-time information as a patient's cancer changes.
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20
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Hachim IY, Villatoro M, Canaff L, Hachim MY, Boudreault J, Haiub H, Ali S, Lebrun JJ. Transforming Growth Factor-beta Regulation of Ephrin Type-A Receptor 4 Signaling in Breast Cancer Cellular Migration. Sci Rep 2017; 7:14976. [PMID: 29101386 PMCID: PMC5670207 DOI: 10.1038/s41598-017-14549-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/11/2017] [Indexed: 12/16/2022] Open
Abstract
Breast cancer consists of a range of tumor subtypes with different clinical characteristics, disease prognosis, and treatment-response. Luminal breast cancer has the best prognosis while basal-like breast cancer (BLBC) represents the worst subtype. Transforming growth factor-beta (TGFβ) plays a prominent role in stimulating the migration and invasion of malignant breast cancer cells contributing to tumor progression. In this study, we identified the Ephrin type-A receptor 4 (EPHA4) as a novel target of TGFβ in breast cancer. Moreover, we show that TGFβ induction of EPHA4 gene expression is specific to basal-like tumors and is required for TGFβ-mediated cell migration. We further addressed the mechanism and found EPHA4 to be required for TGFβ-mediated cell migration in breast cancer through TGFβ-induced short term and long term activation of RhoGTPases. Finally, our data revealed a strong association between high EPHA4 expression and advanced tumor stage, aggressive BLBC molecular subtype and poor prognosis. Importantly, we found significant co-expression of EPHA4 and the TGFβ receptor type-2 (TGFβR2) in breast cancer subtypes associated with increased tumor relapse and drug resistance. Together, this study highlight the important role of the TGFβ/EPHA4 signaling axis in mediating tumor aggressiveness and poor patient survival in human breast cancer.
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Affiliation(s)
- Ibrahim Y. Hachim
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
| | - Manuel Villatoro
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
| | - Lucie Canaff
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
| | - Mahmood Y. Hachim
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada ,grid.412789.10000 0004 4686 5317Sharjah Institute for Medical Research, University of, Sharjah, UAE
| | - Julien Boudreault
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
| | - Halema Haiub
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
| | - Suhad Ali
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
| | - Jean-Jacques Lebrun
- 0000 0000 9064 4811grid.63984.30Department of Medicine, McGill University Health Center, Cancer Research Program, Montreal, QC H4A 3J1 Canada
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21
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Zhang J, Huang Y, Wang C, He Y, Zheng S, Wu K. Efficacy and safety of endocrine monotherapy as first-line treatment for hormone-sensitive advanced breast cancer: A network meta-analysis. Medicine (Baltimore) 2017; 96:e7846. [PMID: 28816986 PMCID: PMC5571723 DOI: 10.1097/md.0000000000007846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/02/2017] [Accepted: 08/01/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Endocrine therapy was recommended as the preferred first-line treatment for hormone receptor-positive (HR+, i.e., ER+ and/or PgR+), human epidermal growth factor receptor-2-negative (HER2-) postmenopausal advanced breast cancer (ABC), but which endocrine monotherapy is optimal lacks consensus. We aimed to identify the optimal endocrine monotherapy with a network meta-analysis. METHODS We performed a network meta-analysis for a comprehensive analysis of 6 first-line endocrine monotherapies (letrozole, anastrozole, exemestane, tamoxifen, fulvestrant 250 mg and 500 mg) for HR+ HER2- metastatic or locally advanced breast cancer in postmenopausal patients. The main outcomes were objective response rate (ORR), time to progression (TTP), and progression-free survival (PFS). Secondary outcomes were adverse events. RESULTS We identified 27 articles of 8 randomized controlled trials including 3492 patients in the network meta-analysis. For ORR, the treatments ranked in descending order of effectiveness were letrozole > exemestane > anastrozole > fulvestrant 500 mg > tamoxifen > fulvestrant 250 mg. For TTP/PFS, the order was fulvestrant 500 mg > letrozole > anastrozole > exemestane > tamoxifen > fulvestrant 250 mg. We directly compared adverse events and found that tamoxifen produced more hot flash events than fulvestrant 250 mg. CONCLUSIONS Fulvestrant 500 mg and letrozole might be optimal first-line endocrine monotherapy choices for HR+ HER2- ABC because of efficacious ORR and TTP/PFS, with a favorable tolerability profile. However, direct comparisons among endocrine monotherapies in the first-line therapy setting are still required to robustly demonstrate any differences among these endocrine agents. Clinical choices should also depend on the specific disease situation and duration of endocrine therapy.
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Affiliation(s)
- Jingwen Zhang
- Department of Preventive Medicine, Shantou University Medical College, Xinling Road
- Department of Non-communicable Disease Control and Prevention, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yanhong Huang
- Mental Health Center, Shantou University Medical College, North Taishan Road, Shantou
| | - Changyi Wang
- Department of Non-communicable Disease Control and Prevention, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yuanfang He
- Department of Preventive Medicine, Shantou University Medical College, Xinling Road
| | - Shukai Zheng
- Department of Preventive Medicine, Shantou University Medical College, Xinling Road
| | - Kusheng Wu
- Department of Preventive Medicine, Shantou University Medical College, Xinling Road
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22
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Hölzel D, Eckel R, Bauerfeind I, Baier B, Beck T, Braun M, Ettl J, Hamann U, Kiechle M, Mahner S, Schindlbeck C, de Waal J, Harbeck N, Engel J. Improved systemic treatment for early breast cancer improves cure rates, modifies metastatic pattern and shortens post-metastatic survival: 35-year results from the Munich Cancer Registry. J Cancer Res Clin Oncol 2017; 143:1701-1712. [PMID: 28429102 DOI: 10.1007/s00432-017-2428-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Systemic therapies (ATHs) in early breast cancer have improved the survival of breast cancer (BC) patients in recent decades. The magnitude of the changes in overall, metastasis-free (MFS) and post-metastatic (PMS) survival and in the metastasis (MET) pattern will be described. PATIENT AND METHODS We analysed 60,227 patients with a diagnosis of T-N-M0 BC between 1978 and 2013 and 11,983 patients with metastases (MET) in the Munich Cancer Registry. Patients will be divided into four time periods to identify relationships between BC and METs. Survival was estimated using Kaplan-Meier curves, and Cox proportional hazards models were used to explore the impact of the BC subtype and MET status on survival with the time periods as surrogate markers for ATH evolution. RESULTS During the observation period, 5-year relative survival has improved from 80.3 to 93.6% with an adjusted hazard ratio of 0.54 (P < 0.0001). Successful implementation of ATH has changed the MET pattern. The percentage of liver and CNS METs has more than doubled, the rate of lung METs remains stable, and the rate of bone METs has been reduced by approximately 50%. MFS has been prolonged with a hazard ratio 0.75 (P < 0.0001), but PMS has declined (hazard ratio 1.36; P < 0.0001); however, effects of adjuvant and palliative treatments cannot be separated. These results do not contradict improvements in advanced BC and do not suggest alterations of MET tumour biology by ATH. CONCLUSIONS Over the past three decades, ATHs have dramatically improved patient survival after BC diagnosis-most likely, by eradicating prevalent micro-METs; as a result, the MET pattern has changed. Eradicating only a portion of the first METs results in delaying the onset of subsequent MET, which leads to an apparently paradoxical effect: an extension of the MET-free interval and a reduction in PMS.
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Affiliation(s)
- Dieter Hölzel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany
| | - Renate Eckel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany
| | - Ingo Bauerfeind
- Head of the Breast Cancer Project Group of the Munich Tumour Centre (TZM) and of Department of Obstetrics and Gynaecology, Klinikum Landshut, Landshut, Germany
| | - Bernd Baier
- Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany
| | - Thomas Beck
- Department of Obstetrics and Gynaecology, Klinikum Rosenheim, Rosenheim, Germany
| | - Michael Braun
- Department of Gynaecology, Rotkreuzklinikum, Munich, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Ulrich Hamann
- Department of Gynaecology, Rotkreuzklinikum, Munich, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | - Johann de Waal
- Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany
| | - Nadia Harbeck
- Breast Centre, Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany.
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23
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Teven C, Schmid D, Sisco M, Ward J, Howard M. Systemic Therapy for Early-Stage Breast Cancer: What the Plastic Surgeon Should Know. EPLASTY 2017; 17:e7. [PMID: 28293332 PMCID: PMC5329939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: We review the types, indications, and common regimens of systemic forms of therapy offered in early-stage breast cancer. We further detail the mechanism of action, approved uses, major toxicities, and relevance to breast reconstruction of specific agents. Methods: A review of the literature on PubMed and Cochrane databases was undertaken to define the indications and common regimens of systemic therapy in early-stage breast cancer. In addition, literature describing relevant information regarding specific systemic agents was reviewed. Results: The main objectives of systemic therapy, when provided in the perioperative setting, are to reduce the risk for future recurrence and prolong overall survival. Systemic forms of therapy consist of chemotherapy, hormonal therapy, and targeted therapy and are increasingly being offered to women with early-stage breast cancer. Similarly, as more women are diagnosed with disease that is amenable to surgical extirpation, rates of breast reconstruction are on the rise. Many agents have effects that may impact patient safety with respect to breast reconstruction. Conclusions: Increasingly, women with breast cancer receive 1 or more forms of systemic therapy during the course of their treatment. It is therefore of significant importance that plastic surgeons have a clear understanding of the issues surrounding the use of systemic agents.
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Affiliation(s)
- Chad M. Teven
- Section of Plastic and Reconstructive Surgery, The University of Chicago Medicine, Chicago, Ill
| | | | - Mark Sisco
- Divisions of Plastic and Reconstructive Surgery
| | - James Ward
- Hematology/Oncology, NorthShore University Health System, Evanston, Ill
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24
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Cotargeting of CYP-19 (aromatase) and emerging, pivotal signalling pathways in metastatic breast cancer. Br J Cancer 2016; 116:10-20. [PMID: 27923036 PMCID: PMC5220158 DOI: 10.1038/bjc.2016.405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/28/2016] [Accepted: 11/08/2016] [Indexed: 01/08/2023] Open
Abstract
Aromatase inhibition is one of the cornerstones of modern endocrine therapy of oestrogen receptor-positive (ER+) metastatic breast cancer (MBC). The nonsteroidal aromatase inhibitors anastrozole and letrozole, as well as the steroidal aromatase inactivator exemestane, are the preferred drugs and established worldwide in all clinical phases of the disease. However, although many patients suffering from MBC experience an initial stabilisation of their metastatic burden, drug resistance and disease progression occur frequently, following in general only a few months on treatment. Extensive translational research during the past two decades has elucidated the major pathways contributing to endocrine resistance and paved the way for clinical studies investigating the efficacy of novel drug combinations involving aromatase inhibitors and emerging drugable targets like mTOR, PI3K and CDK4/6. The present review summarises the basic research that provided the rationale for new drug combinations involving aromatase inhibitors and the main findings of pivotal clinical trials that have already started to change our way to treat hormone-sensitive MBC. The challenging situation of oestrogen receptor-positive and human epidermal growth factor receptor 2-positive (HER2+) MBC is also shortly reviewed to underline the complexity of the clinical scenario in the heterogeneous subgroups of hormone receptor-positive breast cancer patients and the increasing need for personalised medicine. Finally, we summarise some of the promising findings made with the combination of aromatase inhibitors with other potent endocrine treatment options like fulvestrant, a selective oestrogen receptor downregulator.
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25
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Beom SH, Oh J, Kim TY, Lee KH, Yang Y, Suh KJ, Moon HG, Han SW, Oh DY, Han W, Kim TY, Noh DY, Im SA. Efficacy of Letrozole as First-Line Treatment of Postmenopausal Women with Hormone Receptor-Positive Metastatic Breast Cancer in Korea. Cancer Res Treat 2016; 49:454-463. [PMID: 27554482 PMCID: PMC5398408 DOI: 10.4143/crt.2016.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/27/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose Letrozole showed efficacy and generally favorable toxicities, along with the convenience of oral administration in postmenopausal patients with hormone receptor (HR)–positive metastatic breast cancer (MBC). To the best of our knowledge, there have been no reports of the clinical outcomes in Korean patients, although letrozole is widely used in practice. Therefore, this studywas conducted to affirm the efficacy and toxicities of letrozole in Korean patients. Materials and Methods This study retrospectively analyzed 84 HR-positive MBC patients who had been treated with letrozole from January 2001 to December 2012. Clinicopathological characteristics and treatment history were extracted from medicalrecords. All patients received 2.5 mg letrozole once a day until there were disease progressions or unacceptable toxicity. Progression-free survival (PFS) was the primary endpoint, and secondary endpoints were overall survival (OS), objective response rate (ORR), and toxicity. Results The median age of the subjects was 59.3 years. Letrozole treatment resulted in a median PFS of 16.8 months (95% confidence interval [CI], 9.8 to 23.8) and a median OS of 56.4 months (95% CI, 38.1 to 74.7). The ORR was 36.9% for the 84 patients with measurable lesions. Multivariate analysis revealed symptomatic visceral disease (hazard ratio, 3.437; 95% CI, 1.576 to 7.495; p=0.002) and a disease-free interval ≤ 2 years (hazard ratio, 2.697; 95% CI, 1.262 to 5.762; p=0.010) were independently associated with shorter PFS. However, sensitivity to adjuvant hormone treatment was not related to PFS. Letrozole was generally well tolerated. Conclusion Letrozole showed considerable efficacy and tolerability as a first-line treatment in postmenopausal patients with HR-positive MBC.
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Affiliation(s)
- Seung Hoon Beom
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jisu Oh
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yaewon Yang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Koung Jin Suh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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26
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Kümler I, Knoop AS, Jessing CAR, Ejlertsen B, Nielsen DL. Review of hormone-based treatments in postmenopausal patients with advanced breast cancer focusing on aromatase inhibitors and fulvestrant. ESMO Open 2016; 1:e000062. [PMID: 27843622 PMCID: PMC5070302 DOI: 10.1136/esmoopen-2016-000062] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/14/2022] Open
Abstract
Background Endocrine therapy constitutes a central modality in the treatment of oestrogen receptor (ER)-positive advanced breast cancer. Purpose To evaluate the evidence for endocrine treatment in postmenopausal patients with advanced breast cancer focusing on the aromatase inhibitors, letrozole, anastrozole, exemestane and fulvestrant. Methods A review was carried out using PubMed. Randomised phase II and III trials reporting on ≥100 patients were included. Results 35 trials met the inclusion criteria. If not used in the adjuvant setting, a non-steroid aromatase inhibitor was the optimal first-line option. In general, the efficacy of the different aromatase inhibitors and fulvestrant was similar in tamoxifen-refractory patients. A randomised phase II trial of palbociclib plus letrozole versus letrozole alone showed significantly increased progression-free survival (PFS) when compared with endocrine therapy alone in the first-line setting (20.2 vs 10.2 months). Furthermore, the addition of everolimus to exemestane in the Breast Cancer Trials of OraL EveROlimus-2 (BOLERO-2) study resulted in an extension of median PFS by 4.5 months after recurrence/progression on a non-steroid aromatase inhibitor. However, overall survival was not significantly increased. Conclusion Conventional treatment with an aromatase inhibitor or fulvestrant may be an adequate treatment option for most patients with hormone receptor-positive advanced breast cancer. Mammalian target of rapamycin (mTOR) inhibition and cyclin-dependent kinase 4/6 (CDK4/6) inhibition might represent substantial advances for selected patients in some specific settings. However, there is an urgent need for prospective biomarker-driven trials to identify patients for whom these treatments are cost-effective.
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Affiliation(s)
- Iben Kümler
- Department of Oncology , Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Ann S Knoop
- Department of Oncology , Finsen Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Christina A R Jessing
- Department of Oncology , Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Bent Ejlertsen
- Department of Oncology , Finsen Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Dorte L Nielsen
- Department of Oncology , Herlev Hospital, University of Copenhagen , Herlev , Denmark
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27
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Gradishar WJ. Treatment challenges for community oncologists treating postmenopausal women with endocrine-resistant, hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer. Cancer Manag Res 2016; 8:85-94. [PMID: 27468248 PMCID: PMC4946864 DOI: 10.2147/cmar.s98249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Community-based oncologists are faced with challenges and opportunities when delivering quality patient care, including high patient volumes and diminished resources; however, there may be the potential to deliver increased patient education and subsequently improve outcomes. This review discusses the treatment of postmenopausal women with endocrine-resistant, hormone receptor-positive, human epidermal growth factor receptor 2- negative advanced breast cancer in order to illustrate considerations in the provision of pertinent quality education in the treatment of these patients and the management of therapy-related adverse events. An overview of endocrine-resistant breast cancer and subsequent treatment challenges is also provided. Approved treatment options for endocrine-resistant breast cancer include hormonal therapies and mammalian target of rapamycin inhibitors. Compounds under clinical investigation are also discussed.
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Affiliation(s)
- William J Gradishar
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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28
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Yardley DA. Pharmacologic management of bone-related complications and bone metastases in postmenopausal women with hormone receptor-positive breast cancer. BREAST CANCER-TARGETS AND THERAPY 2016; 8:73-82. [PMID: 27217795 PMCID: PMC4861000 DOI: 10.2147/bctt.s97963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is a high risk for bone loss and skeletal-related events, including bone metastases, in postmenopausal women with hormone receptor-positive breast cancer. Both the disease itself and its therapeutic treatments can negatively impact bone, resulting in decreases in bone mineral density and increases in bone loss. These negative effects on the bone can significantly impact morbidity and mortality. Effective management and minimization of bone-related complications in postmenopausal women with hormone receptor-positive breast cancer remain essential. This review discusses the current understanding of molecular and biological mechanisms involved in bone turnover and metastases, increased risk for bone-related complications from breast cancer and breast cancer therapy, and current and emerging treatment strategies for managing bone metastases and bone turnover in postmenopausal women with hormone receptor-positive breast cancer.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN, USA; Tennessee Oncology, Nashville, TN, USA
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29
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Malorni L, Giuliano M, Migliaccio I, Wang T, Creighton CJ, Lupien M, Fu X, Hilsenbeck SG, Healy N, De Angelis C, Mazumdar A, Trivedi MV, Massarweh S, Gutierrez C, De Placido S, Jeselsohn R, Brown M, Brown PH, Osborne CK, Schiff R. Blockade of AP-1 Potentiates Endocrine Therapy and Overcomes Resistance. Mol Cancer Res 2016; 14:470-81. [PMID: 26965145 DOI: 10.1158/1541-7786.mcr-15-0423] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/20/2016] [Indexed: 01/02/2023]
Abstract
UNLABELLED The transcription factor AP-1 is downstream of growth factor (GF) receptors (GFRs) and stress-related kinases, both of which are implicated in breast cancer endocrine resistance. Previously, we have suggested that acquired endocrine resistance is associated with increased activity of AP-1 in an in vivo model. In this report, we provide direct evidence for the role of AP-1 in endocrine resistance. First, significant overlap was found between genes modulated in tamoxifen resistance and a gene signature associated with GF-induced estrogen receptor (ER) cistrome. Interestingly, these overlapping genes were enriched for key signaling components of GFRs and stress-related kinases and had AP-1 motifs in their promoters/enhancers. Second, to determine a more definitive role of AP-1 in endocrine resistance, AP-1 was inhibited using an inducible dominant-negative (DN) cJun expressed in MCF7 breast cancer cells in vitro and in vivo AP-1 blockade enhanced the antiproliferative effect of endocrine treatments in vitro, accelerated xenograft tumor response to tamoxifen and estrogen deprivation in vivo, promoted complete regression of tumors, and delayed the onset of tamoxifen resistance. Induction of DN-cJun after the development of tamoxifen resistance resulted in dramatic tumor shrinkage, accompanied by reduced proliferation and increased apoptosis. These data suggest that AP-1 is a key determinant of endocrine resistance by mediating a global shift in the ER transcriptional program. IMPLICATIONS AP-1 represents a viable therapeutic target to overcome endocrine resistance. Mol Cancer Res; 14(5); 470-81. ©2016 AACR.
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Affiliation(s)
- Luca Malorni
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas. Sandro Pitigliani Medical Oncology Unit and Translational Research Unit, Oncology Department, Hospital of Prato, Prato, Italy.
| | - Mario Giuliano
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas. Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Ilenia Migliaccio
- Sandro Pitigliani Medical Oncology Unit and Translational Research Unit, Oncology Department, Hospital of Prato, Prato, Italy
| | - Tao Wang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Chad J Creighton
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mathieu Lupien
- Ontario Cancer Institute, Princess Margaret Cancer Center-University Health Network, Ontario Institute for Cancer Research and the Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Xiaoyong Fu
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan G Hilsenbeck
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Nuala Healy
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Carmine De Angelis
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas. Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Abhijit Mazumdar
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meghana V Trivedi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas. Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, Texas
| | - Suleiman Massarweh
- Department of Medicine and Stanford Cancer Institute, Stanford University, Stanford, California
| | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Pathology, Baylor College of Medicine, Houston, Texas
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Rinath Jeselsohn
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Myles Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Powel H Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas. Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Rachel Schiff
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Department of Medicine, Baylor College of Medicine, Houston, Texas. Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas.
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30
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Ghosh D, Lo J, Egbuta C. Recent Progress in the Discovery of Next Generation Inhibitors of Aromatase from the Structure-Function Perspective. J Med Chem 2016; 59:5131-48. [PMID: 26689671 DOI: 10.1021/acs.jmedchem.5b01281] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Human aromatase catalyzes the synthesis of estrogen from androgen with high substrate specificity. For the past 40 years, aromatase has been a target of intense inhibitor discovery research for the prevention and treatment of estrogen-dependent breast cancer. The so-called third generation aromatase inhibitors (AIs) letrozole, anastrozole, and the steroidal exemestane were approved in the U.S. in the late 1990s for estrogen-dependent postmenopausal breast cancer. Efforts to develop better AIs with higher selectivity and lower side effects were handicapped by the lack of an experimental structure of this unique P450. The year 2009 marked the publication of the crystal structure of aromatase purified from human placenta, revealing an androgen-specific active site. The structure has reinvigorated research activities on this fascinating enzyme and served as the catalyst for next generation AI discovery research. Here, we present an account of recent developments in the AI field from the perspective of the enzyme's structure-function relationships.
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Affiliation(s)
- Debashis Ghosh
- Department of Pharmacology, State University of New York Upstate Medical University , 750 East Adams Street, Syracuse, New York 13210, United States
| | - Jessica Lo
- Department of Pharmacology, State University of New York Upstate Medical University , 750 East Adams Street, Syracuse, New York 13210, United States
| | - Chinaza Egbuta
- Department of Pharmacology, State University of New York Upstate Medical University , 750 East Adams Street, Syracuse, New York 13210, United States
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31
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Beck JT. Potential role for mammalian target of rapamycin inhibitors as first-line therapy in hormone receptor-positive advanced breast cancer. Onco Targets Ther 2015; 8:3629-38. [PMID: 26675495 PMCID: PMC4676614 DOI: 10.2147/ott.s88037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Despite advances in cytotoxic chemotherapy and targeted therapies, 5-year survival rates remain low for patients with advanced breast cancer at diagnosis. This highlights the limited effectiveness of current treatment options. An improved understanding of cellular functions associated with the development and progression of breast cancer has resulted in the creation of a number of novel targeted molecular therapies. However, more work is needed to improve outcomes, particularly in the first-line recurrent or metastatic hormone receptor-positive breast cancer setting. The phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (mTOR) pathway is a major intracellular signaling pathway that is often upregulated in breast cancer, and overactivation of this pathway has been associated with primary or developed resistance to endocrine treatment. Clinical data from the Phase III Breast Cancer Trials of Oral Everolimus-2 (BOLERO-2) study of the mTOR inhibitor everolimus combined with exemestane in hormone receptor-positive advanced breast cancer were very promising, highlighting the potential role of mTOR inhibitors in combination with endocrine therapies as a first-line treatment option for these patients. It is hoped that the use of mTOR inhibitors combined with current standard-of-care endocrine therapies, such as aromatase inhibitors, in the first-line advanced breast cancer setting may result in greater antitumor effects and also delay or reverse treatment resistance.
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Zucchini G, Armstrong AC, Wardley AM, Wilson G, Misra V, Seif M, Ryder WD, Cope J, Blowers E, Howell A, Palmieri C, Howell SJ. A phase II trial of low-dose estradiol in postmenopausal women with advanced breast cancer and acquired resistance to aromatase inhibition. Eur J Cancer 2015; 51:2725-31. [PMID: 26597446 DOI: 10.1016/j.ejca.2015.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND High-dose oestrogen (HDE) is effective but toxic in postmenopausal women with advanced breast cancer (ABC). Prolonged oestrogen deprivation sensitises BC cell lines to estrogen and we hypothesised that third-generation aromatase inhibitors (AIs) would sensitise BCs to low-dose estradiol (LDE). METHODS A single-arm phase II study of LDE (2 mg estradiol valerate daily) in postmenopausal women with estrogen receptor-positive (ER+) ABC. The primary end-point was clinical benefit (CB) rate. If LDE was ineffective, HDE was offered. If LDE was effective, retreatment with the pre-LDE AI was offered on progression. RESULTS Twenty-one patients were recruited before the trial was closed early due to slow accrual; 19 were assessable for efficacy and toxicity. CB was seen in 5 in 19 patients (26%; 95% confidence interval 9.1-51.2%), all with prolonged SD (median duration 16.8 months; range 11.0-29.6). Treatment was discontinued for toxicity in 4 in 19 patients (21%) and 8 in 11 women without hysterectomy experienced vaginal bleeding (VB). After primary LDE failure, three patients received HDE and one achieved a partial response (PR). Following CB on LDE, four patients restarted pre-LDE AI and three achieved CB including one PR. Those with CB to LDE had a significantly longer duration of first-line endocrine therapy for ABC than those without (54.9 versus 16.8 months; p < 0.01) CONCLUSION: LDE is an effective endocrine option in women with evidence of prolonged sensitivity to AI therapy. LDE is reasonably well tolerated although VB is an issue. Re-challenge with the pre-LDE AI following progression confirms re-sensitisation as a true phenomenon.
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Affiliation(s)
| | - A C Armstrong
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK
| | - A M Wardley
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK
| | - G Wilson
- The Christie NHS Foundation Trust, UK
| | - V Misra
- The Christie NHS Foundation Trust, UK
| | - M Seif
- Central Manchester NHS Foundation Trust, UK
| | - W D Ryder
- The Christie NHS Foundation Trust, UK
| | - J Cope
- The Christie NHS Foundation Trust, UK
| | - E Blowers
- The Christie NHS Foundation Trust, UK
| | - A Howell
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK
| | | | - S J Howell
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK.
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Rumiato E, Brunello A, Ahcene-Djaballah S, Borgato L, Gusella M, Menon D, Pasini F, Amadori A, Saggioro D, Zagonel V. Predictive markers in elderly patients with estrogen receptor-positive breast cancer treated with aromatase inhibitors: an array-based pharmacogenetic study. THE PHARMACOGENOMICS JOURNAL 2015; 16:525-529. [PMID: 26503812 DOI: 10.1038/tpj.2015.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/27/2015] [Accepted: 09/08/2015] [Indexed: 11/09/2022]
Abstract
So far, no reliable predictive clinicopathological markers of response to aromatase inhibitors (AIs) have been identified, and little is known regarding the role played by host genetics. To identify constitutive predictive markers, an array-based association study was performed in a cohort of 55 elderly hormone-dependent breast cancer (BC) patients treated with third-generation AIs. The array used in this study interrogates variants in 225 drug metabolism and disposition genes with documented functional significance. Six variants emerged as associated with response to AIs: three located in ABCG1, UGT2A1, SLCO3A1 with a good response, two in SLCO3A1 and one in ABCC4 with a poor response. Variants in the AI target CYP19A1 resulted associated with a favourable response only as haplotype; haplotypes with increased response association were also detected for ABCG1 and SLCO3A1. These results highlight the relevance of host genetics in the response to AIs and represent a first step toward precision medicine for elderly BC patients.
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Affiliation(s)
- E Rumiato
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A Brunello
- Medical Oncology 1 Unit, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - S Ahcene-Djaballah
- Medical Oncology 1 Unit, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - L Borgato
- Hemato-Oncology Unit, Medical Science Department ULSS 13, Mirano, Venezia, Italy
| | - M Gusella
- Division of Oncology, Rovigo General Hospital, ULSS 18, Rovigo, Italy
| | - D Menon
- Division of Oncology, Rovigo General Hospital, ULSS 18, Rovigo, Italy
| | - F Pasini
- Division of Oncology, Rovigo General Hospital, ULSS 18, Rovigo, Italy
| | - A Amadori
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,Department of Surgery, Oncology, and Gastroenterology, Oncology Section, University of Padova, Padova, Italy
| | - D Saggioro
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - V Zagonel
- Medical Oncology 1 Unit, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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Riseberg D. Treating Elderly Patients With Hormone Receptor-Positive Advanced Breast Cancer. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2015; 9:65-73. [PMID: 26339192 PMCID: PMC4550185 DOI: 10.4137/cmo.s26067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 02/06/2023]
Abstract
As the overall population ages, the proportion of elderly patients (aged ≥65 years) with breast cancer also increases. Studies have shown that elderly patients with hormone receptor–positive breast cancer can derive as much benefit from treatment as do younger patients, yet they remain underrepresented in clinical trials and are often undertreated in clinical practice. Treatment decisions for older patients should not be based solely on chronologic age; a patient’s physiologic functioning and comorbidities must also be taken into consideration. For recurrent or metastatic disease, systemic treatment with endocrine therapies or chemotherapy may prolong a patient’s life and alleviate troublesome symptoms. Resistance to therapy remains a problem in the advanced breast cancer setting, with most patients eventually becoming resistant to additional treatment. New combination regimens that target multiple pathways, such as everolimus plus exemestane, have shown efficacy in elderly patients previously resistant to endocrine therapies, and future research may need to focus on such combinations in order to improve outcomes in this patient group. A number of investigational agents are in clinical development, although few studies identify their effects in the elderly patient population. Optimizing effective yet tolerable therapeutic regimens for elderly patients could improve their outcomes while ensuring that the goals of improved survival and quality of life are considered.
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Affiliation(s)
- David Riseberg
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
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Waks AG, Lennon J, Yadav BS, Hwang H, dSchapirael Carmen M, Johnson NB, Reynolds K, Schapira L, Gilman PB, Overmoyer B. Metastasis to the Cervix Uteri 15 Years After Treatment of Lobular Carcinoma of the Breast. Semin Oncol 2015; 42:e81-94. [DOI: 10.1053/j.seminoncol.2015.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Barton VN, D'Amato NC, Gordon MA, Christenson JL, Elias A, Richer JK. Androgen Receptor Biology in Triple Negative Breast Cancer: a Case for Classification as AR+ or Quadruple Negative Disease. Discov Oncol 2015. [PMID: 26201402 DOI: 10.1007/s12672-015-0232-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype that lacks estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) amplification. Due to the absence of these receptors, TNBC does not respond to traditional endocrine or HER2-targeted therapies that improve patient prognosis in other breast cancer subtypes. TNBC has a poor prognosis, and currently, there are no effective targeted therapies. Some TNBC tumors express androgen receptor (AR) and may benefit from AR-targeted therapies. Here, we review the literature on AR in TNBC and propose that TNBC be further sub-classified as either AR+ TNBC or quadruple negative breast cancer since targeting AR may represent a viable therapeutic option for a subset of TNBC.
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Affiliation(s)
- Valerie N Barton
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, RC1 North P18-5127 Mail Stop 8104, 12800 E. 19th Ave, Aurora, CO, 80015, USA
| | - Nicholas C D'Amato
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, RC1 North P18-5127 Mail Stop 8104, 12800 E. 19th Ave, Aurora, CO, 80015, USA
| | - Michael A Gordon
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, RC1 North P18-5127 Mail Stop 8104, 12800 E. 19th Ave, Aurora, CO, 80015, USA
| | - Jessica L Christenson
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, RC1 North P18-5127 Mail Stop 8104, 12800 E. 19th Ave, Aurora, CO, 80015, USA
| | - Anthony Elias
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, RC1 North P18-5127 Mail Stop 8104, 12800 E. 19th Ave, Aurora, CO, 80015, USA
| | - Jennifer K Richer
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, RC1 North P18-5127 Mail Stop 8104, 12800 E. 19th Ave, Aurora, CO, 80015, USA.
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Karthik GM, Ma R, Lövrot J, Kis LL, Lindh C, Blomquist L, Fredriksson I, Bergh J, Hartman J. mTOR inhibitors counteract tamoxifen-induced activation of breast cancer stem cells. Cancer Lett 2015. [PMID: 26208432 DOI: 10.1016/j.canlet.2015.07.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Breast cancer cells with stem cell characteristics (CSC) are a distinct cell population with phenotypic similarities to mammary stem cells. CSCs are important drivers of tumorigenesis and the metastatic process. Tamoxifen is the most widely used hormonal therapy for estrogen receptor (ER) positive cancers. In our study, tamoxifen was effective in reducing proliferation of ER + adherent cancer cells, but not their CSC population. We isolated, expanded and incubated CSC from seven breast cancers with or without tamoxifen. By genome-wide transcriptional analysis we identified tamoxifen-induced transcriptional pathways associated with ribosomal biogenesis and mRNA translation, both regulated by the mTOR-pathway. We observed induction of the key mTOR downstream targets S6K1, S6RP and 4E-BP1 in-patient derived CSCs by tamoxifen on protein level. Using the mTOR inhibitors rapamycin, everolimus and PF-04691502 (a dual PI3K/mTOR inhibitor) and in combination with tamoxifen, significant reduction in mammosphere formation was observed. Hence, we suggest that the CSC population play a significant role during endocrine resistance through activity of the mTOR pathway. In addition, tamoxifen further stimulates the mTOR-pathway but can be antagonized using mTOR-inhibitors.
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Affiliation(s)
| | - Ran Ma
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - John Lövrot
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lorand Levente Kis
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology/Cytology, Karolinska University Hospital, 17177 Stockholm, Sweden
| | - Claes Lindh
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology/Cytology, Karolinska University Hospital, 17177 Stockholm, Sweden
| | | | - Irma Fredriksson
- Department of Breast and Endocrine Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Radiumhemmet - Karolinska Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology/Cytology, Karolinska University Hospital, 17177 Stockholm, Sweden.
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Liedtke C, Thill M, Hanf V, Schuütz F. AGO Recommendations for the Diagnosis and Treatment of Patients with Advanced and Metastatic Breast Cancer: Update 2015. Breast Care (Basel) 2015; 10:199-205. [PMID: 26557825 DOI: 10.1159/000431248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cornelia Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein/Campus Lübeck, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus Krankenhaus, Frankfurt/M., Germany
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Neuner JM, Kamaraju S, Charlson JA, Wozniak EM, Smith EC, Biggers A, Smallwood AJ, Laud PW, Pezzin LE. The introduction of generic aromatase inhibitors and treatment adherence among Medicare D enrollees. J Natl Cancer Inst 2015; 107:djv130. [PMID: 25971298 DOI: 10.1093/jnci/djv130] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/13/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Aromatase inhibitors (AIs) substantially reduce breast cancer mortality in clinical trials, but high rates of nonadherence to these long-term oral therapies have reduced their impact outside of trials. We examined the association of generic AI availability with AI adherence among a large national breast cancer cohort. METHODS Using a quasi-experimental prepost design, we examined the effect of generic AI introductions (7/2010 and 4/2011) on adherence among a national cohort of women with incident breast cancer in 2006 and 2007 who were enrolled in the Medicare D pharmaceutical coverage program. Medicare D claims were used to calculate AI adherence, defined as a medication possession ratio of 80% or more of eligible days, over 36 months. Multivariable logistic regression models estimated with generalized estimating equations were applied to longitudinal adherence data to control for possible confounders, including receipt of a Medicare D low-income subsidy, and to account for repeated measures. All statistical tests were two-sided. RESULTS Sixteen thousand four hundred sixty-two Medicare D enrollees were eligible. Adherence declined throughout the study. However, among women without a subsidy, the median quarterly out-of-pocket cost of anastrozole fell from $183 in the fourth quarter of 2009 to $15 in 2011, and declines in adherence were attenuated with generic AI introductions. Regression-adjusted adherence probabilities were estimated to be 5.4% higher after generic anastrozole was introduced in 2010 and 11% higher after generic letrozole/exemestane was introduced in 2011. Subsidy recipients had higher adherence rates throughout the study. CONCLUSIONS The introduction of generic medications attenuated the decline in adherence to AIs over three years of treatment among breast cancer survivors not receiving low-income subsidies for Medicare D coverage.
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Affiliation(s)
- Joan M Neuner
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI.
| | - Sailaja Kamaraju
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - John A Charlson
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - Erica M Wozniak
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth C Smith
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - Alana Biggers
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - Alicia J Smallwood
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - Purushottam W Laud
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
| | - Liliana E Pezzin
- Center for Patient Care and Outcomes Research (JMN, SK, JC, EMW, ECS, AJS, PWL, LEP), Division of Hematology and Oncology, Department of Medicine (SK, JC), Division of Biostatistics, Department of the Institute for Health and Society (PWL), Division of General Internal Medicine, Department of Medicine (JMN, AB, LEP), Medical College of Wisconsin, Milwaukee, WI
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Fracture incidence in pre- and postmenopausal women after completion of adjuvant hormonal therapy for breast cancer. Breast 2015; 24:153-8. [DOI: 10.1016/j.breast.2014.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/22/2014] [Indexed: 12/19/2022] Open
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Harb WA. Management of patients with hormone receptor-positive breast cancer with visceral disease: challenges and treatment options. Cancer Manag Res 2015; 7:37-46. [PMID: 25653556 PMCID: PMC4310719 DOI: 10.2147/cmar.s72592] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endocrine therapy is an important treatment option for women with hormone receptor-positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor(®)), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin(®)) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed.
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Steroidal and non-steroidal third-generation aromatase inhibitors induce pain-like symptoms via TRPA1. Nat Commun 2014; 5:5736. [PMID: 25484020 PMCID: PMC4268712 DOI: 10.1038/ncomms6736] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 11/03/2014] [Indexed: 12/20/2022] Open
Abstract
Use of aromatase inhibitors (AIs), exemestane, letrozole and anastrozole, for breast cancer therapy is associated with severe pain symptoms, the underlying mechanism of which is unknown. The electrophilic nature of AIs suggests that they may target the transient receptor potential ankyrin 1 (TRPA1) channel, a major pathway in pain transmission and neurogenic inflammation. AIs evoke TRPA1-mediated calcium response and current in rodent nociceptors and human cells expressing the recombinant channel. In mice, AIs produce acute nociception, which is exaggerated by pre-exposure to proalgesic stimuli, and, by releasing sensory neuropeptides, neurogenic inflammation in peripheral tissues. AIs also evoke mechanical allodynia and decreased grip strength, which do not undergo desensitization on prolonged AI administration. These effects are markedly attenuated by TRPA1 pharmacological blockade or in TRPA1-deficient mice. TRPA1 is a major mediator of the proinflammatory/proalgesic actions of AIs, thus suggesting TRPA1 antagonists for the treatment of pain symptoms associated with AI use.
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Cerebral venous thrombosis in a breast cancer patient taking tamoxifen: Report of a case. Int J Surg Case Rep 2014; 6C:77-80. [PMID: 25528030 PMCID: PMC4334637 DOI: 10.1016/j.ijscr.2014.11.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/11/2014] [Accepted: 11/21/2014] [Indexed: 11/25/2022] Open
Abstract
Tamoxifen could increase the risk for venous thromboembolic complications. Clinicians should concern the possibility of thrombotic event with tamoxifen. In high-risk patients, new aromatase inhibitors might be considered alternative.
Introduction Tamoxifen reduces breast cancer risk, but can cause thromboembolic complications. Cerebral venous thrombosis is a rare form of stroke in which blood clots occlude the dural sinus or cerebral veins. Presentation of case A 46-year old female presented with a severe headache and nausea of subacute onset. She had undergone masectomy for breast cancer 20 months ago and had been taking tamoxifen. Brain CT and MRI confirmed cerebral venous infarction and venous thrombosis in the superior sagittal sinus and straight sinus. She had elevated D-dimer level, decreased levels of protein S activity and antithrombin III. Doppler ultrasound revealed concurrent deep vein thrombosis in her right leg. There was no evidence of breast cancer recurrence. With oral anticoagulation, she discharged without neurological complications. The abnormal laboratory findings of coagulopathy returned to normal after discontinuation of tamoxifen. Discussion Considering the abnormal findings in the workup of coagulopathy and no other risk factor for venous thrombosis, this thromboembolic complication can be attributed to the coagulopathy with use of tamoxifen. Conclusion Clinicians should warn about the possibility of thromboembolic complications with tamoxifen.
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Wong IOL, Schooling CM, Cowling BJ, Leung GM. Breast cancer incidence and mortality in a transitioning Chinese population: current and future trends. Br J Cancer 2014; 112:167-70. [PMID: 25290086 PMCID: PMC4453599 DOI: 10.1038/bjc.2014.532] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Projections of future trends in cancer incidence and mortality are important for public health planning. METHODS By using 1976-2010 data in Hong Kong, we fitted Poisson age-period-cohort models and made projections for future breast cancer incidence and mortality to 2025. RESULTS Age-standardised breast cancer incidence (/mortality) is projected to increase (/decline) from 56.7 (/9.3) in 2011-2015 to 62.5 (/8.6) per 100,000 women in 2021-2025. CONCLUSIONS The incidence pattern may relate to Hong Kong's socio-economic developmental history, while falling mortality trends are, most likely, due to improvements in survival from treatment advancement and improved health service delivery.
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Affiliation(s)
- I O L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C M Schooling
- 1] School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China [2] City University of New York School of Public Health and Hunter College, New York, NY, USA
| | - B J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Cardoso F, Costa A, Norton L, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordström EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van't Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†. Ann Oncol 2014; 25:1871-1888. [PMID: 25234545 PMCID: PMC4176456 DOI: 10.1093/annonc/mdu385] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- F Cardoso
- European School of Oncology & Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
| | - A Costa
- European School of Oncology, Milan, Italy; European School of Oncology, Bellinzona, Switzerland
| | - L Norton
- Breast Cancer Program, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - M Aapro
- Division of Oncology, Institut Multidisciplinaire d'Oncologie, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - C H Barrios
- Department of Medicine, PUCRS School of Medicine, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology/Radiumhemmet, Karolinska Institutet & Cancer Center Karolinska and Karolinska University Hospital, Stockholm, Sweden
| | - L Biganzoli
- Department of Medical Oncology, Sandro Pitigliani Oncology Centre, Prato, Italy
| | - K L Blackwell
- Breast Cancer Clinical Program, Duke Cancer Institute, Durham, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - T Cufer
- University Clinic Golnik, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - N El Saghir
- NK Basile Cancer Institute Breast Center of Excellence, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - D Fenech
- Breast Care Support Group, Europa Donna Malta, Mtarfa, Malta
| | - P Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- BC Cancer Agency, Vancouver, Canada
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, USA
| | - J Gligorov
- APHP Tenon, IUC-UPMC, Francilian Breast Intergroup, AROME, Paris, France
| | - A Goldhirsch
- Program of Breast Health, European Institute of Oncology, Milan, Italy
| | - N Harbeck
- Brustzentrum der Universität München, Munich, Denmark
| | - N Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - C Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B Kaufman
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - U N Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - S D Merjaver
- University of Michigan Medical School and School of Public Health, Ann Arbor, USA
| | - E B Nordström
- Europa Donna Sweden & Bröstcancerföreningarnas Riksorganisation, BRO, Sundbyberg, Sweden
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - A Partridge
- Department Medical Oncology, Division of Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - F Penault-Llorca
- Jean Perrin Centre, Comprehensive Cancer Centre, Clermont Ferrand, France
| | - M J Piccart
- Department of Medicine, Institut Jules Bordet, Brussels, Belgium
| | - H Rugo
- Department of Medicine, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - G Sledge
- Indiana University Medical CTR, Indianapolis, USA
| | - C Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - L Van't Veer
- Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - D Vorobiof
- Sandton Oncology Centre, Johannesburg, South Africa
| | - C Vrieling
- Department of Radiotherapy, Clinique des Grangettes, Geneva, Switzerland
| | - N West
- Nursing Division, Health Board, Cardiff and Vale University, Cardiff, UK
| | - B Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - E Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
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Hanf V, Schütz F, Liedtke C, Thill M. AGO Recommendations for the Diagnosis and Treatment of Patients with Advanced and Metastatic Breast Cancer: Update 2014. ACTA ACUST UNITED AC 2014; 9:202-9. [PMID: 25177262 DOI: 10.1159/000363551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Volker Hanf
- Frauenklinik, Klinikum Fürth, Frankfurt/M., Germany
| | - Florian Schütz
- Universitätsfrauenklinik Heidelberg, Frankfurt/M., Germany
| | - Cornelia Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein/Campus Lübeck, Frankfurt/M., Germany
| | - Marc Thill
- Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus Krankenhaus, Frankfurt/M., Germany
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van Meurs HS, van Lonkhuijzen LR, Limpens J, van der Velden J, Buist MR. Hormone therapy in ovarian granulosa cell tumors: A systematic review. Gynecol Oncol 2014; 134:196-205. [DOI: 10.1016/j.ygyno.2014.03.573] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/25/2014] [Accepted: 03/30/2014] [Indexed: 01/25/2023]
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Layfield DM, Mohamud M, Odofin O, Walsh C, Royle GT, Cutress RI. Tumour grade on core biopsy and evidence of axillary involvement on ultrasound predicts response in elderly co-morbid patients treated with primary hormone therapy for oestrogen receptor positive breast carcinoma. Surgeon 2014; 13:61-8. [PMID: 24411703 DOI: 10.1016/j.surge.2013.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/01/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Treatment of women with oestrogen-receptor positive breast cancer who are high risk for general anaesthetic remains controversial. Current guidance is based on studies pre-dating aromatase inhibitors (AIs) which may have also included hormone-receptor negative patients. Such studies have demonstrated improved disease-free survival and local disease control following surgery when compared with primary hormone therapy (PHT) alone. However uncertainty persists regarding benefit of surgery over optimal hormone treatment in patients with significant co-morbidity. METHOD Retrospective cohort study comparing efficacy of PHT in oestrogen-receptor positive breast cancer patients considered unsuitable for surgery. Co-morbidity was scored retrospectively using the Charlson Index. Overall survival and disease specific survival were noted and multivariate analysis performed to identify predictors of treatment failure. RESULTS 106 patients treated for breast cancer at Southampton University Hospital with PHT without surgery were identified (Mean age 84.1 years, range 48-101). 94.3% had a probability of 10 year survival of 2.25% or less according to the age-weighted Charlson score. Kaplan-Meier analysis demonstrated a four-year survival of 30% and breast cancer specific survival of 60%. Cox proportional hazards model demonstrated high-grade disease (grade III vs. grade I/II: HR = 2.007; 95% Confidence Interval (CI) = 1.004-4.014. P = 0.049) and ultrasound axillary staging (indeterminate/definite lymphatic involvement vs. no involvement: HR = 1.944; 95% CI = 1.010-3.742. P = 0.047) independently predicted early failure of PHT. CONCLUSION A high proportion of elderly and comorbid patients die with breast cancer rather than from breast cancer. Elderly comorbid patients who initially respond to primary hormone therapy have a less than 30% incidence of delayed treatment failure during their life time; however patients with grade III disease or an abnormal axillary ultrasound are twice as likely to fail first choice PHT.
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Affiliation(s)
- D M Layfield
- University of Southampton, UK; Southampton Breast Surgical Unit, University Hospitals Southampton, UK.
| | | | - O Odofin
- Southampton Breast Surgical Unit, University Hospitals Southampton, UK
| | - C Walsh
- Southampton Breast Surgical Unit, University Hospitals Southampton, UK
| | - G T Royle
- Southampton Breast Surgical Unit, University Hospitals Southampton, UK
| | - R I Cutress
- University of Southampton, UK; Southampton Breast Surgical Unit, University Hospitals Southampton, UK
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49
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DeNysschen C, Burton H, Ademuyiwa F, Levine E, Tetewsky S, O'Connor T. Exercise intervention in breast cancer patients with aromatase inhibitor-associated arthralgia: a pilot study. Eur J Cancer Care (Engl) 2013; 23:493-501. [DOI: 10.1111/ecc.12155] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - H. Burton
- Department of Exercise and Nutrition Science; State University of New York at Buffalo; Buffalo New York USA
| | - F. Ademuyiwa
- Department of Medicine; Division of Oncology; Washington University School of Medicine; St. Louis Missouri USA
| | - E. Levine
- Breast Cancer Unit; Roswell Park Cancer Institute; Buffalo New York USA
| | - S. Tetewsky
- Center for Health and Social Research; Buffalo State College; Buffalo New York USA
| | - T. O'Connor
- Breast Cancer Unit; Roswell Park Cancer Institute; Buffalo New York USA
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50
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von Blanckenburg P, Schuricht F, Albert US, Rief W, Nestoriuc Y. Optimizing expectations to prevent side effects and enhance quality of life in breast cancer patients undergoing endocrine therapy: study protocol of a randomized controlled trial. BMC Cancer 2013; 13:426. [PMID: 24047450 PMCID: PMC3848828 DOI: 10.1186/1471-2407-13-426] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/12/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adjuvant endocrine therapy can improve disease-free survival and time before recurrence in breast cancer patients. However, it is associated with considerable side effects that negatively affect patients' quality of life and cause non-adherence. The recently demonstrated effect of individual expectations on side-effect development (nocebo effect) suggests that psychological factors play a role in the prevention of side effects. The aim of this study is to evaluate cognitive-behavioral side-effect prevention training (SEPT) for breast cancer patients. This article describes the study protocol and applied research methods. METHODS/DESIGN In a randomized controlled trial, 184 female breast cancer patients are assigned to receive either SEPT, standard medical care or a manualized supportive therapy at the start of adjuvant endocrine treatment. SEPT consists of three sessions of cognitive-behavioral training including psychoeducation to provide a realistic view of endocrine therapy, imagination-training to integrate positive aspects of medication into daily life, and side-effect management to enhance expectations about coping ability. Side effects three months after the start of endocrine therapy serve as primary outcomes. Secondary outcomes include quality of life, coping ability and patients' medication adherence. Patients' expectations (i.e., expectations about side effects, coping ability, treatment and illness) are analyzed as mediators. DISCUSSION The optimization of expectations might be a potential pathway in health care to improve patients' quality of life during long-term medication intake. The results will provide implications for a possible integration of evidence-based prevention training into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov, (NCT01741883).
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