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Tang P, Ai X, Wang M, Hu Y, Pan Q, Jiang J. Experience with the safe admission of breast and thyroid cancer patients in non-endemic areas during an epidemic outbreak. Front Oncol 2023; 13:1220518. [PMID: 37781204 PMCID: PMC10534036 DOI: 10.3389/fonc.2023.1220518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Background The outbreaks of infectious diseases, such as coronavirus disease 2019 (COVID-19), have seriously affected the normal work and life of the public, as well as the normal diagnosis and treatment of other diseases due to their strong infectivity, high population susceptibility, and diverse clinical manifestations. Breast and thyroid specialists in non-hotspot epidemic areas of COVID-19 must consider factors, including epidemic prevention and control, breast and thyroid cancers and diseases diagnosis and treatment, and access to medical resources to make a reasonable treatment choice and optimize the treatment process. Methods A cohort study was designed under our center's epidemic prevention and control strategy. The study was conducted between February 3 and April 19, 2020, to explore the safety of clinical diagnosis and treatment of breast and thyroid cancer patients during the epidemic. All the outpatients, inpatients, day-time chemotherapy patients, targeted therapy patients, and relevant medical staff in the observation period in the Department of Breast and Thyroid Surgery in Southwest Hospital in Chongqing municipality, China, were included to investigate the detection and infection rate of COVID-19 and suspected patients. Results During the observation period, 27,117 patients were admitted to the outpatient unit. We performed 394 inpatient surgeries and 411 day-time surgeries. In our center, 1,046 and 663 patients received day-time chemotherapy and targeted therapy, respectively. All the patients were diagnosed and treated promptly and safely. Three suspected COVID-19 patients were identified in the outpatient unit. Healthcare staff achieved a "zero" infection of COVID-19. Conclusion The spread and cross-infection of COVID-19 can be avoided in non-hotspot epidemic areas based on scientific prevention and control, and cancer patients can be diagnosed and treated on time. The prevention and control measure implemented in the COVID-19 epidemic for diagnosing and treating cancer patients was effective and can be referenced for other infectious disease outbreaks.
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Affiliation(s)
- Peng Tang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China
| | - Xiang Ai
- Department of Thyroid and Breast Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Minghao Wang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China
| | - Ying Hu
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China
| | - Qinwen Pan
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China
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Nussbaumer RL, Maggi N, Castrezana L, Zehnpfennig L, Schwab FD, Krol J, Oberhauser I, Weber WP, Kurzeder C, Haug MD, Kappos EA. The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery. Breast Cancer Res Treat 2023; 197:333-341. [PMID: 36403182 PMCID: PMC9823081 DOI: 10.1007/s10549-022-06811-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. METHODS This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. RESULTS Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5-40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). CONCLUSION In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.
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Affiliation(s)
- R. L. Nussbaumer
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - N. Maggi
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Castrezana
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Zehnpfennig
- grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - F. D. Schwab
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - J. Krol
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - I. Oberhauser
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - W. P. Weber
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - C. Kurzeder
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - M. D. Haug
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth A. Kappos
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
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Gao W, Wang J, Yin S, Geng C, Xu B. An appropriate treatment interval does not affect the prognosis of patients with breast Cancer. HOLISTIC INTEGRATIVE ONCOLOGY 2022; 1:8. [PMID: 37520334 PMCID: PMC9255457 DOI: 10.1007/s44178-022-00010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/09/2022] [Indexed: 12/24/2022]
Abstract
Purpose Major public health emergencies may lead to delays or alterations in the treatment of patients with breast cancer at each stage of diagnosis and treatment. How much do these delays and treatment changes affect treatment outcomes in patients with breast cancer? Methods This review summarized relevant research in the past three decades and identified the effect of delayed treatment on the prognosis of patients with breast cancer in terms of seeking medical treatment, neoadjuvant treatment, surgery, postoperative chemotherapy, radiotherapy, and targeted therapies. Results Delay in seeking medical help for ≥12 weeks affected the prognosis. Surgical treatment within 4 weeks of diagnosis did not affect patient prognosis. Starting neoadjuvant chemotherapy within 8 weeks after diagnosis, receiving surgical treatment at 8 weeks or less after the completion of neoadjuvant chemotherapy, and receiving radiotherapy 8 weeks after surgery did not affect patient prognosis. Delayed chemotherapy did not increase the risk of relapse in patients with luminal A breast cancer. Every 4 weeks of delay in the start of postoperative chemotherapy in patients with luminal B, triple-negative, or HER2-positive breast cancer treated with trastuzumab will adversely affect the prognosis. Targeted treatment delays in patients with HER2-positive breast cancer should not exceed 60 days after surgery or 4 months after diagnosis. Radiotherapy within 8 weeks after surgery did not increase the risk of recurrence in patients with early breast cancer who were not undergoing adjuvant chemotherapy. Conclusion Different treatments have different time sensitivities, and the careful evaluation and management of these delays will be helpful in minimizing the negative effects on patients.
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Affiliation(s)
- Wei Gao
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Jiaxing Wang
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Sifei Yin
- Department of Chemical and Systems Biology, Stanford University, Stanford, California 94305 USA
| | - Cuizhi Geng
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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Bellon JR, Tayob N, Yang DD, Tralins J, Dang CT, Isakoff SJ, DeMeo M, Burstein HJ, Partridge AH, Winer EP, Krop IE, Tolaney SM. Local Therapy Outcomes and Toxicity From the ATEMPT Trial (TBCRC 033): A Phase II Randomized Trial of Adjuvant Trastuzumab Emtansine Versus Paclitaxel in Combination With Trastuzumab in Women With Stage I HER2-Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2022; 113:117-124. [PMID: 34990776 DOI: 10.1016/j.ijrobp.2021.12.173] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Human epidermal growth factor receptor 2 (HER2)-directed therapy improves local control among women with HER2-positive breast cancer. This retrospective analysis evaluates the safety and efficacy of radiation therapy (RT) among patients receiving adjuvant trastuzumab emtansine (T-DM1) or paclitaxel (T) plus trastuzumab (H) in the ATEMPT (Adjuvant Trastuzumab Emtansine Versus Paclitaxel in Combination With Trastuzumab) trial; Translational Breast Cancer Research Consortium (TBCRC) 033. METHODS AND MATERIALS Patients with stage I HER2-positive breast cancer were randomized 3:1 to receive adjuvant T-DM1 or TH after mastectomy or breast-conserving surgery (BCS). Breast RT was required after BCS and permitted after mastectomy. Patients receiving T-DM1 began RT after 12 weeks of therapy and received RT concurrently with T-DM1. Patients receiving TH began RT after paclitaxel, but concurrent with trastuzumab. RT records were retrospectively reviewed to determine details of radiation delivery and acute RT-related toxicity. RESULTS Protocol therapy was initiated by 497 patients. Among the 299 BCS patients, 289 received whole breast RT (WBRT) and 10 partial breast. Among WBRT patients, 40.2% in the T-DM1 arm and 41.5% of TH patients received hypofractionated (≥2.5 Gy/fraction) RT. Eight mastectomy patients received RT, all conventional fractionation. Skin toxicity (grade ≥2) was seen in 33.9% of patients in the T-DM1 arm and 23.2% in the TH arm (P = .11). In conventionally fractionated WBRT patients, 44.7% had a grade ≥2 skin toxicity compared with 17.9% of patients receiving hypofractionation (P < .001). Five patients experienced pneumonitis after RT (T-DM1: n = 4, 1.0%; TH: n = 1, 0.9%). Three-year invasive disease-free survival was 97.8% for T-DM1 (95% confidence interval, 96.3-99.3) and 93.4% for TH (95% confidence interval, 88.7-98.2). Among the 18 invasive disease-free survival events, 7 were isolated locoregional recurrences (2, T-DM1; 5, TH). CONCLUSIONS RT was well-tolerated when given concurrently with either T-DM1 or TH. Among BCS patients, hypofractionation resulted in lower grade ≥2 acute skin toxicity even with concurrent anti-HER2 therapy. Although follow-up was short, local recurrences were uncommon, attesting to the efficacy of HER2-directed therapy combined with RT.
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Affiliation(s)
- Jennifer R Bellon
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Nabihah Tayob
- Harvard Medical School, Boston, Massachusetts; Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David D Yang
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts
| | | | - Chau T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven J Isakoff
- Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle DeMeo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Harold J Burstein
- Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric P Winer
- Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ian E Krop
- Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sara M Tolaney
- Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Alternative trastuzumab dosing strategies in HER2-positive early breast cancer are associated with patient out-of-pocket savings. NPJ Breast Cancer 2022; 8:32. [PMID: 35288585 PMCID: PMC8921207 DOI: 10.1038/s41523-022-00393-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractPatients with breast cancer frequently experience financial hardship, often due to the high costs of anti-cancer drugs. We sought to develop alternative trastuzumab dosing strategies, compare their pharmacokinetic effectiveness to standard dosing, and assess the expected financial implications of transitioning to them. We extracted clinical data from the records of 135 retrospectively identified patients with HER2-positive early breast cancer at a single, urban comprehensive cancer center who were treated with trastuzumab between 2017 and 2019. We performed pharmacokinetic simulations on a range of trastuzumab dose levels and frequencies, assessing efficacy by trough trastuzumab concentration (Ctrough) and population and individual likelihoods of Ctrough exceeding trastuzumab minimum effective concentration (MEC). We performed deterministic financial modeling to estimate the treatment-associated financial savings from alternative dosing strategies. Trastuzumab maintenance doses of 4 mg/kg every 3 weeks (Q3W) and 6 mg/kg every 4 weeks (Q4W) had nearly identical probabilities of Ctrough being above MEC as standard of care 6 mg/kg every 3 weeks. In the primary financial analysis, both trastuzumab 4 mg/kg Q3W and 6 mg/kg Q4W were associated with significant drug- and administration-related out-of-pocket cost savings over the duration of therapy, ranging from $765 (neoadjuvant, Q4W) to $2791 (adjuvant, Q4W). In particular, Q4W trastuzumab increased savings related to lost wages and travel cost avoidance. Low-dose and reduced frequency trastuzumab in appropriately selected patients may significantly reduce total drug utilization and meaningfully reduce patient financial toxicity. Prospective clinical trials evaluating low-dose or reduced-frequency administration of therapeutic monoclonal antibodies are warranted and needed.
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Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:44-52. [PMID: 34548216 DOI: 10.1016/j.ejso.2021.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The increased use of neoadjuvant chemotherapy (NACT) facilitates an increase in breast-conserving surgery and immediate breast reconstruction. While NACT is considered to have the same oncological safety as adjuvant chemotherapy, evidence on the impact of NACT on surgical outcomes following breast surgery is unclear and varies across studies. The aim of this systematic review and meta-analysis was to assess the impact of NACT on surgical complications in breast cancer patients undergoing any kind of breast surgery. METHODS Database searches were conducted (March 26, 2021) to identify studies assessing the impact of NACT on postoperative complications. Studies were included if they compared a group of patients treated with NACT to a control group that was not, and if they reported at least one of our defined outcomes. Primary effect measures were odds ratios (ORs) and mean difference with a 95% confidence interval. Study quality was assessed by the Newcastle-Ottawa Scale. RESULTS Twenty-six studies comprising 134,191 patients were included. NACT was not associated with an increased complication rate for overall complications (OR: 1.13, 95% CI: 0.86 to 1.47, p = 0.38), individual postoperative complications, nor surgery duration. There was a non-significant trend towards NACT increasing the risk of seroma, wound complications, skin or nipple necrosis, flap ischemia or loss, and implant loss. A significant difference in blood loss was found, favouring NACT (MD = -75.85, 95% CI: -107.47 to -44.23, p < 0.00001). Heterogeneity was significant between the studies (I2>50%). CONCLUSION Compared to a control group, NACT was not found to affect the surgical complications adversely.
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Abstract
BACKGROUND Over than one third (28-58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2) expression. Trastuzumab anti-HER2 monoclonal antibody is still the benchmark treatment of HER2-positive breast tumors. However, FDA has categorized Trastuzumab as a category D drug for pregnant patients with breast cancer. This systemic review aims to synthesize all currently available data of trastuzumab administration during pregnancy and provide an updated view of the effect of trastuzumab on fetal and maternal outcome. METHODS Eligible articles were identified by a search of MEDLINE bibliographic database and ClinicalTrials.gov for the period up to 01/09/2020; The algorithm consisted of a predefined combination of the words "breast", "cancer", "trastuzumab" and "pregnancy". This study was performed in accordance with the PRISMA guidelines. RESULTS A total of 28 eligible studies were identified (30 patients, 32 fetuses). In more than half of cases, trastuzumab was administered in the metastatic setting. The mean duration of trastuzumab administration during gestation was 15.7 weeks (SD: 10.8; median: 17.5; range: 1-32). Oligohydramnios or anhydramnios was the most common (58.1%) adverse event reported in all cases. There was a statistically significant decrease in oligohydramnios/anhydramnios incidence in patients receiving trastuzumab only during the first trimester (P = 0.026, Fisher's exact test). In 43.3% of cases a completely healthy neonate was born. 41.7% of fetuses exposed to trastuzumab during the second and/or third trimester were born completely healthy versus 75.0% of fetuses exposed exclusively in the first trimester. All mothers were alive at a median follow-up of 47.0 months (ranging between 9 and 100 months). Of note, there were three cases (10%) of cardiotoxicity and decreased ejection fraction during pregnancy. CONCLUSIONS Overall, treatment with trastuzumab should be postponed until after delivery, otherwise pregnancy should be closely monitored.
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Wang W, Guo B, Cui C, Sun T, Liu S. Management of early-stage breast cancer patients during the coronavirus disease 2019 (COVID-19) pandemic: The experience in China from a surgical standpoint. J Cancer 2021; 12:2190-2198. [PMID: 33758597 PMCID: PMC7974893 DOI: 10.7150/jca.50501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women globally. Currently, due to limited data, there are no international guidelines for addressing the management of a large group of patients during infectious disease pandemics. Coronavirus disease 2019 (COVID-19), declared as a pandemic by the World Health Organization (WHO), has rapidly spread globally. The COVID-19 pandemic changed our daily routines and forced us to rethink the management of breast cancer patients. Clinicians need to take into account multiple factors such as the timing and delivery of cancer care, epidemic prevention and control, and the allocation of medical resources. Determining ways to reasonably adjust the treatment strategy is a real challenge. In this review, we aim to discuss particular challenges associated with managing breast cancer patients during the COVID-19 pandemic, share experience from Chinese oncologists and surgeons and propose some practical approaches to the management of early-stage breast cancer patients from a surgical standpoint.
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Affiliation(s)
- Wan Wang
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Baoliang Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Street, Harbin 150001, China
| | - Chunguo Cui
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Tong Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Shengnan Liu
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
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Fekete JT, Győrffy B. ROCplot.org: Validating predictive biomarkers of chemotherapy/hormonal therapy/anti-HER2 therapy using transcriptomic data of 3,104 breast cancer patients. Int J Cancer 2019; 145:3140-3151. [PMID: 31020993 DOI: 10.1002/ijc.32369] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/02/2019] [Accepted: 04/17/2019] [Indexed: 11/10/2022]
Abstract
Systemic therapy of breast cancer can include chemotherapy, hormonal therapy and targeted therapy. Prognostic biomarkers are able to predict survival and predictive biomarkers are able to predict therapy response. In this report, we describe the initial release of the first available online tool able to identify gene expression-based predictive biomarkers using transcriptomic data of a large set of breast cancer patients. Published gene expression data of 36 publicly available datasets were integrated with treatment data into a unified database. Response to therapy was determined using either author-reported pathological complete response data (n = 1,775) or relapse-free survival status at 5 years (n = 1,329). Treatment data includes chemotherapy (n = 2,108), endocrine therapy (n = 971) and anti-human epidermal growth factor receptor 2 (HER2) therapy (n = 267). The transcriptomic database includes 20,089 unique genes and 54,675 probe sets. Gene expression and therapy response are compared using receiver operating characteristics and Mann-Whitney tests. We demonstrate the utility of the pipeline by cross-validating 23 paclitaxel resistance-associated genes in different molecular subtypes of breast cancer. An additional set of established biomarkers including TP53 for chemotherapy in Luminal breast cancer (p = 1.01E-19, AUC = 0.769), HER2 for trastuzumab therapy (p = 8.4E-04, AUC = 0.629) and PGR for hormonal therapy (p = 8.6E-05, AUC = 0.7), are also endorsed. The tool is designed to validate and rank new predictive biomarker candidates in real time. By analyzing the selected genes in a large set of independent patients, one can select the most robust candidates and quickly eliminate those that are most likely to fail in a clinical setting. The analysis tool is accessible at www.rocplot.org.
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Affiliation(s)
- János T Fekete
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Balázs Győrffy
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary.,MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary
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10
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De novo vitamin D supplement use post-diagnosis is associated with breast cancer survival. Breast Cancer Res Treat 2018; 172:179-190. [PMID: 30039288 DOI: 10.1007/s10549-018-4896-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/17/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Experimental laboratory data have indicated a protective effect of vitamin D on breast cancer progression, while epidemiological evidence is growing. Using pharmacy claims data, this study investigates the association between vitamin D supplement use initiated after a breast cancer diagnosis and associated mortality. METHODS Women aged 50-80 years with a record of invasive breast cancer were identified on the National Cancer Registry Ireland database (n = 5417). Initiation of de novo vitamin D post-diagnosis was identified from linked national prescription data (n = 2581, 49%). Multivariate Cox proportional hazards models were used to estimate adjusted HRs (95% CIs) for breast cancer-specific mortality. RESULTS There was a 20% reduction in breast cancer-specific mortality in de novo vitamin D users (modelled as a time-varying variable) compared to non-users (HR 0.80; 95% CI 0.64-0.99, p = 0.048) and the reduction was greater at 49% (HR 0.51; 95% CI 0.34-0.74, p < 0.001), if vitamin D was initiated soon after the breast cancer diagnosis (within 6 months). CONCLUSIONS In this large national breast cancer cohort, de novo vitamin D use post-diagnosis was found to be associated with a reduction in breast cancer-specific mortality. Vitamin D, therefore, has the potential as a non-toxic and inexpensive agent to improve survival in breast cancer patients. Findings support the need for RCTs exploring the effect of vitamin D supplementation on breast cancer survival.
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Gullo G, Walsh N, Fennelly D, Bose R, Walshe J, Tryfonopoulos D, O'Mahony K, Hammond L, Silva N, McDonnell D, Ballot J, Quinn C, McDermott EW, Evoy D, Prichard R, Geraghty J, Amstrong J, Crown J. Impact of timing of trastuzumab initiation on long-term outcome of patients with early-stage HER2-positive breast cancer: the "one thousand HER2 patients" project. Br J Cancer 2018; 119:374-380. [PMID: 29773838 PMCID: PMC6070916 DOI: 10.1038/s41416-018-0114-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The optimal timing of (neo)adjuvant trastuzumab initiation with respect to chemotherapy and surgery remains undefined. METHODS Retrospective analysis of a large institutional database of HER2-positive patients who received anti-HER2 therapy. We included all Stage I to III patients treated with trastuzumab with a minimum follow up of 3 years. The date of first breast biopsy was recorded as initial diagnosis. RESULTS A total of 506 patients [adjuvant: 386 (76%)-neo-adjuvant: 120 (24%)] were included. The median time-to-first-trastuzumab (TFT) from diagnosis was 12 weeks (range 1.9-122.3). Median follow-up is 73.3 months (range 1.4-176.3). TFT was significantly shorter in the neo-adjuvant than in the adjuvant cohort (median: 4.4 vs. 14 weeks, p < 0.00001). Despite the neo-adjuvant cohort having significantly more node-positive patients (75 vs. 53%, p < 0.0001), DFS rate (neo-adjuvant: 12.5 vs. adjuvant: 18%, p = 0.094) was numerically superior in neo-adjuvant patients. A TFT ≤ 12 weeks was associated with significantly superior DFS and OS over TFT > 12 weeks. Early concomitant regimens were associated with superior DFS over delayed-concomitant and sequential regimens. CONCLUSIONS Initiating trastuzumab more than 12 weeks from diagnosis has a negative impact on clinical outcome. Neo-adjuvant anti-HER2 therapy could be the optimal strategy to treat early stage HER2-positive breast cancer.
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Affiliation(s)
- Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland. .,School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Naomi Walsh
- National Institute for Cellular Biotechnology, Dublin City University (DCU), Dublin, Ireland
| | - David Fennelly
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Reetesh Bose
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Janice Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Kate O'Mahony
- Aseptic Unit-Pharmacy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Lisa Hammond
- Aseptic Unit-Pharmacy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Nuno Silva
- Aseptic Unit-Pharmacy Department, St Vincent's Private Hospital, Dublin, Ireland
| | - Deirdre McDonnell
- Cancer Clinical Research Trust, St Vincent's University Hospital, Dublin, Ireland
| | - Josephine Ballot
- Cancer Clinical Research Trust, St Vincent's University Hospital, Dublin, Ireland
| | - Cecily Quinn
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Enda W McDermott
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Ruth Prichard
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - James Geraghty
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - John Amstrong
- Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
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Daniels B, Lord SJ, Kiely BE, Houssami N, Haywood P, Lu CY, Ward RL, Pearson SA. Use and outcomes of targeted therapies in early and metastatic HER2-positive breast cancer in Australia: protocol detailing observations in a whole of population cohort. BMJ Open 2017; 7:e014439. [PMID: 28119394 PMCID: PMC5278255 DOI: 10.1136/bmjopen-2016-014439] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The management of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) has changed dramatically with the introduction and widespread use of HER2-targeted therapies. However, there is relatively limited real-world information on patterns of use, effectiveness and safety in whole of population cohorts. The research programme detailed in this protocol will generate evidence on the prescribing patterns, safety monitoring and outcomes of patients with BC treated with HER2-targeted therapies in Australia. METHODS/DESIGN Our ongoing research programme will involve a series of retrospective cohort studies that include every patient accessing Commonwealth-funded HER2-targeted therapies for the treatment of early BC and advanced BC in Australia. At the time of writing, our cohorts consist of 11 406 patients with early BC and 5631 with advanced BC who accessed trastuzumab and lapatinib between 2001 and 2014. Pertuzumab and trastuzumab emtansine were publicly funded for metastatic BC in 2015, and future data updates will include patients accessing these medicines. We will use dispensing claims for cancer and other medicines, medical service claims and demographics data for each patient accessing HER2-targeted therapies to undertake this research. ETHICS AND DISSEMINATION Ethics approval has been granted by the Population Health Service Research Ethics Committee and data access approval has been granted by the Australian Department of Human Services (DHS) External Review Evaluation Committee. Our findings will be reported in peer-reviewed publications, conference presentations and policy forums. By providing detailed information on the use and outcomes associated with HER2-targeted therapies in a national cohort treated in routine clinical care, our research programme will better inform clinicians and patients about the real-world use of these treatments and will assist third-party payers to better understand the use and economic costs of these treatments.
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Affiliation(s)
- Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Belinda E Kiely
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Robyn L Ward
- University of Queensland, Brisbane, Queensland, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, New South Wales, Australia
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Lambertini M, Pondé NF, Solinas C, de Azambuja E. Adjuvant trastuzumab: a 10-year overview of its benefit. Expert Rev Anticancer Ther 2016; 17:61-74. [PMID: 27883296 DOI: 10.1080/14737140.2017.1264876] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Anti-HER2 targeted therapy is one of the key advances in the treatment of breast cancer that have occurred in the last 20 years. In the adjuvant setting, the use of trastuzumab has led to prolonged and sustained survival benefit with very little toxicity as also confirmed by the 10-year follow-up results from the pivotal trials. Despite the survival improvement, several key issues are not entirely resolved in this field. These issues have led to multiple research efforts in de-escalating or escalating the standard treatment with chemotherapy and 1 year of adjuvant trastuzumab. Areas covered: In this paper, we present an in depth overview on the state of the art on these key issues of refining decision-making in adjuvant anti-HER2 therapy. Expert commentary: Despite many important research efforts in the field, chemotherapy plus trastuzumab for a total duration of 1 year remains the standard of care. However, recent data showed that besides standard anthracycline- and taxane-based cytotoxic therapy, alternative chemotherapy regimens can now be proposed to patients with small tumors without nodal involvement and to women at high-risk of developing cardiotoxicity. Of note, besides HER2 itself, biomarkers predicting patients who may truly benefit from anti-HER2 agents are still lacking.
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Affiliation(s)
- Matteo Lambertini
- a BrEAST Data Centre, Institut Jules Bordet , l'Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium.,b Breast Cancer Translational Research Laboratory , Institut Jules Bordet , Brussels , Belgium
| | - Noam F Pondé
- a BrEAST Data Centre, Institut Jules Bordet , l'Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium
| | - Cinzia Solinas
- c Molecular Immunology Unit , Institut Jules Bordet , Brussels , Belgium
| | - Evandro de Azambuja
- a BrEAST Data Centre, Institut Jules Bordet , l'Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium
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