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Cuniolo L, Gipponi M, Murelli F, Depaoli F, Cornacchia C, Franchelli S, Pesce M, Ronda E, Picardi S, Diaz R, Poggio F, Friedman D, De Cian F, Fregatti P. Multidisciplinary and Tailored Treatment of Locally Advanced Breast Cancer in Progression during Neoadjuvant Chemotherapy: Case Report. Curr Oncol 2024; 31:2856-2866. [PMID: 38785498 PMCID: PMC11119312 DOI: 10.3390/curroncol31050217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Locally advanced breast cancer (LABC) is a complex disease that requires a multidisciplinary approach. Neoadjuvant chemotherapy (NAC) is usually performed in order to achieve loco-regional radical resection; although its importance in the multidisciplinary approach to LABC is well recognized, a small number of patients show Progressive Disease (PD). No standard salvage treatment (ST) has been defined and different strategies can be adopted, such as second-line systemic therapies, radiation therapy, and surgery. Herein, a case of LABC in PD during NAC is reported with a literature review, with the aim of highlighting the importance of a tailored multidisciplinary treatment for each patient.
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Affiliation(s)
- Letizia Cuniolo
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Marco Gipponi
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Federica Murelli
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Francesca Depaoli
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Chiara Cornacchia
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Simonetta Franchelli
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Marianna Pesce
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Elena Ronda
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Stefano Picardi
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Raquel Diaz
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Daniele Friedman
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Franco De Cian
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
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2
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Nakhlis F, Niman SM, Ueno NT, Troll E, Ryan S, Yeh E, Warren L, Bellon J, Harrison B, Iwase T, Carisa Le-Petross HT, Saleem S, Teshome M, Whitman GJ, Woodward WA, Overmoyer B, Tolaney SM, Regan M, Lynce F, Layman RM. Clinical outcomes after 1 versus 2-3 lines of neoadjuvant therapy in stage III inflammatory breast cancer. Breast Cancer Res Treat 2024; 204:289-297. [PMID: 38155272 DOI: 10.1007/s10549-023-07195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE Many stage III inflammatory breast cancer (IBC) patients experience a sufficient response to first-line (1L) neoadjuvant chemotherapy (NAC) to allow surgery, while some require additional NAC. We evaluated the pathologic complete response (pCR), breast cancer-free survival (BCFS) and overall survival (OS) among patients requiring 1 vs. 2-3 lines (L) of NAC prior to surgery. METHODS Stage III IBC patients from 2 institutions who received 1L or 2-3L of NAC prior to surgery were identified. Hormone receptor and HER2 status, grade, and pCR were evaluated. BCFS and OS were evaluated by the Kaplan-Meier method. Multivariable Cox models were utilized to estimate the hazard ratio (HR). RESULTS 808 eligible patients (1997-2020) were identified (median age 51 years, median follow-up 69 months). 733 (91%) had 1L and 75 (9%) had 2-3L of NAC. Grade III, triple-negative and HER2-positive disease were more prevalent in 2-3L patients. 178 (24%) 1L and 14 (19%) 2-3L patients had pCR. 376 1L patients and 41 2-3L patients had recurrences. The 5-year BCFS was worse for the 2-3L group (33 vs. 46%, HR = 1.37; 95% CI 0.99-1.91). However, in 192 patients with a pCR, BCFS was similar (76 vs. 83% in 1L vs. 2-3L, respectively). There were 308 deaths (276 among 1L and 32 among 2-3L patients). The 5-year OS in 1L vs. 2-3L was 60 vs. 53% (HR = 1.32, 95% CI 0.91-1.93). CONCLUSIONS Among stage III IBC patients, pCR rates were similar, irrespective of the NAC lines number, and BCFS and OS were comparable with pCR after 1L and 2-3L.
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Affiliation(s)
- Faina Nakhlis
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Ave, Yawkey Suite 1220, Boston, MA, 02215, USA.
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Samuel M Niman
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Troll
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Sean Ryan
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Eren Yeh
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura Warren
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer Bellon
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Beth Harrison
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Toshiaki Iwase
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - H T Carisa Le-Petross
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sadia Saleem
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary J Whitman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy A Woodward
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth Overmoyer
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara M Tolaney
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Meredith Regan
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Filipa Lynce
- Inflammatory Breast Cancer Program, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel M Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ling YX, Xie YF, Wu HL, Wang XF, Ma JL, Fan L, Liu GY. Prognostic factors and clinical outcomes of breast cancer patients with disease progression during neoadjuvant systemic therapy. Breast 2023; 70:63-69. [PMID: 37352573 DOI: 10.1016/j.breast.2023.06.004] [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: 02/16/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Disease progression during neoadjuvant systemic therapy for breast cancer indicates poor prognosis, while predictors of the clinical outcomes of these patients remain unclear. By comparing the clinical outcomes of patients with different patterns of salvage treatment strategies, we try to evaluate the factors predicting distant failure and explore the favourable treatment for them. METHODS Patients with disease progression during neoadjuvant systemic therapy for stage I-III breast cancer diagnosed between January 1, 2008 and July 31, 2021 in Fudan University Shanghai Cancer Center were enrolled. Disease progression was defined as at least a 20% increase in the sum of diameters of target lesions or the appearance of new breast or nodal lesions. Kaplan-Meier, univariate and multivariate Cox proportional hazard regressions were utilized to compare survival outcomes between different salvage treatment strategies. RESULTS Among 3775 patients treated with NST, 60 (1.6%) patients encountered disease progression. A significant difference between the outcomes of patients receiving direct surgery and other salvage modalities was found (p = 0.007). Triple-negative breast cancer (p = 0.010) and not receiving direct surgery (p = 0.016) were independently associated with distant disease-free survival on multivariate analysis. CONCLUSIONS Predictors of distant failure in patients with disease progression include triple-negative breast cancer and not receiving direct surgery. Direct surgery seems to be more favourable than other treatments for patients with disease progression. For inoperable patients, neoadjuvant radiation can increase their operability but not improve their prognosis.
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Affiliation(s)
- Yun-Xiao Ling
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Yi-Fan Xie
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Huai-Liang Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Xiao-Fang Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Jin-Li Ma
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Lei Fan
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Guang-Yu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China.
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YILMAZ C, ÖZDEMİR Ö. Comparison of progressed and unresponsive patients with responsive patients at ınterim assessment during breast cancer neoadjuvant chemotherapy. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1166838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: It was aimed to compare the breast cancer patients who were progressed or unresponsive to neoadjuvant chemotherapy with the patients clinically responsive to the treatment at interim radiological assessment.
Materials and Methods: Female patients operated in our hospital for breast cancer after neoadjuvant chemotherapy were retrospectively screened. Patients having interim radiological assessment were included in the study. Patients were divided into three groups as responsive, unresponsive (stable) and progressive according to the imaging results. Unresponsive and progressive patients were compared to responsive patients in terms of patient and tumor characteristics.
Results: A total of 96 patients were included in the study. According to the interim imaging results, 90.6% of patients (87 patients) had a radiological response to the treatment. Four patients (4.2%) with radiological unresponsiveness and five patients (5.2%) with radiological progression (9 patients in total, 9.4%) were referred to operation. The mean age of the unresponsive patients was found to be statistically higher than the responding patients (60 vs. 49, p=0.035). The tumor grade and Ki-67 index of unresponsive patients were lower than the responsive patients (respectively; 1.5±0.6 vs. 2.4±0.5, p=0.007 and 10±4 vs. 37±22, p=0.003). Although the tumor grade and Ki-67 index were higher in patients who progressed than the responders, they weren’t statistically significant. Unresponsive patients were mostly luminal A (3/4 patients), and progressive patients were mostly triple negative (3/5 patients) molecular subtype.
Conclusion: Luminal breast cancers with low proliferation index and grade tend to be insensitive to neoadjuvant chemotherapy. On the other hand, hormone receptor negative tumors with high proliferation index and grade may respond well to neoadjuvant chemotherapy and may also pose a risk for progression. Further clinical studies are needed.
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Affiliation(s)
- Cengiz YILMAZ
- Sağlık Bilimleri Üniversitesi, İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Tıbbi Onkoloji, İzmir, Türkiye
| | - Özlem ÖZDEMİR
- Sağlık Bilimleri Üniversitesi, İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Tıbbi Onkoloji, İzmir, Türkiye
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Shafaee MN, Makawita S, Lim B, Ellis MJ, Ducan DL, Ludwig MS, Duncan DL. Concurrent Chemo-radiation As a Means of Achieving Pathologic Complete Response in Triple Negative Breast Cancer. Clin Breast Cancer 2021; 22:e536-e543. [DOI: 10.1016/j.clbc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
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Transcriptome Analysis Identifies GATA3-AS1 as a Long Noncoding RNA Associated with Resistance to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients. J Mol Diagn 2021; 23:1306-1323. [PMID: 34358678 DOI: 10.1016/j.jmoldx.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is one of the leading causes of mortality in women worldwide, and neoadjuvant chemotherapy has emerged as an option for the management of locally advanced breast cancer. Extensive efforts have been made to identify new molecular markers to predict the response to neoadjuvant chemotherapy. Transcripts that do not encode proteins, termed long noncoding RNAs (lncRNAs), have been shown to display abnormal expression profiles in different types of cancer, but their role as biomarkers in response to neoadjuvant chemotherapy has not been extensively studied. Herein, lncRNA expression was profiled using RNA sequencing in biopsies from patients who subsequently showed either response or no response to treatment. The GATA3-AS1 transcript was overexpressed in the nonresponder group and was the most stable feature when performing selection in multiple random forest models. GATA3-AS1 was experimentally validated by RT-qPCR in an extended group of 68 patients. Expression analysis confirmed that GATA3-AS1 is overexpressed primarily in patients who were nonresponsive to neoadjuvant chemotherapy, with a sensitivity of 92.9%, a specificity of 75.0%, and an area under the curve of approximately 0.90, as measured by receiver operating characteristic curve analysis. The statistical model was based on luminal B-like patients and adjusted by menopausal status and phenotype (odds ratio, 37.49; 95% CI, 6.74-208.42; P = 0.001); GATA3-AS1 was established as an independent predictor of response. Thus, lncRNA GATA3-AS1 is proposed as a potential predictive biomarker of nonresponse to neoadjuvant chemotherapy.
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Elmore LC, Kuerer HM, Barcenas CH, Smith BD, Miggins MV, Lucci A, Caudle AS, Meric-Bernstam F, Hunt KK, Teshome M. Clinical Course of Breast Cancer Patients with Local-Regional Progression During Neoadjuvant Systemic Therapy. Ann Surg Oncol 2021; 28:5477-5485. [PMID: 34247335 DOI: 10.1245/s10434-021-10444-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neoadjuvant systemic therapy (NST) is standard for locally advanced breast cancer and is now frequently considered for those with early-stage and node-positive disease. We aimed to evaluate the treatment course and outcomes in patients with disease progression during NST. METHODS Patients diagnosed with unilateral stage I-III breast cancer between 2005 and 2015 with documented local-regional progression while receiving NST, by clinical examination and/or imaging after two or more cycles of chemotherapy, were identified from a prospective database, stratified by receipt of surgery and outcomes analyzed. RESULTS Of 6362 patients treated with NST during the study period, 124 (1.9%) developed disease progression. At a median live follow-up of 71 months, 23.4% were alive without disease and 70.2% had died from breast cancer. Median overall survival (OS) time for patients with progression was 26 months and median distant disease-free survival (DFS) was 14 months. Triple-negative breast cancer was associated with a higher likelihood of death (p < 0.001) and development of distant metastasis (p = 0.002). Among patients who had surgery (104, 89.3%), 40 (38.5%) developed local-regional recurrence, 67 (64.4%) developed distant metastasis, and 69 (66.3%) died from breast cancer. Median OS and median distant DFS in this subgroup was 31 and 16 months, respectively. CONCLUSIONS High rates of local-regional and distant failure were seen following disease progression while receiving NST. This suggests aggressive tumor biology and the need to study novel systemic therapies. Poor survival outcomes despite surgical management highlight the importance of careful patient selection when considering operative intervention after progression while receiving NST.
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Affiliation(s)
- Leisha C Elmore
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Makesha V Miggins
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Shin W, Noh JJ, Seo SS, Kang S, Choi CH, Park SY, Kim BG, Lim MC. Survival Effects of Cytoreductive Surgery for Refractory Patients after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer. Yonsei Med J 2020; 61:935-941. [PMID: 33107236 PMCID: PMC7593099 DOI: 10.3349/ymj.2020.61.11.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Salvage second-line chemotherapy is usually recommended for patients with advanced epithelial ovarian cancer (AEOC) who develop progressive disease (PD) after neoadjuvant chemotherapy (NAC). Herein, we investigated the role of cytoreductive surgery (CRS) for such patients. MATERIALS AND METHODS We retrospectively reviewed the medical records of 36 patients with AEOC who developed PD after receiving NAC at two tertiary academic centers with different treatment strategies between 2001 and 2016. Patients who developed PD after NAC were consistently treated with CRS at one hospital (group A; n=13) and second-line chemotherapy at another (group B; n=23). The clinical characteristics and treatment outcomes were compared between the groups. RESULTS Overall survival (OS) was longer in group A than in group B (19.4 months vs. 7.9 months; p=0.011). High-grade serous histology was associated with longer OS than non-high-grade serous types. In group A, optimal surgery resection (<1 cm) was achieved after CRS in 6 patients (46%). Multivariate analysis showed that the treatment option was the only independent predictive factor for OS (hazard ratio, 2.30; 95% confidence interval, 1.02-5.17; p=0.044). CONCLUSION CRS may result in a survival benefit even in patients with AEOC who develop PD after NAC.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Joseph J Noh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
- Precision Medicine Branch, National Cancer Center, Goyang, Korea
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
- Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Byoung Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
- Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Korea
- Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, Korea.
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9
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Zheng Y, Ding X, Zou D, Zhang F, Qin C, Yang H, Mo W, Ding Y, Yu Y. The treatment option of progressive disease in breast cancer during neoadjuvant chemotherapy: a single-center experience. Cancer Biol Ther 2020; 21:675-687. [PMID: 32420815 DOI: 10.1080/15384047.2020.1756707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Patients' responses to breast cancer neoadjuvant chemotherapy (NACT) differ because of heterogeneous tumor characteristics. Reports about NACT progression are sporadic. Here we enrolled 1187 patients who received NACT in our cancer center between January 1, 2007, and December 31, 2016. We analyzed the characteristics and treatments of patients with progressive disease (PD) or non-PD or pathological complete response (pCR). In total, 45 (3.8%) patients had PD. PD patients were associated with a significantly worse disease-free survival (DFS) (hazard ratio (HR) = 3.77; 95% CI, 1.77 to 8.00; P =.001) and overall survival (OS) (HR = 3.85; 95% CI, 1.77 to 8.35; P =.001). For the PD patients, 28 (62.2%) patients received mastectomy immediately after PD, and 17 (37.8%) changed to chemotherapy. DFS and OS exhibited no significant differences between these two salvage therapies. After a change to second chemotherapy, 58.8% (10/17) patients had PD or SD. With the exception of tumor size, pretreatment T stage, and histology type, no other significant differences were noted between PD and pCR patients. Our results demonstrated that PD patients were associated with a significantly worse prognosis. Based on these results, we suggest to give the addition of trastuzumab to HER-2 positive patients instead of changing the chemotherapy regimen and proceeding to surgery instead of further chemotherapy once patients have PD during NACT. Given that some similar characteristics exist between PD and pCR patients, more studies to identify novel molecular markers to predict disease response to NACT should be performed.
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Affiliation(s)
- Yurong Zheng
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Xiaowen Ding
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Dehong Zou
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Fanrong Zhang
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Chengdong Qin
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Hongjian Yang
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Wenju Mo
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Yuqin Ding
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
| | - Yang Yu
- Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital , Hangzhou, China
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Neoadjuvant therapy for breast cancer treatment: an expert panel recommendation from the Brazilian Society of Breast Surgeons 2018. Breast Cancer Res Treat 2018; 172:265-272. [DOI: 10.1007/s10549-018-4912-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 01/30/2023]
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11
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Wong JS, Bellon JR. Radiation, then Rethink. Int J Radiat Oncol Biol Phys 2018; 101:265-266. [PMID: 29726353 DOI: 10.1016/j.ijrobp.2018.02.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Julia S Wong
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer R Bellon
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Tumor Infiltrating Lymphocytes in Breast Cancer Patients with Progressive Disease during Neoadjuvant Chemotherapy. Pathol Oncol Res 2017; 25:1341-1347. [PMID: 29222623 DOI: 10.1007/s12253-017-0368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
A minority of breast cancer (BC) patients progress during neoadjuvant chemotherapy (NCT). The aim of this study was to assess the value of Tumor infiltrating lymphocytes (TILs) in such a high-risk population where valid biomarkers are eagerly needed. A retrospective review identified BC patients who either progressed during NCT or achieved a pathologic complete response (pCR). An experienced BC pathologist semi-quantified stromal TILs in pre-treatment core biopsies using hematoxylin and eosin stained slides. The primary outcome was to compare the levels of TILs between the 2 groups as a continuous and categorical variable using the t-test and X2 test as appropriate. The secondary outcome was to compare survival outcomes between patients with high versus low TILs level using the log-rank test. Fifty patients were successfully identified and assessed for TILs: 21 progressed during NCT and 29 had a pCR. Patients with progressive disease were older with more advanced disease (p = 0.03, p = 0.0001 respectively). A significantly lower mean level of TILs was found in patients with progressive disease compared to patients with pCR: 14.3% (Standard Deviation (SD): 16.9) versus 32.8% (SD: 31), p = 0.01). The level of TILs was neither associated with baseline characteristics nor with survival outcomes. BC patients progressing during NCT have low TILs levels compared to patients with pCR. Prospective studies are needed to establish the utility of TILs as early biomarkers of tumor response, particularly in patients with disease progression who need novel treatment approaches.
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