1
|
Bania A, Adamou A, Saloustros E. Racial and Ethnic Disparities in European Breast Cancer Clinical Trials. Cancers (Basel) 2024; 16:1726. [PMID: 38730678 PMCID: PMC11082959 DOI: 10.3390/cancers16091726] [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: 03/26/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Breast cancer is the most prevalent female cancer worldwide with known correlations between the race and tumor characteristics of the patients and prognosis. International and US-based studies, however, have reported a disproportionate representation of Black and Hispanic patients in clinical trials. This is the first study assessing race and ethnicity reporting trends and inclusion in European breast cancer trials. The PubMed and ClinicalTrials.gov databases were systematically searched for trials on breast cancer treatment conducted exclusively in Europe between 2010 and 2022. Of the 97 identified trials, race was reported in 10.31%. Multinational participation, but not the study size or trial phase, was significantly associated with higher race reporting trends. These 10 trials featured a White-predominant population, with 1.08% Asian and 0.88% Black patients included. The acquisition of the race and ethnicity data of patients in European trials is lower compared to the U.S. or worldwide studies and does not permit extensive analysis of minority participation. In a limited analysis, the low rates of minority participation are concerning, based on population-based data on minorities in select European countries. These observations should encourage race reporting practices in European breast cancer trials and adequate minority participation to support the generalizability of the results of the studies and promote healthcare equity.
Collapse
Affiliation(s)
- Angelina Bania
- Faculty of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece;
| | - Antonis Adamou
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany;
| | - Emmanouil Saloustros
- Division of Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| |
Collapse
|
2
|
Claessens AKM, Busschbach JJV, Ramaekers BLT, Erdkamp FLG, Bouma JM, van Leeuwen-Stok AE, Tjan-Heijnen VCG, Bos MEMM. Cost-effectiveness of continuous versus intermittent chemotherapy for patients with HER2-negative advanced breast cancer. Acta Oncol 2022; 61:619-624. [PMID: 35139727 DOI: 10.1080/0284186x.2022.2033832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anouk K. M. Claessens
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan J. V. Busschbach
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bram L. T. Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frans L. G. Erdkamp
- Department of Medical Oncology, Zuyderland Medical Centre, Geleen, The Netherlands
| | - Jeanette M. Bouma
- Department of Trial Registration, Comprehensive Cancer Centre the Netherlands, Rotterdam, The Netherlands
| | | | - Vivianne C. G. Tjan-Heijnen
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Monique E. M. M. Bos
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | |
Collapse
|
3
|
Kokkali S, Saloustros E, Stefanou D, Makrantonakis P, Kentepozidis N, Boukovinas I, Xenidis N, Katsaounis P, Ardavanis A, Ziras N, Christopoulou A, Rigas G, Kalbakis K, Vardakis N, Emmanouilides C, Athanasiadis I, Anagnostopoulos A, Hatzidaki D, Prinarakis E, Simopoulou F, Kotsakis A, Georgoulias V. Front-Line Bevacizumab plus Chemotherapy with or without Maintenance Therapy for Metastatic Breast Cancer: An Observational Study by the Hellenic Oncology Research Group. Curr Oncol 2022; 29:1237-1251. [PMID: 35200604 PMCID: PMC8871254 DOI: 10.3390/curroncol29020105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians’ discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research.
Collapse
Affiliation(s)
- Stefania Kokkali
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | | | - Dimitra Stefanou
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Paris Makrantonakis
- 2nd Department of Medical Oncology, Theageneio Anticancer Hospital, 54639 Thessaloniki, Greece;
| | - Nikolaos Kentepozidis
- Department of Medical Oncology, 251 Airforce General Hospital, 11525 Athens, Greece;
| | | | - Nikolaos Xenidis
- Department of Medical Oncology, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece;
| | - Panagiotis Katsaounis
- 1st Department of Medical Oncology, Metropolitan General Hospital, 11522 Athens, Greece;
| | - Alexandros Ardavanis
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Nikolaos Ziras
- 2nd Department of Medical Oncology, Metaxas’ Anticancer Hospital, 18537 Piraeus, Greece;
| | | | - George Rigas
- Medical Oncology Unit, General Hospital of Volos, 38222 Volos, Greece;
| | - Kostas Kalbakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | - Nikolaos Vardakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | | | - Ilias Athanasiadis
- 2nd Department of Medical Oncology, MITERA Hospital, 11522 Athens, Greece;
| | | | - Dora Hatzidaki
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Efthimios Prinarakis
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, 41005 Larissa, Greece;
| | - Athanasios Kotsakis
- Department of Oncology, University Hospital of Larissa, 41221 Larissa, Greece;
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
| | - Vassilis Georgoulias
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
| |
Collapse
|
4
|
Ito C, Hashimoto A, Uemura K, Oba K. Misleading Reporting (Spin) in Noninferiority Randomized Clinical Trials in Oncology With Statistically Not Significant Results: A Systematic Review. JAMA Netw Open 2021; 4:e2135765. [PMID: 34874407 PMCID: PMC8652604 DOI: 10.1001/jamanetworkopen.2021.35765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Spin, the inaccurate reporting of randomized clinical trials (RCTs) with results that are not statistically significant for the primary end point, distorts interpretation of results and leads to misinterpretation. However, the prevalence of spin and related factors in noninferiority cancer RCTs remains unclear. OBJECTIVE To examine misleading reporting, or spin, and the associated factors in noninferiority cancer RCTs through a systematic review. DATA SOURCES A systematic search of the PubMed database was performed for articles published between January 1, 2010, and December 31, 2019, using the Cochrane Highly Sensitive Search Strategy. STUDY SELECTION Two investigators independently selected studies using the inclusion criteria of noninferiority parallel-group RCTs aiming to confirm effects to cancer treatments published between January 1, 2010, and December 31, 2019, reporting results that were not statistically significant for the primary end points. DATA EXTRACTION AND SYNTHESIS Standardized data abstraction was used to extract information concerning the trial characteristics and spin based on a prespecified definition. The main investigator extracted the trial characteristics while both readers independently evaluated the spin. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. MAIN OUTCOMES AND MEASURES The main outcome was spin prevalence in any section of the report. Spin was defined as use of specific reporting strategies, from whatever motive, to highlight that the experimental treatment is beneficial, despite no statistically significant difference for the primary outcome, or to distract the reader from results that are not statistically significant. The associations (prevalence difference and odds ratios [ORs]) between spin and trial characteristics were also evaluated. RESULTS The analysis included 52 of 2752 reports identified in the PubMed search. Spin was identified in 39 reports (75.0%; 95% CI, 61.6%-84.9%), including the abstract (34 reports [65.4%; 95% CI, 51.1%-76.9%]) and the main text (38 reports [73.1%; 95% CI, 59.7%-83.3%]). Univariate analysis found that the spin prevalence was higher in reports with data managers (prevalence difference, 27%; 95% CI, 1.1%-50.3%), reports without funding from for-profit sources (prevalence difference, 31.2%; 95% CI, 4.8%-53.8%), and reports of novel experimental treatments (prevalence difference, 37.5%; 95% CI, 5.8%-64.7%). Multivariable analysis found that novel experimental treatment (OR, 4.64; 95% CI, 0.98-22.02) and funding only from nonprofit sources only (OR, 5.20; 95% CI, 1.21-22.29) were associated with spin. CONCLUSIONS AND RELEVANCE In this systematic review, most noninferiority RCTs reporting results that were not statistically significant for the primary end points showed distorted interpretation and inaccurate reporting. The novelty of an experimental treatment and funding only from nonprofit sources were associated with spin.
Collapse
Affiliation(s)
- Chiyo Ito
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
- Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Atsushi Hashimoto
- Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kohei Uemura
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Koji Oba
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
5
|
Masuda N, Yoshinami T, Ikeda M, Mizutani M, Yamaguchi M, Komoike Y, Takashima T, Yoshidome K, Tsurutani J, Iwamoto M, Fujisawa F, Yasojima H, Yamamura J, Morishima H, Aki F, Yamada T, Morita S, Nakayama T. Capecitabine in Combination with Endocrine Therapy as Maintenance Therapy after Bevacizumab Plus Paclitaxel Induction Therapy for Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer: KBCSG-TR1214. Cancers (Basel) 2021; 13:cancers13174399. [PMID: 34503209 PMCID: PMC8430728 DOI: 10.3390/cancers13174399] [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: 05/31/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary To investigate a possible treatment strategy for hormone receptor (HR)-positive, HER2-negative advanced and/or metastatic breast cancer (AMBC), we investigated the clinical usefulness of adding capecitabine to maintenance endocrine therapy after induction chemotherapy and the efficacy of reinduction chemotherapy. Patients who had received bevacizumab–paclitaxel induction therapy and did not have progressive disease were randomized to receive maintenance therapy with endocrine therapy alone (group E; n = 46) or endocrine therapy plus capecitabine (group EC; n = 44). The median progression-free survival (PFS) under maintenance therapy (primary endpoint) was significantly longer in group EC than in group E (11.1 vs. 4.3 months; hazard ratio, 0.53; p < 0.01). At 24 months from the induction therapy start, the overall survival (OS) rate was significantly higher in group EC than in group E (83.5% vs. 62.3%; p = 0.02). Therefore, the addition of capecitabine to maintenance endocrine therapy may be a beneficial option after induction chemotherapy for HR-positive, HER2-negative AMBC patients. Abstract Optimal treatment strategies for hormone receptor (HR)-positive, HER2-negative advanced and/or metastatic breast cancer (AMBC) remain uncertain. We investigated the clinical usefulness of adding capecitabine to maintenance endocrine therapy after induction chemotherapy and the efficacy of reinduction chemotherapy. Patients who had received bevacizumab–paclitaxel induction therapy and did not have progressive disease (PD) were randomized to maintenance therapy with endocrine therapy alone (group E) or endocrine plus capecitabine (1657 mg/m2/day on days 1–21, q4w) (group EC). In case of PD after maintenance therapy, patients received bevacizumab–paclitaxel reinduction therapy. Ninety patients were randomized. The median progression-free survival (PFS) under maintenance therapy (primary endpoint) was significantly longer in group EC (11.1 {95% CI, 8.0–11.8} months) than in group E (4.3 {3.6–6.0} months) (hazard ratio, 0.53; p < 0.01). At 24 months from the induction therapy start, the overall survival (OS) was significantly longer in group EC than in group E (hazard ratio, 0.41; p = 0.046). No difference was found in the time to failure of strategy (13.9 and 16.6 months in groups E and EC, respectively). Increased capecitabine-associated toxicities in group EC were tolerable. Addition of capecitabine to maintenance endocrine therapy may be a beneficial option after induction chemotherapy for HR-positive, HER2-negative AMBC patients.
Collapse
Affiliation(s)
- Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuou-ku, Osaka-shi 540-0006, Osaka, Japan; (M.M.); (H.Y.)
- Correspondence: ; Tel.: +81-6-6942-1331
| | - Tetsuhiro Yoshinami
- Department of Medical Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi 541-8567, Osaka, Japan; (T.Y.); (F.F.)
- Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, 2-2-E10 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Masahiko Ikeda
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital, 5-23-1 Zao-cho, Fukuyama-shi 721-8511, Hiroshima, Japan;
| | - Makiko Mizutani
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuou-ku, Osaka-shi 540-0006, Osaka, Japan; (M.M.); (H.Y.)
| | - Miki Yamaguchi
- Department of Breast Surgery, JCHO Kurume General Hospital, 21 Kushiharamachi, Kurume-shi 830-0013, Fukuoka, Japan;
| | - Yoshifumi Komoike
- Department of Medicine, Kindai University Hospital, 377-2 Ohnohigashi, Osaka-Sayama-shi 589-8511, Osaka, Japan;
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka-shi 545-8585, Osaka, Japan;
| | - Katsuhide Yoshidome
- Department of Breast and Endocrine Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka-shi 543-0035, Osaka, Japan;
| | - Junji Tsurutani
- Advanced Cancer Translation Research Institute, Showa University, 1-5-8 Hatanodai, Shinagawa-ku 142-8555, Tokyo, Japan;
| | - Mitsuhiko Iwamoto
- Breast and Endocrine Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki-shi 569-8686, Osaka, Japan;
| | - Fumie Fujisawa
- Department of Medical Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi 541-8567, Osaka, Japan; (T.Y.); (F.F.)
| | - Hiroyuki Yasojima
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuou-ku, Osaka-shi 540-0006, Osaka, Japan; (M.M.); (H.Y.)
| | - Jun Yamamura
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai-shi 593-8304, Osaka, Japan;
| | - Hirotaka Morishima
- Department of Breast Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kitaku, Sakai-shi 591-8025, Osaka, Japan;
| | - Fuminori Aki
- Ito Surgical Mammary Gland Clinic, 12-10 Fudaba, Kochi-shi 781-0085, Kochi, Japan;
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, 2-2, Yamadaoka, Suita-shi 565-0871, Osaka, Japan;
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi 606-8507, Kyoto, Japan;
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi 541-8567, Osaka, Japan;
| |
Collapse
|
6
|
HASHEMZADEH P, GHORBANZADEH V, DARIUSHNEJAD H. Predicted peptide-based MHC-I, MHC-II, CTL and B-cell epitopes of MUC-1 by immunoinformatics methods: a clue for novel multi-epitope vaccine development against breast cancer. MINERVA BIOTECNOL 2021. [DOI: 10.23736/s1120-4826.19.02598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
7
|
Maltoni R, Palleschi M, Gallerani G, Bravaccini S, Cecconetto L, Melegari E, Altini M, Rocca A. Impressive long-term response with chemo-endocrine therapy in a premenopausal patient with metastatic breast cancer: A case report. Medicine (Baltimore) 2020; 99:e20396. [PMID: 32541460 PMCID: PMC7302633 DOI: 10.1097/md.0000000000020396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Patients with, or who develop, metastatic breast cancer have a 5-year relative survival of about 25%. Endocrine therapy clearly improves outcomes in patients with estrogen receptor-positive breast cancer. In the metastatic setting, the primary goal of treatment is to maintain long-term disease control with good quality of life. Rarely, exceptional responders achieve durable disease control, and potential cures cannot be ruled out. PATIENT CONCERNS We report the case of a 39-year-old woman with primary breast cancer and associated synchronous bone metastases, who experienced a disease response of 12 years with hormonal therapy as maintenance after first line chemotherapy, with a good toxicity profile. DIAGNOSIS The patient was diagnosed with estrogen receptor + human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer with synchronous bone metastases. INTERVENTIONS This patient was treated with chemotherapy for 6 cycles as a first-line therapy following by endocrine treatment given as a maintenance therapy. OUTCOMES Our patient experienced a progression-free survival >12 years with an exceptionally good quality of life. LESSONS Our anecdotal experience highlights the existence of exceptional responders among patients with hormone receptor-positive metastatic breast cancer, who achieve clinical remission and durable disease control with endocrine therapy. Being able to identify these patients could help in the selection of the best treatment option among the many available.
Collapse
|
8
|
Claessens AKM, Erdkamp FLG, Lopez-Yurda M, Bouma JM, Rademaker-Lakhai JM, Honkoop AH, de Graaf H, Tjan-Heijnen VCG, Bos MEMM. Secondary analyses of the randomized phase III Stop&Go study: efficacy of second-line intermittent versus continuous chemotherapy in HER2-negative advanced breast cancer. Acta Oncol 2020; 59:713-722. [PMID: 32141389 DOI: 10.1080/0284186x.2020.1731923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Previously, we showed that reintroduction of the same (first-line) chemotherapy at progression could only partially make up for the loss in efficacy as compared to continuously delivered first-line chemotherapy. Here, we report the probability of starting second-line study chemotherapy in the Stop&Go trial, and the progression-free survival (PFS) and overall survival (OS) of patients who received both the first- and second-line treatment in an intermittent versus continuous schedule.Methods: First-line chemotherapy comprised paclitaxel plus bevacizumab, second-line capecitabine or non-pegylated liposomal doxorubicin, given per treatment line as two times four cycles (intermittent) or as eight consecutive cycles (continuous).Results: Of the 420 patients who started first-line treatment within the Stop&Go trial (210:210), a total of 270 patients continued on second-line study treatment (64% of all), which consisted of capecitabine in 201 patients and of non-pegylated liposomal doxorubicin in 69 patients, evenly distributed between the treatment arms. Median PFS was 3.7 versus 5.0 months (HR 1.07; 95% CI: 0.82-1.38) and median OS 10.9 versus 12.4 months (HR 1.27; 95% CI: 0.98-1.66) for intermittent versus continuous second-line chemotherapy. Second-line PFS was positively influenced by prior hormonal therapy for metastatic disease and longer first-line PFS duration, while triple-negative tumor status had a negative influence. Patients with a shorter time to progression (TTP) in first-line (≤10 months) had a higher probability of starting second-line treatment if they received intermittent compared to continuous chemotherapy (OR 1.97; 95% CI: 1.02-3.80).Conclusion: We recommend continuous scheduling of both the first- and second-line chemotherapy for advanced breast cancer.
Collapse
Affiliation(s)
- Anouk K. M. Claessens
- Department of Medical Oncology, Zuyderland Medical Centre, Geleen, The Netherlands
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frans L. G. Erdkamp
- Department of Medical Oncology, Zuyderland Medical Centre, Geleen, The Netherlands
| | - Marta Lopez-Yurda
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeanette M. Bouma
- Department of Trial Registration, Comprehensive Cancer Centre the Netherlands, Rotterdam, The Netherlands
| | | | - Aafke H. Honkoop
- Department of Medical Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Hiltje de Graaf
- Department of Medical Oncology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Monique E. M. M. Bos
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | |
Collapse
|
9
|
Claessens AKM, Ibragimova KIE, Geurts SME, Bos MEMM, Erdkamp FLG, Tjan-Heijnen VCG. The role of chemotherapy in treatment of advanced breast cancer: an overview for clinical practice. Crit Rev Oncol Hematol 2020; 153:102988. [PMID: 32599374 DOI: 10.1016/j.critrevonc.2020.102988] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022] Open
Abstract
This review aims to evaluate the role of chemotherapy-containing regimens in the treatment of advanced breast cancer (ABC), with the purpose to optimize selection, sequencing and duration of treatment with the currently available agents for clinical practice. Data from observational as well as randomized phase II and III studies were included. Chemotherapy yielded a median overall survival (OS) of 2 years in registration studies, with comparable efficacy of different agents. Combining chemotherapy agents did not yield OS improvement and caused greater toxicity compared with single-agent chemotherapy. Continuing chemotherapy till progression or unacceptable toxicity generated greater efficacy without detrimental impact on quality of life compared with a limited amount of cycles. In real-world studies, benefits after third-line chemotherapy were modest compared with first- and second-line. Furthermore, effects of previous chemotherapy predicted effects of next-line therapy in real-world. Physicians increasingly prescribed capecitabine or taxanes as first- or second-line chemotherapy over time.
Collapse
Affiliation(s)
- Anouk K M Claessens
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands; Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, the Netherlands.
| | - Khava I E Ibragimova
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands.
| | - Sandra M E Geurts
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands.
| | - Monique E M M Bos
- Department of Medical Oncology, Erasmus Medical Centre, PO BOX 2030, 3000 CA Rotterdam, the Netherlands.
| | - Frans L G Erdkamp
- Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, the Netherlands.
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands.
| |
Collapse
|
10
|
Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, Blair SL, Burstein HJ, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Isakoff SJ, Krishnamurthy J, Lyons J, Marcom PK, Matro J, Mayer IA, Moran MS, Mortimer J, O'Regan RM, Patel SA, Pierce LJ, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Young JS, Burns JL, Kumar R. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:452-478. [DOI: 10.6004/jnccn.2020.0016] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Several new systemic therapy options have become available for patients with metastatic breast cancer, which have led to improvements in survival. In addition to patient and clinical factors, the treatment selection primarily depends on the tumor biology (hormone-receptor status and HER2-status). The NCCN Guidelines specific to the workup and treatment of patients with recurrent/stage IV breast cancer are discussed in this article.
Collapse
Affiliation(s)
| | | | - Jame Abraham
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Chau Dang
- 9Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | - Janice Lyons
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Jennifer Matro
- 17Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - Hope S. Rugo
- 23UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Karen Lisa Smith
- 24The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - John H. Ward
- 28Huntsman Cancer Institute at the University of Utah
| | | | | | | |
Collapse
|
11
|
Claessens AKM, Timman R, Busschbach JJ, Bouma JM, Rademaker-Lakhai JM, Erdkamp FLG, Tjan-Heijnen VCG, Bos MEMM. The influence on quality of life of intermittent scheduling in first- and second-line chemotherapy of patients with HER2-negative advanced breast cancer. Breast Cancer Res Treat 2020; 179:677-685. [PMID: 31782032 PMCID: PMC6997247 DOI: 10.1007/s10549-019-05495-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Stop&Go study randomized patients with advanced breast cancer to intermittent (two times four) or continuous (eight subsequent cycles) first- and second-line chemotherapy. METHODS QoL was measured with RAND-36 questionnaires every 12 weeks. The primary objective was to estimate differences in changes from baseline between intermittent and continuous treatment. An effect size of 0.5 SD (5 points) was considered clinically meaningful. RESULTS A total of 398 patients were included with a median follow-up of 11.4 months (IQR 5.6-22.2). Mean physical QoL baseline scores were 38.0 resp. 38.2, and mental scores 45.0 resp. 42.4 for intermittent and continuous treatment. Physical QoL declined linearly in the intermittent arm causing a clinically meaningful difference of 5.40 points at 24 months (p < 0.001), while scores in the continuous arm stabilized after a small decline of ± 3.4 points at 12 months. Conversely, mental QoL was fairly stable and even improved with 1.58 (p = 0.005) and 2.48 points (p < 0.001) at 12 months for intermittent and continuous treatment, respectively. When comparing arms for both components in changes from baseline, the maximum differences were 2.46 (p = 0.101) and 1.95 points (p = 0.182) for physical and mental scores, both measured at 30 months and in favor of continuous treatment. CONCLUSION Intermittent first- and second-line chemotherapy in patients with HER2-negative advanced breast cancer showed a trend for worse impact on QoL compared to continuous chemotherapy, with neither significant nor meaningful differences in course. We recommend prescribing chemotherapy continuously until progressive disease or unacceptable toxicity. Trial registration EudraCT 2010-021519-18; BOOG 2010-02.
Collapse
Affiliation(s)
- Anouk K. M. Claessens
- Department of Medical Oncology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG Geleen, The Netherlands
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jan J. Busschbach
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jeanette M. Bouma
- Department of Trial Registration, Comprehensive Cancer Centre the Netherlands, Vasteland 78, 3011 BN Rotterdam, The Netherlands
| | - Jeany M. Rademaker-Lakhai
- Dutch Breast Cancer Research Group, BOOG Study Center, IJsbaanpad 9, 1076 CV Amsterdam, The Netherlands
| | - Frans L. G. Erdkamp
- Department of Medical Oncology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG Geleen, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Monique E. M. M. Bos
- Department of Medical Oncology, Medical Oncologist, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - the Dutch Breast Cancer Research Group (BOOG)
- Department of Medical Oncology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG Geleen, The Netherlands
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Trial Registration, Comprehensive Cancer Centre the Netherlands, Vasteland 78, 3011 BN Rotterdam, The Netherlands
- Dutch Breast Cancer Research Group, BOOG Study Center, IJsbaanpad 9, 1076 CV Amsterdam, The Netherlands
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Medical Oncology, Medical Oncologist, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| |
Collapse
|
12
|
Lu G, Lai Y, Wang T, Lin W, Lu J, Ma Y, Chen Y, Ma H, Liu R, Li J. Mitochondrial fission regulator 2 (MTFR2) promotes growth, migration, invasion and tumour progression in breast cancer cells. Aging (Albany NY) 2019; 11:10203-10219. [PMID: 31740625 PMCID: PMC6914410 DOI: 10.18632/aging.102442] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
Introduction: Mitochondrial fission regulator 2 (MTFR2) belongs to the MTFR family, and 2 isoforms of MTFR2 are produced by alternative splicing. The role of MTFR2 in breast cancer (BC) remains unknown. Results: MTFR2 was upregulated in BC tissues and was strongly associated with tumor characteristics. Moreover, Kaplan-Meier and Cox proportional hazards analyses indicated that high MTFR2 expression was related to poor overall survival. In addition, the capacity for migration and invasion decreased in two BC cell lines after knockdown of MTFR2. The epithelial-mesenchymal transition pathway was inhibited in MTFR2-silenced cells. MTFR2 can switch glucose metabolism from OXPHS to glycolysis in a HIF1α- and HIF2α-dependent manner. Conclusion: Taken together, our results indicate that increased expression of MTFR2 is associated with tumour progression in breast cancer cells through switching glucose metabolism from OXPHS to glycolysis in a HIF1α- and HIF2α-dependent manner. Materials and methods: We obtained data from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) to analyse MTFR2 expression in BC. The prognostic value of MTFR2 expression was assessed using the Kaplan-Meier method. The biological influence of MTFR2 on BC cell lines was studied using proliferation, Transwell migration, invasion and mitochondrial function assays.
Collapse
Affiliation(s)
- Guanming Lu
- Department of Breast and Thyroid Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Basie, Guangxi, China
| | - Yuanhui Lai
- Department of Breast and Thyroid Surgery, Eastern Hospital of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tiantian Wang
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China
| | - Weihao Lin
- Department of Breast and Thyroid Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinlan Lu
- Department of Stomatology, Affiliated Hospital of Youjiang Medical University for Nationalities, Basie, Guangxi, China
| | - Yanfei Ma
- Department of Breast and Thyroid Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Basie, Guangxi, China
| | - Yongcheng Chen
- Department of Breast and Thyroid Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Basie, Guangxi, China
| | - Haiqing Ma
- Department of Oncology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Ruilei Liu
- Department of Breast and Thyroid Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jie Li
- Department of Breast and Thyroid Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| |
Collapse
|
13
|
Ciruelos E, Pérez-García JM, Gavilá J, Rodríguez A, de la Haba-Rodriguez J. Maintenance Therapy in HER2-Negative Metastatic Breast Cancer: A New Approach for an Old Concept. Clin Drug Investig 2019; 39:595-606. [PMID: 31054086 DOI: 10.1007/s40261-019-00790-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this article is to discuss the role of maintenance therapy with chemotherapy, endocrine therapy, or bevacizumab-based combination therapy in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer. The optimization of maintenance therapy in patients with HER2-negative metastatic breast cancer must be based on disease profile (tumor subtype and endocrine-sensitive status), the prior use of bevacizumab-containing regimens, and the number of prognostic risk factors. Chemotherapy should be used in patients with triple-negative breast cancer and endocrine-resistant hormone receptor-positive metastatic breast cancer, whereas endocrine therapy is the preferred option for patients with endocrine-sensitive hormone receptor-positive metastatic breast cancer. After first-line bevacizumab plus chemotherapy, bevacizumab may be continued until disease progression or unacceptable toxicity, and endocrine therapy or capecitabine may be added. The goals of maintenance therapy in patients with HER2-negative metastatic breast cancer are to improve and maintain clinical response, increase time to progression, extend overall survival, relieve tumor-related symptoms, and delay the use of aggressive therapies, without compromising quality of life. Maintenance therapy, using chemotherapy, endocrine therapy, and combined therapy with bevacizumab, is a reasonable strategy to achieve these goals in patients with either triple-negative breast cancer or hormone receptor-positive and HER2-negative metastatic breast cancer. Ongoing clinical studies of new molecular-targeted therapies may provide additional pharmacological options for future maintenance strategies in these patients.
Collapse
Affiliation(s)
- Eva Ciruelos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Manuel Pérez-García
- IOB Institute of Oncology, Quiron University Hospital, Plaza Alfonso Comin 5-7, 08023, Barcelona, Spain.
| | | | | | - Juan de la Haba-Rodriguez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Universidad de Córdoba, Córdoba, Spain
| |
Collapse
|