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McDonald ES, Scheel JR, Lewin AA, Weinstein SP, Dodelzon K, Dogan BE, Fitzpatrick A, Kuzmiak CM, Newell MS, Paulis LV, Pilewskie M, Salkowski LR, Silva HC, Sharpe RE, Specht JM, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024; 21:S168-S202. [PMID: 38823943 DOI: 10.1016/j.jacr.2024.02.021] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Elizabeth S McDonald
- Research Author, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Scheel
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Basak E Dogan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Fitzpatrick
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | | | - Melissa Pilewskie
- University of Michigan, Ann Arbor, Michigan; Society of Surgical Oncology
| | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - H Colleen Silva
- The University of Texas Medical Branch, Galveston, Texas; American College of Surgeons
| | | | - Jennifer M Specht
- University of Washington, Seattle, Washington; American Society of Clinical Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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2
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Martens GA, Demol J, Dedeurwaerdere F, Breyne J, De Smet K, De Jaeger P, De Smet D. Rational thresholding of circulating tumor DNA concentration for improved surveillance of metastatic breast cancer. ESMO Open 2024; 9:102235. [PMID: 38320429 PMCID: PMC10937210 DOI: 10.1016/j.esmoop.2024.102235] [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: 07/11/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The use of circulating tumor DNA (ctDNA) concentration for metastatic cancer surveillance is promising, but uncertainty remains about cut-offs with clinical validity. MATERIALS AND METHODS This observational study recruited 136 subjects with advanced metastatic breast cancer (irrespective of ERBB2/hormone receptor status) for sequencing of their primary tumor in search for PIK3CA hotspot variants amenable for monitoring by droplet digital PCR (ddPCR). The study analyzed 341 on-treatment samples from 19 patients with PIK3CA variants H1047R or E545K enrolled for long-term (median 85 weeks, range 13-125 weeks), frequent (every 3-5 weeks, median of 14 time points per subject, range 2-29) blood sampling for ctDNA quantification by ddPCR, orthogonally validated by deep sequencing. The diagnostic accuracy of ctDNA versus cancer antigen 15-3 (CA15-3) concentrations to predict disease progression within 12 weeks was investigated using receiver operating characteristic (ROC) analysis. Likelihood ratios were used for rational selection of ctDNA result intervals. RESULTS ctDNA [area under the ROC curve (AUC) 0.848, 95% confidence interval (CI) 0.791-0.895] showed superior diagnostic performance than CA15-3 (AUC 0.670, 95% CI 0.601-0.735, P < 0.001) to predict clinical progression within 12 weeks. ctDNA levels below 10 mutant allele copies/ml had high negative predictive value (88%), while levels above 100 copies/ml detected 64% of progressions 10 weeks earlier versus standard of care. Logistic regression analysis indicated complementary value of ctDNA and the presence of two consecutive CA15-3 rises, resulting in a model with 86% (95% CI 74% to 93%) positive predictive value and a clinically meaningful result in 89% of blood draws. CONCLUSIONS Intensive ctDNA quantification improves metastatic breast cancer surveillance and enables individualized risk-based scheduling of clinical care.
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Affiliation(s)
- G A Martens
- Department of Laboratory Medicine, AZ Delta General Hospital, Roeselare; Department of Biomolecular Medicine, Ghent University, Ghent.
| | - J Demol
- Department of Oncology, AZ Delta General Hospital, Roeselare
| | | | - J Breyne
- Department of Laboratory Medicine, AZ Delta General Hospital, Roeselare
| | - K De Smet
- Department of Radiology, AZ Delta General Hospital, Roeselare
| | - P De Jaeger
- Department of RADar Learning and Innovation Center, AZ Delta General Hospital, Roeselare, Belgium
| | - D De Smet
- Department of Laboratory Medicine, AZ Delta General Hospital, Roeselare
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3
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Wilkinson AN, Seely JM, Rushton M, Williams P, Cordeiro E, Allard-Coutu A, Look Hong NJ, Moideen N, Robinson J, Renaud J, Mainprize JG, Yaffe MJ. Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing. Curr Oncol 2023; 30:7860-7873. [PMID: 37754486 PMCID: PMC10527628 DOI: 10.3390/curroncol30090571] [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: 07/19/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. METHODS ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. RESULTS BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. CONCLUSION The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.
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Affiliation(s)
- Anna N. Wilkinson
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Jean M. Seely
- Department of Radiology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Moira Rushton
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Phillip Williams
- Division of Anatomic Pathology, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada;
| | - Erin Cordeiro
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (E.C.); (A.A.-C.)
| | - Alexandra Allard-Coutu
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (E.C.); (A.A.-C.)
| | | | - Nikitha Moideen
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Jessica Robinson
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Julie Renaud
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - James G. Mainprize
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada; (J.G.M.); (M.J.Y.)
| | - Martin J. Yaffe
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada; (J.G.M.); (M.J.Y.)
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Thill M, Kolberg-Liedtke C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Jackisch C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Müller V, Würstlein R, Janni W, Park-Simon TW. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:306-315. [PMID: 37900553 PMCID: PMC10601669 DOI: 10.1159/000531579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2023 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer (mBC).
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | | | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für Klinische Radiologie, Klinikum der Universität München Campus Großhadern, Munich, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang, Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Andreas D. Hartkopf
- Department für Frauengesundheit, Forschungsinstitut für Frauengesundheit, Universitätsfrauenklinik, Tübingen, Germany
| | - Jörg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Fachklinik für Onkologische Rehabilitation, Immanuel Hospital Märkische Schweiz, Buckow & Immanuel Hospital Rüdersdorf/Medical University of Brandenburg Theodor Fontane, Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik für Gynäkologie, Universitäts Spital, Zürich, Switzerland
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Würstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Wolfgang Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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5
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Saranti G, Zolota V, Kalogeropoulou C, Papathanasiou N, Katsila T, Kitsou K, Haliassos I, Kardamakis D. Diagnostic and Therapeutic Challenges in a Patient with Ureteral Metastases from a Triple Negative Breast Cancer. Curr Oncol 2022; 29:4791-4798. [PMID: 35877240 PMCID: PMC9323522 DOI: 10.3390/curroncol29070380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022] Open
Abstract
Metastatic ureteral tumors arising from a primary breast carcinoma are extremely rare. They present with hematuria and radiological findings compatible with obstructive ureteral phenomena. We present a case of an 87-year-old woman with a history of lymphoma and triple negative breast cancer (TNBC), during an emergency admission for peptic ulcer, developed macroscopic hematuria. Radiologic and endoscopic investigations revealed a remarkable stenosis at the lower segment of the right ureter, attributed to metastases from her breast carcinoma. We report this case with the aim to make both oncologists and urologists aware of this rare condition.
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Affiliation(s)
- Georgia Saranti
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
| | - Vasiliki Zolota
- Department of Histopathology, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Christina Kalogeropoulou
- Department of Radiology, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Nikolaos Papathanasiou
- Department of Nuclear Medicine, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Theodora Katsila
- Institute of Chemical Biology, National Hellenic Research Foundation, 11635 Athens, Greece;
| | - Konstantina Kitsou
- Department of Hygiene and Epidemiology, University of Patras Medical School, 26504 Patras, Greece;
| | - Ilias Haliassos
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
- Correspondence: ; Tel.: +30-6999-424273
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6
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Bhaludin BN, Tunariu N, Senthivel N, Babiker A, Soneji ND, Hujairi N, Sharma B, McGrath SE, Okines AF, Ring AE, Messiou C, Downey K, Koh DM. Does the addition of whole-body MRI to routine imaging influence real-world treatment decisions in metastatic breast cancer? Cancer Imaging 2022; 22:26. [PMID: 35672838 PMCID: PMC9172188 DOI: 10.1186/s40644-022-00464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background The assessment of metastatic breast cancer (MBC) can be limited with routine imaging such as computed tomography (CT) especially in bone-only or bone-predominant disease. This analysis investigates the effects of the use of WBMRI in addition to the use of routine CT, bone scintigraphy (BS) and fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) on influencing systemic anti-cancer treatment (SACT) decisions in patients with known MBC. Methods MBC patients undergoing SACT who had WBMRI undertaken within 8 weeks of either a routine CT, BS or FDG-PET/CT were reviewed retrospectively. The clinical indications for undertaking the WBMRI examinations were recorded. Data on the extent and distribution of the disease were collected and discordance/concordance of disease status across the imaging modalities were compared. SACT decisions at each time point were also evaluated. Results There were 105 MBC patients with 148 WBMRI studies paired with CT, BS or FDG-PET/CT. 50 pairs (33.8%) showed differences in the extent of disease, with 44 pairs due to additional sites (AS) reported on WBMRI alone. 81 patients (Group 1) had one WBMRI paired with routine imaging due to a variety of indications, with clinical symptoms (such as bone pain) being the most common (24.7%). 24 patients (Group 2) had more than one WBMRI study paired with routine imaging comprising 67 pairs. 13/67 pairs (19.4%) showed discordance in assessments. 10/13 pairs had progressive disease (PD) reported on WBMRI alone. SACT change due to AS reported on WBMRI alone occurred in 21/23 pairs (91.3%) in Group 1. SACT change due to PD reported on WBMRI alone in Group 2 occurred in 6/14 pairs (42.9%). SACT change due to AS/PD in both groups occurred in 11/102 pairs (10.8%) with known invasive ductal carcinoma (IDC) and 13/28 pairs (46.4%) with invasive lobular carcinoma (ILC). Conclusions The use of WBMRI in MBC led to earlier recognition of PD and SACT change compared with the other imaging modalities. A higher proportion of discordant response assessments and SACT changes were observed in ILC compared with IDC in our patient group, although larger-scale studies are required to investigate this further.
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Affiliation(s)
- Basrull N Bhaludin
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, England, UK.
| | - Nina Tunariu
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK.,Institute of Cancer Research, London, England, UK
| | - Nishanthi Senthivel
- Department of Medicine - Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK
| | - Amna Babiker
- Department of Medicine - Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK
| | - Neil D Soneji
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, England, UK.,Department of Radiology and Nuclear Medicine, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London, W6 8RF, England, UK
| | - Nabil Hujairi
- Department of Nuclear Medicine, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, England, UK
| | - Bhupinder Sharma
- Department of Radiology and Nuclear Medicine, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, England, UK
| | - Sophie E McGrath
- Department of Medicine - Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK
| | - Alicia F Okines
- Department of Medicine - Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, England, UK
| | - Alistair E Ring
- Department of Medicine - Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK.,Institute of Cancer Research, London, England, UK
| | - Kate Downey
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, England, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, SM2 5PT, England, UK.,Institute of Cancer Research, London, England, UK
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7
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Capeloa T, Krzystyniak J, Rodriguez AC, Payen VL, Zampieri LX, Pranzini E, Derouane F, Vazeille T, Bouzin C, Duhoux FP, Murphy MP, Porporato PE, Sonveaux P. MitoQ Prevents Human Breast Cancer Recurrence and Lung Metastasis in Mice. Cancers (Basel) 2022; 14:cancers14061488. [PMID: 35326639 PMCID: PMC8946761 DOI: 10.3390/cancers14061488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Entry in the metastatic phase is often devastating for cancer patients. Metastases originate from metastatic progenitor cells that are selected in the primary tumor and which simultaneously possess several phenotypic capabilities, including migration, invasion, and clonogenicity. We previously provided in vitro evidence that these features are collectively enforced by mitochondrial superoxide in a paradigm where mitochondria act as metabolic sensors of the tumor microenvironment and produce subcytotoxic levels of superoxide to prime metastatic progenitor cells. We also showed that these metastatic traits can be collectively countered by MitoQ, a mitochondria-targeted antioxidant that selectively deactivates mitochondrial superoxide. Here, we further establish that MitoQ prevents primary tumor recurrence after surgery, tumor take and metastasis as a whole, notably in a model of human breast cancer in mice. Since MitoQ already successfully passed Phase I clinical trials, our findings support the development of this drug as a preventive treatment against breast cancer metastasis. Abstract In oncology, the occurrence of distant metastases often marks the transition from curative to palliative care. Such outcome is highly predictable for breast cancer patients, even if tumors are detected early, and there is no specific treatment to prevent metastasis. Previous observations indicated that cancer cell mitochondria are bioenergetic sensors of the tumor microenvironment that produce superoxide to promote evasion. Here, we tested whether mitochondria-targeted antioxidant MitoQ is capable to prevent metastasis in the MDA-MB-231 model of triple-negative human breast cancer in mice and in the MMTV-PyMT model of spontaneously metastatic mouse breast cancer. At clinically relevant doses, we report that MitoQ not only prevented metastatic take and dissemination, but also local recurrence after surgery. We further provide in vitro evidence that MitoQ does not interfere with conventional chemotherapies used to treat breast cancer patients. Since MitoQ already successfully passed Phase I safety clinical trials, our preclinical data collectively provide a strong incentive to test this drug for the prevention of cancer dissemination and relapse in clinical trials with breast cancer patients.
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Affiliation(s)
- Tania Capeloa
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
| | - Joanna Krzystyniak
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
| | - Amanda Canas Rodriguez
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
| | - Valéry L. Payen
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
| | - Luca X. Zampieri
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
| | - Erica Pranzini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, 50134 Firenze, Italy;
| | - Françoise Derouane
- Pole of Medical Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (F.D.); (F.P.D.)
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Thibaut Vazeille
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
| | - Caroline Bouzin
- IREC Imaging Platform (2IP), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium;
| | - François P. Duhoux
- Pole of Medical Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (F.D.); (F.P.D.)
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Michael P. Murphy
- MRC Mitochondrial Biology Unit, Department of Medicine, University of Cambridge, Cambridge CB2 0XY, UK;
| | - Paolo E. Porporato
- Department of Molecular Biotechnology and Health Science, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy;
| | - Pierre Sonveaux
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (T.C.); (J.K.); (A.C.R.); (V.L.P.); (L.X.Z.); (T.V.)
- Correspondence:
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8
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Courtney D, Davey MG, Moloney BM, Barry MK, Sweeney K, McLaughlin RP, Malone CM, Lowery AJ, Kerin MJ. Breast cancer recurrence: factors impacting occurrence and survival. Ir J Med Sci 2022; 191:2501-2510. [PMID: 35076871 DOI: 10.1007/s11845-022-02926-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Breast cancer mortality has decreased due to improved screening and treatment options. Nevertheless, 25-30% of patients develop disease recurrence and die from the disease dissemination. Patients who develop metastatic disease represent a heterogeneous group and management plans are dependent on molecular subtype, disease burden and metastatic site. AIM To determine predictive clinicopathological factors of disease recurrence and their impact on survival in the molecular era. METHODS Consecutive patients who breast cancer developed recurrence at our tertiary referral centre between 2000 and 2015 were included. Clinicopathological and treatment data were assessed using descriptive statistics. Oncological outcome was assessed using Cox regression and Kaplan Meier analyses. RESULTS Two hundred sixty-five consecutive patients who developed breast cancer recurrence were included; median age at metastasis was 59.3 years (range 27-87 years), and median time to recurrence (TTR) was 47.7 ± 38.5 months (range 3.0-194.3 months). Survival was 24.2% (64/265) 53.2% were luminal A (LABC) (141/265), 18.5% were luminal B (LBBC) (49/265), 18.5% were triple negative (TNBC) (49/265), and 9.8% were human epidermal growth factor receptor-2 overexpressing (HER2 +) (26/265). TTR for patients with LABC was 56.0 ± 41.3 months, LBBC was 48.4 ± 41.1 months, TNBC was 26.9 ± 28.5 months and HER2 + was 34.3 ± 21.8 months. Increased grade (P < 0.001), Nottingham Prognostic Indices (P < 0.001), TNBC (P < 0.001), HER2 + subtype (P < 0.001) and receiving targeted therapy (P = 0.006) predicted shorted TTR. Estrogen receptor positivity (P < 0.001), progesterone receptor positivity (P = 0.010), invasive lobular carcinoma (P = 0.009) and receiving endocrine therapy (P = 0.001) predicted longer TTR. CONCLUSION Readily available clinicopathological factors predict risk of metastatic dissemination. Developing a tailored program to identify patients at risk of recurrence is crucial in controlling metastatic dissemination of breast cancer.
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Affiliation(s)
- Donald Courtney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Matthew G Davey
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland.
| | - Brian M Moloney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Michael K Barry
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Karl Sweeney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Ray P McLaughlin
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Carmel M Malone
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Aoife J Lowery
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
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9
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Review of imaging techniques for evaluating morphological and functional responses to the treatment of bone metastases in prostate and breast cancer. Clin Transl Oncol 2022; 24:1290-1310. [PMID: 35152355 PMCID: PMC9192443 DOI: 10.1007/s12094-022-02784-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.
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10
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Mazumdar A, Jain S, Jain S, Bose SM. Management of Early Breast Cancer – Surgical Aspects. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Thill M, Friedrich M, Kolberg-Liedtke C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Harbeck N, Heil J, Huober J, Jackisch C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Müller V, Janni W, Ditsch N. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2021. Breast Care (Basel) 2021; 16:228-235. [PMID: 34248463 PMCID: PMC8248779 DOI: 10.1159/000516420] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | | | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Brustzentrum, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M. Fallenberg
- Institut für Klinische Radiologie, Klinikum der Universität München Campus Großhadern, Munich, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael P. Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Ulrike Nitz
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Schneeweiss
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Florian Schütz
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Hans-Peter Sinn
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Christine Solbach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Erich-Franz Solomayer
- Institut für Klinische Radiologie, Klinikum der Universität München Campus Großhadern, Munich, Germany
| | - Elmar Stickeler
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christoph Thomssen
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Untch
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Isabell Witzel
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volkmar Müller
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Wolfgang Janni
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
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12
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Srour MK, Lee M, Wolcott-Sapp S, Luu M, Chung A, Giuliano AE, Amersi F. Incidental radiologic findings in breast cancer patients who undergo staging prior to neo-adjuvant chemotherapy. Breast J 2021; 27:345-351. [PMID: 33491830 DOI: 10.1111/tbj.14172] [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: 09/03/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Abstract
NCCN guidelines discourage the use of staging imaging for newly diagnosed patients with early breast cancer (BC). When performed, incidental radiologic findings of uncertain significance are often encountered. The purpose of this study was to compare incidental findings seen on staging imaging with distant recurrence in patients undergoing neo-adjuvant chemotherapy (NAC). 396 patients with BC who had NAC from 2008 to 2016 were identified from a prospectively maintained data base. Staging imaging was reviewed. Of 396 patients with BC treated with NAC, patients with a positive PET/CT for metastatic disease (n = 36, 9.1%), those that did not undergo staging imaging (n = 49, 12.4%), or those that did not have a reported incidental finding (n = 49, 12.4%) were excluded from analysis. Of the 262 patients who met criteria, mean age was 50 years (range: 26-88). 201 (76.7%) patients had stage I-II cancer, and 61 (23.3%) patients had stage III cancer. Overall, 146 (55.7%) patients had an incidental finding on imaging. 90 (34.4%) patients had one finding, 42 (16.0%) patients had two, and 14 (5.3%) patients had three or more findings. The majority of incidental findings were seen in the ovary/uterus (29.7%), followed by lung (18.4%), liver (10.3%), and bone (9.0%). 5 (3.4%) patients had additional imaging performed. At mean follow-up of 3.7 years (range: 0.7-10.8), 43 (15.6%) patients had a distant recurrence. Of these patients, only 5 (1.9%) patients had distant metastasis in the same organ that was initially thought to be an incidental finding. Our results suggest that breast cancer patients with incidental findings on preoperative staging imaging are unlikely to be indicative of sites for future metastasis.
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Affiliation(s)
- Marissa K Srour
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Minna Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sarah Wolcott-Sapp
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alice Chung
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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13
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ePRO-based individual follow-up care for women treated for early breast cancer: impact on service use and workflows. J Cancer Surviv 2021; 15:485-496. [PMID: 33415653 DOI: 10.1007/s11764-020-00942-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The increasing population of breast cancer survivors highlights the need to (re)consider how we utilize available services for survivorship care in oncology clinics. Electronic Patient-Reported Outcomes (ePROs) can be used to identify patients' individual care needs and triage them to the right services. We examined the impact on service use, workflow and workload following the introduction of an ePRO-based individual follow-up (PIFU) for women treated for early breast cancer. METHODS A multi-method approach was used. In a pilot randomized controlled trial, the use of consultations, telephone calls, and specialist referrals were systematically recorded. Comparison was done between PIFU and standard follow-up care (SFU). Focus group interviews with nurse navigators evaluated the impact on workflow and workload qualitatively. RESULTS The 64 women randomized to attend SFU used a mean of 3.8 (95% CI: 3.5-4.1) planned consultations during the 2-year study period compared with a mean of 1.9 consultations (95% CI: 1.4-2.4) for the 60 women randomized to PIFU (P < 0.001). Urgent appointments were more frequent in SFU (mean of 0.47 vs 0.22 per patient, P = 0.03). No statistically significant differences were observed in the use of telephone calls and specialist referrals. The nurse navigators did not experience an increase in their workload, but implementation of PIFU may require a re-structured workflow. CONCLUSIONS The ePRO-based individual follow-up could change organization of care and re-allocate services for those in need of it. IMPLICATIONS FOR CANCER SURVIVORS ePRO-based individual follow-up could potentially ensure more time for those most in need of face-to-face care.
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14
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Maes‐Carballo M, Muñoz‐Núñez I, Martín‐Díaz M, Mignini L, Bueno‐Cavanillas A, Khan KS. Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review. Health Expect 2020; 23:1045-1064. [PMID: 32748514 PMCID: PMC7696137 DOI: 10.1111/hex.13112] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is not clear whether clinical practice guidelines (CPGs) and consensus statements (CSs) are adequately promoting shared decision making (SDM). OBJECTIVE To evaluate the recommendations about SDM in CPGs and CSs concerning breast cancer (BC) treatment. SEARCH STRATEGY Following protocol registration (Prospero no.: CRD42018106643), CPGs and CSs on BC treatment were identified, without language restrictions, through systematic search of bibliographic databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR) and online sources (12 guideline databases and 51 professional society websites) from January 2010 to December 2019. INCLUSION CRITERIA CPGs and CSs on BC treatment were selected whether published in a journal or in an online document. DATA EXTRACTION AND SYNTHESIS A 31-item SDM quality assessment tool was developed and used to extract data in duplicate. MAIN RESULTS There were 167 relevant CPGs (139) and CSs (28); SDM was reported in only 40% of the studies. SDM was reported more often in recent publications after 2015 (42/101 (41.6 %) vs 46/66 (69.7 %), P = .0003) but less often in medical journal publications (44/101 (43.5 %) vs 17/66 (25.7 %), P = .009). In CPGs and CSs with SDM, only 8/66 (12%) met one-fifth (6 of 31) of the quality items; only 14/66 (8%) provided clear and precise SDM recommendations. DISCUSSION AND CONCLUSIONS SDM descriptions and recommendations in CPGs and CSs concerning BC treatment need improvement. SDM was more frequently reported in CPGs and CSs in recent years, but surprisingly it was less often covered in medical journals, a feature that needs attention.
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Affiliation(s)
- Marta Maes‐Carballo
- Department of General SurgeryComplexo Hospitalario de OurenseOurenseSpain
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
| | | | | | | | - Aurora Bueno‐Cavanillas
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
- Instituto de Investigación Biosanitaria IBSGranadaSpain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
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15
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Njor SH, Vejborg I, Larsen MB. Breast cancer survivors' risk of interval cancers and false positive results in organized mammography screening. Cancer Med 2020; 9:6042-6050. [PMID: 32608178 PMCID: PMC7433834 DOI: 10.1002/cam4.3182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Breast cancer survivors are increasing followed for new breast cancers / recurrences by mammography screening only. We aimed at assessing how often breast cancer survivors get a false positive or false negative result at mammography screening. METHODS All mammography screenings performed between 2007 and 2017 in the Danish national mammography screening programme were included. Screenings in women with a breast cancer diagnosis prior to invitation were included in the "breast cancer survivors" group, while remaining screenings were included in the "no previous breast cancer" group. We compared the proportion of false positive screenings and the proportion of breast cancers detected at screening among breast cancer survivors and women without previous breast cancer. The analyses were further stratified according to whether the women had a diagnostic breast imaging in the 21 months prior to the screening. RESULTS At initial screenings, breast cancer survivors had a significant lower false positive risk than other women, while the risk was similar at subsequent screenings. Breast cancer survivors had a significant lower proportion of breast cancers detected at screening compared to other women. This was true both for women who had a diagnostic breast imaging in the 21 months prior to screening and those who did not. CONCLUSION This study shows that breast cancers survivors have a smaller amount of their new breast cancers detected at mammography screening, when compare to the amount of new breast cancers detected at mammography screening among women without previous breast cancer. The lower sensitivity does not seem to be due to different behavior among breast cancer survivors.
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Affiliation(s)
- Sisse Helle Njor
- Department of Public Health Programmes, Regional Hospital Randers, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, aarhus, Denmark
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Regional Hospital Randers, Randers, Denmark
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16
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McKenzie HS, Maishman T, Simmonds P, Durcan L, Eccles D, Copson E. Survival and disease characteristics of de novo versus recurrent metastatic breast cancer in a cohort of young patients. Br J Cancer 2020; 122:1618-1629. [PMID: 32231292 PMCID: PMC7250836 DOI: 10.1038/s41416-020-0784-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is not clear how the pathology, presentation and outcome for patients who present with de novo metastatic breast cancer (dnMBC) compare with those who later develop distant metastases. DnMBC is uncommon in younger patients. We describe these differences within a cohort of young patients in the United Kingdom. METHODS Women aged 40 years or younger with a first invasive breast cancer were recruited to the prospective POSH national cohort study. Baseline clinicopathological data were collected, with annual follow-up. Overall survival (OS) and post-distant relapse-free survival (PDRS) were assessed using Kaplan-Meier curves. RESULTS In total, 862 patients were diagnosed with metastatic disease. DnMBC prevalence was 2.6% (76/2977). Of those with initially localised disease, 27.1% (786/2901) subsequently developed a distant recurrence. Median follow-up was 11.00 years (95% CI 10.79-11.59). Patients who developed metastatic disease within 12 months had worse OS than dnMBC patients (HR 2.64; 1.84-3.77). For PDRS, dnMBC was better than all groups, including those who relapsed after 5 years. Of dnMBC patients, 1.3% had a gBRCA1, and 11.8% a gBRCA2 mutation. CONCLUSIONS Young women with dnMBC have better PDRS than those who develop relapsed metastatic breast cancer. A gBRCA2 mutation was overrepresented in dnMBC.
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Affiliation(s)
- Hayley S McKenzie
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK.
| | - Tom Maishman
- Southampton Clinical Trials Unit, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Peter Simmonds
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Lorraine Durcan
- Southampton Clinical Trials Unit, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Diana Eccles
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Ellen Copson
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK
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Riis CL, Jensen PT, Bechmann T, Möller S, Coulter A, Steffensen KD. Satisfaction with care and adherence to treatment when using patient reported outcomes to individualize follow-up care for women with early breast cancer - a pilot randomized controlled trial. Acta Oncol 2020; 59:444-452. [PMID: 32000559 DOI: 10.1080/0284186x.2020.1717604] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The population of breast cancer survivors is increasing as a positive consequence of early detection and enhanced treatment. The disease and treatment associated side-effects or late-effects often impact on quality of life and daily life functions during survivorship. This calls for optimization of follow-up care. We aimed to evaluate the patients' satisfaction with the care provided, when using electronic patient reported outcomes (ePROs) to individualize follow-up care in women with early breast cancer receiving adjuvant endocrine therapy.Material and methods: Postmenopausal women treated for hormone receptor positive early breast cancer were included in a pilot randomized controlled trial and randomized to receive standard follow-up care with prescheduled consultations every six months or individualized follow-up care with the active use of ePROs to screen for the need of consultations. ePROs were distributed every third month over a two-year period. Primary outcomes were satisfaction with the assigned follow-up care and unmet needs. Secondary outcomes were use of consultations, adherence to treatment and quality of life.Results: Of the 207 consecutive patients who were potentially eligible for the study, 134 women were enrolled (65%). In total 64 women in standard care and 60 women in individualized care were analyzed. No statistically significant differences were reported in relation to satisfaction, unmet needs, adherence to treatment or quality of life. Women in standard care attended twice as many consultations during the two year follow-up period as women in individualized care; 4.3 (95% CI 3.9-4.7) versus 2.1 (95% CI: 1.6-2.6), p < .001.Conclusion: A significant reduction in consultations was observed for the group attending individualized care without compromising the patients' satisfaction, quality of life or adherence to treatment. For the majority of postmenopausal women treated for early breast cancer, implementation of ePROs to individualize follow-up care was feasible.
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Affiliation(s)
- Cathrine L. Riis
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Denmark
| | - Pernille T. Jensen
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Troels Bechmann
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital
| | - Angela Coulter
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Denmark
| | - Karina D. Steffensen
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Denmark
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Abstract
OBJECTIVE. The objective of this study was to demonstrate the feasibility of dual-energy CT (DECT) for locoregional staging of breast cancer and differentiation of tumor histotypes. MATERIALS AND METHODS. From January 2016 to July 2017, a total of 31 patients (mean [± SD] age, 55.8 ± 14.8 years) with breast cancer diagnosed by needle biopsy who underwent preoperative contrast-enhanced DECT for staging purposes were selected from a retrospective review of institutional databases. Monochromatic images obtained at 40 and 70 keV were evaluated by two readers who determining the number of hypervascularized tumors present and the largest tumor diameter for each breast. The attenuation values and iodine concentration of tumors and normal breast tissue and the ratios of these findings in each tissue type were recorded. Cancers were classified as ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma. The reference standard was the final pathologic finding after surgery. RESULTS. A total of 64 tumor lesions were found at histopathologic analysis versus 67 on DECT for 34 breasts (three bilateral cancers were included). Nonparametric statistics were used. The largest lesion diameter observed DECT was 33.2 ± 20.5 mm versus 31.8 ± 20.5 mm on pathologic analysis, and cancer distribution was correctly classified for 31 of 34 (91%) cases. ROC curves derived from lesion iodine concentration showed that the optimal thresholds for distinguishing infiltrating carcinomas (invasive lobular and ductal carcinomas) and from other lesions were 1.70 mg/mL (sensitivity, 94.9%; specificity, 93.0%; AUC value, 0.968). ROC curves derived from the ratio of the iodine concentration in lesions to that in normal breast parenchyma showed that 6.13 was the optimal threshold to distinguish invasive ductal carcinoma from other lesions (sensitivity, 87.0%; specificity, 81.1%; AUC value, 0.914). CONCLUSION. DECT is feasible and seems to be a reliable tool for locoregional staging of breast cancer.
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Li F, Wang B, He M, Chang J, Li J, Shan L, Wang H, Hong W, Luo D, Song Y, Liu L, Li H, Ran L, Chen T. Pilot study of docetaxel combined with lobaplatin or gemcitabine for recurrent and metastatic breast cancer. Medicine (Baltimore) 2019; 98:e18513. [PMID: 31876741 PMCID: PMC6946339 DOI: 10.1097/md.0000000000018513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/24/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study evaluated the efficacy and safety of docetaxel combined with lobaplatin, relative to docetaxel combined with gemcitabine, for treating patients with recurrent metastatic breast cancer (rMBC). METHODS Patients with rMBC received ≥2 cycles (21 days each) of either docetaxel and lobaplatin (DL; n = 21), or docetaxel and gemcitabine (DG; n = 22). On day 1 of each cycle, all patients were given 75 mg/m intravenous docetaxel. Patients in DL and DG were also given, respectively, 35 mg/m intravenous lobaplatin (day 2) or 1000 mg/m intravenous gemcitabine (days 1, 8). RESULTS Five (11.6%) and 16 (37.2%) patients achieved complete remission and partial response, respectively; rates of response and disease control were 48.8%. The response rates of the groups were comparable (47.6%, 50.0%). The median survival times after relapse and metastasis of the DL group (18 months) were significantly less than that of the DG group (25 months). Median progression-free survivals after relapse and metastasis were similar (12 cf. 14 months). The main toxic side reaction was grade 2, with no treatment-related deaths. Rates of the following were comparable between DG and DL: grade 3 or 4 white blood cells (23.8%, 31.8%) and digestive tract toxicity (4.8%, 4.5%); neutropenia (28.6%, 22.7%); anemia (4.8%, nil); and thrombocytopenia (19.0%, 13.6%). Other toxicities included hepatic toxicity, myalgia, infection, and fatigue. CONCLUSIONS Both the DL and DG regimens were associated with encouraging benefits, while treatment-related toxicity was manageable. Therefore, these regimens are effective options for treatment of rMBC. TRIAL REGISTRATION This clinical trial study was approved by the Ethics Committee of Guizhou Cancer Hospital, and has been registered in the China Clinical Trial Center (December 8, 2014, No. ChiCTR-IPR-14005633).
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Affiliation(s)
- Fenghu Li
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Bi Wang
- Department of Obstetrics and Gynecology, Guiyang Maternal and Child Health-Care Hospital
| | - Mingyuan He
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Jianying Chang
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Jiehui Li
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Lang Shan
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Heran Wang
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Wei Hong
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Daiqin Luo
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Yang Song
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Liyang Liu
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Huiqin Li
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Li Ran
- Department of Breast and Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University
- Department of Breast and Gynecologic Oncology, Guizhou Cancer Hospital
| | - Tengxiang Chen
- Guizhou Provincial Key Laboratory of Pathogenesis and Drug Research on Common Chronic Diseases; Guizhou Province Key Laboratory for Regenerative Medicine; Department of Physiology, School of Basic Medicine, Guizhou Medical University, Guiyang, Guizhou, China
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The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast Cancer 2019; 27:17-24. [PMID: 31734900 PMCID: PMC8134289 DOI: 10.1007/s12282-019-01025-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.
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Lewin AA, Moy L, Baron P, Didwania AD, diFlorio-Alexander RM, Hayward JH, Le-Petross HT, Newell MS, Rewari A, Scheel JR, Stuckey AR, Suh WW, Ulaner GA, Vincoff NS, Weinstein SP, Slanetz PJ. ACR Appropriateness Criteria® Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women. J Am Coll Radiol 2019; 16:S428-S439. [DOI: 10.1016/j.jacr.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
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Zhou ZH, Sun LJ, Zhang GM. Ureter - an unusual site of breast cancer metastasis: A case report. World J Clin Cases 2019; 7:3347-3352. [PMID: 31667190 PMCID: PMC6819293 DOI: 10.12998/wjcc.v7.i20.3347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Breast cancer (BCa) is one of the most common malignancies in women; however, ureteral metastasis of BCa has rarely been reported in the literature.
CASE SUMMARY A 55-year-old Chinese woman with an 8-year history of BCa presented with lower back pain that had persisted for 3 mo. The patient underwent bilateral modified radical mastectomy and subclavian and submandibular clearance, and received systemic treatment, including chemotherapy, radiotherapy, and targeted therapy during treatment. Ureteroscopy did not acquire a satisfactory biopsy. Thus, laparoscopic nephroureterectomy was performed, and ureteral metastases of BCa were pathologically confirmed. As suggested by her oncologist, she continued to receive apatinib. Postoperative 3-mo follow-up indicated further progression of axillary lymph node metastases.
CONCLUSION Ureteral metastasis of BCa shows nonspecific symptoms. Diagnosing ureter metastasis from BCa can be established by histopathology and immunohistochemistry.
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Affiliation(s)
- Zhong-Han Zhou
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Li-Jiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Gui-Ming Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
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Srour MK, Lee M, Walcott-Sapp S, Luu M, Chung A, Giuliano AE, Amersi F. Overuse of Preoperative Staging of Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 2019; 26:3289-3294. [DOI: 10.1245/s10434-019-07543-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 08/30/2023]
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Stewart DJ, Macdonald DB, Awan AA, Thavorn K. Optimal frequency of scans for patients on cancer therapies: A population kinetics assessment. Cancer Med 2019; 8:6871-6886. [PMID: 31560842 PMCID: PMC6853816 DOI: 10.1002/cam4.2571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/26/2022] Open
Abstract
Background Optimal frequency of follow‐up scans for patients receiving systemic therapies is poorly defined. Progression‐free survival (PFS) generally follows first‐order kinetics. We used exponential decay nonlinear regression analysis to calculate half‐lives for 887 published PFS curves. Method We used the Excel formula x = EXP(‐tn*0.693/t1/2) to calculate proportion of residual patients remaining progression‐free at different times, where tn is the interval in weeks between scans (eg, 6 weeks), * indicates multiplication, 0.693 is the natural logarithm of 2, and t1/2 is the PFS half‐life in weeks. Results Proportion of residual patients predicted to remain progression‐free at each subsequent scan varied with scan intervals and regimen PFS half‐life. For example, with a 4‐month half‐life (17.3 weeks) and scans every 6 weeks, 21% of patients would progress by the first scan, 21% of the remaining patients would progress by the second scan at 12 weeks, etc With 2, 6‐ and 12‐month half‐lives (for example), the proportion of remaining patients progressing at each subsequent scan if repeated every 3 weeks would be 21%, 8% and 4%, respectively, while with scans every 12 weeks it would be 62%, 27% and 15%, respectively. Furthermore, optimal scan frequency can be calculated for populations comprised of distinct rapidly and slowly progressing subpopulations, as well as with convex curves arising from treatment breaks, where optimal scan frequency may differ during therapy administration vs during more rapid progression after therapy interruption. Conclusions A population kinetics approach permits a regimen‐ and tumor‐specific determination of optimal scan frequency for patients on systemic therapies.
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Incoronato M, Grimaldi AM, Mirabelli P, Cavaliere C, Parente CA, Franzese M, Staibano S, Ilardi G, Russo D, Soricelli A, Catalano OA, Salvatore M. Circulating miRNAs in Untreated Breast Cancer: An Exploratory Multimodality Morpho-Functional Study. Cancers (Basel) 2019; 11:E876. [PMID: 31234535 PMCID: PMC6628327 DOI: 10.3390/cancers11060876] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to identify new disease-related circulating miRNAs with high diagnostic accuracy for breast cancer (BC) and to correlate their deregulation with the morpho-functional characteristics of the tumour, as assessed in vivo by positron emission tomography/magnetic resonance (PET/MR) imaging. A total of 77 untreated female BC patients underwent same-day PET/MR and blood collection, and 78 healthy donors were recruited as negative controls. The expression profile of 84 human miRNAs was screened by using miRNA PCR arrays and validated by real-time PCR. The validated miRNAs were correlated with the quantitative imaging parameters extracted from the primary BC samples. Circulating miR-125b-5p and miR-143-3p were upregulated in BC plasma and able to discriminate BC patients from healthy subjects (miR-125-5p area under the receiver operating characteristic ROC curve (AUC) = 0.85 and miR-143-3p AUC = 0.80). Circulating CA15-3, a soluble form of the transmembrane glycoprotein Mucin 1 (MUC-1) that is upregulated in epithelial cancer cells of different origins, was combined with miR-125b-5p and improved the diagnostic accuracy from 70% (CA15-3 alone) to 89% (CA15-3 plus miR-125b-5p). MiR-143-3p showed a strong and significant correlation with the stage of the disease, apparent diffusion coefficient (ADCmean), reverse efflux volume transfer constant (Kepmean) and maximum standardized uptake value (SUVmax), and it might represent a biomarker of tumour aggressiveness. Similarly, miR-125b-5p was correlated with stage and grade 2 but inversely correlated with the forward volume transfer constant (Ktransmean) and proliferation index (Ki67), suggesting a potential role as a biomarker of a relatively more favourable prognosis. In situ hybridization (ISH) experiments revealed that miR-143-3p was expressed in endothelial tumour cells, miR-125-5p in cancer-associated fibroblasts, and neither in epithelial tumour cells. Our results suggested that miR-125-5p and miR-143-3p are potential biomarkers for the risk stratification of BC, and Kaplan-Maier plots confirmed this hypothesis. In addition, the combined use of miR-125-b-5p and CA15-3 enhanced the diagnostic accuracy up to 89%. This is the first study that correlates circulating miRNAs with in vivo quantified tumour biology through PET/MR biomarkers. This integration elucidates the link between the plasmatic increase in these two potential circulating biomarkers and the biology of untreated BC. In conclusion, while miR-143-3b and miR-125b-5p provide valuable information for prognosis, a combination of miR-125b-5p with the tumour marker CA15-3 improves sensitivity for BC detection, which warrants consideration by further validation studies.
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Affiliation(s)
| | | | | | | | | | | | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy.
| | - Gennaro Ilardi
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy.
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy.
| | - Andrea Soricelli
- IRCCS SDN, 80143 Naples, Italy.
- Department of Motor Sciences & Wellness, University of Naples Parthenope, 80133 Naples, Italy.
| | - Onofrio Antonio Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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Sánchez-Rovira P, Zamora P, Salvador-Bofill J, Morales S, Martínez-Jáñez N, Martínez-de-Dueñas E, Lluch A, Illarramendi JJ, Gómez-Pardo P, Gavilá Gregori J, García-Palomo A, García-Mata J, Fernández Y, Del Barco S, de Juan A, Ciruelos E, Chacón JI, Calvo L, Barnadas A, Albanell J. Broad consensus on the optimal sequence for the systemic treatment of metastatic breast cancer: results from a survey of Spanish medical oncologists. J Drug Assess 2019; 8:62-69. [PMID: 31069129 PMCID: PMC6493326 DOI: 10.1080/21556660.2019.1604375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/26/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of this survey conducted by 20 leading Spanish oncologists was to analyze the concurrence between Spanish clinical practice and the recently published definition of the optimal sequence for the systemic treatment of metastatic breast cancer (MBC) according to patient profiles. Methods: A self-administered questionnaire was developed, divided into five sections comprising 34 specific questions related to sequential treatments, plus three additional general questions. Respondents were asked to justify negative answers. Participants were recruited randomly by invitation out of a total of 619 oncologists. The questionnaire was sent and collected via e-mail between October 2015 and May 2016. A total of 191 completed questionnaires were received. Results: Overall, 70% of oncologists would keep the three patient profiles exactly as proposed (hormone receptor-positive and HER2-negative, HER2-positive, and triple negative breast cancer). Affirmative answers to questions regarding treatment sequences for these patient profiles (1–34) ranged from 77.8–99.5%, with an average of 90.9% of oncologists being in agreement with the recommended sequential treatments. The lowest degree of consensus was observed for endocrine treatments in pre-menopausal women and for chemotherapy options in hormone-resistant patients, whilst the highest degree of consensus was reached for targeted therapies in HER2-positive patients and for endocrine therapy in post-menopausal women. In their comments, participants revealed a number of economic constraints that prevented them from implementing some of the best treatment options. Conclusions: In conclusion, despite the complexity of MBC treatment, there is general agreement on the optimal treatment sequences.
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Affiliation(s)
| | | | | | | | | | | | - Ana Lluch
- Hospital ClínicUniversitari de València, València, Spain
| | | | | | | | | | | | | | | | - Ana de Juan
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eva Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Lourdes Calvo
- Complejo Hospitalario Universitario de A CoruñaA Coruña, Spain
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Gaulin C, Osorio G. Patient Reported Outcomes in Metastatic Breast Cancer Studies: Evaluating the Impact of the FDA Guidance for Industry. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2019. [DOI: 10.29024/jsim.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zugni F, Ruju F, Pricolo P, Alessi S, Iorfida M, Colleoni MA, Bellomi M, Petralia G. The added value of whole-body magnetic resonance imaging in the management of patients with advanced breast cancer. PLoS One 2018; 13:e0205251. [PMID: 30312335 PMCID: PMC6185838 DOI: 10.1371/journal.pone.0205251] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/23/2018] [Indexed: 12/24/2022] Open
Abstract
This study investigates the impact of whole-body MRI (WB-MRI) in addition to CT of chest-abdomen-pelvis (CT-CAP) and 18F-FDG PET/CT (PET/CT) on systemic treatment decisions in standard clinical practice for patients with advanced breast cancer (ABC). WB-MRI examinations in ABC patients were extracted from our WB-MRI registry (2009-2017). Patients under systemic treatment who underwent WB-MRI and a control examination (CT-CAP or PET/CT) were included. Data regarding progressive disease (PD) reported either on WB-MRI or on the control examinations were collected. Data regarding eventual change in treatment after the imaging evaluation were collected. It was finally evaluated whether the detection of PD by any of the two modalities had induced a change in treatment. Among 910 WB-MRI examinations in ABC patients, 58 had a paired control examination (16 CT-CAP and 42 PET/CT) and were analysed. In 23/58 paired examinations, additional sites of disease were reported only on WB-MRI and not on the control examination. In 17/28 paired examinations, PD was reported only on WB-MRI and not on the control examination. In 14 out of the 28 pairs of examinations that were followed by a change in treatment, PD had been reported only on WBMRI (14/28; 50%), while stable disease had been reported on the control examination. In conclusion, WB-MRI disclosed PD earlier than the control examination (CT-CAP or PET/CT), and it was responsible alone for 50% of all changes in treatment.
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Affiliation(s)
- Fabio Zugni
- Post-graduation school in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesca Ruju
- Department of Radiological Science and Radiation Therapy, European Institute of Oncology (IEO), Milan, Italy
| | - Paola Pricolo
- Department of Radiological Science and Radiation Therapy, European Institute of Oncology (IEO), Milan, Italy
| | - Sarah Alessi
- Department of Radiological Science and Radiation Therapy, European Institute of Oncology (IEO), Milan, Italy
| | - Monica Iorfida
- Division of Medical Senology, European Institute of Oncology (IEO), Milan, Italy
| | | | - Massimo Bellomi
- Department of Radiological Science and Radiation Therapy, European Institute of Oncology (IEO), Milan, Italy
- Division of Medical Senology, European Institute of Oncology (IEO), Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
| | - Giuseppe Petralia
- Department of Radiological Science and Radiation Therapy, European Institute of Oncology (IEO), Milan, Italy
- Division of Medical Senology, European Institute of Oncology (IEO), Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
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Controversies in monitoring metastatic breast cancer during systemic treatment. Results of a GIM (Gruppo Italiano Mammella) survey. Breast 2018; 40:45-52. [DOI: 10.1016/j.breast.2018.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/04/2017] [Accepted: 04/09/2018] [Indexed: 11/17/2022] Open
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Kosmin M, Padhani AR, Sokhi H, Thijssen T, Makris A. Patterns of disease progression in patients with local and metastatic breast cancer as evaluated by whole-body magnetic resonance imaging. Breast 2018; 40:82-84. [DOI: 10.1016/j.breast.2018.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 12/01/2022] Open
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31
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Savci-Heijink CD, Halfwerk H, Koster J, Van de Vijver MJ. Association between gene expression profile of the primary tumor and chemotherapy response of metastatic breast cancer. BMC Cancer 2017; 17:755. [PMID: 29132326 PMCID: PMC5683464 DOI: 10.1186/s12885-017-3691-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/16/2017] [Indexed: 12/31/2022] Open
Abstract
Background To better predict the likelihood of response to chemotherapy, we have conducted a study comparing the gene expression patterns of primary tumours with their corresponding response to systemic chemotherapy in the metastatic setting. Methods mRNA expression profiles of breast carcinomas of patients that later developed distant metastases were analyzed using supervised and non-supervised classification techniques to identify predictors of response to chemotherapy. The top differentially expressed genes between the responders and non-responders were identified and further explored. An independent dataset which was generated to predict response to neo-adjuvant CT was utilized for the purpose of validation. Response to chemotherapy was also correlated to the clinicopathologic characteristics, molecular subtypes, metastatic behavior and survival outcomes. Results Anthracycline containing regimens were the most common first line treatment (58.4%), followed by non-anthracycline/non-taxane containing (25.8%) and taxane containing (15.7%) regimens. Response was achieved in 41.6% of the patients to the first line CT and in 21.8% to second line CT. Response was not found to be significantly correlated to tumour type, grade, lymph node status, ER and PR status. Patients with HER2+ tumours showed better response to anthracycline containing therapy (p: 0.002). Response to first and second line chemotherapy did not differ among gene expression based molecular subtypes (p: 0.236 and p: 0.20). Using supervised classification, a 14 gene response classifier was identified. This 14-gene predictor could successfully predict the likelihood of better response to first and second line CT (p: <.0001 and p: 0.761, respectively) in the training set. However, the predictive value of this gene set in data of response to neoadjuvant chemotherapy could not be validated. Conclusions To our knowledge, this is the first study revealing the relation between gene expression profiles of the primary tumours and their chemotherapy responsiveness in the metastatic setting. In contrast to the findings for neoadjuvant chemotherapy treatment, there was no association of molecular subtype with response to chemotherapy in the metastatic setting. Using supervised classification, we identified a classifier of chemotherapy response; however, we could not validate this classifier using neoadjuvant response data. Trial registration Non applicable. Subjects were retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12885-017-3691-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Hans Halfwerk
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, Netherlands
| | - Jan Koster
- Department of Oncogenomics, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, Netherlands
| | - Marc Joan Van de Vijver
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, Netherlands.
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Morritti M, Iodice G, Melaccio A, D'Onofrio L, Bergnolo P, Boglione A, Comandone A, Molinaro P, Garigliano D. Long-term treatment with eribulin in heavily pretreated women with metastatic breast cancer: a case series. Future Oncol 2017; 13:25-33. [PMID: 28481183 DOI: 10.2217/fon-2016-0529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
During the last decades, much effort has been made to develop and test treatments for advanced/metastatic breast cancer (MBC) able to prolong survival and improve patients' quality of life. In this regard, eribulin represents one of the most recent and interesting discoveries. This tubulin-targeting chemotherapy demonstrated a survival benefit in MBC women who progressed after at least two prior lines of chemotherapy for the treatment of metastatic disease (prior therapies should have included an anthracycline and a taxane, in either adjuvant or metastatic setting). Here, we described five cases of heavily pretreated MBC patients who experienced long-lasting control of disease with eribulin.
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Affiliation(s)
- Maria Morritti
- UO Oncologia, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giuseppe Iodice
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Assunta Melaccio
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Loretta D'Onofrio
- Oncologia Medica Policlinico Universitario 'Campus Bio-Medico di Roma', Roma, Italy
| | - Paola Bergnolo
- UOA di Oncologia, Ospedale Humanitas Gradenigo, Torino, Italy
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Kosmin M, Makris A, Joshi PV, Ah-See ML, Woolf D, Padhani AR. The addition of whole-body magnetic resonance imaging to body computerised tomography alters treatment decisions in patients with metastatic breast cancer. Eur J Cancer 2017; 77:109-116. [DOI: 10.1016/j.ejca.2017.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/21/2017] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
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Zamagni C. Eribulin in the treatment of breast cancer: an important weapon in the treatment algorithm. Future Oncol 2017; 13:1-3. [DOI: 10.2217/fon-2017-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Claudio Zamagni
- Policlinico S Orsola-Malpighi, SSD Oncologia Medica “Addarii,” Viale Giambattista Ercolani 4/2, 40138 Bologna, Italy
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Abstract
OBJECTIVE Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen. CONCLUSION Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.
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Affiliation(s)
- Diana L Lam
- 1 Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G2-600, Seattle, WA 98109-1023
| | - Nehmat Houssami
- 2 Screening and Test Evaluation Program, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Janie M Lee
- 1 Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G2-600, Seattle, WA 98109-1023
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One-Step Systemic Staging for Patients with Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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Andre R, Volovat SR, Cardoso F. Treatment of Advanced Disease: Guidelines. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Marshall EM, Bertaut A, Desmoulins I, Darut-Jouve A, Ponnelle T, Poillot ML, Beltjens F, Arveux P. Prognostic Factors of Survival among Women with Metastatic Breast Cancer and Impact of Primary or Secondary Nature of Disease on Survival: A French Population-Based Study. Breast J 2016; 23:138-145. [DOI: 10.1111/tbj.12717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Esaie M. Marshall
- Côte d'Or Breast Cancer Registry; CGFL; Dijon France
- Research Unit 4184; Faculty of Medicine; University of Burgundy; Dijon France
| | - Aurélie Bertaut
- Methodology and Biostatistic Unit; Centre Georges François Leclerc; Dijon France
| | | | | | | | | | | | - Patrick Arveux
- Côte d'Or Breast Cancer Registry; CGFL; Dijon France
- Research Unit 4184; Faculty of Medicine; University of Burgundy; Dijon France
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Kimbung S, Kovács A, Danielsson A, Bendahl PO, Lövgren K, Frostvik Stolt M, Tobin NP, Lindström L, Bergh J, Einbeigi Z, Fernö M, Hatschek T, Hedenfalk I. Contrasting breast cancer molecular subtypes across serial tumor progression stages: biological and prognostic implications. Oncotarget 2016; 6:33306-18. [PMID: 26375671 PMCID: PMC4741767 DOI: 10.18632/oncotarget.5089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/28/2015] [Indexed: 12/22/2022] Open
Abstract
The relevance of the intrinsic subtypes for clinical management of metastatic breast cancer is not comprehensively established. We aimed to evaluate the prevalence and prognostic significance of drifts in tumor molecular subtypes during breast cancer progression. A well-annotated cohort of 304 women with advanced breast cancer was studied. Tissue microarrays of primary tumors and synchronous lymph node metastases were constructed. Conventional biomarkers were centrally assessed and molecular subtypes were assigned following the 2013 St Gallen guidelines. Fine-needle aspirates of asynchronous metastases were transcriptionally profiled and subtyped using PAM50. Discordant expression of individual biomarkers and molecular subtypes was observed during tumor progression. Primary luminal-like tumors were relatively unstable, frequently adopting a more aggressive subtype in the metastases. Notably, loss of ER expression and a luminal to non-luminal subtype conversion was associated with an inferior post-recurrence survival. In addition, ER and molecular subtype assessed at all tumor progression stages were independent prognostic factors for post-recurrence breast cancer mortality in multivariable analyses. Our results demonstrate that drifts in tumor molecular subtypes may occur during tumor progression, conferring adverse consequences on outcome following breast cancer relapse.
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Affiliation(s)
- Siker Kimbung
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Danielsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Lövgren
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marianne Frostvik Stolt
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Nicholas P Tobin
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Linda Lindström
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Department of Biosciences and Nutrition, Karolinska Institutet and University Hospital, Solna, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Thomas Hatschek
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
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40
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Liu ZY, Sun JJ, He KW, Zhuo PY, Yu ZY. Primary or metastatic hepatic carcinoma? A breast cancer patient after adjuvant chemotherapy and radiotherapy postoperatively with intrahepatic cholangiocarcinoma and review of the literature. World J Surg Oncol 2016; 14:183. [PMID: 27422708 PMCID: PMC4946133 DOI: 10.1186/s12957-016-0943-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background The liver is a common site of metastases, followed by the bone and lung in breast cancer. The symptoms of hepatic metastases are similar to intrahepatic cholangiocarcinoma (ICC). ICC is rare, with an overall incidence rate of 0.95 cases per 100,000 adults. The incidence of ICC for patients with breast cancer is very uncommon. Breast cancer patient with ICC is easily misdiagnosed as hepatic metastases. Case presentation We report a breast cancer patient postoperatively who was hospitalized because of having continuous irregular fever for 1 month. Antibiotics were given for 1 week without any significant effect. Her admission bloods revealed elevated levels of carcino-embryonic antigen. Magnetic resonance imaging diagnosis showed multiple liver metastases. We believed that the woman had hepatic metastases until biopsy guided by computed tomography. The liver biopsy pathology analysis considered the possibility of primary intrahepatic cholangiocarcinoma. Conclusions Breast cancer patient with space-occupying lesions in the liver is easily considered to be progressed hepatic metastases. Image-guided biopsy is the best diagnostic method for breast cancer with liver mass to avoid misdiagnosis and classify the molecular subtypes to make appropriate treatment.
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Affiliation(s)
- Zhao-Yun Liu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.,Department of Oncology, Shandong Academy of Medical Sciences, Shandong Cancer Hospital affiliated to Shandong University, 440 Ji-Yan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Ju-Jie Sun
- Department of Oncology, Shandong Academy of Medical Sciences, Shandong Cancer Hospital affiliated to Shandong University, 440 Ji-Yan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Ke-Wen He
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.,Department of Oncology, Shandong Academy of Medical Sciences, Shandong Cancer Hospital affiliated to Shandong University, 440 Ji-Yan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Pei-Ying Zhuo
- Department of Oncology, Shandong Academy of Medical Sciences, Shandong Cancer Hospital affiliated to Shandong University, 440 Ji-Yan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Zhi-Yong Yu
- Department of Oncology, Shandong Academy of Medical Sciences, Shandong Cancer Hospital affiliated to Shandong University, 440 Ji-Yan Road, Jinan, 250117, Shandong Province, People's Republic of China.
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41
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Bychkovsky BL, Lin NU. Imaging in the evaluation and follow-up of early and advanced breast cancer: When, why, and how often? Breast 2016; 31:318-324. [PMID: 27422453 DOI: 10.1016/j.breast.2016.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/16/2016] [Indexed: 11/15/2022] Open
Abstract
Imaging in the evaluation and follow-up of patients with early or advanced breast cancer is an important aspect of cancer care. The role of imaging in breast cancer depends on the goal and should only be performed to guide clinical decisions. Imaging is valuable if a finding will change the course of treatment and improve outcomes, whether this is disease-free survival, overall survival or quality-of-life. In the last decade, imaging is often overused in oncology and contributes to rising healthcare costs. In this context, we review the data that supports the appropriate use of imaging for breast cancer patients. We will discuss: 1) the optimal use of staging imaging in both early (Stage 0-II) and locally advanced (Stage III) breast cancer, 2) the role of surveillance imaging to detect recurrent disease in Stage 0-III breast cancer and 3) how patients with metastatic breast cancer should be followed with advanced imaging.
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Affiliation(s)
- Brittany L Bychkovsky
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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42
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Puglisi F, Rea D, Kroes MA, Pronzato P. Second-line single-agent chemotherapy in human epidermal growth factor receptor 2-negative metastatic breast cancer: A systematic review. Cancer Treat Rev 2016; 43:36-49. [PMID: 26827691 DOI: 10.1016/j.ctrv.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND No 'gold standard' exists for single-agent chemotherapy of human epidermal growth factor receptor 2-negative (HER2-negative) metastatic breast cancer (MBC) in the second-line. The objective of this systematic review is to identify and appraise overall survival (OS), progression-free survival (PFS), time to progression (TTP) and Grade ≥3 adverse event evidence for single-agent chemotherapy in this setting. METHODS MEDLINE, Embase and the Cochrane Library were searched to October 2013, and PubMed October 2013 to November 2014. Electronic database searches were supplemented with hand searching of reference lists and conferences. Eligible randomised controlled trials (RCTs) employed at least one single-agent chemotherapy treatment, enrolled HER2-negative or unselected MBC patients who had progressed following first-line chemotherapy within the metastatic setting, and reported outcomes of interest for the second-line setting. RESULTS Fifty-three RCTs were included in total, with most containing mixed populations by HER2 status and treatment line. Fourteen studies reported data specifically for second- and later-line treatment within the metastatic setting. Median overall survival (OS) in most trials was 8-13 months. Only one trial reported a significant difference between studied interventions in the second-line metastatic setting: nab-paclitaxel (n=131) conferred a statistically significant OS advantage vs. three-weekly paclitaxel (n=136) (median OS 13.0 vs. 10.7 months, respectively; hazard ratio 0.73, p=0.024) and improved overall safety. CONCLUSION One RCT demonstrated significant benefit in this setting in confirmed HER2-negative MBC alongside favourable safety. Treatment line terminology was imprecise. To reliably inform patient treatment decisions, quality-of-life data are needed and precise OS estimation according to underlying patient characteristics.
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Affiliation(s)
- Fabio Puglisi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100 Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Piazzale Kolbe, n. 3, 33100 Udine, Italy.
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Michel A Kroes
- DRG Abacus, Unit 6, Talisman Business Centre, Talisman Road, Bicester, Oxfordshire OX26 6HR, UK.
| | - Paolo Pronzato
- IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Largo Rosanna Benzi, 10, 16132 Genova, Italy.
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Liu LP, Cui LB, Zhang XX, Cao J, Chang N, Tang X, Qi S, Zhang XL, Yin H, Zhang J. Diagnostic Performance of Diffusion-weighted Magnetic Resonance Imaging in Bone Malignancy: Evidence From a Meta-Analysis. Medicine (Baltimore) 2015; 94:e1998. [PMID: 26559290 PMCID: PMC4912284 DOI: 10.1097/md.0000000000001998] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Current state-of-the-art nuclear medicine imaging methods (such as PET/CT or bone scintigraphy) may have insufficient sensitivity for predicting bone tumor, and substantial exposure to ionizing radiation is associated with the risk of secondary cancer development. Diffusion-weighted MRI (DW-MRI) is radiation free and requires no intravenous contrast media, and hence is more suitable for population groups that are vulnerable to ionizing radiation and/or impaired renal functions. This meta-analysis was conducted to investigate whether whole-body DW-MRI is a viable means in differentiating bone malignancy. Medline and Embase databases were searched from their inception to May 2015 without language restriction for studies evaluating DW-MRI for detection of bone lesions. Methodological quality was assessed by the quality assessment of diagnostic studies (QUADAS-2) instrument. Sensitivities, specificities, diagnostic odds ratio (DOR), and areas under the curve (AUC) were used as measures of the diagnostic accuracy. We combined the effects by using the random-effects mode. Potential threshold effects and publication bias were investigated. We included data from 32 studies with 1507 patients. The pooled sensitivity, specificity, and AUC were 0.95 (95% CI, 0.90-0.97), 0.92 (95% CI, 0.88-0.95), and 0.98 on a per-patient basis, and they were 0.91 (95% CI, 0.87-0.94), 0.94 (95% CI, 0.90-0.96), and 0.97 on a per-lesion basis. In subgroup analysis, there is no statistical significance found in the sensitivity and specificity of using DWI only and DWI combined with other morphological or functional imaging sequence in both basis (P > 0.05). A b value of 750 to 1000 s/mm enables higher AUC and DOR for whole-body imaging purpose when compared with other values in both basis either (P < 0.01). The ROC space did not show a curvilinear trend of points and a threshold effect was not observed. According to the Deek's plots, there was no publication bias on both basis. Our results support the use of DWI as an effective means for distinguishing malignant bone lesions; however, various imaging parameters need to be standardized prior to its broad use in clinical practice.
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Affiliation(s)
- Li-Peng Liu
- From the Department of Respiratory Medicine (L-PL, X-XZ, JC, NC, JZ); Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (L-BC, XT, SQ, HY); and Department of Radiology, University of California, San Francisco, California (X-LZ)
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Kimbung S, Loman N, Hedenfalk I. Clinical and molecular complexity of breast cancer metastases. Semin Cancer Biol 2015; 35:85-95. [PMID: 26319607 DOI: 10.1016/j.semcancer.2015.08.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/24/2022]
Abstract
Clinical oncology is advancing toward a more personalized treatment orientation, making the need to understand the biology of metastasis increasingly acute. Dissecting the complex molecular, genetic and clinical phenotypes underlying the processes involved in the development of metastatic disease, which remains the principal cause of cancer-related deaths, could lead to the identification of more effective prognostication and targeted approaches to prevent and treat metastases. The past decade has witnessed significant progress in the field of cancer metastasis research. Clinical and technological milestones have been reached which have tremendously enriched our understanding of the complex pathways undertaken by primary tumors to progress into lethal metastases and how some of these processes might be amenable to therapy. The aim of this review article is to highlight the recent advances toward unraveling the clinical and molecular complexity of breast cancer metastases. We focus on genes mediating breast cancer metastases and organ-specific tropism, and discuss gene signatures for prediction of metastatic disease. The challenges of translating this information into clinically applicable tools for improving the prognostication of the metastatic potential of a primary breast tumor, as well as for therapeutic interventions against latent and active metastatic disease are addressed.
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Affiliation(s)
- Siker Kimbung
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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45
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46
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Di Leo A, Curigliano G, Diéras V, Malorni L, Sotiriou C, Swanton C, Thompson A, Tutt A, Piccart M. New approaches for improving outcomes in breast cancer in Europe. Breast 2015; 24:321-30. [PMID: 25840656 DOI: 10.1016/j.breast.2015.03.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/18/2015] [Accepted: 03/06/2015] [Indexed: 12/12/2022] Open
Abstract
Considerable progress has been made in breast cancer treatment in Europe over the past three decades, yet survival rates for metastatic disease remain poor, underlining the need for further advances. While the use of predictive biomarkers for response to systemic therapy could improve drug development efficiency, progress in identifying such markers has been slow. The currently inadequate classification of breast cancer subtypes is a further challenge. Improved understanding of the molecular pathology of the disease has led to the identification of new targets for drug treatment, and evolving classifications should reflect these developments. Further ongoing challenges include difficulties in finding optimal combinations and sequences of systemic therapies, circumventing multidrug resistance and intra-tumor heterogeneity, problems associated with fragmentation in clinical trials and translational research efforts. Adoption of some of the strategies identified in this article may lead to further improvements in outcomes for patients with the disease.
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Affiliation(s)
- Angelo Di Leo
- Sandro Pitigliani Department of Medical Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy.
| | | | | | - Luca Malorni
- Sandro Pitigliani Department of Medical Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Alastair Thompson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Tutt
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research and Kings College London School of Medicine, London, UK
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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47
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Rayson D, Porter G. Investigations for patients with early-stage breast cancer: oversetting the stage. CMAJ 2015; 187:860-1. [PMID: 26100842 DOI: 10.1503/cmaj.150621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel Rayson
- Division of Medical Oncology (Rayson) and Department of Surgery (Porter), Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS
| | - Geoff Porter
- Division of Medical Oncology (Rayson) and Department of Surgery (Porter), Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS
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48
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Generali D, Venturini S, Rognoni C, Ciani O, Pusztai L, Loi S, Jerusalem G, Bottini A, Tarricone R. A network meta-analysis of everolimus plus exemestane versus chemotherapy in the first- and second-line treatment of estrogen receptor-positive metastatic breast cancer. Breast Cancer Res Treat 2015; 152:95-117. [PMID: 26044370 DOI: 10.1007/s10549-015-3453-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/28/2015] [Indexed: 01/09/2023]
Abstract
The goal of this study was to compare the efficacy and toxicity of chemotherapy to exemestane plus everolimus (EXE/EVE) through a network meta-analysis (NMA) of randomized controlled trials. NMA methods extend standard pairwise meta-analysis to allow simultaneous comparison of multiple treatments while maintaining randomization of individual studies. The method enables "direct" evidence (i.e., evidence from studies directly comparing two interventions) and "indirect" evidence (i.e., evidence from studies that do not compare the two interventions directly) to be pooled under the assumption of evidence consistency. We used NMA to evaluate progression-free survival (PFS) and time to progression (TTP) curves in 34 studies, and response rate (RR) and the hazard ratios (HRs) of the PFS/TTP in 36 studies. A number needed to treat (NNT) analysis was also performed as well as descriptive comparison of reported toxicities. The NMA for PFS/TTP curves and for HR shows EXE/EVE is more efficacious than capecitabine plus sunitinib, CMF, megestrol acetate and tamoxifen, with an average of related-PFS/TTP difference ranging from about 10 months for capecitabine plus sunitinib to more than 6 months for tamoxifen. The NMA for overall RR shows that EXE/EVE provides a better RR than bevacizumab plus capecitabine, capecitabine, capecitabine plus sorafenib, capecitabine plus sunitinib, CMF, gemcitabine plus epirubicin plus paclitaxel, EVE plus tamoxifen, EXE, FEC, megestrol acetate, mitoxantrone, and tamoxifen. Finally, the NMA for NNT shows that EXE/EVE is more beneficial as compared to BMF, capecitabine, capecitabine plus sunitinib, CMF, FEC, megestrol acetate, mitoxantrone, and tamoxifen. The combination of EXE/EVE as first- or second-line therapy for ER+ve/HER2-ve metastatic breast cancer is more efficacious than several chemotherapy regimens that were reported in the literature. Toxicities also favored EXE/EVE in most instances.
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Affiliation(s)
- Daniele Generali
- U.O. di Patologia Mammaria-Breast Cancer Unit, U.S. Terapia Molecolare e Farmacogenomica, AO-Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100, Cremona, Italy.
| | - Sergio Venturini
- Centre for Research on Health and Social Care Management (CeRGAS), Bocconi University, Via Roentgen 1, Milan, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CeRGAS), Bocconi University, Via Roentgen 1, Milan, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CeRGAS), Bocconi University, Via Roentgen 1, Milan, Italy
| | - Lajos Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States
| | - Sherene Loi
- Translational Breast Cancer Genomics and Therapeutics Lab, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Guy Jerusalem
- Centre Hospitalier Universitaire du Sart Tilman Liege and Liege University, Liège, Belgium
| | - Alberto Bottini
- U.O. di Patologia Mammaria-Breast Cancer Unit, U.S. Terapia Molecolare e Farmacogenomica, AO-Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CeRGAS), Bocconi University, Via Roentgen 1, Milan, Italy.,Department of Policy Analysis and Public Management, Bocconi University, Via Roentgen 1, Milan, Italy
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49
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Woolf DK, Padhani AR, Makris A. Assessing response to treatment of bone metastases from breast cancer: what should be the standard of care? Ann Oncol 2015; 26:1048-1057. [PMID: 25471332 DOI: 10.1093/annonc/mdu558] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/13/2014] [Indexed: 01/09/2023] Open
Abstract
Bone is the most common site for breast cancer metastases, occurring in up to 70% of those with metastatic disease. In order to effectively manage these patients, it is essential to have consistent, reproducible and validated methods of assessing response to therapy. We present current clinical practice of imaging response assessment of bone metastases. We also review the biology of bone metastases and measures of response assessment including clinical assessment, tumour markers and imaging techniques; bone scans (BSs), computed tomography (CT), positron emission tomography, magnetic resonance imaging (MRI) and whole-body diffusion-weighted MRI (WB DW-MRI). The current standard of care of BSs and CT has significant limitations and are not routinely recommended for the purpose of response assessment in the bones. WB DW-MRI has the potential to address this unmet need and should be evaluated in clinical trials.
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Affiliation(s)
- D K Woolf
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood.
| | - A R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - A Makris
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood
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50
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Risk of metastasis among rib abnormalities on bone scans in breast cancer patients. Sci Rep 2015; 5:9587. [PMID: 25939860 PMCID: PMC5386210 DOI: 10.1038/srep09587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/12/2015] [Indexed: 12/11/2022] Open
Abstract
Bone scan abnormalities, especially rib lesions, are often confusing for physicians due to a high number of false-positive lesions. This study investigated risk factors that are associated with bone metastasis in 613 breast cancer patients with bone scan abnormalities. Significantly increased rates of bone metastasis were observed in patients with multiple lesions, large tumor sizes, and lymph node involvement. In addition, patients with concurrent lesions of rib and other sites exhibited a significant higher rate of metastatic disease compared to those with other site lesions (P = 0.009). In the subset of 324 patients with rib abnormalities, the rate of metastasis was extremely low in patients with pure rib lesions (1.2%; 95% CI: 0.1%-4.1%). Concurrent lesions of rib and other sites were more likely to be rib metastasis compared to pure rib lesions (P < 0.001). Moreover, multiple rib lesions and lesions located on bilateral ribs were more likely to be rib metastasis (P < 0.001). Our data suggest that patients with pure rib abnormalities could be recommended for follow-up only. However, if concurrent lesions of rib and other sites were detected on bone scans, additional radiological examinations should be performed to patients.
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