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Value of shear wave elasticity in predicting the efficacy of neoadjuvant chemotherapy in different molecular types. Clin Imaging 2022; 89:97-103. [DOI: 10.1016/j.clinimag.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
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Miglietta F, Griguolo G, Bottosso M, Giarratano T, Lo Mele M, Fassan M, Cacciatore M, Genovesi E, De Bartolo D, Vernaci G, Amato O, Porra F, Conte P, Guarneri V, Dieci MV. HER2-low-positive breast cancer: evolution from primary tumor to residual disease after neoadjuvant treatment. NPJ Breast Cancer 2022; 8:66. [PMID: 35595761 PMCID: PMC9122970 DOI: 10.1038/s41523-022-00434-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Abstract
Approximately a half of breast tumors classified as HER2-negative exhibit HER2-low-positive expression. We recently described a high instability of HER2-low-positive expression from primary breast cancer (BC) to relapse. Previous studies reporting discordance in HER2 status between baseline biopsy and residual disease (RD) in patients undergoing neoadjuvant treatment did not include the HER2-low-positive category. The aim of this study is to track the evolution of HER2-low-positive expression from primary BC to RD after neoadjuvant treatment. Patients undergoing neoadjuvant treatment with available baseline tumor tissue and matched samples of RD (in case of no pCR) were included. HER2-negative cases were sub-classified as HER2-0 or HER2-low-positive (IHC 1+ or 2+ and ISH negative). Four-hundred forty-six patients were included. Primary BC phenotype was: HR-positive/HER2-negative 23.5%, triple-negative (TN) 35%, HER2-positive 41.5%. HER2-low-positive cases were 55.6% of the HER2-negative cohort and were significantly enriched in the HR-positive/HER2-negative vs. TN subgroup (68.6% vs. 46.8%, p = 0.001 χ2 test). In all, 35.3% of non-pCR patients (n = 291) had a HER2-low-positive expression on RD. The overall rate of HER2 expression discordance was 26.4%, mostly driven by HER2-negative cases converting either from (14.8%) or to (8.9%) HER2-low-positive phenotype. Among HR-positive/HER2-negative patients with HER2-low-positive expression on RD, 32.0% and 57.1% had an estimated high risk of relapse according to the residual proliferative cancer burden and CPS-EG score, respectively. In conclusion, HER2-low-positive expression showed high instability from primary BC to RD after neoadjuvant treatment. HER2-low-positive expression on RD may guide personalized adjuvant treatment for high-risk patients in the context of clinical trials with novel anti-HER2 antibody-drug conjugates.
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Affiliation(s)
- Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Michele Bottosso
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Tommaso Giarratano
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Marcello Lo Mele
- Surgical Pathology Unit, University Hospital of Padua, 35121, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, 35121, Padua, Italy
- Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Matilde Cacciatore
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Elisa Genovesi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Debora De Bartolo
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, 35121, Padua, Italy
| | - Grazia Vernaci
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Ottavia Amato
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Francesca Porra
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy.
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy.
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128, Padova, Italy
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Guarneri V, Griguolo G, Miglietta F, Conte PF, Dieci MV, Girardi F. Survival after neoadjuvant therapy with trastuzumab-lapatinib and chemotherapy in patients with HER2-positive early breast cancer: a meta-analysis of randomized trials. ESMO Open 2022; 7:100433. [PMID: 35276440 PMCID: PMC8917305 DOI: 10.1016/j.esmoop.2022.100433] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Studies testing the addition of lapatinib to neoadjuvant trastuzumab + chemotherapy reported an increase in pathologic complete response (pCR), with, nevertheless, discordant results in terms of survival, mainly due to suboptimal power. We here leverage the meta-analytic approach to resolve these inconsistencies. METHODS We conducted a meta-analysis of randomized phase II/III studies testing lapatinib + trastuzumab in combination with neoadjuvant chemotherapy for human epidermal growth factor receptor (HER2)-positive early breast cancer (BC). Recurrence-free survival (RFS) and overall survival (OS) were adopted as survival endpoints. Pooled hazard ratios (HR) were obtained for the effect of lapatinib + trastuzumab versus trastuzumab, pCR versus no-pCR in the whole study populations and pCR versus no-pCR according to hormone receptor status. RESULTS Four phase II/III randomized trials were included in the meta-analysis (CALGB 40601, Cher-LOB, NSABP-B41, NeoALTTO) for an overall population of 1410 patients receiving neoadjuvant chemotherapy in association with either trastuzumab, lapatinib or their combination. RFS was significantly improved with dual HER2 blockade as compared to trastuzumab [HR 0.62, 95% confidence interval (CI) 0.46-0.85]. Dual blockade also led to significantly improved OS (HR 0.65, 95% CI 0.43-0.98). For all treatments combined, patients achieving pCR had better RFS and OS than those with residual disease (HR 0.45, 95% CI 0.34-0.60, and HR 0.32, 95% CI 0.22-0.48, for RFS and OS, respectively). In patients with hormone receptor-negative tumors, pCR was associated with 65% and 73% relative reduction of risk of relapse and death, respectively. Patients with hormone receptor-positive tumors also experienced improved RFS if they achieved pCR; however, the benefit was smaller than that in hormone receptor-negative disease. CONCLUSION Findings from this meta-analysis further validate the role of pCR as a strong predictor of outcome in patients with HER2-positive BC, especially in hormone receptor-negative disease. Moreover, we provide robust evidence that dual blockade with lapatinib + trastuzumab in combination with neoadjuvant chemotherapy prolongs OS, suggesting that the role of lapatinib could be reconsidered in the early setting.
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Affiliation(s)
- V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy.
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
| | - F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - P F Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
| | - F Girardi
- Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
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Guarneri V, Dieci MV, Griguolo G, Miglietta F, Girardi F, Bisagni G, Generali DG, Cagossi K, Sarti S, Frassoldati A, Gianni L, Cavanna L, Pinotti G, Musolino A, Piacentini F, Cinieri S, Prat A, Conte P. Trastuzumab-lapatinib as neoadjuvant therapy for HER2-positive early breast cancer: Survival analyses of the CHER-Lob trial. Eur J Cancer 2021; 153:133-141. [PMID: 34153715 DOI: 10.1016/j.ejca.2021.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
AIM The Cher-LOB randomised phase II study showed that the combination of lapatinib-trastuzumab plus chemotherapy increases pathologic complete response (pCR) rate compared with chemotherapy plus either trastuzumab or lapatinib. Here, we report the post hoc survival analysis as per treatment arm, pCR and biomarkers. METHODS The Cher-LOB study randomised 121 patients with human epidermal growth factor receptor 2-positive, stage II-IIIA breast cancer. A specific protocol to collect recurrence-free survival (RFS) and overall survival (OS) data was designed. Tumour-infiltrating lymphocytes (TILs) and PAM50-intrinsic subtyping were evaluated at baseline. RESULTS At 9-year median follow-up, a trend towards RFS improvement with lapatinib-trastuzumab over trastuzumab was observed (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.18-1.05). Combining treatment arms, pCR was significantly associated with both RFS (HR 0.12, 95% CI 0.03-0.49) and OS (HR 0.12, 95% CI 0.03-0.49). TILs were significantly associated with RFS (HR = 0.978 for each 1% increment). Luminal-A subtype was a significant and independent predictor of improved RFS as compared with other PAM50-based intrinsic subtypes at the multivariate analysis including the most relevant clinicopathologic variables (HR 0.29, 95% CI 0.09-0.94, p = 0.040). CONCLUSIONS Cher-LOB trial survival analysis confirmed the prognostic role of pCR and TILs and showed a signal for a better outcome with lapatinib-trastuzumab over trastuzumab. TRIAL REGISTRATION NCT00429299.
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Affiliation(s)
- Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy.
| | - Maria V Dieci
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Fabio Girardi
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Giancarlo Bisagni
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Daniele G Generali
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Samanta Sarti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014 Meldola, Italy
| | - Antonio Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - Federico Piacentini
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Saverio Cinieri
- Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
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Halldorsdottir VG, Dave JK, Marshall A, Forsberg AI, Fox TB, Eisenbrey JR, Machado P, Liu JB, Merton DA, Forsberg F. Subharmonic-Aided Pressure Estimation for Monitoring Interstitial Fluid Pressure in Tumors: Calibration and Treatment with Paclitaxel in Breast Cancer Xenografts. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1401-1410. [PMID: 28433436 PMCID: PMC6082419 DOI: 10.1016/j.ultrasmedbio.2017.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/31/2017] [Accepted: 02/09/2017] [Indexed: 05/07/2023]
Abstract
Interstitial fluid pressure (IFP) in rats with breast cancer xenografts was non-invasively estimated using subharmonic-aided pressure estimation (SHAPE) versus an invasive pressure monitor. Moreover, monitoring of IFP changes after chemotherapy was assessed. Eighty-nine rats (calibration n = 25, treatment n = 64) were injected with 5 × 106 breast cancer cells (MDA-MB-231). Radiofrequency signals were acquired (39 rats successfully imaged) with a Sonix RP scanner (BK Ultrasound, Richmond, BC, Canada) using a linear array (L9-4, transmit/receive: 8/4 MHz) after administration of Definity (Lantheus Medical Imaging, North Billerica, MA, USA; 180 μL/kg) and compared with readings from an invasive pressure monitor (Stryker, Berkshire, UK). An inverse linear relationship was established between tumor IFP and SHAPE (y = -1.06x + 28.27, r = -0.69, p = 0.01) in the calibration group. Use of this relationship in the treatment group resulted in r = 0.74 (p < 0.05) between measured (pressure monitor) and SHAPE-estimated IFP (average error: 6.24 mmHg). No significant before/after differences were observed with respect to paclitaxel treatment (5 mg/kg, Mayne Pharma, Paramus, NJ, USA) with either method (p ≥ 0.15).
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Affiliation(s)
- Valgerdur G Halldorsdottir
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Marshall
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Anya I Forsberg
- Plymouth Whitemarsh High School, Plymouth Meeting, Pennsylvania, USA
| | - Traci B Fox
- Department of Radiologic Sciences, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel A Merton
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Nam K, Eisenbrey JR, Stanczak M, Sridharan A, Berger AC, Avery T, Palazzo JP, Forsberg F. Monitoring Neoadjuvant Chemotherapy for Breast Cancer by Using Three-dimensional Subharmonic Aided Pressure Estimation and Imaging with US Contrast Agents: Preliminary Experience. Radiology 2017; 285:53-62. [PMID: 28467142 DOI: 10.1148/radiol.2017161683] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To determine whether three-dimensional subharmonic aided pressure estimation (SHAPE) and subharmonic imaging can help predict the response of breast cancer to neoadjuvant chemotherapy. Materials and Methods In this HIPAA-compliant prospective study, 17 women (age range, 45-70 years) scheduled to undergo neoadjuvant therapy for breast cancer underwent ultrasonography (US) immediately before therapy and at completion of 10%, 60%, and 100% of chemotherapy. All patients provided written informed consent. At each examination, radiofrequency data were collected from SHAPE and subharmonic imaging during infusion of a US contrast agent. Maximum-frequency magnitude and mean intensity were calculated for SHAPE and subharmonic imaging. The signal differences in the tumor relative to the surrounding area were compared with the final treatment response by using the Student t test. Results Four patients left the study, and data from two patients were discarded because of technical problems. Eight patients completed the entire imaging protocol, and an additional three patients dropped out after the imaging session at completion of 10% of chemotherapy as a result of disease progression (these patients were counted as nonresponders). Patients' imaging outcomes consisted of six responders (tumor volume reduction >90%) and five partial responders or nonresponders. The results at completion of 10% of therapy showed that the subharmonic signal increased more in the tumor than in the surrounding area for responders than in partial responders or nonresponders (mean ± standard deviation, 3.23 dB ± 1.41 vs -0.88 dB ± 1.46 [P = .001], respectively, for SHAPE and 1.32 dB ± 0.73 vs -0.82 dB ± 0.88 [P = .002], respectively, for subharmonic imaging). Moreover, three patients whose tumor measurements initially increased were correctly predicted to be responders with SHAPE and subharmonic imaging after completion of 10% of therapy. Conclusion SHAPE and subharmonic imaging have the potential to help predict response to neoadjuvant chemotherapy for breast cancer as early as completion of 10% of therapy, albeit on the basis of a small sample size. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Kibo Nam
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - John R Eisenbrey
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - Maria Stanczak
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - Anush Sridharan
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - Adam C Berger
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - Tiffany Avery
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - Juan P Palazzo
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
| | - Flemming Forsberg
- From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.)
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Halldorsdottir VG, Dave JK, Eisenbrey JR, Machado P, Zhao H, Liu JB, Merton DA, Forsberg F. Subharmonic aided pressure estimation for monitoring interstitial fluid pressure in tumours--in vitro and in vivo proof of concept. ULTRASONICS 2014; 54:1938-44. [PMID: 24856899 PMCID: PMC4120866 DOI: 10.1016/j.ultras.2014.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 05/18/2023]
Abstract
The feasibility of using subharmonic aided pressure estimation (SHAPE) to noninvasively estimate interstitial fluid pressure (IFP) was studied. In vitro, radiofrequency signals, from 0.2 ml/l of Definity (Lantheus Medical Imaging, N Billerica, MA) were acquired within a water-tank with a Sonix RP ultrasound scanner (Analogic Ultrasound, Richmond, BC, Canada; fT/R=6.7/3.35 MHz and fT/R=10/5 MHz) and the subharmonic amplitudes of the signals were compared over 0-50 mmHg. In vivo, five swine with naturally occurring melanomas were studied. Subharmonic signals were acquired from tumours and surrounding tissue during infusion of Definity and compared to needle-based pressure measurements. Both in vitro and in vivo, an inverse linear relationship between hydrostatic pressure and subharmonic amplitude was observed with r(2)=0.63-0.95; p<0.05, maximum amplitude drop 11.36 dB at 10 MHz and -8 dB, and r(2) as high as 0.97; p<0.02 (10 MHz and -4/-8 dB most promising), respectively, indicating that SHAPE may be useful in monitoring IFP.
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Affiliation(s)
- V G Halldorsdottir
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - J K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - J R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - P Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - H Zhao
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; Department of Ultrasound, The Second People's Hospital of Fujian, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - J B Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - D A Merton
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - F Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
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Early prediction of response to neoadjuvant chemotherapy in patients with breast cancer using diffusion-weighted imaging and gray-scale ultrasonography. Oncol Rep 2014; 31:1555-60. [PMID: 24535214 PMCID: PMC3975989 DOI: 10.3892/or.2014.3025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/22/2014] [Indexed: 02/06/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) is a widely accepted therapeutic option for patients with breast cancer. Although NACT produces good results for breast cancer patients, it has the potential to delay effective treatment in patients with chemotherapy-resistant breast cancer. The purpose of the present study was to evaluate the utility of the pretreatment apparent diffusion coefficient (ADC), which is calculated from diffusion-weighted imaging (DWI), the change in ADC after first administration of NACT, and the change in tumor greatest diameter on ultrasonography in the early prediction of the tumor response to NACT. The response rate of breast tumors to NACT was calculated by the greatest diameter measured by contrast-enhanced MRI obtained before and after NACT. Only the change in ADC was significantly correlated with the response rate. The area under the curve of the change in ADC was sufficiently high (0.90, 95% confidence interval, 0.760–1.040) to discriminate between responders and non-responders. Calculation of the ADC from DWI-MRI was found to be useful for predicting breast tumor response to NACT. Further studies are required to investigate the benefit of changing systemic therapy for breast cancer based on the prediction of the response to NACT by DWI-MRI.
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Lyman GH, Baker J, Geradts J, Horton J, Kimmick G, Peppercorn J, Pruitt S, Scheri RP, Hwang ES. Multidisciplinary care of patients with early-stage breast cancer. Surg Oncol Clin N Am 2013; 22:299-317. [PMID: 23453336 DOI: 10.1016/j.soc.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is a compelling need for close coordination and integration of multiple specialties in the management of patients with early-stage breast cancer. Optimal patient care and outcomes depend on the sequential and often simultaneous participation and dialogue between specialists in imaging, pathologic and molecular diagnostic and prognostic stratification, and the therapeutic specialties of surgery, radiation oncology, and medical oncology. These are but a few of the various disciplines needed to provide modern, sophisticated management. The essential role for coordinated involvement of the entire health care team in optimal management of patients with early-stage breast cancer is likely to increase further.
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Affiliation(s)
- Gary H Lyman
- Comparative Effectiveness and Outcomes Research Program, Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC 27705, USA.
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De novo sequencing of circulating miRNAs identifies novel markers predicting clinical outcome of locally advanced breast cancer. J Transl Med 2012; 10:42. [PMID: 22400902 PMCID: PMC3342150 DOI: 10.1186/1479-5876-10-42] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/08/2012] [Indexed: 12/21/2022] Open
Abstract
Background MicroRNAs (miRNAs) have been recently detected in the circulation of cancer patients, where they are associated with clinical parameters. Discovery profiling of circulating small RNAs has not been reported in breast cancer (BC), and was carried out in this study to identify blood-based small RNA markers of BC clinical outcome. Methods The pre-treatment sera of 42 stage II-III locally advanced and inflammatory BC patients who received neoadjuvant chemotherapy (NCT) followed by surgical tumor resection were analyzed for marker identification by deep sequencing all circulating small RNAs. An independent validation cohort of 26 stage II-III BC patients was used to assess the power of identified miRNA markers. Results More than 800 miRNA species were detected in the circulation, and observed patterns showed association with histopathological profiles of BC. Groups of circulating miRNAs differentially associated with ER/PR/HER2 status and inflammatory BC were identified. The relative levels of selected miRNAs measured by PCR showed consistency with their abundance determined by deep sequencing. Two circulating miRNAs, miR-375 and miR-122, exhibited strong correlations with clinical outcomes, including NCT response and relapse with metastatic disease. In the validation cohort, higher levels of circulating miR-122 specifically predicted metastatic recurrence in stage II-III BC patients. Conclusions Our study indicates that certain miRNAs can serve as potential blood-based biomarkers for NCT response, and that miR-122 prevalence in the circulation predicts BC metastasis in early-stage patients. These results may allow optimized chemotherapy treatments and preventive anti-metastasis interventions in future clinical applications.
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Chen X, Wu J, Lu H, Huang O, Shen K. Measuring β-tubulin III, Bcl-2, and ERCC1 improves pathological complete remission predictive accuracy in breast cancer. Cancer Sci 2011; 103:262-8. [DOI: 10.1111/j.1349-7006.2011.02135.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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A multicenter randomized phase II study of sequential epirubicin/cyclophosphamide followed by docetaxel with or without celecoxib or trastuzumab according to HER2 status, as primary chemotherapy for localized invasive breast cancer patients. Breast Cancer Res Treat 2010; 122:429-37. [PMID: 20480225 DOI: 10.1007/s10549-010-0939-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 05/06/2010] [Indexed: 12/22/2022]
Abstract
To assess anti-tumor activity of sequential epirubicin/cyclophosphamide followed by docetaxel with the randomized addition of celecoxib in HER2 negative patients or trastuzumab in HER2 positive patients. From May 2004 till October 2007, 340 patients with stage II and III breast adenocarcinoma, ineligible for breast conserving surgery, received eight sequential three weekly cycles of EC-D [epirubicin (75 mg/m(2))-cyclophosphamide (750 mg/m(2)) for four cycles followed by docetaxel (100 mg/m(2)) for four cycles]. HER2-negative patients (N = 220) were randomized to receive concomitantly with docetaxel celecoxib 800 mg/day during cycles 5-8 or no additional treatment, while HER2-positive patients confirmed by FISH (N = 120) were randomized to trastuzumab concomitant to docetaxel (8 mg/kg then 6 mg/kg IV every 3 weeks) or no additional preoperative treatment. In the HER2 negative group, pCR (grade 1 and 2 of Chevallier's classification) was observed in 11.5 and 13% of patients treated without and with neoadjuvant Celecoxib, respectively. In the HER2 positive group, pCR rate reached 26% in those who received neoadjuvant trastuzumab versus 19% in the others. There was no unexpected toxicity, no cardiac toxicity, and no toxic death. Triple negative breast cancers experience the highest pCR rate of 30%. Celecoxib is not likely to improve pCR rates in addition to EC-D in patients with HER2-negative tumor. In HER2-positive tumor patients, trastuzumab added to ECD leads to increased pCR rates. It was the only combination to deserve further study according to the two-stage Fleming's design used in this trial.
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Abstract
5-fluorouracil (5-FU) is a chemotherapeutical agent used to treat cancers including breast and colorectal. Working as an antimetabolite to prevent cell proliferation, it primarily inhibits the enzyme thymidylate synthase blocking the thymidine formation required for DNA synthesis. Although having a relatively short half-life (< 30 mins) it readily enters the brain by passive diffusion. Clinically, it is used both as a single agent or in combination with other chemotherapies and has been associated with the long-term side effects of cognitive impairment, known as "chemo brain" or "chemo fog" These accounts have come primarily from patients undergoing treatment for breast cancer who report symptoms including confusion and memory impairment, which can last for months to years. Psychometric studies of patients have suffered from confounding variables, which has led to the use of rodent models to assess the cognitive effects of this drug. Researchers have used behavioral and physiological tests including the Morris water maze, novel object location/recognition tests, shock motivated T-maze, sensory gating and conditioning, to investigate the effect of this drug on cognition. The variety of cognitive tests and the difference in dosing and administration of 5-FU has led to varied results, possibly due to the different brain regions associated with each test and the subtlety of the drug's effect, but overall these studies indicates that 5-FU has a negative effect on memory, executive function and sensory gating. 5-FU has also been demonstrated to have biochemical and structural changes on specific regions of the brain. Evidence shows it can induce apoptosis and depress cell proliferation in the neurogenic regions of the adult brain including the sub granular zone (SGZ) within the hippocampus and in oligodendrocyte precursor populations within white matter tracts. Furthermore, investigations indicate levels ofdoublecortin, a marker for newly formed neurons and brain derived neurotrophic factor, a cell survival modulator, are also reduced by 5-FU in the SGZ. Thus, 5-FU appears to have a lasting negative impact on cognition and to affect cellular and biochemical markers in various brain regions. Further work is needed to understand the exact mechanisms involved and to devise strategies for the prevention or recovery from these symptoms.
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Nahleh Z. Neoadjuvant chemotherapy for “Triple Negative” breast cancer: a review of current practice and future outlook. Med Oncol 2009; 27:531-9. [DOI: 10.1007/s12032-009-9244-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
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Abstract
The care of patients with breast cancer has become increasingly complex with advancements in diagnostic modalities, surgical approaches, and adjuvant treatments. A multidisciplinary approach to breast cancer care is essential to the successful integration of available therapies. This article addresses the key components of multidisciplinary breast cancer care, with a special emphasis on new and emerging approaches over the past 10 years in the fields of diagnostics, surgery, radiation, medical oncology, and plastic surgery.
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Rogalska A, Koceva-Chyła A, Jóźwiak Z. Aclarubicin-induced ROS generation and collapse of mitochondrial membrane potential in human cancer cell lines. Chem Biol Interact 2008; 176:58-70. [DOI: 10.1016/j.cbi.2008.07.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 07/01/2008] [Accepted: 07/04/2008] [Indexed: 01/06/2023]
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