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Nguyen TTA, Postlewait LM, Zhang C, Meisel JL, O'Regan R, Badve S, Kalinsky K, Li X. Utility of Oncotype DX score in clinical management for T1 estrogen receptor positive, HER2 negative, and lymph node negative breast cancer. Breast Cancer Res Treat 2022; 192:509-516. [PMID: 35084624 DOI: 10.1007/s10549-022-06530-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The management of estrogen receptor positive (ER+)/HER2- and lymph node (LN) negative breast cancers can be influenced by Oncotype DX recurrence score (RS) in the USA. However, the benefit of RS in T1 tumors (≤ 1 cm) is not clear. METHODS We retrieved 199 T1 ER+/HER2-/LN- breast cancer diagnosed between 1993 and 2016 that had undergone RS testing. The median follow-up time was 51 months. We examined the disease-free survival (DFS) and distant metastasis and their association with RS and other clinicopathologic features. RESULTS Of the 199 cases, 40 were T1a (≤ 0.5 cm) and 159 were T1b (> 0.5 cm to 1 cm) tumors. In the 40 T1a tumors, 11 would benefit from chemotherapy by the TAILORx study results. Of these T1a tumors, 36 were Nottingham grade 1/2, 3 were grade 3, and 1 was microinvasive carcinoma; 2 (5%) had local recurrence and 1 (2.5%) had distant metastasis to the bone. The only patient with T1a tumor (Nottingham grade 3, RS = 42) and distant metastasis to bone had received adjuvant chemotherapy. In the 159 T1b tumors, 25 would benefit chemotherapy by the TAILORx results. Of the T1b tumors, 149 were Nottingham grade 1/2 and 10 were grade 3. Nine (5.7%) had local recurrence and 2 (1.3%) had distant metastasis to bone and mediastinum, respectively. The two T1b tumors with distant metastasis had a RS 20 and Nottingham grade 2, and RS 27 and Nottingham grade 3, respectively. Both patients received adjuvant chemotherapy. In multivariate analysis of the entire cohort (T1a and T1b tumors), Nottingham tumor grade and receiving chemotherapy were significantly associated with DFS. In univariate analysis of the entire cohort, Nottingham tumor grade, receiving adjuvant chemotherapy, and RS were significantly associated with distant metastasis. CONCLUSION This study demonstrates that the metastatic rate of T1a and T1b ER+/HER2-/LN- breast cancer is very low. Patients with low grade (1 or 2), T1a ER+/HER2-/LN- breast cancer may not need RS for treatment decision-making; however, in patients with high-grade T1a or T1b ER+/HER2-/LN- breast cancer, RS analysis should be strongly considered.
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Affiliation(s)
- Thi Truc Anh Nguyen
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Lauren M Postlewait
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Chao Zhang
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Jane L Meisel
- Department of Hematology and Oncology, Emory University, Atlanta, GA, USA
| | - Ruth O'Regan
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Kevin Kalinsky
- Department of Hematology and Oncology, Emory University, Atlanta, GA, USA
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
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Davey MG, Browne F, Miller N, Lowery AJ, Kerin MJ. OUP accepted manuscript. BJS Open 2022; 6:6580365. [PMID: 35512244 PMCID: PMC9071230 DOI: 10.1093/bjsopen/zrac028] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/02/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew G. Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
- Correspondence to: Matthew G. Davey, Department of Surgery, Galway University Hospitals, Galway H91YR71, Republic of Ireland (e-mail: )
| | - Ferdia Browne
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Nicola Miller
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J. Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J. Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Liu H, Lv L, Gao H, Cheng M. Pathologic Complete Response and Its Impact on Breast Cancer Recurrence and Patient's Survival after Neoadjuvant Therapy: A Comprehensive Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:7545091. [PMID: 35003324 PMCID: PMC8741368 DOI: 10.1155/2021/7545091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Earlier research has illustrated prognostic significance of pathologic complete response (pCR) in neoadjuvant therapy (NAT) for breast cancer, whereas correlation between treatment after achieving pCR and survival improvement remains underexplored. We attempted to measure the relation between pCR achieved after NAT and breast cancer recurrence or patient's survival. METHODS We searched PubMed, EMBASE, Web of Science, and The Cochrane Library databases to find relevant articles from their inception to November 2020. According to eligibility criteria, studies were selected and basic data were extracted. The primary endpoint was the correlation between pCR achieved after NAT and event-free survival (EFS) or overall survival (OS). The results were obtained by directly extracting specific information from the literature or estimating individual data by survival curves on DigitizeIt software, presented with HR and 95% CI. All data were processed on Stata 14.0 software. RESULTS Among 4338 articles, there were 25 eligible articles involving 8767 patients. The EFS of patients achieved pCR after NAT improved obviously (HR = 0.27; 95% CI, 0.24-0.31), especially in triple negative (HR = 0.17; 95% CI, 0.12-0.24) and HER2 positive (HR = 0.24; 95% CI, 0.20-0.30) breast cancer patients. As such, pCR after NAT was implicated in significantly increased OS (HR = 0.32; 95% CI, 0.27-0.37). CONCLUSION Achieving pCR after NAT was notably related to the improvement of EFS and OS, especially for patients with triple-negative and HER2-positive breast cancer. pCR can be a surrogate indicator for outcome of breast cancer patients after NAT, as well as a predictor of treatment efficacy after NAT. Besides, well-designed studies are still warranted for confirmation.
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Affiliation(s)
- Hui Liu
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Liqiong Lv
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Hui Gao
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Ming Cheng
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
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Spring LM, Fell G, Arfe A, Sharma C, Greenup R, Reynolds KL, Smith BL, Alexander B, Moy B, Isakoff SJ, Parmigiani G, Trippa L, Bardia A. Pathologic Complete Response after Neoadjuvant Chemotherapy and Impact on Breast Cancer Recurrence and Survival: A Comprehensive Meta-analysis. Clin Cancer Res 2020; 26:2838-2848. [PMID: 32046998 PMCID: PMC7299787 DOI: 10.1158/1078-0432.ccr-19-3492] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE While various studies have highlighted the prognostic significance of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAT), the impact of additional adjuvant therapy after pCR is not known. EXPERIMENTAL DESIGN PubMed was searched for studies with NAT for breast cancer and individual patient-level data was extracted for analysis using plot digitizer software. HRs, with 95% probability intervals (PI), measuring the association between pCR and overall survival (OS) or event-free survival (EFS), were estimated using Bayesian piece-wise exponential proportional hazards hierarchical models including pCR as predictor. RESULTS Overall, 52 of 3,209 publications met inclusion criteria, totaling 27,895 patients. Patients with a pCR after NAT had significantly better EFS (HR = 0.31; 95% PI, 0.24-0.39), particularly for triple-negative (HR = 0.18; 95% PI, 0.10-0.31) and HER2+ (HR = 0.32; 95% PI, 0.21-0.47) disease. Similarly, pCR after NAT was also associated with improved survival (HR = 0.22; 95% PI, 0.15-0.30). The association of pCR with improved EFS was similar among patients who received subsequent adjuvant chemotherapy (HR = 0.36; 95% PI, 0.19-0.67) and those without adjuvant chemotherapy (HR = 0.36; 95% PI, 0.27-0.54), with no significant difference between the two groups (P = 0.60). CONCLUSIONS Achieving pCR following NAT is associated with significantly better EFS and OS, particularly for triple-negative and HER2+ breast cancer. The similar outcomes with or without adjuvant chemotherapy in patients who attain pCR likely reflects tumor biology and systemic clearance of micrometastatic disease, highlighting the potential of escalation/deescalation strategies in the adjuvant setting based on neoadjuvant response.See related commentary by Esserman, p. 2771.
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Affiliation(s)
- Laura M Spring
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Chandni Sharma
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | | | - Kerry L Reynolds
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Barbara L Smith
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Brian Alexander
- Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Steven J Isakoff
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Giovanni Parmigiani
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Lorenzo Trippa
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
- Harvard Medical School, Boston, Massachusetts
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Xie F, Chen R, Zhang L, Yin Z, Zhu Q, You S, Jiang C, Li Y, Li S, Zha X, Wang J. Efficacy of two-weekly nanoparticle albumin-bound paclitaxel as neoadjuvant chemotherapy for breast cancer. Nanomedicine (Lond) 2019; 14:1595-1603. [PMID: 30977429 DOI: 10.2217/nnm-2018-0485] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Compare the two-weekly regimens of nanoparticle albumin-bound paclitaxel (nab-P) with solvent-based paclitaxel (sb-P) as neoadjuvant chemotherapy for breast cancer. Materials & methods: Patients (n = 162) with operable early breast cancer received four cycles of dose-dense epirubicin and cyclophosphamide followed by four two-weekly cycles of nab-P (n = 83) or sb-P (n = 79), with trastuzumab when needed. Results: Across all the patients, the ypT0 ypN0 and ypT0/is ypN0 pathological complete response rates in the nab-P group were not superior to those in the sb-P group. However, pathological complete response rates for triple-negative breast cancer were significantly better with nab-P than with sb-P. Meanwhile, nab-P also induced more peripheral sensory neuropathy. Conclusion: The two-weekly nab-P regimen is a good neoadjuvant chemotherapy choice for triple-negative breast cancer.
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Affiliation(s)
- Fei Xie
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Rui Chen
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Ling Zhang
- Thyroid & Mammary Gland Surgery Department, Nanjing Jiangbei People's Hospital, Nanjing 210000, PR China
| | - Zinan Yin
- Endocrine Department, Peking Union Medical College, Beijing 100000, PR China
| | - Qiannan Zhu
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Sainan You
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Chaojun Jiang
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Yan Li
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Shuo Li
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Xiaoming Zha
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Jue Wang
- Breast Disease Department, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
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Neely C, You S, Mendoza PM, Aneja R, Sahin AA, Li X. Comparing breast biomarker status between routine immunohistochemistry and FISH studies and Oncotype DX testing, a study of 610 cases. Breast J 2018; 24:889-893. [DOI: 10.1111/tbj.13110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Cameron Neely
- Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Shuo You
- Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Pia M. Mendoza
- Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Ritu Aneja
- Department of Biology; Georgia State University; Atlanta Georgia
| | - Aysegul A. Sahin
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
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7
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Meisel J, Zhang C, Neely C, Mendoza P, You S, Han T, Liu Y, Sahin AA, O'Regan R, Li X. Evaluation of Prognosis in Hormone Receptor-Positive/HER2-Negative and Lymph Node-Negative Breast Cancer With Low Oncotype DX Recurrence Score. Clin Breast Cancer 2017; 18:347-352. [PMID: 29305309 DOI: 10.1016/j.clbc.2017.12.006] [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] [Received: 08/29/2017] [Revised: 11/13/2017] [Accepted: 12/07/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancers without lymph node metastasis have good prognosis. We compared the prognosis of hormone receptor-positive, HER2-negative, lymph node-negative cancers with Oncotype DX score ranges of 1 to 10 (1-10 group) and 11 to < 18 (11-18 group). PATIENTS AND METHODS A total of 107 cases in the 1-10 group and 225 cases in the 11-18 group were reviewed. All patients received surgery. The use of chemotherapy, radiotherapy, and endocrine therapy, and overall survival (OS), disease-free survival (DFS), and distant metastasis were compared between groups. RESULTS There were no statistical differences in the use of chemotherapy (5.05% vs. 6.05%, P = .724) or radiotherapy (52.53% vs. 59.07%, P = .276) between the 1-10 group and the 11-18 group, respectively. The median OS and DFS were 47 and 45 months, respectively, in the 1-10 group, and 49 and 48 months in the 11-18 group. No significant difference was seen in OS (P = .995), DFS (P = .148), or rates of metastasis (P = .998). The 11-18 group had more death events and distant metastasis (death, 5 events; recurrence, 2 events; metastasis, 2 events) than the 1-10 group (death, 0 events; recurrence, 4 events; metastasis, 0 events). The majority of recurrences seen in both groups were in young patients who failed to comply with their endocrine therapy regimen. CONCLUSION Patients in both the 1-10 group and the 11-18 group had good prognoses. Those who experienced recurrence were more likely to be premenopausal and to have failed to comply with the recommended endocrine therapy regimen. Endocrine therapy remains important in these patients.
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Affiliation(s)
- Jane Meisel
- Department of Hematology and Oncology, Emory University, Atlanta, GA
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Cameron Neely
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Pia Mendoza
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Shuo You
- Winship Institute, Emory University, Atlanta, GA
| | - Tatiana Han
- Winship Institute, Emory University, Atlanta, GA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ruth O'Regan
- Department of Medicine, University of Wisconsin, Madison, WI
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA.
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Arciero CA, Yang J, Peng L, Ward KC, O'Regan R, Sahin AA, Li X. African American patients with breast cancer have worse prognosis than white patients in certain subtypes and stages. Breast Cancer Res Treat 2017; 166:743-755. [PMID: 28856481 DOI: 10.1007/s10549-017-4484-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Racial disparity of breast cancer in each subtype and substage is not clear. METHODS We reviewed 156,938 patients with breast cancer from 2010 to 2012 from the National Cancer Institute Surveillance, Epidemiology, and End Results database. Breast cancer was subtyped by hormone receptor (HR) and human epidermal growth factor 2 (HER2) status as HR+/HER2-, HR+/HER2+, HR-/HER2+, and HR-/HER2-. RESULTS African American (AA) patients had worse overall survival (OS) and breast cancer cause-specific survival (BCSS) in HR+/HER2- stages III and IV breast cancer and HR-/HER2+ stage IV cancer; they had worse OS but not BCSS in HR+ /HER2- stage II cancer and HR-/HER2- stage II cancer. CONCLUSION AA patients with breast cancer had worse survival in certain subtype and stage, especially in ER+ breast cancer.
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Affiliation(s)
| | - Jing Yang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Ruth O'Regan
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, Suite H175, Atlanta, GA, 30322, USA.
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Yamamoto S, Maeda N, Nagashima Y, Kubo H, Sato Y, Matsui H, Inoue Y, Shindo Y, Kanekiyo S, Sakamoto K, Suzuki N, Takeda S, Ueno T, Yoshino S, Hazama S, Oka M, Nagano H. A phase II, multicenter, single-arm study of tri-weekly low-dose nanoparticle albumin-bound paclitaxel chemotherapy for patients with metastatic or recurrent breast cancer. Breast Cancer 2017; 24:783-789. [PMID: 28439763 DOI: 10.1007/s12282-017-0779-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nanoparticle albumin-bound (nab)-paclitaxel is a solvent-free formulation of paclitaxel that is bound to albumin and has demonstrated improved progression free survival in previous studies of breast cancer. However, it is difficult to treat Japanese patients with metastatic or recurrent breast cancer with the recommended dose of 260 mg/m2 of (nab)-paclitaxel for more than six cycles due to the occurrence of adverse events. To evaluate the treatment continuity and safety of low-dose nab-paclitaxel, we conducted a phase II study of nab-paclitaxel in patients with metastatic or recurrent breast cancer who had received up to one prior chemotherapy. PATIENTS AND METHODS Treatment included low doses of 180 mg/m2 nab-paclitaxel that were administered on day 1 of each 3-week cycle to 35 patients. The primary endpoint was the completion rate of six cycles of treatment. RESULTS A total of 35 eligible patients were enrolled and received a median of eight (range 2-24) cycles of low-dose nab-paclitaxel therapy. The completion rate of six cycles of treatment was 66%. ORR and clinical benefit rate was 23 and 71%, respectively. Median PFS was 6.5 months and median OS was 44 months. Adverse events were relatively mild. Commonly observed grade 3/4 adverse events were neutropenia (46%), leukopenia (9%), and hypertension (3%). No grade 3-4 peripheral sensory neuropathy occurred. CONCLUSION Treatment with a low dose of nab-paclitaxel once every 3 weeks was tolerable and of acceptable safety and might be beneficial for patients with metastatic or recurrent breast cancer.
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Affiliation(s)
- Shigeru Yamamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Noriko Maeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yukiko Nagashima
- Department of Surgery, Shimonoseki Medical Center, Shimonoseki, Yamaguchi, Japan
| | - Hidefumi Kubo
- Department of Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, Japan
| | - Yoko Sato
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroto Matsui
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yuka Inoue
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Shinsuke Kanekiyo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kazuhiko Sakamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Nobuaki Suzuki
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Tomio Ueno
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Shigefumi Yoshino
- Oncology Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Shoichi Hazama
- Department of Translational Research and Developmental Therapeutics Against Cancer, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Masaaki Oka
- Yamaguchi University, Yamaguchi, Yamaguchi, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Brufsky A. nab-Paclitaxel for the treatment of breast cancer: an update across treatment settings. Exp Hematol Oncol 2017; 6:7. [PMID: 28344858 PMCID: PMC5361712 DOI: 10.1186/s40164-017-0066-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/02/2017] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The purpose of this systematic review is to discuss recent studies and ongoing trials of nab-paclitaxel in breast cancer and to examine the potential role of nab-paclitaxel as a backbone for immuno-oncology therapies. METHODS PubMed and selected congress proceedings were searched for studies of nab-paclitaxel in breast cancer published between 2013 and 2015. All phase II and III clinical trials, retrospective analyses, and institutional studies were included. Active, ongoing, phase II or III trials on nab-paclitaxel that were listed on ClinicalTrials.gov were also included. RESULTS Sixty-three studies, including 23 in early-stage and 30 in metastatic breast cancer (some studies not classifiable by setting), were included in this analysis. Trials of neoadjuvant nab-paclitaxel-containing regimens have reported pathological complete response rates ranging from 5.7 to 53%. Median overall survival in metastatic breast cancer studies ranged from 10.8 to 23.5 months, depending on dose and regimen. Adverse event profiles of nab-paclitaxel were generally similar to those reported from previous studies. Several ongoing trials are evaluating nab-paclitaxel in the early-stage and metastatic settings, including in combination with immuno-oncology agents. CONCLUSIONS nab-Paclitaxel continues to demonstrate promising efficacy in breast cancer. Recent studies demonstrate high pathological complete response rates in early-stage breast cancer, particularly in triple-negative breast cancer, an area of high unmet need, and encouraging overall survival in metastatic breast cancer across doses and schedules. Ongoing trials will provide further insights into the role of nab-paclitaxel in breast cancer including use as a potential backbone chemotherapy agent for immuno-oncology therapies such as checkpoint inhibitors.
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Affiliation(s)
- Adam Brufsky
- Division of Hematology/Oncology, University of Pittsburgh, 300 Halket Street, Suite 4628, Pittsburgh, PA 15213 USA
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11
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Chen WY, Zhang XY, Liu T, Liu Y, Zhao YS, Pang D. Chromobox homolog 2 protein: A novel biomarker for predicting prognosis and Taxol sensitivity in patients with breast cancer. Oncol Lett 2016; 13:1149-1156. [PMID: 28454227 PMCID: PMC5403172 DOI: 10.3892/ol.2016.5529] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 11/10/2016] [Indexed: 02/06/2023] Open
Abstract
Polycomb group (PcG) complexes modify histones to silence tumor suppressor genes, which exhibit an important function in tumorigenesis and progression. The chromobox (Cbx) protein family is a critical component of PcG-mediated repression. Cbx2, a member of the Cbx protein family, is hypothesized to exhibit a vital role in breast cancer. In the present study, immunohistochemical analysis using tissue microarrays was performed to determine the levels of Cbx2 protein expression in breast cancer. The association between Cbx2 expression and the clinical features and prognosis of 455 breast cancer patients was analyzed. In addition, the efficacy of Taxol was evaluated by comparing the survival of patients with high or low Cbx2 expression. The results revealed that Cbx2 expression was higher in cancer tissues compared with adjacent normal tissues. Furthermore, high Cbx2 expression was significantly associated with large tumor size, lymph node metastasis, high TNM stage and positive human epidermal growth factor receptor-2 (HER-2) status. Patients with high Cbx2 expression also exhibited a shorter mean overall survival (OS) time (74.37 months) compared with patients with low Cbx2 expression (77.37 months). Univariate analysis indicated that high Cbx2 expression increased the risk of mortality by 1.826-fold compared with low Cbx2 expression [hazard ratio (HR), 1.826; 95% confidence interval (CI), 1.069–3.116; P=0.027]. Among patients with high Cbx2 expression, the mean OS time of individuals treated with Taxol (71.01 months) was lower compared with patients that had not received Taxol treatment (78.43 months; log-rank test statistic, 13.03; P<0.001). However, no significant difference in OS time was identified in the low expression group. The results of the current study revealed that Cbx2 may present a novel biomarker for predicting the prognosis of breast cancer patients. Cbx2 may also represent a potential target for treatment due to its important function in Taxol treatment responses.
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Affiliation(s)
- Wang Yang Chen
- Heilongjiang Academy of Medical Sciences, Harbin, Heilongjiang 150044, P.R. China.,Department of Cancer Epidemiology, Institute of Cancer Prevention and Treatment, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Xian Yu Zhang
- Department of Breast Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Tong Liu
- Department of Breast Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Yang Liu
- Department of Breast Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Ya Shuang Zhao
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang 150040, P.R. China
| | - Da Pang
- Department of Breast Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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Li X, Wetherilt CS, Krishnamurti U, Yang J, Ma Y, Styblo TM, Meisel JL, Peng L, Siddiqui MT, Cohen C, Aneja R. Stromal PD-L1 Expression Is Associated With Better Disease-Free Survival in Triple-Negative Breast Cancer. Am J Clin Pathol 2016; 146:496-502. [PMID: 27686176 DOI: 10.1093/ajcp/aqw134] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer, and there is no approved targeted therapy. We studied the expression of programmed cell death protein 1 (PD-1) and its ligand (PD-L1) in TNBC. METHODS Full-face sections from 136 TNBC cases without neoadjuvant therapy between 2004 and 2013 were stained and evaluated for immune cell PD-1 staining and stromal or tumoral PD-L1 staining using the H-score (staining percentage × intensity). Nottingham histologic grade, lymphovascular invasion (LVI), mitotic count, and tumor-infiltrating lymphocytes (TILs) were evaluated. Tumor size, lymph node status, Ki-67 score, metastasis, overall survival (OS), and disease-free survival (DFS) were retrieved from medical records. RESULTS Of the 136 TNBC cases, 69 (51%) had any PD-L1 staining and 35 (26%) had PD-L1 staining with an H-score of 5 or more; 117 (86%) had any PD-1 staining and 68 (50%) had PD-1 staining with an H-score of 5 or more. Tumor size and LVI were significantly associated with worse OS and DFS, and TILs and LVI were significantly associated with metastasis in univariate analysis. Stromal PD-L1 expression was significantly associated with better DFS in multivariate analysis. PD-1 expression was not associated with DFS, OS, or metastasis. CONCLUSIONS PD-L1 expression is seen in a high proportion of TNBCs and associated with better DFS.
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Affiliation(s)
- Xiaoxian Li
- From the Department of Pathology and Laboratory Medicine,
| | | | | | | | | | | | - Jane L Meisel
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | | | | | - Cynthia Cohen
- From the Department of Pathology and Laboratory Medicine
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta
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13
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[Evaluation of breast HER2+ cancer pathologic response after a taxan plus trastuzumab-based chemotherapy]. ACTA ACUST UNITED AC 2016; 44:396-402. [PMID: 27451068 DOI: 10.1016/j.gyobfe.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In our study, we aimed to assess the pathologic complete response after neo-additive chemotherapy that contains a taxan associated to trastuzumab for patients treated from breast cancer at the institute Jean-Godinot between 2012 and 2014, and to evaluate factors associated to this pathologic complete response. METHODS Retrospective study with clinical, anatomopathologic and radiologic parameters analysis before and after new adjuvant chemotherapy. The statistical analysis was done on logiciel XL-STAT, the Mann-Whitney-Wilcoxon for quantitative variables and Fisher exact tests for qualitative variables, the Spearman rang test. RESULTS The rate of pathologic complete response is 38.8%. The prognostic factor associated to pathologic complete response is a Ki-67>44%. CONCLUSION The pathologic complete response rate corresponds to international lower rate; because of the lack of several data, we found out only one prognostic factor, Ki-67>44%.
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Docosahexaenoic Acid Modulates a HER2-Associated Lipogenic Phenotype, Induces Apoptosis, and Increases Trastuzumab Action in HER2-Overexpressing Breast Carcinoma Cells. BIOMED RESEARCH INTERNATIONAL 2015; 2015:838652. [PMID: 26640797 PMCID: PMC4659962 DOI: 10.1155/2015/838652] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/11/2015] [Accepted: 10/11/2015] [Indexed: 12/12/2022]
Abstract
In breast cancer, lipid metabolic alterations have been recognized as potential oncogenic stimuli that may promote malignancy. To investigate whether the oncogenic nature of lipogenesis closely depends on the overexpression of HER2 protooncogene, the normal breast cell line, HB4a, was transfected with HER2 cDNA to obtain HER2-overexpressing HB4aC5.2 cells. Both cell lines were treated with trastuzumab and docosahexaenoic acid. HER2 overexpression was accompanied by an increase in the expression of lipogenic genes involved in uptake (CD36), transport (FABP4), and storage (DGAT) of exogenous fatty acids (FA), as well as increased activation of “de novo” FA synthesis (FASN). We further investigate whether this lipogenesis reprogramming might be regulated by mTOR/PPARγ pathway. Inhibition of the mTORC1 pathway markers, p70S6 K1, SREBP1, and LIPIN1, as well as an increase in DEPTOR expression (the main inhibitor of the mTOR) was detected in HB4aC5.2. Based on these results, a PPARγ selective antagonist, GW9662, was used to treat both cells lines, and the lipogenic genes remained overexpressed in the HB4aC5.2 but not HB4a cells. DHA treatment inhibited all lipogenic genes (except for FABP4) in both cell lines yet only induced death in the HB4aC5.2 cells, mainly when associated with trastuzumab. Neither trastuzumab nor GW9662 alone was able to induce cell death. In conclusion, oncogenic transformation of breast cells by HER2 overexpression may require a reprogramming of lipogenic genetic that is independent of mTORC1 pathway and PPARγ activity. This reprogramming was inhibited by DHA.
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