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Lacaze JL, Aziza R, Chira C, De Maio E, Izar F, Jouve E, Massabeau C, Pradines A, Selmes G, Ung M, Zerdoud S, Dalenc F. Diagnosis, biology and epidemiology of oligometastatic breast cancer. Breast 2021; 59:144-156. [PMID: 34252822 PMCID: PMC8441842 DOI: 10.1016/j.breast.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/01/2022] Open
Abstract
Does oligometastatic breast cancer (OMBC) deserve a dedicated treatment? Although some authors recommend multidisciplinary management of OMBC with a curative intent, there is no evidence proving this strategy beneficial in the absence of a randomized trial. The existing literature sheds little light on OMBC. Incidence is unknown; data available are either obsolete or biased; there is no consensus on the definition of OMBC and metastatic sites, nor on necessary imaging techniques. However, certain proposals merit consideration. Knowledge of eventual specific OMBC biological characteristics is limited to circulating tumor cell (CTC) counts. Given the data available for other cancers, studies on microRNAs (miRNAs), circulating tumor DNA (ctDNA) and genomic alterations should be developed Finally, safe and effective therapies do exist, but results of randomized trials will not be available for many years. Prospective observational cohort studies need to be implemented.
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Affiliation(s)
- Jean-Louis Lacaze
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France.
| | - Richard Aziza
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Imagerie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Ciprian Chira
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eleonora De Maio
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Françoise Izar
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eva Jouve
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Carole Massabeau
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Anne Pradines
- Institut Claudius Regaud (ICR), Département Biologie Médicale Oncologique, Centre de Recherche en Cancérologie de Toulouse, (CRCT), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), INSERM UMR-1037, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Gabrielle Selmes
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Mony Ung
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Slimane Zerdoud
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Médecine Nucléaire, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Florence Dalenc
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, Université de Toulouse, UPS, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
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van Ommen-Nijhof A, Steenbruggen TG, Schats W, Wiersma T, Horlings HM, Mann R, Koppert L, van Werkhoven E, Sonke GS, Jager A. Prognostic factors in patients with oligometastatic breast cancer - A systematic review. Cancer Treat Rev 2020; 91:102114. [PMID: 33161237 DOI: 10.1016/j.ctrv.2020.102114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
AIM Oligometastatic breast cancer (OMBC) is a disease-entity with potential for long-term remission in selected patients. Those with truly limited metastatic load (rather than occult widespread metastatic disease) may benefit from multimodality treatment including local ablative therapy of distant metastases. In this systematic review, we studied factors associated with long-term survival in patients with OMBC. METHODS Eligible studies included patients with OMBC who received a combination of local and systemic therapy as multimodal approach and reported overall survival (OS) or progression-free survival (PFS), or both. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of each included study. Independent prognostic factors for OS and/or PFS are summarized. RESULTS Of 1271 screened abstracts, 317 papers were full-text screened and twenty studies were included. Eleven of twenty studies were classified as acceptable quality. Definition of OMBC varied between studies and mostly incorporated the number and/or location of metastases. The 5-year OS ranged between 30 and 79% and 5-year PFS ranged between 25 and 57%. Twelve studies evaluated prognostic factors for OS and/or PFS in multivariable models. A solitary metastasis, >24 months interval between primary tumor and OMBC, no or limited involved axillary lymph nodes at primary diagnosis, and hormone-receptor positivity were associated with better outcome. HER2-positivity was associated with worse outcome, but only few patients received anti-HER2 therapy. CONCLUSIONS OMBC patients with a solitary distant metastasis and >24 months disease-free interval have the best OS and may be optimal candidates to consider a multidisciplinary approach.
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Affiliation(s)
- Annemiek van Ommen-Nijhof
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands.
| | - Tessa G Steenbruggen
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Winnie Schats
- Department of Scientific Information Service, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Terry Wiersma
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Hugo M Horlings
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Ritse Mann
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Linetta Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, PO Box 2060, 3000 CB Rotterdam, the Netherlands
| | - Erik van Werkhoven
- Department of Biostatistics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 2060, 3000 CB Rotterdam, the Netherlands
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Welt A, Bogner S, Arendt M, Kossow J, Huffziger A, Pohlkamp C, Steiniger H, Becker U, Alashkar F, Kohl M, Wiesweg M, Richly H, Hense J, Scheulen ME, Schuler M, Seeber S, Tewes M. Improved survival in metastatic breast cancer: results from a 20-year study involving 1033 women treated at a single comprehensive cancer center. J Cancer Res Clin Oncol 2020; 146:1559-1566. [PMID: 32189107 PMCID: PMC7230039 DOI: 10.1007/s00432-020-03184-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/12/2020] [Indexed: 10/31/2022]
Abstract
PURPOSE Diagnosis and treatment of breast cancer have changed profoundly over the past 25 years. The outcome improved dramatically and was well quantified for early stage breast cancer (EBC). However, progress in the treatment of metastatic disease has been less convincingly demonstrated. We have studied survival data of patients with metastatic breast cancer (MBC) from a large academic cancer center over a period of 20 years. METHODS Data from 1033 consecutive MBC patients who were treated at the Department of Medical Oncology of the West German Cancer Center from January 1990 to December 2009 were retrospectively analyzed for overall survival (OS) and risk factors. Patients were grouped in 5-year cohorts, and survival parameters of each cohort were compared before and after adjustment for risk factors. RESULTS Overall survival of patients with MBC treated at specialized center has significantly improved from 1990 to 2010 (hazard ratio 0.7, 95%CI 0.58-0.84). The increments in OS have become less profound over time (median OS 1990-1994: 24.2 months, 1995-1999: 29.6 months, 2000-2004: 36.5 months, 2005-2009: 37.8 months). CONCLUSION Survival of patients with MBC has improved between 1990 and 2004, but less from 2005 to 2009. Either this suggests an unnoticed shift in the patient population, or a lesser impact of therapeutic innovations introduced in the most recent period.
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Affiliation(s)
- Anja Welt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Simon Bogner
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Marina Arendt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Computer Science, University of Applied Sciences and Arts, Dortmund, Germany
| | - Josef Kossow
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Surgery, Herz-Jesu-Krankenhaus, Münster, Germany
| | - Antonia Huffziger
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Medicine, Augusta Krankenhaus, Düsseldorf, Germany
| | - Christian Pohlkamp
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Munich Leukemia Laboratory (MLL), München, Germany
| | - Heike Steiniger
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Practice for Internal Medicine, Hematology and Oncology, Oberhausen, Germany
| | - Ute Becker
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Medicine I, St. Bernhard Hospital, Kamp-Lintfort, Germany
| | - Ferras Alashkar
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Hematology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marzena Kohl
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Practice for General Medicine, Essen, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Heike Richly
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Max E Scheulen
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Practice for General Medicine, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Siegfried Seeber
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Practice for Internal Medicine, Preventicum, Essen, Germany
| | - Mitra Tewes
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget 2015; 6:8491-524. [PMID: 25940699 PMCID: PMC4496163 DOI: 10.18632/oncotarget.3455] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 12/15/2022] Open
Abstract
Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.
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Affiliation(s)
- Diane K. Reyes
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Kenneth J. Pienta
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
- Departments of Pharmacology and Molecular Sciences, and Chemical and Biomolecular Engineering, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
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Rastogi S, Gulia S, Bajpai J, Ghosh J, Gupta S. Oligometastatic breast cancer: A mini review. Indian J Med Paediatr Oncol 2014; 35:203-6. [PMID: 25336790 PMCID: PMC4202615 DOI: 10.4103/0971-5851.142035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
With few exceptions such as germ cell tumors, trophoblastic neoplasms and colonic cancers, metastatic solid tumors are considered largely incurable. It is increasingly appreciated that oligometaststic cancer differs from multi-metastatic disease in prognosis and survival. Oligometastatic breast cancer (OMBC) is, therefore, sometimes considered as an intermediate biological state between localized and widely metastatic disease. There is no strict definition of OMBC with studies using different criteria. Treatment of OMBC is still controversial in view of sparse data that is retrospective. However, there is an increasing shift toward individualized, multidisciplinary management of OMBC with the intent to cure some patients. This article will concisely review the subject of OMBC from points of view of biology and practical management recommendations.
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Affiliation(s)
- Sameer Rastogi
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
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Dellas K. Does Radiotherapy Have Curative Potential in Metastatic Patients? The Concept of Local Therapy in Oligometastatic Breast Cancer. Breast Care (Basel) 2011; 6:363-368. [PMID: 22619646 PMCID: PMC3357150 DOI: 10.1159/000333115] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 1995, Hellmann and Weichselbaum defined for the first time the term oligometastases which is used to describe limited metastasis with a maximum of 3-4 clinically detectable metastases. It is assumed that these patients have a better prognosis and that local treatment of the metastases plays a significant part in the further development of the disease. Therefore, these patients could benefit from a curative local therapy of the manifested metastases. Local therapy measures include mainly radiotherapeutic methods alongside invasive ablative processes, such as surgical resection and radiofrequency ablation. Patients subjected to radiation therapy benefit especially from the usage of modern precision technology as it reduces the radiation exposure to the normal tissue, and because short radiation sessions with escalating doses are possible (e.g. radiation surgery, image-assisted radiation therapy, stereotactic radiation). Initial clinical studies show very good local tumor control rates which are on a par with resection and ablative methods, but with very few side effects and risks. This article summarizes the integration of the concept of oligometastases in the radiotherapy of limited metastatic breast cancer.
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Affiliation(s)
- Kathrin Dellas
- North European Radiooncological Center Kiel and University of Luebeck, Department of Radiotherapy, Germany
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De Giorgi U, Rosti G, Ciucci G, Kopf B, Minzi C, Argnani M, Marangolo M. Multiple cycles of PBPC-supported high-dose carboplatin and paclitaxel following mobilization with epirubicin and cisplatin are feasible but ineffective in treating patients with advanced non-small cell lung cancer. Bone Marrow Transplant 2007; 40:735-9. [PMID: 17700603 DOI: 10.1038/sj.bmt.1705793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We verified the feasibility of a multi-cycle peripheral blood progenitor cell (PBPC)-supported high-dose chemotherapy (HDC) regimen in patients with non-small cell lung cancer (NSCLC). The HDC regimen consisted of a single course of high-dose epirubicin given in combination with cisplatin plus filgrastim, followed by three courses of high doses of carboplatin and paclitaxel with PBPC reinfusion and filgrastim. Of the 16 enrolled patients, 13 provided an adequate number of PBPCs by a single leukapheresis, while in the three needed two procedures, with a median number of CD34+, CD34+/CD33- and CD34+/CD38- cells collected per patient was 13.5 x 10(6), 10.9 x 10(6) and 0.9 x 10(6)/kg, respectively. No toxic death occurred, and the collected PBPCs supported a rapid hematopoietic reconstitution after HDC; however, seven patients early interrupted the treatment early due to early progressive disease (n=4) or prolonged grade 3 peripheral neurotoxicity (n=3). Despite an overall response rate of 42%, the median survival for stage IV patients has been 5 months (range: 1-25+). Of two patients with stage IIIB NSCLC, one is continuously disease-free at 71+ months, while of 14 with stage IV disease, one is currently alive with disease at 25+ months. In conclusion, the combination of high-dose epirubicin with cisplatin plus filgrastim is an effective regimen in releasing large amounts of PBPCs, which can then be safely employed to support multiple courses of HDC. Multiple cycles of PBPC-supported high-dose carboplatin and paclitaxel are ineffective in treating patients with advanced NSCLC.
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Affiliation(s)
- U De Giorgi
- Istituto Oncologico Romagnolo-Department of Oncology and Hematology, Santa Maria delle Croci Hospital, Ravenna, Italy.
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Kurian S, Qazilbash M, Fay J, Wolff S, Herzig R, Hobbs G, Bunner P, Weisenborn R, Aya-Ay M, Lynch J, Ericson S. Complete response after high-dose chemotherapy and autologous hemopoietic stem cell transplatation in metastatic breast cancer results in survival benefit. Breast J 2007; 12:531-5. [PMID: 17238982 DOI: 10.1111/j.1524-4741.2006.00341.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Metastatic breast cancer is an incurable disease even with high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (ASCT). Even though phase III studies have not shown a survival advantage for this group as a whole, it is possible that a small subset of patients may benefit from HDC/ASCT with careful patient selection. A total of 198 patients from three different institutions were treated with HDC/ASCT. After complete staging, patients with central nervous system or bone marrow involvement were excluded. The HDC regimen consisted of: Carboplatin 600 mg/m(2) IV infusion over 48 hours, Thiotepa 300 mg/m(2) IV infusion over 2 hours, and Cytoxan 60 mg/kg IV infusion given over 2 hours x3 days. The median age at the time of transplant was 46 (24-62) years and median follow-up was 20 months. Hormone receptor status was known in 148 patients, of whom 84 had estrogen receptor (ER) and/or progestrone receptor (PgR)-positive tumors. Eighty patients had no evidence of disease at the time of HDC/ASCT (CR1). At the completion of HDC and ASCT, complete responses (CR) were seen in an additional 57 patients (CR2). Using Kaplan-Meier analysis, the median relapse-free survival (RFS) for the entire group was 15 months and overall survival (OS) was 27 months. The patients in CR1 had a median RFS and OS of 20.7 and 50.6 months, respectively. This was very similar to the RFS and OS in patients achieving CR2 after HDC/ASCT (p < 0.001; median: 19 and 40 months, respectively). In contrast, the patients with persistent residual disease had an RFS and OS of 7 and 12 months (p < 0.001). These data show that patients achieving a CR after HDC/ASCT have a better relapse-free and OS, when compared to patients with persistent residual disease after HDC/ASCT. This study suggests that a subset of patients with residual metastatic breast cancer after standard chemotherapy can achieve CR with HDC and ASCT which may result in better long-term outcome.
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Affiliation(s)
- Sobha Kurian
- West Virginia University, Morgantown, West Virginia 26505, USA.
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9
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Seeber S, Welt A. Program Surveillance in Women with Early Breast Cancer – Pro. Breast Care (Basel) 2007. [DOI: 10.1159/000111602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Stemmler HJ, Menzel H, Salat C, Lindhofer H, Kahlert S, Heinemann V, Kolb HJ. Lasting remission following multimodal treatment in a patient with metastatic breast cancer. Anticancer Drugs 2006; 16:1135-7. [PMID: 16222157 DOI: 10.1097/01.cad.0000180122.24031.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a lasting remission from multimodal treatment in a patient with hepatic metastasized breast cancer. After surgical removal of a singular hepatic metastasis, the patient underwent leukapheresis of peripheral blood mononuclear cell (PBMCs). For induction chemotherapy, the patient received 2 cycles of epirubicin and paclitaxel (ET). After 1 cycle of epirubicin and ifosfamide (EI), peripheral blood stem cells were harvested. After a final cycle of ET, the patient underwent high-dose chemotherapy (HDCT; thiotepa 600 mg/m/melphalan 180 mg/m) and autologous stem cell transplantation. Once reconstitution was achieved, PBMCs were reinfused followed by i.v. application of a trifunctional antibody (TrAb) with specificities anti-EpCAMxanti-CD3. TrAbs are able to simultaneously bind tumor cells, T cells, and additionally FcgammaR type I and III+accessory cells via their Fc region. Side-effects during treatment were hematotoxicity, mucositis and gastrointestinal toxicity. TrAb treatment resulted in intermittent fever, chills, elevated liver enzymes, systemic inflammatory response syndrome and pulmonary leakage. With a follow-up period of more than 8 years the patient is still in remission (96+months). This case suggests the feasibility and efficacy of combining surgery, standard and HDCT, and subsequent immunotherapy in metastatic breast cancer. Further investigation of this approach is indicated in a subgroup of patients with oligometastatic breast cancer.
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Affiliation(s)
- H J Stemmler
- Department of Hematology/Oncology, Klinikum Grosshadern, University of Munich, Munich, Germany.
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