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Davey MG, Ryan ÉJ, Burke D, McKevitt K, McAnena PF, Kerin MJ, Lowery AJ. Evaluating the Clinical Utility of Routine Sentinel Lymph Node Biopsy and the Value of Adjuvant Chemotherapy in Elderly Patients Diagnosed With Oestrogen Receptor Positive, Clinically Node Negative Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211022203. [PMID: 34177266 PMCID: PMC8207274 DOI: 10.1177/11782234211022203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
Background Sentinel lymph node biopsy (SLNB) provides staging information and guides adjuvant therapy in early breast cancer (EBC). Routine SLNB in oncogeriatricians with low-risk EBC remains controversial. Aims To evaluate axillary management in elderly patients diagnosed with oestrogen receptor positive (ER+), clinically lymph node negative (cLN-) EBC, and to assess whether SLNB affects further axillary management or adjuvant chemotherapy (ACTX) decision making. Methods Female patients aged > 65 years, diagnosed with ER+, human epidermal growth factor receptor-2 negative (HER2-), and cLN- breast cancer (BC), who underwent surgery and SLNB were included. Clinicopathological predictors of ACTX and completion axillary lymph node dissection (CALND) were determined. Kaplan-Meier analyses assessed survival outcomes. Results A total of 253 patients were included (median age: 72 years, range: 66-90), all underwent SLNB; 50 (19.8%) had lymphatic metastasis on SLNB (SLNB+). Of these, 19 proceeded to CALND (38.0%), 10 (52.6%) of whom had further axillary disease (ALND+). 20 of the 50 SLNB+ patients received ACTX (40.0%) as did 31 of the 203 SLNB- patients (15.2%) (P < .001). Oncotype DX (ODX) testing was utilized in 82 cases (32.8%). Younger age (P < .001), SLNB+ (P < .001) and ODX score (P = .003) were all associated with ACTX prescription. ODX > 25 (OR: 4.37, 95% CI: 1.38-13.80, P = .012) independently predicted receiving ACTX. Receiving ACTX and proceeding to CALND did not improve disease-free (P = .485 and P = .345) or overall survival (P = .981 and P = .646). Conclusions Routine SNLB may not be necessary in elderly patients diagnosed with ER+, cLN- EBC. Future oncogeriatric practice is likely to see genomic testing guiding ACTX prescription in this group.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland
| | - Daniel Burke
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland
| | - Kevin McKevitt
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland
| | - Peter F McAnena
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Aoife J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
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Estévez LG, Suarez-Gauthier A, García E, Miró C, Calvo I, Fernández-Abad M, Herrero M, Marcos M, Márquez C, Lopez Ríos F, Perea S, Hidalgo M. Molecular effects of lapatinib in patients with HER2 positive ductal carcinoma in situ. Breast Cancer Res 2014; 16:R76. [PMID: 25186428 PMCID: PMC4448559 DOI: 10.1186/bcr3695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/01/2014] [Indexed: 02/02/2023] Open
Abstract
Introduction Human epidermal growth factor receptor 2 (HER2) amplification is frequent in ductal carcinoma in situ (DCIS) of the breast and is associated with poorly differentiated tumors and adverse prognosis features. This study aimed to determine the molecular effects of the HER2 inhibitor lapatinib in patients with HER2 positive DCIS. Methods Patients with HER2 positive DCIS received 1,500 mg daily of lapatinib for four consecutive weeks prior to surgical resection. Magnetic resonance imaging (MRI) was used to determine changes in tumor volume. The molecular effects of lapatinib on HER2 signaling (PI3K/AKT and RAS/MAPK pathways), cell proliferation (Ki67 and p27) and apoptosis (TUNEL) were determined in pre and post-lapatinib treatment samples. Results A total of 20 patients were included. Lapatinib was well tolerated with only minor and transient side effects. The agent effectively modulated HER2 signaling decreasing significantly pHER2 and pERK1 expression, together with a decrease in tumor size evaluated by MRI. There was no evidence of changes in Ki67. Conclusions Four weeks of neoadjuvant lapatinib in patients with HER2-positive DCIS resulted in inhibition of HER2 and RAS/MAPK signaling pathway. Trial registration 2008-004492-21 (Registered June 25th 2008). Electronic supplementary material The online version of this article (doi:10.1186/bcr3695) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura G Estévez
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Ana Suarez-Gauthier
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Elena García
- Pathology Department, Hospital Universitario Fundación Alcorcón, Madrid, 28922, Spain.
| | - Cristina Miró
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Isabel Calvo
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - María Fernández-Abad
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Mercedes Herrero
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Manuel Marcos
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Cristina Márquez
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Fernando Lopez Ríos
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Sofía Perea
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain.
| | - Manuel Hidalgo
- Breast Cancer Program, Centro Integral Oncológico Clara Campal, C/Oña 10, Madrid, 28050, Spain. .,Clinical Research Program, Spanish National Cancer Research Center, Madrid, 28029, Spain.
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Recommendations for research priorities in breast cancer by the coalition of cancer cooperative groups scientific leadership council: imaging and local therapy. Breast Cancer Res Treat 2010; 120:273-84. [PMID: 20024613 DOI: 10.1007/s10549-009-0655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/14/2009] [Indexed: 02/03/2023]
Abstract
Imaging and local therapy are important modalities for detection and management of localized breast cancer. Improvements in screening and local therapy have contributed to reduced breast cancer-associated morbidity and mortality. The Coalition of Cancer Cooperative Groups (CCCG) convened the Scientific Leadership Council (SLC) in breast cancer, an expert panel, to identify priorities for future research and current trials with greatest practice-changing potential. Panelists formed a consensus on research priorities for breast imaging and locoregional therapy, and also identified six trials judged to be of high priority. Current high priority trials included trials determining: (1) the role of accelerated partial breast versus whole-breast radiation (B39), (2) the feasibility, safety, and local and systemic control of small localized breast cancers treated with tumor ablation (Z1072), (3) the role of removal of the primary cancer in selected patients with metastatic disease (E2108), and (4) the clinical and biological effects of pre-operative anti-HER2-directed and ER-directed therapies in localized or locally advanced breast cancer (B41, Z1031, Z1041). Ongoing and future trials will further refine optimal locoregional management, and additional research is required to develop improved screening methods and identify high risk populations most likely to benefit from targeted screening.
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Lee JH, Rosen EL, Mankoff DA. The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 1—Overview, Detection, and Staging. J Nucl Med 2009; 50:569-81. [DOI: 10.2967/jnumed.108.053512] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Contractor KB, Kaur K, Rodrigues GS, Kulkarni DM, Singhal H. Male breast cancer: is the scenario changing. World J Surg Oncol 2008; 6:58. [PMID: 18558006 PMCID: PMC2440380 DOI: 10.1186/1477-7819-6-58] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 06/16/2008] [Indexed: 01/21/2023] Open
Abstract
Background The overall incidence of male breast cancer is around 1% of all breast cancers and is on the rise. In this review we aim to present various aspects of male breast cancer with particular emphasis on incidence, risk factors, patho-physiology, treatment, prognostic factors, and outcome. Methods Information on all aspects of male breast cancer was gathered from available relevant literature on male breast cancer from the MEDLINE database over the past 32 years from 1975 to 2007. Various reported studies were scrutinized for emerging evidence. Incidence data were also obtained from the IARC, Cancer Mondial database. Conclusion There is a scenario of rising incidence, particularly in urban US, Canada and UK. Even though more data on risk factors is emerging about this disease, more multi-institutional efforts to pool data with large randomized trials to show treatment and survival benefits are needed to support the existing vast emerging knowledge about the disease.
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Affiliation(s)
- Kaiyumars B Contractor
- Department of Surgery, Oncology, Reproductive Medicine and Anaesthetics, Imperial College, London, UK.
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