1
|
Jiang M, Avery K, Ahmed R, de Boniface J, Chatterjee S, Dodwell D, Dubsky P, Finestone S, Iwata H, Lee HB, MacKenzie M, Meyn A, Poulakaki F, Richardson AL, Sepulveda K, Spillane A, Thompson AM, Werutsky G, Wright JL, Zdenkowski N, Cowan K, McIntosh SA, Potter S. Exploring locoregional treatment reporting in neoadjuvant systemic breast cancer treatment studies: A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108554. [PMID: 39059194 DOI: 10.1016/j.ejso.2024.108554] [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: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024]
Abstract
Accurate information about locoregional treatments in breast cancer neoadjuvant systemic therapy (NST) trials is vital to support surgical decision-making and allow meaningful interpretation of long-term oncological outcomes. This systematic review (PROSPERO registration CRD42023470891) aimed to describe the current practice of outcome reporting in NST studies. A systematic search identified primary research studies published 01/01/2018-08/09/2023 reporting outcomes in patients receiving NST for breast cancer followed by locoregional treatment. Included were randomised controlled trials (RCTs) and non-randomised studies (NRS) with >250 participants reporting at least one locoregional treatment outcome. Outcomes were extracted verbatim and categorised using content analysis. Descriptive statistics were used to summarise results. Of the 3111 abstracts screened, 137 studies (22 RCTs and 115 NRS) reporting at least one locoregional outcome in 575,531 patients were included. The 137 studies reported a total of 510 surgical outcomes with a median of 3 (range 1-12) per study. No single outcome was reported in all studies. Type of breast (n = 129, 94.2 %) and axillary (n = 86, 62.8 %) surgery were reported most frequently. Only 34 % (n = 47) studies reported how treatment response was assessed and if/how this informed surgical decision-making. Only a fifth (n = 28) reported outcomes relating to surgical de-escalation. Only 72 studies (52.6 %) reported any radiation therapy (RT)-related outcome, most frequently whether RT had been received (n = 63/72, 87.5 %). Current reporting of locoregional treatment outcomes in NST studies is poor, inconsistent and urgently needs to be improved. A core outcome set and reporting guidelines may improve the quality and value of future research.
Collapse
Affiliation(s)
- Michael Jiang
- Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Bristol Medical School, Bristol, UK; North Bristol NHS Trust, Bristol, UK
| | - Kerry Avery
- Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Bristol Medical School, Bristol, UK; Centre for Surgical Research, Bristol Medical School, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK
| | | | - Jana de Boniface
- Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Instituet, Stockholm, Sweden
| | | | - David Dodwell
- Oxford Population Health, University of Oxford, Oxford, UK
| | - Peter Dubsky
- Hirslanden Klinik St Anna, Lucerne, Switzerland; University of Lucerne, Lucerne, Switzerland
| | | | | | - Han-Byoel Lee
- Dept. of Surgery, Seoul National University College of Medicine, Cancer Research Institute, Seoul National University, South Korea
| | | | | | - Fiorita Poulakaki
- Europa Donna - the European Breast Cancer Coalition, Milan, Italy; Breast Surgery Department, Athens Medical Centre, Greece
| | | | | | - Andrew Spillane
- University of Sydney, Sydney, Australia; Mater Hospital Wollstonecraft New South Wales, Australia; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | | | | | | | | | | | - Shelley Potter
- Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Bristol Medical School, Bristol, UK; North Bristol NHS Trust, Bristol, UK.
| |
Collapse
|
2
|
Potter S, Avery K, Ahmed R, de Boniface J, Chatterjee S, Dodwell D, Dubsky P, Iwata H, Jiang M, Lee HB, MacKenzie M, Poulakaki F, Richardson AL, Sepulveda K, Spillane A, Thompson AM, Werutsky G, Wright JL, Zdenkowski N, Cowan K, McIntosh S. Protocol for the development of a core outcome set and reporting guidelines for locoregional treatment in neoadjuvant systemic breast cancer treatment trials: the PRECEDENT project. BMJ Open 2024; 14:e084488. [PMID: 38643011 PMCID: PMC11033665 DOI: 10.1136/bmjopen-2024-084488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Neoadjuvant systemic anticancer therapy (neoSACT) is increasingly used in the treatment of early breast cancer. Response to therapy is prognostic and allows locoregional and adjuvant systemic treatments to be tailored to minimise morbidity and optimise oncological outcomes and quality of life. Accurate information about locoregional treatments following neoSACT is vital to allow the translation of downstaging benefits into practice and facilitate meaningful interpretation of oncological outcomes, particularly locoregional recurrence. Reporting of locoregional treatments in neoSACT studies, however, is currently poor. The development of a core outcome set (COS) and reporting guidelines is one strategy by which this may be improved. METHODS AND ANALYSIS A COS for reporting locoregional treatment (surgery and radiotherapy) in neoSACT trials will be developed in accordance with Core Outcome Measures in Effectiveness Trials (COMET) and Core Outcome Set-Standards for Development guidelines. Reporting guidance will be developed concurrently.The project will have three phases: (1) generation of a long list of relevant outcome domains and reporting items from a systematic review of published neoSACT studies and interviews with key stakeholders. Identified items and domains will be categorised and formatted into Delphi consensus questionnaire items. (2) At least two rounds of an international online Delphi survey in which at least 250 key stakeholders (surgeons/oncologists/radiologists/pathologists/trialists/methodologists) will score the importance of reporting each outcome. (3) A consensus meeting with key stakeholders to discuss and agree the final COS and reporting guidance. ETHICS AND DISSEMINATION Ethical approval for the consensus process will be obtained from the Queen's University Belfast Faculty Ethics Committee. The COS/reporting guidelines will be presented at international meetings and published in peer-reviewed journals. Dissemination materials will be produced in collaboration with our steering group and patient advocates so the results can be shared widely. REGISTRATION The study has been prospectively registered on the COMET website (https://www.comet-initiative.org/Studies/Details/2854).
Collapse
Affiliation(s)
- Shelley Potter
- Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - Kerry Avery
- Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Rosina Ahmed
- Tata Medical Center, Kolkata, West Bengal, India
| | - Jana de Boniface
- Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Instituet, Stockholm, Sweden
| | | | | | - Peter Dubsky
- Hirslanden Klinik St Anna, Lucerne, Switzerland
- University of Lucerne, Luzern, Switzerland
| | | | - Michael Jiang
- Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
| | - Han-Byoel Lee
- Breast Care Centre, Dept. of Surgery, Seoul National University Hospital, Seoul, South Korea
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | | | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Centre, Athens, Greece
- Europa Donna The European Breast Cancer Coalition, Milan, Italy
| | | | | | | | - Alastair M Thompson
- Department of Surgical Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | - Stuart McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| |
Collapse
|
3
|
Vilhais G, Alpuim Costa D, Fontes-Sousa M, Ribeiro PC, Martinho F, Botelho de Sousa C, Santos CR, Negreiros I, Canastra A, Borralho P, Guia Pereira A, Marçal C, Germano Sousa J, Chaleira R, Rocha JC, Calhau C, Faria A. Case report: Primary CDK4/6 inhibitor and endocrine therapy in locally advanced breast cancer and its effect on gut and intratumoral microbiota. Front Oncol 2024; 14:1360737. [PMID: 38601755 PMCID: PMC11004348 DOI: 10.3389/fonc.2024.1360737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
Locally advanced breast cancer poses significant challenges to the multidisciplinary team, in particular with hormone receptor (HR) positive, HER2-negative tumors that classically yield lower pathological complete responses with chemotherapy. The increasingly significant use of CDK 4/6 inhibitors (CDK4/6i) plus endocrine therapy (ET) in different breast cancer settings has led to clinical trials focusing on this strategy as a primary treatment, with promising results. The impact of the microbiota on cancer, and vice-versa, is an emerging topic in oncology. The authors report a clinical case of a postmenopausal female patient with an invasive breast carcinoma of the right breast, Luminal B-like, staged as cT4cN3M0 (IIIB). Since the lesion was considered primarily inoperable, the patient started letrozole and ribociclib. Following 6 months of systemic therapy, the clinical response was significant, and surgery with curative intent was performed. The final staging was ypT3ypN2aM0, R1, and the patient started adjuvant letrozole and radiotherapy. This case provides important insights on primary CDK4/6i plus ET in locally advanced unresectable HR+/HER2- breast cancer and its potential implications in disease management further ahead. The patient's gut microbiota was analyzed throughout the disease course and therapeutic approach, evidencing a shift in gut microbial dominance from Firmicutes to Bacteroidetes and a loss of microbial diversity following 6 months of systemic therapy. The analysis of the intratumoral microbiota from the surgical specimen revealed high microbial dissimilarity between the residual tumor and respective margins.
Collapse
Affiliation(s)
- Guilherme Vilhais
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal
| | - Diogo Alpuim Costa
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Medical Oncology Department, Hospital de Cascais, Cascais, Portugal
- Breast Unit, CUF Oncologia, Lisbon, Portugal
| | - Mário Fontes-Sousa
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal
- Breast Unit, CUF Oncologia, Lisbon, Portugal
| | - Pedro Casal Ribeiro
- Bioinformatics Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | | | | | - Catarina Rodrigues Santos
- Breast Unit, CUF Oncologia, Lisbon, Portugal
- Surgery Department, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOL-FG), Lisbon, Portugal
| | | | - Ana Canastra
- Anatomic Pathology Department, CUF Oncologia, Lisbon, Portugal
| | - Paula Borralho
- Breast Unit, CUF Oncologia, Lisbon, Portugal
- Anatomic Pathology Department, CUF Oncologia, Lisbon, Portugal
- Institute of Anatomic Pathology, Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisbon, Portugal
| | - Ana Guia Pereira
- Genetics Laboratory, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | - Cristina Marçal
- Clinical Pathology Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | - José Germano Sousa
- Clinical Pathology Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | - Renata Chaleira
- Psychology Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Júlio César Rocha
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Rede de Investigação em Saúde (RISE), NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Unidade Universitária Lifestyle Medicine José de Mello Saúde, NOVA Medical School (NMS), Lisbon, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Rede de Investigação em Saúde (RISE), NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Unidade Universitária Lifestyle Medicine José de Mello Saúde, NOVA Medical School (NMS), Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Ana Faria
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Rede de Investigação em Saúde (RISE), NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| |
Collapse
|
4
|
Zaborowski AM, Doogan K, Clifford S, Dowling G, Kazi F, Delaney K, Yadav H, Brady A, Geraghty J, Evoy D, Rothwell J, McCartan D, Heeney A, Barry M, Walsh SM, Stokes M, Kell MR, Allen M, Power C, Hill ADK, Connolly E, Alazawi D, Boyle T, Corrigan M, O’Leary P, Prichard RS. Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study. Br J Surg 2024; 111:znad401. [PMID: 38055888 PMCID: PMC10763529 DOI: 10.1093/bjs/znad401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+). METHODS A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy. RESULTS A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease. CONCLUSION The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.
Collapse
Affiliation(s)
| | - Katie Doogan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Siobhan Clifford
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gavin Dowling
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Farah Kazi
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Karina Delaney
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Himanshu Yadav
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Aaron Brady
- Department of Breast Surgery, Bon Secours Hospital Cork, Cork, Ireland
| | - James Geraghty
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Anna Heeney
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mitchel Barry
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm R Kell
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Allen
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Dhafir Alazawi
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Terence Boyle
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Mark Corrigan
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Peter O’Leary
- Department of Breast Surgery, Bon Secours Hospital Cork, Cork, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Zaborowski AM, Wong SM. Neoadjuvant systemic therapy for breast cancer. Br J Surg 2023; 110:765-772. [PMID: 37104057 PMCID: PMC10683941 DOI: 10.1093/bjs/znad103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/28/2023]
Affiliation(s)
| | - Stephanie M Wong
- Department of Surgery and Oncology, McGill University Medical School, Montreal, Quebec, Canada
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| |
Collapse
|