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Pala L, Sala I, Pagan E, De Pas T, Zattarin E, Catania C, Cocorocchio E, Rossi G, Laszlo D, Ceresoli G, Canzian J, Valenzi E, Bagnardi V, Conforti F. "Heterogeneity of treatment effect on patients' long-term outcome according to pathological response type in neoadjuvant RCTs for breast cancer.". Breast 2024; 73:103672. [PMID: 38244459 PMCID: PMC10831306 DOI: 10.1016/j.breast.2024.103672] [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: 08/31/2023] [Revised: 12/02/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION To provide evidence explaining the poor association between pCR and patients' long-term outcome at trial-level in neoadjuvant RCTs for breast cancer (BC), we performed a systematic-review and meta-analysis of all RCTs testing neoadjuvant treatments for early-BC and reporting the hazard ratio of DFS (HRDFS) for the intervention versus control arm stratified by pathological response type (i.e., pCR yes versus no). METHODS The objective was to explore differences of treatment effects on DFS across patients with and without pCR. We calculated the pooled HRDFS in the two strata of pathological response (i.e., pCR yes versus no) using a random-effects model, and assessed the difference between these two estimates using an interaction test. RESULTS Ten RCTs and 8496 patients were included in the analysis. Patients obtaining pCR in the intervention-arm had a higher, although not statistically significant, risk of DFS-event as compared with patients obtaining pCR in the control-arm: the pooled HRDFS for the experimental versus control arm was 1.23 (95%CI, 0.91-1.65). On the opposite, the risk of DFS-event was higher for control as compared with the intervention-arm in the stratum of patients without pCR: the pooled HRDFS was 0.86 (95%CI, 0.78-0.95). Treatment effect on DFS was significantly different according to pathological response type (interaction test p: 0.014). CONCLUSION We reported new evidence that contributes to explaining the poor surrogacy value of pCR at trial-level in neoadjuvant RCTs for early-BC.
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Affiliation(s)
- Laura Pala
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Tommaso De Pas
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Emma Zattarin
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Chiara Catania
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Giovanna Rossi
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Daniele Laszlo
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Jacopo Canzian
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Elena Valenzi
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Fabio Conforti
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
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Zhang N, Song Q, Liang H, Wang Z, Wu Q, Zhang H, Zhang L, Liu A, Wang H, Wang J, Lin L. Early prediction of pathological response to neoadjuvant chemotherapy of breast tumors: a comparative study using amide proton transfer-weighted, diffusion weighted and dynamic contrast enhanced MRI. Front Med (Lausanne) 2024; 11:1295478. [PMID: 38298813 PMCID: PMC10827983 DOI: 10.3389/fmed.2024.1295478] [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: 09/16/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Objective To examine amide proton transfer-weighted (APTw) combined with diffusion weighed (DWI) and dynamic contrast enhanced (DCE) MRI for early prediction of pathological response to neoadjuvant chemotherapy in invasive breast cancer. Materials In this prospective study, 50 female breast cancer patients (49.58 ± 10.62 years old) administered neoadjuvant chemotherapy (NAC) were enrolled with MRI carried out both before NAC (T0) and at the end of the second cycle of NAC (T1). The patients were divided into 2 groups based on tumor response according to the Miller-Payne Grading (MPG) system. Group 1 included patients with a greater degree of decrease in major histologic responder (MHR, Miller-Payne G4-5), while group 2 included non-MHR cases (Miller-Payne G1-3). Traditional imaging protocols (T1 weighted, T2 weighted, diffusion weighted, and DCE-MRI) and APTw imaging were scanned for each subject before and after treatment. APTw value (APTw0 and APTw1), Dmax (maximum diameter, Dmax0 and Dmax1), V (3D tumor volume, V0 and V1), and ADC (apparent diffusion coefficient, ADC0 and ADC1) before and after treatment, as well as changes between the two times points (ΔAPT, ΔDmax, ΔV, ΔADC) for breast tumors were compared between the two groups. Results APT0 and APT1 values significantly differed between the two groups (p = 0.034 and 0.01). ΔAPTw values were significantly lower in non-MHR tumors compared with MHR tumors (p = 0.015). ΔDmax values were significantly higher in MHR tumors compared with non-MHR tumors (p = 0.005). ADC0 and ADC1 values were significantly higher in MHR tumors than in non-MHR tumors (p = 0.038 and 0.035). AUC (Dmax+DWI + APTw) = AUC (Dmax+APTw) > AUC (APTw) > AUC (Dmax+DWI) > AUC (Dmax). Conclusion APTw imaging along with change of tumor size showed a significant potential in early prediction of MHR for NAC treatment in breast cancer, which might allow timely regimen refinement before definitive surgical treatment.
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Affiliation(s)
- Nan Zhang
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Hongbing Liang
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Zhuo Wang
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Qi Wu
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Haonan Zhang
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Lina Zhang
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Huali Wang
- Department of Pathology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jiazheng Wang
- MSC Clinical and Technical Solutions, Philips Healthcare, Beijing, China
| | - Liangjie Lin
- MSC Clinical and Technical Solutions, Philips Healthcare, Beijing, China
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Xue J, Yan X, Ding Q, Li N, Wu M, Song J. Effect of neoadjuvant chemotherapy on the immune microenvironment of gynaecological tumours. Ann Med 2023; 55:2282181. [PMID: 37983527 PMCID: PMC10836282 DOI: 10.1080/07853890.2023.2282181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
Purpose: To assess the impact of neoadjuvant chemotherapy (NACT) on the tumor immune microenvironment (TIME) in gynaecological tumors, with a focus on understanding the potential for enhanced combination therapies.Methods: We systematically queried the PubMed, Embase, and Cochrane databases, encompassing reviews, clinical trials, and case studies, to undertake a thorough analysis of the impact of NACT on the TIME of gynaecological tumors.Results: NACT induces diverse immune microenvironment changes in gynaecological tumors. In cervical cancer, NACT boosts immune-promoting cells, enhancing tumor clearance. Ovarian cancer studies yield variable outcomes, influenced by patient-specific factors and treatment regimens. Limited research exists on NACT's impact on endometrial cancer's immune microenvironment, warranting further exploration. In summary, NACT-induced immune microenvironment changes display variability. Clinical trials highlight personalized immunotherapy's positive impact on gynaecological tumor prognosis, suggesting potential avenues for future cancer treatments. However, rigorous investigation is needed to determine the exact efficacy and safety of combining NACT with immunotherapy.Conclusion: This review provides a solid foundation for the development of late-stage immunotherapy and highlights the importance of therapeutic strategies targeting immune cells in TIME in anti-tumor therapy.
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Affiliation(s)
- Jing Xue
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PR China
- Shanxi Medical University, Taiyuan, Shanxi Province, PR China
| | - Xia Yan
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PR China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, Shanxi Province, PR China
| | - Qin Ding
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PR China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, Shanxi Province, PR China
| | - Nan Li
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PR China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, Shanxi Province, PR China
| | - Menghan Wu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PR China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, Shanxi Province, PR China
| | - Jianbo Song
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PR China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, Shanxi Province, PR China
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Wang Y, Gao P, Hao Z, Chen L, Li X, Jiao Y, Liu J, Li J, Zhang Y, Peng X, Ning B, Zhan X. The effect of neoadjuvant chemotherapy on the tumor immune microenvironment in gastrointestinal tumors. Front Oncol 2022; 12:1054598. [DOI: 10.3389/fonc.2022.1054598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
In recent years, numerous studies have demonstrated that the tumor immune microenvironment (TIME) is capable of regulating the growth of tumors, and tumor-infiltrating immune cells in the TIME can affect the prognosis and treatment responses of patients. Consequently, therapies targeting these immune cells have emerged as important antitumor treatments. As a crucial componet of the perioperative treatment of malignant tumors, neoadjuvant chemotherapy (NACT) can improve the surgical resection rate and prognosis of patients and is a suitable clinical model to evaluate the effect of chemotherapy on the TIME. To provide a rationale for developing valid combinational therapies, this review summarizes the impact of NACT on the TIME, the relationship between tumor-infiltrating immune cells and treatment responses of patients, and the prognostic value of these infiltrating immune cells.
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Conforti F, Pala L, Bagnardi V, De Pas T, Colleoni M, Buyse M, Hortobagyi G, Gianni L, Winer E, Loibl S, Cortes J, Piccart M, Wolff AC, Viale G, Gelber RD. Surrogacy of Pathologic Complete Response in Trials of Neoadjuvant Therapy for Early Breast Cancer: Critical Analysis of Strengths, Weaknesses, and Misinterpretations. JAMA Oncol 2022; 8:1668-1675. [PMID: 36201176 DOI: 10.1001/jamaoncol.2022.3755] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The pathologic complete response (pCR) is supported by regulatory agencies as a surrogate end point for long-term patients' clinical outcomes in the accelerated approval process of new drugs tested in neoadjuvant randomized clinical trials (RCTs) for early breast cancer (BC). However, a meaningful association between pCR and patients' survival has been proven only at the patient level (ie, significantly better survival of patients who achieved pCR compared with those who did not), but not at trial level (ie, poor association between degree of improvement in pCR rate and survival reported across trials). Observations We critically discuss the potential reasons of such discrepancy between pCR surrogacy value at the patient and trial level, as well as the relevant implications for both clinical research and drug regulatory policy. We also describe alternative surrogate end points, including combined end points that jointly analyzed pathological response and event-free survival data, or the assessment of circulating tumor DNA (ctDNA). Such proposed surrogate end points could overcome limits of pCR and provide a reasonable trade-off between the 2 conflicting needs to have access to effective therapies rapidly, and to reliably assess patients' clinical benefit. Conclusions and Relevance Using surrogate end points to grant drug approvals is justified only when they can provide accurate prediction of a drug's effect on the long-term patient outcomes. Evidence currently available does not support pCR used alone as a reliable surrogate end point in regulatory neoadjuvant RCTs for BC. The surrogacy value at trial level of potentially more robust surrogate end points needs to be urgently tested.
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Affiliation(s)
- Fabio Conforti
- European Institute of Oncology, Milan, Italy.,Department of Medical Oncology, Cliniche, Humanitas Gavazzeni, Bergamo, Italy
| | - Laura Pala
- European Institute of Oncology, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Medical Oncology, Cliniche, Humanitas Gavazzeni, Bergamo, Italy.,Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Tommaso De Pas
- European Institute of Oncology, Milan, Italy.,Harvard T.H. Chan School of Public Health, and Frontier Science & Technology Research Foundation, Boston, Massachusetts
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Gabriel Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Eric Winer
- Yale Cancer Center, New Haven, Connecticut
| | - Sibylle Loibl
- Center for Hematology and Oncology Bethanien, Frankfurt, Germany
| | - Javier Cortes
- International Breast Cancer Center, Pangaea Oncology, Quiron Group, Madrid and Barcelona, Spain.,Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy
| | - Richard D Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, and Frontier Science & Technology Research Foundation, Boston, Massachusetts
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Dayyani F, Smith BR, Nguyen NT, Daly S, Hinojosa MW, Seyedin SN, Kuo J, Samarasena JB, Lee JG, Taylor TH, Cho MT, Senthil M. A phase Ib feasibility trial of response adapted neoadjuvant therapy in gastric cancer (RANT-GC). Future Oncol 2022; 18:2615-2622. [PMID: 35603628 DOI: 10.2217/fon-2022-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Current guidelines recommend neoadjuvant (NAC) and/or adjuvant chemotherapy for locally advanced gastric cancers (LAGCs). However, the choice and duration of NAC regimen is standardized, rather than personalized to biologic response, despite the availability of several different classes of agents for the treatment of gastric cancer (GC). The current trial will use a tumor-informed ctDNA assay (Signatera™) and monitor response to NAC. Based on ctDNA kinetics, the treatment regimen is modified. This is a prospective single center, single arm, open label study in clinical stage IB-III GC. ctDNA is measured at baseline and repeated every 8 weeks. Imaging is performed at the same intervals. The primary endpoint is the feasibility of this approach, defined as percentage of patients completing gastrectomy.
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Affiliation(s)
- Farshid Dayyani
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Brian R Smith
- Department of Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Shaun Daly
- Department of Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Marcelo W Hinojosa
- Department of Surgery, University of California Irvine, Orange, CA 92868, USA
| | - Steven N Seyedin
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Jeffrey Kuo
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Jason B Samarasena
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - John G Lee
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Thomas H Taylor
- Department of Epidemiology, University of California Irvine, Irvine, CA 92617, USA
| | - May T Cho
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Maheswari Senthil
- Department of Surgery, University of California Irvine, Orange, CA 92868, USA
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Darvishi B, Eisavand MR, Majidzadeh-A K, Farahmand L. Matrix stiffening and acquired resistance to chemotherapy: concepts and clinical significance. Br J Cancer 2022; 126:1253-1263. [PMID: 35124704 PMCID: PMC9043195 DOI: 10.1038/s41416-021-01680-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/10/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023] Open
Abstract
Extracellular matrix (ECM) refers to the non-cellular components of the tumour microenvironment, fundamentally providing a supportive scaffold for cellular anchorage and transducing signaling cues that orchestrate cellular behaviour and function. The ECM integrity is abrogated in several cases of cancer, ending in aberrant activation of a number of mechanotransduction pathways and induction of multiple tumorigenic events such as extended proliferation, cell death resistance, epithelial-mesenchymal transition and most importantly the development of chemoresistance. In this regard, the present study mainly aims to elucidate how the ECM-stiffening process may contribute to the development of chemoresistance during cancer progression and what pharmacological approaches are required for tackling this issue. Hence, the first section of this review explains the process of ECM stiffening and the ways it may affect biochemical pathways to induce chemoresistance in a clinic. In addition, the second part focuses on describing some of the most important pharmacological agents capable of targeting ECM components and underlying pathways for overcoming ECM-induced chemoresistance. Finally, the third part discusses the obtained results from the application of these agents in the clinic for overcoming chemoresistance.
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Affiliation(s)
- Behrad Darvishi
- grid.417689.5Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Mohammad Reza Eisavand
- grid.417689.5Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Keivan Majidzadeh-A
- grid.417689.5Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Leila Farahmand
- grid.417689.5Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
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Identifying Circulating Tumor DNA Mutations Associated with Neoadjuvant Chemotherapy Efficacy in Local Advanced Breast Cancer. Appl Biochem Biotechnol 2022; 194:3961-3973. [PMID: 35579744 DOI: 10.1007/s12010-022-03946-0] [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] [Indexed: 11/02/2022]
Abstract
Circulating tumor DNA (ctDNA) correlates with tumor burden and provides early detection of treatment response and tumor genetic alterations in breast cancer. Neoadjuvant chemotherapy (NACT) has become standard therapy for local advanced breast cancer (LABC). The aim of our study was to investigate plasma ctDNA as a prognostic marker for outcome in patients with LABC treated with NACT. A total of 56 patients with LABC were involved in this study. ctDNA mutations were investigated by using a 100 gene panel-target capture next-generation sequencing. The patients then received standard NACT therapy: adriamycin and cyclophosphamide and paclitaxel (AC-T) or AC-TH (AC-T+ Trastuzumab) regimen. The efficacy of NACT was evaluated by Miller-Payne grading system. A predictive and weight model was used to screen ctDNA point mutation biomarkers for NACT. The ctDNA mutational profile of LABC patients was identified. For nonsynonymous mutations, the top 5 mutated genes were MTHFR (51/56, 91.1%), XPC (50/56, 89.3%), ABCB1 (48/51, 94.1%), BRCA2 (38/56, 67.9%), and XRCC1 (38/56, 67.9%). In addition, the mutation frequencies of PIK3CA and TP53 were 32.1% (18/56) and 26.8% (15/56), respectively. The predictive model indicated that XRCC1 44055726 (TG>-) mutation (25/56, 44.6%) was significantly associated with Miller-Payne 4-5 and Miller-Payne 3-5 responses. While mTOR 11249132(G>C) mutation (23/56, 41.1%) was associated with Miller-Payne 1-4 or Miller-Payne 1-3 responses. Furthermore, XRCC1 44055726 (TG>-) accompanied by mTOR wild type predicted a good NACT efficacy in all response classification systems. The ROC curves to discriminate good neoadjuvant chemotherapy efficiency (Miller-Payne 4-5) and poor efficiency (Miller-Payne 1-3) were created, and AUC value was 0.77. Our results suggested that ctDNA mutation of XRCC1 44055726 (TG>-) might be a positive biomarker for NACT therapy in LABC, while mTOR 11249132(G>C) mutation was potentially associated with NACT resistance.
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Luo M, Chen H, Deng H, Jin Y, Wang G, Zhang K, Ma H, Chen Y, Zhang S, Zhou J. Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy in cT 1-2N + Breast Cancer Patients: A Single Center Experience and Review of Current Literature. Front Oncol 2022; 12:881047. [PMID: 35656513 PMCID: PMC9152099 DOI: 10.3389/fonc.2022.881047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Postmastectomy radiotherapy (PMRT) after neoadjuvant chemotherapy (NAC) in breast cancer patients with initial clinical stage cT1-2N+, especially for those who achieved ypT1-2N0, is still controversial. This study was to evaluate the survival prognosis of cT1-2N+ patients after NAC with or without PMRT, and to discuss the selection of patients who may omit PMRT. Patients and Methods From January 2005 to December 2017, 3055 female breast cancer patients underwent mastectomy in our medical center, among whom 215 patients of cT1-2N+ stage, receiving NAC with or without PMRT were finally analyzed. The median follow-up duration was 72.6 months. The primary endpoint was disease-free survival (DFS), and secondary endpoint was overall survival (OS). Comparison was conducted between PMRT and non-PMRT subgroups. Results Of the 215 eligible patients, 35.8% (77/215) cT1-2N+ patients achieved ypT0-2N0 after NAC while 64.2% (138/215) of the patients remained nodal positive (ypT0-2N+). The 5-year DFS of ypT0-2N0 non-PMRT was 79.5% (95% confidence interval [CI] 63.4-95.6%). No statistically significant difference was observed between the ypT0-2N0 PMRT and non-PMRT subgroups for the 5-year DFS (78.5% vs 79.5%, p = 0.673) and OS (88.8% vs 90.8%, p = 0.721). The 5-years DFS didn't obviously differ between the ypT0-2N0 non-PMRT subgroup and cT1-2N0 subgroup (79.5% vs 93.3%, p = 0.070). By using Cox regression model in multivariate analyses of prognosis in ypT0-2N+ PMRT subgroup, HER2 overexpression and triple-negative breast cancer were significantly poor predictors of DFS and OS, while ypN stage was significant independent predictors of OS. Conclusion An effective response to NAC (ypT0-2N0) indicates a sufficiently favorable prognosis, and PMRT might be omitted for cT1-2N+ breast cancer patients with ypT0-2N0 after NAC.
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Affiliation(s)
- Meng Luo
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Huihui Chen
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Deng
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Jin
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gui Wang
- Department of General Surgery, Longquan People’s Hospital, Longquan, China
| | - Kun Zhang
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Ma
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiding Chen
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Suzhan Zhang
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Jiaojiao Zhou
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
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Gene signatures in patients with early breast cancer and relapse despite pathologic complete response. NPJ Breast Cancer 2022; 8:42. [PMID: 35351903 PMCID: PMC8964729 DOI: 10.1038/s41523-022-00403-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/16/2022] [Indexed: 12/17/2022] Open
Abstract
A substantial minority of early breast cancer (EBC) patients relapse despite their tumors achieving pathologic complete response (pCR) after neoadjuvant therapy. We compared gene expression (BC360; nCounter® platform; NanoString) between primary tumors of patients with post-pCR relapse (N = 14) with: (i) matched recurrent tumors from same patient (intraindividual analysis); and (ii) primary tumors from matched controls with pCR and no relapse (N = 41; interindividual analysis). Intraindividual analysis showed lower estrogen receptor signaling signature expression in recurrent tumors versus primaries (logFC = −0.595; P = 0.022). Recurrent tumors in patients with distant metastases also exhibited reduced expression of immune-related expression parameters. In interindividual analyses, primary tumor major histocompatibility complex class II expression was lower versus controls in patients with any relapse (logFC = −0.819; P = 0.030) or distant relapse (logFC = −1.151; P = 0.013). Primaries with later distant relapse also had greater homologous recombination deficiency than controls (logFC = 0.649; P = 0.026). Although no associations remained statistically significant following adjustment for false discovery rate, our results show that transcriptomic analyses have potential for prognostic value and may help in selecting optimal treatment regimens for EBC at risk of relapse and warrant further investigation.
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Conforti F, Pala L, Sala I, Oriecuia C, De Pas T, Specchia C, Graffeo R, Pagan E, Queirolo P, Pennacchioli E, Colleoni M, Viale G, Bagnardi V, Gelber RD. Evaluation of pathological complete response as surrogate endpoint in neoadjuvant randomised clinical trials of early stage breast cancer: systematic review and meta-analysis. BMJ 2021; 375:e066381. [PMID: 34933868 PMCID: PMC8689398 DOI: 10.1136/bmj-2021-066381] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate pathological complete response as a surrogate endpoint for disease-free survival and overall survival in regulatory neoadjuvant trials of early stage breast cancer. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, and Scopus to 1 December 2020. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised clinical trials that tested neoadjuvant chemotherapy given alone or combined with other treatments, including anti-human epidermal growth factor 2 (anti-HER2) drugs, targeted treatments, antivascular agents, bisphosphonates, and immune checkpoint inhibitors. DATA EXTRACTION AND SYNTHESIS Trial level associations between the surrogate endpoint pathological complete response and disease-free survival and overall survival. METHODS A weighted regression analysis was performed on log transformed treatment effect estimates (hazard ratio for disease-free survival and overall survival and relative risk for pathological complete response), and the coefficient of determination (R2) was used to quantify the association. The secondary objective was to explore heterogeneity of results in preplanned subgroups analysis, stratifying trials according treatment type in the experimental arm, definition used for pathological complete response (breast and lymph nodes v breast only), and biological features of the disease (HER2 positive or triple negative breast cancer). The surrogate threshold effect was also evaluated, indicating the minimum value of the relative risk for pathological complete response necessary to confidently predict a non-null effect on hazard ratio for disease-free survival or overall survival. RESULTS 54 randomised clinical trials comprising a total of 32 611 patients were included in the analysis. A weak association was observed between the log(relative risk) for pathological complete response and log(hazard ratio) for both disease-free survival (R2=0.14, 95% confidence interval 0.00 to 0.29) and overall survival (R2 =0.08, 0.00 to 0.22). Similar results were found across all subgroups evaluated, independently of the definition used for pathological complete response, treatment type in the experimental arm, and biological features of the disease. The surrogate threshold effect was 5.19 for disease-free survival but was not estimable for overall survival. Consistent results were confirmed in three sensitivity analyses: excluding small trials (<200 patients enrolled), excluding trials with short median follow-up (<24 months), and replacing the relative risk for pathological complete response with the absolute difference of pathological complete response rates between treatment arms. CONCLUSION A lack of surrogacy of pathological complete response was identified at trial level for both disease-free survival and overall survival. The findings suggest that pathological complete response should not be used as primary endpoint in regulatory neoadjuvant trials of early stage breast cancer.
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Affiliation(s)
- Fabio Conforti
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laura Pala
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Chiara Oriecuia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tommaso De Pas
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Rossella Graffeo
- Breast Unit of Southern Switzerland, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Paola Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Viale
- Department of Pathology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Richard D Gelber
- Medical School, Harvard T H Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA, USA
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Williams TL, Saadat LV, Gonen M, Wei A, Do RKG, Simpson AL. Radiomics in surgical oncology: applications and challenges. Comput Assist Surg (Abingdon) 2021; 26:85-96. [PMID: 34902259 DOI: 10.1080/24699322.2021.1994014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Surgery is a curative treatment option for many patients with malignant tumors. Increased attention has focused on the combination of surgery with chemotherapy, as multimodality treatment has been associated with promising results in certain cancer types. Despite these data, there remains clinical equipoise on optimal timing and patient selection for neoadjuvant or adjuvant strategies. Radiomics, an emerging field involving the extraction of advanced features from radiographic images, has the potential to revolutionize oncologic treatment and contribute to the advance of personalized therapy by helping predict tumor behavior and response to therapy. This review analyzes and summarizes studies that use radiomics with machine learning in patients who have received neoadjuvant and/or adjuvant chemotherapy to predict prognosis, recurrence, survival, and therapeutic response for various cancer types. While studies in both neoadjuvant and adjuvant settings demonstrate above average performance on ability to predict progression-free and overall survival, there remain many challenges and limitations to widespread implementation of this technology. The lack of standardization of common practices to analyze radiomics, limited data sharing, and absence of auto-segmentation have hindered the inclusion and rapid adoption of radiomics in prospective, clinical studies.
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Affiliation(s)
- Travis L Williams
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily V Saadat
- Department of Surgery - Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice Wei
- Department of Surgery - Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amber L Simpson
- School of Computing, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Virostko J, Sorace AG, Slavkova KP, Kazerouni AS, Jarrett AM, DiCarlo JC, Woodard S, Avery S, Goodgame B, Patt D, Yankeelov TE. Quantitative multiparametric MRI predicts response to neoadjuvant therapy in the community setting. Breast Cancer Res 2021; 23:110. [PMID: 34838096 PMCID: PMC8627106 DOI: 10.1186/s13058-021-01489-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether advanced quantitative magnetic resonance imaging (MRI) can be deployed outside of large, research-oriented academic hospitals and into community care settings to predict eventual pathological complete response (pCR) to neoadjuvant therapy (NAT) in patients with locally advanced breast cancer. METHODS Patients with stage II/III breast cancer (N = 28) were enrolled in a multicenter study performed in community radiology settings. Dynamic contrast-enhanced (DCE) and diffusion-weighted (DW)-MRI data were acquired at four time points during the course of NAT. Estimates of the vascular perfusion and permeability, as assessed by the volume transfer rate (Ktrans) using the Patlak model, were generated from the DCE-MRI data while estimates of cell density, as assessed by the apparent diffusion coefficient (ADC), were calculated from DW-MRI data. Tumor volume was calculated using semi-automatic segmentation and combined with Ktrans and ADC to yield bulk tumor blood flow and cellularity, respectively. The percent change in quantitative parameters at each MRI scan was calculated and compared to pathological response at the time of surgery. The predictive accuracy of each MRI parameter at different time points was quantified using receiver operating characteristic curves. RESULTS Tumor size and quantitative MRI parameters were similar at baseline between groups that achieved pCR (n = 8) and those that did not (n = 20). Patients achieving a pCR had a larger decline in volume and cellularity than those who did not achieve pCR after one cycle of NAT (p < 0.05). At the third and fourth MRI, changes in tumor volume, Ktrans, ADC, cellularity, and bulk tumor flow from baseline (pre-treatment) were all significantly greater (p < 0.05) in the cohort who achieved pCR compared to those patients with non-pCR. CONCLUSIONS Quantitative analysis of DCE-MRI and DW-MRI can be implemented in the community care setting to accurately predict the response of breast cancer to NAT. Dissemination of quantitative MRI into the community setting allows for the incorporation of these parameters into the standard of care and increases the number of clinical community sites able to participate in novel drug trials that require quantitative MRI.
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Affiliation(s)
- John Virostko
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX, 78712, USA
- Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX, USA
- Department of Oncology, University of Texas at Austin, Austin, TX, USA
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kalina P Slavkova
- Department of Physics, University of Texas at Austin, Austin, TX, USA
| | - Anum S Kazerouni
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Angela M Jarrett
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Julie C DiCarlo
- Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX, USA
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Stefanie Woodard
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Avery
- Austin Radiological Association, Austin, TX, USA
| | - Boone Goodgame
- Dell Seton Medical Center at the University of Texas, Austin, USA
| | | | - Thomas E Yankeelov
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX, 78712, USA.
- Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX, USA.
- Department of Oncology, University of Texas at Austin, Austin, TX, USA.
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA.
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA.
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Sardesai SD, Thomas A, Gallagher C, Lynce F, Ottaviano YL, Ballinger TJ, Schneider BP, Storniolo AM, Bauchle A, Althouse SK, Perkins SM, Masters AR, Stratford RE, Dong Z, Liu JY, Zhang JT, Miller KD. Inhibiting Fatty Acid Synthase with Omeprazole to Improve Efficacy of Neoadjuvant Chemotherapy in patients with Operable TNBC. Clin Cancer Res 2021; 27:5810-5817. [PMID: 34400413 DOI: 10.1158/1078-0432.ccr-21-0493] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/26/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Fatty acid synthase (FASN) is overexpressed in 70% of operable triple negative breast cancer (TNBC) and is associated with poor prognosis. Proton pump inhibitors selectively inhibit FASN activity and induce apoptosis in TNBC cell lines. EXPERIMENTAL DESIGN Patients with operable TNBC were enrolled in this single arm Phase II study. Patients began omeprazole (OMP) 80 mg PO BID for 4-7 days prior to neoadjuvant anthracycline- taxane based chemotherapy (AC-T) and continued until surgery. The primary endpoint was pathologic complete response (pCR) in patients with baseline FASN overexpression (FASN+). Secondary endpoints included pCR in all surgery patients, change in FASN expression, enzyme activity, and downstream protein expression after OMP monotherapy; safety, and limited OMP pharmacokinetics. RESULTS Forty-two patients were recruited with a median age of 51y (28-72). Most patients had {greater than or equal to}cT2 (33, 79%) and {greater than or equal to}N1 (22, 52%) disease. FASN overexpression prior to AC-T was identified in 29/34 (85%) evaluable samples. The pCR rate was 72.4% (95% CI 52.8, 87.3) in FASN+ patients and 74.4% (95% CI 57.9, 87.0) in all surgery patients. Peak OMP concentration was significantly higher than the IC50 for FASN inhibition observed in preclinical testing; FASN expression decreased with OMP monotherapy (mean change 0.12 (SD 0.25) ; p = 0.02). OMP was well tolerated with no {greater than or equal to} grade 3 toxicities. CONCLUSIONS FASN is commonly expressed in early TNBC. OMP can be safely administered in doses that inhibit FASN. The addition of OMP to neoadjuvant AC-T yields a promising pCR rate that needs further confirmation in randomized studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna Maria Storniolo
- Susan G. Komen Tissue Bank at the IU Simon Cancer Center, Indiana University School of Medicine
| | - Amber Bauchle
- Clinical Trials Office- School of Medicine, Indiana University Health
| | - Sandra K Althouse
- Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Andrea R Masters
- Clinical Pharmacology Analytical Core, Indiana University Simon Cancer Center
| | | | - Zizheng Dong
- Department of Cancer Biology, University of Toledo College of Medicine and Life Sciences
| | - Jing-Yuan Liu
- Department of Medicine, University of Toledo College of Medicine and Life Sciences
| | - Jian-Ting Zhang
- Departments of Cancer Biology, University of Toledo College of Medicine and Life Sciences
| | - Kathy D Miller
- Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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The implications of a pathological complete response of the primary tumour after neoadjuvant chemotherapy for breast cancer on axillary surgery. J Egypt Natl Canc Inst 2021; 33:5. [PMID: 33555499 DOI: 10.1186/s43046-021-00061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Management of the node-positive axilla after neoadjuvant chemotherapy is controversial. The aim of this study is to predict the group of patients who may require a less invasive approach for axillary management. One possible group are patients with pathological complete response of the primary after chemotherapy. RESULTS A unicentral retrospective cohort study including all breast cancer patients with axillary node metastases at presentation who received neoadjuvant chemotherapy resulting in pathological complete response. Pathological complete response in the axillary lymph nodes was recorded. A correlation between the response in the primary tumour and the lymph nodes was assessed. A subgroup analysis was conducted for different biological groups. Complete response was seen in the axillary nodes in 80.5% of patients. Patients with lobular cancer were less likely to show a similar response in the axilla as the primary tumour (p = 0.077). A higher incidence of axillary response was observed in HER2-positive tumours (p = 0.082). All patients with grade 3 tumours achieved complete response in the axilla (p = 0.094). Patients with negative or weak positive hormone receptor status had a significantly higher rate of complete response in the axilla compared to strongly positive hormone receptor status (OR, 7.8; 95% CI, 1.7-34.5; p = 0.007). CONCLUSION A less invasive axillary surgery may be safely recommended in selected group of node-positive patients after neoadjuvant chemotherapy when the primary tumour shows complete response. This group may include HER2-positive, ER-negative and grade 3 tumours. Less response is expected in ER-positive and lobular carcinoma even with complete response in the primary.
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16
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de Melo Gagliato D, Lei X, Giordano SH, Valero V, Barcenas CH, Hortobagyi GN, Chavez-MacGregor M. Impact of Delayed Neoadjuvant Systemic Chemotherapy on Overall Survival Among Patients with Breast Cancer. Oncologist 2020; 25:749-757. [PMID: 32431013 DOI: 10.1634/theoncologist.2019-0744] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Delays in the initiation of therapy among patients with early stage breast cancer (BC) can negatively affect outcomes. Patients treated with neoadjuvant systemic chemotherapy (NSC) usually display tumors with high-risk features. Considering these high-risk characteristics and the evidence supporting adverse outcomes associated with delays in adjuvant chemotherapy initiation, we sought to determine whether a delay in NSC initiation is associated with overall survival (OS). METHODS We identified patients diagnosed between January 1995 and December 2015 with invasive primary BC (stage I-III) who received NSC at MD Anderson Cancer Center. Patients were categorized according to their time from BC diagnosis to NSC (in days) into three subgroups: 0-30, 31-60, and ≥61 days. Primary endpoint was OS. Descriptive statistics and Cox's proportional hazard models were used. RESULTS A total of 5,137 patients were included. Median follow-up was 6.5 years. The 5-year OS estimates according to time to NSC were 87%, 85%, and 83% in patients who received NSC within 0-30, 31-60, and ≥61 days after diagnosis, respectively (p = .006). In multivariable analysis, compared with time to NSC of 0-30 days, delayed NSC ≥61 days was associated with an increased risk of death (31-60 days: hazard ratio [HR] = 1.05 [95% confidence interval (CI) 0.92-1.19]; ≥61 days, HR = 1.28 [95% CI 1.06-1.54]). In stratified analyses, the association between delay in NSC initiation and increased risk of death was statistically significant for patients with stage I and II BC (31-60 days: HR = 1.22 [95% CI 1.02-1.47]; ≥61 days, HR = 1.41 [95% CI 1.07-1.86]) and among patients with HER2-positive tumors ( ≥61 days, HR = 1.86 [95% CI 1.21-2.86]). CONCLUSION A delay in NSC initiation of more than 61 days after BC diagnosis was associated with an increased risk of death. Early initiation of NSC should be a priority; multidisciplinary teams must focus on coordination of care and patient-centered, timely treatment planning and delivery. IMPLICATIONS FOR PRACTICE The results of this study showed that a delay in neoadjuvant systemic chemotherapy initiation of more than 61 days after breast cancer diagnosis is associated with an increased risk of death; therefore, efforts must focus on early initiation of therapy, which should be a priority. Multidisciplinary teams must enhance coordination of care and patient-centered, timely treatment planning and delivery.
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Affiliation(s)
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Cheng Q, Huang J, Liang J, Ma M, Ye K, Shi C, Luo L. The Diagnostic Performance of DCE-MRI in Evaluating the Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer: A Meta-Analysis. Front Oncol 2020; 10:93. [PMID: 32117747 PMCID: PMC7028702 DOI: 10.3389/fonc.2020.00093] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/17/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Neoadjuvant chemotherapy (NAC) is commonly utilized in preoperative treatment for local breast cancer, and it gives high clinical response rates and can result in pathologic complete response (pCR) in 6–25% of patients. In recent years, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been increasingly used to assess the pathological response of breast cancer to NAC. In present analysis, we assess the diagnostic performance of DCE-MRI in evaluating the pathological response of breast cancer to NAC. Materials and Methods: A systematic search in PubMed, the Cochrane Library, and Web of Science for original studies was performed. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the methodological quality of the included studies. Patient, study, and imaging characteristics were extracted, and sufficient data to reconstruct 2 × 2 tables were obtained. Data pooling, heterogeneity testing, forest plot construction, meta-regression analysis and sensitivity analysis were performed using Stata version 12.0 (StataCorp LP, College Station, TX). Results: Eighteen studies (969 patients with breast cancer) were included in the present meta-analysis. The pooled sensitivity and specificity of DCE-MRI were 0.80 (95% confidence interval [CI]: 0.70, 0.88) and 0.84 (95% [CI]: 0.79, 0.88), respectively. Meta-regression analysis found no significant factors affecting heterogeneity. Sensitivity analysis showed that studies that set pathological complete response (pCR) (n = 14) as a responder showed a tendency for higher sensitivity compared with those that set pCR and near pCR together (n = 5) as a responder (0.83 vs. 0.72), and studies (n = 14) that used DCE-MRI to early predict the pathological response of breast cancer had a higher sensitivity (0.83 vs. 0.71) and equivalent specificity (0.80 vs. 0.86) compared to studies (n = 5) that assessed the response after NAC completion. Conclusion: Our results indicated that DCE-MRI could be considered an important auxiliary method for evaluating the pathological response of breast cancer to NAC and used as an effective method for dynamically monitoring the efficacy during NAC. DCE-MRI also performed well in predicting the pCR of breast cancer to NAC. However, due to the heterogeneity of the included studies, caution should be exercised in applying our results.
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Affiliation(s)
- Qingqing Cheng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiaxi Huang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mengjie Ma
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Kunlin Ye
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
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18
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Lanjewar S, Patil P, Fineberg S. Pathologic reporting practices for breast cancer specimens after neoadjuvant chemotherapy-a survey of pathologists in academic institutions across the United States. Mod Pathol 2020; 33:91-98. [PMID: 31383962 DOI: 10.1038/s41379-019-0326-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 11/09/2022]
Abstract
Neoadjuvant chemotherapy is increasingly being used to treat primary invasive breast carcinoma. Response to neoadjuvant chemotherapy is an important determinant of prognosis. A multidisciplinary group published recommendations for standardization of pathologic reporting of postneoadjuvant chemotherapy specimens. Based on these recommendations, we sent a survey to 26 pathologists currently practicing breast pathology in academic centers across the United States. The survey consisted of six questions with yes/no answers. The pathologists were encouraged to add comments. We received responses from 23 breast pathologists from 19 centers. The questions and responses were as follows: 1. Do you grade tumors after neoadjuvant chemotherapy?-17 (74%) responded yes and 6 (26%) responded no. 2. Do you routinely repeat hormone receptors, HER2/Neu results after neoadjuvant chemotherapy?-15 (65%) responded yes and 8 (35%) responded no. 3. If there are features of tumor regression/tumor bed at the margin but no actual tumor at the margin do you report this?-11 (48%) responded yes and 8 (35%) responded no and 4 (17%) reported a variable practice. 4. Do you report number of nodes with fibrosis/changes of regression?-17 (74%) responded yes and 6 (26%) responded no. 5. Do you report residual cancer burden score on your report or at least provide information on your report so clinicians can calculate residual cancer burden?-17 (74%) responded yes and 6 (26%) responded no. 6. Do you have a specific synoptic for cases after neoadjuvant chemotherapy?-5 (22%) responded yes and 18 (78%) responded no. The major reasons provided for nonadherence to recommended guidelines included pathologists were unaware of prognostic importance of providing the information, reporting practices were clinician driven and some pathologists were unaware of the recommendation. We document that academic breast pathology practices show significant variability in reporting of postneoadjuvant chemotherapy cases. We document barriers to standard practice and provide recommendations we hope will contribute to a more uniform reporting practice for these complex specimens.
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Affiliation(s)
- Sonali Lanjewar
- Montefiore Medical Center and the Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA.,Methodist Lebonheur Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Priyanka Patil
- Montefiore Medical Center and the Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA.
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Liu YH, Lin YS. Platelet-lymphocyte and neutrophil-lymphocyte ratios: Predictive factors of response and toxicity for docetaxel-combined induction chemotherapy in advanced head and neck cancers. J Chin Med Assoc 2019; 82:849-855. [PMID: 31453862 DOI: 10.1097/jcma.0000000000000178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although the effect of induction chemotherapy (IC) is still controversial in cancers of the oral cavity, the oropharynx, and the sinonasal tract, it is still used in some inoperable cases and for organ preservation in laryngeal or hypopharyngeal cancers. Taxane has played a greater role and produces a better overall response but a higher rate of acute toxicity. We investigated the response and risk of IC with docetaxel-combined regimens in advanced head and neck cancers. METHODS We retrospectively reviewed the medical history of patients with advanced head and neck cancer between 2011 and 2017. We enrolled 40 patients who completed the initial tumor survey, ICs with docetaxel-combined regimens, and definite therapeutic strategies including concurrent chemoradiation or surgery. The demographic data, laboratory results, overall response, and acute toxicity were analyzed. RESULTS There were 14 patients (35.0%) with partial response at least. There were 24 (60.0%) with at least one acute toxicity beyond grade III. Univariate analysis and multivariate linear regression analysis showed that a platelet-lymphocyte ratio (PLR) <8.5 correlates with a better overall response (p < 0.05), and a neutrophil-lymphocyte ratio (NLR) ≥3.5 correlates with a higher possibility of severe acute toxicity within one month after ICs (p < 0.05), especially hematologic side effects. CONCLUSION A pretreatment PLR <8.5 could predict better overall response, and a pretreatment NLR ≥3.5 could predict more severe acute toxicity after docetaxel-combined ICs. Through a simple hematological examination, we could try to identify a better response of tumor regression and anticipate potentially harmful side effects after ICs.
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Affiliation(s)
- Yu-Hsi Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yaoh-Shiang Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Otorhinolaryngology, Head and Neck Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC
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Wang X, Yin Z, Wang D, Zhang J, Wang S, Zhao J, Wang Q, Zhao L, Zhu L, Xu L, Wang P. Greater negative lymph node count predicts favorable survival of patients with breast cancer in the setting of neoadjuvant chemotherapy and mastectomy. Future Oncol 2019; 15:3701-3709. [DOI: 10.2217/fon-2019-0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: Adequate lymph node evaluation is recommended in patients with malignant tumors. However, the role of negative lymph nodes (NLNs) remains unclear in breast cancer (BC), especially in patients who have received neoadjuvant chemotherapy and mastectomy. Materials & methods: A total of 435 patients were included in the analysis. On multivariate analysis, NLN count was an independent predictor of 5 year disease-free survival and 5 year overall survival. Results: Patients with NLN count <10 showed significantly worse 5 year disease-free survival than those with NLN count ≥10 (34.8 and 78.2%; p = 0.000); the corresponding 5 year overall survival rates were also significantly different (52.0 and 82.7%; p = 0.000). Conclusion: This is the first study that confirms the relationship between NLN count and prognosis of patients in the setting of neoadjuvant chemotherapy and mastectomy. More NLNs imply better prognosis.
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Affiliation(s)
- Xin Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Zhenzhen Yin
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Daquan Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Jiaqi Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Shuai Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Jinlin Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
- Tianjin Key Laboratory of Radiation Medicine & Molecular Nuclear Medicine, Tianjin, PR China
| | - Qi Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
- Tianjin Key Laboratory of Radiation Medicine & Molecular Nuclear Medicine, Tianjin, PR China
| | - Li Zhu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Liming Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
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Ruzzenente A, Bagante F, Ratti F, Beal EW, Alexandrescu S, Merath K, Makris EA, Poultsides GA, Margonis GA, Weiss MJ, Popescu I, Aldrighetti L, Guglielmi A, Pawlik TM. Response to preoperative chemotherapy: impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases. HPB (Oxford) 2019; 21:1230-1239. [PMID: 30792047 DOI: 10.1016/j.hpb.2019.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/29/2018] [Accepted: 01/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Progression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size. METHODS Patients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS). RESULTS Among 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66%) or irinotecan-based (34%). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55%, 35%, and 0% for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ -10% had a 5-year OS of 27% compared with 49% for patients with a Δ-TBS < -10%. CONCLUSIONS Prognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status.
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Affiliation(s)
| | - Fabio Bagante
- Department of Surgery, University of Verona, Verona, Italy; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Georgios A Margonis
- Department of Surgery, The Johns Hopkins University Hospital, Baltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University Hospital, Baltimore, MD, USA
| | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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22
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Van Soom T, El Bakkali S, Gebruers N, Verbelen H, Tjalma W, van Breda E. The effects of chemotherapy on energy metabolic aspects in cancer patients: A systematic review. Clin Nutr 2019; 39:1863-1877. [PMID: 31420208 DOI: 10.1016/j.clnu.2019.07.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/06/2019] [Accepted: 07/25/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Cancer survival rates have increased significantly creating more awareness for comorbidities affecting the Quality of Life. Chemotherapy may induce serious metabolic alterations. These complications can create an energy imbalance, worsening prognosis. The effect of chemotherapy on energy metabolism remains largely unknown. The purpose of this systematic review is to determine the impact of chemotherapy on energy metabolism, creating more insight in a patients' energy requirements. METHODS We identified relevant studies up to May 2nd, 2019 using PubMed and Web of Science. Studies including all types of cancer and stages were selected. Only patients that underwent chemotherapy whether or not followed by surgery or radiotherapy were selected. Maximum follow-up was set at 6 months. Resting energy expenditure (REE), measured by indirect calorimetry (IC) or predicted by the Harris-Benedict equation (HBEq), was our primary outcome. Results regarding body composition were considered as secondary outcome parameter. RESULTS 16 studies were selected, including 267 patients. Overall, a significant decrease in REE [-1.5% to -24.91%] 1-month post-chemotherapy was reported. Two studies on breast cancer conducted a 3 and 6-month follow-up and found an increase in REE of 4.01% and 5.72% (p < .05), revealing a U-shaped curve in the expression of REE. Changes are accompanied by (non)significant variations in body composition (Fatmass (FM) and Fatfree Mass (FFM)). HBEq tends to underestimate REE by 4.03%-27.1%. CONCLUSION Alterations in REE, accompanied by changes in body composition, are found during and after chemotherapy in all cancer types and stages, revealing a U-shaped curve. Changes in FFM are suggested to induce variations in REE concomitant to catabolic effects of the disease and administered drug. HBEq tends to underestimate REE, stressing the need for adequate assessment to meet patients' energy requirements and support dietary needs.
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Affiliation(s)
- Timia Van Soom
- University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, Antwerp Multidisciplinary Research Unit (AM2RUN), Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Samera El Bakkali
- University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, Antwerp Multidisciplinary Research Unit (AM2RUN), Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Nick Gebruers
- University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, Antwerp Multidisciplinary Research Unit (AM2RUN), Universiteitsplein 1, 2610, Wilrijk, Belgium; Antwerp University Hospital (UZA), Multidisciplinary Edema Clinic, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Hanne Verbelen
- University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, Antwerp Multidisciplinary Research Unit (AM2RUN), Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Wiebren Tjalma
- Antwerp University Hospital (UZA), Multidisciplinary Edema Clinic, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Eric van Breda
- University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, Antwerp Multidisciplinary Research Unit (AM2RUN), Universiteitsplein 1, 2610, Wilrijk, Belgium.
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23
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Ahmed SH. Safety of neoadjuvant chemotherapy for the treatment of breast cancer. Expert Opin Drug Saf 2019; 18:817-827. [DOI: 10.1080/14740338.2019.1644318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Mou P, Wang H, An L, Yin Q, Chang J. RS7435335 located in the UGT2B7 gene may be a possible genetic marker for the clinical response and prognosis of breast cancer patients receiving neoadjuvant chemotherapy. J Cell Biochem 2019; 120:7167-7173. [PMID: 30552707 DOI: 10.1002/jcb.27990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the predictive efficacy and prognostic value of rs7435335 located in the UGT2B7 gene as a genetic marker in breast cancer patients receiving neoadjuvant chemotherapy (NAC). METHODS A total of 190 patients with breast cancer treated with NAC were enrolled to detect the rs7435335 SNP by sequenom. Miller-Payne grades were used to evaluate the treatment efficacy. The association between rs7435335 and chemotherapy efficacy and prognosis was analyzed. RESULTS Altogether, 42 cases (22.1%) achieved pathologic complete response (pCR). The results of the univariate analysis showed that rs7435335 had no statistically significant difference with pCR and Miller-Payne grades (P > 0.05). When grouping was done in accordance with the ER status, the pCR and Miller-Payne grades significantly associated with rs7435335 ( P < 0.05) only in the ER-negative group. Multivariate logistic regression analysis suggested that rs7435335 in the ER-negative group was an independent predictor of pCR ( P < 0.05). Survival analysis showed that the disease-free survival (DFS) time in patients with GA genotype was longer than that of GG genotype, and rs7435335 predicted the DFS in the ER-negative group. CONCLUSION The UGT2B7 rs7435335 is associated with the NAC efficacy and prognosis. Patients with GA genotype have better efficacy and prognosis. Rs7435335 was found to be a possible gene marker for pCR and prognosis in ER-negative patients who received NAC.
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Affiliation(s)
- Peng Mou
- Breast Surgery Department, People's Hospital of Rizhao, Rizhao, Shandong, China
| | - HuiJun Wang
- Breast Surgery Department, People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Liping An
- Oncology Department, People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Qiang Yin
- Breast Surgery Department, People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Juan Chang
- Department of Nursing, Rizhao LanShan of People's Hospital, Rizhao, Shandong, China
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25
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Ireland LV, Mielgo A. Macrophages and Fibroblasts, Key Players in Cancer Chemoresistance. Front Cell Dev Biol 2018; 6:131. [PMID: 30356656 PMCID: PMC6189297 DOI: 10.3389/fcell.2018.00131] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022] Open
Abstract
Chemotherapy is routinely used in cancer treatment to eliminate primary and metastatic tumor cells. However, tumors often display or develop resistance to chemotherapy. Mechanisms of chemoresistance can be either tumor cell autonomous or mediated by the tumor surrounding non-malignant cells, also known as stromal cells, which include fibroblasts, immune cells, and cells from the vasculature. Therapies targeting cancer cells have shown limited effectiveness in tumors characterized by a rich tumor stroma. Tumor-associated macrophages (TAMs) and cancer-associated fibroblasts (CAFs) are the most abundant non-cancerous cells in the tumor stroma and have emerged as key players in cancer progression, metastasis and resistance to therapies. This review describes the recent advances in our understanding of how CAFs and TAMs confer chemoresistance to tumor cells and discusses the therapeutic opportunities of combining anti-tumor with anti-stromal therapies. The continued elucidation of the mechanisms by which TAMs and CAFs mediate resistance to therapies will allow the development of improved combination treatments for cancer patients.
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Affiliation(s)
| | - Ainhoa Mielgo
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
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26
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Wang X, Xu L, Yin Z, Wang D, Wang Q, Xu K, Zhao J, Zhao L, Yuan Z, Wang P. Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cT1-2N0-1 after neoadjuvant chemotherapy. Cancer Manag Res 2018; 10:4105-4112. [PMID: 30323666 PMCID: PMC6174313 DOI: 10.2147/cmar.s173628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective In order to identify risk factors associated with locoregional recurrence (LRR) and assess the role of postmastectomy radiotherapy (PMRT) in early breast cancer (BC), managed with neoadjuvant chemotherapy (NAC) and mastectomy, a retrospective analysis of BC diagnosed with clinical stage T1-2N0-1 was conducted. Patients and methods A total of 217 patients were included in this analysis. The median age was 50 years (24-72 years). The clinical stage distributions were cT1 in 15 cases, cT2 in 202, cN0 in 53, and cN1 in 161 cases. All patients were treated with NAC and mastectomy, and 128 patients received PMRT. Results With a median follow-up time of 61 months, the 5-year cumulative LRR rate was 12%. Multivariate analysis demonstrated that pathological N stage, lymph-vascular invasion, and histological grade were independent prognostic factors associated with LRR. A nomogram model based on these factors was established, based on which the patients were deeply stratified into low- and high-risk group. In the low-risk group, radiotherapy did not decrease LRR (3.3% in PMRT group, 1.7% in no PMRT group, P=0.192). While in the high-risk group, PMRT significantly decreased LRR (21.8% in PMRT group, 42.2% in no PMRT group, P=0.031). Conclusion Lymph-vascular invasion, histological grade, as well as pathological N stage were important prognostic factors associated with LRR in BC patients staged in cT1-2N0-1, who were managed with NAC and mastectomy. In our cohort, not only clinical and pathological stage information but also other risk factors were taken into consideration when adjuvant PMRT was recommended. In the high-risk subgroup, PMRT significantly improved the prognosis.
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Affiliation(s)
- Xin Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Liming Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Zhenzhen Yin
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Daquan Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Qi Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Kunpeng Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Jinlin Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer, Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China,
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27
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Wan CF, Liu XS, Wang L, Zhang J, Lu JS, Li FH. Quantitative contrast-enhanced ultrasound evaluation of pathological complete response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy. Eur J Radiol 2018; 103:118-123. [PMID: 29803376 DOI: 10.1016/j.ejrad.2018.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To clarify whether the quantitative parameters of contrast-enhanced ultrasound (CEUS) can be used to predict pathological complete response (pCR) in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS Fifty-one patients with histologically proved locally advanced breast cancer scheduled for NAC were enrolled. The quantitative data for CEUS and the tumor diameter were collected at baseline and before surgery, and compared with the pathological response. Multiple logistic regression analysis was performed to examine quantitative parameters at CEUS and the tumor diameter to predict the pCR, and receiver operating characteristic (ROC) curve analysis was used as a summary statistic. RESULTS Multiple logistic regression analysis revealed that PEAK (the maximum intensity of the time-intensity curve during bolus transit), PEAK%, TTP% (time to peak), and diameter% were significant independent predictors of pCR, and the area under the ROC curve was 0.932(Az1), and the sensitivity and specificity to predict pCR were 93.7% and 80.0%. The area under the ROC curve for the quantitative parameters was 0.927(Az2), and the sensitivity and specificity to predict pCR were 81.2% and 94.3%. For diameter%, the area under the ROC curve was 0.786 (Az3), and the sensitivity and specificity to predict pCR were 93.8% and 54.3%. The values of Az1 and Az2 were significantly higher than that of Az3 (P = 0.027 and P = 0.034, respectively). However, there was no significant difference between the values of Az1 and Az2 (P = 0.825). CONCLUSION Quantitative analysis of tumor blood perfusion with CEUS is superior to diameter% to predict pCR, and can be used as a functional technique to evaluate tumor response to NAC.
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Affiliation(s)
- Cai-Feng Wan
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China
| | - Xue-Song Liu
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China
| | - Lin Wang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China
| | - Jie Zhang
- Department of Breast Surgeon, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China
| | - Jin-Song Lu
- Department of Breast Surgeon, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China.
| | - Feng-Hua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China.
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Cain H, Macpherson I, Beresford M, Pinder S, Pong J, Dixon J. Neoadjuvant Therapy in Early Breast Cancer: Treatment Considerations and Common Debates in Practice. Clin Oncol (R Coll Radiol) 2017; 29:642-652. [DOI: 10.1016/j.clon.2017.06.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 01/16/2023]
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Furman‐Haran E, Nissan N, Ricart‐Selma V, Martinez‐Rubio C, Degani H, Camps‐Herrero J. Quantitative evaluation of breast cancer response to neoadjuvant chemotherapy by diffusion tensor imaging: Initial results. J Magn Reson Imaging 2017; 47:1080-1090. [DOI: 10.1002/jmri.25855] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/25/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Edna Furman‐Haran
- Weizmann Institute of Science, Department of Biological ServicesRehovot Israel
| | - Noam Nissan
- Sheba Medical Center, Radiology DepartmentTel Hashomer Israel
| | | | | | - Hadassa Degani
- Weizmann Institute of Science, Department of Biological RegulationRehovot Israel
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Li M, Xu B, Shao Y, Liu H, Du B, Yuan J. Magnetic resonance imaging patterns of tumor regression in breast cancer patients after neo-adjuvant chemotherapy, and an analysis of the influencing factors. Breast J 2017; 23:656-662. [PMID: 28397346 DOI: 10.1111/tbj.12811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study was to analyze the patterns of breast tumor shrinkage in patients after neo-adjuvant chemotherapy (NAC) based on magnetic resonance imaging (MRI), and to evaluate the influential factors. Preoperative breast dynamic contrast-enhanced MRI was performed on 88 patients before NAC, every 2 weeks during their chemotherapy treatment, and the week before their surgery. The MRI enhancement pattern of the primary tumors was classified into one of four categories based on BI-RADS-MRI: type I (postcontrast mass image), II (multiple small masses image), III (postcontrast mass image with peripheral non-mass enhancement image), and IV (nonmass enhancement image). Multivariate regression and χ2 test analyses were employed to establish significant associations. Two kinds of tumor regression patterns were observed: concentric shrinkage was observed in 39 lesions of 88 patients (44.3%), and nests or dendritic shrinkage was observed for the other 49 lesions (55.7%). ER+/HER2-, HER2+, and type I lesions were observed in 23 (62.2%), 21 (63.6%), and 29 (60.0%) patients, respectively, out of 49 nest or dendritic shrinkage pattern lesions. Triple negative breast cancer lesions, and type II, III, and IV lesions were observed in 13 (72.2%), 9 (81.8%), 10 (62.5%), and 10 (76.9%) patients, respectively, out of 39 lesions with a concentric shrinkage pattern. Molecular subtypes (χ2 =7.171, P<.05) and the MRI schedule of enhancement (χ2 =11.244, P<.05) were significantly associated with the tumor regression patterns. Multivariate analysis showed molecular subtypes (P<.05) and MRI pattern enhancement (P<.05) were significant predictive factors. Molecular subtypes and the MRI enhancement patterns of the primary tumors were significant predictive factors for tumor regression patterns of breast cancer after NAC.
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Affiliation(s)
- ManMan Li
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Xu
- The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Yingbo Shao
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Liu
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - BingJie Du
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - JunHui Yuan
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Tudorica A, Oh KY, Chui SYC, Roy N, Troxell ML, Naik A, Kemmer KA, Chen Y, Holtorf ML, Afzal A, Springer CS, Li X, Huang W. Early Prediction and Evaluation of Breast Cancer Response to Neoadjuvant Chemotherapy Using Quantitative DCE-MRI. Transl Oncol 2016; 9:8-17. [PMID: 26947876 PMCID: PMC4800060 DOI: 10.1016/j.tranon.2015.11.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 02/03/2023] Open
Abstract
The purpose is to compare quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) metrics with imaging tumor size for early prediction of breast cancer response to neoadjuvant chemotherapy (NACT) and evaluation of residual cancer burden (RCB). Twenty-eight patients with 29 primary breast tumors underwent DCE-MRI exams before, after one cycle of, at midpoint of, and after NACT. MRI tumor size in the longest diameter (LD) was measured according to the RECIST (Response Evaluation Criteria In Solid Tumors) guidelines. Pharmacokinetic analyses of DCE-MRI data were performed with the standard Tofts and Shutter-Speed models (TM and SSM). After one NACT cycle the percent changes of DCE-MRI parameters Ktrans (contrast agent plasma/interstitium transfer rate constant), ve (extravascular and extracellular volume fraction), kep (intravasation rate constant), and SSM-unique τi (mean intracellular water lifetime) are good to excellent early predictors of pathologic complete response (pCR) vs. non-pCR, with univariate logistic regression C statistics value in the range of 0.804 to 0.967. ve values after one cycle and at NACT midpoint are also good predictors of response, with C ranging 0.845 to 0.897. However, RECIST LD changes are poor predictors with C = 0.609 and 0.673, respectively. Post-NACT Ktrans, τi, and RECIST LD show statistically significant (P < .05) correlations with RCB. The performances of TM and SSM analyses for early prediction of response and RCB evaluation are comparable. In conclusion, quantitative DCE-MRI parameters are superior to imaging tumor size for early prediction of therapy response. Both TM and SSM analyses are effective for therapy response evaluation. However, the τi parameter derived only with SSM analysis allows the unique opportunity to potentially quantify therapy-induced changes in tumor energetic metabolism.
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Affiliation(s)
- Alina Tudorica
- Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Karen Y Oh
- Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Stephen Y-C Chui
- Medical Oncology, Oregon Health & Science University, Portland, OR, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Nicole Roy
- Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Megan L Troxell
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Arpana Naik
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Surgical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Kathleen A Kemmer
- Medical Oncology, Oregon Health & Science University, Portland, OR, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yiyi Chen
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Megan L Holtorf
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Aneela Afzal
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Charles S Springer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Wei Huang
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA.
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