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Gan L, Miao YM, Dong XJ, Zhang QR, Ren Q, Zhang N. Investigation on sexual function in young breast cancer patients during endocrine therapy: a latent class analysis. Front Med (Lausanne) 2023; 10:1218369. [PMID: 37484843 PMCID: PMC10358731 DOI: 10.3389/fmed.2023.1218369] [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: 05/07/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Backgrounds The aim of this study was to investigate the sexual function status of young breast cancer patients during endocrine therapy, identify potential categories of sexual function status, and analyze the factors affecting the potential categories of sexual function status during endocrine therapy. Methods A cross-sectional survey was conducted on 189 young breast cancer patients who underwent postoperative adjuvant endocrine therapy in Shanghai Ruijin Hospital. The latent class analysis was used to identify potential categories of patient sexual function characteristics with respect to the FSFI sex health measures. Logistic regression analysis was used to analyze the influencing factors for the high risk latent class groups. A nomogram prognostic model were then established to identify high risk patients for female sexual dysfunction (FSD), and C-index was used to determine the prognostic accuracy. Results Patients were divided into a "high dysfunction-low satisfaction" group and a "low dysfunction-high satisfaction" group depending on the latent class analysis, accounting for 69.3% and 30.7%, respectively. Patients who received aromatase inhibitors (AI) combined with ovarian function suppression (OFS) treatment (p = 0.027), had poor body-image after surgery (p = 0.007), beared heavy medical economy burden(p < 0.001), and had a delayed recovery of sexual function after surgery (p = 0.001) were more likely to be classified into the "high dysfunction-low satisfaction" group, and then conducted into the nomogram. The C-index value of the nomogram for predicting FSD was 0.782. Conclusion The study revealed the heterogeneity of sexual function status among young breast cancer patients during endocrine therapy, which may help identify high-risk patients and provide early intervention.
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Affiliation(s)
- Lu Gan
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Ming Miao
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Jing Dong
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Rong Zhang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Ren
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zhang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Jiang M, Chen W, Hu Y, Chen C, Li H. Adjuvant ovarian suppression for premenopausal hormone receptor-positive breast cancer: A network meta-analysis. Medicine (Baltimore) 2021; 100:e26949. [PMID: 34414958 PMCID: PMC8376312 DOI: 10.1097/md.0000000000026949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/23/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ovarian function suppressor (OFS) plus either tamoxifen (TAM) or aromatase inhibitor (AI) could improve the survival outcome for premenopausal hormone receptor-positive (HR+) breast cancer. However, the optimal OFS-based regimen and medication duration remain uncertain. This article aims to systematically evaluate the OFS-based adjuvant endocrine therapy for premenopausal breast cancer. METHODS We searched several public databases from January 1980 to November 2020. A random model was adopted in this meta-analysis. We used the hazard ratio (HR) with a 95% confidence interval (CI) for the statistical analysis of efficacy. The primary outcome measures included overall survival and disease-free survival. RESULTS A total of 32 articles with 37,224 cases were included in this network meta-analysis. OFS+TAM improved 5-year disease-free survival (HR -0.09, 95% CI -0.16 to -0.01) and 5-year overall survival (HR -0.18, 95% CI -0.33 to -0.03) compared with TAM monotherapy. For OFS+AI, although the 5-year disease-free survival was improved (HR -0.18, 95% CI -0.29 to -0.08), the 5-year overall survival was not improved (HR -0.13, 95% CI -0.43 to 0.18). In subgroup analysis, both OFS+AI and OFS+TAM showed a protective effect in stage I-III patients compared with stage I-II patients. For the course of therapy, OFS+TAM for 2-years could achieve clinical benefit and the best course of therapy of OFS+AI still waits for further study. CONCLUSIONS OFS+TAM might be a better option than OFS+AI for premenopausal intensive adjuvant endocrine therapy. Stage III patients are more suitable for the OFS-based therapy. For the medication duration, the 2-years course of OFS+TAM could be effective. This analysis provides helpful information for selecting therapeutic regimen in intensive adjuvant endocrine therapy and identifying the target population.
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Affiliation(s)
- Mengjie Jiang
- Department of Radiotherapy, First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Wuzhen Chen
- Department of Breast Surgery (Surgical Oncology), Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Yujie Hu
- Department of Radiotherapy, First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Chao Chen
- Department of Radiotherapy, First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Huafeng Li
- Department of Radiotherapy, First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
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Bešlija S, Gojković Z, Cerić T, Abazović AM, Marijanović I, Vranić S, Mustedanagić–Mujanović J, Skenderi F, Rakita I, Guzijan A, Koprić D, Humačkić A, Trokić D, Alidžanović J, Efendić A, Šišić I, Drljević H, Bešlagić V, Babić B, Pašić A, Ramić A, Mikić D, Guzin Z, Karan D, Buhovac T, Miletić D, Šečić S, Šahmić AĐ, Mujbegović L, Kubura A, Burina M, Lalović N, Dukić N, Mašić JV, Ćuk M, Stanušić R. 2020 consensus guideline for optimal approach to the diagnosis and treatment of HER2-positive breast cancer in Bosnia and Herzegovina. Bosn J Basic Med Sci 2021; 21:120-135. [PMID: 32415816 PMCID: PMC7982071 DOI: 10.17305/bjbms.2020.4846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.
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Affiliation(s)
- Semir Bešlija
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zdenka Gojković
- University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Timur Cerić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Inga Marijanović
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Semir Vranić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Faruk Skenderi
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ivanka Rakita
- University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Aleksandar Guzijan
- University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Dijana Koprić
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Alen Humačkić
- Cantonal Hospital “Dr. Safet Mujić”, Mostar, Bosnia and Herzegovina
| | - Danijela Trokić
- Radiotherapy Center, International Medical Centers, Banja Luka, Bosnia and Herzegovina
| | | | - Alma Efendić
- Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Ibrahim Šišić
- Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Harun Drljević
- Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Vanesa Bešlagić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Božana Babić
- University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Azra Pašić
- Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Anela Ramić
- Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Dijana Mikić
- University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Zlatko Guzin
- Cantonal Hospital “Dr. Safet Mujić”, Mostar, Bosnia and Herzegovina
| | - Dragana Karan
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Teo Buhovac
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Dragana Miletić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Senad Šečić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Đozić Šahmić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Alisa Kubura
- Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Mensura Burina
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Nenad Lalović
- University Hospital Foča, Foča, Bosnia and Herzegovina
| | | | | | - Mirjana Ćuk
- University Hospital Foča, Foča, Bosnia and Herzegovina
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Singhal M, Sahoo TP, Aggarwal S, Singhvi A, Kaushal V, Rajpurohit S, Parthasarthi KM, Vora A, Ganvir M, Gupta S, Parikh PM. Practical consensus recommendations on ovarian suppression in early breast cancer (adjuvant). South Asian J Cancer 2020; 7:151-155. [PMID: 29721484 PMCID: PMC5909295 DOI: 10.4103/sajc.sajc_125_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Substantial survival benefits exist for patients with early-stage breast cancer who undergo treatment with single-modality ovarian suppression, but its value is uncertain. Expert oncologist discussed to determine whether additional benefits exist with ovarian suppression plus multiple adjuvant therapy which provides a new treatment option that reduces the risk of recurrence in early breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- M Singhal
- Department of Medical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - T P Sahoo
- Department of Medical Oncology, Chirayu Cancer Hospital, Bhopal, Madhya Pradesh, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - A Singhvi
- Department of Medical Oncology, Choitram Hospital, Indore, Madhya Pradesh, India
| | - V Kaushal
- Department of Radiation Oncology, RCC, Rohtak, Haryana, India
| | - S Rajpurohit
- Department of Medical Oncology, RGCI, New Delhi, India
| | - K M Parthasarthi
- Department of Medical Oncology, Dharamshila Cancer Hospital, New Delhi, India
| | - A Vora
- Department of Medical Oncology, Hope Clinic, New Delhi, India
| | - M Ganvir
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
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5
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Review of concepts in therapeutic decision-making in HER2-negative luminal metastatic breast cancer. Clin Transl Oncol 2020; 22:1364-1377. [PMID: 32052382 PMCID: PMC7316841 DOI: 10.1007/s12094-019-02269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/08/2019] [Indexed: 11/09/2022]
Abstract
Purpose Hormone receptor (HR)-positive, Human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) requires a therapeutic approach that takes into account multiple factors, with treatment being based on anti-estrogen hormone therapy (HT). As consensus documents are valuable tools that assist in the decision-making process for establishing clinical strategies and optimize the delivery of health services, this consensus document has been created with the aim of developing recommendations on cretiera for hormone sensitivity and resistance in HER2-negative luminal MBC and facilitating clinical decision-making. Methods This consensus document was generated using a modification of the RAND/UCLA methodology, which included the definition of the project and identification of issues of interest, a non-exhaustive systematic review of the literature, an analysis and synthesis of the scientific evidence, preparation of recommendations, and external evaluation with a panel of 64 medical oncologists specializing in breast cancer. Results A Spanish panel of experts reached consensus on 32 of the 32 recommendations/conclusions presented in the first round and were accepted with an approval rate of 100% about definition of metastatic disease not susceptible to local curative treatment, definition of hormone sensitivity and hormone resistance in metastatic luminal disease and therapeutic decision-making. Conclusion We have developed a consensus document with recommendations on the treatment of patients with HER2-negative luminal MBC that will help to improve therapeutic benefits.
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6
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Huerta-Reyes M, Maya-Núñez G, Pérez-Solis MA, López-Muñoz E, Guillén N, Olivo-Marin JC, Aguilar-Rojas A. Treatment of Breast Cancer With Gonadotropin-Releasing Hormone Analogs. Front Oncol 2019; 9:943. [PMID: 31632902 PMCID: PMC6779786 DOI: 10.3389/fonc.2019.00943] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022] Open
Abstract
Although significant progress has been made in the implementation of new breast cancer treatments over the last three decades, this neoplasm annually continues to show high worldwide rates of morbidity and mortality. In consequence, the search for novel therapies with greater effectiveness and specificity has not come to a stop. Among the alternative therapeutic targets, the human gonadotropin-releasing hormone type I and type II (hGnRH-I and hGnRH–II, respectively) and its receptor, the human gonadotropin-releasing hormone receptor type I (hGnRHR-I), have shown to be powerful therapeutic targets to decrease the adverse effects of this disease. In the present review, we describe how the administration of GnRH analogs is able to reduce circulating concentrations of estrogen in premenopausal women through their action on the hypothalamus–pituitary–ovarian axis, consequently reducing the growth of breast tumors and disease recurrence. Also, it has been mentioned that, regardless of the suppression of synthesis and secretion of ovarian steroids, GnRH agonists exert direct anticancer action, such as the reduction of tumor growth and cell invasion. In addition, we discuss the effects on breast cancer of the hGnRH-I and hGnRH-II agonist and antagonist, non-peptide GnRH antagonists, and cytotoxic analogs of GnRH and their implication as novel adjuvant therapies as antitumor agents for reducing the adverse effects of breast cancer. In conclusion, we suggest that the hGnRH/hGnRHR system is a promising target for pharmaceutical development in the treatment of breast cancer, especially for the treatment of advanced states of this disease.
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Affiliation(s)
- Maira Huerta-Reyes
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), Hospital de Especialidades, Mexico City, Mexico
| | - Guadalupe Maya-Núñez
- Unidad de Investigación Médica en Medicina Reproductiva, IMSS, Unidad Médica de Alta Especialidad No. 4, Mexico City, Mexico
| | - Marco Allán Pérez-Solis
- Unidad de Investigación Médica en Medicina Reproductiva, IMSS, Unidad Médica de Alta Especialidad No. 4, Mexico City, Mexico
| | - Eunice López-Muñoz
- Unidad de Investigación Médica en Medicina Reproductiva, IMSS, Unidad Médica de Alta Especialidad No. 4, Mexico City, Mexico
| | - Nancy Guillén
- Centre National de la Recherche Scientifique, CNRS-ERL9195, Paris, France
| | - Jean-Christophe Olivo-Marin
- Unité d'Analyse d'Images Biologiques, Institut Pasteur, Paris, France.,Centre National de la Recherche Scientifique, CNRS-UMR3691, Paris, France
| | - Arturo Aguilar-Rojas
- Unidad de Investigación Médica en Medicina Reproductiva, IMSS, Unidad Médica de Alta Especialidad No. 4, Mexico City, Mexico.,Unité d'Analyse d'Images Biologiques, Institut Pasteur, Paris, France
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7
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Ferraro E, Trapani D, Marrucci E, Curigliano G. Evaluating triptorelin as a treatment option for breast cancer. Expert Opin Pharmacother 2019; 20:1809-1818. [PMID: 31500470 DOI: 10.1080/14656566.2019.1650020] [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: 10/26/2022]
Abstract
Introduction: Triptorelin is a luteinizing hormone-releasing hormone analog (LH-RHa) inducing ovarian function suppression (OFS). It is approved by FDA and EMA in association with tamoxifen or aromatase inhibitor (AI) and with fulvestrant and palbociclib in premenopausal women with hormone receptor (HR)-positive breast cancer. Its potential role to preserve ovarian function during chemotherapy has also been recently clarified. Areas covered: Several studies have investigated the role of adding OFS to tamoxifen and aromatase inhibitors as adjuvant treatment in early breast cancer. The addition of triptorelin is not free from adverse events as the combination with tamoxifen and exemestane resulted in an increase of endocrine-deprivation symptoms. Clinical trials have explored the combination of LH-RHa with chemotherapy in fertility preservation, demonstrating no detrimental effect on patients' oncological outcome. This is all discussed in this evaluation. Expert opinion: Triptorelin represents a standard-of-care in premenopausal women with HR-positive breast cancer and in some cases of male breast cancer. In the adjuvant setting, a personalized approach is required to combine LH-RHa with the right partner considering the risk of recurrence and the toxicity profile. LH-RHa may be offered to breast cancer patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency.
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Affiliation(s)
- Emanuela Ferraro
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS , Milan , Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan , Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS , Milan , Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan , Italy
| | - Eleonora Marrucci
- Campus Bio-Medico University of Rome, Rome, Italy; Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS , Milan , Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS , Milan , Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan , Italy
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8
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Daguenet E, Jmour O, Vallard A, Guy JB, Jacquin JP, Méry B, Magné N. [LHRH analogs in adjuvant endocrine therapy for pre-menopausal localized breast cancers: Ending the controversy for novel guidelines?]. Bull Cancer 2019; 106:342-353. [PMID: 30853114 DOI: 10.1016/j.bulcan.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/13/2019] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
Endocrine treatment represents the cornerstone of endocrine-sensitive pre-menopausal early breast cancer. The estrogen blockade plays a leading role in the therapeutic management with surgery, radiotherapy and selective antiestrogen treatment. For several years, selective estrogen receptor modulators, such as tamoxifen, have revolutionized medical care of hormone receptors-positive breast cancer and have conquered the therapeutic arsenal while becoming the gold standard of treatment. Other combinations associating the ovarian function suppression using LHRH agonists with tamoxifen or aromatase inhibitors have been recently investigated, leading to mitigated opinions regarding the clinical benefit of these associations. We propose here a comprehensive overview on existing data and their actualization concerning LHRH analogues, whilst emphasizing benefit-risk balance for this targeted population.
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Affiliation(s)
- Elisabeth Daguenet
- Institut de cancérologie Lucien-Neuwirth, département de la recherche et de l'enseignement (DURE), 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France
| | - Omar Jmour
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France
| | - Jean-Baptiste Guy
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France
| | - Jean-Philippe Jacquin
- Institut de Cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France
| | - Benoîte Méry
- Institut de Cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de la recherche et de l'enseignement (DURE), 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France; Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez, France.
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9
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Systemic Treatment of HER2-Negative Metastatic Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Ordu Ç, Pilancı KN, Alço G, Elbüken F, Köksal Üİ, İlgun S, Sarsenov D, Aydın AE, Öztürk A, Erdoğan Zİ, Ağaçayak F, Çubuk F, Tecimer C, Eralp Y, Duymaz T, Aktepe F, Özmen V. Prognostic Significance of Adjuvant Chemotherapy Induced Amenorrhea in Luminal A and B Subtypes. Eur J Breast Health 2018; 14:173-179. [PMID: 30123884 DOI: 10.5152/ejbh.2018.3808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/26/2018] [Indexed: 02/02/2023]
Abstract
Objective In this retrospective study, chemotherapy induced amenorrhea in patients with early stage breast cancer and its effects on survival were investigated. Materials and Methods Two hundred fifty-two patients received adjuvant chemotherapy without ovarian suppression treatment (OST) from 600 premenopausal patients were included in the study. Patients were divided into two groups; with amenorrhea and without, and compared with clinicopathologic features and survival. SPSS version 17 was used. Results Chemotherapy-induced amenorrhea (CIA) was observed in 145 (57.5%) of 252 patients who received no OST during follow-up. The 5-year OS rate of patients with CIA was significantly higher than patients without CIA (p= 0.042, 95.9% vs. 89.7% vs. 158.88 vs. 135.33 months, respectively). In the subgroup analysis, the OS in patients with hormone receptor (+) was significantly higher than in those receptor (-) in patients with CIA (p=0.011, 97.5% vs. 90.9% vs. 162.13 vs. 126.16 months, respectively). The OS was significantly longer in the luminal A molecular subtype than in those with luminal B molecular subtype, in patients with CIA, but the difference was not significant in patients without CIA (p=0.027 vs. p=0.074, respectively). Conclusion As a conclusion; survival advantage of the chemotherapy induced amenorrhea more pronounced with hormone receptor positivity, lymph node involvement, and advanced disease over patients who do not develop amenorrhea. This advantage of amenorrhea development further prolongs survival compared with luminal B in the luminal A molecular subtype.
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Affiliation(s)
- Çetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Kezban Nur Pilancı
- Department of Medical Oncology, Haseki Research and Training Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Filiz Elbüken
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Ülkühan İner Köksal
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Serkan İlgun
- Department of General Surgery, Gaziosmanpaşa Research and Training Hospital, İstanbul, Turkey
| | - Dauren Sarsenov
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Ayşe Esra Aydın
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgery, Biruni University, İstanbul, Turkey
| | - Zeynep İyigün Erdoğan
- Department of Physical Therapy and Rehabilitation, Şişli Florence Nightingale Hospital, İstanbul, Turkey
| | - Filiz Ağaçayak
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Fatmagül Çubuk
- Department of General Surgery, Gaziosmanpaşa Research and Training Hospital, İstanbul, Turkey
| | - Coşkun Tecimer
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Yeşim Eralp
- Department of Medical Oncology, Istanbul University School of Medicine, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, İstanbul Bilim University, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of Medical Oncology, Istanbul University School of Medicine, İstanbul, Turkey
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11
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Tancredi R, Furlanetto J, Loibl S. Endocrine Therapy in Premenopausal Hormone Receptor Positive/Human Epidermal Growth Receptor 2 Negative Metastatic Breast Cancer: Between Guidelines and Literature. Oncologist 2018; 23:974-981. [PMID: 29934412 DOI: 10.1634/theoncologist.2018-0077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/13/2018] [Indexed: 11/17/2022] Open
Abstract
There is growing interest in the endocrine treatment (ET) of premenopausal women with hormone receptor positive (HR+) metastatic breast cancer (MBC). This review summarizes available data on endocrine therapy for this patient subset and aims to define the most appropriate treatment approach. The combination of luteinizing hormone-releasing hormone (LHRH) agonists plus tamoxifen seems effective and safe and is considered as being superior to either approach alone; still, single-agent therapy remains an acceptable treatment option. Due to their mechanism of action, aromatase inhibitors alone are not suitable for the treatment of premenopausal patients, but the combination with LHRH agonists may result in excellent disease control. Fulvestrant, in conjunction with LHRH agonists, also yields interesting results regarding clinical benefit rate and time to progression; currently, other orally available selective estrogen receptor downregulators are under clinical evaluation. Recently, targeted drugs have been added to ET in order to reverse endocrine resistance, but only limited information regarding their activity in premenopausal patients is available. The cyclin dependent kinase 4 and 6 inhibitor palbociclib when combined with fulvestrant and LHRH agonists was shown to prolong progression-free survival over endocrine therapy alone in pretreated patients; similar results were obtained with the addition of abemacicilib or ribociclib to endocrine therapy. Currently, activity of the mammalian target of rapamycin inhibitor everolimus in combination with letrozole and goserelin is under assessment in premenopausal patients after progression on tamoxifen (MIRACLE trial). IMPLICATIONS FOR PRACTICE This review provides clinicians with an overview on the available data regarding endocrine treatment of hormone receptor positive (HR+) metastatic breast cancer (MBC) in premenopausal women and summarizes the treatment options available in routine clinical practice. Knowledge of an up-to-date therapeutic approach in women with premenopausal HR+ MBC will lead to better disease management, thereby improving disease control and quality of life while minimizing side effects.
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Affiliation(s)
- Richard Tancredi
- Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy
- GBG Forschungs GmbH, Neu-Isenburg, Germany
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12
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Bardia A, Hurvitz S. Targeted Therapy for Premenopausal Women with HR +, HER2 - Advanced Breast Cancer: Focus on Special Considerations and Latest Advances. Clin Cancer Res 2018; 24:5206-5218. [PMID: 29884743 DOI: 10.1158/1078-0432.ccr-18-0162] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/12/2018] [Accepted: 06/06/2018] [Indexed: 11/16/2022]
Abstract
The incidence of advanced breast cancer in premenopausal women is increasing, and breast cancer in younger women is often more aggressive and has a worse prognosis compared with breast cancer in older women. Premenopausal women with hormone receptor-positive (HR+) breast cancer are frequently under-represented in clinical trials, and treatment strategies in the premenopausal setting are usually extrapolated from data from postmenopausal patients, with the addition of ovarian function suppression to endocrine therapy in HR+ disease. However, the underlying biology of breast cancer in premenopausal women can be different from postmenopausal women, and treatment strategies should ideally be specifically tested in premenopausal patients. Recent phase III trials have now investigated cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in premenopausal patients with HR+, HER2- advanced breast cancer: Palbociclib and abemaciclib have been tested in a subset of premenopausal patients in the PALOMA-3 and MONARCH-2 studies, and ribociclib has been tested in the phase III MONALEESA-7 trial, which was entirely dedicated to premenopausal women. This comprehensive review summarizes the differences in the biology of HR+, HER2- breast cancer in the premenopausal population compared with the postmenopausal population; discusses special considerations for treatment of premenopausal women; and reviews the evidence from clinical trials investigating endocrine therapy, other targeted treatments, and ovarian function suppression in the HR+, HER2- advanced breast cancer setting. Clin Cancer Res; 24(21); 5206-18. ©2018 AACR.
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Affiliation(s)
- Aditya Bardia
- Massachusetts General Hospital Cancer Center/Harvard Medical School, Boston, Massachusetts.
| | - Sara Hurvitz
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California
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13
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Ferrandina G, Amadio G, Marcellusi A, Azzolini E, Puggina A, Pastorino R, Ricciardi W, Scambia G. Bilateral Salpingo-Oophorectomy Versus GnRH Analogue in the Adjuvant Treatment of Premenopausal Breast Cancer Patients: Cost-Effectiveness Evaluation of Breast Cancer Outcome, Ovarian Cancer Prevention and Treatment. Clin Drug Investig 2018; 37:1093-1102. [PMID: 28895089 DOI: 10.1007/s40261-017-0571-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE: There is no available evidence to recommend gonadotropin-releasing hormone (GnRH) analogue-based ovarian suppression versus bilateral salpingo-oophorectomy (BSO) in the adjuvant treatment of early breast cancer, since the two approaches are considered equivalent in terms of oncologic outcome. The role of surgical ovarian ablation has been revitalized based on the advances of minimally invasive surgery, and a better understanding of clinical and molecular basis of hereditary breast/ovarian cancer syndromes. The aim of this study is to analyze the cost-effectiveness of laparoscopic BSO and GnRH analogue administration in patients aged 40-49 years with hormone-sensitive breast cancer. METHODS A probabilistic decision tree model was developed to evaluate costs and outcomes of ovarian ablation through laparoscopic BSO, or ovarian suppression through monthly injections of GnRH analogue. Results were expressed as incremental costs per quality-adjusted life years (QALYs) gained. RESULTS Laparoscopic BSO strategy was associated with a lower mean total cost per patient than GnRH treatment, and considering the difference in terms of QALYs, the incremental effectiveness did not demonstrate a notable difference between the two approaches. From the National Health Service perspective, and for a time horizon of 5 years, laparoscopic BSO was the dominant option compared to GnRH treatment; laparoscopic BSO was less expensive than GnRH, €2385 [95% confidence interval (CI) = 2044, 2753] vs €7093 (95% CI = 3409, 12,105), respectively, and more effective. CONCLUSION Surgical ovarian ablation is more cost-effective than GnRH administration in the adjuvant treatment of hormone-sensitive breast cancer patients aged 40-49 years, and the advantage of preventing ovarian cancer through laparoscopic BSO should be considered.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A.Gemelli", Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Giulia Amadio
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A.Gemelli", Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Andrea Marcellusi
- Economic Evaluation and HTA (CEIS-EEHTA), IGF Department, Faculty of Economics, University of Rome "Tor Vergata", Via Columbia 2, 00133, Rome, Italy
| | - Elena Azzolini
- Department of Public Health, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Anna Puggina
- Department of Public Health, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Roberta Pastorino
- Department of Public Health, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Walter Ricciardi
- Department of Public Health, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A.Gemelli", Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy
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14
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Abstract
Endocrine therapy (ET) of hormone receptor (HR)-positive and human epidermal growth factor receptor 2-(HER2)-negative metastatic breast cancer (MBC) historically focused on estrogen deprivation and antagonism. The identification of several intracellular pathways promoting resistance to antiestrogen therapy led to the introduction of novel endocrine drug combinations that reformed treatment schema and expanded therapeutic options. There is no doubt that efforts to overcome or delay resistance to ET are fruiting, particularly with the introduction of cyclin-dependent kinase 4/6 inhibitors such as palbociclib and ribociclib, and mechanistic target of rapamycin inhibitors such as everolimus. Although still considered incurable by currently available treatment modalities, many patients with MBC nowadays enjoy several years of good quality life coupled with decent tumor control. The diversity of therapies and unusual pattern of side effects can be quite perplexing to the treating physician. The sequence of variable agents and management of side effects, in addition to the timing of initiation of cytotoxic chemotherapy, is among the challenges faced by oncologists. In this review, we shed a spotlight on mechanisms of resistance to ET, and provide a review of landmark studies that have recently reshaped the landscape of treatment options for patients with metastatic HR-positive, HER2-negative MBC. A suggested treatment strategy for newly diagnosed patients is also discussed herein.
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Affiliation(s)
- Mohamad Adham Salkeni
- Department of Medicine, West Virginia University Cancer Institute, Morgantown, WV 26506, USA
| | - Samantha June Hall
- Department of Medicine, West Virginia University Cancer Institute, Morgantown, WV 26506, USA
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15
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Loibl S, Turner NC, Ro J, Cristofanilli M, Iwata H, Im SA, Masuda N, Loi S, André F, Harbeck N, Verma S, Folkerd E, Puyana Theall K, Hoffman J, Zhang K, Bartlett CH, Dowsett M. Palbociclib Combined with Fulvestrant in Premenopausal Women with Advanced Breast Cancer and Prior Progression on Endocrine Therapy: PALOMA-3 Results. Oncologist 2017; 22:1028-1038. [PMID: 28652278 DOI: 10.1634/theoncologist.2017-0072] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/23/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The efficacy and safety of palbociclib, a cyclin-dependent kinase 4/6 inhibitor, combined with fulvestrant and goserelin was assessed in premenopausal women with advanced breast cancer (ABC) who had progressed on prior endocrine therapy (ET). PATIENTS AND METHODS One hundred eight premenopausal endocrine-refractory women ≥18 years with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) ABC were among 521 women randomized 2:1 (347:174) to fulvestrant (500 mg) ± goserelin with either palbociclib (125 mg/day orally, 3 weeks on, 1 week off) or placebo. This analysis assessed whether the overall tolerable safety profile and significant progression-free survival (PFS) improvement extended to premenopausal women. Potential drug-drug interactions (DDIs) and ovarian suppression with goserelin were assessed via plasma pharmacokinetics and biochemical analyses, respectively. (ClinicalTrials.gov identifier: NCT01942135) RESULTS: Median PFS for premenopausal women in the palbociclib (n = 72) versus placebo arm (n = 36) was 9.5 versus 5.6 months, respectively (hazard ratio, 0.50, 95% confidence interval: 0.29-0.87), and consistent with the significant PFS improvement in the same arms for postmenopausal women. Any-grade and grade ≤3 neutropenia, leukopenia, and infections were among the most frequent adverse events reported in the palbociclib arm with concurrent goserelin administration. Hormone concentrations were similar between treatment arms and confirmed sustained ovarian suppression. Clinically relevant DDIs were not observed. CONCLUSION Palbociclib combined with fulvestrant and goserelin was an effective and well-tolerated treatment for premenopausal women with prior endocrine-resistant HR+/HER2- ABC. Inclusion of both premenopausal and postmenopausal women in pivotal combination ET trials facilitates access to novel drugs for young women and should be considered as a new standard for clinical trial design. IMPLICATIONS FOR PRACTICE PALOMA-3, the first registrational study to include premenopausal women in a trial investigating a CDK4/6 inhibitor combined with endocrine therapy, has the largest premenopausal cohort reported in an endocrine-resistant setting. In pretreated premenopausal women with hormone receptor-positive advanced breast cancer, palbociclib plus fulvestrant and goserelin (luteinizing hormone-releasing hormone [LHRH] agonist) treatment almost doubled median progression-free survival (PFS) and significantly increased the objective response rate versus endocrine monotherapy, achieving results comparable to those reported for chemotherapy without apparently interfering with LHRH agonist-induced ovarian suppression. The significant PFS gain and tolerable safety profile strongly support use of this regimen in premenopausal women with endocrine-resistant disease who could possibly delay chemotherapy.
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Affiliation(s)
- Sibylle Loibl
- German Breast Group GBG Forschungs GmbH, Neu-Isenburg, Germany
- Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | | | - Jungsil Ro
- National Cancer Center, Goyang-si, South Korea
| | - Massimo Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Norikazu Masuda
- Breast Oncology, NHO Osaka National Hospital, Osaka-city, Japan
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
| | - Sunil Verma
- University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | | | | | - Ke Zhang
- Pfizer Inc., San Diego, California, USA
| | | | - Mitchell Dowsett
- Royal Marsden Hospital and Institute of Cancer Research, London, UK
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16
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Gupta JC, Hada RS, Sahai P, Talwar GP. Development of a novel recombinant LHRH fusion protein for therapy of androgen and estrogen dependent cancers. Protein Expr Purif 2017; 134:132-138. [PMID: 28410993 DOI: 10.1016/j.pep.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/29/2017] [Accepted: 04/04/2017] [Indexed: 01/31/2023]
Abstract
LHRH based vaccines are promising candidates for therapy of androgen and estrogen dependent cancers. We report in this communication development of a novel recombinant protein vaccine candidate against LHRH. A synthetic gene was designed in which the codon sequence in the LHRH decapeptide was modified by substituting the codon for 6-glycine with that of l-leucine. Further the LHRH(6leu) gene was linked to heat-labile enterotoxin of E. coli (LTB) as carrier. This LHRH(6leu)-LTB gene was cloned into a prokaryotic expression vector under the control of inducible and strong bacteriophage T7 promoter to over-express LHRH(leu) fused to LTB as recombinant protein in E. coli. Recombinant LHRH(leu)-LTB protein of ∼14 kDa size, was purified from inclusion bodies using in-situ refolding on the column and Ni-NTA based immobilized affinity chromatography. Western blot confirmed the immunoreactivity of purified LHRH(leu)-LTB fusion protein with anti-LHRH monoclonal antibody. The vaccine protein was further characterized by mass spectroscopy, circular dichroism and fluorescence spectroscopy. This communication reports a recombinant LHRH fusion protein with potential for blocking of sex hormones production for eventual therapy of sex hormones dependent neoplasms.
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Affiliation(s)
- Jagdish C Gupta
- Talwar Research Foundation, E-8 Neb Valley, New Delhi 110068, India.
| | - Rohit S Hada
- Talwar Research Foundation, E-8 Neb Valley, New Delhi 110068, India
| | - P Sahai
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110067, India
| | - G P Talwar
- Talwar Research Foundation, E-8 Neb Valley, New Delhi 110068, India
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17
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Ovarian ablation for premenopausal breast cancer: A review of treatment considerations and the impact of premature menopause. Cancer Treat Rev 2017; 55:26-35. [DOI: 10.1016/j.ctrv.2017.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/14/2023]
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18
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Suh KJ, Kim SH, Lee KH, Kim TY, Kim YJ, Han SW, Kang E, Kim EK, Kim K, No JH, Han W, Noh DY, Lee M, Kim HS, Im SA, Kim JH. Bilateral Salpingo-oophorectomy Compared to Gonadotropin-Releasing Hormone Agonists in Premenopausal Hormone Receptor-Positive Metastatic Breast Cancer Patients Treated with Aromatase Inhibitors. Cancer Res Treat 2017; 49:1153-1163. [PMID: 28253566 PMCID: PMC5654164 DOI: 10.4143/crt.2016.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/01/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose Although combining aromatase inhibitors (AI) with gonadotropin-releasing hormone agonists (GnRHa) is becoming more common, it is still not clear if GnRHa is as effective as bilateral salpingo-oophorectomy (BSO). Materials and Methods We retrospectively analyzed data of 66 premenopausal patients with hormone receptor– positive, human epidermal growth factor receptor 2–negative recurrent and metastatic breast cancer who had been treated with AIs in combination with GnRHa or BSO between 2002 and 2015. Results The median patient age was 44 years. Overall, 24 (36%) received BSO and 42 (64%) received GnRHa. The clinical benefit rate was higher in the BSO group than in the GnRHa group (88% vs. 69%, p=0.092). Median progression-free survival (PFS) was longer in the BSO group, although statistical significance was not reached (17.2 months vs. 13.3 months, p=0.245). When propensity score matching was performed, the median PFS was 17.2 months for the BSO group and 8.2 months for the GnRHa group (p=0.137). Multivariate analyses revealed that the luminal B subtype (hazard ratio, 1.67; 95% confidence interval [CI], 1.08 to 2.60; p=0.022) and later-line treatment (≥ third line vs. first line; hazard ratio, 3.24; 95% CI, 1.59 to 6.59; p=0.001) were independent predictive factors for a shorter PFS. Incomplete ovarian suppression was observed in a subset of GnRHa-treated patients whose disease showed progression, with E2 levels higher than 21 pg/mL. Conclusion Both BSO and GnRHa were found to be effective in our AI-treated premenopausal metastatic breast cancer patient cohort. However, further studies in larger populations are needed to determine if BSO is superior to GnRHa.
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Affiliation(s)
- Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eunyoung Kang
- Department of Surgery and Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery and Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kidong Kim
- Department of 5Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery and Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery and Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Seung Kim
- Department of Surgery and Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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19
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Park WC. Role of Ovarian Function Suppression in Premenopausal Women with Early Breast Cancer. J Breast Cancer 2016; 19:341-348. [PMID: 28053622 PMCID: PMC5204040 DOI: 10.4048/jbc.2016.19.4.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/07/2016] [Indexed: 01/21/2023] Open
Abstract
Historically, endocrine therapy for breast cancer began with ovarian ablation (OA) for the treatment of premenopausal patients. After the identification of estrogen receptors and the development of many antiestrogens, tamoxifen has been approved and used as the standard endocrine therapy for hormonal receptor (HR)-positive premenopausal patients to date. With the development of luteinizing hormone-releasing hormone agonists, the paradigm of endocrine therapy for premenopausal women with HR-positive breast cancer began to change from OA to ovarian function suppression (OFS). To date, the indication for OFS was limited to those premenopausal patients with HR-positive breast cancer who were unable to use tamoxifen as the primary adjuvant endocrine therapy. However, following the definitive demonstration of the therapeutic role of OFS added to tamoxifen or aromatase inhibitor after chemotherapy in large randomized trials, such as Tamoxifen and Exemestane Trial or Suppression of Ovarian Function Trial, the American Society of Clinical Oncology guidelines for the use of endocrine therapy in premenopausal HR-positive breast cancer were recently updated to recommend OFS in high-risk patients who required adjuvant chemotherapy. In contrast, the role of OFS to protect ovarian function during chemotherapy in premenopausal women has remained controversial, and some evidence showing the protective effect of OFS on the ovaries during chemotherapy as well as its therapeutic effect for breast cancer in premenopausal women with HR-negative breast cancer was recently published. Further evaluation is necessary to determine its exact role. In conclusion, the role of OA or OFS has been evolving, not only to improve the efficacy of breast cancer treatment, but also to preserve ovary function. OFS remains a main strategy for premenopausal women with HR-positive early breast cancer, though its exact role should be determined in further studies.
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Affiliation(s)
- Woo-Chan Park
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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20
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Visser K, Zierau O, Macejová D, Goerl F, Muders M, Baretton GB, Vollmer G, Louw A. The phytoestrogenic Cyclopia extract, SM6Met, increases median tumor free survival and reduces tumor mass and volume in chemically induced rat mammary gland carcinogenesis. J Steroid Biochem Mol Biol 2016; 163:129-35. [PMID: 27142456 DOI: 10.1016/j.jsbmb.2016.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 02/07/2023]
Abstract
SM6Met, a phytoestrogenic extract of Cyclopia subternata indigenous to the Western Cape province of South Africa, displays estrogenic attributes with potential for breast cancer chemoprevention. In this study, we report that SM6Met, in the presence of estradiol, induces a significant cell cycle G0/G1 phase arrest similar to the selective estrogen receptor modulator, tamoxifen. Furthermore, as a proof of concept, in the N-Methyl-N-nitrosourea induced rat mammary gland carcinogenesis model, SM6Met increases tumor latency by 7days and median tumor free survival by 42 days, while decreasing palpable tumor frequency by 32%, tumor mass by 40%, and tumor volume by 53%. Therefore, the current study provides proof of concept that SM6Met has definite potential as a chemopreventative agent against the development and progression of breast cancer.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/isolation & purification
- Antineoplastic Agents, Phytogenic/pharmacology
- Cell Line, Tumor
- Cyclopia Plant/chemistry
- Estrogen Antagonists/pharmacology
- Female
- G1 Phase Cell Cycle Checkpoints/drug effects
- G1 Phase Cell Cycle Checkpoints/genetics
- Humans
- Mammary Glands, Animal/drug effects
- Mammary Glands, Animal/metabolism
- Mammary Glands, Animal/pathology
- Mammary Neoplasms, Experimental/chemically induced
- Mammary Neoplasms, Experimental/drug therapy
- Mammary Neoplasms, Experimental/mortality
- Mammary Neoplasms, Experimental/pathology
- Methylnitrosourea
- Phytoestrogens/isolation & purification
- Phytoestrogens/pharmacology
- Rats
- Receptors, Estrogen/antagonists & inhibitors
- Receptors, Estrogen/genetics
- Receptors, Estrogen/metabolism
- Survival Analysis
- Tamoxifen/pharmacology
- Tumor Burden/drug effects
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Affiliation(s)
- Koch Visser
- Biochemistry Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Oliver Zierau
- Molecular Cell Physiology and Endocrinology, Institute for Zoology, Technische Universität Dresden, Dresden, Germany
| | - Dana Macejová
- Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Florian Goerl
- Institute for Pathology, Radeberg, Germany; Institute for Pathology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Michael Muders
- Institute for Pathology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Gustavo B Baretton
- Institute for Pathology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Günter Vollmer
- Molecular Cell Physiology and Endocrinology, Institute for Zoology, Technische Universität Dresden, Dresden, Germany
| | - Ann Louw
- Biochemistry Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
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21
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Asiri MA, Tunio MA, Abdulmoniem R. Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis. BREAST CANCER-TARGETS AND THERAPY 2016; 8:109-16. [PMID: 27307764 PMCID: PMC4887042 DOI: 10.2147/bctt.s94617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA) on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. Materials and methods The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. Results Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (P<0.00001) and increase in progression-free survival in patients treated with RT-OA (P<0.00001). However, there was no difference in overall survival (P=0.37). The majority of patients were treated with larger field sizes with parallel-opposed anteroposterior and posteroanterior pelvic fields. RT-OA was generally well tolerated. Radiotherapy doses of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions were associated with excellent amenorrhea rates. The resultant funnel plot showed no publication bias (Egger test P=0.16). Conclusion RT-OA is cost-effective and can safely be used in pre/perimenopausal women with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies. However, further studies incorporating three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are warranted.
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Affiliation(s)
- Mushabbab Al Asiri
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mutahir A Tunio
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Luteal versus follicular phase surgical oophorectomy plus tamoxifen in premenopausal women with metastatic hormone receptor-positive breast cancer. Eur J Cancer 2016; 60:107-16. [PMID: 27107325 DOI: 10.1016/j.ejca.2016.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/09/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE In premenopausal women with metastatic hormone receptor-positive breast cancer, hormonal therapy is the first-line therapy. Gonadotropin-releasing hormone analogue + tamoxifen therapies have been found to be more effective. The pattern of recurrence risk over time after primary surgery suggests that peri-operative factors impact recurrence. Secondary analyses of an adjuvant trial suggested that the luteal phase timing of surgical oophorectomy in the menstrual cycle simultaneous with primary breast surgery favourably influenced long-term outcomes. METHODS Two hundred forty-nine premenopausal women with incurable or metastatic hormone receptor-positive breast cancer entered a trial in which they were randomised to historical mid-luteal or mid-follicular phase surgical oophorectomy followed by oral tamoxifen treatment. Kaplan-Meier methods, the log-rank test, and multivariable Cox regression models were used to assess overall and progression-free survival (PFS) in the two randomised groups and by hormone-confirmed menstrual cycle phase. RESULTS Overall survival (OS) and PFS were not demonstrated to be different in the two randomised groups. In a secondary analysis, OS appeared worse in luteal phase surgery patients with progesterone levels <2 ng/ml (anovulatory patients; adjusted hazard ratio 1.46, 95% confidence interval [CI]: 0.89-2.41, p = 0.14) compared with those in luteal phase with progesterone level of 2 ng/ml or higher. Median OS was 2 years (95% CI: 1.7-2.3) and OS at 4 years was 26%. CONCLUSIONS The history-based timing of surgical oophorectomy in the menstrual cycle did not influence outcomes in this trial of metastatic patients. ClinicalTrials.gov number NCT00293540.
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Bellet M, Gray KP, Francis PA, Láng I, Ciruelos E, Lluch A, Climent MA, Catalán G, Avella A, Bohn U, González-Martin A, Ferrer R, Catalán R, Azaro A, Rajasekaran A, Morales J, Vázquez J, Fleming GF, Price KN, Regan MM. Twelve-Month Estrogen Levels in Premenopausal Women With Hormone Receptor-Positive Breast Cancer Receiving Adjuvant Triptorelin Plus Exemestane or Tamoxifen in the Suppression of Ovarian Function Trial (SOFT): The SOFT-EST Substudy. J Clin Oncol 2016; 34:1584-93. [PMID: 26729437 DOI: 10.1200/jco.2015.61.2259] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To describe estradiol (E2), estrone (E1), and estrone sulfate (E1S) levels during the first year of monthly triptorelin plus exemestane or tamoxifen and to assess possible suboptimal suppression while receiving exemestane plus triptorelin. PATIENTS AND METHODS Premenopausal patients with early breast cancer on the Suppression of Ovarian Function Trial who selected triptorelin as the ovarian suppression method and were randomly assigned to exemestane plus triptorelin or tamoxifen plus triptorelin were enrolled until the target population of 120 patients was reached. Blood sampling time points were 0, 3, 6, 12, 18, 24, 36, and 48 months. Serum estrogens were measured with a highly sensitive and specific assay. This preplanned 12-month analysis evaluated E2, E1, E1S, follicle-stimulating hormone, and luteinizing hormone levels in all patients and the proportion of patients with E2 levels greater than 2.72 pg/mL at any time point during treatment with exemestane plus triptorelin. RESULTS One hundred sixteen patients (exemestane, n = 86; tamoxifen, n = 30; median age, 44 years; median E2, 51 pg/mL; 55% prior chemotherapy) started triptorelin and had one or more samples drawn. With exemestane plus triptorelin, median reductions from baseline E2, E1, and E1S levels were consistently ≥ 95%, resulting in significantly lower levels than with tamoxifen plus triptorelin at all time points. Among patients on exemestane plus triptorelin, 25%, 24%, and 17% had an E2 level greater than 2.72 pg/mL at 3, 6, and 12 months, respectively. Baseline factors related to on-treatment E2 level greater than 2.72 pg/mL were no prior chemotherapy (P = .06), higher body mass index (P = .05), and lower follicle-stimulating hormone and luteinizing hormone (each P < .01). CONCLUSION During the first year, most patients on exemestane plus triptorelin had E2 levels below the defined threshold of 2.72 pg/mL, consistent with levels reported in postmenopausal patients on aromatase inhibitors, but at each time point, at least 17% of patients had levels greater than the threshold.
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Affiliation(s)
- Meritxell Bellet
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary.
| | - Kathryn P Gray
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Prudence A Francis
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - István Láng
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Eva Ciruelos
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Ana Lluch
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Miguel Angel Climent
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Gustavo Catalán
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Antoni Avella
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Uriel Bohn
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Antonio González-Martin
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Roser Ferrer
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Roberto Catalán
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Analía Azaro
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Agnita Rajasekaran
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Josefa Morales
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Josep Vázquez
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Gini F Fleming
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Karen N Price
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Meredith M Regan
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
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Liedtke C, Kolberg HC. Current Medical Treatment of Patients with Non-Colorectal Liver Metastases: Primary Tumor Breast Cancer. VISZERALMEDIZIN 2015; 31:424-32. [PMID: 26889146 PMCID: PMC4748775 DOI: 10.1159/000441961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND (Metastatic) breast cancer is a heterogeneous entity in which every disease subtype requires an individualized systemic treatment approach. METHODS We reviewed the currently available data regarding systemic therapy of breast cancer and present a review of historical and current treatment approaches, with the publications cited covering a time span from 1896 to the last ASCO 2015. RESULTS Systemic therapy of metastatic breast cancer may include chemotherapy, endocrine therapy, and targeted therapies (e.g. antibody-based approaches). Based on the patient's breast cancer subtype, these agents may be employed alone or in combination. Therefore, characterization of the phenotype of the disease is necessary and may include biopsy of the metastatic site. Novel therapeutic approaches include immunologic therapies as well as PARP, PI3K and CDK 4/6 inhibitors, which are currently under investigation in clinical trials. CONCLUSION Systemic therapy of metastatic breast cancer requires complex and individualized treatment approaches that are best offered in an interdisciplinary setting.
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Affiliation(s)
- Cornelia Liedtke
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein – Campus Lübeck, Lübeck, Germany
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Reinert T, Barrios CH. Optimal management of hormone receptor positive metastatic breast cancer in 2016. Ther Adv Med Oncol 2015; 7:304-20. [PMID: 26557899 PMCID: PMC4622303 DOI: 10.1177/1758834015608993] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hormone receptor positive tumors represent the most common form of breast cancer and account for most of the deaths from the disease. Endocrine therapy represents the main initial therapeutic strategy for these patients and has been associated with significant clinical benefits in a majority of patients. While in early stages endocrine therapy is administered as part of a curative approach once clinical metastases develop, the disease is considered incurable and the main management objectives are tumor control and quality of life. The two major clinical paradigms of always indicating endocrine therapy in the absence of visceral crises and sequencing endocrine treatments have been guiding our therapeutic approach to these patients. However, for many decades, we have delivered endocrine therapy with a 'one size fits all' approach by applying agents that interfere with hormone receptor signaling equally in every clinical patient scenario. We have been unable to incorporate the well-known biologic principle of different degrees of hormone receptor dependency in our therapeutic recommendations. Recent developments in the understanding of molecular interactions of hormone signaling with other important growth factor, metabolic and cell division pathways have opened the possibility of improving results by modulating hormone signaling and interfering with resistance mechanisms yet to be fully understood. Unfortunately, limitations in the design of trials conducted in this area have made it difficult to develop predictive biomarkers and most of the new combinations with targeted agents, even though showing improvements in clinical endpoints, have been directed to an unselected population of patients. In this review we explore some of the current and most relevant literature in the management of hormone receptor positive advance breast cancer.
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Affiliation(s)
- Tomas Reinert
- Instituto do Câncer, Sistema de Saúde Mãe de Deus, Porto Alegre, RS, Brazil
| | - Carlos H. Barrios
- PUCRS School of Medicine, Department of Medicine, Padre Chagas 66/203, CEP 90 570 080, Porto Alegre, RS, Brazil
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Noguchi S, Kim HJ, Jesena A, Parmar V, Sato N, Wang HC, Lokejaroenlarb S, Isidro J, Kim KS, Itoh Y, Shin E. Phase 3, open-label, randomized study comparing 3-monthly with monthly goserelin in pre-menopausal women with estrogen receptor-positive advanced breast cancer. Breast Cancer 2015; 23:771-9. [PMID: 26350351 PMCID: PMC4999470 DOI: 10.1007/s12282-015-0637-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monthly goserelin 3.6 mg dosing suppresses estradiol (E2) production and has proven efficacy in pre-menopausal women with estrogen receptor (ER)-positive breast cancer. This non-inferiority study evaluated the efficacy and safety of 3-monthly goserelin 10.8 mg compared with monthly goserelin 3.6 mg. METHODS This was a Phase 3, open-label, multicenter trial. Pre-menopausal women with ER-positive advanced breast cancer were randomized to 3-monthly goserelin 10.8 mg or monthly goserelin 3.6 mg; all patients received concomitant tamoxifen (20 mg daily). The primary endpoint was progression-free survival (PFS) rate at 24 weeks; non-inferiority was to be confirmed if the entire 95 % confidence interval (CI) for the treatment difference was above -17.5 %. Secondary endpoints included objective response rate (ORR), serum E2 levels, safety, and tolerability. RESULTS In total, 222 patients were randomized (goserelin 10.8 mg, n = 109; goserelin 3.6 mg, n = 113). PFS rate at week 24 was 61.5 % (goserelin 10.8 mg) and 60.2 % (goserelin 3.6 mg); treatment difference (95 % CI) was 1.3 % (-11.4, 13.9), confirming non-inferiority of goserelin 10.8 mg compared with goserelin 3.6 mg. ORR was 23.9 % (goserelin 10.8 mg) and 26.9 % (goserelin 3.6 mg); treatment difference (95 % CI) was -3.0 % (-15.5, 9.7). At week 24, mean serum E2 concentrations were similar in the goserelin 10.8 mg and goserelin 3.6 mg groups (20.3 pg/mL and 24.8 pg/mL, respectively). CONCLUSION A regimen of 3-monthly goserelin 10.8 mg demonstrated non-inferiority compared with monthly goserelin 3.6 mg for PFS rate at 24 weeks, with similar pharmacodynamic and safety profiles, in pre-menopausal women with ER-positive breast cancer.
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Affiliation(s)
- Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | | | - Vani Parmar
- Breast Disease Management Group, Tata Memorial Hospital, Mumbai, India
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hwei-Chung Wang
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | | | - Jofel Isidro
- Great Saviour International Hospital, Iloilo, Philippines
| | - Ku Sang Kim
- Department of Breast and Thyroid Surgery, Ulsan City Hospital, Ulsan, Korea
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Iwase H, Yamamoto Y. Clinical benefit of sequential use of endocrine therapies for metastatic breast cancer. Int J Clin Oncol 2015; 20:253-61. [DOI: 10.1007/s10147-015-0793-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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Arnedos M, Smith I. Progression of endocrine therapies for breast cancer: where are we headed? Expert Rev Anticancer Ther 2014; 7:1651-64. [DOI: 10.1586/14737140.7.11.1651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Rody A, Loibl S, von Minckwitz G, Kaufmann M. Use of goserelin in the treatment of breast cancer. Expert Rev Anticancer Ther 2014; 5:591-604. [PMID: 16111461 DOI: 10.1586/14737140.5.4.591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gonadotropin-releasing hormone analogs are, alongside tamoxifen, one of the most commonly used drugs in the treatment of pre-/perimenopausal endocrine-responsive breast cancer. Goserelin, as a principal agent of this class of drugs, is mainly investigated in clinical trials. The indirect comparison of goserelin with tamoxifen as a single drug in the adjuvant setting showed similar efficacy. Furthermore, goserelin is as effective as cyclophosphamide, methotrexate and 5-fluorouracil chemotherapy, and total endocrine blockade as a combination of gonadotropin-releasing hormone analog and tamoxifen showed a comparable benefit with anthracycline-containing adjuvant chemotherapy. Goserelin administered after cessation of chemotherapy leads to a further improvement and may be equieffective as tamoxifen or a combination of both. Data concerning taxane-based and dose-dense chemotherapy as well as combination of gonadotropin-releasing hormone analogs with third-generation aromatase inhibitors are still lacking (ongoing suppression of ovarian function, tamoxifen and exemestane, and premenopausal endocrine-responsive chemotherapy trials). Moreover, duration of therapy with gonadotropin-releasing hormone analogs (2-3 years or longer) is still a matter of debate. Palliative endocrine treatment is standard in the first-line therapy of patients without life-threatening disease and endocrine-responsive breast cancer. Treatment decisions depend upon adjuvant endocrine pretreatment. Clinical data regarding ovarian protection by synchronous use of gonadotropin-releasing hormone in young breast cancer patients receiving chemotherapy are incoherent.
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Affiliation(s)
- Achim Rody
- Department of Obstetrics and Gynecology, JW Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
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Wu S, Li Q, Zhu Y, Sun J, Li F, Lin H, Guan X, He Z. Role of goserelin in combination with endocrine therapy for the treatment of advanced breast cancer in premenopausal women positive for hormone receptor: a retrospective matched case-control study. Cancer Biother Radiopharm 2013; 28:697-702. [PMID: 23806020 DOI: 10.1089/cbr.2012.1436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This research was to investigate the role of goserelin in combination with endocrine therapy for the treatment of advanced breast cancer in premenopausal women positive for hormone receptors. METHODS We retrospectively analyzed 40 patients as the treatment group with advanced breast cancer who, were positive for hormone receptors, received goserelin in combination with endocrine therapy and 40 patients as the control group received endocrine therapy alone, matched for age, gender, receptor status, and tumor stage. RESULTS The median period of follow-up was 38.9 months. The response status at 6 months, the overall clinical benefit rate was 87.5% and 70.0% in the treatment group and control group, respectively. The mean progression-free survival (PFS) in the treatment group and control group was 27.9 and 16.9 months, respectively. The 1-, 2-, and 3-year PFS rates were 87.5%, 66.2%, and 49.7%, respectively, in the treatment group and 59.2%, 38.8%, and 35.3%, respectively, in the control group (p=0.076). The 1-, 2-, and 3-year overall survival (OS) rates were 100%, 87.2%, and 76.6%, respectively, in the treatment group and 90.0%, 74.2%, and 55.8%, respectively, in the control group (p=0.048). For the treatment group with age <40 years, PFS (p=0.036) and OS (p=0.014) were significantly longer than the control group, but it was no effect on the prognosis with the patients aged ≥40 years. Continued use of goserelin after disease progress again in the median survival time was significantly longer than nonusers (28.2 months vs. 7.0 months), and there is the potential benefit of OS (p=0.070). CONCLUSIONS For premenopausal hormone receptor-positive advanced breast cancer, goserelin-combined endocrine therapy can be used for those <40 years, the standard endocrine treatment for patients, we recommend continued use of goserelin for patients with disease progress again.
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Affiliation(s)
- Sangang Wu
- 1 Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University , Xiamen, People's Republic of China
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Schiavon G, Smith IE. Endocrine therapy for advanced/metastatic breast cancer. Hematol Oncol Clin North Am 2013; 27:715-36, viii. [PMID: 23915741 DOI: 10.1016/j.hoc.2013.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
First-line endocrine therapy by estrogen antagonism or suppression of estrogen achieves objective responses (ORs) and clinical benefit (CB) in around 30% and 50% of estrogen receptor-positive metastatic breast cancer patients, respectively. Aromatase inhibitors (AIs) are the most effective treatment in previously untreated postmenopausal women. Tamoxifen is an effective alternative. The optimal endocrine therapy on relapse remains uncertain. Tamoxifen and fulvestrant achieve CB in around 50% of patients and ORs of 10%. CB of exemestane after nonsteroidal AIs is 30% to 50% but ORs are rare. Targeted agents (eg, everolimus) plus endocrine therapy are likely to become increasingly important in overcoming endocrine resistance.
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Affiliation(s)
- Gaia Schiavon
- Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
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Barrios C, Forbes JF, Jonat W, Conte P, Gradishar W, Buzdar A, Gelmon K, Gnant M, Bonneterre J, Toi M, Hudis C, Robertson JFR. The sequential use of endocrine treatment for advanced breast cancer: where are we? Ann Oncol 2012; 23:1378-86. [PMID: 22317766 PMCID: PMC6267865 DOI: 10.1093/annonc/mdr593] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/23/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hormone receptor-positive advanced breast cancer is an increasing health burden. Although endocrine therapies are recognised as the most beneficial treatments for patients with hormone receptor-positive advanced breast cancer, the optimal sequence of these agents is currently undetermined. METHODS We reviewed the available data on randomised controlled trials (RCTs) of endocrine therapies in this treatment setting with particular focus on RCTs reported over the last 15 years that were designed based on power calculations on primary end points. RESULTS In this paper, data are reviewed in postmenopausal patients for the use of tamoxifen, aromatase inhibitors and fulvestrant. We also consider the available data on endocrine crossover studies and endocrine therapy in combination with chemotherapy or growth factor therapies. Treatment options for premenopausal patients and those with estrogen receptor-/human epidermal growth factor receptor 2-positive tumours are also evaluated. CONCLUSION We present the level of evidence available for each endocrine agent based on its efficacy in advanced breast cancer and a diagram of possible treatment pathways.
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Affiliation(s)
- C. Barrios
- Internal Medicine Department, PUCRS School of Medicine, Porto Alegre,
Brazil
| | - J. F. Forbes
- School of Medicine & Public Health, University of Newcastle, Newcastle,
Australia
| | - W. Jonat
- Department of Obstetrics and Gynaecology, University of Kiel, Kiel,
Germany
| | - P. Conte
- Department of Oncology and Hematology, University of Modena and Reggio
Emilia, Modena, Italy
| | - W. Gradishar
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University
Feinberg School of Medicine, Chicago
| | - A. Buzdar
- Department of Breast Medical Oncology, University of Texas MD Anderson
Cancer Center, Houston, USA
| | - K. Gelmon
- Department of Medical Oncology, University of British Columbia, Vancouver,
Canada
| | - M. Gnant
- Department of Surgery, Comprehensive Cancer Centre Vienna, Medical
University of Vienna, Vienna, Austria
| | - J. Bonneterre
- Integrated Clinical Research Unit, Centre Oscar Lambret, Lille, France
| | - M. Toi
- Breast Surgery Department, Kyoto University, Kyoto, Japan
| | - C. Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New
York, USA
| | - J. F. R. Robertson
- Faculty of Medicine and Health Sciences, Nottingham University, Derby,
UK
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Di Leo A, Malorni L. Polyendocrine treatment in estrogen receptor-positive breast cancer: a "FACT" yet to be proven. J Clin Oncol 2012; 30:1897-900. [PMID: 22547606 DOI: 10.1200/jco.2012.41.7394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gogineni K, DeMichele A. Current approaches to the management of Her2-negative metastatic breast cancer. Breast Cancer Res 2012; 14:205. [PMID: 22429313 PMCID: PMC3446361 DOI: 10.1186/bcr3064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
While metastatic breast cancer (MBC) remains incurable, a vast array of active therapeutic agents has provided the opportunity for long-term disease control while maintaining quality of life and physical function. Optimal management of MBC balances a multitude of factors, including a woman's performance status, social support, symptoms, disease burden, prior therapies, and surrogates for tumor biology. Choosing the most appropriate initial therapy and subsequent sequence of treatments demands flexibility as goals and patient preferences may change. Knowledge of the estrogen receptor (ER), progesterone receptor (PR), and Her2 receptor status of the metastatic tumor has become critical to determining the optimal treatment strategy in the metastatic setting as targeted therapeutic approaches are developed. Patients with ER+ or PR+ breast cancer or both have a wide array of hormonal therapy options that can forestall the use of cytotoxic therapies, although rapidly progressive phenotypes and the emergence of resistance may ultimately lead to the need for chemotherapy in this setting. So-called 'triple-negative' breast cancer - lacking ER, PR, and Her2 overexpression - remains a major challenge. These tumors have an aggressive phenotype, and clear targets for therapy have not yet been established. Chemotherapy remains the mainstay of treatment in this group, but biologically based clinical trials of new agents are critical to developing a more effective set of therapies for this patient population.
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Affiliation(s)
- Keerthi Gogineni
- Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, West Pavilion, 3rd Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Role of hormonal manipulations in patients with hormone-sensitive metastatic breast cancer. Eur J Cancer 2011; 47 Suppl 3:S28-37. [PMID: 21943985 DOI: 10.1016/s0959-8049(11)70144-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yao S, Xu B, Li Q, Zhang P, Yuan P, Wang J, Ma F, Fan Y. Goserelin plus letrozole as first- or second-line hormonal treatment in premenopausal patients with advanced breast cancer. Endocr J 2011; 58:509-16. [PMID: 21532215 DOI: 10.1507/endocrj.k11e-020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A promising new option as the treatment of choice for premenopausal patients with metastatic breast cancer (MBC) could be the combination of a luteinising hormone-releasing hormone analog and an aromatase inhibitor. Very little data about the use of goserelin with anastrozole in advanced breast cancer are available, and no cohort studies on the efficacy of goserelin with letrozole in advanced premenopausal breast cancer patients have been reported. We present the single-centre, retrospective, experience of goserelin plus letrozole in a total of 52 premenopausal women with MBC. All patients received goserelin 3.6 mg by subcutaneous injection every 4 weeks along with letrozole 2.5 mg daily as first-line (n=36) and second-line (n=16) hormonal treatment. The median duration of goserelin with letrozole treatment was 11 (range, 2-61) months, and the median duration of overall follow-up was 31 (range, 3-66) months. The objective response rate (ORR) was 21.1%, with two complete response (CR) (3.8%) and nine partial response (PR) (17.3%). Stable disease (SD) lasting more than 6 months was achieved by 26 patients (50.0%). Thus, goserelin with letrozole conferred clinical benefit (CB) in 37 women (71.1%). The progression-free survival (PFS) was 10 months. CR was exclusively observed in hormone receptor-double-positive patients. Drug therapy was well tolerated; no grade 3/4 toxicities were reported. Goserelin plus letrozole appears to be an efficacious and well-tolerated regimen in women with advanced breast cancer. Further prospectively randomized studies involving more patients and longer follow-up are indicated.
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Affiliation(s)
- Shuyang Yao
- Department of Medical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100021, China
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Comen EA, Fornier MN. Algorithms for the treatment of patients with metastatic breast cancer and prior exposure to taxanes and anthracyclines. Clin Breast Cancer 2010; 10 Suppl 2:S7-19. [PMID: 20805067 DOI: 10.3816/cbc.2010.s.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
At present, metastatic breast cancer (MBC) remains an incurable disease, with the goals of care aimed at maximizing the patient's duration and quality of life. Treatment options for a patient with MBC have become more efficacious and numerous. In addition to endocrine and chemotherapy agents, a number of targeted agents, including trastuzumab and bevacizumab, are available. The option to use novel agents combined with a multitude of standard chemotherapies has further enhanced the landscape of therapeutic options. As such, specific regimens must be evaluated within the framework of the individual patient, answering such questions as whether to treat with sequential single agents or combination regimens as well as which agents to use and in what sequence. The concept of personalized care is even more apparent in the setting of MBC, where the goal of palliation is intrinsically more nuanced than that of curative intent. This review will broadly assess the evidence for current treatment options with attention to varying clinical scenarios. Ultimately, delivering quality of care necessitates balancing an understanding of evidence-based data with sensitive attention to quality-of-life goals.
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Affiliation(s)
- Elizabeth A Comen
- Department of Medicine, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Carlson RW, Theriault R, Schurman CM, Rivera E, Chung CT, Phan SC, Arun B, Dice K, Chiv VY, Green M, Valero V. Phase II Trial of Anastrozole Plus Goserelin in the Treatment of Hormone Receptor–Positive, Metastatic Carcinoma of the Breast in Premenopausal Women. J Clin Oncol 2010; 28:3917-21. [DOI: 10.1200/jco.2009.24.9565] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To explore the antitumor activity of the aromatase inhibitor, anastrozole, in the treatment of premenopausal women with hormone receptor–positive, metastatic breast cancer who have been rendered functionally postmenopausal with the use of the luteinizing hormone-releasing hormone agonist, goserelin. Patients and Methods Premenopausal women with estrogen and/or progesterone receptor–positive, metastatic or recurrent breast cancer were enrolled in this prospective, single-arm, multicenter phase II trial. Patients were treated with goserelin 3.6 mg subcutaneous monthly and began anastrozole 1-mg daily 21 days after the first injection of goserelin. Patients continued on treatment until disease progression or unacceptable toxicity. Results Thirty-five patients were enrolled of which 32 were evaluable for response and toxicity. Estradiol suppression was assessed, with mean estradiol levels of 18.7 pg/mL at 3 months and 14.8 pg/mL at 6 months. One participant (3.1%) experienced a complete response, 11 (34.4%) experienced partial response, and 11 (34.4%) experienced stable disease for 6 months or longer for a clinical benefit rate of 71.9%. Median time to progression was 8.3 months (range, 2.1 to 63+) and median survival was not been reached (range, 11.1 to 63+). The most common adverse events were fatigue (50%), arthralgias (53%), and hot flashes (59%). There were no grade 4 to 5 toxicities. Conclusion The combination of goserelin plus anastrozole has substantial antitumor activity in the treatment of premenopausal women with hormone receptor–positive metastatic breast cancer.
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Affiliation(s)
- Robert. W. Carlson
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Richard Theriault
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Christine M. Schurman
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Edgardo Rivera
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Cathie T. Chung
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - See-Chun Phan
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Banu Arun
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Kristine Dice
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Vivian Y. Chiv
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Marjorie Green
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Vicente Valero
- From the Stanford Cancer Center, Stanford University, Stanford, CA; and the University of Texas M. D. Anderson Cancer Center, Houston, TX
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Abstract
AIMS Endocrine therapy is a pivotal treatment for women with hormone-receptor positive breast cancer. In premenopausal women, endocrine therapy primarily consists of tamoxifen and ovarian suppressive strategies. Younger women experience improvements in the risks of relapse or death from breast cancer with the use of chemotherapy as well, with part of this benefit explained by resultant premature amenorrhea. Unfortunately despite a centuries worth of clinical trials, the most efficacious combination of hormonal therapies and chemotherapy has yet to be determined. This paper serves as a comprehensive review of the substantial data in the adjuvant treatment of premenopausal, hormone receptor-positive women with breast cancer. METHODS AND RESULTS PubMed and American Society of Clinical Oncology (ASCO) Proceedings searches from 1896 to present were performed. All of the trials examining the role of ovarian suppression and tamoxifen with and without chemotherapy in premenopausal women were included. The current data suggests that endocrine therapy can be an important alternative to chemotherapy in select patient populations, and improvements in outcome are also seen with the combination of hormonal and chemotherapy strategies in other populations. A majority of the trials examined did not use what is considered to be current standards of care regarding chemotherapy regimens and durations of adjuvant hormonal therapy. Many unanswered questions remain particularly regarding the combined use of ovarian suppression and tamoxifen in women who are also receiving chemotherapy. CONCLUSION There is a persistent need to define optimal endocrine therapy in premenopasusal women with hormone-receptor positive breast cancer. Contemporaneous trials, such as the SOFT trial will provide direction, and additional biomarker and pharmacogenomic data will further supplement individualized patient decision making.
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Beslija S, Bonneterre J, Burstein H, Cocquyt V, Gnant M, Heinemann V, Jassem J, Köstler W, Krainer M, Menard S, Petit T, Petruzelka L, Possinger K, Schmid P, Stadtmauer E, Stockler M, Van Belle S, Vogel C, Wilcken N, Wiltschke C, Zielinski C, Zwierzina H. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20:1771-85. [DOI: 10.1093/annonc/mdp261] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Morris PG, McArthur HL, Hudis CA. Therapeutic options for metastatic breast cancer. Expert Opin Pharmacother 2009; 10:967-81. [PMID: 19351274 DOI: 10.1517/14656560902834961] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Metastatic breast cancer (MBC) remains an incurable disease despite ongoing therapeutic advances. Recently there has been progress extending the range of available cytotoxic chemotherapy drugs and optimizing their scheduling. In addition, a greater understanding of tumor biology has led to the development of a number of targeted therapies. Several of these newer agents, such as trastuzumab, lapatinib and bevacizumab, have demonstrated activity in combination with chemotherapy and have improved the prognosis of patients with MBC. We hope that further progress elucidating the pathophysiology and biology of MBC will continue to lead to corresponding advances in treatment.
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Affiliation(s)
- Patrick G Morris
- Memorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, NY 10065, New York, USA
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43
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Abstract
Breast cancer growth and dissemination is regulated by estrogen and different growth factor receptor signalling pathways. The increasing knowledge of the biology of breast cancer regarding the interaction of these signalling pathways provides a tool to understand endocrine therapies response and resistance mechanisms. In patients with slowly progressive disease, no visceral involvement, and minimal symptoms, endocrine therapy could be the strategy of choice, even if the tumor has low estrogen receptor expression. Ovarian suppression and tamoxifen are recommended for premenopausal patients whether aromatase inhibitors are the option for postmenopausal ones. Chemotherapy still remains as the right alternative for hormone unresponsive or resistant patients. This is a review focused on the different strategies and combinations of endocrine therapies for metastatic breast cancer patients considering the potential strategies clinically tested to overcome resistance and the different treatments of choice available for each scenario of disseminated disease.
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Boughey JC, Buzdar AU, Hunt KK. Recent Advances in the Hormonal Treatment of Breast Cancer. Curr Probl Surg 2008; 45:13-55. [DOI: 10.1067/j.cpsurg.2007.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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45
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Kaufmann M, Graf E, Jonat W, Eiermann W, Vescia S, Geberth M, Conrad B, Gademann G, Albert US, Loibl S, von Minckwitz G, Schumacher M. A randomised trial of goserelin versus control after adjuvant, risk-adapted chemotherapy in premenopausal patients with primary breast cancer - GABG-IV B-93. Eur J Cancer 2007; 43:2351-8. [PMID: 17897821 DOI: 10.1016/j.ejca.2007.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/16/2007] [Accepted: 08/07/2007] [Indexed: 11/30/2022]
Abstract
GABG-IV B-93 is a prospective, randomised study comparing goserelin (n=384) with no further treatment (n=392) in hormone receptor (HR)-negative breast cancer patients (n=465) after 3 cycles cyclophosphamide, methotrexate, 5-fluorouracil (CMF) for patients with 0-3 positive lymph nodes (LN) or 4 cycles epirubicin, cyclophosphamide (EC) followed by 3 cycles CMF for patients with 4-9 positive LN. After completion of the ZEBRA trial the study was amended to enrol also HR-positive patients with 1-9+LN (n=311). After a median follow-up of 4.7 years neither HR-negative nor HR-positive patients showed a benefit for goserelin. The adjusted estimated hazard ratio for event-free survival in HR-negative patients was 1.01 (goserelin versus control, 95% confidence interval [CI] 0.72-1.42, P=0.97) and 0.77 in HR-positive patients (95% CI 0.47-1.24, P=0.27). These results do not support the general use of goserelin after adjuvant chemotherapy in this group of premenopausal patients.
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Affiliation(s)
- Manfred Kaufmann
- Universitäts-Frauenklinik, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
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Cheung KL. Endocrine therapy for breast cancer: an overview. Breast 2007; 16:327-43. [PMID: 17499991 DOI: 10.1016/j.breast.2007.03.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 03/19/2007] [Accepted: 03/22/2007] [Indexed: 01/08/2023] Open
Abstract
Endocrine therapy for breast cancer has been established in the adjuvant treatment for primary disease and in the treatment of advanced disease. The ER remains the best predictor of response although other factors exist and need to be identified. Pharmacological manipulation has been replacing ablative procedures. Tamoxifen used to be the most popular agent of choice and promising new agents include the pure anti-oestrogens and the third generation selective aromatase inhibitors. Ongoing and future studies will optimise treatment in established areas and will exploit its potential roles in preoperative use and chemoprevention.
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Affiliation(s)
- K L Cheung
- Division of Breast Surgery, University of Nottingham, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Colozza M, de Azambuja E, Personeni N, Lebrun F, Piccart MJ, Cardoso F. Achievements in systemic therapies in the pregenomic era in metastatic breast cancer. Oncologist 2007; 12:253-70. [PMID: 17405890 DOI: 10.1634/theoncologist.12-3-253] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over the last decades, the introduction of several new agents into clinical practice has significantly improved disease control and obtained some, albeit rare, survival benefits in metastatic breast cancer (MBC). Despite these results, the choice of treatment for the majority of patients is still empirically based, since the only two predictive factors with level 1 evidence for clinical use are hormonal receptor status for endocrine therapy and HER-2 status for trastuzumab therapy. Important improvements in the endocrine therapy of both pre- and postmenopausal women with hormone-responsive disease have been achieved. For premenopausal women, ovarian function suppression with luteinizing hormone-releasing hormone analogs combined with tamoxifen has become the standard treatment, although aromatase inhibitors plus ovarian function suppression are under evaluation. In postmenopausal patients, aromatase inhibitors have proved to be superior to standard endocrine therapies in either first- or second-line treatment and a novel antiestrogen compound, fulvestrant, has been introduced in clinical practice. Chemotherapy remains the treatment of choice for hormone unresponsive or resistant patients. Anthracyclines and taxanes have been used either alone or in combination as first-line chemotherapy, but with the more frequent use of these agents in the adjuvant setting, new standards are needed for first-line chemotherapy, and new and more efficacious treatments are required. In the subgroup of patients with tumors that overexpress HER-2, the use of trastuzumab alone or in combination with chemotherapy has modified the natural history of these tumors, even if only about one out of two patients obtains a clinical response. In this review we summarize the main achievements and the currently available treatment options for patients with MBC.
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48
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Tan SH, Wolff AC. Luteinizing hormone-releasing hormone agonists in premenopausal hormone receptor-positive breast cancer. Clin Breast Cancer 2007; 7:455-64. [PMID: 17386122 DOI: 10.3816/cbc.2007.n.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ovarian function suppression for the treatment of premenopausal breast cancer was first used in the late 19th century. Traditionally, ovarian function suppression had been accomplished irreversibly via irradiation or surgery, but analogues of the luteinizing hormone-releasing hormone (LH-RH) have emerged as reliable and reversible agents for this purpose, especially the LH-RH agonists. Luteinizing hormone-releasing hormone antagonists are in earlier stages of development in breast cancer and are not currently in clinical use. Luteinizing hormonereleasing hormone agonists act by pituitary desensitization and receptor downregulation, thereby suppressing gonadotrophin release. Limited information is available comparing the efficacies of the depot preparations of various agonists, but pharmacodynamic studies have shown comparable suppressive capabilities on estradiol and luteinizing hormone. At present, only monthly goserelin is Food and Drug Administration-approved for the treatment of estrogen receptor-positive, premenopausal metastatic breast cancer in the United States. Luteinizing hormone-releasing hormone agonists have proven to be as effective as surgical oophorectomy in premenopausal advanced breast cancer. They offer similar outcomes compared with tamoxifen, but the endocrine combination appears to be more effective than LH-RH agonists alone. In the adjuvant setting, LH-RH agonists versus no therapy reduce the annual odds of recurrence and death in women aged>50 years with estrogen receptor-positive tumors. Luteinizing hormone-releasing hormone agonists alone or in combination with tamoxifen have shown disease-free survival rates similar to chemotherapy with CMF (cyclophosphamide/methotrexate/5-fluorouracil). Outcomes of chemotherapy with or without LH-RH agonists are comparable, though a few trials favor the combination in young premenopausal women (aged<40 years). Adjuvant LH-RH agonists with or without tamoxifen might be as efficacious as tamoxifen alone, and the additional benefit from chemotherapy is unclear. Adequately powered studies are now studying the relative merits of combining adjuvant tamoxifen or aromatase inhibitors with ovarian function suppression, the additional benefits of adding ovarian function suppression to chemotherapy, and the need for adjuvant chemotherapy for women treated with combined ovarian function suppression and anti-estrogen therapy.
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Affiliation(s)
- Sing-Huang Tan
- Department of Hematology-Oncology, National University Hospital, Singapore
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49
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Paillocher N, Lacourtoisie SA, Fondrinier É, Catala L, Morand C, Boursier J, Guerin O, Descamps P. [Infiltrating breast cancer in women younger than 25 years: 13 cases]. Presse Med 2007; 35:1618-1624. [PMID: 17086115 DOI: 10.1016/s0755-4982(06)74869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To study the prognosis of breast cancer in woman younger than 25 years and to compare it with that of other age groups to identify prognostic and histologic factors specific to this group. METHOD Retrospective study of all cases of infiltrating ductal carcinoma treated at our hospital from January 1977 through July 2005, examining clinical, histologic, and treatment variables as well as 5-year overall survival and 5-years disease-free survival rates. RESULTS The study included 13 women younger than 25 years at diagnosis. Their average age at diagnosis was 23.3 years (CI=1 year). Time from initial signs of disease until diagnosis averaged 6.6 months (CI=2.5). Clinically, the average tumor size was 28.78 mm (CI=6.06), with 46% classified as T1, 31% as T2 and 23% as T4d. We found 92.3% to be invasive ductal carcinoma, with 30% including an in-situ component; 53.8% were SBR grade 3 and 23% included axillary node invasion. Hormone receptors were present in 61.5% of tumors. During the follow-up period, we observed two deaths (with a 5-year overall survival rate, however, of 91%) and 6 recurrences (5-year disease-free survival: 66.5%). CONCLUSION Prognosis appears unfavorable among young women (younger than 40 years) with breast cancer. In our series, neither prognosis nor clinical or histologic characteristics differed in the subgroup of very young women (younger than 26 years).
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Affiliation(s)
| | | | - Éric Fondrinier
- Service d'oncologie chirurgicale, centre Paul Papin, Angers (49)
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50
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Beslija S, Bonneterre J, Burstein H, Cocquyt V, Gnant M, Goodwin P, Heinemann V, Jassem J, Köstler WJ, Krainer M, Menard S, Petit T, Petruzelka L, Possinger K, Schmid P, Stadtmauer E, Stockler M, Van Belle S, Vogel C, Wilcken N, Wiltschke C, Zielinski CC, Zwierzina H. Second consensus on medical treatment of metastatic breast cancer. Ann Oncol 2006; 18:215-25. [PMID: 16831851 DOI: 10.1093/annonc/mdl155] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The present consensus manuscript defines evidence-based recommendations for state-of-the-art treatment of metastatic breast cancer depending on disease-associated and biologic variables.
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Affiliation(s)
- S Beslija
- Central European Cooperative Oncology Group (CECOG), Schwarzspanierstrasse 7/5, A-1090 Vienna, Austria
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