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Dellapasqua S, Trillo Aliaga P, Munzone E, Bagnardi V, Pagan E, Montagna E, Cancello G, Ghisini R, Sangalli C, Negri M, Mazza M, Iorfida M, Cardillo A, Sciandivasci A, Bianco N, De Maio AP, Milano M, Campennì GM, Sansonno L, Viale G, Morra A, Leonardi MC, Galimberti V, Veronesi P, Colleoni M. Pegylated Liposomal Doxorubicin (Caelyx®) as Adjuvant Treatment in Early-Stage Luminal B-like Breast Cancer: A Feasibility Phase II Trial. Curr Oncol 2021; 28:5167-5178. [PMID: 34940072 PMCID: PMC8700739 DOI: 10.3390/curroncol28060433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Adjuvant chemotherapy for Luminal B-like breast cancers usually includes anthracycline-based regimens. However, some patients are reluctant to receive chemotherapy because of side-effects, especially alopecia, and ask for a “less intensive” or personalized approach. Patients and methods: We conducted a phase II feasibility trial to evaluate pegylated liposomal doxorubicin (PLD, Caelyx®) as adjuvant chemotherapy. Patients who received surgery for pT1–3, any N, and luminal B-like early-stage breast cancer (EBC) candidates for adjuvant chemotherapy were included. PLD was administered intravenously at 20 mg/m2 biweekly for eight courses. Endocrine therapy was given according to menopausal status. Trastuzumab was administered in HER2-positive disease. The primary endpoint was to evaluate the feasibility of this regimen, defined as the ability of a patient to achieve a relative dose intensity (RDI) of at least 85% of the eight cycles of treatment. Secondary endpoints included adverse events (AEs), tolerability, breast cancer-free survival, disease-free survival, and overall survival. Results: From March 2016 to July 2018, 63 patients were included in the trial. Median age was 49 years (range: 33–76), with mostly pre- and peri-menopausal (65%) and stage I–II (94%). Only 5% of patients had HER2-positive EBC. Median RDI was 100% (range: 12.5–100%; interquartile range, IQR: 87.5–100%). The proportion of patients meeting the primary endpoint was 84% (95% confidence interval, CI: 73–92%). Overall, 55 out of 63 enrolled patients completed treatment (87%, 95% CI: 77–94%). Most common AEs were palmar-plantar erythrodysesthesia (12.2%), fatigue (10.4%), and mucositis (8.5%). Only 13% of patients had G3 AEs. None had alopecia. After a median follow-up of 3.9 years (range: 0.3–4.7) two distant events were observed, and all patients were alive at the date of last visit. Conclusions: The trial successfully met its primary endpoint: the regimen was feasible and well tolerated and could be considered for further evaluation as a treatment option for patients with contraindications to standard anthracyclines or requiring a personalized, less intensive approach.
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Affiliation(s)
- Silvia Dellapasqua
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
- Correspondence: ; Tel.: +39-02-57-489-502
| | - Pamela Trillo Aliaga
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Elisabetta Munzone
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (V.B.); (E.P.)
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (V.B.); (E.P.)
| | - Emilia Montagna
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Giuseppe Cancello
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Raffaella Ghisini
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Claudia Sangalli
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Mara Negri
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Manuelita Mazza
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Monica Iorfida
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Anna Cardillo
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Angela Sciandivasci
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Nadia Bianco
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Ana Paula De Maio
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Monica Milano
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Giuseppe Maria Campennì
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Loredana Sansonno
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology IRCCS and University of Milan, 20141 Milan, Italy;
| | - Anna Morra
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.M.); (M.C.L.)
| | - Maria Cristina Leonardi
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.M.); (M.C.L.)
| | - Viviana Galimberti
- Division of Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.G.); (P.V.)
| | - Paolo Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.G.); (P.V.)
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
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Zhang J, Jiang H, Zhang J, Bao G, Zhang G, Wang H, Wang X. Effectiveness and safety of pegylated liposomal doxorubicin versus epirubicin as neoadjuvant or adjuvant chemotherapy for breast cancer: a real-world study. BMC Cancer 2021; 21:1301. [PMID: 34872507 PMCID: PMC8650529 DOI: 10.1186/s12885-021-09050-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pegylated liposomal doxorubicin (PLD) is an improved formulation of doxorubicin with comparable effectiveness but significantly lower cardiotoxicity than conventional anthracycline. This study aimed to evaluate the real-world effectiveness and safety of PLD versus epirubicin as neoadjuvant or adjuvant treatment for breast cancer. METHODS Clinical data of invasive breast cancer patients who received neoadjuvant or adjuvant chemotherapy with PLD or epirubicin were retrospectively collected. Propensity score matching (PSM) was performed to reduce the risk of selection bias. The molecular typing of these patients included Luminal A, Luminal B, HER2-positive, and basal-like/triple-negative. The primary outcome was pathological complete response (pCR) rate for neoadjuvant chemotherapy and 3-year disease-free survival (DFS) rate for adjuvant chemotherapy. Noninferiority was suggested if the lower limit of the 95% CI for the 3-year DFS rate difference was greater than - 10%. The secondary outcome was adverse reactions. RESULTS A total of 1213 patients were included (neoadjuvant, n = 274; adjuvant, n = 939). pCR (ypT0/Tis ypN0) rates of patients who received neoadjuvant chemotherapy were 11.6% for the PLD group and 7.0% for the epirubicin group, but the difference was not statistically significant (P = 0.4578). The 3-year DFS rate of patients who received adjuvant chemotherapy was 94.9% [95%CI, 91.1-98.6%] for the PLD group and 95.4% [95%CI, 93.0-97.9%] for the epirubicin group (P = 0.5684). Rate difference between the two groups and its 95% CI was - 0.55 [- 5.02, 3.92]. The lower limit of the 95% CI was - 5.0% > - 10.0%, suggesting that PLD is not be inferior to epirubicin in adjuvant chemotherapy for breast cancer. The incidences of myelosuppression, decreased appetite, alopecia, gastrointestinal reactions, and cardiotoxicity were lower in the PLD group than in the epirubicin group, while the incidence of nausea was higher in the PLD group. CONCLUSIONS In the neoadjuvant and adjuvant treatment of breast cancer, effectiveness is similar but toxicities are different between the PLD-containing regimen and epirubicin-containing regimen. Therefore, further study is warranted to explore PLD-based neoadjuvant and adjuvant chemotherapy for breast cancer.
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Affiliation(s)
- Jin Zhang
- Third Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Hongchuan Jiang
- Department of Breast Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Guoqiang Bao
- General Surgery Department, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Guoqiang Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150040, China
| | - Haibo Wang
- Department of Breast Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Xi Wang
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
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Ganesan K, Wang Y, Gao F, Liu Q, Zhang C, Li P, Zhang J, Chen J. Targeting Engineered Nanoparticles for Breast Cancer Therapy. Pharmaceutics 2021; 13:pharmaceutics13111829. [PMID: 34834243 PMCID: PMC8623926 DOI: 10.3390/pharmaceutics13111829] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/26/2021] [Indexed: 12/11/2022] Open
Abstract
Breast cancer (BC) is the second most common cancer in women globally after lung cancer. Presently, the most important approach for BC treatment consists of surgery, followed by radiotherapy and chemotherapy. The latter therapeutic methods are often unsuccessful in the treatment of BC because of their various side effects and the damage incurred to healthy tissues and organs. Currently, numerous nanoparticles (NPs) have been identified and synthesized to selectively target BC cells without causing any impairments to the adjacent normal tissues or organs. Based on an exploratory study, this comprehensive review aims to provide information on engineered NPs and their payloads as promising tools in the treatment of BC. Therapeutic drugs or natural bioactive compounds generally incorporate engineered NPs of ideal sizes and shapes to enhance their solubility, circulatory half-life, and biodistribution, while reducing their side effects and immunogenicity. Furthermore, ligands such as peptides, antibodies, and nucleic acids on the surface of NPs precisely target BC cells. Studies on the synthesis of engineered NPs and their impact on BC were obtained from PubMed, Science Direct, and Google Scholar. This review provides insights on the importance of engineered NPs and their methodology for validation as a next-generation platform with preventive and therapeutic effects against BC.
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Affiliation(s)
- Kumar Ganesan
- Li Ka Shing Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China; (K.G.); (Y.W.); (Q.L.)
| | - Yan Wang
- Li Ka Shing Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China; (K.G.); (Y.W.); (Q.L.)
| | - Fei Gao
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; (F.G.); (C.Z.)
| | - Qingqing Liu
- Li Ka Shing Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China; (K.G.); (Y.W.); (Q.L.)
- Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518063, China
| | - Chen Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; (F.G.); (C.Z.)
| | - Peng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China;
| | - Jinming Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; (F.G.); (C.Z.)
- Correspondence: (J.Z.); (J.C.); Tel.: +852-3917-6479 (J.C.)
| | - Jianping Chen
- Li Ka Shing Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China; (K.G.); (Y.W.); (Q.L.)
- Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518063, China
- Correspondence: (J.Z.); (J.C.); Tel.: +852-3917-6479 (J.C.)
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The Efficacy of Pegylated Liposomal Doxorubicin-Based Neoadjuvant Chemotherapy in Breast Cancer: A Retrospective Case-Control Study in Taiwan. Biochem Res Int 2020; 2020:5729389. [PMID: 32399300 PMCID: PMC7204388 DOI: 10.1155/2020/5729389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/08/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is a global issue regarding women's health, and high incident rates remain in the Taiwanese female population. Chemotherapy, using anthracycline-based chemotherapeutic agents in neoadjuvant settings, has been introduced as a promising new therapeutic option for treatment of invasive breast cancer. Set apart from conventional anthracycline regimens such as epirubicin, pegylated liposomal doxorubicin (Lipo-Dox®, PLD) was introduced for providing a justifiable treatment effect, while offering a favorable toxicity profile for breast cancer patients in a metastatic setting. However, the efficacy of PLD in neoadjuvant settings for breast cancer patients has not yet been sufficiently reported. This study aims to investigate the efficacy of PLD-based neoadjuvant chemotherapy in breast cancer patients using a retrospective matched case-control study. A total of 183 PLD cases and 183 epirubicin-based controls were included after a 1 : 1 ratio case-control matching procedure was held, according to the matching criteria. These criteria included the patient's preoperative clinical stage, molecular subtype, chemotherapy regimen with taxanes prior to surgery, and histological grade. All data were collected according to an institutional review board approved protocol. The study results reported that the PLD and epirubicin groups both obtained similar outcomes in pathologic complete response (pCR), recurrence, and overall survival rate with no statistically significant differences. Overall, the study results demonstrate that PLD-based neoadjuvant chemotherapy offers a similar effect of treatment with a favorable toxicity profile within the study follow-up duration, when compared with conventional epirubicin-based neoadjuvant chemotherapy.
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