1
|
Sun J, Li L, Chen X, Yang C, Wang L. The circRNA-0001361/miR-491/FGFR4 axis is associated with axillary response evaluated by ultrasound following NAC in subjects with breast cancer. Biochem Biophys Rep 2023; 34:101481. [PMID: 37250983 PMCID: PMC10209698 DOI: 10.1016/j.bbrep.2023.101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background miR-491-5p has been reported to regulate the expression of FGFR4 and promote gastric cancer metastasis. Hsa_circ_0001361 was demonstrated to play an oncogenic role in bladder cancer invasion and metastasis by sponging the expression of miR-491-5p. This work aimed to study the molecular mechanism of the effect of hsa_circ_0001361 on axillary response in the treatment of breast cancer. Methods Ultrasound examinations was performed to evaluate the response of breast cancer patients receiving NAC treatment. Quantitative real-time PCR, IHC assay, luciferase assay and Western blot were performed to analyze the molecular interaction between miR-491, circRNA_0001631 and FGFR4. Results Patients with low circRNA_0001631 expression had a better outcome after NAC treatment. The expression of miR-491 was remarkably higher in the tissue sample and serum collected from patients with lower circRNA_0001631 expression. On the contrary, the FGFR4 expression was notably suppressed in the tissue sample and serum collected from patients with lower circRNA_0001631 expression when compared with patients with high circRNA_0001631 expression. The luciferase activities of circRNA_0001631 and FGFR4 were effectively suppressed by miR-491 in MCF-7 and MDA-MB-231 cells. Moreover, inhibition of circRNA_0001631 expression using circRNA_0001361 shRNA effectively suppressed the expression of FGFR4 protein in MCF-7 and MDA-MB-231 cells. Up-regulation of circRNA_0001631 expression remarkably enhanced the expression of FGFR4 protein in MCF-7 and MDA-MB-231 cells. Conclusion Our study suggested that the up-regulation of hsa_circRNA-0001361 could up-regulate the expression of FGFR4 via sponging the expression of miR-491-5p, resulting in the alleviated axillary response after neoadjuvant chemotherapy (NAC) in breast cancer.
Collapse
Affiliation(s)
| | | | | | - Chunfeng Yang
- Department of Ultrasound, Yantai Yuhuangding Hospital, Yantai, 264099, China
| | - Li Wang
- Department of Ultrasound, Yantai Yuhuangding Hospital, Yantai, 264099, China
| |
Collapse
|
2
|
Chen CH, Weng TH, Chuang CH, Huang KY, Huang SC, Chen PR, Huang HH, Huang LY, Shen PC, Chuang PY, Huang HY, Wu YS, Chang HC, Weng SL, Liao KW. Transdermal nanolipoplex simultaneously inhibits subcutaneous melanoma growth and suppresses systemically metastatic melanoma by activating host immunity. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2023; 47:102628. [PMID: 36400317 DOI: 10.1016/j.nano.2022.102628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/22/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
Benefit for clinical melanoma treatments, the transdermal neoadjuvant therapy could reduce surgery region and increase immunotherapy efficacy. Using lipoplex (Lipo-PEG-PEI-complex, LPPC) encapsulated doxorubicin (DOX) and carrying CpG oligodeoxynucleotide; the transdermally administered nano-liposomal drug complex (LPPC-DOX-CpG) would have high cytotoxicity and immunostimulatory activity to suppress systemic metastasis of melanoma. LPPC-DOX-CpG dramatically suppressed subcutaneous melanoma growth by inducing tumor cell apoptosis and recruiting immune cells into the tumor area. Animal studies further showed that the colonization and growth of spontaneously metastatic melanoma cells in the liver and lung were suppressed by transdermal LPPC-DOX-CpG. Furthermore, NGS analysis revealed IFN-γ and NF-κB pathways were triggered to recruit and activate the antigen-presenting-cells and effecter cells, which could activate the anti-tumor responses as the major mechanism responsible for the therapeutic effect of LPPC-DOX-CpG. Finally, we have successfully proved transdermal LPPC-DOX-CpG as a promising penetrative carrier to activate systemic anti-tumor immunity against subcutaneous and metastatic tumor.
Collapse
Affiliation(s)
- Chia-Hung Chen
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan, ROC
| | - Tzu-Han Weng
- Dependent of Medical Education, MacKay Memorial Hospital, Taipei 10449, Taiwan, ROC
| | - Cheng-Hsun Chuang
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Kai-Yao Huang
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan, ROC; Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan, ROC
| | - Sih-Cheng Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Pin-Rong Chen
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Hsiao-Hsuan Huang
- Industrial Development Graduate Program of College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Ling-Ya Huang
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Pei-Chun Shen
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Po-Ya Chuang
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Hsiao-Yen Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Yi-Syuan Wu
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Hao-Chiun Chang
- Ph.D. Degree Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC
| | - Shun-Long Weng
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan, ROC; Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan, ROC; MacKay Junior College of Medicine, Nursing and Management, Taipei City 11260, Taiwan, ROC.
| | - Kuang-Wen Liao
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC; Drug Development and Value Creation Research Center, College of Dental Medicine, Kaohsiung Medical University School of Dentistry, Graduate Institute of Medicine, College of Medicine, Center for Cancer Research, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan, ROC; Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC; Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan City 70101, Taiwan, ROC; Ph.D. Degree Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30068, Taiwan, ROC.
| |
Collapse
|
3
|
Stege H, Haist M, Nikfarjam U, Schultheis M, Heinz J, Pemler S, Loquai C, Grabbe S. The Status of Adjuvant and Neoadjuvant Melanoma Therapy, New Developments and Upcoming Challenges. Target Oncol 2021; 16:537-552. [PMID: 34554353 PMCID: PMC8484171 DOI: 10.1007/s11523-021-00840-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
The global incidence of malignant melanoma, the leading cause of skin cancer death, has steadily increased in recent years. Surgical excision is the treatment of choice for early-stage melanoma. However, 40-60% of patients with high-risk melanoma or with nodal involvement eventually experience loco-regional relapse or tumor progression. Adjuvant therapy aims to reduce the rate of recurrence in radically operated high-risk patients with melanoma and thus improves survival. Interferon-α has long been the only approved drug for adjuvant melanoma therapy, despite an unclear survival benefit. The landmark success of immune-checkpoint inhibitors and BRAF/MEK-directed targeted therapies in the treatment of patients with stage IV melanoma led to the initiation of clinical trials in the adjuvant setting. These trials demonstrated the efficacy of immune-checkpoint inhibitors and targeted therapies for the adjuvant treatment of high-risk patients with melanoma, as shown both by an increase in recurrence-free survival and the emergence of long-term survivors, finally resulting in the approval of the cytotoxic T-lymphocyte antigen 4 inhibitor ipilimumab, PD1 inhibitors (nivolumab, pembrolizumab), and BRAF/MEK inhibitors for adjuvant melanoma therapy. This review aims to delineate the advances in adjuvant melanoma therapy, issuing particularly recent results from clinical trials. Moreover, we also discuss pending issues and future challenges, which comprise the adequate selection of adjuvant regimens for patient subgroups and the identification of markers likely to predict the individual response to adjuvant treatments. Last, we outline the role of emerging neoadjuvant approaches, which may complement adjuvant strategies and are currently investigated in clinical trials.
Collapse
Affiliation(s)
- Henner Stege
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Maximilian Haist
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ulrike Nikfarjam
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jaqueline Heinz
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Saskia Pemler
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
4
|
Abstract
With the universal adoption of immune checkpoint blockade and agents targeting BRAF-mutated melanomas in the metastatic setting, numerous clinical trials have evaluated these agents in the neoadjuvant setting. These smaller trials have shown promising results with high pathologic response rates and acceptable safety. Larger prospective randomized trials are under way to determine if all patients with resectable metastatic disease should be receiving neoadjuvant therapy.
Collapse
Affiliation(s)
- Michael C Lowe
- Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA.
| | - Ragini R Kudchadkar
- Department of Hematology and Oncology, Winship Cancer Institute, 1365 Clifton Road, Atlanta, GA 30322, USA
| |
Collapse
|
5
|
Han D, van Akkooi ACJ, Straker RJ, Shannon AB, Karakousis GC, Wang L, Kim KB, Reintgen D. Current management of melanoma patients with nodal metastases. Clin Exp Metastasis 2021; 39:181-199. [PMID: 33961168 PMCID: PMC8102663 DOI: 10.1007/s10585-021-10099-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/22/2021] [Indexed: 12/26/2022]
Abstract
The management of melanoma patients with nodal metastases has undergone dramatic changes over the last decade. In the past, the standard of care for patients with a positive sentinel lymph node biopsy (SLNB) was a completion lymph node dissection (CLND), while patients with palpable macroscopic nodal disease underwent a therapeutic lymphadenectomy in cases with no evidence of systemic spread. However, studies have shown that SLN metastases present as a spectrum of disease, with certain SLN-based factors being prognostic of and correlated with outcomes. Furthermore, the results of key clinical trials demonstrate that CLND provides no survival benefit over nodal observation in positive SLN patients, while other clinical trials have shown that adjuvant immune checkpoint inhibitor therapy or targeted therapy after CLND is associated with a recurrence-free survival benefit. Given the efficacy of these systemic therapies in the adjuvant setting, these agents are now being evaluated and utilized as neoadjuvant treatments in patients with regionally-localized or resectable metastatic melanoma. Multiple options now exist to treat melanoma patients with nodal disease, and determining the best treatment course for a particular case requires an in-depth knowledge of current data and an informed discussion with the patient. This review will provide an overview of the various options for treating melanoma patients with nodal metastases and will discuss the data that supported the development of these treatment options.
Collapse
Affiliation(s)
- Dale Han
- Division of Surgical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L619, Portland, OR, 97239, USA.
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Richard J Straker
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Adrienne B Shannon
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Lin Wang
- California Pacific Medical Center and Research Institute, San Francisco, CA, USA
| | - Kevin B Kim
- California Pacific Medical Center and Research Institute, San Francisco, CA, USA
| | - Douglas Reintgen
- Department of Surgery, Morsani School of Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
6
|
Chen Y, Guan Y, Wang J, Ma F, Luo Y, Chen S, Zhang P, Li Q, Cai R, Li Q, Mo H, Fan Y, Zhao W, Xu B. Comparison of capecitabine-based regimens with platinum-based regimens in Chinese triple-negative breast cancer patients with liver metastasis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:109. [PMID: 33569411 PMCID: PMC7867954 DOI: 10.21037/atm-20-4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Capecitabine-based chemotherapy (CBC) presents potential value in patients with liver metastasis; platinum-based chemotherapy (PBC) has shown promising benefit in patients with triple-negative breast cancer (TNBC). For TNBC patients with liver metastasis, which treatment strategy is better remains to be further studied. The aim of this study was to report the first real-world data evaluating the efficacy and safety of PBC versus CBC in the first-line treatment in Chinese TNBC patients with liver metastasis. Methods TNBC patients with liver metastasis pretreated with anthracyclines/taxanes in 4 institutions of China between January 2010 and December 2019 were included. Objective response rate (ORR), overall survival, treatment pattern, and toxicity profile were assessed between PBC and CBC groups. Results A total of 59 TNBC patients with liver metastasis were identified. Among these, 33 were treated with PBC and 26 were treated with CBC. The ORR was higher in the CBC group than in the PBC group (57.7% versus 30.3%, P=0.035). Median overall survival was also greatly improved (19.2 versus 14.4 months, P=0.041). Docetaxel/cisplatin was more likely to be used for PBC, and paclitaxel/capecitabine was the main regimen for CBC. Multivariable Cox regression analysis indicated that CBC was an independent predictor for overall survival after adjustment for baseline factors including age, tumor size, nodal status, prior anthracyclines/taxanes use, and tumor grade (odds ratio =0.51; 95% confidence interval, 0.27-0.98; P=0.042). Adverse events were not different except gastrointestinal tract toxicities, hand-foot syndrome and hematologic toxicity. Conclusions For TNBC patients with liver metastasis, capecitabin-based chemotherapy might be more suitable than the platinum-based regimen in the first-line treatment, as measured by objective response rate and overall survival. Further large-scale studies are warranted.
Collapse
Affiliation(s)
- Yimeng Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Guan
- Department of Medical Oncology, Beijing Chao-Yang Hospital, Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruigang Cai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongnan Mo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihong Zhao
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
7
|
Garutti M, Buriolla S, Bertoli E, Vitale MG, Rossi E, Schinzari G, Minisini AM, Puglisi F. "To Anticipate": Neoadjuvant Therapy in Melanoma with a Focus on Predictive Biomarkers. Cancers (Basel) 2020; 12:E1941. [PMID: 32708968 PMCID: PMC7409214 DOI: 10.3390/cancers12071941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Despite surgical resection and adjuvant therapies, stage III melanomas still have a substantial risk of relapse. Neoadjuvant therapy is an emerging strategy that might offer superior efficacy compared to adjuvant therapy. Moreover, neoadjuvant therapy has some virtual advantages: it might allow for less demolitive surgery, permit the in vivo evaluation of drug efficacy, help tailor adjuvant treatments, and play a crucial role in innovative translational research. Herein, we review the available literature to explore the scientific background behind the neoadjuvant approach. We also discuss published clinical trials with a focus on predictive biomarkers and ongoing studies. Finally, we outline a possible framework for future neoadjuvant clinical trial development based on the International Neoadjuvant Melanoma Consortium guidelines.
Collapse
Affiliation(s)
- Mattia Garutti
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.B.); (E.B.); (F.P.)
| | - Silvia Buriolla
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.B.); (E.B.); (F.P.)
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.G.V.); (A.M.M.)
| | - Elisa Bertoli
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.B.); (E.B.); (F.P.)
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.G.V.); (A.M.M.)
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.G.V.); (A.M.M.)
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (G.S.)
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (G.S.)
- Medical Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Marco Minisini
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.G.V.); (A.M.M.)
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria del Friuli Centrale, 33100 Udine, Italy
| | - Fabio Puglisi
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.B.); (E.B.); (F.P.)
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.G.V.); (A.M.M.)
| |
Collapse
|
8
|
Abstract
OPINION STATEMENT Patients with clinical stage III melanoma, defined as palpable lymph nodes with or without in-transit metastases, have poor prognosis even with recent advances with targeted and checkpoint inhibitor therapy in the adjuvant setting. Neoadjuvant therapy for clinical stage III melanoma is an attractive treatment paradigm as patient outcomes may be improved by earlier introduction to systemic therapy. Additionally, preoperative therapy that shrinks disease has the potential to improve surgical morbidity. Neoadjuvant therapy also provides for pathologic response assessment which can serve as a way to stratify patient outcomes and subsequent disease relapse risk. Early trials of neoadjuvant immunotherapy are yielding promising results, with high rates of pathologic complete response (pCR) and improved relapse-free survival rates. Ipilimumab, nivolumab with or without ipilimumab, and pembrolizumab have been investigated in the neoadjuvant setting. A meta-analysis has shown a 1-year relapse-free survival rate of over 80% with neoadjuvant immunotherapy. Importantly, pooled data also shows that pCR strongly correlates with outcomes. Early phase trials have also highlighted the importance of dosing of neoadjuvant therapy to appropriately balance response and immune related toxicities, which can be severe. The combination of ipilimumab 1 mg/kg and nivolumab 3 mg/kg has been identified as an optimal regimen for further study. Translational studies have highlighted the ability of neoadjuvant immunotherapy to expand tumor-specific T cells in both the tumor microenvironment and peripheral blood. At this time, surgical resection and adjuvant therapy remains standard of care for clinical stage III melanoma; however, appropriate patients should be considered for ongoing neoadjuvant clinical trials.
Collapse
Affiliation(s)
- Meredith S Pelster
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. #430, Houston, TX, 77030, USA.
| |
Collapse
|
9
|
Khunger A, Buchwald ZS, Lowe M, Khan MK, Delman KA, Tarhini AA. Neoadjuvant therapy of locally/regionally advanced melanoma. Ther Adv Med Oncol 2019; 11:1758835919866959. [PMID: 31391869 PMCID: PMC6669845 DOI: 10.1177/1758835919866959] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022] Open
Abstract
Locally/regionally advanced melanoma confers a major challenge in terms of surgical and medical management. Surgical treatment carries the risks of surgical morbidities and potential complications that could be lasting. In addition, these patients continue to have a high risk of relapse and death despite the use of standard adjuvant therapy. Neoadjuvant therapy has the potential to significantly improve the clinical outcome of these patients, particularly in this era of newer and effective targeted and immunotherapeutic agents. Previous neoadjuvant studies tested chemotherapy with temozolomide where the clinical activity was limited. Biochemotherapy (BCT) was tested in two studies in the neoadjuvant setting and showed high tumor response rates; however, BCT was ultimately abandoned following its failure to demonstrate survival benefits in randomized trials of metastatic disease. Success of immunotherapy and targeted therapy in prolonging the lives of patients with metastatic melanoma generated considerable interest to investigate these novel strategies in the adjuvant and neoadjuvant settings. A number of neoadjuvant targeted and immunotherapy studies have been completed in melanoma to date and have yielded promising clinical activity. Given these encouraging results, a number of studies with other molecularly targeted and immunotherapeutic agents and their combinations are ongoing in the neoadjuvant setting; long-term outcome data are eagerly awaited. Such studies also provide access to biospecimens before and during therapy, allowing for the conduct of biomarker and mechanistic studies that may have a significant impact in guiding adjuvant therapy choices and drug development.
Collapse
Affiliation(s)
- Arjun Khunger
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Zachary S. Buchwald
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Lowe
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammad K. Khan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Keith A. Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ahmad A. Tarhini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Comprehensive Cancer Center, 1365 Clifton Rd Atlanta, GA 30322, USA
| |
Collapse
|
10
|
Pathak M, Dwivedi SN, Deo SVS, Thakur B, Sreenivas V, Rath GK. Effectiveness of taxanes over anthracyclines in neoadjuvant setting: A systematic-review and meta-analysis. World J Meta-Anal 2019; 7:170-183. [DOI: 10.13105/wjma.v7.i4.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anthracyclines and taxanes are more active group of chemotherapy regimen. Randomized controlled trials (RCTs) reported variable evidences regarding efficacy of taxanes over anthracyclines for tumor response and survival outcomes. The present study compares the relative efficacy of taxanes over anthracyclines using pathological complete response (pCR), clinical responses, breast-conserving surgeries and survival outcomes in female breast cancer patients by systematic review and meta-analysis of available RCTs.
AIM To assess the effectiveness of taxanes over anthracyclines in neoadjuvant setting in terms of tumor response and survival outcomes.
METHODS All RCTs assessing efficacy of taxanes over anthracyclines in neoadjuvant setting for management of breast cancer searched through PubMed and Cochrane register of controlled trials on 28 April 2017 and published in English language were considered. Following PRISMA guideline, retrieved records were screened and data were extracted by two independent reviewers. Meta-analysis was performed using fixed effect or random effect method depending on heterogeneity assessed using I2 statistic. Subgroup meta-analyses on the basis of taxane alone or taxane along with anthracycline in comparison to anthracycline alone were also performed for each considered outcomes.
RESULTS A total of 16 RCTs involving 6752 breast cancer patients were found eligible. Taxanes based chemotherapy significantly improved pCR (n = 7, RR = 1.48, 95%CI: 1.04-2.12), disease free survival [n = 6, RR = 0.89 (0.80-0.99)] and loco-regional recurrence free survival [n = 4, RR = 0.74 (0.59-0.94)]. Interestingly in subgroup analysis, addition of taxane to anthracyclines showed better effectiveness regarding these survivals over anthracyclines than taxane alone over anthracycline.
CONCLUSION Addition of taxanes to anthracyclines based chemotherapy significantly improves pCR, disease free survival and loco-regional recurrence free survival but with no significant impact on breast conservation rates.
Collapse
Affiliation(s)
- Mona Pathak
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
- Division of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - SVS Deo
- Department of Surgical Oncology, BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Thakur
- Division of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, India
| | - Vishnubhatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Goura Kishor Rath
- Department of Radiotherapy, BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
11
|
Lai J, Pan Z, Chen P, Ye G, Chen K, Su F. Development and validation of a nomogram incorporating axillary lymph node ratio to predict survival in node-positive breast cancer patients after neoadjuvant chemotherapy. Jpn J Clin Oncol 2019; 49:22-28. [PMID: 30508184 DOI: 10.1093/jjco/hyy181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/09/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Over the past decade, several studies have highlighted that axillary lymph node ratio (ratio of involved over excised axillary lymph nodes) was a superior predictor for survival outcomes compared with ypN staging. Thus, this study aimed to integrate the prognostic value of axillary lymph node ratio to improve individualized prediction of survival in node-positive breast cancer patients after neoadjuvant chemotherapy. Methods A clinical data of 339 node-positive breast cancer patients after neoadjuvant chemotherapy from two independent centers were retrospectively reviewed. A nomogram incorporating axillary lymph node ratio was constructed to predict disease-free survival based on Cox proportional hazards model. The discrimination, calibration ability, and clinical usefulness of the axillary lymph node ratio-based model were evaluated using C-index, calibration curve, risk group stratification and decision curve analysis and were compared with the TNM staging system. Results Independent prognostic factors for disease-free survival were age, pathological T stage, axillary lymph node ratio, histological grade, estrogen receptor status, Ki67 and lymphovascular invasion, which were entered into the nomogram. The C-index of the axillary lymph node ratio-based nomogram was higher than that of the TNM staging system (0.773 vs 0.610). The calibration plot indicated close agreement between model predictions and actual observations. Based on the risk group stratification of the nomogram, Kaplan-Meier curves demonstrated significant differences between the low-risk and high-risk groups (P < 0.0001). Conclusions The axillary lymph node ratio-based nomogram provided more accurate individualized risk prediction of disease-free survival in node-positive breast cancer patients after neoadjuvant chemotherapy. This practical tool may assist oncologists in selecting the high-risk patients who are in need of a specific treatment strategy.
Collapse
Affiliation(s)
- Jianguo Lai
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zihao Pan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Peixian Chen
- Department of Breast Oncology, Cancer Center, First People's Hospital of Foshan (Affiliated Foshan Hospital of Sun Yat-Sen University), Foshan, China
| | - Guolin Ye
- Department of Breast Oncology, Cancer Center, First People's Hospital of Foshan (Affiliated Foshan Hospital of Sun Yat-Sen University), Foshan, China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
12
|
Tarhini A, Lin Y, Lin H, Rahman Z, Vallabhaneni P, Mendiratta P, Pingpank JF, Holtzman MP, Yusko EC, Rytlewski JA, Rao UNM, Ferris RL, Kirkwood JM. Neoadjuvant ipilimumab (3 mg/kg or 10 mg/kg) and high dose IFN-α2b in locally/regionally advanced melanoma: safety, efficacy and impact on T-cell repertoire. J Immunother Cancer 2018; 6:112. [PMID: 30352626 PMCID: PMC6199801 DOI: 10.1186/s40425-018-0428-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/10/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neoadjuvant immunotherapy utilizing novel combinations has the potential to transform the standard of care for locally/regionally advanced melanoma. We hypothesized that neoadjuvant ipilimumab in combination with high dose IFNα2b (HDI) is safe and associated with durable pathologic complete responses (pCR). METHODS Patients with locally/regionally advanced melanoma were randomized to ipilimumab 3 or 10 mg/kg × 4 doses bracketing definitive surgery, then every 12 weeks × 4. HDI was given concurrently. We evaluated the safety and efficacy of the combination with ipilimumab 3 or 10 mg/kg. The impact on T-cell fraction and clonality were investigated in tumor and blood. RESULTS Thirty patients (age 37-76), 15 each at 3 and 10 mg/kg, 18 male and 12 female were treated. Considering immune related adverse events (irAEs) of interest, more grade 3/4 irAEs were seen with ipilimumab 10 mg/kg versus 3 mg/kg (p = 0.042). Among 28 evaluable patients, 11 relapsed, of whom 5 died. Median follow-up for 17 patients who have not relapsed was 32 months. The radiologic preoperative response rate was 36% (95% CI, 21-54); 4 patients at ipilimumab 3 mg/kg and 6 at 10 mg/kg and 2 (at 10 mg/kg) later relapsed. The pCR was 32% (95% CI, 18-51); 5 patients at ipilimumab 3 mg/kg and 4 at 10 mg/kg and one (at 3 mg/kg) had a late relapse. In patients with pCR, T-cell fraction was significantly higher when measured in primary melanoma tumors (p = 0.033). Higher tumor T-cell clonality in primary tumor and more so following neoadjuvant therapy was significantly associated with improved relapse free survival. CONCLUSIONS Neoadjuvant ipilimumab-HDI was relatively safe and exhibited promising tumor response rates with an associated measurable impact on T-cell fraction and clonality. Most pCRs were durable supporting the value of pCR as a primary endpoint in neoadjuvant immunotherapy trials. TRIAL REGISTRATION ClinicalTrials.gov, NCT01608594 . Registered 31 May 2012.
Collapse
Affiliation(s)
- Ahmad Tarhini
- UPMC Hillman Cancer Center, Pittsburgh, USA. .,Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute and Case Comprehensive Cancer Center, 9500 Euclid Ave CA6-157, Cleveland, OH, 44195, USA.
| | - Yan Lin
- UPMC Hillman Cancer Center, Pittsburgh, USA
| | - Huang Lin
- UPMC Hillman Cancer Center, Pittsburgh, USA
| | | | | | - Prateek Mendiratta
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute and Case Comprehensive Cancer Center, 9500 Euclid Ave CA6-157, Cleveland, OH, 44195, USA
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Vitásková D, Melichar B, Bartoušková M, Vlachová Z, Vrána D, Janková J, Adam T, Juráňová J, Zlámalová N, Kujovská Krčmová L, Javorská L, Klos D, Študentová H. Neoadjuvant combination therapy with trastuzumab in a breast cancer patient with synchronous rectal carcinoma: a case report and biomarker study. Pteridines 2017. [DOI: 10.1515/pterid-2017-0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
We report a patient who presented with synchronous second primary human epidermal growth factor receptor (HER)-2-positive breast cancer and rectal cancer that both required simultaneous neoadjuvant therapy. A modified regimen combining anti-HER-2 monoclonal antibody trastuzumab with chemotherapy and external beam radiation was selected. An organ-preserving surgical procedure was possible both in the breast and the rectum. Citrulline decreased rapidly after the start of the treatment, and then gradually returned to pre-treatment levels after the completion of chemoradiation. Urinary neopterin concentrations exhibited a fluctuating course. Both serum neopterin and C-reactive protein concentrations were more or less stable during the initial administration of trastuzumab, paclitaxel and carboplatin and then increased steeply during chemoradiation and subsequently declined to pre-treatment levels during the weekly trastuzumab administration. Changes were observed in the serum retinol concentrations. A decline in lymphocyte counts was accompanied by marked changes in peripheral blood cell count-derived ratios. The present case report demonstrates a successful combination of two neoadjuvant regimens in a patient with two synchronous different second primary tumors. Data from this case also illustrate the use of biomarkers for monitoring of intensive therapeutic regimens in medical and radiation oncology.
Collapse
Affiliation(s)
- Denisa Vitásková
- Department of Oncology , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
| | - Bohuslav Melichar
- Department of Oncology , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
- Institute of Molecular and Translational Medicine , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
| | - Marie Bartoušková
- Department of Oncology , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
| | - Zuzana Vlachová
- Department of Oncology , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
| | - David Vrána
- Department of Oncology , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
- Institute of Molecular and Translational Medicine , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
| | - Jana Janková
- Institute of Molecular and Clinical Pathology , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
| | - Tomáš Adam
- Institute of Molecular and Translational Medicine , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
- Department of Clinical Biochemistry , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
| | - Jarmila Juráňová
- Department of Hemato-Oncology , Palacký University Medical School and Teaching Hospital , Olomouc , Czech Republic
| | - Nora Zlámalová
- First Department of Surgery , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
| | - Lenka Kujovská Krčmová
- Third Department of Medicine (Gerontology and Metabolic Care) , Charles University Teaching Hospital , Hradec Králové , Czech Republic
- Department of Analytical Chemistry , Charles University School of Pharmacy , Hradec Králové , Czech Republic
| | - Lenka Javorská
- Third Department of Medicine (Gerontology and Metabolic Care) , Charles University Teaching Hospital , Hradec Králové , Czech Republic
- Department of Analytical Chemistry , Charles University School of Pharmacy , Hradec Králové , Czech Republic
| | - Dušan Klos
- First Department of Surgery , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
| | - Hana Študentová
- Department of Oncology , Palacký University Medical School and Teaching Hospital , I.P. Pavlova 6, 779 00 Olomouc , Czech Republic
| |
Collapse
|
14
|
Saloustros E, Nikolaou M, Kalbakis K, Polyzos A, Christofillakis C, Kentepozidis N, Pistamaltzian N, Kourousis C, Vamvakas L, Georgoulias V, Mavroudis D. Weekly Paclitaxel and Carboplatin Plus Bevacizumab as First-Line Treatment of Metastatic Triple-Negative Breast Cancer. A Multicenter Phase II Trial by the Hellenic Oncology Research Group. Clin Breast Cancer 2017; 18:88-94. [PMID: 29153775 DOI: 10.1016/j.clbc.2017.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/03/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) lacks a standard targeted therapeutic strategy and is treated with conventional cytotoxic agents. Because of the sensitivity of TNBC to platinum compounds and the synergistic effect of bevacizumab with paclitaxel we investigated the efficacy and toxicity of weekly paclitaxel and carboplatin in combination with bevacizumab as first-line treatment in metastatic TNBC. PATIENTS AND METHODS This phase II study followed the Simon's 2-stage optimal design. Paclitaxel (90 mg/m2) and carboplatin (2 area under the curve) were administered on days 1, 8, and 15 every 4 weeks, preceded by bevacizumab 10 mg/kg on days 1 and 15. The primary end point was the objective response rate (ORR). The null hypothesis that the ORR is ≤ 40% could be rejected if the number of objective responses was ≥ 23 among 46 evaluable patients. RESULTS A total of 46 patients were enrolled. Seven (15.2%) complete and 23 (50%) partial responses were observed for an ORR of 65.2% (95% confidence interval, 52.9%-80.4%). The median progression-free survival was 10.3 months, the median overall survival 25.7 months, and the median duration of response 18.2 months. Neutropenia Grade III and IV was experienced by 13 (28.3%) and 6 (13.04%) patients, respectively. One patient developed an uneventful Grade IV thrombocytopenia. There was 1 toxic death due to febrile neutropenia. Other Grade III toxicities included anemia (n = 2), neurotoxicity (n = 2), thrombocytopenia (n = 1), and diarrhea (n = 1). No serious bevacizumab-related toxicities were observed. CONCLUSION The study achieved its primary end point by showing clinical activity for weekly paclitaxel with carboplatin and bevacizumab combination. This regimen merits further evaluation in this setting.
Collapse
Affiliation(s)
- Emmanouil Saloustros
- Oncology Unit, General Hospital of Heraklion 'Venizelio-Pananio', Heraklion, Crete, Greece
| | - Michail Nikolaou
- Department of Internal Medicine, "Hippokratio" General Hospital of Athens, Athens, Greece
| | - Konstantinos Kalbakis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Aris Polyzos
- 1st Department of Medicine, Medical School, University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Nikolaos Kentepozidis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | - Lampros Vamvakas
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Vasilios Georgoulias
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Dimitris Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece.
| |
Collapse
|
15
|
Neoadjuvant Chemotherapy Creates Surgery Opportunities For Inoperable Locally Advanced Breast Cancer. Sci Rep 2017; 7:44673. [PMID: 28327615 PMCID: PMC5361098 DOI: 10.1038/srep44673] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/13/2017] [Indexed: 11/19/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC), the systematic chemotherapy given to patients with locally advanced and inoperable breast caner, has been proven to be of great clinical values. Many scientific reports confirmed NAC could effectively eliminate sub-clinical disseminated lesions of tumor, and improve long-term and disease-free survival rate of patients with locally advanced breast cancer (LABC); however, up to now, LABC is still a serious clinical issue given improved screening and early diagnosis. This study, with main focus on inoperable LABC, investigated the values of NAC in converting inoperable LABC into operable status and assessed the prognosis. Sixty-one patients with inoperable LABC were initially treated with neoadjuvant chemotherapy; their local conditions were improved to operable status. Radical surgery was exerted on 49 patients. Original chemotherapy was performed after surgery, followed by local radiotherapy. And endocrine therapy was optional according to the hormone receptor status. The quality of life for most patients with skin diabrosis was obviously improved because their local conditions were under control. For all recruited cases, the survival duration and life quality were significantly improved in patients who finished both NAC and surgery compared to those who did not. Further more, this study demonstrates improved prognostic consequences.
Collapse
|
16
|
Tan QW, Luo T, Zheng H, Tian TL, He P, Chen J, Zeng HL, Lv Q. Weekly taxane-anthracycline combination regimen versus tri-weekly anthracycline-based regimen for the treatment of locally advanced breast cancer: a randomized controlled trial. CHINESE JOURNAL OF CANCER 2017; 36:27. [PMID: 28270181 PMCID: PMC5340016 DOI: 10.1186/s40880-017-0196-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/07/2016] [Indexed: 02/05/2023]
Abstract
Background Extensive studies have confirmed the efficacy of taxanes in combination with anthracycline-based chemotherapy on breast cancer. However, few studies have assessed the efficacy of weekly taxane–anthracycline regimens on locally advanced breast cancer. This study was to compare the efficacy and safety of a weekly taxane–anthracycline regimen with those of tri-weekly anthracycline-based regimen in patients with locally advanced breast cancer. Methods Patients with locally advanced breast cancer were randomized to receive 4–6 cycles of neoadjuvant chemotherapy with tri-weekly 5-fluorouracil–epirubicin–cyclophosphamide (FEC) regimen or weekly paclitaxel–epirubicin (PE) regimen. The primary endpoint was the pathologic complete response (pCR) rate. Other endpoints included the clinical tumor response, breast-conserving surgery rate, and adverse events. Results Between March 2010 and September 2013, 293 patients were randomized to the FEC (n = 151) and PE (n = 142) arms. The overall clinical response rate was significantly higher in the PE arm than in the FEC arm (76.06% vs. 59.95%, P = 0.001). Consistently, the post-chemotherapy pathologic T and N stages were significantly lower in the PE arm than in the FEC arm (P < 0.001). However, the pCR rate was similar in the two arms (10.61% vs. 12.31%, P = 0.665). Overall, 36 (27.27%) patients in the FEC arm and 6 (35.28%) in the PE arm were qualified for breast-conserving surgery. Most adverse events were comparable in both arms, with more severe neutropenia in the PE arm than in the FEC arm (11.97% vs. 5.96%, P = 0.031). Conclusions In patients with locally advanced breast cancer, weekly PE was not superior to FEC in terms of pCR. However, weekly PE has a higher response rate and superior down-staging effects. On this account, the PE regimen may be considered an alternative option for locally advanced breast cancer. Long-term follow-up data are needed to confirm the efficacy of this regimen on locally advanced breast cancer. Trial registration Chinese clinical trial registry, ChiCTR-TRC-10001043, September 21, 2014
Collapse
Affiliation(s)
- Qiu-Wen Tan
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Ting Luo
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Hong Zheng
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Ting-Lun Tian
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Ping He
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Jie Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - He-Lin Zeng
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China.
| |
Collapse
|
17
|
Ascierto PA, Agarwala S, Botti G, Cesano A, Ciliberto G, Davies MA, Demaria S, Dummer R, Eggermont AM, Ferrone S, Fu YX, Gajewski TF, Garbe C, Huber V, Khleif S, Krauthammer M, Lo RS, Masucci G, Palmieri G, Postow M, Puzanov I, Silk A, Spranger S, Stroncek DF, Tarhini A, Taube JM, Testori A, Wang E, Wargo JA, Yee C, Zarour H, Zitvogel L, Fox BA, Mozzillo N, Marincola FM, Thurin M. Future perspectives in melanoma research : Meeting report from the "Melanoma Bridge". Napoli, December 1st-4th 2015. J Transl Med 2016; 14:313. [PMID: 27846884 PMCID: PMC5111349 DOI: 10.1186/s12967-016-1070-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022] Open
Abstract
The sixth "Melanoma Bridge Meeting" took place in Naples, Italy, December 1st-4th, 2015. The four sessions at this meeting were focused on: (1) molecular and immune advances; (2) combination therapies; (3) news in immunotherapy; and 4) tumor microenvironment and biomarkers. Recent advances in tumor biology and immunology has led to the development of new targeted and immunotherapeutic agents that prolong progression-free survival (PFS) and overall survival (OS) of cancer patients. Immunotherapies in particular have emerged as highly successful approaches to treat patients with cancer including melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), bladder cancer, and Hodgkin's disease. Specifically, many clinical successes have been using checkpoint receptor blockade, including T cell inhibitory receptors such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death-1 (PD-1) and its ligand PD-L1. Despite demonstrated successes, responses to immunotherapy interventions occur only in a minority of patients. Attempts are being made to improve responses to immunotherapy by developing biomarkers. Optimizing biomarkers for immunotherapy could help properly select patients for treatment and help to monitor response, progression and resistance that are critical challenges for the immuno-oncology (IO) field. Importantly, biomarkers could help to design rational combination therapies. In addition, biomarkers may help to define mechanism of action of different agents, dose selection and to sequence drug combinations. However, biomarkers and assays development to guide cancer immunotherapy is highly challenging for several reasons: (i) multiplicity of immunotherapy agents with different mechanisms of action including immunotherapies that target activating and inhibitory T cell receptors (e.g., CTLA-4, PD-1, etc.); adoptive T cell therapies that include tissue infiltrating lymphocytes (TILs), chimeric antigen receptors (CARs), and T cell receptor (TCR) modified T cells; (ii) tumor heterogeneity including changes in antigenic profiles over time and location in individual patient; and (iii) a variety of immune-suppressive mechanisms in the tumor microenvironment (TME) including T regulatory cells (Treg), myeloid derived suppressor cells (MDSC) and immunosuppressive cytokines. In addition, complex interaction of tumor-immune system further increases the level of difficulties in the process of biomarkers development and their validation for clinical use. Recent clinical trial results have highlighted the potential for combination therapies that include immunomodulating agents such as anti-PD-1 and anti-CTLA-4. Agents targeting other immune inhibitory (e.g., Tim-3) or immune stimulating (e.g., CD137) receptors on T cells and other approaches such as adoptive cell transfer are tested for clinical efficacy in melanoma as well. These agents are also being tested in combination with targeted therapies to improve upon shorter-term responses thus far seen with targeted therapy. Various locoregional interventions that demonstrate promising results in treatment of advanced melanoma are also integrated with immunotherapy agents and the combinations with cytotoxic chemotherapy and inhibitors of angiogenesis are changing the evolving landscape of therapeutic options and are being evaluated to prevent or delay resistance and to further improve survival rates for melanoma patients' population. This meeting's specific focus was on advances in immunotherapy and combination therapy for melanoma. The importance of understanding of melanoma genomic background for development of novel therapies and biomarkers for clinical application to predict the treatment response was an integral part of the meeting. The overall emphasis on biomarkers supports novel concepts toward integrating biomarkers into personalized-medicine approach for treatment of patients with melanoma across the entire spectrum of disease stage. Translation of the knowledge gained from the biology of tumor microenvironment across different tumors represents a bridge to impact on prognosis and response to therapy in melanoma. We also discussed the requirements for pre-analytical and analytical as well as clinical validation process as applied to biomarkers for cancer immunotherapy. The concept of the fit-for-purpose marker validation has been introduced to address the challenges and strategies for analytical and clinical validation design for specific assays.
Collapse
Affiliation(s)
- Paolo A. Ascierto
- IRCCS Istituto Nazionale Tumori, Fondazione “G. Pascale”, Naples, Italy
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Sanjiv Agarwala
- Department of Oncology and Hematology, St. Luke’s University Hospital and Temple University, Bethlehem, PA USA
| | - Gerardo Botti
- IRCCS Istituto Nazionale Tumori, Fondazione “G. Pascale”, Naples, Italy
| | | | - Gennaro Ciliberto
- IRCCS Istituto Nazionale Tumori, Fondazione “G. Pascale”, Naples, Italy
| | - Michael A. Davies
- Division of Cancer Medicine, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Sandra Demaria
- Departments of Radiation Oncology and Pathology, Weill Cornell Medical College, New York, NY USA
| | - Reinhard Dummer
- Skin Cancer Unit, Department of Dermatology, University Hospital Zürich, 8091 Zurich, Switzerland
| | | | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Yang Xin Fu
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX USA
| | - Thomas F. Gajewski
- Departments of Medicine and of Pathology, Immunology and Cancer Program, The University of Chicago Medicine, Chicago, IL USA
| | - Claus Garbe
- Department of Dermatology, Center for Dermato Oncology, University of Tübingen, Tübingen, Germany
| | - Veronica Huber
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samir Khleif
- Georgia Regents University Cancer Center, Georgia Regents University, Augusta, GA USA
| | | | - Roger S. Lo
- Departments of Medicine and Molecular and Medical Pharmacology, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center at the University of California Los Angeles (UCLA), Los Angeles, CA USA
| | - Giuseppe Masucci
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry, National Research Council, Sassari, Italy
| | - Michael Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY USA
| | - Igor Puzanov
- Department of Medicine, Early Phase Clinical Trials Program, Roswell Park Cancer Institute, New York, NY USA
| | - Ann Silk
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI USA
| | | | - David F. Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, MD USA
| | - Ahmad Tarhini
- Departments of Medicine, Immunology and Dermatology, University of Pittsburgh, Pittsburgh, PA USA
| | - Janis M. Taube
- Department of Dermatology, Johns Hopkins University SOM, Baltimore, MD USA
| | | | - Ena Wang
- Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Jennifer A. Wargo
- Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Cassian Yee
- The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Hassane Zarour
- Departments of Medicine, Immunology and Dermatology, University of Pittsburgh, Pittsburgh, PA USA
| | - Laurence Zitvogel
- Gustave Roussy Cancer Center, U1015 INSERM, Villejuif, France
- University Paris XI, Kremlin Bicêtre, France
| | - Bernard A. Fox
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Center, Providence Portland Medical Center, Portland, OR USA
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR USA
| | - Nicola Mozzillo
- IRCCS Istituto Nazionale Tumori, Fondazione “G. Pascale”, Naples, Italy
| | | | - Magdalena Thurin
- Cancer Diagnosis Program, National Cancer Institute, NIH, Bethesda, MD USA
| |
Collapse
|
18
|
Tarhini AA. Neoadjuvant therapy for melanoma: a promising therapeutic approach and an ideal platform in drug development. Am Soc Clin Oncol Educ Book 2016:e535-42. [PMID: 25993220 DOI: 10.14694/edbook_am.2015.35.e535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with locoregionally advanced but surgically operable melanoma continue to carry a high risk of relapse and death despite the best available standard management approaches. Neoadjuvant studies targeting this patient population tested chemotherapy with temozolomide and biochemotherapy (BCT), in which BCT demonstrated high tumor response rates but was eventually abandoned with the failure of BCT to deliver survival benefits in randomized trials of metastatic disease. Smaller neoadjuvant immunotherapy studies with interferon (IFN) alfa and ipilimumab have yielded promising clinical activity and important mechanistic insights and biomarker findings. Newer targeted and immunotherapeutic agents and combinations currently are being translated into the neoadjuvant setting at an accelerated pace and carry significant clinical promise. In drug development, the neoadjuvant approach allows access to blood and tumor tissue before and after initiation of systemic therapy, which allows for the conduct of novel mechanistic and biomarker studies in the circulation and the tumor microenvironment. Such studies may guide drug development and allow for the discovery of predictive biomarkers selected on the basis of their capacity to classify patients according to the degree of benefit from treatment or the risk for significant toxicity.
Collapse
Affiliation(s)
- Ahmad A Tarhini
- From the University of Pittsburgh School of Medicine and Cancer Institute, Pittsburgh, PA
| |
Collapse
|
19
|
Wang J, Xu B, Yuan P, Ma F, Li Q, Zhang P, Cai R, Fan Y, Luo Y, Li Q. Capecitabine combined with docetaxel versus vinorelbine followed by capecitabine maintenance medication for first-line treatment of patients with advanced breast cancer: Phase 3 randomized trial. Cancer 2015; 121:3412-21. [PMID: 26096296 DOI: 10.1002/cncr.29492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND In this prospective study, progression-free survival (PFS) and the safety profiles of docetaxel/capecitabine (TX) and vinorelbine/capecitabine (NX) followed by capecitabine maintenance therapy were compared in patients with metastatic breast cancer. METHODS Patients with advanced metastatic breast cancer were randomly assigned to a TX group (n = 104) and an NX group (n = 102), both of which included capecitabine maintenance medication. The primary endpoint was progression-free survival (PFS). RESULTS The trial met its primary endpoint and was closed to accrual subsequent to interim analysis. Forty-eight patients in the TX group (46.2%) and 42 patients in the NX group (41.2%) received maintenance medication. The median PFS (8.4 vs 7.1 months; P = .0026; 95% confidence interval, 1.18-2.3; hazard ratio, 1.65), the response duration (7.8 vs 6.6 months; P = .0451), and the median overall survival (OS) (35.3 vs 19.8 months; P = .1349; 95% confidence interval, 0.88-2.47; hazard ratio, 1.48) in the TX group appeared to be longer compared with those in the NX group, although the difference did reach not statistical significance. Patients aged ≥40 years who were postmenopausal and presented with visceral metastases were more likely to benefit from the TX regimen in terms of PFS and OS, whereas positive hormone receptor and human epidermal growth factor receptor 2 status or a history of taxane treatments did not affect differences in PFS and OS between the TX and NX groups. Hand-foot syndrome occurred more frequently in the TX group than in the NX group (47% vs 16.7%; P < .0001), but the frequencies of other minor adverse effects were similar in both groups. CONCLUSIONS A TX regimen for advanced breast cancer followed by capecitabine maintenance medication led to longer PFS and response duration than an NX regimen, even for patients who had previously received taxane in (neo)adjuvant settings. Cancer 2015. © 2015 American Cancer Society. Cancer 2015;121:3435-43. © 2015 American Cancer Society.
Collapse
Affiliation(s)
- Jiayu Wang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Peng Yuan
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ruigang Cai
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ying Fan
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
20
|
LZTS1 downregulation confers paclitaxel resistance and is associated with worse prognosis in breast cancer. Oncotarget 2015; 5:970-7. [PMID: 24448468 PMCID: PMC4011598 DOI: 10.18632/oncotarget.1630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Leucine Zipper Tumor Suppressor 1 (LZTS1) is a tumor suppressor gene, located at chromosome 8p22, which is frequently altered in human cancer. In normal tissue, its ubiquitous expression regulates cell mitosis by the stabilization of microtubule networks. LZTS1-deficient mouse embryonic fibroblasts have been shown to have an accelerated mitotic progression, and a higher resistance to taxanes, microtubule-stabilizing drugs. We investigate the role of Lzts1 in paclitaxel-resistance in breast cancer cells. Downregulation of Lzts1 expression significantly decreases sensitivity to paclitaxel in vitro. We further analyzed Lzts1 expression by immunohistochemistry in 270 primary breast cancer samples and 16 normal breast specimens. Lzts1 was significantly downregulated in breast cancer samples and its deregulation was associated with a higher incidence of tumor recurrence, and to a worse overall survival. Moreover, Lzts1-negative tumors were associated with unfavorable outcome after taxanes-based therapy. Thus our data suggest that Lzts1 deregulation is involved in breast cancer and its immunohistochemical evaluation may serve as a prognostic factor for breast cancer therapy.
Collapse
|
21
|
Análisis de la efectividad del tratamiento neoadyuvante al añadir docetaxel secuencial a fluorouracilo, epirrubicina y ciclofosfamida en pacientes con cáncer de mama avanzado: resultados preliminares de respuesta tumoral. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
22
|
Wu SG, Li Q, Zhou J, Sun JY, Li FY, Lin Q, Lin HX, Gaun XX, He ZY. Using the Lymph Node Ratio to Evaluate the Prognosis of Stage II/III Breast Cancer Patients Who Received Neoadjuvant Chemotherapy and Mastectomy. Cancer Res Treat 2014; 47:757-64. [PMID: 25672578 PMCID: PMC4614219 DOI: 10.4143/crt.2014.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/11/2014] [Indexed: 01/23/2023] Open
Abstract
Purpose This study was conducted to investigate the prognostic value of lymph node ratio (LNR) in stage II/III breast cancer patients who undergo mastectomy after neoadjuvant chemotherapy. Materials and Methods Clinical and pathological data describing stage II/III breast cancer patients were included in this retrospective study. The primary outcomes were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Results Among 277 patients, there were 43 ypN0, 64 ypN1, 89 ypN2, and 81 ypN3 cases. Additionally, there were 43, 57, 92 and 85 cases in the LNR 0, 0.01-0.20, 0.21-0.65, and > 0.65 groups, respectively. The median follow-up was 49.5 months. Univariate analysis showed that both ypN stage and LNR were prognostic factors of LRFS, DMFS, DFS, and OS (p < 0.05). Multivariate analysis showed that LNR was an independent prognostic factor of LRFS, DMFS, DFS, and OS (p < 0.05), while ypN stage had no effect on prognosis (p > 0.05). Conclusion The integrated use of LNR and ypN may be suitable for evaluation the prognosis of stage II/III breast cancer patients who undergo mastectomy after neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- San-Gang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Qun Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Juan Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qin Lin
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huan-Xin Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xun-Xing Gaun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
23
|
Tibau A, López-Vilaró L, Pérez-Olabarria M, Vázquez T, Pons C, Gich I, Alonso C, Ojeda B, Ramón y Cajal T, Lerma E, Barnadas A, Escuin D. Chromosome 17 centromere duplication and responsiveness to anthracycline-based neoadjuvant chemotherapy in breast cancer. Neoplasia 2014; 16:861-7. [PMID: 25379022 PMCID: PMC4212250 DOI: 10.1016/j.neo.2014.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 12/05/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) and topoisomerase II alpha (TOP2A) genes have been proposed as predictive biomarkers of sensitivity to anthracycline chemotherapy. Recently, chromosome 17 centromere enumeration probe (CEP17) duplication has also been associated with increased responsiveness to anthracyclines. However, reports are conflicting and none of these tumor markers can yet be considered a clinically reliable predictor of response to anthracyclines. We studied the association of TOP2A gene alterations, HER2 gene amplification, and CEP17 duplication with response to anthracycline-based neoadjuvant chemotherapy in 140 patients with operable or locally advanced breast cancer. HER2 was tested by fluorescence in situ hybridization and TOP2A and CEP17 by chromogenic in situ hybridization. Thirteen patients (9.3%) achieved pathologic complete response (pCR). HER2 amplification was present in 24 (17.5%) of the tumors. TOP2A amplification occurred in seven tumors (5.1%). CEP17 duplication was detected in 13 patients (9.5%). CEP17 duplication correlated with a higher rate of pCR [odds ratio (OR) 6.55, 95% confidence interval (95% CI) 1.25-34.29, P = .026], and analysis of TOP2A amplification showed a trend bordering on statistical significance (OR 6.97, 95% CI 0.96-50.12, P = .054). TOP2A amplification and CEP17 duplication combined were strongly associated with pCR (OR 6.71, 95% CI 1.66-27.01, P = .007). HER2 amplification did not correlate with pCR. Our results suggest that CEP17 duplication predicts pCR to primary anthracycline-based chemotherapy. CEP17 duplication, TOP2A amplifications, and HER2 amplifications were not associated with prognosis.
Collapse
Key Words
- CEP17, chromosome 17 centromere enumeration probe
- CI, confidence interval
- CISH, chromogenic in situ hybridization
- DFS, disease-free survival
- EC-D, epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) followed by docetaxel (100 mg/m2)
- ER, estrogen receptor
- FEC75, fluorouracil (600 mg/m2), epirubicin (75 mg/m2), and cyclophosphamide (600 mg/m2)
- FISH, fluorescence in situ hybridization
- HER2, human epidermal growth factor receptor 2
- HR, hazard ratio
- OR, odds ratio
- OS, overall survival
- PR, progesterone receptor
- TOP2A, topoisomerase II alpha
- pCR, pathologic complete response
Collapse
Affiliation(s)
- Ariadna Tibau
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ; Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain
| | - Laura López-Vilaró
- Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain ; Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Tania Vázquez
- Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain
| | - Cristina Pons
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignasi Gich
- Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen Alonso
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Belén Ojeda
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Ramón y Cajal
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Lerma
- Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain ; Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Agustí Barnadas
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ; Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain ; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Daniel Escuin
- Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain
| |
Collapse
|
24
|
Mooney R, Weng Y, Garcia E, Bhojane S, Smith-Powell L, Kim SU, Annala AJ, Aboody KS, Berlin JM. Conjugation of pH-responsive nanoparticles to neural stem cells improves intratumoral therapy. J Control Release 2014; 191:82-9. [PMID: 24952368 PMCID: PMC4156897 DOI: 10.1016/j.jconrel.2014.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 12/31/2022]
Abstract
Intratumoral drug delivery is an inherently appealing approach for concentrating toxic chemotherapies at the site of action. This mode of administration is currently used in a number of clinical treatments such as neoadjuvant, adjuvant, and even standalone therapies when radiation and surgery are not possible. However, even when injected locally, it is difficult to achieve efficient distribution of chemotherapeutics throughout the tumor. This is primarily attributed to the high interstitial pressure which results in gradients that drive fluid away from the tumor center. The stiff extracellular matrix also limits drug penetration throughout the tumor. We have previously shown that neural stem cells can penetrate tumor interstitium, actively migrating even to hypoxic tumor cores. When used to deliver therapeutics, these migratory neural stem cells result in dramatically enhanced tumor coverage relative to conventional delivery approaches. We recently showed that neural stem cells maintain their tumor tropic properties when surface-conjugated to nanoparticles. Here we demonstrate that this hybrid delivery system can be used to improve the efficacy of docetaxel-loaded nanoparticles when administered intratumorally. This was achieved by conjugating drug-loaded nanoparticles to the surface of neural stem cells using a bond that allows the stem cells to efficiently distribute nanoparticles throughout the tumor before releasing the drug for uptake by tumor cells. The modular nature of this system suggests that it could be used to improve the efficacy of many chemotherapy drugs after intratumoral administration.
Collapse
Affiliation(s)
- Rachael Mooney
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
| | - Yiming Weng
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Elizabeth Garcia
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Sukhada Bhojane
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Leslie Smith-Powell
- Department of Analytical Pharmacology, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Seung U Kim
- Division of Neurology, Department of Medicine, UBC Hospital, University of British Columbia, Vancouver, British Columbia V6T2B5, Canada
| | - Alexander J Annala
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Karen S Aboody
- Department of Neurosciences, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA; Division of Neurosurgery, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Jacob M Berlin
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
| |
Collapse
|
25
|
Prognostic significance of the ratio of absolute neutrophil to lymphocyte counts for breast cancer patients with ER/PR-positivity and HER2-negativity in neoadjuvant setting. Tumour Biol 2014; 35:9823-30. [PMID: 24986572 DOI: 10.1007/s13277-014-2282-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022] Open
Abstract
The aim of this study was to determine the predictive or prognostic impact of absolute neutrophil count/absolute lymphocyte count ratio (NLR) in breast cancer patients with estrogen receptor/progesterone receptor (ER/PR)-positive and human epidermal growth factor receptor 2 (HER2)-negative subtype who have received neoadjuvant chemotherapy (NAC). We performed retrospective analysis of 157 patients with primary breast cancer with ER/PR-positive and HER2-negative subtype who were treated with NAC, followed by definitive surgical resection. The median follow-up after surgery was 21 months (range, 1-108 months). On univariate analysis, high NLR (>2.25) correlated with poorer recurrence-free survival (RFS) and overall survival (OS) (P = 0.001 and P < 0.001). Subgroup analysis of non-pathologic complete response (pCR) subgroup showed that high NLR was significant for RFS and OS (P = 0.001 and P < 0.001). Particularly, high NLR patients had inferior clinical outcomes in the high clinical stage. Uni- and multivariate Cox analysis showed NLR to be an only predictor of RFS and OS. The NLR is an independent prognostic factor for RFS and OS in breast cancer patients with ER/PR-positive and HER2-negative subtype receiving NAC. The NLR provides additional prognostic information to choose suitable patients who might profit from further therapy.
Collapse
|
26
|
Mrózek E, Layman R, Ramaswamy B, Lustberg M, Vecchione A, Knopp MV, Shapiro CL. Phase II trial of neoadjuvant weekly nanoparticle albumin-bound paclitaxel, carboplatin, and biweekly bevacizumab therapy in women with clinical stage II or III HER2-negative breast cancer. Clin Breast Cancer 2014; 14:228-34. [PMID: 24703985 DOI: 10.1016/j.clbc.2014.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/12/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND We hypothesized that adding bevacizumab to neoadjuvant chemotherapy (NCT) with nab-P and carboplatin would increase the rates of pCR in BC patients and that early changes in tumor vascularity imaged by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) would predict pCR. METHODS Thirty-three women with clinical stage II or III HER2-negative BC received nab-P 100 mg/m2 and carboplatin area under the curve = 2 on days 1, 8, and 15 in combination with bevacizumab 10 mg/kg on days 1 and 15 administered every 28 days. RESULTS Six patients (18%) achieved pCR, all pCRs occurred in triple-negative BC (TNBC) (pCR = 50% for TNBC). At the end of cycle 2, the changes in relative angiogenic volume were significantly different between responders and nonresponders (P = .001). The major toxicity of this NCT was myelosuppression. CONCLUSION NCT with weekly nab-P, carboplatin, and biweekly bevacizumab resulted in a pCR rate that was neither superior to the historical data with anthracycline- or taxane-containing NCT nor to carboplatin and taxane combinations in patients with HER2-negative BC. In patients with TNBC, the observed pCR rate was 50%. The early changes in the relative angiogenic volume imaged by DCE-MRI could predict pCR.
Collapse
Affiliation(s)
- Ewa Mrózek
- Division of Medical Oncology, The Ohio State University Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH.
| | - Rachel Layman
- Division of Medical Oncology, The Ohio State University Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, The Ohio State University Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Maryam Lustberg
- Division of Medical Oncology, The Ohio State University Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Andrea Vecchione
- Department of Molecular Virology, Immunology, and Medical Genetics, College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Michael V Knopp
- Division of Imaging Science, Department of Radiology, The Ohio State University, Columbus, OH
| | - Charles L Shapiro
- Division of Medical Oncology, The Ohio State University Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| |
Collapse
|
27
|
Tarhini AA, Edington H, Butterfield LH, Lin Y, Shuai Y, Tawbi H, Sander C, Yin Y, Holtzman M, Johnson J, Rao UNM, Kirkwood JM. Immune monitoring of the circulation and the tumor microenvironment in patients with regionally advanced melanoma receiving neoadjuvant ipilimumab. PLoS One 2014; 9:e87705. [PMID: 24498358 PMCID: PMC3912016 DOI: 10.1371/journal.pone.0087705] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022] Open
Abstract
We evaluated neoadjuvant ipilimumab in patients with surgically operable regionally advanced melanoma in order to define markers of activity in the blood and tumor as assessed at baseline (before ipilimumab) and early on-treatment. Patients were treated with ipilimumab (10 mg/kg intravenously every 3 weeks ×2 doses) bracketing surgery. Tumor and blood biospecimens were obtained at baseline and at surgery. Flow cytometry and immunohistochemistry for select biomarkers were performed. Thirty five patients were enrolled; IIIB (3; N2b), IIIC (32; N2c, N3), IV (2). Worst toxicities included Grade 3 diarrhea/colitis (5; 14%), hepatitis (2; 6%), rash (1; 3%), elevated lipase (3; 9%). Median follow up was 18 months: among 33 evaluable patients, median progression free survival (PFS) was 11 months, 95% CI (6.2–19.2). There was a significant decrease in circulating myeloid derived suppressor cells (MDSC). Greater decrease in circulating monocyte gate MDSC Lin1−/HLA-DR−/CD33+/CD11b+ was associated with improved PFS (p = 0.03). There was a significant increase in circulating regulatory T cells (Treg; CD4+CD25hi+Foxp3+) that, unexpectedly, was associated with improved PFS (HR = 0.57; p = 0.034). Baseline evidence of fully activated type I CD4+ and CD8+ antigen-specific T cell immunity against cancer-testis (NY-ESO-1) and melanocytic lineage (MART-1, gp100) antigens was detected and was significantly potentiated after ipilimumab. In tumor, there was a significant increase in CD8+ T cells after ipilimumab (p = 0.02). Ipilimumab induced increased tumor infiltration by fully activated (CD69+) CD3+/CD4+ and CD3+/CD8+ T cells with evidence of induction/potentiation of memory T cells (CD45RO+). The change in Treg observed within the tumor showed an inverse relationship with clinical benefit and greater decrease in tumor MDSC subset Lin1−/HLA-DR−/CD33+/CD11b+ was associated with improved PFS at one year. Neoadjuvant evaluation revealed a significant immunomodulating role for ipilimumab on Treg, MDSC and effector T cells in the circulation and tumor microenvironment that warrants further pursuit in the quest for optimizing melanoma immunotherapy.
Collapse
Affiliation(s)
- Ahmad A. Tarhini
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Howard Edington
- Department of Surgery, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, United States of America
| | - Lisa H. Butterfield
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
| | - Yan Lin
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America
| | - Yongli Shuai
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America
| | - Hussein Tawbi
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
| | - Cindy Sander
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
| | - Yan Yin
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
| | - Matthew Holtzman
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Uma N. M. Rao
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - John M. Kirkwood
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
| |
Collapse
|
28
|
Use of Cox's Cure Model to Establish Clinical Determinants of Long-Term Disease-Free Survival in Neoadjuvant-Chemotherapy-Treated Breast Cancer Patients without Pathologic Complete Response. Int J Breast Cancer 2014; 2013:354579. [PMID: 24383004 PMCID: PMC3870117 DOI: 10.1155/2013/354579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 12/31/2022] Open
Abstract
In prognostic studies for breast cancer patients treated with neoadjuvant chemotherapy (NAC), the ordinary Cox proportional-hazards (PH) model has been often used to identify prognostic factors for disease-free survival (DFS). This model assumes that all patients eventually experience relapse or death. However, a subset of NAC-treated breast cancer patients never experience these events during long-term follow-up (>10 years) and may be considered clinically “cured.” Clinical factors associated with cure have not been studied adequately. Because the ordinary Cox PH model cannot be used to identify such clinical factors, we used the Cox PH cure model, a recently developed statistical method. This model includes both a logistic regression component for the cure rate and a Cox regression component for the hazard for uncured patients. The purpose of this study was to identify the clinical factors associated with cure and the variables associated with the time to recurrence or death in NAC-treated breast cancer patients without a pathologic complete response, by using the Cox PH cure model. We found that hormone receptor status, clinical response, human epidermal growth factor receptor 2 status, histological grade, and the number of lymph node metastases were associated with cure.
Collapse
|
29
|
Issa-Nummer Y, Darb-Esfahani S, Loibl S, Kunz G, Nekljudova V, Schrader I, Sinn BV, Ulmer HU, Kronenwett R, Just M, Kühn T, Diebold K, Untch M, Holms F, Blohmer JU, Habeck JO, Dietel M, Overkamp F, Krabisch P, von Minckwitz G, Denkert C. Prospective validation of immunological infiltrate for prediction of response to neoadjuvant chemotherapy in HER2-negative breast cancer--a substudy of the neoadjuvant GeparQuinto trial. PLoS One 2013; 8:e79775. [PMID: 24312450 PMCID: PMC3846472 DOI: 10.1371/journal.pone.0079775] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/04/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction We have recently described an increased lymphocytic infiltration rate in breast carcinoma tissue is a significant response predictor for anthracycline/taxane-based neoadjuvant chemotherapy (NACT). The aim of this study was to prospectively validate the tumor-associated lymphocyte infiltrate as predictive marker for response to anthracycline/taxane-based NACT. Patients and Methods The immunological infiltrate was prospectively evaluated in a total of 313 core biopsies from HER2 negative patients of the multicenter PREDICT study, a substudy of the neoadjuvant GeparQuinto study. Intratumoral lymphocytes (iTuLy), stromal lymphocytes (strLy) as well as lymphocyte-predominant breast cancer (LPBC) were evaluated by histopathological assessment. Pathological complete response (pCR) rates were analyzed and compared between the defined subgroups using the exact test of Fisher. Results Patients with lymphocyte-predominant breast cancer (LPBC) had a significantly increased pCR rate of 36.6%, compared to non-LPBC patients (14.3%, p<0.001). LPBC and stromal lymphocytes were significantly independent predictors for pCR in multivariate analysis (LPBC: OR 2.7, p = 0.003, strLy: OR 1.2, p = 0.01). The amount of intratumoral lymphocytes was significantly predictive for pCR in univariate (OR 1.2, p = 0.01) but not in multivariate logistic regression analysis (OR 1.2, p = 0.11). Conclusion Confirming previous investigations of our group, we have prospectively validated in an independent cohort that an increased immunological infiltrate in breast tumor tissue is predictive for response to anthracycline/taxane-based NACT. Patients with LPBC and increased stromal lymphocyte infiltration have significantly increased pCR rates. The lymphocytic infiltrate is a promising additional parameter for histopathological evaluation of breast cancer core biopsies.
Collapse
Affiliation(s)
| | | | | | - Georg Kunz
- Department of Gynecology and Obstetrics, St. Johannes Hospital, Dortmund, Germany
| | | | | | | | | | | | | | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Kurt Diebold
- Gemeinschaftspraxis für Pathologie Hamm, Hamm, Germany
| | - Michael Untch
- Breast Center, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Holms
- Gynäkologie und Geburtshilfe, St. Barbara-Klinik Hamm-Heessen, Germany
| | - Jens-Uwe Blohmer
- Breast Center, St. Gertrauden Krankenhaus Berlin, Berlin, Germany
| | | | - Manfred Dietel
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany
- University Women's Hospital, Frankfurt, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
30
|
Acceptable cardiac safety profile of neoadjuvant 5-fluorouracil, epirubicin, cyclophosphamide and celecoxib (FEC-C) for breast cancer: a subanalysis of biomarkers for cardiac injury. Int J Biol Markers 2013; 28:E92-9. [PMID: 23592005 DOI: 10.5301/jbm.5000012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/20/2022]
Abstract
PURPOSES This substudy aimed to examine the changes in biomarkers for cardiac injury in patients who received neoadjuvant 5-fluorouracil, epirubicin, cyclophosphamide with concurrent celecoxib (FEC-C). METHODS Thirty-four female patients with histologically confirmed locally advanced breast cancer preoperatively received 3 cycles of FEC-C (500 mg/m<sup>2</sup>, 75 mg/m<sup>2</sup>, 500 mg/m<sup>2</sup>) with concurrent celecoxib (400 mg bid). Blood samples were drawn from patients on day (D) 0, D3, D21, D42, and D63 (end of therapy), and the serum levels of lactate dehydrogenase (LDH) and plasma levels of cardiac troponin I (cTnI) and N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) were measured with commercially available test kits. RESULTS All patients tolerated this regimen well. Neither life-threatening toxicity nor clinical symptoms of cardiac damage were observed. Serum LDH increased significantly from baseline after 3 cycles of FEC-C (p<0.0001), but the change was possibly brought about by chemotherapy-induced liver derangement. However, NT-proBNP decreased significantly (p=0.009), while cTnI increased nonsignificantly (p=0.078) after 3 cycles of FEC-C compared to baseline, although this increase was still regarded as normal. CONCLUSIONS Short-term use of the FEC-C regimen has proven to be effective in locally advanced breast cancer, with an acceptable cardiac safety profile.
Collapse
|
31
|
Keam B, Im SA, Lim Y, Han SW, Moon HG, Oh DY, Cho N, Lee SH, Han W, Moon WK, Kim DW, Kim TY, Park IA, Noh DY. Clinical usefulness of AJCC response criteria for neoadjuvant chemotherapy in breast cancer. Ann Surg Oncol 2013; 20:2242-9. [PMID: 23529780 DOI: 10.1245/s10434-012-2756-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Recently, the American Joint Committee on Cancer (AJCC) 7th edition proposed new response criteria for neoadjuvant chemotherapy (NAC) in breast cancer. The purpose of this study was to evaluate the clinical usefulness of AJCC response criteria. METHODS A total of 398 consecutive stage II or III breast cancer patients who received NAC were enrolled in this study. AJCC response criteria were as follows: (1) complete response (CR)-absence of invasive carcinoma in the breast and node; (2) partial response (PR)-decrease in either or both T or N stage; (3) no response (NR)-no change or increase in either or both T or N stage. RESULTS Complete response, PR, and NR by AJCC criteria were 9.8, 59.3, and 30.7 %, respectively. Among the 398 patients, 337 patients were available for both paired pre- and post- breast MRI and chest CT. AJCC response criteria were significantly associated with RECIST criteria (P < 0.001). AJCC response was significantly associated with relapse-free survival (RFS) and overall survival (OS). The 5-year RFS rates were 89.6 % in CR, 74.1 % in PR, and 62.6 % in NR (P = 0.002). The 5-year OS rates were 97.4 % in CR, 88.6 % in PR, and 78.3 % in NR (P = 0.012). When adjusting potential prognostic factors, AJCC response was independently associated with RFS and OS. CONCLUSIONS AJCC response criteria for NAC in breast cancer have clinical usefulness in evaluating response of NAC, as well as predicting survival. AJCC response criteria can discriminate among patient subgroups with respect to survival.
Collapse
Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Increased efficacy of a dose-dense regimen of neoadjuvant chemotherapy in breast carcinoma: a retrospective analysis. Med Oncol 2012; 29:2577-85. [PMID: 22392196 DOI: 10.1007/s12032-012-0195-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 02/16/2012] [Indexed: 12/31/2022]
Abstract
Neoadjuvant chemotherapy is being increasingly used in the treatment of breast carcinoma. We performed a single-center retrospective analysis of the results of neoadjuvant therapy in 376 breast carcinoma patients treated with three different regimens combining doxorubicin and paclitaxel (AT), dose-dense doxorubicin and cyclophosphamide with sequential weekly paclitaxel (DD AC-P), or the combination of trastuzumab with chemotherapy (DD AC-PT). The expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (HER)-2 was determined immunohistochemically. Pathological response was determined in 318 patients. Pathological complete response (pCR) was observed in 18% of patients. The pCR rate was significantly higher in patients treated with DD regimen (22 vs. 13%) and younger than 55 years (23 vs. 13%). The pCR rate was higher in patients with triple negative (TN) tumors (43%) and tumors over-expressing HER-2 (HER-2+; 28%) compared to patients with ER- or PR-positive tumors not expressing HER-2 (ER/PR+HER-2-; 6%). In patients with TN tumors pCR rate was significantly higher after treatment with DD AC-P compared to AT (61 vs. 22%, p=0.005). pCR was associated with significantly improved relapse-free survival (RFS) and overall survival (OS), but when analysis was performed based on tumor phenotype, the difference was significant only in patients with TN tumors. In multivariate analysis, pCR, stage, and ER expression were significant predictors of RFS, while pCR, stage, ER and DD regimen were significant predictors of OS. In conclusion, present data indicate superiority of a DD regimen in obtaining pCR in patients with breast carcinoma treated with neoadjuvant chemotherapy. The difference in efficacy is due mostly to markedly higher pCR rate in patients with TN tumors.
Collapse
|
33
|
Predictive value of FDG PET/CT for pathologic axillary node involvement after neoadjuvant chemotherapy. Breast Cancer 2012; 20:167-73. [DOI: 10.1007/s12282-011-0323-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022]
|
34
|
Keam B, Im SA, Koh Y, Han SW, Oh DY, Cho N, Kim JH, Han W, Kang KW, Moon WK, Kim TY, Park IA, Noh DY, Chung JK, Bang YJ. Early metabolic response using FDG PET/CT and molecular phenotypes of breast cancer treated with neoadjuvant chemotherapy. BMC Cancer 2011; 11:452. [PMID: 22011459 PMCID: PMC3224348 DOI: 10.1186/1471-2407-11-452] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 10/20/2011] [Indexed: 11/22/2022] Open
Abstract
Background This study was aimed 1) to investigate the predictive value of FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography) for histopathologic response and 2) to explore the results of FDG PET/CT by molecular phenotypes of breast cancer patients who received neoadjuvant chemotherapy. Methods Seventy-eight stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. FDG PET/CTs were acquired before chemotherapy and after the first cycle of chemotherapy for evaluating early metabolic response. Results The mean pre- and post-chemotherapy standard uptake value (SUV) were 7.5 and 3.9, respectively. The early metabolic response provided by FDG PET/CT after one cycle of neoadjuvant chemotherapy was correlated with the histopathologic response after completion of neoadjuvant chemotherapy (P = 0.002). Sensitivity and negative predictive value were 85.7% and 95.1%, respectively. The estrogen receptor negative phenotype had a higher pre-chemotherapy SUV (8.6 vs. 6.4, P = 0.047) and percent change in SUV (48% vs. 30%, P = 0.038). In triple negative breast cancer (TNBC), the pre-chemotherapy SUV was higher than in non-TNBC (9.8 vs. 6.4, P = 0.008). Conclusions The early metabolic response using FDG PET/CT could have a predictive value for the assessment of histopathologic non-response of stage II/III breast cancer treated with neoadjuvant chemotherapy. Our findings suggest that the initial SUV and the decline in SUV differed based on the molecular phenotype. Trial Registration ClinicalTrials.gov: NCT01396655
Collapse
Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Chimiothérapie adjuvante de cancer du sein et fertilité : estimation de l’impact, options de préservation et place de l’oncologue. Bull Cancer 2011; 98:741-51. [DOI: 10.1684/bdc.2011.1391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
36
|
Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy. J Cancer Res Clin Oncol 2011; 137:1301-8. [DOI: 10.1007/s00432-011-0991-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 05/26/2011] [Indexed: 01/25/2023]
|
37
|
Walker LG, Eremin JM, Aloysius MM, Vassanasiri W, Walker MB, El-Sheemy M, Cowley G, Beer J, Samphao S, Wiseman J, Jibril JA, Valerio D, Clarke DJ, Kamal M, Thorpe GW, Baria K, Eremin O. Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer. BMC Cancer 2011; 11:179. [PMID: 21592370 PMCID: PMC3117815 DOI: 10.1186/1471-2407-11-179] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 05/18/2011] [Indexed: 11/22/2022] Open
Abstract
Background Weekly docetaxel has occasionally been used in the neoadjuvant to downstage breast cancer to reduce toxicity and possibly enhance quality of life. However, no studies have compared the standard three weekly regimen to the weekly regimen in terms of quality of life. The primary aim of our study was to compare the effects on QoL of weekly versus 3-weekly sequential neoadjuvant docetaxel. Secondary aims were to determine the clinical and pathological responses, incidence of Breast Conserving Surgery (BCS), Disease Free Survival (DFS) and Overall Survival (OS). Methods Eighty-nine patients receiving four cycles of doxorubicin and cyclophosphamide were randomised to receive twelve cycles of weekly docetaxel (33 mg/m2) or four cycles of 3-weekly docetaxel (100 mg/m2). The Functional Assessment of Cancer Therapy-Breast and psychosocial questionnaires were completed. Results At a median follow-up of 71.5 months, there was no difference in the Trial Outcome Index scores between treatment groups. During weekly docetaxel, patients experienced less constipation, nail problems, neuropathy, tiredness, distress, depressed mood, and unhappiness. There were no differences in overall clinical response (93% vs. 90%), pathological complete response (20% vs. 27%), and breast-conserving surgery (BCS) rates (49% vs. 42%). Disease-free survival and overall survival were similar between treatment groups. Conclusions Weekly docetaxel is well-tolerated and has less distressing side-effects, without compromising therapeutic responses, Breast Conserving Surgery (BCS) or survival outcomes in the neoadjuvant setting. Trial registration ISRCTN: ISRCTN09184069
Collapse
Affiliation(s)
- Leslie G Walker
- Oncology Health Centres and the Institute of Rehabilitation, University of Hull, Kingston upon Hull, East Riding of Yorkshire HU3 2PG, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Saxena N, Hartman M, Aziz R, Rapiti E, Bhoo Pathy N, Lim SE, Iau P, Taib NA, Schaffar R, Neyroud-Caspar I, Yip CH, Lee SC, Verkooijen HM. Prognostic value of axillary lymph node status after neoadjuvant chemotherapy. Results from a multicentre study. Eur J Cancer 2011; 47:1186-92. [DOI: 10.1016/j.ejca.2010.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 12/07/2010] [Accepted: 12/14/2010] [Indexed: 11/27/2022]
|
39
|
Lyou CY, Cho N, Kim SM, Jang M, Park JS, Baek SY, Moon WK. Computer-aided evaluation of breast MRI for the residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Korean J Radiol 2011; 12:34-43. [PMID: 21228938 PMCID: PMC3017882 DOI: 10.3348/kjr.2011.12.1.34] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/14/2010] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Materials and Methods Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics. Results For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 ± 1.7 cm) was significantly smaller than the mean histological diameter (2.6 ± 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 ± 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confidence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confidence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106). Conclusion CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement.
Collapse
Affiliation(s)
- Chae Yeon Lyou
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | | | | | | | | | | | | |
Collapse
|
40
|
Ito Y, Nagasaki K, Miki Y, Iwase T, Akiyama F, Matsuura M, Horii R, Makita M, Tokudome N, Ushijima M, Yoshimoto M, Takahashi S, Noda T, Hatake K. Prospective randomized phase II study determines the clinical usefulness of genetic biomarkers for sensitivity to primary chemotherapy with paclitaxel in breast cancer. Cancer Sci 2011; 102:130-6. [PMID: 20880335 PMCID: PMC11159154 DOI: 10.1111/j.1349-7006.2010.01740.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In patients with breast cancer, taxane as well as anthracycline play central roles in systemic chemotherapy. By evaluating the pathological response, we can gauge sensitivity to primary chemotherapy. However, biomarkers that would predict a response to taxane have not yet been established. We conducted a prospective randomized trial to evaluate whether selecting patients using sensitivity testing based on the gene expression of the tumor might enhance the probability of the pathological response. Five genes were identified as biomarkers derived from a microarray of DNA gene profiles from microdisected breast tumors. In the experimental arm (B1), 12 cycles of weekly paclitaxel, 80 mg/m(2) , were preoperatively given when the sensitivity test was positive and therefore judged to be sensitive to paclitaxel. When the test was negative, meaning insensitive to paclitaxel, four cycles of FEC100 were given (arm B2). In the control arm (A), paclitaxel was administered weekly without the use of the sensitivity test. A total of 92 patients were enrolled and 86 patients were analyzed. The pathological response rate (pRR) of each arm was 36.4% in B1 (expected sensitive to paclitaxel), 21.1% in A (control) and 12.5% in B2, respectively. Weekly paclitaxel-treated patients selected by the sensitivity test did not enhance the pRR. The study failed to validate sensitivity testing using five gene expressions for primary chemotherapy with paclitaxel in patients with breast cancer. However, this study suggests that a randomized phase II study is a robust tool for obtaining a rapid conclusion on the usefulness of biomarkers and could be the foundation for further large clinical trials.
Collapse
Affiliation(s)
- Yoshinori Ito
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research Breast Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Derleth C, Mayer IA. Antiangiogenic therapies in early-stage breast cancer. Clin Breast Cancer 2010; 10 Suppl 1:E23-31. [PMID: 20587404 DOI: 10.3816/cbc.2010.s.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Angiogenesis, which is crucial for the growth and spread of cancer cells, has become an important target for antineoplastic therapies in a variety of malignant tumors. Vascular endothelial growth factor and its receptor promote formation of new blood vessels in tumors. Several drugs, most notably the monoclonal antibody bevacizumab, have been developed to inhibit this process. Clinical trials utilizing bevacizumab and other antiangiogenic drugs in metastatic breast cancer have demonstrated enhanced response rates and prolonged progression-free survival, though no overall survival benefit has been seen. Trials are now under way exploring the use of antiangiogenic agents in patients with early stage breast cancer. We performed a comprehensive review of the published literature (English language), US National Institutes of Health clinical trials registry (ClinicalTrials.gov), and established cooperative groups that revealed approximately 75 clinical trials, completed or ongoing, utilizing antiangiogenic drugs in early-stage breast cancer. A number of phase II trials in the neoadjuvant setting have reported preliminary results suggesting response rates similar to those seen with traditional anthracycline-plus-taxane combination regimens. Most of these early trials have not yet met any survival endpoints. Studies are also ongoing in the adjuvant setting, and these have not yet been reported. The toxicities associated with these agents are similar to those that have been reported in the metastatic trials. Most of these side effects are grade 1 or 2 and are easily manageable; however, there remain a small percentage of patients who sustain life-threatening vascular events, bleeding, or wound-healing complications. This number is significantly higher in patients receiving antiangiogenic drugs when compared with controls. While we eagerly await completion and results of this impressive portfolio of studies in early breast cancer with antiangiogenic agents, there is an urgent need for a more rational patient/antiangiogenic therapy selection with greater insight into predictive factors for toxicities, therapy efficacy, and clinical benefit.
Collapse
Affiliation(s)
- Christina Derleth
- Department of Medicine and Breast Cancer Research Program, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | | |
Collapse
|
42
|
Is it Possible to Increase pCR in the Neoadjuvant Treatment With a Dose-Dense/Sequential Combination? Am J Clin Oncol 2010; 33:432-7. [DOI: 10.1097/coc.0b013e3181b4eff9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Monitoring the Effect of Docetaxel Treatment in MCF7 Xenografts Using Multimodal In Vivo and Ex Vivo Magnetic Resonance Methods, Histopathology, and Gene Expression. Transl Oncol 2010; 3:252-63. [PMID: 20689767 DOI: 10.1593/tlo.09322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 03/17/2010] [Accepted: 03/22/2010] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to evaluate the sensitivity of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted (DW)-MRI, in vivo MR spectroscopy (MRS), and ex vivo high-resolution magic angle spinning (HR MAS) MRS for the detection of early treatment effects after docetaxel administration. Docetaxel is an antitumor agent that leads to mitotic arrest, apoptosis, and mitotic catastrophe cell death. Gene expression analysis was performed to detect altered regulation in gene expression pathways related to docetaxel treatment effects. Histopathology was used as a measure of alterations in apoptosis and proliferation due to docetaxel. Experiments were performed using MCF7 mouse xenografts, randomized into a docetaxel (30 mg/kg) treatment group and a control group given saline. MRI/MRS was performed 1 day before treatment and 1, 3, and 6 days after treatment. Parametric images of the extracellular extravascular volume fraction (v(e)) transfer constant (K(trans)) and the apparent diffusion coefficient (ADC) were calculated from the DCE-MRI and DW-MRI data. Biopsies were analyzed by HR MAS MRS, and histopathology and gene expression profiles were determined (Illumina). A significant increase in the ADC 3 and 6 days after treatment and a significant decrease in total choline and a higher v(e) were found in treated tumors 6 days after treatment. No significant difference was found in the K(trans) between the two groups. Our results show that docetaxel induces apoptosis and decreases proliferation in MCF7 xenografts. Further, these phenomena can be monitored by in vivo MRS, DW-MRI, and gene expression.
Collapse
|
44
|
Identification of residual breast tumour localization after neo-adjuvant chemotherapy using a radioactive 125 Iodine seed. Eur J Surg Oncol 2010; 36:164-9. [DOI: 10.1016/j.ejso.2009.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/11/2009] [Accepted: 10/13/2009] [Indexed: 11/22/2022] Open
|
45
|
Bauer JA, Chakravarthy AB, Rosenbluth JM, Mi D, Seeley EH, De Matos Granja-Ingram N, Olivares MG, Kelley MC, Mayer IA, Meszoely IM, Means-Powell JA, Johnson KN, Tsai CJ, Ayers GD, Sanders ME, Schneider RJ, Formenti SC, Caprioli RM, Pietenpol JA. Identification of markers of taxane sensitivity using proteomic and genomic analyses of breast tumors from patients receiving neoadjuvant paclitaxel and radiation. Clin Cancer Res 2010; 16:681-90. [PMID: 20068102 DOI: 10.1158/1078-0432.ccr-09-1091] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To identify molecular markers of pathologic response to neoadjuvant paclitaxel/radiation treatment, protein and gene expression profiling were done on pretreatment biopsies. EXPERIMENTAL DESIGN Patients with high-risk, operable breast cancer were treated with three cycles of paclitaxel followed by concurrent paclitaxel/radiation. Tumor tissue from pretreatment biopsies was obtained from 19 of the 38 patients enrolled in the study. Protein and gene expression profiling were done on serial sections of the biopsies from patients that achieved a pathologic complete response (pCR) and compared to those with residual disease, non-pCR (NR). RESULTS Proteomic and validation immunohistochemical analyses revealed that alpha-defensins (DEFA) were overexpressed in tumors from patients with a pCR. Gene expression analysis revealed that MAP2, a microtubule-associated protein, had significantly higher levels of expression in patients achieving a pCR. Elevation of MAP2 in breast cancer cell lines led to increased paclitaxel sensitivity. Furthermore, expression of genes that are associated with the basal-like, triple-negative phenotype were enriched in tumors from patients with a pCR. Analysis of a larger panel of tumors from patients receiving presurgical taxane-based treatment showed that DEFA and MAP2 expression as well as histologic features of inflammation were all statistically associated with response to therapy at the time of surgery. CONCLUSION We show the utility of molecular profiling of pretreatment biopsies to discover markers of response. Our results suggest the potential use of immune signaling molecules such as DEFA as well as MAP2, a microtubule-associated protein, as tumor markers that associate with response to neoadjuvant taxane-based therapy.
Collapse
Affiliation(s)
- Joshua A Bauer
- Departments of Biochemistry, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Parmar V, Badwe RA. Breast conservation in locally advanced breast cancer. Indian J Surg Oncol 2010; 1:3-7. [PMID: 22930610 DOI: 10.1007/s13193-010-0003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 10/10/2009] [Indexed: 10/19/2022] Open
Abstract
Absence of breast cancer screening in India, lack of awareness in rural population, social inhibitions and poor socioeconomic status leads to a situation where a large proportion of women in India are still presenting with locally advanced breast cancer (LABC) at the time of initial diagnosis, although, there are relatively more of early stage cases detected in the metros and urban areas than maybe a decade ago. With advances in care and introduction of newer chemotherapeutic agents, it has now become feasible to offer neoadjuvant therapy with effective tumor downsizing, thus making it possible to even consider breast conservation surgery in select patients with locally advanced and unresectable disease at presentation. With reports suggesting apparent safety of the procedure, breast conservation treatment after chemotherapy is now being offered as routine care in most major centers for selective women with LABC. Multimodality therapy is the standard of care with neoadjuvant systemic therapy for all women with LABC.
Collapse
|
47
|
A gene expression signature that predicts the therapeutic response of the basal-like breast cancer to neoadjuvant chemotherapy. Breast Cancer Res Treat 2009; 123:691-9. [PMID: 19967557 DOI: 10.1007/s10549-009-0664-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 11/21/2009] [Indexed: 10/20/2022]
Abstract
Several gene expression profiles have been reported to predict breast cancer response to neoadjuvant chemotherapy. These studies often consider breast cancer as a homogeneous entity, although higher rates of pathologic complete response (pCR) are known to occur within the basal-like subclass. We postulated that profiles with higher predictive accuracy could be derived from a subset analysis of basal-like tumors in isolation. Using a previously described "intrinsic" signature to differentiate breast tumor subclasses, we identified 50 basal-like tumors from two independent clinical trials associated with gene expression profile data. 24 tumor data sets were derived from a 119-patient neoadjuvant trial at our institution and an additional 26 tumor data sets were identified from a published data set (Hess et al. J Clin Oncol 24:4236-4244, 2006). The combined 50 basal-like tumors were partitioned to form a 37 sample training set with 13 sequestered for validation. Clinical surveillance occurred for a mean of 26 months. We identified a 23-gene profile which predicted pCR in basal-like breast cancers with 92% predictive accuracy in the sequestered validation data set. Furthermore, distinct cluster of patients with high rates of cancer recurrence was observed based on cluster analysis with the 23-gene signature. Disease-free survival analysis of these three clusters revealed significantly reduced survival in the patients of this high recurrence cluster. We identified a 23-gene signature which predicts response of basal-like breast cancer to neoadjuvant chemotherapy as well as disease-free survival. This signature is independent of tissue collection method and chemotherapeutic regimen.
Collapse
|
48
|
Ionta MT, Atzori F, Deidda MC, Pusceddu V, Palmeri S, Frau B, Murgia M, Barca M, Minerba L, Massidda B. Long-term outcomes in stage IIIB breast cancer patients who achieved less than a pathological complete response (<pCR) after primary chemotherapy. Oncologist 2009; 14:1051-60. [PMID: 19897535 DOI: 10.1634/theoncologist.2009-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Pathological complete response (pCR) to primary chemotherapy is the main determinant for improved disease-free survival (DFS) and overall survival (OS). The primary endpoints of our study were the long-term DFS and OS rates in homogeneously treated stage IIIB breast cancer patients who failed to achieve a pCR (<pCR), in relation to residual tumor burden. The secondary endpoint was the prognostic relevance of hormone receptor (HR) and human epidermal growth factor receptor (HER)-2 status. METHODS We analyzed 58 of 74 consecutive stage IIIB patients treated between 1996 and 2001 who achieved <pCR following a primary cisplatin, epirubicin, and vinorelbine regimen for up to six cycles. At the time of patient accrual, trastuzumab was not available. After definitive surgery, pathological residual disease remained in 40 (69%) patients in both the breast and axilla, in 14 (24%) patients in only the breast, and in four (7%) patients in only the axilla. RESULTS Fifty-eight (78%) of 74 patients achieved <pCR and 16 (22%) had pCR both in the breast and axilla. After a median follow-up of 99 months (range, 72-134 months), in patients with <pCR the estimated 10-year DFS and OS rates were 37.6% and 50.3%, respectively, significantly worse than in the pCR group (p = .003 and p = .008, respectively). Patients with four or more axillary nodes involved had a significantly worse 10-year DFS rate (28.9% versus 62.7%; p = .036). Patients with HR(-) tumors had significantly lower 10-year DFS (17.3% versus 46.4%; p = .018) and OS (17.3% versus 70.2%; p = .002) rates. Overall, the triple-negative (TN) group showed only a marginally significantly worse OS rate (p = .048). HER-2 status alone, in the absence of trastuzumab, did not appear to significantly affect outcomes. CONCLUSIONS Our data suggest that, in stage IIIB patients who achieve <pCR, the number of residual nodes and HR(-) status are strong predictors of poor outcomes. After a long follow-up time, HER-2 expression does not appear to significantly affect DFS and OS. TN patients showed a trend toward early recurrence and death.
Collapse
Affiliation(s)
- Maria Teresa Ionta
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria, Cagliari, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Jung SY, Kim SK, Nam BH, Min SY, Lee SJ, Park C, Kwon Y, Kim EA, Ko KL, Park IH, Lee KS, Shin KH, Lee S, Kim SW, Kang HS, Ro J. Prognostic Impact of [18F] FDG-PET in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy. Ann Surg Oncol 2009; 17:247-53. [DOI: 10.1245/s10434-009-0710-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 08/20/2009] [Indexed: 11/18/2022]
|
50
|
Kelly AM, Dwamena B, Cronin P, Carlos RC. Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta analysis. Acad Radiol 2009; 16:551-63. [PMID: 19345896 DOI: 10.1016/j.acra.2009.01.026] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 01/12/2009] [Accepted: 01/27/2009] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Breast cancer is the leading cause of mortality in women worldwide. Lymphatic mapping with sentinel node biopsy has the potential to reduce the morbidity associated with breast cancer staging in women after neoadjuvant therapy. MATERIALS AND METHODS A systematic search of world literature between 1996 and 2007 of sentinel node mapping in patients with early-stage breast carcinoma after chemotherapy was undertaken. Potentially eligible studies were identified using database-specific search strategies incorporating appropriate Boolean combinations of the keywords sentinel node biopsy or sentinel node localization or lymphatic mapping; breast cancer or malignancy or neoplasm; and preoperative or neoadjuvant chemotherapy. The electronic searches were augmented with a manual search of reference lists from identified articles. Successful lymph node mapping, defined as successful identification rate (SIR), and false-negative rate (FNR) was summarized using a bivariate random effects mixed model. The extent of heterogeneity was assessed using the inconsistency statistic. The effect of study level covariates, such as use of immunohistochemistry or dual mapping technique, and individual quality criteria, such as study design or multi-institution participation, on SIR and FNR were analyzed using metaregression. RESULTS A total of 24 trials of 1799 subjects were reported that met eligibility criteria. All studies identified were published between 2000 and 2007. Lymph node involvement was found in 758 patients (37%) and ranged from 25% to 96% across studies. The proportion of patients who had successful lymph node mapping ranged from 63% to 100%, with 79% of studies reporting a rate of less than 95%. The summary successful identification rate was 0.896 (95% confidence interval [CI] 0.860-0.923) with moderate heterogeneity. The summary FNR was 0.084 (95% CI 0.064-0.109) with no significant heterogeneity. Increasing prevalence of lymph node involvement and same-day mapping and lymph node dissection both significantly reduced the FNR. CONCLUSIONS The present systematic review demonstrates robust estimates of successful identification rate and false-negative rates of sentinel lymph node mapping and biopsy after neoadjuvant therapy for early-stage breast cancer patients. With a 90% SIR and 8% FNR, this technique is a reliable tool for planning treatment in this population as an alternative to completion axillary lymph node dissection.
Collapse
|