1
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Alkan AH, Ensoy M, Cansaran-Duman D. A new therapeutic strategy for luminal A-breast cancer treatment: vulpinic acid as an anti-neoplastic agent induces ferroptosis and apoptosis mechanisms. Med Oncol 2024; 41:229. [PMID: 39158808 DOI: 10.1007/s12032-024-02473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
Breast cancer is a common invasive tumor in women, and the most common subtype of breast cancer is luminal A. Hormonal therapies are the primary treatment for luminal A, but treatment options are limited. Vulpinic acid (VA), a lichen compound, inhibited cancer cells. Here, we aimed to reveal the functional role and mechanism of VA in luminal A breast cancer. Experiments associated with the ferroptosis mechanism were performed to reveal the role of vulpinic acid on luminal A-breast cancer and the underlying mechanisms. The results showed that VA induced the ferroptosis pathway by decreasing glutathione (GSH) levels while increasing lipid reactive oxygen species (ROS), lipid peroxidation (MDA), and intracellular Fe2+ levels in MCF-7 cells. After treatment of MCF-7 cells with VA, the ferroptosis-related gene expression profile was significantly altered. Western blot analysis showed that GPX4 protein levels were down-regulated and LPCAT3 protein levels were up-regulated after VA treatment. Our study suggests that apoptosis and ferroptosis act together in VA-mediated tumor suppression in MCF-7 breast cancer cells. These findings suggest that VA, an anti-neoplastic agent, could potentially treat luminal A targeted breast cancer via the ferroptosis pathway.
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Affiliation(s)
- Ayşe Hale Alkan
- Biotechnology Institute, Ankara University, Keçiören, 06135, Ankara, Turkey
| | - Mine Ensoy
- Biotechnology Institute, Ankara University, Keçiören, 06135, Ankara, Turkey
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2
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Alavanda C, Dirimtekin E, Mortoglou M, Arslan Ates E, Guney AI, Uysal-Onganer P. BRCA Mutations and MicroRNA Expression Patterns in the Peripheral Blood of Breast Cancer Patients. ACS OMEGA 2024; 9:17217-17228. [PMID: 38645356 PMCID: PMC11025100 DOI: 10.1021/acsomega.3c10086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/08/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
Breast cancer (BC) persists as the predominant malignancy globally, standing as the foremost cause of cancer-related mortality among women. Despite notable advancements in prevention and treatment, encompassing the incorporation of targeted immunotherapies, a continued imperative exists for the development of innovative methodologies. These methodologies would facilitate the identification of women at heightened risk, enhance the optimization of therapeutic approaches, and enable the vigilant monitoring of emergent treatment resistance. Circulating microRNAs (miRNAs), found either freely circulating in the bloodstream or encapsulated within extracellular vesicles, have exhibited substantial promise for diverse clinical applications. These applications range from diagnostic and prognostic assessments to predictive purposes. This study aimed to explore the potential associations between BRCA mutations and specific miRNAs (miR-21, miR-155, miR-126, and miR-200c) expression that are known to be dysregulated in BC patient samples. Our findings indicate a robust correlation between miRNA expression status and disease subtypes. We found a correlation between the expression status of miRNAs and distinct disease subtypes. Intriguingly, however, no significant associations were discerned between disease status, subtypes, or miRNA expression levels and the presence of BRCA mutations. To advance the validation of miRNAs as clinically relevant biomarkers, additional investigations within larger and meticulously selected patient cohorts are deemed imperative. These microRNA entities hold the potential to emerge as groundbreaking and readily accessible tools, poised for seamless integration into the landscape of clinical practice.
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Affiliation(s)
- Ceren Alavanda
- Department
of Medical Genetics, School of Medicine, Marmara University, 34854 Istanbul, Turkey
- Department
of Medical Genetics, Van Research and Training
Hospital, 10300 Van, Turkey
| | - Esra Dirimtekin
- Department
of Medical Genetics, School of Medicine, Marmara University, 34854 Istanbul, Turkey
| | - Maria Mortoglou
- Cancer
Mechanisms and Biomarkers Research Group, School of Life Sciences, University of Westminster, W1W 6UW London, U.K.
| | - Esra Arslan Ates
- Department
of Medical Genetics, Istanbul University-Cerrahpasa,
Cerrahpasa Faculty of Medicine, 34098 Istanbul, Turkey
| | - Ahmet Ilter Guney
- Department
of Medical Genetics, School of Medicine, Marmara University, 34854 Istanbul, Turkey
| | - Pinar Uysal-Onganer
- Cancer
Mechanisms and Biomarkers Research Group, School of Life Sciences, University of Westminster, W1W 6UW London, U.K.
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3
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Nielsen TO, Leung SCY, Riaz N, Mulligan AM, Kos Z, Bane A, Whelan TJ. Ki67 assessment protocol as an integral biomarker for avoiding radiotherapy in the LUMINA breast cancer trial. Histopathology 2023; 83:903-911. [PMID: 37609778 DOI: 10.1111/his.15032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/24/2023]
Abstract
AIMS The LUMINA trial demonstrated a very low local recurrence rate in women ≥55 years with low-risk luminal A breast cancer (defined as grade I-II, T1N0, hormone receptor positive, HER2 negative and Ki67 index ≤13.25%) treated with breast-conserving surgery and endocrine therapy (but no other systemic therapy), supporting the safe omission of radiation in these women. Here we describe the protocol for Ki67 assessment, the companion diagnostic used to guide omission of adjuvant radiotherapy. METHODS Ki67 immunohistochemistry was performed on full-face sections at one of three regional labs. Pathologists trained in the International Ki67 in Breast Cancer Working Group (IKWG) method demarcated tumour areas on scanned slides and scored 100 nuclei from each of at least five randomly selected 1-mm fields. For cases with high Ki67 heterogeneity, further virtual cores were selected and scored in order to confidently assign a case as luminal A (≤13.25%) or B (>13.25%). Interlaboratory variability was assessed through an annual quality assurance programme during the study period. RESULTS From the quality assurance programme, the mean Ki67 index across all cases/labs was 13%. The observed intraclass correlation coefficient (ICC) and kappa statistics were ≥0.9 and ≥0.7, respectively, indicating a substantial level of agreement. Median scoring time was 4 min per case. The IKWG-recommended scoring method, performed directly from slides, requiring up to four scored fields, is concordant with the LUMINA scoring method (ICC ≥ 0.9). CONCLUSION Ki67 is a practical, reproducible, and inexpensive biomarker that can identify low-risk luminal A breast cancers as potential candidates for radiation de-escalation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov number, NCT01791829.
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Affiliation(s)
- Torsten O Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samuel C Y Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nazia Riaz
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anna M Mulligan
- University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anita Bane
- University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Timothy J Whelan
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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4
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Tau S, Miller TW. The role of cancer cell bioenergetics in dormancy and drug resistance. Cancer Metastasis Rev 2023; 42:87-98. [PMID: 36696004 PMCID: PMC10233409 DOI: 10.1007/s10555-023-10081-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
While anti-cancer drug treatments are often effective for the clinical management of cancer, these treatments frequently leave behind drug-tolerant persister cancer cells that can ultimately give rise to recurrent disease. Such persistent cancer cells can lie dormant for extended periods of time, going undetected by conventional clinical means. Understanding the mechanisms that such dormant cancer cells use to survive, and the mechanisms that drive emergence from dormancy, is critical to the development of improved therapeutic strategies to prevent and manage disease recurrence. Cancer cells often exhibit metabolic alterations compared to their non-transformed counterparts. An emerging body of evidence supports the notion that dormant cancer cells also have unique metabolic adaptations that may offer therapeutically targetable vulnerabilities. Herein, we review mechanisms through which cancer cells metabolically adapt to persist during drug treatments and develop drug resistance. We also highlight emerging therapeutic strategies to target dormant cancer cells via their metabolic features.
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Affiliation(s)
- Steven Tau
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Dartmouth Cancer Center, Lebanon, NH, USA
| | - Todd W Miller
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Dartmouth Cancer Center, Lebanon, NH, USA.
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, HB-7936, Lebanon, NH 03756, USA.
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5
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Lashen AG, Toss MS, Ghannam SF, Makhlouf S, Green A, Mongan NP, Rakha E. Expression, assessment and significance of Ki67 expression in breast cancer: an update. J Clin Pathol 2023; 76:357-364. [PMID: 36813558 DOI: 10.1136/jcp-2022-208731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Ki67 expression is one of the most important and cost-effective surrogate markers to assess for tumour cell proliferation in breast cancer (BC). The Ki67 labelling index has prognostic and predictive value in patients with early-stage BC, particularly in the hormone receptor-positive, HER2 (human epidermal growth factor receptor 2)-negative (luminal) tumours. However, many challenges exist in using Ki67 in routine clinical practice and it is still not universally used in the clinical setting. Addressing these challenges can potentially improve the clinical utility of Ki67 in BC. In this article, we review the function, immunohistochemical (IHC) expression, methods for scoring and interpretation of results as well as address several challenges of Ki67 assessment in BC. The prodigious attention associated with use of Ki67 IHC as a prognostic marker in BC resulted in high expectation and overestimation of its performance. However, the realisation of some pitfalls and disadvantages, which are expected with any similar markers, resulted in an increasing criticism of its clinical use. It is time to consider a pragmatic approach and weigh the benefits against the weaknesses and identify factors to achieve the best clinical utility. Here we highlight the strengths of its performance and provide some insights to overcome the existing challenges.
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Affiliation(s)
- Ayat Gamal Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzan Fathy Ghannam
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histology, Suez Canal University, Ismailia, Egypt
| | - Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Andrew Green
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
| | - Nigel P Mongan
- School of Veterinary Medicine and Sciences, University of Nottingham, Nottingham, UK.,Department of Pharmacology, Weill Cornell Medicine, New York, New York, USA
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK .,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.,Pathology Department, Hamad Medical Corporation, Doha, Qatar
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6
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Gholivand K, Barzegari A, Yousefian M, Malekshah RE, Faraghi M. Experimental and theoretical evaluation of biological properties of a phosphoramide functionalized graphene oxide. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2023. [DOI: 10.1016/j.bcab.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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7
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Shenasa E, Stovgaard ES, Jensen MB, Asleh K, Riaz N, Gao D, Leung S, Ejlertsen B, Laenkholm AV, Nielsen TO. Neither Tumor-Infiltrating Lymphocytes nor Cytotoxic T Cells Predict Enhanced Benefit from Chemotherapy in the DBCG77B Phase III Clinical Trial. Cancers (Basel) 2022; 14:cancers14153808. [PMID: 35954471 PMCID: PMC9367267 DOI: 10.3390/cancers14153808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Apart from the direct killing of cancer cells, cyclophosphamide-based chemotherapy has been shown to induce an antitumor immune response, and is being used in combination with immunotherapies in cancer care. We assessed the interaction of chemotherapy with immune biomarkers expressed on primary tumor tissue from a randomized phase III clinical trial, and confirmed that the presence of tumor-infiltrating lymphocytes is linked to improved survival in premenopausal women with high-risk breast cancer, regardless of their treatment allocation. However, immune biomarkers including tumor-infiltrating lymphocytes do not predict extra benefit from cyclophosphamide chemotherapy. This finding applies across the major molecular subgroups, including non-luminal and basal breast cancers that tend to be more immunogenic, and are often considered the most suitable subsets for receiving immunotherapy. Abstract Recent studies have shown that immune infiltrates in the tumor microenvironment play a role in response to therapy, with some suggesting that patients with immunogenic tumors may receive increased benefit from chemotherapies. We evaluated this hypothesis in early breast cancer by testing the interaction between immune biomarkers and chemotherapy using materials from DBCG77B, a phase III clinical trial where high-risk premenopausal women were randomized to receive chemotherapy or no chemotherapy. Tissue microarrays were evaluated for tumor-infiltrating lymphocytes (TILs) assessed morphologically on hematoxylin and eosin-stained slides, and by immunohistochemistry for CD8, FOXP3, LAG-3, PD-1 and PD-L1. Following REMARK reporting guidelines, data analyses were performed according to a prespecified statistical plan, using 10-year invasive disease-free survival as the endpoint. Differences in survival probabilities between biomarker groups were evaluated by Kaplan–Meier and Cox proportional hazard ratio analyses and prediction for treatment benefit by an interaction test. Our results showed that stromal TILs were associated with an improved prognosis (HR = 0.93; p-value = 0.03), consistent with previous studies. However, none of the immune biomarkers predicted benefit from chemotherapy in the full study set nor within major breast cancer subtypes. Our study indicates that primary tumors with higher immune infiltration do not derive extra benefit from cyclophosphamide-based cytotoxic chemotherapy.
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Affiliation(s)
- Elahe Shenasa
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | | | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Karama Asleh
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | - Nazia Riaz
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
- Centre for Regenerative Medicine and Stem Cell Research, Aga Khan University, Karachi 74800, Pakistan
| | - Dongxia Gao
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | - Samuel Leung
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Anne-Vibeke Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Torsten O. Nielsen
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
- Correspondence:
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8
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Zheng K, Yao S, Yao W, Li Q, Wang Y, Zhang L, Chen X, Xiong H, Yuan X, Wang Y, Zou Y, Xiong H. Association Between RSK2 and Clinical Indexes of Primary Breast Cancer: A Meta-Analysis Based on mRNA Microarray Data. Front Genet 2021; 12:770134. [PMID: 34790230 PMCID: PMC8591226 DOI: 10.3389/fgene.2021.770134] [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: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Although ribosomal protein S6 kinases, 90 kDa, polypeptide 3 (RSK2, RPS6KA3) has been reported to play an important role in cancer cell proliferation, invasion, and migration, including breast cancer, its clinical implication in primary breast cancer patients is not well understood, and there were not many studies to explore the relationship between RSK2 and breast cancer on a clinical level. Methods: A systematic series matrix file search uploaded from January 1, 2008 to November 31, 2017 was undertaken using ArrayExpress and Gene Expression Omnibus (GEO) databases. Search filters were breast cancer, RNA assay, and array assay. Files eligible for inclusion met the following criteria: a) sample capacity is over 100, b) tumor sample comes from unselected patient’s primary breast tumor tissue, and c) expression of RSK2 and any clinical parameters of patients were available from the files. We use median as the cutoff value to assess the association between the expression of RSK2 and the clinical indexes of breast cancer patients. Finding: The meta-analysis identified 13 series matrix files from GEO database involving 3,122 samples that come from patients’ primary breast cancer tissue or normal tissue. The expression of RSK2 in tumor tissues is lower than that in normal tissues [odds ratio (OR), 0.54; 95% credible interval (CI), 0.44–0.67; Cochran’s Q test p = 0.14; I2 = 41.7%]. Patients with a high expression of RSK2 showed more favorable overall survival [hazard ratio (HR), 0.71; 95% CI, 0.49–0.94; Cochran’s Q test p = 0.95; I2 = 0.0%] and less potential of distant metastasis (OR, 0.59; 95% CI, 0.41–0.87; Cochran’s Q test p = 0.88; I2 = 0.0%) and lymph node infiltration (OR, 0.81; 95% CI, 0.65–0.998; Cochran’s Q test p = 0.09; I2 = 42.8%). Besides, the expression of RSK2 in luminal breast cancer is lower than Cochran’s Q test p = 0.06; I2 = 63.5%). RSK2 overexpression corresponded with higher histological grade (OR, 1.329; 95% CI, 1.03–1.721; Cochran’s Q test p = 0.69; I2 = 0.0%). RSK2 expression is also associated with estrogen receptor (ER) and age. Conclusion: The meta-analysis provides evidence that RSK2 is a potential biomarker in breast cancer patients. The expression of RSK2 is distinctive in different intrinsic subtypes of breast cancer, indicating that it may play an important role in specific breast cancer. Further study is needed to uncover the mechanism of RSK2 in breast cancer. Systematic Review Registration: (website), identifier (registration number).
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Affiliation(s)
- Kun Zheng
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Yao
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Yao
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianxia Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yali Wang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lili Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuqiong Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huihua Xiong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihua Wang
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Yanmei Zou
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xiong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Chen L, Ji N, Zhang M, Chen W. The Influence of Wuzhi Capsule on the Pharmacokinetics of Cyclophosphamide. Recent Pat Anticancer Drug Discov 2021; 17:195-203. [PMID: 34758719 DOI: 10.2174/1574892816666211110152119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/15/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cyclophosphamide is approved for the treatment of a variety of tumors, yet the use of cyclophosphamide is limited by kidney and liver toxicity. In the clinic, the Wuzhi capsule is approved to attenuate cyclophosphamide toxicity in the kidney and liver. OBJECTIVE We aimed to investigate the effects of the principal ingredients of Wuzhi capsule, schisandrin A (SIA) and schisantherin A (STA), on the pharmacokinetics of cyclophosphamide. METHODS The essential pharmacokinetic data and physicochemical parameters of SIA, STA, and cyclophosphamide were collected. Physiologically based pharmacokinetic (PBPK) models of SIA, STA, and cyclophosphamide were built in Simcyp Simulator and verified using published clinical pharmacokinetic data. The verified PBPK models were used to predict potential herb-drug interactions (HDIs) between cyclophosphamide and SIA and STA in cancer patients. RESULTS The area under the plasma concentration-time curve (AUC) of cyclophosphamide was increased by 18% and 1% when co-administered with STA and SIA at a single dose, respectively, and increased by 301% and 29% when co-administered with STA and SIA at multiple doses, respectively. The maximum concentration (Cmax) of cyclophosphamide was increased by 75% and 7% when co-administered with STA and SIA at multiple doses, respectively. CONCLUSION The AUC and Cmax of cyclophosphamide were increased when cyclophosphamide was combined with the Wuzhi capsule, compared to cyclophosphamide alone. Our study shows that the adverse drug reactions and toxicity of cyclophosphamide should be closely monitored and an effective dosage adjustment of cyclophosphamide may need to be considered when co-administered with the Wuzhi capsule.
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Affiliation(s)
- Lu Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing. China
| | - Ning Ji
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY. United States
| | - Min Zhang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing. China
| | - Wanyi Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing. China
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10
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Houvenaeghel G, de Nonneville A, Cohen M, Chopin N, Coutant C, Reyal F, Mazouni C, Gimbergues P, Azuar AS, Chauvet MP, Classe JM, Daraï E, Martinez A, Rouzier R, de Lara CT, Lambaudie E, Barrou J, Goncalves A. Lack of prognostic impact of sentinel node micro-metastases in endocrine receptor-positive early breast cancer: results from a large multicenter cohort ☆. ESMO Open 2021; 6:100151. [PMID: 33984674 PMCID: PMC8314870 DOI: 10.1016/j.esmoop.2021.100151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/15/2023] Open
Abstract
Background Prognostic impact of lymph node micro-metastases (pN1mi) has been discordantly reported in the literature. The need to clarify this point for decision-making regarding adjuvant therapy, particularly for patients with endocrine receptor (ER)-positive status and HER2-negative tumors, is further reinforced by the generalization of gene expression signatures using pN status in their recommendation algorithm. Patients and methods We retrospectively analyzed 13 773 patients treated for ER-positive breast cancer in 13 French cancer centers from 1999 to 2014. Five categories of axillary lymph node (LN) status were defined: negative LN (pN0i−), isolated tumor cells [pN0(i+)], pN1mi, and pN1 divided into single (pN1 = 1) and multiple (pN1 > 1) macro-metastases (>2 mm). The effect of LN micro-metastases on outcomes was investigated both in the entire cohort of patients and in clinically relevant subgroups according to tumor subtypes. Propensity-score-based matching was used to balance differences in known prognostic variables associated with pN status. Results As determined by sentinel LN biopsy, 9427 patients were pN0 (68.4%), 546 pN0(i+) (4.0%), 1446 pN1mi (10.5%) and 2354 pN1 with macro-metastases (17.1%). With a median follow-up of 61.25 months, pN1 status, but not pN1mi, significantly impacted overall survival (OS), disease-free survival (DFS), metastasis-free survival (MFS), and breast-cancer-specific survival. In the subgroup of patients with known tumor subtype, pN1 = 1, as pN1 > 1, but not pN1mi, had a significant prognostic impact on OS. DFS and MFS were only impacted by pN1 > 1. Similar results were observed in the subgroup of patients with luminal A-like tumors (n = 7101). In the matched population analysis, pN1macro, but not pN1mi, had a statistically significant negative impact on MFS and OS. Conclusion LN micro-metastases have no detectable prognostic impact and should not be considered as a determining factor in indicating adjuvant chemotherapy. The evaluation of the risk of recurrence using second-generation signatures should be calculated considering micro-metastases as pN0. LN micro-metastases have no detectable prognostic impact. pN1 status, but not pN1mi, significantly impacted overall survival, disease-free survival, metastasis-free survival. In the subgroup of patients with known tumor subtype, pN1=1, as pN1>1, but not pN1mi, had a significant prognostic impact on OS. LN micro-metastases should not be considered as a determining factor in indicating adjuvant chemotherapy.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France.
| | - A de Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - M Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - N Chopin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - C Coutant
- Department of Surgical Oncology, Centre Georges François Leclerc, Dijon, France
| | - F Reyal
- Department of Surgical Oncology, Institut Curie, Paris Cedex 05, Paris, France
| | - C Mazouni
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - P Gimbergues
- Department of Surgical Oncology, Centre Jean Perrin, Clermont Ferrand, France
| | - A-S Azuar
- Department of Surgical Oncology, Hôpital de Grasse, Grasse, France
| | - M-P Chauvet
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - J-M Classe
- Department of Surgical Oncology, Institut René Gauducheau, St Herblain, France
| | - E Daraï
- Department of Surgical Oncology, Hôpital Tenon, Paris, France
| | - A Martinez
- Department of Surgical Oncology, Centre Claudius Regaud, Toulouse, France
| | - R Rouzier
- Department of Surgical Oncology, Hôpital René Huguenin, Saint Cloud, France
| | - C T de Lara
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - E Lambaudie
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - J Barrou
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - A Goncalves
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
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11
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Huang Y, Le J, Miao A, Zhi W, Wang F, Chen Y, Zhou S, Chang C. Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound. Gland Surg 2021; 10:1280-1290. [PMID: 33968680 DOI: 10.21037/gs-20-836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Elucidation the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer is important for informing therapeutic decisions. This study aimed at evaluating the potential value of contrast-enhanced ultrasound (CEUS) parameters in predicting breast cancer responses to NAC. Methods We performed CEUS examinations before and after two cycles of NAC. Quantitative CEUS parameters [maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT)], tumor diameter, and their changes were measured and compared to histopathological responses, according to the Miller-Payne Grading (MPG) system (score 1, 2, or 3: minor response; score 4 or 5: good response). Prediction models for good response were developed by multiple logistic regression analysis and internally validated through bootstrap analysis. The receiver operating characteristic (ROC) curve was used to evaluate the performance of prediction models. Results A total of 143 patients were enrolled in this study among whom 98 (68.5%) achieved a good response and while 45 (31.5%) exhibited a minor response. Several imaging variables including diameter, IMAX, changes in diameter (Δdiameter), IMAX (ΔIMAX) and TTP (ΔTTP) were found to be significantly associated with good therapeutic responses (P<0.05). The areas under the curve (AUC) increased from 0.748 to 0.841 in the multivariate model that combined CEUS parameters and molecular subtypes with a sensitivity and specificity of 0.786, 0.745, respectively. Tumor molecular subtype was the primary predictor of primary endpoint. Conclusions CEUS is a potential tool for predicting responses to NAC in locally advanced breast cancer patients. Compared to the other molecular subtypes, triple negative and HER2+/ER- subtypes are more likely to exhibit a good response to NAC.
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Affiliation(s)
- Yunxia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Le
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Aiyu Miao
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenxiang Zhi
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fen Wang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaling Chen
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Nielsen TO, Leung SCY, Rimm DL, Dodson A, Acs B, Badve S, Denkert C, Ellis MJ, Fineberg S, Flowers M, Kreipe HH, Laenkholm AV, Pan H, Penault-Llorca FM, Polley MY, Salgado R, Smith IE, Sugie T, Bartlett JMS, McShane LM, Dowsett M, Hayes DF. Assessment of Ki67 in Breast Cancer: Updated Recommendations From the International Ki67 in Breast Cancer Working Group. J Natl Cancer Inst 2020; 113:808-819. [PMID: 33369635 PMCID: PMC8487652 DOI: 10.1093/jnci/djaa201] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
Ki67 immunohistochemistry (IHC), commonly used as a proliferation marker in breast cancer, has limited value for treatment decisions due to questionable analytical validity. The International Ki67 in Breast Cancer Working Group (IKWG) consensus meeting, held in October 2019, assessed the current evidence for Ki67 IHC analytical validity and clinical utility in breast cancer, including the series of scoring studies the IKWG conducted on centrally stained tissues. Consensus observations and recommendations are: 1) as for estrogen receptor and HER2 testing, preanalytical handling considerations are critical; 2) a standardized visual scoring method has been established and is recommended for adoption; 3) participation in and evaluation of quality assurance and quality control programs is recommended to maintain analytical validity; and 4) the IKWG accepted that Ki67 IHC as a prognostic marker in breast cancer has clinical validity but concluded that clinical utility is evident only for prognosis estimation in anatomically favorable estrogen receptor–positive and HER2-negative patients to identify those who do not need adjuvant chemotherapy. In this T1-2, N0-1 patient group, the IKWG consensus is that Ki67 5% or less, or 30% or more, can be used to estimate prognosis. In conclusion, analytical validity of Ki67 IHC can be reached with careful attention to preanalytical issues and calibrated standardized visual scoring. Currently, clinical utility of Ki67 IHC in breast cancer care remains limited to prognosis assessment in stage I or II breast cancer. Further development of automated scoring might help to overcome some current limitations.
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Affiliation(s)
- Torsten O Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samuel C Y Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Dodson
- The UK National External Quality Assessment Scheme for Immunocytochemistry and In-Situ Hybridisation, London, UK
| | - Balazs Acs
- Department of Oncology and Pathology, Cancer Centre Karolinska (CCK), Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
| | - Sunil Badve
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Carsten Denkert
- Philipps University Marburg and University Hospital Marburg, Marburg, Germany
| | - Matthew J Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Hans H Kreipe
- Medical School Hannover, Institute of Pathology, Hannover, Germany
| | | | - Hongchao Pan
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Mei-Yin Polley
- Department of Public Health Sciences, University of Chicago Biological Sciences, Chicago, IL, USA
| | - Roberto Salgado
- Department of Pathology, GasthuisZusters Antwerpen / Hospital Network Antwerp (GZA-ZNA), Antwerp, Belgium.,Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ian E Smith
- Breast Unit, Royal Marsden Hospital, London, UK
| | - Tomoharu Sugie
- Department of Surgery, Kansai Medical University, Shinmachi, Hirakata City, Osaka Prefecture, Japan
| | - John M S Bartlett
- Diagnostic Development Program, Ontario Institute for Cancer Research, Toronto, ON, Canada.,Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Lisa M McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Mitch Dowsett
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
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13
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Li Y, Ma L. Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis. World J Surg Oncol 2020; 18:316. [PMID: 33267822 PMCID: PMC7712980 DOI: 10.1186/s12957-020-02089-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the association between chemotherapy and prognosis of patients with breast cancer of luminal A subtype and lymph node-positive, luminal A subtype breast cancer Methods Articles published between January 1, 2010, and May 1, 2020, were collected from PubMed, Embase, and Web of Science databases. On the basis of a test for heterogeneity, we selected the random effects model or fixed effects model for meta-analysis. Article quality was evaluated by sensitivity analysis, and Begg’s and Egger’s tests were used to measure publication bias. Results Six eligible articles were identified. The hazard ratio of overall survival of luminal A breast cancer patients who received both chemotherapy and endocrine therapy was 1.73 (95% CI 1.23, 2.43). The hazard ratio of overall survival for lymph node-positive, luminal A breast cancer patients who received chemotherapy and endocrine therapy was 1.86 and 95% CI 1.26, 2.81. The hazard ratio of relapse-free survival to disease-free survival was 1.30 (95% CI 0.85, 1.77). Tumor size, vascular invasion, and age did not show significant correlations with breast cancer prognosis. Conclusion Compared with endocrine therapy alone, the addition of chemotherapy did not improve the prognosis of patients with luminal type A and lymph node positive cancer; instead, side effects of the additional chemotherapy may have negatively affected prognosis. Prospective studies are needed to determine whether the number of positive lymph nodes also correlates with efficacy of chemotherapy of luminal type A breast cancer.
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Affiliation(s)
- Yilun Li
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Li Ma
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China.
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14
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Han Y, Wang J, Sun Y, Yu P, Yuan P, Ma F, Fan Y, Luo Y, Zhang P, Li Q, Cai R, Chen S, Li Q, Xu B. Prognostic Model and Nomogram for Estimating Survival of Small Breast Cancer: A SEER-based Analysis. Clin Breast Cancer 2020; 21:e497-e505. [PMID: 33277191 DOI: 10.1016/j.clbc.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Different clinicopathologic characteristics could contribute to inconsistent prognoses of small breast neoplasms (T1a/T1b). This study was done to conduct a retrospective analysis and establish a clinical prediction model to predict individual survival outcomes of patients with small carcinomas of the breast. MATERIALS AND METHODS Based on the Surveillance, Epidemiology, and End Results (SEER) database, eligible patients with small breast carcinomas were analyzed. Univariate analysis and multivariate analysis were performed to clarify the indicators of overall survival. Pooling risk factors enabled nomograms to be constructed and further predicted 3-year, 5-year, and 10-year survival of patients with small breast cancer. The model was internally validated for discrimination and calibration. RESULTS A total of 17,543 patients with small breast neoplasms diagnosed between 2013 and 2016 were enrolled. Histologic grade, lymph node stage, estrogen receptor or progesterone receptor status, and molecular subtypes of breast cancer were regarded as the risk factors of prognosis in a Cox proportional hazards model (P < .05). A nomogram was constructed to give predictive accuracy toward individual survival rate of patients with small breast neoplasms. CONCLUSIONS This prognostic model provided a robust and effective method to predict the prognosis of patients with small breast cancer.
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Affiliation(s)
- Yiqun Han
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yanxia Sun
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Yu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peng Yuan
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruigang Cai
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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15
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Zhang H, Zhang N, Moran MS, Li Y, Liang Y, Su P, Haffty BG, Yang Q. Special subtypes with favorable prognosis in breast cancer: A registry-based cohort study and network meta-analysis. Cancer Treat Rev 2020; 91:102108. [PMID: 33075683 DOI: 10.1016/j.ctrv.2020.102108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to explore whether cribriform and adenoid cystic carcinoma had comparable prognoses to mucinous, tubular and papillary carcinoma, which were long recognized as favorable histologies by NCCN guidelines. METHODS A retrospective analysis based on the Surveillance, Epidemiology, and End Results Study (SEER) database (1994-2014) was conducted. The prognostic significance of all clinicopathological factors was calculated using univariate and multivariate analyses. A systematic review based on PubMed and network meta-analysis was conducted. RESULTS From the SEER database, the histologic subtypes of breast cancer (tubular, cribriform, adenoid cystic, mucinous, and papillary) were sorted by overall survival (OS) (94.4%, 91.6%, 90.8%, 87.6%, and 84.2%, respectively) and tubular, cribriform, mucinous, papillary, and adenoid cystic carcinoma by breast cancer-specific survival (BCSS) (99.4%, 98.4%, 97.7%, 95.2%, and 94.9%, respectively). A network meta-analysis combining 11 studies (886,649 patients) was conducted, which demonstrated consistent outcomes. SEER-based analyses revealed that, among the favorable subtypes, systemic chemotherapy did not improve OS or BCSS in hormone receptor-positive, node-negative patients, validating that these subtypes are generally associated with excellent outcomes, for which systemic chemotherapy may not be warranted. CONCLUSIONS Our data are consistent with guidelines suggesting that the mucinous, tubular, and papillary subtypes of breast cancer have favorable histologies. SEER data and meta-analysis supports this favorable category to include adenoid cystic and cribriform carcinoma, whose OS and BCSS outcomes are comparable to the former three. These findings add to the body of data, suggesting that patients with these histologic subtypes confer excellent prognosis, which may guide optimal therapeutic management strategies.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson and New Jersey Medical School, New Brunswick, NJ, USA
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China; Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China.
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16
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Gao HF, Li WP, Zhu T, Yang CQ, Yang M, Zhang LL, Ji F, Cheng MY, Li JQ, Wang K. Adjuvant chemotherapy could benefit early-stage ER/PR positive mucinous breast cancer: A SEER-based analysis. Breast 2020; 54:79-87. [PMID: 32947149 PMCID: PMC7502365 DOI: 10.1016/j.breast.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/15/2020] [Accepted: 09/07/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to explore the value of adjuvant chemotherapy in patients with early-stage ER/PR-positive mucinous carcinoma. Methods We identified early-stage ER/PR-positive mucinous carcinoma patients in the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity-score matching (PSM) analysis to eliminate selection bias and differences in baseline characteristics. Univariate and multivariate analyses were performed to identify significant prognostic factors. The primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS), which were evaluated with the Kaplan-Meier method. Results After propensity score matching, 805 pairs were selected. Patients with early-stage ER/PR-positive mucinous adenocarcinoma in the chemotherapy group had a better OS, but not BCSS, than those in the nonchemotherapy group after PSM (OS: p < 0.001; BCSS: p = 0.285). After stratifying by tumor size and lymph node status, adjuvant chemotherapy could significantly improve the OS of early-stage ER/PR-positive patients with tumors larger than 3 cm (p = 0.004) if they had negative lymph nodes (LNs). For patients positive LNs, the OS was significantly different between the chemotherapy group and the non-chemotherapy group when the tumors were larger than 1 cm (T = 1–2.9 cm, p = 0.006; T>3 cm, p = 0.049, respectively). Conclusion Adjuvant chemotherapy maybe improves prognosis in patients with negative LNs and tumors larger than 3 cm, or patients with LNs metastasis and tumors larger than 1 cm. We suggest considering clinical characteristics meanwhile when deciding chemotherapy or not. Randomized controlled trials (RCT) are expected to confirm our results in the future. Propensity-score matching was used to narrow selection bias. Chemotherapy benefits patients with negative nodes and tumors larger than 3 cm. Chemotherapy benefits patients with positive nodes and tumors larger than 1 cm. Randomized controlled trials are expected in the future.
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Affiliation(s)
- Hong-Fei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Wei-Ping Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ci-Qiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Liu-Lu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Min-Yi Cheng
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jie-Qing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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17
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Conte B, Bruzzone M, Lambertini M, Poggio F, Bighin C, Blondeaux E, De Laurentiis M, Valle E, Cognetti F, Nisticò C, De Placido S, Garrone O, Gamucci T, Montemurro F, Puglisi F, Cardinali B, Fregatti P, Miglietta L, Boccardo F, Ceppi M, Del Mastro L. Effect of dose-dense adjuvant chemotherapy in hormone receptor positive/HER2-negative early breast cancer patients according to immunohistochemically defined luminal subtype: an exploratory analysis of the GIM2 trial. Eur J Cancer 2020; 136:43-51. [PMID: 32634760 DOI: 10.1016/j.ejca.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Luminal A-like and luminal B-like subtypes have different sensitivity to (neo)adjuvant chemotherapy, but their role in predicting dose-dense (DD) efficacy in the high-risk setting is unknown. In this exploratory analysis of the Gruppo Italiano Mammella 2 (GIM2) trial, we investigated DD efficacy according to luminal-like subtypes. METHODS Patients with node-positive early breast cancer were randomised to receive either DD or standard-interval (SI) anthracycline-based chemotherapy followed by paclitaxel. In our analysis, luminal A-like cohort was identified as having a Ki67 < 20% and a progesterone receptor (PgR) ≥ 20%; luminal B-like cohort as having a Ki67 ≥ 20% and/or a PgR < 20%. RESULTS Out of 2003 patients enrolled in the GIM2 trial, 412 had luminal A-like and 638 luminal B-like breast cancer. After a median follow-up of 7.9 years, disease-free survival (DFS) was 80.8% (95% confidence interval [CI] 76.4-84.5) and 70.5% (66.5-74.2) in luminal A-like and luminal B-like cohorts; overall survival (OS) was 91.6% (88.2-94.1) and 85.1% (81.7-87.9), respectively. We found no significant interaction between treatment and luminal subtype (interaction p = 0.603 and 0.535 for DFS and OS, respectively). When DD efficacy was investigated separately in each cohort, luminal-B like cohort appeared to benefit more from the DD schedule both in terms of DFS (unadjusted hazard ratio [HR] 0.72 [95% CI 0.54-0.96]) and OS (unadjusted HR 0.61 [95% CI 0.40-0.94]), compared with the luminal A-like cohort (unadjusted HR for DFS 0.89 [95% CI 0.59-1.33]; unadjusted HR for OS 0.83 [95% CI 0.45-1.54]). CONCLUSIONS No significant interaction between luminal-like subtype and treatment was observed. Patients in the luminal B-like cohort seemed to benefit more from DD schedule.
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Affiliation(s)
- Benedetta Conte
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Carrer de Rosselló, 149, 08036, Barcelona, Spain
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Matteo Lambertini
- Medical Oncology Department, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 1632, Genoa, GE, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy
| | - Francesca Poggio
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Claudia Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Eva Blondeaux
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Michelino De Laurentiis
- Breast Unit, Istituto Nazionale Tumori-Fondazione "G. Pascale", Via Mariano Semmola, 53, 80131, Naples, NA, Italy
| | - Enrichetta Valle
- Department of Medical Oncology, Ospedale Businco, Via Edward Jenner, 1, 09121, Cagliari, CA, Italy
| | - Francesco Cognetti
- Department of Clinical and Molecolar Medicine, La Sapienza University, Viale Regina Elena, 324, 00161, Rome, RM, Italy
| | - Cecilia Nisticò
- Department of Medical Oncology 1, Istituto Nazionale Tumori "Regina Elena", Via Elio Chianesi, 53, 00128, Rome, RM, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, NA, Italy
| | - Ornella Garrone
- Breast Unit, Department of Oncology, Azienda Ospedaliera Santa Croce e Carle, Via Michele Coppino, 26, 12100, Cuneo, CN, Italy
| | - Teresa Gamucci
- Department of Medical Oncology, Ospedale Sandro Pertini, Via dei Monti Tiburtini, 385/389, 00157, Rome, RM, Italy; Department of Medical Oncology, Ospedale SS Trinità, Località San Marciano, 03039, Sora, FR, Italy
| | - Filippo Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale, 142, 10060, Turin, TO, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Piazzale Massimiliano Kolbe, 4, 33100, Udine, Italy; Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico Aviano - National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, PN, Italy
| | - Barbara Cardinali
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genova, Viale Benedetto XV, 6, 1612, Genoa, GE, Italy; Department of Surgery, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 1632, Genoa, GE, Italy
| | - Loredana Miglietta
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Francesco Boccardo
- Medical Oncology Department, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 1632, Genoa, GE, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy; Breast Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
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18
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Amaral de Mascena Costa L, Harmon AC, Aguiar Coelho Teixeira A, Cássio Silva de Lima F, de Sousa Araújo S, Del Piero F, Diógenes da Silva Souza H, Filgueiras de Athayde Filho P, Alves Junior S, de Mascena Diniz Maia M, Wischral A, Adrião Gomes Filho M, Mathis JM. Cytotoxic Activity of the Mesoionic Compound MIH 2.4Bl in Breast Cancer Cell Lines. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420913330. [PMID: 32655277 PMCID: PMC7331763 DOI: 10.1177/1178223420913330] [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] [Received: 09/29/2019] [Accepted: 02/25/2020] [Indexed: 12/24/2022]
Abstract
In this work, we report the synthesis of a new 1,3-thiazolium-5-thiolate derivative of a mesoionic compound (MIH 2.4Bl) and the characterization of its selective cytotoxicity on a panel of breast cancer cells lines. The cytotoxic effect of MIH 2.4Bl on breast cancer cell lines was determined by XTT and crystal violet assays, flow cytometry analysis, electron microscopy characterization, and terminal deoxynucleotidyl transferase (TdT) deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) apoptosis assays. As determined using XTT cell growth and survival assays, MIH 2.4Bl exhibited growth inhibition activity on most breast cancer cell lines tested, compared with normal human mammary epithelial cells. Three breast cancer cell lines (MCF-7, T-47D, and ZR-75-1) showed a more potent sensitivity index to growth inhibition by MIH 2.4Bl than the other breast cancer cell lines. Interestingly, these 3 cell lines were derived from tumors of Luminal A origin and have ER (estrogen receptor), PR (progesterone receptor), and HER2 (human epidermal growth factor receptor 2) positive expression. Additional analysis of cytotoxicity mediated by MIH 2.4Bl was performed using the MCF-7 cell line. MCF-7 cells displayed both time- and dose-dependent decreases in cell growth and survival, with a maximum cytotoxic effect observed at 72 and 96 hours. The MCF-7 cells were also characterized for cell cycle changes upon treatment with MIH 2.4Bl. Using flow cytometry analysis of cell cycle distribution, a treatment-dependent effect was observed; treatment of cells with MIH 2.4Bl increased the G2/M population to 34.2% compared with 0.1% in untreated (control) cells. Ultrastructural analysis of MFC-7 cells treated with MIH 2.4Bl at 2 different concentrations (37.5 and 75 μM) was performed by transmission electron microscopy. Cells treated with 37.5 μM MIH 2.4Bl showed morphologic changes beginning at 6 hours after treatment, while cells treated with 75 μM showed changes beginning at 3 hours after treatment. These changes were characterized by an alteration of nuclear morphology and mitochondrial degeneration consistent with apoptotic cell death. Results of a TUNEL assay performed on cells treated for 96 hours with MIH 2.4Bl supported the observation of apoptosis. Together, these results suggest that MIH 2.4Bl is a promising candidate for treating breast cancer and support further in vitro and in vivo investigation.
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Affiliation(s)
- Luciana Amaral de Mascena Costa
- Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Recife, Brazil.,Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Ashlyn C Harmon
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | | | - Filipe Cássio Silva de Lima
- Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Recife, Brazil.,Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Silvany de Sousa Araújo
- Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Recife, Brazil
| | - Fabio Del Piero
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | | | | | - Severino Alves Junior
- Department of Fundamental Chemistry, Federal University of Pernambuco, Recife, Brazil
| | | | - Aurea Wischral
- Department of Veterinary Medicine, Federal Rural University of Pernambuco, Recife, Brazil
| | - Manoel Adrião Gomes Filho
- Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Recife, Brazil
| | - J Michael Mathis
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA.,Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
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19
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Bago-Horvath Z, Rudas M, Singer CF, Greil R, Balic M, Lax SF, Kwasny W, Hulla W, Gnant M, Filipits M. Predictive Value of Molecular Subtypes in Premenopausal Women with Hormone Receptor-positive Early Breast Cancer: Results from the ABCSG Trial 5. Clin Cancer Res 2020; 26:5682-5688. [PMID: 32546648 DOI: 10.1158/1078-0432.ccr-20-0673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/08/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the predictive value of molecular breast cancer subtypes in premenopausal patients with hormone receptor-positive early breast cancer who received adjuvant endocrine treatment or chemotherapy. EXPERIMENTAL DESIGN Molecular breast cancer subtypes were centrally assessed on whole tumor sections by IHC in patients of the Austrian Breast and Colorectal Cancer Study Group Trial 5 who had received either 5 years of tamoxifen/3 years of goserelin or six cycles of cyclophosphamide, methotrexate, and fluorouracil (CMF). Luminal A disease was defined as Ki67 <20% and luminal B as Ki67 ≥20%. The luminal B/HER2-positive subtype displayed 3+ HER2-IHC or amplification by ISH. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Cox models adjusted for clinical and pathologic factors. RESULTS 185 (38%), 244 (50%), and 59 (12%) of 488 tumors were classified as luminal A, luminal B/HER2-negative and luminal B/HER2-positive, respectively. Luminal B subtypes were associated with poor outcome. Patients with luminal B tumors had a significantly shorter RFS [adjusted HR for recurrence: 2.22; 95% confidence interval (CI), 1.41-3.49; P = 0.001] and OS (adjusted HR for death: 3.51; 95% CI, 1.80-6.87; P < 0.001). No interaction between molecular subtypes and treatment was observed (test for interaction: P = 0.84 for RFS; P = 0.69 for OS). CONCLUSIONS Determination of molecular subtypes by IHC is an independent prognostic factor for recurrence and death in premenopausal women with early-stage, hormone receptor-positive breast cancer but is not predictive for outcome of adjuvant treatment with tamoxifen/goserelin or CMF.See related commentary by Hunter et al., p. 5543.
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Affiliation(s)
- Zsuzsanna Bago-Horvath
- Department of Pathology, Breast Health Center and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Margaretha Rudas
- Institute of Cancer Research, Department of Medicine I, Breast Health Center and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Gynecology, Breast Health Center and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- III Medical Department, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Oncology, Medical University Graz, Graz, Austria
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,Johannes Kepler University Linz, Austria
| | - Werner Kwasny
- Department of Surgery, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Wolfgang Hulla
- Department of Pathology, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Breast Health Center and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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20
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Yu J, Wu J, Huang O, He J, Zhu L, Chen W, Li Y, Chen X, Shen K. Clinicopathological characteristics, adjuvant chemotherapy decision and disease outcome in patients with breast cancer with a 21-gene recurrence score of 26-30. Oncol Lett 2020; 20:1545-1556. [PMID: 32724396 PMCID: PMC7377026 DOI: 10.3892/ol.2020.11734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
Abstract
Recurrence score (RS) could be used to predict clinical outcomes and chemotherapy efficacy in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative and lymph node-negative breast cancer. However, the clinical features and management of patients with an RS of 26–30 are not completely understood. In the present study, 783 patients with HR+/HER2−, lymph node-negative early breast cancer and RS ≥18 were included and categorized into RS=18−25 (47.8%), 26–30 (25.5%) or ≥31 (26.7%) groups. Clinicopathological characteristics, adjuvant chemotherapy usage and disease outcomes were compared. Alterations in the adjuvant chemotherapy recommendation after 21-gene RS testing were also analyzed. The results indicated that patients with RS=26−30 had higher progesterone receptor (PR) expression [odds ratio (OR)=2.84; P<0.001] and lower Ki-67 index (OR, 1.88; P=0.032) compared with patients with RS ≥31. Multivariate analysis demonstrated that age ≤50 years (OR, 5.75; P=0.001) and luminal-B subtype (OR, 7.75; P<0.001) were factors that were independently associated with chemotherapy usage in the RS=26−30 group. Among 104 patients who were not recommended chemotherapy before 21-gene RS testing, the treatment decision for 52 patients was changed to recommend chemotherapy once an RS of 26–30 was identified. The patient adherence rate to the treatment recommendation was 95.0% (190/200). After a median follow-up of 21.5 months, 6 patients displayed disease recurrence in the RS=26−30 group, and there was no significant difference between patients receiving chemotherapy and patients not receiving chemotherapy. In conclusion, patients with RS=26−30 had tumors with higher PR expression and lower Ki-67 index compared with those of patients with RS ≥31. Age, luminal subtype and RS testing influenced chemotherapy usage in patients with RS=26−30; however, no significant benefit from adjuvant chemotherapy was observed in a short term of 2 years.
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Affiliation(s)
- Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jianrong He
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Li Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Weiguo Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Yafen Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
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21
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Hampsch RA, Wells JD, Traphagen NA, McCleery CF, Fields JL, Shee K, Dillon LM, Pooler DB, Lewis LD, Demidenko E, Huang YH, Marotti JD, Goen AE, Kinlaw WB, Miller TW. AMPK Activation by Metformin Promotes Survival of Dormant ER + Breast Cancer Cells. Clin Cancer Res 2020; 26:3707-3719. [PMID: 32321715 DOI: 10.1158/1078-0432.ccr-20-0269] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite adjuvant endocrine therapy for patients with estrogen receptor alpha (ER)-positive breast cancer, dormant residual disease can persist for years and eventually cause tumor recurrence. We sought to deduce mechanisms underlying the persistence of dormant cancer cells to identify therapeutic strategies. EXPERIMENTAL DESIGN Mimicking the aromatase inhibitor-induced depletion of estrogen levels used to treat patients, we developed preclinical models of dormancy in ER+ breast cancer induced by estrogen withdrawal in mice. We analyzed tumor xenografts and cultured cancer cells for molecular and cellular responses to estrogen withdrawal and drug treatments. Publicly available clinical breast tumor gene expression datasets were analyzed for responses to neoadjuvant endocrine therapy. RESULTS Dormant breast cancer cells exhibited upregulated 5' adenosine monophosphate-activated protein kinase (AMPK) levels and activity, and upregulated fatty acid oxidation. While the antidiabetes AMPK-activating drug metformin slowed the estrogen-driven growth of cells and tumors, metformin promoted the persistence of estrogen-deprived cells and tumors through increased mitochondrial respiration driven by fatty acid oxidation. Pharmacologic or genetic inhibition of AMPK or fatty acid oxidation promoted clearance of dormant residual disease, while dietary fat increased tumor cell survival. CONCLUSIONS AMPK has context-dependent effects in cancer, cautioning against the widespread use of an AMPK activator across disease settings. The development of therapeutics targeting fat metabolism is warranted in ER+ breast cancer.
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Affiliation(s)
- Riley A Hampsch
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jason D Wells
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Nicole A Traphagen
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Charlotte F McCleery
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer L Fields
- Department of Microbiology & Immunology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kevin Shee
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Lloye M Dillon
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Darcy B Pooler
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Lionel D Lewis
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Eugene Demidenko
- Department of Community & Family Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Yina H Huang
- Department of Microbiology & Immunology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jonathan D Marotti
- Department of Pathology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Comprehensive Breast Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Abigail E Goen
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - William B Kinlaw
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Todd W Miller
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. .,Department of Comprehensive Breast Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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22
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Singer CF, Pfeiler G, Hubalek M, Bartsch R, Stöger H, Pichler A, Petru E, Bjelic-Radisic V, Greil R, Rudas M, Maria Tea MK, Wette V, Petzer AL, Sevelda P, Egle D, Dubsky PC, Filipits M, Fitzal F, Exner R, Jakesz R, Balic M, Tinchon C, Bago-Horvath Z, Frantal S, Gnant M. Efficacy and safety of the therapeutic cancer vaccine tecemotide (L-BLP25) in early breast cancer: Results from a prospective, randomised, neoadjuvant phase II study (ABCSG 34). Eur J Cancer 2020; 132:43-52. [PMID: 32325419 DOI: 10.1016/j.ejca.2020.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune-based strategies represent a promising approach in breast cancer (BC) treatment. The glycoprotein mucin-1 (MUC-1) is overexpressed in more than 90% of BC patients, and is targeted by the cancer vaccine tecemotide. We have investigated the efficacy and safety of tecemotide when added to neoadjuvant standard-of-care (SoC) treatment in early BC patients. PATIENTS AND METHODS A total of 400 patients with HER2-early BC were recruited into this prospective, multicentre, randomised 2-arm academic phase II trial. Patients received preoperative SoC treatment (chemotherapy or endocrine therapy) with or without tecemotide. Postmenopausal women with oestrogen receptor (ER)+++, or ER++ and Ki67 < 14%, and G1,2 tumours ('luminal A' tumours) received 6 months of letrozole. Postmenopausal patients with triple-negative, ER-/+/++ and Ki67 ≥ 14%, and with G3 tumours, as well as premenopausal patients, received four cycles of epirubicin/cyclophosphamide plus four cycles of docetaxel. Primary end-point was residual cancer burden (RCB; 0/I versus II/III) at surgery. Secondary end-points included pathological complete response (pCR), safety, and quality of life. FINDINGS We observed no significant difference in RCB 0/I rates between patients with (36.4%) and without (31.9%) tecemotide in the overall study population (p = 0.40) nor in endocrine and chemotherapy-treated subgroups (25.0% versus 13.3%, p = 0.17; 39.6% versus 37.8%, p = 0.75, respectively). The addition of tecemotide did not affect overall pCR rates (22.5% versus 17.4%, p = 0.23), MUC-1 expression, or tumour-infiltrating lymphocytes content. Tecemotide did not increase toxicity when compared to SoC therapy alone. INTERPRETATION Neoadjuvant tecemotide is safe, but does not improve RCB or pCR rates in patients receiving standard neoadjuvant therapy.
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Affiliation(s)
- Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Angelika Pichler
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal Germany, Germany
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg Cancer Research Institute-CCCIT, Cancer Cluster Salzburg, Salzburg, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Medical University of Vienna, Vienna, Austria
| | - Muy-Kheng Maria Tea
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Andreas L Petzer
- Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern, Elisabethinen, Linz, Austria
| | - Paul Sevelda
- Karl Landsteiner Institute for Gynecologic Oncology and Senology, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter C Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breastcenter St. Anna, Lucerne, Switzerland
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Raimund Jakesz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Christoph Tinchon
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Zsuzsanna Bago-Horvath
- Department of Pathology, Medical University of Vienna, Medical University of Vienna, Vienna, Austria
| | - Sophie Frantal
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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23
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Kim HS, Lee JU, Yoo TK, Chae BJ, Son D, Kim YJ, Park WC. Omission of Chemotherapy for the Treatment of Mucinous Breast Cancer: A Nationwide Study from the Korean Breast Cancer Society. J Breast Cancer 2019; 22:599-612. [PMID: 31897333 PMCID: PMC6933040 DOI: 10.4048/jbc.2019.22.e46] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/10/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Mucinous breast carcinoma (MBC) is a rare type of breast cancer. Although patients with MBC may have a better prognosis than that of patients with invasive ductal carcinoma, many clinicians administer adjuvant chemotherapy regimens similar to those for other breast tumors. Using data from a nationwide clinical database, this study evaluated the significance of adjuvant systemic chemotherapy and whether it can be omitted in MBC patients. METHODS We included 3,076 patients with a diagnosis of MBC recorded in the Korean Breast Cancer Registry between January 1990 and August 2016. We used the Kaplan-Meier method to analyze breast cancer-specific survival (BCCS) and overall survival (OS). Multivariate analysis was performed using a Cox proportional hazard ratio (HR) model to estimate the adjusted HR for each prognostic factor. RESULTS A total of 2,988 MBC patients were enrolled and followed-up for a median of 100 months (range, 2-324 months). Multivariate analysis revealed that axillary lymph node (ALN) metastasis and estrogen receptor (ER) negativity were significant prognostic factors for BCSS. Meanwhile, old age, pathologic tumor stage, and ALN metastasis were significant prognostic factors for OS. Subgroup analysis of ER-positive MBC showed that ALN metastasis was a significant prognostic factor for BCSS. Additionally, old age, pathologic tumor stage, and ALN metastasis were prognostic factors for OS. Ultimately, ALN metastasis was the most statistically significant prognostic factor for MBC. However, chemotherapy had no significant effect on BCSS and OS. The Kaplan-Meier curves of BCSS and OS based on pathologic tumor and nodal stages and age revealed that chemotherapy did not statistically significantly improve prognosis, except for the N3 stage. CONCLUSION Our large retrospective analysis revealed that adjuvant chemotherapy provided little benefit to improve the prognosis of most ER-positive MBC patients. Therefore, chemotherapy can be omitted in the treatment of most ER-positive MBC.
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Affiliation(s)
- Hyung Suk Kim
- Division of Breast Surgery, Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jong Uk Lee
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Donghee Son
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Yun Jin Kim
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Woo Chan Park
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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24
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Guideline-concordant chemotherapy in patients with hormone receptor-positive and node-positive, early breast cancer leads to better overall and metastases-free survival with limited benefit in elderly patients. Arch Gynecol Obstet 2019; 301:573-583. [PMID: 31749031 PMCID: PMC7033056 DOI: 10.1007/s00404-019-05387-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022]
Abstract
Purpose The German guideline for breast cancer recommends using chemotherapy (CHT) in patients with hormone receptor-positive and node-positive, invasive breast cancer. The aim of this study was to analyse the effects of CHT in this patient group on overall survival (OS) and distant metastases-free survival (DMFS), especially considering the 70-year threshold. Methods 1772 patients from the clinical cancer registry Regensburg (Germany) with hormone receptor-positive and node-positive, invasive breast cancer diagnosed between 2003 and 2013 were analysed in a retrospective cohort study. OS and DMFS were evaluated by means of Kaplan–Meier and multivariable Cox-regression method. Results were further examined according to age at diagnosis. Results The comparison of 1544 patients with CHT to 228 patients without CHT showed a significant benefit for CHT regarding 5-year OS (91.3% vs. 76.8%) and 5-year DMFS (86.7% vs. 74.4%, both p < 0.001). Likewise, better OS and DMFS were seen in patients aged < 70 years using CHT compared to patients without CHT of the same age. Patients aged ≥ 70 years with CHT had a minimal benefit regarding 5-year OS compared to patients without CHT, but no advantage considering DMFS. All results were confirmed in multivariable analyses except for patients being ≥ 70 years of age. Conclusion Patients with hormone receptor-positive and node-positive, invasive breast cancer benefit from chemotherapy with regard to a significantly better overall and distant metastases-free survival, although chemotherapy use in patients aged ≥ 70 years results in a smaller benefit considering OS and no benefit considering DMFS.
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25
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Abubakar M, Figueroa J, Ali HR, Blows F, Lissowska J, Caldas C, Easton DF, Sherman ME, Garcia-Closas M, Dowsett M, Pharoah PD. Combined quantitative measures of ER, PR, HER2, and KI67 provide more prognostic information than categorical combinations in luminal breast cancer. Mod Pathol 2019; 32:1244-1256. [PMID: 30976105 PMCID: PMC6731159 DOI: 10.1038/s41379-019-0270-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
Although most women with luminal breast cancer do well on endocrine therapy alone, some will develop fatal recurrence thereby necessitating the need to prospectively determine those for whom additional cytotoxic therapy will be beneficial. Categorical combinations of immunohistochemical measures of ER, PR, HER2, and KI67 are traditionally used to classify patients into luminal A-like and B-like subtypes for chemotherapeutic reasons, but this may lead to the loss of prognostically relevant information. Here, we compared the prognostic value of quantitative measures of these markers, combined in the IHC4-score, to categorical combinations in subtypes. Using image analysis-based scores for all four markers, we computed the IHC4-score for 2498 patients with luminal breast cancer from two European study populations. We defined subtypes (A-like (ER + and PR + : and HER2- and low KI67) and B-like (ER + and/or PR + : and HER2 + or high KI67)) by combining binary categories of these markers. Hazard ratios and 95% confidence intervals for associations with 10-year breast cancer-specific survival were estimated in Cox proportional-hazard models. We accounted for clinical prognostic factors, including grade, tumor size, lymph-nodal involvement, and age, by using the PREDICT-score. Overall, Subtypes [hazard ratio (95% confidence interval) B-like vs. A-like = 1.64 (1.25-2.14); P-value < 0.001] and IHC4-score [hazard ratio (95% confidence interval)/1 standard deviation = 1.32 (1.20-1.44); P-value < 0.001] were prognostic in univariable models. However, IHC4-score [hazard ratio (95% confidence interval)/1 standard deviation = 1.24 (1.11-1.37); P-value < 0.001; likelihood ratio chi-square (LRχ2) = 12.5] provided more prognostic information than Subtype [hazard ratio (95% confidence interval) B-like vs. A-like = 1.38 (1.02-1.88); P-value = 0.04; LRχ2 = 4.3] in multivariable models. Further, higher values of the IHC4-score were associated with worse prognosis, regardless of subtype (P-heterogeneity = 0.97). These findings enhance the value of the IHC4-score as an adjunct to clinical prognostication tools for aiding chemotherapy decision-making in luminal breast cancer patients, irrespective of subtype.
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Affiliation(s)
- Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
| | - Jonine Figueroa
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
| | - H Raza Ali
- Cancer Research UK (CRUK) Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Fiona Blows
- Center for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Carlos Caldas
- Cancer Research UK (CRUK) Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Research Centre, Cambridge, UK
| | - Douglas F Easton
- Center for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mark E Sherman
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Mitch Dowsett
- Breast Cancer Now Toby Robins Research Centre, Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London, UK
| | - Paul D Pharoah
- Cancer Research UK (CRUK) Cambridge Institute, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Varga Z, Sinn P, Seidman AD. Author's reply to: Comparing the performance of gene expression assays in breast cancer. Int J Cancer 2019; 145:1163-1164. [PMID: 30895601 DOI: 10.1002/ijc.32289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Zsuzsanna Varga
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Sinn
- Department of Gynecologic Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
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Suthers GK. Comparing the performance of gene expression assays in breast cancer. Int J Cancer 2019; 145:1162. [PMID: 30895596 DOI: 10.1002/ijc.32290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Graeme K Suthers
- Sonic Healthcare (Australia), Macquarie Park, NSW, Australia.,Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
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Matikas A, Foukakis T, Swain S, Bergh J. Avoiding over- and undertreatment in patients with resected node-positive breast cancer with the use of gene expression signatures: are we there yet? Ann Oncol 2019; 30:1044-1050. [PMID: 31131397 PMCID: PMC6695578 DOI: 10.1093/annonc/mdz126] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Prediction of benefit from adjuvant chemotherapy following resection of early breast cancer and, as a result, proper selection of candidates remains an elusive goal since the relative magnitude of benefit is the same regardless of the presence of clinicopathologic factors. Multiple studies, including randomized trials, establish the role of certain gene expression signatures in node-negative disease since they predict the risk of breast cancer relapse being so low that adjuvant chemotherapy can be omitted. In contrast, more limited data are available in higher risk, node-positive breast cancer patients, making the exclusion of adjuvant chemotherapy potentially hazardous. 'Prospective-retrospective' studies and limited prospective data show that several signatures, namely Oncotype Dx, MammaPrint, Prosigna, EndoPredict and Breast Cancer Index, select with different levels of success node-positive patients at very low risk for distant recurrence despite not receiving chemotherapy, although the long-term follow-up is still awaited. Pending, however the publication of the results from ongoing randomized studies which enroll patients with node-positive disease, major caution is warranted. Improper use and misinterpretation of these transcriptomic profiles can lead to undertreatment and exposure of patients to unnecessary risks resulting in increased breast cancer mortality for patients with axillary node-positive disease. With this review we critically discuss the available data on gene expression signatures that are used in clinical practice and offer practical recommendations regarding the management of patients with ER-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-positive breast cancer.
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Affiliation(s)
- A Matikas
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm; Breast Center, Theme Cancer, Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - T Foukakis
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm; Breast Center, Theme Cancer, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - S Swain
- Georgetown Lombardi Comprehensive Cancer Center, Washington; MedStar Health, Washington, USA
| | - J Bergh
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm; Breast Center, Theme Cancer, Karolinska University Hospital, Solna, Stockholm, Sweden
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He L, Lv Y, Song Y, Zhang B. The prognosis comparison of different molecular subtypes of breast tumors after radiotherapy and the intrinsic reasons for their distinct radiosensitivity. Cancer Manag Res 2019; 11:5765-5775. [PMID: 31303789 PMCID: PMC6612049 DOI: 10.2147/cmar.s213663] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/25/2019] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy can increase the cell cycle arrest that promotes apoptosis, reduces the risk of tumor recurrence and has become an irreplaceable component of systematic treatment for patients with breast cancer. Substantial advances in precise radiotherapy unequivocally indicate that the benefits of radiotherapy vary depending on intrinsic subtypes of the disease; luminal A breast cancer has the highest benefit whereas human epidermal growth factor receptor 2 (HER2)-positive and triple negative breast cancer (TNBC) are affected to a lesser extent irrespective of the selection of radiotherapy strategies, such as conventional whole-breast irradiation (CWBI), accelerated partial-breast irradiation (APBI), and hypofractionated whole-breast irradiation (HWBI). The benefit disparity correlates with the differential invasiveness, malignance, and radiosensitivity of the subtypes. A combination of a number of molecular mechanisms leads to the strong radioresistant profile of HER2-positive breast cancer, and sensitization to irradiation can be induced by multiple drugs or compounds in luminal disease and TNBC. In this review, we aimed to summarize the prognostic differences between various subtypes of breast tumors after CWBI, APBI, and HWBI, the potential reasons for drug-enhanced radiosensitivity in luminal breast tumors and TNBC, and the robust radioresistance of HER2-positive cancer. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/ugTrSMuQVI8
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Affiliation(s)
- Lin He
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yang Lv
- Department of Oncology, The PLA Navy Anqing Hospital, Anqing, Anhui Province, People's Republic of China
| | - Yuhua Song
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Biyuan Zhang
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
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Adjuvant Chemotherapy Guidance in Young Breast Cancer Patients With Luminal Subtypes and Stage pT1N0. J Surg Res 2019; 240:165-174. [PMID: 30951993 DOI: 10.1016/j.jss.2019.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/28/2018] [Accepted: 01/25/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study evaluated whether young breast cancer patients (≤ 40 y of age) with luminal subtypes and stage pT1N0 can benefit from chemotherapy (CHT). MATERIALS AND METHODS This study included 688 patients aged ≤ 40 y with luminal subtypes and stage pT1N0 breast cancer. The overall survival and disease-free survival (DFS) rates in the whole cohort and subgroups were compared between patients receiving CHT followed by endocrinotherapy (ET) (CHT→ET group) and those receiving only ET (ET-alone group). RESULTS Univariate analysis identified that the tumors in the CHT→ET group were more aggressive than those in the ET-alone group. However, the overall survival and DFS rates did not differ significantly between the CHT→ET and ET-alone groups (P = 0.416 and 0.21, respectively), implying that a subgroup of patients could benefit from CHT. Subgroup analysis of DFS rates revealed that patients with human epidermal growth factor receptor 2 overexpression (P = 0.042), histological classification grade 3 (P = 0.030), progesterone receptor ≤ 20% (P = 0.033), and clinical stage T1c (P = 0.038) could benefit from CHT. Further analysis showed that these four risk factors combined predicted whether the patient could benefit from CHT. CONCLUSIONS Young patients with hormone receptor-positive and stage pT1N0 breast cancer may benefit from CHT only if they exhibit at least two of the following risk factors: progesterone receptor ≤ 20%, human epidermal growth factor receptor 2 overexpression, histological grading 3, or clinical stage T1c.
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Stenmark Tullberg A, Lundstedt D, Olofsson Bagge R, Karlsson P. Positive sentinel node in luminal A-like breast cancer patients - implications for adjuvant chemotherapy? Acta Oncol 2019; 58:162-167. [PMID: 30407093 DOI: 10.1080/0284186x.2018.1533647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In luminal A-like breast cancer, the indication for adjuvant chemotherapy still is largely based on lymph nodestatus. Sentinel node (SN) positive patients who are no longer recommended an axillary lymph node dissection (ALND) risk undertreatment, especially if they have ≥4 lymph node metastases (LNMs). AIM To quantify the group of SN positive luminal A-like patients with ≥4 LNMs and to investigate if the ratio between positive SNs and examined SNs (SN ratio) can provide information of the axillary tumor burden. MATERIAL AND METHODS Nearly 370 patients between 2014-2016 in Western Sweden with a clinically node-negative invasive breast cancer treated with both SNB and subsequent ALND were included. SNB findings were compared to ALND findings and the ability of the SN ratio to describe the axillary tumor burden was evaluated using multivariable analysis. RESULTS In total,17.6% of patients with luminal A-like tumors had ≥4 LNMs. The SN ratio was statistically significant for predicting ≥4 LNMs among luminal A-like patients (p = .013, OR 1.89 (95% CI 1.14-3.12) per 0.1 increment in SN ratio). CONCLUSIONS One sixth of patients with SN positive luminal A-like tumors risk undertreatment. The SN ratio may aid in identifying many of these patients.
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Affiliation(s)
- Axel Stenmark Tullberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Dan Lundstedt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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32
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Sønderstrup IMH, Jensen MBR, Ejlertsen B, Eriksen JO, Gerdes AM, Kruse TA, Larsen MJ, Thomassen M, Lænkholm AV. Subtypes in BRCA-mutated breast cancer. Hum Pathol 2019; 84:192-201. [DOI: 10.1016/j.humpath.2018.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 01/06/2023]
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Jensen MB, Lænkholm AV, Nielsen TO, Eriksen JO, Wehn P, Hood T, Ram N, Buckingham W, Ferree S, Ejlertsen B. The Prosigna gene expression assay and responsiveness to adjuvant cyclophosphamide-based chemotherapy in premenopausal high-risk patients with breast cancer. Breast Cancer Res 2018; 20:79. [PMID: 30053900 PMCID: PMC6062869 DOI: 10.1186/s13058-018-1012-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022] Open
Abstract
Background The PAM50-based (Prosigna) risk of recurrence (ROR) score and intrinsic subtypes are prognostic for women with high-risk breast cancer. We investigate the predictive ability of Prosigna regarding the effectiveness of cyclophosphamide-based adjuvant chemotherapy in premenopausal patients with high-risk breast cancer. Methods Prosigna assays were performed on the NanoString platform in tumors from participants in Danish Breast Cancer Group (DBCG) 77B, a four-arm trial that randomized premenopausal women with high-risk early breast cancer to no systemic treatment, levamisole, oral cyclophosphamide (C) or cyclophosphamide, methotrexate and fluorouracil (CMF). Results In total, this retrospective analysis included 460 women (40% of the 1146 randomized patients). The continuous Prosigna ROR score was prognostic in the no systemic treatment group (unadjusted P < 0.001 for disease-free survival (DFS), P = 0.001 for overall survival (OS)). No statistically significant interaction of continuous ROR score and treatment on DFS and OS was found. A highly significant association was observed between intrinsic subtypes and C/CMF treatment for DFS (Pinteraction = 0.003 unadjusted, P = 0.001 adjusted) and OS (Pinteraction = 0.04). In the adjusted analysis treatment with C/CMF was associated with a reduced risk of DFS events in patients with basal-like (hazard ratio (HR) 0.14; 95% CI 0.06; 0.32) and luminal B (HR 0.48; 95% CI 0.27; 0.84) subtypes but not in patients with Human epidermal growth factor receptor-enriched (HR 1.05; 95% CI 0.56; 1.95) or luminal A (HR 0.61; 95% CI 0.32; 1.16) subtypes. Conclusion The Prosigna ROR score and intrinsic subtypes were prognostic in high-risk premenopausal patients with breast cancer, and intrinsic subtypes identify high-risk patients with or without major benefit from adjuvant C/CMF treatment. Electronic supplementary material The online version of this article (10.1186/s13058-018-1012-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, DBCG Secretariat, Bldg. 2501 Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Torsten O Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jens Ole Eriksen
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Pernille Wehn
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Tressa Hood
- NanoString Technologies, Inc, Seattle, WA, USA
| | | | | | - Sean Ferree
- NanoString Technologies, Inc, Seattle, WA, USA
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Gao JJ, Swain SM. Luminal A Breast Cancer and Molecular Assays: A Review. Oncologist 2018; 23:556-565. [PMID: 29472313 DOI: 10.1634/theoncologist.2017-0535] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/18/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Chemotherapy has been the historical mainstay of treatment for patients with breast cancer, with immunohistochemical markers and tumor characteristics driving treatment decisions. The discovery of different intrinsic subtypes of breast cancer has advanced the understanding of breast cancer, with gene-based assays shedding further light on tumor behavior and response to treatment. DESIGN This review focuses on the landscape of the luminal A subtype, its definition based on immunohistochemistry (IHC) and gene assays, the prognostic and predictive value of these assays, guideline recommendations, and treatment implications. RESULTS Clinical studies of the prognostic value of gene-based and IHC-based assays in patients with luminal A-subtype breast cancers suggest a better prognosis for these patients compared with those with breast cancers of other subtypes. CONCLUSION In today's era of precision medicine, the best treatment regimen for patients with luminal A-subtype tumors is still undetermined, but available data raise the question whether chemotherapy can be omitted and endocrine therapy alone is sufficient for this patient population. IMPLICATIONS FOR PRACTICE Immunohistochemical markers have traditionally guided treatment decisions in breast cancer. However, advances in gene-expression profiling and availability of gene-based assays have launched these newer tests into everyday clinical practice. Luminal A-subtype tumors are a unique subset that may have favorable tumor biology. Properly defining this tumor subtype is important and may identify a subset of patients for whom endocrine therapy alone is sufficient.
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Affiliation(s)
- Jennifer J Gao
- Medical Oncology Service, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandra M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C., USA
- MedStar Georgetown University Hospital, Washington, D.C., USA
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Jensen MB, Nielsen TO, Knoop AS, Laenkholm AV, Balslev E, Ejlertsen B. Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials. Acta Oncol 2018; 57:135-140. [PMID: 29168407 DOI: 10.1080/0284186x.2017.1400181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient characteristics and subtypes as assigned by immunohistochemistry panels. PATIENTS AND METHODS In November 1977 through January 1983, 2862 patients with tumors larger than 5 cm or positive axillary nodes were included in the DBCG 77 trials. Archival tumor tissue from patients randomly assigned to no systemic treatment was analyzed for ER, PR, Ki67, EGFR and HER2. Intrinsic subtypes were defined as follows: Luminal A, ER or PR >0%, HER2-negative, PR >10% and Ki67 < 14%; Luminal B, ER or PR >0%, (PR ≤10% or HER2-positive or Ki67 ≥ 14%); HER2E, ER 0%, PR 0%, HER2 positive; Core basal, ER 0%, PR 0%, HER2 negative and EGFR positive. Multivariate categorical and fractional polynomials (MFP) models were used to construct prognostic subsets by clinicopathologic characteristics. RESULTS In a multivariate model, mortality rate was significantly associated with age, tumor size, nodal status, invasion, histological type and grade, as well as subtype classification. CONCLUSIONS With 35 years of follow-up, in this population of high-risk patients with no systemic therapy, no subgroup based on a composite prognostic score and/or molecular subtypes could be identified without excess mortality as compared to the background population.
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Affiliation(s)
- Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG), Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torsten O. Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Ann S. Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Eva Balslev
- Department of Pathology, Herlev University Hospital, Herlev, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG), Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Ejlertsen B, Offersen BV, Overgaard J, Christiansen P, Jensen MB, Kroman N, Knoop AS, Mouridsen H. Forty years of landmark trials undertaken by the Danish Breast Cancer Cooperative Group (DBCG) nationwide or in international collaboration. Acta Oncol 2018; 57:3-12. [PMID: 29205077 DOI: 10.1080/0284186x.2017.1408962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Over the past 40 years the Danish Breast Cancer Cooperative Group (DBCG) has made significant contributions to improve outcome and to make treatment of patients with early breast cancer more tolerable through nationwide and international trials evaluating loco-regional and systemic treatments. These trials have been instrumental to establish standards for the treatment of early breast cancer. METHODS The DBCG 82 trials had a global impact by documenting that the significant gain in loco-regional recurrence from postmastectomy radiation added to systemic therapy was associated with a reduction in distant recurrence and mortality in high-risk pre- and postmenopausal patients. The DBCG trials comparing breast conserving surgery and radiotherapy with mastectomy and more recently the trial of internal mammary node irradiation also had a major impact of practice. The trials initiated by the DBCG 40 years ago on tamoxifen and cyclophosphamide based chemotherapy became instrumental for the development of adjuvant systemic therapy not only due to their positive results but by sharing these important data with other members of the Early Breast Cancer Trialist' Collaborative Group (EBCTCG). Trials from the DBCG have also been important for highlighting the relative importance of anthracyclines and taxanes in the adjuvant setting. Furthermore, DBCG has made a major contribution to the development of aromatase inhibitors and targeted adjuvant treatment for human epidermal growth factor receptor 2 positive breast cancers. RESULTS The substantial impact of these treatment improvements is illustrated by a 46.7% 10-year overall survival of early breast cancer patients treated in 1978-1987 compared to 71.5% for patients treated 2008-2012. CONCLUSIONS The trials conducted and implemented by the DBCG appear to have a major impact on the substantial survival improvements in breast cancer.
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Affiliation(s)
- Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Vrou Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Ann Søgaard Knoop
- Department of Oncology, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Henning Mouridsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Laurberg T, Tramm T, Nielsen T, Alsner J, Nord S, Myhre S, Sørlie T, Leung S, Fan C, Perou C, Gelmon K, Overgaard J, Voduc D, Prat A, Cheang MCU. Intrinsic subtypes and benefit from postmastectomy radiotherapy in node-positive premenopausal breast cancer patients who received adjuvant chemotherapy - results from two independent randomized trials. Acta Oncol 2018; 57:38-43. [PMID: 29172851 DOI: 10.1080/0284186x.2017.1401735] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The study of the intrinsic molecular subtypes of breast cancer has revealed differences among them in terms of prognosis and response to chemotherapy and endocrine therapy. However, the ability of intrinsic subtypes to predict benefit from adjuvant radiotherapy has only been examined in few studies. METHODS Gene expression-based intrinsic subtyping was performed in 228 breast tumors collected from two independent post-mastectomy clinical trials (British Columbia and the Danish Breast Cancer Cooperative Group 82b trials), where pre-menopausal patients with node-positive disease were randomized to adjuvant radiotherapy or not. All patients received adjuvant chemotherapy and a subgroup of patients underwent ovarian ablation. Tumors were classified into intrinsic subtypes: Luminal A, Luminal B, HER2-enriched, Basal-like and Normal-like using the research-based PAM50 classifier. RESULTS In the British Columbia study, patients treated with radiation had an overall significant lower incidence of locoregional recurrence compared to the controls. For Luminal A tumors the risk of loco-regional recurrence was low and was further lowered by adjuvant radiation. These findings were validated in the DBCG 82b study. The individual data from the two cohorts were merged, the hazard ratio (HR) for loco-regional recurrence associated with giving radiation was 0.34 (0.19 to 0.61) overall and 0.12 (0.03 to 0.52) for Luminal A tumors. CONCLUSIONS In both postmastectomy trials, patients with Luminal A tumors turned out to have a significant lower incidence of loco-regional recurrence when randomized to adjuvant radiotherapy, leaving no indication to omit postmastectomy adjuvant radiation in pre-menopausal high-risk patients with Luminal A tumors. It was not possible to evaluate the effect of radiotherapy among the other subtypes because of limited sample sizes.
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Affiliation(s)
- Tinne Laurberg
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Torsten Nielsen
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Silje Nord
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Simen Myhre
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Therese Sørlie
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Samuel Leung
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Cheng Fan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Charles Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Karen Gelmon
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - David Voduc
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Hequet D, Callens C, Gentien D, Albaud B, Mouret-Reynier MA, Dubot C, Cottu P, Huchon C, Zilberman S, Berseneff H, Foa C, Salmon R, Roulot A, Lerebours F, Salomon A, Ghali N, Morel P, Li Q, Cayre A, Guinebretière JM, Hornberger J, Penault-Llorca F, Rouzier R. Prospective, multicenter French study evaluating the clinical impact of the Breast Cancer Intrinsic Subtype-Prosigna® Test in the management of early-stage breast cancers. PLoS One 2017; 12:e0185753. [PMID: 29045452 PMCID: PMC5646764 DOI: 10.1371/journal.pone.0185753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022] Open
Abstract
Purpose The Prosigna® breast cancer prognostic gene signature assay identifies a gene-expression profile that permits the classification of tumors into subtypes and gives a score for the risk of recurrence (ROR) at 10 years. The primary objective of this multicenter study was to evaluate the impact of Prosigna’s assay information on physicians’ adjuvant treatment decisions in patients with early-stage breast cancer. Secondary objectives were to assess confidence of practitioners in their therapeutic recommendations before and after the added information provided by the Prosigna assay; and to evaluate the emotional state of patients before and after the Prosigna test results. Methods Consecutive patients with invasive early-stage breast cancer were enrolled in a prospective, observational, multicenter study carried out in 8 hospitals in France. The Prosigna test was carried out on surgical specimens using the nCounter® Analysis System located at the Institut Curie. Both before and after receiving the Prosigna test results, physicians completed treatment confidence questionnaires and patients completed questionnaires concerning their state of anxiety, the difficulties felt in face of the therapy and quality of life. Information was also collected at 6 months regarding the physicians’ opinion on the test results and the patients’ degree of anxiety, difficulties with therapy and quality of life. Results Between March 2015 and January 2016, 8 study centers in France consecutively enrolled 210 postmenopausal women with estrogen receptor (ER) positive, human epidermal growth hormone-2 (HER-2) negative, and node negative tumors, either stage 1 or stage 2. Intrinsic tumor subtypes as assessed by the Prosigna test were 114 (58.2%) Luminal A, 79 (40.3%) Luminal B, 1 (0.5%) HER-2 enriched (HER-2E), and 2 (1.0%) basal-like. Before receiving the Prosigna test results, physicians categorized tumor subtypes based on immunohistochemistry (IHC) as Luminal A in 126 (64%) patients and Luminal B in 70 (36%) patients, an overall discordance rate of 25%. The availability of Prosigna assay results was significantly associated with the likelihood of change in treatment recommendations, with 34 patients (18%) having their treatment plan changed from Adjuvant Chemotherapy to No Adjuvant Chemotherapy or vice versa (p<0.001, Fisher’s exact test). Prosigna test results also decreased patients’ anxiety about the chosen adjuvant therapy, and improved emotional well-being and measures of personal perceptions of uncertainty. Conclusions The results of this prospective decision impact study are consistent with 2 previous, identically designed studies carried out in Spain and Germany. The availability of Prosigna test results increased the confidence of treating physicians in their adjuvant treatment decisions, and led to an 18% change in chemotherapy treatment plan (from Adjuvant Chemotherapy to No Adjuvant Chemotherapy or vice versa). Prosigna testing decreased anxiety and improved measures of health-related quality of life in patients facing adjuvant therapy. The 25% discordance between Prosigna test and IHC subtyping underlines the importance of molecular testing for optimal systemic therapy indications in early breast cancer.
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Affiliation(s)
- Delphine Hequet
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, St Cloud, France
- INSERM-U900 –Bioinformatics, biostatistics, epidemiology and computational systems. Biology of cancer, St Cloud, France
- * E-mail:
| | - Céline Callens
- Department of Pharmacogenomics, Institut Curie, Paris, France
| | - David Gentien
- Institut Curie, PSL Research University, Translational Research Department, Genomic platform, Paris, France
| | - Benoit Albaud
- Institut Curie, PSL Research University, Translational Research Department, Genomic platform, Paris, France
| | | | - Coraline Dubot
- Department of Medical Oncology, Institut Curie-Centre René Huguenin, St Cloud, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie-Centre René Huguenin, St Cloud, France
| | - Cyrille Huchon
- Department of Gynecology, Poissy-St Germain hospital, Poissy, France
| | | | | | - Cyril Foa
- Department of Medical Oncology, Private Hospital Clairval, Marseille, France
| | - Rémy Salmon
- Department of Surgery, Private Hospital Les Peupliers, Paris, France
| | - Aurélie Roulot
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, St Cloud, France
| | - Florence Lerebours
- Department of Medical Oncology, Institut Curie-Centre René Huguenin, St Cloud, France
| | - Anne Salomon
- Department of Pathology, Institut Curie-Centre René Huguenin, St Cloud, France
| | - Nadeem Ghali
- NanoString Technologies, Inc., Seattle, WA, United States of America
| | - Pascale Morel
- NanoString Technologies, Inc., Seattle, WA, United States of America
| | - Qianyi Li
- Cedar Associates LLC, Menlo Park, CA, United States of America
| | - Anne Cayre
- Department of Pathology, Centre Jean Perrin-UMR INSERM 1240, University Clermont Auvergne, Clermont-Ferrand, France
| | | | - John Hornberger
- NanoString Technologies, Inc., Seattle, WA, United States of America
- Stanford University School of Medicine, Department of Internal Medicine, Stanford, CA, United States of America
| | - Frédérique Penault-Llorca
- Department of Pathology, Centre Jean Perrin-UMR INSERM 1240, University Clermont Auvergne, Clermont-Ferrand, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, St Cloud, France
- INSERM-U900 –Bioinformatics, biostatistics, epidemiology and computational systems. Biology of cancer, St Cloud, France
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Tobin NP, Lundberg A, Lindström LS, Harrell JC, Foukakis T, Carlsson L, Einbeigi Z, Linderholm BK, Loman N, Malmberg M, Fernö M, Czene K, Perou CM, Bergh J, Hatschek T. PAM50 Provides Prognostic Information When Applied to the Lymph Node Metastases of Advanced Breast Cancer Patients. Clin Cancer Res 2017; 23:7225-7231. [PMID: 28972041 DOI: 10.1158/1078-0432.ccr-17-2301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/29/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Transcriptional pathway activity and the molecular subtypes of breast cancer metastases have been shown to significantly influence patient postrelapse survival. Here, we further determine the relevance of clinically employed gene signatures in the advanced breast cancer (ABC) setting.Experimental Design: Sufficient RNA for expression profiling was obtained from distant metastatic or inoperable loco-regional relapse tissue by fine-needle aspiration from 109 patients of the Swedish TEX clinical trial. Gene signatures (GGI, 70 gene, recurrence score, cell-cycle score, risk of recurrence score, and PAM50) were applied to all metastases, and their relationship to long- (5-year) and short-term (1.5-year) postrelapse survival at all and locoregional lymph nodes (n = 40) versus other metastatic sites (n = 69) combined was assessed using Kaplan-Meier and/or multivariate Cox regression analyses.Results: The majority of metastases were classified into intermediate or high-risk groups by all signatures, and a significant association was found between metastatic signature subgroups and primary tumor estrogen receptor status and histologic grade (P < 0.05). When considering all sites of metastasis, only PAM50 was statistically significant in Kaplan-Meier analysis (Log-rank P = 0.008 and 0.008 for long- and short-term postrelapse breast cancer-specific survival, respectively). This significance remained in both uni- and multivariate models when restricting analyses to lymph node metastases only, and a similar trend was observed in other metastatic sites combined, but did not reach formal significance.Conclusions: Our findings are the first to demonstrate that the PAM50 signature can provide prognostic information from the lymph node metastases of ABC patients. Clin Cancer Res; 23(23); 7225-31. ©2017 AACR.
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Affiliation(s)
- Nicholas P Tobin
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.
| | - Arian Lundberg
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Linda S Lindström
- Department of Biosciences and Nutrition, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - J Chuck Harrell
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Theodoros Foukakis
- Department of Oncology and Pathology, Karolinska Institutet, Radiumhemmet, Karolinska Oncology, University Hospital, Stockholm, Sweden
| | - Lena Carlsson
- Department of Oncology, Sundsvall General Hospital, Sundsvall, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Barbro K Linderholm
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Loman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Department of Oncology, Skåne University Hospital, Helsingborg, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Medicon Village, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Charles M Perou
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, Radiumhemmet, Karolinska Oncology, University Hospital, Stockholm, Sweden.,Department of Public Health, Oxford University, Oxford, United Kingdom
| | - Thomas Hatschek
- Department of Oncology and Pathology, Karolinska Institutet, Radiumhemmet, Karolinska Oncology, University Hospital, Stockholm, Sweden
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40
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Ejlertsen B, Tuxen MK, Jakobsen EH, Jensen MB, Knoop AS, Højris I, Ewertz M, Balslev E, Danø H, Vestlev PM, Kenholm J, Nielsen DL, Bechmann T, Andersson M, Cold S, Nielsen HM, Maae E, Carlsen D, Mouridsen HT. Adjuvant Cyclophosphamide and Docetaxel With or Without Epirubicin for Early TOP2A-Normal Breast Cancer: DBCG 07-READ, an Open-Label, Phase III, Randomized Trial. J Clin Oncol 2017; 35:2639-2646. [DOI: 10.1200/jco.2017.72.3494] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose Administration of anthracycline and taxane therapy in the adjuvant setting is considered a standard for breast cancer. We evaluated a non–anthracycline-based regimen in TOP2A-normal patients. Patients and Methods In this multicenter, open-label, phase III trial, 2,012 women with early TOP2A-normal breast cancer and at least one high-risk factor were randomly assigned to receive six cycles of docetaxel (75 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks (DC) or three cycles of epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) followed by three cycles of docetaxel (100 mg/m2; EC-D). The primary end point was disease-free survival (DFS) after a median of 5 years of follow-up. Secondary end points were patient-reported toxicity, overall survival (OS), and distant disease–free survival. Results At a median estimated potential follow-up of 69 months, 5-year DFS was 87.9% (95% CI, 85.6% to 89.8%) in the EC-D arm and 88.3% (95% CI, 86.1% to 90.1%) in the DC arm. There was no significant difference in the risk of DFS events (hazard ratio [HR], 1.00; 95% CI, 0.78 to 1.28; P = 1.00), distant disease–free survival (HR, 1.12; 95% CI, 0.86 to 1.47; P = .40), or mortality (HR, 1.15; 95% CI, 0.83 to 1.59; P = .41) in the intent-to-treat analysis. A significant interaction between menopausal status and treatment group was observed for DFS ( P = .04) but not for OS ( P = .07). Patients with grade 3 tumors derived most benefit from DC, and patients with grade 1 to 2 tumors derived most benefit from EC-D (DFS: interaction P = .02; and OS: interaction P = .03). Patients receiving EC-D reported significantly more stomatitis, myalgia or arthralgia, vomiting, nausea, fatigue, and peripheral neuropathy, whereas edema was more frequent after DC. Conclusion This study provides evidence to support no overall outcome benefit from adjuvant anthracyclines in patients with early TOP2A-normal breast cancer.
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Affiliation(s)
- Bent Ejlertsen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Malgorzata K. Tuxen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Erik Hugger Jakobsen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Maj-Britt Jensen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Ann Soegaard Knoop
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Inger Højris
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Marianne Ewertz
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Eva Balslev
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Hella Danø
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Peter Michael Vestlev
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Julia Kenholm
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Dorte L. Nielsen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Troels Bechmann
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Michael Andersson
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Søren Cold
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Hanne Melgaard Nielsen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Else Maae
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Dorte Carlsen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
| | - Henning T. Mouridsen
- Bent Ejlertsen, Maj-Britt Jensen, and Henning T. Mouridsen, Danish Breast Cancer Cooperative Group, Rigshospitalet; Ann Soegaard Knoop and Michael Andersson, Rigshospitalet; Malgorzata K. Tuxen, Eva Balslev, Dorte L. Nielsen, and Dorte Carlsen, Herlev and Gentofte Hospital, Copenhagen; Erik Hugger Jakobsen, Troels Bechmann, and Else Maae, Lillebaelt Hospital, Vejle; Inger Højris and Hanne Melgaard Nielsen, Aarhus University Hospital, Aarhus; Marianne Ewertz, Odense University Hospital, Institute of
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Nitz U, Gluz O, Christgen M, Kates RE, Clemens M, Malter W, Nuding B, Aktas B, Kuemmel S, Reimer T, Stefek A, Lorenz-Salehi F, Krabisch P, Just M, Augustin D, Liedtke C, Chao C, Shak S, Wuerstlein R, Kreipe HH, Harbeck N. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res Treat 2017; 165:573-583. [PMID: 28664507 PMCID: PMC6336763 DOI: 10.1007/s10549-017-4358-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023]
Abstract
Background The prospective phase 3 PlanB trial used the Oncotype DX® Recurrence Score® (RS) to define a genomically low-risk subset of clinically high-risk pN0-1 early breast cancer (EBC) patients for treatment with adjuvant endocrine therapy (ET) alone. Here, we report five-year data evaluating the prognostic value of RS, Ki-67, and other traditional clinicopathological parameters. Methods A central tumour bank was prospectively established within PlanB. Following an early amendment, hormone receptor (HR)+ , pN0-1 RS ≤ 11 patients were recommended to omit chemotherapy. Patients with RS ≥ 12, pN2-3, or HR-negative/HER2-negative disease were randomised to anthracycline-containing or anthracycline-free chemotherapy. Primary endpoint: disease-free survival (DFS). PlanB Clinicaltrials.gov identifier: NCT01049425. Findings From 2009 to 2011, PlanB enrolled 3198 patients (central tumour bank, n = 3073) with the median age of 56 years, 41.1% pN+, and 32.5% grade 3 EBC. Chemotherapy was omitted in 348/404 (86.1%) eligible RS ≤ 11 patients. After 55 months of median follow-up, five-year DFS in ET-treated RS ≤ 11 patients was 94% (in both pN0 and pN1) versus 94% (RS 12–25) and 84% (RS > 25) in chemotherapy-treated patients (p < 0.001); five-year overall survival (OS) was 99 versus 97% and 93%, respectively (p < 0.001). Nodal status, central/local grade, tumour size, continuous Ki-67, progesterone receptor (PR), IHC4, and RS were univariate prognostic factors for DFS. In a multivariate analysis including all univariate prognostic markers, only pN2-3, central and local grade 3, tumour size >2 cm, and RS, but not IHC4 or Ki-67 were independent adverse factors. If RS was excluded, IHC4 or both Ki-67 and PR entered the model. The impact of RS was particularly pronounced in patients with intermediate Ki-67 (>10%, <40%) tumours. Interpretation The excellent five-year outcomes in clinically high-risk, genomically low-risk (RS ≤ 11) pN0-1 patients without adjuvant chemotherapy support using RS with standardised pathology for treatment decisions in HR+ HER2-negative EBC. Ki-67 has the potential to support patient selection for genomic testing.
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Affiliation(s)
- Ulrike Nitz
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany. .,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.
| | - Matthias Christgen
- Institute of Pathology, Medical School Hannover, Carl-Neuberg-Str. 1., 30625, Hannover, Germany
| | - Ronald E Kates
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany
| | - Michael Clemens
- Department of Oncology, Clinics Mutterhaus der Borromäerinnen, Feldstraße 16, 54290, Trier, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Center, University Clinics Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Benno Nuding
- Department of Gynecology and Obstetrics, Evangelical Hospital, Ferrenbergstraße 24, 51465, Bergisch Gladbach, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Clinics Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sherko Kuemmel
- Clinics Essen-Mitte, Breast Centre, Henricistraße 92, 45136, Essen, Germany
| | - Toralf Reimer
- Department of Gynecology and Obstetrics, Clinics Suedstadt, Südring 81, 18059, Rostock, Germany
| | - Andrea Stefek
- Johanniter Clinics Stendal, Breast Center Altmark, Bahnhofstraße 24 - 26, 39576, Stendal, Germany
| | - Fatemeh Lorenz-Salehi
- Department of Gynecology, Dr. Horst-Schmidt Clinics, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany
| | - Petra Krabisch
- Klinikum ChemnitzFlemmingstraße 2, 09116, Chemnitz, Germany
| | - Marianne Just
- Oncological Practice, Teutoburger Str. 60 33604, Bielefeld, Germany
| | - Doris Augustin
- Breast Centre Ostbayern, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Cornelia Liedtke
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | | | | | - Rachel Wuerstlein
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Carl-Neuberg-Str. 1., 30625, Hannover, Germany
| | - Nadia Harbeck
- West German Study Group, Ludwig-Weber-Str. 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
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42
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Fleischer T, Klajic J, Aure MR, Louhimo R, Pladsen AV, Ottestad L, Touleimat N, Laakso M, Halvorsen AR, Alnæs GIG, Riis ML, Helland Å, Hautaniemi S, Lønning PE, Naume B, Børresen-Dale AL, Tost J, Kristensen VN. DNA methylation signature (SAM40) identifies subgroups of the Luminal A breast cancer samples with distinct survival. Oncotarget 2017; 8:1074-1082. [PMID: 27911866 PMCID: PMC5352035 DOI: 10.18632/oncotarget.13718] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/07/2016] [Indexed: 01/20/2023] Open
Abstract
Breast cancer patients with Luminal A disease generally have a good prognosis, but among this patient group are patients with good prognosis that are currently overtreated with adjuvant chemotherapy, and also patients that have a bad prognosis and should be given more aggressive treatment. There is no available method for subclassification of this patient group. Here we present a DNA methylation signature (SAM40) that segregates Luminal A patients based on prognosis, and identify one good prognosis group and one bad prognosis group. The prognostic impact of SAM40 was validated in four independent patient cohorts. Being able to subdivide the Luminal A patients may give the two-sided benefit of identifying one subgroup that may benefit from a more aggressive treatment than what is given today, and importantly, identifying a subgroup that may benefit from less treatment.
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Affiliation(s)
- Thomas Fleischer
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Jovana Klajic
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
- Department of Clinical Molecular Biology and Laboratory Science (EpiGen), Akershus University hospital, Division of Medicine, Lørenskog, Norway
| | - Miriam Ragle Aure
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Riku Louhimo
- Systems Biology Laboratory, Institute of Biomedicine and Genome-Scale Biology Research Program, University of Helsinki, Finland
| | - Arne V. Pladsen
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Lars Ottestad
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Nizar Touleimat
- Laboratory for Epigenetics and Environment, Centre National de Génotypage, CEA – Institut de Génomique, France
| | - Marko Laakso
- Systems Biology Laboratory, Institute of Biomedicine and Genome-Scale Biology Research Program, University of Helsinki, Finland
| | - Ann Rita Halvorsen
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Grethe I. Grenaker Alnæs
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Margit L.H. Riis
- Department of Clinical Molecular Biology and Laboratory Science (EpiGen), Akershus University hospital, Division of Medicine, Lørenskog, Norway
- Department of Surgery, Akershus University Hospital, Lørenskog, Norway
- Deptartment of Breast and Endocrine Surgery, Oslo University Hospital, Ullevål, Norway
| | - Åslaug Helland
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Sampsa Hautaniemi
- Systems Biology Laboratory, Institute of Biomedicine and Genome-Scale Biology Research Program, University of Helsinki, Finland
| | - Per Eystein Lønning
- Section of Oncology, Institute of Clinical Science, University of Bergen, Bergen, Norway
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Naume
- Cancer Clinic, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - Anne-Lise Børresen-Dale
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
| | - Jörg Tost
- Laboratory for Epigenetics and Environment, Centre National de Génotypage, CEA – Institut de Génomique, France
| | - Vessela N. Kristensen
- Department of Cancer Genetics, Institute for Cancer Research, OUS Radiumhospitalet, Oslo, Norway
- Department of Clinical Molecular Biology and Laboratory Science (EpiGen), Akershus University hospital, Division of Medicine, Lørenskog, Norway
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43
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Diessner J, Wischnewsky M, Blettner M, Häusler S, Janni W, Kreienberg R, Stein R, Stüber T, Schwentner L, Bartmann C, Wöckel A. Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study. PLoS One 2016; 11:e0168730. [PMID: 27992550 PMCID: PMC5167411 DOI: 10.1371/journal.pone.0168730] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/05/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision. METHODS In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading. RESULTS There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46-1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45-1.88). CONCLUSIONS The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings-that are in line with several publications-should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.
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Affiliation(s)
- Joachim Diessner
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Manfred Wischnewsky
- Faculty of Mathematics and Computer Science, University of Bremen Bremen, Germany
| | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), University of Mainz, Mainz, Germany
| | - Sebastian Häusler
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Wolfgang Janni
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Rolf Kreienberg
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Roland Stein
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Tanja Stüber
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Lukas Schwentner
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Catharina Bartmann
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Achim Wöckel
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
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44
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Tevaarwerk AJ, Wisinski KB, O'Regan RM. Endocrine Therapy in Premenopausal Hormone Receptor-Positive Breast Cancer. J Oncol Pract 2016; 12:1148-1156. [PMID: 27858538 DOI: 10.1200/jop.2016.016865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Systemic therapy for premenopausal women with hormone receptor-positive breast cancer has evolved in the last 5 years, but critical questions remain. Recent randomized trials have demonstrated a benefit for the addition of ovarian suppression to endocrine therapy in patients with breast cancers considered to be at high risk for recurrence, whereas those with lower-risk cancers seem to have a favorable outcome with tamoxifen alone. Two large randomized trials have demonstrated a benefit for extending adjuvant tamoxifen beyond 5 years. Currently the choice of systemic therapy is selected empirically but molecular profiling may, in the near future, provide a more conclusive means of selecting an endocrine therapeutic approach for premenopausal patients. Given that a significant subset of hormone receptor-positive cancers are intrinsically resistant to endocrine agents, as well as the finding that inhibiting cyclin-dependent kinases 4 and 6 and mammalian target of rapamycin appears to potentially reverse this resistance in patients with metastatic disease, evaluation of these agents in the early-stage setting is ongoing.
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