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Larionov AA. Current Therapies for Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer Patients. Front Oncol 2018; 8:89. [PMID: 29670855 PMCID: PMC5894159 DOI: 10.3389/fonc.2018.00089] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/14/2018] [Indexed: 01/01/2023] Open
Abstract
The median survival of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) has more than doubled, since the discovery of HER2-targeted treatments: it rose from less than 2 years in 2001 (prior introduction of trastuzumab) to more than 4 years in 2017. The initial generation of HER2-targeted therapies included trastuzumab with taxanes in the first line, followed by the addition of lapatinib and by a switch to another cytotoxic agent after progression. Results of CLEOPATRA, EMILIA, and TH3RESA trials have changed this clinical practice. The current consensus includes horizontal dual blockade (trastuzumab + pertuzumab) with taxanes or vinorelbine in the first line, followed by trastuzumab-emtansine (T-DM1) in the second line, with addition of lapatinib in the later lines of treatment. However, the fast and simultaneous development of new drugs led to a relative shortage of clinical evidence to support this sequence. Triple-positive breast cancers (TPBC), which express both hormonal receptors and HER2, constitute nearly half of HER2-positive cases. For these tumors, the current consensus is to add endocrine therapy after completion of cytotoxic treatment. Again, this consensus is not fully evidence-based. In view of the recent progress in treatment of estrogen-receptor positive breast cancers, a series of trials is evaluating addition of CDK4/6 inhibitors, aromatase inhibitors or fulvestrant to HER2-targeted and cytotoxic chemotherapy in TPBC patients. Despite the remarkable progress in treatment of HER2-positive breast cancer, metastatic disease is still incurable in the majority of patients. A wide range of novel therapies are under development to prevent and overcome resistance to current HER2-targeted agents. This review discusses pivotal clinical trials that have shaped current clinical practices, the current consensus recommendations, and the new experimental treatments in metastatic HER2-positive breast cancer.
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Affiliation(s)
- Alexey A Larionov
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Treatment and pattern of bone metastases in 1094 patients with advanced breast cancer – Results from the prospective German Tumour Registry Breast Cancer cohort study. Eur J Cancer 2017; 79:139-148. [DOI: 10.1016/j.ejca.2017.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 12/31/2022]
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Fietz T, Tesch H, Rauh J, Boller E, Kruggel L, Jänicke M, Marschner N. Palliative systemic therapy and overall survival of 1,395 patients with advanced breast cancer - Results from the prospective German TMK cohort study. Breast 2017; 34:122-130. [PMID: 28586735 DOI: 10.1016/j.breast.2017.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 11/18/2022] Open
Abstract
Data on treatment and outcome of advanced breast cancer in routine practice are rare, especially concerning recurrent disease, but important to complement the results from clinical trials and to improve the standard of care. We present data on choice of systemic first-line treatment, number of treatment lines, and survival of patients treated by medical oncologists in Germany. 1395 patients recruited by 124 sites at start of first-line therapy into the ongoing, prospective German clinical cohort study TMK (Tumour Registry Breast Cancer) between February 2007 and October 2015 were analysed. The median OS was 33.8 months (95% CI 30.2-40.2) for HR-positive/HER2-negative, 38.2 months (95% CI 31.3-43.0) for HER2-positive and 16.8 months (95% CI 11.5-22.0) for triple negative breast cancer. Patients with triple negative tumours more often died before start of a third-line therapy than patients with HR-positive or HER2-positive tumours (44% vs. 25%). Use of taxane-based chemotherapies has increased since 2007, with 65% of all first-line chemotherapy-treatments containing taxanes in 2013-15 (60% HR-positive/HER2-negative, 75% HER2-positive, 56% triple negative). 52% of the patients with HR-positive/HER2-negative tumours received first-line endocrine therapy in 2013-15; when restricted to patients with only non-visceral metastases this percentage increased to 63%. To our knowledge, this is the first cohort study showing systemic first-line therapy for all subtypes of advanced breast cancer. Overall survival in the TMK is comparable to that reported by clinical trials despite the inclusion of older and comorbid patients.
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Affiliation(s)
- Thomas Fietz
- Outpatient-Centre for Internal Medicine, Haematology and Oncology, Singen, Germany
| | - Hans Tesch
- Outpatient-Centre for Haematology and Medical Oncology at Bethanien, Frankfurt/Main, Germany
| | - Jacqueline Rauh
- Joint Outpatient-Centre for Internal Medicine, Witten, Germany
| | | | - Lisa Kruggel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Norbert Marschner
- Outpatient-Centre for Interdisciplinary Oncology and Haematology, Freiburg, Germany.
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Moris D, Kontos M, Spartalis E, Fentiman IS. The Role of NSAIDs in Breast Cancer Prevention and Relapse: Current Evidence and Future Perspectives. Breast Care (Basel) 2016; 11:339-344. [PMID: 27920627 DOI: 10.1159/000452315] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) have received considerable interest as potential chemopreventive agents. The aim of this review is to summarize the accumulated knowledge on the effect of NSAIDs on breast cancer incidence and natural history, and the underlying pathophysiology. NSAIDs mainly block inflammation by inhibiting cyclooxygenase enzymes, leading to lower prostaglandin synthesis. The latter has been reported to affect breast cancer risk through hormonal and inflammation-related pathways. Intensity, dose, frequency, duration, and timing of administration may also be significant. There is currently enough evidence to support a role of NSAIDs in breast cancer prevention and relapse, which deserves further large-scale experimental and clinical investigation.
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Affiliation(s)
- Demetrios Moris
- 1st Department of Surgery, University of Athens, 'Laikon' General Hospital, Athens, Greece, London, United Kingdom
| | - Michalis Kontos
- 1st Department of Surgery, University of Athens, 'Laikon' General Hospital, Athens, Greece, London, United Kingdom
| | - Eleftherios Spartalis
- 1st Department of Surgery, University of Athens, 'Laikon' General Hospital, Athens, Greece, London, United Kingdom
| | - Ian S Fentiman
- Research Oncology, Bermondsey Wing, Guy's Hospital, London, United Kingdom
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Untch M, Augustin D, Ettl J, Haidinger R, Harbeck N, Lück HJ, Lüftner D, Marmé F, Müller L, Overkamp F, Ruckhäberle E, Thill M, Thomssen C, Wuerstlein R, Marschner N. ABC3 Consensus Commented from the Perspective of the German Guidelines: Third International Consensus Conference for Advanced Breast Cancer (ABC3), Lisbon, 07. 11. 2015. Geburtshilfe Frauenheilkd 2016; 76:156-163. [PMID: 26941448 PMCID: PMC4771501 DOI: 10.1055/s-0042-101168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 12/17/2022] Open
Abstract
The Third International Consensus Conference for Advanced Breast Cancer ABC3 on the diagnosis and treatment of advanced breast cancer was held in Lisbon from 5 to 7 November 2015. This year the focus was the treatment of metastatic breast cancer (stage IV) - including the patient perspectives. Important topics were questions relating to quality of life, the care for long-term survivors as well as the management of disease-related symptoms and treatment-based side effects. The use of standardised tools to assess individual treatment success and the benefits of new substances were important points for discussion. The diagnosis and treatment of inoperable locally advanced breast cancer were discussed two years ago during the ABC2 consensus 1. A working group of German breast cancer experts commented on the results of the ABC panellists, paying particular attention to the German guidelines (AGO, S3, DGHO) on the diagnosis and treatment of breast cancer 2, 3, 4, 5 in Germany.
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Affiliation(s)
- M. Untch
- Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin-Buch, Berlin; Writing Committee
| | - D. Augustin
- Mammazentrum Ostbayern, DONAUISAR Klinikum Deggendorf, Deggendorf
| | - J. Ettl
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich
| | - R. Haidinger
- Brustkrebs Deutschland e. V. (patient representative)
| | - N. Harbeck
- Brustzentrum, Klinikum der Universität München, München; Writing Committee, ABC Panel Member
| | - H.-J. Lück
- Gynäkologisch-Onkologische Praxis, Hannover
| | - D. Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Berlin, Campus Benjamin Franklin, Berlin; Writing Committee
| | - F. Marmé
- Sektion Gynäkologische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg
| | - L. Müller
- Onkologie UnterEms, Leer-Emden-Papenburg
| | - F. Overkamp
- Medizinischer Onkologe, OncoConsult.Hamburg GmbH, Hamburg
| | - E. Ruckhäberle
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf
| | - M. Thill
- Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, Agaplesion Markus Krankenhaus, Frankfurt am Main
| | - C. Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität, Halle an der Saale; Writing Committee, ABC Panel Member
| | - R. Wuerstlein
- Brustzentrum, Klinikum der Universität München, Munich; Writing Committee
| | - N. Marschner
- Gemeinschaftspraxis für interdisziplinäre Onkologie und Hämatologie, Freiburg; Writing Committee
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Thomssen C, Augustin D, Ettl J, Haidinger R, Lück HJ, Lüftner D, Marmé F, Marschner N, Müller L, Overkamp F, Ruckhäberle E, Thill M, Untch M, Wuerstlein R, Harbeck N. ABC3 Consensus: Assessment by a German Group of Experts. Breast Care (Basel) 2016; 11:61-70. [PMID: 27051399 DOI: 10.1159/000443515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Advanced Breast Cancer Third International Consensus Conference on the diagnosis and treatment of advanced breast cancer took place in Lisbon, Portugal, on November 5-7, 2015. This year's conference (ABC3) was focused on the treatment of metastatic breast cancer (stage IV), as it was 4 years ago at the first consensus meeting (ABC1). A matter of particular interest was the patients' perspective. Thus, patient-relevant issues were addressed by the consensus discussions, such as those on treatment goals, quality of life, care of long-term survivors ('survivorship issues'), and coping with disease-related symptoms and the side effects of treatment. Further important issues on the agenda were the use of standardized instruments for the assessment of individual treatment success ('patient-reported outcome measures') and the evaluation of the benefit of novel drugs (e.g. the European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale). Diagnosis and treatment of inoperable locally advanced breast cancer had already been discussed 2 years earlier at the ABC2 Consensus and were not dealt with in the framework of this year's ABC3 Consensus. With regard to country-specific peculiarities, which unavoidably found their way into the ABC Consensus, a working group of German breast cancer experts commented on the voting results of the ABC panelists. As for the past consensus, the group specially considered the German guidelines for the diagnosis and treatment of breast cancer (AGO (Gyneco-Oncology Working Group), S3, DGHO (German Society of Hematology and Medical Oncology)) in order to adapt the ABC3 consensus for everyday therapy in Germany.
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Affiliation(s)
- Christoph Thomssen
- University Clinic and Outpatient Clinic of Gynecology, Martin-Luther-University, Halle an der Saale, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital, Deggendorf, Germany
| | - Johannes Ettl
- Gynecology Outpatient Clinic, Klinikum rechts der Isar, Technical University Munich, Germany
| | | | | | - Diana Lüftner
- Medical Clinic focusing on Hematology, Oncology and Tumor Immunology, Charité Berlin, Benjamin Franklin Campus, Berlin, Germany
| | - Frederik Marmé
- Gyneco-Oncology Section, National Center of Tumor Diseases (NCT), Heidelberg, Germany
| | - Norbert Marschner
- Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg i.Br., Germany
| | - Lothar Müller
- Onkologie UnterEms Leer-Emden-Papenburg, Leer, Germany
| | | | | | - Marc Thill
- Clinic for Gynecology and Obstetrics, Interdisciplinary Breast Center, Agaplesion Markus Hospital, Frankfurt/M., Germany
| | - Michael Untch
- Gynecology Clinic, HELIOS Hospital Berlin Buch, Berlin, Germany
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Liedtke C, Kolberg HC. Current Medical Treatment of Patients with Non-Colorectal Liver Metastases: Primary Tumor Breast Cancer. VISZERALMEDIZIN 2015; 31:424-32. [PMID: 26889146 PMCID: PMC4748775 DOI: 10.1159/000441961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND (Metastatic) breast cancer is a heterogeneous entity in which every disease subtype requires an individualized systemic treatment approach. METHODS We reviewed the currently available data regarding systemic therapy of breast cancer and present a review of historical and current treatment approaches, with the publications cited covering a time span from 1896 to the last ASCO 2015. RESULTS Systemic therapy of metastatic breast cancer may include chemotherapy, endocrine therapy, and targeted therapies (e.g. antibody-based approaches). Based on the patient's breast cancer subtype, these agents may be employed alone or in combination. Therefore, characterization of the phenotype of the disease is necessary and may include biopsy of the metastatic site. Novel therapeutic approaches include immunologic therapies as well as PARP, PI3K and CDK 4/6 inhibitors, which are currently under investigation in clinical trials. CONCLUSION Systemic therapy of metastatic breast cancer requires complex and individualized treatment approaches that are best offered in an interdisciplinary setting.
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Affiliation(s)
- Cornelia Liedtke
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein – Campus Lübeck, Lübeck, Germany
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