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Maes-Carballo M, Martín-Díaz M, Mignini L, Khan KS, Trigueros R, Bueno-Cavanillas A. Quality indicators for the diagnosis and treatment of breast cancer integrated assistance: A critical appraisal. Semergen 2024; 50:102067. [PMID: 37827047 DOI: 10.1016/j.semerg.2023.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Quality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. METHODS We studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. RESULTS Four indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6-68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1-60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3-87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0-50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). CONCLUSION The study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables.
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Affiliation(s)
- M Maes-Carballo
- Academic Department of General Surgery, Complexo Universitario Hospitalario de Ourense, Spain; Academic Department of General Surgery, Hospital Público de Verín, Spain; Department of Preventive Medicine and Public Health, University of Granada, Spain.
| | - M Martín-Díaz
- Academic Department of General Surgery, Hospital Santa Ana de Motril, Spain
| | - L Mignini
- Unidad de Mastología de Grupo Oroño, Rosario, Argentina
| | - K S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - R Trigueros
- Department of Psychology, University of Almeria, Spain
| | - A Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
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Efficacy of Eribulin mesylate in older patients with breast cancer: A pooled analysis of clinical trial and real-world data. J Geriatr Oncol 2020; 11:976-981. [DOI: 10.1016/j.jgo.2020.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/08/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022]
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Oral vinorelbine versus intravenous vinorelbine, in combination with epirubicin as first-line chemotherapy in Chinese patients with metastatic breast cancer. Cancer Chemother Pharmacol 2019; 85:205-215. [PMID: 31838561 PMCID: PMC6994442 DOI: 10.1007/s00280-019-04000-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/22/2019] [Indexed: 02/05/2023]
Abstract
Oral VRL offers easier administration, better quality of life, and cost saving. This study aimed to evaluate the treatment efficacy in terms of tumor response of the two formulations of vinorelbine (VRL, oral and IV) in combination with epirubicin (EPI); and the effect of EPI co-administration on VRL pharmacokinetics (PK) in Chinese patients with metastatic breast cancer (MBC) using a phase 2, open label, randomized trial. Patients were aged 18–70 years, had histologically confirmed MBC, Karnofsky Performance Status ≥ 70%, and life expectancy ≥ 12 weeks. The treatment consisted of 6 cycles of 3 weeks each. VRL dose was: (Oral-VRL) 60 mg/m2 for cycle 1, 80 mg/m2 for cycles 2–6, and (IV-VRL) 25 mg/m2 for cycle 1 and 30 mg/m2 for cycles 2–6. EPI dose of 75 mg/m2 was given on day 1 in both arms for all cycles. 133 patients were enrolled: 66 in Oral-VRL and 67 in IV-VRL arms. The median age for Oral-VRL and IV-VRL arms was 48.4 and 50.0 years, respectively. Objective response rates were 50.0% (95% CI 37.4–62.6%) for Oral-VRL and 53.7% (95% CI 41.1–66.0%) for IV-VRL. Both treatment arms met the efficacy objective target of at least 31 responses, demonstrating efficacy as first-line treatment for MBC. Similar blood PK profiles, exposures, and VRL clearance were observed between VRL + EPI vs VRL-only modalities for both arms. Oral VRL is comparable to IV VRL and an effective first-line treatment for Chinese patients with MBC. The activity of VRL + EPI combination is unaltered when VRL is given orally at recommended doses.
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Pedersini R, Vassalli L, Claps M, Tulla A, Rodella F, Grisanti S, Amoroso V, Roca E, Simoncini EL, Berruti A. Eribulin in Heavily Pretreated Metastatic Breast Cancer Patients in the Real World: A Retrospective Study. Oncology 2018; 94 Suppl 1:10-15. [PMID: 30036867 DOI: 10.1159/000489063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate efficacy and safety of eribulin in heavily pretreated patients with advanced breast cancer (BC) in a real-life setting. METHODS This retrospective monocentric study included patients with HER-2-negative metastatic BC, pretreated with anthracyclines and taxanes, who were referred to the Oncology Department of Spedali Civili of Brescia from May 2012 to April 2017. Patients received the same dose of eribulin as that used in the EMBRACE trial: 1.4 mg/m2 on days 1 and 8 every 21 days. RESULTS In a total of 53 patients, 32% obtained a partial response, 11% a stable disease, and 43% a clinical benefit (CB). After a median follow-up of 36 months, median progression-free survival (PFS) was 4.7 months and median overall survival (OS) 13.53 months. Median PFS was significantly longer in patients who reported a CB compared to those with no CB, while survival outcomes (PFS and OS) were better in patients who received > 6 cycles of eribulin. Eribulin showed a good tolerability profile with acceptable toxicities, similar to those reported in EMBRACE. CONCLUSIONS Our experience in a real-world setting confirms the activity, efficacy, and good tolerability profile of eribulin in heavily pretreated BC patients.
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Affiliation(s)
- Rebecca Pedersini
- Breast Unit-Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Lucia Vassalli
- Breast Unit-Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Melanie Claps
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Antonella Tulla
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Filippo Rodella
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | | | - Vito Amoroso
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Elisa Roca
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | | | - Alfredo Berruti
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
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Morgillo F, Della Corte CM, Diana A, Mauro CD, Ciaramella V, Barra G, Belli V, Franzese E, Bianco R, Maiello E, de Vita F, Ciardiello F, Orditura M. Phosphatidylinositol 3-kinase (PI3Kα)/AKT axis blockade with taselisib or ipatasertib enhances the efficacy of anti-microtubule drugs in human breast cancer cells. Oncotarget 2017; 8:76479-76491. [PMID: 29100327 PMCID: PMC5652721 DOI: 10.18632/oncotarget.20385] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/26/2017] [Indexed: 01/14/2023] Open
Abstract
Purpose The Phosphatidylinositol 3-kinase (PI3Ks) pathway is commonly altereted in breast cancer patients, but its role is still unclear. Taselisib, a mutant PI3Kα selective inhibitor, and ipatasertib, an AKT inhibitor, are currently under investigation in clinical trials in combination with paclitaxel or hormonal therapies in breast cancer. The aim of this study was to evaluate if PI3K or AKT inhibition can prevent resistance to chemotherapy and potentiate its efficacy. Experimental design The efficacy of combined treatment of ipatasertib and taselisib plus vinorelbine or paclitaxel or eribulin was evaluated in vitro on human breast cancer cells (with different expression profile of hormonal receptors, HER2, and of PI3Ka mutation) on cell survival by using MTT (3,(4,5-dimethylthiazol-2)2,5 difeniltetrazolium bromide) and colony forming assays on cell apoptosis by flow-cytometry analysis. We also investigated the effect of combined treatment on downstream intracellular signaling, by western blot analysis, and on metastatic properties, by migration assays. Finally, we analyzed changes in cell cytoskeleton by immunofluorescence. Results A significant synergism of ipatasertib or taselisib plus anti-microtubule chemotherapy in terms of anti-proliferative, pro-apoptotic and anti-metastatic effect was observed. The combined treatment completely inhibited the activation of proteins downstream of PI3K and MAPK pathways and affected the expression of survivin. Combined treatments completely disorganized the cytoskeleton in human breast cancer cells, with contemporary delocalization of survivin from cytoplasm to nucleus, thus suggesting a potential mechanism for this combination. Conclusions Targeting PI3K may enhance the efficacy of anti-microtubule drugs in human breast cancer cells.
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Affiliation(s)
- Floriana Morgillo
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Carminia Maria Della Corte
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Anna Diana
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Concetta di Mauro
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, Napoli, Italy
| | - Vincenza Ciaramella
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Giusi Barra
- Immunologia Clinica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Valentina Belli
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Elisena Franzese
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Roberto Bianco
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, Napoli, Italy
| | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Ferdinando de Vita
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Fortunato Ciardiello
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Michele Orditura
- Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale “F. Magrassi”, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli, Italy
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Orditura M, Gravina A, Riccardi F, Diana A, Mocerino C, Leopaldi L, Fabozzi A, Giordano G, Nettuno R, Incoronato P, Barzelloni ML, Caputo R, Pisano A, Grimaldi G, Genua G, Montesarchio V, Barbato E, Iodice G, Lieto E, Procaccini E, Mabilia R, Febbraro A, Laurentiis MD, Ciardiello F. Eribulin for metastatic breast cancer (MBC) treatment: a retrospective, multicenter study based in Campania, south Italy (Eri-001 trial). ESMO Open 2017; 2:e000176. [PMID: 28761747 PMCID: PMC5519815 DOI: 10.1136/esmoopen-2017-000176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND On the basis of the results of two pivotal phase III clinical trials, eribulin mesylate is currently approved in EU for the treatment of advanced breast cancer (aBC) in patients who have previously received an anthracycline and a taxane in either the adjuvant or the metastatic setting, and at least one chemotherapeutic regimen for metastatic disease. METHODS In our study, we investigated the efficacy and tolerability of eribulin as second or further line chemotherapy in 137 women affected by aBC. RESULTS Eribulin as monotherapy provided benefit in terms of progression-free survival (PFS), response rate (RR) and disease control rate (DCR) independently of its use as second or late-line therapy. The overall RR and DCR were 17.5% and 64%, respectively. In particular, DCR and overall RR were 50% and 13.6%, 65.4% and 21.1%, 70.4% and 14.8% and 66.7% and 16.7% in second, third, fourth and further lines of treatment, respectively. Median PFS (mPFS) according to the line of therapy was 5.7, 6.3, 4.5 and 4.0 months in patients treated with eribulin in second, third, fourth and over the fourth line, respectively. No significant difference in terms of mPFS was found between the various BC subtypes. Overall, eribulin resulted safe and most adverse events were of grade 1 or 2 and easily manageable. Grades 3-4 toxicities were neutropaenia and neurotoxicity. CONCLUSIONS With the limitations due to the observational nature of our findings, eribulin was shown to be an effective and safe therapeutic option in heavily pretreated patients with aBC.
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Affiliation(s)
- Michele Orditura
- Dipartimento di Internistica Clinica e Sperimentale Flaviano Magrassi, Università degli Studi della Campania"Luigi Vanvitelli", Naples, Italy
| | - Adriano Gravina
- Department of Breast Oncology, National Cancer Institute ‘Fondazione Pascale’, Naples, Italy
| | | | - Anna Diana
- Dipartimento di Internistica Clinica e Sperimentale Flaviano Magrassi, Università degli Studi della Campania"Luigi Vanvitelli", Naples, Italy
| | | | - Luigi Leopaldi
- U.O. Oncologia Medica ASL NA1, Ospedale San Gennaro, Naples, Italy
| | - Alessio Fabozzi
- U.O. Oncologia Ospedale Sacro Cuore di Gesú, Fatebenefratelli, Benevento, Italy
- SSD oncologia del melanoma e dell'esofago, ISTITUTO ONCOLOGICO VENETO IRCCS, Padova, Italy
| | - Guido Giordano
- U.O. Oncologia Ospedale Sacro Cuore di Gesú, Fatebenefratelli, Benevento, Italy
| | - Raffaele Nettuno
- U.O.S. di Oncologia ASL Caserta—PO AGP, di Piedimonte Matese (CE), Italy
| | | | | | - Roberta Caputo
- Department of Breast Oncology, National Cancer Institute ‘Fondazione Pascale’, Naples, Italy
| | - Agata Pisano
- U.O.C. Oncoematologia Ospedale Santa Maria Delle Grazie, Pozzuoli (NA), Italy
| | - Giuseppe Grimaldi
- U.O. Medicina—Oncoematologia Ospedale Umberto I, Nocera Inferiore (SA), Italy
| | - Geppino Genua
- U.O. Oncologia Ospedale Civile ASL AV/1, Ariano Irpino (AV), Italy
| | | | - Enrico Barbato
- U.O.S.D. Oncologia Medica Ospedale ‘Moscati’, Aversa (CE), Italy
| | - Giovanni Iodice
- Department of Breast Oncology, National Cancer Institute ‘Fondazione Pascale’, Naples, Italy
| | - Eva Lieto
- IX Divisione di Chirurgia Generale Dipartimento di Scienze Cardiotoraciche e Respiratorie Seconda, Università degli Studi di Napoli, Naples, Italy
| | - Eugenio Procaccini
- Breast Unit Second University of Naples School of Medicine, Naples, Italy
| | | | - Antonio Febbraro
- U.O. Oncologia Ospedale Sacro Cuore di Gesú, Fatebenefratelli, Benevento, Italy
| | - Michelino De Laurentiis
- Department of Breast Oncology, National Cancer Institute ‘Fondazione Pascale’, Naples, Italy
| | - Fortunato Ciardiello
- Dipartimento di Internistica Clinica e Sperimentale Flaviano Magrassi, Università degli Studi della Campania"Luigi Vanvitelli", Naples, Italy
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