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Kooijman MML, Hage JJ, Scholten AN, van Duijnhoven F, Breugem CC, Woerdeman LAE. Oncological status is not a determinant of refraining from breast reconstruction among 490 candidates for mastectomy and post-mastectomy radiotherapy. J Plast Reconstr Aesthet Surg 2023; 85:360-366. [PMID: 37544198 DOI: 10.1016/j.bjps.2023.07.035] [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: 12/11/2022] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Although breast reconstruction in the setting of post-mastectomy radiotherapy (PMRT) is controversial, we offer nipple-sparing mastectomy and immediate implant-based breast reconstruction ([N]SSM/IIBR) to women needing primary mastectomy regardless of PMRT. Nevertheless, some of these women have no reconstruction. PURPOSE To assess the uptake of breast reconstruction in women who undergo PMRT and the patient characteristics associated with such uptake. Additionally, we assessed the determinants of forgoing breast reconstruction. METHODOLOGY Demographic, physical and oncological characteristics of women who underwent mastectomy, PMRT and breast reconstruction were compared to the characteristics of those who did not undergo breast reconstruction from 2013 through 2018. As determinants of delaying or refraining from breast reconstruction, we distinguished between an oncological reason, patient's preference, patient's co-morbidity, combined tobacco abuse and obesity and the need for PMRT. RESULTS 490 women received PMRT. Of these, 396 women (81%) underwent combined [N]SSM/IIBR and PMRT or mastectomy and PMRT with delayed breast reconstruction. Ninety-four additional women (19%) did not undergo breast reconstruction. The latter group differed significantly from those who did in demographic and physical characteristics but not in terms of oncological diagnosis and history. Patient's preference was the single most frequent determinant of not performing either immediate or delayed breast reconstruction among these 94 women. Oncological status was not a major determinant in refraining from reconstruction. CONCLUSION The significant difference in non-oncological characteristics between the reconstructed and non-reconstructed women confirms the importance of these characteristics in the preference for either reconstruction or non-reconstruction.
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Affiliation(s)
- Merel M L Kooijman
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - J Joris Hage
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - Astrid N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Leonie A E Woerdeman
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Bastos MCS, de Almeida AP, Bagnoli F, de Oliveira VM. Early breast cancer: concept and therapeutic review. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S114. [PMID: 37556633 PMCID: PMC10411694 DOI: 10.1590/1806-9282.2023s114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Breast cancer treatment has evolved significantly over the years, both in terms of local and systemic approaches. Halsted's radical mastectomy gave way to modified mastectomies and to conservative surgeries, along with breast reconstruction and repair. Although the use of new drugs has directly increased the survival of patients submitted to adjuvant or neoadjuvant systemic therapies, the de-escalation of drugs may also be beneficial in numerous cases. Therefore, breast cancer treatment must be increasingly customized and assessed using a multidisciplinary approach. This study aimed to review the concept and therapy of early breast cancer. METHODS A narrative review of the literature was carried out in the PubMed database in December 2022, where the keywords for the searches were as follows: early breast cancer, surgical treatment of breast cancer, systemic treatment of breast cancer, neoadjuvant chemotherapy in breast cancer, adjuvant treatment of luminal breast cancer, early triple negative tumor, and early positive Her-2 tumor. Articles that were historically important in the treatment of breast cancer and articles that impacted management with scientific relevance were selected for this review. DISCUSSION As new evidence continues to update existing knowledge, breast cancer treatment is becoming increasingly personalized and must now take into account the different tumor variants and their clinical stages, the age of patients and relevant comorbidities, as well as personal expectations and desires. CONCLUSION This literature review of current studies shows that the primary therapy for patients with early breast cancer continues to be surgery, although a customized and multidisciplinary approach is now required.
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Affiliation(s)
| | | | - Fábio Bagnoli
- Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil
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Seth I, Bulloch G, Jennings M, Seth N, Gracias D, Hunter-Smith DJ, Rozen WM. The effect of chemotherapy on the complication rates of breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 82:186-197. [PMID: 37182249 DOI: 10.1016/j.bjps.2023.04.007] [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: 08/30/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The impact of chemotherapy on complications following breast reconstruction surgery (BRS) is currently inconclusive. This meta-analysis investigates the impact of chemotherapy on complication rates in BRS. METHODS Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines was used to search relevant studies published from January 2006 to March 2022. The complication rates of neoadjuvant systemic therapy (NST) and adjuvant systemic therapy (AST) were analyzed via RevMan software 5.4, and a P value of< 0.05 was considered significant. The quality of selected studies was performed using the Newcastle-Ottawa scale for quality assessment. RESULTS A total of 18 studies comprising 49,217 patients were included. There was no significant difference in the total complications rate, major complications, or minor complications between NST and BRS or control. The rate of wound dehiscence was higher in the NST group compared with the BRS only group [RR= 1.54, 95% CI, (1.08, 2.18), P = 0.02], and the rate of infection was lower in the NST group compared with the BRS only group, [RR= 0.75, 95% CI, (0.61, 0.94), P = 0.01]. No significant difference in the rates of hematoma, seroma, skin necrosis, and implant loss was detected between NST and AST, or NST with BRS only. No statistically significant differences in total complication rates were observed between flap and implant BRS types (P = 0.88). CONCLUSION No significant differences between AST and NST were detected for complications. Significantly, NST had more wound dehiscence and less infection rates compared with BRS only groups, possibly reflecting selection bias or issues in the design of reported studies. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia; Faculty of Science, Medicine, and Health, University of Melbourne, Victoria 3010, Australia; Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Gabriella Bulloch
- Faculty of Science, Medicine, and Health, University of Melbourne, Victoria 3010, Australia
| | - Matthew Jennings
- Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia
| | - Nimish Seth
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Dylan Gracias
- Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia
| | - David J Hunter-Smith
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
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Jankowski C, Michel E, Vincent L, Beltjens F, Arnould L, Ladoire S, Coutant C. Axillary pathologic response after neoadjuvant chemotherapy and surgery according to breast cancers subtypes and survival impact. Bull Cancer 2023:S0007-4551(23)00153-4. [PMID: 37080848 DOI: 10.1016/j.bulcan.2023.03.009] [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: 12/22/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To retrospectively assess the rate of pathologic complete response in the axilla according to breast cancer biologic subtypes, and to study the impact of nodal response on survival. METHODS Inclusion criteria were all T-stage breast cancers with initial lymph node involvement, non-metastatic, treated with neoadjuvant chemotherapy followed by surgery with axillary lymph node dissection, managed at the George-François Leclerc Cancer Center in Dijon, France, between 2000 and 2018. RESULTS Among 437 patients included, the rate of complete nodal response rate varied according to tumor subtypes: 69.4% in Hormone Receptors (HR)-/HER2-positive, 47.4% in HR-/HER2-negative, 46.7% in HR+/HER2-positive, 8.5% in HR+/HER2-negative. By multivariate analysis, the factors significantly associated with complete nodal response were HER2-positive profile (OR 4.48 [2.14-9.65], P<0.001 if HR+; OR 8.02 [3.54-18.74], P<0.001 if HR-), triple negative tumors (OR 3.01 [1.40-6.58], P=0.005), SBRIII grade (OR 6.85 [2.28-29.58], P=0.002) and breast complete response (OR 18.69 [9.67-38.53], P<0.001). Five-year recurrence rates were 15.7% in ypN0, 23% in ypN1, 41.2% in ypN2, 50% in ypN3 patients (P<0.001). Five-year overall survival rates were 92.2% in ypN0, 85.7% in ypN1, 72.2% in ypN2, 65.4% in ypN3 patients (P<0.001). CONCLUSION The impact of nodal response on survival was significant. Pathologic complete response in the axilla appears to be a good surrogate marker of long-term outcome in patients treated for these cancers.
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Affiliation(s)
- Clémentine Jankowski
- Georges-François-Leclerc Cancer Center, Department of Surgical Oncology, 1, rue du Professeur-Marion, 21079 Dijon cedex, France.
| | - Eloïse Michel
- Georges-François-Leclerc Cancer Center, Department of Surgical Oncology, 1, rue du Professeur-Marion, 21079 Dijon cedex, France
| | - Laura Vincent
- Georges-François-Leclerc Cancer Center, Department of Surgical Oncology, 1, rue du Professeur-Marion, 21079 Dijon cedex, France
| | - Françoise Beltjens
- Georges-François-Leclerc Cancer Center, Department of Biology and Pathology of Tumors, 1, rue du Professeur-Marion, 21079 Dijon cedex, France
| | - Laurent Arnould
- Georges-François-Leclerc Cancer Center, Department of Biology and Pathology of Tumors, 1, rue du Professeur-Marion, 21079 Dijon cedex, France
| | - Sylvain Ladoire
- University of Burgundy, 7, boulevard Jeanne d'Arc, 21000 Dijon, France; Georges-François Leclerc cancer center, Department of Medical Oncology, 1, rue du Professeur-Marion, 21079 Dijon cedex, France
| | - Charles Coutant
- Georges-François-Leclerc Cancer Center, Department of Surgical Oncology, 1, rue du Professeur-Marion, 21079 Dijon cedex, France; University of Burgundy, 7, boulevard Jeanne d'Arc, 21000 Dijon, France
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5
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Mathonnet A, Dabakuyo S, Philip CA, Jankowski C, Cortet M. [How is our practice of mastectomy? Analysis based on population data in a French department]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:770-776. [PMID: 36183985 DOI: 10.1016/j.gofs.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this research was to study the evolution of the mastectomy rate in patients with breast cancer between 1998 and 2015, based on population data from the Côte d'Or breast cancer registry of the FRANCIM network ("France cancer incidence and mortality"). METHODS In this study on population register we included patients who had presented a primary breast cancer (invasive cancer and/or carcinoma in situ [CIS]) between 1998 and 2015 in the Côte d'Or department. We estimated the annual proportions of mastectomies, then calculated their evolution trends over this period. RESULTS Between 1998 and 2015, 7093 patients were included. The overall proportion of mastectomies was stable at 28% and did not respond to a time trend (Sen's slope of 0.2% per year; P=0.289). There was an increase in the proportion of lobular carcinomas (slope at 0.3% per year; P <0.05), with a rising proportion of mastectomy for lobular carcinomas (slope at 0.6% per year; P<0.05) but decreasing for ductal (slope at -0.8% per year; P<0.05). The proportion of mastectomy was stable for plurifocal cancers but the proportion of plurifocal cancers increased over time (slope at 0.8% per year; P<0.05). CONCLUSION Therefore, mastectomy remained a stable practice over the 18 years of analysis in the Côte d'Or region. However, this overall stability is the result of variations in the profiles of diagnosed cancers and surgical practices.
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Affiliation(s)
- A Mathonnet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France.
| | - S Dabakuyo
- Registre des cancers du sein et des cancers gynécologiques de Côte d'Or, unité de recherche en epidémiologie et qualité de vie, Inserm U1231, Georges François Leclerc Centre-UNICANCER, Dijon, France
| | - C-A Philip
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
| | - C Jankowski
- Service de chirurgie oncologique, centre de lutte contre le cancer Georges-François Leclerc, Dijon, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
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Gao H, Zhou H, Gao Y, He L, Li W, Xu M, Feng H, Feng X, Qiu C. Establishment of a new cell line of canine inflammatory mammary cancer: IMC-118. Vet Comp Oncol 2022; 20:679-687. [PMID: 35429113 DOI: 10.1111/vco.12822] [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: 01/09/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
Canine inflammatory mammary cancer (IMC) has long been regarded as an attractive animal model for research into human inflammatory breast cancer (IBC), Although some canine mammary tumour cell lines corresponding to human mammary cancer cell lines have been established, there is still a need to supplement the canine mammary tumour cell bank. The goal of this study was to create a new type of IMC cell line. The primary tumour, IMC-118, was identified as IMC by pathology examination. Immunohistochemistry analysis revealed negative immunoreactivity to oestrogen receptor (ER), but positive immunoreactivity to progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2). Immunofluorescence (IF) analysis revealed that the IMC-118 cell line from this primary tumour was negative for ER but positive for PR and HER-2, and was also positive for epithelial and mesenchymal cell markers. This cell line was cultured stably for more than 50 passages and grew well after cryopreservation. In vivo, tumour masses and metastases in the lungs were discovered after inoculating the IMC-118 cells into the nude mice model. As a result, a novel canine IMC cell line, IMC-118, was effectively established, and could be employed as a promising model for immunotherapy and epithelial-mesenchymal transition mechanism of IMC research in both dogs and humans.
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Affiliation(s)
- Hongbo Gao
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Han Zhou
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yiming Gao
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Lixin He
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Wenxuan Li
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Meixia Xu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Huili Feng
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xiujuan Feng
- Nanjing Police Dog Research Institute of the Ministry of the Public Security, Nanjing, China
| | - Changwei Qiu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
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Nodehi RS, Kalantari B, Raafat J, Ansarinejad N, Moazed V, Mortazavizadeh SMR, Hosseinzadeh M, Ghaderi B, Jenabian A, Qadyani M, Haghighat S, Allahyari A, Mirzania M, Seghatoleslami M, Payandeh M, Alikhasi A, Kafi H, Shahi F. A randomized, double-blind, phase III, non-inferiority clinical trial comparing the efficacy and safety of TA4415V (a proposed Trastuzumab biosimilar) and Herceptin (Trastuzumab reference product) in HER2-positive early-stage breast Cancer patients. BMC Pharmacol Toxicol 2022; 23:57. [PMID: 35902898 PMCID: PMC9336069 DOI: 10.1186/s40360-022-00599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background This study compared efficacy and safety of TA4415V, a trastuzumab biosimilar, with reference trastuzumab in patients with human epidermal growth factor receptor 2–positive (HER2-positive) early-stage breast cancer treated in the neoadjuvant setting in Iran. Methods Patients were randomly assigned to receive neoadjuvant TA4415V or reference trastuzumab concurrently with docetaxel (TH phase) for 4 cycles after treatment with 4 cycles of doxorubicin and cyclophosphamide (AC phase). Chemotherapy was followed by surgery. The primary endpoint was the comparison of pathologic complete response (pCR) rate in the per-protocol population. Secondary endpoints included comparisons of overall response rate (ORR), breast-conserving surgery (BCS), safety, and immunogenicity. Results Ninety-two participants were analyzed in the per-protocol population (TA4415V, n = 48; reference trastuzumab, n = 44). The pCR rates were 37.50% and 34.09% with TA4415V and reference drug, respectively. The 95% CI of the estimated treatment outcome difference (− 0·03 [95% CI − 0.23 to 0.16]) was within the non-inferiority margin. No statistically significant difference was observed between the groups for other efficacy variables in the ITT population: ORR (89.13% vs. 83.33%; p = 0.72) and BCS (20.37% vs. 12.96%; p = 0.42) in the TA4415V and reference drug group, respectively. At least one grade 3 or 4 adverse events occurred in 27 (50%) patients in the TA4415V group versus 29 (53.70%) in the reference trastuzumab group (p = 0.70). The decrease in left ventricular ejection fraction (LVEF), as an adverse event of special interest (AESI) for trastuzumab, was compared between treatment groups in TH phase. Results demonstrated an LVEF decrease in 7 (12.96%) and 9 (16.67%) patients in TA4415V and reference trastuzumab groups, respectively (p = 0.59). Anti-drug antibodies (ADA) were not detected in any samples of groups. Conclusions Non-inferiority for efficacy was demonstrated between TA4415V and Herceptin based on the ratio of pCR rates in HER2-positive early breast cancer patients. In addition, ORR and BCS, as secondary endpoints, were not significantly different. Safety profile and immunogenicity were also comparable between the two groups. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-022-00599-x.
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Affiliation(s)
- Reza Safaei Nodehi
- Department of Internal Medicine, Hematology and Medical Oncology Ward, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Behjat Kalantari
- Department of Internal Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Jahangir Raafat
- Cancer Research Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vahid Moazed
- Department of Internal Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Bayazid Ghaderi
- Liver and Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arash Jenabian
- Department of Medical Oncology and Hematology, Boali Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mojtaba Qadyani
- Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Haghighat
- Hematology Research Center, Department of Hematology, Medical Oncology, and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolghasem Allahyari
- Division of Hematology and Medical Oncology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrzad Mirzania
- Hematology and Medical Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Seghatoleslami
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrdad Payandeh
- Regenerative Medicine Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Afsaneh Alikhasi
- Department of Radiology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Kafi
- Medical Department, Orchid Pharmed Company, Tehran, Iran
| | - Farhad Shahi
- Department of Internal Medicine, Hematology and Medical Oncology Ward, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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8
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Orozco JIJ, Keller JK, Chang SC, Fancher CE, Grumley JG. Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer undergoing Upfront Surgery. Ann Surg Oncol 2022; 29:6299-6310. [PMID: 35896922 DOI: 10.1245/s10434-022-12190-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Randomized, controlled trials comparing breast-conserving therapy (BCT) with mastectomy have demonstrated equivalent overall survival (OS), but recent observational studies have shown improved OS in patients undergoing BCT. These studies provide limited data on young patients who are traditionally offered mastectomy due to perceived higher disease risk. This study examines the OS in a contemporary series of young women with breast cancer undergoing upfront BCT compared with mastectomy. METHODS Women ≤40 years old with primary invasive T1-T2, N0-N1 breast cancer were identified from the National Cancer Database between 2006 and 2016. Patient cohorts were based according to locoregional treatment: BCT, mastectomy alone (Mx), and mastectomy with radiotherapy (Mx/RT). Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) were performed to account for treatment selection bias effects in OS. RESULTS A total of 15,611 patients met the study criteria; 9,509 patients (60.9%) had BCT, 4,020 (25.8%) had Mx/RT, and 2,082 (13.3%) had Mx alone. The median follow-up was 4.6 years (interquartile range [IQR] 3.0-6.4). After IPTW-adjustment, the 5-year OS was similar for BCT (95%), Mx (95%), and Mx/RT (94%), and there was no significant difference in OS in Mx (hazard ratio [HR] = 1.16, 95% confidence interval [CI] 0.90-1.51) and Mx/RT (HR = 1.08, 95% CI 0.88-1.34) compared with BCT. Mx/RT was associated with decreased survival in patients with pT2N0 (HR = 1.78, 95% CI 1.12-2.84). CONCLUSIONS Among young patients with early-stage breast cancer, overall survival was equivalent regardless of surgical approach. Breast-conserving therapy remains a safe option in young women despite the clinical tendency to offer upfront mastectomy in young patients.
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Affiliation(s)
- Javier I J Orozco
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Jennifer K Keller
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shu-Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Saint Joseph Health, Portland, OR, USA
| | - Crystal E Fancher
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Janie G Grumley
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
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Polgár C, Kahán Z, Ivanov O, Chorváth M, Ligačová A, Csejtei A, Gábor G, Landherr L, Mangel L, Mayer Á, Fodor J. Radiotherapy of Breast Cancer-Professional Guideline 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610378. [PMID: 35832115 PMCID: PMC9272418 DOI: 10.3389/pore.2022.1610378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
The international radiotherapy (RT) expert panel has revised and updated the RT guidelines that were accepted in 2020 at the 4th Hungarian Breast Cancer Consensus Conference, based on new scientific evidence. Radiotherapy after breast-conserving surgery (BCS) is indicated in ductal carcinoma in situ (stage 0), as RT decreases the risk of local recurrence (LR) by 50-60%. In early stage (stage I-II) invasive breast cancer RT remains a standard treatment following BCS. However, in elderly (≥70 years) patients with stage I, hormone receptor-positive tumour, hormonal therapy without RT can be considered. Hypofractionated whole breast irradiation (WBI) and for selected cases accelerated partial breast irradiation are validated treatment alternatives to conventional WBI administered for 5 weeks. Following mastectomy, RT significantly decreases the risk of LR and improves overall survival of patients who have 1 to 3 or ≥4 positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be substituted with axillary RT. After neoadjuvant systemic treatment (NST) followed by BCS, WBI is mandatory, while after NST followed by mastectomy, locoregional RT should be given in cases of initial stage III-IV and ypN1 axillary status.
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Affiliation(s)
- Csaba Polgár
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Olivera Ivanov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department for Radiation Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Martin Chorváth
- Department of Radiation Oncology, St. Elisabeth Cancer Institute, Slovak Medical University, Bratislava, Slovakia
| | - Andrea Ligačová
- Department of Radiation Oncology, St. Elisabeth Cancer Institute, Slovak Medical University, Bratislava, Slovakia
| | - András Csejtei
- Department of Oncoradiology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Gabriella Gábor
- Oncoradiology Centre, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - László Landherr
- Municipal Oncoradiology Centre, Uzsoki Street Hospital, Budapest, Hungary
| | - László Mangel
- Oncotherapy Institute, University of Pécs, Pécs, Hungary
| | - Árpád Mayer
- Municipal Oncoradiology Centre, Uzsoki Street Hospital, Budapest, Hungary
| | - János Fodor
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
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10
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Lemaitre J, Lechartier C. [Interest of axillary surgery before or after neoadjuvant chemotherapy in breast cancer: Literature review]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:283-287. [PMID: 34999005 DOI: 10.1016/j.gofs.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Affiliation(s)
- J Lemaitre
- CRLCC René-Gauducheau, institut de cancérologie de l'Ouest à Nantes, boulevard Professeur Jacques-Monod, 44800 Saint-Herblain, France; Université de Nantes, Nantes, France.
| | - C Lechartier
- CRLCC René-Gauducheau, institut de cancérologie de l'Ouest à Nantes, boulevard Professeur Jacques-Monod, 44800 Saint-Herblain, France; Université de Nantes, Nantes, France.
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11
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Guay E, Cordeiro E, Roberts A. Time to treatment and hospital visits for patients undergoing neoadjuvant chemotherapy for breast cancer in a single payer system. J Surg Oncol 2022; 125:824-830. [PMID: 34989410 DOI: 10.1002/jso.26786] [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: 10/28/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemotherapy (NAC) requires coordination of various services to ensure timely and accurate delivery of care. This can result in multiple hospital visits and extend time to treatment (TTT). The primary purpose of our study was to evaluate time to NAC for patients at a regional cancer centre. Healthcare resource use in the form of hospital visits before NAC was also evaluated. METHODS A retrospective chart analysis of patients with invasive breast cancer who underwent NAC between 1 January 2012 and 31 December 2018 was performed. RESULTS Overall, 286 patients underwent NAC. Median TTT was 22 days (range: 2-105). Median number of visits between first consultation and NAC was 5 (range: 0-12). Majority of additional visits were for diagnostic imaging/interventions, with a median number of 4 visits (range: 0-10). Each additional hospital visit increased time to NAC treatment by 14%. CONCLUSIONS Women undergoing NAC require multiple visits before initiating treatment-the majority of these visits are for diagnostic imaging. These results support the need for the coordination of multidisciplinary care and diagnostic imaging for breast cancer patients undergoing NAC to reduce hospital visits, improve the patient experience, and reduce TTT.
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Affiliation(s)
- Evelyne Guay
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Roberts
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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12
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PET imaging in breast cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Guay E, Cordeiro E, Roberts A. Young Women with Breast Cancer: Chemotherapy or Surgery First? An Evaluation of Time to Treatment for Invasive Breast Cancer. Ann Surg Oncol 2021; 29:2254-2260. [PMID: 34837134 PMCID: PMC8625669 DOI: 10.1245/s10434-021-11102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022]
Abstract
Background Breast cancer in young women (ages 18–40 years) is rare, yet remains a leading cause of cancer-related death. Time to treatment (TTT) is an increasingly important factor in breast cancer outcomes, specifically time to systemic therapy. Our objective was to review patterns of care for young women presenting with invasive breast cancer and compare TTT for surgery first versus neoadjuvant chemotherapy (NAC). Patients and Methods A retrospective chart review of young women with non-metastatic, non-inflammatory invasive breast cancer between 2012 and 2018 at a single institution was completed. The primary outcome was time to first treatment (surgery or NAC). Results One hundred forty-two young women were treated for invasive breast cancer during the study period. The majority of patients underwent surgery first (57.7%) compared with NAC (42.3%). Women who underwent NAC were more likely to have abnormal lymph nodes on imaging (p = 0.002) and clinical exam (p < 0.0001) and were also more likely to have larger tumor sizes (p < 0.05). The majority of triple negative patients underwent NAC first (88% [14/16]). Median TTT was significantly longer for surgery (27 [range 7–70] days) versus (20.5 [3–50] days) chemotherapy (p = 0.004). Median number of additional hospital visits prior to surgery was 4 (range 1–8) versus 5 (0–11) for NAC (p < 0.001). Conclusions Young women with breast cancer who undergo NAC have a shorter TTT and clinically similar median number of hospital visits compared with women undergoing surgery first. These results support the use of NAC in young women, when indicated, as additional workup and consultations prior to NAC do not delay care.
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Affiliation(s)
- Evelyne Guay
- School of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Roberts
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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14
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Kim SJ, Cho NC, Hahn YI, Kim SH, Fang X, Surh YJ. STAT3 as a Potential Target for Tumor Suppressive Effects of 15-Deoxy-Δ 12,14-prostaglandin J 2 in Triple Negative Breast Cancer. J Cancer Prev 2021; 26:207-217. [PMID: 34703823 PMCID: PMC8511581 DOI: 10.15430/jcp.2021.26.3.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
STAT3 plays a prominent role in proliferation and survival of tumor cells. Thus, STAT3 has been considered to be a prime target for development of anti-cancer therapeutics. The electrophilic cyclopentenone prostaglandin,15-deoxy-Δ12,14-prostaglandin J2 (15d-PGJ2) has been well recognized for its capability to modulate intracellular signaling pathways involved in cancer cell growth and progression. We previously reported that 15d-PGJ2 had potent cytotoxicity against harvey-ras transformed human mammary epithelial cells through direct interaction with STAT3. In this study, we have attempted to verify the inhibitory effects of 15d-PGJ2 on STAT3 signaling in human breast tumor cells. The triple negative breast cancer cell lines, MDA-MB-231 and MDA-MB-468 displaying constitutive phosphorylation of STAT3 on the tyrosine 705 (Tyr705) residue, underwent apoptosis upon inhibition of STAT3 by 15d-PGJ2. In contrast, estrogen receptor positive MCF-7 breast cancer cells that do not exhibit elevated STAT3 phosphorylation were much less susceptible to 15d-PGJ2-induced apoptosis as assessed by PARP cleavage. Furthermore, 15d-PGJ2 inhibited interleukin-6-induced tyrosine phosphorylation of STAT3 in LNCaP cells. According to molecular docking studies, 15d-PGJ2 may preferentially bind to the cysteine 259 residue (Cys259) present in the coiled-coil domain of STAT3. Site-directed mutagenesis of STAT3 identified Cys259 to be the critical amino acid for the 15d-PGJ2-induced apoptosis as well as epithelial-to-mesenchymal transition. Taken together, these findings suggest STAT3 inactivation through direct chemical modification of its Cys259 as a potential therapeutic approach for treatment of triple negative breast cancer treatment.
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Affiliation(s)
- Su-Jung Kim
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Nam-Chul Cho
- Korea Chemical Bank, Korea Research Institute of Chemical Technology, Daejeon, Korea
| | - Young-Il Hahn
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science, Seoul National University, Seoul, Korea
| | - Seong Hoon Kim
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Xizhu Fang
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Young-Joon Surh
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science, Seoul National University, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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15
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Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, Khan SA, Loibl S, Morris EA, Perez A, Regan MM, Spears PA, Sudheendra PK, Symmans WF, Yung RL, Harvey BE, Hershman DL. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol 2021; 39:1485-1505. [PMID: 33507815 PMCID: PMC8274745 DOI: 10.1200/jco.20.03399] [Citation(s) in RCA: 407] [Impact Index Per Article: 135.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To develop guideline recommendations concerning optimal neoadjuvant therapy for breast cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the literature on neoadjuvant therapy for breast cancer and provide recommended care options. RESULTS A total of 41 articles met eligibility criteria and form the evidentiary basis for the guideline recommendations. RECOMMENDATIONS Patients undergoing neoadjuvant therapy should be managed by a multidisciplinary care team. Appropriate candidates for neoadjuvant therapy include patients with inflammatory breast cancer and those in whom residual disease may prompt a change in therapy. Neoadjuvant therapy can also be used to reduce the extent of local therapy or reduce delays in initiating therapy. Although tumor histology, grade, stage, and estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) expression should routinely be used to guide clinical decisions, there is insufficient evidence to support the use of other markers or genomic profiles. Patients with triple-negative breast cancer (TNBC) who have clinically node-positive and/or at least T1c disease should be offered an anthracycline- and taxane-containing regimen; those with cT1a or cT1bN0 TNBC should not routinely be offered neoadjuvant therapy. Carboplatin may be offered to patients with TNBC to increase pathologic complete response. There is currently insufficient evidence to support adding immune checkpoint inhibitors to standard chemotherapy. In patients with hormone receptor (HR)-positive (HR-positive), HER2-negative tumors, neoadjuvant chemotherapy can be used when a treatment decision can be made without surgical information. Among postmenopausal patients with HR-positive, HER2-negative disease, hormone therapy can be used to downstage disease. Patients with node-positive or high-risk node-negative, HER2-positive disease should be offered neoadjuvant therapy in combination with anti-HER2-positive therapy. Patients with T1aN0 and T1bN0, HER2-positive disease should not be routinely offered neoadjuvant therapy.Additional information is available at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
- Larissa A Korde
- Clinical Investigations Branch, CTEP, DCTD, National Cancer Institute, Bethesda, MD
| | | | - Lisa A Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | | | | | - Alejandra Perez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Plantation, FL
| | | | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY
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16
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Neoadjuvant Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Ther 2021; 28:e150-e156. [PMID: 33369918 DOI: 10.1097/mjt.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Fountzila E, Ignatiadis M. Neoadjuvant immunotherapy in breast cancer: a paradigm shift? Ecancermedicalscience 2020; 14:1147. [PMID: 33574892 PMCID: PMC7864681 DOI: 10.3332/ecancer.2020.1147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/19/2022] Open
Abstract
Despite advances in clinical management, a proportion of patients with early-stage triple-negative breast cancer (TNBC) recur after local treatment. The concept of neoadjuvant systemic therapy has been widely adopted to improve clinical outcomes of patients with TNBC and other breast tumour types. Recently, promising data were reported from the first prospective phase III, randomised trial assessing neoadjuvant chemotherapy combined with the programmed cell death protein 1 (PD-1) inhibitor pembrolizumab versus placebo in patients with early-stage TNBC. The addition of pembrolizumab resulted in a significant increase in pathologic complete response (pCR) rates. Similarly, in the IMpassion031 trial, the use of atezolizumab in combination with neoadjuvant chemotherapy in patients with early-stage TNBC led to improved pCR rates compared to placebo, regardless of programmed death ligand 1 (PD-L1) expression. Ongoing trials are testing other PD-1/PD-L1 inhibitors in combination with neoadjuvant chemotherapy in TNBC and other tumour subtypes. However, not all patients benefit from the addition of immunotherapy, while a proportion of patients experiences serious adverse events. It is critical to identify predictive biomarkers of response, to accurately select patients who will benefit from immunotherapy, thus sparing the rest from ineffective treatments with unnecessary toxicity and treatment costs. In this review, we summarise the literature on reported and ongoing neoadjuvant clinical trials evaluating immunotherapy in breast cancer.
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Affiliation(s)
- Elena Fountzila
- European University Cyprus, German Oncology Center, Agios Athanasios, 22006, Cyprus
- Second Department of Medical Oncology, Euromedica General Clinic, Thessaloniki, 54645, Greece
| | - Michail Ignatiadis
- Department of Medical Oncology & Academic Trials Promoting Team, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, 1000, Belgium
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18
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Onal C, Findikcioglu A, Guler OC, Reyhan M. The use of 18F-FDG positron emission tomography to detect mediastinal lymph nodes in metastatic breast cancer. Breast 2020; 54:197-202. [PMID: 33125983 PMCID: PMC7593617 DOI: 10.1016/j.breast.2020.10.011] [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: 06/16/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To assess the predictive value of 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) in detecting mediastinal lymph node metastasis with histopathologic verification in breast cancer (BC) patients. MATERIALS AND METHODS Between February 2012 and October 2019, 37 BC patients who underwent histopathological verification for FDG-PET positive mediastinal lymph nodes were retrospectively analyzed. Nine patients (24%) were screened before beginning treatment, while 27 (76%) were screened at the time of disease progression, an average of 39 months after completion of initial treatment. RESULTS The histopathologic diagnosis revealed lymph node metastasis from BC in 15 patients (40%) and benign disease in 22 patients (60%). The standardized uptake value (SUVmax) of mediastinal lymph nodes was significantly higher in patients with lymph node metastasis compared to those with benign histology (9.0 ± 3.5 vs. 5.9 ± 2.4; P = 0.007). The cut-off value of SUVmax after the ROC curve analysis for pathological lymph node metastasis was 6.4. Two of the 15 patients with mediastinal SUVmax ≤ 6.4 and 13 of the 22 patients with SUVmax > 6.4 had lymph node metastasis. Age and pathological findings were prognostic factors for overall survival in univariate analysis. The treatment decision was changed in 19 patients (51%) after mediastinoscopic evaluation of the entire cohort. CONCLUSIONS This is the first study to support the need for pathologic confirmation of a positive PET/CT result following evaluation of mediastinal lymph nodes for staging BC, either at initial diagnosis or at the time of progression. Treatment decisions were consequently altered for nearly half of the patients.
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Affiliation(s)
- Cem Onal
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey.
| | - Alper Findikcioglu
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Thoracic Surgery, Adana, Turkey
| | - Ozan Cem Guler
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
| | - Mehmet Reyhan
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Nuclear Medicine, Adana, Turkey
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19
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Caveolin-1 inhibits breast cancer stem cells via c-Myc-mediated metabolic reprogramming. Cell Death Dis 2020; 11:450. [PMID: 32528105 PMCID: PMC7290025 DOI: 10.1038/s41419-020-2667-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022]
Abstract
Breast cancer stem cells (BCSCs) are considered to be the root of breast cancer occurrence and progression. However, the characteristics and regulatory mechanisms of BCSCs metabolism have been poorly revealed, which hinders the development of metabolism-targeted treatment strategies for BCSCs elimination. Herein, we demonstrated that the downregulation of Caveolin-1 (Cav-1) usually occurred in BCSCs and was associated with a metabolic switch from mitochondrial respiration to aerobic glycolysis. Meanwhile, Cav-1 could inhibit the self-renewal capacity and aerobic glycolysis activity of BCSCs. Furthermore, Cav-1 loss was associated with accelerated mammary-ductal hyperplasia and mammary-tumor formation in transgenic mice, which was accompanied by enrichment and enhanced aerobic glycolysis activity of BCSCs. Mechanistically, Cav-1 could promote Von Hippel-Lindau (VHL)-mediated ubiquitination and degradation of c-Myc in BCSCs through the proteasome pathway. Notably, epithelial Cav-1 expression significantly correlated with a better overall survival and delayed onset age of breast cancer patients. Together, our work uncovers the characteristics and regulatory mechanisms of BCSCs metabolism and highlights Cav-1-targeted treatments as a promising strategy for BCSCs elimination.
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20
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Özgür E, Ferhatoğlu F, Şen F, Saip P, Gezer U. Circulating lncRNA H19 may be a useful marker of response to neoadjuvant chemotherapy in breast cancer. Cancer Biomark 2020; 27:11-17. [PMID: 31640083 DOI: 10.3233/cbm-190085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Novel biomarkers are needed to predict the effectiveness of the treatment of presurgical neoadjuvant chemotherapy (NAC) in breast cancer (BC). OBJECTIVE This is an exploratory study to assess the impact of 3 cancer-related long non-coding RNAs (lncRNAs) (H19, MALAT1 and GA5) in blood plasma of patients with BC in predicting the response to NAC. METHODS The plasma levels of RNAs were relatively measured by quantitative PCR at baseline, and at the end of the fourth cycle of NAC in patients with locally advanced BC. RESULTS Only H19 was associated with patients' characteristics, and with the response to NAC. Higher plasma expression of H19 was associated with younger age at diagnosis, triple negative tumors, and Ki-67 index. Patients with a pathological complete response (20%) had lower pre-therapeutic levels of H19 compared with the non-complete responders (relative levels 0.1 vs 0.2, respectively, P: 0.04). In addition, the patients with higher degree of downstaging of initial tumors had lower baseline levels of H19 among non-complete responders. CONCLUSION Our study reveals that H19, but not MALAT1 and GAS5, may be a useful marker of response to NAC in BC.
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Affiliation(s)
- Emre Özgür
- Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ferhat Ferhatoğlu
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | | | - Pinar Saip
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ugur Gezer
- Department of Basic Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
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21
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Kogawa T, Fujii T, Wu J, Harano K, Fouad TM, Liu DD, Shen Y, Masuda H, Krishnamurthy S, Chavez-MacGregor M, Lim B, Murthy RK, Valero V, Tripathy D, Ueno NT. Prognostic Value of HER2 to CEP17 Ratio on Fluorescence In Situ Hybridization Ratio in Patients with Nonmetastatic HER2-Positive Inflammatory and Noninflammatory Breast Cancer Treated with Neoadjuvant Chemotherapy with or without Trastuzumab. Oncologist 2020; 25:e909-e919. [PMID: 32003919 DOI: 10.1634/theoncologist.2018-0611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/19/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We previously reported that in patients with HER2-positive (HER2+) locally advanced breast cancer treated with neoadjuvant trastuzumab-containing regimens, high HER2 to centromere enumerator probe 17 ratio on fluorescence in situ hybridization (HER2 FISH ratio) was an independent predictor of high pathologic complete response (pCR) rate, which translated into improved recurrence-free survival (RFS). We sought to determine whether high HER2 FISH ratio is a predictor of pCR and prognosis in patients with HER2+ nonmetastatic inflammatory breast cancer (IBC) and non-IBC treated with neoadjuvant chemotherapy with or without trastuzumab. MATERIALS AND METHODS This study included all patients with histologically proven stage III, HER2+ primary IBC, and non-IBC treated with neoadjuvant chemotherapy with or without trastuzumab and definitive surgery during 1999-2012. Univariate and multivariate logistic regression models were applied to assess the effect of covariates on pCR. Kaplan-Meier estimates with log-rank test were employed for survival analysis. Univariate and multivariate Cox proportional hazards models were used to assess the effect of covariates on RFS and overall survival (OS). RESULTS The study included 555 patients with stage III, HER+ breast cancer, 181 patients with IBC, and 374 with non-IBC. In the IBC cohort, HER2 FISH ratio was not significantly associated with pCR, RFS, or OS. In the non-IBC cohort, higher HER2 FISH ratio was significantly associated with higher pCR rate and longer OS. CONCLUSION HER2 FISH ratio showed prognostic value among patients with HER2+ non-IBC but not HER2+ IBC treated with neoadjuvant chemotherapy. This disparity may be due to the underlying aggressive nature of IBC. IMPLICATIONS FOR PRACTICE The findings of this study indicate that the HER2 to fluorescence in situ hybridization ratio as a continuous variable has promise as a predictor of pathologic complete response to neoadjuvant chemotherapy in patients with HER2-positive (HER2+) noninflammatory breast cancer (non-IBC) regardless of the results on HER2 immunohistochemical testing. In the future, some patients with HER2+ non-IBC and a high HER2 FISH ratio might even be offered personalized treatment options, such as nonsurgical treatment.
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Affiliation(s)
- Takahiro Kogawa
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Takeo Fujii
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenichi Harano
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tamer M Fouad
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hiroko Masuda
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mariana Chavez-MacGregor
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bora Lim
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rashmi K Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Korhonen KE, Pantel AR, Mankoff DA. 18F-FDG-PET/CT in Breast and Gynecologic Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Zhao Y, Wei L, Liu J, Li F. Chemoresistance was correlated with elevated expression and activity of indoleamine 2,3-dioxygenase in breast cancer. Cancer Chemother Pharmacol 2019; 85:77-93. [PMID: 31844921 DOI: 10.1007/s00280-019-04009-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indoleamine 2,3-dioxygenase (IDO) catalyses degradation of the essential amino acid tryptophan leading to the production of immunosuppressive kynurenine and tryptophan exhausting. IDO expression and activity contribute to aggressive tumor growth, inferior therapeutic gain and poor prognosis. The aim of this study was to explore the association between chemoresistance and IDO expression, activity in breast cancer METHODS: Immunohistochemistry was applied for evaluating IDO expression in biopsy tissues. Serum IDO activity was examined via High-performance liquid chromatography (HPLC). Western blots (WB), HPLC and Real-time PCR (RT-PCR) were used to analyze IDO protein, IDO enzyme activity and IDO gene expression in original and paclitaxel-resistant cells respectively. Logistic regression and survival analysis were applied to explore the association between chemoresistance and IDO expression, activity in breast cancer. RESULTS IDO expression in tumor tissues was associated with serum IDO activity (P = 0.004). Both IDO expression in tumor and serum activity were associated with clinical tumor stage, node stage and estrogen receptor (ER) status (all P < 0.05); clinical response and pathologic complete response (pCR) to NAC were both related to IDO expression and activity prior NAC (all P < 0.05). Multivariate analysis showed IDO activity before NAC was the only independent factor affected pCR (P = 0.032). ROC curves showed that the IDO expression and activity had discriminative ability for predicting the clinical response and pCR. In the prognostic analysis, patients with high IDO expression had significantly impaired overall survival (5 year survival rate: 53.57% vs 80.00%) and progression-free survival (5 year survival rate: 46.43% vs 72.00%, P = 0.031 and P = 0.046). In vitro, significantly increased IDO protein, IDO mRNA expression and IDO enzyme activity in paclitaxel-resistant cells were demonstrated in comparing of sensitive cells. CONCLUSION IDO expression and activity associated with advanced breast cancer, poor response to neoadjuvant chemotherapy and prognosis. IDO expression and activity were significantly increased in paclitaxel-resistant breast cancer cells.
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Affiliation(s)
- Yang Zhao
- The Second Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Breast Surgery, Cangzhou People's Hospital, Cangzhou, 061000, Hebei, China
| | - Lijuan Wei
- Department of Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Juntian Liu
- The Second Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Fangxuan Li
- Department of Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China.
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24
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Wang S, Liu X, Huang R, Zheng Y, Wang N, Yang B, Situ H, Lin Y, Wang Z. XIAOPI Formula Inhibits Breast Cancer Stem Cells via Suppressing Tumor-Associated Macrophages/C-X-C Motif Chemokine Ligand 1 Pathway. Front Pharmacol 2019; 10:1371. [PMID: 31803057 PMCID: PMC6874098 DOI: 10.3389/fphar.2019.01371] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/29/2019] [Indexed: 12/24/2022] Open
Abstract
Macrophages are the most abundant stromal cells associated with the host immune system in multiple malignancies including breast cancer. With proven clinical efficacy and no noticeable adverse effects, XIAOPI formula (XPS) has been approved for breast hyperplasia treatment by the State Food and Drug Administration of China (SFDA) in 2018. The existing knowledge about the anti-breast cancer activities and mechanisms of XPS has been very limited. The present study aimed to investigate whether XPS could exert an anti-breast cancer effect by regulating tumor-associated macrophages (TAMs) in tumor microenvironment. Herein, breast cancer cells and TAMs were co-cultured using the transwell co-culture system to simulate the coexistence of them. XPS could significantly inhibit the proliferation, colony formation, breast cancer stem cells (CSCs) subpopulation, mammosphere formation abilities as well as stemness-related genes expression in both human and mouse breast cancer cells in the co-culture system. Additionally, XPS could suppress M2 phenotype polarization as well as C-X-C motif chemokine ligand 1 (CXCL1) expression and secretion of TAMs. Notably, further mechanistic explorations verified TAMs/CXCL1 as the critical target of XPS in inhibiting breast CSCs self-renewal in the co-culture system as the exogenous CXCL1 administration could abrogate the inhibitory effect of XPS on breast CSCs self-renewal. More importantly, XPS significantly inhibited mammary tumor growth, breast CSCs subpopulation, and TAMs/CXCL1 activity in mouse 4T1-Luc xenografts in vivo without any detectable side effects. Taken together, this study not only uncovers the immunomodulatory mechanism of XPS in treating breast cancer but also sheds novel insights into TAMs/CXCL1 as a potential molecular target for breast CSCs elimination.
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Affiliation(s)
- Shengqi Wang
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Post-doctoral Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Liu
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Renlun Huang
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yifeng Zheng
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Post-doctoral Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Neng Wang
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,College of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bowen Yang
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Honglin Situ
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Lin
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiyu Wang
- Integrative Research Laboratory of Breast Cancer, The Research Center for Integrative Medicine, Discipline of Integrated Chinese and Western Medicine & The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Post-doctoral Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,College of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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25
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Chantarasriwong O, Milcarek AT, Morales TH, Settle AL, Rezende CO, Althufairi BD, Theodoraki MA, Alpaugh ML, Theodorakis EA. Synthesis, structure-activity relationship and in vitro pharmacodynamics of A-ring modified caged xanthones in a preclinical model of inflammatory breast cancer. Eur J Med Chem 2019; 168:405-413. [DOI: 10.1016/j.ejmech.2019.02.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
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26
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O'Neil DS, Nietz S, Buccimazza I, Singh U, Čačala S, Stopforth LW, Joffe M, Jacobson JS, Neugut AI, Crew KD, Ruff P, Cubasch H. Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy. Oncologist 2018; 24:933-944. [PMID: 30518615 PMCID: PMC6656461 DOI: 10.1634/theoncologist.2018-0535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022] Open
Abstract
In sub‐Saharan Africa, clinical decisions can be affected by resource constraints. This article analyzes the clinical and sociodemographic factors associated with receiving neoadjuvant chemotherapy among patients from a previously existing cohort: women enrolled in the prospective South African Breast Cancer and HIV Outcomes study. Background. In the U.S., neoadjuvant chemotherapy (NAC) for nonmetastatic breast cancer (BC) is used with extensive disease and aggressive molecular subtypes. Little is known about the influence of demographic characteristics, clinical factors, and resource constraints on NAC use in Africa. Materials and Methods. We studied NAC use in a cohort of women with stage I–III BC enrolled in the South African Breast Cancer and HIV Outcomes study at five hospitals. We analyzed associations between NAC receipt and sociodemographic and clinical factors, and we developed Cox regression models for predictors of time to first treatment with NAC versus surgery. Results. Of 810 patients, 505 (62.3%) received NAC. Multivariate analysis found associations between NAC use and black race (odds ratio [OR] 0.49; 95% confidence limit [CI], 0.25–0.96), younger age (OR 0.95; 95% CI, 0.92–0.97 for each year), T‐stage (T4 versus T1: OR 136.29; 95% CI, 41.80–444.44), N‐stage (N2 versus N0: OR 35.64; 95% CI, 16.56–76.73), and subtype (triple‐negative versus luminal A: OR 5.16; 95% CI, 1.88–14.12). Sites differed in NAC use (Site D versus Site A: OR 5.73; 95% CI, 2.72–12.08; Site B versus Site A: OR 0.37; 95% CI, 0.16–0.86) and time to first treatment: Site A, 50 days to NAC versus 30 days to primary surgery (hazard ratio [HR] 1.84; 95% CI, 1.25–2.71); Site D, 101 days to NAC versus 126 days to primary surgery (HR 0.49; 95% CI, 0.27–0.89). Conclusion. NAC use for BC at these South African hospitals was associated with both tumor characteristics and heterogenous resource constraints. Implications for Practice. Using data from a large breast cancer cohort treated in South Africa's public healthcare system, the authors looked at determinants of neoadjuvant chemotherapy use and time to initiate treatment. It was found that neoadjuvant chemotherapy was associated with increasing tumor burden and aggressive molecular subtypes, demonstrating clinically appropriate care in a lower resource setting. Results of this study also showed that time to treatment differences between chemotherapy and surgery varied by hospital, suggesting that differences in resource limitations were influencing clinical decision making. Practice guidelines and care quality metrics designed for low‐ and middle‐income countries should accommodate heterogeneity of available resources.
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Affiliation(s)
- Daniel S O'Neil
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York New York, USA
| | - Sarah Nietz
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Ines Buccimazza
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Urishka Singh
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Sharon Čačala
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Laura W Stopforth
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Maureen Joffe
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York New York, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York New York, USA
| | - Katherine D Crew
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York New York, USA
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Division of Medical Oncology, Department of Medicine, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Herbert Cubasch
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
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27
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Tran WT, Childs C, Probst H, Farhat G, Czarnota GJ. Imaging Biomarkers for Precision Medicine in Locally Advanced Breast Cancer. J Med Imaging Radiat Sci 2018; 49:342-351. [DOI: 10.1016/j.jmir.2017.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022]
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28
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Benbrahim Z, Berrada A, Amaadour L, Zahra El M'rabet F, Elfatemi H, Elfakir S, Mellas N, Arifi S. [Comparative study of inflammatory and non-inflammatory locally advanced breast cancer - the experience of a Moroccan hospital]. ACTA ACUST UNITED AC 2018; 45:604-608. [PMID: 29100820 DOI: 10.1016/j.gofs.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The locally advanced breast cancer (LABC) covers large tumor heterogeneity. It consists of non-inflammatory LABC and inflammatory breast cancer (IBC). This study aimed to compare the epidemiological, clinical and pathological, as well as the prognosis of IBC versus non-inflammatory LABC. METHODS This is a retrospective study of 150 cases of IBC and non-inflammatory LABC collected in medical oncology department of the CHU Hassan II of Fez during a period of 4 years [January 2009-January 2013]. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Analysis of the various prognostic factors was performed according to the Cox model. RESULTS IBC represented 28.7% of LABC. The median age was 47 years. The median tumor size was greater in non-inflammatory LABC compared with IBC (9.5 versus 6cm; P=0.0014). Lymph node invasion was more common in the IBC (49.7% versus 45.9%; P=0.01). An SBR grade 3 was more frequently noted in the IBC (P=0.011). The two groups were well balanced with regard to HR, HER2 status and pathologic complete response. Non-inflammatory LABC had the best OS and DFS (24 vs. 22 months; P=0.03 and 18 vs. 17 months; P=0.025 respectively). CONCLUSION IBC has a worse prognosis compared to non-inflammatory LABC. New therapeutic approaches are needed to improve the prognosis of these patients.
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Affiliation(s)
- Z Benbrahim
- Service d'oncologie médicale, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, route sidi Hrazem, Fès, Maroc.
| | - A Berrada
- Service d'oncologie médicale, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, route sidi Hrazem, Fès, Maroc
| | - L Amaadour
- Service d'oncologie médicale, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, route sidi Hrazem, Fès, Maroc
| | - F Zahra El M'rabet
- Service d'oncologie médicale, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, route sidi Hrazem, Fès, Maroc
| | - H Elfatemi
- Service d'anatomo-pathologie, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, Fès, Maroc
| | - S Elfakir
- Département d'épidémiologie et de santé communautaire, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, Fès, Maroc
| | - N Mellas
- Service d'oncologie médicale, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, route sidi Hrazem, Fès, Maroc
| | - S Arifi
- Service d'oncologie médicale, faculté de médecine et de pharmacie de Fès, université Sidi Mohammed Ben Abdellah, CHU Hassan II de Fès, route sidi Hrazem, Fès, Maroc
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29
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Jin L, Wu X, Zha L, Feng Y, Xu J, Zheng H, Shao J, Zhao M, Cui X, Giuliano AE, Gong Y. Adjacent skin rotation flap for large defect in primary breast tumor. J Surg Oncol 2018; 118:1199-1204. [PMID: 30293235 DOI: 10.1002/jso.25240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/27/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUNDS Surgical resection of large primary breast tumor often results in large chest wall defects. The purpose of this study is to evaluate the feasibility of using adjacent skin rotation (ASR) flap in patients with giant primary breast tumor. METHODS A total of 26 giant primary breast tumor patients treated with ASR flap were included in this study. The postoperative conditions, including operating time, blood loss, length of hospital stay, and clinical complications were observed. Meanwhile, the information on 17 breast tumor patients treated with transverse rectus abdominis myocutaneous (TRAM) flap were collected and assigned to a control group. RESULTS The mean defect size after mastectomy was 16.7 × 13.4 cm, while the median follow-up period was 13 months after surgery. A total of 15.4% patients had developed with local complications, and one of them had more than one complication. When comparing the postoperative outcomes, statistically significant differences were found between the two groups with respect to operating time, blood loss, and length of hospital stay (P < 0.001). CONCLUSIONS ASR flap is a reliable technique for immediate reconstruction of massive chest wall defects in patients with giant primary breast tumor.
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Affiliation(s)
- Liting Jin
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Xinhong Wu
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Li Zha
- Department of Ultrasonography, Hubei Cancer Hospital, Wuhan, China
| | - Yaojun Feng
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Juan Xu
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Hongmei Zheng
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Jun Shao
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Minjian Zhao
- Department of General Surgery, Ezhou Central Hospital, Hubei, China
| | - Xiaojiang Cui
- Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Armando E Giuliano
- Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yiping Gong
- Department of Breast Surgery, Hubei Cancer Hospital, Wuhan, China.,Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, China
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30
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Validation of the 21-gene test as a predictor of clinical response to neoadjuvant hormonal therapy for ER+, HER2-negative breast cancer: the TransNEOS study. Breast Cancer Res Treat 2018; 173:123-133. [PMID: 30242578 PMCID: PMC6394785 DOI: 10.1007/s10549-018-4964-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
Purpose The Recurrence Score test is validated to predict benefit of adjuvant chemotherapy. TransNEOS, a translational study of New Primary Endocrine-therapy Origination Study (NEOS), evaluated whether Recurrence Score results can predict clinical response to neoadjuvant letrozole. Methods NEOS is a phase 3 clinical trial of hormonal therapy ± adjuvant chemotherapy for postmenopausal patients with ER+, HER2-negative, clinically node-negative breast cancer, after six months of neoadjuvant letrozole and breast surgery. TransNEOS patients had tumors ≥ 2 cm and archived core-biopsy samples taken before neoadjuvant letrozole and subsequently sent for Recurrence Score testing. The primary endpoint was to evaluate clinical (complete or partial) response to neoadjuvant letrozole for RS < 18 versus RS ≥ 31. Secondary endpoints included evaluation of clinical response and rate of breast-conserving surgery (BCS) by continuous Recurrence Score result, ESR1 and PGR single-gene scores, and ER gene-group score. Results Of 295 TransNEOS patients (median age 63 years; median tumor size 25 mm; 66% grade 1), 53.2% had RS < 18, 28.5% had RS18–30, and 18.3% had RS ≥ 31. Clinical response rates were 54% (RS < 18), 42% (RS18–30), and 22% (RS ≥ 31). A higher proportion of patients with RS < 18 had clinical responses (p < 0.001 vs. RS ≥ 31). In multivariable analyses, continuous Recurrence Score result (p < 0.001), ESR1 score (p = 0.049), PGR score (p < 0.001), and ER gene-group score (p < 0.001) were associated with clinical response. Recurrence Score group was significantly associated with rate of BCS after neoadjuvant treatment (RS < 18 vs. RS ≥ 31, p = 0.010). Conclusion The Recurrence Score test is validated to predict clinical response to neoadjuvant letrozole in postmenopausal patients with ER+, HER2-negative, clinically node-negative breast cancer. Electronic supplementary material The online version of this article (10.1007/s10549-018-4964-y) contains supplementary material, which is available to authorized users.
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31
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Huang L, Chen S, Yang WT, Shao Z. Risk factors of locoregional relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy following mastectomy and radiotherapy. Oncotarget 2018; 8:39703-39710. [PMID: 28055977 PMCID: PMC5503645 DOI: 10.18632/oncotarget.14407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
Abstract
We seek to investigate the prognostic factors that could possibly increase the locoregional recurrence of breast cancer patients who do not achieve pathological complete response after neoadjuvant chemotherapy, and to build a prognostic nomogram to predict patients' outcome. The retrospective analysis included 510 patients who had received neoadjuvant chemotherapy followed by surgery and radiotherapy. 62 locoregional events occurred after a median 61 months of follow-up. The five-year cumulative incidence of local recurrence and regional recurrence were 8.63% and 4.31%, respectively. Multivariate analysis revealed that positivity for ≥ 4 lymph nodes and Ki-67 index ≥ 14% were independent factors. According to our prognostic model, the 5-year locoregional free survival rates in the low, intermediate, and high-risk groups were 95.5%, 89.1%, and 67.1%, respectively (p < 0.001). Annual recurrence curves indicated that the relapse peak after mastectomy emerged in the first 1 year. Positivity for ≥ 4 lymph nodes and Ki-67 index ≥ 14% were independent factors for locoregional recurrence. This prognostic model has considerable clinical value in predicting locoregional recurrence, which could help clinicians to design appropriate locoregional treatment specifically and to perform surveillance individually.
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Affiliation(s)
- Liang Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wentao T Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, China
| | - Zhiming Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Response to neoadjuvant chemotherapy for breast cancer judged by PERCIST - multicenter study in Japan. Eur J Nucl Med Mol Imaging 2018; 45:1661-1671. [PMID: 29754160 DOI: 10.1007/s00259-018-4008-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate therapeutic response to neoadjuvant chemotherapy (NAC) and predict breast cancer recurrence using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST). MATERIALS AND METHODS Fifty-nine breast cancer patients underwent fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) before and after NAC prior to planned surgical resection. Pathological complete response (pCR) of the primary tumor was evaluated using PERCIST, while effects of clinicopathological factors on progression-free survival (PFS) were examined using log-rank and Cox methods. RESULTS Fifty-six patients and 54 primary tumors were evaluated. Complete metabolic response (CMR), partial metabolic response, stable metabolic disease, and progressive metabolic disease were seen in 45, 7, 3, and 1 patients, respectively, and 43, 7, 3, and 1 primary tumors, respectively. Eighteen (33.3%) of the 54 primary tumors showed pCR. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PERCIST to predict pCR were 100% (18/18), 30.6% (11/36), 41.9% (18/43), 100% (11/11), and 53.7% (29/54), respectively. An optimal percent decrease in peak standardized uptake value for a primary tumor corrected for lean body mass (SULpeak) of 84.3% was found to have a sensitivity of 77.8% (14/18), specificity of 77.8% (28/36), PPV of 63.6% (14/22), NPV of 87.5% (28/32), and accuracy of 77.8% (42/54). Seven (12.5%) of the 56 patients developed recurrent disease (median follow-up 28.1 months, range 11.4-96.4 months). CMR (p = 0.031), pCR (p = 0.024), and early TNM stage (p = 0.033) were significantly associated with longer PFS. CONCLUSION PERCIST is useful for predicting pathological response and prognosis following NAC in breast cancer patients. However, FDG-PET/CT showed a tendency toward underestimation of the residual tumor, and relatively low specificity and PPV of PERCIST showed that a combination of other imaging modalities would still be needed to predict pCR.
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33
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Valachis A, Mamounas EP, Mittendorf EA, Hayashi N, Ishitobi M, Natoli C, Fitzal F, Rubio IT, Tiezzi DG, Shin HC, Anderson SJ, Hunt KK, Matsuda N, Ohsumi S, Totomi A, Nilsson C. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis. Cancer 2018; 124:2923-2930. [DOI: 10.1002/cncr.31518] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/05/2018] [Accepted: 03/18/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Antonios Valachis
- Centre for Clinical Research Sormland; Uppsala University; Uppsala Sweden
| | - Eleftherios P. Mamounas
- Comprehensive Breast Program; University of Florida Health Cancer Center-Orlando Health; Orlando Florida
| | - Elizabeth A. Mittendorf
- Department of Breast Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Naoki Hayashi
- Department of Breast Surgery; St. Luke's International Hospital; Tokyo Japan
| | - Makoto Ishitobi
- Department of Breast Surgery; Osaka International Cancer Institute; Osaka Japan
- Department of Endocrine Surgery; Osaka International Cancer Institute; Osaka Japan
| | - Clara Natoli
- Department of Oral, Medical and Biotechnological Sciences; University G. D'Annunzio; Chieti-Pescara Italy
| | - Florian Fitzal
- Department of Surgery, Breast Health Center; Medical University Vienna; Vienna Austria
| | - Isabel T. Rubio
- Breast Surgical Oncology, Breast Cancer Center; University Hospital VAll d'Hebron; Barcelona Spain
| | - Daniel G. Tiezzi
- Breast Disease Division, Department of Gynecology and Obstetrics, Ribeirao Preto Medical School; University of Sao Paulo; Sao Paulo Brazil
| | - Hee-Chul Shin
- Department of Surgery; Chung-Ang University Hospital; Seoul South Korea
| | - Stewart J. Anderson
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Department of Biostatistics, University of Pittsburgh Graduate School of Public Health; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Naoko Matsuda
- Department of Breast Surgery; St. Luke's International Hospital; Tokyo Japan
| | - Shozo Ohsumi
- Department of Breast Oncology; NHO Shikoku Cancer Center; Matsuyama Japan
| | - Athina Totomi
- Centre for Clinical Research Sormland; Uppsala University; Uppsala Sweden
| | - Cecilia Nilsson
- Centre for Clinical Research; Vastmanlands County Hospital; Vasteras Sweden
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Gentile LF, Plitas G, Zabor EC, Stempel M, Morrow M, Barrio AV. Tumor Biology Predicts Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients Presenting with Locally Advanced Breast Cancer. Ann Surg Oncol 2017; 24:3896-3902. [PMID: 28916978 PMCID: PMC5697706 DOI: 10.1245/s10434-017-6085-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is used to convert patients with inoperable locally advanced breast cancer (LABC) to operability, but has not traditionally been used to avoid mastectomy or axillary dissection in this subset. OBJECTIVE The purpose of this study was to determine the rates of pathologic complete response (pCR) in LABC patients, and identify factors predictive of pCR to determine if responding patients might be suitable for limited surgery. METHODS From 2006 to 2016, 1522 patients received NAC followed by surgery; 321 had advanced disease in the breast (cT4) and/or in the nodes (cN2/N3). pCR rates were assessed by T and N stage, and receptor subtype. RESULTS Of 321 LABC patients, 223 were cT4, 77 were cN2, and 82 were cN3. Forty-three percent were hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative (HR+/HER2-), 23% were triple negative, and 34% were HER2+. The overall pCR rate was 25% and differed by receptor subtype (HR+/HER2- 7%, triple negative 23%, HER2+ 48%; p < 0.001). Breast pCR occurred in 27% of patients and was similar in T4 versus non-T4 disease (29% vs. 22%; p = 0.26). Nodal pCR was achieved in 38% of cN+ patients and did not differ by nodal stage (cN1 43%, cN2 36%, cN3 32%; p = 0.23). Nodal pCR was significantly more common than breast pCR (p = 0.014) across all tumor subtypes. Receptor subtype was the only predictor of overall pCR (p < 0.001). CONCLUSION In patients with LABC, pCR after NAC was seen in 25%, and did not differ by T or N stage. Tumor biology, but not extent of disease, predicted pCR. Studies assessing the feasibility of surgical downstaging with NAC in LABC patients are warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoadjuvant Therapy
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Remission Induction
- Survival Rate
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Affiliation(s)
- Lori F Gentile
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - George Plitas
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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An YY, Kim SH, Kang BJ. Residual microcalcifications after neoadjuvant chemotherapy for locally advanced breast cancer: comparison of the accuracies of mammography and MRI in predicting pathological residual tumor. World J Surg Oncol 2017; 15:198. [PMID: 29110671 PMCID: PMC5674773 DOI: 10.1186/s12957-017-1263-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022] Open
Abstract
Background The aims of this study were to correlate residual mammographic microcalcifications after neoadjuvant chemotherapy (NAC) with pathological results and to compare the accuracy of mammography (MG) and magnetic resonance imaging (MRI) in predicting the size of residual tumors. Methods The imaging findings and pathological results for 29 patients with residual microcalcifications after NAC were reviewed. We compared the agreement of the measured extent of residual microcalcifications based on MG and residual enhancement based on MRI with the residual tumor size based on pathology. Results At final pathology, residual microcalcifications were malignant in 55.2% of cases and benign in 44.8% of cases. In 36% of non-pCR cases, the remaining microcalcifications were benign. Compared with the measurements of residual tumor obtained from pathology, MG showed poor agreement, and MRI showed moderate agreement, for the entire group (concordance correlation coefficient [CCC] = 0.196 vs. 0.566). Regarding the receptor status, the agreement of measurements obtained by MG was superior to that obtained by MRI (CCC = 0.5629, 0.5472 vs. 0.4496, 0.4279) for ER(+) and HER2(−) tumors. In ER(−) tumors, the measurements obtained by MG showed the lowest agreement with the pathological tumor size, which had the highest agreement with those obtained by MRI (CCC = − 0.0162 vs. 0.8584). Conclusions Residual mammographic microcalcifications after NAC did not correlate with malignancy in 44.8% of cases. Residual microcalcifications on MG were poorly correlated with pathological tumor size, and MRI might be more reliable for predicting residual tumor size after NAC. Tumor receptor status affected the accuracy of both MG and MRI for predicting residual tumor size after NAC. Trial registration CRIS, KCT0002281; registered 6 April 2015, retrospectively registered
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Affiliation(s)
- Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, 16247, Gyeonggi-do, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Racial and Socioeconomic Disparities Are More Pronounced in Inflammatory Breast Cancer Than Other Breast Cancers. J Cancer Epidemiol 2017; 2017:7574946. [PMID: 28894467 PMCID: PMC5574219 DOI: 10.1155/2017/7574946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/11/2017] [Indexed: 01/04/2023] Open
Abstract
Inflammatory breast cancer (IBC) is a rare yet aggressive form of breast cancer. We examined differences in patient demographics and outcomes in IBC compared to locally advanced breast cancer (LABC) and all other breast cancer patients from the Breast and Prostate Cancer Data Quality and Patterns of Care Study (POC-BP), containing information from cancer registries in seven states. Out of 7,624 cases of invasive carcinoma, IBC and LABC accounted for 2.2% (N = 170) and 4.9% (N = 375), respectively. IBC patients were more likely to have a higher number (P = 0.03) and severity (P = 0.01) of comorbidities than other breast cancer patients. Among IBC patients, a higher percentage of patients with metastatic disease versus nonmetastatic disease were black, on Medicaid, and from areas of higher poverty and more urban areas. Black and Hispanic IBC patients had worse overall and breast cancer-specific survival than white patients; moreover, IBC patients with Medicaid, patients from urban areas, and patients from areas of higher poverty and lower education had worse outcomes. These data highlight the effects of disparities in race and socioeconomic status on the incidence of IBC as well as IBC outcomes. Further work is needed to reveal the causes behind these disparities and methods to improve IBC outcomes.
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Sajjadi AY, Isakoff SJ, Deng B, Singh B, Wanyo CM, Fang Q, Specht MC, Schapira L, Moy B, Bardia A, Boas DA, Carp SA. Normalization of compression-induced hemodynamics in patients responding to neoadjuvant chemotherapy monitored by dynamic tomographic optical breast imaging (DTOBI). BIOMEDICAL OPTICS EXPRESS 2017; 8:555-569. [PMID: 28270967 PMCID: PMC5330555 DOI: 10.1364/boe.8.000555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/04/2016] [Accepted: 12/05/2016] [Indexed: 05/03/2023]
Abstract
We characterize novel breast cancer imaging biomarkers for monitoring neoadjuvant chemotherapy (NACT) and predicting outcome. Specifically, we recruited 30 patients for a pilot study in which NACT patients were imaged using dynamic tomographic optical breast imaging (DTOBI) to quantify the hemodynamic changes due to partial mammographic compression. DTOBI scans were obtained pre-treatment (referred to as day 0), as well as 7 and 30 days into therapy on female patients undergoing NACT. We present data for the 13 patients who participated in both day 0 and 7 measurements and had evaluable data, of which 7 also returned for day 30 measurements. We acquired optical images over 2 minutes following 4-8 lbs (18-36 N) of compression. The timecourses of tissue-volume averaged total hemoglobin (HbT), as well as hemoglobin oxygen saturation (SO2) in the tumor vs. surrounding tissues were compared. Outcome prediction metrics based on the differential behavior in tumor vs. normal areas for responders (>50% reduction in maximum diameter) vs. non-responders were analyzed for statistical significance. At baseline, all patients exhibit an initial decrease followed by delayed recovery in HbT, and SO2 in the tumor area, in contrast to almost immediate recovery in surrounding tissue. At day 7 and 30, this contrast is maintained in non-responders; however, in responders, the contrast in hemodynamic time-courses between tumor and normal tissue starts decreasing at day 7 and substantially disappears at day 30. At day 30 into NACT, responding tumors demonstrate "normalization" of compression induced hemodynamics vs. surrounding normal tissue whereas non-responding tumors did not. This data suggests that DTOBI imaging biomarkers, which are governed by the interplay between tissue biomechanics and oxygen metabolism, may be suitable for guiding NACT by offering early predictions of treatment outcome.
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Affiliation(s)
- Amir Y Sajjadi
- Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Radiology, Harvard Medical School, Charlestown, MA 02129, USA; These authors contributed equally to this work;
| | - Steven J Isakoff
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA 02114, USA; These authors contributed equally to this work;
| | - Bin Deng
- Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Radiology, Harvard Medical School, Charlestown, MA 02129, USA
| | - Bhawana Singh
- Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Radiology, Harvard Medical School, Charlestown, MA 02129, USA
| | - Christy M Wanyo
- Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, MA 0211, USA
| | - Michelle C Specht
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA 02114, USA
| | - Lidia Schapira
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA 02114, USA
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA 02114, USA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA 02114, USA
| | - David A Boas
- Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Radiology, Harvard Medical School, Charlestown, MA 02129, USA
| | - Stefan A Carp
- Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Radiology, Harvard Medical School, Charlestown, MA 02129, USA
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Chang JH, Jeon W, Kim K, Shin KH, Han W, Noh DY, Im SA, Kim TY, Bang YJ. Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy. J Breast Cancer 2017; 19:394-401. [PMID: 28053627 PMCID: PMC5204045 DOI: 10.4048/jbc.2016.19.4.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC). METHODS Between March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/- multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12-106) months. RESULTS The 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures. CONCLUSION Among breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.
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Affiliation(s)
- Ji Hyun Chang
- Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Wan Jeon
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Wang LY, Xie H, Zhou H, Yao WX, Zhao X, Wang Y. Efficacy of carboplatin-based preoperative chemotherapy for triple-negative breast cancer. A meta-analysis of randomized controlled trials. Saudi Med J 2017; 38:18-23. [PMID: 28042625 PMCID: PMC5278059 DOI: 10.15537/smj.2017.1.14969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives: To evaluate the efficacy and safety of carboplatin-based preoperative chemotherapy in triple-negative breast cancer patients (TNBC). Methods: PubMed, EMBASE, the Web of Science, the Cochrane Library, major clinical trial registries, and abstract collections from major international meetings were systematically searched for relevant randomized controlled trials. Endpoints included rates of pathologic complete response (pCR), overall response (ORR), breast-conserving surgery (BCS) and toxicity. Pooled relative risk (RR) was calculated for each endpoint using a fixed- or random-effect model depending on the heterogeneity among included studies. Results: A total of 5 randomized controlled trials involving 1007 patients were included in the meta-analysis. Carboplatin-based chemotherapy was associated with a pooled pCR rate of 53.3%, which was significantly higher than the rate associated with non-carboplatin therapy (37.8%, RR: 1.41, 95% confidence interval [CI]: 1.23 to 1.62, p<0.00001). Compared with non-carboplatin therapy (48.1%), carboplatin-based chemotherapy increased BCS rate (59.7%, RR: 1.24, 95% CI: 1.06 to 1.46, p=0.007). Carboplatin-based chemotherapy was associated with similar ORR as non-carboplatin therapy. Carboplatin-based chemotherapy was associated with higher incidence of grade 3 or 4 anemia, neutropenia, febrile neutropenia, and thrombocytopenia than non-carboplatin therapy, while the 2 regimens were associated with similar incidence of fatigue, leucopenia, and nausea/vomiting. Conclusion: The available evidence suggests that carboplatin-based preoperative chemotherapy is associated with significantly better pCR and BCS rates than non-carboplatin-based therapy in TNBC patients.
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Affiliation(s)
- Li-Yang Wang
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. E-mail.
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Neoadjuvant systemic therapy in breast cancer: Challenges and uncertainties. Eur J Obstet Gynecol Reprod Biol 2016; 210:144-156. [PMID: 28039758 DOI: 10.1016/j.ejogrb.2016.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/20/2016] [Accepted: 12/13/2016] [Indexed: 12/29/2022]
Abstract
The management of locally advanced breast cancer (LABC) remains a major clinical issue, despite progress achieved in diagnosis and therapy. Preoperative or neoadjuvant therapy has gained interest since breast cancer has been regarded as a systemic disease. Comparing adjuvant versus neoadjuvant treatment, the neoadjuvant approach offers the advantage of downstaging the disease and testing the efficacy of therapy administered to patients. A large number of clinical trials have attempted to define the optimal neoadjuvant treatment, but little attention has been paid to the sequence of chemotherapy. Moreover, the integration of antibodies against Human Epidermal Receptor-2 (HER-2) and other biological therapies that may improve the long-term control of breast cancer patients, have a special clinical interest. In this review, we will discuss these topics attempting to answer the questions why, when and which regimen to use for patients with LABC. Especially, the introduction of the platina derivatives in neoadjuvant trials with their exceptional high pathological complete response rates are challenging to rethink the optimal treatment options in early and locally advanced breast cancer.
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Yadav P, Mirza M, Nandi K, Jain SK, Kaza RCM, Khurana N, Ray PC, Saxena A. Serum microRNA-21 expression as a prognostic and therapeutic biomarker for breast cancer patients. Tumour Biol 2016; 37:15275-15282. [PMID: 27696295 DOI: 10.1007/s13277-016-5361-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022] Open
Abstract
MiRNA-21 is recognized as the main active candidate and high expression in many solid tumors consequential cell proliferation, differentiation, apoptosis, and closely related to metastasis of disease. The study aimed to evaluate the serum miRNA-21 expression and therapy outcome in breast cancer patients and cell lines. Seventy-five histopathologically confirmed newly diagnosed breast cancer patients were included in the study; before and after therapy, patient's blood sample were collected and analyzed for serum microRNA-21 expression by quantitative real-time PCR. In patients, 8.9 mean fold increased microRNA-21 expression was observed compared to controls. Increased expression was found to be associated with advanced stage (11.72-fold), lymph node involvement (11.12-fold), and distant metastases (20.17-fold). After treatment significant decrease in miRNA-21 expression was observed and found to be significant (p < 0.0001). Patients treated with neoadjuvant therapy had significant impact on miRNA-21 suppression and found to be significantly associated with different clinicopathological features of patients. Increased miRNA-21 expression was also found to be significantly associated with poor survival of breast cancer patients (p = 0.002). MicroRNA-21 expression could be used as promising predictive indicators for breast cancer prognosis. MicroRNA-21 over-expression was associated with response to neoadjuvant therapy and may perhaps be considered as primary treatment choice.
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Affiliation(s)
- Prasant Yadav
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - Masroor Mirza
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - Kajal Nandi
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - S K Jain
- Department of Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - R C M Kaza
- Department of Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - P C Ray
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India
| | - Alpana Saxena
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, 110002, India.
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Potential Clinical Applications of 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Mammography in Breast Cancer. Nucl Med Mol Imaging 2016; 51:217-226. [PMID: 28878847 DOI: 10.1007/s13139-016-0446-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/19/2016] [Accepted: 07/29/2016] [Indexed: 01/30/2023] Open
Abstract
The whole-body positron emission tomography (PET)/magnetic resonance (MR) scan is a cutting edge technology providing comprehensive structural information from MR imaging and functional features from PET in a single session. Recent research findings and clinical experience have shown that 18F-fluorodeoxyglucose (FDG) whole-body PET/MR imaging has a diagnostic performance comparable with or superior to that of PET/CT in the field of oncology, including for breast cancer. In particular, FDG PET/MR mammography in the prone position with the breast hanging in a pendant manner can provide more comprehensive information about the metabolism, anatomy, and functional features of a breast lesion than a whole-body PET/MR scan. This article reports on current state-of-the-art PET/MR mammography in patients with breast cancer and the prospects for potential application in the future.
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Abstract
NEOADJUVANT CHEMOTHERAPY IN HER2-POSITIVE AND TRIPLE-NEGATIVE BREAST CANCER: Neoadjuvant chemotherapy is a standard option in the management of operable breast cancer, as effective as adjuvant chemotherapy in term of survival and with the potential to increase the rate of breast conservation. In HER2+ and triple-negative breast cancers, neoadjuvant chemotherapy is associated with a high probability of pathological complete response, which strongly predicts survival outcome. In HER2+ breast cancer, trastuzumab, in combination with neoadjuvant chemotherapy, mostly anthracyclines and taxane-based, demonstrated a significant increase in pathological complete response rate. Recently, dual HER2 blockade strategies (lapatinib-trastuzumab or pertuzumab-trastuzumab) demonstrated a significant improvement in terms of pathological complete response over trastuzumab. In triple-negative breast cancer, recent data indicate that incorporating platinum compounds to neoadjuvant chemotherapy also significantly improves this parameter. Yet, in both subtypes, whether these substantial improvements may lead to significant benefits in terms of survival and breast conserving surgery remains to be demonstrated.
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Affiliation(s)
- Anthony Gonçalves
- Département d'oncologie médicale, Institut Paoli-Calmettes, Marseille, 13009; Centre de recherche en cancérologie de Marseille (Institut Paoli-Calmettes, Inserm 1068, Cnrs 7258, Aix-Marseille Université), Marseille, 13009; Aix-Marseille Université, Marseille, 13006.
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Jing H, Cheng W, Li ZY, Ying L, Wang QC, Wu T, Tian JW. Early Evaluation of Relative Changes in Tumor Stiffness by Shear Wave Elastography Predicts the Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1619-1627. [PMID: 27302898 DOI: 10.7863/ultra.15.08052] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/01/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Neoadjuvant chemotherapy plays an important role in comprehensive therapy for breast cancer, but response prediction is imperfect. Shear wave elastography (SWE) is a novel technique that can quantitatively evaluate tissue stiffness. In this study, we sought to investigate the application value of SWE for early prediction of the response to neoadjuvant chemotherapy in patients with breast cancer. METHODS We prospectively evaluated tumor stiffness in 62 patients with breast cancer using SWE, which was performed at baseline and after the second cycle of neoadjuvant chemotherapy. After chemotherapy, all of the patients underwent surgery. We investigated the correlations between the relative changes in tumor stiffness (Δ stiffness) after 2 cycles of chemotherapy and the pathologic response to the therapy. RESULTS Compared with baseline values, tumor stiffness after 2 cycles of neoadjuvant chemotherapy was significantly decreased in responders (P < .001) but not in nonresponders (P = .172). The Δstiffness was significantly higher in responders (-42.194%) than in nonresponders (-23.593%; P = .001). As determined at either the baseline or after the second cycle of chemotherapy, tumor stiffness was significantly lower in responders than in nonresponders (P = .033 and .009, respectively). The Δ stiffness threshold for distinguishing between responders and nonresponders was -36.1% (72.92% sensitivity and 85.71% specificity). Furthermore, correlating Δ stiffness with clinical and pathologic characteristics, we found that estrogen and progesterone receptor expression showed statistically significant correlations with Δ stiffness (estrogen receptor, P = .008; progesterone receptor, P = .023). CONCLUSIONS Early evaluation of relative changes in tumor stiffness using SWE could effectively predict the response to neoadjuvant chemotherapy in patients with breast cancer and might indicate better therapeutic strategies on a timelier basis.
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Affiliation(s)
- Hui Jing
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China. Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zi-Yao Li
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Liu Ying
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiu-Cheng Wang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Tong Wu
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia-Wei Tian
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Nahleh ZA, Barlow WE, Hayes DF, Schott AF, Gralow JR, Sikov WM, Perez EA, Chennuru S, Mirshahidi HR, Corso SW, Lew DL, Pusztai L, Livingston RB, Hortobagyi GN. SWOG S0800 (NCI CDR0000636131): addition of bevacizumab to neoadjuvant nab-paclitaxel with dose-dense doxorubicin and cyclophosphamide improves pathologic complete response (pCR) rates in inflammatory or locally advanced breast cancer. Breast Cancer Res Treat 2016; 158:485-95. [PMID: 27393622 PMCID: PMC4963434 DOI: 10.1007/s10549-016-3889-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 01/09/2023]
Abstract
SWOG S0800, a randomized open-label Phase II clinical trial, compared the combination of weekly nab-paclitaxel and bevacizumab followed by dose-dense doxorubicin and cyclophosphamide (AC) with nab-paclitaxel followed or preceded by AC as neoadjuvant treatment for HER2-negative locally advanced breast cancer (LABC) or inflammatory breast cancer (IBC). Patients were randomly allocated (2:1:1) to three neoadjuvant chemotherapy arms: (1) nab-paclitaxel with concurrent bevacizumab followed by AC; (2) nab-paclitaxel followed by AC; or (3) AC followed by nab-paclitaxel. The primary endpoint was pathologic complete response (pCR) with stratification by disease type (non-IBC LABC vs. IBC) and hormone receptor status (positive vs. negative). Overall survival (OS), event-free survival (EFS), and toxicity were secondary endpoints. Analyses were intent-to-treat comparing bevacizumab to the combined control arms. A total of 215 patients were accrued including 11 % with IBC and 32 % with triple-negative breast cancer (TNBC). The addition of bevacizumab significantly increased the pCR rate overall (36 vs. 21 %; p = 0.019) and in TNBC (59 vs. 29 %; p = 0.014), but not in hormone receptor-positive disease (24 vs. 18 %; p = 0.41). Sequence of administration of nab-paclitaxel and AC did not affect the pCR rate. While no significant differences in OS or EFS were seen, a trend favored the addition of bevacizumab for EFS (p = 0.06) in TNBC. Overall, Grade 3-4 adverse events did not differ substantially by treatment arm. The addition of bevacizumab to nab-paclitaxel prior to dose-dense AC neoadjuvant chemotherapy significantly improved the pCR rate compared to chemotherapy alone in patients with triple-negative LABC/IBC and was accompanied by a trend for improved EFS. This suggests reconsideration of the role of bevacizumab in high-risk triple-negative locally advanced breast cancer.
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Affiliation(s)
- Z A Nahleh
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
| | - W E Barlow
- SWOG Statistical Center, Seattle, WA, USA
| | - D F Hayes
- University of Michigan, Ann Arbor, MI, USA
| | - A F Schott
- University of Michigan, Ann Arbor, MI, USA
| | - J R Gralow
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - W M Sikov
- Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - E A Perez
- Genentech, Inc., San Francisco, CA, USA.,Mayo Clinic, Jacksonville, FL, USA
| | - S Chennuru
- Hematology Oncology Consultants, Inc., Westerville, OH, USA.,Columbus NCI Community Oncology Research Program, Columbus, OH, USA
| | - H R Mirshahidi
- Loma Linda University Cancer Center, Loma Linda, CA, USA
| | - S W Corso
- Gibbs Cancer Center and Research Institute/Southeast Clinical Oncology Research (SCOR) Consortium NCORP/Upstate Carolina CCOP (previous), Spartanburg, SC, USA
| | - D L Lew
- SWOG Statistical Center, Seattle, WA, USA
| | | | | | - G N Hortobagyi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Li Z, Dai K, Wang C, Song Y, Gu F, Liu F, Fu L. Expression of Polo-Like Kinase 4(PLK4) in Breast Cancer and Its Response to Taxane-Based Neoadjuvant Chemotherapy. J Cancer 2016; 7:1125-32. [PMID: 27326256 PMCID: PMC4911880 DOI: 10.7150/jca.14307] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/22/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Polo-like kinase 4(PLK4) is an important evolutionarily regulator involved in centrosome duplication. We here investigated the expression of PLK4 mRNA and PLK4 in breast cancer, and evaluated its predictive value for response to taxane-based neoadjuvant chemotherapy. METHOD The PLK4 mRNA expression was measured in breast cancer tissues and corresponding normal breast tissues from 30 breast cancer patients by quantitative real-time polymerase chain reaction (PCR).The association of the expression of PLK4 with clinicopathological parameters and prognostic significance was evaluated in 154 cases of invasive breast cancer. In addition, we immunohistochemically examined the changes of PLK4 expression in biopsy and postoperative tumor specimens of another 64 breast cancer patients who received taxane-based neoadjuvant chemotherapy. RESULTS The level of PLK4 mRNA expression in cancerous tissues had a significant difference compared to the corresponding normal breast tissues (P=0.021). There is a correlation of PLK4 expression with higher incidence of lymph node metastasis and distant metastasis or surrounding recurrence (P=0.043; P=0.006). High PLK4 expression was found to be a detrimental prognostic factor measured by overall survival (OS) (P=0.003) and progress-free survival (PFS) (P=0.003). Moreover, the results demonstrated that PLK4 expression was a negative predictor of response to taxane-based neoadjuvant chemotherapy (rs= - 0.253, P=0.044). CONCLUSION The findings of this current study indicated that PLK4 expression in breast cancer could be a potential prognostic factor and a negative predictor of response to taxane-based neoadjuvant chemotherapy.
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Affiliation(s)
| | | | | | | | | | - Fangfang Liu
- Department of Breast Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Li Fu
- Department of Breast Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
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Nakatsukasa K, Koyama H, Oouchi Y, Imanishi S, Mizuta N, Sakaguchi K, Fujita Y, Imai A, Okamoto A, Hamaoka A, Soushi M, Fujiwara I, Kotani T, Matsuda T, Fukuda K, Morita M, Kawakami S, Kadotani Y, Konishi E, Yanagisawa A, Goto M, Yamada K, Taguchi T. Docetaxel, cyclophosphamide, and trastuzumab as neoadjuvant chemotherapy for HER2-positive primary breast cancer. Breast Cancer 2016; 24:92-97. [PMID: 26874836 DOI: 10.1007/s12282-016-0677-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/28/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The standard primary systemic therapy for human epidermal growth factor receptor 2-positive (HER2+) breast cancer is anthracyclines and/or taxanes combined with trastuzumab, which demonstrates a high pathological complete response (pCR). A pCR is a predictive marker of prognosis. However, results slightly differ, depending on the hormone receptor status. The efficacy and tolerability of docetaxel, cyclophosphamide, and trastuzumab (HER-TC) as neoadjuvant chemotherapy (NAC) remain unclear. We performed a prospective multicenter study of HER-TC NAC for HER2+ primary breast cancer. METHODS Eligible patients had a clinical diagnosis of HER2+ invasive breast cancer greater than 1 cm but less than 7 cm and a tumor stage of N0 or N1. T hey were diagnosed between July 2011 and February 2014. For NAC, four cycles of HER-TC (6 mg/kg loading dose, 8 mg/kg, 75, and 600 mg/m2) were administered intravenously every 3 weeks. We investigated the pCR of the primary breast tumors. A pCR was defined as no histological evidence of invasive carcinoma or the appearance of only ductal carcinoma in situ. RESULTS We enrolled 42 patients. The completion rate for four cycles of HER-TC was 97.6 % (41/42 patients). The overall pCR rate was 43.9 % (18/41 patients). The pCR rate for patients with the luminal HER2 subtype [estrogen receptor (ER)-positive+, HER2+] and the HER2-enriched subtype (ER-, HER2+) was 40.0 % (8/20 patients) and 47.6 % (10/21 patients), respectively. A pCR was achieved with nearly the same probability for each subtype. CONCLUSIONS Four cycles of HER-TC may be a NAC option for HER2-positive breast cancer.
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Affiliation(s)
- Katsuhiko Nakatsukasa
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | | | | | | | - Naruhiko Mizuta
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kouichi Sakaguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshifumi Fujita
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Aya Imai
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Akiko Okamoto
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Asako Hamaoka
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Mari Soushi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | | | | | | | | | | | | | | | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mariko Goto
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Chen X, Ye G, Zhang C, Li X, Shen K. Non-anthracycline-containing docetaxel and cyclophosphamide regimen is associated with sustained worse outcome compared with docetaxel, anthracycline and cyclophosphamide in neoadjuvant treatment of triple negative and HER2-positive breast cancer patients: updated follow-up data from NATT study. Chin J Cancer Res 2016; 28:561-569. [PMID: 28174484 PMCID: PMC5242451 DOI: 10.21147/j.issn.1000-9604.2016.06.02] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective A previous study demonstrated that non-anthracycline-containing docetaxel plus cyclophosphamide (TC) regimen was inferior to docetaxel, anthracycline and cyclophosphamide (TAC) in neoadjuvant treatment of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor-2-(HER2)-positive breast cancer in a short-term follow-up. Herein, long-term follow-up survival outcomes have been investigated. Methods TNBC or HER2-positive patients were randomized to receive 6 cycles of TC or TAC neoadjuvant treatment. The primary endpoint was pathological complete remission (pCR). Secondary endpoints included clinical response rate, event-free survival (EFS), and overall survival (OS). Results A cohort of 96 patients consisted of 45 in TC and 51 in TAC arm. With a median follow-up period of 53 (range, 8–76) months, the patients achieving pCR post neoadjuvant chemotherapy exhibited superior EFS and OS than patients without pCR (P<0.05). TAC treatment resulted in consistently better EFS than TC treatment: the estimated 5-year EFS was 66.1% vs. 29.8% (P=0.002). Moreover, the estimated 5-year OS was also in favor of TAC: 88.4% vs. 51.6% (P<0.001). Multivariable analysis demonstrated that the treatment regimen was an independent prognostic factor, and patients treated with TAC had a superior EFS [hazard ratio (HR), 0.48; 95% confidence interval (95% CI), 0.26–0.90; P=0.021] and OS (HR, 0.20; 95% CI, 0.08–0.60; P=0.003).
Conclusions The updated long-term follow-up data demonstrated a sustained benefit in EFS and OS from anthracycline-containing TAC treatment, indicating that anthracycline is an essential and effective drug in this clinical trial.
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Affiliation(s)
- Xiaosong Chen
- Comprehensive Breast Health Center, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Guolin Ye
- Department of Breast Surgery, The First People's Hospital of Foshan, Foshan 528000, China
| | - Chenfang Zhang
- Department of Breast Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China
| | - Xinzheng Li
- Department of Breast Surgery, Shanxi Provincial Cancer Hospital, Taiyuan 030013, China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Cao L, Yao GY, Liu MF, Chen LJ, Hu XL, Ye CS. Neoadjuvant Bevacizumab plus Chemotherapy versus Chemotherapy Alone to Treat Non-Metastatic Breast Cancer: A Meta-Analysis of Randomised Controlled Trials. PLoS One 2015; 10:e0145442. [PMID: 26717149 PMCID: PMC4699216 DOI: 10.1371/journal.pone.0145442] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/03/2015] [Indexed: 12/29/2022] Open
Abstract
Purpose Results from previous randomised controlled trials (RCTs) investigating whether the addition of bevacizumab to neoadjuvant chemotherapy (NAC) could statistically significantly increase the pathological complete response (pCR) and to identify which subgroup would benefit most from such regimens have produced conflicting results. This meta-analysis was designed to assess the efficacy and safety of bevacizumab plus chemotherapy compared with chemotherapy alone in the neoadjuvant setting. Methods A literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane library was performed to identify eligible studies. The primary endpoint of interest was pCR. The secondary endpoints were clinical complete rate (cCR), surgery rate, breast-conserving surgery (BCS) rate, and toxicity. The meta-analysis was performed using Review Manager software version 5.3. Results Nine RCTs matched the selection criteria, yielding a total of 4967 patients (bevacizumab plus chemotherapy: 50.1%, chemotherapy alone: 49.9%). The results of this meta-analysis demonstrated that the addition of bevacizumab to NAC significantly increased the pCR rate (odds ratio [OR] = 1.34 [1.18–1.54]; P < 0.0001) compared with chemotherapy alone. Subgroup analysis showed that the effect of bevacizumab was more pronounced in patients with HER2-negative cancer (OR = 1.34 [1.17–1.54]; P < 0.0001) compared with HER2-positive cancer (OR = 1.69 [0.90–3.20]; P = 0.11). Similarly, in patients with HER2-negative cancer, the effect of bevacizumab was also more pronounced in patients with HR-negative cancer (OR = 1.38 [1.09–1.74]; P = 0.007) compared with HR-positive cancer (OR = 1.36 [0.78–2.35]; P = 0.27). No significant differences were observed between the groups with respect to cCR, surgery rate, or BCS rate. Additionally bevacizumab was associated with a higher incidence of neutropenia, febrile neutropenia, and hand–foot syndrome. Conclusions Higher proportions of patients achieved pCR when bevacizumab was added to NAC compared with when they received chemotherapy alone; acceptable toxicities were also found. Subgroup analysis demonstrated that patients with histologically confirmed HER2-negative and HR-negative breast cancer benefited the most.
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Affiliation(s)
- Li Cao
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Guang-yu Yao
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Min-feng Liu
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Lu-jia Chen
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xiao-lei Hu
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Chang-sheng Ye
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
- * E-mail:
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50
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Kogawa T, Fouad TM, Liu DD, Wu J, Shen Y, Masuda H, Fujii T, Chavez-MacGregor M, Alvarez RH, Hortobágyi GN, Valero V, Ueno NT. High HER2/Centromeric Probe for Chromosome 17 Fluorescence In Situ Hybridization Ratio Predicts Pathologic Complete Response and Survival Outcome in Patients Receiving Neoadjuvant Systemic Therapy With Trastuzumab for HER2-Overexpressing Locally Advanced Breast Cancer. Oncologist 2015; 21:21-7. [PMID: 26659222 DOI: 10.1634/theoncologist.2015-0101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The present study was performed to determine whether the human epidermal growth factor receptor-related 2 (HER2)/centromeric probe for chromosome 17 fluorescence in situ hybridization (FISH) ratio is a predictor of a pathologic complete response (pCR), recurrence-free survival (RFS), and/or overall survival (OS) in patients receiving neoadjuvant systemic treatment (NST) with trastuzumab (NST-T) for HER2+ locally advanced breast cancer (LABC). PATIENTS AND METHODS The present retrospective study included 555 patients with HER2+ LABC who had undergone NST and definitive surgery (1999-2012); 373 had concurrently received trastuzumab. HER2-positivity was considered present with an immunohistochemical score of 3+ and/or HER2 FISH ratio of ≥2.0. We used logistic regression analysis and Cox proportional hazard modeling to determine whether a high HER2 FISH ratio, either as a continuous variable or with a cutoff of ≥7.0, would predict for pCR (no invasive disease in the breast and no tumor in the ipsilateral axillary lymph nodes), RFS, and/or OS. RESULTS The pCR group's median HER2 FISH ratio was significantly higher than that of the non-pCR group (6.4 vs. 5.2; p = .003). The logistic regression model demonstrated that the independent predictors of pCR included a high HER2 FISH ratio as a continuous variable (p = .04). The multicovariate Cox proportional hazard model showed that a high HER2 FISH ratio (with a cutoff of ≥7.0 or as a continuous variable) was a significant prognostic indicator of longer RFS time (p = .047 and p = .04, respectively). Similarly, a high HER2 FISH ratio of ≥7.0 was associated with longer OS (p = .06). CONCLUSION A high HER2 FISH ratio is a predictor of pCR in patients with HER2+ LABC who receive NST-T. IMPLICATIONS FOR PRACTICE This study demonstrated the optimal predictive and prognostic value of a HER2/centromeric probe for chromosome 17 FISH ratio for primary HER2+ breast cancer treated with trastuzumab combined with neoadjuvant systemic treatment (NST-T). This suggests that a high HER2 FISH ratio is a potential indicator for a high pathologic complete response rate and a better prognosis when patients are treated with NST-T.
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Affiliation(s)
- Takahiro Kogawa
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tamer M Fouad
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hiroko Masuda
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Takeo Fujii
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mariana Chavez-MacGregor
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ricardo H Alvarez
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel N Hortobágyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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