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Scandurra G, Lombardo V, Scibilia G, Sambataro D, Gebbia V, Scollo P, Pecorino B, Valerio MR. New Frontiers in the Treatment of Patients with HER2+ Cancer and Brain Metastases: Is Radiotherapy Always Useful? Cancers (Basel) 2024; 16:2466. [PMID: 39001528 PMCID: PMC11240652 DOI: 10.3390/cancers16132466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Brain metastases (BM) pose a significant challenge in the management of HER2+ breast cancer since almost 50% of patients with HER2+ breast cancer develop brain tumors. The complex process of brain metastases involves genetic mutations, adaptations and mechanisms to overcome the blood-brain barrier. While radiotherapy is still fundamental in local therapy, its use is associated with cognitive adverse effects and limited long-term control, necessitating the exploration of alternative treatments. Targeted therapies, including tyrosine kinase inhibitors, monoclonal antibodies, and antibody-drug conjugates, offer promising options for HER2+ breast cancer patients with BM. Clinical trials have demonstrated the efficacy of these agents in controlling tumor growth and improving patient outcomes, posing the question of whether radiotherapy is always the unique choice in treating this cancer. Ongoing research into novel anti-HER2 antibodies and innovative combination therapies holds promise for advancing treatment outcomes and enhancing patient care in this clinical scenario. This narrative review provides a comprehensive overview of traditional medical treatments, molecularly targeted therapy and investigational agents in the management of HER2+ breast cancer with BM, highlighting the evolving landscape and potential future directions in treatment strategies to improve patient survival and quality of life.
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Affiliation(s)
- Giuseppa Scandurra
- Medical Oncology Unit, Cannizzaro Hospital, 95126 Catania, Italy
- Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy
| | | | - Giuseppe Scibilia
- Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy
- Gynecology Unit, Giovanni Paolo II Hospital, 97100 Ragusa, Italy
| | - Daniela Sambataro
- Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy
- Medical Oncology Unit, Umberto I Hospital, 94100 Enna, Italy
| | - Vittorio Gebbia
- Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy
- Medical Oncology Unit, CdC Torina, 90145 Palermo, Italy
| | - Paolo Scollo
- Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy
- Gynecology and Obstetrics Unit, Cannizzaro Hospital, 95126 Catania, Italy
| | - Basilio Pecorino
- Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy
- Gynecology and Obstetrics Unit, Umberto I Hospital, 94100 Enna, Italy
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Yuan B, Hu D, Song F, Xiao S. Survival benefit of primary tumor surgery and personalized treatment strategy for patients with bone metastasis from breast cancer. Asian J Surg 2024; 47:1429-1432. [PMID: 38036358 DOI: 10.1016/j.asjsur.2023.11.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Bei Yuan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Dong Hu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Song
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Songhua Xiao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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Le Scodan R, Ghannam Y, Kirova Y, Bourgier C, Richard Tallet A. Radiation therapy of the primary tumour and oligometastatic sites in patients with breast cancer with synchronous metastases: A literature review. Cancer Radiother 2024; 28:3-14. [PMID: 38065784 DOI: 10.1016/j.canrad.2023.08.007] [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: 02/09/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 02/04/2024]
Abstract
De novo metastatic breast cancer represents 5 to 8% of all breast cancers (2500 new cases per year in France). Systemic treatment is the cornerstone of treatment, whereas radiation therapy usually has a palliative intent. Advances in systemic and local treatments (surgery and radiation therapy) have substantially improved overall survival. In the recent breast cancer statistics in the United States, the 5-year relative survival for patients diagnosed during 2012-2018 was 29% for stage IV (Breast Cancer Statistics). Thus, an increasing proportion of metastatic breast cancers present a prolonged complete response to systemic therapy, which raises the question of the impact of local treatment on patient survival. Radiation therapy has shown its value for early breast cancer, but its place in the local management of the primary tumour or oligometastatic sites for de novo metastatic breast cancer remains under debate. This article is a literature review assessing the role of radiation therapy directed to the primary tumour and oligometastatic sites of breast cancer in patients with synchronous metastases, in order to highlight clinicians in their therapeutic decision.
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Affiliation(s)
- R Le Scodan
- Institut de cancérologie et radiothérapie brétillien (ICRB), hôpitaux privés rennais, centre hospitalier privé Saint-Grégoire, Vivalto, Saint-Grégoire, France.
| | - Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, Angers, France
| | - Y Kirova
- Département de radiothérapie, institut Curie, Paris, France
| | - C Bourgier
- Université de Montpellier, Montpellier, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, institut régional du cancer Montpellier (ICM), Montpellier, France
| | - A Richard Tallet
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), Inserm UMR 1068, Marseille, France
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Ren C, Sun J, Kong L, Wang H. Breast surgery for patients with de novo metastatic breast cancer: A meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107308. [PMID: 38048724 DOI: 10.1016/j.ejso.2023.107308] [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: 04/27/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
The role of breast surgery in the treatment of patients with de novo metastatic breast cancer(dnMBC) remains controversial, with conflicting trial results. We did a meta-analysis to comprehensively investigate and assess whether breast surgery is associated with survival and quality of life outcomes in patients with dnMBC.We systematically searched PubMed, Embase, Google Scholar, Scopus, and Web of Science, from database inception to March 30, 2022, for randomized controlled trials(RCTs) that compared breast surgery or locoregional therapy with non-surgical treatment based on systemic therapy for managing dnMBC.We also reviewed abstracts and presentations from major conference proceedings. We excluded non-randomised trials and considered only papers published in English. The primary outcomes were overall survival(OS),locoregional progression-free survival(LPFS), distant progression-free survival(DPFS), and quality of life(QoL). The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects model or fixed effects model were used to calculate the effect sizes of included RCTs.Quality of evidence was assessed with GRADE criteria. Data analysis was performed with STATA 17.0. A total of 1018 women from seven randomized clinical trials were included in the analysis. Pooled analyses revealed that compared with systemic therapy, breast surgery was not associated with beneficial outcomes in OS(hazard ratio [HR],0.87; 95%CI,0.68 to 1.11; I2 = 53.08 %; p = 0.265),DPFS(HR,1.20; 95%CI,0.94 to 1.54; I2 = 86.45 %; p = 0.136), or QoL-global health status (standardized mean difference[SMD],0.08; 95%CI,-0.15 to 0.32; I2 = 79.45 %; p = 0.478) and QoL-mental-physical functionality(SMD,-0.19; 95%CI,-0.50 to 0.13; I2 = 0.00 %; p = 0.255), but was associated with a benefit in LPFS(HR,0.27; 95%CI,0.19 to 0.38; I2 = 84.16 %; p < 0.001). These findings were consistent in subgroup analyses of the timing of surgery, site and number of metastases and tumor molecular subtype. The evidence grade was moderate because of the substantial heterogeneity among studies. Based on the RCTs evidence, we found that breast surgery may benefit locoregional control but does not prolong OS and improve QoL in patients with dnMBC. The Prospero registration number: CRD42020206460.
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Affiliation(s)
- Chongxi Ren
- Department of Surgical Oncology, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cang Zhou, 061001, China.
| | - Jianna Sun
- Department of Breast Cancer Center, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Cang Zhou, 061001, China
| | - Lingjun Kong
- Department of Neurosurgery, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cang Zhou, 061001, China
| | - Hongqiao Wang
- Department of Surgical Oncology, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cang Zhou, 061001, China
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Brandão M, Martins-Branco D, De Angelis C, Vuylsteke P, Gelber RD, Van Damme N, van Walle L, Ferreira AR, Lambertini M, Poggio F, Verhoeven D, Barbeaux A, Duhoux FP, Wildiers H, Caballero C, Awada A, Piccart-Gebhart M, Punie K, de Azambuja E. Surgery of the primary tumor in patients with de novo metastatic breast cancer: a nationwide population-based retrospective cohort study in Belgium. Breast Cancer Res Treat 2024; 203:351-363. [PMID: 37878152 DOI: 10.1007/s10549-023-07116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/24/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE We aimed to assess the impact of surgery of primary tumor in overall survival (OS) of women with de novo metastatic breast cancer. METHODS Nationwide, population-based retrospective cohort study of women diagnosed with de novo metastatic breast cancer in Belgium, between Jan/2010-Dec/2014. Data was obtained from the Belgian Cancer Registry and administrative databases. "Surgery" group was defined by surgery of primary tumor up to nine months after diagnosis. We excluded women who did not receive systemic treatment or did not complete nine months follow-up after diagnosis. All the subsequent analyses reporting on overall survival and the stratified outcome analyses were performed based on this nine-month landmark cohort. OS was estimated using Kaplan-Meier method and compared using adjusted Cox proportional hazards models controlling for confounders with 95% confidence intervals (CI). We performed a stratified analysis according to surgery timing and a propensity score matching analysis. RESULTS 1985 patients, 534 (26.9%) in the "Surgery" and 1451 (73.1%) in the "No Surgery" group. Patients undergoing surgery were younger (p < 0.001), had better performance status (PS) (p < 0.001), and higher proportion of HER2-positive and triple-negative breast cancer (p = 0.012). Median follow-up was 86.0 months (82.6-88.5). Median OS was 60.1 months (57.1-68.2) in the "Surgery" vs. 41.9 months (39.8-44.2) in the "No Surgery" group (adjusted HR 0.56; 0.49-0.64). OS was similar when surgery was performed upfront or after systemic treatment. Propensity score matching analysis confirmed the same findings. CONCLUSION Among patients receiving systemic treatment for de novo metastatic breast cancer and surviving nine months or more, those who received surgery of the primary tumor within nine months of diagnosis have longer subsequent survival than those who did not.
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Affiliation(s)
- Mariana Brandão
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Diogo Martins-Branco
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Claudia De Angelis
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Clinical Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Peter Vuylsteke
- CHU UCL Namur, Site Ste Elisabeth, UC Louvain, Namur, Belgium
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Richard D Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, United States of America
| | | | | | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
- Católica Medical School, Universidade Católica Portuguesa, Rio de Mouro, Portugal
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Didier Verhoeven
- Medical Oncology, AZ Klina, University of Antwerp, Antwerp, Belgium
| | | | - Francois P Duhoux
- Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium
| | | | - Ahmad Awada
- Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Martine Piccart-Gebhart
- Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium
| | - Evandro de Azambuja
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Zhao J, Bian S, Di X, Xiao C. A Nomogram and Risk Classification System Predicting the Prognosis of Patients with De Novo Metastatic Breast Cancer Undergoing Immediate Breast Reconstruction: A Surveillance, Epidemiology, and End Results Population-Based Study. Curr Oncol 2023; 31:115-131. [PMID: 38248093 PMCID: PMC10814717 DOI: 10.3390/curroncol31010008] [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: 10/16/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Background The lifespan of patients diagnosed with de novo metastatic breast cancer (dnMBC) has been prolonged. Nonetheless, there remains substantial debate regarding immediate breast reconstruction (IBR) for this particular subgroup of patients. The aim of this study was to construct a nomogram predicting the breast cancer-specific survival (BCSS) of dnMBC patients who underwent IBR. Methods A total of 682 patients initially diagnosed with metastatic breast cancer (MBC) between 2010 and 2018 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. All patients were randomly allocated into training and validation groups at a ratio of 7:3. Univariate Cox hazard regression, least absolute shrinkage and selection operator (LASSO), and best subset regression (BSR) were used for initial variable selection, followed by a backward stepwise multivariate Cox regression to identify prognostic factors and construct a nomogram. Following the validation of the nomogram with concordance indexes (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analyses (DCAs), risk stratifications were established. Results Age, marital status, T stage, N stage, breast subtype, bone metastasis, brain metastasis, liver metastasis, lung metastasis, radiotherapy, and chemotherapy were independent prognostic factors for BCSS. The C-indexes were 0.707 [95% confidence interval (CI), 0.666-0.748] in the training group and 0.702 (95% CI, 0.639-0.765) in the validation group. In the training group, the AUCs for BCSS were 0.857 (95% CI, 0.770-0.943), 0.747 (95% CI, 0.689-0.804), and 0.700 (95% CI, 0.643-0.757) at 1 year, 3 years, and 5 years, respectively, while in the validation group, the AUCs were 0.840 (95% CI, 0.733-0.947), 0.763 (95% CI, 0.677-0.849), and 0.709 (95% CI, 0.623-0.795) for the same time points. The calibration curves for BCSS probability prediction demonstrated excellent consistency. The DCA curves exhibited strong discrimination power and yielded substantial net benefits. Conclusions The nomogram, constructed based on prognostic risk factors, has the ability to provide personalized predictions for BCSS in dnMBC patients undergoing IBR and serve as a valuable reference for clinical decision making.
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Affiliation(s)
- Jingjing Zhao
- Tianjin Fourth Central Hospital, The Fourth Central Hospital Affiliated to Nankai University, Tianjin 300140, China; (J.Z.); (S.B.)
| | - Shichang Bian
- Tianjin Fourth Central Hospital, The Fourth Central Hospital Affiliated to Nankai University, Tianjin 300140, China; (J.Z.); (S.B.)
| | - Xu Di
- Tianjin Fourth Central Hospital, The Fourth Central Hospital Affiliated to Nankai University, Tianjin 300140, China; (J.Z.); (S.B.)
| | - Chunhua Xiao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
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Cui H, Ren X, Zhao X, Dai L, Liu D, Bao Y, Hu L, Xiao Z, Ma X, Kang H. Prognostic value and mode selection of locoregional treatment in Stage-IV breast cancer patients. J Cancer Res Clin Oncol 2023; 149:13591-13605. [PMID: 37515611 DOI: 10.1007/s00432-023-05159-2] [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: 05/30/2023] [Accepted: 07/09/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE This study aimed to assess the actual prognostic significance of different locoregional treatment (LRT) (surgery and radiotherapy) modalities for stage-IV breast cancer (BC) patients and construct a competing risk nomogram to make precise predictions of the breast cancer-specific death (BCSD) risk among LRT recipients. METHODS A total of 9279 eligible stage-IV BC patients from the Surveillance Epidemiology and End Results (SEER) database were included in this study. Initially, we evaluated the impact of LRT on survival both before and after the propensity score matching (PSM). Then, we used the Cox hazard proportional model and competing risk model to identify the independent prognostic factors for LRT recipients. Based on the screened variables, a comprehensive nomogram was established. RESULTS Kaplan-Meier curves demonstrated that LRT significantly prolonged overall survival (OS) and breast cancer-specific survival (BCSS) (P < 0.001). In addition, patients treated with surgery combined with postoperative radiotherapy (PORT) possessed the optimal survival (P < 0.001). Regardless of the surgical modalities, primary tumor resection combined with radiotherapy could ameliorate the prognosis (P < 0.05). Subgroup analysis showed that in patients with T2-T4 stage, PORT had a survival benefit compared with those undergoing surgery combined with preoperative radiotherapy (PRRT) and surgery only. Based on the screened independent prognostic factors, we established a comprehensive nomogram to forecast BCSD in 1 year, 2 years and 3 years, which showed robust predictive ability. CONCLUSION PORT was associated with a lower BCSD in stage-IV BC patients. The practical nomogram could provide a precise prediction of BCSD for LRT recipients, which was meaningful for patients' individualized management.
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Affiliation(s)
- Hanxiao Cui
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xueting Ren
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuyan Zhao
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Luyao Dai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dandan Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuanhang Bao
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liqun Hu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhengtao Xiao
- Department of Biochemistry and Molecular Biology, School of Basic Medical College, Xi'an Jiaotong University, Xi'an, China.
| | - Xiaobin Ma
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Huafeng Kang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Li C, Liu M, Zhang Y, Wang Y, Li J, Sun S, Liu X, Wu H, Feng C, Yao P, Jia Y, Zhang Y, Wei X, Wu F, Du C, Zhao X, Zhang S, Qu J. Novel models by machine learning to predict prognosis of breast cancer brain metastases. J Transl Med 2023; 21:404. [PMID: 37344847 PMCID: PMC10286496 DOI: 10.1186/s12967-023-04277-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Breast cancer brain metastases (BCBM) are the most fatal, with limited survival in all breast cancer distant metastases. These patients are deemed to be incurable. Thus, survival time is their foremost concern. However, there is a lack of accurate prediction models in the clinic. What's more, primary surgery for BCBM patients is still controversial. METHODS The data used for analysis in this study was obtained from the SEER database (2010-2019). We made a COX regression analysis to identify prognostic factors of BCBM patients. Through cross-validation, we constructed XGBoost models to predict survival in patients with BCBM. Meanwhile, a BCBM cohort from our hospital was used to validate our models. We also investigated the prognosis of patients treated with surgery or not, using propensity score matching and K-M survival analysis. Our results were further validated by subgroup COX analysis in patients with different molecular subtypes. RESULTS The XGBoost models we created had high precision and correctness, and they were the most accurate models to predict the survival of BCBM patients (6-month AUC = 0.824, 1-year AUC = 0.813, 2-year AUC = 0.800 and 3-year survival AUC = 0.803). Moreover, the models still exhibited good performance in an externally independent dataset (6-month: AUC = 0.820; 1-year: AUC = 0.732; 2-year: AUC = 0.795; 3-year: AUC = 0.936). Then we used Shiny-Web tool to make our models be easily used from website. Interestingly, we found that the BCBM patients with an annual income of over USD$70,000 had better BCSS (HR = 0.523, 95%CI 0.273-0.999, P < 0.05) than those with less than USD$40,000. The results showed that in all distant metastasis sites, only lung metastasis was an independent poor prognostic factor for patients with BCBM (OS: HR = 1.606, 95%CI 1.157-2.230, P < 0.01; BCSS: HR = 1.698, 95%CI 1.219-2.365, P < 0.01), while bone, liver, distant lymph nodes and other metastases were not. We also found that surgical treatment significantly improved both OS and BCSS in BCBM patients with the HER2 + molecular subtypes and was beneficial to OS of the HR-/HER2- subtype. In contrast, surgery could not help BCBM patients with HR + /HER2- subtype improve their prognosis (OS: HR = 0.887, 95%CI 0.608-1.293, P = 0.510; BCSS: HR = 0.909, 95%CI 0.604-1.368, P = 0.630). CONCLUSION We analyzed the clinical features of BCBM patients and constructed 4 machine-learning prognostic models to predict their survival. Our validation results indicate that these models should be highly reproducible in patients with BCBM. We also identified potential prognostic factors for BCBM patients and suggested that primary surgery might improve the survival of BCBM patients with HER2 + and triple-negative subtypes.
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Affiliation(s)
- Chaofan Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Mengjie Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Yinbin Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Jia Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Shiyu Sun
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Xuanyu Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Huizi Wu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Cong Feng
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Peizhuo Yao
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Yiwei Jia
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Yu Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Xinyu Wei
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Fei Wu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Chong Du
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Xixi Zhao
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China
| | - Shuqun Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China.
| | - Jingkun Qu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, People's Republic of China.
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9
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Merloni F, Palleschi M, Gianni C, Casadei C, Curcio A, Romeo A, Rocchi M, Cima S, Sirico M, Sarti S, Cecconetto L, Mariotti M, Di Menna G, De Giorgi U. Locoregional treatment of de novo stage IV breast cancer in the era of modern oncology. Front Oncol 2023; 13:1083297. [PMID: 36793604 PMCID: PMC9923000 DOI: 10.3389/fonc.2023.1083297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
Approximately 6% of metastatic breast cancers arise de novo. While systemic therapy (ST) remains the treatment backbone as for patients with metachronous metastases, locoregional treatment (LRT) of the primary tumor remains a controversial method. The removal of the primary has an established role for palliative purposes, but it is unclear if it could also determine a survival benefit. Retrospective evidence and pre-clinical studies seem to support the removal of the primary as an effective approach to improve survival. On the other hand, most randomized evidence suggests avoiding LRT. Both retrospective and prospective studies suffer several limitations, ranging from selection bias and outdated ST to a small sample of patients. In this review we discuss available data and try to identify subgroups of patients which could benefit the most from LRT of the primary, to facilitate clinical practice decisions, and to hypothesize future studies design on this topic.
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Affiliation(s)
- Filippo Merloni
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michela Palleschi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Caterina Gianni
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, Pierantoni-Morgagni Hospital Forlì and Santa Maria delle Croci Hospital Ravenna, Forli, Italy
| | - Antonino Romeo
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maddalena Rocchi
- Breast Surgery Unit, Pierantoni-Morgagni Hospital Forlì and Santa Maria delle Croci Hospital Ravenna, Forli, Italy
| | - Simona Cima
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marianna Sirico
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Samanta Sarti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Lorenzo Cecconetto
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marita Mariotti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giandomenico Di Menna
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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10
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Hotton J, Lusque A, Leufflen L, Campone M, Levy C, Honart JF, Mailliez A, Debled M, Gutowski M, Leheurteur M, Goncalves A, Jankowski C, Guillermet S, Bachelot T, Ferrero JM, Eymard JC, Petit T, Pouget N, de La Lande B, Frenel JS, Villacroux O, Simon G, Pons-Tostivint E, Marchai F. Early Locoregional Breast Surgery and Survival in de novo Metastatic Breast Cancer in the Multicenter National ESME Cohort. Ann Surg 2023; 277:e153-e161. [PMID: 33534229 DOI: 10.1097/sla.0000000000004767] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to evaluate the impact of local surgery performed during the year after MBC diagnosis on patients' outcomes from a large reallife cohort. SUMMARY BACKGROUND DATA Locoregional treatment for patients with MBC at the time of diagnosis remains debated. METHODS Women with newly diagnosed, de novo stage IV MBC and who started MBC treatment between January 2008 and December 2014 in one of the 18 French Comprehensive Cancer Centers were included (NCT03275311). The impact of local surgery performed during the first year on overall survival (OS) and progression-free survival (PFS) was evaluated by the Cox proportional hazards model in a 12 month-landmark analysis. RESULTS Out of 16,703 patients in the ESME database, 1977 had stage IV MBC at diagnosis, were alive and progression-free at 12 months and eligible for this study. Among them, 530 (26.8%) had received primary breast cancer surgery within 12 months. A greater proportion of patients who received surgery had less than 3 metastatic sites than the no-surgery group (90.8% vs 78.2%, P < 0.0001). Surgery within 12 months was associated with treatment with chemotherapy, HER2-targeted therapy (89.1% vs 69.6%, P < 0.0001) and locoregional radiotherapy (81.7% vs 32.5%, P < 0.0001). Multivariable analyses showed that surgery performed within 12 months was associated with longer OS and PFS (adjusted HR [95%CI] = 0.75 [0.61-0.92] and 0.72 [0.63-0.83], respectively), which were also affected by pattern and number of metastatic sites, histological subtype, and age. CONCLUSIONS In the large ESME cohort, surgery within 1 year after de novo MBC diagnosis was associated with a significantly better OS and PFS.
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Affiliation(s)
- Judicaël Hotton
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
- Department of Surgical Oncology, Institut Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irene-Joliot-Curie, 31059 Toulouse, France
| | - Léa Leufflen
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes & Angers, 15 rue Andre Boquel, 49055 Angers, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Jean-Francois Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de l'Argonne, F-33000 Bordeaux, France
| | - Marian Gutowski
- Department of Surgical Oncology, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille
| | - Clementine Jankowski
- Department of Surgical Oncology, Centre Georges Francois Leclerc, 1 rue Professeur Marion, 21079 Dijon, France
| | - Sophie Guillermet
- Department of Surgical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Thomas Bachelot
- Department of Surgical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacas-sagne, 33 Avenue de Valambrose, 06189 Nice, France
| | - Jean-Christophe Eymard
- Department of Medical Oncology, Institut Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l,Hopital, 67000 Strasbourg, France
| | - Nicolas Pouget
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Brigitte de La Lande
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancerologie de l,Ouest - Rene Gauducheau, Boulevard Professeur Jacques Monod, 44805 Nantes, France
| | - Olivier Villacroux
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; and
| | - Gaëtane Simon
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; and
| | - Elvire Pons-Tostivint
- Department of Medical Oncology, Centre Leon Berard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irtine-Joliot-Curie, 31059 Toulouse, France
| | - Frédéric Marchai
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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11
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Torrisi R, Jacobs F, Miggiano C, De Sanctis R, Santoro A. HR +/HER2 - de novo metastatic breast cancer: a true peculiar entity? Drugs Context 2023; 12:dic-2022-12-2. [PMID: 36926051 PMCID: PMC10012832 DOI: 10.7573/dic.2022-12-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023] Open
Abstract
De novo metastatic breast cancer (dnMBC) accounts for ~6-10% of all breast cancers and for ~30% of MBC with increasing incidence over time. Hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) tumours are the most frequent subtype with a similar incidence to that observed amongst recurrent MBC (rMBC). Higher frequency of PI3KCA and ARID2 mutations and a lower frequency of ESR1 mutations and of genes involved in DNA damage, as compared with rMBC, have been reported in HR+/HER2- dnMBC; however, these are not correlating with prognosis, whilst tumour mutational burden is inversely correlated with outcome. Bone represents the most frequent metastatic site, being the single site in up to 60% of patients with dnMBC. HR+/HER2- dnMBC has been generally reported to have better outcomes than rMBC, with a median overall survival ranging from 26 months to nearly 5 years in patients with favourable features such as age <40 years and bone-only disease, but not when compared with patients with late recurring disease (≥2-5 years). Analyses of the de novo cohorts within randomized clinical trials and large real-world series report a better outcome after treatment with CDK4/6 inhibitors and endocrine agents as compared to rMBC. Despite the limitations of retrospective studies and controversial results of the randomized trials, locoregional treatment of the primary tumour after response to systemic therapy appears to confer a survival benefit, particularly in patients with favourable prognostic factors. Altogether genomic, biological and clinical findings highlight HR+/HER2- dnMBC as a peculiar entity as compared with rMBC and deserve a dedicated treatment algorithm. This article is part of the Tackling clinical complexity in breast cancer Special Issue: https://www.drugsincontext.com/special_issues/tackling-clinical-complexity-in-breast-cancer/.
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Affiliation(s)
- Rosalba Torrisi
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy
| | - Flavia Jacobs
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Chiara Miggiano
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rita De Sanctis
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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12
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Loco-Regional Treatment of the Primary Tumor in De Novo Metastatic Breast Cancer Patients Undergoing Front-Line Chemotherapy. Cancers (Basel) 2022; 14:cancers14246237. [PMID: 36551722 PMCID: PMC9777012 DOI: 10.3390/cancers14246237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Loco-regional therapy (LRT) in de novo metastatic breast cancer (MBC) has been investigated in several clinical trials, with heterogeneous and conflicting results. METHODS We conducted a retrospective study of de novo MBC patients treated with front-line chemotherapy (FLC) followed by LRT of the primary tumor. Our aims were to evaluate the characteristics, treatment, and oncological outcomes in terms of progression-free survival (PFS), distant progression-free survival (DPFS), and overall survival (OS) of de novo MBC. We also investigated possible subgroups of patients with better outcomes according to menopausal status, biological sub-type, location, number of metastases, and radiologic complete response after FLC. RESULTS We included 61 patients in the study. After a median follow-up of 55 months, disease progression occurred in 60.7% of patients and 49.2% died. There were no significant differences in PFS, DPFS, and OS between different subgroups of de novo MBC patients. A trend toward better PFS and DPFS was observed in triple-positive tumors, without a statistically significant difference in OS. CONCLUSIONS No specific subgroup of de novo MBC patients showed a statistically significant survival advantage after FLC followed by LRT of the primary tumor.
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13
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Li C, Liu M, Li J, Wang W, Feng C, Cai Y, Wu F, Zhao X, Du C, Zhang Y, Wang Y, Zhang S, Qu J. Machine learning predicts the prognosis of breast cancer patients with initial bone metastases. Front Public Health 2022; 10:1003976. [PMID: 36225783 PMCID: PMC9549149 DOI: 10.3389/fpubh.2022.1003976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023] Open
Abstract
Background Bone is the most common metastatic site of patients with advanced breast cancer and the survival time is their primary concern; however, we lack accurate predictive models in clinical practice. In addition to this, primary surgery for breast cancer patients with bone metastases is still controversial. Method The data used for analysis in this study were obtained from the SEER database (2010-2019). We made a COX regression analysis to identify prognostic factors of patients with bone metastatic breast cancer (BMBC). Through cross-validation, we constructed an XGBoost model to predicting survival in patients with BMBC. We also investigated the prognosis of patients treated with neoadjuvant chemotherapy plus surgical and chemotherapy alone using propensity score matching and K-M survival analysis. Results Our validation results showed that the model has high sensitivity, specificity, and correctness, and it is the most accurate one to predict the survival of patients with BMBC (1-year AUC = 0.818, 3-year AUC = 0.798, and 5-year survival AUC = 0.791). The sensitivity of the 1-year model was higher (0.79), while the specificity of the 5-year model was higher (0.86). Interestingly, we found that if the time from diagnosis to therapy was ≥1 month, patients with BMBC had even better survival than those who started treatment immediately (HR = 0.920, 95%CI 0.869-0.974, P < 0.01). The BMBC patients with an income of more than USD$70,000 had better OS (HR = 0.814, 95%CI 0.745-0.890, P < 0.001) and BCSS (HR = 0.808 95%CI 0.735-0.889, P < 0.001) than who with income of < USD$50,000. We also found that compared with chemotherapy alone, neoadjuvant chemotherapy plus surgical treatment significantly improved OS and BCSS in all molecular subtypes of patients with BMBC, while only the patients with bone metastases only, bone and liver metastases, bone and lung metastases could benefit from neoadjuvant chemotherapy plus surgical treatment. Conclusion We constructed an AI model to provide a quantitative method to predict the survival of patients with BMBC, and our validation results indicate that this model should be highly reproducible in a similar patient population. We also identified potential prognostic factors for patients with BMBC and suggested that primary surgery followed by neoadjuvant chemotherapy might increase survival in a selected subgroup of patients.
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Affiliation(s)
- Chaofan Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengjie Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jia Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Weiwei Wang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Cong Feng
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yifan Cai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fei Wu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xixi Zhao
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chong Du
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yinbin Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuqun Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingkun Qu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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14
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Exploring the Value of Additional Primary Tumour Excision Combined with Systemic Therapy Administered in Different Sequences for Patients with de Novo Metastatic Breast Cancer. Breast J 2022; 2022:5049445. [PMID: 36082023 PMCID: PMC9436631 DOI: 10.1155/2022/5049445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022]
Abstract
Introduction Uncertainty still remains regarding the survival improvement derived from immediate surgery or subsequent surgery in addition to systemic therapy for patients with de novo metastatic breast cancer. The current study aimed to examine the effect of combined treatment administered in different sequences on the survival of these patients. Materials and Methods We conducted a retrospective cohort study of patients with de novo stage IV breast cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019. Patients were categorized into 3 groups: (1) systemic therapy without primary surgery, (2) systemic therapy after primary surgery, and (3) systemic therapy before primary surgery. Cumulative incidence curves with Gray's test were used to compare breast cancer-specific death (BCSD) between groups. Kaplan–Meier curves with the log-rank test were applied to compare overall survival (OS) between groups. A competing risk model and a proportional hazards model were generated to adjust for important prognostic factors. Propensity score matching (PSM) was performed in the primary survival analysis. Stratified analysis was also performed. Results Patients who underwent systemic therapy after primary surgery and who underwent systemic therapy before primary surgery both showed a significantly reduced risk of BCSD compared to patients who received systemic therapy without primary surgery [subdistribution hazard ratio (SHR): 0.74; 95% confidence interval (CI): 0.69–0.79; and P < 0.001, and SHR: 0.62; 95% CI: 0.56–0.67; and P < 0.001, respectively]. A statistically significant disparity was also noted in OS. In the setting of single-organ metastasis, including the bone, lung, and liver, patients receiving the combination therapy showed an improved prognosis compared with patients receiving systemic therapy without primary surgery. Conclusions Additional primary tumour excision, whether before or after systemic therapy, may provide survival benefits for patients presenting with de novo metastatic breast cancer, especially for patients with single-organ disease involving the bone, lung, and liver but not the brain. Further investigations mainly focused on these carefully selected candidates are required to improve personalized treatment for metastatic breast cancer.
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15
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Beduk Esen CS, Gultekin M, Yildiz F. Role of radiotherapy in oligometastatic breast cancer: Review of the literature. World J Clin Oncol 2022; 13:39-48. [PMID: 35116231 PMCID: PMC8790304 DOI: 10.5306/wjco.v13.i1.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/05/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Metastatic breast cancer has been historically considered as an incurable disease. Radiotherapy (RT) has been traditionally used for only palliation of the symptoms caused by metastatic lesions. However, in recent years the concept of oligometastatic disease has been introduced in Cancer Medicine as a clinical scenario with a limited number of metastases (≤ 5) and involved organs (≤ 2) with controlled primary tumor. The main hypothesis in oligometastatic disease is that locoregional treatment of primary tumor site and metastasis-directed therapies with surgery and/or RT may improve outcomes. Recent studies have shown that not all metastatic breast cancer patients have the same prognosis, and selected patients with good prognostic features as those younger than 55 years, hormone receptor-positive, limited bone or liver metastases, a low-grade tumor, good performance status, long disease-free interval (> 12 mo), and good response to systemic therapy may provide maximum benefit from definitive treatment procedures to all disease sites. While retrospective and prospective studies on locoregional treatment in oligometastatic breast cancer demonstrated conflicting results, there is an increasing trend in favor of locoregional treatment. Currently, available data also demonstrated the improvements in survival with metastasis-directed therapy in oligometastatic breast cancer. The current review will discuss the concept of oligometastases and provide up-to-date information about the role of RT in oligometastatic breast cancer.
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Affiliation(s)
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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16
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Marks CE, Thomas SM, Fayanju OM, DiLalla G, Sammons S, Hwang ES, Plichta JK. Metastatic breast cancer: Who benefits from surgery? Am J Surg 2022; 223:81-93. [PMID: 34325907 PMCID: PMC8688223 DOI: 10.1016/j.amjsurg.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND We sought to identify characteristics of metastatic breast cancer (MBC) patients who may benefit most from primary tumor resection. METHODS Recursive partitioning analysis (RPA) was used to categorize non-surgical patients with de novo MBC in the NCDB (2010-2015) into 3 groups (I/II/III) based on 3-year overall survival (OS). After bootstrapping (BS), group-level profiles were applied, and the association of surgery with OS was estimated using Cox proportional hazards models. RESULTS All patients benefitted from surgery (median OS, surgery vs no surgery): 72.7 vs 42.9 months, 47.3 vs 30.4 months, 23.8 vs 14.4 months (all p < 0.001) in BS-groups I, II, and III, respectively. After adjustment, surgery remained associated with improved OS (HR 0.52, 95% CI 0.50-0.55). The effect of surgery on OS differed quantitatively across groups. CONCLUSION Prognostic groups may inform the degree of benefit from surgery, with the greatest benefit seen in those with the most favorable survival.
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Affiliation(s)
- Caitlin E. Marks
- Duke University Medical Center, Department of Surgery. Durham, NC
| | - Samantha M. Thomas
- Duke Cancer Institute. Durham, NC.,Biostatistics Shared Resource, Duke Cancer Institute. Durham, NC.,Duke University, Department of Biostatistics & Bioinformatics. Durham, NC
| | - Oluwadamilola M. Fayanju
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Cancer Institute. Durham, NC.,Duke University Medical Center, Department of Population Health Sciences. Durham, NC.,Durham VA Medical Center, Department of Surgery. Durham, NC
| | - Gayle DiLalla
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Women’s Cancer Care Raleigh. Raleigh, NC
| | - Sarah Sammons
- Duke Cancer Institute. Durham, NC.,Duke University Medical Center, Department of Medicine. Durham, NC
| | - E. Shelley Hwang
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Cancer Institute. Durham, NC
| | - Jennifer K. Plichta
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Cancer Institute. Durham, NC.,Duke University Medical Center, Department of Population Health Sciences. Durham, NC
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17
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Gaillard T, Carton M, Mailliez A, Desmoulins I, Mouret-Reynier MA, Petit T, Leheurteur M, Dieras V, Ferrero JM, Uwer L, Guiu S, Gonçalves A, Levy C, Debled M, Dalenc F, Patsouris A, Bachelot T, Eymard JC, Chevrot M, Conversano A, Robain M, Hequet D. De novo metastatic breast cancer in patients with a small locoregional tumour (T1-T2/N0): Characteristics and prognosis. Eur J Cancer 2021; 158:181-188. [PMID: 34689042 DOI: 10.1016/j.ejca.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The estimated rate of de novo metastatic breast cancer (dnMBC) at the time of diagnosis is between 5 to 12%. International guidelines recommend metastatic work-up (MWU) only in women with advanced breast cancer. The purpose of this study was to describe the characteristics and prognosis of patients with dnMBC diagnosed without an initial indication for MWU. METHODS We conducted a retrospective, comparative study in dnMBC patients selected from the ESME-MBC cohort. Patients were treated in France between 2008 and 2016. We compared two populations: patients in whom dnMBC was diagnosed by staging although not indicated by guidelines (non-guideline staging [NGS]) and those in whom dnMBC was diagnosed by guideline staging (GS). RESULTS During the study period, 22,463 patients with MBC were included in the ESME cohort. Among them, 6698 were dnMBC patients. In 247 of these patients (6% of dnMBC and 1% of the overall population), dnMBC was diagnosed by non-guideline staging. Women in this group were significantly younger (57 vs. 59 years, p = 0.02) and had fewer metastatic sites at diagnosis than dnMBC-GS patients. The two groups were not significantly different in terms of the other characteristics. Overall survival (OS) and progression-free survival (PFS) were better in the dnMBC-NGS group than in the dnMBC-GS group. The impact on survival was confirmed by univariate and multivariate analysis (HR 1.83 [1.31-2.57], p < 0.01). CONCLUSION This study provides the first description of a very specific population. These patients with dnMBC-NGS were younger and more likely to have oligometastatic disease with a better prognosis.
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Affiliation(s)
- T Gaillard
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.
| | - M Carton
- Department of Biostatistics, Institut Curie, Paris & Saint-Cloud, France
| | - A Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - I Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - M A Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - T Petit
- Department of Medical Oncology, ICANS Centre Paul Strauss, Strasbourg, France
| | - M Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - V Dieras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - L Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - S Guiu
- Department of Medical Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli Calmette, Marseille, France
| | - C Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Dalenc
- Department of Medical Oncology, IUCT-Oncopole Institut Claudius Regaud, Toulouse, France
| | - A Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers & Nantes, France
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - J C Eymard
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - M Chevrot
- Real World Data Department, Unicancer Data Office, Paris, France
| | - A Conversano
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - M Robain
- Real World Data Department, Unicancer Data Office, Paris, France
| | - D Hequet
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
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Chen YQ, Xu JW, Xu XF, Wang XL, Huo LQ, Wang L, Zhou GH, Gu J. Predicting the survival benefit of local surgery in patients aged 70 years or older with stage IV breast cancer: A population-based analysis. Breast 2021; 59:124-134. [PMID: 34229127 PMCID: PMC8261080 DOI: 10.1016/j.breast.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The aim of this study was to establish individualized nomograms to predict survival outcomes in older female patients with stage IV breast cancer who did or did not undergo local surgery, and to determine which patients could benefit from surgery. METHODS A total of 3,129 female patients with stage IV breast cancer aged ≥70 years between 2010 and 2015 were included in the Surveillance, Epidemiology, and End Results program. Multivariate Cox regression analysis was used to identify risk factors for overall survival (OS) and breast cancer-specific survival (BCSS). Survival analysis was performed using the Kaplan-Meier plot and log-rank test. Nomograms and risk stratification models were constructed. RESULTS Patients who underwent surgery had better OS (HR = 0.751, 95% CI [0.668-0.843], P < 0.001) and BCSS (HR = 0.713, 95% CI [0.627-0.810], P < 0.001) than patients who did not undergo surgery. Patients with human epidermal growth factor receptor 2-positive, lung or liver metastases may not benefit from surgery. In the stratification model, low-risk patients benefited from surgery (OS, HR = 0.688, 95% CI [0.568-0.833], P < 0.001; BCSS, HR = 0.632, 95% CI [0.509-0.784], P < 0.001), while patients in the high-risk group had similar outcomes (OS, HR = 0.920, 95% CI [0.709-1.193], P = 0.509; BCSS, HR = 0.953, 95% CI [0.713-1.275], P = 0.737). CONCLUSION Older female patients with stage IV breast cancer who underwent surgery had better OS and BCSS than those who did not in each specific subgroup. Patients in low- or intermediate-risk group benefit from surgery while those in the high-risk group do not.
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Affiliation(s)
- Yu-Qiu Chen
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China; Clinical Pharmacology, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Jia-Wei Xu
- Nanjing Medical School, Nanjing, 210002, Jiangsu, China
| | - Xiao-Fan Xu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Xu-Lin Wang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Li-Qun Huo
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Lu Wang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China
| | - Guo-Hua Zhou
- Clinical Pharmacology, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China.
| | - Jun Gu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command, PLA, Nanjing, 210002, Jiangsu, China.
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Pertuzumab and Trastuzumab Combination with Concomitant Locoregional Radiotherapy for the Treatment of Breast Cancers with HER2 Receptor Overexpression. Cancers (Basel) 2021; 13:cancers13194790. [PMID: 34638275 PMCID: PMC8507738 DOI: 10.3390/cancers13194790] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This retrospective study demonstrates that the combination of locoregional breast RT with dual HER2 blockade by pertuzumab/trastuzumab was very well tolerated, suggesting that RT can be safely administered to patients with HER2-positive breast cancer during dual HER2 blockade. Excellent locoregional control was achieved in irradiated patients. Abstract Background: The combination of pertuzumab and trastuzumab dual HER2 blockade with concomitant curative dose locoregional breast radiotherapy in patients with metastatic breast cancer is an important part of treatment strategy. Methods: This was a retrospective study conducted at the Institut Curie on all patients treated concomitantly with pertuzumab/trastuzumab and locoregional breast radiotherapy. Toxicity was evaluated according to the NCICTCAEv4.0. Overall survival, progression-free survival and locoregional recurrence-free survival were evaluated in metastatic patients who were initially well controlled by chemotherapy, for whom local treatment was decided by the multidisciplinary team. Results: Fifty-five patients treated between October 2013 and December 2019 were included, with a median follow-up of 4.1 years. The median age was 53 years (range: 28–81). All patients received curative dose radiotherapy (RT) concomitantly with pertuzumab and trastuzumab (Pertu/Trastu). The median radiation dose was 50 Gy. Safety evaluation did not reveal any significant adverse effects, with 3 cases of grade 3 radiodermatitis (5.4%), but no significant gastrointestinal or cardiac toxicity. The mean difference in LVEF before any chemotherapy and after radiotherapy was −2.43% (p < 0.01). Conclusions: This study demonstrates that the combination of locoregional breast RT with dual HER2 blockade by Pertu/Trastu was very well tolerated, suggesting that RT can be safely administered to patients with HER2-positive breast cancer.
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Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk NZ, Utkan Z, Evrensel T, Sezgin E. Primary Surgery with Systemic Therapy in Patients with de Novo Stage IV Breast Cancer: 10-year Follow-up; Protocol MF07-01 Randomized Clinical Trial. J Am Coll Surg 2021; 233:742-751.e5. [PMID: 34530124 DOI: 10.1016/j.jamcollsurg.2021.08.686] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this randomized clinical trial was to evaluate the overall survival (OS) data of patients diagnosed with de novo stage IV breast cancer (BC) who received locoregional treatment (LRT) over a 10-year follow-up. STUDY DESIGN The MF07-01 is a 1:1 multicenter, randomized clinical trial comparing the LRT with systemic therapy (ST), where ST was given to all patients either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS A total of 278 patients were randomized and 265 patients were in the final analysis. At 10-year follow-up, survivals were 19% (95% CI 13%-28%) and 5% (95% CI 2%-12%) in the LRT group and ST group, respectively. Median survival was 46 months for the LRT group and 35 months for the ST group, and hazard of death was 29% lower in the LRT group compared with the ST group (hazard ratio [HR] 0.71; 95% CI 0.59-0.86; p = 0.0003). CONCLUSIONS Patients with a diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 14% higher chance of OS by the end of the 10-year follow-up compared with the patients who received only ST. The longer study follow-up revealed that LRT should be presented to patients when discussing treatment options.
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Affiliation(s)
- Atilla Soran
- Department of Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA.
| | - Vahit Ozmen
- Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Capa, Istanbul, Turkey
| | | | - Abdullah Igci
- Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Zafer Utkan
- Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Uludag University School of Medicine, Bursa, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Izmir, Turkey
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Dieng O, Laurence V, Logerot C, Kirova YM. Eribulin combined with radiation therapy in a young patient re-irradiated for a new lesion of breast cancer. Breast J 2021; 27:787-790. [PMID: 34396635 DOI: 10.1111/tbj.14278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Eribulin is widely used in the treatment of metastatic breast cancer, with a manageable toxicity profile. This aggressive disease often requires systemic and local treatments, comprising surgery or radiotherapy. However, eribulin is usually discontinued during radiation therapy due to the lack of data concerning the safety of this combination, especially in the setting of repeat locoregional radiation therapy. Our patient was diagnosed with ER positive invasive ductal carcinoma of the left breast initially treated by surgery, radiation therapy, chemotherapy, and hormone therapy. She then received various lines of chemotherapy for multiple triple-negative relapses in the left axillary region. Since October 2020, she has been treated by eribulin. In order to improve local control, it was decided to add local radiation therapy to the region of recurrence in addition to systemic therapy. She underwent radiation therapy concomitantly with eribulin from February to March 2021. Treatment was very well tolerated, and no acute toxicity was reported. This is the first published case of repeat locoregional radiation therapy in combination with eribulin.
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Affiliation(s)
- Oulimata Dieng
- Department of Radiation Oncology, Institut Curie, Paris, France
| | | | | | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.,University Versailles St Quentin, Versailles, France
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22
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Kim YJ, Kim YJ, Kim YB, Lee IJ, Kwon J, Kim K, Cha J, Kim M, Jo IY, Kim JH, Park J, Kim JH, Kim J, Shin KH, Kim SS. Effect of Postoperative Radiotherapy after Primary Tumor Resection in De Novo Stage IV Breast Cancer: A Multicenter Retrospective Study (KROG 19-02). Cancer Res Treat 2021; 54:478-487. [PMID: 34265890 PMCID: PMC9016291 DOI: 10.4143/crt.2021.632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the impact of postoperative radiotherapy (PORT) in de novo metastatic breast cancer (dnMBC) patients undergoing planned primary tumor resection (PTR) and to identify the subgroup of patients who would most benefit from PORT. Materials and Methods This study enrolled 426 patients with dnMBC administered PTR alone or with PORT. The primary and secondary outcomes were overall and progression-free survival (OS and PFS), respectively. Results The median follow-up time was 53.7 months (range, 3.1-194.4). The 5-year OS and PFS rates were 73.2% and 32.0%, respectively. For OS, clinical T3/4 stage, triple-negative breast cancer (TNBC), postoperative chemotherapy alone were significantly poor prognostic factors, and administration of PORT failed to show its significance. Regarding PFS, PORT was a favorable prognostic factor (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.50-0.82, p <0.001), in addition to T1/2 stage, ≤5 metastases, and non-TNBC. According to the multivariate analyses of OS in the PORT group, we divided the patients into three groups [Group 1, T1/2 and non-TNBC (n=193); Group 2, T3/4 and non-TNBC (n=171); and Group 3, TNBC (n=49)], and evaluated the effect of PORT. Although PORT had no significance for OS in all subgroups, it was a significant factor for good prognosis regardingPFS in Group 1 and 2, not in Group 3. Conclusion PORT was associated with a significantly better PFS in patients with dnMBC who underwent PTR. Patients with clinical T1/2 stage and non-TNBC benefited most from PORT, while those with TNBC showed little benefit.
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Affiliation(s)
- Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Joo Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Korea
| | - Jung Hoon Kim
- Department of Radiation Oncology, Konyang University College of Medicine, Daejeon, Korea
| | - Jaehyeon Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Juree Kim
- Department of Radiation Oncology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Soares LR, Freitas-Junior R, Curado MP, Paulinelli RR, Martins E, Oliveira JC. Low Overall Survival in Women With De Novo Metastatic Breast Cancer: Does This Reflect Tumor Biology or a Lack of Access to Health Care? JCO Glob Oncol 2021; 6:679-687. [PMID: 32348160 PMCID: PMC7193803 DOI: 10.1200/jgo.19.00408] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE As a result of its epidemiologic and therapeutic aspects, metastatic breast cancer (MBC) is a highly relevant clinical condition. This study aimed to estimate overall survival (OS) in women with de novo MBC in a Brazilian population. PATIENTS AND METHODS Patients were identified in the Goiânia population-based cancer registry between 1995 and 2011. All women with metastatic disease at diagnosis were included in the study. OS was analyzed at 5 and 10 years of follow-up. We used the Kaplan-Meier estimator and Cox regression for statistical analysis. RESULTS Over the 16-year period covered by the study, 5,289 women were diagnosed with breast cancer in Goiânia. Of these, 277 women (5.2%) had MBC. OS rates at 5 and 10 years were 19.9% and 7.3%, respectively. The mean OS time of women treated in the public health system was 7.5 months shorter than in women who had private health care (19.7 v 27.2 months, respectively). In the univariable analysis, the following factors were statistically significant for OS: T3/4 staging, histologic grade 3, progesterone receptor status, tumor phenotype, breast surgery, CNS metastasis at initial presentation, and surgery for resection of metastasis. In multivariable analysis, initial CNS metastasis (hazard ratio, 3.09; 95% CI, 1.16 to 8.19) and breast surgery (hazard ratio, 0.45; 95% CI, 0.25 to 0.78) remained independent prognostic factors. CONCLUSION OS was lower than rates found in specialist centers in Brazil and in developed countries. Several intrinsic and extrinsic factors were significant in predicting OS. Despite the difference in the 5-year survival rate, the type of access to health care was not significant in the multivariable analysis of the entire period.
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Affiliation(s)
- Leonardo R Soares
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Ruffo Freitas-Junior
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.,Hospital Araújo Jorge, Association for the Combat of Cancer in Goiás, Goiânia, Goiás, Brazil
| | - Maria P Curado
- A.C. Camargo Cancer Center, Fundação Antônio Prudente, São Paulo, São Paulo, Brazil
| | - Regis R Paulinelli
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.,Hospital Araújo Jorge, Association for the Combat of Cancer in Goiás, Goiânia, Goiás, Brazil
| | - Edesio Martins
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - José C Oliveira
- Goiânia Population-Based Cancer Registry, Association for the Combat of Cancer in Goiás, Goiânia, Goiás, Brazil
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Impact of loco-regional treatment including radiotherapy in patients presenting with metastatic breast cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
The impact of loco-regional treatment (LRT) with radiotherapy (RT) in patients presenting with metastatic breast cancer (MBC) has not been widely studied. The aim of this study was to review the treatment outcomes of LRT including RT in patients with MBC.
Materials and methods:
Patients who presented with MBC were included in this retrospective study. Analysis was undertaken to determine the difference in local disease control, overall survival (OS) and progression-free survival (PFS) with systemic treatment alone, surgery alone, surgery plus RT and RT alone with long-rank test. Multivariate analysis was done, using the cox regression for factors affecting PFS and OS.
Results:
From 2007 to 2014, data of 257 patients with MBC were collected. Totally, 185 patients received LRT and 72 did not. LRT was surgery plus RT, surgery only and RT only in 113, 47 and 25 patients, respectively. Cytotoxic chemotherapy and hormone therapy were received by 205 and 166 patients, respectively. Median follow-up was 36 months (6–120 months). PFS and OS at 3 years with and without LRT were 31% versus 6% (p < 0·001) and 41% versus 17% (p < 0·001), respectively. PFS at 3 years with surgery plus RT, RT alone and surgery was 40, 33 and 6%, respectively. OS at 3 years with surgery plus RT, RT alone and surgery was 50, 38 and 17%, respectively. Patients without LRT had worse PFS and OS, 6 and 17%, respectively. RT had significant impact on PFS and OS along with chemotherapy and hormone treatment.
Conclusion:
In patients with MBC, improved local control, PFS and OS were achieved with loco-regional RT. Loco-regional RT along with chemotherapy and hormones were significant factors for PFS and OS irrespective of surgery.
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Ben Dhia S, Loap P, Loirat D, Vincent-Salomon A, Cao K, Escalup L, Fourquet A, Kirova Y. [Concurrent radiation therapy and dual HER2 blockade in breast cancer: Assessment of toxicity]. Cancer Radiother 2021; 25:424-431. [PMID: 33771453 DOI: 10.1016/j.canrad.2020.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE The tolerance of the concurrent use of radiotherapy, pertuzumab and trastuzumab is unknown. The purpose of this study was to evaluate the toxicity of this association in patients treated for HER2 positive metastatic and/or locally recurrent unrespectable breast cancer. MATERIAL AND METHODS A retrospective study was performed in our institution for all consecutive patients treated with concurrent irradiation, pertuzumab and trastuzumab. The radiotherapy was performed while pertuzumab and trastuzumab were administrated as a maintenance treatment at the dose of 420mg (total dose) and 6mg/kg respectively every 3 weeks without chemotherapy. Toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Left ventricular ejection fraction (LVEF) was measured at baseline and then every 3-4 months. RESULTS We studied 77 patients. treated in between 2013 and 2019 with median follow-up of 38 months (range 0-264 months). Median age was 53 years (33-86). There were 50 patients (64.9%) with metastatic and 27 patients (35.1%) with recurrent disease. All patients received docetaxel followed by P-T as first line treatment and they received 34 cycles (10-85) of pertuzumab and trastuzumab. All patients experienced partial or complete response according to RECIST criteria. Irradiation volumes were whole breast (41 patients, 53.2%) and chest wall (29 patients, 37.7%) at a dose of 50Gy with a median duration of 39 days. Radiotherapy of lymph nodes was performed in 53 patients (68.8%) as following: supraclavicular-infraclavicular and axillary lymph nodes in 52 patients (67.5%), and internal mammary nodes in 31 patients (40.3%). For 20 patients. (26.0%) radiotherapy was palliative: bone irradiation (12 patients, 15.6%), whole-brain radiotherapy (2 patients, 2.6%), cerebral metastasis irradiation (6 patients). As early toxicity we observed: radio dermatitis as following: 36 patients (46.8%) presented grade I, 17 patients (22.1%) presented grade II, and 3 patients (3.9%) presented grade III. One patient (1.3%) presented grade II esophagitis. One patient (1.3%) presented asymptomatic decrease of LVEF during treatment and 6 patients (7.7%) presented a decrease of LVEF. There was no radiation-induced pneumonitis. As late toxicity, we observed 1 (1.3%) case of grade I and 1 (1.3%) with grade II telangiectasia. There was 1 case (1.3%) of grade III cardiac toxicity, 8 months after the concurrent treatment. CONCLUSION The concurrent use of radiotherapy, pertuzumab and trastuzumab is feasible with good tolerance. Larger prospective data with longer follow-up is needed to confirm these results.
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Affiliation(s)
- S Ben Dhia
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - P Loap
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - D Loirat
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | | | - K Cao
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - L Escalup
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Locoregional Therapy for the Primary Tumour in Women with a De Novo Diagnosis of Metastatic Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Soran A, Dogan L, Isik A, Ozbas S, Trabulus DC, Demirci U, Karanlik H, Soyder A, Dag A, Bilici A, Dogan M, Koksal H, Sendur MAN, Gulcelik MA, Maralcan G, Cabioglu N, Yeniay L, Utkan Z, Simsek T, Karadurmus N, Daglar G, Yildiz B, Uras C, Tukenmez M, Yildirim A, Kutun S, Ozaslan C, Karaman N, Akcay MN, Toktas O, Sezgin E. The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study. Ann Surg Oncol 2021; 28:5048-5057. [PMID: 33532878 DOI: 10.1245/s10434-021-09621-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND More evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM). METHODS The prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group). RESULTS We included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30-0.54, p < 0.0001). CONCLUSION In this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, UPMC (University of Pittsburgh Medical Center) Magee-Womens Hospital, Pittsburgh, USA.
| | - Lutfi Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Arda Isik
- Department of Surgery, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Serdar Ozbas
- Private, Breast and Endocrine Surgeon, Ankara, Turkey
| | - Didem Can Trabulus
- Department of Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Umut Demirci
- Department of Medical Oncology, Memorial Ankara Hospital, University of Uskudar School of Medicine, Istanbul, Turkey
| | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Aykut Soyder
- Department of Surgery, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Ahmet Dag
- Department of Surgery, School of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, School of Medicine, Medipol University, Istanbul, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hande Koksal
- Department of Surgery, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Mehmet Ali Nahit Sendur
- Department of Medical Oncology, School of Medicine, Yıldırım Beyazit University, Ankara, Turkey
| | - Mehmet Ali Gulcelik
- Department of Surgical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gokturk Maralcan
- Department of Surgery, School of Medicine, Sanko University, Gaziantep, Turkey
| | - Neslihan Cabioglu
- Department of Surgery, School of Medicine Istanbul University, Istanbul, Turkey
| | - Levent Yeniay
- Department of Surgery, School of Medicine, Ege University, Izmir, Turkey
| | - Zafer Utkan
- Department of Surgery, School of Medicine, Kocaeli University, İzmit, Turkey
| | - Turgay Simsek
- Department of Surgery, School of Medicine, Kocaeli University, İzmit, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gul Daglar
- Private, Breast and Endocrine Surgeon, Ankara, Turkey
| | - Birol Yildiz
- Department of Medical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cihan Uras
- Department of Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of Surgery, School of Medicine Istanbul University, Istanbul, Turkey
| | - Ahmet Yildirim
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Suat Kutun
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cihangir Ozaslan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Niyazi Karaman
- Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Müfide Nuran Akcay
- Department of Surgery, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Osman Toktas
- Department of Surgery, School of Medicine, Yuzuncuyıl University, Van, Turkey
| | - Efe Sezgin
- Department of Food and Engineering, Faculty of Engineering, Izmir Institute of Technology, Izmir, Turkey
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Liu D, Wu J, Lin C, Andriani L, Ding S, Shen K, Zhu L. Breast Subtypes and Prognosis of Breast Cancer Patients With Initial Bone Metastasis: A Population-Based Study. Front Oncol 2020; 10:580112. [PMID: 33344236 PMCID: PMC7739957 DOI: 10.3389/fonc.2020.580112] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/03/2020] [Indexed: 01/10/2023] Open
Abstract
Background Metastatic breast cancer (MBC) is a highly heterogeneous disease and bone is one of the most common metastatic sites. This retrospective study was conducted to investigate the clinical features, prognostic factors and benefits of surgery of breast cancer patients with initial bone metastases. Methods From 2010 to 2015, 6,860 breast cancer patients diagnosed with initial bone metastasis were analyzed from Surveillance, Epidemiology, and End Results (SEER) database. Univariate and Multivariable analysis were used to identify prognostic factors. A nomogram was performed based on the factors selected from cox regression result. Survival curves were plotted according to different subtypes, metastatic burdens and risk groups differentiated by nomogram. Results Hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) positive patients showed the best outcome compared to other subtypes. Patients of younger age (<60 years old), white race, lower grade, lower T stage (<=T2), not combining visceral metastasis tended to have better outcome. About 37% (2,249) patients received surgery of primary tumor. Patients of all subtypes could benefit from surgery. Patients of bone-only metastases (BOM), bone and liver metastases, bone and lung metastases also showed superior survival time if surgery was performed. However, patients of bone and brain metastasis could not benefit from surgery (p = 0.05). The C-index of nomogram was 0.66. Cutoff values of nomogram point were identified as 87 and 157 points, which divided all patients into low-, intermediate- and high-risk groups. Patients of all groups showed better overall survival when receiving surgery. Conclusion Our study has provided population-based prognostic analysis in patients with initial bone metastatic breast cancer and constructed a predicting nomogram with good accuracy. The finding of potential benefit of surgery to overall survival will cast some lights on the treatment tactics of this group of patients.
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Affiliation(s)
- Deyue Liu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Caijin Lin
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lisa Andriani
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuning Ding
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Pons-Tostivint E, Alouani E, Kirova Y, Dalenc F, Vaysse C. Is there a role for locoregional treatment of the primary tumor in de novo metastatic breast cancer in the era of tailored therapies?: Evidences, unresolved questions and a practical algorithm. Crit Rev Oncol Hematol 2020; 157:103146. [PMID: 33227574 DOI: 10.1016/j.critrevonc.2020.103146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Improvements in systemic therapies have changed the face of de novo metastatic breast cancer (dnMBC), with a 5-year survival rate exceeding 25 %. Increasing evidence suggests that a subset of patients could benefit from a locoregional treatment (LRT) with prolonged survival, although the diversity of publications on the subject make it difficult to draw any conclusions. In this review, we summarize the available data on retrospective, prospective and current ongoing clinical trials. Since factors such as tumor biology, pattern of metastatic dissemination and the timing of the treatment are closely linked to the therapeutic strategy, we focus on papers which include these aspects. We discuss recent studies indicating that exclusive radiotherapy provides results comparable with those obtained by surgery. We will then discuss the biological rationale for LRT. Finally, we propose a decision-tree to select the optimal candidates for LRT in dnMBC patients.
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Affiliation(s)
- E Pons-Tostivint
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.
| | - E Alouani
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - Y Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - F Dalenc
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - C Vaysse
- Surgical Department, Toulouse University Hospital Center (CHU Toulouse), IUCT-Oncopole, 31000, Toulouse, France
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30
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Lee JS, Toktas O, Soran A. Role of Locoregional Treatment in De Novo Stage IV Breast Cancer. Clin Med Insights Oncol 2020; 14:1179554920942440. [PMID: 32994701 PMCID: PMC7502854 DOI: 10.1177/1179554920942440] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/16/2020] [Indexed: 12/27/2022] Open
Abstract
It is estimated that approximately 154000 women in the United States have stage IV breast cancer (BC). A subset of this group has metastatic disease at presentation, known as de novo stage IV disease. De novo stage IV BC accounts for approximately 6% of all BC diagnoses in the United States. Traditionally, stage IV BC patients are treated with primary systemic therapy with a palliative intent reserving possible locoregional treatment (LRT) as last resort. There has been a lot of interest in the role of LRT in de novo stage IV BC for the past decade with mixed conclusions. Although this review is not intended to be a comprehensive overview of all literature regarding this topic to date, we will review the recent findings in literature focusing on the studies with larger sample sizes to investigate the role of LRT in de novo stage IV BC.
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Affiliation(s)
- Joanna S Lee
- Section of Breast Surgical Oncology, Division of Surgical Oncology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Osman Toktas
- Section of Breast Surgical Oncology, Division of Surgical Oncology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Atilla Soran
- Section of Breast Surgical Oncology, Division of Surgical Oncology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA, USA
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31
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Ghannam Y, Bourgier C, Legouté F, Gonzalez-Moya A, Lizée T, Trémolières P, Hennequin C. [Treatment of primary disease with irradiation in case of de novo metastatic breast cancer]. Cancer Radiother 2020; 24:567-575. [PMID: 32814669 DOI: 10.1016/j.canrad.2020.06.008] [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: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022]
Abstract
Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France.
| | - C Bourgier
- Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier IRCM, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Inserm, U1194, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - F Legouté
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - A Gonzalez-Moya
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - P Trémolières
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris, France
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Yoshimura M. Radiation therapy for primary tumor of de novo stage IV breast cancer. Transl Cancer Res 2020; 9:5108-5116. [PMID: 35117877 PMCID: PMC8797856 DOI: 10.21037/tcr.2020.02.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022]
Abstract
Despite recent advances in multimodality treatments such as endocrine therapy, chemotherapy, molecularly targeted therapy, and radiation therapy, it is still very difficult to cure de novo stage IV breast cancer patients completely. The traditional role of radiation therapy for these patients has been a palliative treatment strategy that aims to control tumor progression and suppress tumor related symptoms. Recently, several non-randomized retrospective studies on de novo stage IV breast cancer have revealed that locoregional radiation therapy (LRRT) might confer a survival benefit. However, there is no high level evidence to support the impact of LRRT on survival among patients with de novo metastatic disease so far. This article aimed to summarize the literature and to discuss whether treating the primary lesion with radiation therapy could improve clinical survival outcomes among de novo stage IV breast cancer patients. The issue of patient selection will be discussed because not all de novo stage IV breast cancer patients could benefit from LRRT. This article also explores the clinical evidence regarding LRRT for de novo metastatic disease across various cancers such as prostate, uterine cervical, non-small-cell lung, and head and neck cancers. Many retrospective trials have shown the impact of locoregional treatment (LRT) on survival in de novo metastatic breast cancer. However, since the backgrounds of patients treated with LRRT are quite different from those of patients who did not receive LRRT and the treatment consists of surgery and/or radiation therapy, the role of radiation therapy alone remains unclear. Several reports investigated prognostic factors to detect the benefits of LRRT, which still remains conflicting and no consensus exists. However, selected patients with de novo metastatic disease with better performance status, low tumor burden, and estrogen receptor positivity should be considered for the addition of radiation therapy delivered to the primary site. To explore proper decision-making regarding LRRT, further prospective randomized trials are eagerly awaited.
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Affiliation(s)
- Michio Yoshimura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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Frank S, Carton M, Dubot C, Campone M, Pistilli B, Dalenc F, Mailliez A, Levy C, D'Hondt V, Debled M, Vermeulin T, Coudert B, Perrin C, Gonçalves A, Uwer L, Ferrero JM, Eymard JC, Petit T, Mouret-Reynier MA, Patsouris A, Guesmia T, Bachelot T, Robain M, Cottu P. Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life ESME metastatic breast cancer cohort. Breast 2020; 52:50-57. [PMID: 32380440 PMCID: PMC7375638 DOI: 10.1016/j.breast.2020.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Young age is a poor prognostic factor in early stage breast cancer (BC) but its value is less established in metastatic BC (MBC). We evaluated the impact of age at MBC diagnosis on overall survival (OS) across three age groups (<40, 40 to 60 and > 60 years(y)). METHODS ESME MBC database is a national cohort, collecting retrospective data from 18 participating French cancer centers between January 01, 2008 and December 31, 2014. RESULTS Among 14 403 women included, 1077 (7.5%), 6436 (44.7%) and 6890 (47.8%) pts were <40, 40-60 and > 60 y respectively. Pts <40 had significantly more aggressive presentations than other age groups: more frequent HER2+ (25.7 vs 15.3% in >60y) and triple negative subtypes (27.4 vs 14.6% in >60y), and more frequent visceral involvement (36.3 vs 29.8% in >60y). At a median follow-up of 48 months, median OS differed across age groups: 38.8, 38.4 and 35.6 months for pts <40, 40-60 and > 60y, respectively (p < 0.0001). Compared to pts <40y, older pts had a statistically significant higher risk of death (all causes of death included), although of limited clinical value (HR = 1.1, IC 95%:1.01-1.20). There was a significant trend for better OS in pts <40y with HER2+ and luminal diseases. A possible explanation is a greater use of anti-Her2 therapies as first-line treatments: 86.6, 81.9 and 74.9% for pts <40, 40-60 and > 60y, respectively (p < 0.0001). CONCLUSION Although young age seems associated with more aggressive presentations at diagnosis of MBC, it has no deleterious effect on OS in this large series.
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Affiliation(s)
- Sophie Frank
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
| | - Matthieu Carton
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
| | - Coraline Dubot
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
| | - Mario Campone
- Institut de Cancérologie de l'Ouest, site René Gauducheau, Site Hospitalier Nord, Boulevard Jacques Monod, 44800, Saint-Herblain, France.
| | - Barbara Pistilli
- Gustave Roussy, 39, Rue Camille Desmoulins, 94800, Villejuif, France.
| | - Florence Dalenc
- Institut Claudius Régaud, 1, Av Irène Joliot Curie, 31059, Toulouse, France.
| | - Audrey Mailliez
- Centre Oscar Lambret, 3, Rue Frédéric Combemale, 59000, Lille, France.
| | - Christelle Levy
- Centre François Baclesse, 3, Avenue du Général Harris, 14000, Caen, France.
| | - Véronique D'Hondt
- Institut du Cancer de Montpellier, 208, Av. Apothicaires, 34298, Montpellier, France.
| | - Marc Debled
- Institut Bergonié, 229, Cours de l'Argonne, 33000, Bordeaux, France.
| | | | - Bruno Coudert
- Centre Georges-François Leclerc, 1, Rue du Professeur Marion, 21079, Dijon, France.
| | - Christophe Perrin
- Centre Eugène Marquis, Avenue de la Bataille Flandre Dunkerque, 35042, Rennes, France.
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, 232, BD Ste Marguerite, 13009, Marseille, France.
| | - Lionel Uwer
- Institut de Cancérologie de Lorraine, 6, Avenue Bourgogne, 54519, Vandoeuvre les Nancy, France.
| | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, 33, Avenue de Valombrose, 06189, Nice, France.
| | | | - Thierry Petit
- Centre Paul Strauss, 3, Rue de la Porte de l'Hôpital, 67065, Strasbourg, France.
| | | | - Anne Patsouris
- Institut de Cancérologie de l'Ouest, site Paul Papin, 15, Rue André Boquel, 49055, Angers, France.
| | - Tahar Guesmia
- R&D Unicancer, 67 avenue Fontainebleau 94270 Le Kremlin Bicêtre, France.
| | | | - Mathieu Robain
- R&D Unicancer, 67 avenue Fontainebleau 94270 Le Kremlin Bicêtre, France.
| | - Paul Cottu
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
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Pons-Tostivint E, Kirova Y, Lusque A, Campone M, Geffrelot J, Rivera S, Mailliez A, Pasquier D, Madranges N, Firmin N, Crouzet A, Gonçalves A, Jankowski C, De La Motte Rouge T, Pouget N, De La Lande B, Mouttet-Boizat D, Ferrero JM, Uwer L, Eymard JC, Mouret-Reynier MA, Petit T, Courtinard C, Filleron T, Robain M, Dalenc F. Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis. Radiother Oncol 2020; 145:109-116. [DOI: 10.1016/j.radonc.2019.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
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Mudgway R, Chavez de Paz Villanueva C, Lin AC, Senthil M, Garberoglio CA, Lum SS. The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy. Ann Surg Oncol 2020; 27:2711-2720. [PMID: 32157524 DOI: 10.1245/s10434-020-08310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We sought to examine the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients in the era of HER2 targeted therapy. METHODS We conducted a retrospective cohort study of women with HER2+ stage IV breast cancer in the National Cancer Database from 2010 to 2012 comparing those who did and did not undergo definitive breast surgery. RESULTS Of 3231 patients, treatment included primary site surgery in 35.0%; chemo/targeted therapy in 89.4%; endocrine therapy in 37.7%; and radiation in 31.8%. Surgery was associated with Medicare/other government (OR 1.36, 95% CI 1.03-1.81) or private insurance (OR 1.93, 95% CI 1.53-2.42) versus none/Medicaid, radiation (OR 2.10, 95% CI 1.76-2.51), chemo/targeted therapy (OR 1.99, 95% CI 1.47-2.70), and endocrine therapy (OR 1.73, 95% CI 1.40-2.14). Non-Hispanic Black versus White patients (OR 0.68, 95% CI 0.53-0.87) were less likely to have surgery. Overall mortality was associated with insurance (Medicare/other government versus none/Medicaid, HR 0.36, p < 0.0001), receipt of chemo/targeted therapy (HR 0.76, p = 0.008), endocrine therapy (HR 0.70, p = 0.0006), and radiation therapy (HR 1.33, p = 0.0009), NH Black versus White race/ethnicity (HR 1.39, p = 0.002), visceral versus bone-only metastases (HR 1.44, p = 0.0003), and lowest versus highest income quartile (HR 1.36, p = 0.01). Propensity score analysis showed surgery was associated with improved survival versus no surgery (HR 0.56, 95% CI 0.40-0.77). CONCLUSIONS Surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in selected patients.
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Affiliation(s)
- Ross Mudgway
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA.,School of Medicine, University of California, Riverside, Riverside, CA, USA
| | | | - Ann C Lin
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Maheswari Senthil
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Carlos A Garberoglio
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Sharon S Lum
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA. .,School of Medicine, University of California, Riverside, Riverside, CA, USA.
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Gera R, Chehade HELH, Wazir U, Tayeh S, Kasem A, Mokbel K. Locoregional therapy of the primary tumour in de novo stage IV breast cancer in 216 066 patients: A meta-analysis. Sci Rep 2020; 10:2952. [PMID: 32076063 PMCID: PMC7031518 DOI: 10.1038/s41598-020-59908-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy. However, there is mounting evidence that resection of the primary tumour and/or localised radiotherapy (locoregional therapy; LRT) could be associated with overall survival improvements. We aimed to conduct a meta-analysis to inform decision making. Using the PubMed, Cochrane and Ovid SP databases, a literature review and meta-analysis were conducted to assess the effect of LRT on overall survival. Studies were analysed for the impact of LRT on survival. All forms of LRT resulted in a significant 31.8% reduction in mortality (N = 42; HR = 0.6823 (95% CI 0.6365; 0.7314)). Surgical resection resulted in a significant 36.2% reduction in mortality (N = 37; HR = 0.6379 (95% CI 0.5974; 0.6811)). The prospective trials reported a 19.23% reduction in mortality which was not statistically significant (N = 3, HR = 0.8077 (95% CI 0.5704; 1.1438). 216 066 patients were included. This is the largest meta-analysis regarding this question to date. Our meta-analysis shows that LRT of the primary tumour seems to improve overall survival in de novo stage IV disease. Therefore, this therapeutic option should be considered in selected patients after a careful multidisciplinary discussion.
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Affiliation(s)
- Ritika Gera
- The London Breast Institute, Princess Grace Hospital, London, UK
| | | | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Salim Tayeh
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Abdul Kasem
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, UK.
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Wang Z, Wang H, Sun X, Fang Y, Lu SS, Ding SN, Chen XS, Shen KW. A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis. Front Oncol 2020; 10:14. [PMID: 32038988 PMCID: PMC6992581 DOI: 10.3389/fonc.2020.00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: This research aimed to construct a novel model for predicting overall survival (OS) and surgical benefit in triple-negative breast cancer (TNBC) patients with de novo distant metastasis. Methods: We collected data from the Surveillance, Epidemiology, and End Results (SEER) database for TNBC patients with distant metastasis between 2010 and 2016. Patients were excluded if the data regarding metastatic status, follow-up time, or clinicopathological information were incomplete. Univariate and multivariate analyses were applied to identify significant prognostic parameters. By integrating these variables, a predictive nomogram and risk stratification model were constructed and assessed with C-indexes and calibration curves. Results: A total of 1,737 patients were finally identified. Patients enrolled from 2010 to 2014 were randomly assigned to two cohorts, 918 patients in the training cohort and 306 patients in the validation cohort I, and 513 patients enrolled from 2015 to 2016 were assigned to validation cohort II. Seven clinicopathological factors were included as prognostic variables in the nomogram: age, marital status, T stage, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The C-indexes were 0.72 [95% confidence interval [CI] 0.68-0.76] in the training cohort, 0.71 (95% CI 0.68-0.74) in validation cohort I and 0.71 (95% CI 0.67-0.75) in validation cohort II. Calibration plots indicated that the nomogram-based predictive outcome had good consistency with the recoded prognosis. A risk stratification model was further generated to accurately differentiate patients into three prognostic groups. In all cohorts, the median overall survival time in the low-, intermediate- and high-risk groups was 17.0 months (95% CI 15.6-18.4), 11.0 months (95% CI 10.0-12.0), and 6.0 months (95% CI 4.7-7.3), respectively. Locoregional surgery improved prognosis in both the low-risk [hazard ratio [HR] 0.49, 95% CI 0.41-0.60, P < 0.0001] and intermediate-risk groups (HR 0.55, 95% CI 0.46-0.67, P < 0.0001), but not in high-risk group (HR 0.73, 95% CI 0.52-1.03, P = 0.068). All stratified groups could prognostically benefit from chemotherapy (low-risk group: HR 0.50, 95% CI 0.35-0.69, P < 0.0001; intermediate-risk group: HR 0.34, 95% CI 0.26-0.44, P < 0.0001; and high-risk group: HR 0.16, 95% CI 0.10-0.25, P < 0.0001). Conclusion: A predictive nomogram and risk stratification model were constructed to assess prognosis in TNBC patients with de novo distant metastasis; these methods may provide additional introspection, integration and improvement for therapeutic decisions and further studies.
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Affiliation(s)
- Zheng Wang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Sun
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Fang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang-Shuang Lu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Ning Ding
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Song Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun-Wei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lin H, Wu Y, Liang G, Chen L. Establishing a predicted model to evaluate prognosis for initially diagnosed metastatic Her2-positive breast cancer patients and exploring the benefit from local surgery. PLoS One 2020; 15:e0242155. [PMID: 33170907 PMCID: PMC7654787 DOI: 10.1371/journal.pone.0242155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For patients initially diagnosed with metastatic Her2-positive breast cancer (MHBC), we intended to construct a nomogram with risk stratification to predict prognosis and to explore the role of local surgery. METHODS We retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier (KM) method and log-rank test were used for the selection of significant variables. Cox regression analysis and Fine-Gray test were utilized to confirm independent prognostic factors of overall survival (OS) and breast cancer-specific survival (BCSS). A nomogram predicting 1-year, 3-year, and 5-year OS was developed and validated. Patients were stratified based on the optimal cut-off values of total personal score. KM method and log-rank test were used to estimate OS prognosis and benefit from local surgery and chemotherapy. RESULTS There were 1680 and 717 patients in the training and validation cohort. Age, race, marriage, T stage, estrogen receptor (ER) status, visceral metastasis (bone, brain, liver and lung) were identified as independent prognostic factors for OS and BCSS, while histology was also corelated with OS. C-indexes in the training and validation cohort were 0.70 and 0.68, respectively. Calibration plots indicated precise predictive ability. The total population was divided into low- (<141 points), intermediate- (142-208 points), and high-risk (>208 points) prognostic groups. Local surgery and chemotherapy brought various degrees of survival benefit for patients with diverse-risk prognosis. CONCLUSIONS We constructed a model with accurate prediction and discrimination. It would provide a reference for clinicians' decision-making. Surgery on the primary lesion was recommended for patients with good physical performance status, while further study on optimal surgical opportunity was needed.
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Affiliation(s)
- Hong Lin
- Department of Oncology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yanxuan Wu
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Guoxi Liang
- Department of Oncology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Liming Chen
- Department of Oncology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- * E-mail:
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Traitement de la maladie primitive (cancers du sein, du poumon non à petites cellules et de la prostate), par irradiation, au stade d’emblée métastatique. Cancer Radiother 2019; 23:486-495. [DOI: 10.1016/j.canrad.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
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