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Jacob SA, Do V, Wilson BE, Ng WL, Barton MB. The value of first-line chemotherapy and targeted therapy in the treatment of breast cancer. Eur J Cancer Care (Engl) 2020; 30:e13352. [PMID: 33146449 DOI: 10.1111/ecc.13352] [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] [Received: 01/19/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the value (survival benefit and cost) of first-line chemotherapy and targeted therapy in breast cancer at a population level. METHODS Based on guideline recommendations, a model of optimal utilisation was constructed for first-line chemotherapy and targeted therapy in breast cancer, calculating the survival benefit and average cost of all regimens recommended for each treatment indication at 5 years and at 10 years. RESULTS Survival benefits from chemotherapy and targeted therapy differ markedly depending on the treatment indications. The cost per life-year gained at 5 years is $38,044 for stages I and II, $33,749 for stage III and $ 151,668 for patients presenting with stage IV breast cancer. The cost per life-year gained at 10 years is $ 13,587 for early breast cancer. The most expensive chemotherapy indication in breast cancer is the treatment of metastatic HER2-positive breast cancer costing $330,978 per LYG for a survival benefit of 11% at 5 years falling to zero survival benefit at 10 years. CONCLUSION There are large differences in value between the different indications for first-course chemotherapy and targeted therapy in the treatment of breast cancer that should be considered when pricing cancer drugs.
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Affiliation(s)
- Susannah A Jacob
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Viet Do
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Radiation Oncology, Liverpool Hospital Cancer Therapy Centre, Sydney, NSW, Australia
| | - Brooke E Wilson
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Medical Oncology, Liverpool Hospital Cancer Therapy Centre, Sydney, NSW, Australia
| | - Weng L Ng
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Medical Oncology, Liverpool Hospital Cancer Therapy Centre, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Michael B Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Radiation Oncology, Liverpool Hospital Cancer Therapy Centre, Sydney, NSW, Australia
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Gastric Linitis Plastica and Peritoneal Carcinomatosis as First Manifestations of Occult Breast Carcinoma: A Case Report and Literature Review. Case Rep Oncol Med 2018; 2018:4714708. [PMID: 30073103 PMCID: PMC6057327 DOI: 10.1155/2018/4714708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 12/27/2022] Open
Abstract
Gastric linitis plastica is a diffuse involvement of the stomach walls by neoplastic cells. It represents about 3–19% of primitive gastric adenocarcinomas, but it can also be the manifestation of a metastatic disease. Breast cancer is the most frequent malignancy in women, and the metastatic spread to the stomach occurs in less than 10% of the cases. We present an unusual case of gastric linitis plastica and peritoneal carcinomatosis as manifestations of an occult breast cancer in a 53-year-old woman. Imaging and endoscopic evaluation were not able to discriminate a primary from a secondary gastric lesion. The histological evaluation excluded the diagnosis of a primary gastric neoplasia. The IHC profile was consistent with the diagnosis of metastases from the breast cancer. Due to the hormonal receptors' positivity, we started therapy with fulvestrant (500 mg, day 0, 14, and 28 and every 28 days thereafter by intramuscular injection). After 20 months, the same therapy is still ongoing and well tolerated, while the patient is in good condition with improvement of the dysphagia. Almost 2 years after the diagnosis of linitis plastica, the primitive breast lesion is still occult.
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Yagi Y, Sasaki S, Yoshikawa A, Tsukioka Y, Fukushima W, Fujimura T, Hirosawa H, Izumi R, Saito K. Metastatic gastric carcinoma from breast cancer mimicking primary linitis plastica: A case report. Oncol Lett 2015; 10:3483-3487. [PMID: 26788154 PMCID: PMC4665745 DOI: 10.3892/ol.2015.3788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 09/17/2015] [Indexed: 12/18/2022] Open
Abstract
Metastases to the gastrointestinal tract rarely occur in breast cancer except in invasive lobular carcinoma. The present study reports a rare case of metastatic gastric cancer from invasive ductal carcinoma (IDC) of the breast mimicking primary gastric linitis plastica. A 51-year-old premenopausal female, who had a history of partial mastectomy for right breast cancer at the age of 40, was referred to Toyama City Hospital (Toyoma, Japan) for an endoscopic diagnosis of gastric linitis plastica. Abdominal computed tomography (CT) revealed left hydronephrosis, while peritoneal metastasis and malignant ascites were not detected. Chest CT detected a left lung tumor, which had invaded the left upper bronchus. Biopsy specimens were obtained and the histopathological findings on both the gastric tumor and lung tumor demonstrated poorly differentiated adenocarcinoma, whereas the histology of the original breast cancer was IDC with a solid-tubular type. Immunohistochemistry revealed that the biopsied specimens of the gastric and lung tumors were positive for estrogen receptor (ER), progesterone receptor (PgR) and negative for human epithelial growth factor receptor-2 (HER2). These molecular characteristics indicated the case was metastatic gastric carcinoma from the breast cancer with lung metastasis, since the statuses of ER, PgR and HER2 were concordant with those of the original breast cancer. However, the possibility of primary gastric cancer could not be completely ruled out. Therefore, a total gastrectomy was performed for the purpose of both diagnosis and treatment. Pathological examination of the resected specimen provided a definite diagnosis of multiple metastatic gastric carcinomas from the breast. To the best of our knowledge, metastatic gastric cancer derived from the breast presenting as linitis plastica 11 years following the surgical removal of IDC has not been described previously.
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Affiliation(s)
- Yasumichi Yagi
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Shozo Sasaki
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Akemi Yoshikawa
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Yuji Tsukioka
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Wataru Fukushima
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Takashi Fujimura
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Hisashi Hirosawa
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Ryohei Izumi
- Department of Surgery, Toyama City Hospital, Toyama 939-8511, Japan
| | - Katsuhiko Saito
- Department of Pathology, Toyama City Hospital, Toyama 939-8511, Japan
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Impact of age-related socio-economic and clinical determinants of quality of life among long-term breast cancer survivors. Maturitas 2015; 81:362-70. [PMID: 25911244 DOI: 10.1016/j.maturitas.2015.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The main purpose of this study was to identify age-related socioeconomic and clinical determinants of quality of life among breast cancer survivors five years after the diagnosis. The secondary objective was to describe quality of life in the studied population according to age. STUDY DESIGN A cross-sectional survey in five-year breast cancer survivors was conducted in women diagnosed with breast cancer in 2007 and 2008 in Côte d'Or. MAIN OUTCOME MEASURES Quality of life was assessed with the SF-12, the EORTC-QLQ-C30 and the EORTC-QLQ-BR23 questionnaires. Socio-economic deprivation was assessed by the EPICES questionnaire. Social support was assessed by the Sarason questionnaire and clinical features were collected through the Côte d'Or breast cancer registry. Age-related determinants of quality of life were identified using multivariate mixed model analysis for each SF-12 dimension. RESULTS Overall 396 women completed the questionnaires. Women aged <65 years had a better quality of life and a greater availability of social support than did women aged ≥65 years. Body mass index, relapse and EPICES were found to be determinants of quality of life in younger women (p<0.006). For older women, comorbidities and EPICES deprivation scores were predictors of low quality of life scores (p<0.006). CONCLUSIONS Five years after breast cancer diagnosis, disease severity did not affect quality of life. The major determinants of quality of life in younger women were disease relapse and EPICES deprivation scores while those in older women were comorbidities and EPICES deprivation scores.
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