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Moore AM, Caudle AS, Sun SX, Yi M, Smith BD, Valero V, Yang W, Kuerer HM, Hunt KK, Teshome M. Residual Nodal Burden After Neoadjuvant Chemotherapy in cN1 Breast Cancer Patients with Positive Nodes at Targeted Axillary Dissection. Ann Surg Oncol 2024:10.1245/s10434-024-15797-6. [PMID: 39044106 DOI: 10.1245/s10434-024-15797-6] [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: 04/25/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Targeted axillary dissection (TAD) facilitates nodal staging in cN1 breast cancer after neoadjuvant chemotherapy (NAC). Completion axillary node dissection (cALND) remains the standard of care for TAD-positive patients. This study investigated factors associated with additional positive nodes at cALND (cALND+) and the impact on the residual cancer burden (RCB). METHODS Retrospective review of cN1 breast cancer patients treated with NAC and TAD was conducted from July 2013 to June 2023. The review defined cN1 status by ultrasound (US) and biopsy. Patient, tumor, and treatment characteristics were evaluated. Multivariate analysis was performed to identify factors associated with cALND+, and RCB was calculated. RESULTS Of 902 patients who underwent TAD, 554 (61.4%) were TAD-positive. 457 underwent cALND, and 124 (27%) were cALND+ (average 4.1 additional +nodes). The cALND+ patients had larger primary tumors at diagnosis (4 vs 3.5 cm; p = 0.04), more than three suspicious nodes on initial US (30% vs 13%; p ≤ 0.0001), larger residual primary tumors on pathology (median, 3 vs 2.1 cm; p = 0.0004), and more positive TAD nodes (median, 2 vs 1; p ≤ 0.0001). In the multivariate analysis, the factors associated with cALND+ were more than three suspicious nodes on initial US (odds ratio [OR], 2.9; p ≤ 0.0001), more positive TAD nodes (OR, 1.1; p ≤ 0.0001), larger clipped node metastasis (OR, 1.1; p ≤ 0.0001), and larger residual tumor on pathology (OR, 1.1; p = 0.006). Of 65 cALND+ patients with RCB class I or II, 29 (45%) had an increase in RCB based on cALND. CONCLUSION Of cN1 breast cancer patients treated with NAC who are TAD-positive, approximately 25% will have additional nodal disease on cALND. In these patients, positive cALND is associated with greater disease burden, which has potential implications for RCB status and prognosis.
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Affiliation(s)
- Alexandra M Moore
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susie X Sun
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Min Yi
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Smith
- Department of Breast Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Yang
- Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Surgery, Division of Surgical Oncology, University of California Los Angeles, Los Angeles, CA, USA
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Moraru L, Mitranovici MI, Moraru R, Voidazan S, Munteanu M, Georgescu R, Costachescu D, Turdean SG. Combining Molecular and Traditional Prognostic Factors: A Holistic Approach to Breast Cancer Prognostication. Diagnostics (Basel) 2024; 14:1449. [PMID: 39001339 PMCID: PMC11241232 DOI: 10.3390/diagnostics14131449] [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: 05/21/2024] [Revised: 06/20/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024] Open
Abstract
Breast cancer is a heterogeneous disease with various morphologies and molecular features, and it is the second leading cause of cancer death in women in developed countries. According to the literature, we currently lack both prognostic biomarkers and therapeutic targets. The most important prognostic factors are disease stage and Nottingham grade. We conducted a retrospective analysis involving 273 patients with BC who underwent neoadjuvant therapy before proceeding to curative surgical treatment between 1 January 2014 and 31 December 2023. Pathological procedures were conducted at the Department of Pathology, Emergency County Hospital of Targu Mureș, Romania. A statistical analysis was performed. Regarding the relationship between Nottingham grade and Ki67, grade I was associated with a Ki67 of less than 14. The relationship between tumor grade and luminal was similar (p = 0.0001): Grade I was associated with luminal A. Regarding TNM stage, it was statistically significantly correlated with TILs (p = 0.01) and RCB (p = 0.0001). Stages III and IV were associated with a high RCB and poor prognosis. Regarding the prognostic value, Nottingham grade 3 and TNM stages III and IV were correlated with low overall survival and disease-free survival, with poor prognosis, and, among the molecular variables, RCB played the most important prognostic role.
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Affiliation(s)
- Liviu Moraru
- Department of Anatomy, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Melinda Ildiko Mitranovici
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
| | - Raluca Moraru
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Mihai Munteanu
- Faculty of Electrical Engineering, Technical University, George Baritiu Street, 400394 Cluj Napoca, Romania
| | - Rares Georgescu
- Department of Surgery, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Dan Costachescu
- Department of Orthopedisc-Traumatology, Urology, Radiology and Medical Imaging, University of Medicine and Pharmacy Victor Babes, Square Eftimie Murgu, 300041 Timisoara, Romania
| | - Sabin Gligore Turdean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
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3
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Silva AAR, Cardoso MR, de Oliveira DC, Godoy P, Talarico MCR, Gutiérrez JM, Rodrigues Peres RM, de Carvalho LM, Miyaguti NADS, Sarian LO, Tata A, Derchain SFM, Porcari AM. Plasma Metabolome Signatures to Predict Responsiveness to Neoadjuvant Chemotherapy in Breast Cancer. Cancers (Basel) 2024; 16:2473. [PMID: 39001535 PMCID: PMC11240312 DOI: 10.3390/cancers16132473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) has arisen as a treatment option for breast cancer (BC). However, the response to NACT is still unpredictable and dependent on cancer subtype. Metabolomics is a tool for predicting biomarkers and chemotherapy response. We used plasma to verify metabolomic alterations in BC before NACT, relating to clinical data. METHODS Liquid chromatography coupled to mass spectrometry (LC-MS) was performed on pre-NACT plasma from patients with BC (n = 75). After data filtering, an SVM model for classification was built and validated with 75%/25% of the data, respectively. RESULTS The model composed of 19 identified metabolites effectively predicted NACT response for training/validation sets with high sensitivity (95.4%/93.3%), specificity (91.6%/100.0%), and accuracy (94.6%/94.7%). In both sets, the panel correctly classified 95% of resistant and 94% of sensitive females. Most compounds identified by the model were lipids and amino acids and revealed pathway alterations related to chemoresistance. CONCLUSION We developed a model for predicting patient response to NACT. These metabolite panels allow clinical gain by building precision medicine strategies based on tumor stratification.
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Affiliation(s)
- Alex Ap. Rosini Silva
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
| | - Marcella R. Cardoso
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Faculty of Medical Sciences, University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas 13083881, São Paulo, Brazil
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Danilo Cardoso de Oliveira
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
| | - Pedro Godoy
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
| | - Maria Cecília R. Talarico
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Faculty of Medical Sciences, University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas 13083881, São Paulo, Brazil
| | - Junier Marrero Gutiérrez
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
| | - Raquel M. Rodrigues Peres
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
| | - Lucas M. de Carvalho
- Post Graduate Program in Health Sciences, São Francisco University, Bragança Paulista 12916900, São Paulo, Brazil
| | - Natália Angelo da Silva Miyaguti
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
| | - Luis O. Sarian
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Faculty of Medical Sciences, University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas 13083881, São Paulo, Brazil
| | - Alessandra Tata
- Laboratory of Experimental Chemistry, Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), Viale Fiume 78, 36100 Vicenza, Italy;
| | - Sophie F. M. Derchain
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Faculty of Medical Sciences, University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas 13083881, São Paulo, Brazil
| | - Andreia M. Porcari
- MSLife Laboratory of Mass Spectrometry, Health Sciences Postgraduate Program, São Francisco University, Av. São Francisco de Assis, 218, Sala 211, Prédio 5, Bragança Paulista 12916900, São Paulo, Brazil; (A.A.R.S.); (D.C.d.O.)
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Costarelli L, Arienzo F, Broglia L, La Pinta M, Scavina P, Meli EZ, Colavito MH, Ascarelli A, Campagna D, Mastropietro T, Manna E, Amato M, Andrulli AD, Schiavone A, Minelli M, Fortunato L. Clipping a Positive Lymph Node Improves Accuracy of Nodal Staging After Neoadjuvant Chemotherapy for Breast Cancer Patients, but Does It Drive Management Changes? Ann Surg Oncol 2024; 31:3186-3193. [PMID: 38427160 DOI: 10.1245/s10434-024-15052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy for cN+ breast cancer patients after neoadjuvant chemotherapy (NAC) is controversial because the false-negative rate (FNR) is high. Identification of three or more SLNs with a dual tracer improves these results, and inclusion of a clipped lymph node (CLN) (targeted axillary dissection [TAD]) may be even more effective. METHODS A retrospective, single-institution analysis of consecutive cN+ patients undergoing NAC from 2019 to 2021 was performed. Patients routinely underwent placement of a clip in the positive lymph node before NAC, and TAD was performed after completion of therapy. RESULTS The study analyzed 73 patients, and the identification rate for CLN was 98.6% (72/73). A complete response in the lymph nodes was achieved for 43 (59%) of the 73 patients. Overall, the CLN was not a SLN in 18 (25%) of 73 cases, and for women who had one or two and those who had three or more SLNs identified, this occurred in 11 (32%) and 7 (21%) of 34 cases, respectively. Failure of SLN or TAD to identify a positive residual lymph node status after NAC occurred in 10 (15%) of 69 and 2 (3%) of 73 cases, respectively (p = 0.01). In four cases, a SLN was not retrieved (5.5%), and two of these cases had a positive CLN. In three cases, the CLN was the only positive node and did not match with a SLN, directing lymphadenectomy and oncologic management change in two cases. Therefore, 7 (10%) of 73 cases had a change in surgical or oncologic management with TAD. CONCLUSIONS For a conservative axillary treatment in this setting, TAD is an effective method. It is more accurate than SLN alone and allows management changes. Further studies are warranted.
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Affiliation(s)
- Leopoldo Costarelli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy.
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
| | - Francesca Arienzo
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Laura Broglia
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Massimo La Pinta
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Paola Scavina
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Emanuele Zarba Meli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Maria Helena Colavito
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Alessandra Ascarelli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Domenico Campagna
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Tiziana Mastropietro
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Elena Manna
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Michela Amato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angela Damiana Andrulli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Radiotherapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Alfonso Schiavone
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Mauro Minelli
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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5
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Jiang W, Lee S, Caruana D, Zhuang KD, Cazzato R, Latich I. Recent Advances in Minimally Invasive Management of Osteolytic Periacetabular Skeletal Metastases. Semin Intervent Radiol 2024; 41:154-169. [PMID: 38993598 PMCID: PMC11236455 DOI: 10.1055/s-0044-1787165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Painful skeletal osteolytic metastases, impending pathological fractures, and nondisplaced fractures present as a devastating clinical problem in advanced stage cancer patients. Open surgical approaches provide excellent mechanical stabilization but are often associated with high complication rates and slow recovery times. Percutaneous minimally invasive interventions have arisen as a pragmatic and logical treatment option for patients with late-stage cancer in whom open surgery may be contraindicated. These percutaneous interventions minimize soft tissue dissection, allow for the immediate initiation or resumption of chemotherapies, and present with fewer complications. This review provides the most up-to-date technical and conceptual framework for the minimally invasive management of osseous metastases with particular focus on periacetabular lesions. Fundamental topics discussed are as follows: (1) pathogenesis of cancer-induced bone loss and the importance of local cytoreduction to restore bone quality, (2) anatomy and biomechanics of the acetabulum as a weight-bearing zone, (3) overview of ablation options and cement/screw techniques, and (4) combinatorial approaches. Future studies should include additional studies with more long-term follow-up to better assess mechanical durability of minimally invasive interventions. An acetabulum-specific functional and pain scoring framework should be adopted to allow for better cross-study comparison.
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Affiliation(s)
- Will Jiang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Sangmin Lee
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
| | - Dennis Caruana
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Roberto Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
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6
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Diwanji D, Onishi N, Hathi DK, Lawhn-Heath C, Kornak J, Li W, Guo R, Molina-Vega J, Seo Y, Flavell RR, Heditsian D, Brain S, Esserman LJ, Joe BN, Hylton NM, Jones EF, Ray KM. 18F-FDG Dedicated Breast PET Complementary to Breast MRI for Evaluating Early Response to Neoadjuvant Chemotherapy. Radiol Imaging Cancer 2024; 6:e230082. [PMID: 38551406 PMCID: PMC10988337 DOI: 10.1148/rycan.230082] [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: 08/08/2023] [Revised: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Abstract
Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (18F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and 18F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney U tests. Results High Ki-67 tumors had higher baseline SUVmean (difference, 5.1; P = .01) and SUVpeak (difference, 5.5; P = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUVmax (-6.2 [-10.2, -2.6]; P < .001), SUVmean (-2.6 [-4.9, -1.3]; P < .001), SUVpeak (-4.2 [-6.9, -2.3]; P < .001), and TLG (-29.1 mL3 [-71.4, -6.8]; P = .005) and MRI measures of SERpeak (-1.0 [-1.3, -0.2]; P = .02) and FTV (-11.6 mL3 [-22.2, -1.7]; P = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUVmax of -34.3% (-55.9%, 1.5%; P = .06) and in PEpeak of -42.4% (95% CI: -110.5%, 8.5%; P = .08). Conclusion 18F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Keywords: Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Devan Diwanji
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Natsuko Onishi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Deep K. Hathi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Courtney Lawhn-Heath
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - John Kornak
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Wen Li
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ruby Guo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Julissa Molina-Vega
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Youngho Seo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Robert R. Flavell
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Diane Heditsian
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Susie Brain
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Laura J. Esserman
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Bonnie N. Joe
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Nola M. Hylton
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ella F. Jones
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Kimberly M. Ray
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
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7
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Lee H, Jang Y, Cho YA, Cho EY. Residual pure intralymphatic carcinoma component only (lymphovascular tumor emboli without invasive carcinoma) after neoadjuvant chemotherapy is associated with poor outcome: Not pathologic complete response. Hum Pathol 2024; 145:1-8. [PMID: 38311186 DOI: 10.1016/j.humpath.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Residual pure intralymphatic carcinoma (PIC) component only after neoadjuvant chemotherapy (NAC) is lymphovascular tumor emboli without invasive carcinoma and extremely rare form of residual tumor after NAC. Although several studies have been published, the prognostic influence of residual PIC component only had not been fully evaluated. This study aims to evaluate the clinicopathologic features and the prognostic value of residual PIC component only. We reviewed the 251 patients with no residual invasive carcinoma in breast after NAC and found 12 patients with residual PIC component only after NAC. Five cases were triple negative, 6 were HER2 positive, and 1 was estrogen receptor positive and HER2 negative. The extent of PIC component ranged from 0.18 to 50.00 mm. The detailed microscopic PIC component findings did not significantly correlate with regional lymph node metastasis, local recurrence, or distant metastasis (p > 0.05). In multivariate survival analysis, the presence of lymph node metastasis and pretreatment ki-67 labeling index more than 50 % was statistically associated with greater risk of relapse [Cox proportional hazards ratio (HR) = 3.236, 95 % confidence interval (CI), 1.461-7.280, p = 0.004; HR = 3.046, 95 % CI, 1.421-6.529, p = 0.004, respectively) and residual PIC component only tended to be associated with greater risk of relapse (HR = 2.378, 95 % CI, 0.853-6.631; p = 0.098), but not reached to statistically significance. In patients without lymph node metastasis, the presence of residual PIC component only was associated with worse disease-free survival (p = 0.004). Although the number of published studies still limited, residual residual PIC component only after NAC is associated with poor outcome, and it should not be considered as pathological complete response.
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Affiliation(s)
- Hyunwoo Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Yunjeong Jang
- Department of Pathology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, 07804, Republic of Korea
| | - Yoon Ah Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Eun Yoon Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea.
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8
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Pham HK, Le TD, Nguyen TPH, Le TU, Ta HHD, Nguyen VC. Assessment of residual cancer burden and survival in neoadjuvant chemotherapy of inoperable stage III breast cancer: A ten-year follow-up analysis in Vietnam. Pathol Res Pract 2024; 254:155099. [PMID: 38244433 DOI: 10.1016/j.prp.2024.155099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Prognostic scores such as Residual Cancer Burden (RCB), Clinical Pathological Score (CPS), and Neo-Bioscore have been introduced to categorize breast cancer patients into different prognostic risk groups after neoadjuvant chemotherapy (NAC). PURPOSE To evaluate the prognostic value of the residual cancer burden index in a large group of Vietnamese breast cancer patients treated with neoadjuvant chemotherapy in real-world settings. METHODS 126 patients diagnosed with stage III breast cancer received neoadjuvant chemotherapy according to the AP regimes. After operation of BC, pathologic complete response (pCR) and Residual cancer burden (RCB) were evaluated. All breast cancer patients' survival were analyzed by using Kaplan-Meier and Log-Rank models. RESULTS The average overall survival (OS) time was 75 months, with 90 (71.4%) recurrence and 82 (65%) mortality. The Kaplan Meier curve between OS and DFS with subgroups RCB indicate that the groups with higher RCB had a lower probability of survival, with statistical significance. Adjusted Cox regression model for age, menstruation, side of breast, clinical respose and overall stage illustrate that patients in RCB group 3 had a 2.7 times higher risk of mortality (95% CI: 1.28-5.67) compared to RCB group 0, p = 0.01. Patients with higher RCB levels had a higher risk of mortality. CONCLUSION Stage IIIC, RCB score and RCB group are the independent prognostic factors for predicting survival time of breast cancer patients receiving neoadjuvant treatment.
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Affiliation(s)
| | | | | | | | | | - Van-Chu Nguyen
- National Cancer Hospital, Vietnam; Hanoi Medical University, Vietnam.
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9
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Zheng X, Huang Y, Lin Y, Zhu T, Zou J, Wang S, Wang K. 18F-FDG PET/CT-based deep learning radiomics predicts 5-years disease-free survival after failure to achieve pathologic complete response to neoadjuvant chemotherapy in breast cancer. EJNMMI Res 2023; 13:105. [PMID: 38052965 DOI: 10.1186/s13550-023-01053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND This study aimed to assess whether a combined model incorporating radiomic and depth features extracted from PET/CT can predict disease-free survival (DFS) in patients who failed to achieve pathologic complete response (pCR) after neoadjuvant chemotherapy. RESULTS This study retrospectively included one hundred and five non-pCR patients. After a median follow-up of 71 months, 15 and 7 patients experienced recurrence and death, respectively. The primary tumor volume underwent feature extraction, yielding a total of 3644 radiomic features and 4096 depth features. The modeling procedure employed Cox regression for feature selection and utilized Cox proportional-hazards models to make predictions on DFS. Time-dependent receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were utilized to evaluate and compare the predictive performance of different models. 2 clinical features (RCB, cT), 4 radiomic features, and 7 depth features were significant predictors of DFS and were included to develop models. The integrated model incorporating RCB, cT, and radiomic and depth features extracted from PET/CT images exhibited the highest accuracy for predicting 5-year DFS in the training (AUC 0.943) and the validation cohort (AUC 0.938). CONCLUSION The integrated model combining radiomic and depth features extracted from PET/CT images can accurately predict 5-year DFS in non-pCR patients. It can help identify patients with a high risk of recurrence and strengthen adjuvant therapy to improve survival.
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Affiliation(s)
- Xingxing Zheng
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yuhong Huang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingyi Lin
- Shantou University Medical College, Shantou, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jiachen Zou
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Medical University, Zhanjiang, China
| | - Shuxia Wang
- Department of Nuclear Medicine and PET Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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10
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Lim HF, Sharma A, Gallagher C, Hall P. Value of ultrasound in assessing response to neoadjuvant chemotherapy in breast cancer. Clin Radiol 2023; 78:912-918. [PMID: 37734976 DOI: 10.1016/j.crad.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
AIM To analyse the utility of ultrasound in assessing response to neoadjuvant chemotherapy (NAC) and predicting residual cancer burden (RCB) index and pathological complete response (pCR) MATERIALS AND METHODS: This was a retrospective study with 417 patients over 7 years. The difference in longest diameter (LD) of the index lesion from baseline to end, baseline to mid, and mid to end was evaluated with respect to RCB class using logistic regression and ordered logistic regression. RESULTS Change in LD measurements from baseline to end, baseline to mid, and mid to end of chemotherapy as a predictor of RCB class show a negative relationship with a statistically significant association. This would suggest that a smaller change in LD measurements would be associated with an eventual higher RCB class. Change in LD measurements from baseline to end and baseline to mid chemotherapy as a predictor of pCR class show a negative relationship with a statistically significant association (p<0.05). This similarly indicates an inversely proportional relationship between changes in LD measurements and RCB class 0 for baseline to end and baseline to mid. CONCLUSION This study has shown significance in reducing LD measurements on ultrasound as a predictor of PCR and RCB class. This adds weight to the current practice of using ultrasound at the start, mid and end of chemotherapy cycles to monitor NACT responses.
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Affiliation(s)
- H F Lim
- Department of Radiology, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, UK.
| | - A Sharma
- Department of Radiology, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, UK
| | - C Gallagher
- Department of Oncology, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, UK
| | - P Hall
- Department of Oncology, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, UK
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11
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Justo-Garrido M, López-Saavedra A, Alcaraz N, Cortés-González CC, Oñate-Ocaña LF, Caro-Sánchez CHS, Castro-Hernández C, Arriaga-Canon C, Díaz-Chávez J, Herrera LA. Association of SLC12A1 and GLUR4 Ion Transporters with Neoadjuvant Chemoresistance in Luminal Locally Advanced Breast Cancer. Int J Mol Sci 2023; 24:16104. [PMID: 38003293 PMCID: PMC10670992 DOI: 10.3390/ijms242216104] [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: 09/29/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Chemoresistance to standard neoadjuvant treatment commonly occurs in locally advanced breast cancer, particularly in the luminal subtype, which is hormone receptor-positive and represents the most common subtype of breast cancer associated with the worst outcomes. Identifying the genes associated with chemoresistance is crucial for understanding the underlying mechanisms and discovering effective treatments. In this study, we aimed to identify genes linked to neoadjuvant chemotherapy resistance in 62 retrospectively included patients with luminal breast cancer. Whole RNA sequencing of 12 patient biopsies revealed 269 differentially expressed genes in chemoresistant patients. We further validated eight highly correlated genes associated with resistance. Among these, solute carrier family 12 member 1 (SLC12A1) and glutamate ionotropic AMPA type subunit 4 (GRIA4), both implicated in ion transport, showed the strongest association with chemoresistance. Notably, SLC12A1 expression was downregulated, while protein levels of glutamate receptor 4 (GLUR4), encoded by GRIA4, were elevated in patients with a worse prognosis. Our results suggest a potential link between SLC12A1 gene expression and GLUR4 protein levels with chemoresistance in luminal breast cancer. In particular, GLUR4 protein could serve as a potential target for drug intervention to overcome chemoresistance.
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Affiliation(s)
- Montserrat Justo-Garrido
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Alejandro López-Saavedra
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Nicolás Alcaraz
- The Bioinformatics Centre, Department of Biology, University of Copenhagen, 2200 Copenhagen, Denmark;
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Carlo C. Cortés-González
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Luis F. Oñate-Ocaña
- Department of Gastroenterology, National Cancer Institute (INCan), Tlalpan, Mexico City 14080, Mexico;
| | | | - Clementina Castro-Hernández
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Cristian Arriaga-Canon
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - José Díaz-Chávez
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
| | - Luis A. Herrera
- Cancer Research Unit, Institute of Biomedical Research, National Autonomous University of Mexico (UNAM)-National Institute of Cancerology, San Fernando Av #22, XVI Section, Mexico City 14080, Mexico; (M.J.-G.); (A.L.-S.); (C.C.C.-G.); (C.C.-H.); (C.A.-C.)
- School of Medicine and Health Sciences-Tecnológico de Monterrey, Mexico City 14380, Mexico
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12
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Malhaire C, Selhane F, Saint-Martin MJ, Cockenpot V, Akl P, Laas E, Bellesoeur A, Ala Eddine C, Bereby-Kahane M, Manceau J, Sebbag-Sfez D, Pierga JY, Reyal F, Vincent-Salomon A, Brisse H, Frouin F. Exploring the added value of pretherapeutic MR descriptors in predicting breast cancer pathologic complete response to neoadjuvant chemotherapy. Eur Radiol 2023; 33:8142-8154. [PMID: 37318605 DOI: 10.1007/s00330-023-09797-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/14/2023] [Accepted: 05/13/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate the association between pretreatment MRI descriptors and breast cancer (BC) pathological complete response (pCR) to neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS Patients with BC treated by NAC with a breast MRI between 2016 and 2020 were included in this retrospective observational single-center study. MR studies were described using the standardized BI-RADS and breast edema score on T2-weighted MRI. Univariable and multivariable logistic regression analyses were performed to assess variables association with pCR according to residual cancer burden. Random forest classifiers were trained to predict pCR on a random split including 70% of the database and were validated on the remaining cases. RESULTS Among 129 BC, 59 (46%) achieved pCR after NAC (luminal (n = 7/37, 19%), triple negative (n = 30/55, 55%), HER2 + (n = 22/37, 59%)). Clinical and biological items associated with pCR were BC subtype (p < 0.001), T stage 0/I/II (p = 0.008), higher Ki67 (p = 0.005), and higher tumor-infiltrating lymphocytes levels (p = 0.016). Univariate analysis showed that the following MRI features, oval or round shape (p = 0.047), unifocality (p = 0.026), non-spiculated margins (p = 0.018), no associated non-mass enhancement (p = 0.024), and a lower MRI size (p = 0.031), were significantly associated with pCR. Unifocality and non-spiculated margins remained independently associated with pCR at multivariable analysis. Adding significant MRI features to clinicobiological variables in random forest classifiers significantly increased sensitivity (0.67 versus 0.62), specificity (0.69 versus 0.67), and precision (0.71 versus 0.67) for pCR prediction. CONCLUSION Non-spiculated margins and unifocality are independently associated with pCR and can increase models performance to predict BC response to NAC. CLINICAL RELEVANCE STATEMENT A multimodal approach integrating pretreatment MRI features with clinicobiological predictors, including tumor-infiltrating lymphocytes, could be employed to develop machine learning models for identifying patients at risk of non-response. This may enable consideration of alternative therapeutic strategies to optimize treatment outcomes. KEY POINTS • Unifocality and non-spiculated margins are independently associated with pCR at multivariable logistic regression analysis. • Breast edema score is associated with MR tumor size and TIL expression, not only in TN BC as previously reported, but also in luminal BC. • Adding significant MRI features to clinicobiological variables in machine learning classifiers significantly increased sensitivity, specificity, and precision for pCR prediction.
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Affiliation(s)
- Caroline Malhaire
- Department of Medical Imaging, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France.
- Institut Curie, Research Center, U1288-LITO, Inserm, Paris-Saclay University, 91401, Orsay, France.
| | - Fatine Selhane
- Gustave Roussy, Department of Imaging, Paris-Saclay University, 94805, Villejuif, France
| | | | - Vincent Cockenpot
- Pathology Unit, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Pia Akl
- Women Imaging Unit, HCL, Radiologie du Groupement Hospitalier Est, 3 Quai Des Célestins, 69002, Lyon, France
| | - Enora Laas
- Department of Surgical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Audrey Bellesoeur
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Catherine Ala Eddine
- Department of Medical Imaging, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Melodie Bereby-Kahane
- Department of Medical Imaging, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Julie Manceau
- Department of Medical Imaging, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Delphine Sebbag-Sfez
- Department of Medical Imaging, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | | | - Herve Brisse
- Department of Medical Imaging, Institut Curie, PSL Research University, 26 Rue d'Ulm, 75005, Paris, France
| | - Frederique Frouin
- Institut Curie, Research Center, U1288-LITO, Inserm, Paris-Saclay University, 91401, Orsay, France
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13
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Go J, Ahn JH, Park JM, Choi SB, Kim JY, Park HS, Kim SI, Park BW, Park S. Distinct Prognosis of Minimal Residual Disease According to Breast Cancer Subtype in Patients with Breast or Nodal Pathologic Complete Response After Neoadjuvant Chemotherapy. Ann Surg Oncol 2023; 30:7060-7068. [PMID: 37537485 DOI: 10.1245/s10434-023-13938-x] [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: 09/30/2022] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Few studies have reported on patient prognosis according to residual cancer burden after neoadjuvant chemotherapy (NAC). Herein, we evaluated the survival of patients based on residual disease after NAC to identify subpopulations with distinct prognoses. METHODS We retrospectively reviewed 728 patients treated with NAC from 2010 to 2017. Patients were divided into four subgroups depending on post-surgical residual disease according to the staging system: pathological complete response (pCR) (ypT0/TisN0), minimal residual disease (MRD) (ypT1mi/T1aN0 or ypT0/Tis ypN0i+/N1mic), node-only pCR (≥ ypT1b ypN0), and breast-only pCR (ypT0/Tis ≥ ypN1a). Clinicopathological characteristics and survival outcomes were analyzed by adjusting for factors affecting survival. RESULTS Overall, 50.4% (n = 367) of patients achieved pCR, with the MRD group accounting for 16.5% (n = 120). Although age and clinical stage were not different among the study groups, histologic grade, subtypes, chemotherapy response, and local treatment showed differences. Event-free survival (EFS) and overall survival (OS) demonstrated no significant difference between the pCR and MRD groups. In the multivariate analysis, pCR status was the only significant factor in EFS, and no statistical difference was noted between the pCR and MRD groups. However, clinical stage, pCR status, and subtype significantly affected the OS. MRD showed favorable outcomes in terms of both EFS and OS in all subtypes, except for those with triple-negative breast cancer (TNBC). CONCLUSION Patients with MRD showed outcomes comparable to those of patients who achieved pCR and may be candidates for de-escalation of post-NAC treatment, except for those with a TNBC subtype.
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Affiliation(s)
- Jieon Go
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Min Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soon Bo Choi
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Ye Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Seok Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Il Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Woo Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
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14
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Jung HH, Kim JY, Cho EY, Lee JE, Kim SW, Nam SJ, Park YH, Ahn JS, Im YH. A Retrospective Exploratory Analysis for Serum Extracellular Vesicles Reveals APRIL (TNFSF13), CXCL13, and VEGF-A as Prognostic Biomarkers for Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer. Int J Mol Sci 2023; 24:15576. [PMID: 37958571 PMCID: PMC10647725 DOI: 10.3390/ijms242115576] [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: 09/13/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) is widely used as a standard treatment for early-stage triple-negative breast cancer (TNBC). While patients who achieve pathologic complete response (pCR) have a highly favorable outcome, patients who do not achieve pCR have variable prognoses. It is important to identify patients who are most likely to have poor survival outcomes to identify candidates for more aggressive therapeutic approaches after NAC. Many studies have demonstrated that cytokines and growth factors packaged into extracellular vesicles (EVs) have an essential role in tumor progression and drug resistance. In this study, we examined the role of serum-derived EV-associated cytokines as prognostic biomarkers for long-term outcomes in patients who underwent anthracycline-taxane-based NAC. We isolated extracellular vesicles from the serum of 190 TNBC patients who underwent NAC between 2015 and 2018 at Samsung Medical Center. EV-associated cytokine concentrations were measured with ProcartaPlex Immune Monitoring 65-plex panels. The prognostic value of EV-associated cytokines was studied. We found that patients with high EV_APRIL, EV_CXCL13, and EV_VEGF-A levels had shorter overall survival (OS). We further evaluated the role of these selected biomarkers as prognostic factors in patients with residual disease (RD) after NAC. Even in patients with RD, high levels of EV_APRIL, EV_CXCL13, and EV_VEGF-A were correlated with poor OS. In all subgroup analyses, EV_CXCL13 overexpression was significantly associated with poor overall survival. Moreover, multivariate analysis indicated that a high level of EV_CXCL13 was an independent predictor of poor OS. Correlation analysis between biomarker levels in EVs and serum showed that EV_VEGF-A positively correlated with soluble VEGF-A but not CXCL13. An elevated level of soluble VEGF-A was also associated with poor OS. These findings suggest that EV_APRIL, EV_CXCL13, and EV_VEGF-A may be useful in identifying TNBC patients at risk of poor survival outcomes after NAC.
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Affiliation(s)
- Hae Hyun Jung
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea; (H.H.J.); (J.-Y.K.); (Y.H.P.)
- Biomedical Research Institute, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Ji-Yeon Kim
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea; (H.H.J.); (J.-Y.K.); (Y.H.P.)
- Biomedical Research Institute, Samsung Medical Center, Seoul 06351, Republic of Korea
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
| | - Eun Yoon Cho
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
- Department of Pathology, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Jeong Eon Lee
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
- Department of Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Seok Won Kim
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
- Department of Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Seok Jin Nam
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
- Department of Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Yeon Hee Park
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea; (H.H.J.); (J.-Y.K.); (Y.H.P.)
- Biomedical Research Institute, Samsung Medical Center, Seoul 06351, Republic of Korea
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
| | - Young-Hyuck Im
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea; (H.H.J.); (J.-Y.K.); (Y.H.P.)
- Biomedical Research Institute, Samsung Medical Center, Seoul 06351, Republic of Korea
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (E.Y.C.); (J.E.L.); (S.W.K.); (S.J.N.)
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15
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Sullu Y, Tomak L, Demirag G, Kuru B, Ozen N, Karagoz F. Evaluation of the relationship between Ki67 expression level and neoadjuvant treatment response and prognosis in breast cancer based on the Neo-Bioscore staging system. Discov Oncol 2023; 14:190. [PMID: 37875716 PMCID: PMC10597910 DOI: 10.1007/s12672-023-00809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/20/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is widely used in the treatment of primary breast cancer. Different staging systems have been developed to evaluate the residual tumor after NAC and classify patients into different prognostic groups. Ki67, a proliferation marker, has been shown to be useful in predicting treatment response and prognosis. We aimed to investigate the prognostic importance Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels in breast cancer patients who received NAC and correlations between Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels. METHODS A total of 176 invasive breast carcinoma patients who underwent NAC were included in the study. Ki67 levels were evaluated by immunohistochemical methods in Trucut biopsy and surgical excision specimens. Patients were classified into prognostic groups using the Neo-Bioscore staging system. RESULTS Patients with high pretreatment Ki67 score were more likely to be in the higher Neo-Bioscore risk group (p < 0.001). Patients with a high posttreatment Ki67 score were more likely to be in the higher Neo-Bioscore prognostic risk group (p < 0.001). Overall survival (OS) and disease-free survival (DFS) were shorter in patients with high posttreatment Ki67 scores and in patients in the higher Neo-Bioscore risk group. We also determined a cutoff 37% for pathological complete response. CONCLUSION Neo-Bioscore staging system is found to be important in predicting survival. The posttreatment Ki67 level is more important than pretreatment Ki67 level in predicting survival.
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Affiliation(s)
- Yurdanur Sullu
- Department of Pathology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey.
| | - Leman Tomak
- Department of Biostatistics and Informatics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Guzin Demirag
- Department of Medical Oncology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Bekir Kuru
- Department of Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Necati Ozen
- Department of Surgery, Medical Park Hospital, Samsun, Turkey
| | - Filiz Karagoz
- Department of Pathology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey
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16
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Debien V, Marta GN, Agostinetto E, Sirico M, Jacobs F, Molinelli C, Moreau M, Paesmans M, De Giorgi U, Santoro A, Taylor D, Duhoux FP, Botticelli A, Barchiesi G, Speranza I, Lambertini M, Wildiers H, Azambuja ED, Piccart M. Real-world clinical outcomes of patients with stage I HER2-positive breast cancer treated with adjuvant paclitaxel and trastuzumab. Crit Rev Oncol Hematol 2023; 190:104089. [PMID: 37562696 DOI: 10.1016/j.critrevonc.2023.104089] [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: 03/03/2023] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
Up to 20% of breast cancer overexpress HER2 protein, making it a reliable target for antibody-based treatments. In early HER2-positive breast cancer avoiding anthracycline-based chemotherapy is a challenge. Based on the single-arm phase II APT trial results, adjuvant paclitaxel/trastuzumab is an accepted regimen for patients with stage I HER2-positive disease. In our retrospective study of 240 patients, the median tumor size was 12.0 mm (IQR 9 -15), and 204 (85%) had estrogen receptor-positive disease. After a median follow-up of 4.6 years, 3-year real-world disease-free survival, distant DFS, and overall survival were 98.8% (95% confidence interval (CI), 96.2-99.6), 99.2% (95% CI, 96.7-99.8), and 98.3% (95% CI, 96.2-99.6), respectively. In a real-world setting, an adjuvant paclitaxel/trastuzumab regimen was associated with low recurrence rates among women with stage I, HER2-positive breast cancer. Additionally, we reviewed other treatment optimization strategies attempted or ongoing in HER2-positive breast cancer.
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Affiliation(s)
- Veronique Debien
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium.
| | - Guilherme Nader Marta
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Elisa Agostinetto
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Marianna Sirico
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Flavia Jacobs
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Chiara Molinelli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michel Moreau
- Unité de Gestion de l'Information, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Marianne Paesmans
- Unité de Gestion de l'Information, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | | | | | - Andrea Botticelli
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Università di Roma Sapienza, Rome, Italy
| | - Giacomo Barchiesi
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Università di Roma Sapienza, Rome, Italy
| | - Iolanda Speranza
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Università di Roma Sapienza, Rome, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Evandro de Azambuja
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Martine Piccart
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
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17
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Oner G, Broeckx G, Van Berckelaer C, Zwaenepoel K, Altintas S, Canturk Z, Tjalma W, Berneman Z, Peeters M, Pauwels P, van Dam PA. The immune microenvironment characterisation and dynamics in hormone receptor-positive breast cancer before and after neoadjuvant endocrine therapy. Cancer Med 2023; 12:17901-17913. [PMID: 37553911 PMCID: PMC10524081 DOI: 10.1002/cam4.6425] [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: 11/05/2022] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Oestrogen receptor positive (ER+)/HER-2 negative breast cancer (BC) is considered to be an immunologically cold tumour compared to triple negative breast cancer. Therefore, the tumour microenvironment (TME) of ER+/HER-2 negative BC is understudied. The aim of this project is to investigate the TME and the immune response during neoadjuvant endocrine therapy (NET) and to correlate this with the treatment response in a real life setting. METHODS Expression of immune checkpoint receptors and immune cells was examined immunohistochemically, pre- and post-NET in a cohort of 56 ER+/HER-2 negative BC patients. They were treated with tamoxifen (n = 16), an aromatase inhibitor (n = 40) or a combination of an aromatase inhibitor with a PI3K inhibitor (n = 11) for a median duration of 6 months (range 1-32 months). Immunohistochemical staining with monoclonal antibodies for PDL-1, PD-1, TIM-3, LAG-3, CTLA-4, CD4, CD68 and FOXP3 were performed. All staining procedures were done according to validated protocols, and scoring was done by a pathologist specialized in breast cancer. Positivity was defined as staining >1% on TILs. Response to NET was evaluated according to tumour size change on imaging and Ki-67 change. RESULTS The median age was 61.02 (37-90) years. Diameter of tumour size decreased with a mean of 8.1 mm (-16 mm to 45 mm) (p < 0.001) during NET and the value of Ki-67 value decreased with a median of 9 after NET (p < 0.001). An increase in PD-L1 expression after NET showed a trend towards significant (p = 0.088) and CD-4+ T cells significantly increased after NET (p = 0.03). A good response to NET defined as a decrease in tumour size and/or decrease of Ki-67 was found to be associated with a longer duration of NET, a change of CD4+ T-cells and a higher number of CD68+ tumour-associated macrophages before the start of NET. CONCLUSION The immune microenvironment plays an important role in ER+/HER-2 negative BC. NET influences the composition and functional state of the infiltrating immune cells. Furthermore, changes in the immune microenvironment are also associated with treatment response.
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Affiliation(s)
- Gizem Oner
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
- Department of General SurgeryKocaeli UniversityKocaeliTurkey
| | - Glenn Broeckx
- Department of HistopathologyAntwerp University HospitalEdegemBelgium
| | | | - Karen Zwaenepoel
- Department of HistopathologyAntwerp University HospitalEdegemBelgium
| | - Sevilay Altintas
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
| | - Zafer Canturk
- Department of General SurgeryKocaeli UniversityKocaeliTurkey
| | - Wiebren Tjalma
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
| | - Zwi Berneman
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
- Department of HematologyAntwerp University HospitalEdegemBelgium
| | - Marc Peeters
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
| | - Patrick Pauwels
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
- Department of HistopathologyAntwerp University HospitalEdegemBelgium
| | - Peter A. van Dam
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
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18
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Lejeune M, Reverté L, Gallardo N, Sauras E, Bosch R, Mata D, Roso A, Petit A, Peg V, Riu F, García-Fontgivell J, Relea F, Vieites B, de la Cruz-Merino L, Arenas M, Rodriguez V, Galera J, Korzynska A, Plancoulaine B, Álvaro T, López C. Matrix Metalloproteinase-9 Expression Is Associated with the Absence of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer Patients. Int J Mol Sci 2023; 24:11297. [PMID: 37511057 PMCID: PMC10378773 DOI: 10.3390/ijms241411297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is particularly challenging due to the weak or absent response to therapeutics and its poor prognosis. The effectiveness of neoadjuvant chemotherapy (NAC) response is strongly influenced by changes in elements of the tumor microenvironment (TME). This work aimed to characterize the residual TME composition in 96 TNBC patients using immunohistochemistry and in situ hybridization techniques and evaluate its prognostic implications for partial responders vs. non-responders. Compared with non-responders, partial responders containing higher levels of CD83+ mature dendritic cells, FOXP3+ regulatory T cells, and IL-15 expression but lower CD138+ cell concentration exhibited better OS and RFS. However, along with tumor diameter and positive nodal status at diagnosis, matrix metalloproteinase-9 (MMP-9) expression in the residual TME was identified as an independent factor associated with the impaired response to NAC. This study yields new insights into the key components of the residual tumor bed, such as MMP-9, which is strictly associated with the lack of a pathological response to NAC. This knowledge might help early identification of TNBC patients less likely to respond to NAC and allow the establishment of new therapeutic targets.
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Affiliation(s)
- Marylène Lejeune
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
| | - Laia Reverté
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
| | - Noèlia Gallardo
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
| | - Esther Sauras
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
- Clinical Studies Unit, Hospital de Tortosa Verge de la Cinta, Carretera Esplanetes, 14, 43500 Tortosa, Spain
| | - Ramon Bosch
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
| | - Daniel Mata
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
| | - Albert Roso
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Anna Petit
- Pathology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Vicente Peg
- Pathology Department, Hospital Universitari de Vall Hebron, 08035 Barcelona, Spain
| | - Francisco Riu
- Pathology Department, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - Joan García-Fontgivell
- Pathology Department, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
| | - Fernanda Relea
- Pathology Department, Hospital General de Ciudad Real, 13005 Ciudad Real, Spain
| | - Begoña Vieites
- Pathology Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | | | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Valeri Rodriguez
- Oncology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), 43500 Tortosa, Spain
| | - Juana Galera
- Gynaecology Department, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
| | - Anna Korzynska
- Laboratory of Processing and Analysis of Microscopic Images, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109 Warsaw, Poland
| | - Benoît Plancoulaine
- ANTICIPE, INSERM, François Baclesse Comprehensive Cancer Center, University Caen Normandy, 14000 Caen, France
| | - Tomás Álvaro
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
| | - Carlos López
- Oncological Pathology and Bioinformatics Research Group, Molecular Biology and Research Section, Pathology Department, Hospital de Tortosa Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Esplanetes, 14, 43500 Tortosa, Spain
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19
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C AS, Shah M, Nandy D, Gupta R. Genomic Index of Sensitivity to Chemotherapy for Triple Negative Breast Cancer. Asian Pac J Cancer Prev 2023; 24:2043-2053. [PMID: 37378935 PMCID: PMC10505887 DOI: 10.31557/apjcp.2023.24.6.2043] [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: 02/22/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Patients with triple-negative breast cancer (TNBC) frequently develop resistance to chemotherapy. Studies have shown that microRNAs (miRNAs) are often aberrantly expressed in TNBC and are associated with drug resistance. However, a prognostic strategy that correlates miRNAs with chemotherapy resistance remains largely unknown. METHODS To identify breast cancer chemoresistance-associated miRNAs, the miRNA microarray dataset GSE71142 was downloaded from the Gene Expression Omnibus database. Differentially expressed miRNAs (DE-miRNAs) in chemoresistant groups were identified using the LIMMA package in R. Potential target genes were predicted using the miRTarBase 9. Functional and pathway enrichment analyses was done using WebGestalt. A protein-protein interaction network was visualized using Cytoscape software. The top six hub genes regulated by DE-miRNAs were identified using the random forest model. The chemotherapy resistance index (CRI) in TNBC was defined as sum of the median expression levels of the top six hub genes. The association of CRI with distant relapse risk was evaluated using point-biserial correlation coefficient in the validation cohorts of patients with TNBC. The correlation between CRI and cumulative hazard rate was estimated using the Cox model, and the predicted rate of distant relapse was obtained from the Breslow-type estimator of the survival function. All statistical computations were performed using Origin2019b. RESULTS A total of 12 DE-miRNAs were screened, including six upregulated and six downregulated miRNAs in chemoresistant breast cancer tissues compared with chemosensitive tissues. Based on fold changes, miR-214-3p, miR-4758-3p, miR-200c-3p, miR-4254, miR-140-3p, and miR-24-3p were the top six most upregulated miRNAs, whereas miR-142-5p, miR-146-5p, miR-1268b, miR-1275, miR-4447, and miR-4472 were the top six most downregulated miRNAs. The top three hub genes for upregulated miRNAs were RAC1, MYC, and CCND1 and for downregulated miRNAs were IL-6, SOCS1, and PDGFRA. CRI was significantly associated with the risk of distant relapse. CONCLUSION CRI predicted survival benefits with reduced hazard rate.
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Affiliation(s)
- Ahammad Sameer C
- Department of Applied Sciences, Parul University, Vadodara, India.
| | - Manan Shah
- Parul Sevashram Hospital, Parul University, Vadodara, India.
| | - Dipayan Nandy
- Parul Sevashram Hospital, Parul University, Vadodara, India.
| | - Reeshu Gupta
- Department of Applied Sciences, Parul University, Vadodara, India.
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20
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O'Shaughnessy J, Gradishar W, O'Regan R, Gadi V. Risk of Recurrence in Patients with HER2+ Early-Stage Breast Cancer: Literature Analysis of Patient and Disease Characteristics. Clin Breast Cancer 2023; 23:350-362. [PMID: 37149421 DOI: 10.1016/j.clbc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) overexpression occurs in 15% to 20% of patients with early-stage breast cancers (EBCs). Without HER2-targeted therapy, 30% to 50% of patients relapse within 10 years, many developing incurable metastatic disease. This literature review was designed to identify and validate patient- and disease-related factors associated with recurrence in patients with HER2+ EBC. Peer-reviewed primary research articles and congress abstracts were identified by searching MEDLINE. Articles published in English from 2019 to 2022 were included to identify contemporary treatment options. Results were analyzed for the relationship between risk factors and surrogates of HER2+ EBC recurrence to determine how identified risk factors affected HER2+ EBC recurrence. Sixty-one articles and 65 abstracts that assessed age at diagnosis, body mass index (BMI), tumor size at diagnosis, hormone receptor (HR) status, pathologic complete response (pCR) status, and biomarkers were analyzed. We confirmed the results of previously published reviews reporting residual cancer burden >0, non-pCR, and fewer tumor-infiltrating lymphocytes (TILs) as risk factors of recurrence. HR status remained an important risk factor for recurrence, with HER2+/HR+ disease more likely to recur. Two or more positive lymph nodes, higher BMI, larger primary tumor size, and low Ki67 were more commonly associated with HER2+ EBC recurrence. The identification of patient and disease factors frequently associated with HER2+ EBC recurrence in the literature provides insight into potential recurrence risk factors. Further investigation into the risk factors identified in this review could lead to improved treatments for patients at high risk for HER2+ EBC recurrence.
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Affiliation(s)
- Joyce O'Shaughnessy
- Baylor University Medical Center, Dallas, TX; Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX.
| | | | - Ruth O'Regan
- Department of Medicine, University of Rochester, Rochester, NY
| | - Vijayakrishna Gadi
- Department of Medicine, University of Illinois Chicago, Chicago, IL; Translational Oncology Program, University of Illinois Cancer Center, Chicago, IL
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21
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Early Assessment of Neoadjuvant Chemotherapy Response Using Multiparametric Magnetic Resonance Imaging in Luminal B-like Subtype of Breast Cancer Patients: A Single-Center Prospective Study. Diagnostics (Basel) 2023; 13:diagnostics13040694. [PMID: 36832182 PMCID: PMC9955433 DOI: 10.3390/diagnostics13040694] [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: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
This study aimed to evaluate the performance of multiparametric breast magnetic resonance imaging (mpMRI) for predicting response to neoadjuvant chemotherapy (NAC) in patients with luminal B subtype breast cancer. The prospective study included thirty-five patients treated with NAC for both early and locally advanced breast cancer of the luminal B subtype at the University Hospital Centre Zagreb between January 2015 and December 2018. All patients underwent breast mpMRI before and after two cycles of NAC. Evaluation of mpMRI examinations included analysis of both morphological (shape, margins, and pattern of enhancement) and kinetic characteristics (initial signal increase and post-initial behavior of the time-signal intensity curve), which were additionally interpreted with a Göttingen score (GS). Histopathological analysis of surgical specimens included grading the tumor response based on the residual cancer burden (RCB) grading system and revealed 29 NAC responders (RCB-0 (pCR), I, II) and 6 NAC non-responders (RCB-III). Changes in GS were compared with RCB classes. A lack of GS decrease after the second cycle of NAC is associated with RCB class and non-responders to NAC.
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22
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Obesity is associated with early recurrence on breast cancer patients that achieved pathological complete response to neoadjuvant chemotherapy. Sci Rep 2022; 12:21145. [PMID: 36477462 PMCID: PMC9729290 DOI: 10.1038/s41598-022-25043-2] [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: 01/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) is associated with good long-term prognosis in breast cancer (BC) patients. However, some patients still recur and eventually die from this disease. For years, clinical stage at diagnosis has been consistently linked to recurrence and survival in the pCR setting. Herein, we aimed to identify other potential predictors of recurrence and survival in patients that achieved pCR. We performed a retrospective analysis of patients diagnosed between 2011 and 2020 in our center. We calculated overall survival (OS), invasive disease-free survival (IDFS), distant disease-free survival (DDFS), and BC-specific survival (BCSS). Among the 241 patients included into our study 36% were obese (Body Mass Index (BMI) > 29.9 kg/m2) and 47% were stage III. Multivariate analysis confirmed that obesity was a significant risk factor associated with early recurrence and poorer survival in these patients. In summary, obesity and clinical stage predict early recurrence and poorer survival in patients that achieved pCR after NCT. Pending further investigation and based on our findings we speculate that weight management could be beneficial for this subset of patients. To our knowledge, this is the first Latin American report linking obesity and recurrence within this setting.
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23
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Phadke S. Optimization of Neoadjuvant Therapy for Early-Stage Triple-Negative and HER2 + Breast Cancer. Curr Oncol Rep 2022; 24:1779-1789. [PMID: 36181611 DOI: 10.1007/s11912-022-01331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Neoadjuvant, or pre-operative, therapy for the treatment of early-stage breast cancer has several potential benefits, especially for patients with triple-negative or HER2 + subtypes. This review provides an overview of optimal practices for utilizing neoadjuvant therapy, guidelines for decision-making, and ongoing clinical trials that are expected to help refine therapy choices. RECENT FINDINGS For triple-negative disease, the addition of the checkpoint inhibitor pembrolizumab to chemotherapy has shown remarkable efficacy, increasing response rates and survival. In the HER2 + setting, we are now able to safely avoid use of anthracyclines in most patients and refine adjuvant treatment choices based on response to neoadjuvant therapy. Results from recent clinical studies highlight advancements in systemic therapy and mark steps toward precision medicine, although reliable biomarkers of therapy response are still needed.
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Affiliation(s)
- Sneha Phadke
- Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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24
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Agostinetto E, Gligorov J, Piccart M. Systemic therapy for early-stage breast cancer: learning from the past to build the future. Nat Rev Clin Oncol 2022; 19:763-774. [PMID: 36253451 PMCID: PMC9575647 DOI: 10.1038/s41571-022-00687-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
Abstract
The treatment of breast cancer has improved dramatically over the past century, from a strictly surgical approach to a coordinated one, including local and systemic therapies. Systemic therapies for early-stage disease were initially tested against observation or placebo only in adjuvant trials. Subsequent clinical trials focusing on treatment 'fine-tuning' had a marked increase in cohort size, duration and costs, leading to a growing interest in the neoadjuvant setting in the past decade. Neoadjuvant trial designs have the advantages of enabling the direct evaluation of treatment effects on tumour diameter and offer unique translational research opportunities through the comparative analysis of tumour biology before, during and after treatment. Current technologies enabling the identification of better predictive biomarkers are shaping the new era of (neo)adjuvant trials. An urgent need exists to reinforce collaboration between the pharmaceutical industry and academia to share data and thus establish large databases of biomarker data coupled with patient outcomes that are easily accessible to the scientific community. In this Review, we summarize the evolution of (neo)adjuvant trials from the pre-genomic to the post-genomic era and provide critical insights into how neoadjuvant studies are currently designed, discussing the need for better end points and treatment strategies that are more personalized, including in the post-neoadjuvant setting.
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Affiliation(s)
- Elisa Agostinetto
- Institut Jules Bordet and l'Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie AP-HP Sorbonne Université, Inserm U938, Cours St-Paul, Paris, France
| | - Martine Piccart
- Institut Jules Bordet and l'Université Libre de Bruxelles, Brussels, Belgium.
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25
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Gouveia MC, Amorim de Araújo Lima Santos C, Impieri Souza A. Study protocol: Randomized, open-label, non-inferiority clinical trial for evaluating the clinical and pathological response rates to neoadjuvant hormone therapy and chemotherapy in patients with luminal-subtype breast tumors. Contemp Clin Trials Commun 2022; 30:101013. [PMID: 36262803 PMCID: PMC9574413 DOI: 10.1016/j.conctc.2022.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/19/2022] [Accepted: 10/01/2022] [Indexed: 11/04/2022] Open
Abstract
Background Despite neoadjuvant hormone therapy (NHT) is being underused, it is an effective treatment for luminal tumors at a lower cost and with fewer side effects compared to those associated with neoadjuvant chemotherapy (NCT). The lack of robust comparative data between NHT and NCT is a factor that limits its use in clinical practice. Methods This study will be a randomized, open-label, non-inferiority clinical trial. Patients diagnosed with HER2-negative luminal-subtype breast cancer will be identified at the time of diagnosis. Menopausal patients randomized for NHT should receive anastrozole for at least six months. Premenopausal women should receive anastrozole associated with subcutaneous goserelin acetate every 12 weeks for at least six months. Patients randomized for NCT will receive a standard institutional regimen based on anthracyclines and taxanes. Sample size was calculated considering the CPS + EG as a method for evaluating response and prognosis, where a score <3 was defined as good. The non-inferiority margin for NHT was set at 15%. The study considered a power of 80%, a significance level of 5%, and an outcome proportion in each group of 69%, resulting in 118 patients in each group. We estimated at 10% of losses, resulting in a sample of 130 patients in each group. Conclusion The non-inferiority of NHT in relation to NCT will provide further evidence that replacing NCT with NHT is safe and effective in eligible patients, which is particularly relevant for populations with limited access to health services and for institutions with few available resources.
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Affiliation(s)
- Maria Carolina Gouveia
- Corresponding author.. Research department, Rua do Coelhos, 300, Boa Vista, Recife, PE, 50070-550, Brazil.
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26
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The Impact of Tumor Infiltrating Lymphocytes Densities and Ki67 Index on Residual Breast Cancer Burden following Neoadjuvant Chemotherapy. Int J Breast Cancer 2022; 2022:2597889. [PMID: 36133828 PMCID: PMC9484975 DOI: 10.1155/2022/2597889] [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: 07/12/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
To avoid unnecessary neoadjuvant chemotherapy in case anticipating a poor therapy response, it is essential to find the pathological parameters that would predict pathological complete response or at least a decrease in tumor burden following neoadjuvant chemotherapy. The purpose of this study is to investigate the hypothesis that tumor infiltrating lymphocytes can predict the efficacy of neoadjuvant chemotherapy and to find the Ki67 cutoff value that best predicts the benefit of chemotherapy. 153 cases of breast cancer were chosen, based on their molecular subtype: triple negative subtype (77) and luminal, HER2-ve subtype (76). Histopathological assessment of pretherapy core biopsies was conducted to assess variable pathological parameters including TILs rates with the aid of immunohistochemical staining for CD20 and CD3. Moreover, core biopsies were stained for Ki67, and the findings were compared to the residual cancer burden following neoadjuvant chemotherapy. On analyzing and contrasting the two groups, a significant association between molecular subtype and pathological complete response was confirmed, while tumor-infiltrating lymphocytes in either group had no effect on therapy response. We used receiver operating characteristic curve analysis to determine that a cutoff of 36% for Ki67 is the most accurate value to predict complete therapy response.
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27
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Nandi SK, Pradhan A, Das B, Das B, Basu S, Mallick B, Dutta A, Sarkar DK, Mukhopadhyay A, Mukhopadhyay S, Bhattacharya R. Kaempferol attenuates viability of ex-vivo cultured post-NACT breast tumor explants through downregulation of p53 induced stemness, inflammation and apoptosis evasion pathways. Pathol Res Pract 2022; 237:154029. [PMID: 35961057 DOI: 10.1016/j.prp.2022.154029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/15/2023]
Abstract
Early onset of chemotherapy evasion is a therapeutic challenge. Chemotherapy-induced upregulation of stem cell markers imparts invasiveness and metastatic property to the resident tumor. The efficacy of Kaempferol in attenuating epithelial to mesenchymal transition has earlier been established in the breast cancer cell. In our study population, progression-free survival was observed to be statistically more significant in post-NACT low-grade tumors than the high-grade tumors. Further, in post-NACT TNBCs, high-grade tumors showed a preponderance of strong nuclear p53 expression and very low expression of Caspase 3, indicating that, altered p53 expression predisposes these tumors to apoptosis escape and up-regulation of stemness markers. Herein, we report the robust efficacy of Kaempferol on ex-vivo grown breast tumors, derived from post-NACT TNBC patients, through downregulation of nuclear p53, CD44, ALDH1, NANOG, MDR1, Ki67, BCL2 and upregulation of Caspase 3. Such tumors also showed concurrent deregulated RNA and protein expression of CD44, NANOG, ALDH1 and MDR1 with upregulation of Caspase 3 and cleaved Caspase 3, upon Kaempferol treatment. Validation of efficacy of the treatment dosage of Kaempferol through immunophenotyping on MDA-MB-231, suggested that Kaempferol at its IC-50 dosage was effective against CD44 and CD326 positive breast cancer through deregulating their expression. Protein-protein interaction network through STRING pathway analysis and co-expression study of candidate proteins showed the highest degree of co-expression of p53 and KI-67, CD44, NF- kappaB, ALDH1, NANOG, MDR1, and BCL2. Thus, potentially targetable oncogenic protein markers, that are susceptible to downregulation by Kaempferol, provides insight into biomarker-driven therapeutic approaches with it.
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Affiliation(s)
- Sourav Kumar Nandi
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India
| | - Ayan Pradhan
- Department of General Surgery, Institute of Post graduate Medical Education & Research and SSKM Hospital, 244B AJC Bose Road, Kolkata 700020, India
| | - Basudeb Das
- Department of Life Science, National Institute of Technology, Rourkela, Odisha, 769008, India
| | - Biswajit Das
- Department of Pathology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India
| | - Sudarshana Basu
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India
| | - Bibekanand Mallick
- Department of Life Science, National Institute of Technology, Rourkela, Odisha, 769008, India
| | - Amitava Dutta
- Department of Pathology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India
| | - Diptendra Kumar Sarkar
- Department of General Surgery, Institute of Post graduate Medical Education & Research and SSKM Hospital, 244B AJC Bose Road, Kolkata 700020, India
| | - Ashis Mukhopadhyay
- Department of Haematooncology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India
| | - Soma Mukhopadhyay
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India.
| | - Rittwika Bhattacharya
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata 700094, India.
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28
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Elder EA, Livasy CA, Donahue EE, Neelands B, Patrick A, Needham M, Sarantou T, Hadzikadic-Gusic L, Heeke AL, White RL. Residual Cancer Burden Class Associated with Survival Outcomes in Women with Different Phenotypic Subtypes of Breast Cancer After Neoadjuvant Chemotherapy. Ann Surg Oncol 2022; 29:8060-8069. [PMID: 35980548 DOI: 10.1245/s10434-022-12300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The residual cancer burden class informs survival outcomes after neoadjuvant chemotherapy. We evaluated the prognostic ability of the RCB for survival outcomes in women with different phenotypic subtypes of breast cancer treated with neoadjuvant chemotherapy. Additional variables were assessed for inclusion with the RCB to further improve the model's discriminative ability. PATIENTS AND METHODS We conducted a retrospective review of patients completing at least 75% of the recommended cycles of neoadjuvant chemotherapy between 1 January 2010 and 31 December 2016. Phenotypic subtypes were defined by hormone receptor and human epidermal growth factor receptor 2 (HER2) status at diagnosis, classified as HR+/HER2-, HER2+, or triple-negative breast cancer (TNBC). The RCB class was calculated and survival endpoints of overall survival, recurrence-free survival, and distant recurrence-free survival were analyzed using Kaplan-Meier and Cox proportional hazards methods. The discriminative ability of the models was quantified by Harrell's C-index. RESULTS Overall, 532 women met the inclusion criteria. Median follow-up was 65 months. In univariate models, RCB was significantly associated with OS, RFS, and DRFS. The RCB class had good discriminative ability for OS, RFS, and DRFS survival, with Harrell's C-indices of 0.68, 0.67, and 0.68, respectively. The RCB class discriminated well for each survival endpoint within HER2+ and TNBC, but did not discriminate well for HR+/HER2- (OS Harrell's C-indices of 0.77, 0.75, and 0.52, respectively). CONCLUSIONS The RCB class was prognostic for OS, RFS, and DRFS after neoadjuvant chemotherapy, but prognostic discrimination between patients with subtype HR+/HER2- was not observed during the follow-up period for which the overall event rate was low.
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Affiliation(s)
- Erin A Elder
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Chad A Livasy
- Department of Pathology, Levine Cancer Institute, Charlotte, NC, USA
| | - Erin E Donahue
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC, USA
| | - Brittany Neelands
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA.,Clinical Trials Department, Levine Cancer Institute, Charlotte, NC, USA
| | - Alicia Patrick
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA.,Clinical Trials Department, Levine Cancer Institute, Charlotte, NC, USA
| | - Mckenzie Needham
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA.,Clinical Trials Department, Levine Cancer Institute, Charlotte, NC, USA
| | - Terry Sarantou
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Arielle L Heeke
- Department of Medical Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - Richard L White
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA.
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29
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Biomarker Dynamics and Long-Term Treatment Outcomes in Breast Cancer Patients with Residual Cancer Burden after Neoadjuvant Therapy. Diagnostics (Basel) 2022; 12:diagnostics12071740. [PMID: 35885644 PMCID: PMC9318288 DOI: 10.3390/diagnostics12071740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
A residual cancer burden after neoadjuvant therapy (NAT) for breast cancer (BC) is associated with worse treatment outcomes compared to patients who achieved pathologic complete remission. This single-institutional retrospective study of 767 consecutive patients, including 468 patients with assessable residual cancer burden (aRCB) after NAT, with a median follow-up of 36 months, evaluated the biomarkers assessed before NAT from a biopsy and after NAT from a surgical specimen, their dynamics, and effect on long-term outcomes in specific breast cancer subtypes. The leading focus was on proliferation index Ki-67, which was significantly altered by NAT in all BC subtypes (p < 0.001 for HER2 positive and luminal A/B HER2 negative and p = 0.001 for TNBC). Multivariable analysis showed pre-NAT and post-NAT Ki-67 as independent predictors of survival outcomes for luminal A/B HER2 negative subtype. For TNBC, post-NAT Ki-67 was significant alone, and, for HER2 positive, the only borderline association of pre-NAT Ki-67 was observed in relation to the overall survival. Steroid and HER2 receptors were re-assessed just in a portion of the patients with aRCB. The concordance of both assessments was 92.9% for ER status, 80.1% for PR, and 92.2% for HER2. In conclusion, these real-world data of a consecutive cohort confirmed the importance of biomarkers assessment in patients with aRCB, and the need to consider specific BC subtypes when interpreting their influence on prognosis.
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30
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Pestana CV, Livasy CA, Donahue EE, Neelands B, Tan AR, Sarantou T, Hadzikadic-Gusic L, White RL. Does Residual Cancer Burden Predict Local Recurrence After Neoadjuvant Chemotherapy? Ann Surg Oncol 2022; 29:7716-7724. [PMID: 35810226 DOI: 10.1245/s10434-022-12038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The extent of residual disease after neoadjuvant chemotherapy (NAC) can be quantified by the Residual Cancer Burden (RCB), a prognostic tool used to estimate survival outcomes in breast cancer. This study investigated the association between RCB and locoregional recurrence (LRR). METHODS The study reviewed 532 women with breast cancer who underwent NAC between 2010 and 2016. Relapse in the ipsilateral breast, skin/subcutis at the surgical site, chest wall, pectoralis, or regional lymph nodes defined an LRR. The LRR cumulative incidence (LRCI) was estimated using the Fine and Gray competing-risks model, with death and distant recurrence defined as competing events. The association of LRCI with prognostic variables was evaluated. RESULTS Overall, 5.5% of the patients experienced an LRR after a median follow-up period of 65 months. The 5-year LRCI rates by RCB were as follows: RCB-0 (0.9%), RCB-1 (3.2%), RCB-2 (6.0%), and RCB-3 (12.9%). In the univariable analysis, LRCI varied significantly by RCB (p = 0.010). The multivariable analysis showed a significant association of LRCI with increasing RCB, and the patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) phenotype were at lower risk for LRR than those with HER2+ and triple-negative cancers (p < 0.032). The patients with RCB-3 were at a higher risk for local relapse than those with RCB-0 (hazard ratio, 13.78; confidence interval, 2.25-84.45; p = 0.04). Type of operation (p = 0.04) and use of adjuvant radiation (p = 0.046) were statistically significant in the multivariable model. CONCLUSIONS The study results demonstrate a significant association between LRCI and increasing RCB, although distant recurrence is a substantial driver of disease outcomes. Future prospective studies should examine the role of RCB in clinical decisions regarding indications for adjuvant therapy.
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Affiliation(s)
- Christine V Pestana
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Chad A Livasy
- Department of Pathology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Erin E Donahue
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Brittany Neelands
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Antoinette R Tan
- Department of Solid Tumor and Investigational Therapeutics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Terry Sarantou
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Richard L White
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
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31
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Agostinetto E, Nader-Marta G, Paesmans M, Ameye L, Veys I, Buisseret L, Neven P, Taylor D, Fontaine C, Duhoux FP, Canon JL, Denys H, Coussy F, Chakiba C, Ribeiro JM, Piccart M, Desmedt C, Ignatiadis M, Aftimos P. ROSALINE: a phase II, neoadjuvant study targeting ROS1 in combination with endocrine therapy in invasive lobular carcinoma of the breast. Future Oncol 2022; 18:2383-2392. [PMID: 35695563 DOI: 10.2217/fon-2022-0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Invasive lobular carcinoma (ILC) is the most common histologic subtype of breast cancer after invasive ductal carcinoma (i.e., no special type [NST]). ILC differs from NST in clinical presentation, site-specific metastases and response to conventional therapies. Loss of E-cadherin protein expression, due to alterations in its encoding gene CDH1, is the most frequent oncogenic event in ILC. Synthetic lethality approaches have shown promising antitumor effects of ROS1 inhibitors in models of E-cadherin-defective breast cancer in in vivo studies and provide the rationale for testing their clinical activity in patients with ILC. Entrectinib is a tyrosine kinase inhibitor targeting TRK, ROS1 and ALK tyrosine kinases. Here, the authors present ROSALINE (NCT04551495), a phase II study testing neoadjuvant entrectinib and endocrine therapy in women with estrogen receptor-positive, HER2-negative early ILC.
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Affiliation(s)
- Elisa Agostinetto
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium.,Humanitas University, Department of Biomedical Sciences, via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | | | - Marianne Paesmans
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Lieveke Ameye
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Veys
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Buisseret
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | - Martine Piccart
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Desmedt
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium
| | - Michail Ignatiadis
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Aftimos
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
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Maddox AL, Brehove MS, Eliato KR, Saftics A, Romano E, Press MF, Mortimer J, Jones V, Schmolze D, Seewaldt VL, Jovanovic-Talisman T. Molecular Assessment of HER2 to Identify Signatures Associated with Therapy Response in HER2-Positive Breast Cancer. Cancers (Basel) 2022; 14:2795. [PMID: 35681773 PMCID: PMC9179327 DOI: 10.3390/cancers14112795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Trastuzumab, the prototype HER2-directed therapy, has markedly improved survival for women with HER2-positive breast cancers. However, only 40-60% of women with HER2-positive breast cancers achieve a complete pathological response to chemotherapy combined with HER2-directed therapy. The current diagnostic assays have poor positive-predictive accuracy in identifying therapy-responsive breast cancers. Here, we deployed quantitative single molecule localization microscopy to assess the molecular features of HER2 in a therapy-responsive setting. Using fluorescently labeled trastuzumab as a probe, we first compared the molecular features of HER2 in trastuzumab-sensitive (BT-474 and SK-BR-3) and trastuzumab-resistant (BT-474R and JIMT-1) cultured cell lines. Trastuzumab-sensitive cells had significantly higher detected HER2 densities and clustering. We then evaluated HER2 in pre-treatment core biopsies from women with breast cancer undergoing neoadjuvant therapy. A complete pathological response was associated with a high detected HER2 density and significant HER2 clustering. These results established the nano-organization of HER2 as a potential signature of therapy-responsive disease.
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Affiliation(s)
- Adam L. Maddox
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (A.L.M.); (M.S.B.); (K.R.E.); (A.S.); (E.R.)
| | - Matthew S. Brehove
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (A.L.M.); (M.S.B.); (K.R.E.); (A.S.); (E.R.)
| | - Kiarash R. Eliato
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (A.L.M.); (M.S.B.); (K.R.E.); (A.S.); (E.R.)
| | - Andras Saftics
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (A.L.M.); (M.S.B.); (K.R.E.); (A.S.); (E.R.)
| | - Eugenia Romano
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (A.L.M.); (M.S.B.); (K.R.E.); (A.S.); (E.R.)
| | - Michael F. Press
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA;
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Veronica Jones
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Victoria L. Seewaldt
- Department of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Tijana Jovanovic-Talisman
- Department of Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (A.L.M.); (M.S.B.); (K.R.E.); (A.S.); (E.R.)
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Dülgar Ö, Öven BB, Atcı MM, Arıkan R, Ay S, Ayhan M, Selvi O, Ozyukseler DT, Bayram E, Özcan E, Yasin Aİ, Gümüş M. Is the benefit of using adjuvant capecitabine in patients with residual triple-negative breast cancer related to pathological response to neoadjuvant chemotherapy? Expert Rev Anticancer Ther 2022; 22:773-780. [PMID: 35543015 DOI: 10.1080/14737140.2022.2076670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Triple-negative-breast-cancer (TNBC) has a poor prognosis if pathologic complete response (pCR) cannot be achieved after receiving neoadjuvant chemotherapy (NAC). The group of patients that benefit most from adjuvant capecitabine remains unclear. MATERIALS AND METHODS We collected data from 218 consecutive patients who had previously received NAC and operated for TNBC from eight cancer centers. Data of 160 patients without PCR was included in the statistical analysis. Pathologic response to NAC was defined into two groups as having good-pathologic response (MillerPayneGrading (MPG) IV-III) or poor-pathologic response (MPG I-II). The histopathological characteristics of patients were compared in regard to adjuvant capecitabine usage. RESULTS Univariate-analysis revealed that age, histological subtype, clinical stage, size of tumor, number of lymph-nodes, menopausal status, pathological T and N stage, were significantly different between two groups. In multivariate-analysis, menopausal status (p=0.043) and residual tumor size (p<0.001) were found to be independent prognostic factors for pathological response. The hazard ratio for disease recurrence and death in the poor responsive group with adjuvant capecitabin was 2.94 (95% confidence interval (CI), 1.21 to 7.10; p=0.016) and 4.080 (95% CI, 1.22 to 13.64; p=0.022) respectively. DFS (p=0.58) and OS (p=0.89) improvements with adjuvant capecitabine were not demonstrated in good response groups. CONCLUSION This multicenter study suggested that only the poor responsive group to NAC achieved benefit from adjuvant capecitabine. Postmenopausal status and residual tumor size were related to poor prognosis.
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Affiliation(s)
- Özgecan Dülgar
- Department of Medical Oncology Istanbul Medeniyet University, Göztepe Training and Research Hospital
| | - Başak Bala Öven
- Department of Medical Oncology, Yeditepe University Faculty of Medicine
| | | | - Rukiye Arıkan
- Department of Medical Oncology, Faculty of Medicine, Marmara University
| | - Seval Ay
- Department of Medical Oncology Istanbul Medeniyet University, Göztepe Training and Research Hospital
| | - Murat Ayhan
- Department of Medical Oncology, Kartal Dr Lütfi Kirdar City Hospital
| | - Oğuzhan Selvi
- Department of Medical Oncology, İstanbul Prof Dr Cemil Taşcıoğlu City Hospital
| | | | - Ertuğrul Bayram
- Department of Medical Oncology, Çukurova University Faculty of Medicine
| | - Erkan Özcan
- Department of Medical Oncology, Trakya University Faculty of Medicine
| | - Ayşe İrem Yasin
- Department of Medical Oncology, Bezmialem Vakif University Faculty of Medicine
| | - Mahmut Gümüş
- Department of Medical Oncology Istanbul Medeniyet University, Göztepe Training and Research Hospital
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Joshi S, Garlapati C, Bhattarai S, Su Y, Rios-Colon L, Deep G, Torres MA, Aneja R. Exosomal Metabolic Signatures Are Associated with Differential Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer. Int J Mol Sci 2022; 23:5324. [PMID: 35628139 PMCID: PMC9141543 DOI: 10.3390/ijms23105324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 01/21/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) is commonly used in breast cancer (BC) patients to increase eligibility for breast-conserving surgery. Only 30% of patients with BC show pathologic complete response (pCR) after NAC, and residual disease (RD) is associated with poor long-term prognosis. A critical barrier to improving NAC outcomes in patients with BC is the limited understanding of the mechanisms underlying differential treatment outcomes. In this study, we evaluated the ability of exosomal metabolic profiles to predict NAC response in patients with BC. Exosomes isolated from the plasma of patients after NAC were used for metabolomic analyses to identify exosomal metabolic signatures associated with the NAC response. Among the 16 BC patients who received NAC, eight had a pCR, and eight had RD. Patients with RD had 2.52-fold higher exosome concentration in their plasma than those with pCR and showed significant enrichment of various metabolic pathways, including citrate cycle, urea cycle, porphyrin metabolism, glycolysis, and gluconeogenesis. Additionally, the relative exosomal levels of succinate and lactate were significantly higher in patients with RD than in those with pCR. These data suggest that plasma exosomal metabolic signatures could be associated with differential NAC outcomes in BC patients and provide insight into the metabolic determinants of NAC response in patients with BC.
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Affiliation(s)
- Shriya Joshi
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.J.); (C.G.); (S.B.)
| | - Chakravarthy Garlapati
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.J.); (C.G.); (S.B.)
| | - Shristi Bhattarai
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.J.); (C.G.); (S.B.)
| | - Yixin Su
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (Y.S.); (L.R.-C.); (G.D.)
| | - Leslimar Rios-Colon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (Y.S.); (L.R.-C.); (G.D.)
- Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA
| | - Gagan Deep
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (Y.S.); (L.R.-C.); (G.D.)
| | - Mylin A. Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.J.); (C.G.); (S.B.)
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Treatment Efficacy Score - continuous residual cancer burden-based metric to compare neoadjuvant chemotherapy efficacy between randomized trial arms in breast cancer trials. Ann Oncol 2022; 33:814-823. [PMID: 35513244 DOI: 10.1016/j.annonc.2022.04.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/28/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Difference in pathologic complete response (pCR) rate after neoadjuvant chemotherapy does not capture the impact of treatment on down staging of residual cancer in the experimental arm. We developed a method to compare the entire distribution of residual cancer burden (RCB) values between clinical trial arms to better quantify the differences in cytotoxic efficacy of treatments. PATIENTS AND METHODS The Treatment Efficacy Score (TES) reflects the area between the weighted cumulative distribution functions of RCB values from two trial arms. TES is based on a modified Kolmogorov-Smirnov (KS) test with added weight function to capture the importance of high RCB values and uses the area under the difference between two distribution functions as statistical metric. The higher the TES the greater the shift to lower RCB values in the experimental arm. We developed TES from the durvalumab + olaparib arm (n=72) and corresponding controls (n=282) of the I-SPY2 trial. The 11 other experimental arms and control cohorts (n=947) were used as validation sets to assess the performance of TES. We compared TES to KS, Mann-Whitney, and Fisher's exact tests to identify trial arms with higher cytotoxic efficacy and assessed associations with trial arm level survival differences. Significance was assessed with permutation test. RESULTS In the validation set, TES identified arms with higher pCR rate but was more accurate to identify regimens as less effective if treatment did not reduce the frequency of high RCB values, even if pCR rate improved. The correlation between TES and survival was higher than the correlation between pCR rate difference and survival. CONCLUSION TES quantifies the difference between the entire distribution of pathologic responses observed in trial arms and could serve as a better early surrogate to predict trial arm level survival differences than pCR rate difference alone.
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Yau C, Osdoit M, van der Noordaa M, Shad S, Wei J, de Croze D, Hamy AS, Laé M, Reyal F, Sonke GS, Steenbruggen TG, van Seijen M, Wesseling J, Martín M, Del Monte-Millán M, López-Tarruella S, Boughey JC, Goetz MP, Hoskin T, Gould R, Valero V, Edge SB, Abraham JE, Bartlett JMS, Caldas C, Dunn J, Earl H, Hayward L, Hiller L, Provenzano E, Sammut SJ, Thomas JS, Cameron D, Graham A, Hall P, Mackintosh L, Fan F, Godwin AK, Schwensen K, Sharma P, DeMichele AM, Cole K, Pusztai L, Kim MO, van 't Veer LJ, Esserman LJ, Symmans WF. Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients. Lancet Oncol 2022; 23:149-160. [PMID: 34902335 PMCID: PMC9455620 DOI: 10.1016/s1470-2045(21)00589-1] [Citation(s) in RCA: 179] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have independently validated the prognostic relevance of residual cancer burden (RCB) after neoadjuvant chemotherapy. We used results from several independent cohorts in a pooled patient-level analysis to evaluate the relationship of RCB with long-term prognosis across different phenotypic subtypes of breast cancer, to assess generalisability in a broad range of practice settings. METHODS In this pooled analysis, 12 institutes and trials in Europe and the USA were identified by personal communications with site investigators. We obtained participant-level RCB results, and data on clinical and pathological stage, tumour subtype and grade, and treatment and follow-up in November, 2019, from patients (aged ≥18 years) with primary stage I-III breast cancer treated with neoadjuvant chemotherapy followed by surgery. We assessed the association between the continuous RCB score and the primary study outcome, event-free survival, using mixed-effects Cox models with the incorporation of random RCB and cohort effects to account for between-study heterogeneity, and stratification to account for differences in baseline hazard across cancer subtypes defined by hormone receptor status and HER2 status. The association was further evaluated within each breast cancer subtype in multivariable analyses incorporating random RCB and cohort effects and adjustments for age and pretreatment clinical T category, nodal status, and tumour grade. Kaplan-Meier estimates of event-free survival at 3, 5, and 10 years were computed for each RCB class within each subtype. FINDINGS We analysed participant-level data from 5161 patients treated with neoadjuvant chemotherapy between Sept 12, 1994, and Feb 11, 2019. Median age was 49 years (IQR 20-80). 1164 event-free survival events occurred during follow-up (median follow-up 56 months [IQR 0-186]). RCB score was prognostic within each breast cancer subtype, with higher RCB score significantly associated with worse event-free survival. The univariable hazard ratio (HR) associated with one unit increase in RCB ranged from 1·55 (95% CI 1·41-1·71) for hormone receptor-positive, HER2-negative patients to 2·16 (1·79-2·61) for the hormone receptor-negative, HER2-positive group (with or without HER2-targeted therapy; p<0·0001 for all subtypes). RCB score remained prognostic for event-free survival in multivariable models adjusted for age, grade, T category, and nodal status at baseline: the adjusted HR ranged from 1·52 (1·36-1·69) in the hormone receptor-positive, HER2-negative group to 2·09 (1·73-2·53) in the hormone receptor-negative, HER2-positive group (p<0·0001 for all subtypes). INTERPRETATION RCB score and class were independently prognostic in all subtypes of breast cancer, and generalisable to multiple practice settings. Although variability in hormone receptor subtype definitions and treatment across patients are likely to affect prognostic performance, the association we observed between RCB and a patient's residual risk suggests that prospective evaluation of RCB could be considered to become part of standard pathology reporting after neoadjuvant therapy. FUNDING National Cancer Institute at the US National Institutes of Health.
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Affiliation(s)
- Christina Yau
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - Marie Osdoit
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Surgery, Institut Curie, Paris, France
| | | | - Sonal Shad
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jane Wei
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Diane de Croze
- Department of Tumor Biology, Institut Curie, Paris, France
| | | | - Marick Laé
- Department of Tumor Biology, Institut Curie, Paris, France; Department of Pathology, Université de Rouen Normandie, Rouen, France
| | - Fabien Reyal
- Department of Surgery, Institut Curie, Paris, France
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Tessa G Steenbruggen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maartje van Seijen
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jelle Wesseling
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Miguel Martín
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Del Monte-Millán
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sara López-Tarruella
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - Tanya Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rebekah Gould
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Edge
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - John M S Bartlett
- Diagnostic Development Program, Ontario Institute for Cancer Research, Toronto, Canada; Deanery of Molecular, Genetic and Population Health Sciences, Edinburgh Cancer Research Centre, Edinburgh, UK; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Caldas
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Larry Hayward
- Department of Oncology, Western General Hospital, Edinburgh, UK
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Elena Provenzano
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | | | - Jeremy S Thomas
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - David Cameron
- Department of Oncology, Western General Hospital, Edinburgh, UK
| | - Ashley Graham
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Peter Hall
- Department of Oncology, Western General Hospital, Edinburgh, UK
| | - Lorna Mackintosh
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelsey Schwensen
- Department of Medical Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Priyanka Sharma
- Department of Medical Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Angela M DeMichele
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Cole
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Lajos Pusztai
- Department of Medical Oncology, Yale University, New Haven, CT, USA
| | - Mi-Ok Kim
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Laura J van 't Veer
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - W Fraser Symmans
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Symmans WF, Yau C, Chen YY, Balassanian R, Klein ME, Pusztai L, Nanda R, Parker BA, Datnow B, Krings G, Wei S, Feldman MD, Duan X, Chen B, Sattar H, Khazai L, Zeck JC, Sams S, Mhawech-Fauceglia P, Rendi M, Sahoo S, Ocal IT, Fan F, LeBeau LG, Vinh T, Troxell ML, Chien AJ, Wallace AM, Forero-Torres A, Ellis E, Albain KS, Murthy RK, Boughey JC, Liu MC, Haley BB, Elias AD, Clark AS, Kemmer K, Isaacs C, Lang JE, Han HS, Edmiston K, Viscusi RK, Northfelt DW, Khan QJ, Leyland-Jones B, Venters SJ, Shad S, Matthews JB, Asare SM, Buxton M, Asare AL, Rugo HS, Schwab RB, Helsten T, Hylton NM, van 't Veer L, Perlmutter J, DeMichele AM, Yee D, Berry DA, Esserman LJ. Assessment of Residual Cancer Burden and Event-Free Survival in Neoadjuvant Treatment for High-risk Breast Cancer: An Analysis of Data From the I-SPY2 Randomized Clinical Trial. JAMA Oncol 2021; 7:1654-1663. [PMID: 34529000 DOI: 10.1001/jamaoncol.2021.3690] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Residual cancer burden (RCB) distributions may improve the interpretation of efficacy in neoadjuvant breast cancer trials. Objective To compare RCB distributions between randomized control and investigational treatments within subtypes of breast cancer and explore the relationship with survival. Design, Setting, and Participants The I-SPY2 is a multicenter, platform adaptive, randomized clinical trial in the US that compares, by subtype, investigational agents in combination with chemotherapy vs chemotherapy alone in adult women with stage 2/3 breast cancer at high risk of early recurrence. Investigational treatments graduated in a prespecified subtype if there was 85% or greater predicted probability of higher rate of pathologic complete response (pCR) in a confirmatory, 300-patient, 1:1 randomized, neoadjuvant trial in that subtype. Evaluation of a secondary end point was reported from the 10 investigational agents tested in the I-SPY2 trial from March 200 through 2016, and analyzed as of September 9, 2020. The analysis plan included modeling of RCB within subtypes defined by hormone receptor (HR) and ERBB2 status and compared control treatments with investigational treatments that graduated and those that did not graduate. Interventions Neoadjuvant paclitaxel plus/minus 1 of several investigational agents for 12 weeks, then 12 weeks of cyclophosphamide/doxorubicin chemotherapy followed by surgery. Main Outcomes and Measures Residual cancer burden (pathological measure of residual disease) and event-free survival (EFS). Results A total of 938 women (mean [SD] age, 49 [11] years; 66 [7%] Asian, 103 [11%] Black, and 750 [80%] White individuals) from the first 10 investigational agents were included, with a median follow-up of 52 months (IQR, 29 months). Event-free survival worsened significantly per unit of RCB in every subtype of breast cancer (HR-positive/ERBB2-negative: hazard ratio [HZR], 1.75; 95% CI, 1.45-2.16; HR-positive/ERBB2-positive: HZR, 1.55; 95% CI, 1.18-2.05; HR-negative/ERBB2-positive: HZR, 2.39; 95% CI, 1.64-3.49; HR-negative/ERBB2-negative: HZR, 1.99; 95% CI, 1.71-2.31). Prognostic information from RCB was similar from treatments that graduated (HZR, 2.00; 95% CI, 1.57-2.55; 254 [27%]), did not graduate (HZR, 1.87; 95% CI, 1.61-2.17; 486 [52%]), or were control (HZR, 1.79; 95% CI, 1.42-2.26; 198 [21%]). Investigational treatments significantly lowered RCB in HR-negative/ERBB2-negative (graduated and nongraduated treatments) and ERBB2-positive subtypes (graduated treatments), with improved EFS (HZR, 0.61; 95% CI, 0.41-0.93) in the exploratory analysis. Conclusions and Relevance In this randomized clinical trial, the prognostic significance of RCB was consistent regardless of subtype and treatment. Effective neoadjuvant treatments shifted the distribution of RCB in addition to increasing pCR rate and appeared to improve EFS. Using a standardized quantitative method to measure response advances the interpretation of efficacy. Trial Registration ClinicalTrials.gov Identifier: NCT01042379.
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Affiliation(s)
- W Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Christina Yau
- Department of Surgery, University of California, San Francisco
| | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco
| | - Ron Balassanian
- Department of Pathology, University of California, San Francisco
| | - Molly E Klein
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Lajos Pusztai
- Department of Medicine, Medical Oncology, Yale University, New Haven, Connecticut
| | - Rita Nanda
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Barbara A Parker
- Division of Hematology-Oncology, Department of Medicine, University of California, San Diego, La Jolla
| | - Brian Datnow
- Department of Pathology, University of California, San Diego, La Jolla
| | - Gregor Krings
- Department of Pathology, University of California, San Francisco
| | - Shi Wei
- Department of Anatomic Pathology, University of Alabama at Birmingham
| | - Michael D Feldman
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Xiuzhen Duan
- Department of Pathology, Loyola University, Chicago, Illinois
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Husain Sattar
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Laila Khazai
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Jay C Zeck
- Department of Pathology, Georgetown University, Washington, DC
| | - Sharon Sams
- Department of Pathology, University of Colorado Anschutz Medical Center, Aurora
| | | | - Mara Rendi
- Department of Anatomic Pathology, University of Washington, Seattle
| | - Sunati Sahoo
- Department of Pathology, University of Texas Southwestern, Dallas
| | - Idris Tolgay Ocal
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Fang Fan
- Department of Pathology, University of Kansas Medical Center, Kansas City
| | | | - Tuyethoa Vinh
- Department of Pathology, Inova Health System, Fairfax, Virginia
| | - Megan L Troxell
- Department of Pathology, Oregon Health and Science University, Portland
| | - A Jo Chien
- Division of Hematology-Oncology, Department of Medicine, University of California, San Francisco
| | - Anne M Wallace
- Department of Surgery, University of California, San Diego, La Jolla
| | - Andres Forero-Torres
- Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham
| | - Erin Ellis
- Medical Oncology, Swedish Cancer Institute, Seattle, Washington
| | - Kathy S Albain
- Division of Hematology-Oncology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Rashmi K Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Minetta C Liu
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Barbara B Haley
- Division of Hematology-Oncology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Anthony D Elias
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora
| | - Amy S Clark
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Kathleen Kemmer
- Division of Hematology-Oncology, Department of Medicine, Oregon Health & Science University, Portland
| | - Claudine Isaacs
- Division of Hematology-Oncology, Department of Medicine, Georgetown University, Washington, DC
| | - Julie E Lang
- Department of Surgery, University of Southern California, Los Angeles
| | - Hyo S Han
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Kirsten Edmiston
- Department of Surgery, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Rebecca K Viscusi
- Department of Surgery, University of Arizona Health Sciences, Tucson, Arizona
| | - Donald W Northfelt
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Qamar J Khan
- Division of Oncology, Department of Medicine, University of Kansas, Kansas City
| | | | - Sara J Venters
- Department of Laboratory Medicine, University of California, San Francisco
| | - Sonal Shad
- Department of Surgery, University of California, San Francisco
| | | | - Smita M Asare
- Quantum Leap Healthcare Collaborative, San Francisco, California
| | | | - Adam L Asare
- Quantum Leap Healthcare Collaborative, San Francisco, California
| | - Hope S Rugo
- Division of Hematology-Oncology, Department of Medicine, University of California, San Francisco
| | - Richard B Schwab
- Division of Hematology-Oncology, Department of Medicine, University of California, San Diego, La Jolla
| | - Teresa Helsten
- Division of Hematology-Oncology, Department of Medicine, University of California, San Diego, La Jolla
| | - Nola M Hylton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Laura van 't Veer
- Department of Laboratory Medicine, University of California, San Francisco
| | | | - Angela M DeMichele
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Douglas Yee
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis
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Yu Y, Wu S, Xing H, Han M, Li J, Liu Y. Development and Validation of a Novel Model for Predicting Prognosis of Non-PCR Patients After Neoadjuvant Therapy for Breast Cancer. Front Oncol 2021; 11:675533. [PMID: 34540660 PMCID: PMC8440922 DOI: 10.3389/fonc.2021.675533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Pathologic complete response (pCR) after neoadjuvant therapy is an important indicator of long-term prognosis and the primary endpoint of many neoadjuvant studies. For breast cancer patients who do not achieve pCR, prognostic indicators related to prognosis are particularly important. This study is constructing a prediction model with more accurate and reliable prediction results by combining multiple clinicopathological factors, so as to provide a more accurate decision-making basis for subsequent clinical treatment. Patients and Methods In this study, 1,009 cases of invasive breast cancer and surgically resected after neoadjuvant therapy from 2010 to 2017. All indicators in this trial were interpreted in a double-blind manner by two pathologists with at least 10 years of experience, including histological grading, Tils, ER, PR, HER2, and Ki67. The prediction model used R language to calculate the calibration degree and ROC curve of the prediction model in the training set and validation set. Results Through univariate survival analysis, the results showed histological grade (P=0.037), clinical stage (P<0.001), HER2 (P=0.044), RCB class (P<0.001), Tils (P<0.001), lymph node status (P =0.049), MP grade (P=0.013) are related to OS in non-PCR patients after neoadjuvant. Data were analyzed by substituting in a multivariate analysis, and the results were that clinical stage, HER2, RCB grading, and Tils grading were correlated with OS in non-PCR patients after neoadjuvant therapy for breast cancer. Among all cases in the training set, the prediction model predicted that the 3-year survival AUC value was 0.95 and 5-year survival AUC value was 0.79, and the RCB classification of 3-year survival and 5-year survival were 0.70 and 0.67, respectively, which proved that the prediction model could predict the OS of non-PCR patients after neoadjuvant therapy for breast cancer more accurately than the RCB classification, and showed the same results in HR, HER2+, and TN classifications. It also showed the same results in validation set. Conclusion These data indicate that the predicted values of the prediction model developed in this study match the actual survival rates without underestimating the mortality risk and have a relatively accurate prediction effect.
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Affiliation(s)
- Yongqiang Yu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Si Wu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Xing
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mengxue Han
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinze Li
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Saleh RR, Nadler MB, Desnoyers A, Meti N, Fazelzad R, Amir E. Platinum-based chemotherapy in early-stage triple negative breast cancer: A meta-analysis. Cancer Treat Rev 2021; 100:102283. [PMID: 34530283 DOI: 10.1016/j.ctrv.2021.102283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The addition of platinum agents to anthracycline and taxane-based chemotherapy in early-stage triple negative breast cancer (TNBC) patients improves pathological complete response (pCR). Long-term outcomes, such as disease-free survival (DFS) and overall survival (OS), have not been well-established. METHODS A systematic literature review identified studies using platinum-based treatment in TNBC patients in the neoadjuvant or adjuvant setting with reportable long-term outcomes. Hazard ratios (HR) from collected data were pooled in a meta-analysis using generic inverse-variance and random effects modeling. Subgroup analyses were conducted based on treatment setting and study design. RESULTS Fourteen studies comprising 3518 patients met the inclusion criteria. Median follow up was 56.2 months. All studies reported DFS and 9 studies (64%) reported OS. DFS was significantly better in platinum-based treatment (HR 0.71, 95% confidence interval (CI) 0.56-0.89; p = 0.03). However, OS was no different (HR 0.98, 95% CI 0.75-1.27; p = 0.87). There was a non-significant difference between platinum exposure in the adjuvant compared to neoadjuvant setting for both DFS (HR 0.75 vs 0.62, p = 0.43) and for OS (HR 0.90 vs 1.10, p = 0.58). The addition of platinum was associated with more thrombocytopenia and all-grade neuropathy and non-significant increases in neutropenia and grade 3-4 neuropathy. CONCLUSIONS Platinum-based treatment improves DFS but not OS. The reporting of toxicity was suboptimal, but in general adding platinum increased toxicity. The discordant effect of platinum-based treatment on DFS and OS suggest the potential development of platinum resistance and worse outcomes after recurrence. Platinum-based chemotherapy cannot be recommended in unselected patients with early TNBC.
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Affiliation(s)
- Ramy R Saleh
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Michelle B Nadler
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Desnoyers
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Meti
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada; Information Specialist, Library and Information Services, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eitan Amir
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
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Oshi M, Gandhi S, Huyser MR, Tokumaru Y, Yan L, Yamada A, Matsuyama R, Endo I, Takabe K. MELK expression in breast cancer is associated with infiltration of immune cell and pathological compete response (pCR) after neoadjuvant chemotherapy. Am J Cancer Res 2021; 11:4421-4437. [PMID: 34659896 PMCID: PMC8493385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023] Open
Abstract
In experimental settings, maternal embryonic leucine zipper kinase (MELK), an apical member of the snf1/AMPK serine-threonine kinases family, plays a role in tumor growth. We investigated the clinical relevance of MELK expression by performing silico analyses of 7,135 breast cancer patients using multiple independent large cohorts. In triple negative breast cancer (TNBC) found that elevated MELK expression significantly correlates with Nottingham histologic grade and tumor growth according to American Joint Committee Cancer (AJCC) stage. High MELK tumor enriched cell proliferation-related gene sets as well as DNA repair, unfolded protein response, and MTORC signaling gene sets. In two independent cohorts a high mutation rate and worse survival was significantly associated with high MELK tumor. In immune-related gene sets including, allograft rejection, interferon (IFN)-α response, and IFN-γ response, high MELK tumor significantly enriched. Pro-cancer regulatory T cells, T helper type 2 cells and anti-cancer immune cells including CD4+ memory T cells, T helper type1 cells, CD8+ T cells, M1 macrophages, gamma-delta T cells, and dendritic cells with high levels of cytolytic activity (CYT) were highly infiltrated. MELK expression did not correlate with the responses to any of the drugs tested in cell lines. However, pathologic complete response was significantly associated with high MELK following NAC in both TNBC and ER-positive plus HER2-negative breast cancer. In conclusion, cell proliferation, immune response, and NAC breast cancer response was associated with MELK expression.
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Affiliation(s)
- Masanori Oshi
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer CenterBuffalo, New York 14263, USA
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of MedicineYokohama 236-0004, Japan
| | - Shipra Gandhi
- Department of Medical Oncology, Roswell Park Comprehensive Cancer CenterElm & Carlton Streets, Buffalo, NY 14263, USA
| | - Michelle R Huyser
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer CenterBuffalo, New York 14263, USA
| | - Yoshihisa Tokumaru
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer CenterBuffalo, New York 14263, USA
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University1-1 Yanagido, Gifu 501-1194, Japan
| | - Li Yan
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer CenterBuffalo, New York 14263, USA
| | - Akimitsu Yamada
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of MedicineYokohama 236-0004, Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of MedicineYokohama 236-0004, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of MedicineYokohama 236-0004, Japan
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer CenterBuffalo, New York 14263, USA
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of MedicineYokohama 236-0004, Japan
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental SciencesNiigata 951-8520, Japan
- Department of Breast Surgery, Fukushima Medical University School of MedicineFukushima 960-1295, Japan
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New YorkBuffalo, New York 14263, USA
- Department of Breast Surgery and Oncology, Tokyo Medical UniversityTokyo 160-8402, Japan
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Shah VV, Duncan AD, Jiang S, Stratton SA, Allton KL, Yam C, Jain A, Krause PM, Lu Y, Cai S, Tu Y, Zhou X, Zhang X, Jiang Y, Carroll CL, Kang Z, Liu B, Shen J, Gagea M, Manu SM, Huo L, Gilcrease M, Powell RT, Guo L, Stephan C, Davies PJ, Parker-Thornburg J, Lozano G, Behringer RR, Piwnica-Worms H, Chang JT, Moulder SL, Barton MC. Mammary-specific expression of Trim24 establishes a mouse model of human metaplastic breast cancer. Nat Commun 2021; 12:5389. [PMID: 34508101 PMCID: PMC8433435 DOI: 10.1038/s41467-021-25650-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/17/2021] [Indexed: 12/24/2022] Open
Abstract
Conditional overexpression of histone reader Tripartite motif containing protein 24 (TRIM24) in mouse mammary epithelia (Trim24COE) drives spontaneous development of mammary carcinosarcoma tumors, lacking ER, PR and HER2. Human carcinosarcomas or metaplastic breast cancers (MpBC) are a rare, chemorefractory subclass of triple-negative breast cancers (TNBC). Comparison of Trim24COE metaplastic carcinosarcoma morphology, TRIM24 protein levels and a derived Trim24COE gene signature reveals strong correlation with human MpBC tumors and MpBC patient-derived xenograft (PDX) models. Global and single-cell tumor profiling reveal Met as a direct oncogenic target of TRIM24, leading to aberrant PI3K/mTOR activation. Here, we find that pharmacological inhibition of these pathways in primary Trim24COE tumor cells and TRIM24-PROTAC treatment of MpBC TNBC PDX tumorspheres decreased cellular viability, suggesting potential in therapeutically targeting TRIM24 and its regulated pathways in TRIM24-expressing TNBC.
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Affiliation(s)
- Vrutant V Shah
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aundrietta D Duncan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA
- Salarius Pharmaceuticals, Houston, TX, USA
| | - Shiming Jiang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Thoracic Head and Neck Medicine Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sabrina A Stratton
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kendra L Allton
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Neurodegeneration Consortium, Therapeutics Discovery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clinton Yam
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abhinav Jain
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA
| | - Patrick M Krause
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yue Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirong Cai
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yizheng Tu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xinhui Zhou
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaomei Zhang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yan Jiang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher L Carroll
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Institute of Applied Cancer Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhijun Kang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Institute of Applied Cancer Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bin Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Shen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mihai Gagea
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sebastian M Manu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Gilcrease
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reid T Powell
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M College of Medicine, Houston, TX, USA
| | - Lei Guo
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M College of Medicine, Houston, TX, USA
| | - Clifford Stephan
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M College of Medicine, Houston, TX, USA
| | - Peter J Davies
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M College of Medicine, Houston, TX, USA
| | - Jan Parker-Thornburg
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermina Lozano
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA
| | - Richard R Behringer
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA
| | - Helen Piwnica-Worms
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey T Chang
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA.
- Department of Integrative Biology and Pharmacology, University of Texas Health Sciences Center at Houston, Houston, TX, USA.
| | - Stacy L Moulder
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Michelle Craig Barton
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Epigenetics and Molecular Carcinogenesis, Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX, USA.
- Division of Oncological Sciences, Cancer Early Detection Advanced Research, Center Knight Cancer Institute Oregon Health & Science University, Portland, OR, USA.
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Wetzel CL, Sutton TL, Gardiner S, Farinola M, Johnson N, Garreau JR. Loss of HER2-positivity following neoadjuvant targeted therapy for breast cancer is not associated with inferior oncologic outcomes. J Surg Oncol 2021; 124:1224-1234. [PMID: 34416025 DOI: 10.1002/jso.26646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are treated with trastuzumab-based neoadjuvant therapy (NAT); some patients with residual disease post-NAT show loss of HER2 amplification and has been inconsistently associated with oncologic outcomes. METHODS We queried our multi-institutional cancer registry for women with HER2-positive breast cancer undergoing NAT from 2011 to 2018. Clinicopathologic, treatment-related, and outcomes data were collected. Kaplan-Meier and Cox proportional hazards analysis were used to evaluate oncologic outcomes. RESULTS A total of 348 patients were identified; 166 (48%) had a pathologic complete response. Of the 182 patients with residual disease, 87 (48%) were HER2-positive, 34 (19%) were HER2-negative, and 61 (33%) were HER2-unknown, with a median follow-up of 44 months. There were no factors associated with HER2 loss apart from age. On Kaplan-Meier analysis, estimated 5-year recurrence-free survival (RFS) and overall survival (OS) for patients with HER2-positive residual disease was 81% and 92%, respectively, and 74% (log rank p = 0.75) and 81% (p = 0.35) in patients with HER2-negative residual disease. CONCLUSION The loss of HER2-positivity following NAT is not associated with worse 5-year RFS or OS. We do not recommend retesting HER2 status following NAT for the purpose of clinical management; these patients should complete targeted adjuvant therapy.
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Affiliation(s)
- Catherine L Wetzel
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Thomas L Sutton
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Stuart Gardiner
- Legacy Health, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Maryam Farinola
- Department of Pathology, Legacy Health, Portland, Oregon, USA
| | - Nathalie Johnson
- Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, Portland, Oregon, USA
| | - Jennifer R Garreau
- Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, Portland, Oregon, USA
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Sentinel lymph node assessment in breast cancer-an update on current recommendations. Virchows Arch 2021; 480:95-107. [PMID: 34164706 DOI: 10.1007/s00428-021-03128-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy (SLNB) has become the preferred method of surgical pathological nodal staging of early breast cancer by the end of the nineties. As the most likely sites of metastasis, the SLNs allow a more precise staging, and indeed gross sectioning, step sectioning, immunohistochemistry, and molecular staging methods have been used to disclose metastatic involvement of these lymph nodes. This review summarizes the backgrounds of SLNB, trends in related surgery and pathology. It also gives an insight into European National recommendations related to SLN and divergent daily practices in European pathology departments, on the basis of replies to questionnaires from 84 pathologists from 38 European countries. The questionnaires revealed the post-neoadjuvant setting as an area where a significant minority of pathologists report less confidence in classifying residual nodal involvement into TNM categories. The review also summarizes the neoadjuvant therapy-related aspects of SLNB.
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Wang L, Asirvatham JR, Ma Y, Reisenbichler ES, Jorns JM. HER-2/neu-positive breast cancer neoadjuvant chemotherapy response after implementation of 2018 ASCO/CAP focused update. Breast J 2021; 27:631-637. [PMID: 34018281 DOI: 10.1111/tbj.14241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
Human Epidermal Growth Factor Receptor 2 (HER2), a routinely tested breast cancer marker, is associated with worse prognosis yet increased sensitivity to targeted neoadjuvant therapy (NAT) in breast cancer patients. The presence of HER2 in breast carcinoma can be detected with either immunohistochemistry (IHC) or in situ hybridization (ISH). In this study, we examine the relationship between clinicopathological features, HER2 detection method (IHC vs ISH), and prognostic outcomes in NAT-treated HER2-positive breast cancer patients. We included 99 HER2-positive patients from three academic institutions following 2018 HER2 testing updates and conducted a retrospective correlational study. Seventy-one (72%) were HER2-positive by IHC and 28 (28%) were positive following reflexive ISH. Multivariate analysis showed biomarker status to be significantly associated with pathologic complete response (pCR) (p = 0.003), Residual Cancer Burden (RCB) (p = 0.007), and tumor size downstaging (p = 0.002) and HER2 detection method of IHC to be significantly associated with pCR (p = 0.05), RCB (p = 0.004), and nodal downstaging (p= 0.03). In conclusion, HER2 detection method and biomarker subtype allow for further prognostic stratification of HER2-positive patients when 2018 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guideline updates are applied.
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Affiliation(s)
- Lin Wang
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Yanlin Ma
- University of Virginia, Charlottesville, VA, USA
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Patterns of Recurrence after Neoadjuvant Therapy in Early Breast Cancer, according to the Residual Cancer Burden Index and Reductions in Neoadjuvant Treatment Intensity. Cancers (Basel) 2021; 13:cancers13102492. [PMID: 34065332 PMCID: PMC8161089 DOI: 10.3390/cancers13102492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The residual cancer burden (RCB) score provides prognostic information on the survival of breast cancer patients who underwent neoadjuvant systemic therapy, with the greatest impact of higher scores on worse recurrence-free survival (RFS) and overall survival (OS) in triple-negative and HER2 positive patients. The impact of chemotherapy dose reduction on RCB is currently unknown, and should therefore be critically evaluated by clinicians. Our study confirms the prognostic relevance of the RCB score and suggests a potential association of the RCB with dose reduction having adverse impact on the RCB, thereby potentially impacting the prognosis of patients, as shown here in a large breast cancer cohort at the Medical University of Graz. Abstract Background: The prognostic performance of the residual cancer burden (RCB) score is a promising tool for breast cancer patients undergoing neoadjuvant therapy. We independently evaluated the prognostic value of RCB scores in an extended validation cohort. Additionally, we analyzed the association between chemotherapy dose reduction and RCB scores. Methods: In this extended validation study, 367 breast cancer patients with available RCB scores were followed up for recurrence-free survival (RFS), distant disease-free survival (DDFS), and overall survival (OS). We also computed standardized cumulative doses of anthracyclines and taxanes (A/Ts) to investigate a potential interaction between neoadjuvant chemotherapy dose reduction and RCB scores. Results: Higher RCB scores were consistently associated with adverse clinical outcomes across different molecular subtypes (HR for RFS = 1.60, 95% CI 1.33–1.93, p < 0.0001; HR for DDFS = 1.70, 95% CI 1.39–2.05, p < 0.0001; HR for OS = 1.67, 95% CI 1.34–2.08, p < 0.0001). The adverse impact prevailed throughout 5 years of follow-up, with a peak for relapse risk between 1–2 years after surgery. Clinical outcomes of patients with RCB class 1 did not differ substantially at 5 years compared to RCB class 0. A total of 180 patients (49.1%) underwent dose reduction of neoadjuvant A/T chemotherapy. We observed a statistically significant interaction between dose reduction and higher RCB scores (interaction p-value = 0.042). Conclusion: Our results confirm RCB score as a prognostic marker for RFS, DDFS, and OS independent of the molecular subtype. Importantly, we show that lower doses of cumulative neoadjuvant A/T were associated with higher RCB scores in patients who required a dose reduction.
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Kantor O, Laws A, Pastorello RG, King C, Wong S, Dey T, Schnitt S, King TA, Mittendorf EA. Comparison of Breast Cancer Staging Systems After Neoadjuvant Chemotherapy. Ann Surg Oncol 2021; 28:7347-7355. [PMID: 33956276 DOI: 10.1245/s10434-021-09951-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND No consensus exists for optimal staging following neoadjuvant chemotherapy (NAC). We compared the performance of the American Joint Committee on Cancer (AJCC) pathologic prognostic staging system, Residual Cancer Burden (RCB) Index, and the Neo-Bioscore in breast cancer patients after NAC. METHODS Patients with stage I-III breast cancer who received NAC at Dana-Farber Cancer Institute from 2004 to 2014 were identified. Kaplan-Meier curves were used to estimate disease-free survival (DFS) and overall survival (OS), and model fits were compared by receiver operator characteristic (ROC) curve using the c-statistic and DeLong's test. RESULTS Overall, 802 patients with a median age of 48 years received NAC. Most patients presented with cT2 (n = 470, 58.6%) and cN1 (n = 422, 52.6%) disease. The subtype was estrogen receptor (ER)- and/or progesterone receptor (PR)-positive/human epidermal growth factor receptor 2 (HER2)-negative in 296 (36.9%) patients, HER2-positive in 261 (32.5%) patients, and triple-negative in 245 (30.5%) patients. Median follow-up was 79.5 months. There were 174 recurrences (30 local, 25 regional, 145 distant), with 676 (76.8%) patients alive at last follow-up. AJCC pathologic prognostic staging and RCB had better discrimination for estimated 7-year DFS and OS compared with the Neo-Bioscore. The ROC c-statistics for DFS model fit were similar for AJCC pathologic prognostic stage (0.72) and RCB (0.71, p = non-significant); both had improved model fit versus the Neo-Bioscore (0.65, p < 0.01). The c-statistics for OS were 0.74, 0.71, and 0.70 for AJCC pathologic prognostic stage, RCB, and Neo-Bioscore, respectively (p = non-significant). CONCLUSIONS These results validate the ability of these staging systems to stratify survival outcomes in NAC patients, with best discrimination achieved using AJCC pathologic prognostic stage or RCB.
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Affiliation(s)
- Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Ricardo G Pastorello
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Claire King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Stephanie Wong
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
| | - Tanujit Dey
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart Schnitt
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
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Grandal B, Mangiardi-Veltin M, Laas E, Laé M, Meseure D, Bataillon G, El-Alam E, Darrigues L, Dumas E, Daoud E, Vincent-Salomon A, Talagrand LS, Pierga JY, Reyal F, Hamy AS. PD-L1 Expression after Neoadjuvant Chemotherapy in Triple-Negative Breast Cancers Is Associated with Aggressive Residual Disease, Suggesting a Potential for Immunotherapy. Cancers (Basel) 2021; 13:cancers13040746. [PMID: 33670162 PMCID: PMC7916886 DOI: 10.3390/cancers13040746] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 12/31/2022] Open
Abstract
The consequences of neoadjuvant chemotherapy (NAC) for PD-L1 activity in triple-negative breast cancers (TNBC) are not well-understood. This is an important issue as PD-LI might act as a biomarker for immune checkpoint inhibitors' (ICI) efficacy, at a time where ICI are undergoing rapid development and could be beneficial in patients who do not achieve a pathological complete response. We used immunohistochemistry to assess PD-L1 expression in surgical specimens (E1L3N clone, cutoff for positivity: ≥1%) on both tumor (PD-L1-TC) and immune cells (PD-L1-IC) from a cohort of T1-T3NxM0 TNBCs treated with NAC. PD-L1-TC was detected in 17 cases (19.1%) and PD-L1-IC in 14 cases (15.7%). None of the baseline characteristics of the tumor or the patient were associated with PD-L1 positivity, except for pre-NAC stromal TIL levels, which were higher in post-NAC PD-L1-TC-positive than in negative tumors. PD-L1-TC were significantly associated with a higher residual cancer burden (p = 0.035) and aggressive post-NAC tumor characteristics, whereas PD-L1-IC were not. PD-L1 expression was not associated with relapse-free survival (RFS) (PD-L1-TC, p = 0.25, and PD-L1-IC, p = 0.95) or overall survival (OS) (PD-L1-TC, p = 0.48, and PD-L1-IC, p = 0.58), but high Ki67 levels after NAC were strongly associated with a poor prognosis (RFS, p = 0.0014, and OS, p = 0.001). A small subset of TNBC patients displaying PD-L1 expression in the context of an extensive post-NAC tumor burden could benefit from ICI treatment after standard NAC.
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Affiliation(s)
- Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.L.); (E.D.); (E.D.); (A.-S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
| | - Manon Mangiardi-Veltin
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
| | - Enora Laas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.L.); (E.D.); (E.D.); (A.-S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
| | - Marick Laé
- Department of Pathology, Henri Becquerel Cancer Center, INSERM U1245, UniRouen Normandy University, 76038 Rouen, France;
- Department of Pathology, Institut Curie, University Paris, 75005 Paris, France; (D.M.); (G.B.); (E.E.-A.); (A.V.-S.)
| | - Didier Meseure
- Department of Pathology, Institut Curie, University Paris, 75005 Paris, France; (D.M.); (G.B.); (E.E.-A.); (A.V.-S.)
| | - Guillaume Bataillon
- Department of Pathology, Institut Curie, University Paris, 75005 Paris, France; (D.M.); (G.B.); (E.E.-A.); (A.V.-S.)
| | - Elsy El-Alam
- Department of Pathology, Institut Curie, University Paris, 75005 Paris, France; (D.M.); (G.B.); (E.E.-A.); (A.V.-S.)
| | - Lauren Darrigues
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.L.); (E.D.); (E.D.); (A.-S.H.)
| | - Eric Daoud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.L.); (E.D.); (E.D.); (A.-S.H.)
| | - Anne Vincent-Salomon
- Department of Pathology, Institut Curie, University Paris, 75005 Paris, France; (D.M.); (G.B.); (E.E.-A.); (A.V.-S.)
| | - Laure-Sophie Talagrand
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France;
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.L.); (E.D.); (E.D.); (A.-S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
- Correspondence: ; Tel.: +33-144324660 or +33-615271980
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.L.); (E.D.); (E.D.); (A.-S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (M.M.-V.); (L.D.); (L.-S.T.)
- Department of Pathology, Henri Becquerel Cancer Center, INSERM U1245, UniRouen Normandy University, 76038 Rouen, France;
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The Prognostic Value of Lymph Node Involvement after Neoadjuvant Chemotherapy Is Different among Breast Cancer Subtypes. Cancers (Basel) 2021; 13:cancers13020171. [PMID: 33418983 PMCID: PMC7825348 DOI: 10.3390/cancers13020171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/29/2020] [Accepted: 01/02/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Little is known about whether residual axillary disease after neoadjuvant chemotherapy carries a different prognostic value by breast cancer subtype. We retrospectively evaluated the axillary involvement (0, 1 to 3 positive nodes, ≥4 positive nodes) on surgical specimens from a cohort of 1197 patients treated with neoadjuvant chemotherapy, and analyzed its association with survival outcomes. Relapse free survival was significantly associated with the number of positive nodes, but this effect was different by breast cancer subtype (Pinteraction = 0.004). High risk patients were those with 4 or more nodes involved in the luminal subgroup, whereas patients with 1 node or more involved had a decreased prognosis in triple negative and HER2 positive breast cancer subgroups. The prognostic value of residual axillary disease should be interpreted according to breast cancer subtype to accurately stratify patients with a high risk of recurrence after neoadjuvant chemotherapy who should be offered second line therapies. Abstract Introduction: The three different breast cancer subtypes (Luminal, HER2-positive, and triple negative (TNBCs) display different natural history and sensitivity to treatment, but little is known about whether residual axillary disease after neoadjuvant chemotherapy (NAC) carries a different prognostic value by BC subtype. Methods: We retrospectively evaluated the axillary involvement (0, 1 to 3 positive nodes, ≥4 positive nodes) on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between nodal involvement (ypN) binned into three classes (0; 1 to 3; 4 or more), relapse-free survival (RFS) and overall survival (OS) among the global population, and according to BC subtypes. Results: 1197 patients were included in the analysis (luminal (n = 526, 43.9%), TNBCs (n = 376, 31.4%), HER2-positive BCs (n = 295, 24.6%)). After a median follow-up of 110.5 months, ypN was significantly associated with RFS, but this effect was different by BC subtype (Pinteraction = 0.004), and this effect was nonlinear. In the luminal subgroup, RFS was impaired in patients with 4 or more nodes involved (HR 2.8; 95% CI [1.93; 4.06], p < 0.001) when compared with ypN0, while it was not in patients with 1 to 3 nodes (HR = 1.24, 95% CI = [0.86; 1.79]). In patients with TNBC, both 1-3N+ and ≥4 N+ classes were associated with a decreased RFS (HR = 3.19, 95% CI = [2.05; 4.98] and HR = 4.83, 95% CI = [3.06; 7.63], respectively versus ypN0, p < 0.001). Similar decreased prognosis were observed among patients with HER2-positive BC (1-3N +: HR = 2.7, 95% CI = [1.64; 4.43] and ≥4 N +: HR = 2.69, 95% CI = [1.24; 5.8] respectively, p = 0.003). Conclusion: The prognostic value of residual axillary disease should be considered differently in the 3 BC subtypes to accurately stratify patients with a high risk of recurrence after NAC who should be offered second line therapies.
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Simon V, Laot L, Laas E, Rozette S, Guerin J, Balezeau T, Nicolas M, Pierga JY, Coussy F, Laé M, De Croze D, Grandal B, Abecassis J, Dumas E, Lerebours F, Reyal F, Hamy AS. No Impact of Smoking Status on Breast Cancer Tumor Infiltrating Lymphocytes, Response to Neoadjuvant Chemotherapy and Prognosis. Cancers (Basel) 2020; 12:cancers12102943. [PMID: 33053866 PMCID: PMC7601636 DOI: 10.3390/cancers12102943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Tobacco use is associated with an increase in breast cancer mortality. Pathologic complete response (pCR) rate to neoadjuvant chemotherapy is influenced by tumor-infiltrating lymphocyte (TIL) levels and is associated with a better long-term survival outcome. The aim of this study was to evaluate the impact of smoking status on TIL levels, response to neoadjuvant chemotherapy and prognosis for breast cancer patients. We retrospectively assessed pre- and post-neoadjuvant chemotherapy tumor infiltrating lymphocyte (TILs) levels and pathological complete response (pCR) rates in a cohort of 956 specimens of breast cancer (BC) patients treated with neoadjuvant chemotherapy, according to their smoking status. To our knowledge, this is the largest cohort of BC patients used to study this topic so far. We found no impact of smoking status on tumor infiltrating lymphocyte levels, response to neoadjuvant chemotherapy and prognosis in the whole population and within each BC subtype. Abstract Tobacco use is associated with an increase in breast cancer (BC) mortality. Pathologic complete response (pCR) rate to neoadjuvant chemotherapy (NAC) is influenced by tumor-infiltrating lymphocyte (TIL) levels and is associated with a better long-term survival outcome. The aim of our study is to evaluate the impact of smoking status on TIL levels, response to NAC and prognosis for BC patients. We retrospectively evaluated pre- and post-NAC stromal and intra tumoral TIL levels and pCR rates on a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012 at Institut Curie. Smoking status (current, ever, never smokers) was collected in clinical records. We analyzed the association between smoking status, TIL levels, pCR rates and survival outcomes among the whole population, and according to BC subtype. Nine hundred and fifty-six BC patients with available smoking status information were included in our analysis (current smokers, n = 179 (18.7%); ever smokers, n = 154 (16.1%) and never smokers, n = 623 (65.2%)). Median pre-NAC TIL levels, pCR rates, or median post-NAC TIL levels were not significantly different according to smoking status, neither in the whole population, nor in any BC subtype group. With a median follow-up of 101.4 months, relapse-free survival (RFS) and overall survival (OS) were not significantly different by smoking status. We did not find any significant effect of tobacco use on pre- and post-NAC TILs nor response to NAC. Though our data seem reassuring, BC treatment should still be considered as a window of opportunity to offer BC patients accurate smoking cessation interventions.
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Affiliation(s)
- Vanille Simon
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Enora Laas
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Sonia Rozette
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France; (J.G.); (T.B.)
| | - Thomas Balezeau
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France; (J.G.); (T.B.)
| | - Marion Nicolas
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Marick Laé
- Department of Tumor Biology, Institut Curie, 75005 Paris, France; (M.L.); (D.D.C.)
| | - Diane De Croze
- Department of Tumor Biology, Institut Curie, 75005 Paris, France; (M.L.); (D.D.C.)
| | - Beatriz Grandal
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Judith Abecassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Florence Lerebours
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
- Correspondence: ; Tel.: +33-144-324-087 or +33-615-271-980
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
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