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Xu D, Wu J, Yu J, Yang Y, Wen X, Yang J, Wei H, Xu X, Li Y, Yang L, Wang L, Wang Y, Ma W, Li N. A historical controlled study of domestic trastuzumab and pertuzumab in combination with docetaxel for the neoadjuvant treatment of early HER2-positive breast cancer. Front Oncol 2024; 14:1281643. [PMID: 38406813 PMCID: PMC10884175 DOI: 10.3389/fonc.2024.1281643] [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: 08/22/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background HER2-positive molecular breast cancer subtypes are characterized by high aggressiveness and malignancy, and their metastasis and mortality rates are among the highest of all types of breast cancer. The use of anti-HER2-targeted agents in neoadjuvant therapy has significantly improved the prognosis of patients with HER2-positive breast cancer. In this study, we investigated the efficacy and safety of a neoadjuvant Chinese THP regimen (docetaxel, trastuzumab biosimilar TQB211 plus the pertuzumab biosimilar TQB2440 or pertuzumab) for ER/PR-negative and HER2-positive breast cancer in China. Method All enrolled patients received the THP regimen (T: docetaxel 75 mg/m2 per cycle; H: trastuzumab biosimilar TQB211 8 mg/kg in the first cycle and 6 mg/kg maintenance dose in cycles 2 to 4; P: pertuzumab biosimilar TQB2440 or pertuzumab 840 mg in the first cycle, maintenance dose 420 mg in cycles 2 to 4) every 3 weeks for 4 cycles. The biosimilar TQB2440 pertuzumab and pertuzumab were randomly assigned to patients. Docetaxel, TQB211, and TQB2440 were all developed by Chiatai Tianqing. The primary endpoint was the complete pathological response (pCR) in the breast, and the secondary endpoint was cardiac safety. Results Of the 28 eligible patients, 19 (67.9%) achieved tpCR. The tpCR rate was higher than in the NeoSphere trial (pCR63.2%) and the PEONY study (tpCR52.5%). The adverse events that occurred most frequently were leukopenia and neutropenia, with incidence rates of 82.1% and 75.0%, respectively. Of these, grade 3 leukopenia and neutropenia occupied 46.4% and 35.7%. Other grade 3 or higher adverse events were bone marrow suppression (7.1%), lymphopenia (3.6%), and anemia (3.6%). There were no events of heart failure in patients and no patient died during the neoadjuvant phase. Conclusion Domestic dual-target HP has a more satisfactory efficacy and safety in the neoadjuvant phase of treatment. Clinical trial registration https://clinicaltrials.gov/study/NCT05985187, NCT05985187.
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Affiliation(s)
- Dongdong Xu
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Jiang Wu
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Jing Yu
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Yuqing Yang
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Xinxin Wen
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Jixin Yang
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Hongliang Wei
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Xiaolong Xu
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Yike Li
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Liu Yang
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Lei Wang
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
| | - Yijia Wang
- Department of Psychology, Colorado College, Colorado Springs, CO, United States
| | - Wen Ma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Nanlin Li
- Department of Thyroid Breast & Vascular Surgery, Xi’jing Hospital, Air Force Medical University (AFMU), Xi’an, China
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Zhang M, Liao J, Jia Z, Qin C, Zhang L, Wang H, Liu Y, Jiang C, Han M, Li J, Wang K, Wang X, Bu H, Yao J, Liu Y. High Dynamic Range Dual-Modal White Light Imaging Improves the Accuracy of Tumor Bed Sampling After Neoadjuvant Therapy for Breast Cancer. Am J Clin Pathol 2023; 159:293-303. [PMID: 36799717 DOI: 10.1093/ajcp/aqac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/01/2022] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES Accurate evaluation of residual cancer burden remains challenging because of the lack of appropriate techniques for tumor bed sampling. This study evaluated the application of a white light imaging system to help pathologists differentiate the components and location of tumor bed in specimens. METHODS The high dynamic range dual-mode white light imaging (HDR-DWI) system was developed to capture antiglare reflection and multiexposure HDR transmission images. It was tested in 60 specimens of modified radical mastectomy after neoadjuvant therapy. We observed the differential transmittance among tumor tissue, fibrosis tissue, and adipose tissue. RESULTS The sensitivity and specificity of HDR-DWI were compared with x-ray or visual examination to determine whether HDR-DWI was superior in identifying tumor beds. We found that tumor tissue had lower transmittance (0.12 ± 0.03) than fibers (0.15 ± 0.04) and fats (0.27 ± 0.07) (P < .01). CONCLUSIONS HDR-DWI was more sensitive in identifying fiber and tumor tissues than cabinet x-ray and visual observation (P < .01). In addition, HDR-DWI could identify more fibrosis areas than the currently used whole slide imaging did in 12 samples (12/60). We have determined that HDR-DWI can provide more in-depth tumor bed information than x-ray and visual examination do, which will help prevent diagnostic errors in tumor bed sampling.
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Affiliation(s)
- Meng Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun Liao
- AI Lab, Tencent, Shenzhen, China
| | - Zhanli Jia
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Lingling Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Han Wang
- AI Lab, Tencent, Shenzhen, China
| | - Yao Liu
- 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
| | - Kun Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinran Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Dubashi B, Matta K, Kayal S, Thumathy D, Nisha Y, Dharanipragada K, Gunaseelan K, ch Toi P, Ganesan P. Modified neoadjuvant clinicopathological risk stratification as a prognostic score in early and locally advanced triple-negative breast cancer. J Cancer Res Ther 2022; 18:168-172. [DOI: 10.4103/jcrt.jcrt_986_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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In Vitro Screening for Cytotoxic Activity of Herbal Extracts. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:2675631. [PMID: 28386288 PMCID: PMC5366791 DOI: 10.1155/2017/2675631] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/16/2017] [Accepted: 03/06/2017] [Indexed: 12/15/2022]
Abstract
Experimental studies have shown that a variety of chemopreventive plant components affect tumor initiation, promotion, and progression and the main difference, between botanical medicines and synthetic drugs, resides in the presence of complex metabolite mixtures shown by botanical medicine which in turn exert their action on different levels and via different mechanisms. In the present study, we performed an in vitro screening of ethanol extracts from commercial plants in order to investigate potential antitumor activity against human tumor cell lines. Experimental results obtained through a variety of methods and techniques indicated that extracts of I. verum, G. glabra, R. Frangula, and L. usitatissimum present significant reduction in in vitro tumor cell proliferation, suggesting these extracts as possible chemotherapeutical adjuvants for different cancer treatments.
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Pennisi A, Kieber-Emmons T, Makhoul I, Hutchins L. Relevance of Pathological Complete Response after Neoadjuvant Therapy for Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:103-6. [PMID: 27478380 PMCID: PMC4961053 DOI: 10.4137/bcbcr.s33163] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/10/2015] [Accepted: 12/13/2015] [Indexed: 12/30/2022]
Abstract
Breast cancer is a heterogeneous disease, and the different biological subtypes have different prognostic impacts. Neoadjuvant trials have recently become popular as they offer several advantages compared to traditional adjuvant trials. Studies have shown that patients who achieve pathological complete response (pCR) after neoadjuvant treatment have a better long-term outcome. Consequently, increasing the rate of pCR became the end point of neoadjuvant trials with the expectation of translation into improved survival. However, the definition of pCR has lacked uniformity, and the prognostic impact of achievement of pCR on survival in different breast cancer subtypes is uncertain. In this review, we present the controversies associated with the use of pCR as an end point in neoadjuvant trials.
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Affiliation(s)
- Angela Pennisi
- Department of Internal Medicine, Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thomas Kieber-Emmons
- Department of Internal Medicine, Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Issam Makhoul
- Department of Internal Medicine, Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Laura Hutchins
- Department of Internal Medicine, Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Zhang M, Wei W, Liu J, Yang H, Jiang Y, Tang W, Li Q, Liao X. Comparison of the effectiveness and toxicity of neoadjuvant chemotherapy regimens, capecitabine/epirubicin/cyclophosphamide vs 5-fluorouracil/epirubicin/cyclophosphamide, followed by adjuvant, capecitabine/docetaxel vs docetaxel, in patients with operable breast cancer. Onco Targets Ther 2016; 9:3443-50. [PMID: 27354816 PMCID: PMC4907713 DOI: 10.2147/ott.s104431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to compare the effectiveness and toxicity of neoadjuvant chemotherapy regimens, xeloda/epirubicin/cyclophosphamide (XEC) vs 5-fluorouracil/epirubicin/cyclophosphamide (FEC), followed by adjuvant chemotherapy regimens, capecitabine/taxotere (XT) vs taxotere (T), in axillary lymph node (LN)-positive early-stage breast cancer. In this randomized, Phase III trial, 137 patients with operable primary breast cancer (T2-0, N0-1) who were tested axillary LN positive through aspiration biopsy of axillary LNs were randomized (1:1) to four 3-weekly cycles of XEC or FEC. Patients underwent surgery within 4-6 weeks after the fourth cycle, followed by four adjuvant cycles of 3-weekly XT or T. The primary end point was tumor pathological complete response. Toxicity profiles were secondary objectives. In total, 131 patients had clinical and radiological evaluation of response and underwent surgery. Treatment with XEC led to an increased rate of pathological complete response in primary tumor (18% vs 6%, respectively, P=0.027) and objective remission rate (87% vs 73%, P=0.048) compared to FEC. Clinical complete response occurred in 20% and 7% for XEC and FEC, respectively. Compared to FEC, XEC was associated with more hand-foot syndrome (57% vs 11%, P<0.001) and 3/4 grade nausea/vomiting/diarrhea (30% vs 14%, P=0.034) but less phlebitis (3% vs 14%, P=0.035). XT and T adjuvant chemotherapy regimens were well tolerated: treatment-related 3/4 grade adverse events occurred in 28% and 17% of patients receiving XT and T, respectively.
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Affiliation(s)
- Minmin Zhang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Wei Wei
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jianlun Liu
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Huawei Yang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yi Jiang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Wei Tang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Qiuyun Li
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiaoming Liao
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Charehbili A, de Groot S, van der Straaten T, Swen JJ, Pijl H, Gelderblom H, van de Velde CJH, Nortier JWR, Guchelaar HJ, Kroep JR. Exploratory analysis of candidate germline gene polymorphisms in breast cancer patients treated with neoadjuvant anthracycline-containing chemotherapy and associations with febrile neutropenia. Pharmacogenomics 2015; 16:1267-76. [PMID: 26289095 DOI: 10.2217/pgs.15.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM SNPs may be associated with (side) effects of chemotherapy and may be useful as biomarkers to predict febrile neutropenia. PATIENTS & METHODS 187 DNA samples extracted from formalin-fixed paraffin-embedded tissue from patients with stage II/III HER2-negative breast cancer were genotyped. RESULTS Candidate SNPs were selected and explored for association with febrile neutropenia and/or pathological complete response. TT genotype of 388 C>T in FGFR4 (rs351855) had a tendency toward higher incidence of febrile neutropenia during neoadjuvant chemotherapy, compared with the CT (p = 0.383) genotype and compared with the CC genotype (p = 0.068). CONCLUSION The TT genotype of 388 C>T FGFR4 may be related to incidence of febrile neutropenia during neoadjuvant TAC (docetaxel, doxorubicin, cyclophosphamide) chemotherapy and is possibly useful as a patient-related risk factor when assessing febrile neutropenia risk. Original submitted 23 January 2015; Revision submitted 26 May 2015.
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Affiliation(s)
- A Charehbili
- Department of Medical Oncology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - S de Groot
- Department of Medical Oncology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - T van der Straaten
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - J J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Pijl
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J W R Nortier
- Department of Medical Oncology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - H J Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Menekşe E, Özyazıcı S, Karateke F, Turan Ü, Kuvvetli A, Gökler C, Özdoğan M, Önel S. Rhomboid Flap Technique in Breast-conserving Surgery: An Alternative Method for the Reconstruction of Lumpectomy Defects. THE JOURNAL OF BREAST HEALTH 2015; 11:186-191. [PMID: 28331719 DOI: 10.5152/tjbh.2015.2572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to present our experience with rhomboid flap reconstruction, which is a simple technique, in breast cancer patients who underwent breast-conserving surgery. METHODS We reviewed the medical records of 13 patients with breast cancer who underwent rhomboid flap reconstruction. The patients were evaluated for tumor size, safe surgical margin, and other clinical and pathological features. RESULTS The mean age of the patients was 43.1 years (range: 28-69 years). The mean tumor diameter was 30.8 mm (range: 15-60 mm). The mean of the safe margin of resection was evaluated to be 17.8 mm (range: 5-30 mm). Re-excision was required for one patient in the same session. CONCLUSION Rhomboid flap reconstruction can facilitate the applicability of breast-conserving surgery in early breast cancer patients with large tumor-to-breast-size ratio or tumors close to the skin.
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Affiliation(s)
- Ebru Menekşe
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sefa Özyazıcı
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Faruk Karateke
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Turan
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cihan Gökler
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Özdoğan
- Department of Surgery, Adana Medline Hospital, Adana, Turkey
| | - Safa Önel
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
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Rebollo-Aguirre Á, Gallego-Peinado M, Sánchez-Sánchez R, Pastor-Pons E, García-García J, Chamorro-Santos C, Menjón-Beltrán S. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Molecular subtyping of early-stage breast cancer identifies a group of patients who do not benefit from neoadjuvant chemotherapy. Breast Cancer Res Treat 2013; 139:759-67. [DOI: 10.1007/s10549-013-2572-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 01/20/2023]
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Rebollo-Aguirre AC, Gallego-Peinado M, Sánchez-Sánchez R, Pastor-Pons E, García-García J, Chamorro-Santos CE, Menjón-Beltrán S. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis. Rev Esp Med Nucl Imagen Mol 2013; 32:240-5. [PMID: 23684711 DOI: 10.1016/j.remn.2013.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA). RESULTS Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2. CONCLUSION SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.
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Affiliation(s)
- A C Rebollo-Aguirre
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
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Fontein DBY, van de Water W, Mieog JSD, Liefers GJ, van de Velde CJH. Timing of the sentinel lymph node biopsy in breast cancer patients receiving neoadjuvant therapy - recommendations for clinical guidance. Eur J Surg Oncol 2013; 39:417-24. [PMID: 23473972 DOI: 10.1016/j.ejso.2013.02.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/10/2013] [Accepted: 02/01/2013] [Indexed: 12/20/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) is an increasingly important component in the treatment of both locally advanced and early-stage breast cancer. With this, a debate on the timing of the sentinel lymph node biopsy (SLNB) has emerged. At the end of the last century, the SLNB was introduced as an axillary staging modality, and this paper aims to further elucidate this issue in the context of NAC. We compiled available data on the SLNB after NAC and provide clinical guidance for timing the SLNB in this context. On the basis of our findings, we recommend that the SLNB can be performed after NAC in all cases. In patients with a clinically node-negative (cN0) status prior to NAC, the SLNB should be performed after NAC, and in case of a histologically confirmed negative SLNB, a completion axillary lymph node dissection (ALND) has no added value and can be omitted. In patients with clinically positive nodal involvement (cN+) prior to NAC, all axillary surgery can also be performed after NAC.
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Affiliation(s)
- Duveken B Y Fontein
- Leiden University Medical Center, Department of Surgery, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
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Shen K, Song N, Kim Y, Tian C, Rice SD, Gabrin MJ, Symmans WF, Pusztai L, Lee JK. A systematic evaluation of multi-gene predictors for the pathological response of breast cancer patients to chemotherapy. PLoS One 2012. [PMID: 23185353 PMCID: PMC3504014 DOI: 10.1371/journal.pone.0049529] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Previous studies have reported conflicting assessments of the ability of cell line-derived multi-gene predictors (MGPs) to forecast patient clinical outcomes in cancer patients, thereby warranting an investigation into their suitability for this task. Here, 42 breast cancer cell lines were evaluated by chemoresponse tests after treatment with either TFAC or FEC, two widely used standard combination chemotherapies for breast cancer. We used two different training cell line sets and two independent prediction methods, superPC and COXEN, to develop cell line-based MGPs, which were then validated in five patient cohorts treated with these chemotherapies. This evaluation yielded high prediction performances by these MGPs, regardless of the training set, chemotherapy, or prediction method. The MGPs were also able to predict patient clinical outcomes for the subgroup of estrogen receptor (ER)-negative patients, which has proven difficult in the past. These results demonstrated a potential of using an in vitro-based chemoresponse data as a model system in creating MGPs for stratifying patients’ therapeutic responses. Clinical utility and applications of these MGPs will need to be carefully examined with relevant clinical outcome measurements and constraints in practical use.
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Affiliation(s)
- Kui Shen
- Precision Therapeutics, Inc., Pittsburgh, Pennsylvania, United States of America
| | - Nan Song
- Precision Therapeutics, Inc., Pittsburgh, Pennsylvania, United States of America
| | - Youngchul Kim
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Chunqiao Tian
- Precision Therapeutics, Inc., Pittsburgh, Pennsylvania, United States of America
| | - Shara D. Rice
- Precision Therapeutics, Inc., Pittsburgh, Pennsylvania, United States of America
| | - Michael J. Gabrin
- Precision Therapeutics, Inc., Pittsburgh, Pennsylvania, United States of America
| | - W. Fraser Symmans
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Lajos Pusztai
- Division of Breast Medical Oncology, Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Jae K. Lee
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail:
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Tan MP. Alternatives for optimizing outcomes in oncoplastic breast surgery. Ann Surg Oncol 2012; 19:2327-33. [PMID: 22395982 DOI: 10.1245/s10434-012-2261-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast conservation treatment (BCT) is an accepted option for the treatment of breast malignancies. However, as suboptimal surgical techniques result in poor cosmetic outcomes, a plethora of operative approaches to prevent potential deformity has emerged in contemporary literature. Many of these procedures, referred to as oncoplastic breast surgery (OBS), depend on complex mammoplasty-type procedures, often with contralateral symmetrisation, and the frequent use of volume replacement techniques with implants or autologous tissue flaps. However, there have been reports of moderately high rates of complications for these types of procedures. OBJECTIVE To propose surgical approaches that reduce tissue manipulation and lower complication rates without sacrificing local control and survival. METHODS A description of methods is presented, involving closely coordinated collaboration with members of the interdisciplinary team to enable accurate resection with minimal tissue loss for appropriate margins, allowing adequate retained tissue for acceptable cosmesis. RESULTS Using these techniques, more women with breast malignancies may undergo BCT without elaborate mammoplasty procedures or volume replacement operations with implants or autologous flaps. CONCLUSIONS The approaches described are alternatives to the conventional volume displacement techniques for optimising outcomes with OBS. They allow a greater proportion of women to undergo BCT with less tissue manipulation and lower complication rates.
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Affiliation(s)
- Mona P Tan
- Breast Surgical Oncology, MammoCare, The Breast Clinic and Surgery, Singapore, Singapore.
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15
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Zapf I, Tizedes G, Pavlovics G, Kovács G, Kálmán E, Szalai G, Kövér E, Farkas R, Horváth OP. [Primary systemic therapy in breast cancer patients (2007-2010)]. Magy Seb 2011; 64:223-8. [PMID: 21997525 DOI: 10.1556/maseb.64.2011.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION/AIM The importance of preoperative neoadjuvant (NA) systemic treatment in operable breast cancer has significantly increased in the last few years. The aim of our retrospective study was to determine the effect of NA therapy in breast cancer patients treated in our unit and analyze radiological and pathological response rates in the context of surgical treatment. MATERIALS AND METHODS One hundred and fourteen cases of breast cancer with NA therapy were analyzed and clinical data were collected from March 2007 to December 2010. Twenty-two patients received NA treatment for inoperable tumours. As far as operable cancers (92 patients), the indications for NA treatment were high tumour grade, presence of axillary metastasis and relatively young age. 5-Fluorouracil-Epirubicin-Cyclophosphamid or Taxotere-Epirubicin regimens were administered in 6 cycles followed by radiological evaluation and surgery. Herein, we compared the preoperative staging with the pathological results after surgery. RESULTS NA therapy resulted in complete regression in 17% of patients, significant regression in 21%, while moderate regression was achieved in 43% of patients. No regression was detected in 19%. The decrease in T stage was not followed by decrease in N stage in significant number of cases. Moreover, in some cases NA therapy caused complete radiological regression, while histologically it still remained positive. In certain cases, breast conserving surgery was feasible due to down-staging caused by NA therapy. CONCLUSION NA therapy was effective primarily in decreasing tumour size; however, it was less effective on axillary lymph node metastases. Due to the presence of the residual DCIS component, the volume of resection could not be decreased as much as down-staging of the invasive cancer would have permitted.
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Affiliation(s)
- István Zapf
- Pécsi Tudományegyetem, Klinikai Központ Sebészeti Klinika 7624 Pécs Ifjúság út 13.
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16
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Glück S, Ross JS, Royce M, McKenna EF, Perou CM, Avisar E, Wu L. TP53 genomics predict higher clinical and pathologic tumor response in operable early-stage breast cancer treated with docetaxel-capecitabine ± trastuzumab. Breast Cancer Res Treat 2011; 132:781-91. [PMID: 21373875 DOI: 10.1007/s10549-011-1412-7] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/13/2011] [Indexed: 11/28/2022]
Abstract
To determine rates of pathologic complete response (pCR) and near-complete response (npCR) in operable early-stage breast cancer using neoadjuvant capecitabine plus docetaxel, with or without trastuzumab, and investigate biomarkers of pathologic response. Women with operable early-stage breast cancer were enrolled in a multicenter study of neoadjuvant therapy for four 21-day cycles with capecitabine 825 mg/m(2) plus docetaxel 75 mg/m(2) if human epidermal growth factor receptor 2 (HER2)-negative, and additionally, a standard trastuzumab dose if HER2-positive. Primary endpoint was rate of pCR and npCR. Secondary endpoints were potential associations between response and TP53 mutational analysis using the AmpliChip TP53 assay or immunohistochemical (IHC) staining, and genomic subtyping using the PAM50 assay. In patients who completed treatment and surgery, pCR and npCR rates were 15.8% in patients with HER2-negative and 50% in patients with HER2-positive tumors. Stratified by genomic subtype, patients of HER2-enriched subtype had the best response (72.2%), and luminal A (9.1%) and B (4.8%) subtypes, the poorest. Of 147 patients tested for TP53 mutations using the AmpliChip assay, 78 variants were detected; 55 were missense. Response rate among TP53-mutated patients was 30%, significantly higher than TP53 wild-type patients (10%; P = 0.0032). Concordance between AmpliChip mutation status versus TP53 IHC staining was 65%, with AmpliChip status predictive of response and IHC status not predictive. Capecitabine plus docetaxel in HER2-negative, and with trastuzumab in HER2-positive patients, provided a good response rate with four cycles of non-anthracycline-containing therapy. TP53 mutational analysis and genomic subtyping were predictive.
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Affiliation(s)
- Stefan Glück
- Division of Hematology/Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, 1475 NW 12th Ave., Suite 3510, Miami, FL 33136, USA.
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