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Rousset-Jablonski C, Lortal B, Lantheaume S, Arnould L, Simon H, Tuszynski AS, Courtier M, Debbah S, Lefrançois M, Balbin S, Kably AS, Toledano A. French national survey on breast cancer care: caregiver and patient views. Breast Cancer 2024:10.1007/s12282-024-01576-4. [PMID: 38635135 DOI: 10.1007/s12282-024-01576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To improve the quality of care for patients with breast cancer, an analysis of the health-care pathway, considering feedback from both health-care practitioners (HCPs) and patients, is needed. METHODS Between 2020 and 2022, we conducted a survey at French breast cancer centers and analyzed information from questionnaires completed by HCPs and patients. We collected information on center organization, diagnostic processes, treatment decisions and modalities, supportive care, patient advocacy groups, and work issues. RESULTS Twenty-three breast cancer centers were included and questionnaires completed by 247 HCPs and 249 patients were analyzed. The centers closely followed the legal French framework for cancer treatments, which includes formal diagnostic announcements, multidisciplinary tumor boards, personalized treatment summaries, and supportive care access. HCPs and patients were satisfied with the time to diagnosis (≤ 2 weeks as evaluated by 75% of patients), time to surgery (mean 61 days), time between surgery and chemotherapy (mean 47 days), and time between surgery and radiotherapy (mean 81 days). Fertility preservation counseling for women under 40 years of age was systematically offered by 67% of the HCPs. The majority (67%) of the patients indicated that they had received a personalized treatment summary; the topics discussed included treatments (92%), tumor characteristics (84%), care pathways (79%), supportive care (52%), and breast reconstruction (33%). Among HCPs, 44% stated that reconstructive surgery was offered to all eligible patients and 57% and 45% indicated coordination between centers and primary care physicians for adverse effects management and access to supportive care should be improved, for chemotherapy and radiotherapy, respectively. Regarding patient advocacy groups, 34% of HCPs did not know whether patients had contact and only 23% of patients declared that they had such contact. For one-third of working patients, work issues were not discussed. Twenty-eight percent of patients claimed that they had faced difficulties for supportive care access. Among HCPs, 13% stated that a formal personalized survivorship treatment program was administered to almost all patients and 37% almost never introduced the program to their patients. Compliance to oral treatments was considered very good for 75-100% of patients by 62% of HCPs. CONCLUSIONS This study provides an updated analysis of breast cancer care pathways in France. Overall, the initial processes of diagnosis, announcement, and treatment were swift and were in agreement with the best care standards. No barriers to accessing care were identified. Based on the study findings, we proposed several strategies to improve the quality of care for patients in supportive care, coordination with primary care physicians, reconstructive surgery, and fertility preservation access.
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Affiliation(s)
- Christine Rousset-Jablonski
- Centre Léon Bérard, Lyon, France.
- Unité INSERM U1290 RESHAPE, Lyon, France.
- Hôpital Femme Mère Enfant, Bron, France.
| | | | | | | | | | | | | | | | | | | | | | - Alain Toledano
- Institut de Radiothérapie et de Radiochirurgie Hartmann - ELSAN, Levallois-Perret, France
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Fervers B, Pérol O, Lasset C, Moumjid N, Vidican P, Saintigny P, Tardy J, Biaudet J, Bonadona V, Triviaux D, Marijnen P, Mongondry R, Cattey-Javouhey A, Buono R, Bertrand A, Marec-Bérard P, Rousset-Jablonski C, Pilleul F, Christophe V, Girodet M, Praud D, Solodky ML, Crochet H, Achache A, Michallet M, Galvez C, Miermont A, Sebileau D, Zrounba P, Beaupère S, Philip T, Blay JY. An Integrated Cancer Prevention Strategy: the Viewpoint of the Leon Berard Comprehensive Cancer Center Lyon, France. Cancer Prev Res (Phila) 2024; 17:133-140. [PMID: 38562091 PMCID: PMC10985472 DOI: 10.1158/1940-6207.capr-23-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 04/04/2024]
Abstract
This article describes some of the key prevention services in the Leon Berard Comprehensive Cancer Center (CLB) Lyon, France, which are based on clinical prevention services, outreach activities, and collaboration with professional and territorial health communities. In addition, research is embedded at all stages of the prevention continuum, from understanding cancer causes through to the implementation of prevention interventions during and after cancer. Health promotion activities in the community and dedicated outpatient primary cancer prevention services for individuals at increased risk have been implemented. The CLB's experience illustrates how prevention can be integrated into the comprehensive mission of cancer centers, and how in turn, the cancer centers may contribute to bridging the current fragmentation between cancer care and the different components of primary, secondary, and tertiary prevention. With increasing cancer incidence, the shift toward integrated prevention-centered cancer care is not only key for improving population health, but this may also provide a response to the shortage of hospital staff and overcrowding in cancer services, as well as offer opportunities to reduce carbon emissions from cancer care.
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Affiliation(s)
- Beatrice Fervers
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Inserm U1296 Radiations: Defense, Health, Environment, Léon Bérard Cancer Center, Lyon, France
| | - Olivia Pérol
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Inserm U1296 Radiations: Defense, Health, Environment, Léon Bérard Cancer Center, Lyon, France
| | - Christine Lasset
- Department of Prevention and Public Healthcare, Léon Bérard Cancer Center, Lyon, France
| | - Nora Moumjid
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- UR 4129, P2S, Université Lyon 1, Lyon, France
| | - Pauline Vidican
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Inserm U1296 Radiations: Defense, Health, Environment, Léon Bérard Cancer Center, Lyon, France
| | - Pierre Saintigny
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
- CRCL, University Lyon, Claude Bernard Lyon 1 University, Inserm 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center, Lyon, France
| | - Juliette Tardy
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Inserm U1296 Radiations: Defense, Health, Environment, Léon Bérard Cancer Center, Lyon, France
| | - Julien Biaudet
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Inserm U1296 Radiations: Defense, Health, Environment, Léon Bérard Cancer Center, Lyon, France
| | - Valérie Bonadona
- Department of Prevention and Public Healthcare, Léon Bérard Cancer Center, Lyon, France
| | - Dominique Triviaux
- Interdisciplinary Department of Supportive Care in Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Philippe Marijnen
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
| | - Rodolf Mongondry
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
| | | | - Romain Buono
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
| | - Amandine Bertrand
- Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Léon Bérard Cancer Center, 69008 Lyon, France
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France
- Département de Sciences Humaines et Sociales (SHS), Léon Bérard Cancer Center, Lyon, France
| | - Perrine Marec-Bérard
- Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Christine Rousset-Jablonski
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
| | - Frank Pilleul
- Department of Radiology, Léon Bérard Cancer Center, Lyon, France
- CREATIS, UMR CNRS 5220 – INSERM 1206, Université Claude Bernard Lyon 1, Lyon, France
| | - Veronique Christophe
- CRCL, University Lyon, Claude Bernard Lyon 1 University, Inserm 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center, Lyon, France
- Département de Sciences Humaines et Sociales (SHS), Léon Bérard Cancer Center, Lyon, France
| | - Magali Girodet
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France
- Département de Sciences Humaines et Sociales (SHS), Léon Bérard Cancer Center, Lyon, France
| | - Delphine Praud
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Inserm U1296 Radiations: Defense, Health, Environment, Léon Bérard Cancer Center, Lyon, France
| | - Marie-Laure Solodky
- Department of Medecine of Health Care Workers, Léon Bérard Cancer Center, Lyon, France
| | | | | | - Mauricette Michallet
- Department of Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | | | | | | | | | | | - Jean-Yves Blay
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
- Unicancer, Paris, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
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3
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Petiot F, Descargues P, Devouassoux-Shisheboran M, You B, Rousset-Jablonski C, Raffin D, Hajri T, Gertych W, Glehen O, Philip CA, Lamblin G, Golfier F, Bolze PA. Retrospective analysis of uterine involvement in low grade serous ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 2024; 294:191-197. [PMID: 38295707 DOI: 10.1016/j.ejogrb.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Low grade serous ovarian carcinoma (LGSOC) accounts for 2.5% of all ovarian carcinoma more affects younger women than high grade serous ovarian carcinoma. Hysterectomy is performed routinely for LGSOC treatment, but fertility sparring surgery (FSS) is feasible for some early stages. Currently, there is no study about uterine involvement in LGSOC. We evaluate uterine involvement in LGSOC patients and aim to identify pre-operative predictive factors. METHODS Retrospective observational study of LGSOC patients treated between January 2000 and May 2022 in the Hospices Civils de Lyon. All cases were viewed, reviewed or approved by an expert pathologist. RESULTS Among 535 serous ovarian carcinomas, 26 were included. Most patients (73 %) had FIGO III disease. Median OS was 115 months and median PFS was 42 months. Uterine involvement was found in 58 % patients who underwent hysterectomy (14/24), serosal involvement was the most frequent type of involvement (n = 13, 54 %). Myometrial involvement was found in 8 patients (33 %) and was associated with serosal involvement (7/8). Among patients with a macroscopic disease-free uterus during exploratory laparoscopy, 31 % had a microscopic serosal involvement. None patient with presumed early stage (FIGO I) were upstaged due to uterine involvement (serosal or myometrial). In patients with stage FIGO IIII, 72 % of uterine involvement were found. Univariate analysis did not show any predictive factor of myometrial involvement. There was no difference on OS nor PFS between patients with or without myometrial involvement. CONCLUSIONS In early stages LGSOC, FSS may be considered for selected patients. In advanced stages, hysterectomy should be performed routinely, since no predictive factor for uterine involvement were identified.
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Affiliation(s)
- Florian Petiot
- Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France.
| | - Pierre Descargues
- Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France
| | | | - Benoit You
- Université Lyon 1, CHU Lyon Sud, Department of Medical Oncology, Pierre Bénite, France
| | - Christine Rousset-Jablonski
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France; Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Delphine Raffin
- Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France
| | - Touria Hajri
- French Trophoblastic Disease Reference Center, CHU Lyon Sud, Pierre Bénite, France
| | - Witold Gertych
- Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France
| | - Olivier Glehen
- Université Lyon 1, CHU Lyon Sud, Department of Digestive Surgery, Pierre Bénite, France
| | - Charles-André Philip
- Université Lyon 1, CHU Croix-Rousse, Department of Obstetrics and Gynecology, Lyon, France
| | - Géry Lamblin
- Université Lyon 1, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, Bron, France
| | - François Golfier
- Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France
| | - Pierre-Adrien Bolze
- Université Lyon 1, CHU Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France
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4
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Dabi Y, Fauconnier A, Rousset-Jablonski C, Tavenet A, Pizzofferrato AC, Deffieux X. Do women with suspected endometriosis benefit from pelvic examination to improve diagnostic and management strategy? J Gynecol Obstet Hum Reprod 2024; 53:102724. [PMID: 38224817 DOI: 10.1016/j.jogoh.2024.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To analyze the literature and expose best evidence available regarding the benefit of pelvic examination for women with suspected endometriosis METHODS: the AGREE II and GRADE systems for grading scientific evidence. RESULTS Endometriosis is characterized by the heterogeneity in its clinical presentation with many different symptoms reported by patients. In the literature, questioning for each symptom has a high sensitivity, reaching 76-98 %, but lacks specificity (20 - 58 %). The symptom-based approach is limited by its low specificity, the absence of external validation for most of the models developed and the inability to characterize the extent of the disease, which could have major implications in the decision - making process. The latest systematic review and meta-analysis included a total of 30 studies with 4,565 participants, compared the diagnostic performance of several modalities for endometriosis. Physical examination had a pooled sensitivity of 71 % and a specificity of 69 %, with an average diagnostic accuracy of 0.76. Overall, the value of pelvic examination is conferred by its high positive likehood ratio and specificity. Besides its diagnostic value, pelvic examination improves patients' management by allowing the identification of a possible myofascial syndrome as a differential diagnosis. It also increases the quality of the preoperative workup and influences the quality of surgical excision and decreases the time to diagnosis. CONCLUSION Despite the lack of studies in the primary care context, pelvic examination (vaginal speculum and digital vaginal examination) increases the diagnostic value for suspected endometriosis in association with questioning for symptoms.
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Affiliation(s)
- Yohann Dabi
- Sorbonne Université, Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Assistance Publique des Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique 6 (GRC6), Centre Expert Endométriose (C3E), Sorbonne Université, France.
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 Risques cliniques et sécurité en santé des femmes et en santé périnatale, Montigny-le-Bretonneux, France; Université Department of Obstetrics and Gynecology, intercommunal Hospital of Poissy / Saint-Germain-en-Laye, Poissy, France
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, Lyon, France; Service de Gynécologie Obstétrique, Centre Hospitalier Lyon Sud, Pierre Bénite, France; INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Anne-Cécile Pizzofferrato
- Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC 1402, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France
| | - Xavier Deffieux
- Université Paris Saclay, Service de gynécologie obstétrique, hôpital Antoine Béclère, APHP, Clamart, F-92140 France
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5
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Lambertini M, Blondeaux E, Agostinetto E, Hamy AS, Kim HJ, Di Meglio A, Bernstein Molho R, Hilbers F, Pogoda K, Carrasco E, Punie K, Bajpai J, Ignatiadis M, Moore HCF, Phillips KA, Toss A, Rousset-Jablonski C, Peccatori FA, Renaud T, Ferrari A, Paluch-Shimon S, Fruscio R, Cui W, Wong SM, Vernieri C, Ruddy KJ, Dieci MV, Matikas A, Rozenblit M, Villarreal-Garza C, De Marchis L, Del Mastro L, Puglisi F, Del Pilar Estevez-Diz M, Rodriguez-Wallberg KA, Mrinakova B, Meister S, Livraghi L, Clatot F, Yerushalmi R, De Angelis C, Sánchez-Bayona R, Meattini I, Cichowska-Cwalińska N, Berlière M, Salama M, De Giorgi U, Sonnenblick A, Chiodi C, Lee YJ, Maria C, Azim HA, Boni L, Partridge AH. Pregnancy After Breast Cancer in Young BRCA Carriers: An International Hospital-Based Cohort Study. JAMA 2024; 331:49-59. [PMID: 38059899 PMCID: PMC10704340 DOI: 10.1001/jama.2023.25463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Importance Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure Pregnancy after breast cancer. Main Outcomes and Measures Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration ClinicalTrials.gov Identifier: NCT03673306.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Agostinetto
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Antonio Di Meglio
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Rinat Bernstein Molho
- Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center Affiliated to Tel Aviv University, Tel Hashomer, Israel
| | - Florentine Hilbers
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Estela Carrasco
- Hereditary Cancer Genetics Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Halle C. F. Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology (IRCCS), Milan, Italy
| | | | - Alberta Ferrari
- Hereditary Breast and Ovarian Cancer Unit and General Surgery 3–Senology, Surgical Department, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Robert Fruscio
- UO Gynecology, Department of Medicine and Surgery, University of Milan–Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie M. Wong
- Stroll Cancer Prevention Centre, Jewish General Hospital, and McGill University Medical School, Montreal, Quebec, Canada
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM ETS, AIRC Institute of Molecular Oncology, Milan, Italy
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Maria Vittoria Dieci
- Dipartimento di Scienze Chirurgiche, Oncologiche, e Gastroenterologiche, Università di Padova, Padova, Italy
- Oncologia 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alexios Matikas
- Department of Oncology/Pathology, Karolinska Institute, and Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mariya Rozenblit
- Department of Medical Oncology, Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Laura De Marchis
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- Division of Oncology, Department of Hematology, Oncology, and Dermatology, Umberto 1 University Hospital, Rome, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bela Mrinakova
- First Department of Oncology, Comenius University and St Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Ludwig Maximilian University (LMU) Hospital, LMU Munich, Germany
| | - Luca Livraghi
- Department of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Rinat Yerushalmi
- Department of Medical Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Carmine De Angelis
- Department of Medical Oncology, University of Naples Federico II, Napoli, Italy
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M. Serio, University of Florence, and Radiation Oncology Unit, Oncology Department, Florence University Hospital, Florence, Italy
| | - Natalia Cichowska-Cwalińska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
- Early Phase Clinical Trials Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Martine Berlière
- Department of Medical Oncology and Breast Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Mahmoud Salama
- Oncofertility Consortium and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Camila Chiodi
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Camille Maria
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
- Cairo Oncology Center, Cairo, Egypt
| | - Luca Boni
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Deffieux X, Pizzoferrato AC, Gaucher L, Rousset-Jablonski C, Le Ray C, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Artzner F, Tavenet A, Gantois A, Fauconnier A. Pelvic exam in Gynecology and Obstetrics: French Guidelines for Clinical Practice. Eur J Obstet Gynecol Reprod Biol 2023; 291:131-140. [PMID: 37871350 DOI: 10.1016/j.ejogrb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Anne-Cécile Pizzoferrato
- Service de Gynécologie Obstétrique, Hôpital Universitaire de La Miletrie, Poitiers F-86000, France; INSERM CIC 1402, Université de Poitiers, Poitiers F-86000, France
| | - Laurent Gaucher
- Collège National des Sages-Femmes de France, CNSF, Paris F-75010, France; Public Health Unit, Hospices Civils de Lyon, Bron F-69500, France; INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon 1, Lyon F-69008, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, Département de Chirurgie, et Centre Hospitalier Lyon Sud, Service de Gynécologie-Obstétrique, INSERM U1290 RESHAPE, Lyon F-69000, France
| | - Camille Le Ray
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | | | - Julia Maruani
- Cabinet Médical, 6 Rue Docteur Albert Schweitzer, Marseille F-13006, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | | | - Yoann Athiel
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, Université de Lille, Lille F-59000, France
| | - Alexandre Bailleul
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France
| | - Mathilde Bourdon
- Université Paris Cité, APHP, Center Hospitalier Universitaire (CHU) Cochin Port Royal, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, F-75014, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes F-44000, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance Publique - Hôpitaux de Paris, Bondy F-93140, France; Institut de Recherche Interdisciplinaire sur Les Enjeux Sociaux, UMR 8156-997, UFR SMBH, Université Sorbonne Paris Nord, Bobigny F-9300, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France
| | - Yohann Dabi
- Sorbonne université - APHP - Hôpital Tenon, Service de gynécologie obstétrique et médecine de la reproduction, Paris F75020, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, Faculté de médecine, Université de Bordeaux, 146 rue Léo Saignat, Bordeaux F-33076, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, Paris F-75005, France
| | - Anne Freyens
- DUMG (Département Universitaire de Médecine Générale), Université Paul Sabatier, Toulouse F-31000, France
| | - Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux, Bordeaux, France; Univ. Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Département de maïeutique, Center hospitalier de Melun Santepole, Melun F-77000, France
| | - Elisabeth Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, Créteil F-94000, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France; Université de Bordeaux, Bordeaux Institute of Oncology - Unité Inserm 1312, Bordeaux F-33000, France
| | - Nadege Lauchet
- Groupe Médical François Perrin, 9 rue François Perrin, Limoges F-87000, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France; UMR_S1085, Université d'Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, INSERM, LTSI - UMR 1099, Rennes F-35000, France; Département de gynécologie et obstétrique, CHU de Rennes, Rennes F-35000, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126 Boulevard Saint Germain, Paris F-75006, France
| | | | - Marine Masson
- Département de médecine générale, Poitiers F-86000, France
| | - Caroline Matteo
- Cabinet de maïeutique, 181 rue du Docteur Cauvin, Marseille F-13015, France
| | - Anne Pinton
- Service de gynécologie obstétrique, Hôpital Trousseau, APHP, 26, avenue du Dr-Arnold-Netter, Paris F-75012, France; Sorbonne Université, Paris F-75013, France
| | - Emmanuelle Sabbagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | - Camille Sallee
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU de Limoges, Limoges F-87000 France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes F- 44000, France; Laboratoire Mouvement, Interactions, Performance (MIP), EA 4334, Nantes Université, Nantes F- 44322, France
| | - Isabelle Heron
- Service d'endocrinologie, Université de Rouen, Hôpital Charles Nicolle, Rouen F-76000, France; Cabinet médical, 7 rue de Lessard, Rouen F-76100, France
| | - France Artzner
- CIANE, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101 rue Pierre Corneille, Lyon F-69003, France
| | - Arounie Tavenet
- ENDOFRANCE, Association de lutte contre l'endométriose. 3 rue de la Gare, Tresilley F-70190, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France hébergé au Réseau de Santé Périnatal Parisien (RSPP), Paris F75010, France
| | - Arnaud Fauconnier
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
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7
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Cottin V, Blanchard E, Kerjouan M, Lazor R, Reynaud-Gaubert M, Taille C, Uzunhan Y, Wemeau L, Andrejak C, Baud D, Bonniaud P, Brillet PY, Calender A, Chalabreysse L, Court-Fortune I, Desbaillets NP, Ferretti G, Guillemot A, Hardelin L, Kambouchner M, Leclerc V, Lederlin M, Malinge MC, Mancel A, Marchand-Adam S, Maury JM, Naccache JM, Nasser M, Nunes H, Pagnoux G, Prévot G, Rousset-Jablonski C, Rouviere O, Si-Mohamed S, Touraine R, Traclet J, Turquier S, Vagnarelli S, Ahmad K. French recommendations for the diagnosis and management of lymphangioleiomyomatosis. Respir Med Res 2023; 83:101010. [PMID: 37087906 DOI: 10.1016/j.resmer.2023.101010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The present article is an English-language version of the French National Diagnostic and Care Protocol, a pragmatic tool to optimize and harmonize the diagnosis, care pathway, management and follow-up of lymphangioleiomyomatosis in France. METHODS Practical recommendations were developed in accordance with the method for developing a National Diagnosis and Care Protocol for rare diseases of the Haute Autorité de Santé and following international guidelines and literature on lymphangioleiomyomatosis. It was developed by a multidisciplinary group, with the help of patient representatives and of RespiFIL, the rare disease network on respiratory diseases. RESULTS Lymphangioleiomyomatosis is a rare lung disease characterised by a proliferation of smooth muscle cells that leads to the formation of multiple lung cysts. It occurs sporadically or as part of a genetic disease called tuberous sclerosis complex (TSC). The document addresses multiple aspects of the disease, to guide the clinicians regarding when to suspect a diagnosis of lymphangioleiomyomatosis, what to do in case of recurrent pneumothorax or angiomyolipomas, what investigations are needed to make the diagnosis of lymphangioleiomyomatosis, what the diagnostic criteria are for lymphangioleiomyomatosis, what the principles of management are, and how follow-up can be organised. Recommendations are made regarding the use of pharmaceutical specialties and treatment other than medications. CONCLUSION These recommendations are intended to guide the diagnosis and practical management of pulmonary lymphangioleiomyomatosis.
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Affiliation(s)
- Vincent Cottin
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France; UMR 754, INRAE, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France.
| | - Elodie Blanchard
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), GH Sud Haut-Lévêque, Avenue Magellan, 33600 Pessac, France
| | - Mallorie Kerjouan
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), CHU Pontchailloux, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Romain Lazor
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, BU44/07.2137, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Martine Reynaud-Gaubert
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), Hôpital Nord, Chemin Bourrely, 13015 Marseille, France; URMITE-CNRS-IRD UMR 6236, Aix-Marseille Université, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - Camille Taille
- Centre de Référence Constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France; Université Paris-Diderot, 17 rue Jean Antoine de Baïf, 75013 Paris, France
| | - Yurdagül Uzunhan
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France; Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France
| | - Lidwine Wemeau
- Centre de Référence constitutif des maladies pulmonaires rares, CHRU, 5 rue Oscar Lambret, 59000 Lille, France
| | - Claire Andrejak
- Service de pneumologie, CHU Amiens, 1 Place Victor Pauchet, 80054 Amiens, France; UFR de médecine, 3 rue Louvels, 80000 Amiens, France
| | - Dany Baud
- Hôpital Suisse de Paris, 10 rue Minard, 92130 Issy les Moulineaux, France
| | - Philippe Bonniaud
- Centre de Référence constitutif des maladies pulmonaires rares, CHU de Dijon, BP 77908, 21079, Dijon, France; INSERM, LNC UMR1231, LipSTIC LabEx Team, 21000 Dijon, France
| | - Pierre-Yves Brillet
- Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France; Service de radiologie, hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Alain Calender
- Département de génétique, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France; IBCP, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France
| | - Lara Chalabreysse
- Service de pathologie, Groupe hospitalier est, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France; Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France
| | | | | | - Gilbert Ferretti
- Pole imagerie, CHU Grenoble Alpes, Boulevard Chantourne, 38700 La Tronche, France
| | - Anne Guillemot
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Laurane Hardelin
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Marianne Kambouchner
- Service d'anatomopatholologie, Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Violette Leclerc
- Association France Lymphangioléiomyomatose, 4, Rue des Vieux-Moulins, 56 680 Plouhinec, France
| | - Mathieu Lederlin
- Service de radiologie, CHU Pontchailloux, 2 rue Henri le Guilloux, 35000 Rennes, France
| | | | - Alain Mancel
- Association France Lymphangioléiomyomatose, 4, Rue des Vieux-Moulins, 56 680 Plouhinec, France
| | - Sylvain Marchand-Adam
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), Hôpital Bretonneau, CHRU Tours, 2 Boulevard Tonnellé, 37000 Tours, France; Université de Tours, CEPR INSERMU1100, 10 Boulevard Tonnellé, 37000 Tours, France
| | - Jean-Michel Maury
- Service de chirurgie thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Jean-Marc Naccache
- Service de pneumologie, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France
| | - Mouhamad Nasser
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Hilario Nunes
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France; Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France
| | - Gaële Pagnoux
- Service de radiologie, Hôpital Edouard Herriot, 5 place d'Arsonval, 69008 Lyon, France
| | - Grégoire Prévot
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), service de pneumologie, hôpital Larrey, 24 chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | | | - Olivier Rouviere
- Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France; Service de radiologie, Hôpital Edouard Herriot, 5 place d'Arsonval, 69008 Lyon, France
| | - Salim Si-Mohamed
- Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France; Service d'imagerie, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Renaud Touraine
- Laboratoire de Génétique Chromosomique et Moléculaire, CHU-Hôpital Nord, Laboratoire AURAGEN (Plan France Médecine Génomique 2025), 42270 Saint Priest en Jarest, France
| | - Julie Traclet
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Ségolène Turquier
- Service d'exploration fonctionnelle respiratoire, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Stéphane Vagnarelli
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Kaïs Ahmad
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
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8
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Rousset-Jablonski C. [Fertility and gonadal disorders in patients with Hodgkin lymphoma]. Rev Prat 2023; 73:651-653. [PMID: 37458555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Christine Rousset-Jablonski
- Centre Léon-Bérard, centre hospitalier Lyon-Sud, Inserm U1290 Research on Healthcare Performance (RESHAPE), Lyon, France
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Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Ruíz-Borrego M, Moore HCF, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Smith KL, Ferreiro T, Ribi K, Ruddy K, Kammler R, El-Abed S, Viale G, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer. N Engl J Med 2023; 388:1645-1656. [PMID: 37133584 PMCID: PMC10358451 DOI: 10.1056/nejmoa2212856] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Prospective data on the risk of recurrence among women with hormone receptor-positive early breast cancer who temporarily discontinue endocrine therapy to attempt pregnancy are lacking. METHODS We conducted a single-group trial in which we evaluated the temporary interruption of adjuvant endocrine therapy to attempt pregnancy in young women with previous breast cancer. Eligible women were 42 years of age or younger; had had stage I, II, or III disease; had received adjuvant endocrine therapy for 18 to 30 months; and desired pregnancy. The primary end point was the number of breast cancer events (defined as local, regional, or distant recurrence of invasive breast cancer or new contralateral invasive breast cancer) during follow-up. The primary analysis was planned to be performed after 1600 patient-years of follow-up. The prespecified safety threshold was the occurrence of 46 breast cancer events during this period. Breast cancer outcomes in this treatment-interruption group were compared with those in an external control cohort consisting of women who would have met the entry criteria for the current trial. RESULTS Among 516 women, the median age was 37 years, the median time from breast cancer diagnosis to enrollment was 29 months, and 93.4% had stage I or II disease. Among 497 women who were followed for pregnancy status, 368 (74.0%) had at least one pregnancy and 317 (63.8%) had at least one live birth. In total, 365 babies were born. At 1638 patient-years of follow-up (median follow-up, 41 months), 44 patients had a breast cancer event, a result that did not exceed the safety threshold. The 3-year incidence of breast cancer events was 8.9% (95% confidence interval [CI], 6.3 to 11.6) in the treatment-interruption group and 9.2% (95% CI, 7.6 to 10.8) in the control cohort. CONCLUSIONS Among select women with previous hormone receptor-positive early breast cancer, temporary interruption of endocrine therapy to attempt pregnancy did not confer a greater short-term risk of breast cancer events, including distant recurrence, than that in the external control cohort. Further follow-up is critical to inform longer-term safety. (Funded by ETOP IBCSG Partners Foundation and others; POSITIVE ClinicalTrials.gov number, NCT02308085.).
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Affiliation(s)
- Ann H Partridge
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Samuel M Niman
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Monica Ruggeri
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Fedro A Peccatori
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Hatem A Azim
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Marco Colleoni
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Cristina Saura
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Chikako Shimizu
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Anna B Sætersdal
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Judith R Kroep
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Audrey Mailliez
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Ellen Warner
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Virginia F Borges
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Frédéric Amant
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Andrea Gombos
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Akemi Kataoka
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Christine Rousset-Jablonski
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Simona Borstnar
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Junko Takei
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Jeong E Lee
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Janice M Walshe
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Manuel Ruíz-Borrego
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Halle C F Moore
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Christobel Saunders
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Vesna Bjelic-Radisic
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Snezana Susnjar
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Fatima Cardoso
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Karen L Smith
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Teresa Ferreiro
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Karin Ribi
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Kathryn Ruddy
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Roswitha Kammler
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Sarra El-Abed
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Giuseppe Viale
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Martine Piccart
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Larissa A Korde
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Aron Goldhirsch
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Richard D Gelber
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Olivia Pagani
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
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11
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Corvest V, Marec-Bérard P, Lervat C, Pacquement H, Toulmonde M, Gentet JC, Laurence V, Cleirec M, Mansuy L, Bompas E, Castex MP, Taque S, Filhon B, Tabone MD, Verité C, Entz-Werle N, Saumet L, Guimard G, Pondrom M, Chevreau C, Flandrin J, Duranteau L, Rousset-Jablonski C, Brugières L, Jimenez M, Le Deley MC, Gaspar N, Fresneau B. Late toxicity comparison of alkylating-based maintenance regimen with cyclophosphamide (VAC) vs ifosfamide (VAI) in Ewing sarcoma survivors treated in the randomized clinical trial Euro-EWING99-R1 in France. Int J Cancer 2023; 152:1659-1667. [PMID: 36250317 PMCID: PMC10092329 DOI: 10.1002/ijc.34326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
In Euro-EWING99-R1 randomized trial, cyclophosphamide was shown to be noninferior to ifosfamide in the consolidation of standard-risk Ewing sarcoma (SR-EWS) after a common induction with VIDE (vincristine-ifosfamide-doxorubicin-etoposide). We present the results of the late effects analysis of VAC (vincristine-dactinomycin-cyclophoshamide) vs VAI (vincristine-dactinomycin-ifosfamide) conducted in Euro-EWING99-R1 French cohort. Of 267 French randomized patients, 204 were alive and free-of-relapse at 5-years including 172 with available long-term follow-up data concerning cardiac, renal and/or gonadal functions (sex-ratio M/F = 1.3, median age at diagnosis = 14 years): 84 randomized in VAC (median cumulative doses: cyclophosphamide = 9.7 g/m2 , ifosfamide = 59.4 g/m2 ) and 88 in VAI (ifosfamide = 97.1 g/m2 ). With a median follow-up of 10 years (range = 5-17), five late relapses and five second malignancies were recorded. The 10-year event-free survival among 5-year free-of-relapse survivors was similar between VAC and VAI (93% vs 95%, P = .63). We estimated the 10-year cumulative probabilities of cardiac and kidney toxicities at 4.4% (95% confidence interval [95% CI] = 1.1%-7.6%) and 34.8% (95% CI = 26.8%-42.0%), respectively. Cardiac toxicity cumulative probability was similar in both arms, whereas kidney toxicity was higher in VAI (at 10 years, 43.0% vs 25.7%, P = .02), resulting from significant difference in glomerular toxicity (31.1% vs 13.1%, P < .01). At 10 years, gonadal toxicity was observed in 27% and 28% of pubertal men and women, respectively, without significant difference between VAC and VAI. Kidney and gonadal toxicities represent major issues in Euro-EWING99-R1, with significantly higher risk of kidney toxicities with VAI, without significant gonadal toxicity reduction. These results support the need to limit cumulative doses of both alkylating agents and to use mixed regimen as in VIDE-VAC or VDC/IE (vincristine-doxorubicin-cyclophoshamide/ifosfamide-etoposide).
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Affiliation(s)
- Victoria Corvest
- Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, France
| | - Perrine Marec-Bérard
- Department of Oncology for Child and Adolescent, Centre Léon Bérard, Pediatric Oncology and Hematology Institute (IHOPe), Lyon, France
| | - Cyril Lervat
- Centre Oscar Lambret, Unité d'Oncologie Pédiatrique, Lille, France
| | | | - Maud Toulmonde
- Département d'Oncologie Médicale, Institut Bergonié, Unités Sarcomes et Phases Précoces, Bordeaux, France
| | - Jean-Claude Gentet
- Department of Pediatric Hematology, Immunology and Oncology, APHM - La Timone Children's Hospital, Marseille, France
| | - Valérie Laurence
- Medical Oncology, Adolescents and Young Adults Unit, Institut Curie, Paris, France
| | - Morgane Cleirec
- Service d'Oncologie Pédiatrique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Ludovic Mansuy
- Department of Pediatric Hematology and Oncology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | | | - Sophie Taque
- Department of Pediatric Onco-Hematology, Rennes University Hospital, Rennes, France
| | - Bruno Filhon
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Marie-Dominique Tabone
- Service d'Hémato-Oncologie Pédiatrique, Hôpital Armand Trousseau - AP-HP, Sorbonne Université, Paris, France
| | - Cécile Verité
- Department of Pediatric and Adolescent Hematology and Oncology, Pellegrin Hospital, Bordeaux, France
| | - Natacha Entz-Werle
- Pédiatrie Onco-Hématologie, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Laure Saumet
- Service d'Onco-Hématologie Pédiatrique, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Gregory Guimard
- Department of Paediatric Oncology/Hematology, CHU de Reims, American Hospital, Reims, France
| | - Morgane Pondrom
- Department of Pediatric Hemato-Oncology, Nice University Hospital, Nice, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud IUCT-O, Toulouse, France
| | - Jennifer Flandrin
- Service de Gynécologie Adolescente et Jeune Adulte (GYNADO), Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Lise Duranteau
- Service de Gynécologie Adolescente et Jeune Adulte (GYNADO), Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Christine Rousset-Jablonski
- Département de Chirurgie, Centre Léon Bérard, INSERM U1290, RESearch in HealthcAre PErformance (RESHAPE), Lyon, France
| | - Laurence Brugières
- Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, France
| | - Marta Jimenez
- Research and Development Department, Unicancer, Paris, France
| | - Marie-Cécile Le Deley
- Unité de Méthodologie et Biostatistiques, Centre Oscar Lambret, Lille, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
| | - Nathalie Gaspar
- Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, France
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
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12
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Lebreton C, Quesada S, Bini M, Babin G, Rossi L, Chopin N, Croce S, Hartog C, Renaud T, Gaillard AL, Petit A, Serre AA, Trédan O, Rowinski E, Cockenpot V, Treilleux I, Rousset-Jablonski C, Méeus P, Guyon F, Ray-Coquard I. [Treatments for rare ovarian tumors: What's new?]. Bull Cancer 2023:S0007-4551(23)00151-0. [PMID: 37045734 DOI: 10.1016/j.bulcan.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
Even if each rare ovarian tumor (ROT) has a low incidence, the sum of all these entities represents almost the half of all ovarian neoplasms. Thus, development of dedicated clinical trial emerged as a prerequisite to improve their managements. Owing to the spreading of dedicated institutional networks and (supra)national collaborations, the number of clinical trials has increased the past few years, with different types of trials; while some focused on specific molecular features, others assessed innovative molecules. Furthermore, relevant randomized clinical trials were designed as a mean to position new treatment options. Currently, innovative molecular-driven trials, based on master protocol trials are emerging and may shed light towards the improvement of personalized medicine regarding ROT.
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Affiliation(s)
- Coriolan Lebreton
- Institut Bergonié, département d'oncologie médicale, Bordeaux, France; University of Bordeaux, ARTiSt Lab, Inserm U1312, Bordeaux, France.
| | - Stanislas Quesada
- Institut régional du cancer de Montpellier, département d'oncologie médicale, Montpellier, France
| | - Marta Bini
- Instituto Nazionale dei Tumori, Milano, Italie
| | - Guillaume Babin
- University of Bordeaux, ARTiSt Lab, Inserm U1312, Bordeaux, France; Institut Bergonié, département de chirurgie, Bordeaux, France
| | - Léa Rossi
- Centre Léon-Bérard, département de chirurgie, Lyon, France
| | - Nicolas Chopin
- Centre Léon-Bérard, département de chirurgie, Lyon, France
| | - Sabrina Croce
- Institut Bergonié, département de biopathologie, Bordeaux, France; University of Bordeaux, SARCOTARGET Lab, Inserm U1312, Bordeaux, France
| | - Cécile Hartog
- University of Bordeaux, ARTiSt Lab, Inserm U1312, Bordeaux, France; Centre Léon-Bérard, département de chirurgie, Lyon, France
| | - Tiphaine Renaud
- Institut Bergonié, département de gynécologie médicale, Bordeaux, France
| | | | - Adeline Petit
- Institut Bergonié, département de radiothérapie et curiethérapie, Bordeaux, France
| | - Anne-Agathe Serre
- Centre Léon-Bérard, département de radiothérapie et curiethérapie, Lyon, France
| | - Olivier Trédan
- Centre Léon-Bérard, département d'oncologie médicale, Lyon, France
| | - Elise Rowinski
- Centre Léon-Bérard, département d'oncologie médicale, Lyon, France
| | | | | | | | - Pierre Méeus
- Centre Léon-Bérard, département de chirurgie, Lyon, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie, Bordeaux, France
| | - Isabelle Ray-Coquard
- Centre Léon-Bérard, département d'oncologie médicale, Lyon, France; University of Claude-Bernard Lyon 1, health services and performance research lab (EA 7425 HESPER), Lyon, France
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Partridge A, Pagani O, Niman SM, Ruggeri M, Peccatori FAA, Azim HA, Colleoni M, Saura C, Shimizu C, Saetersdal A, Kroep J, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe J, Borrego MR, Moore H, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Smith KL, Vilarino TF, Ribi K, Ruddy K, El-Abed S, Piccart M, Korde LA, Goldhirsch A, Gelber RD. Abstract GS4-09: Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48-14/BIG 8-13). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs4-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Pregnancy after breast cancer (BC) is of substantial importance for many young women at diagnosis and during follow-up. BC treatment including standard endocrine therapy (ET) (5-10 years) may reduce ovarian reserve and the chances of subsequent successful pregnancy, given conception is contraindicated during ET. A temporary interruption of ET to attempt and carry a pregnancy in this population has never been prospectively studied.
Methods: POSITIVE is a single-arm, prospective, investigator-initiated, international trial evaluating the safety and pregnancy outcomes of interrupting ET for young women with early-stage hormone-receptor-positive (HR+) BC who desire pregnancy. The primary objective is to assess the risk of BC relapse associated with ET interruption for ~2 years to achieve pregnancy. Women ≤42 years with stage I-III HR+ BC who received adjuvant ET (SERM alone, GnRH analogue plus SERM or AI) for 18 to 30 months and wished to interrupt ET to attempt pregnancy were eligible. The primary endpoint is breast cancer free interval (BCFI) defined as the time from enrollment to the first BC event (local, regional, distant recurrence or a new invasive contralateral BC). Planned sample size was 500 patients. Three interim analyses of BCFI were reviewed by the Data Safety Monitoring Committee (DSMC) to assure a 95% chance of stopping the trial early if the annual BCFI event rate exceeded 4%; with primary analysis triggered after 1600 patient years of follow-up (pyfu) and no more than 46 BCFI events defined as the safety threshold. The DSMC recommended continuing the study following each interim analysis. We now report the primary results.
Results: From 12/2014 to 12/2019, 518 women were enrolled. At enrollment, the median age of participants was 37 years (27-43 years); 75.0% were nulliparous, 93.4% had stage I/II disease, 66.3% node-negative. Median time from BC diagnosis to enrollment was 29 months (IQR: 25-32). Tamoxifen alone was the most prescribed ET (41.7%), followed by tamoxifen+ovarian function suppression (35.7%). 62.0% of participants had received neo/adjuvant chemotherapy. At a median follow-up of 41 months (1638 pyfu), 44 participants had experienced a BCFI event, not exceeding the pre-specified safety threshold of 46 events. The 3-year BCFI failure percent was 8.9% (95% CI: 6.3 to 11.6%), similar to the 9.2% (95% CI: 7.6 to 10.8%) calculated in the comparative external control cohort from the SOFT/TEXT trials (Sun et al, Breast 2020). Of 497 women followed for pregnancy status, 368 (74.0%) had at least one pregnancy, 317 (63.8%) had at least one live birth, with a total of 365 babies born. Based on competing risk analysis, 76.3% of patients resumed ET (half within 26 months), 8.3% had BCFI event/death before ET resumption, and 15.4% had not resumed ET yet.
Conclusions: The POSITIVE trial demonstrates that for young women with early HR+ BC desiring pregnancy, temporary interruption of ET to attempt pregnancy does not confer a greater short-term risk of recurrence than that observed in a modern historical control group that did not interrupt ET. Most participants have had a live birth. Further follow-up is planned to confirm long-term safety. These results should be considered in counselling BC patients desiring future pregnancy.
Citation Format: Ann Partridge, Olivia Pagani, Samuel M. Niman, Monica Ruggeri, Fedro Alessandro A. Peccatori, Hatem A. Azim, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna Saetersdal, Judith Kroep, Audrey Mailliez, Ellen Warner, Virginia F. Borges, Frédéric Amant, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Junko Takei, Jeong Eon Lee, Janice Walshe, Manuel Ruiz Borrego, Halle Moore, Christobel Saunders, Vesna Bjelic-Radisic, Snezana Susnjar, Fatima Cardoso, Karen L. Smith, Teresa Ferreiro Vilarino, Karin Ribi, Kathryn Ruddy, Sarra El-Abed, Martine Piccart, Larissa A. Korde, Aron Goldhirsch, Richard D. Gelber. Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS4-09.
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Affiliation(s)
| | - Olivia Pagani
- 2Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz; Geneva University Hospitals, Lugano University and Swiss Group for Clinical Cancer Research (SAKK), Vaud, Switzerland
| | | | - Monica Ruggeri
- 4ETOP IBCSG Partners Foundation, Bern, Bern, Switzerland
| | | | - Hatem A. Azim
- 6School of Medecine, Monterrey Institute of Technology
| | - Marco Colleoni
- 7Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Lombardia, Italy
| | - Cristina Saura
- 8Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Barcelona, Catalonia
| | - Chikako Shimizu
- 9National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | | | | | | | - Ellen Warner
- 13Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | - Akemi Kataoka
- 17The Cancer Institute Hospital Of JFCR, Koto-ku, Tokyo, Japan
| | | | | | - Junko Takei
- 20Department of Breast Surgical Oncology and Department of Clinical Genetics, St. Luke’s international hospital, Chu-o-ku, Tokyo, Japan
| | | | - Janice Walshe
- 22Department of Medical Oncology St. Vincent’s University Hospital and Tallaght University Hospital
| | | | | | | | | | - Snezana Susnjar
- 27Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Fatima Cardoso
- 28Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal, Lisbon, Portugal
| | - Karen L. Smith
- 29Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | - Karin Ribi
- 31International Breast Cancer Study Group, Bern, Bern, Switzerland
| | | | | | - Martine Piccart
- 34Institut Jules Bordet – Université Libre de Bruxelles, Anderlecht, Brussels Hoofdstedelijk Gewest, Belgium
| | - Larissa A. Korde
- 35Division of Cancer Treatment and Diagnosis, National Cancer Institute
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Courbiere B, Drikes B, Grob A, Hamidou Z, Saultier P, Bertrand Y, Gandemer V, Plantaz D, Plat G, Poirée M, Ducassou S, Pochon C, Dalle JH, Thouvenin S, Paillard C, Kanold J, Sirvent A, Rousset-Jablonski C, Duros S, Gueniffey A, Cohade C, Boukaidi S, Frantz S, Agopiantz M, Poirot C, Genod A, Pirrello O, Gremeau AS, Bringer-Deutsch S, Auquier P, Michel G. The uterine volume is dramatically decreased after hematopoietic stem cell transplantation during childhood regardless of the conditioning regimen. Fertil Steril 2023; 119:663-672. [PMID: 36627013 DOI: 10.1016/j.fertnstert.2022.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To study the impact of hematopoietic stem cell transplantation (HSCT) on the uterine volume of childhood acute leukemia (AL) survivor depending on age at HSCT and the type of myeloablative conditioning regimen. SETTING Thirteen French University Teaching Hospitals. DESIGN Prospective cohort study. PATIENT(S) Eighty-eight women who underwent HSCT during childhood or adolescence for AL compared to a control group. INTERVENTION(S) A multicentric prospective national study compared the uterine volume in a cohort of childhood AL survivor adult women treated with HSCT, matched 1:1 to control women. Pelvic magnetic resonance imaging scans included diffusion-weighted imaging sequences. Scans were centralized for a double-blinded reading by 2 radiologists. MAIN OUTCOME MEASURE(S) Uterine volume, uterine body-to-cervix ratio, and apparent diffusion coefficient. RESULT(S) The mean age at HSCT was 9.1 ± 0.3 years with a mean follow-up duration of 16.4 ± 0.5 years. The cohort of 88 HSCT survivor women was composed of 2 subgroups depending on the myeloablative conditioning regimen received: an alkylating agent-based regimen group (n = 34) and a total body irradiation (TBI)-based regimen group (n = 54). Among the 88 women, 77 were considered as having a "correct hormonal balance" with estrogens supplied by hormone replacement therapy (HRT) for premature ovarian insufficiency (POI) or because of a residual ovarian function. In the control group (n = 88), the mean uterine volume was 79.7 ± 3.3 mL. The uterine volume significantly decreased in all HSCT survivor women. After the alkylating agent-based regimen, the uterine volume was 45.3 ± 5.6 mL, corresponding to a significant volume reduction of 43.1% (28.8-57.4%) compared with that of the control group. After TBI, the uterine volume was 19.6 ± 1.9 mL, corresponding to a significant volume reduction of 75.3% (70.5%-80.2%) compared with that of the control group. After the alkylating agent-based regimen, the uterine volume dramatically decreased in women with POI without HRT compared with that in those with a correct hormonal balance (15.2 ± 2.6 vs. 49.3 ± 6 mL). In contrast, after TBI, the uterine volume was similar in all women, with no positive effect of hormonal impregnation on the uterine volume (16.3 ± 2.6 vs. 20.1 ± 2.2 mL, respectively). CONCLUSION(S) The uterine volume was diminished after HSCT, regardless of the conditioning regimen. The physiopathology needs to be further investigated: specific impact of a high dose of an alkylating agent; impact of hormone deprivation around puberty; poor compliance to HRT; or different myometrial impact of HRT compared with endogenous ovarian estrogens? CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov/NCT03583294 (enrollment of the first subject, November 11, 2017; enrollment of the last subject, June 25, 2021).
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Affiliation(s)
- Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception/Aix-Marseille Université, IMBE, CNRS, IRD, Avignon Université, Marseille, France.
| | - Benjamin Drikes
- Department of Radiology, University Teaching Hospital Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Anaïs Grob
- Department of Radiology, University Teaching Hospital Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Zeinab Hamidou
- CEReS Research Unit EA 3279 and Department of Public Health, Hôpital de la Timone, Marseille, France
| | - Paul Saultier
- Department of Pediatric Hematology, Immunology and Oncology, AP-HM, La Timone Children's Hospital, Marseille, France; Aix Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
| | - Yves Bertrand
- Department of Pediatric Hematology and Oncology, University Hospital of Lyon, Lyon, France
| | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France
| | - Dominique Plantaz
- Department of Pediatric Hematology-Oncology, University Hospital of Grenoble, Grenoble, France
| | - Geneviève Plat
- Department of Pediatric Hematology and Oncology, University Hospital of Toulouse, Toulouse, France
| | - Maryline Poirée
- Department of Pediatric Hematology and Oncology, University Hospital L'Archet, Nice, France
| | - Stéphane Ducassou
- Department of Pediatric Hematology and Oncology, University Hospital of Bordeaux, Bordeaux, France
| | - Cécile Pochon
- Department of Pediatric Hematology and Oncology, Children's Hospital of Brabois, Vandoeuvre-Les-Nancy, France
| | - Jean-Hugues Dalle
- Department of Hematology and immunology, Hôpital Robert-Debré, GHU APHP-Nord Université de Paris-Cité, Paris, France
| | - Sandrine Thouvenin
- Department of Pediatric Onco-hematology, CHU de Saint-Etienne, Saint-Etienne, France
| | - Catherine Paillard
- Department of Pediatric Hematology-Oncology, University Hospital, Strasbourg, France
| | - Justyna Kanold
- Department of Pediatric Hematology and Oncology, CIC Inserm 501, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Sirvent
- Department of Pediatric Onco-Hematology, University Hospital of Montpellier, Montpellier, France
| | - Christine Rousset-Jablonski
- Département de Chirurgie Oncologique, Centre Léon Bérard, Lyon, France, and Hospices Civils de Lyon, Département de Gynécologie-Obstétrique, Groupe Hospitalier Sud, Pierre Benite Cedex, France; INSERM U1290 RESHAPE RESearch in HealthcAre PErformance, Université Lyon 1, Lyon, France
| | - Solène Duros
- Département de Gynécologie-Obstétrique et Reproduction Humaine, CHU Rennes, Rennes, France
| | - Aurore Gueniffey
- Centre Hospitalier Universitaire de Grenoble, Hôpital Couple-Enfant, Centre Clinique et Biologique d'Assistance Médicale à la Procréation- Centre d'étude et de conservation des œufs et du sperme humains (CECOS), La Tronche, France
| | - Clementine Cohade
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Samir Boukaidi
- Department of Obstetrics and Gynecology and Reproductive Medicine, CHU de Nice, Archet 2 Hospital, Nice, France
| | - Sandrine Frantz
- Service de Chirurgie Gynécologique et Médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux cedex, France
| | - Mikael Agopiantz
- Department of Reproductive Medicine, CHRU de Nancy, Université de Lorraine, Nancy, France INSERM U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Catherine Poirot
- Department of Hematology, AYA Unit, Saint Louis Hospital, Paris, France, Médecine Sorbonne Université, Site Pitié Salpêtrière, Paris, France, and Department of Reproductive Biology, Cochin Hospital AP-HP, Paris, France
| | - Anne Genod
- Service de Gynécologie-Obstétrique, Université Jean-Monnet, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - Olivier Pirrello
- Assisted Reproductive Technique Unit, CMCO, University Hospital of Strasbourg, Schiltigheim, France
| | - Anne-Sophie Gremeau
- Department of Gynecologic Surgery and IVF, Clermont-Ferrand, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Sophie Bringer-Deutsch
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Arnaud-de-Villeneuve, Montpellier, France
| | - Pascal Auquier
- CEReS Research Unit EA 3279 and Department of Public Health, Hôpital de la Timone, Marseille, France
| | - Gérard Michel
- CEReS Research Unit EA 3279 and Department of Public Health, Hôpital de la Timone, Marseille, France; Department of Pediatric Hematology, Immunology and Oncology, AP-HM, La Timone Children's Hospital, Marseille, France
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Sebbag C, Rousset-Jablonski C, Coussy F, Ray-Coquard I, Garin C, Evrevin C, Cessot M, Labrosse J, Laot L, Darrigues L, Bobrie A, Sénéchal-Davin C, Espié M, Giacchetti S, Plu-Bureau G, Maitrot-Mantelet L, Gompel A, Santulli P, Asselain B, Hotton J, Coutant C, Guerin J, Decanter C, Mailliez A, Brain E, Dumas E, Sablone L, Seintinelles RN, Reyal F, Hamy AS. Contraception in breast cancer survivors from the FEERIC case-control study (performed on behalf of the Seintinelles research network). Breast 2022; 67:62-70. [PMID: 36630821 PMCID: PMC9982267 DOI: 10.1016/j.breast.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. STUDY DESIGN The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18-43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. RESULTS In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p < 0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy-induced ovary damage at BC diagnosis (OR = 2.47 95%CI [ 1.39-4.37] and anti-HER2 treatment (OR = 2.46, 95% CI [ 1.14-6.16]) were significantly associated with the use of a contraception in multivariate analysis. CONCLUSION In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling.
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Affiliation(s)
- Clara Sebbag
- Department of Medical Oncology, Institut Curie, Paris, France,Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Université Paris Cité, Paris, France
| | - Christine Rousset-Jablonski
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Isabelle Ray-Coquard
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Clémentine Garin
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Clémence Evrevin
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Marion Cessot
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Julie Labrosse
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lauren Darrigues
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Angélique Bobrie
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | | | - Marc Espié
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Sylvie Giacchetti
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Geneviève Plu-Bureau
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Anne Gompel
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | - Pietro Santulli
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Judicaël Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Charles Coutant
- Department of Surgical Oncology, Centre Georges-François Leclerc - Unicancer, Dijon, France,Clinical Research Department, Centre Georges-François Leclerc - Unicancer, Dijon, France
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambert, Lille, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Laura Sablone
- Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France
| | | | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Department of Surgical Oncology, Institut Curie, Paris, France,Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France,Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Paris, France; Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France; Department of Surgical Oncology, Institut Curie, Paris, France; Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France; Université Paris Cité, Paris, France.
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16
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Rousset-Jablonski C, Mekki Y, Denis A, Reynaud Q, Nove-Josserand R, Durupt S, Touzet S, Perceval M, Ray-Coquard I, Golfier F, Durieu I. Human papillomavirus prevalence, persistence and cervical dysplasia in females with cystic fibrosis. J Cyst Fibros 2022:S1569-1993(22)01415-1. [DOI: 10.1016/j.jcf.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
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Rousset-Jablonski C, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Jacoud F, Berard M, Viprey M, Van Ganse E, Durieu I, Belhassen M. Cancer incidence and prevalence in cystic fibrosis patients with and without a lung transplant in France. Front Public Health 2022; 10:1043691. [PMID: 36483264 PMCID: PMC9723348 DOI: 10.3389/fpubh.2022.1043691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cystic fibrosis (CF) care and the life expectancy of affected patients have substantially improved in recent decades, leading to an increased number of patients being diagnosed with comorbidities, including cancers. Our objective was to characterize the epidemiology of cancers between 2006 and 2017 in CF patients with and without a lung transplant. Methods Medical records of CF patients from 2006 to 2016 in the French CF Registry were linked to their corresponding claims data (SNDS). The annual prevalence and incidence rates of cancers were estimated from 2006 to 2017 in CF patients without lung transplant and in those with lung transplant after transplantation. Results Of the 7,671 patients included in the French CF Registry, 6,187 patients (80.7%) were linked to the SNDS; among them, 1,006 (16.3%) received a lung transplant. The prevalence of any cancer increased between 2006 and 2017, from 0.3 to 1.0% and from 1.3 to 6.3% in non-transplanted and transplanted patients, respectively. When compared to the general population, the incidence of cancer was significantly higher in both non-transplanted [Standardized Incidence Ratio (SIR) = 2.57, 95%CI 2.05 to 3.17] and transplanted (SIR = 19.76, 95%CI 16.45 to 23.55) patients. The median time between transplant and the first cancer was 3.9 years. Among the 211 incident cancer cases, the most frequent malignant neoplasms were skin neoplasm (48 cases), lung cancers (31 cases), gastro-intestinal (24 cases), and hematologic cancers (17 cases). Conclusion The overall burden of cancer in CF patients is high, particularly following lung transplantation. Therefore, specific follow-up, screening and cancer prevention for CF patients with transplants are necessary.
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Affiliation(s)
- Christine Rousset-Jablonski
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France,Département de chirurgie, Centre Léon Bérard, Lyon, France,*Correspondence: Christine Rousset-Jablonski
| | | | - Quitterie Reynaud
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France
| | | | | | - Flore Jacoud
- PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | | | - Marie Viprey
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Eric Van Ganse
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,PELyon, PharmacoEpidemiologie Lyon, Lyon, France,Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France
| | - Isabelle Durieu
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France
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Rousset-Jablonski C, Durieu I, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Berard M, Jacoud F, Viprey M, Van Ganse E, Belhassen M. Incidence et prévalence des cancers chez les patients atteints de mucoviscidose : données issues du chainage entre le Système national des données de santé (SNDS) et le registre français de la mucoviscidose. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lambertini M, Massarotti C, Havas J, Pistilli B, Martin AL, Jacquet A, Coutant C, Coussy F, Mérimèche AD, Lerebours F, Rousset-Jablonski C, Jouannaud C, Rigal O, Fournier M, Soulie P, Franzoi MA, Del Mastro L, Partridge AH, André F, Vaz-Luis I, Di Meglio A. Contraceptive Use in Premenopausal Women With Early Breast Cancer. JAMA Netw Open 2022; 5:e2233137. [PMID: 36149651 PMCID: PMC9508662 DOI: 10.1001/jamanetworkopen.2022.33137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE As life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant. OBJECTIVE To examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer. DESIGN, SETTING, AND PARTICIPANTS The Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022. EXPOSURES Contraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2). MAIN OUTCOMES AND MEASURES Contraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis. RESULTS A total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P < .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44). CONCLUSIONS AND RELEVANCE Findings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, School of Medicine, University of Genova, Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Julie Havas
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | - Charles Coutant
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | | | | | | | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Marion Fournier
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Patrick Soulie
- Department of Medical Oncology, Institut de Cancérologie de L’ouest-Paul Papin, Angers, France
| | - Maria Alice Franzoi
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fabrice André
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
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Trémollieres FA, Chabbert-Buffet N, Plu-Bureau G, Rousset-Jablonski C, Lecerf JM, Duclos M, Pouilles JM, Gosset A, Boutet G, Hocke C, Maris E, Hugon-Rodin J, Maitrot-Mantelet L, Robin G, André G, Hamdaoui N, Mathelin C, Lopes P, Graesslin O, Fritel X. Management of postmenopausal women: Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Groupe d'Etude sur la Ménopause et le Vieillissement (GEMVi) Clinical Practice Guidelines. Maturitas 2022; 163:62-81. [PMID: 35717745 DOI: 10.1016/j.maturitas.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022]
Abstract
AIM The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). MATERIALS AND METHODS Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. SUMMARY RECOMMENDATIONS The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).
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Affiliation(s)
- F A Trémollieres
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France; Inserm U1048-I2MC-Equipe 9, Université Toulouse III Paul-Sabatier, 1, avenue du Professeur-Jean-Poulhes, BP 84225, 31432 Toulouse cedex 4, France.
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, APHP Sorbonne Universitaire, Site Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Plu-Bureau
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France; Université de Paris, Paris, France; Inserm U1153 Equipe EPOPEE, Paris, France
| | - C Rousset-Jablonski
- Département de chirurgie oncologique, Centre Léon Bérard, 28, Promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France; Département d'obstétrique et gynécologie, Hospices Civils de Lyon, CHU Lyon Sud, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon, EA 7425 HESPER-Health Services and Performance Research, 8, avenue Rockefeller, 69003 Lyon, France
| | - J M Lecerf
- Service de nutrition et activité physique, Institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille cedex, France; Service de médecine interne, CHRU Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Duclos
- Service de médecine du sport et des explorations fonctionnelles, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, UFR Médecine, BP 10448, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - J M Pouilles
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - A Gosset
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - G Boutet
- AGREGA, Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33000 Bordeaux, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Maris
- Département d'obstétrique et gynécologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, UF de gynécologie endocrinienne, Hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - G André
- 15, boulevard Ohmacht, 67000 Strasbourg, France
| | - N Hamdaoui
- Centre Hospitalier Universitaire Nord, Assistance publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - C Mathelin
- Institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS UMR7104 Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
| | - P Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain, 44819 St Herblain, France; Université ́de Nantes, 44093 Nantes cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, Institut Mère-Enfant Alix de Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Meglio AD, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Galbiati RG, Dieci MV, Pérez-Fidalgo A, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Abstract PD5-06: Safety of assisted reproductive technologies (ART) following treatment completion in young women with germline BRCA pathogenic variants having a pregnancy after breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd5-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Young breast cancer (BC) survivors are at risk of infertility. Ovarian stimulation for fertility preservation before (neo)adjuvant chemotherapy is standard of care. Research efforts have shown no negative prognostic effect of pregnancy following BC therapy, also among BRCA carriers. Currently, poor evidence is available on the safety to undergo ART following BC treatment, with no data in carriers of germline BRCA pathogenic variants. To provide evidence on the safety of fertility treatments in this specific population, we assessed the outcomes of a cohort of BRCA-mutated BC survivors who had a pregnancy after prior BC history by comparing the group of patients who underwent ART to achieve pregnancy to the group with spontaneous pregnancy. METHODS: We conducted a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤ 40 years with stage I-III BC, between January 2000 and December 2012, bearing germline BRCA1/2 pathogenic variants. Survivors with a pregnancy (any outcome) after BC, with no disease-free survival (DFS) event before pregnancy, were assigned to the ART and non-ART group if their pregnancy was achieved through ART or spontaneously, respectively. ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), and embryo transfer under hormonal replacement therapy (HRT). RESULTS: Of 1,424 patients registered in the study, 168 with a pregnancy after BC were included in the present analysis. A total of 22 patients were included in the ART group and 146 in the non-ART group. Before BC diagnosis, 18.2% patients in the ART group had at least one child, compared to 38.4% in the non-ART group (P=0.030). Patients had a median age at BC diagnosis of 33.0 vs 30.2 years old in the ART group and in the non-ART group, respectively (P=0.004); 45.4% and 17.1% had grade 1-2 tumors, respectively (P=0.008), and 59.1% vs 31.5% had hormone receptor-positive tumors, respectively (P=0.016). Both cohorts had similar tumor size and nodal stage characteristics. Type and duration of endocrine therapy were comparable between groups. The type of ART was not specified in 5 survivors (22.7%). Ovulation induction was used in 1 patient (4.5%), ovarian stimulation in 7 patients (31.8%), embryo transfer under HRT following oocyte donation in 5 patients (22.7%), and embryo transfer under HRT following oocyte and/or embryo cryopreservation for fertility preservation in 4 patients (18.2%). Median age at conception among survivors was 39.7 years in the ART group versus 35.4 years in the non-ART group (P<0.001). Overall, no differences in obstetrical outcomes were observed between groups, although there were more delivery complications in the ART group vs the non-ART group (22.1% vs 4.1%, respectively, P=0.011). Median follow-up from pregnancy was 3.4 years (range: 0.8-8.6) for patients in the ART group vs 5.0 years (range: 0.8-17.6) in the non-ART group (P=0.009). In the ART group, 2 patients (9.1%) experienced a DFS event (both were loco-regional recurrences) as compared to 40 patients (27.4%) in the non-ART group (P=0.182). No patients died in the ART group compared to 10 patients (6.9%) in the non-ART group. CONCLUSIONS: To our knowledge, this is the first study assessing the safety of ART in BC survivors bearing germline BRCA pathogenic variants. Even though the exposed cohort was small, results showed that the use of ART does not appear to increase the relapse risk at short-term follow-up. Further reproductive studies in BRCA-mutated BC patients are warranted.
Citation Format: Margherita Condorelli, Marco Bruzzone, Marcello Ceppi, Alberta Ferrari, Albert Grinshpun, Anne-Sophie Hamy, Evandro de Azambuja, Estela Carrasco, Fedro A. Peccatori, Antonio Di Meglio, Shani Paluch-Shimon, Philip D. Poorvu, Marta Venturelli, Christine Rousset-Jablonski, Claire Senechal, Luca Livraghi, Riccardo Ponzone, Laura De Marchis, Katarzyna Pogoda, Amir Sonnenblick, Cynthia Villarreal-Garza, Octavi Córdoba, Luis Teixeira, Florian Clatot, Kevin Punie, Rossella Graffeo Galbiati, Maria Vittoria Dieci, Alejandro Pérez-Fidalgo, Francois P. Duhoux, Fabio Puglisi, Arlindo R. Ferreira, Eva Blondeaux, Tamar Peretz-Yablonski, Olivier Caron, Claire Saule, Lieveke Ameye, Judith Balmaña, Ann H. Partridge, Hatem A. Azim, Jr, Isabelle Demeestere, Matteo Lambertini. Safety of assisted reproductive technologies (ART) following treatment completion in young women with germline BRCA pathogenic variants having a pregnancy after breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD5-06.
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Affiliation(s)
- Margherita Condorelli
- Hôpital Erasme, Fertility Clinic, and Université Libre de Bruxelles, Research Laboratory on Human Reproduction, Bruxelles, Belgium
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Evandro de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonio Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Shani Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Philip D. Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Marta Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Christine Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard, Lyon, France, and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - Laura De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Cynthia Villarreal-Garza
- Department of Research and Breast Tumors, Instituto Nacional de Cancerologia and, Mexico City, Mexico
| | - Octavi Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Luis Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Rossella Graffeo Galbiati
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alejandro Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - Francois P. Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Arlindo R. Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Eva Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tamar Peretz-Yablonski
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Olivier Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claire Saule
- Department of Genetics, Institut Curie, Paris, France
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Isabelle Demeestere
- Hôpital Erasme, Fertility Clinic, and Université Libre de Bruxelles, Research Laboratory on Human Reproduction, Bruxelles, Belgium
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova and Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Mangiardi-Veltin M, Sebbag C, Rousset-Jablonski C, Ray-Coquard I, Berkach C, Laot L, Wang Y, Abdennebi I, Labrosse J, Sautter C, Toussaint A, Sablone L, Laas E, Khallouch S, Coussy F, Santulli P, Chapron C, Bobrie A, Jacot W, Sella N, Dumas E, Sénéchal-Davin C, Espie M, Giacchetti S, Maitrot L, Plu-Bureau G, Coutant C, Guerin J, Asselain B, Fumoleau P, Rodrigues M, Decanter C, Mailliez A, Delrieu L, Lemoine A, Jouannaud C, Houdre D, Reyal F, Hamy AS. Pregnancy, fertility concerns, and fertility preservation procedures in French breast cancer survivors in the FEERIC national study (on behalf of the Seintinelles research network). Reprod Biomed Online 2022; 44:1031-1044. [DOI: 10.1016/j.rbmo.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
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Stempak-Droissart T, Rousset-Jablonski C, Spritzer PM, Lalhou N, Larger E, Pichard C, Plessier A, Gompel A. Impact of vascular liver disease on the menstrual cycle and metabolic status in premenopausal women. Clin Res Hepatol Gastroenterol 2022; 46:101756. [PMID: 34303004 DOI: 10.1016/j.clinre.2021.101756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Vascular liver disease (VLD) are rare liver diseases, which affect women at reproductive ages. Main complications are bleeding (portal hypertension, thrombopenia or anticoagulation related) and thromboembolism. Failure of liver function can occur. Thus endocrine abnormalities management and contraception are challenging. PURPOSE to evaluate the impact on the menstrual cycles and related endocrine abnormalities in women with VLD and respective roles of liver function and portal hypertension. STUDY DESIGN This was a single-center observational cohort study. Forty-seven premenopausal women with vascular liver disease were included for endocrine and gynecological assessments. Endocrine evaluation was performed at inclusion. Tolerance of contraception was followed up and assessed at 3 and 12 months. PARTICIPANTS, SETTING, METHODS Forty-seven women (aged 16-50) followed in a Reference Center for Liver Vascular Disease between February 2009 and November 2016 were included and addressed for gynecological and endocrinological management. Twenty-five women had extrahepatic portal vein obstruction, 17 had Budd Chiari Syndrome and five had a porto-sinusoidal vascular disease. We explored gonadotropin at baseline and after GnRH, testosterone, sex hormone binding globulin (SHBG), androstenedione, GH axis and glucose metabolism. All women underwent pelvic ultrasonography. RESULTS Vascular liver disease was associated with abnormal menstrual cycles in 53% of the women and clinical and/or biological hyperandrogenism and/or a polycystic ovary morphology was identified in 38%. Portal hypertension was correlated to higher testosterone levels (P = 0.04), whereas higher elevated levels SHBG in 28%, correlated with liver failure (P = 0.01). Sixteen had glucose intolerance profile or diabetes. IGF-1 levels were highly correlated with hepatic failure. Abnormal uterine bleeding occurred in 21% of women, 87% of which were due to gynecological pathologies revealed by anticoagulant treatment. Progestin contraception was well tolerated and helped to control bleeding. CONCLUSION AND IMPLICATIONS endocrine abnormalities, prior described in association with cirrhosis, are also identified in patients with vascular liver disease, and require specific management. Glucose intolerance profile is frequent, further studies are needed to assess significant consequences on cardio-vascular system.
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Affiliation(s)
- Tatiana Stempak-Droissart
- Université de Paris, Department of Gynecological Endocrinology, Hôpitaux Universitaires Centre, AP-HP, Paris, France; Department of Obstetrics and Gynecology, Groupe hospitalier Sud Ile de France, Centre hospitalier de Melun, Melun, France
| | | | - Poli M Spritzer
- Université de Paris, Department of Gynecological Endocrinology, Hôpitaux Universitaires Centre, AP-HP, Paris, France; Division of Endocrinology, Hospital de Clinicas de Porto Alegre and Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Najiba Lalhou
- Laboratory of Hormonal Biology, Groupe hospitalier Cochin-Port Royal, AP-HP, Paris, France
| | - Etienne Larger
- Université de Paris, Department of Diabetology, Groupe hospitalier Cochin-PorRoyal, AP-HP, Paris, France
| | - Caroline Pichard
- Department of Endocrinology and metabolic diseases, Groupe hospitalier La Pitié-Salpêtrière, APHP, Paris, Fance
| | - Aurélie Plessier
- Beaujon Hospital, AP-HP, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Paris, Université Paris 7-Denis-Diderot, ERN Rare liver Clichy, France
| | - Anne Gompel
- Université de Paris, Department of Gynecological Endocrinology, Hôpitaux Universitaires Centre, AP-HP, Paris, France.
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Braham I, Morisot A, Boukaïdi S, Perceval M, Durieu I, Rousset-Jablonski C, Hieronimus S, Leroy S, Chevalier N. The Prognosis of ART Is Not Altered in Cystic Fibrosis Women: A Case-Report Study. Front Endocrinol (Lausanne) 2022; 13:773753. [PMID: 35265034 PMCID: PMC8898889 DOI: 10.3389/fendo.2022.773753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
RESEARCH QUESTION Unlike in men, a very limited number of studies were focused on the specificity of ART management of cystic fibrosis (CF) in women. The purpose of this study was to determine the causes of infertility in patients, the appropriate ART treatment, and their prognosis in terms of pregnancy. DESIGN We conducted a multicentre analytical case-control study including CF women who were age-matched to non-CF women. We reported the causes of infertility, the ART management type and pregnancy outcomes. RESULTS 17 cases were compared to 34 controls. There was no significant difference between the groups concerning cause infertility. There was a non-statistically significant trend with a lower antral follicle count in CF compared to controls (19.5 versus 26.8, p=0.08). IUI seemed to be as successful as IVF/ICSI in CF as opposed to controls where the IVF/ICSI was the most effective (in CF group for HCG >100 UI/L: 38.8% vs. 36.8%, p=0.4175). There were more embryos obtained in CF than in controls (3.1 versus 1.6, p=0.02). The number of oocytes and embryos obtained and pregnancy outcomes remained similar between DF508 homozygous group and others CFTR mutations group. The results of ART procedures and pregnancy evolution were not influenced by FEV1. CONCLUSION In absence of any other pathology, IUI may be first option for CF women. If insemination fails, IVF with a low dose of gonadotropins may be more appropriate to prevent the risk of hyperstimulation syndrome. FEV1 and genetic do not seem to be contributing factors in the prognosis of ART.
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Affiliation(s)
- Inès Braham
- Université Côte d’Azur, CHU de Nice, Département d’Endocrinologie-Diabétologie et Reproduction, Nice, France
| | - Adeline Morisot
- Université Côte d’Azur, CHU de Nice, Département de Santé Publique, Nice, France
| | - Samir Boukaïdi
- Université Côte d’Azur, CHU de Nice, Centre d’aide médicale à la procréation, Nice, France
| | - Marie Perceval
- Hospices Civils de Lyon, CHU de Lyon, Centre de Ressources et de Compétences de la Mucoviscidose, Lyon, France
| | - Isabelle Durieu
- Hospices Civils de Lyon, CHU de Lyon, Centre de Ressources et de Compétences de la Mucoviscidose, Lyon, France
| | | | - Sylvie Hieronimus
- Université Côte d’Azur, CHU de Nice, Département d’Endocrinologie-Diabétologie et Reproduction, Nice, France
| | - Sylvie Leroy
- Université Côte d’Azur, CHU de Nice, Centre de Ressources et de Compétences de la Mucoviscidose, Nice, France
| | - Nicolas Chevalier
- Université Côte d’Azur, CHU de Nice, Département d’Endocrinologie-Diabétologie et Reproduction, Nice, France
- Université Côte d’Azur, Inserm U1065, C3M, Nice, France
- *Correspondence: Nicolas Chevalier,
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25
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Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Di Meglio A, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Graffeo R, Dieci MV, Pérez-Fidalgo JA, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Safety of assisted reproductive techniques in young women harboring germline pathogenic variants in BRCA1/2 with a pregnancy after prior history of breast cancer. ESMO Open 2021; 6:100300. [PMID: 34775302 PMCID: PMC8593447 DOI: 10.1016/j.esmoop.2021.100300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knowledge is growing on the safety of assisted reproductive techniques (ART) in cancer survivors. No data exist, however, for the specific population of breast cancer patients harboring germline BRCA1/2 pathogenic variants. PATIENTS AND METHODS This is a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤40 years with stage I-III breast cancer, between January 2000 and December 2012, harboring known germline BRCA1/2 pathogenic variants. Patients included in this analysis had a post-treatment pregnancy either achieved through use of ART (ART group) or naturally (non-ART group). ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection, and embryo transfer under hormonal replacement therapy. RESULTS Among the 1424 patients registered in the study, 168 were eligible for inclusion in the present analysis, of whom 22 were in the ART group and 146 in the non-ART group. Survivors in the ART group conceived at an older age compared with those in the non-ART group (median age: 39.7 versus 35.4 years, respectively). Women in the ART group experienced more delivery complications compared with those in the non-ART group (22.1% versus 4.1%, respectively). No other apparent differences in obstetrical outcomes were observed between cohorts. The median follow-up from pregnancy was 3.4 years (range: 0.8-8.6 years) in the ART group and 5.0 years (range: 0.8-17.6 years) in the non-ART group. Two patients (9.1%) in the ART group experienced a disease-free survival event (specifically, a locoregional recurrence) compared with 40 patients (27.4%) in the non-ART group. In the ART group, no patients deceased compared with 10 patients (6.9%) in the non-ART group. CONCLUSION This study provides encouraging safety data on the use of ART in breast cancer survivors harboring germline pathogenic variants in BRCA1/2, when natural conception fails or when they opt for ART in order to carry out preimplantation genetic testing.
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Affiliation(s)
- M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - A Grinshpun
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A S Hamy
- Department of Medical Oncology, Institut Curie, Paris, France
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - S Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - P D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - C Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - C Senechal
- Cancer Genetics Unit, Bergonie Institute, Bordeaux, France
| | - L Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Siena, Siena, Italy
| | - R Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - L De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - K Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - C Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - O Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - L Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - F Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - R Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - F P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - F Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - E Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - T Peretz-Yablonski
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - O Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Saule
- Department of Genetics, Institut Curie, Paris, France
| | - L Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - J Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Gernier F, Gompel A, Rousset-Jablonski C, Kalbacher E, Floquet A, Berton-Rigaud D, Tredan O, Alexandre J, Follana P, Zannetti A, Dohollou N, Grellard JM, Clarisse B, Licaj I, Ahmed-Lecheheb D, Fauvet R, Pautier P, Joly F. Menopausal symptoms in epithelial ovarian cancer survivors: a GINECO VIVROVAIRE2 study. Gynecol Oncol 2021; 163:598-604. [PMID: 34649724 DOI: 10.1016/j.ygyno.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We have previously shown that epithelial ovarian cancer (EOC) and its treatments have negative effects on long-term quality of life (QoL) and fatigue. The present multicenter study investigated the main menopausal symptoms and gynecological management of EOC survivors (EOCS). METHODS 166 patients with relapse-free ≥3 years after the end of treatment attended a consultation with a gynecologist, including a questionnaire related to vasomotor symptoms (VMS) and sexuality, a clinical examination, a blood sample and an osteodensitometry. QoL, fatigue, insomnia and mood disorders were measured with validated questionnaires and correlated to VMS. VMS and QoL were assessed according to natural menopause (NM) or surgical menopause (SM). RESULTS Mean age at the survey was 62 [21-83] years and stage III/IV (48%). Mean delay since the end of treatment was 6 years. Fifty-nine patients (36%) had SM. Half of patients reported VMS. Seventy-two percent of EOCS with SM had VMS compared to 41% with NM (P < .001). VMS were not associated with poor global QoL, fatigue, insomnia or mood disorders. Two-thirds of EOCS reported a decrease in libido. Patients with SM showed a greater decrease in libido than NM (P < .02). Fourteen percent of them had osteoporosis and 50% osteopenia. Among the 85 patients with VMS, 80 did not receive HRT after cancer treatment. At the time of the survey, only 7 (4%) patients were receiving hormone replacement therapy (HRT). CONCLUSIONS VMS and sexual disorders are frequently reported by EOCS, particularly among patients with SM. Most EOCS with menopausal symptoms could benefit from HRT to improve these symptoms.
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Affiliation(s)
- F Gernier
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; INSERM, U1086, Caen, France.
| | - A Gompel
- Université de Paris, Paris, France
| | | | - E Kalbacher
- Department of Oncology, CHU Jean Minjoz, Besançon, France
| | - A Floquet
- Department of Oncology, Institut Bergonie, Bordeaux, France
| | - D Berton-Rigaud
- Institut de Cancérologie de l'Ouest, Site René Gauducheau, Department of Oncology, Saint Herblain, France
| | - O Tredan
- Department of Oncology, Centre Léon Bérard, Lyon, France
| | - J Alexandre
- Department of Oncology, Hospital Cochin, Paris, France
| | - P Follana
- Department of Oncology, Centre Antoine Lacassagne, Nice, France
| | - A Zannetti
- Department of Oncology, Centre Hospitalier de Cholet, Cholet, France
| | - N Dohollou
- Polyclinique Bordeaux Nord Aquitaine, Department of Oncology, Bordeaux, France
| | - J-M Grellard
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France
| | - B Clarisse
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France
| | - I Licaj
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway; Clinipace Biostatistics, Morrisville, NC 27560, USA
| | - D Ahmed-Lecheheb
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; INSERM, U1086, Caen, France
| | - R Fauvet
- INSERM, U1086, Caen, France; Department of Gynecology and Obstetrics, Caen University Hospital, Caen, France; University of Caen Normandy, INSERM U1199, BIOTICLA, France
| | - P Pautier
- Department of Oncology, Gustave Roussy, Villejuif, France
| | - F Joly
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; INSERM, U1086, Caen, France; University of Caen Normandy, UMR-S1077, Caen, France; Department of Oncology, CHU de Caen, Caen, France
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27
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Bertrand A, Aho S, Rousset-Jablonski C, Cessot M, Christophe V, Marec-Bérard P, Ray-Coquard I. Dedicated Program for Adolescent and Young Adults With Cancer: A Better Way to Inform About Sexual and Fertility Issues. JCO Oncol Pract 2021; 17:642. [PMID: 34436935 DOI: 10.1200/op.21.00452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amandine Bertrand
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Simon Aho
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Christine Rousset-Jablonski
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Marion Cessot
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Véronique Christophe
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Perrine Marec-Bérard
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Isabelle Ray-Coquard
- Amandine Bertrand, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France, RESHAPE U1290, Lyon, France, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Simon Aho, MD, Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Christine Rousset-Jablonski, PhD, RESHAPE U1290, Lyon, France, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Marion Cessot, MD, Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Véronique Christophe, PhD, Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France; Perrine Marec-Bérard, MD, Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; and Isabelle Ray-Coquard, PhD, RESHAPE U1290, Lyon, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Borrego MR, Moore HC, Saunders C, Cardoso F, Susnjar S, Bjelic-Radisic V, Smith KL, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Who are the women who enrolled in the POSITIVE trial: A global study to support young hormone receptor positive breast cancer survivors desiring pregnancy. Breast 2021; 59:327-338. [PMID: 34390999 PMCID: PMC8365381 DOI: 10.1016/j.breast.2021.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Premenopausal women with early hormone-receptor positive (HR+) breast cancer receive 5–10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may wane. The POSITIVE study investigates the impact of temporary ET interruption to allow pregnancy. Methods POSITIVE enrolled women with stage I-III HR + early breast cancer, ≤42 years, who had received 18–30 months of adjuvant ET and wished to interrupt ET for pregnancy. Treatment interruption for up to 2 years was permitted to allow pregnancy, delivery and breastfeeding, followed by ET resumption to complete the planned duration. Findings From 12/2014 to 12/2019, 518 women were enrolled at 116 institutions/20 countries/4 continents. At enrolment, the median age was 37 years and 74.9 % were nulliparous. Fertility preservation was used by 51.5 % of women. 93.2 % of patients had stage I/II disease, 66.0 % were node-negative, 54.7 % had breast conserving surgery, 61.9 % had received neo/adjuvant chemotherapy. Tamoxifen alone was the most prescribed ET (41.8 %), followed by tamoxifen + ovarian function suppression (OFS) (35.4 %). A greater proportion of North American women were <35 years at enrolment (42.7 %), had mastectomy (59.0 %) and received tamoxifen alone (59.8 %). More Asian women were nulliparous (81.0 %), had node-negative disease (76.2%) and received tamoxifen + OFS (56.0 %). More European women had received chemotherapy (69.3 %). Interpretation The characteristics of participants in the POSITIVE study provide insights to which patients and doctors considered it acceptable to interrupt ET to pursue pregnancy. Similarities and variations from a regional, sociodemographic, disease and treatment standpoint suggest specific sociocultural attitudes across the world. Fertility and pregnancy are priority concerns for young breast cancer survivors. POSITIVE explores a transient interruption of endocrine therapy to allow conception. Patients' characteristics highlight features considered suitable to study enrolment. Overall, patients enrolled had a relatively high median age and low-risk disease. Variations emerged across continents suggesting specific sociocultural attitudes.
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Affiliation(s)
- Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
| | - Samuel M Niman
- International Breast Cancer Study Group Statistical Center, Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Monica Ruggeri
- International Breast Cancer Study Group, Program for Young Patients, Coordinating Center, Effingerstrasse 40, Bern, 3008, Switzerland.
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, 20141, Italy.
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, San Pedro Garza Garcia, 66278, Mexico.
| | - Marco Colleoni
- International Breast Cancer Study Group, Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Cristina Saura
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Medical Oncology Service, Barcelona, Spain.
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, 1-21-1, Japan.
| | - Anna Barbro Sætersdal
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France.
| | - Ellen Warner
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada.
| | - Virginia F Borges
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, CO, USA.
| | - Frédéric Amant
- Department of Oncology, KU Leuven and Leuven Cancer Institute, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Andrea Gombos
- Institut Jules Bordet and L'Universite Libre de Bruxelles, Brussels, Belgium.
| | - Akemi Kataoka
- Breast Oncology Cancer, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | | | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Junko Takei
- St Luke's International Hospital, Breast Center, Tokyo, Japan.
| | - Jeong Eon Lee
- Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Clinical Research and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Janice M Walshe
- Cancer Trials Ireland and Medical Oncology Department, St. Vincent's University Hospital and Tallaght University Hosptial, Dublin, Ireland.
| | - Manuel Ruíz Borrego
- Hospital Virgen del Rocio Sevilla, GEICAM Spanish Breast Cancer Group, Sevilla, Spain.
| | - Halle Cf Moore
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
| | - Christobel Saunders
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia.
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal.
| | - Snezana Susnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany; Medical University Graz, Department Gynaecology, Graz, Austria.
| | - Karen L Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
| | - Martine Piccart
- Institut Jules Bordet and L'Universite Libre de Bruxelles, Brussels, Belgium.
| | - Larissa A Korde
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA.
| | - Aron Goldhirsch
- International Breast Cancer Study Group, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, MA, USA.
| | - Olivia Pagani
- Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Vaud, Switzerland.
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Denis-Laroque L, Drouet Y, Plotton I, Chopin N, Bonadona V, Lornage J, Salle B, Lasset C, Rousset-Jablonski C. Anti-müllerian hormone levels and antral follicle count in women with a BRCA1 or BRCA2 germline pathogenic variant: A retrospective cohort study. Breast 2021; 59:239-247. [PMID: 34304065 PMCID: PMC8326804 DOI: 10.1016/j.breast.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Some studies suggested a decreased ovarian reserve among BRCA1/2 pathogenic variant carriers, with conflicting results. Methods We conducted a retrospective single-center observational study of ovarian reserve and spontaneous fertility comparing BRCA1/2 pathogenic variant carriers to controls (women who attended consultations to discuss fertility preservation before gonadotoxic treatment). Measures of associations between plasma AMH concentration, AFC and BRCA1/2 status were modelled by nonlinear generalized additive regression models and logistic regressions adjusted for age at plasma storage, oral contraceptive use, body mass index, cigarette smoking, and the AMH assay technique. Results The whole population comprised 119 BRCA1/2 pathogenic variant carriers and 92 controls. A total of 110 women (42 carriers, among whom 30 were cancer-free, and 68 controls) underwent an ovarian reserve evaluation. Spontaneous fertility analysis included all women who previously attempted to become pregnant (134 women). We observed a tendency towards a premature decrease in ovarian reserve in BRCA1/2 pathogenic variant carriers, but no difference in mean AMH or AFC levels was found between BRCA1/2 pathogenic variant carriers and controls. An analysis of the extreme levels of AMH (≤5 pmol/l) and AFC (≤7 follicles) by logistic regression suggested a higher risk of low ovarian reserve among BRCA1/2 pathogenic variant carriers (adjusted odds ratio (OR) = 3.57, 95% CI = 1.00–12.8, p = 0.05; and adjusted OR = 4.99, 95% CI = 1.10–22.62, p = 0.04, respectively). Discussion Attention should be paid to BRCA1/2 pathogenic variant carriers’ ovarian reserve, considering this potential risk of premature alteration. A tendency towards a premature decrease in the ovarian reserve in BRCA1/2 pathogenic variant carriers was found. BRCA1/2 pathogenic variant carriers presented a higher risk of a low ovarian reserve. Information and education regarding reproduction is mandatory among BRCA1/2 pathogenic variant carriers.
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Affiliation(s)
- Laurie Denis-Laroque
- Centre Léon Bérard, Department of Surgical Oncology, 28 rue Laënnec, 69008, Lyon, France
| | - Youenn Drouet
- Centre Léon Bérard, Département Prévention et Santé Publique, 28, Rue Laënnec, Lyon, 69008, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie évolutive, 16, rue Raphael Dubois, Villeurbanne Cedex, 69622, France
| | - Ingrid Plotton
- Hormonology and Molecular Endocrinology, Biology and Est Pathology Center, Hospices Civils de Lyon, 69500, U1208, Université Claude Bernard Lyon1, Bron, France
| | - Nicolas Chopin
- Centre Léon Bérard, Department of Surgical Oncology, 28 rue Laënnec, 69008, Lyon, France
| | - Valérie Bonadona
- Centre Léon Bérard, Département Prévention et Santé Publique, 28, Rue Laënnec, Lyon, 69008, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie évolutive, 16, rue Raphael Dubois, Villeurbanne Cedex, 69622, France
| | - Jacqueline Lornage
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Médecine de La Reproduction, Bron, France
| | - Bruno Salle
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Médecine de La Reproduction, Bron, France
| | - Christine Lasset
- Centre Léon Bérard, Département Prévention et Santé Publique, 28, Rue Laënnec, Lyon, 69008, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie évolutive, 16, rue Raphael Dubois, Villeurbanne Cedex, 69622, France
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, Department of Surgical Oncology, 28 rue Laënnec, 69008, Lyon, France; Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Obstetrics and Gynecology, 165 Chemin Du Grand Revoyet, 69310, Pierre-Bénite, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France.
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Rousset-Jablonski C, Haesebaert J, Denis A, Reix P, Llerena C, Perceval M, Touzet S, Durieu I. Human Papilloma Virus Vaccination Among Female Patients Attending French Pediatric Cystic Fibrosis Centers. J Pediatr Adolesc Gynecol 2021; 34:317-323. [PMID: 33338628 DOI: 10.1016/j.jpag.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To describe human papilloma virus (HPV) vaccination practice among adolescent girls with cystic fibrosis (CF) and to identify reasons for non-vaccination. DESIGN Cross-sectional multicentric study. SETTING AND PARTICIPANTS Girls aged 9-17 years, attending 7 French pediatric CF centers, and their accompanying adult. INTERVENTIONS Administration of a self-report questionnaire. MAIN OUTCOME MEASURES The proportion of girls having received or receiving HPV vaccination, compliance with the vaccination schedule, factors associated with vaccination, and reasons for vaccination and for non-vaccination. RESULTS A total of 113 girls and 104 accompanying adults participated. The mean age was 13.6 years (standard deviation 2.5; range 9-17). A total of 34 (30.9%) patients reported having received HPV vaccination. Among the 34 girls aged 15 years or older, 15 (44.1%) were vaccinated. Most patients (58.8%) started vaccination between 11 and 14 years of age (mean age 13.9). Most vaccine prescriptions (67.6%) were made by a CF center health care provider. Factors associated with vaccination were older age (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.01-1.6, P = .037 for each year older), previous vaccination by the accompanying parent of one of their children for hepatitis B (OR = 8.01, 95% CI = 0.96-67.02), P = .055), and parental influence on decision-making (OR = 2.77, 95% CI = 0.97-7.95, P = .058). Health care providers' positive advice and fear of HPV-related disease were the main reasons given to justify vaccination decisions. Insufficient knowledge and concerns about potential side effects were the main barriers. CONCLUSION HPV vaccination remains insufficient among girls with CF. CF health care providers may play a crucial role in HPV vaccination acceptance, and their sensitization to cervical cancer prevention is mandatory.
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Affiliation(s)
- Christine Rousset-Jablonski
- Department of Internal medicine, Cystic Fibrosis Adult Reference Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France; Department of Surgical Oncology, Leon Berard Cancer Center, Centre Léon Bérard, Lyon, France; EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France.
| | - Julie Haesebaert
- EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France; Pôle de Santé Publique-Service de Recherche et d'Epidémiologie Cliniques, Hospices civils de Lyon, Groupement hospitalier Est, Bron, France
| | - Angélique Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Philippe Reix
- Service de Pneumologie Pédiatrique et CRCM enfant, Hospices civils de Lyon, Hôpital Femme Mère Enfant, Bron, France; UMR 5558 (EMET), CNRS, LBBE, Université de Lyon, Villeurbanne, France
| | - Cathy Llerena
- Pneumologie Pédiatrique, Antenne Pédiatrique du CIC, Center Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Marie Perceval
- Department of Internal medicine, Cystic Fibrosis Adult Reference Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France
| | - Sandrine Touzet
- EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Durieu
- Department of Internal medicine, Cystic Fibrosis Adult Reference Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France; EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France
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Rousset-Jablonski C. [How to diagnose menopause? Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. Gynecol Obstet Fertil Senol 2021; 49:318-328. [PMID: 33867317 DOI: 10.1016/j.gofs.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The diagnosis of menopause is sometimes difficult. The objective of this chapter is to describe the process of diagnosing menopause in a physiological situation, then in different clinical situations: women using hormonal contraception (per os, implant or intrauterine device), women with a history of hysterectomy, women previously treated for cancer. A review of the literature was carried out via Pubmed, Medline and Cochrane Library. The recommendations of international societies were also taken into account: International Menopause Society (IMS) https://www.imsociety.org, European Menopause and Andropause Society (EMAS) https://www.emas-online.org. In a classic situation, the diagnosis of menopause is a clinical diagnosis, made retrospectively, based on a 12-month period of consecutive amenorrhoea in a compatible age group (after 45 years of age). No hormonal dosage or imaging is indicated to make a diagnosis of menopause in a classic situation. In women using oestroprogestogen or progestative-only-pill contraception, implant, or Levonorgestrel-intrauterine device (LNG IUD), hormonal assays or pelvic ultrasound are neither recommended to make a diagnosis of menopause (grade C), nor to decide to stop contraception (grade C). The proposed strategy is the discontinuation of oral contraception, removal of the implant or LNG-IUD, and clinical follow-up (occurrence of amenorrhea) (expert opinion). In women with a history of hysterectomy, in the absence of evaluable clinical symptoms (amenorrhea), a repeat FSH≥40 combined with low estradiol (<20pg/ml) at least 3 months after the procedure could be a diagnostic orientation towards menopausal status. After cancer, in women who have received gonadotoxic treatment, the classic clinical criteria of 12 months of amenorrhea cannot be used to make a diagnosis of menopause with certainty (expert opinion). No further examination can be recommended to make a definite diagnosis of menopause (expert opinion). In breast cancer, the hormonal status to be taken into account when choosing initial hormone therapy is the one found before starting any treatment. If at the time of diagnosis of breast cancer the menopausal status is not known due to hormonal contraception, it is preferable to consider the patient as non-menopausal by default for the choice of hormone therapy for the cancer.
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Affiliation(s)
- C Rousset-Jablonski
- Department of Surgical Oncology, centre Léon-Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France; Department of Obstetrics and Gynecology, Lyon Sud University Hospital, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Research on HealthcAre PErformance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
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Trémollieres F, Chabbert-Buffet N, Plu-Bureau G, Rousset-Jablonski C, Lecerf JM, Duclos M, Pouilles JM, Gosset A, Boutet G, Hocke C, Maris E, Hugon-Rodin J, Maitrot-Mantelet L, Robin G, André G, Hamdaoui N, Mathelin C, Lopes P, Graesslin O, Fritel X. [Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines (Short version)]. Gynecol Obstet Fertil Senol 2021; 49:305-317. [PMID: 33863697 DOI: 10.1016/j.gofs.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- F Trémollieres
- Centre de ménopause et maladies osseuses métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France; Inserm U1048-I2MC-Équipe 9, Université Toulouse III Paul-Sabatier, 1, avenue du Professeur-Jean-Poulhès, BP 84225, 31432 Toulouse cedex 4, France.
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, APHP Sorbonne Universitaire, Site Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Plu-Bureau
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France; Université de Paris, Paris, France; Inserm U1153 Equipe EPOPEE, Paris, France
| | - C Rousset-Jablonski
- Département de chirurgie oncologique, Centre Léon Bérard, 28, Prom.-Léa-et-Napoléon-Bullukian, 69008 Lyon, France; Département d'obstétrique et gynécologie, Hospices Civils de Lyon, CHU Lyon Sud, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon, EA 7425 HESPER-Health Services and Performance Research, 8, avenue Rockefeller, 69003 Lyon, France
| | - J-M Lecerf
- Service de nutrition et activité physique, Institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille cedex, France; Service de médecine interne, CHRU Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Duclos
- Service de médecine du sport et des explorations fonctionnelles, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, UFR Médecine, BP 10448, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - J-M Pouilles
- Centre de ménopause et maladies osseuses métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - G Boutet
- AGREGA, Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33000 Bordeaux, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Maris
- Département d'obstétrique et gynécologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - J Hugon-Rodin
- Service de Gynécologie, Groupe hospitalier Paris Saint Joseph, Inserm, U1153, epidémiologie obstétricale, périnatale et pédiatrique, Centre de recherche en épidémiologie et statistiques, Paris, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, UF de gynécologie endocrinienne, Hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - G André
- 15, boulevard Ohmacht, 67000 Strasbourg, France
| | - N Hamdaoui
- Centre Hospitalier Universitaire Nord, Assistance publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - C Mathelin
- Institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS UMR7104 Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
| | - P Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain, 44819 St Herblain, France; Université de Nantes, 44093 Nantes cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, Institut Mère-Enfant Alix de Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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Lambertini M, Ceppi M, Hamy AS, Caron O, Poorvu PD, Carrasco E, Grinshpun A, Punie K, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Toss A, Senechal C, Puglisi F, Pogoda K, Pérez-Fidalgo JA, De Marchis L, Ponzone R, Livraghi L, Estevez-Diz MDP, Villarreal-Garza C, Dieci MV, Clatot F, Duhoux FP, Graffeo R, Teixeira L, Córdoba O, Sonnenblick A, Ferreira AR, Partridge AH, Meglio AD, Saule C, Peccatori FA, Bruzzone M, Mastro LD, Ameye L, Balmaña J, Azim HA. Abstract PD10-06: Clinical behavior and outcomes of BRCA-mutated breast cancer in young patients according to type of BRCA mutation and hormone receptor status: Results from an international cohort study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd10-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Young breast cancer patients (pts) carrying a germline BRCA mutation (mBRCA) have similar outcomes as non-carriers. However, there is currently lack of evidence regarding the impact of mBRCA type and hormone receptor status on clinical behavior and outcomes of mBRCA breast cancer. We aim to address these questions in the largest dataset to date of young mBRCA breast cancer pts.
Methods: This was an international, multicenter, hospital-based, retrospective cohort study. Women harboring deleterious germline mBRCA1 or mBRCA2 that received a diagnosis of stage I-III invasive early breast cancer at age ≤40 years between January 2000 and December 2012 were included. Baseline pts, tumor, and treatment characteristics, pattern and risk over time of disease-free survival (DFS) events, and survival outcomes (DFS, distant recurrence-free interval [DRFI] and overall survival [OS]) were compared between mBRCA1 and mBRCA2 pts overall and by hormone receptor status. Multivariate Cox proportional hazard models were used to compare hazard rates (HRs).
Results: 1,236 young mBRCA breast cancer pts were included. Among 808 and 428 pts with mBRCA1 or mBRCA2, respectively, 191 (23.6%) and 356 (83.2%) had hormone receptor-positive tumors while 617 (76.4%) and 72 (16.8%) hormone receptor-negative disease (p<0.001). Compared to mBRCA2 breast cancer pts, those with mBRCA1 were younger, more likely to have reported Jewish ancestry, had more grade 3 tumors, less nodal involvement, lobular histology and HER2 positivity, and received more frequently chemotherapy (all p<0.001). More mBRCA1 pts with hormone receptor-positive tumors did not receive adjuvant endocrine therapy (14.7% vs. 4.2%, p<0.001). No difference between mBRCA1 and mBRCA2 pts was observed in risk-reducing mastectomy (43.9% vs. 46.0%; p=0.371) or salpingo-oophorectomy (48.3% vs. 48.8%; p=1.0). Median follow-up was 7.9 years (range 5.6-10.6 years). Second primary breast cancers (17.0% vs. 12.2%, p=0.025) and non-breast primary malignancies (4.3% vs. 1.9%, p=0.033) were more frequent among mBRCA1 pts compared to mBRCA2 pts, while distant recurrences were less frequent (10.4% vs. 15.4%, p=0.013). 8-year DFS was 62.8% and 65.9% for mBRCA1 and mBRCA2 pts, respectively (adjusted HR 0.76; 95% CI 0.60-0.96). The worse DFS in mBRCA1 was observed regardless of hormone receptor status (pinteraction=0.848): hormone receptor-positive (adjusted HR 0.77; 95% CI 0.58-1.03) and hormone receptor-negative (adjusted HR 0.73; 95% CI 0.48-1.13). No differences in DRFI and OS were observed between mBRCA1 and mBRCA2 pts. Compared to pts with hormone receptor-negative disease, those with hormone receptor-positive breast cancer had higher chances of developing distant (± loco-regional) recurrences (16.1% vs. 9.0%; p<0.001) and less frequent second primary malignancies (BC: 12.1% vs. 17.9%, p=0.005; non-BC: 2.8% vs. 4.0%, p=0.216). No differences in DFS and OS were observed between pts with hormone receptor-positive or negative breast cancer. However, there was a trend towards worse DRFI in women with hormone receptor-positive breast cancer as compared to those with hormone receptor-negative disease (8-year DRFI: 83.4% vs. 90.1%; adjusted HR 1.39; 95% CI 0.94-2.05).
Conclusions: In this large unique dataset, young mBRCA1 breast cancer pts had worse DFS than those with mBRCA2 mostly due to higher rates of second primary malignancies. Hormone receptor positivity had no positive prognostic value in young mBRCA breast cancer pts with a trend towards worse DRFI in those with hormone receptor-negative disease. These results provide important information for counseling young mBRCA breast cancer pts regarding treatment, prevention and follow-up care strategies.
Citation Format: Matteo Lambertini, Marcello Ceppi, Anne-Sophie Hamy, Olivier Caron, Philip D. Poorvu, Estela Carrasco, Albert Grinshpun, Kevin Punie, Christine Rousset-Jablonski, Alberta Ferrari, Shani Paluch-Shimon, Angela Toss, Claire Senechal, Fabio Puglisi, Katarzyna Pogoda, Jose Alejandro Pérez-Fidalgo, Laura De Marchis, Riccardo Ponzone, Luca Livraghi, Maria Del Pilar Estevez-Diz, Cynthia Villarreal-Garza, Maria Vittoria Dieci, Florian Clatot, Francois P. Duhoux, Rossella Graffeo, Luis Teixeira, Octavi Córdoba, Amir Sonnenblick, Arlindo R. Ferreira, Ann H. Partridge, Antonio Di Meglio, Claire Saule, Fedro A. Peccatori, Marco Bruzzone, Lucia Del Mastro, Lieveke Ameye, Judith Balmaña, Hatem A. Azim, Jr. Clinical behavior and outcomes of BRCA-mutated breast cancer in young patients according to type of BRCA mutation and hormone receptor status: Results from an international cohort study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD10-06.
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Affiliation(s)
- Matteo Lambertini
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Philip D. Poorvu
- 4Dana-Farber Cancer Institute, Harvard Medical School, Harvard Medical School, Boston, MA
| | - Estela Carrasco
- 5Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Kevin Punie
- 7Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Alberta Ferrari
- 9Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Angela Toss
- 11Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Fabio Puglisi
- 13Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
| | - Katarzyna Pogoda
- 14Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | | | | | - Maria Del Pilar Estevez-Diz
- 19Instituto do Cancer do Estado de Sao Paulo – Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Rossella Graffeo
- 24Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luis Teixeira
- 25Saint-Louis Hospital, APHP, Université de Paris, Paris, France
| | | | | | | | - Ann H. Partridge
- 4Dana-Farber Cancer Institute, Harvard Medical School, Harvard Medical School, Boston, MA
| | | | | | | | - Marco Bruzzone
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lieveke Ameye
- 31Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Judith Balmaña
- 5Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Hatem A. Azim
- 32Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep J, Warner E, Borges VF, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Yamauchi H, Lee JE, Walshe JM, Borrego MR, Moore HCF, Saunders C, Cardoso F, Susnjar S, Bjelic-Radisic V, Smith KL, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Abstract PS12-17: Baseline characteristics of women enrolled in the POSITIVE trial (pregnancy outcome and safety of interrupting therapy for women with endocrine responsIVE breast cancer). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pregnancy is a major concern for young breast cancer (BC) survivors. Conception after BC in women with hormone receptor positive (HR+) disease is affected by the standard 5-10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may be waning. The POSITIVE Trial (IBCSG 48-14/BIG 8-13/Alliance A221405/NCT02308085) investigates the impact of temporary ET interruption to allow pregnancy.
Methods: POSITIVE enrolled premenopausal women with stage I-III HR+ early BC, ≤42 years of age, who had received adjuvant ET (SERM alone, ovarian function suppression (OFS) plus SERM or AI) for 18 to 30 months, and wished to interrupt ET to attempt pregnancy. An interruption of ET for up to 2 years was foreseen to allow pregnancy (after a 3-month ET washout period), delivery, and breastfeeding if desired/feasible. Resumption of ET to complete 5-10 years of treatment was planned as soon as pregnancy/breastfeeding was completed or after it was ensured conception was not possible. We report baseline characteristics of participants enrolled in POSITIVE by region of enrollment.
Results: From 12/2014 to 12/2019, 518 participants were enrolled at 116 centers in 20 countries across 4 continents. The table shows the baseline characteristics of the enrolled women.
Several differences were seen across regions: A higher proportion of participants <35 yrs (43%) enrolled in North America than in Europe (33%) or Asia (26%). Eighty-one percent of Asian women had no children at enrollment compared to 75% and 68% of European and North American women, respectively. Consistently, a greater percent of women in Asia (56%) had used fertility preservation measures, compared to Europe (53%) and North America (43%). Stage distribution was also different across continents: a greater percent of Asian participants had stage I, grade 1 and node-negative disease (51%, 29% and 76 %, respectively) compared to European (46%, 14% and 67%) and North American (43%, 16% and 55%) women. Only 19% of Asian women had either 1-3 positive nodes and grade 3 tumors, the proportion increased to 28% and 35% in Europe and to 41% and 38% in North America, respectively. North American women were more likely to have had mastectomy (60% vs. Asian (44%) and European (41%)); European women were more likely to have had chemotherapy (69% vs. North American (56%) and Asian (42%)). ET administration prior to enrollment differed substantially by region: Most North American women had SERM (T) alone (58%), and when OFS was added to oral ET, it was combined with AI in 19% and with T in 8% of participants, respectively. In Asia most women received T + OFS (55%), followed by T alone (36%), and AI + OFS (6%). In Europe, T + OFS was the most frequent treatment (40%), followed by T alone (37%) and AI + OFS (17%). Median duration of ET before enrollment was similar across regions (22-24 months).
Conclusion: Regional variation of baseline characteristics of women enrolled in the POSITIVE trial may provide important insights into different medical and sociocultural attributes and attitudes of the study participants and investigators from those regions.
Affiliation: POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group
CharacteristicRegion: Europe / North America / Asia-Pacific61% / 23% / 16%Median age at enrollment, yrs (IQR)37 (33-39)Caucasian race77%No children prior to enrollment74%Prior fertility preservation measures taken51%Stage I / II46% / 45%0 / 1 positive nodes65% / 21%Grade 2 / 348% / 33%HER2-negative74%Mastectomy46%Chemotherapy61%ET: SERM alone / SERM+OFS / AI+OFS41% / 35% / 16%Median duration of prior ET, mos (IQR)23 (20-27)
Citation Format: Ann H Partridge, Samuel M Niman, Monica Ruggeri, Fedro A Peccatori, Hatem A Azim, Jr, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna Barbro Sætersdal, Judith Kroep, Ellen Warner, Virginia F Borges, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Hideko Yamauchi, Jeong Eon Lee, Janice M Walshe, Manuel Ruíz Borrego, Halle CF Moore, Christobel Saunders, Fatima Cardoso, Snezana Susnjar, Vesna Bjelic-Radisic, Karen L Smith, Martine Piccart, Larissa A Korde, Aron Goldhirsch, Richard D Gelber, Olivia Pagani. Baseline characteristics of women enrolled in the POSITIVE trial (pregnancy outcome and safety of interrupting therapy for women with endocrine responsIVE breast cancer) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-17.
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Affiliation(s)
- Ann H Partridge
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Samuel M Niman
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Monica Ruggeri
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Fedro A Peccatori
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Hatem A Azim
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Marco Colleoni
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Cristina Saura
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Chikako Shimizu
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Anna Barbro Sætersdal
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Judith Kroep
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Ellen Warner
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Virginia F Borges
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Andrea Gombos
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Akemi Kataoka
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Christine Rousset-Jablonski
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Simona Borstnar
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Hideko Yamauchi
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Jeong Eon Lee
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Janice M Walshe
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Manuel Ruíz Borrego
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Halle CF Moore
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Christobel Saunders
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Fatima Cardoso
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Snezana Susnjar
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Vesna Bjelic-Radisic
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Karen L Smith
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Martine Piccart
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Larissa A Korde
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Aron Goldhirsch
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Richard D Gelber
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Olivia Pagani
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
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Lambertini M, Ceppi M, Hamy AS, Caron O, Poorvu PD, Carrasco E, Grinshpun A, Punie K, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Toss A, Senechal C, Puglisi F, Pogoda K, Pérez-Fidalgo JA, De Marchis L, Ponzone R, Livraghi L, Estevez-Diz MDP, Villarreal-Garza C, Dieci MV, Clatot F, Duhoux FP, Graffeo R, Teixeira L, Córdoba O, Sonnenblick A, Ferreira AR, Partridge AH, Di Meglio A, Saule C, Peccatori FA, Bruzzone M, t'Kint de Roodenbeke MD, Ameye L, Balmaña J, Del Mastro L, Azim HA. Clinical behavior and outcomes of breast cancer in young women with germline BRCA pathogenic variants. NPJ Breast Cancer 2021; 7:16. [PMID: 33579978 PMCID: PMC7880991 DOI: 10.1038/s41523-021-00224-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
Young breast cancer (BC) patients carrying a germline BRCA pathogenic variant (mBRCA) have similar outcomes as non-carriers. However, the impact of the type of gene (BRCA1 vs. BRCA2) and hormone receptor status (positive [HR+] vs. negative [HR-]) on clinical behavior and outcomes of mBRCA BC remains largely unknown. This is an international, multicenter, hospital-based, retrospective cohort study that included mBRCA patients diagnosed, between January 2000 and December 2012, with stage I-III invasive early BC at age ≤40 years. From 30 centers worldwide, 1236 young mBRCA BC patients were included. Among 808 and 428 patients with mBRCA1 or mBRCA2, 191 (23.6%) and 356 (83.2%) had HR+tumors, respectively (P < 0.001). Median follow-up was 7.9 years. Second primary BC (P = 0.009) and non-BC malignancies (P = 0.02) were more frequent among mBRCA1 patients while distant recurrences were less frequent (P = 0.02). Irrespective of hormone receptor status, mBRCA1 patients had worse disease-free survival (DFS; adjusted HR = 0.76, 95% CI = 0.60-0.96), with no difference in distant recurrence-free interval (DRFI) and overall survival (OS). Patients with HR+ disease had more frequent distant recurrences (P < 0.001) and less frequent second primary malignancies (BC: P = 0.005; non-BC: P = 0.18). No differences in DFS and OS were observed according to hormone receptor status, with a tendency for worse DRFI (adjusted HR = 1.39, 95% CI = 0.94-2.05) in patients with HR+ BC. Type of mBRCA gene and hormone receptor status strongly impact BC clinical behavior and outcomes in mBRCA young patients. These results provide important information for patients' counseling on treatment, prevention, and surveillance strategies.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy.
- Department of Medical Oncology, U.O.C, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Olivier Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III - Breast Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, aBRCAdaBRA onlus, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Shaare Zedek Medical Centre and Department of Oncology, Sheba Medical Center, Tel Hashomer, Jerusalem, Israel
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Laura De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- University of Siena, Siena, Italy
| | - Maria Del Pilar Estevez-Diz
- Departament of Oncology, Instituto do Cancer do Estado de Sao Paulo - Faculdade de Medicina da Universidade de Sao Paulo, Pacaembu, Sao Paulo, Brazil
| | - Cynthia Villarreal-Garza
- Department of Research and Breast Tumors, Mexican National Cancer Institute, Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Francois P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Rossella Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luis Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - Octavi Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio Di Meglio
- Predictive Biomarkers and New Therapeutic Strategies in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Claire Saule
- Department of Genetics, Institut Curie, Paris, France
| | - Fedro A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, NL, Mexico
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David E, Belot A, Lega JC, Durieu I, Rousset-Jablonski C. [Human papillomavirus and systemic lupus erythematosus]. Rev Med Interne 2021; 42:498-504. [PMID: 33485700 DOI: 10.1016/j.revmed.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 01/27/2023]
Abstract
Infection with human papillomavirus (HPV) is one of the most widespread sexually transmitted diseases and the main risk factor for cervical cancer. Underlying conditions, like immunosuppression, favour the persistence and the progression of cervical lesions to an aggressive form. Patients with autoimmune diseases, and particularly systemic lupus erythematosus (SLE), may be prone to HPV infection and cervical dysplasia. However, the risk factors for developing persistent HPV-related infection, dysplasia and cancer are not identified for patients with SLE. The existence of an increased risk of cervical cancer compared to the general population remains debated. Thus, HPV vaccine is recommended for SLE patients as well as for the general population. Vaccine coverage of SLE patients is not known in France. Adolescents with chronic health condition seem to be insufficiently vaccinated regarding their vulnerability to infectious diseases. Strategies are required to decrease HPV vaccination barriers.
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Affiliation(s)
- E David
- Service de médecine interne et pathologie vasculaire, centre hospitalier Lyon Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France.
| | - A Belot
- Service de rhumatologie, néphrologie et dermatologie pédiatrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, hôpital Femme-mère-enfant, Lyon, France
| | - J-C Lega
- Service de médecine interne et pathologie vasculaire, centre hospitalier Lyon Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - I Durieu
- EA 7425 HESPER, médecine interne et pathologie vasculaire, groupement hospitalier Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - C Rousset-Jablonski
- Service de médecine interne, service de gynécologie-oncologie, centre Léon-Bérard, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France; EA 7425 HESPER, université Claude-Bernard Lyon 1, Lyon, France.
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Hodroj K, Stevovic A, Attignon V, Ferraioli D, Meeus P, Croce S, Chopin N, Rossi L, Floquet A, Rousset-Jablonski C, Tredan O, Guyon F, Treilleux I, Rannou C, Morfouace M, Ray-Coquard I. Molecular Characterization of Ovarian Yolk Sac Tumor (OYST). Cancers (Basel) 2021; 13:cancers13020220. [PMID: 33435376 PMCID: PMC7826864 DOI: 10.3390/cancers13020220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Ovarian yolk sac tumors (OYSTs) are rare and specific therapeutic strategies are needed after the failure of platinum-based first-line and salvage regimens. This retrospective study included ten patients with OYST, including patients with relapsed disease and disease-free patients. Three patients (33.3%) harbored oncogenic mutations in KRAS, KIT and ARID1A, which may be used as a target. Our series shows that relapsed patients with molecular analysis had clinically relevant molecular alterations. Future research with dedicated trials and multicenter international collaborations are needed to demonstrate the efficacy of specific therapeutic strategies after failure of platinum-based first-line and salvage regimens. Abstract Most patients with malignant ovarian germ cell tumors (MOGTCs) have a very good prognosis and chemotherapy provides curative treatment; however, patients with yolk sac tumors (OYSTs) have a significantly worse prognosis. OYSTs are rare tumors and promising results are expected with the use of specific therapeutic strategies after the failure of platinum-based first-line and salvage regimens. We initiated a project in collaboration with EORTC SPECTA, to explore the molecular characteristics of OYSTs. The pilot project used retrospective samples from ten OYST relapsed and disease-free patients. Each patient had a molecular analysis performed with FoundationOne CDx describing the following variables according to the Foundation Medicine Incorporation (FMI): alteration type (SNV, deletion), actionable gene alteration, therapies approved in EU (for patient’s tumor type and other tumor types), tumor mutational burden (TMB), and microsatellite instability (MSI) status. A total of 10 patients with OYST diagnosed between 2007 and 2017 had a molecular analysis. A molecular alteration was identified in four patients (40%). A subset of three patients (33.3% of all patients) harbored targetable oncogenic mutations in KRAS, KIT, ARID1A. Two patients at relapse harbored a targetable mutation. This retrospective study identifies clinically relevant molecular alterations for all relapsed patients with molecular analysis. Dedicated studies are needed to demonstrate the efficacy of specific therapeutic strategies after the failure of platinum-based first-line and salvage regimens and to explore the potential relationship of a molecular alteration and patient outcome.
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Affiliation(s)
- Khalil Hodroj
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
- Correspondence:
| | | | - Valery Attignon
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Domenico Ferraioli
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Pierre Meeus
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Sabrina Croce
- Institut Bergonié, 33000 Bordeaux, France; (S.C.); (A.F.); (F.G.)
| | - Nicolas Chopin
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Lea Rossi
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Anne Floquet
- Institut Bergonié, 33000 Bordeaux, France; (S.C.); (A.F.); (F.G.)
| | - Christine Rousset-Jablonski
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Olivier Tredan
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Frédéric Guyon
- Institut Bergonié, 33000 Bordeaux, France; (S.C.); (A.F.); (F.G.)
| | - Isabelle Treilleux
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Corinne Rannou
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
| | - Marie Morfouace
- EORTC, Translational Research, 1200 Brussels, Belgium; (A.S.); (M.M.)
| | - Isabelle Ray-Coquard
- Centre Léon Berard (CLB), 69008 Lyon, France; (V.A.); (D.F.); (P.M.); (N.C.); (L.R.); (C.R.-J.); (O.T.); (I.T.); (C.R.); (I.R.-C.)
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Rousset-Jablonski C, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Berard M, Jacoud F, Viprey M, Van Ganse E, Belhassen M, Durieu I. WS08.2 Cancer incidence and prevalence among patients with cystic fibrosis: data from the National French Cystic Fibrosis Registry. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: Guidelines from the French national college of obstetricians and gynecologists (CNGOF). Eur J Obstet Gynecol Reprod Biol 2020; 256:492-501. [PMID: 33262005 DOI: 10.1016/j.ejogrb.2020.11.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
It is recommended to classify Borderline Ovarian Tumors (BOTs) according to the WHO classification. Transvaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended to perform a pelvic MRI (Grade A) with a score for malignancy (ADNEX MR/O-RADS) (Grade C) included in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being BOT (Grade C). It is recommended to evaluate serum levels of HE4 and CA125 and to use the ROMA score for the diagnosis of indeterminate ovarian mass on imaging (grade A). If there is a suspicion of a mucinous BOT on imaging, serum levels of CA 19-9 may be proposed (Grade C). For Early Stages (ES) of BOT, if surgery without risk of tumor rupture is possible, laparoscopy with protected extraction is recommended over laparotomy (Grade C). For treatment of a bilateral serous ES BOT with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended where possible (Grade B). For mucinous BOTs with a treatment strategy of fertility and/or endocrine function preservation, unilateral salpingo-oophorectomy is recommended (grade C). For mucinous BOTs treated by initial cystectomy, unilateral salpingo-oophorectomy is recommended (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). For ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only in case of a macroscopically pathological appendix (Grade C). Restaging surgery is recommended in cases of serous BOTs with micropapillary architecture and an incomplete abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended for mucinous BOTs after initial cystectomy or in cases where the appendix was not examined (Grade C). If restaging surgery is decided for ES BOTs, the following procedures should be performed: peritoneal washing (grade C), omentectomy (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix and appendectomy in case of a pathological macroscopic appearance (grade C) as well as unilateral salpingo-oophorectomy in case of a mucinous BOT initially treated by cystectomy (grade C). In advanced stages (AS) of BOT, it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). For AS BOT in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed (Grade C). Restaging surgery aimed at removing all lesions, not performed initially, is recommended for AS BOTs (Grade C). After treatment, follow-up for a duration greater than 5 years is recommended due to the median recurrence time of BOTs (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). If the determination of tumor markers is normal preoperatively, the routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of an initial elevation in serum CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In case of conservative treatment, it is recommended to use transvaginal and transabdominal ultrasound during follow up of a treated BOT (Grade B). In the event of a BOT recurrence in a woman of childbearing age, a second conservative treatment may be proposed (Grade C). A consultation with a physician specialized in Assisted Reproductive Technique (ART) should be offered in the case of BOTs in women of childbearing age (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). In the case of optimally treated BOT, there is no evidence to contraindicate the use of ART. The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After management of mucinous BOT, for women under 45 years, given the benefit of Hormonal Replacement Therapy (HRT) on cardiovascular and bone risks, and the lack of hormone sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). Over 45 years of age, HRT can be prescribed in case of a climacteric syndrome after individual benefit to risk assessment (Grade C).
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Affiliation(s)
- N Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - C Huchon
- Service de Gynécologie & Obstétrique, Hopital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université de Paris, Paris, France.
| | - C Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté De Médecine UPMC, Sorbonne Université, France
| | - H Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - S Bendifallah
- Service De Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - P A Bolze
- Service De Chirurgie Gynécologique Et Oncologique, Obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - J L Brun
- Service De Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française De Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - G Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - P Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - E Chereau
- Service De Gynécologie Obstétrique, Hopital Saint Joseph, Marseille, France
| | - B Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Institut De Pathologie Multi-Sites Des HOSPICES CIVILS De LYON, Centre Hospitalier Lyon Sud, Centre De Biologie Et Pathologie Sud, 165 Chemin Du Grand Revoyet, 69495 Pierre Bénite. Société Française de Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - C Eymerit-Morin
- Service d'Anatomie Et Cytologie Pathologiques, Hôpital Tenon, HUEP, UPMC Paris VI, Sorbonne Universities, 4 rue de la Chine, 75020 Paris, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - R Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - E Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - T Gauthier
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey 87042 Limoges, France
| | - M Grynberg
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - M Koskas
- Service De Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - E Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - L Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - J Levêque
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - F Margueritte
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey, 87042 Limoges, France
| | - E Mathieu D'argent
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - K Nyangoh-Timoh
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - L Ouldamer
- Département De Gynécologie, Centre Hospitalier Universitaire De Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - J Raad
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - E Raimond
- Département de Gynécologie Obstétrique, Institut Alix De Champagne, CHU Reims, Reims, France
| | - R Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - L Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - P Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - C Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - I Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - C Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - M Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital De Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - E Daraï
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
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Huchon C, Bourdel N, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers. J Gynecol Obstet Hum Reprod 2020; 50:101965. [PMID: 33160106 DOI: 10.1016/j.jogoh.2020.101965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence (rate per 100 000) of borderline ovarian tumors (BOTs) increases progressively with age, starting at 15-19 years and peaking at around 4.5 cases per 100 000 at an age of 55-59 years (LE3) with a median age of 46 years. The five year survival for FIGO stages I, II, III and IV is 99.7 % (95 % CI: 96.2-100 %), 99.6 % (95 % CI: 92.6-100 %), 95.3 % (95 % CI: 91.8-97.4 %) and 77.1 % (95 % CI: 58.0-88.3 %), respectively (LE3). An epidemiological association exists between the individual risk of BOT and family history of BOT and certain other cancers (pancreatic, lung, bone, leukemia) (LE3), a personal history of benign ovarian cyst (LE2), a personal history of tubo-ovarian infection (LE3), the use of a levonorgestrel intrauterine device (LE3), oral contraceptive use (LE3), multiparity (LE3), Hormonal replacement therapy (LE3), high consumption of Coumestrol (LE4), medical treatment for infertility with progesterone (LE3) and non-steroidal anti-inflammatory drug use (LE3). Screening for BOTs is not recommended for patients (Grade C). The overall risk of recurrence of BOTs varies between 2% and 24 %, with an overall survival greater than 94 % at 10 years, and the risk of an invasive recurrence of a BOT ranges from 0.5 % to 3.8 %. The use of scores and nomograms can be useful in assessing the risk of recurrence, and providing patients with information (Grade C). The WHO classification is recommended for classifying BOTs. It is recommended that the presence of a microinvasive focus (<5 mm) and microinvasive carcinoma (<5 mm with an atypical nuclei and a desmoplastic stroma reaction) within a BOT be reported. In cases of serous BOT, it is recommended to specify the classic histological subtype or micropapillary / cribriform type (Grade C). When confronted with a BOT, it is recommended that the invasive or non-invasive nature of peritoneal implants can be investigated based solely on the invasion and destruction of underlying adipose or peritoneal tissue which has a desmoplastic stromal reaction where in contact with the invasive clusters (Grade B). For bilateral mucinous BOTs and / or in cases with peritoneal implants or peritoneal pseudomyxoma, it is recommended to also look for a primitive digestive or pancreato-biliary cancer (Grade C). It is recommended to sample ovarian tumors suspected of being BOTs by focusing samples on vegetations and solid components, with at least 1 sample per cm in tumors with a size less than 10 cm and 2 samples per cm in tumors with a size greater than 10 cm (Grade C). In cases of BOTs and in the absence of macroscopic omental involvement after careful macroscopic examination, it is recommended to perform at least 4-6 systematic sampling blocks and to include all peritoneal implants (Grade C). It is recommended to consult an expert pathologist in gynecology when a BOT suspicion requires intraoperative extemporaneous histology (grade C). Endo-vaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended that a pelvic MRI be performed (Grade A). To analyze an adnexal mass with MRI, it is recommended to use an MRI protocol with T2, T1, T1 Fat Sat, dynamic and diffusion sequences as well as gadolinium injection (Grade B). To characterize an adnexal mass with MRI, it is recommended to include a score system for malignancy (ADNEX MR/O-RADS) (Grade C) in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being a BOT (Grade C). Macroscopic MRI features should be analyzed to differentiate BOT subtypes (Grade C). Pelvic ultrasound is the first-line examination for the detection and characterization of adnexal masses during pregnancy (Grade C). Pelvic MRI is recommended from 12 weeks of gestation in case of an indeterminate adnexal mass and should provide a diagnostic score (Grade C). Gadolinium injection must be minimized as fetal impairment has been proven (Grade C). It is recommended that serum levels of HE4 and CA125 be evaluated and that the ROMA score for the diagnosis of an indeterminate ovarian mass on imaging be used (grade A). In case of suspicion of a mucinous BOT on imaging, dosage of serum levels of CA 19-9 can be considered (Grade C). If the determination of tumor markers is normal preoperatively, routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of preoperative elevation in tumor markers, the determination of serum CA 125 levels is recommended in the follow-up of BOT (Grade B). When conservative treatment of a BOT has been adopted, the use of endovaginal and transabdominal ultrasonography is recommended during follow-up (Grade B).
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Affiliation(s)
- Cyrille Huchon
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Elisabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005 Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020 Paris, France; UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Lise Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Jean Levêque
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Emmanuelle Mathieu D'argent
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Krystel Nyangoh-Timoh
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Lobna Ouldamer
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51000 Reims, France
| | - Rajeev Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000 Besançon, France
| | - Lucie Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, D'argent Mathieu E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation. J Gynecol Obstet Hum Reprod 2020; 50:101966. [PMID: 33144266 DOI: 10.1016/j.jogoh.2020.101966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the Early Stages (ES) of Borderline Ovarian Tumor (BOT), if surgery without risk of tumor rupture is possible, then laparoscopy with protected extraction is recommended over laparotomy (Grade C). In case of bilateral serous ES BOT treatment with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended if possible (Grade B). In case of mucinous BOT treatment with a strategy to preserve fertility and/or endocrine function, unilateral adnexectomy is recommended (grade C). In the case of a mucinous BOT in a patient who has had an initial cystectomy, unilateral adnexectomy is recommended (grade C). In the case of treatment of a serous ES BOT in a patient who has had an initial cystectomy, with a strategy to preserve fertility and/or endocrine function, restaging surgery for adnexectomy is not recommended in the absence of suspicious residual lesions at the time of surgery and/or postoperative imaging (reference ultrasonography or pelvic MRI) (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). In cases of ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only if there is a macroscopically pathological aspect to the appendix (Grade C). Restaging surgery is recommended in case of a serous BOT with a micropapillary aspect and an unsatisfactory inspection of the abdominal cavity during initial surgery (Grade C). Restaging surgery is recommended in cases of mucinous BOT if only a cystectomy has been performed or if the appendix has not been evaluated (Grade C). If restaging surgery is decided for an ES BOT, the following procedures should be performed: peritoneal cytology (grade C), omentectomy (there is no data in literature to recommend which type of omentectomy should be performed) (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix +/- appendectomy in case of pathological macroscopic appearance (grade C) and unilateral adnexectomy in case of a mucinous BOT (grade C). In advanced stages of BOT it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). In cases of an advanced stage BOT, in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed after a multidisciplinary meeting (Grade C). Second surgery aimed at removing all lesions, if not performed initially, is recommended in cases of advanced stage BOT (Grade C). It is not recommended to perform completion surgery after conservative treatment (preservation of the ovaries and the uterus) and after the achievement of fertility desire for a serous BOT (Grade B). After treatment for a BOT, follow-up beyond 5 years is recommended due to the median time to recurrence (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). In the particular case of an initial elevation of CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In cases treated conservatively (ovarian and uterine conservation), it is recommended to use endovaginal and transabdominal ultrasonography during the follow up period (Grade B). In the event of a recurrence of a BOT, in a woman of childbearing age, a conservative treatment strategy can again be proposed (Grade C). In the presence of non-invasive BOT implants, conservative treatment may be considered after a first non-invasive recurrence in women who wish to preserve their fertility (Grade C). Pelvic MRI is recommended after 12 weeks of amenorrhea in case of an undetermined adnexal mass and should be concluded with a diagnostic score (Grade C). The injection of gadolinium, in case of pregnancy, should be discussed on a case-by-case basis due to the proven risks for the foetus (Grade C). If feasible, a laparoscopic approach should be preferred during pregnancy (Grade C). A consultation with a specialist reproductive physician should be offered to patients with a BOT and of childbearing age (Grade C). It is recommended that patients be provided with full information on the risk of decreased ovarian reserve following to surgical treatment. It is recommended that the ovarian reserve be evaluated prior to surgical management of a suspected BOT (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). There is no specific data on the management of infertility following to conservative treatment of BOT. In case of durable infertility following to conservative treatment of BOT, a consultation with a specialist reproductive physician is required (Grade C). In the case of optimally treated BOT, there is no evidence in literature to contraindicate the use of Assisted Reproductive Techniques (ART). The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After treatment of a mucinous BOT, for women aged under 45 years, given the benefit of hormonal replacement therapy (HRT) on cardiovascular and bone risks, and the lack of hormone-sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). After treatment of a mucinous BOT, for women over 45 years of age, there is no argument to contraindicate the use of HRT. HRT can be prescribed in case of a climacteric syndrome, as part of an individual benefit to risk assessment (Grade C).
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Affiliation(s)
- Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Cyrille Huchon
- Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010, Paris, France.
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Elizabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020, Paris, UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240, Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000, Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Lise Lecointre
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000, Rennes, France
| | - Jean Levêque
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Emmanuelle D'argent Mathieu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Krystel Nyangoh-Timoh
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Lobna Ouldamer
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51100, Reims, France
| | - Rajeev Ramanah
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Lucie Rolland
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000, Besançon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
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Lambertini M, Ameye L, Hamy AS, Zingarello A, Poorvu PD, Carrasco E, Grinshpun A, Han S, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Cortesi L, Senechal C, Miolo G, Pogoda K, Pérez-Fidalgo JA, De Marchis L, Ponzone R, Livraghi L, Estevez-Diz MDP, Villarreal-Garza C, Dieci MV, Clatot F, Berlière M, Graffeo R, Teixeira L, Córdoba O, Sonnenblick A, Luna Pais H, Ignatiadis M, Paesmans M, Partridge AH, Caron O, Saule C, Del Mastro L, Peccatori FA, Azim HA. Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations. J Clin Oncol 2020; 38:3012-3023. [PMID: 32673153 DOI: 10.1200/jco.19.02399] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Young women with germline BRCA mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with BRCA mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations. PATIENTS AND METHODS This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline BRCA mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors. RESULTS Of 1,252 patients with germline BRCA mutations (BRCA1, 811 patients; BRCA2, 430 patients; BRCA1/2, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; P = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; P = .66) were observed between the pregnancy and nonpregnancy cohorts. CONCLUSION Pregnancy after breast cancer in patients with germline BRCA mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.,Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | | | - Anna Zingarello
- Département Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sileny Han
- Multidisciplinary Breast Center, Department of Gynaecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | | | - Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Gianmaria Miolo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Laura De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Siena, Siena, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Oncology, Instituto do Cancer do Estado de São Paulo-Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cynthia Villarreal-Garza
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico.,Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Nuevo Leon, Mexico
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Martine Berlière
- Department of Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc UCL, Brussels, Belgium
| | - Rossella Graffeo
- Breast Unit of Southern Switzerland, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luis Teixeira
- Breast Disease Unit Saint-Louis Hospital, APHP, Université de Paris, Inserm, U976 HIPI Unit, F-75010, Paris, France
| | - Octavi Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Helena Luna Pais
- Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de, Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Olivier Caron
- Département Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claire Saule
- Department of Genetics, Institut Curie, Paris, France
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fedro A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Hatem A Azim
- Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Nuevo Leon, Mexico
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Rousset-Jablonski C, Reynaud Q, Perceval M, Nove-Josserand R, Durupt S, Ray-Coquard I, Golfier F, Durieu I. Improvement in contraceptive coverage and gynecological care of adult women with cystic fibrosis following the implementation of an on-site gynecological consultation. Contraception 2020; 101:183-188. [DOI: 10.1016/j.contraception.2019.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022]
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Aust S, Eberst L, Tredan O, Rousset-Jablonski C, Treilleux I, Méeus P, Chopin N, Beurrier F, Charreton A, Véronique D, Hallouz A, Coulon A, Ricoeur A, Mastier C, Bouhamama A, Racadot S, Devouassoux-Shisheboran M, Haddad V, Ray-Coquard I. Detailed overview on rare malignant ovarian tumors. Bull Cancer 2020; 107:385-390. [PMID: 32115180 DOI: 10.1016/j.bulcan.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/29/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
The group of rare malignant ovarian tumors includes the group of germ cell tumors, sex cords stromal ovarian tumors, small cell carcinoma, malignant Brenner tumors, rare epithelial tumors such as mucinous carcinoma, clear cell carcinoma, or low-grade serous carcinoma, as well as ovarian carcinosarcoma. Together they comprise about 10% of all ovarian tumors. Due to their low prevalence and their heterogeneity, data and treatment recommendations are limited. Even though all ovarian tumors are staged according to the FIGO staging of epithelial ovarian tumors, treatment differs especially in germ cell tumors and sex cords stromal ovarian tumors. Non-epithelial ovarian tumors can arise from a variety of ovarian precursor cells such as germ cells, granulosa cells, theca cells, or stromal fibroblasts. As can be expected already due to their divergent precursor lesions, these malignancies are substantially different but united by their rarity. This overview article gives a comprehensive summary on the pathology and clinical presentation, as well as therapy recommendations of a selection of those rare ovarian tumors, based on the latest national guidelines and related important publications.
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Affiliation(s)
- Stefanie Aust
- Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Lauriane Eberst
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Olivier Tredan
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | | | | | - Pierre Méeus
- Department of Surgery, centre Léon-Bérard, Lyon, France
| | | | - Fred Beurrier
- Department of Surgery, centre Léon-Bérard, Lyon, France
| | | | - Daval Véronique
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Amina Hallouz
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Agnès Coulon
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, centre Léon-Bérard, Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, centre Léon-Bérard, Lyon, France
| | - Amine Bouhamama
- Department of Interventional Radiology, centre Léon-Bérard, Lyon, France
| | | | | | - Véronique Haddad
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, centre Léon-Bérard, University Claude Bernard (UCBL Lyon1), Lyon, France.
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Rousset-Jablonski C, Pautier P, Chopin N. [Borderline Ovarian Tumours: CNGOFS Guidelines for Clinical Practice - Hormonal Contraception and MHT/HRT after Borderline Ovarian Tumour]. ACTA ACUST UNITED AC 2020; 48:337-340. [PMID: 32004788 DOI: 10.1016/j.gofs.2020.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Contraceptive options and menopause management are frequent clinical issues among women previously treated for a borderline ovarian tumour (BOT). OBJECTIVES To synthesize knowledge on BOT and risk related to hormonal contraception and to menopausal hormone therapy (MHT), and to propose recommendations on contraception and MHT after BOT treatment. METHODS Systematic review of the literature about hormonal contraception and BOT and on MHT and BOT was conducted on PubMed/Medline and the Cochrane Library. RESULTS There are no data concerning hormonal contraception after BOT. Current or previous oral contraception is associated with a trend towards decreased risk of serous BOT. Mucinous BOT risk is not or slightly decreased by oral contraception. Hormonal contraception is thus not contraindicated in women previously treated for a BOT (grade C). MHT is associated with a trend towards increased risk of serous BOT. No relation was found between MHT and risk of mucinous BOT. Serous BOTs with high-risk histological criteria (micropapillary pattern, stromal microinvasion or peritoneal implants) are at high-risk of invasive potentially hormone-sensitive recurrence. Hence, caution is needed in the decisions of using MHT after serous BOT with one of these high-risk histological criteria, and MHT should be discussed on a case to case basis. MHT can be prescribed without restriction in women previously treated for mucinous and serous BOT without high-risk histological criteria (grade C). CONCLUSION Hormonal contraception can be used after BOT. The histological characteristics of the tumour must be taken into account when deciding on the use of HRT/THM.
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Affiliation(s)
- C Rousset-Jablonski
- Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; EA 7425 Health Service and Performance Research (Hesper), université Claude-Bernard Lyon 1, domaine Rockefeller, 8, avenue Rockefeller, 69373 Lyon cedex 8, France; Centre hospitalier Lyon Sud, Pierre-Bénite, France.
| | - P Pautier
- Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - N Chopin
- Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
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Rousset-Jablonski C, Selle F, Adda-Herzog E, Planchamp F, Selleret L, Pomel C, Daraï E, Chabbert-Buffet N, Pautier P, Trémollières F, Guyon F, Rouzier R, Laurence V, Chopin N, Faure-Conter C, Bentivegna E, Vacher-Lavenu MC, Lhomme C, Floquet A, Treilleux I, Lecuru F, Gouy S, Kalbacher E, Genestie C, Thibault DLMR, Ferron G, Devouassoux M, Kurtz JE, Provansal M, Namer M, Joly F, Pujade-Lauraine E, Grynberg M, Querleu D, Morice P, Gompel A, Ray-Coquard I. Fertility preservation, contraception and menopause hormone therapy in women treated for rare ovarian tumours: guidelines from the French national network dedicated to rare gynaecological cancers. Eur J Cancer 2019; 116:35-44. [DOI: 10.1016/j.ejca.2019.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
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Rousset-Jablonski C, Reynaud Q, Perceval M, Nove-Josserand R, Durupt S, Golfier F, Durieu I. P342 Gynaecological management of adult women with cystic fibrosis: positive impact of an on-site gynaecological consultation offer. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze P, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la motte rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda M, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2: systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up). J Gynecol Obstet Hum Reprod 2019; 48:379-386. [DOI: 10.1016/j.jogoh.2019.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Lambertini M, Ameye L, Hamy AS, Zingarello A, Poorvu PD, Carrasco E, Grinshpun A, Han S, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Cortesi L, Senechal C, Miolo G, Pogoda K, Perez-Fidalgo JA, De Marchis L, Del Mastro L, Peccatori F, Azim HA. Safety of pregnancy following breast cancer (BC) in patients (pts) carrying a BRCA mutation (mBRCA): Results of an international cohort study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11506 Background: Very limited data are available on the safety of pregnancy and reproductive outcomes in mBRCA pts with prior BC history. We report the results of the largest study to date addressing these questions. Methods: This international, multicenter, hospital-based, retrospective cohort study included consecutive pts with invasive early BC (stage I-III) diagnosed between Jan-2000 and Dec-2012 at the age of ≤40 years and carrying a deleterious germline mBRCA. Primary endpoints were pregnancy rate and disease-free survival (DFS); overall survival (OS) and pregnancy outcomes were secondary endpoints. To account for guarantee-time bias, we performed two survival analyses: 1) Case-control approach matching pregnant and non-pregnant (1:3) pts for classic prognostic factors (each non-pregnant control had a disease-free interval ≥ than the time elapsing between BC diagnosis and date of pregnancy of the matched pregnant case); 2) Extended Cox model with time-varying covariates including all pts. Results: 1,252 mBRCA BC pts (811 mBRCA1, 430 mBRCA2, 11 mBRCA1&2) were included from 30 centers worldwide, of whom 195 pts had a pregnancy (pregnancy rate = 16% [95% CI 14-18]) after a median 4.5 years (range 3.1-6.7 years) following BC diagnosis. Pregnant pts were younger and had more ER-negative tumors (all p < 0.01). 16 (8.2%) and 20 (10.3%) pts had an induced and spontaneous abortion, respectively. Among the 150 (76.9%) pts who conceived (n = 170 babies), pregnancy complications and congenital anomalies were described in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up was 8.3 years (range 8.1-8.7 years). In the case-control analysis, pregnant pts had better DFS (HR 0.71; 95% CI 0.51-0.99; p = 0.045), with no difference in OS (HR 0.86; 95% CI 0.44-1.67; p = 0.65). Subgroup analysis suggested that the superior outcome was restricted to mBRCA1 pregnant pts (p-interaction < 0.01). Similar results were obtained in the second supportive analysis. Conclusions: Pregnancy following BC is safe in mBRCA pts, particularly mBRCA1, with no detrimental impact on maternal prognosis or fetal outcomes . These findings are of paramount importance for fertility counseling in young mBRCA BC pts.
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Affiliation(s)
- Matteo Lambertini
- Policlinico San Martino Hospital - University of Genova, Genova, Italy
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | | | | | - Sileny Han
- BGOG & Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Alberta Ferrari
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | | | | | - Gianmaria Miolo
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Katarzyna Pogoda
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Jose Alejandro Perez-Fidalgo
- Hospital Clínico Universitario de Valencia, INCLIVA, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | | | - Lucia Del Mastro
- Ospedale Policlinico San Martino-Oncologia Medica, Genova, Italy
| | | | - Hatem A. Azim
- American University of Beirut (AUB), Beirut, Lebanon
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Joly F, Pautier P, Kalbacher E, Gernier F, Fauvet R, Floquet A, Berton-Rigaud D, Tredan O, Follana P, Alexandre J, Zannetti A, Dohollou N, Trager S, Licaj I, Grellard JM, Clarisse B, Ahmed-Lecheheb D, Rousset-Jablonski C, Gompel A. Menopausal symptoms in epithelial ovarian cancer survivors: The GINECO VIVROVAIRE2 study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5555 Background: We have previously shown that Epithelial Ovarian Cancer and its treatments have significant negative effects on Quality of Life (QoL) and long term fatigue. The aim of the present multicentric VIVROVAIRE2 study was to report the main menopausal, VasoMotor Symptoms (VMS) of Epithelial Ovarian Cancer survivors (EOCS). Methods: 166 patients of the 322 EOCS without relapse ≥3 years after first line of treatment accepted to participate to a gynecological consultation carried out by a gynecologist, including a questionnaire related to menopausal symptoms, a clinical examination, and an osteodensitometry. VMS (hot flashes and/or night sweats) were described according to natural menopause (NM) or surgically induced menopause (SIM). QoL and Fatigue were measured with the validated questionnaires FACT-G and FACT Fatigue. Results: Median age was 62 years [20-83], FIGO stage III/IV (48%) and < 10% BRCA1&2 mutated. Histological subtypes were: high grade serous 31%, low grade serous 23%, endometrioid G2-3 (14%) endometriod G1( 4%), clear-cell 21%, mucinous 5%. All EOCS had surgery, 97% of patients received platinum and taxane chemotherapy, median delay from treatment was 5 years [3-24] and 59 (36%) had SIM. 14% of EOCS had osteoporosis; this rate was similar to the general population. 52% of patients (85) reported either hot flashes (47%) or night sweats (32%). 72% with SIM had VMS compared to 41% with NM (p < 0.001). VMS were not associated with poor global QoL or fatigue. At the time of the survey, only 8 (5 SIM & 3 NM) EOCS received hormone replacement therapy (HRT). Among the 85 EOCS with VMS, 80 (94%) (38 SIM (93%) 42 NM (95%)) did not benefit from HRT after cancer treatment. Among 80 EOCS with VMS and no HRT, 25 (66%) with SIM and 34 (81%) of NM had high grade serous, endometriod G2-3, clear cell and mucinous histology. Conclusions: Vasomotor symptoms are frequently reported by EOCS, particularly among surgically induced menopause patients. A majority of EOCS with these symptoms might have beneficiated from hormone replacement therapy.
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Affiliation(s)
- Florence Joly
- Centre François Baclesse, CHU Côte de Nacre, Univ. UniCaen, Caen, France
| | | | | | - François Gernier
- INSERM U1086, Clinical Research Department, Centre François Baclesse, Caen, France
| | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | - Dominique Berton-Rigaud
- GINECO and Institut de Cancérologie de l'Ouest (ICO) René Gauducheau, Saint-Herblain, France
| | - Olivier Tredan
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
| | - Philippe Follana
- GINECO and Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Jerome Alexandre
- Department of Medical Oncology, Hopital Cochin, Université Paris Descartes, CARPEM, APHP, Paris, France
| | | | | | | | - Idlir Licaj
- Centre François Baclesse, Clinical Research Department, Caen, France
| | | | | | - Djihane Ahmed-Lecheheb
- UNICANCER, Centre François Baclesse, Clinical Research Department, av général Harris, Caen, France
| | | | - Anne Gompel
- Hôpitaux Universitaires Cochin Hôtel-Dieu Broca, Paris, France
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