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Fukada I. [Overview of Clinical Application of Whole Genome Analysis for Cancer]. Gan To Kagaku Ryoho 2024; 51:7-13. [PMID: 38247084] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Cancer genomic medicine in Japan began in earnest with the implementation of gene panel testing covered by national health insurance in June 2019. However, the information obtained from this testing is limited to less than 0.1% of the entire genome. To enhance the effectiveness of therapy, understand the intricate biology of cancer, and develop new therapeutic drugs, it has become essential to promote the analysis of the whole genome. In Japan, the Action Plan for Whole Genome Analysis(Version 1)was released in December 2019. In 2021, AMED project"the full-scale operation of cancer whole genome analysis"was launched. The Action Plan for Whole Genome Analysis 2022 set a goal to return the information promptly to patients and citizens. Project Implementation Preparation Office was organized in April 2023 for acceleration of the system development for the clinical whole genome analysis. This paper introduces the current efforts and discuss the future perspectives of cancer genome medicine in Japan.
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Affiliation(s)
- Ippei Fukada
- Genomic Medicine, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research
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2
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Fukada I, Mori S, Hayashi N, Hosonaga M, Xiaofei W, Yamazaki M, Ueki A, Kiyotani K, Tonooka A, Takeuchi K, Ueno T, Takahashi S. Prognostic impact of cancer genomic profile testing for advanced or metastatic solid tumors in clinical practice. Cancer Sci 2023; 114:4632-4642. [PMID: 37858313 PMCID: PMC10728004 DOI: 10.1111/cas.15993] [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: 08/02/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Cancer genomic profile (CGP) testing, which is covered by the national health insurance system in Japan, has been introduced as a routine clinical practice. However, the effects of CGP testing on prognoses remain unclear. Drug accessibility rates and prognoses after CGP testing were retrospectively investigated in 713 patients who underwent CGP testing examined by our molecular tumor board between November 2019 and October 2022,. Overall survival (OS) was examined using the log-rank test and the Kaplan-Meier method. The median age of patients (326 males and 387 females) was 58 years (12-85 years). CGP testing revealed one or more gene mutations in 681 cases (95.5%), among which actionable gene mutations were detected in 439 (61.6%). Although treatment options were recommended for 285 cases (40.0%) by the molecular tumor board, only 45 received treatment based on their gene mutations. During the median observation period of 8.6 months, 351 (49.2%) patients died of the exacerbation of existing diseases. No significant differences were observed in OS between patients treated with and without genomically matched therapy (p = 0.285). According to clinical responses to treatment based on gene mutations, median OS was significantly longer in patients who achieved partial response and stable disease (26.5 months; 95% CI 14.4-38.6) than in those with progressive disease and not evaluated (9.8 months; 95% CI 5.8-13.8, p = 0.013). Responses to treatment based on gene mutations may improve prognoses, and it is important to increase the drug accessibility rate after CGP testing.
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Affiliation(s)
- Ippei Fukada
- Genomic MedicineCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- Breast Medical OncologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Seiichi Mori
- Division of Cancer Genomics, Japanese Foundation for Cancer ResearchCancer InstituteTokyoJapan
| | - Naomi Hayashi
- Genomic MedicineCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Mari Hosonaga
- Breast Medical OncologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Wang Xiaofei
- Medical OncologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Masumi Yamazaki
- Genomic MedicineCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- The Advanced Medical DevelopmentCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Arisa Ueki
- Clinical Genetic OncologyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Kazuma Kiyotani
- Project for Immunogenomics, Cancer Precision Medicine CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Akiko Tonooka
- Division of PathologyCancer Institute, Japanese Foundation for Cancer ResearchTokyoJapan
- Department of PathologyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Kengo Takeuchi
- Division of PathologyCancer Institute, Japanese Foundation for Cancer ResearchTokyoJapan
- Department of PathologyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
- Pathology Project for Molecular TargetsCancer Institute, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Takayuki Ueno
- The Advanced Medical DevelopmentCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- Breast SurgeryCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Shunji Takahashi
- Genomic MedicineCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- Medical OncologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
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3
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Ohmoto A, Hayashi N, Fukada I, Yamazaki M, Yunokawa M, Kasuga A, Shinozaki E, Ueki A, Tonooka A, Takeuchi K, Mori S, Kiyotani K, Takahashi S. Druggable gene alterations in Japanese patients with rare malignancy. Neoplasia 2022; 33:100834. [PMID: 36088851 PMCID: PMC9471185 DOI: 10.1016/j.neo.2022.100834] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Abstract
Without a current standard of care, patients with rare malignancy are subjected to precision oncology with next-generation sequencing to identify a course of treatment. We sought to establish the clinical relevance of comprehensive genomic profiling (CGP) among patients with rare malignancy. Rare malignancy was defined using the Rare Cancers in Europe definition (<6 cases per 100,000 individuals). We analyzed gene mutations, fusions, tumor mutational burden (TMB), and microsatellite instability (MSI) status. Level A gene alterations, categorized using Clinical Interpretations of Variants in Cancer and MD Anderson Knowledge Base for Precision Oncology, were considered druggable. Rare malignancy accounted for 149 (45%) cases, with female genital cancers (32%) most common. Among the rare malignancy cases, we identified a lower frequency of mutation in TP53 (41% vs. 60%, P<0.001), KRAS (13% vs. 43%, P<0.001) and APC (3% vs. 25%, P<0.001), and a higher frequency of ARID1A mutation (14% vs. 6%, P=0.03), as compared with common malignancies. TMB-high and MSI-high cases were found in 8% and 2% of cases, respectively. Druggable alterations were detected in 37 patients with rare malignancy; this percentage tended to be higher than that for patients with common malignancies (25% vs. 17%, P=0.08). Common druggable alterations were BRAF V600E, ERBB2 amplification, PIK3CA E542K, and BRCA1/2 variant. Five of the 37 patients with druggable alterations received genome-driven treatment. There was no significant difference in overall survival between the rare and common malignancy groups. Our results provide clues for future clinical development and treatment success among Japanese patients with rare cancers.
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Affiliation(s)
- Akihiro Ohmoto
- Division of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naomi Hayashi
- Division of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Genomic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Division of Genomic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Breast Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masumi Yamazaki
- Division of Genomic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Center for Advanced Medical Development, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mayu Yunokawa
- Division of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Gynecologic Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Kasuga
- Division of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Division of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Arisa Ueki
- Division of Clinical Genetic Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Tonooka
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichi Mori
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuma Kiyotani
- Project for Immunogenomics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Division of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Genomic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Center for Advanced Medical Development, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
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4
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Hayashi N, Fukada I, Ohmoto A, Yamazaki M, Wang X, Hosonaga M, Takahashi S. Evaluation of an inflammation-based score for identification of appropriate patients for comprehensive genomic profiling. Discov Oncol 2022; 13:109. [PMID: 36260237 PMCID: PMC9582079 DOI: 10.1007/s12672-022-00574-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
Performance status (PS) is widely used as an assessment of general condition in patients before performing comprehensive genomic profiling (CGP). However, PS scoring is dependent on each physician, and there is no objective and universal indicator to identify appropriate patients for CGP. Overall, 263 patients were scored using the modified Glasgow prognostic score (mGPS) from 0 to 2 based on the combination of serum albumin and c-reactive protein (CRP): 0, albumin ≥ 3.5 g/dl and CRP ≤ 0.5 mg/dl; 1, albumin < 3.5 g/dl or CRP > 0.5 mg/dl; and 2, albumin < 3.5 g/dl and CRP > 0.5 mg/dl. Overall survival was compared between mGPS 0-1 and mGPS 2 groups. The prognosis of patients with PS 0-1 and mGPS 2 was also evaluated. Thirty-nine patients (14.8%) were mGPS 2. Patients with mGPS 2 had significant shorter survival (14.7 months vs 4.6 months, p < 0.01). Twenty-eight patients were PS 0-1 and mGPS 2, and their survival was also short (5.6 months). Evaluation of mGPS is a simple and useful method for identifying patients with adequate prognosis using CGP.
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Affiliation(s)
- Naomi Hayashi
- Department of Genomic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan.
- Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Ippei Fukada
- Department of Genomic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
- Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiro Ohmoto
- Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masumi Yamazaki
- Department of Genomic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
- The Center for Advanced Medical Development, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Xiaofei Wang
- Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mari Hosonaga
- Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Department of Genomic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
- Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- The Center for Advanced Medical Development, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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5
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Ohmoto A, Hayashi N, Fukada I, Yamazaki M, Yunokawa M, Kasuga A, Shinozaki E, Ueki A, Tonooka A, Takeuchi K, Mori S, Kiyotani K, Takahashi S. Abstract 5735: Druggable gene alterations in Japanese patients with rare malignancy. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5735] [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: In the absence of a current standard of care, precision oncology with next-generation sequencing provides an important therapeutic option for patients with rare malignancy. Here, we sought to establish the clinical relevancy of comprehensive genomic profiling (CGP) for patients with rare malignancy.
Methods: We reviewed 341 patients who underwent CGP (FoundationOne CDx; OncoGuide NCC OncoPanel System)in our institution between 2019 and 2021. Cases were classified as common or rare malignancy based on the Rare Cancers in Europe (RARECARE) definition (incidence of <6 cases per 100,000 individuals). We analyzed the genomic features in the rare malignancy cohort, including gene mutations, gene fusions, tumor mutational burden (TMB), and microsatellite instability (MSI) status. Gene variants, amplifications, and fusions categorized as evidence level A using Clinical Interpretations of Variants in Cancer (CIViC) and MD Anderson Knowledge Base for Precision Oncology were considered as druggable alterations. CGP testing was used to calculate overall survival (OS) to death or at the last follow-up.
Results: With the exception of 7 unclassifiable cases, rare malignancy accounted for 149 of the 334 cases (45%), with the most common being female genital cancers (32%), followed by digestive cancers (24%), sarcoma (16%), and others (28%). Many (83%) of the patients with rare malignancy harbored at least one pathogenic/likely-pathogenic variant. The commonly mutated genes were TP53 (41%), PIK3CA (20%), ARID1A (14%), and KRAS (13%). ERBB2amplification was detected in 6% of patients (median copy number, 8). Gene fusion in EWSR1 was found in 4% of patients (sarcoma) and in FGFR2 in 1% (cholangiocarcinoma and salivary duct carcinoma). TMB-high (≥10 mut/Mb) and MSI-high cases were found in 8% and 2% of cases, respectively. Druggable alterations were detected in 36 patients; this percentage was not significantly different to that of common malignancy (24% vs. 17%, P=0.10). The common druggable alterations were BRAF V600E (n=10), ERBB2 amplification (n=9), PIK3CA E542K (n=6), and BRCA1/2 variant (n=6). There was no significant difference in OS between the rare and common malignancy groups (1-year OS rate: 62% vs. 46%, P=0.24).
Conclusion: In this study, the ratio of rare malignancy was higher than that typically found in previous epidemiological studies (about 20%-25%). We observed no adverse impact for OS, which might be due to the high number of patients (n=48) with intractable pancreatic cancer. Remarkably, >20% of patients harbored a potential druggable alteration. Our results suggest the clinical relevance of CGP for patients with rare malignancy, and its potential utility to provide clues for future clinical development.
Citation Format: Akihiro Ohmoto, Naomi Hayashi, Ippei Fukada, Masumi Yamazaki, Mayu Yunokawa, Akiyoshi Kasuga, Eiji Shinozaki, Arisa Ueki, Akiko Tonooka, Kengo Takeuchi, Seiichi Mori, Kazuma Kiyotani, Shunji Takahashi. Druggable gene alterations in Japanese patients with rare malignancy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5735.
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Affiliation(s)
| | - Naomi Hayashi
- 1Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- 1Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Mayu Yunokawa
- 1Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Arisa Ueki
- 1Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Tonooka
- 1Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Seiichi Mori
- 1Japanese Foundation for Cancer Research, Tokyo, Japan
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Chin YM, Shibayama T, Chan HT, Otaki M, Hara F, Kobayashi T, Kobayashi K, Hosonaga M, Fukada I, Inagaki L, Ono M, Ito Y, Takahashi S, Ohno S, Ueno T, Nakamura Y, Low SK. Serial circulating tumor DNA monitoring of CDK4/6 inhibitors response in metastatic breast cancer. Cancer Sci 2022; 113:1808-1820. [PMID: 35201661 PMCID: PMC9128178 DOI: 10.1111/cas.15304] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Cyclin‐dependent kinase 4/6 inhibitors (CDK4/6i) significantly improve progression‐free survival and have become the standard therapy for estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative metastatic breast cancer patients. Treatment surveillance by radiological imaging has some limitations in detection and repeated biopsy genomic profiling is not clinically feasible. Serial circulating tumor DNA (ctDNA) analysis may provide insights into treatment response. Here we performed serial ctDNA analysis (n = 178) on 33 patients. Serial ctDNA analysis identified disease progression with sensitivity of 75% and specificity of 92%. In eight of 12 patients (61%) responding to CDK4/6i who eventually developed progressive disease, serial sampling every 3 or 6 months captured the initial rise of ctDNA with an average lead time of 3 months. In three of eight patients that did not respond to CDK4/6i (progressive disease at first radiological assessment, 3 months), biweekly sequencing within the first cycle of CDK4/6i treatment (1 month) detected sustained ctDNA levels (≥0.2% variant allele frequency), with lead time of 2 months. Serial ctDNA analysis tracked RECIST response, including clinically challenging scenarios (bone metastases or small‐sized target lesions), as well as detecting acquired genetic alterations linked to CDK4/6i resistance in the G1 to S transition phase. Circulating tumor DNA analysis was more sensitive than carcinoembryonic antigen or cancer antigen 15‐3 serum tumor markers at monitoring tumor response to CDK4/6i treatment. Our findings indicated the possible clinical utility of serial ctDNA analysis for earlier progressive disease detection and real‐time monitoring of CDK4/6i response.
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Affiliation(s)
- Yoon Ming Chin
- Cancer Precision Medicine Center, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.,Cancer Precision Medicine Inc., Kawasaki, Japan
| | - Tomoko Shibayama
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiu Ting Chan
- Cancer Precision Medicine Center, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masumi Otaki
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Fumikata Hara
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Kobayashi
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kokoro Kobayashi
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mari Hosonaga
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Lina Inagaki
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makiko Ono
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Department of Comprehensive Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Ueno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Nakamura
- Cancer Precision Medicine Center, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Siew-Kee Low
- Cancer Precision Medicine Center, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
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Fukuda T, Hattori M, Ozaki Y, Inagaki L, Hosonaga M, Fukada I, Kobayashi K, Hara F, Kobayashi T, Yoshio S, Ueno T, Takano T, Ohno S. Abstract P1-15-02: Low incidence of hepatitis B reactivation after chemotherapy in Japanese breast cancer patients with resolved HBV. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-15-02] [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: Recently, chemotherapy-induced reactivation of hepatitis B virus (HBV) has been reported not only in patients with HBV surface antigen positive (HBsAg+) but also in patients with resolved HBV (HBsAg-, anti-HBV-core antibody positive (anti-HBc+). The incidnce of HBV reactivation after adjuvant/neo-adjuvant chemotherapy for breast cancer in patients with resolved HBV infection remains unclear. In this study, we surveyed the incidence of HBV reactivation in Japanese breast cancer patients who received adjuvant/neo-adjuvant chemotherapy. Methods: A total of 3042 breast cancer patients who received neoadjuvant and/or adjuvant chemotherapy from June 2008 to December 2016 were included in this study. HBsAg, anti-HBc and anti-HBV-surface antibody (anti-HBs) were tested before chemotherapy. Serum HBV-DNA levels were subsequently measured and monitored for one year after the completion of adjuvant/neo-adjuvant chemotherapy if the patient exhibited a resolved HBV infection. Results: Of the 3042 patients (pts), 32 (1.05%)cases were positive for HBsAg and 2992 pts were negative for HBsAg. 301 pts (9.9 %) were revealed resolved HBV infection; 221 pts were with anti-HBc+ and anti-HBs+, 40 pts were with anti-HBc+ and anti-HBs-, and 130 pts were with anti-HBc- and anti-HBs+. Of the 130 pts with anti-HBc- and anti-HBs+, 77 pts were previously vaccinated for hepatitis B. The antibody-positive rate by age group was 2.7% (1/37) for patients in their 20s, 4.1% (14/344) for those in their 30s, 6.5% (67/1037) for those in their 40s, 9.4% (77/817) for those in their 50s, 16.6% (109/655) for those in their 60s, 20% (30/150) for those in their 70s, and 0% (0/2) for those in their 80s. Among the 301 pts with resolved HBV infection, 71 pts were monitored for one year after the completion of their chemotherapy. The median monitoring period was 579 days (386-3458). In our monitoring period, only one patient (1.4%) was diagnosed with HBV reactivation based on a slightly elevated HBV-DNA level at 1-year-test. No death or hepatitis due to HBV reactivation occurred during the monitoring period. Conclusions: The prevalence of resolved HBV infection in Japan showed an increasing trend with age. Adjuvant/neoadjuvant chemotherapy for breast cancer patients with resolved HBV infection has a risk of HBV reactivation. Our study suggested the risk of reactivation was low and the risk of a flare of HBV disease could be controlled with screening and carefully monitoring.
Citation Format: Takayo Fukuda, Masaya Hattori, Yukinori Ozaki, Lina Inagaki, Mari Hosonaga, Ippei Fukada, Kokoro Kobayashi, Fumikata Hara, Takayuki Kobayashi, Sachiyo Yoshio, Takayuki Ueno, Toshimi Takano, Shinji Ohno. Low incidence of hepatitis B reactivation after chemotherapy in Japanese breast cancer patients with resolved HBV [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 P1-15-02.
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Affiliation(s)
- Takayo Fukuda
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yukinori Ozaki
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Lina Inagaki
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Mari Hosonaga
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Ippei Fukada
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | | | - Fumikata Hara
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | | | - Sachiyo Yoshio
- Department of Liver Diseases, Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Takayuki Ueno
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Toshimi Takano
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Shinji Ohno
- The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
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8
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Ozaki Y, Aoyama Y, Masuda J, Inagaki L, Kawai S, Shibayama T, Maeda T, Kurata M, Yoshida K, Saeki S, Hosonaga M, Fukada I, Hara F, Kobayashi T, Kobayashi K, Miyake S, Takano T, Ueno T, Ohno S. Trastuzumab and fulvestrant combination therapy for women with advanced breast cancer positive for hormone receptor and human epidermal growth factor receptor 2: a retrospective single-center study. BMC Cancer 2022; 22:36. [PMID: 34983437 PMCID: PMC8728947 DOI: 10.1186/s12885-021-09128-1] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trastuzumab and fulvestrant combination therapy is one of the treatment options for patients with hormone receptor- and human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer; however, there are limited studies evaluating the efficacy of this combination therapy. METHODS We retrospectively reviewed the data of women with hormone receptor- and HER2-positive metastatic breast cancer who received trastuzumab and fulvestrant combination therapy between August 1997 and August 2020 at the Cancer Institute Hospital. The primary endpoint of this study was progression-free survival, and the secondary endpoints were response rate, overall survival and safety. RESULTS We reviewed the data of 1612 patients with recurrent or metastatic breast cancer, of which 118 patients were diagnosed with hormone receptor- and HER2-positive breast cancer. Of these, 28 patients who received trastuzumab and fulvestrant combination therapy were eligible for this study. The median treatment line for advanced breast cancer was 6 (range, 1-14), the median progression-free survival was 6.4 months (95% confidence interval [CI], 3.46-8.17), and the median overall survival was 35.3 months (95% CI, 20.0-46.7). Of the 28 patients, partial response was observed in 1 (4%), stable disease in 17 (61%), and progressive disease in 10 (36%) patients. The disease control rate was 64%. Adverse events of grade ≥ 3 were not observed. CONCLUSIONS Trastuzumab and fulvestrant combination therapy showed moderate clinical efficacy and no severe toxicity after standard anti-HER2 treatment, which is a reasonable treatment option for patients with hormone receptor- and HER2-positive metastatic breast cancer. These data contribute to understanding the efficacy of trastuzumab and fulvestrant combination therapy as control data for further development of anti-HER2 agents plus hormone therapy.
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Affiliation(s)
- Yukinori Ozaki
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. .,Department of Clinical Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yosuke Aoyama
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Jun Masuda
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Lina Inagaki
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Saori Kawai
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomoko Shibayama
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tetsuyo Maeda
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mami Kurata
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kazuyo Yoshida
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Sumito Saeki
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mari Hosonaga
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ippei Fukada
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Fumikata Hara
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takayuki Kobayashi
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kokoro Kobayashi
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Miyake
- Department of Clinical Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimi Takano
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takayuki Ueno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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9
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Fukada I, Ito Y, Kondo N, Ohtani S, Hattori M, Tokunaga E, Matsunami N, Mashino K, Kosaka T, Tanabe M, Yotsumoto D, Yamanouchi K, Sawaki M, Kashiwaba M, Kawabata H, Kuroi K, Morita S, Ohno S, Toi M, Masuda N. A phase II study of sequential treatment with anthracycline and taxane followed by eribulin in patients with HER2-negative, locally advanced breast cancer (JBCRG-17). Breast Cancer Res Treat 2021; 190:425-434. [PMID: 34554370 PMCID: PMC8558278 DOI: 10.1007/s10549-021-06396-0] [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: 06/29/2021] [Accepted: 09/11/2021] [Indexed: 11/26/2022]
Abstract
Purpose The sequence of taxanes (T) followed by anthracyclines (A) as neoadjuvant chemotherapy has been the standard of care for almost 20 years for locally advanced breast cancer (LABC). Sequential administration of eribulin (E) following A/T could provide a greater response rate for women with LABC. Methods In this single-arm, multicenter, Phase II prospective study, the patients received 4 cycles of the FEC regimen and 4 cycles of taxane. After the A/T-regimen, 4 cycles of E were administered followed by surgical resection. The primary endpoint was the clinical response rate. Eligible patients were women aged 20 years or older, with histologically confirmed invasive breast cancer, clinical Stage IIIA (T2–3 and N2 only), Stage IIIB, and Stage IIIC, HER2-negative. Results A preplanned interim analysis aimed to validate the trial assumptions was conducted after treatment of 20 patients and demonstrated that clinical progressive disease rates in the E phase were significantly higher (30%) than assumed. Therefore, the Independent Data Monitoring Committee recommended stopping the study. Finally, 53 patients were enrolled, and 26 patients received the A/T/E-regimen. The overall observed clinical response rate (RR) was 73% (19/26); RRs were 77% (20/26) in the AT phase and 23% (6/26) in the E phase. Thirty percent (8/26) of patients had PD in the E phase, 6 of whom had achieved cCR/PR in the AT phase. Reported grade ≥ 3 AEs related to E were neutropenia (42%), white blood cell count decrease (27%), febrile neutropenia (7.6%), weight gain (3.8%), and weight loss (3.8%). Conclusion Sequential administration of eribulin after the A/T-regimen provided no additional effect for LABC patients. Future research should continue to focus on identifying specific molecular biomarkers that can improve response rates.
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Affiliation(s)
- Ippei Fukada
- Department of Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yoshinori Ito
- Department of Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Eriko Tokunaga
- Department of Breast Oncology, National Kyusyu Cancer Center, Fukuoka, Japan
| | - Nobuki Matsunami
- Department of Breast Surgery, Osaka Rosai Hospital, Osaka, Japan.,Department of Breast Surgery, Shuto General Hospital, Yamaguchi, Japan
| | - Kohjiro Mashino
- Department of Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Taijiro Kosaka
- Department of Breast Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.,Department of Breast Surgery, Hito Medical Center, Ehime, Japan
| | - Masahiko Tanabe
- Department of Breast Oncology, Juntendo University Hospital, Tokyo, Japan.,Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Yotsumoto
- Department of Breast Surgery, Social Medical Corporation Hakuaikai, Sagara Hospital, Kagoshima, Japan
| | - Kosho Yamanouchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Masahiro Kashiwaba
- Department of Breast Oncology, Breastopia Miyazaki Hospital, Miyazaki, Japan.,Adachi Breast Clinic, Kyoto, Japan
| | - Hidetaka Kawabata
- Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan
| | - Katsumasa Kuroi
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masakazu Toi
- Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, NHO Osaka National Hospital, Osaka, Japan
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10
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Inagaki L, Fukuda T, Uehiro N, Kataoka A, Morizono H, Kurata M, Kawai S, Masuda J, Shibayama T, Ozaki Y, Hosonaga M, Fukada I, Kobayashi K, Hara F, Kobayashi T, Ueno T, Takano T, Ito Y, Takahashi S, Ohno S. MO33-7 Preparedness for COVID-19 pandemic and impact on medical oncology for breast cancer. Ann Oncol 2021. [PMCID: PMC8311549 DOI: 10.1016/j.annonc.2021.05.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Fukada I, Hayashi N, Yamazaki M, Oh G, Hosonaga M, Nakajima T, Mori S, Takeuchi K, Takahashi S. MO9-5 Clinical implementation of cancer genomic medicine using gene profiling test under national health insurance in Japan. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.582] [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: 10/20/2022] Open
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12
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Abe T, Ito Y, Fukada I, Shibayama T, Ono M, Kobayashi T, Kobayashi K, Takahashi S, Horii R, Akiyama F, Iwase T, Ueno T, Ohno S. Abstract P4-08-29: Lymphatic invasion is an independent risk factor in patients with small node-negative luminal breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-08-29] [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]
In patients with node-negative (N0), hormone receptor-positive, human epidermal growth factor receptor (HER2) -negative (luminal) breast cancer, the impact of lymphatic invasion (ly) on the prognosis remains to be clarified.
[Methods]
Among 3,158 patients with primary breast cancers who underwent surgery in our institute from January 2007 to December 2009, we analyzed 1027 N0 luminal invasive breast cancers without preoperative systemic therapy. The luminal breast cancer was defined as hormone receptor-positive (ER of ≥ 10% or PgR of ≥ 10%) and HER2-negative (immunohistochemistry: 0, 1+ or FISH: ratio < 2.0) cancer in the postoperative pathological specimen. ly was defined as positive when cancer cell nests were detected within the lymph duct in the whole specimen. N0 was confirmed pathologically by the sentinel lymph node biopsy in all the patients. The Fisher's exact test was used for comparison between different categories. The distant recurrence rate (DRR) was analyzed using the Kaplan-Meier method and the log-rank test. For multivariate analysis, Cox's regression analysis was performed.
[Results]
The median follow-up period was 103.8 months (range: 5.6-128.8). Recurrence with distant metastasis occurred in 26 patients (2.5%). There were 5 (0.7%) deaths related to breast cancer. ly was detected in 240 patients (23.4%). In the ly-positive group, the tumor size was larger (p = 0.007), and the nuclear grade (NG) was higher (p < 0.001) than in the ly-negative group. Postoperative endocrine therapy (p < 0.001) and postoperative chemotherapy (p < 0.001) were more frequently employed for patients with ly-positive tumor. The univariate analysis showed that ly positivity (p < 0.001), large tumor size (p < 0.001), high NG (p < 0.001), PgR negativity (p = 0.002) and the history of adjuvant chemotherapy (p < 0.001) were associated with high DRR. In the multivariate analysis, large tumor size (p = 0.007) and PgR negativity (p = 0.015) remained significant. Although positive ly had a risk ratio of 2.2, it was not an independent risk factor.When restricted to T1 tumor (n = 899), the aforementioned factors still showed prognostic value in the univariate analysis, among which ly positivity (p = 0.004)remained significant together with PgR negativity (p = 0.047)in themultivariate analysis.The 8-year DRR was very favorable (0.8%) in patients with ly-negative T1N0 tumor while it was modest (6.6%) in patients with ly-positive T1N0 tumor (p < 0.001). Only 1.3% of the patients had received adjuvant chemotherapy in the ly-negative group while 27% of the patients had in the ly-positive group.
[Conclusion]
Lymphatic invasion was associated with higher DRR although it was not independent in the multivariate analysis among patients with N0 luminal breast cancer. When restricted to patients with T1N0 luminal breast cancer, the presence of ly was independently associated with higher risk of distant recurrence. It suggests that the assessment of ly is clinically more relevant when considering treatment options for small luminal breast cancer.
Citation Format: Abe T, Ito Y, Fukada I, Shibayama T, Ono M, Kobayashi T, Kobayashi K, Takahashi S, Horii R, Akiyama F, Iwase T, Ueno T, Ohno S. Lymphatic invasion is an independent risk factor in patients with small node-negative luminal breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-29.
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Affiliation(s)
- T Abe
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Ito
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - I Fukada
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Shibayama
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Ono
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Kobayashi
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Kobayashi
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Takahashi
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - R Horii
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - F Akiyama
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Iwase
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Ueno
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Ohno
- Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute, the Japanese Foundation for Cancer Research, Tokyo, Japan
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Araki K, Ito Y, Fukada I, Kobayashi K, Miyagawa Y, Imamura M, Kira A, Takatsuka Y, Egawa C, Suwa H, Ohno S, Miyoshi Y. Predictive impact of absolute lymphocyte counts for progression-free survival in human epidermal growth factor receptor 2-positive advanced breast cancer treated with pertuzumab and trastuzumab plus eribulin or nab-paclitaxel. BMC Cancer 2018; 18:982. [PMID: 30326862 PMCID: PMC6191898 DOI: 10.1186/s12885-018-4888-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 04/09/2018] [Accepted: 10/02/2018] [Indexed: 01/04/2023] Open
Abstract
Background Although peripheral blood-based parameters (PBBPs) are reported as prognostic indicators in patients with breast cancers, their utility has not been studied in human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (ABC). Tumor-infiltrating lymphocytes (TILs) might be a predictive factor in patients with HER2-positive ABC treated with pertuzumab and trastuzumab (PT) plus docetaxel. We aimed to evaluate whether PBBPs could have predictive value in HER2-positive ABC treated with pertuzumab and trastuzumab (PT) combined with eribulin (ERI) or nab-paclitaxel (Nab-PTX). Methods Data from 51 patients included in two single-arm, phase II trials were included in this retrospective-prospective study; the ERI + PT (N = 30) and Nab-PTX + PT (N = 21) combinations were registered under clinical trials number UMIN000012375 and UMIN000006838, respectively. We assessed PBBPs using prospectively collected data and investigated the association with progression-free survival (PFS); we evaluated absolute lymphocyte count (ALC), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The cutoff values for ALC, NLR, and PLR were set at 1000 or 1500 cells/μL, 2, and 250, respectively. Results PFS was significantly improved in patients with ALC ≥1500/μL compared to those with ALC 1000–, <1500/μL or ALC < 1000/μL (P = 0.0106). High baseline ALC was significantly associated with improved PFS (≥1500/μL; hazard ratio [HR]: 0.3715; 95% confidence interval [CI]: 0.1735–0.7955; P = 0.0108). In contrast, improved PFS was not significantly associated with NLR or PLR. Improved PFS in patients with ALC ≥1500/μL was observed irrespective of visceral metastasis or chemotherapy regimen. Conclusions Our results showed that baseline ALC was a predictive factor for PFS in HER2-positive ABC treated with PT irrespective of combined chemotherapy regimen. Anti-tumor effects might be mediated not only by the tumor microenvironment, but also by systemic peripheral circulating lymphocytes. Baseline systemic parameters such as peripheral lymphocyte count might be beneficial in addition to disease extent for predicting the efficacy of PT treatment. Trial registration UMIN000012375, registration date: 21NOV2013, and UMIN000006838, registration date: 6DEC2011.
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Affiliation(s)
- Kazuhiro Araki
- Hyogo College of Medicine, Department of Surgery, Division of Breast and Endocrine Surgery, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.,The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Breast Medical Oncology, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshinori Ito
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Breast Medical Oncology, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ippei Fukada
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Breast Medical Oncology, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kokoro Kobayashi
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Breast Medical Oncology, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshimasa Miyagawa
- Hyogo College of Medicine, Department of Surgery, Division of Breast and Endocrine Surgery, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Michiko Imamura
- Hyogo College of Medicine, Department of Surgery, Division of Breast and Endocrine Surgery, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ayako Kira
- Hyogo College of Medicine, Department of Surgery, Division of Breast and Endocrine Surgery, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuichi Takatsuka
- Hyogo College of Medicine, Department of Surgery, Division of Breast and Endocrine Surgery, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Chiyomi Egawa
- Kansai Rosai Hospital, Department of Surgery, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Hirofumi Suwa
- Hyogo Prefectural Amagasaki General Medical Center, Department of Breast Surgery, 2-17-77 East Namba-machi, Amagasaki, Hyogo, 660-8550, Japan
| | - Shinji Ohno
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Breast Medical Oncology, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yasuo Miyoshi
- Hyogo College of Medicine, Department of Surgery, Division of Breast and Endocrine Surgery, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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14
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Araki K, Ito Y, Fukada I, Kobayashi K, Ohno S, Miyagawa Y, Imamura M, Kira A, Takatsuka Y, Egawa C, Suwa H, Miyoshi Y. Abstract P2-09-31: Predictive impact of absolute lymphocyte counts for progression-free survival in HER2-positive advanced breast cancer treated with pertuzumab and trastuzumab plus eribulin or nab-paclitaxel. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-31] [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: Tumor-infiltrating lymphocytes might be a one of predictive outcome of human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (ABC) patients (pts) who treated with trastuzumab and pertuzumab (TP) plus docetaxel. Although peripheral blood-based parameter (PBBP) is reported as a prognostic indicator of patients with early breast cancers, utility of PBBP has not been studied in HER2-positive ABC.
Objective:The aim of our study was to determine whether PBBP is significant for predictive efficacy in HER2-positive ABC treated with TP combined with eribulin (ERI) or nab-paclitaxel (Nab-PTX).
Methods: The 51 patients' data from two single arm phase II trials was included in this retrospective-prospective study; ERI + TP (n=30) or Nab-PTX + TP (n=21) registered with UMIN000012375 or UMIN000006838, respectively. We assessed the PBBP in prospectively collected data and investigated their association with progression-free survival (PFS). In consideration of PBBP, we evaluated absolute lymphocyte count (ALC), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The cutoff values of ALC, NLR, and PLR were set at 1000 cells/μL, 2, and 250, respectively.
Results:Median age at baseline was 58 years (range: 31-77). Median number of previous chemotherapy was 3 (range: 1-10). Pts had multiple metastases, 53% with LNs, 35% with bone, 25% with lung, 20% with liver, and 6% with brain. The objective response rate (CR+PR) and clinical benefit rate (CR+PR+ more than 6 month SD) were 37% (n=19) and 59% (n=30), respectively. The median PFS of all pts was 301 days (range: 21-1281). The PFS of pts with ALC-High was significantly better than those of ALC-low (hazard ratio (HR): 2.74, 95% confidence interval (CI): 1.28 to 5.86; p= .0097). Furthermore, improved PFS was obtained in pts with ALC greater than 1500 cells/μL compared with less than 1000 cells/uL (HR: 4.05, 95% CI: 1.60 to 11.6; p= .0029). Significant associations seem to exist irrespective of number of previous chemotherapy. Since we combined different studies for evaluating PBBP, ERI and Nab-PTX were calculated separately. Marginally significant associations between ALC and PFS were obtained both in ERI (HR: 2.18, 95% CI: 0.87 to 5.60; p=.0973) and Nab-PTX (HR: 3.26, 95% CI: 0.80 to 12.4; p=.0939). The PFS of NLR-low pts was significantly better than those of NLR-high (HR: 2.29, 95% CI: 1.01 to 5.90; p= .0477), but this statistical difference was inferior to those of ALC. There was no significant association between PLR and PFS.
Conclusions: Pre-treatment ALC-High was significantly correlated with favorable PFS of pts treated with TP irrespective of combination chemotherapy in HER2-positve ABC. Prolonged PFS of TP combination therapy might be obtained mediating through host systemic onco-immunity. These data obtained here suggest that a usefulness of ALC for selecting pts who might have clinical benefit from TP combination therapy for heavily treated HER2-positve ABC.
Citation Format: Araki K, Ito Y, Fukada I, Kobayashi K, Ohno S, Miyagawa Y, Imamura M, Kira A, Takatsuka Y, Egawa C, Suwa H, Miyoshi Y. Predictive impact of absolute lymphocyte counts for progression-free survival in HER2-positive advanced breast cancer treated with pertuzumab and trastuzumab plus eribulin or nab-paclitaxel [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-31.
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Affiliation(s)
- K Araki
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Y Ito
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - I Fukada
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - K Kobayashi
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - S Ohno
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Y Miyagawa
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - M Imamura
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - A Kira
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Y Takatsuka
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - C Egawa
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - H Suwa
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Y Miyoshi
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Breast Medical Oncology, Breast Oncology Center, The Cancer Institute of the Japanese Foundation for Cancer Research Japan, Koto, Tokyo, Japan; Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
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Fukada I, Araki K, Kobayashi K, Shibayama T, Takahashi S, Gomi N, Kokubu Y, Oikado K, Horii R, Akiyama F, Iwase T, Ohno S, Hatake K, Sata N, Ito Y. Pattern of Tumor Shrinkage during Neoadjuvant Chemotherapy Is Associated with Prognosis in Low-Grade Luminal Early Breast Cancer. Radiology 2018; 286:49-57. [DOI: 10.1148/radiol.2017161548] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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16
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Araki K, Fukada I, Yanagi H, Kobayashi K, Shibayama T, Horii R, Takahashi S, Akiyama F, Ohno S, Ito Y. First report of eribulin in combination with pertuzumab and trastuzumab for advanced HER2-positive breast cancer. Breast 2017; 35:78-84. [DOI: 10.1016/j.breast.2017.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 12/26/2022] Open
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Yokoe T, Fukada I, Kobayashi K, Shibayama T, Miyagi Y, Yoshida A, Iwase T, Ohno S, Ito Y. Cystoid Macular Edema during Treatment with Paclitaxel and Bevacizumab in a Patient with Metastatic Breast Cancer: A Case Report and Literature Review. Case Rep Oncol 2017; 10:605-612. [PMID: 28868019 PMCID: PMC5567006 DOI: 10.1159/000477897] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022] Open
Abstract
We present a case of a metastatic breast cancer patient with cystoid macular edema (CME) occurring during treatment with paclitaxel and bevacizumab. She had a history of neoadjuvant chemotherapy and partial mastectomy plus axillary lymph node dissection for stage IIB left-breast cancer. Twenty-four months later, she was diagnosed with multiple bone metastases and underwent chemotherapy with paclitaxel and bevacizumab. Thirty-three months after the initiation of the chemotherapy, she noticed bilateral blurred vision. The retinal thickening with macular edema was observed by optical coherence tomography, resulting in a diagnosis of CME. With cessation of paclitaxel and administrating ocular instillation of a nonsteroidal anti-inflammatory drug, her macular edema gradually reduced and disappeared in a month. While CME caused by chemotherapy is very rare, taxane may cause ocular adverse events such as CME. It is important to urge patients to consult an ophthalmologist promptly when they have visual complaints during taxane chemotherapy.
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Affiliation(s)
- Takamichi Yokoe
- Department of Breast Surgical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kokoro Kobayashi
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoko Shibayama
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yumi Miyagi
- Department of Breast Surgical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Ophthalmology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Department of Breast Surgical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Department of Breast Surgical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Abe T, Fukada I, Shiga T, Morizono H, Ikebata K, Shibayama T, Kobayashi K, Iwase T, Ohno S, Ito Y. A Case of Recurrent Breast Cancer Identified by Pulmonary Tumor Thrombotic Microangiopathy. Case Rep Oncol 2017; 10:620-626. [PMID: 28868021 PMCID: PMC5567112 DOI: 10.1159/000477842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare, cancer-related, pulmonary complication that causes hypoxia and pulmonary hypertension. We report on a 42-year-old woman who was diagnosed with recurrent breast cancer that was detected due to the presence of PTTM. Eleven months after surgery for heterochronous bilateral cancer of the left breast, she developed progressive dyspnea but computerized tomography showed no pulmonary thromboembolism, and a transthoracic echocardiography revealed mild pulmonary hypertension. She was diagnosed with PTTM by cytology from pulmonary artery catheterization and perfusion lung scintigraphy. Also, the patients complained of back pain after admission, bone scintigraphy showed multiple bone metastases. Despite the early diagnosis of PTTM, her platelet count decreased, her performance status rapidly deteriorated, and her dyspnea worsened. Thus, we could not treat her with chemotherapy. She died due to respiratory failure 19 days after admission. To the best of our knowledge, this is the first report of recurrent breast cancer identified by the manifestation of PTTM. Although PTTM is a rare phenomenon, it should be considered in the differential diagnosis of acute dyspnea or pulmonary hypertension in patients with breast cancer. Furthermore, upon diagnosis, the patient should be referred to a cardiologist as soon as possible.
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Affiliation(s)
- Tomomi Abe
- Department of Breast Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Taro Shiga
- Department of General Medicine, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetomo Morizono
- Department of Breast Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koichi Ikebata
- Department of Cytology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoko Shibayama
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kokoro Kobayashi
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Department of Breast Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Department of Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Fukada I, Ito Y, Kobayashi K, Shibayama T, Miyamoto K, Takahashi S, Horii R, Akiyama F, Iwase T, Ohno S. Predictive factors and value of ypN+ after neoadjuvant chemotherapy in clinically lymph node-negative breast cancer. Breast 2017. [DOI: 10.1016/s0960-9776(17)30296-5] [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: 12/01/2022] Open
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20
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Araki K, Fukada I, Kobayashi K, Takahashi S, Ito Y. Abstract P5-15-11: Eribulin should be a candidate strategy in combination with pertuzumab plus trastuzumab for taxane pretreated HER2 positive advance breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-15-11] [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: Pertuzumab (P) improves clinical outcome when combined with docetaxel and trastuzumab (T). The efficacy of continuing multiple anti-HER2 therapy including P and/or T after initial progression is unclear. Eribulin mesylate (ERI) is able to overcome taxane (TAX) resistance advanced breast cancer (ABC). The objective of this study is to investigate the efficacy and safety of ERI plus P and T for both TAX and T pretreated HER2-positive ABC. Methods: This is a single institute, open-label, single-arm, Phase II study with pharmacokinetics (PK) of ERI (UMIN000012375). The initial dose of P is 840 mg, followed by 420 mg q3w; the initial dose of T 8 mg/kg, followed by 6 mg/kg q3w; ERI is administered at 1.4 mg on Days 1 and 8 of each cycle, q3w. Dose reductions of ERI (to 1.1 and 0.7 mg/m2) were permitted to manage any toxicity (more than grade 3). Patients (Pts) must have previous treatment with both TAX and T. The primary endpoint is assessed overall response rate (ORR). Secondary endpoints include progression-free survival (PFS), overall survival (OS), safety, and PK of ERI. Left ventricular ejection function (LVEF) was evaluated before and end of this study. Results: Thirty Pts were enrolled. Median age at baseline was 57 years. Half of Pts had endocrine positive. All Pts were treated with TAX and T. Twenty-one Pts were treated with anthracycline-based treatment (70%). Median number of previous chemotherapy was 4 (2-5). Pts had multiple metastases, 40% with bone, 36.7% with lung, 20% with liver, and 10% with brain. Pts received a median number of 8 cycles of ERI (mean dose 1.2 ± 0.19 mg/sqm), 8 cycles of both P and T. Total number of 27 Pts needed to reduce dose of ERI because of adverse events (AEs) especially grade 3 neutropenia. The ORR (CR+PR) was 34.8% (95% CI 16.4-57.3, n=23) with median PFS of 42.6 weeks (95% CI 20.3-51.9, n=30). Clinical benefit rate (CR+PR+≥6 month SD) was 60.9% (95% CI 16.4-57.3%). T-DM1 pretreated affected poor outcome than the other factors (p=0.0011). The most common grade 3/4 AEs were neutropenia in 20 Pts (66.7%) without febrile neutropenia. Grade 1/2 AEs were fatigue in 24 Pts (80%), anorexia in 23 Pts (76.7%), anemia in 22 Pts (73.3%), diarrhea in 20 Pts (66.7%), peripheral neuropathy in 16 Pts (53.3%), and hand-foot syndrome in 12 Pts (43.3%). Baseline LVEF was 67%. One Pt had asymptomatic LVEF decrease (below an absolute value of 55%). Otherwise, there was no overall decrease in mean LVEF from baseline. Nine points (pre-dose, end of infusion, 0.5, 1, 2, 4, 24, 72, and 168 h after ERI) of PK analyses were evaluated in 6 Pts, and 3 point (pre-dose, end of infusion, and 168 h after ERI) in 10 Pts. PK parameters of ERI were as follows; Maximum plasma concentration (Cmax) was 375.96 (257.6-531.8) ng/ml, terminal half-life was 36.807 (31.90-40.80) h, total clearance was 1.945 (1.15-3.15) L/h/m2. Cmax of ERI was not correlated with neutrophil count (R2=0.2338, n=16). Conclusions: The combination of ERI plus P and T was well tolerated; no new safety signals ware observed. PK parameter of ERI were as same as previous reports when combined with both P and T. ERI might be a one of strategy in combination with P plus T for TAX pretreated HER2 positive ABC.
Citation Format: Araki K, Fukada I, Kobayashi K, Takahashi S, Ito Y. Eribulin should be a candidate strategy in combination with pertuzumab plus trastuzumab for taxane pretreated HER2 positive advance breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-15-11.
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Affiliation(s)
- K Araki
- Breast Medical Oncology, The Cancer Institute Hospital Ariake, the Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
| | - I Fukada
- Breast Medical Oncology, The Cancer Institute Hospital Ariake, the Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
| | - K Kobayashi
- Breast Medical Oncology, The Cancer Institute Hospital Ariake, the Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
| | - S Takahashi
- Breast Medical Oncology, The Cancer Institute Hospital Ariake, the Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
| | - Y Ito
- Breast Medical Oncology, The Cancer Institute Hospital Ariake, the Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
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Fukada I, Ito Y, Shibayama T, Kobayashi K, Teruya N, Takahashi S, Horii R, Akiyama F, Iwase T, Toi M, Ohno S. 89P Questionnaire survey on patients’ preference for orally disintegrating tablets or granules of S-1 in postoperative adjuvant treatment for breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw575.028] [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: 11/14/2022] Open
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Fukada I, Ito Y, Shibayama T, Kobayashi K, Teruya N, Takahashi S, Horii R, Akiyama F, Iwase T, Toi M, Ohno S. 89P Questionnaire survey on patients' preference for orally disintegrating tablets or granules of S-1 in postoperative adjuvant treatment for breast cancer. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00249-0] [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: 10/22/2022] Open
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23
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Kobayashi K, Ito Y, Shibayama T, Fukada I, Ishizuka N, Horii R, Takahashi S, Akiyama F, Iwase T, Ohno S. Eribulin mesylate may improve the sensitivity of endocrine therapy in metastatic breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fukada I, Araki K, Kobayashi K, Shibayama T, Hatano M, Takahashi S, Iwase T, Ohno S, Ito Y. Imatinib could be a new strategy for pulmonary hypertension caused by pulmonary tumor thrombotic microangiopathy in metastatic breast cancer. Springerplus 2016; 5:1582. [PMID: 27652155 PMCID: PMC5025414 DOI: 10.1186/s40064-016-3280-4] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/09/2016] [Indexed: 11/20/2022]
Abstract
Introduction Pulmonary tumor thrombotic microangiopathy (PTTM) is rare, cancer-related pulmonary complication leading to hypoxia, pulmonary hypertension, and heart failure. The standard treatment for PTTM is not established. However, imatinib, a tyrosine kinase inhibitor of the PDGF receptor, may cause regression of pulmonary hypertension and pulmonary artery remodeling in PTTM. Case descriptions We report two cases of PTTM who received an anti-PDGF agent of imatinib for PTTM developed during chemotherapy for metastatic breast cancer. Case 1: 61-year-old woman who underwent resection of the left breast and axillary lymph node dissection and received adjuvant chemotherapy (CAF followed by docetaxel), then endocrine therapy for 5 years. Twelve years after surgery, multiple bone and mediastinal lymph node metastases occurred. She was under treatment with eribulin for one year but admitted because of rapid progressing dyspnea. Case 2: 45-year-old woman with metastatic breast cancer in multiple bones was under treatment for 5 years. Receiving capecitabine, she suffered from dyspnea for 2 months, she was admitted to our hospital with diagnosis of severe hypoxia. In both cases, the wedged pulmonary arterial blood cell sampling revealed cytologically malignant cells which confirmed the diagnosis of PTTM. They were treated with imatinib, which alleviated pulmonary hypertension. However, they died due to progression of metastatic breast cancer. Discussion and Evaluation Single use of imatinib did not showed sufficient efficacy. It is necessary to conduct a well-designed clinical trial using chemotherapies combined with imatinib for PTTM. Conclusions Imatinib, which alleviated pulmonary hypertension, could be a new strategy for pulmonary tumor thrombotic microangiopathy in patient with metastatic breast cancer.
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Affiliation(s)
- Ippei Fukada
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Kazuhiro Araki
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Kokoro Kobayashi
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Tomoko Shibayama
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Masaru Hatano
- Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shunji Takahashi
- Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550 Japan
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Kobayashi T, Tomomatsu J, Fukada I, Shibayama T, Teruya N, Ito Y, Iwase T, Ohno S, Takahashi S. Eribulin-induced liver dysfunction as a prognostic indicator of survival of metastatic breast cancer patients: a retrospective study. BMC Cancer 2016; 16:404. [PMID: 27389013 PMCID: PMC4936231 DOI: 10.1186/s12885-016-2436-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/07/2015] [Accepted: 06/20/2016] [Indexed: 01/03/2023] Open
Abstract
Background Eribulin is a non-taxane, microtubule dynamics inhibitor that increases survival of patients with metastatic breast cancer. Although eribulin is well tolerated in patients with heavily pretreated disease, eribulin-induced liver dysfunction (EILD) can occur, resulting in treatment modification and subsequent poor disease control. We aimed to clarify the effect of EILD on patient survival. Methods The medical records of 157 metastatic breast cancer patients treated with eribulin between July 2011 and November 2013 at Cancer Institute Hospital were retrospectively analyzed. EILD was defined as 1) an increase in alanine aminotransferase or aspartate aminotransferase levels >3 times the upper limit of normal, and/or 2) initiation of a liver-supporting oral drug therapy such as ursodeoxycholic acid or glycyron. Fatty liver was defined as a decrease in the liver-to-spleen attenuation ratio to <0.9 on a computed tomography scan. Results EILD occurred in 42 patients, including one patient for whom eribulin treatment was discontinued due to severe EILD. The patients who developed EILD had significantly higher body mass indices (BMIs) than those who did not develop EILD (24.5 vs. 21.5, respectively; P < 0.0001), with no difference in the dose intensity of eribulin between the two groups (P = 0.76). Interestingly, the patients with EILD exhibited significantly longer progression-free survival (PFS) and overall survival (OS) than those without EILD (P = 0.010 and P = 0.032, respectively). Similarly, among 80 patients without liver metastasis, 19 with EILD exhibited significantly longer PFS and OS than the others (P = 0.0012 and P = 0.044, respectively), and EILD was an independent prognostic factor of PFS (P = 0.0079) in multivariate analysis. During eribulin treatment, 18 patients developed fatty liver, 11 of whom developed EILD, with a median BMI of 26.7. Conclusions Although EILD and fatty liver occurred at a relatively high frequency in our study, most of the patients did not experience severe adverse effects. Surprisingly, the development of EILD was positively associated with patient survival, especially in patients without liver metastases. EILD may be a clinically useful predictive biomarker of survival, but further studies are needed to confirm these findings in another cohort of patients.
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Affiliation(s)
- Takayuki Kobayashi
- Department of Medical oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Jyunichi Tomomatsu
- Department of Medical oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ippei Fukada
- Department of Breast Medical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomoko Shibayama
- Department of Breast Medical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Natsuki Teruya
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshinori Ito
- Department of Breast Medical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takuji Iwase
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinji Ohno
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shunji Takahashi
- Department of Medical oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Fukada I, Araki K, Kobayashi K, Kobayashi T, Horii R, Akiyama F, Takahashi S, Iwase T, Ito Y. Therapeutic effect of taxanes on metastatic breast cancer of various immunohistochemical subtypes. Oncol Lett 2016; 12:663-669. [PMID: 27347197 DOI: 10.3892/ol.2016.4627] [Citation(s) in RCA: 2] [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: 02/03/2015] [Accepted: 04/29/2016] [Indexed: 01/19/2023] Open
Abstract
Taxane drugs play a central role in chemotherapy for breast cancer. However, previous studies have reported that taxanes are relatively ineffective in patients with operable luminal breast cancer compared with other subtypes. Between January 2000 and August 2008, 293 patients with metastatic breast cancer were treated with taxanes in The Cancer Institute Hospital of The Japanese Foundation for Cancer Research and were included in the present study. The patients were divided into 4 subtypes based on the immunohistochemically evaluated estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status. The clinicopathological features, response rate (RR) and time to progression (TTP) were analyzed retrospectively. In total, 159 patient tissues were classified as luminal type (ER+ and/or PgR+ and HER2-), 28 patient tissues were classified as luminal-HER2 type (ER+ and/or PgR+ and HER2+), 57 patient tissues were classified as HER2 type (ER-, PgR- and HER2+), and 49 patient tissues were classified as triple-negative type (ER-, PgR- and HER2-). Among the 4 subtypes, the clinical benefit rate was 51.6, 78.6, 71.9 and 40.8%, respectively. There were significant differences in TTP between subtypes (median TTP, 8.3 months in luminal, 14.1 months in luminal-HER2, 10.6 months in HER2, and 4.2 months in triple-negative; P<0.001). Patients with luminal type tumors had a significantly longer TTP than patients with triple-negative type tumors. The present data suggested that the immunohistochemical subtypes were associated with the therapeutic effect of taxanes for metastatic breast cancer and that taxanes yielded an acceptable RR and TTP in luminal metastatic breast cancer. Additional investigations are required to elucidate the predictive markers of taxane therapy for patients with metastatic breast cancer in each immunohistochemical subtype.
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Affiliation(s)
- Ippei Fukada
- Department of Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Kazuhiro Araki
- Department of Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Kokoro Kobayashi
- Department of Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Takayuki Kobayashi
- Department of Medical Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Rie Horii
- Department of Pathology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Futoshi Akiyama
- Department of Pathology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Takuji Iwase
- Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Yoshinori Ito
- Department of Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
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Kondo N, Ito Y, Fukada I, Ohtani S, Hattori M, Tokunaga E, Matsunami N, Mashino K, Kosaka T, Tanabe M, Yotsumoto D, Yamanouchi K, Sawaki M, Kashiwaba M, Kawabata H, Kuroi K, Morita S, Ohno S, Toi M, Masuda N. Efficacy study of sequential therapy with anthracycline, taxane, and eribulin in patients with HER2-negative locally advanced breast cancer (JBCRG-17). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | - Yoshinori Ito
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Department of Breast Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | | | | | | | | | | | - Daisuke Yotsumoto
- Sagara Hospital, Social Medical Corporation Hakuaikai, Kagoshima, Japan
| | - Kosho Yamanouchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | | | - Katsumasa Kuroi
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Ohno
- Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan
| | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norikazu Masuda
- Breast Oncology, NHO Osaka National Hospital, Osaka-City, Japan
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Fukada I, Araki K, Kobayashi K, Gomi N, Horii R, Akiyama F, Takahashi S, Iiwase T, Ohno S, Ito Y. Abstract P4-02-13: The pattern of tumor shrinkage is associated with prognosis in low grade luminal early breast cancer during neoadjuvant chemotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-02-13] [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: In neoadjuvant chemotherapy (NAC) for early breast cancer, the pathological response rate in estrogen receptor (ER)-positive tumors has been low in comparison with those of ER-negative tumors. Therefore, surrogate makers other than the pCR rate are needed during NAC for luminal breast cancer. Using MRI, we analyzed the patterns of tumor shrinkage after NAC as a surrogate prognostic factor in low grade luminal breast cancer. METHODS: Of 854 patients who had received NAC in a single institute from Jan. 2000 to Dec. 2009, 183 patients with low grade luminal breast cancer were retrospectively evaluated for this study. They were defined as ER and/or PgR positive in more than 10% of cancer cells and HER2 negative (IHC 0, 1+ or FISH <2.0) with nuclear grade 1 and 2. RESULTS: The median observation period was 67.9 months following surgery, and recurrence was observed in 31 patients (16.9%). The median age was 49 (22-76) years. One hundred eighty patients received anthracycline-containing chemotherapy, and 158 received taxane. There were 16 deaths (8.7%) related to breast cancer. We categorized the patterns of tumor shrinkage by MRI into 6 types: concentric shrinkage (CS), diffuse decrease (DD), reduction to small foci (RSF), decrease of intensity only (DIO), no change (NC), and enlargement (EL). According to our categorization, CS occurred in 97 (53.0%), RSF in 7 (3.8%), DD in 62 (33.9%), DIO in 7 (3.8%), NC in 5 (2.7%), and EL in 5 (2.7%). As expected, there were statistically significant differences in both the median DFS and OS in each pattern of tumor shrinkage (p <0.001 and p=0.001, respectively); in particular, the CS pattern had excellent prognosis. Multivariate analysis demonstrated that concentric shrinkage was the only significant good prognostic factor for OS (p=0.015). CONCLUSIONS: Tumor shrinkage patterns as revealed by MRI could be important surrogate prognostic factors for NAC in early low grade luminal breast cancer.
Citation Format: Fukada I, Araki K, Kobayashi K, Gomi N, Horii R, Akiyama F, Takahashi S, Iiwase T, Ohno S, Ito Y. The pattern of tumor shrinkage is associated with prognosis in low grade luminal early breast cancer during neoadjuvant chemotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-13.
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Affiliation(s)
- I Fukada
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - K Araki
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - K Kobayashi
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - N Gomi
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - R Horii
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - F Akiyama
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - S Takahashi
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - T Iiwase
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - S Ohno
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
| | - Y Ito
- Breast Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Division of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research; Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research; Breast Oncology Center, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research
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Kobayashi T, Nakano K, Tomomatsu J, Nara E, Ito Y, Kobayashi K, Fukada I, Araki K, Shimomura A, Shimoi T, Kodaira M, Yunokawa M, Yonemori K, Shimizu C, Nakamura K, Kotani N, Inatani M, Tamura K, Takahashi S. Abstract P3-14-10: Phase Ia/Ib study of taselisib (GDC-0032), a potent and selective phosphoinositide 3-kinase inhibitor, in Japanese patients with advanced solid tumors or hormone receptor-positive locally advanced or metastatic breast cancer (JO29196 study). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-14-10] [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:
Taselisib (GDC-0032) is an orally bioavailable, potent and selective phosphoinositide 3-kinase (PI3K) inhibitor. Preclinical data showed that taselisib had increased antitumor activity against PIK3CA (gene encoding the PI3Kα isoform) mutant tumors. This study aimed to investigate the safety, tolerability and pharmacokinetics (PK) of taselisib as monotherapy and in combination with fulvestrant in Japanese patients (pts).
Materials and methods:
A 3+3 design was used. In Phase Ia, pts with advanced solid tumors received taselisib tablet monotherapy (2, 4 or 6 mg once daily [QD]), and safety and PK were evaluated. In Phase Ib, pts with hormone receptor-positive locally advanced or metastatic breast cancer received taselisib (2 or 4 mg QD) in combination with fulvestrant (500 mg at a time), and safety and PK were evaluated. Maximal administered doses of 6 mg QD as a single agent and 4 mg QD in combination with fulvestrant were based upon prior clinical trial experience with taselisib (Juric D. et al. AACR 2013, Abstract LB-64; Juric D. et al. SABCS 2013, Abstract PD1-3).
Results:
As of 15 Mar 2015, 9 pts (PIK3CA mutant: 2 pts) were enrolled in Phase Ia and 3 pts in Phase Ib. Phase Ia dose-escalation study has been completed and Phase Ib is ongoing.
In Phase Ia, no dose-limiting toxicity (DLT) was observed at any dose level tested (maximum administered dose of 6 mg QD). Common (≥3 pts) adverse reactions (ARs) were stomatitis (4 pts), rash (3 pts) and diarrhea (3 pts); the only Grade ≥3 AR was neutropenia (1 pt). Partial response was observed in 1 pt who received taselisib 4 mg and had a PIK3CA mutant breast tumor. Stable disease was observed in 4 pts. Cmax and AUC indicated a dose-proportional PK profile of taselisib within the dose range tested. Moreover, taselisib PK in Japanese pts was consistent with the PK reported from North American and European pts (Juric D. et al. AACR 2013, Abstract LB-64).
In Phase Ib, 3 pts received taselisib 2 mg in combination with fulvestrant and no DLT was observed. Preliminary ARs were similar to those with monotherapy and no Grade ≥3 AR was reported. Confirmation of tolerability of taselisib 4 mg in combination with fulvestrant is under evaluation.
Conclusion:
Taselisib monotherapy was well tolerated in Japanese pts up to a dose of 6 mg, which is the recommended dose in non-Japanese pts. Promising preliminary activity of monotherapy was observed in advanced solid tumors, especially in a pt with PIK3CA mutant tumor. The combination of taselisib 2 mg with fulvestrant is well tolerated. Investigation of tolerability of taselisib 4 mg in combination with fulvestrant is ongoing. Final results of this study will be presented here at the Symposium this year.
Citation Format: Kobayashi T, Nakano K, Tomomatsu J, Nara E, Ito Y, Kobayashi K, Fukada I, Araki K, Shimomura A, Shimoi T, Kodaira M, Yunokawa M, Yonemori K, Shimizu C, Nakamura K, Kotani N, Inatani M, Tamura K, Takahashi S. Phase Ia/Ib study of taselisib (GDC-0032), a potent and selective phosphoinositide 3-kinase inhibitor, in Japanese patients with advanced solid tumors or hormone receptor-positive locally advanced or metastatic breast cancer (JO29196 study). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-14-10.
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Affiliation(s)
- T Kobayashi
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - K Nakano
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - J Tomomatsu
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - E Nara
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Y Ito
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - K Kobayashi
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - I Fukada
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - K Araki
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - A Shimomura
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - T Shimoi
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - M Kodaira
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - M Yunokawa
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - K Yonemori
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - C Shimizu
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - K Nakamura
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - N Kotani
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - M Inatani
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - K Tamura
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - S Takahashi
- The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
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Kobayashi K, Ito Y, Matsuura M, Fukada I, Horii R, Takahashi S, Akiyama F, Iwase T, Hozumi Y, Yasuda Y, Hatake K. Impact of immunohistological subtypes on the long-term prognosis of patients with metastatic breast cancer. Surg Today 2015; 46:821-6. [PMID: 26467559 DOI: 10.1007/s00595-015-1252-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 03/09/2015] [Accepted: 08/13/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Although improved long-term prognoses for patients with metastatic breast cancer (MBC) have been demonstrated, few reports address overall survival (OS) with sufficient follow-up. Furthermore, the relevance of immunohistological subtypes to OS in MBC has not been clarified. METHODS We evaluated, retrospectively, the OS of patients who had been initiated on systemic therapy for MBC between 2000 and 2008. RESULTS The subjects of this study were 527 patients with MBC treated by systemic therapy. The median survival time (MST) was 55.5 months. The MST for each immunohistological subtype was as follows: luminal, 59.9 months; luminal-HER2, not reached; triple-negative, 18.6 months; and HER2-enriched, 49.9 months. According to multivariate analysis, metastasis-free intervals of ≥2 years and treatment with anthracycline for MBC were predictive of better OS. The predictors of shorter OS included disease progression after first-line treatment for MBC, triple-negative, and all histological factors, except papillotubular carcinoma, with liver metastasis, and having three or more initial metastatic sites. CONCLUSIONS The prognosis of the patients with MBC in this series was better than that reported before 2000, which is probably attributable to the use of novel, improved pharmacological agents. For example, luminal-HER2 tumors can be treated using both aromatase inhibitors and trastuzumab. Because of the lower toxicities, it is now possible to administer these agents for longer periods, resulting in better prognoses.
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Affiliation(s)
- Kokoro Kobayashi
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yoshinori Ito
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaaki Matsuura
- Division of Cancer Genomics, Cancer Institute of Japanese Foundation for Cancer Research, and Bioinformatics Group, Genome Center of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Horii
- Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Futoshi Akiyama
- Department of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Department of Breast Surgical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuo Hozumi
- Department of Breast Oncology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshikazu Yasuda
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Kiyohiko Hatake
- Department of Hematology and Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Fukada I. 1855 The early onset of peripheral neuropathy of paclitaxel is a strong predictor for prolongation of PFS in patients with metastatic breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30805-x] [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: 11/29/2022]
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Fukuda T, Tanabe M, Kobayashi K, Fukada I, Takahashi S, Iwase T, Ito Y. Combination chemotherapy with mitomycin C and methotrexate is active against metastatic HER2-negative breast cancer even after treatment with anthracycline, taxane, capecitabine, and vinorelbine. Springerplus 2015. [PMID: 26217553 PMCID: PMC4514730 DOI: 10.1186/s40064-015-1159-4] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Combination chemotherapy with mitomycin C and methotrexate (MM) was reported to be effective for 24% of patients with metastatic breast cancer (MBC) who had been treated with anthracycline and taxane. Antimetabolites such as capecitabine and antitubulins such as vinorelbine have been generally used for MBC treatment after anthracycline and taxane. A subsequent choice of chemotherapy should be offered to patients with MBC who have kept good performance status (PS) after being aggressively treated with anthracycline, taxane, capecitabine, and vinorelbine (ATCV), but is not well clear which treatment is superior to others after ATCV. In this study, we examined whether MM treatment is a good choice following ATCV. Methods We retrospectively reviewed the medical records of 31 patients with HER2-negative metastatic breast cancer who were treated with MM following ATCV. One cycle of MM was defined as MMC 8 mg/m2 on day 1 and MTX 60 mg/m2 on day 1 and day 15, administered intravenously every 4 weeks. Results Response rate and clinical benefit rate were 9.7 and 19.4%, respectively. Median times to progression and times to failure were 3.9 and 3.7 months, respectively. Adverse events of grade 3 and/or 4 were observed in 36% patients. Thrombocytopenia of grade 3 or 4 was 12.9 and 3.2%. Grades 3 and 4 of leucopenia and anemia were 12.9 and 9.7%, respectively. Conclusion MM is effective and tolerable for MBC patients even after aggressive treatment with ATCV. MM is one treatment choice when patients have kept good PS and bone marrow function even after multiple regimens of chemotherapy.
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Affiliation(s)
- Takayo Fukuda
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan ; Department of Translational Oncology, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa Japan
| | - Masahiko Tanabe
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan ; Department of Breast Oncology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo Japan
| | - Kokoro Kobayashi
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan
| | - Ippei Fukada
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan
| | - Shunji Takahashi
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan
| | - Takuji Iwase
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan
| | - Yoshinori Ito
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan
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Makita M, Sakai T, Kataoka A, Kitagawa D, Ogiya A, Morizono H, Miyagi Y, Iijima K, Kobayashi K, Kobayashi T, Fukada I, Araki K, Takahashi S, Ito Y, Gomi N, Oguchi M, Kita M, Arai M, Akiyama F, Iwase T. Decreased hormonal sensitivity after childbirth rather than the tumor size influences the prognosis of very young breast cancer patients. Springerplus 2015. [PMID: 26207196 PMCID: PMC4508278 DOI: 10.1186/s40064-015-1150-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose There is a significant difference in the mean tumor size between very young breast cancer patients and their elder counterparts. A simple comparison may show obvious prognostic differences. We investigated the prognostic impact of age by reducing the influence of the tumor size, which is thought to be a confounding factor. Patients and methods We investigated 1,880 consecutive pT1-4N0-3M0 breast cancer patients treated at less than 45 years of age between 1986 and 2002 and conducted a case–control study of breast cancer subjects less than 30 years of age. Each patient (Younger than 30) was matched with a corresponding control subject (Elder counterpart) based on an age 15 years above the patient’s age, a similar tumor size and a status of being within 1 year after surgery. In addition, we assessed 47 patients with pregnancy-associated breast cancer (PABC). The levels of hormone receptors were measured using an enzyme immunoassay (EIA), and receptor-positive cases were divided into “weakly” and “strongly” positive groups based on the median value. Years from the last childbirth (YFLC) was categorized as “recent” and “past” at the time point of 8 years. Results There were fewer past YFLC cases, more partial mastectomy cases, a higher rate of scirrhous carcinoma or solid-tubular carcinoma in the Younger than 30 group than in the Elder counterpart group. The rates of a PgR-negative status in the Younger than 30 and Elder counterpart groups were 45.1 and 29.9%, respectively, As for the relationship between the PgR-negative rate and YFLC, the rates of a PgR-negative status in the past YFLC, nulliparous, recent YFLC and PABC groups were 31.9, 37.7, 44.4 and 65.7%, respectively. On the other hand, the rates of strongly positive cases were 42.6, 30.2, 22.2 and 8.6%, respectively. The 10-year recurrence-free survival rates in the Younger than 30, Elder counterpart and PABC groups were 61.7, 65.6 and 54.1%, respectively. The differences between the groups were not significant. In a multivariate analysis, independent prognostic facers included the number of lymph node metastases (4–9, HR:3.388, 95% CI 1.363–8.425, p = 0.0086, over 10, HR: 6.714, 2.033–22.177, p = 0.0018), solid-tubular carcinoma (HR 3.348, 1.352–8.292, p = 0.0090), scirrhous carcinoma (HR 2.294, 1.013–5.197, p = 0.0465) and past YFLC (HR 0.422, 0.186–0.956, p = 0.0387). An age younger than 30 was not found to be an independent prognostic factor. Conclusions The prognosis of the very young women was the same as their elder counterparts with a matched tumor size, and age was not identified to be an independent prognostic factor according to the multivariate analysis. Recent childbirth probably influences the prognosis of patients younger than 30 years of age with breast cancer by lowering hormonal sensitivity.
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Affiliation(s)
- Masujiro Makita
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan ; Department of Breast Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-machi, Nakahara-ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Takehiko Sakai
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Akemi Kataoka
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Dai Kitagawa
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Hidetomo Morizono
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Yumi Miyagi
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Kotaro Iijima
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
| | - Kokoro Kobayashi
- Department of Breast Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Takayuki Kobayashi
- Department of Breast Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Ippei Fukada
- Department of Breast Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Kazuhiro Araki
- Department of Breast Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Shunji Takahashi
- Department of Breast Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Breast Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Naoya Gomi
- Department of Diagnostic Radiology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Masahiko Oguchi
- Department of Radiation Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Mizuho Kita
- Department of Clinical Genetic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Masami Arai
- Department of Clinical Genetic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Futoshi Akiyama
- Department of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Takuji Iwase
- Department of Breast Surgical Oncology, Cancer Institute Hospital, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550 Japan
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Fukada I, Ito Y. [Management of anthracycline and taxane therapy-induced symptoms for the patients with breast cancer]. Nihon Rinsho 2015; 73 Suppl 2:548-552. [PMID: 25831820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fukada I, Araki K, Minatsuki S, Fujino T, Hatano M, Numakura S, Abe H, Ushiku T, Iwase T, Ito Y. Imatinib alleviated pulmonary hypertension caused by pulmonary tumor thrombotic microangiopathy in a patient with metastatic breast cancer. Clin Breast Cancer 2014; 15:e167-70. [PMID: 25468406 DOI: 10.1016/j.clbc.2014.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Ippei Fukada
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Kazuhiro Araki
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeo Fujino
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoe Numakura
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuji Iwase
- Department of Breast Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Fukada I, Araki K, Takahashi S, Kobayashi T, Kobayashi K, Shibayama T, Ito Y. The Pattern of Tumor Shrinkage is Associated with Prognosis in Luminal Breast Cancer During Neoadjuvant Chemotherapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu435.31] [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: 11/13/2022] Open
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37
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Kobayashi T, Fukada I, Kobayashi K, Shibayama T, Ito Y, Takahashi S. Prognostic effect of eribulin-induced liver dysfunction in metastatic breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Takayuki Kobayashi
- Department of Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ippei Fukada
- Department of Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kokoro Kobayashi
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoko Shibayama
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Department of Medical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Hattori M, Ito Y, Takahashi S, Fukada I, Iwase T, Iwata H, Hatake K. Abstract P5-13-12: Risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen negative/ hepatitis B core antibody positive and/or hepatitis B surface antibody positive breast cancer patients who receive chemotherapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-13-12] [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: Recently, chemotherapy-induced reactivation of hepatitis B virus (HBV) has been reported not only in patients positive for hepatitis B surface antigen (HBsAg), but also in patients negative for it. Although HBV reactivation is associated with substantial morbidity and mortality in patients undergoing cancer chemotherapy, the exact frequency and risk for HBV reactivation in HBsAg-negative breast cancer patients who receive chemotherapy remains unclear. In this study, we examined the frequency and risk for HBV reactivation in Japanese breast cancer patients who have received chemotherapy.
Methods: A total of 562 HBsAg-negative breast cancer patients received chemotherapy from June 2008 to May 2009 at the Cancer Institute Hospital of JFCR in Japan. Antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen (anti-HBs) were screened for before chemotherapy in all patients. In patients who were positive for anti-HBc and/or anti-HBs, serum HBV-DNA levels were measured and monitored during and after chemotherapy.
Results: 93 (17.4%) HBsAg-negative breast cancer patients were found to have resolved hepatitis B (HBsAg-negative, anti-HBc-positive and/or anti-HBs-positive). One patient was found to be positive for HBV DNA before the initiation of chemotherapy and received adjuvant chemotherapy with Entecavir prophylaxis. 65 patients received chemotherapy in adjuvant or neoadjuvant setting, 28 patients received it for metastatic disease. In our monitoring period (median 15.3 months), no HBsAg-negative/ anti-HBc-positive and/or anti-HBs-positive breast cancer patients developed HBV reactivation during and after their chemotherapy.
Conclusions: A number of HBsAg-negative breast cancer patients have received chemotherapy with a risk for HBV reactivation; however, it has been determined that conventional chemotherapy regimens for breast cancer are unlikely to increase the risk of developing HBV reactivation in these patients.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-12.
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Affiliation(s)
- M Hattori
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Y Ito
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - S Takahashi
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - I Fukada
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - T Iwase
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - H Iwata
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - K Hatake
- Aichi Cancer Center, Nagoya, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
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Araki K, Fukada I, Takahashi S, Ito Y. Abstract P6-06-45: Predictive significance of the mucocutaneous toxicities, but not dose intensity of capecitabine for the treatment of lapatinib plus capecitabine in patients with HER2 positive metastatic breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-06-45] [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: There are no definitive predictive markers, except HER2 overexpression, for anti-HER2 therapeutic sensitivity of patients (Pts) with HER2-positive breast cancer. The aim of this study was to evaluate clinical predictive factors for lapatinib plus capecitabine (LAPCAP) in Pts with HER2 positive metastatic breast cancer (HER2MBC).
Methods: This retrospective observational study was used data from our single institutional medical record system from June 2009 to March 2013. Evaluation of female Pts with HER2MBC who were treated with LAPCAP (LAP at 1250 mg/day continuously plus CAP at 2000 mg/m2 on days 1 through 14 of a 21-day cycle) included baseline clinical characteristics, dose modifications of LAPCAP, clinical efficacy, and incidence of adverse events (AEs). Dose-intensity was compared with reference standard regimens. The Kaplan Meier method was used to estimate time to progression free survival (PFS).
Results: A total 76 Pts were included in this analysis. At a median follow-up of 20 months, median age was 56 years (range, 36 to 75) and 41 of 76 Pts had received prior (neo- or) adjuvant chemotherapy including 18 trastuzumab (Tmab) containing regimen. Visceral metastases (Mets) were identified in 49, bone Mets in 37, lymph nodes Mets in 36, brain Mets in 17, and chest wall Mets in 16. The median number of prior chemotherapy or hormonal therapy for MBC before LAPCAP was 2 (range, 0 to 13), and 66 of 76 Pts had previously received Tmab containing regimen with taxanes for 40 Pts, vinorelbine for 36, CAP for 29, and hormonal therapies for 15. In LAPCAP, the overall response rate was 21% including 2 CRs and 14 PRs, and the clinical-benefit rates which had more than 6-month SD was 60%. During initial 12 months observation, 93% of Pts had any AEs. The most common AEs were hand-foot syndrome (HFS) in 55 Pts. Those Pts who had HFS had better PFS than those who did not have (p = 0. 23×10−4). Since HFS was one of the well-known AEs associated with CAP, we sought whether CAP dose influenced PFS or not. However, we did not find any relationship between cumulative or relative dose intensity of CAP and PFS in Pts who treated with LAPCAP. Because several studies with EGFR-targeted agents showed a positive correlation between cutaneous toxicities and outcomes, we sought whether the incidence of any AEs other than HFS influenced PFS in 76 Pts. HFS, and diarrhea, as well as skin rash were statistically significant favorable factors (p = 0. 23×10−4, 0. 60×10−2, and 0. 28×10−1) in Log rank analysis. Furthermore, median PFS of Pts who had all 3 AEs (n = 21) were 377 days, while 84 days (n = 7) who had not (p = 0.58×10−8). We did not find any other clinical predictive factors except these 3 AEs. Furthermore, we compared 20 Pts with longer PFS who had more than 12-month to 26 Pts with shorter PFS that had less than 6-month. Longer PFS had more statistically significant incidence of diarrhea (p = 0. 49×10−2), HFS (p = 0. 49×10−2), and skin rash (p = 0.36×10−1) than shorter one.
Conclusions: In LAPCAP, dose of CAP did not influence PFS, but EGFR inhibitor related toxicities might be alternative predicative markers for LAPCAP in HER2MBC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-45.
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Affiliation(s)
- K Araki
- Cancer Institute Hospital - The Cancer Institute of the Japanese Foundation for Cancer Research, Koto-Ku, Tokyo, Japan
| | - I Fukada
- Cancer Institute Hospital - The Cancer Institute of the Japanese Foundation for Cancer Research, Koto-Ku, Tokyo, Japan
| | - S Takahashi
- Cancer Institute Hospital - The Cancer Institute of the Japanese Foundation for Cancer Research, Koto-Ku, Tokyo, Japan
| | - Y Ito
- Cancer Institute Hospital - The Cancer Institute of the Japanese Foundation for Cancer Research, Koto-Ku, Tokyo, Japan
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Araki K, Fukada I, Kobayashi K, Takahashi S, Ito Y. Toxicities Can Be a Surrogate Predictive Marker for Lapatinib Efficacy in Patients with HER2 Positive Breast Cancer. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.84] [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: 11/14/2022] Open
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41
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Fukada I, Kobayashi K, Kobayashi T, Araki K, Takahashi S, Ito Y. Therapeutic Effect of Taxane for the Metastatic and Recurrent Breast Cancer in Intrinsic Subtypes. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.7] [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: 11/14/2022] Open
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42
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Fukada I, Takahashi S, Tanabe M, Araki K, Kobayashi T, Kobayashi K, Gomi N, Horii R, Akiyama F, Iwase T, Ito Y. Magnetic resonance imaging with concentric shrinkage as a prognostic factor in patients with luminal breast cancer during neoadjuvant chemotherapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11587] [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
e11587 Background: The important characteristics of breast cancer is its tumor heterogeneity and response to neoadjuvant chemotherapy (NAC). We analyzed the patterns of tumor shrinkage as a prognostic indicator after NAC for luminal breast cancer. Methods and Results. Methods: Of 854 patients who had received NAC in the single institute between January 2000 and December 2009, 265 luminal breast cancerwere retrospevively examined. Luminal breast cancer was defined as ER and/or PgR positive in more than 10% of cancer cells and HER2 negative (IHC 0, 1+ or FISH <2.0). Before and after NAC, the primary lesion was evaluated by enhanced MRI in 235 patients. Results: The median follow-up period was 51.4 months. 38 patients(16.2%) experienced recurrence after a median DFI of 49.1 months. The median age was 50 and 232 patients received anthracycline containing chemotherapy and 179 patients received taxane. 120 out of 235 patients exhibited concentric shrinkage pattern. Multivariate analysis for DFS identified Age(49>), strong ER/PgR positivity and concentric shrinkage as significantly favorable, and lymph node metastases as significantly unfavorable prognostic factors. Multivariate analysis for OS identified tumor size as significantly unfavorable prognostic factors(p=0.012). Conclusions: the tumor shrinkage pattern could be an important prognostic factor for luminal breast cancer and this suggests that a concentric shrinkage pattern of response may be infrequently associated with chemotherapy-resistant residual cancer cells.
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Affiliation(s)
- Ippei Fukada
- Department of Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuhiro Araki
- Department of Medical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Kobayashi
- Department of Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kokoro Kobayashi
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoya Gomi
- Department of Diagnostic Imaging, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Horii
- Division of Pathology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Futoshi Akiyama
- Division of Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Fukada I, Nishimura S, Tanabe M, Morizono H, Makita M, Gomi N, Horii R, Akiyama F, Iwase T. Clear cell sarcoma of the neck which metastasized to the mammary gland. Case Rep Oncol 2013; 6:55-61. [PMID: 23467306 PMCID: PMC3573807 DOI: 10.1159/000345843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 12/18/2022] Open
Abstract
Malignant neoplasms very rarely metastasize to the mammary gland, the incidence of which is reported as 0.5-2%. Clear cell sarcoma is a rare neoplasm, accounting for approximately 1% of all soft tissue tumors, which commonly occurs in the distal extremities of young adults aged approximately 20 to 40 years. So it is also called malignant melanoma of soft parts because it frequently produces melanin. We report a case of a 26-year-old woman who presented with a neck mass. The mass was surgically removed, and pathological diagnosis was clear cell sarcoma of the neck, harboring the EWS-ATF1 chimeric gene. Computed tomography detected a right breast mass 11 months after operation. She was referred to our department, and the right breast tumor was resected. Histopathological examination revealed a 2.5-cm, well-defined mass composed of nests of small, spindle-shaped tumor cells with abundant, clear cytoplasm containing round nuclei and prominent nucleoli. The tumor cells were immunohistochemically positive for HMB45, S-100, and Melan-A. These findings led to a diagnosis of metastasis of clear cell sarcoma to the mammary gland. This is the first report of clear cell sarcoma of the neck which metastasized to the mammary gland.
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Affiliation(s)
- Ippei Fukada
- Department of Breast Medical Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichiro Nishimura
- Division of Breast Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiko Tanabe
- Division of Breast Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetomo Morizono
- Division of Breast Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masujiro Makita
- Division of Breast Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoya Gomi
- Department of Diagnostic Imaging, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Horii
- Division of Pathology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Futoshi Akiyama
- Division of Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Division of Breast Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, and the Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Fukada I, Ito Y, Takahashi S, Tsutsumi C, Kobayashi T, Kobayashi K, Nakayama Y, Kawai Y, Hatake K. Concentric Tumor Shrinkage by Chemotherapy is a Good Prognostic Factor in Neoadjuvant Chemotherapy for Luminal Breast Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32360-7] [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: 10/25/2022] Open
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Fukada I, Ikeda H, Yamaguchi K, Okabe M, Tsuruta A, Morimoto Y, Kawamoto K, Sano K, Paku T, Imai S, Yoshida Y, Ito T, Ogasahara K. [A case of recurrent pancreatic cancer with lung metastasis responding to S-1 combined gemcitabine chemotherapy]. Gan To Kagaku Ryoho 2009; 36:1733-1736. [PMID: 19838037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The patient was a 54-year-old male. In July 2004, he underwent resection of the pancreatic body tail region to treat pancreatic body tail cancer. On histopathological examination, the stump of the extirpated specimen was positive for tumor cells. After surgery, 10 courses of therapy with gemcitabine hydrochloride(GEM, 1, 000 mg/m(2), 3-week administration followed by 1-week discontinuation)were performed, and follow-up was continued. In February 2006, local relapse was detected. Chemotherapy with GEM was administered for 1 year and 9 months. However, in November 2007, an increase in the recurrent lesion size and right lung metastasis were noted. The regimen was switched to combination therapy with S-1 and GEM(S-1 60 mg/m(2) day, continuous administration on days 1 to 14 and 2-week discontinuation; and GEM 1, 000 mg/ m(2), administered on days 8 and 15). After the end of the 11th course, PET-CT revealed the disappearance of FDG accumulation in the recurrent and metastatic lesion sites. During the treatment period, there were no grade 3 or higher adverse reactions. The patient is being treated at the outpatient clinic (as of January 2009).
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