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Jibiki N, Nakazawa T, Nogami M, Yoshida K, Hasegawa A, Guo F, Hiroshima K. Prognostic Evaluation of HER2-positive Early Breast Cancers Using Clinico-pathological Criteria. Cancer Diagn Progn 2024; 4:326-332. [PMID: 38707735 PMCID: PMC11062154 DOI: 10.21873/cdp.10328] [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] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim HER2-positive breast carcinomas (BCs) generally behave more aggressively and show higher cytological and histological grade than HER2-negative BCs. However, the clinical properties of HER2-positive early BCs have not been studied extensively. Hence, the therapeutic significance of neoadjuvant chemotherapy (NAC) for this BC remains debatable. Patients and Methods We retrospectively examined the clinicopathological features of 94 HER2-positive early BCs who perioperatively received anti-HER2 drugs, without undergoing NAC prior to surgery. Results The patients' five year-disease free survival (DFS) and overall survival (OS) rates were 95.6% and 100%, respectively. Univariate analysis demonstrated significant differences in distant metastasis-free survival (DMFS) between clinical and pathological tumor stages (T stages). Pathological T1 stage and clinical T1 stage tumors showed significantly higher DMSF than pT2-3 and cT2-3 (p=0.0002 and 0.0294). Multivariate analysis disclosed no significant differences in DFS, OS, and DMFS with respect to preoperative clinical tumor stage, patient age, type of surgery, postoperative therapy, and pathological factors. Recurrences occurred in nine patients: four (4.3%) and five (5.3%) patients showed local and distant recurrences, respectively. One patient with cT2 BC died of disease. Interestingly, four of the five BCs with distant recurrence pathologically demonstrated lymph vessel invasion. The prognoses of patients with HER2-positive stage cT1/2N0M0 BC were highly favorable. Conclusion The indications for NAC in small, localized, and node-negative HER2-positive BC should be carefully assessed based on the presence of a larger tumor size, postoperative pathological evaluation of tumor size, and lymph vessel invasion.
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Affiliation(s)
- Norie Jibiki
- Department of Breast and Endocrine Surgery, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
| | - Tadao Nakazawa
- Department of Pathology, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
| | - Mako Nogami
- Department of Breast and Endocrine Surgery, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
| | - Keita Yoshida
- Department of Pathology, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
| | - Atsuko Hasegawa
- Department of Pathology, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
| | - Feng Guo
- Department of Pathology, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Woman's Medical University Yachiyo Medical Center (TYMC), Chiba, Japan
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Bonneau M, Bellesoeur A. [Adjuvant olaparib - High risk early breast cancer with BRCA1 or BRCA2 germline mutation]. Bull Cancer 2023; 110:1092-1093. [PMID: 37716861 DOI: 10.1016/j.bulcan.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Maëva Bonneau
- Institut universitaire du cancer de Toulouse, département d'oncologie médicale, Toulouse, France.
| | - Audrey Bellesoeur
- Institut Curie, département d'oncologie médicale, Paris, France; Institut Curie, département de radio-pharmacologie, Saint-Cloud, France
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Chin-Lenn L, De Boer RH, Segelov E, Marx GM, Hughes TM, McCarthy NJ, White SC, Foo SS, Rutovitz JJ, Della-Fiorentina S, Jennens R, Antill YC, Tsoi D, Cronk MF, Lombard JM, Kiely BE, Chirgwin JH, Gorelik A, Mann GB. The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable. Asia Pac J Clin Oncol 2018; 14:410-416. [PMID: 30270527 DOI: 10.1111/ajco.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 07/08/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24-40% of hormone receptor+/HER2- patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. METHODS Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. RESULTS Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%. Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)-more likely if lower grade and if ER and/or PR > 10%. Fourteen percent of patients with pre-ODX TR for HT added CT-more likely if ER and/or PR ≤10% and if Ki67 > 15% Overall, TR for CT decreased from 47% to 24%. CONCLUSION Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.
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Affiliation(s)
- L Chin-Lenn
- The Royal Melbourne Hospital, Parkville, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
| | - R H De Boer
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - E Segelov
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - G M Marx
- Sydney Adventist Hospital, Wahroonga, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - T M Hughes
- Sydney Adventist Hospital, Wahroonga, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - N J McCarthy
- ICON Cancer Care Wesley, Auchenflower, QLD, Australia
| | - S C White
- Austin Health, Heidelberg, VIC, Australia
| | - S S Foo
- Epworth Eastern Hospital, Box Hill, VIC, Australia.,St Vincent's Private Hospital, East Melbourne, VIC, Australia
| | - J J Rutovitz
- Northern Haematology and Oncology Group, Wahroonga, NSW, Australia
| | | | - R Jennens
- Epworth Hospital, East Melbourne, Australia
| | | | - D Tsoi
- St John of God Murdoch Hospital, Murdoch, VIC, Australia
| | - M F Cronk
- Sunshine Coast Hospital and Health Services, Nambour, QLD, Australia
| | - J M Lombard
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | - B E Kiely
- Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia
| | | | - A Gorelik
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - G B Mann
- The Royal Melbourne Hospital, Parkville, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
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Aapro M, De Laurentiis M, Rea D, Bargallo Rocha JE, Elizalde R, Landherr L, Linderholm B, Mamounas E, Markopoulos C, Neven P, Petrovsky A, Rouzier R, Smit V, Svedman C, Schneider D, Thomssen C, Martin M. The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2-) breast cancer: When might multigene assays be of value? Breast 2017; 33:191-199. [PMID: 28441617 DOI: 10.1016/j.breast.2017.01.012] [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: 10/31/2015] [Revised: 01/15/2017] [Accepted: 01/23/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions. METHODS The MAGIC survey captured respondents' demographics, practice patterns, relevance of traditional parameters for treatment decisions, and use of or interest in using multigene assays. Using this information, a predictive model was created to simulate treatment recommendations for 672 patient profiles. RESULTS The survey was completed by 911 respondents (879 clinicians, 32 pathologists) from 52 countries. Chemo-endocrine therapy was recommended more often than endocrine therapy alone, but there was substantial heterogeneity in treatment recommendations in 52% of the patient profiles; approximately every fourth physician provided a different treatment recommendation. The majority of physicians indicated they wanted to use multigene assays clinically. Lack of reimbursement/availability were the main reasons for non-usage. CONCLUSIONS The survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2- patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.
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Affiliation(s)
- Matti Aapro
- Genolier Breast Center, Clinic of Genolier, Route du Muids 3, 1272 Genolier, Switzerland.
| | - Michelino De Laurentiis
- Department of Senology, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, 80131 Naples, Italy
| | - Dan Rea
- School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT Birmingham, United Kingdom
| | - Juan Enrique Bargallo Rocha
- Department of Surgery, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI Delegación Tlalpan, 14080 Mexico City, Mexico
| | - Roberto Elizalde
- División Ginecologia y Mastologia, Hospital Dr. I. Pirovano, Av Monroe 3555, 1428 Buenos Aires, Argentina
| | - László Landherr
- Department of Oncoradiology, Uzsoki Teaching Hospital, Uzsoki u. 29-41, 1145 Budapest, Hungary
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska Academy and University Hospital, Per Dubbsgatan 15, 413 45 Gothenburg, Sweden; Department of Oncology/Pathology, Karolinska Institutet, Karolinska Univ Hospital, Z1:00, 171 76 Stockholm, Sweden
| | - Eleftherios Mamounas
- University of Florida Health Cancer Center at Orlando Health, 1400 S. Orange Avenue, 32806 Orlando, FL, USA
| | - Christos Markopoulos
- Department of Surgery, Athens University Medical School, Iassiou Street 8, 11521 Athens, Greece
| | - Patrick Neven
- Multidisciplinary Breast Centre and Gynaecological Oncology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Alexander Petrovsky
- Department of Radiosurgery, Russian Cancer Research Center, 23 Kashirskoye Shosse, Moscow, Russia
| | - Roman Rouzier
- Department of Surgery, Institut Curie-Université Versailles-Saint-Quentin, 35 rue Dailly, 92220 Paris-Saint-Cloud, France
| | - Vincent Smit
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Christer Svedman
- Medical Affairs, Genomic Health, Quai du Sujet 10, Stockholm, Sweden
| | - Daniel Schneider
- International, Genomic Health, Quai du Sujet 10, Geneva, Switzerland
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Miguel Martin
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense, c/Dr Esquerdo 46, 28007 Madrid, Spain
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