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Berg T, Jensen MB, Rossing M, Axelsen CT, Kümler I, Søndergaard L, Vogsen M, Knoop AS, Ejlertsen B. Incidence and survival of primary metastatic breast cancer in Denmark; implication of breast cancer screening, classification, and staging practice. Acta Oncol 2024; 63:277-287. [PMID: 38711384 DOI: 10.2340/1651-226x.2023.37270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/08/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Primary metastatic breast cancer (pMBC) accounts for 5-10% of annual breast cancers with a median survival of 3-4 years, varying among subtypes. In Denmark, the incidence of breast cancer increased until 2010, followed by a stabilisation. Several factors influencing pMBC incidence and survival, including screening prevalence, staging methods, and classification standards, remain pivotal but inadequately documented. MATERIAL AND METHOD This retrospective observational study involving pMBC patients diagnosed between 2000 and 2020 encompassed all Danish oncology departments. Data from the Danish Breast Cancer Group database and the National Patient Register included diagnosis specifics, demographics, treatment, and follow-up. RESULTS Between 2000 and 2020, 3,272 patients were diagnosed with pMBC, a rise from 355 patients in 2000-2004 to 1,323 patients in 2015-2020. The increase was particularly observed in patients aged 70 years or older. Changes in tumour subtypes were observed, notably with a rise in human epidermal growth factor receptor 2 (HER2)-positive cases but a steady distribution of estrogen receptor (ER) status. Diagnostic practices changed over the two decades, with 6% evaluated with PET/CT (positron emission tomography-computed tomography) or CT (computed tomography) with a bone evaluation in 2000-2004 and 65% in 2015-2020. Overall survival (OS) improved from 23 months in 2000-2004 to 33 months in 2015-2020. In patients with ER-positive and HER2-positive disease, the multivariable model showed improved survival by year of diagnosis, and further, patients with ER-negative/HER2-negative disease fared worse the first 2 years after diagnosis. INTERPRETATION Our study delineates changes in the treatment and survival of pMBC over two decades. Stage migration, screening introduction, and changes in registration practice, however, prevent a valid assessment of a possible causal relationship.
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Affiliation(s)
- Tobias Berg
- Danish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Iben Kümler
- Department of Oncology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
| | - Lise Søndergaard
- Department of Oncology, Zealand University Hospital, Næstved Sygehus, Denmark
| | - Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann S Knoop
- anish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bent Ejlertsen
- anish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Munck F, Jensen MB, Vejborg I, Gerlach MK, Maraldo MV, Kroman NT, Tvedskov THF. Residual Axillary Metastases in Node-Positive Breast Cancer Patients After Neoadjuvant Treatment: A Register-Based Study. Ann Surg Oncol 2024:10.1245/s10434-024-15354-1. [PMID: 38704502 DOI: 10.1245/s10434-024-15354-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Lymph node (LN) metastasis after neoadjuvant chemotherapy (NACT) generally warrants axillary lymph node dissection, which opposes guidelines of upfront surgery in many cases. We investigated the risk of having additional metastases in the axilla when the LNs removed by targeted axillary dissection (TAD) harbored metastases after NACT. We aimed to identify subgroups suitable for de-escalated axillary treatment. METHODS This register-based study used data from the Danish Breast Cancer Cooperative Group database. Data were analyzed with logistic regression models. The primary outcome was the metastatic burden in non-TAD LNs in patients with positive TAD LNs after NACT. RESULTS Among 383 patients, < 66.6% positive TAD LNs (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17-0.62), only isolated tumor cells (ITCs) [OR 0.11, 95% CI < 0.01-0.82], and breast pathological complete response (pCR) [OR 0.07, 95% CI < 0.01-0.56] were associated with a low risk of having more than three positive non-TAD LNs. In 315 patients with fewer than three positive non-TAD LNs, the proportion of positive TAD LNs (OR 0.45, 95% CI 0.27-0.76 for 33.3-66.6% vs. > 66.6%), size of the TAD LN metastasis (OR 0.14, 95% CI 0.04-0.54 for ITC vs. macrometastasis), tumor size at diagnosis (OR 0.30, 95% CI 0.15-0.64 for 20-49 mm vs. ≥ 50 mm) and breast pCR (OR 0.38, 95% CI 0.15-0.96) were associated with residual LN metastases in the axilla. CONCLUSIONS Breast pCR or ITC only in TAD LNs can, with reasonable certainty, preclude more than three positive non-TAD LNs. Additionally, patients with only ITCs in the TAD LN had a low risk of having any non-TAD LN metastases after NACT. De-escalated axillary treatment may be considered in both subgroups.
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Affiliation(s)
- Frederikke Munck
- Department of Breast Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark.
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Breast Examinations and Capital Mammography Screening, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Maria K Gerlach
- Department of Pathology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Maja V Maraldo
- Department of Clinical Oncology, Center of Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Tove H F Tvedskov
- Department of Breast Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark
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Andersen HH, Bojesen SE, Johansen JS, Ejlertsen B, Berg T, Tuxen M, Madsen K, Danø H, Flyger H, Jensen MB, Nielsen DL. Prognostic Value of Pretreatment Plasma C-Reactive Protein in Patients with Early-Stage Breast Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:662-670. [PMID: 38358318 DOI: 10.1158/1055-9965.epi-23-1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/22/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Breast cancer incidence is now the highest among all cancers and accountable for 6.6% of all cancer-related deaths worldwide. Studies of the prognostic utility of plasma C-reactive protein (CRP) measurement in early-stage breast cancer have given discrepant results. METHODS We identified 6,942 patients in the Danish Breast Cancer Cooperative Group database with early-stage breast cancer diagnosed between 2002 and 2016 who had a measure of pretreatment plasma CRP. Outcomes were recurrence-free interval and survival for a period up to 10 years. We analyzed associations with plasma CRP using Fine-Gray proportional subdistribution hazards model with recurrence-free interval. Data on plasma CRP were analyzed per doubling of concentration and in relation to CRP levels of <3 mg/L, 3 to 10 mg/L, and >10 mg/L and stratified according to standard clinical parameters in sensitivity analyses. RESULTS A doubling of the plasma CRP concentration was associated with increased risk of recurrence (multivariate adjusted HR, 1.05; 95% CI, 1.01-1.08) and shorter survival (HR, 1.13; 95% CI, 1.09-1.16) in multivariate analyses. Survival was shorter in patients with plasma CRP levels of 3 to 10 and >10 mg/L versus <3 mg/L, with multivariate adjusted HRs of 1.30; 95% CI, 1.17-1.45 and 1.65; 95% CI, 1.39-1.95, respectively. CONCLUSIONS Elevated plasma CRP measured before treatment in patients with early-stage breast cancer is an independent biomarker of increased risk of recurrence and early death. IMPACT CRP measures before treatment might be used to individualize follow-up of patients with early-stage breast cancer.
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Affiliation(s)
- Høgni H Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Stig E Bojesen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Julia S Johansen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group (DBCG), Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group (DBCG), Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Malgorzata Tuxen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Kasper Madsen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Hella Danø
- Department of Oncology, North Zealand Hospital, Hillerød, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group (DBCG), Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dorte L Nielsen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Berg T, Jensen MB, Celik A, Talman ML, Misiakou MA, Knoop AS, Nielsen FC, Ejlertsen B, Rossing M. Molecular subtyping improves breast cancer diagnosis in the Copenhagen Breast Cancer Genomics Study. JCI Insight 2024; 9:e178114. [PMID: 38587073 DOI: 10.1172/jci.insight.178114] [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: 11/30/2023] [Accepted: 02/16/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUNDIntrinsic molecular subtypes define distinct biological breast cancers and can be used to further improve diagnosis and risk allocation.METHODSThe Copenhagen Breast Cancer Genomics Study (CBCGS) prospectively included women diagnosed with breast cancer at Rigshospitalet from 2014 to 2021. Eligible patients were females with a primary invasive breast cancer (T1c, if N0M0; otherwise, any T, any N, or any M stage) and no prior malignancy. All patients underwent molecular profiling with the CIT256 and PAM50 molecular profile.RESULTSIn the study period, 2,816 patients were included in the CBCGS. Molecular subtyping showed an increase in nonluminal (molecular-apocrine, luminal C, and Basal-like) as compared with luminal (luminal A, luminal B, and Normal-like) subtypes with increasing stage from I to IV. Across all stages, we found a significant difference in survival among subtypes; 91% of patients with LumA were alive at 5 years compared with 91% for LumB, 84% for LumC, 82% for mApo, and 80% for Basal-like. We identified 442 tumors (16%) that were discordant in subtype between CIT256 and IHC. Discordant subtype proved to be a risk factor of death among patients with IHC luminal breast cancer (hazard ratio [HR], 2.08; 95% CI, 1.51-2.86) in a multivariable Cox regression analysis. Discordance occurred more often among patients with N3, stage IV, or grade III disease.CONCLUSIONOur findings indicate that molecular subtypes are a predominant classification for survival. Assessment is particularly crucial for patients with IHC luminal breast cancer with known high-risk factors, since they are at an increased risk of harboring an aggressive molecular subtype.
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Affiliation(s)
- Tobias Berg
- Danish Breast Cancer Group
- Department of Clinical Oncology
- Center for Genomic Medicine, and
| | | | | | - Maj-Lis Talman
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Finn Cilius Nielsen
- Center for Genomic Medicine, and
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group
- Department of Clinical Oncology
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, and
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Berg T, Jensen MB, Rossing M, Bechmann T, Donskov F, Knoop AS, Ejlertsen B. Development and Methodological Validation of a Modified Staging System for de Novo Metastatic Breast Cancer. JAMA Netw Open 2024; 7:e242174. [PMID: 38477916 PMCID: PMC10938173 DOI: 10.1001/jamanetworkopen.2024.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Importance Validation of a new method for prognostication of de novo metastatic breast cancer (dnMBC) to better reflect the heterogenecity of the disease. Objective To perform external methodological validation of the Plichta staging system, a novel prognostic system for de novo metastatic breast cancer (dnMBC). Design, Setting, and Participants This retrospective cohort study used a multicenter, nationwide, population-based Danish Breast Cancer Group database to validate the new method. Participants were patients with dnMBC diagnosed between 2010 and 2019. Data were analyzed from April to June 2023. Main outcomes and measures A recursive partitioning analysis (RPA) was performed, as demonstrated by Plichta and colleagues, to group patients with similar overall survival (OS) based on clinical factors. The main outcome was to group patients into 4 prognostic groups based on 3-year OS as stage IVa, greater than 70%; stage IVb, 50% to 70%; stage IVc, 25% to less than 50%; or stage IVd, less than 25%. Bootstrapping was applied for 1000 iterations, with final stage assignments based on the most commonly occurring assignment. Results A total of 1859 women were included with a median (IQR) age of 69 (57-77) years. With a median potential follow-up of 89.9 (95% CI, 86.4-95.1) months and a median OS of 31.7 (95% CI, 29.5-34.1) months, the RPA stratified patients into 10 groups, with organ sites, estrogen receptor status, and human epidermal growth factor receptor 2 status as the key clinical factors. Three-year survival rates ranged from 62% (95% CI, 56%-69%) to 8% (95% CI, 3%-21%), which were further combined into 3 stage groups: IVb, 59.4% (95% CI, 56.2%-62.8%); IVc, 39.4% (95% CI, 36.2%-43.0%); and IVd, 15.4% (95% CI, 11.2%-21.3%) (P < .001). Following bootstrapping, an IVa group emerged, resulting in 4 stage groups with separate 3-year OS rates identified as IVa, 75.8% (95% CI, 67.8%-84.7%); IVb, 58.8% (95% CI, 55.5%-62.3%); IVc, 39.2% (95% CI, 35.8%-43.0%); and IVd, 14.4% (95% CI, 10.8%-19.4%) (P < .001). Conclusions and relevance These findings provide external and independent validation of the methods applied in the novel Plichta staging system for dnMBC. This could guide future revisions of the current American Joint Committee on Cancer staging guidelines and may be incorporated as a stratification factor in clinical trials.
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Affiliation(s)
- Tobias Berg
- Danish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Troels Bechmann
- Department of Oncology, Regional Hospital West Jutland, Herning, Denmark
| | - Frede Donskov
- Department of Oncology, Southern Denmark University Hospital, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ann Søegaard Knoop
- Danish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nielsen JM, Humaidan P, Jensen MB, Alsbjerg B. Early pregnancy bleeding after assisted reproductive technology: a systematic review and secondary data analysis from 320 patients undergoing hormone replacement therapy frozen embryo transfer. Hum Reprod 2023; 38:2373-2381. [PMID: 37897214 DOI: 10.1093/humrep/dead218] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/14/2023] [Indexed: 10/29/2023] Open
Abstract
STUDY QUESTION How common is bleeding in early pregnancy after Hormone Replacement Therapy (HRT) Frozen Embryo Transfer (FET) and does bleeding affect the reproductive outcome? SUMMARY ANSWER A total of 47% of HRT-FET patients experience bleeding before the eighth week of gestation, however, bleeding does not affect the reproductive outcome. WHAT IS KNOWN ALREADY Bleeding occurs in 20% of spontaneously conceived pregnancies, although most will proceed to term. However, our knowledge regarding bleeding in early pregnancy after HRT-FET and the reproductive outcome is sparse. STUDY DESIGN, SIZE, DURATION We performed a systematic review of the existing literature on early pregnancy bleeding after assisted reproductive technology (ART) to evaluate the bleeding prevalence and resulting reproductive outcome in this population. A random-effects proportional meta-analysis was conducted. Subsequently, we performed a prospective cohort study including 320 pregnant patients undergoing HRT-FET and a secondary analysis of the cohort study was performed to evaluate bleeding prevalence and reproductive outcome. The trial was conducted from January 2020 to November 2022 in a public fertility clinic. PARTICIPANTS/MATERIALS, SETTING, METHODS A systematic literature search was performed, using MESH terms and included studies with data from ART patients and with early pregnancy bleeding as a separate outcome. The cohort study included patients with autologous vitrified blastocyst transfer treated in an HRT-FET protocol. In the event of a positive HCG-test, an early pregnancy scan was performed around 8 weeks of gestation. During this visit, patients answered a questionnaire regarding bleeding or spotting and its duration after the positive pregnancy test. The information was verified through medical files, and these were used to obtain information on reproductive outcomes. MAIN RESULTS AND THE ROLE OF CHANCE The review revealed a total of 12 studies of interest. The studies reported a prevalence of early pregnancy bleeding ranging from 2.1% to 36.2%. The random effects proportional meta-analysis resulted in a pooled effect estimate of the prevalence of early pregnancy bleeding in the ART population of 18.1% (95% CI (10.5; 27.1)). Four of the included studies included data on miscarriage rate following an episode of bleeding. All four studies showed a significantly increased risk of miscarriage in patients with early pregnancy bleeding as compared to patients with no history of bleeding. No studies investigated bleeding after HRT-FET specifically. In our HRT-FET cohort study, we found that a total of 47% (149/320) of patients with a positive pregnancy test experienced bleeding before 8 weeks of gestation. Generally, the bleeding was described as spotting with a median of 2 days (range 0.5-16 days). Out of 149 patients with one or several bleeding episodes, a total of 106 patients (71%) had an ongoing pregnancy at 12 weeks of gestation. In comparison, 171 patients reported no bleeding episodes and a total of 115 (67%) of these patients had an ongoing pregnancy at 12 weeks of gestation. This difference was not significant (P = 0.45). Furthermore there was no difference in the live birth rate between the two groups (P = 0.29). LIMITATIONS, REASONS FOR CAUTION Most studies included in the review were older and not all studies specified the type of ART. Moreover, the studies were of moderate methodological quality. The patients in the cohort study were treated in a personalized HRT-FET protocol using a rectal supplementary rescue regimen if serum progesterone levels were <35 nmol/l at embryo transfer. The results may not be applicable to other FET protocols, and the present data were based on self-reported symptoms. The systematic review revealed an increased risk of miscarriage following an episode of early pregnancy bleeding. However our cohort study found no such association. This discrepancy can partly be due to the fact, that the four studies in the review only included episodes of heavy bleeding. Also, none of the four studies included data on HRT-FET cycles making them unfit for direct comparison. WIDER IMPLICATIONS OF THE FINDINGS Episodes of early bleeding during pregnancy are associated with distress for the pregnant woman, especially in a cohort of infertile patients. Our cohort study showed that at least minor bleeding seems to be a common adverse event of early pregnancy after HRT-FET. From the systematic review, it seems that this prevalence is higher than what has previously been described in relation to other types of ART. However, minor bleeding during early pregnancy after HRT-FET does not seem to affect the reproductive outcome. Knowledge regarding the frequent occurrence of bleeding during early pregnancy after HRT-FET and the fact that this should not be used as a prognostic parameter will help the clinician in counselling patients. STUDY FUNDING/COMPETING INTEREST(S) Gedeon Richter Nordic supported this investigator-initiated study with an unrestricted grant as well as study medication (Cyclogest). B.A. has received an unrestricted grant from Gedeon Richter Nordic and Merck and honoraria for lectures from Gedeon Richter, Merck, IBSA, and Marckyrl Pharma. P.H. received honoraria for lectures from Merck, Gedeon Richter, Institut Biochimique SA (IBSA), and Besins as well as unrestricted research grants from Merck, Gedeon Richter, and Institut Biochimique SA (IBSA). The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER EudraCT no.: 2019-001539-29.
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Affiliation(s)
- J M Nielsen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - P Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M B Jensen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - B Alsbjerg
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Reznitsky FM, Jensen JD, Knoop A, Jensen MB, Laenkholm AV. Evaluation of tumor-infiltrating lymphocytes, PD-L1, and PIK3CA mutations and association with prognosis in HER2-positive early stage breast cancer. Acta Oncol 2023; 62:1913-1920. [PMID: 37961947 DOI: 10.1080/0284186x.2023.2279685] [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: 08/19/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Tumor-infiltrating lymphocytes (TILs) have predictive and prognostic potential in HER2-positive breast cancer (HER2+ BC). Programmed death-ligand 1 (PD-L1) is an immune checkpoint protein, with important roles in the tumor microenvironment, possibly in both tumor and immune cells (ICs), providing rationale for targeting with immune-checkpoint therapy. PIK3CA mutations are oncogenic, activating mutations, which are also of relevance in breast cancer. Herein, we investigate the frequency of TILs, PD-L1 and PIK3CA mutations, and whether these factors influence outcome, in early HER2+ BC. MATERIALS AND METHODS Stromal TILs (sTILs) and PD-L1 expressions were assessed using full tumor-sections and TMA, respectively, from 236 patients with HER2+ BC. TILs were assessed, according to a standardized method, as continuous measurement and according to three predefined categories: low (0-10%), intermediate (11-59%), and high (60-100%). PD-L1 immunohistochemistry (Ventana SP263) was evaluated and positivity defined as ≥1% expression in tumor and ICs. PIK3CA mutations (exons 9 and 20) were determined by pyrosequencing. RESULTS Fourteen percent of patients had high sTILs and 25% had a PIK3CA mutation. PD-L1 expression was more frequent in ICs (68%) than tumor cells (24%). Patients with low sTILs had a significantly worse overall survival (multivariate: HR 2.80; 95% CI 1.36-5.78; p = .02). DISCUSSION Patients with low sTILs had a significantly poorer survival, despite adequate treatment with adjuvant therapy.
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Affiliation(s)
- Frances M Reznitsky
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Ann Knoop
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Copenhagen, Denmark
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Nielsen K, Sode M, Jensen MB, Berg T, Knoop A, Ejlertsen B, Lænkholm AV. High inter-laboratory variability in the assessment of HER2-low breast cancer: a national registry study on 50,714 Danish patients. Breast Cancer Res 2023; 25:139. [PMID: 37946261 PMCID: PMC10636935 DOI: 10.1186/s13058-023-01739-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Considering the recent advancements in the treatment of breast cancer with low expression of human epidermal growth factor receptor 2 (HER2), we aimed to examine inter-laboratory variability in the assessment of HER2-low breast cancer across all Danish pathology departments. METHODS From the Danish Breast Cancer Group, we obtained data on all women diagnosed with primary invasive breast cancer in 2007-2019 who were subsequently assigned for curatively intended treatment. RESULTS Of 50,714 patients, HER2 score and status were recorded for 48,382, among whom 59.2% belonged to the HER2-low group (score 1+ or 2+ without gene amplification), 26.8% had a HER2 score of 0, and 14.0% were HER2 positive. The proportion of HER2-low cases ranged from 46.3 to 71.8% among pathology departments (P < 0.0001) and from 49.3 to 65.6% over the years (P < 0.0001). In comparison, HER2 positivity rates ranged from 11.8 to 17.2% among departments (P < 0.0001) and from 12.6 to 15.7% over the years (P = 0.005). In the eight departments with the highest number of patients, variability in HER2-low cases increased from 2011 to 2019, although the same immunohistochemical assay was used. By multivariable logistic regression, the examining department was significantly related to both HER2 score 0 and HER2 positivity (P < 0.0001) but showed greater dispersion in odds ratios in the former case (range 0.25-1.41 vs. 0.84-1.27). CONCLUSIONS Our data showed high inter-laboratory variability in the assessment of HER2-low breast cancer. The findings cast doubt on whether the current test method for HER2 is robust and reliable enough to select HER2-low patients for HER2-targeted treatment in daily clinical practice.
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Affiliation(s)
- Kåre Nielsen
- Department of Pathology, Zealand University Hospital, Sygehusvej 9, 4000, Roskilde, Denmark.
- University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark.
| | - Michael Sode
- Department of Pathology, Zealand University Hospital, Sygehusvej 9, 4000, Roskilde, Denmark
- University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, DBCG, Rigshospitalet (Copenhagen University Hospital), Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group, DBCG, Rigshospitalet (Copenhagen University Hospital), Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet (Copenhagen University Hospital), Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ann Knoop
- University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet (Copenhagen University Hospital), Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Bent Ejlertsen
- University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Danish Breast Cancer Group, DBCG, Rigshospitalet (Copenhagen University Hospital), Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet (Copenhagen University Hospital), Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Pathology, Zealand University Hospital, Sygehusvej 9, 4000, Roskilde, Denmark
- University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
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Alsbjerg B, Jensen MB, Povlsen BB, Elbaek HO, Laursen RJ, Kesmodel US, Humaidan P. Rectal progesterone administration secures a high ongoing pregnancy rate in a personalized Hormone Replacement Therapy Frozen Embryo Transfer (HRT-FET) protocol: a prospective interventional study. Hum Reprod 2023; 38:2221-2229. [PMID: 37759346 PMCID: PMC10628493 DOI: 10.1093/humrep/dead185] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/11/2023] [Indexed: 09/29/2023] Open
Abstract
STUDY QUESTION Can supplementation with rectal administration of progesterone secure high ongoing pregnancy rates (OPRs) in patients with low serum progesterone (P4) on the day of blastocyst transfer (ET)? SUMMARY ANSWER Rectally administered progesterone commencing on the ET day secures high OPRs in patients with serum P4 levels below 35 nmol/l (11 ng/ml). WHAT IS KNOWN ALREADY Low serum P4 levels at peri-implantation in Hormone Replacement Therapy Frozen Embryo Transfer (HRT-FET) cycles impact reproductive outcomes negatively. However, studies have shown that patients with low P4 after a standard vaginal progesterone treatment can obtain live birth rates (LBRs) comparable to patients with optimal P4 levels if they receive additionalsubcutaneous progesterone, starting around the day of blastocyst transfer. In contrast, increasing vaginal progesterone supplementation in low serum P4 patients does not increase LBR. Another route of administration rarely used in ART is the rectal route, despite the fact that progesterone is well absorbed and serum P4 levels reach a maximum level after ∼2 h. STUDY DESIGN, SIZE, DURATION This prospective interventional study included a cohort of 488 HRT-FET cycles, in which a total of 374 patients had serum P4 levels ≥35 nmol/l (11 ng/ml) at ET, and 114 patients had serum P4 levels <35 nmol/l (11 ng/ml). The study was conducted from January 2020 to November 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients underwent HRT-FET in a public Fertility Clinic, and endometrial preparation included oral oestradiol (6 mg/24 h), followed by vaginal micronized progesterone, 400 mg/12 h. Blastocyst transfer and P4 measurements were performed on the sixth day of progesterone administration. In patients with serum P4 <35 nmol/l (11 ng/ml), 'rescue' was performed by rectal administration of progesterone (400 mg/12 h) starting that same day. In pregnant patients, rectal administration continued until Week 8 of gestation, and oestradiol and vaginal progesterone treatment continued until Week 10 of gestation. MAIN RESULTS AND THE ROLE OF CHANCE Among 488 HRT-FET single blastocyst transfers, the mean age of the patients at oocyte retrieval (OR) was 30.9 ± 4.6 years and the mean BMI at ET 25.1 ± 3.5 kg/m2. The mean serum P4 level after vaginal progesterone administration on the day of ET was 48.9 ± 21.0 nmol/l (15.4 ± 6.6 ng/ml), and a total of 23% (114/488) of the patients had a serum P4 level lower than 35 nmol/l (11 ng/ml). The overall, positive hCG rate, clinical pregnancy rate, OPR week 12, and total pregnancy loss rate were 66% (320/488), 54% (265/488), 45% (221/488), and 31% (99/320), respectively. There was no significant difference in either OPR week 12 or total pregnancy loss rate between patients with P4 ≥35 nmol/l (11 ng/ml) and patients with P4 <35 nmol/l, who received rescue in terms of rectally administered progesterone, 45% versus 46%, P = 0.77 and 30% versus 34%, P = 0.53, respectively. OPR did not differ whether patients had initially low P4 and rectal rescue or were above the P4 cut-off. Logistic regression analysis showed that only age at OR and blastocyst scoring correlated with OPR week 12, independently of other factors like BMI and vitrification day of blastocysts (Day 5 or 6). LIMITATIONS, REASONS FOR CAUTION In this study, vaginal micronized progesterone pessaries, a solid pessary with progesterone suspended in vegetable hard fat, were used vaginally as well as rectally. It is unknown whether other vaginal progesterone products, such as capsules, gel, or tablet, could be used rectally with the same rescue effect. WIDER IMPLICATIONS OF THE FINDINGS A substantial part of HRT-FET patients receiving vaginal progesterone treatment has lowserum P4. Adding rectally administered progesterone in these patients increases the reproductive outcome. Importantly, rectal progesterone administration is considered convenient, and progesterone pessaries are easy to administer rectally and of low cost. STUDY FUNDING/COMPETING INTEREST(S) Gedeon Richter Nordic supported the study with an unrestricted grant as well as study medication. B.A. has received unrestricted grant from Gedeon Richter Nordic and Merck and honoraria for lectures from Gedeon Richter, Merck, IBSA and Marckyrl Pharma. P.H. has received honoraria for lectures from Gedeon Richter, Merck, IBSA and U.S.K. has received grant from Gedeon Richter Nordic, IBSA and Merck for studies outside this work and honoraria for teaching from Merck and Thillotts Pharma AB and conference expenses covered by Merck. The other co-authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER (25) EudraCT no.: 2019-001539-29.
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Affiliation(s)
- B Alsbjerg
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M B Jensen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - B B Povlsen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - H O Elbaek
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - R J Laursen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - U S Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - P Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Celik A, Berg T, Jensen MB, Jakobsen E, Nielsen HM, Kümler I, Glavicic V, Jensen JD, Knoop A. Real-World Survival and Treatment Regimens Across First- to Third-Line Treatment for Advanced Triple-Negative Breast Cancer. Breast Cancer (Auckl) 2023; 17:11782234231203292. [PMID: 37810797 PMCID: PMC10552450 DOI: 10.1177/11782234231203292] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Metastatic triple-negative breast cancer (mTNBC) is an aggressive subtype of breast cancer with poor survival. Currently, the literature lacks comprehensive real-world evidence on locally recurrent and mTNBC patients. To validate the optimal treatment for patients with mTNBC, real-world evidence in combination with data from clinical trials must be evaluated as complementary. Objectives The objective of the study is to examine outcomes and treatment patterns of patients with advanced triple-negative breast cancer (TNBC) utilizing real-world data of patients from all oncology sites across Denmark. Design This is a retrospective, non-interventional, multi-site, population-based observational study conducted across all oncology departments in Denmark. Methods We included all women diagnosed with metastatic or locally recurrent TNBC from January 1, 2017, to December 31, 2019, using the national Danish Breast Cancer Group database. The primary endpoints were overall survival (OS) and progression-free survival (PFS) in the first to third treatment line. Results The study included 243 women diagnosed with metastatic or recurrent TNBC. The median OS (mOS) was 11.6 months after the first line of treatment, 6.5 months after the second line, and 6.5 months after the third line. De novo mTNBC was associated with shorter OS (mOS: 8.3 vs 14.2 months), and those with a relapse within 18 months of primary diagnosis had shorter OS than those with a relapse after 18 months (mOS: 10.0 vs 18.2). In the first line, taxane was the preferred choice of treatment for patients with de novo mTNBC, whereas capecitabine was preferred for patients with recurrent TNBC. Conclusions This real-world, nationwide study demonstrated poor OS among patients with metastatic or recurrent TNBC, with a mOS of 11.6 months (95% CI, 9.9-17.3). Patients who presented with de novo mTNBC or who had a relapse of their breast cancer within 18 months of primary diagnosis had shorter OS. Registration The study was registered and approved by the Danish Capital Regions research overview (P-2021-605).
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Affiliation(s)
- Alan Celik
- Danish Breast Cancer Group (DBCG), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group (DBCG), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group (DBCG), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Oncology, Hospital of Southern Jutland Sonderborg Branch, Sonderborg, Denmark
| | | | - Iben Kümler
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Vesna Glavicic
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | | | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Welk A, Otten ND, Jensen MB. Invited review: The effect of milk feeding practices on dairy calf behavior, health, and performance-A systematic review. J Dairy Sci 2023; 106:5853-5879. [PMID: 37474370 DOI: 10.3168/jds.2022-22900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/20/2023] [Indexed: 07/22/2023]
Abstract
The aim of this systematic review was to summarize the literature assessing the effects of milk feeding practices on behavior, health, and performance on dairy calves. Peer-reviewed, published articles, written in English, directly comparing the effects of milk allowance, milk feeding methods, or milk feeding frequency on dairy calves were eligible for inclusion. Outcome measures could include sucking behavior, sucking on a teat (nutritive sucking, non-nutritive sucking on a teat), abnormal sucking behavior (non-nutritive sucking on pen fixtures, other oral behaviors, or cross-sucking), signs of hunger (vocalizations or unrewarded visits at the milk feeder), activity (lying time or locomotor play), feeding behavior (milk intake, starter intake, milk meal duration, or starter meal duration), growth (body weight or average daily gain), and health (occurrence of diarrhea, respiratory disease, or mortality). We conducted 2 targeted searches using Web of Science and PubMed to identify key literature. The resulting articles underwent a 2-step screening process. This process resulted in a final sample of 94 studies. The majority of studies investigated milk allowance (n = 69). Feeding higher milk allowances had a positive or desirable effect on growth, reduced signs of hunger, and increased locomotor play behavior during the preweaning period, whereas starter intake was reduced. Studies addressing health pointed to no effect of milk allowance, with no consistent evidence indicating that higher milk allowances result in diarrhea. Studies addressing milk feeding methods (n = 14) found that feeding milk by teat reduced cross-sucking and other abnormal oral behaviors. However, results on the effect of access to a dry teat were few and mixed. Milk feeding frequency (n = 14 studies) appeared to have little effect on feed intakes and growth; however, there is some evidence that calves with lower feeding frequency experience hunger. Overall, findings strongly suggest feeding higher volumes of milk using a teat; however, further work is needed to determine the optimal feeding frequency for dairy calves.
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Affiliation(s)
- A Welk
- Department of Animal and Veterinary Sciences, Aarhus University, 8830 Tjele, Denmark
| | - N D Otten
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark
| | - M B Jensen
- Department of Animal and Veterinary Sciences, Aarhus University, 8830 Tjele, Denmark.
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Garly R, Knoop A, Jensen MB, Berg T, Nielsen HM, Kümler I. Atezolizumab and nab-paclitaxel for advanced breast cancer in Danish real-world patients. Dan Med J 2023; 70:A01230034. [PMID: 37622644] [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] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The Danish Medicines Council recommends that patients with estrogen receptor and human epidermal growth factor receptor 2-negative, programmed death-ligand 1 (PD-L1)-positive advanced breast cancer receive atezolizumab in combination with nab-paclitaxel. The approval was largely based on results from Impassion130 that showed a beneficial progression-free survival (PFS) and overall survival (OS) in PD-L1-positive patients who received atezolizumab and nab-paclitaxel. METHODS We conducted a retrospective, population-based study that included patients who received atezolizumab for advanced breast cancer from October 2019 to September 2022. The primary endpoints were PFS and OS. RESULTS This study included 74 advanced breast cancer patients. Their median age was 54.5 years, and 21 (28.4%) of the patients had de novo advanced disease. Most patients received first-line treatment with atezolizumab (83.8%). The median PFS was 6.0 months (95% confidence interval (CI): 4.7-8.4 months) and the median OS was 14.3 months (95% CI: 9.9-22.2 months). A total of 48 patients received atezolizumab and nab-paclitaxel in accordance with guidelines from the Danish Medicines Council. CONCLUSIONS This real-world study expectedly showed numerically lower survival outcomes than the phase III trial Impassion130, but met the standards of efficacy set by real-world studies in other countries. A need exists for increased attention to the criteria for receiving atezolizumab. FUNDING none. TRIAL REGISTRATION The study was approved by the Oncological Committee of the DBCG, the Research Overview of the Capital (P-2022-828) and the Centre for Health of the Capital Region (R-22060674).
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Affiliation(s)
- Rasmus Garly
- Danish Breast Cancer Cooperative Group (DBCG), Copenhagen University Hospital - Rigshospitalet
| | - Ann Knoop
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG), Copenhagen University Hospital - Rigshospitalet
| | - Tobias Berg
- Danish Breast Cancer Cooperative Group (DBCG), Copenhagen University Hospital - Rigshospitalet
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet
| | | | - Iben Kümler
- Department of Oncology, Copenhagen University Hospital - Herlev Hospital, Denmark
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Cold S, Jensen MB, Ejlertsen B. Response to Van Cauwenberge, Borremans, Van Houdt, et al. J Natl Cancer Inst 2023; 115:1000. [PMID: 37216920 PMCID: PMC10407702 DOI: 10.1093/jnci/djad088] [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] [Received: 03/31/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Artzi D, Berg T, Celik A, Kümler I, Kenholm J, Al-Rawi S, Jensen MB, Andersson M, Knoop A. Real-world survival of Danish patients with HER2-positive metastatic breast cancer. Acta Oncol 2023:1-7. [PMID: 37338513 DOI: 10.1080/0284186x.2023.2224926] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND The purpose was to investigate the treatment flow of patients with HER2-positive metastatic breast cancer (mBC), progression-free survival (PFS) and overall survival (OS) across treatment lines and adherence to guidelines (defined as trastuzumab, pertuzumab and chemotherapy first line, where 85% received vinorelbine as backbone and T-DM1 second line). Furthermore, we identified clinical markers to predict the risk of developing brain metastases. MATERIAL AND METHODS Patients with HER2-positive mBC, diagnosed between 01.01.2014-31.12.2019, registered in the database of the Danish Breast Cancer Group were included in this real-word study. Clinical follow-up was assessed until 01.10.2020 and complete follow-up for overall survival until 01.10.2021. Survival data were analyzed using the Kaplan-Meier method with guidelines adherence analyzed as a time-varying covariate, and the risk of CNS metastasis was estimated by the cumulative incidence function. RESULTS 631 patients were included. 329 (52%) patients followed the guidelines. The median OS for all patients was 42.3 months (95% Cl, 38.2-48.4), and significantly higher for the patients who followed guidelines; NA (95% CI, 78.2-NA). The median PFS for all patients was 13.4 months (95% Cl, 12.1-14.8), 6.6 (95% Cl, 5.8-7.6) and 5.8 (95% Cl, 4.9-6.9) for first, second and third line of treatment, respectively. Patients with ER-negative mBC had a higher risk of developing brain metastases and patients with high tumor burden had a higher risk of developing brain metastases with an adjusted HR of 0.69 (95% CI, 0.49-0.98), p = 0.047 and 2.69 (95% CI, 1.45-5.00), p = 0.002, respectively. CONCLUSION We found that only half of the patients with HER2-positive mBC, received first and second-line treatment according to national guidelines. Patients receiving treatment according to guidelines had a significantly higher median OS compared to patients who did not. We also found that patients with ER-negative disease or high tumor burden had a significantly higher risk of developing brain metastases.
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Affiliation(s)
- Daniel Artzi
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias Berg
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alan Celik
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Iben Kümler
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Julia Kenholm
- Department of Oncology, Gødstrup Hospital, Gødstrup, Herning, Denmark
| | - Sami Al-Rawi
- Department of Oncology, Næstved Hospital, Næstved, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Andersson
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Lauritzen AD, Berg T, Jensen MB, Lillholm M, Knoop A. Identifying recurrent breast cancer patients in national health registries using machine learning. Acta Oncol 2023; 62:350-357. [PMID: 37074036 DOI: 10.1080/0284186x.2023.2201687] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND More than 4500 women are diagnosed with breast cancer each year in Denmark, however, despite adequate treatment 10-30% of patients will experience a recurrence. The Danish Breast Cancer Group (DBCG) stores information on breast cancer recurrence but to improve data completeness automated identification of patients with recurrence is needed. METHODS We included patient data from the DBCG, the National Pathology Database, and the National Patient Registry for patients with an invasive breast cancer diagnosis after 1999. In total, relevant features of 79,483 patients with a definitive surgery were extracted. A machine learning (ML) model was trained, using a simplistic encoding scheme of features, on a development sample covering 5333 patients with known recurrence and three times as many non-recurrent women. The model was validated in a validation sample consisting of 1006 patients with unknown recurrence status. RESULTS The ML model identified patients with recurrence with AUC-ROC of 0.93 (95% CI: 0.93-0.94) in the development, and an AUC-ROC of 0.86 (95% CI: 0.83-0.88) in the validation sample. CONCLUSION An off-the-shelf ML model, trained using the simplistic encoding scheme, could identify recurrence patients across multiple national registries. This approach might potentially enable researchers and clinicians to better and faster identify patients with recurrence and reduce manual patient data interpretation.
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Affiliation(s)
| | - Tobias Berg
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Danish Breast Cancer Group, Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Martin Lillholm
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Ann Knoop
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Garly R, Berg T, Jensen MB, Knoop A, Volmer L, Glavicic V, Khan H, Poulsen PB, Olsen J, Kümler I. A retrospective, non-interventional study of breast cancer patients diagnosed with ER+/HER2 negative, locally advanced or metastatic breast cancer treated with palbociclib in Denmark. Acta Oncol 2023; 62:290-297. [PMID: 37010239 DOI: 10.1080/0284186x.2023.2194030] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND The recommended first-line treatment for advanced, ER+/HER2 negative breast cancer is a CDK 4/6 inhibitor in combination with an endocrine backbone. This study investigated the use of palbociclib, as first- or second-line therapy for advanced breast cancer patients in a real-world setting. MATERIAL AND METHODS This retrospective, population-based study included all Danish, advanced breast cancer patients with ER+/HER2 negative disease who initiated first- or second-line treatment with palbociclib from January 1st, 2017, until December 31st, 2020. The primary outcomes were PFS and OS. RESULTS The study included 1054 advanced breast cancer patients with a mean age of 66.8 years. Median OS was 51.7 months (95% CI, 44.9-54.6) for all patients in the first-line setting (n = 728) and median PFS was 24.3 months (95% CI, 21.7-27.8). Patients treated in second line (n = 326) had a median OS of 32.5 months (95% CI, 29.9-35.9) and a median PFS of 13.6 months (95% CI, 11.5-15.7). In first-line setting, the PFS and OS were significantly different for endocrine sensitive patients treated with AI (aromatase inhibitor) (n = 423) vs. fulvestrant (n = 158) as endocrine backbone to palbociclib (median PFS AI 31.3 months vs fulvestrant 19.9 months, p = 0.002 and median OS AI 56.9 months vs. fulvestrant 43.6 months, p = 0.001). In endocrine resistant patients (n = 145), no statistically significant difference in PFS was shown (median PFS AI 21.5 months vs. fulvestrant 12.0 months, p = 0.09), whereas OS was significantly different (median OS AI 43.5 months vs. fulvestrant 28.8 months, p = 0.02). CONCLUSION In this real-world study, treatment with palbociclib combination therapy met the standards of efficacy set by the phase III trials, PALOMA-2 and PALOMA-3, and the standards set by real-world studies in other countries. The study showed significantly different outcomes in terms of PFS and OS in endocrine sensitive patients comparing AI vs. fulvestrant as endocrine backbone to palbociclib as first-line therapy.
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Affiliation(s)
- Rasmus Garly
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Volmer
- Department of Oncology, Vejle Hospital, Vejle, Denmark
| | - Vesna Glavicic
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | | | | | | | - Iben Kümler
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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Due A, Berg T, Jensen MB, Yammeni S, Volmer L, Brems-Eskildsen AS, Andersen KK, Rana S, Knoop A, Kümler I. A nationwide observational study in heavily pretreated metastatic HER2-positive breast cancer patients. Acta Oncol 2023; 62:126-133. [PMID: 36929759 DOI: 10.1080/0284186x.2023.2176257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Current guidelines in HER2-positive metastatic breast cancer (mBC) recommend the combination of trastuzumab and a chemotherapeutic agent for 3rd line or later treatments. This study aims to describe the treatment of HER2-positive mBC in 3rd line or later after previous treatment with T-DM1 for mBC in a real-world setting. MATERIAL AND METHODS This observational population-based study included all women diagnosed with HER2-positive mBC in Denmark, previously treated with T-DM1 in the metastatic setting. Patients were included on the date of progression leading to initiation of 3rd line treatment if the patient had received T-DM1 in 1st or 2nd line. If the patient received T-DM1 in 3rd line or later the inclusion was based on the date of progression on T-DM1. The primary end points were overall survival (OS) and progression-free survival (PFS). RESULTS The study included 272 women with a mean age of 59 (27-86) and a median of 3 (2-11) treatment lines prior to inclusion. At index, all patients had received T-DM1 and 167 (62%) patients had received pertuzumab in the metastatic setting. During follow-up 183 patients received chemotherapy. Of these patients, 120 received chemotherapy combined with trastuzumab, 50 received chemotherapy combined with other HER2-targeted therapy, and 13 received chemotherapy as monotherapy. The remaining 89 patients received either HER2-targeted monotherapy (41), endocrine therapy (31), experimental treatment (10), or no treatment (7). Median PFS was 5.5 months (95% CI, 4.8-6.5) and median OS was 18.5 months (95% CI, 16.2-21.3). CONCLUSION In this real-world study, we found that patients were treated with a wide variety of anti-cancer agents with modest efficacy. However, patients in this study did not have access to newer therapies like tucatinib and T-DXd.
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Affiliation(s)
- Asbjørn Due
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sophie Yammeni
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Lone Volmer
- Department of Oncology, Sygehus Lillebælt Syddansk Universitets Hospital, Vejle Sygehus, Denmark
| | | | | | - Saeeda Rana
- Daiichi-Sankyo Nordics ApS, Munchen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Iben Kümler
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
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Cold S, Cold F, Jensen MB, Cronin-Fenton D, Christiansen P, Ejlertsen B. Response to Pederson et al. and Chlebowski et al. J Natl Cancer Inst 2023; 115:229-230. [PMID: 36409030 PMCID: PMC9905950 DOI: 10.1093/jnci/djac214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Frederik Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Clinical Institute, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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19
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Offersen BV, Alsner J, Nielsen HM, Jakobsen EH, Nielsen MH, Stenbygaard L, Pedersen AN, Thomsen MS, Yates E, Berg M, Lorenzen EL, Jensen I, Josipovic M, Jensen MB, Overgaard J. Partial Breast Irradiation Versus Whole Breast Irradiation for Early Breast Cancer Patients in a Randomized Phase III Trial: The Danish Breast Cancer Group Partial Breast Irradiation Trial. J Clin Oncol 2022; 40:4189-4197. [PMID: 35930754 DOI: 10.1200/jco.22.00451] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE On the basis of low risk of local recurrence in elderly patients with breast cancer after conservative surgery followed by whole breast irradiation (WBI), the Danish Breast Cancer Group initiated the noninferiority external-beam partial breast irradiation (PBI) trial (ClinicalTrials.gov identifier: NCT00892814). We hypothesized that PBI was noninferior to WBI regarding breast induration. METHODS Patients operated with breast conservation for relatively low-risk breast cancer were randomly assigned to WBI versus PBI, and all had 40 Gy/15 fractions. The primary end point was 3-year grade 2-3 breast induration. RESULTS In total, 865 evaluable patients (434 WBI and 431 PBI) were enrolled between 2009 and 2016. Median follow-up was 5.0 years (morbidity) and 7.6 years (locoregional recurrence). The 3-year rate of induration was 9.7% for WBI and 5.1% for PBI (P = .014). Large breast size was significantly associated with induration with a 3-year incidence of 13% (WBI) and 6% (PBI) for large-breasted patients versus 6% (WBI) and 5% (PBI) for small-breasted patients. PBI showed no increased risk of dyspigmentation, telangiectasia, edema, or pain, and patient satisfaction was high. Letrozole and smoking did not increase the risk of radiation-associated morbidity. Sixteen patients had a locoregional recurrence (six WBI and 10 PBI; P = .28), 20 patients had a contralateral breast cancer, and eight patients had distant failure (five WBI and three PBI). A nonbreast second cancer was detected in 73 patients (8.4%), and there was no difference between groups. CONCLUSION External-beam PBI for patients with low-risk breast cancer was noninferior to WBI in terms of breast induration. Large breast size was a risk factor for radiation-associated induration. Few recurrences were detected and unrelated to PBI.
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Affiliation(s)
- Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne M Nielsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette H Nielsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lars Stenbygaard
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Anders N Pedersen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mette S Thomsen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Yates
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Berg
- Department of Medical Physics, Lillebaelt Hospital, Vejle, Denmark
| | - Ebbe L Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ingelise Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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20
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Cold S, Cold F, Jensen MB, Cronin-Fenton D, Christiansen P, Ejlertsen B. Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study. J Natl Cancer Inst 2022; 114:1347-1354. [PMID: 35854422 PMCID: PMC9552278 DOI: 10.1093/jnci/djac112] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/21/2022] [Accepted: 05/16/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Women treated for breast cancer (BC) often suffer genitourinary syndrome of menopause. These symptoms may be alleviated by vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT). However, there are concerns of risks of recurrence of BC and death following treatment. METHODS Our study included longitudinal data from a national cohort of postmenopausal women, diagnosed 1997-2004 with early-stage invasive estrogen receptor-positive nonmetastatic BC, who received no treatment or 5 years of adjuvant endocrine therapy. We ascertained prescription data on hormone therapy, VET or MHT, from a national prescription registry. We evaluated mortality and risk of recurrence associated with use of VET and MHT vs non-use using multivariable models adjusted for potential confounders. RESULTS Among 8461 women who had not received VET or MHT before BC diagnosis, 1957 and 133 used VET and MHT, respectively, after diagnosis. Median follow-up was 9.8 years for recurrence and 15.2 years for mortality. The adjusted relative risk of recurrence was 1.08 (95% confidence interval [CI] = 0.89 to 1.32) for VET (1.39 [95% CI = 1.04 to 1.85 in the subgroup receiving adjuvant aromatase inhibitors]) and 1.05 (95% CI = 0.62 to 1.78) for MHT. The adjusted hazard ratios for overall mortality were 0.78 (95% CI = 0.71 to 0.87) and 0.94 (95% CI = 0.70 to 1.26) for VET and MHT, respectively. CONCLUSIONS In postmenopausal women treated for early-stage estrogen receptor-positive BC, neither VET nor MHT was associated with increased risk of recurrence or mortality. A subgroup analysis revealed an increased risk of recurrence, but not mortality, in patients receiving VET with adjuvant aromatase inhibitors.
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Affiliation(s)
- Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Frederik Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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21
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Shenasa E, Stovgaard ES, Jensen MB, Asleh K, Riaz N, Gao D, Leung S, Ejlertsen B, Laenkholm AV, Nielsen TO. Neither Tumor-Infiltrating Lymphocytes nor Cytotoxic T Cells Predict Enhanced Benefit from Chemotherapy in the DBCG77B Phase III Clinical Trial. Cancers (Basel) 2022; 14:cancers14153808. [PMID: 35954471 PMCID: PMC9367267 DOI: 10.3390/cancers14153808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Apart from the direct killing of cancer cells, cyclophosphamide-based chemotherapy has been shown to induce an antitumor immune response, and is being used in combination with immunotherapies in cancer care. We assessed the interaction of chemotherapy with immune biomarkers expressed on primary tumor tissue from a randomized phase III clinical trial, and confirmed that the presence of tumor-infiltrating lymphocytes is linked to improved survival in premenopausal women with high-risk breast cancer, regardless of their treatment allocation. However, immune biomarkers including tumor-infiltrating lymphocytes do not predict extra benefit from cyclophosphamide chemotherapy. This finding applies across the major molecular subgroups, including non-luminal and basal breast cancers that tend to be more immunogenic, and are often considered the most suitable subsets for receiving immunotherapy. Abstract Recent studies have shown that immune infiltrates in the tumor microenvironment play a role in response to therapy, with some suggesting that patients with immunogenic tumors may receive increased benefit from chemotherapies. We evaluated this hypothesis in early breast cancer by testing the interaction between immune biomarkers and chemotherapy using materials from DBCG77B, a phase III clinical trial where high-risk premenopausal women were randomized to receive chemotherapy or no chemotherapy. Tissue microarrays were evaluated for tumor-infiltrating lymphocytes (TILs) assessed morphologically on hematoxylin and eosin-stained slides, and by immunohistochemistry for CD8, FOXP3, LAG-3, PD-1 and PD-L1. Following REMARK reporting guidelines, data analyses were performed according to a prespecified statistical plan, using 10-year invasive disease-free survival as the endpoint. Differences in survival probabilities between biomarker groups were evaluated by Kaplan–Meier and Cox proportional hazard ratio analyses and prediction for treatment benefit by an interaction test. Our results showed that stromal TILs were associated with an improved prognosis (HR = 0.93; p-value = 0.03), consistent with previous studies. However, none of the immune biomarkers predicted benefit from chemotherapy in the full study set nor within major breast cancer subtypes. Our study indicates that primary tumors with higher immune infiltration do not derive extra benefit from cyclophosphamide-based cytotoxic chemotherapy.
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Affiliation(s)
- Elahe Shenasa
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | | | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Karama Asleh
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | - Nazia Riaz
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
- Centre for Regenerative Medicine and Stem Cell Research, Aga Khan University, Karachi 74800, Pakistan
| | - Dongxia Gao
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | - Samuel Leung
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Anne-Vibeke Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Torsten O. Nielsen
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver V6H 3Z6, BC, Canada
- Correspondence:
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22
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Thygesen T, Slots C, Jensen MB, Ditzel N, Kassem M, Langhorn L, Andersen MØ. Comparison of off-the-shelf β-tricalcium phosphate implants with novel resorbable 3D printed implants in mandible ramus of pigs. Bone 2022; 159:116370. [PMID: 35183809 DOI: 10.1016/j.bone.2022.116370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/16/2021] [Accepted: 02/12/2022] [Indexed: 11/24/2022]
Abstract
Facial reconstructive surgery has already implemented the use of 3D printed Patient Specific Implants derived from CAD/CAM-based technologies as an alternative to preformed bone graft substitutes. 3D-printed patient-specific implants derived from CAD/CAM-based technologies are used in facial reconstructive surgery as an alternative to preformed bone graft substitutes. However, to minimize the invasiveness and long-term adverse effects of surgical interventions, the implant needs to exhibit exact fitting, porosity, density, and volume and be made from resorbable materials that allow ingrowth and formation of new bone tissue. Therefore, we present this pilot study using 3D-printed implants consisting of pure β-TCP, produced using a novel technique that assures these properties. Eight pigs received 3D-printed truncated porous cone bone implants paired with either an off-the-shelve a chronOS (DePuy Synthes chronOS Vivify Preforms) preformed block (n = 4) or a no-implant void (n = 4) in a surgically created defect on each side of the angle of the mandible. After 6 months, CT data showed that all 3D-printed implants performed as well as did the off-the-shelve implants, with predicted osteointegration medially and laterally and with minimal gapping between the implants and native bone. The CT findings were confirmed by histological analysis that revealed that the 3D-printed implants together with the off-the-shelve implants were almost complete resorbed. Much of the resorbed volume had been replaced by vascularized compact bone, and fusion between newly formed bone and native bone was observed in all implants, further indicating that the 3D-printed implants and off-the-shelve implants performed equally well. Only soft tissue developed in the void control sites. Further studies are needed to confirm these initial findings.
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Affiliation(s)
- T Thygesen
- Clinic for Oral and Maxillofacial Surgery, Vestre Stationsvej 15, 5000 Odense C, Denmark
| | - C Slots
- Ossiform ApS, Oslogade 1, 5000 Odense C, Denmark
| | - M B Jensen
- Ossiform ApS, Oslogade 1, 5000 Odense C, Denmark.
| | - N Ditzel
- Clinical Institute, Molecular Endocrinology Laboratory, J. B. Winsløws Vej 25, 2nd floor, 5000 Odense C, Denmark
| | - M Kassem
- Clinical Institute, Molecular Endocrinology Laboratory, J. B. Winsløws Vej 25, 2nd floor, 5000 Odense C, Denmark
| | - L Langhorn
- Biomedical Laboratory, University of Southern Denmark, J. B. Winsløwsvej 25, 5000 Odense C, Denmark
| | - M Ø Andersen
- Department of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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23
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Lefort M, Sharmin S, Andersen JB, Vukusic S, Casey R, Debouverie M, Edan G, Ciron J, Ruet A, De Sèze J, Maillart E, Zephir H, Labauge P, Defer G, Lebrun-Frenay C, Moreau T, Berger E, Clavelou P, Pelletier J, Stankoff B, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Wahab A, Camdessanché JP, Maurousset A, Ben Nasr H, Hankiewicz K, Pottier C, Maubeuge N, Dimitri-Boulos D, Nifle C, Laplaud DA, Horakova D, Havrdova EK, Alroughani R, Izquierdo G, Eichau S, Ozakbas S, Patti F, Onofrj M, Lugaresi A, Terzi M, Grammond P, Grand'Maison F, Yamout B, Prat A, Girard M, Duquette P, Boz C, Trojano M, McCombe P, Slee M, Lechner-Scott J, Turkoglu R, Sola P, Ferraro D, Granella F, Shaygannejad V, Prevost J, Maimone D, Skibina O, Buzzard K, Van der Walt A, Karabudak R, Van Wijmeersch B, Csepany T, Spitaleri D, Vucic S, Koch-Henriksen N, Sellebjerg F, Soerensen PS, Hilt Christensen CC, Rasmussen PV, Jensen MB, Frederiksen JL, Bramow S, Mathiesen HK, Schreiber KI, Butzkueven H, Magyari M, Kalincik T, Leray E. Impact of methodological choices in comparative effectiveness studies: application in natalizumab versus fingolimod comparison among patients with multiple sclerosis. BMC Med Res Methodol 2022; 22:155. [PMID: 35637426 PMCID: PMC9150358 DOI: 10.1186/s12874-022-01623-8] [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: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Natalizumab and fingolimod are used as high-efficacy treatments in relapsing–remitting multiple sclerosis. Several observational studies comparing these two drugs have shown variable results, using different methods to control treatment indication bias and manage censoring. The objective of this empirical study was to elucidate the impact of methods of causal inference on the results of comparative effectiveness studies. Methods Data from three observational multiple sclerosis registries (MSBase, the Danish MS Registry and French OFSEP registry) were combined. Four clinical outcomes were studied. Propensity scores were used to match or weigh the compared groups, allowing for estimating average treatment effect for treated or average treatment effect for the entire population. Analyses were conducted both in intention-to-treat and per-protocol frameworks. The impact of the positivity assumption was also assessed. Results Overall, 5,148 relapsing–remitting multiple sclerosis patients were included. In this well-powered sample, the 95% confidence intervals of the estimates overlapped widely. Propensity scores weighting and propensity scores matching procedures led to consistent results. Some differences were observed between average treatment effect for the entire population and average treatment effect for treated estimates. Intention-to-treat analyses were more conservative than per-protocol analyses. The most pronounced irregularities in outcomes and propensity scores were introduced by violation of the positivity assumption. Conclusions This applied study elucidates the influence of methodological decisions on the results of comparative effectiveness studies of treatments for multiple sclerosis. According to our results, there are no material differences between conclusions obtained with propensity scores matching or propensity scores weighting given that a study is sufficiently powered, models are correctly specified and positivity assumption is fulfilled. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01623-8.
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Affiliation(s)
- M Lefort
- Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Univ Rennes, EHESP, CNRS, Inserm, Rennes, France.,Univ Rennes, CHU Rennes, Investigation Clinique de Rennes)], CIC 1414 [(Centre d, 35000, InsermRennes, France
| | - S Sharmin
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - J B Andersen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet Glostrup, Denmark
| | - S Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de La Myéline Et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Lyon/Bron, France.,Centre Des Neurosciences de Lyon, UMR5292, Observatoire Français de La Sclérose en Plaques, INSERM, 1028 et CNRS, 69003, Lyon, France.,Université, Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69000, Lyon, France
| | - R Casey
- Service de Neurologie, Sclérose en Plaques, Pathologies de La Myéline Et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Lyon/Bron, France.,Centre Des Neurosciences de Lyon, UMR5292, Observatoire Français de La Sclérose en Plaques, INSERM, 1028 et CNRS, 69003, Lyon, France.,Université, Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69000, Lyon, France.,Eugene Devic EDMUS Foundation, 69677, Lyon/Bron, France
| | - M Debouverie
- Centre Hospitalier Régional Universitaire de Nancy, Hôpital Central, Service de neurologie, Nancy, France
| | - G Edan
- Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Service de neurologie, Rennes, France
| | - J Ciron
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, CRC-SEP, Département de neurologie, Toulouse, France
| | - A Ruet
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Service de neurologie, Bordeaux, France
| | - J De Sèze
- Service des maladies inflammatoires du système nerveux - neurologie, centre d'investigation clinique de Strasbourg, Hôpitaux Universitaire de Strasbourg, Hôpital de Hautepierre, INSERM 1434, Strasbourg, France
| | - E Maillart
- Assistance Publique Des Hôpitaux de Paris, Hôpital de La Pitié-Salpêtrière, Service de neurologie, Paris, France
| | - H Zephir
- Centre Hospitalier Universitaire de Lille, Hôpital Salengro, Service de neurologie D, Lille, France
| | - P Labauge
- Centre Hospitalier Universitaire de Montpellier, Hôpital Gui de Chauliac, Service de neurologie, Montpellier, France
| | - G Defer
- Centre Hospitalier Universitaire de Caen Normandie, Hôpital Côte de Nacre, Service de neurologie, Caen, France
| | - C Lebrun-Frenay
- Centre Hospitalier Universitaire de Nice, UR2CA-URRIS,, Université Nice Côte d'Azur, Hôpital, Pasteur 2, Service de neurologie, Nice, France
| | - T Moreau
- Centre Hospitalier Universitaire Dijon Bourgogne, Hôpital François Mitterrand, Maladies Inflammatoires du Système Nerveux Et Neurologie Générale, Service de neurologie, Dijon, France
| | - E Berger
- Centre Hospitalier Régional Universitaire de Besançon, Hôpital Jean Minjoz, Service de neurologie, Besançon, France
| | - P Clavelou
- Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de neurologie, Clermont-Ferrand, France
| | - J Pelletier
- Service de Neurologie, Aix Marseille Univ, APHM, Hôpital de La Timone, Pôle de Neurosciences Cliniques, 13005, Marseille, France
| | - B Stankoff
- Assistance Publique Des Hôpitaux de Paris, Hôpital Saint-Antoine, Service de neurologie, Paris, France
| | - O Gout
- Fondation Adolphe de Rothschild de L'œil Et du Cerveau, Service de neurologie, Paris, France
| | - E Thouvenot
- Centre Hospitalier Universitaire de Nîmes, Hôpital Carémeau, Service de neurologie, Nîmes, France
| | - O Heinzlef
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Service de neurologie, Poissy, France
| | - A Al-Khedr
- Centre Hospitalier Universitaire d'Amiens Picardie, Site sud, Service de neurologie, Amiens, France
| | - B Bourre
- Rouen University Hospital, 76000, Rouen, France
| | - O Casez
- Centre Hospitalier Universitaire Grenoble-Alpes, Site nord, Service de neurologie, Grenoble/La Tronche, France
| | - P Cabre
- Centre Hospitalier Universitaire de Martinique, Hôpital Pierre Zobda-Quitman, Service de neurologie, Fort-de-France, France
| | - A Montcuquet
- Centre Hospitalier Universitaire Limoges, Hôpital Dupuytren, Service de neurologie, Limoges, France
| | - A Wahab
- Assistance Publique Des Hôpitaux de Paris, Hôpital Henri Mondor, Service de neurologie, Créteil, France
| | - J P Camdessanché
- Centre Hospitalier Universitaire de Saint-Étienne, Hôpital Nord, Service de neurologie, Saint-Étienne, France
| | - A Maurousset
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Service de neurologie, Tours, France
| | - H Ben Nasr
- Centre Hospitalier Sud Francilien, Service de neurologie, Corbeil-Essonnes, France
| | - K Hankiewicz
- Centre Hospitalier de Saint-Denis, Hôpital Casanova, Service de neurologie, Saint-Denis, France
| | - C Pottier
- Centre Hospitalier de Pontoise, Service de neurologie, Pontoise, France
| | - N Maubeuge
- Centre Hospitalier Universitaire de Poitiers, Site de La Milétrie, Service de neurologie, Poitiers, France
| | - D Dimitri-Boulos
- Assistance Publique Des Hôpitaux de Paris, Hôpital Bicêtre, Service de neurologie, Le Kremlin-Bicêtre, France
| | - C Nifle
- Centre Hospitalier de Versailles, Hôpital André-Mignot, Service de neurologie, Le Chesnay, France
| | - D A Laplaud
- CHU de Nantes, Service de Neurologie & CIC015 INSERM, 44093, Nantes, France.,INSERM CR1064, 44000, Nantes, France
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - G Izquierdo
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Dokuz Eylul University, Konak/Izmir, Turkey
| | - F Patti
- GF Ingrassia Department, University of Catania, Catania, Italy.,Policlinico G Rodolico, Catania, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - A Lugaresi
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - P Grammond
- CISSS Chaudiere-Appalache, Levis, Canada
| | | | - B Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Prat
- Hopital Notre Dame, Montreal, Canada.,CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- Hopital Notre Dame, Montreal, Canada.,CHUM and Universite de Montreal, Montreal, Canada
| | - P Duquette
- Hopital Notre Dame, Montreal, Canada.,CHUM and Universite de Montreal, Montreal, Canada
| | - C Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - P McCombe
- University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Herston, Australia
| | - M Slee
- Flinders University, Adelaide, Australia
| | - J Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - R Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - P Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | | | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | | | - O Skibina
- Monash University, Melbourne, Australia
| | - K Buzzard
- Monash University, Melbourne, Australia
| | | | | | - B Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - D Spitaleri
- Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - S Vucic
- Westmead Hospital, Sydney, Australia
| | - N Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital Aarhus, Aarhus, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - P S Soerensen
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - C C Hilt Christensen
- Department of Neurology, Aalborg University Hospital, Multiple Sclerosis Unit, Aalborg, Denmark
| | - P V Rasmussen
- Aarhus University Hospital, Neurology, PJJ Boulevard, DK-8200, Aarhus N, Denmark
| | - M B Jensen
- Department of Neurology, University Hospital of Northern Sealand, Copenhagen, Denmark
| | - J L Frederiksen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S Bramow
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - H K Mathiesen
- Department of Neurology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - K I Schreiber
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - H Butzkueven
- Central Clinical School, Monash University, Melbourne, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - M Magyari
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.,Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - T Kalincik
- Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - E Leray
- Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Univ Rennes, EHESP, CNRS, Inserm, Rennes, France. .,Univ Rennes, CHU Rennes, Investigation Clinique de Rennes)], CIC 1414 [(Centre d, 35000, InsermRennes, France.
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24
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Celik A, Berg T, Nielsen LB, Jensen MB, Ejlertsen B, Knoop A, Andersson M. First-Line Treatment of HER2-Positive Metastatic Breast Cancer With Dual Blockade Including Biosimilar Trastuzumab (SB3): Population-Based Real-World Data From the DBCG. Breast Cancer (Auckl) 2022; 16:11782234221086992. [PMID: 35359608 PMCID: PMC8961366 DOI: 10.1177/11782234221086992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Dual blockade with trastuzumab and pertuzumab in combination with chemotherapy is the recommended first-line therapy for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC). The purpose of this retrospective study is to examine the clinical outcomes of the trastuzumab biosimilar SB3 in first-line dual blockade treatment using real-world data of patients with HER-positive mBC. Methods In Denmark, all women with breast cancer are registered in the database of the Danish Breast Cancer Group (DBCG). From this prospective observational registry, we extracted information on primary diagnosis and treatment of all women with HER2-positive mBC who received first-line treatment with SB3 and pertuzumab from September 1, 2018, to February 29, 2020. Retrospectively collected data from the DBCG database included information concerning treatment start, end, and reason for discontinuation. The primary endpoints for the study were overall survival (OS) and progression-free survival (PFS). Results The study included 117 women who received first-line treatment with SB3 and pertuzumab for their HER2-positive mBC. The study population had a mean age of 60 years. A total of 71 patients (61%) had recurrent disease and 46 patients (39%) presented with de novo mBC. The median follow-up was 11.1 and 15.4 months for PFS and OS, respectively. At 12 months, OS was 84% (95% confidence interval [CI], 78-91), whereas the median OS was not reached. The median PFS was 12.7 months (95% CI, 11.1-16.2). Median time on treatment was 8.7 months (95% CI, 7.6-11.4); 36 patients (31%) were still on treatment at end of study. Conclusions This retrospective real-world, nationwide study demonstrated comparable median PFS to the historical data of using reference trastuzumab and pertuzumab as first-line dual blockade.
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Affiliation(s)
- Alan Celik
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Birk Nielsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Andersson
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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25
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Gottschau M, Bens A, Friis S, Cronin-Fenton D, Aalborg GL, Jensen MB, Ejlertsen B, Kroman N, Mellemkjaer L. Use of beta-blockers and risk of contralateral breast cancer. Int J Cancer 2022; 150:1619-1626. [PMID: 34985760 DOI: 10.1002/ijc.33923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022]
Abstract
Beta-blockers have shown anti-neoplastic effects in laboratory studies but epidemiologic evidence in relation to contralateral breast cancer (CBC) is sparse. We investigated post-diagnosis beta-blocker use and risk of CBC in a cohort of 52 723 women with breast cancer by using nationwide Danish health registers and the Danish Breast Cancer Group database. We defined post-diagnosis beta-blocker use as a time-varying covariate starting one year after a second prescription was redeemed. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CBC associated with beta-blocker use compared with non-use. We identified 1444 women with CBC of whom 209 women were beta-blocker users. We found an overall HR of 1.08 (95% CI: 0.93-1.27) for beta-blocker use and risk of CBC with no substantial variation according to cumulative amount, intensity or selectivity of beta-blocker use. Hence, our cohort study of women with breast cancer did not sustain a protective effect of beta-blocker use on risk of CBC, irrespective of beta-blocker type.
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Affiliation(s)
| | - Annet Bens
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Herlev University Hospital, Copenhagen, Denmark
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26
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Franchi GA, Jensen MB, Foldager L, Larsen M, Herskin MS. Effects of dietary and milking frequency changes and administration of cabergoline on clinical udder characteristics in dairy cows during dry-off. Res Vet Sci 2022; 143:88-98. [PMID: 34999440 DOI: 10.1016/j.rvsc.2021.12.019] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
We investigated the effects of 2 diet energy densities [normal lactation diet (NORM) vs. energy-reduced diet (REDU), both fed for ad libitum intake] and 2 daily milking frequencies [twice (2×) vs. once (1×)] during 1 week before the dry-off day, as well as effects of an injection of either a dopamine agonist [cabergoline (CAB); Velactis, Ceva Santé Animale, Libourne, France; labelled for use only with abrupt dry-off, e.g. no reduction in diet energy density or milking frequency before the last milking] or saline (SAL) following the last milking, on clinical udder characteristics of Holstein cows. During a week before and after the last milking, the following measures were recorded: palpation-based udder firmness and soreness; image-based hock-hock distance; responsiveness to mechanical udder stimulation and degree of udder fill measured with a dynamometer. Before the last milking, REDU cows displayed lower odds of having a firm udder and lower degree of udder fill, as well as lower responsiveness to mechanical udder stimulation, than NORM cows. After the last milking, REDU cows displayed shorter hock-hock distance compared with NORM cows. The effects of milking frequency on the clinical udder characteristics were unclear. Within 24 h following injection, CAB cows showed lower odds of having a firm udder, shorter hock-hock distance, and lower degree of udder fill than SAL cows, irrespective of treatment group before dry-off. In this study, reducing diet energy density prior to dry-off, and to some extent administering the dopamine agonist cabergoline after the last milking, resulted in fewest clinical udder changes.
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Affiliation(s)
- G A Franchi
- Aarhus University, Department of Animal Science, Blichers Allé 20, 8830 Tjele, Denmark.
| | - M B Jensen
- Aarhus University, Department of Animal Science, Blichers Allé 20, 8830 Tjele, Denmark
| | - L Foldager
- Aarhus University, Department of Animal Science, Blichers Allé 20, 8830 Tjele, Denmark; Aarhus University, Bioinformatics Research Centre, C.F. Møllers Allé 8, 8000 Aarhus, Denmark
| | - M Larsen
- Aarhus University, Department of Animal Science, Blichers Allé 20, 8830 Tjele, Denmark
| | - M S Herskin
- Aarhus University, Department of Animal Science, Blichers Allé 20, 8830 Tjele, Denmark
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27
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Viuff JH, Greiber IK, Karlsen MA, Storgaard L, Kroman N, Jensen MB, Eibye S, Hjortshøj CS, Ejlertsen B, Winther JF, Kjær SK, Mellemkjær L. Survival in Women Diagnosed With Breast Cancer During Pregnancy. Clin Breast Cancer 2021; 22:e517-e525. [PMID: 34963614 DOI: 10.1016/j.clbc.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/20/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pregnancy rarely coincides with breast cancer, but when it does, uncertainties remain about how survival is affected. In a nation-wide study, we investigated survival in women diagnosed with breast cancer during pregnancy. MATERIALS AND METHODS Through health registries, we identified women with breast cancer at ages 15-44 years from 1973-2016 in Denmark and included 156 who were pregnant at diagnosis and 11,110 who were not. We compared overall mortality in pregnant and non-pregnant women using multivariate Cox regression stratified by time since cancer: <2 and ≥2 years. RESULTS During the first 2 years after diagnosis, the hazard ratio of overall death was 2.28 (95% CI: 1.48-3.52) for pregnant versus non-pregnant breast cancer patients after adjustment for age and calendar period and 1.62 (95% CI: 1.05-2.50) after further adjustment for extent of disease. Adjusting for additional tumor characteristics, the hazard ratio was still significantly increased. Beyond the first 2 years, there was no excess mortality. CONCLUSION Our study identifies the early period after breast cancer as a period of particular interest in future studies on survival after breast cancer in pregnancy. We found no evidence that survival is affected by pregnancy when 2 or more years have passed since diagnosis.
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Affiliation(s)
- Jakob H Viuff
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Iben K Greiber
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mona Aa Karlsen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Storgaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone Eibye
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cristel S Hjortshøj
- Department of Pediatrics, Section of Pediatric Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Susanne K Kjær
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Mellemkjær
- Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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28
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Jørgensen N, Hviid TVF, Nielsen LB, Sønderstrup IMH, Eriksen JO, Ejlertsen B, Gerdes AM, Kruse TA, Thomassen M, Jensen MB, Lænkholm AV. Tumour-infiltrating CD4-, CD8- and FOXP3-positive immune cells as predictive markers of mortality in BRCA1- and BRCA2-associated breast cancer. Br J Cancer 2021; 125:1388-1398. [PMID: 34365471 PMCID: PMC8576013 DOI: 10.1038/s41416-021-01514-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/09/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognostic value of tumour-infiltrating lymphocytes (TILs) in breast cancer is well-established. However, the investigation of specific T-cell subsets exclusively in BRCA-associated breast cancer is sparse. METHODS Tumour tissues from 414 BRCA-mutated breast cancer patients were analysed by immunohistochemistry and digital image analysis for expression of CD4, CD8 and FOXP3 immune markers. Distribution of CD4-, CD8- and FOXP3-positive cells and clinicopathological characteristics were assessed according to groups of low or high expression. The prognostic value was evaluated as continuous variables in univariate and multivariate analyses of overall survival and disease-free survival. RESULTS Both CD4 and CD8 expression are associated with histological diagnosis, tumour grade and oestrogen and progesterone receptor expression status. CD4 expression is associated with BRCA gene status. A high percentage of tumour-infiltrating CD4-, CD8- or FOXP3-positive cells is significantly associated with lower mortality in BRCA1- and BRCA2-associated breast cancer and CD8-positive cells are associated with disease-free survival. No heterogeneity according to BRCA gene status was found for the prognostic value of the immune markers. CONCLUSIONS The results support a prognostic role of specific T-cell subsets in BRCA-associated breast cancer and the promising potential of targeting the immune system in the treatment of these patients.
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Affiliation(s)
- Nanna Jørgensen
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI), Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Vauvert F Hviid
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI), Zealand University Hospital, Roskilde, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Lise B Nielsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ida M H Sønderstrup
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Jens Ole Eriksen
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Marie Gerdes
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben A Kruse
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
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29
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Franchi GA, Herskin MS, Tucker CB, Larsen M, Jensen MB. Assessing effects of dietary and milking frequency changes and injection of cabergoline during dry-off on hunger in dairy cows using 2 feed-thwarting tests. J Dairy Sci 2021; 104:10203-10216. [PMID: 34099287 DOI: 10.3168/jds.2020-20046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 01/09/2023]
Abstract
We investigated the single and combined effects of 2 feeding levels (normal lactation diet vs. energy-reduced diet, both fed for ad libitum intake) and 2 daily milking frequencies (twice vs. once) during 1 wk before the dry-off day (d 0), as well as an intramuscular injection of either a dopamine agonist (cabergoline; Velactis, Ceva Santé Animale; labeled for use only with abrupt dry-off, e.g., no reduction in feeding level or milking frequency before the last milking) or saline after the last milking on d 0 on the feeding motivation of clinically healthy, loose-housed, pregnant, lactating Holstein cows. From d 0, all cows were fed the same dry-cow diet for ad libitum intake. Cows were subjected to 2 feed-thwarting tests, a test in the home pen using their diets (test A: d -6, -1, and 1; during 35 min when the feed bins were filled, but locked) and another test carried out in an adjacent pen in which access to concentrate provided in a familiar plastic box was blocked by a wire-mesh lid (test B: d -5 and 2). In test A, we recorded how often cows attempted to feed per 35 min, whether cows vocalized during the 35-min period, and latency to feed within 300 s after feed bins were unlocked. In test B, we recorded latency to approach either of 2 familiar boxes (the wire-mesh box and an identical open box with a small portion of concentrate) within 600 s and how often cows directed behaviors toward the wire-mesh box (number of occurences/5 min). On d -6 (test A), no clear differences in feeding motivation among treatments were found. On d -5 and -1, cows fed the energy-reduced diet displayed a higher probability of vocalizing (test A), were more than 50% quicker to feed (test A), were approximately 5× quicker to approach a box (test B), and directed 60% more behavior toward the wire-mesh box (test B) than cows fed the normal diet. Moreover, cows fed the energy-reduced diet attempted to feed approximately 75% more on d -1 compared with d -6 (test A). On d 2 (test B), cows previously fed the normal diet directed 40% more behavior toward the wire-mesh box than cows previously fed the energy-reduced diet. Reducing feeding level, either before or on the dry-off day, resulted in consistently increased feeding motivation, interpreted as a sign of hunger. No clear effects of change in milking frequency, singly or combined with reduced diet energy density, on feeding motivation were found before d 0. Whereas, on d 2, cows previously milked twice daily were quicker to approach a box than cows previously milked once daily. Cows injected with cabergoline attempted to feed more, but showed lower probability of vocalizing compared with saline-injected cows (d 1; test A), irrespective of treatment before d 0. The effects of cabergoline on feeding motivation are not easily interpreted and warrant further investigation. From a hunger perspective, reducing milking frequency rather than diet energy density seems to be a less negative management to reduce milk production before dry-off.
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Affiliation(s)
- G A Franchi
- Department of Animal Science, Aarhus University, Blichers Allé 20, 8830 Tjele, Denmark
| | - M S Herskin
- Department of Animal Science, Aarhus University, Blichers Allé 20, 8830 Tjele, Denmark
| | - C B Tucker
- Department of Animal Science, Center for Animal Welfare, University of California, Davis 95616
| | - M Larsen
- Department of Animal Science, Aarhus University, Blichers Allé 20, 8830 Tjele, Denmark
| | - M B Jensen
- Department of Animal Science, Aarhus University, Blichers Allé 20, 8830 Tjele, Denmark.
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30
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Stovgaard ES, Asleh K, Riaz N, Leung S, Gao D, Nielsen LB, Lænkholm AV, Balslev E, Jensen MB, Nielsen D, O Nielsen T. The immune microenvironment and relation to outcome in patients with advanced breast cancer treated with docetaxel with or without gemcitabine. Oncoimmunology 2021; 10:1924492. [PMID: 34026336 PMCID: PMC8118411 DOI: 10.1080/2162402x.2021.1924492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Preclinical studies suggest that some effects of conventional chemotherapy, and in particular, gemcitabine, are mediated through enhanced antitumor immune responses. The objective of this study was to use material from a randomized clinical trial to evaluate whether patients with preexisting immune infiltrates responded better to treatment with gemcitabine + docetaxel (GD) compared to docetaxel alone. Formalin fixed, paraffin-embedded breast cancer tissues from SBG0102 phase 3 trial patients randomly assigned to treatment with GD or docetaxel were used. Immunohistochemical staining for CD8, FOXP3, LAG3, PD-1, PD-L1 and CD163 was performed. Tumor infiltrating lymphocytes (TILs) and tumor associated macrophages were evaluated. Prespecified statistical analyses were performed in a formal prospective-retrospective design. Time to progression was primary endpoint and overall survival secondary endpoint. Correlations between biomarker status and endpoints were evaluated using the Kaplan–Meier method and Cox proportional hazards models. Biomarker data was obtained for 237 patients. There was no difference in treatment effect according to biomarker status for the whole cohort. In planned subgroup analysis by PAM50 subtype, in non-luminal (basal-like and HER2E) breast cancers FOXP3 was a significant predictor of treatment effect with GD compared to docetaxel, with a HR of 0.22 (0.09–0.52) for tumors with low FOXP3 compared to HR 0.92 (0.47–1.80) for high FOXP3 TILs (Pinteraction = 0.01). Immune biomarkers were not predictive of added benefit of gemcitabine in a cohort of mixed breast cancer subtypes. However, in non-luminal breast cancers, patients with low FOXP3+ TILs may have significant benefit from added gemcitabine.
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Affiliation(s)
- Elisabeth S Stovgaard
- Department of Pathology, Herlev and Gentofte, University of Copenhagen, Herlev, Denmark
| | - Karama Asleh
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, BC, Canada
| | - Nazia Riaz
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, BC, Canada.,Centre for Regenerative Medicine and Stem Cell Research, Aga Khan University, Karachi, Pakistan
| | - Samuel Leung
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, BC, Canada
| | - Dongxia Gao
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, BC, Canada
| | - Lise B Nielsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev and Gentofte, University of Copenhagen, Herlev, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev and Gentofte, University of Copenhagen, Herlev, Denmark
| | - Torsten O Nielsen
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
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31
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Bjertrup AJ, Jensen MB, Schjødt MS, Parsons CE, Kjærbye-Thygesen A, Mikkelsen RL, Moszkowicz M, Frøkjær VG, Vinberg M, Kessing LV, Væver MS, Miskowiak KW. Cognitive processing of infant stimuli in pregnant women with and without affective disorders and the association to postpartum depression. Eur Neuropsychopharmacol 2021; 42:97-109. [PMID: 33158668 DOI: 10.1016/j.euroneuro.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/21/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Pregnancy and childbirth are among the strongest risk factors for depression but the neurocognitive mechanisms underlying this enhanced risk are unknown. This study investigated emotional and non-emotional cognition in 57 pregnant women with or without an affective disorder during their third trimester, and the association between cognitive biases and subsequent postpartum depression (PPD). Of the pregnant women, 22 had a diagnosis of unipolar disorder (UD) and seven of bipolar disorder (BD) in full or partial remission, while 28 had no history of affective disorder. We included a control group of 29 healthy non-pregnant women. First, participants were interviewed, completed non-emotional and emotional cognitive tests and lastly filled out questionnaires. The participants were assessed two times after birth: at a home visit shortly after birth, and with a telephone interview to assess PPD in the first six months after birth. Healthy pregnant women rated infant cries less negatively than non-pregnant women, possibly reflecting preparation for motherhood. Pregnant women with UD exhibited a negative bias in ratings of infant cries, whereas pregnant women with BD showed a positive bias in ratings of infant happy faces and recognition of adult facial expressions. Across all pregnant women, more negative ratings of infant cries were associated with enhanced risk of PPD. Negatively biased perception of infant cries during pregnancy may thus signal vulnerability toward PPD.
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Affiliation(s)
- A J Bjertrup
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M B Jensen
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M S Schjødt
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - C E Parsons
- Interacting Minds Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Kjærbye-Thygesen
- Department of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, University of Copenhagen, Hvidovre, Denmark
| | - R L Mikkelsen
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M Moszkowicz
- Child and Adolescent Psychiatric Center, Infant Psychiatric Unit, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Denmark
| | - V G Frøkjær
- Neurobiology Research Unit, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Denmark
| | - M Vinberg
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Faculty of Health and Medical Sciences, University of Copenhagen, Hillerød, Denmark
| | - L V Kessing
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M S Væver
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - K W Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark.
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Collin LJ, Cronin-Fenton DP, Ahern TP, Goodman M, McCullough LE, Waller LA, Kjærsgaard A, Damkier P, Christiansen PM, Ejlertsen B, Jensen MB, Sørensen HT, Lash TL. Early Discontinuation of Endocrine Therapy and Recurrence of Breast Cancer among Premenopausal Women. Clin Cancer Res 2020; 27:1421-1428. [PMID: 33334905 DOI: 10.1158/1078-0432.ccr-20-3974] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Premenopausal women diagnosed with estrogen receptor (ER)-positive breast cancer are prescribed 5-10 years of endocrine therapy to prevent or delay recurrence. In this study, we evaluated the association between early discontinuation of endocrine therapy and breast cancer recurrence in a cohort of premenopausal women. EXPERIMENTAL DESIGN We identified 4,503 patients with premenopausal ER-positive breast cancer who initiated adjuvant endocrine therapy and were registered in the Danish Breast Cancer Group clinical database (2002-2011). Women were excluded if they had a recurrence or were lost to follow-up less than 1.5 years after breast cancer surgery. Endocrine therapy was considered complete if the patient received at least 4.5 years of treatment or discontinued medication less than 6 months before recurrence. Exposure status was updated annually and modeled as a time-dependent variable. We accounted for baseline and time-varying confounders via time-varying weights, which we calculated from multivariable logistic regression models, and included in regression models to estimate HRs and 95% confidence intervals (CIs) associating early discontinuation with recurrence. RESULTS Over the study follow-up, 1,001 (22%) women discontinued endocrine therapy. We observed 202 (20%) recurrences among those who discontinued endocrine therapy, and 388 (11%) among those who completed the recommended treatment. The multivariable-adjusted estimated rate of recurrence was higher in women who discontinued endocrine therapy relative to those who completed their treatment (hazard ratio, 1.67; 95% CI, 1.25-2.14). CONCLUSIONS These results highlight the importance of clinical follow-up and behavioral interventions that support persistence of adjuvant endocrine therapy to prevent breast cancer recurrence.
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Affiliation(s)
- Lindsay J Collin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Thomas P Ahern
- Department of Surgery, The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, Vermont
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta Georgia
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peer M Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Rigshospitalet, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Berg T, Jensen MB, Jakobsen EH, Al-Rawi S, Kenholm J, Andersson M. Neoadjuvant chemotherapy and HER2 dual blockade including biosimilar trastuzumab (SB3) for HER2-positive early breast cancer: Population based real world data from the Danish Breast Cancer Group (DBCG). Breast 2020; 54:242-247. [PMID: 33186804 PMCID: PMC7670201 DOI: 10.1016/j.breast.2020.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Dual blockade with trastuzumab and pertuzumab combined with neoadjuvant chemotherapy (NACT) has been increasingly used for HER2-positive tumours >2 cm and/or with positive axillary lymph nodes in order to evaluate pathologic response and obtain better surgical management. SB3 is a registered biosimilar trastuzumab approved following a phase III trial demonstrating similar efficacy in the neoadjuvant setting as trastuzumab. However, the study was done without pertuzumab. METHOD The database of the Danish Breast Cancer Group was used to extract data on all patients who started NACT with SB3 and pertuzumab between September 1, 2018 and August 31, 2019. The primary endpoint was pathological complete response (pCR) rate. RESULTS In total 215 patients received NACT and dual blockade. The median age was 55 (24-81). NACT used was cyclophosphamide and epirubicin followed by weekly paclitaxel (62% on six cycles, 35% on eight cycles) or other chemotherapy followed by weekly paclitaxel (3%). Overall, 56% of patients achieved pCR. 60 of 88 node-positive patients pre-NACT achieved ypN0(i-) after neoadjuvant treatment. pCR rate was significantly associated with estrogen receptor status and malignancy grade. An association with CEP17/HER2-ratio was assessed. CONCLUSION Real world data on dual blockade with SB3 and pertuzumab in combination with NACT in a nationwide population-based study show a pCR rate comparable to that seen in previous clinical studies.
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Affiliation(s)
- Tobias Berg
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Juliane Maries Vej 5, 2100, Copenhagen, Denmark; Danish Breast Cancer Group, Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Erik H Jakobsen
- Department of Oncology, Sygehus Lillebælt, Beriderbakken 4, 7100, Vejle, Denmark
| | - Sami Al-Rawi
- Department of Oncology, Region Zealand, Ringstedgade 61, 4700, Næstved, Denmark
| | - Julia Kenholm
- Department of Oncology, Hospital Unit West, Gl. Landevej 61, 7400, Herning, Denmark
| | - Michael Andersson
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Juliane Maries Vej 5, 2100, Copenhagen, Denmark
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Laugaard Lorenzen E, Christian Rehammar J, Jensen MB, Ewertz M, Brink C. Radiation-induced risk of ischemic heart disease following breast cancer radiotherapy in Denmark, 1977–2005. Radiother Oncol 2020; 152:103-110. [DOI: 10.1016/j.radonc.2020.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
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Christensen CØ, Jensen MB, Hermann AP, Ewertz M. Osteoporosis after adjuvant treatment for early-stage breast cancer. Dan Med J 2020; 67:A04200223. [PMID: 33215600] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Adjuvant treatment of early-stage breast cancer has been associated with bone loss in randomised trials, but evidence from unselected populations is needed. In a single-center study, we assessed the annual percentage change in bone mineral density (∆BMDt) and risk of osteoporosis from two to five years after adjuvant chemotherapy in patients with oestrogen-receptor-positive and oestrogen-receptor-negative tumours. METHODS Dual energy X-ray absorptiometry (DXA) was performed in 241 recurrence-free Danish breast cancer patients, among whom 157 had a prior DXA scan within two years of chemotherapy ("early"). Linear regression was used to assess ∆BMDt in spine and hip according to age, different health-related variables and time since early DXA. RESULTS Based on 157 patients, we observed annual decreases in spine BMD of 1.73% (95% confidence interval (CI): -2.01--1.44, p less than 0.001) and hip BMD of 1.30% (95% CI: -1.51--1.09, p less than 0.001). Patients aged less than 50 years at diagnosis had a significant decrease in mean spine BMD of 2.23% (95% CI: -2.78--1.68), whereas the decline was more limited in patients aged 50-59 years and patients aged 60 years or older with a mean spine BMD of 1.70% (95% CI: -2.07--1.34) and 0.81% (95% CI: -1.42--0.20), respectively. The results persisted in multivariable analyses. Osteoporosis was diagnosed in 9% of patients, all postmenopausal. CONCLUSIONS Adjuvant anthracycline-taxane-based chemotherapy followed by endocrine therapy caused bone loss, especially in younger compared with older patients with early-stage breast cancer, confirming the results from randomised trials. FUNDING This work was supported by the Region of Southern Denmark (grant number 13/7078); the University of Southern Denmark (grant number 00-101-000); the Danish Cancer Society (grant number R90-A6210-14-52); the Department of Oncology and Department of Endocrinology, Odense University Hospital; and the Consultant Council Scholarship, Odense University Hospital. TRIAL REGISTRATION The study was approved by the Ethics Committee in Region of Southern Denmark (Project ID S-20140142) and the Danish Data Protection Board (ID 2008-58-0035).
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Olafsdottir EJ, Borg A, Jensen MB, Gerdes AM, Johansson ALV, Barkardottir RB, Johannsson OT, Ejlertsen B, Sønderstrup IMH, Hovig E, Lænkholm AV, Hansen TVO, Olafsdottir GH, Rossing M, Jonasson JG, Sigurdsson S, Loman N, Nilsson MP, Narod SA, Tryggvadottir L. Breast cancer survival in Nordic BRCA2 mutation carriers-unconventional association with oestrogen receptor status. Br J Cancer 2020; 123:1608-1615. [PMID: 32939053 PMCID: PMC7686356 DOI: 10.1038/s41416-020-01056-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background The natural history of breast cancer among BRCA2 carriers has not been clearly established. In a previous study from Iceland, positive ER status was a negative prognostic factor. We sought to identify factors that predicted survival after invasive breast cancer in an expanded cohort of BRCA2 carriers. Methods We studied 608 women with invasive breast cancer and a pathogenic BRCA2 mutation (variant) from four Nordic countries. Information on prognostic factors and treatment was retrieved from health records and by analysis of archived tissue specimens. Hazard ratios (HR) were estimated for breast cancer-specific survival using Cox regression. Results About 77% of cancers were ER-positive, with the highest proportion (83%) in patients under 40 years. ER-positive breast cancers were more likely to be node-positive (59%) than ER-negative cancers (34%) (P < 0.001). The survival analysis included 584 patients. Positive ER status was protective in the first 5 years from diagnosis (multivariate HR = 0.49; 95% CI 0.26–0.93, P = 0.03); thereafter, the effect was adverse (HR = 1.91; 95% CI 1.07–3.39, P = 0.03). The adverse effect of positive ER status was limited to women who did not undergo endocrine treatment (HR = 2.36; 95% CI 1.26–4.44, P = 0.01) and patients with intact ovaries (HR = 1.99; 95% CI 1.11–3.59, P = 0.02). Conclusions The adverse effect of a positive ER status in BRCA2 carriers with breast cancer may be contingent on exposure to ovarian hormones.
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Affiliation(s)
| | - Ake Borg
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Marie Gerdes
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rosa B Barkardottir
- Laboratory of Cell Biology, Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Oskar T Johannsson
- Department of Oncology, Landspitali University Hospital, Reykjavik, Iceland
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Eivind Hovig
- Department of Tumor Biology, Institute for Cancer Research, Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Thomas van Overeem Hansen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jon G Jonasson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland
| | - Stefan Sigurdsson
- Cancer Research Laboratory, BMC, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Steven A Narod
- Womens' College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland. .,Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland.
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Heeg E, Jensen MB, Hölmich LR, Bodilsen A, Tollenaar RAEM, Laenkholm AV, Offersen BV, Ejlertsen B, Mureau MAM, Christiansen PM. Rates of re-excision and conversion to mastectomy after breast-conserving surgery with or without oncoplastic surgery: a nationwide population-based study. Br J Surg 2020; 107:1762-1772. [PMID: 32761931 PMCID: PMC7689836 DOI: 10.1002/bjs.11838] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/09/2020] [Accepted: 05/31/2020] [Indexed: 01/17/2023]
Abstract
Background There is no consensus regarding the impact of oncoplastic surgery (OPS) on rates of re‐excision and conversion to mastectomy following breast‐conserving surgery (BCS). Here these two outcomes after BCS and OPS were compared in a nationwide population‐based setting. Methods In Denmark, all OPS is registered and categorized into volume displacement, volume reduction or volume replacement. Patients who underwent BCS or OPS between 2012 and 2018 were selected from the Danish Breast Cancer Group database. Multivariable analyses were performed to adjust for confounders, and propensity score matching to limit potential confounding by indication bias. Results A total of 13 185 patients (72·5 per cent) underwent BCS and 5003 (27·5 per cent) OPS. Volume displacement was used in 4171 patients (83·4 per cent), volume reduction in 679 (13·6 per cent) and volume replacement in 153 (3·1 per cent). Re‐excision rates were 15·6 and 14·1 per cent after BCS and OPS respectively. After adjusting for confounders, patients were less likely to have a re‐excision following OPS than BCS (odds ratio (OR) 0·80, 95 per cent c.i. 0·72 to 0·88), specifically after volume displacement and reduction. The rate of conversion to mastectomy was similar after OPS and BCS (3·2 versus 3·7 per cent; P = 0·105), but with a lower risk in adjusted analysis (OR 0·69, 0·58 to 0·84), specifically after volume displacement and reduction procedures. Findings were similar after propensity score matching. Conclusion A modest decrease in re‐excision rate and less frequent conversion to mastectomy were observed after OPS compared with BCS.
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Affiliation(s)
- E Heeg
- Dutch Institute for Clinical Auditing, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - M B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
| | - L R Hölmich
- Department of Plastic Surgery, Herlev Gentofte Hospital, Herlev, Denmark
| | | | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - A V Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | | | - B Ejlertsen
- Danish Breast Cancer Cooperative Group, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - P M Christiansen
- Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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Skriver SK, Jensen MB, Eriksen JO, Ahlborn LB, Knoop AS, Rossing M, Ejlertsen B, Laenkholm AV. Induction of PIK3CA alterations during neoadjuvant letrozole may improve outcome in postmenopausal breast cancer patients. Breast Cancer Res Treat 2020; 184:123-133. [PMID: 32748297 DOI: 10.1007/s10549-020-05833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Estrogen receptor positive (ER+) breast cancer constitutes almost 85% of all breast cancer patients and are a genetically highly heterogenic group. Data on the association of somatic alterations to outcome and prognosis are however sparse. In this neoadjuvant endocrine phase II trial including postmenopausal breast cancer patients with ER+, HER2 normal breast cancer, we investigated the rate of pathogenic mutations before and after treatment as well as the association with treatment response and survival. METHODS Pretreatment and posttreatment tumour samples from 109 patients treated with neoadjuvant letrozole were collected and analysed with Next Generation Sequencing utilizing a panel of 12 genes (ALK, BRAF, EGFR, ERBB2, ERBB3, ESR1, KIT, KRAS, NRAS, PDGFRA, PIK3CA, and RAF1). Residual disease was assessed by a modified Miller Payne scale and the Residual Cancer Burden index. Survival data were collected prospectively. RESULTS Among the 109 patients, 52 had at least one pathogenic mutation in the pretreatment sample and 60 in the posttreatment sample. The most frequently mutated gene was PIK3CA, followed by EGFR and KRAS. Twelve different pathogenic PIK3CA mutations were identified, primarily in exon 20 and exon 9. An altered PIK3CA mutation profile from the pre- to the posttreatment specimen was significantly associated to improved pathological outcome. Overall and Disease-Free Survival benefits in PIK3CA mutated patients was observed. CONCLUSION Considerable heterogeneity was identified both among patients and between pre- and posttreatment samples. PIK3CA has the potential to be a predictive biomarker. To further assess the implications of a treatment related altered PIK3CA mutation profile, more data are needed.
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Affiliation(s)
- Signe Korsgaard Skriver
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Section 5703 Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Maj-Britt Jensen
- The Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens-Ole Eriksen
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Lise Barlebo Ahlborn
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Soegaard Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Section 5703 Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Section 5703 Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,The Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Vogsen M, Bille C, Jylling AMB, Jensen MB, Ewertz M. Adherence to treatment guidelines and survival in older women with early-stage breast cancer in Denmark 2008-2012. Acta Oncol 2020; 59:741-747. [PMID: 32364416 DOI: 10.1080/0284186x.2020.1757148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The aims of this study were to compare patients 70 years or older with younger patients, to examine whether Danish patients with early-stage breast cancer aged 70 years or more received treatment according to guidelines, the reasons for deviating from the guidelines, and to analyze whether such deviations affected survival.Methods: From the Danish Breast Cancer Cooperative Group (DBCG) database we identified 23,247 women diagnosed with early-stage breast cancer in Denmark from 2008 to 2012. 17,391 were aged less than 70 years and 5856 were 70+ years. We reviewed medical charts of 441 patients aged 70+ years from Funen (a region of Denmark) to ascertain whether treatment was given according to the guidelines of DBCG and if not, the reason for deviating. Overall survival was analyzed by Cox proportional hazards models.Results: Up to age 80 years most women (94%) had surgery according to guidelines, decreasing to 41% in women aged 85+ years, the main reason for omitting surgery being patients' requests. Patients with breast cancer over the age of 80 years did not have an excess mortality compared with the general population in Funen. Compared with women who had surgery according to guidelines, women who did not have surgery had a significantly higher risk of dying with a hazard ratio (HR) of 8.38 (95% Confidence Intervals (CI) 4.46-15.8) if they were less than 80 years and HR = 2.56 (95% CI 1.63-4.01) if they were 80 years or more (p = .003 for interaction).Conclusions: Adherence to treatment according to guidelines decreases with increasing age, mainly for patients aged 80+ years. Our results suggest that surgery is important for the survival of patients aged less than 80 years.
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Affiliation(s)
- Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Bille
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Banke A, Fosbøl EL, Ewertz M, Videbæk L, Dahl JS, Poulsen MK, Cold S, Jensen MB, Gislason GH, Schou M, Møller JE. Long-Term Risk of Heart Failure in Breast Cancer Patients After Adjuvant Chemotherapy With or Without Trastuzumab. JACC Heart Fail 2020; 7:217-224. [PMID: 30819377 DOI: 10.1016/j.jchf.2018.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/05/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to evaluate the long-term risk of developing heart failure (HF) in patients receiving trastuzumab therapy. BACKGROUND Trastuzumab has improved the prognosis in patients with HER2-positive breast cancer, but it can induce left ventricular dysfunction with reduced ejection fraction or HF during treatment. The long-term risk of HF is less well described. METHODS In a nationwide Danish retrospective cohort study, 9,901 patients scheduled for adjuvant treatment for early-stage breast cancer were identified in the Danish Breast Cancer Cooperative Group database. Of these, 8,812 patients (25% HER2-positive; 51.7 ± 8.5 years of age) received chemotherapy including anthracycline; and if they were HER2 positive, trastuzumab was added. The primary endpoint was a diagnosis of HF assessed before and after 18 months in a landmark analysis to distinguish short- and long-term risks. RESULTS Median follow-up was 5.4 years (interquartile range [IQR]: 4.1 to 6.8 years). In the trastuzumab group, 60 patients had HF by 9 years versus 51 in the group who were treated with chemotherapy alone, corresponding to incidence rates per 1,000 patient years of 5.3 (95% confidence interval [CI]: 4.1 to 6.8) versus 1.4 (95% CI: 1.1 to 1.8), respectively. The cumulative incidence of HF was higher in the trastuzumab group at both the short- and long-term (p < 0.01), yielding adjusted hazard ratios of 8.7 (95% CI: 4.6 to 16.5; p < 0.01) for early HF and 1.9 (95% CI: 1.2 to 3.3; p = 0.01) for late HF associated with trastuzumab treatment. CONCLUSIONS Trastuzumab treatment is associated with a 2-fold increased risk of late HF compared with chemotherapy treatment alone.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Cardiotoxicity/epidemiology
- Cardiotoxicity/etiology
- Chemotherapy, Adjuvant
- Cohort Studies
- Cyclophosphamide/administration & dosage
- Denmark/epidemiology
- Docetaxel/administration & dosage
- Epirubicin/administration & dosage
- Female
- Heart Failure/chemically induced
- Heart Failure/epidemiology
- Humans
- Incidence
- Longitudinal Studies
- Mastectomy, Segmental
- Middle Aged
- Receptor, ErbB-2/metabolism
- Retrospective Studies
- Risk
- Stroke Volume
- Trastuzumab/therapeutic use
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Affiliation(s)
- Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Ewertz
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University, Herlev and Gentofte Hospital, Hellerup, Denmark; Danish Heart Foundation, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Heeg E, Jensen MB, Mureau MAM, Ejlertsen B, Tollenaar RAEM, Christiansen PM, Vrancken Peeters MTFD. Breast-contour preserving procedures for early-stage breast cancer: a population-based study of the trends, variation in practice and predictive characteristics in Denmark and the Netherlands. Breast Cancer Res Treat 2020; 182:709-718. [PMID: 32524354 PMCID: PMC7320958 DOI: 10.1007/s10549-020-05725-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Breast-contour preservation (BCP) is possible for most women treated for early-stage breast cancer. BCP can be defined as primary breast-conserving treatment (BCT), neoadjuvant chemotherapy (NAC) followed by BCT and immediate postmastectomy breast reconstruction (IBR). This study provides insight in current BCP strategies in Denmark and the Netherlands and aims to identify opportunities for improvement within both countries. METHODS A total of 92,881 patients with early-stage breast cancer who were operated in Denmark and the Netherlands between 2012 and 2017 were selected from the Danish Breast Cancer Group and the Dutch National Breast Cancer Audit databases. BCP procedures and predictive factors were analyzed within and between both countries. RESULTS BCP was achieved in 76.7% (n = 16,355) of the Danish and in 74.5% (n = 53,328) of the Dutch patients. While BCP rate did not change significantly over time in Denmark (p = 0.250), a significant increase in BCP rate from 69.5% in 2012 to 78.5% in 2017 (p < 0.001) was observed in the Netherlands. In both countries, variation in BCP rates between hospitals decreased over time. NAC followed by BCT and postmastectomy IBR was substantially more often used in the Netherlands compared to Denmark, specifically in patients younger than 50 years. CONCLUSIONS In more than 75% of all Danish and Dutch patients, surgically treated for early-stage breast cancer, the breast-contour was preserved. The different use of BCP strategies within Denmark and the Netherlands and the differences observed between hospitals in both countries emphasize the need for more (inter)national consensus on treatment modalities.
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Affiliation(s)
- E Heeg
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands. .,Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - M B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B Ejlertsen
- Danish Breast Cancer Cooperative Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - P M Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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Andersson M, Jensen MB. Neoadjuvant chemotherapy (NACT) and HER2 double inhibition including biosimilar trastuzumab (ONTRUZANT) for HER2-positive early breast cancer (EBC): Population-based real world data from the Danish Breast Cancer Group (DBCG). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
577 Background: Increasingly, HER2-positive early breast cancer (EBC) is treated by NACT combined with trastuzumab and pertuzumab followed by surgery. Ontruzant is registered as a biosimilar trastuzumab based on the totality of evidence including a randomized phase III study of NACT+Herceptin versus NACT+Ontruzant demonstrating similar pCR-rates (Pivot et al. J Clin Oncol 2018;36:968). However, no data exist for the efficacy of the combination of NACT with pertuzumab+Ontruzant (p+O). This investigator-initiated study was conducted to assess real world efficacy in HER2-positive EBC patients treated with NACT+p+O based on data from DBCG. DBCG has since 1977 provided guidelines for treatment of breast cancer and collected data from Danish hospital departments of surgery, pathology, and oncology prospectively on NACT, date and type of surgery and patho-anatomic findings. Methods: From the DBCG database, information was extracted for consecutive patients with unilateral early HER2-positive breast cancer registered to have received NACT+p+O from September 1, 2018 to August 31, 2019. pCR was defined as absence of residual invasive tumor in the breast and axillary lymph nodes (ypT0/Tis ypN0(i-)). Results: 215 patients received NACT+p+O. Median age was 54.8 years (range 24-81). NACT used, in combination with concurrent p+O, was cyclophosphamide+epirubicin followed by paclitaxel (62% on 6 cycles and 35% on 8 cycles) or other chemotherapy followed by paclitaxel (3%). Overall, 56% of patients achieved a pCR (Table). 68% of node-positive patients before receiving NACT+p+O had tumor-free axillary nodes after completing NACT+p+O. Conclusions: Real-world data from a nationwide population based study demonstrated a pCR-rate with NACT+p+O comparable to that seen in clinical studies with NACT+p+Herceptin (Chen et al. BMC Cancer 2019;19:973). pCR-rate was highly dependent on estrogen receptor (ER)-status and malignancy grade but not on clinical nodal status and tumor size. 68% of patients with cN+ converted to ypN0(i-). [Table: see text]
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Affiliation(s)
- Michael Andersson
- Department of Oncology, Rigshospitalet University Hospital, Copenhagen, Denmark
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Christensen T, Berg T, Nielsen LB, Andersson M, Jensen MB, Knoop A. Dual HER2 blockade in the first-line treatment of metastatic breast cancer - A retrospective population-based observational study in Danish patients. Breast 2020; 51:34-39. [PMID: 32200206 PMCID: PMC7375653 DOI: 10.1016/j.breast.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives Randomized clinical trials do not include a population that truly reflects a real-world population, due to their inclusion and exclusion criteria. This leads to concerns about the applicability of these studies in a clinical practice. In the present study, we aim to describe the clinical and demographic characteristics, treatment patterns, and clinical outcomes in a population of patients with HER2-positive metastatic breast cancer who received pertuzumab and trastuzumab as first-line treatment in a real-world setting. Methods The database of the Danish Breast Cancer Group was used to assemble data on patients included in the period April 2013 to August 2017. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Results A cohort of 291 patients with a median age of 58 years was registered. Hereof 112 (38%) patients with de novo disease (primary disseminated) and 179 (62%) with recurrence. The median follow-up for OS was 24.1 months. The median OS was 41.8 months (95% CI, 37.7 to NE) and the median PFS was 15.8 months (95% CI, 14.0 to 19.9). For de novo patients alone, the median OS was not reached whereas the median PFS was 17.9 months (95% CI, 14.3 to 27.3). Hazard ratios for patients receiving vinorelbine showed comparable results as for the whole population. Conclusion This heterogeneous patient population in a real-world setting had a PFS comparable with what could be expected from the related randomized trial. The de novo patients had better OS and PFS as compared to patients with recurrence. Patients with HER2-positive metastatic breast cancer. Pertuzumab and trastuzumab as first-line treatment in a real-world setting. A cohort of 291 patients; 112 with de novo disease and 179 with recurrence. Median OS; 41.8 months and median PFS; 15.8 months. PFS comparable with what could be expected from the related randomized trial.
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Affiliation(s)
- Thomas Christensen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Tobias Berg
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lise Birk Nielsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Standboulevarden 49, 2100, Copengahen, Denmark
| | - Michael Andersson
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Standboulevarden 49, 2100, Copengahen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Jensen MB, Lænkholm AV, Balslev E, Buckingham W, Ferree S, Glavicic V, Dupont Jensen J, Søegaard Knoop A, Mouridsen HT, Nielsen D, Nielsen TO, Ejlertsen B. The Prosigna 50-gene profile and responsiveness to adjuvant anthracycline-based chemotherapy in high-risk breast cancer patients. NPJ Breast Cancer 2020; 6:7. [PMID: 32140564 PMCID: PMC7044229 DOI: 10.1038/s41523-020-0148-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022] Open
Abstract
The DBCG89D trial randomized high-risk early breast cancer patients to adjuvant CMF (cyclophosphamide, methotrexate and fluorouracil) or CEF (cyclophosphamide, epirubicin and fluorouracil). Prosigna assays were performed by researchers with no access to clinical data. Time to distant recurrence (DR) was the primary endpoint, time to recurrence (TR) and overall survival (OS) secondary. Among the 980 Danish patients enrolled, Prosigna results were obtained in 686. Continuous ROR score was associated with DR for CMF (adjusted hazard ratio (HR) 1.20, 95% CI 1.09-1.33), and for CEF (HR 1.04, 95% CI 0.92-1.18), P interaction = 0.06. DR was significantly longer in CEF compared to CMF treated patients with Her2-enriched tumors (HR 0.58, 95% CI 0.38-0.86), but not in patients with luminal tumors. Heterogeneity of treatment effect was significant for TR and OS. In this prospective-retrospective analysis, patients with Her2-enriched breast cancer derived substantial benefit from anthracycline chemotherapy whereas anthracyclines are not an essential component of chemotherapy for patients with luminal subtypes. The benefit of CEF vs. CMF correlated with increasing ROR Score.
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Affiliation(s)
- Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | | | - Sean Ferree
- NanoString Technologies Inc, Seattle, WA USA
| | - Vesna Glavicic
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | | | - Ann Søegaard Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning T. Mouridsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Torsten O. Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC Canada
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Bens A, Dehlendorff C, Friis S, Cronin-Fenton D, Jensen MB, Ejlertsen B, Lash TL, Kroman N, Mellemkjær L. The role of H1 antihistamines in contralateral breast cancer: a Danish nationwide cohort study. Br J Cancer 2020; 122:1102-1108. [PMID: 32063603 PMCID: PMC7109031 DOI: 10.1038/s41416-020-0747-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Preclinical studies have shown both pro- and antineoplastic effects of antihistamines. Here, we evaluated the effect of H1 antihistamines on contralateral breast cancer (CBC) risk, and whether cationic amphiphilic (CAD) antihistamines could increase the sensitivity to chemotherapy. Methods From the Danish Breast Cancer Group clinical database, we identified all women aged ≥20 years with a first-time diagnosis of breast cancer during 1996–2012. Information on drug use, CBC and potential confounding factors was retrieved from nationwide registries. Using Cox proportional hazard regression models, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for CBC associated with H1-antihistamine use. Results We identified 52,723 patients with breast cancer with a total of 310,583 person-years of follow-up. Among them, 1444 patients developed a new primary tumour in the contralateral breast. Post-diagnosis use of H1 antihistamines (≥2 prescriptions) was not strongly associated with CBC risk (HR 1.08, 95% CI: 0.90–1.31) compared with non-use (<2 prescriptions). Use of CAD antihistamines among patients receiving chemotherapy was not associated with a decrease in CBC risk. Conclusions Taken together, our findings do not suggest any association of H1-antihistamine use with CBC development.
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Affiliation(s)
- Annet Bens
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Søren Friis
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Niels Kroman
- Department of Breast Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Lene Mellemkjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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Skriver SK, Jensen MB, Knoop AS, Ejlertsen B, Laenkholm AV. Abstract P4-10-18: Changes in tumour infiltrating lymphocytes during neoadjuvant endocrine therapy and possible clinical implications for guiding therapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-10-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Stromal Tumour Infiltrating Lymphocytes (sTILs) has been established as a predictive biomarker for response to neoadjuvant chemotherapy irrespective of subtype. While increased sTIL levels is associated with prolonged survival among patients with triple-negative and HER2 positive breast cancer increased sTILs has in Estrogen Receptor positive (ER+) breast cancer been suggested to be an adverse prognostic factor. It has been hypothesised that differences in the cellular composition of immune cells may explain the dissimilarity in prognostic impact according to breast cancer subtype.
Here, we report data from a neoadjuvant phase II study, treating postmenopausal patients with primary ER+, HER2 negative, operable breast cancer with letrozole for four months by the Danish Breast Cancer Group (DBCG). We analysed the association of sTILs, and changes in sTILs during neoadjuvant endocrine treatment (NET), with pathological response and correlation with other clinicopathological variables such as Ki67, as potential biomarkers for risk-stratification of patients following NET.
Method: 113 postmenopausal patients with ER+, HER2 negative breast cancer were treated with NET for four months. Endpoint was pathological response assessed by a modified Miller Payne scale and the Residual Cancer Burden (RCB) score. Pretherapeutic core biopsies and post therapeutic surgical specimens were assessed centrally for the percentage of sTILs on HE sections according to the International TILs working group guidelines. sTILs association to pathological response were assessed with univariate logistic regression. Odds Ratio (OR) was estimated with a 95 % confidence interval. Correlation of sTILs and Ki67 were tested with Pearson´s correlation coefficient. Changes in sTILs with a paired t-test. Level of significance was set to 5 %.
Results: sTILs concentration increased with mean 6.8 % (p <.0001) during treatment in the assessable patients (range -39 % - 60 %). Forty-four percent had no pathological response as assessed by the modified Miller Payne scale and 11 % had RCB-Class III after NET. Increase in sTILs was significantly associated with poorer pathological response with OR=1.38 (95 % CI: 1.05 - 1.82; p = 0.03) per 10 % increase for no pathological response, and correspondingly OR=1.78 (95 % CI: 1.27 - 2.50; p <.0001) for higher level RCB-class per 10 % increase.
The correlation between pre-therapeutic sTILs and Ki67 was moderate (Pearson 0.4; p = 0.0004), however the association grew stronger post treatment (Pearson 0.5; p <.0001).
Conclusion: Increased sTILs activity during NET was associated with poor treatment response. An increase in sTILs during NET could be considered indictive for potential immunogenic tumours, suggesting that patients with increasing sTIL in residual disease after NET might derive benefit from the addition of immunotherapy.
We found a significant correlation between sTILs and Ki67 levels. Ki67 has been established as a window of opportunity biomarker for antiproliferative response. Combining biomarkers of antiproliferative response such as Ki67 with biomarkers of immunogenetic significance might be important to determine optimal combination of adjuvant therapy. A window of opportunity study with an aromatase inhibitor could show if it is feasible to detect a rise in sTILs early enough to guide adjuvant treatment in the perioperative setting.
Citation Format: Signe Korsgaard Skriver, Maj-Britt Jensen, Ann Soegaard Knoop, Bent Ejlertsen, Anne-Vibeke Laenkholm. Changes in tumour infiltrating lymphocytes during neoadjuvant endocrine therapy and possible clinical implications for guiding therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-10-18.
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Affiliation(s)
| | - Maj-Britt Jensen
- 2Danish Breast Cancer Group (DBCG), University of Copenhagen, Copenhagen Ø, Denmark
| | | | - Bent Ejlertsen
- 1Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
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Lænkholm AV, Jensen MB, Eriksen JO, Roslind A, Buckingham W, Ferree S, Nielsen T, Ejlertsen B. Population-based Study of Prosigna-PAM50 and Outcome Among Postmenopausal Women With Estrogen Receptor-positive and HER2-negative Operable Invasive Lobular or Ductal Breast Cancer. Clin Breast Cancer 2020; 20:e423-e432. [PMID: 32253134 DOI: 10.1016/j.clbc.2020.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The Prosigna-PAM50 risk of recurrence (ROR) score has documented clinical utility for the prediction of 10-year distant recurrence (DR). The present study investigated the value of Prosigna-PAM50 for predicting 10-year DR and overall survival after 5 years of endocrine treatment for postmenopausal patients with invasive lobular carcinoma. PATIENTS AND METHODS Using the Danish Breast Cancer Group database, we identified patients with a diagnosis from 2000 to 2003 of estrogen receptor-positive, human epidermal growth factor receptor 2-negative invasive ductal (n = 1570) or lobular (n = 341) cancer > 20 mm or 1 to 3 positive lymph nodes and applied multivariate Cox models. RESULTS The median follow-up for DR was 9.3 years and for overall survival 15.2 years. Of the 341 lobular and 1570 ductal cases, 140 (41%) and 349 (22%) were classified as low ROR, with a 10-year DR rate of 7.7% (95% confidence interval [CI], 3.7%-13.6%) and 3.5% (95% CI, 1.8%-6.2%), respectively. The 10-year DR rate for the intermediate ROR group for those with lobular cancer was 18% (95% CI, 10.1%-27.9%) compared with 9.7% (95% CI, 6.7%-13.4%) for those with ductal cancer. Luminal B tumors had a significantly worse outcome than luminal A tumors in both lobular (hazard ratio, 1.89; 95% CI, 1.03%-3.45%; P = .04) and ductal (hazard ratio, 3.18; 95% CI, 2.29%-4.43%; P < .0001) cancer. CONCLUSION Prosigna PAM-50 provides significant prognostic information beyond the clinicopathologic factors in patients with invasive lobular breast cancer. Those with lobular cancer had worse 10-year DR rates compared with those with ductal cancer in the same ROR category. Our results could have an effect on the treatment decisions regarding the addition of chemotherapy for those in the intermediate ROR group.
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Affiliation(s)
- Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark.
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark
| | - Jens Ole Eriksen
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Anne Roslind
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | | | - Torsten Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark
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Jensen MB, Herskin MS, Canibe N, Forkman B, Pedersen LJ. Effect of straw amount on feed intake and weight gain in growing pigs housed in pens with partly slatted floor. Animal 2019; 14:1659-1666. [PMID: 31865933 DOI: 10.1017/s1751731119002957] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The provision of straw to pigs kept in conventional pens with concrete floor improves animal welfare, but the effects of straw on pigs' performance are unclear. In two steps, we investigated the relationship between amount of straw provided to pigs and measures of performance in a set-up maintaining constant space allowance and controlled room temperature. From approximately 30- to 85-kg BW, pigs were housed in groups of 18 in pens (5.48 m × 2.48 m) with concrete floor (1/3 solid, 1/3 drained and 1/3 slatted). The pens were cleaned manually twice a week, and the designated amount of fresh uncut wheat straw was provided daily onto the solid part of the floor. In the first step, 48 pens were assigned to 10-, 500- or 1000-g straw per pig per day, while in the second step, 90 pens were assigned to 10-, 80-, 150-, 220-, 290-, 360-, 430- or 500-g straw per pig per day. Pigs were weighed at the start of the experimental period at approximately 30 kg and again at approximately 85-kg BW. The average daily gain increased 8.1 g (SEM 17) for every extra 100-g straw added daily (P < 0.001) resulting in 40 g higher average daily gain with 500 compared to 10-g straw per pig per day. The feed conversion ratio was not affected by the amount of straw provided, as the feed intake tended to be higher with increasing amounts of straw. Thus, between 10 and 500 g, the more straw provided, the higher the daily weight gain. As the nutritional value of straw is considered minimal, this result is likely due to improved gut health from the increasing amounts of straw ingested and increased feed intake due to increased stimulation of exploratory behaviour with increasing amounts of straw available, or a combination of these. The observed tendency for a higher feed intake supports this suggestion, but studies are needed to establish the impact of these two contributing factors.
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Affiliation(s)
- M B Jensen
- Department of Animal Science, Aarhus University, AU-FOULUM, Blichers Allé 20, 8830 Tjele, Denmark
| | - M S Herskin
- Department of Animal Science, Aarhus University, AU-FOULUM, Blichers Allé 20, 8830 Tjele, Denmark
| | - N Canibe
- Department of Animal Science, Aarhus University, AU-FOULUM, Blichers Allé 20, 8830 Tjele, Denmark
| | - B Forkman
- Department of Veterinary and Animal Sciences, Faculty of Health Sciences, University of Copenhagen, Grønnegårdsvej 8, 1870 Frederiksberg C, Denmark
| | - L J Pedersen
- Department of Animal Science, Aarhus University, AU-FOULUM, Blichers Allé 20, 8830 Tjele, Denmark
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Fangel MV, Nielsen PB, Kristensen JK, Larsen TB, Overvad TF, Lip GYH, Jensen MB. 408Albuminuria as a predictor of incident ischemic stroke and myocardial infarction in patients with type 2 diabetes but without cardiovascular disease: A Danish cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Risk stratification in patients with type 2 diabetes continues to be an important priority in the management of diabetes-related morbidity and mortality. International guidelines generally recognize patients with diabetes and cardiovascular disease as high-risk patients. Risk stratification is, however, more uncertain in diabetes patients without cardiovascular disease. Micro- and macroalbuminuria have previously been identified as predictors of cardiovascular events and mortality in general cohorts of diabetes patients. However, less is known about the predictive value of albuminuria in patients with diabetes but without established cardiovascular disease.
Purpose
We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes and without a diagnosis of cardiovascular disease.
Methods
We linked Danish nationwide registries to identify patients with type 2 diabetes and without cardiovascular disease from May 2005 through June 2015. Based on two consecutive measurements of the urinary albumin excretion rate or albumin-to-creatinine ratio patients were stratified in categories of normoalbuminuria, microalbuminuria, and macroalbuminuria. Patients were followed for the outcomes ischemic stroke, myocardial infarction, and all-cause mortality until December 31, 2015. Five-year risk of outcomes were presented as cumulative incidence functions (with death as a competing event). Associations between albuminuria level and incidence of ischemic stroke, myocardial infarction, and all-cause mortality were evaluated with Cox proportional hazard regression adjusted for cardiovascular risk factors.
Results
The study population included 78,841 patients with type 2 diabetes (44.7% females, mean age 63.2). When comparing patients with microalbuminuria to patients with normoalbuminuria in an age- and sex-adjusted analysis, we found hazard ratios (HRs) of 1.45 (95% CI: 1.24–1.69), 1.45 (95% CI: 1.24–1.70), and 1.50 (95% CI: 1.39–1.61) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. Furthermore, macroalbuminuria was associated with HRs of 2.05 (95% CI: 1.70–2.48), 2.25 (95% CI: 1.86–2.71), and 2.03 (95% CI: 1.85–2.23) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. Similar results were found after adjusting for cardiovascular risk factors.
Conclusions
In this nationwide cohort study of patients with type 2 diabetes but without cardiovascular disease, patients with micro- and macroalbuminuria had a higher risk of incident ischemic stroke, myocardial infarction, and all-cause mortality. This finding supports that patients with micro- or macroalbuminuria should be screened regularly and followed closely in clinical practice. Moreover, these findings suggest that patients with type 2 diabetes and micro- or macroalbuminuria may benefit from intensive vascular risk reduction.
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Affiliation(s)
- M V Fangel
- Aalborg University, Center for General Practice at Aalborg University, Aalborg, Denmark
| | - P B Nielsen
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty og Health, Aalborg, Denmark
| | - J K Kristensen
- Aalborg University, Center for General Practice at Aalborg University, Aalborg, Denmark
| | - T B Larsen
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty og Health, Aalborg, Denmark
| | - T F Overvad
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty og Health, Aalborg, Denmark
| | - G Y H Lip
- Institute of Cardiovascular Medicine & Science of Liverpool, Liverpool, United Kingdom
| | - M B Jensen
- Aalborg University, Center for General Practice at Aalborg University, Aalborg, Denmark
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Prajapati B, Jensen MB, Jørgensen NOG, Petersen NB. Grey water treatment in stacked multi-layer reactors with passive aeration and particle trapping. Water Res 2019; 161:181-190. [PMID: 31195334 DOI: 10.1016/j.watres.2019.05.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
When adequately treated, grey water represents a potent alternative water resource, as it constitutes a large proportion of household wastewater. The objective of this paper was to test a full scale version of a novel compact grey water treatment technology, based on passive aeration and particle trapping in multiple layers. Using a modified dual porosity filtration technology, grey water from a public bath was passed through a stack of eight reactors, each 0.75 m × 0.55 × 0.22 m, serially connected for gravity driven flow from top to bottom in a zig-zag pattern. The topmost reactor served as pre-filter for removal of hair and other larger debris. The lower seven reactors facilitated degradation of bulk organic contaminants in biofilm established on a stack of five fibrous polyamide nets, and trapping of particles by sedimentation on five interlaid corrugated plastic plates. By operating the reactors in a time-controlled batch-mode, the corrugated plates further served to trap air and thus ensure passive aeration of the subsequent batch. The production rate was 1.2 m3/d and the hydraulic retention time 2 h, at an aerial footprint of 0.4 m2, excluding storage tanks. After two weeks of initialization, a biofilm had established and the system was monitored for additionally three weeks. Significantly improved effluent quality was obtained as measured from reductions in turbidity (95%), total suspended solids (94%), chemical oxygen demand (87%), and microbiological parameters (55-98%), and from stable level of dissolved oxygen in effluent of 3.5 mg/L. Future optimization includes custom-made reactors for maximizing production capacity, improved removal of total N and total P, and addition of final disinfection.
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Affiliation(s)
- B Prajapati
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Denmark.
| | - M B Jensen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Denmark.
| | - N O G Jørgensen
- Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, 1871, Frederiksberg C, Denmark.
| | - N B Petersen
- Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, 1871, Frederiksberg C, Denmark.
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