1
|
Accomasso F, Actis S, Minella C, Rosso R, D’Alonzo M, Ponzone R, Bounous V, Biglia N. P147 Clinical, pathological, and prognostic features of male breast cancer. A multicenter study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00264-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
|
2
|
Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Di Meglio A, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Graffeo R, Dieci MV, Pérez-Fidalgo JA, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Safety of assisted reproductive techniques in young women harboring germline pathogenic variants in BRCA1/2 with a pregnancy after prior history of breast cancer. ESMO Open 2021; 6:100300. [PMID: 34775302 PMCID: PMC8593447 DOI: 10.1016/j.esmoop.2021.100300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knowledge is growing on the safety of assisted reproductive techniques (ART) in cancer survivors. No data exist, however, for the specific population of breast cancer patients harboring germline BRCA1/2 pathogenic variants. PATIENTS AND METHODS This is a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤40 years with stage I-III breast cancer, between January 2000 and December 2012, harboring known germline BRCA1/2 pathogenic variants. Patients included in this analysis had a post-treatment pregnancy either achieved through use of ART (ART group) or naturally (non-ART group). ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection, and embryo transfer under hormonal replacement therapy. RESULTS Among the 1424 patients registered in the study, 168 were eligible for inclusion in the present analysis, of whom 22 were in the ART group and 146 in the non-ART group. Survivors in the ART group conceived at an older age compared with those in the non-ART group (median age: 39.7 versus 35.4 years, respectively). Women in the ART group experienced more delivery complications compared with those in the non-ART group (22.1% versus 4.1%, respectively). No other apparent differences in obstetrical outcomes were observed between cohorts. The median follow-up from pregnancy was 3.4 years (range: 0.8-8.6 years) in the ART group and 5.0 years (range: 0.8-17.6 years) in the non-ART group. Two patients (9.1%) in the ART group experienced a disease-free survival event (specifically, a locoregional recurrence) compared with 40 patients (27.4%) in the non-ART group. In the ART group, no patients deceased compared with 10 patients (6.9%) in the non-ART group. CONCLUSION This study provides encouraging safety data on the use of ART in breast cancer survivors harboring germline pathogenic variants in BRCA1/2, when natural conception fails or when they opt for ART in order to carry out preimplantation genetic testing.
Collapse
Affiliation(s)
- M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - A Grinshpun
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A S Hamy
- Department of Medical Oncology, Institut Curie, Paris, France
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - S Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - P D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - C Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - C Senechal
- Cancer Genetics Unit, Bergonie Institute, Bordeaux, France
| | - L Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Siena, Siena, Italy
| | - R Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - L De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - K Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - C Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - O Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - L Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - F Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - R Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - F P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - F Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - E Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - T Peretz-Yablonski
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - O Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Saule
- Department of Genetics, Institut Curie, Paris, France
| | - L Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - J Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| |
Collapse
|
3
|
Villasco A, Actis S, Borella F, D’Alonzo M, Ponzone R, De Sanctis C, Benedetto C, Biglia N. Evaluation of the efficacy of Trastuzumab in patients with HER2 positive small (pT1mi/a) breast cancers. A multicenter retrospective study on 100 patients. Breast 2021. [DOI: 10.1016/s0960-9776(21)00090-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
4
|
Sorbello V, Fuso L, Sfiligoi C, Scafoglio C, Ponzone R, Biglia N, Weisz A, Sismondi P, De Bortoli M. Quantitative Real-Time RT-PCR Analysis of Eight Novel Estrogen-Regulated Genes in Breast Cancer. Int J Biol Markers 2018; 18:123-9. [PMID: 12841681 DOI: 10.1177/172460080301800205] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Biological markers capable of predicting the risk of recurrence and the response to treatment in breast cancer are eagerly awaited. Estrogen and progesterone receptors (ER, PgR) in tumor cells mark cancers that are more likely to respond to endocrine treatment, but up to 40% of such patients do not respond. Here, the expression of a group of estrogen-regulated genes, previously identified by microarray analysis of in vitro models, was measured in breast tumors and possible associations with other clinicopathological variables were investigated. Methods The expression of CD24, CD44, HAT-1, BAK-1, G1P3, TIEG, NRP-1 and RXRα was measured by quantitative real-time RT-PCR on RNA from eighteen primary breast tumors. Statistical analyses were used to identify correlations among the eight genes and the available clinicopathological data. Results Variable expression levels of all the genes were observed in all the samples examined. Significant associations of CD24 with tumor size, CD44 with lymph node invasion, and HAT-1 and BAK-1 with ER positivity were found. The possible combinatorial value of these genes was assessed. Unsupervised hierarchical clustering analysis demonstrated that the expression profile of these genes was able to predict ER status with an acceptable approximation. Conclusions Eight novel potential markers for breast cancer have been preliminarily characterized. As expected from in vitro data, their expression is able to discriminate ER- versus ER+ tumors.
Collapse
Affiliation(s)
- V Sorbello
- Laboratory of Oncological Gynecology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Modaffari P, Ponzone R, Cipullo I, D'Alonzo M, Bounous V, Maggiorotto F, Biglia N. What do women and men feel about BRCA diagnosis? Breast 2017. [DOI: 10.1016/s0960-9776(17)30403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
6
|
Zucchini G, Petrelli A, Kubatzki F, Cargnelutti M, Di Virgilio MR, Sarotto I, Martincich L, Ponzone R, Martinello R, Sapino A, Nuzzo A, Giordano S, Montemurro F. Abstract P1-09-21: Clinical evaluation of miR-100 as a predictor of endocrine-responsiveness in hormone-receptor positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Micro RNAs (miRNAs) are short, non-coding RNA molecules that act as negative regulators of gene-expression, mainly at the post-transcriptional level. Alterations in miRNA functions have been implicated in a variety of human diseases, including cancer
We demonstrated that the ectopic expression of miR-100 in cancer stem cells (CSCs) derived from aggressive, basal-like BC (HRs and HER2 negative) caused loss of stemness and the acquisition of a hormone receptor positive and endocrine treatment sensitive phenotype (Petrelli et al, Oncotarget 6;2315-30, 2015). We therefore sought to study whether miR-100 is a determinant of the endocrine-responsive phenotype in HR-positive BC patients (pts).
Methods: Women with newly diagnosed, estrogen-receptor and/or progesterone-receptor positive, HER2 negative BC were eligible for this study. Treatment consisting of tamoxifen for pre-menopausal and letrozole for post-menopausal pts was administered daily for 21 days (+/- 3 days) before breast surgery. MiR-100 levels in pre-treatment tumor biopsies, measured as fold-change with respect to a reference RNA and transformed to the natural logarithms to normalize the data, were correlated with proliferative response to endocrine therapy, as measured by Ki67 expression in the final surgical specimen. The primary end-point was a complete proliferative response (CPR), defined as a post-treatment Ki67≤1%. Additionally, we considered a “post-hoc” composite endpoint where response was defined as a post treatment Ki67 <10% together with a Ki67 reduction ≥80% compared to pre-treatment values. The target accrual is 88 patients (pts). Here we report the results of the first interim analysis focusing on post-menopausal pts receiving letrozole.
Results: A total of 42 pts were evaluable for miR-100 levels and response to endocrine therapy. Median ER and PgR expression was 99% (58%-99%) and 96% (0-99%) respectively. Median pre-treatment Ki67 was 18% (5-76%). Thirty-one tumors were ductal carcinomas, 9 were lobular and 2 were “other” histotypes. The median (range) miR-100 values in pre-treatment specimens was 2.253 (0.460-3.750). After treatment, median Ki67 was 4% (1%-46%) and the median percentage variation with respect to baseline values was -74% (0% to -94%). A CPR was observed in 5/42 pts (12%, 95% C.I. 5%-25%). The median miR-100 levels in responders and non-responders were 3.058 and 2.198, respectively (p = 0.03). Logistic regression analysis showed that each unit increase in miR-100 was associated with a 7-fold increase in the likelihood of a CPR (OR 7.056, 95% C.I. 1.103-45.141, p = 0.04).
Considering the composite end-point, 17/42 pts (40%, 95% C.I. 27%-56%) were considered responders. Median miR-100 levels in responders and non-responders were 2.427 and 1.956, respectively (p = 0.05).
Conclusions: preliminary results of this prospective clinical trial suggest that miR-100 can be a modulator of the endocrine-responsive phenotype in post-m pts with HR-positive breast cancer. The study is completing its target accrual and an investigation of miR-100 targets is being conducted.
GZ and AP contributed equally to this work.
Supported by Associazione Italiana per la Ricerca Sul Cancro (Investigator Grant IG-2013 Ref. 14451).
Citation Format: Zucchini G, Petrelli A, Kubatzki F, Cargnelutti M, Di Virgilio MR, Sarotto I, Martincich L, Ponzone R, Martinello R, Sapino A, Nuzzo A, Giordano S, Montemurro F. Clinical evaluation of miR-100 as a predictor of endocrine-responsiveness in hormone-receptor positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-21.
Collapse
Affiliation(s)
- G Zucchini
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - A Petrelli
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - F Kubatzki
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - M Cargnelutti
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | | | - I Sarotto
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - L Martincich
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - R Ponzone
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - R Martinello
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - A Sapino
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - A Nuzzo
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - S Giordano
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| | - F Montemurro
- Candiolo Cancer Institute-FPO (IRCCS), Candiolo, Italy
| |
Collapse
|
7
|
Gatti M, Salatino A, Cattari G, Rivolin A, Ponzone R, Gabriele P. Radiation therapy and breast reconstruction: Outcomes and complications in our experience. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
8
|
Gatti M, Belli G, Salatino A, Maggio A, Cattari G, Squintu S, Rivolin A, Ponzone R, Gabriele P. EP-1167: Radiation therapy and breast reconstruction: outcomes and complications in our experience. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Marocco F, Vaira M, Milani A, Genta S, Maggiorotto F, Magistris A, Cinquegrana A, Robella M, De Simone M, Aglietta M, Ponzone R, Valabrega G. Secondary cytoreductive surgery, hyperthermic intraperitoneal intraoperative chemotherapy, and chemotherapy alone: a retrospective comparison of alternative approaches in relapsed platinum sensitive ovarian cancer. EUR J GYNAECOL ONCOL 2016; 37:638-643. [PMID: 29787001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The best treatment for relapsed platinum sensitive epithelial ovarian cancer (EOC) is controversial. The aim of the study was to compare progression-free survival (PFS) and overall survival (OS) in platinum-sensitive EOC patients treated with chemotherapy alone (CTA), secondary cytoreductive surgery (SCR) or SCR plus hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC). MATERIALS AND METHODS Retrospective analysis of the clinical outcome of 46 EOC patients with at least 30 months of follow-up. RESULTS Median follow-up time was 32 months for the CTA group, 30 months for the SCR group, and 45 months for the SCR + HIPEC group. Fifteen recurrences were observed in the CTA group, seven in the SCR group, and 16 in the SCR + HIPEC group. The median time elapsed between first and second recurrence (PFI-2) was significantly higher among patients treated with SCR + HIPEC, in comparison with patients treated with CTA (p = 0.012 andp = 0.017, respectively). On the contrary, PFI-2 did not significantly differ between the SCR and SCR + HIPEC groups (p = 0.877). A statistically significant difference in OS favouring SCR + HIPEC in comparison with CTA (p = 0.04) was observed. CONCLUSIONS SCR HIPEC compared with CTA improves PFI-2 in patients with platinum-sensitive EOC recurrence. SCR + HIPEC might also improve OS in comparison with CTA. No improvement in favor of SCR + HIPEC vs SCR was observed,. These results further support the need of a randomized trial comparing chemotherapy with SCR ± HIPEC in this setting.
Collapse
|
10
|
Biglia N, Ponzone R, Bounous V, Mariani L, Maggiorotto F, Benevelli C, Liberale V, Ottino M, Sismondi P. Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery. Breast 2014; 23:870-5. [DOI: 10.1016/j.breast.2014.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/22/2014] [Accepted: 09/22/2014] [Indexed: 12/21/2022] Open
|
11
|
Sini V, Lunardi G, Cirillo M, Turazza M, Bighin C, Giraudi S, Levaggi A, Piccioli P, Bisagni G, Gnoni R, Stridi G, Porpiglia M, Picardo E, Ponzone R, Marenco D, Mansutti M, Puglisi F, Del Mastro L. Body mass index and circulating oestrone sulphate in women treated with adjuvant letrozole. Br J Cancer 2014; 110:1133-8. [PMID: 24448359 PMCID: PMC3950872 DOI: 10.1038/bjc.2014.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/05/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity is an independent adverse prognostic factor in early breast cancer patients, but it is still controversial whether obesity may affect adjuvant endocrine therapy efficacy. The aim of our study (ancillary to the two clinical trials Gruppo Italiano Mammella (GIM)4 and GIM5) was to investigate whether the circulating oestrogen levels during treatment with the aromatase inhibitor letrozole are related to body mass index (BMI) in postmenopausal women with breast cancer. METHODS Plasma concentration of oestrone sulphate (ES) was evaluated by radioimmunoassay in 370 patients. Plasma samples were obtained after at least 6 weeks of letrozole therapy (steady-state time). Patients were divided into four groups according to BMI. Differences among the geometric means (by ANOVA and ANCOVA) and correlation (by Spearman's rho) between the ES levels and BMI were assessed. RESULTS Picomolar geometric mean values (95% confidence interval, n=patients) of circulating ES during letrozole were 58.6 (51.0-67.2, n=150) when BMI was <25.0 kg m(-2); 65.6 (57.8-74.6, n=154) when 25.0-29.9 kg m(-2); 59.3 (47.1-74.6, n=50) when 30.0-34.9 kg m(-2); and 43.3 (23.0-81.7, n=16) when ≥35.0 kg m(-2). No statistically significant difference in terms of ES levels among groups and no correlation with BMI were observed. CONCLUSIONS Body mass index does not seem to affect circulating oestrogen levels in letrozole-treated patients.
Collapse
Affiliation(s)
- V Sini
- 1] Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy [2] Oncology Unit, Surgical and Medical Department of Clinical Sciences, Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - G Lunardi
- Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy
| | - M Cirillo
- Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy
| | - M Turazza
- Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy
| | - C Bighin
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - S Giraudi
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - A Levaggi
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - P Piccioli
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - G Bisagni
- Department of Oncology, Azienda Ospedaliera ASMN, viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - R Gnoni
- Department of Oncology, Azienda Ospedaliera ASMN, viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - G Stridi
- Department of Oncology, Azienda Ospedaliera ASMN, viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - M Porpiglia
- University Department of Gynecology and Obstetrics, S.Anna Hospital, Corso Spezia, 60, 10126 Turin, Italy
| | - E Picardo
- University Department of Gynecology and Obstetrics, S.Anna Hospital, Corso Spezia, 60, 10126 Turin, Italy
| | - R Ponzone
- Gynecological Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, 10060 Candiolo (Turin), Italy
| | - D Marenco
- 1] Gynecological Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, 10060 Candiolo (Turin), Italy [2] Gynecology and Obstetrics, Santa Croce Hospital, Piazza Amedeo Ferdinando, 3, 10024 Moncalieri (Turin), Italy
| | - M Mansutti
- Oncology Department, University Hospital of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - F Puglisi
- Oncology Department, University Hospital of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - L Del Mastro
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| |
Collapse
|
12
|
Affiliation(s)
- M. Spada
- Istituto di Clinica Pediatrica, Piazza Polonia 94, 10126 Torino, Italy
| | - T. Parrella
- Istituto di Clinica Pediatrica, Piazza Polonia 94, 10126 Torino, Italy
| | - R. Ponzone
- Istituto di Clinica Pediatrica, Piazza Polonia 94, 10126 Torino, Italy
| | - S. Ferraris
- Istituto di Clinica Pediatrica, Piazza Polonia 94, 10126 Torino, Italy
| | - O. Guardamagna
- Istituto di Clinica Pediatrica, Piazza Polonia 94, 10126 Torino, Italy
| | - A. Ponzone
- Istituto di Clinica Pediatrica, Piazza Polonia 94, 10126 Torino, Italy
| | - N. Blau
- Department of Pediatrics, University of Zürich, CH-8032 Zürich, Switzerland
| |
Collapse
|
13
|
Guardamagna O, Spada M, Ponzone A, Viora E, Ponzone R, Binkert F, Matasovic A, Kierat L, Blau N. Prenatal Diagnosis of Dihydropteridine Reductase Deficiency in a Twin Pregnancy. Pteridines 2013. [DOI: 10.1515/pteridines.1991.3.12.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- O. Guardamagna
- Department of Pediatrics Piazza Polonia, 94, 10126 Torino Italy
| | - M. Spada
- of Pediatrics Piazza Polonia, 94, 10126 Torino Italy
| | - A. Ponzone
- Department of Pediatrics Piazza Polonia, 94, 10126 Torino Italy
| | - E. Viora
- Department of Obstetrics and Gynecology, Piazza Polonia, 94, 10126 Torino Italy
| | - R. Ponzone
- Department of Obstetrics and Gynecology, Piazza Polonia, 94, 10126 Torino Italy
| | - F. Binkert
- Institute of Medical Genetics University of Zürich, Switzerland
| | - A. Matasovic
- Department of Pediatrics, University of Zürich, Switzerland
| | - L. Kierat
- Department of Pediatrics, University of Zürich, Switzerland
| | - N. Blau
- Department of Pediatrics, University of Zürich, Switzerland
| |
Collapse
|
14
|
Montemurro F, Gatti M, Redana S, Jacomuzzi ME, Nanni D, Durando A, Popolo M, Ponzone R, Rossi A, Albieri V, Valabrega G, Sismondi P, Gabriele P, Aglietta M. Concurrent Radiotherapy Does Not Affect Adjuvant CMF Delivery but is Associated with Increased Toxicity in Women with Early Breast Cancer. J Chemother 2013; 18:90-7. [PMID: 16572899 DOI: 10.1179/joc.2006.18.1.90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We evaluated whether concurrent radiotherapy (RT) affected delivery and toxicity of adjuvant intravenous CMF (cyclophosphamide, methotrexate and 5-fluorouracil) in women with operable breast cancer. The medical charts of 321 consecutive breast cancer patients who received CMF either alone for 6 cycles, or for 4 cycles following of an anthracycline (A-CMF) were reviewed. One hundred forty-four women underwent radiotherapy concurrently with CMF. Optimal CMF delivery (success as opposite to failure) was defined as the combined achievement of an average relative dose intensity (aRDI) > or = 85% and an average percent of the total dose (aPTD) > or = 90% for the three drugs in the CMF regimen. Multivariate logistic regression analysis showed that concurrent-RT did not affect CMF delivery (OR for success 1.391 p=0.230). The sequential A-CMF regimen (OR for success 0.208, 95% C.I. 0.120-0.360, p<0.001) and age > or = 56 (OR for success 0.351, 95% C.I. 0.200-0.161, p<0.001) were independently associated with suboptimal CMF delivery. Moreover, concurrent RT was independently associated with increased leukopenia, thrombocytopenia, upper abdominal pain, mucositis and fatigue. Our retrospective analysis suggests that concurrent-RT has no impact on optimal CMF delivery, but it increases the burden of CMF-related toxicity.
Collapse
Affiliation(s)
- F Montemurro
- Unit of Medical Oncology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ponzone R, Giai M, Roagna R, Sgro L, Biglia N, Welch H, Sismondi P. Clinical and ethical issues in the diagnosis of hereditary breast cancer (review). Int J Oncol 2013; 10:323-8. [PMID: 21533379 DOI: 10.3892/ijo.10.2.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A small subset of breast and ovarian cancers is related to the mutation of dominant susceptibility genes. The recent isolation of BRCA1 and BRCA2 has created great interest and expectations among members of families with a positive history for breast/ovarian cancer. We reviewed the literature to explore the clinical implications of genetic testing for BRCA1 and BRCA2 mutations among high risk women. Both the value of the information provided by the test and the efficacy of the preventive and diagnostic measures presently available have been examined. We also specifically address the issue of ethical dilemmas arising from widespread availability of genetic information, including psycological reactions of those who receive the test, genetic discrimination by health insurance companies or employers and prenatal testing for BRCA1 mutations.
Collapse
Affiliation(s)
- R Ponzone
- HARTWELL LAB,CANC RES INST,LONDON SW3 6JJ,ENGLAND
| | | | | | | | | | | | | |
Collapse
|
16
|
Biglia N, Maggiorotto F, Liberale V, Bounous VE, Sgro LG, Pecchio S, D'Alonzo M, Ponzone R. Clinical-pathologic features, long term-outcome and surgical treatment in a large series of patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Eur J Surg Oncol 2013; 39:455-60. [PMID: 23490334 DOI: 10.1016/j.ejso.2013.02.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/15/2013] [Accepted: 02/01/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE OF THE STUDY A retrospective analysis on 1407 patients with invasive ductal carcinoma (IDC) and 243 invasive lobular carcinoma (ILC) was performed in order to compare the histological features, the immunohistochemical characteristics, the surgical treatment and the clinical outcome in the two groups. RESULTS ILC seems to be more likely multifocal, estrogen receptor positive, HER-2 negative and to have a lower proliferative index compared to IDC. ILC, when treated with conservative surgery, required more frequently re-excision and/or mastectomy because of positive resection margins. No difference was observed in terms of 5-year disease free survival and local relapse free survival between the two groups, in the whole series and in the subgroup of patients treated with breast-conserving treatment. CONCLUSION ILC can be safely treated with conservative surgery but a more accurate preoperative evaluation of tumor size and multifocality could be advocated, in order to reduce the re-excision rate.
Collapse
Affiliation(s)
- N Biglia
- Academic Division of Gynaecology and Obstetrics, Mauriziano Hospital "Umberto I", University of Turin, Largo Turati 62, Turin, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Gatti M, Bresciani S, Ponzone R, Panaia R, Salatino A, Stasi M, Gabriele P. PO-0632 TOXICITY AND COSMETIC OUTCOME OF THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY FOR PARTIAL BREAST IRRADIATION. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
18
|
Montemurro F, Maggiorotto F, Valabrega G, Kubatzki F, Rossi V, Marocco F, Magistris A, Gatti M, Sarotto I, Aglietta M, Ponzone R. P3-07-04: Does Omission of Axillary Dissection after a Positive Sentinel Node Biopsy Influence Indication to Adjuvant Chemotherapy in Operable Breast Cancer Patients? Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-07-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Based on the recently published ACSOG Z0011 study (JAMA 2011;305:569), axillary dissection (AD) may be avoided in breast cancer (BC) patients with a clinically negative axilla and a positive sentinel lymph node (SLN) biopsy receiving breast conserving surgery (BCS). Because the number of positive axillary lymph nodes (ALN) is a widely accepted prognostic marker, we evaluated the potential impact of omission of AD on indication to adjuvant chemotherapy (ACT).
Patients and methods: Among 1497 patients operated at our Institution over 10 years, we identified 321 patients fulfilling the inclusion criteria of the ACSOG Z0011 study (BCS plus SLNB, cT1-2, cN0 breast cancer and 1 to 2 positive SLN). All patients underwent AD. Each case, which was anonymized, was reviewed by our breast team in two rounds. In the first round, patient age, histopathology, linfovascular invasion, tumor grade, hormone receptor, HER2, and ki67 status and number of positive SN nodes (micro and/or macrometastatic) were available. In the second round, the information on ALN was added. At each round, the panel chose between three indications: 1) Recommend ACT; 2) Discuss ACT; 3) No ACT. Results: SN was micrometastatic in 145 (45%) and macrometastatic in 176 patients (55%). ALD revealed non-SNs metastases in 96 patients (30%). Forty-four of these patients had >3 positive ALN (range 4–24). Indications at round 1 and 2 are summarized below.
As a result of the disclosure of the total number of involved ALN, a change in the indication occurred in 51 patients (16%). The most frequent change was a recommendation to ACT (35 patients, 69% of the changes). Among these patients, 9 changed from No-ACT to recommend ACT. All except one change in the indication to ACT occurred in patients with immunohistochemically defined Luminal A and Luminal B/HER2 negative tumors and were mostly towards ACT. Conclusions: Omission of AD in patients with a positive SLN receiving BCS would have altered the indication to ACT in 16% of the patients at our Institution. Changes occurred almost exclusively in patients with hormone receptor positive/HER2−negative tumors. The implications of omission of AD must be taken into account before its widespread acceptance, including the possibility of a biologically tailored surgical approach.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-04.
Collapse
Affiliation(s)
- F Montemurro
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - F Maggiorotto
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - G Valabrega
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - F Kubatzki
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - V Rossi
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - F Marocco
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - A Magistris
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - M Gatti
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - I Sarotto
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - M Aglietta
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| | - R Ponzone
- 1Fondazione del Piemonte per l'Oncologia/IRCC, Candiolo, Torino, Italy
| |
Collapse
|
19
|
Rossi V, Sarotto I, Maggiorotto F, Tomasi CN, Redana S, Aglietta M, Ponzone R, Montemurro F. P2-12-31: Moderate Immunohistochemical Expression of HER2 (2+) without HER2 Gene-Amplification Is a Negative Prognostic Factor in Early Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-12-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: We sought to evaluate whether moderate HER2 immunohistochemical (IHC) expression (2+ and no HER2/amplification) identifies early breast cancer (EBC) with a distinct prognostic profile.
Methods: A total of 1295 women (median age 58, range 22–94) undergoing surgery for EBC from Jan 1995 to Sept 2009 were retrospectively reviewed. All patients had undergone HER2 testing by the HercepTest and, when needed, by fluorescence in-situ hybridization (FISH). All tests were carried on at our Institutional Surgical Pathology laboratory. The impact of HER2 status on disease-free survival (DFS) was corrected for other clinical and pathological potential covariates by Cox Proportional Regression Analysis.
Results: A total of 494 (38%), 486 (38%), 119 (9%) and 196 (15%) of the patients had HER2 0+, 1+ 2+ and positive (3+ or FISH+) tumors, respectively. Sixty-one of 196 patients with HER2−positive EBC received adjuvant trastuzumab. A total of 298 DFS events occurred at median follow-up of 59 months (4-137 months). By using HER2 0+ status as reference, multivariate analysis revealed that HER2 2+ expression was associated with a significant increase in the risk of a DFS event (HR 2.303, 95% C.I. 1.501−3.533, p<0.001), whereas HER2 1+ was not (HR 0.976, 95% C.I. 0.698−1.365, p=0.889). We performed exploratory two-group comparisons by further classifying tumors according to hormone-receptor status (cutoff for ER and PgR positivity ≥10% of stained cells). Results are summarized in the table. HER2 2+ expression was associated with worse prognosis in both ER and/or PgR positive and ER/PgR negative tumors. In the latter group, HER2 2+ expression was associated with a particularly high rate of DFS events, with a 60-month projected DFS of 20%. Furthermore, while DFS curves plateaued at 60 months for HER2−positive tumors (with and without adjuvant trastuzumab) and for ER/PgR negative tumors with HER2 0/1+ expression, hormone receptor positive/HER2 2+ tumors displayed a particularly high rate of late relapses (beyond 60 months). Results did not change using a 1% cutoff to define ER and PgR positivity.
Conclusion: Moderate HER2 positivity (IHC 2+/FISH negative) identifies EBC patients at increased risk of a DFS event, regardless of hormone receptor status. Due to suggestions from large randomized trials that the benefits of trastuzumab may not be limited to HER2−positive tumors, patients with HER2 2+ EBC are ideal candidates for studies testing this hypothesis.
Multivariate Hazard Ratios, corrected by age, lymph-node status, tumor diameter, tumor grade, proliferation (Ki 67 index) and receipt of adjuvant chemotherapy
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-31.
Collapse
Affiliation(s)
- V Rossi
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - I Sarotto
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - F Maggiorotto
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - Cont N Tomasi
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - S Redana
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - M Aglietta
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - R Ponzone
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| | - F Montemurro
- 1Institute for Cancer Research and Treatment IRCC, Candiolo, Turin, Italy
| |
Collapse
|
20
|
Gatti M, Bresciani S, Ponzone R, Panaia R, Salatino A, Stasi M, Gabriele P. Toxicity and cosmetic outcome of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Lunardi G, Del Mastro L, Bighin C, Bisagni G, Driol P, Garrone O, Giraudi S, Marroni P, Piccioli P, Ponzone R, Porpiglia M, Venturini M. Effects of body mass index (BMI) on plasma levels of estrone sulfate (ES) in postmenopausal women with breast cancer (BC) during letrozole (L) treatment. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
22
|
Biglia N, Bounous VE, Martincich L, Panuccio E, Liberale V, Ottino L, Ponzone R, Sismondi P. Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast. Eur J Surg Oncol 2011; 37:199-204. [PMID: 21237612 DOI: 10.1016/j.ejso.2010.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/06/2010] [Accepted: 12/09/2010] [Indexed: 12/19/2022] Open
Abstract
AIMS The role of magnetic resonance imaging (MRI) in the local staging of breast cancer is currently uncertain. The purpose of this prospective study is to evaluate the accuracy of preoperative MRI compared to conventional imaging in detecting breast cancer and the effect of preoperative MRI on the surgical treatment in a subgroup of women with dense breasts, young age, invasive lobular cancer (ILC) or multiple lesions. METHODS Between January 2006 and October 2007, 91 patients with newly diagnosed breast cancer underwent preoperative clinical breast examination, mammography, bilateral breast ultrasonography and high-resolution breast MRI. All patients had histologically verified breast cancer. The imaging techniques were compared using the final pathological report as gold standard. RESULTS The sensitivity of MRI for the main lesion was 98.9%, while for multiple lesions sensitivity was 90.7% and specificity 85.4%. After preoperative MRI, 13 patients (14.3%) underwent additional fine needle/core biopsies, 9 of whom had specimen positive for cancer. Preoperative MRI changed the surgical plan in 26 patients: in 19.8% of the cases breast conservative surgery was converted to mastectomy and in 7.7% of the patients a wider excision was performed. At a mean follow-up of 48 months, 2 local recurrences occurred (local failure rate = 2.5%). CONCLUSIONS Enhanced sensitivity of breast MRI may change the surgical approach, by increasing mastectomy rate or suggesting the need of wider local excision. MRI can play an important role in preoperative planning if used in selected patients with high risk of multifocal/multicentric lesions. However, the histologic confirmation of all suspicious findings detected by MRI is mandatory prior to definite surgery.
Collapse
Affiliation(s)
- N Biglia
- Oncological Gynaecology, Torino, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Lunardi G, Lastraioli S, Bruzzi P, Pronzato P, Bisagni G, Ponzone R, Porpiglia M, Russo S, Del Mastro L, Venturini M. Single-nucleotide polymorphisms (SNPs) of CYP19A1 and plasma levels of estrone sulfate (ES) in postmenopausal women with breast cancer (BC) during letrozole (L) treatment. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
24
|
Cassina E, Cont NT, Ponzone R, Liberale V, Maggiorotto F, Sismondi P. 277 Updated results of a monocentric phase II trial of Axillary Reverse Mapping (ARM) in breast cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Biglia N, Sgandurra P, Peano E, Marenco D, Moggio G, Bounous V, Tomasi Cont N, Ponzone R, Sismondi P. Non-hormonal treatment of hot flushes in breast cancer survivors: gabapentin vs. vitamin E. Climacteric 2009; 12:310-8. [PMID: 19415540 DOI: 10.1080/13697130902736921] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
26
|
Lunardi G, Del Mastro L, Serra M, Driol P, Boni C, Cognetti F, Ponzone R, Porpiglia M, Venturini M, Pronzato P. Plasma levels of estrone sulfate (ES) in postmenopausal women with breast cancer (BC) during letrozole (L) treatment: Association with single nucleotide polymorphisms (SNPs) of CYP19A1. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
555 Background: The CYP19A1 gene encodes aromatase, a key enzyme for estrogen biosynthesis. We investigated the association between four CYP19A1 SNPs, affecting different circulating estrogen levels (rs10046 C>T, rs4646 G>T, rs749292 C>T, rs727479 T>G), and suppression of plasma ES levels induced by 6 weeks (time needed to reach L steady-state concentrations) of L (25 mg/d). Methods: Patients were enrolled into a prospective, italian multi-centre trial (GIM5) testing the correlation of CYP19A1 SNPs with the efficacy of L adjuvant therapy, after 5 years of tamoxifen, in postmenopausal early BC patients. Blood samples for hormone measurements were obtained immediately before starting L (baseline) and following 6 wks of treatment. SNPs were identified from DNA obtained from peripheral blood cells by Hexaprimer Amplification Refractory Mutation System PCR (H-ARMS-PCR). Plasma ES levels were evaluated by Radio Immuno Assay (RIA). Results: SNPs and hormone levels were evaluated in at least 129 patients. SNPs of CYP19A1 were associated with different baseline plasma ES levels. Mean inhibition of aromatase activity induced by L ranges from 71% to 79%, as a function of the SNPs. After 6 weeks of L no difference in ES levels was observed between patients with different SNPs (Table). Conclusions: L therapy induces a higher aromatase suppression in patients with SNPs associated with higher baseline plasma ES levels. The difference in ES levels associated with genetic variation at the CYP19A1 locus disappeared after L therapy. [Table: see text] [Table: see text]
Collapse
Affiliation(s)
- G. Lunardi
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - L. Del Mastro
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - M. Serra
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - P. Driol
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - C. Boni
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - F. Cognetti
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - R. Ponzone
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - M. Porpiglia
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - M. Venturini
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - P. Pronzato
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| |
Collapse
|
27
|
Biglia N, Mariani L, Ponzone R, Sismondi P. Oral contraceptives, salpingo-oophorectomy and hormone replacement therapy in BRCA1–2 mutation carriers. Maturitas 2008; 60:71-7. [DOI: 10.1016/j.maturitas.2008.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 03/19/2008] [Indexed: 10/22/2022]
|
28
|
Gatti M, Baiotto B, Madeddu A, Ponzone R, Siatis D, Malinverni G, Delmastro E, Bona C, Stasi M, Gabriele P. Accelerated partial breast irradiation using 3D conformal radiotherapy: initial clinical experience. Cancer Radiother 2006. [DOI: 10.1016/j.canrad.2006.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
29
|
Ponzone R, Montemurro F, Maggiorotto F, Robba C, Gregori D, Jacomuzzi ME, Kubatzki F, Marenco D, Dominguez A, Biglia N, Sismondi P. Clinical outcome of adjuvant endocrine treatment according to PR and HER-2 status in early breast cancer. Ann Oncol 2006; 17:1631-6. [PMID: 16980602 DOI: 10.1093/annonc/mdl296] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Patients with estrogen receptor (ER)+/progesterone receptor (PR)- and/or HER-2 overexpressing breast carcinomas may derive lower benefit from endocrine treatment. We examined retrospectively data from 972 breast cancer patients who received tamoxifen (725), tamoxifen + Gn-RH analogs (127) and aromatase inhibitors (120) as adjuvant treatments. ER+/PR- versus ER+/PR+ tumours were characterised by larger size (P = 0.001), higher tumour grade (P = 0.001), higher Ki-67 expression (P = 0.001) and lower mean ER (P = 0.000) and HER-2 expression (P = 0.000). At univariate analysis, tumour grading [hazard ratio (HR) = 4.0; 95% confidence interval (CI) = 1.4-11.1; P = 0.007], nodal status (HR = 3.4; 95% CI 1.2-5.7; P = 0.000), tumour diameter (HR = 2.9; 95% CI 1.7-4.7; P = 0.000) lack of PR expression (HR = 2.1; 95% CI 1.3-3.4; P = 0.002) and HER-2 overexpression (HR = 1.9; 95% CI 1.0-3.5; P = 0.03), as well as Ki 67 expression (HR = 1.7; 95% CI 1.0-2.7; P = 0.04) were associated with shorter disease-free survival (DFS). At the multivariate analysis, nodal status (HR = 3.6; 95% CI 1.9-6.8; P = 0.0001), lack of PR expression (HR = 2.3; 95% CI 1.3-4.0; P = 0.003) and tumour diameter (HR = 2.1; 95% CI 1.1-3.8; P = 0.018) retained their prognostic significance, whereas HER-2 overexpression was associated with a trend towards shorter DFS that was of borderline statistical significance (HR = 2.0; 95 % CI 1.0-3.9; P = 0.05). Our data suggest that lack of PR expression and HER-2 overexpression are both associated with aggressive tumour features, but the prognostic information of PR status on the risk of recurrence in endocrine-treated breast cancer patients is stronger.
Collapse
Affiliation(s)
- R Ponzone
- Academic Units of Gynaecological Oncology, University of Turin, Institute for Cancer Research and Treatment (IRCC) of Candiolo, A.S.O. Ordine Mauriziano, Turin, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Biglia N, Torta R, Roagna R, Maggiorotto F, Cacciari F, Ponzone R, Kubatzki F, Sismondi P. Evaluation of low-dose venlafaxine hydrochloride for the therapy of hot flushes in breast cancer survivors. Maturitas 2005; 52:78-85. [PMID: 16143229 DOI: 10.1016/j.maturitas.2005.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Revised: 01/03/2005] [Accepted: 01/04/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of long-term treatment with venlafaxine at low dose for the reduction of vasomotor symptoms in breast cancer survivors. DESIGN Forty consecutive breast cancer patients suffering troublesome hot flushes have been treated for 8 weeks with venlafaxine XR 37.5 mg/day in an open-label study. Vasomotor symptoms have been evaluated before starting treatment and every 4 weeks with a hot flushes diary pointing out the number and the severity of vasomotor symptoms. A Beck Depression Inventory (BDI) was completed at baseline and at the end of the treatment. RESULTS Thirty patients had completed the first 4 weeks of treatment, reporting a reduction of hot flushes frequency of 39% as compared to baseline (p<0.001). After 8 weeks of treatment, a further significant reduction was observed both for the hot flushes frequency (-53%; p<0.001) and for the hot flushes score (-59%; p<0.001), a measure which reflects both the number and the severity of hot flushes. Very few side effects were reported, mostly nausea in the first 2 weeks of assumption and mouth dryness. Only 23 women had completed BDI at week 8; a reduction of 23% was observed (p=0.000). CONCLUSION Venlafaxine is an effective treatment for the relief of vasomotor symptoms in patients previously treated for breast cancer. A favourable effect is maintained also in those patients using tamoxifen as adjuvant therapy. The use of the low dose (37.5 mg/day) is associated with minimal side effects and produces a good improvement in hot flushes if pursued over 8 weeks.
Collapse
Affiliation(s)
- N Biglia
- Academic Gynaecological Oncology Department, University of Turin, IRCC (Institute for Cancer Research and Treatment) of Candiolo, Turin and Mauriziano Umberto I Hospital, Largo Turati 62, Torino 10128, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Biglia N, Sgro L, Defabiani E, De Rosa G, Ponzone R, Marenco D, Sismondi P. The influence of hormone replacement therapy on the pathology of breast cancer. Eur J Surg Oncol 2005; 31:467-72. [PMID: 15922881 DOI: 10.1016/j.ejso.2005.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Revised: 01/27/2005] [Accepted: 02/01/2005] [Indexed: 11/25/2022] Open
Abstract
AIM OF THE STUDY To assess whether the pathological characteristics of breast carcinomas arising in post-menopausal women who ever used hormonal replacement therapy (HRT) differ from those of post-menopausal patients who never used HRT. MATERIALS AND METHODS Six hundred and forty three consecutive breast cancer patients were entered in a case control-study. Cases were represented by 111 breast cancer patients who had used or were using HRT at the time of diagnosis, while the remaining 532 patients who never used HRT were chosen as controls. RESULTS Tumour diameter was smaller in HRT users (17.6 vs 22.1 mm; p=0.002) and tumours of lobular histology were almost twice more frequent among HRT users as in 'never users' (21 vs 12%; p=0.01). No differences were found in grading, hormonal receptor status and axillary nodal status. The expression of c-erb B-2, p53, Ki67 and PS2 measured by immunohistochemistry was similar in the two groups. CONCLUSIONS Our findings suggest that HRT use may modify the pathological presentation of breast cancer. Further studies are indicated, while other clinical-pathological characteristics did not differ according to HRT use.
Collapse
Affiliation(s)
- N Biglia
- Gynaecological Oncology Unit, Institute for Cancer Research and Treatment (IRCC) of Candiolo and Mauriziano Umberto I Hospital, University of Turin, Largo Turati 62, 10128 Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
32
|
Montemurro F, Donadio M, Clavarezza M, Redana S, Vietti Ramus G, Durando A, Iacomuzzi ME, Ponzone R, Valabrega G, Venturini M, Aglietta M. Outcome of patients with HER2+ advanced breast cancer (ABC) progressing during trastuzumab (T)-based treatment. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. Montemurro
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - M. Donadio
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - M. Clavarezza
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - S. Redana
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - G. Vietti Ramus
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - A. Durando
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - M. E. Iacomuzzi
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - R. Ponzone
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - G. Valabrega
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - M. Venturini
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| | - M. Aglietta
- Institute for Cancer Research and Treatment, Candiolo, Italy; Molinette Hosp, Torino, Italy; National Institute for Cancer Research, Genova, Italy; Osp Giovanni Bosco, Torino, Italy; Osp S. Anna, Torino, Italy
| |
Collapse
|
33
|
Abstract
Breast carcinoma is the most frequent tumor in the female population. Many factors can influence the risk of breast cancer; some of them, such as old age and breast cancer 1/2 (BRCA1/BRCA2) gene mutations, are associated with a fourfold increase in risk. A previous diagnosis of atypical ductal or lobular hyperplasia or having a first-degree relative with a carcinoma are factors associated with a two- to fourfold increase in risk. A relative risk between 1 and 2 is associated with longer exposure to endogenous hormones as a result of early menarche, late menopause and obesity, or with recent and prolonged use of hormone replacement therapy (HRT) or with behavioural factors such as high alcohol and fat intake. Is it possible to modify breast cancer risk in postmenopausal women? Risk factors related to lifestyle can be changed, even if it is not clear whether modifying these behavioural factors during the postmenopausal period will influence the overall breast cancer risk. For instance, the influence of exogenous hormones throughout life (both oral contraceptives and HRT) should be evaluated according to the individual risk-benefit ratio. The problem is even more complex for women who carry genetic mutations and for those who have close relatives with breast cancer, who may be candidates for risk reduction strategies. Prophylactic bilateral mastectomy is still controversial, but is frequently offered to or requested by this group of women and may be indicated in BRCA1/BRCA2 carriers. Chemoprevention with tamoxifen and with the new selective estrogen receptor modulators, namely raloxifene, is very promising and deserves a thorough discussion for all high-risk women.
Collapse
Affiliation(s)
- N Biglia
- Academic Department of Gynecological Oncology, Mauriziano 'Umberto I' Hospital (Torino) and Institute for Cancer Research and Treatment (I.RCC) of Candiolo, Turin, Italy
| | | | | | | | | | | |
Collapse
|
34
|
Ponzone R, Biglia N, Maggiorotto F, Kubatzki F, Elia O, De Rosa G, Sismondi P. Sentinel node dissection as definitive treatment for node negative breast cancer patients. Eur J Surg Oncol 2003; 29:703-6. [PMID: 14602486 DOI: 10.1016/j.ejso.2003.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AIMS Negative sentinel node may predict tumour-free axillary nodes in breast cancer. We report the performance of sentinel node dissection at our Institution. METHODS We analysed data from 212 consecutive women with primary invasive breast tumours less than 3 cm in diameter and no axillary lymphadenopathy who underwent radioguided sentinel node dissection by means of 99mTc-colloidal albumin between 1999 and 2002. Completion axillary node dissection was performed if sentinel nodes contained metastases or if no sentinel nodes were identified. RESULTS Sentinel nodes were identified in 207/212 of the patients. Fifty-seven patients had tumour-positive sentinel nodes. Only tumour diameter showed significant association with sentinel node status (p<0.000). Per-operative histologic evaluation had a sensitivity of 67.3% and a negative predictive value of 90.4%. No subset of sentinel node positive patients was identified for whom axillary node dissection could be safely avoided. No recurrences were detected at a median follow-up of 15 months. CONCLUSION Radioguided sentinel node dissection offers a reliable way to assess nodal status in most breast cancer patients. In our experience, both preoperative lymphoscintigraphy and intraoperative histologic evaluation add useful information to the procedure.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Italy
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Staging
- Outcome Assessment, Health Care
- Predictive Value of Tests
- Radionuclide Imaging
- Sentinel Lymph Node Biopsy/standards
- Technetium Tc 99m Aggregated Albumin
Collapse
Affiliation(s)
- R Ponzone
- Academic Gynaecological Oncology Unit, Institute for Cancer Research and Treatment (IRCC) of Candiolo, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
35
|
Sismondi P, Ponzone R, Biglia N, Roagna R, Cacciari F, Maggiorotto F. Sentinel node biopsy for breast cancer: yes, less surgery is better surgery. EUR J GYNAECOL ONCOL 2003; 24:107-12. [PMID: 12701957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Breast surgery evolves towards always more precise, but less invasive techniques. The halstedian concept of radical surgery has been abandoned and the majority of patients are now allowed to preserve their breasts provided they receive radiation therapy after surgery. In many institutions standard axillary lymph-node dissection is being replaced by the less invasive and probably also more accurate staging technique known as sentinel-node dissection. Nevertheless, the procedure requires interdisciplinary collaboration and rigorous quality control monitoring to provide optimal results. Many issues, some of which will be discussed in the light of our personal experience, still need to be tested in clinical controlled trials.
Collapse
Affiliation(s)
- P Sismondi
- Academic Gynecological Oncology Unit, Institute for Cancer Research and Treatment (IRCC) of Candiolo, Turin, and Mauriziano Umberto 1st Hospital of Turin, Italy
| | | | | | | | | | | |
Collapse
|
36
|
Ponzone R, Franziska K, Marenco D, Biglia N, Elia O, Sgro L, Cacciari F, Sismondi P. COMPARISON BETWEEN SUBDERMAL AND SUBAREOLAR INJECTION OF RADIOACTIVE TRACER FOR SENTINEL NODE DISSECTION IN BREAST CANCER PATIENTS. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
37
|
Mariani L, Marenco D, Ponzone R, Biglia N, Cozzarella M, Campagna L, Dato FA, Sismondi P. SHORT-TERM MORBIDY ASSOCIATED WITH SENTINEL NODE DISSECTION AS COMPARED TO AXILLARY DISSECTION IN BREAST CANCER PATIENTS. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
38
|
Sorbello V, Sfiligoi C, Ponzone R, Biglia N, Defabiani E, Maggiorotto F, Sismondi P, De Bortoli M. GENES ASSOCIATED WITH UNFAVOURABLE OUTCOME REVEALED BY CDNA MICROARRAY ANALYSIS IN ARCHIVAL BREAST CANCER TISSUES. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
39
|
Ponzone R, Maggiorotto F, Biglia N, Elia O, Roagna R, Kubatzki F, Ujcic E, Sismondi P. SENTINEL NODE DISSECTION AS DEFINITIVE TREATMENT FOR NODE NEGATIVE BREAST CANCER PATIENTS – 2. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
40
|
Yousef GM, Scorilas A, Magklara A, Memari N, Ponzone R, Sismondi P, Biglia N, Abd Ellatif M, Diamandis EP. The androgen-regulated gene human kallikrein 15 (KLK15) is an independent and favourable prognostic marker for breast cancer. Br J Cancer 2002; 87:1294-300. [PMID: 12439720 PMCID: PMC2408911 DOI: 10.1038/sj.bjc.6600590] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/10/2002] [Accepted: 07/23/2002] [Indexed: 11/23/2022] Open
Abstract
Many kallikrein genes were found to be differentially expressed in various malignancies, and prostate specific antigen (encoded by the KLK3 gene) is the best tumour marker for prostate cancer. Prostate specific antigen has recently been shown to be an independent favourable prognostic marker for breast cancer. KLK15 is newly discovered kallikrein gene that is located adjacent to KLK3 on chromosome 19q13.4. KLK15 has 41% similarity to KLK3 and the encoded protein, hK15, can activate pro-prostate specific antigen. We studied the expression of KLK15 by real-time quantitative reverse transcriptase-polymerase chain reaction in 202 tissues from patients with breast carcinoma of various stages, grades and histological types. KLK15 expression was found to be a significant predictor of progression-free survival (hazard ratio of 0.41 and P=0.011) and overall survival (hazard ratio of 0.34 and P=0.009). When all other known confounders were controlled in the multivariate analysis, KLK15 retained its prognostic significance. Higher concentrations of KLK15 mRNA were found more frequently in node negative patients (P=0.042). No association was found between KLK15 expression and any other clinicopathological variable. Further, KLK15 is an independent prognostic factor of progression-free survival and overall survival in the subgroup of patients with lower grade and those with oestrogen receptor and progesterone receptor negative tumours in both univariate and multivariate analysis. KLK15 levels of expression were slightly higher (although not statistically significant) in the oestrogen receptor negative and progesterone receptor negative subgroups of patients. KLK15 is up-regulated by androgens in breast cancer cell lines. Time-course and blocking experiments suggest that this regulation is mediated through the androgen receptor.
Collapse
Affiliation(s)
- G M Yousef
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Yousef GM, Borgoño CA, Scorilas A, Ponzone R, Biglia N, Iskander L, Polymeris ME, Roagna R, Sismondi P, Diamandis EP. Quantitative analysis of human kallikrein gene 14 expression in breast tumours indicates association with poor prognosis. Br J Cancer 2002; 87:1287-93. [PMID: 12439719 PMCID: PMC2408908 DOI: 10.1038/sj.bjc.6600623] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2002] [Revised: 09/03/2002] [Accepted: 09/04/2002] [Indexed: 01/03/2023] Open
Abstract
KLK14 (formerly known as KLK-L6) is a recently identified member of the human kallikrein gene family. This family harbours several genes aberrantly expressed in various cancers as well as established (PSA/hK3, hK2) and potential (hK6, hK10) cancer markers. Similar to other kallikrein genes, KLK14 was found to be regulated by steroid hormones, particularly androgens and progestins, in breast and ovarian cancer cell lines. Preliminary studies indicated that KLK14 is differentially expressed in breast, ovarian, prostatic and testicular tumours. Given the above, we determined the prognostic significance of KLK14 expression in breast cancer. We studied KLK14 expression in 178 histologically confirmed epithelial breast carcinomas by quantitative reverse transcription-polymerase chain reaction and correlated with clinicopathological variables (tumour stage, grade, histotype etc.) and with outcome (disease-free survival and overall survival), monitored over a median of 76 months. KLK14 mRNA levels ranged from 0 to 1,219 arbitrary units in breast cancer tissues, with a mean+/-s.e. of 136+/-22. An optimal cutoff value of 40.5 arbitrary units was selected, to categorise tumours as KLK14-positive or negative. Higher concentrations of KLK14 mRNA were more frequently found in patients with advanced stage (III) disease (P=0.032). No statistically significant association was found between KLK14 and the other clinicopathological variables. KLK14 overexpression was found to be a significant predictor of decreased disease-free survival (hazard ratio of 2.31, P=0.001) and overall survival (hazard ratio of 2.21, P=0.005). Cox multivariate analysis indicated that KLK14 was an independent prognostic indicator of disease-free survival and overall survival. KLK14 also has independent prognostic value in subgroups of patients with a tumour size </=2 cm and positive nodal, oestrogen receptor and progestin receptor status. We conclude that KLK14 expression, as assessed by quantitative reverse transcription-polymerase chain reaction, is an independent marker of unfavourable prognosis for breast cancer.
Collapse
Affiliation(s)
- G M Yousef
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Chang A, Yousef GM, Scorilas A, Grass L, Sismondi P, Ponzone R, Diamandis EP. Human kallikrein gene 13 (KLK13) expression by quantitative RT-PCR: an independent indicator of favourable prognosis in breast cancer. Br J Cancer 2002; 86:1457-64. [PMID: 11986781 PMCID: PMC2375362 DOI: 10.1038/sj.bjc.6600283] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2001] [Revised: 02/14/2002] [Accepted: 02/27/2002] [Indexed: 11/09/2022] Open
Abstract
Kallikreins are a group of serine proteases with diverse physiological functions. KLK13 (previously known as KLK-L4) is a novel kallikrein gene located on chromosome 19q13.4 and shares a high degree of homology with other kallikrein family members. Many kallikrein genes were found to be differentially expressed in various malignancies, and their regulation is controlled by steroid hormones in prostate and breast cancer cell lines. We studied the expression of KLK13 by quantitative reverse transcriptase-polymerase chain reaction in 173 patients with epithelial breast carcinoma. An optimal cutoff point equal to the 40th percentile was defined, based on the ability of KLK13 to predict disease-free survival. KLK13 values were then associated with other established prognostic factors and with disease-free survival and overall survival. Higher positivity for KLK13 expression was found in older, oestrogen receptor positive patients. In univariate analysis, KLK13 expression is a significant predictor of improved disease-free survival and overall survival (P<0.001 and P=0.009, respectively). Cox multivariate analysis indicated that KLK13 was an independent prognostic variable in the subgroups of patients with Grade I-II tumours and in patients who were oestrogen receptor and progesterone receptor positive, and node positive. Hazard ratios derived from Cox analysis, related to disease-free survival and overall survival were 0.22 (P=0.001) and 0.24 (P=0.008), respectively, for the Grade I-II group; 0.36 (P=0.008) and 0.44 (P=0.038), respectively, for the node positive group and 0.36 (P=0.008) and 0.18 (P=0.008), respectively, for the oestrogen receptor positive group. The adjusted hazard ratio for progesterone receptor positive patients for disease-free survival was 0.25 (P=0.012). For patients in the node positive and oestrogen receptor positive subgroup (n=51) the adjusted hazard ratio was 0.25 (P=0.006) and for the node positive and progesterone receptor positive subgroup (n=46) the hazard ratio was 0.24 (P=0.008). Taken together, these data suggest that higher KLK13 expression in these subgroups of breast cancer patients is associated with an approximately 55 to 80% reduction in the risk of relapse or death. We conclude that KLK13 expression, as assessed by quantitative reverse transcriptase-polymerase chain reaction, is an independent favourable prognostic marker for breast carcinoma.
Collapse
Affiliation(s)
- A Chang
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Data on hormone replacement therapy and breast cancer risk come from a number of observational studies (mostly American studies). Those published up to 1995 were reanalyzed by the Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC). They involved populations where exceedingly high estrogen doses were used as first-line therapy, and a progestin was added in a minority of women. Overall, the CGHFBC reanalysis found that the relative risk increased by 0.023 for each year of use (with an absolute excess risk of two or six cases out of 1000 women treated for 5 or 10 years, respectively). Further American studies, published in 2000 and involving populations where lower doses were used, showed a risk increase of 0.01 per year of estrogen-only use. Both the CGHFBC reanalysis and the further studies did not find an increase of risk in treated overweight women. Possibly, overweight women already have a maximal estrogenic stimulus on the breast due to extraglandular estrogen production. An additional explanation could be that oral estrogens, through their hepatocellular effects, reverse some biological features of obesity (e.g. decreased sex hormone binding globulin level and increased insulin-like growth factor-I bioactivity) that potentially increase breast cancer risk, so balancing the estrogen stimulation. The CGHFBC reanalysis did not show a substantial difference in breast cancer risk between the majority using estrogen alone and the small minority using estrogen plus progestin. Conversely, Swedish studies and the recent American studies suggest that the risk increase could be higher with the addition of a progestin, compared with estrogen-only use. The biological effect of progesterone/progestins on the breast tissue is controversial. Even if the observed increase in risk could be partially ascribed to non-progesterone-like effects of some progestins (e.g. opposing the hepatocellular effects of oral estrogens) and also (in the American studies) to use-bias, a detrimental action due to progesterone-like effects cannot be excluded. However, the theoretical possibility exists that low doses of oral estrogens, plus a progestin providing progesterone-like effects only, will be shown to be associated with a limited breast cancer risk increase.
Collapse
Affiliation(s)
- C Campagnoli
- Endocrinological Gynecology Unit, St Anna Hospital, Turin, Italy
| | | | | | | | | |
Collapse
|
44
|
Sismondi P, Biglia N, Ujcic E, Ponzone R, Roagna R. Raloxifene and endometrial cancer. Tumori 2001; 87:S18-9. [PMID: 11765199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- P Sismondi
- Department of Gynecological Oncology, Mauriziano Umberto I Hospital, University of Turin
| | | | | | | | | |
Collapse
|
45
|
|
46
|
Sismondi P, Biglia N, Roagna R, Ponzone R, Ambroggio S, Sgro L, Cozzarella M. How to manage the menopause following therapy for breast cancer. is raloxifene a safe alternative? Eur J Cancer 2000; 36 Suppl 4:S74-6. [PMID: 11056328 DOI: 10.1016/s0959-8049(00)00235-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Raloxifene is a selective oestrogen receptor modulator (SERM) that has anti-oestrogenic effects on breast and endometrial tissue and oestrogenic actions on bone, lipid metabolism and blood clotting. In postmenopausal women raloxifene decreases bone turnover and increases bone mineral density, reducing the incidence of vertebral fractures. Unlike tamoxifen, raloxifene does not cause endometrial hyperplasia or cancer, as demonstrated by endometrial monitoring with ultrasonography and biopsy during treatment. Evidence suggests that raloxifene lowers total low-density lipoprotein cholesterol levels behaving like oestrogens, but does not increase high-density lipoprotein cholesterol levels. In randomised clinical trials on postmenopausal women with osteoporosis, raloxifene reduced the risk of newly diagnosed ER-positive invasive breast cancer by 76% during a median of 40 months of treatment. However, raloxifene does not alleviate early menopausal symptoms, such as hot flushes and urogenital atrophy, and may even exacerbate some of them. In conclusion, raloxifene may be an alternative for the prevention of long-term effects of oestrogen deficiency (osteoporosis and heart diseases) in women with previous breast cancer not having hot flushes. For symptomatic patients, the association of raloxifene with different drugs which have demonstrated efficacy in the control of vasomotor symptoms is now under evaluation.
Collapse
Affiliation(s)
- P Sismondi
- Department of Gynecological Oncology, University of Turin, Mauriziano 'Umberto I' Hospital, c.so G. Ferraris 122, 10128, Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
47
|
Black MH, Giai M, Ponzone R, Sismondi P, Yu H, Diamandis EP. Serum total and free prostate-specific antigen for breast cancer diagnosis in women. Clin Cancer Res 2000; 6:467-73. [PMID: 10690525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Prostate-specific antigen (PSA) is a serine protease expressed at high levels in prostate epithelium, and elevated PSA in serum is a well-established marker of prostate cancer. Recently, the relative proportions of free PSA and PSA complexed to the serine protease inhibitor alpha 1-antichymotrypsin have become important variables in distinguishing between prostate cancer and benign prostatic hyperplasia. Numerous studies have demonstrated the production of PSA in female tissues such as the breast, and low levels of PSA are present in female sera. The objective of this study was to measure and compare the relative proportions of free PSA and PSA complexed to the serine protease inhibitor alpha 1-antichymotrypsin in the serum of women with breast cancer or benign breast disease or women with no known malignancies. PSA was measured with an established immunoassay for total PSA and a novel immunoassay for free PSA, both of which had a detection limit of 0.001 microgram/liter (1 ng/liter). The percentage of breast cancer patients with free PSA as the predominant molecular form (> 50% of total PSA) in serum was five times higher than that of healthy women or women with benign breast disease, and PSA decreased in the serum of breast cancer patients after surgery. The diagnostic use of free PSA for breast cancer is limited at this point, due to the low diagnostic sensitivity (approximately 20%); however, free PSA as the predominant molecular form shows a high diagnostic specificity (approximately 96%) in comparison to women free of breast cancer or with benign breast disease. These results suggest that the clinical applicability of free PSA for breast cancer diagnosis and the biological mechanism behind its increase should be further investigated.
Collapse
Affiliation(s)
- M H Black
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
The demand for hormone replacement therapy (HRT) by women who enter the menopause is rapidly increasing in all developed countries. The concern that HRT may enhance morbidity and mortality from malignant diseases still limits the widespread adoption of hormonal treatments. Overall, epidemiological data on cancer incidence and HRT are reassuring, although long-term or inappropriate therapies may slightly increase the risk of developing malignant diseases. Many commercial hormonal compounds are currently available and the safest HRT regimen with regard to cancer risk must be identified. It is equally important that the best strategies for breast and endometrial surveillance in women commencing HRT be outlined, bearing in mind that the diffusion of hormonal therapies may be halted by unnecessary medical interventions.
Collapse
Affiliation(s)
- P Sismondi
- Department of Gynaecological Oncology, University of Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
49
|
Scorilas A, Diamandis EP, Levesque MA, Papanastasiou-Diamandi A, Khosravi MJ, Giai M, Ponzone R, Roagna R, Sismondi P, López-Otin C. Immunoenzymatically determined pepsinogen C concentration in breast tumor cytosols: an independent favorable prognostic factor in node-positive patients. Clin Cancer Res 1999; 5:1778-85. [PMID: 10430082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The aim of this study was to determine the concentration and to evaluate the prognostic value of pepsinogen C (PepC) in breast cancer patients. PepC is an aspartic proteinase that is involved in the digestion of proteins in the stomach and is also synthesized by a subset of human breast tumors. PepC concentrations were measured with a highly sensitive immunofluorometric assay, which uses two monoclonal antibodies that are specific for PepC and has a detection limit of 0.1 ng/ml. Breast tumor cytosols from 151 patients (median follow-up, 67 months), stratified according to nodal status, were evaluated. An optimal cutoff value, equal to 1.75 ng/mg of extracted protein, was first defined by statistical analysis. PepC status was then compared with other established prognostic factors, in terms of disease-free survival (DFS) and overall survival (OS). High PepC concentrations were found in small (P = 0.003) and well-differentiated tumors (P = 0.042) as well as in stage I (P = 0.003) and node-negative patients (P = 0.040). Statistically significant associations of PepC concentration with patient age and estrogen receptor and progesterone receptor status were not observed. In univariate Cox regression analysis of the entire cohort of patients, negative PepC proved to be a significant predictor of reduced DFS (P = 0.0086) and OS (P = 0.025). Multivariate analysis in subgroups of patients defined by nodal status indicated that PepC status was a strong predictor of DFS (P = 0.0039) and the strongest factor for predicting OS (P = 0.0046) in node-positive but not in node-negative patients. Our results suggest that PepC may be used as an independent favorable prognostic factor in node-positive breast cancer patients because there were no significant associations between PepC and the other prognostic factors evaluated in this group of patients.
Collapse
Affiliation(s)
- A Scorilas
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Ponzone A, Spada M, Ferrero GB, Ponzone R, Ferraris S. Newborn feeding and screening for phenylketonuria. Acta Paediatr 1999; 88:347-8. [PMID: 10229052 DOI: 10.1080/08035259950170178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|