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1.
Cletus A. Arciero Jing Yang Limin Peng Kevin C. Ward Ruth O’Regan Aysegul A. Sahin Xiaoxian Li 《Breast cancer research and treatment》2017,166(3):743-755
Purpose
Racial disparity of breast cancer in each subtype and substage is not clear.Methods
We reviewed 156,938 patients with breast cancer from 2010 to 2012 from the National Cancer Institute Surveillance, Epidemiology, and End Results database. Breast cancer was subtyped by hormone receptor (HR) and human epidermal growth factor 2 (HER2) status as HR+/HER2?, HR+/HER2+, HR?/HER2+, and HR?/HER2?.Results
African American (AA) patients had worse overall survival (OS) and breast cancer cause-specific survival (BCSS) in HR+/HER2? stages III and IV breast cancer and HR?/HER2+ stage IV cancer; they had worse OS but not BCSS in HR+ /HER2? stage II cancer and HR?/HER2? stage II cancer.Conclusion
AA patients with breast cancer had worse survival in certain subtype and stage, especially in ER+ breast cancer.2.
Elizabeth M. Cespedes Feliciano Marilyn L. Kwan Lawrence H. Kushi Erin K. Weltzien Adrienne L. Castillo Bette J. Caan 《Breast cancer research and treatment》2017,161(3):549-556
Purpose
We hypothesized different Overall Survival (OS) in metastatic breast cancer (MBC) after relapse vs de novo presentation.Methods
We identified women in British Columbia with MBC diagnosed between 01/2001 and 12/2009. OS from MBC was calculated for relapsed vs de novo cohorts in 3 subgroups, based on hormone receptors (HR) and HER2 status. Age at MBC, disease-free interval (DFI), de novo vs relapsed, year of MBC diagnosis, and systemic treatment were entered into univariable and multivariable analyses.Results
We identified 3645 pts with known HR of which 2796 had known HER2. Median follow-up was 91 months. Median OS was longer for de novo vs relapsed MBC: HR+/HER2- 34 versus 23 months (mos) (p < 0.0001), HR?/HER2- (TN) 11 versus 8 mos (p = 0.02), HER2+ 29 versus 15 mos (p < 0.0001). For TN disease, no variable independently discriminated a group with increased risk of death. For both the HR +/HER2- and the HER2 + groups, relapsed vs de novo status (HzR 1.4 [95% CI 1.2–1.5; p < 0.0001], and HzR 1.6 [95% CI 1.4–1.9; p < 0.0001], respectively) and age >50 (HzR 1.2 [95% CI 1.1–1.4; p = 0.001] and HzR 1.3 [95% CI 1.1–1.5; p = 0.01], respectively) were associated with increased risk of death on multivariable analysis.Conclusion
These data provide information that may guide discussions about prognosis between physicians and patients with MBC. In addition, it highlights the importance of stratifying for initial stage at diagnosis in future MBC therapeutic trials.3.
Joyce O’Shaughnessy Katarina Petrakova Gabe S. Sonke Pierfranco Conte Carlos L. Arteaga David A. Cameron Lowell L. Hart Cristian Villanueva Erik Jakobsen Joseph T. Beck Deborah Lindquist Farida Souami Shoubhik Mondal Caroline Germa Gabriel N. Hortobagyi 《Breast cancer research and treatment》2018,168(1):127-134
Purpose
Determine the efficacy and safety of first-line ribociclib plus letrozole in patients with de novo advanced breast cancer.Methods
Postmenopausal women with HR+ , HER2? advanced breast cancer and no prior systemic therapy for advanced disease were enrolled in the Phase III MONALEESA-2 trial (NCT01958021). Patients were randomized to ribociclib (600 mg/day; 3 weeks-on/1 week-off) plus letrozole (2.5 mg/day; continuous) or placebo plus letrozole until disease progression, unacceptable toxicity, death, or treatment discontinuation. The primary endpoint was investigator-assessed progression-free survival; predefined subgroup analysis evaluated progression-free survival in patients with de novo advanced breast cancer. Secondary endpoints included safety and overall response rate.Results
Six hundred and sixty-eight patients were enrolled, of whom 227 patients (34%; ribociclib plus letrozole vs placebo plus letrozole arm: n = 114 vs. n = 113) presented with de novo advanced breast cancer. Median progression-free survival was not reached in the ribociclib plus letrozole arm versus 16.4 months in the placebo plus letrozole arm in patients with de novo advanced breast cancer (hazard ratio 0.45, 95% confidence interval 0.27–0.75). The most common Grade 3/4 adverse events were neutropenia and leukopenia; incidence rates were similar to those observed in the full MONALEESA-2 population. Ribociclib dose interruptions and reductions in patients with de novo disease occurred at similar frequencies to the overall study population.Conclusions
Ribociclib plus letrozole improved progression-free survival vs placebo plus letrozole and was well tolerated in postmenopausal women with HR+, HER2? de novo advanced breast cancer.4.
S. A. M. Gernaat P. J. Ho N. Rijnberg M. J. Emaus L. M. Baak M. Hartman D. E. Grobbee H. M. Verkooijen 《Breast cancer research and treatment》2017,161(3):537-548
Purpose
To analyze the prognostic influence of metastatic pattern (MP) compared with other biologic and clinical factors in stage IV breast cancer at initial diagnosis (BCID) and evaluate factors associated with specific sites of metastases (SSM).Methods
We evaluated women with stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results program from 2010 to 2013. MP was categorized as bone-only, visceral, bone and visceral (BV), and other. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with SSM.Results
We included 9143 patients. Bone represented 37.5% of patients, visceral 21.9%, BV 28.8%, and other 11.9%. Median OS by MP was as follows: bone 38 months, visceral 21 months, BV 19 months, and other 33 months (P < 0.0001). Univariate analysis showed that higher number of metastatic sites had worse prognosis. In multivariate analysis, older age (hazard ratio 1.9), black race (hazard ratio 1.17), grade 3/4 tumors (hazard ratio 1.6), triple-negative (hazard ratio 2.24), BV MP (hazard ratio 2.07), and unmarried patients (hazard ratio 1.25) had significantly shorter OS. As compared with HR+/HER2? tumors, triple-negative and HR?/HER2+ had higher odds of brain, liver, lung, and other metastases. HR+/HER2+ had higher odds of liver metastases. All three subtypes had lower odds of bone metastases.Conclusions
There were substantial differences in OS according to MP. Tumor subtypes have a clear influence among other factors on SSM. We identified several prognostic factors that could guide therapy selection in treatment naïve patients.5.
Ricardo Costa C. A. Santa-Maria D. M. Scholtens S. Jain L. Flaum W. J. Gradishar C. V. Clevenger V. G. Kaklamani 《Breast cancer research and treatment》2017,165(3):585-592
Purpose
The prolactin (PRL) receptor is over-expressed in breast cancer, and pre-clinical data indicate that it contributes to breast oncogenesis. Cabergoline is a potent dopamine receptor agonist of D2 receptors and has a direct inhibitory effect on pituitary PRL secretion.Methods
A phase II study of cabergoline in patients with metastatic breast cancer was conducted. The primary end point of the study was to determine the clinical benefit rate (CBR) at 2 months. Eligible patients had tumors of any receptor status with no limit of prior lines of therapy. Measurable and unmeasurable diseases were allowed. Cabergoline 1 mg orally, twice weekly (1 cycle = 4 weeks) was given until disease progression or unacceptable toxicity. PRL receptor immunohistochemical staining was performed on available baseline tumor tissue; serial serum PRL levels were assessed.Results
Twenty women were enrolled; 18 were evaluable for CBR. Tumor receptor status was distributed as follows: HR?any/HER2+ 2(10%), HR+/HER2? 18 (90%). The CBR was 33% (6/18), median progression free survival was 1.8 months, and median overall survival was 10.4 months. Two patients experienced disease control for over 12 months. Most common treatment-related adverse events were nausea (30%), fatigue (25%), and elevation in alkaline phosphatase (15%). Nine patients had baseline tissue for analysis; there was no association between baseline tumor PRL receptor expression and clinical benefit (p = 0.24). Change in serum PRL level and response were not correlated after 2 months of treatment (p = 0.64).Conclusion
Cabergoline was well tolerated, and while the ORR was low, a small subset of patients experienced extended disease control.6.
Shih-Fan Lai Yu-Hsuan Chen Tony Hsiang-Kuang Liang Che-Yu Hsu Huang-Chun Lien Yen-Sen Lu Chiun-Sheng Huang Sung-Hsin Kuo 《Journal of neuro-oncology》2018,138(3):637-647
Introduction
Whole brain (WB) re-irradiation for breast cancer patients with progressive brain metastasis after first-course WB radiotherapy (WBRT) is controversial. In this study, we sought to investigate the association between the molecular sub-classifications and breast-specific Graded Prognostic Assessment (GPA, which includes the Karnofsky performance status, molecular subtypes, and age as its indices) and the outcomes of breast cancer patients who received WB re-irradiation.Methods
Twenty-three breast cancer patients who received WB re-irradiation for relapsed and progressive intracranial lesions after first-course WBRT between 2004 and 2016 were retrospectively reviewed. Patients were divided according to the 4 molecular subtypes of luminal A/B (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]?), luminal HER2 (HR+/HER2+), HER2 (HR?/HER2+), and triple negative (HR?/HER2?). The clinical and radiological responses and survival rates after WB re-irradiation were analyzed.Results
At 1 month after WB re-irradiation, 13 of 23 patients (56.5%) exhibited disappearance or alleviation of neurological symptoms. The median survival time after WB re-irradiation was 2.93 months (95% confidence interval [CI], 1.79–4.08). After WB re-irradiation, patients with HER2-negative tumors had poorer median survival times than those with HER2-positive tumors (2.23 vs. 3.0 months, respectively; p?=?0.022). Furthermore, patients with high breast GPA scores (2.5–4.0, n?=?11) had longer median survivals than those with low-scores (0–2.0, n?=?12) after WB re-irradiation (4.37 vs. 1.57 months, respectively; p?<?0.005).Conclusions
WB re-irradiation may be a feasible treatment option for certain breast cancer patients who develop brain metastatic lesions after first-course WBRT when these lesions are ineligible for radiosurgery or surgery.7.
Purpose of Review
Most women with hormone receptor (HR)-positive, HER2-negative (HR+/HER2?) breast cancer will ultimately develop endocrine-resistant disease, either primary or acquired. This review will discuss the proposed mechanisms underlying endocrine resistance and key advances in the treatment of endocrine-resistant breast cancer.Recent Findings
Estrogen receptor 1 mutations (ESR1) occur in the majority of patients with HR+/HER2? metastatic breast cancer after prolonged exposure to aromatase inhibitors. Data from the SoFEA trial showed that patients had improved progression-free survival (PFS) after taking fulvestrant compared with exemestane. Fulvestrant is currently the only selective estrogen receptor degrader (SERD) available and development of oral novel SERDs with higher bioavailability and potency are currently being investigated.Summary
Despite significant advances in the treatment of HR+/HER2? breast cancer over the past four decades, a significant proportion of patients do still develop endocrine resistance following optimal endocrine therapy. In this review, we aim to provide an overview of the different classes of novel agents currently being investigated to overcome endocrine resistance.8.
Yuko Nakayama Hiroshi Nakagomi Masato Omori Masayuki Inoue Kazunori Takahashi Masahiro Maruyama Atsushi Takano Kazushige Furuya Kenji Amemiya Eri Ishii Toshio Oyama 《Breast cancer (Tokyo, Japan)》2016,23(4):633-639
Background
The discordance of the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) expressions between primary cancer and metastatic lesions is an important issue when selecting the optimal treatments for patients with metastatic breast cancer. A rebiopsy for the metastatic cancer is recommended before selecting the treatment; however, it is not easy to take a tissue sample for all metastatic lesions. Fine needle aspiration cytology (FNA) for regional lymph nodes and aspiration for pleural effusions or ascites are less invasive procedures to obtain the necessary samples to examine the HR/HER2 expression. These cytologic materials are able to be stained as a tissue sample using the cell block method.Patients
We examined the HR/HER2 expression of 20 patients with breast cancer (8 with synchronous metastases and 12 with metachronous metastases) using the cell block method. Among 8 patients with synchronous metastases, 7 patients with axillary lymph node (LN) metastasis were examined by fine needle aspiration (FNA), and one patient with pleural metastases was analyzed for the aspirated fluid. While in 12 patients with metachronous metastases, 7 patients were examined for their pleural effusion, 3 patients were examined for regional lymph node metastases, and 1 patient were examined for aspirated ascites. We compared the HR/HER expression between primary cancer and metastatic lesion in 17 patients (5 cases of 8 synchronous metastases, and all of 12 metachronous metastases).Results
Discordance of HR was seen in 4 of 17 patients (24 %). Three cases with axillary LN metastasis (2 cases with synchronous metastases and one with metachronous metastasis) showed negative change of ER. Negative change of HER2 expression was seen in one patient with ascites caused by peritoneal dissemination.Conclusions
Cytology materials are easily obtained by FNA for LN metastases and aspiration for malignant effusions and analyzed for HR/HER2 expression using cell block method. We should take advantage of cell block analysis to determine the discordance of the HR/HER2 expression to select the optimal treatment for metastatic breast cancer.9.
Inbal Barnes-Kedar Rinat Bernstein-Molho Nava Ginzach Shulamit Hartmajer Tamar Shapira Nurit Magal Marina Lifshitc Kalis Tamar Peretz Mordechai Shohat Lina Basel-Salmon Eitan Friedman Lily Bazak Yael Goldberg 《Breast cancer research and treatment》2018,171(1):151-159
Purpose
Patients treated with trastuzumab for HER2-positive metastatic breast cancer (HER2+MBC) are living longer, but there is little information on their outcomes and treatment experience beyond the median survival from clinical trials and real-world observational studies. We aim to describe the real-world treatment patterns and overall survival (OS) for women surviving five or more years from initiation of trastuzumab for HER2+MBC.Methods
This is a retrospective, whole-of-population cohort study of women initiating trastuzumab for HER2+MBC between 2001 and 2011, followed to 2016. We defined long-term survivors (LTS) as those patients surviving?≥?5 years from trastuzumab initiation. We used dispensing claims to describe timing of cancer treatments used by LTS and to estimate time on and off HER2-targeted therapies, and OS from trastuzumab initiation for HER2+MBC.Results
Of 4177 women initiating trastuzumab for HER2+MBC, 1082 (26%) survived ≥?5 years. Median age for LTS was 54 years (IQR 46–63). At a median follow-up of 9.4 years, 36% of LTS died; their conditional probability of surviving an additional 5 years was 55%. Median time on trastuzumab and all HER2-targeted therapy was 58.9 months (27.6–88.1) and 69.1 months (35.6–124.5), respectively. 85% of LTS had a period off HER2 therapy, lasting a median of 30.4 months (8.2–NR).Conclusions
LTS generally receive HER2-targeted therapies for periods of time longer than in clinical trials, but most LTS also had breaks in treatment. More research is needed to understand the effects of long-term treatment and to identify patients who may be able to safely discontinue HER2-targeted therapy.10.
Andrew Robinson Osama Souied A. Brianne Bota Nathalie Levasseur Carol Stober John Hilton Dalia Kamel Brian Hutton Lisa Vandermeer Sasha Mazzarello Anil A. Joy Dean Fergusson Sheryl McDiarmid Mathew McInnes Risa Shorr Mark Clemons 《Breast cancer research and treatment》2018,167(3):607-614
Purpose
Prospective information regarding the tolerability and efficacy of endocrine therapy (ET) alone and in combination with targeted agents in older patients in the metastatic setting is limited. This review summarizes available trial data in this population.Methods
We searched PubMed for Phase 2 or 3 trials with age-stratified patient cohorts (≥ 65 vs. < 65 years in most studies) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2?) advanced breast cancer treated with ET ± targeted agents.Results
We identified 19 studies reporting 10 clinical trials. Efficacy was similar in age-stratified subsets. There was a reduced disease progression risk for ET + everolimus, palbociclib, or ribociclib versus ET alone. In the first-line setting, median progression-free survival (mPFS) in older patients was 8.5, 26.2 months, and not reached with letrozole + temsirolimus, palbociclib, and ribociclib, respectively, and in younger patients was 9.0, 18.8 months, and not reached, respectively. In the second-line setting, older patients had mPFS of 6.8 and 9.9 months with everolimus + exemestane and palbociclib + fulvestrant, respectively, and younger patients had mPFS of 8.1 and 9.5 months, respectively. Tolerability was worse for combination therapy versus monotherapy. No age-related differences in discontinuations were observed for CDK4/6 inhibitors, although a higher rate of treatment discontinuation was observed for patients ≥ 70 years receiving everolimus + exemestane. Adverse event rates were similar in age-stratified subsets.Conclusions
ET + CDK4/6 or mTOR inhibitors are likely safe and effective in older patients with HR+, HER2? advanced breast cancer.11.
Hiroaki Inoue Rie Horii Yoshinori Ito Takuji Iwase Shinji Ohno Futoshi Akiyama 《Breast cancer (Tokyo, Japan)》2018,25(3):268-274
Background
Immune responses play an important role in interrupting the progression of cancer cells. Tumor-infiltrating lymphocytes (TILs) are basic components of the immune system. In triple negative breast cancer, increased number of TILs is associated with excellent prognosis and response of chemotherapy. Here, we investigated whether TILs affect the efficacy of trastuzumab-based treatment in human epidermal growth factor receptor 2 (HER2)-positive breast cancer.Methods
The study included 97 patients with stage I-III HER2-positive breast cancer. All patients were preoperatively treated with an anthracycline-based combination regimen, followed by taxane with trastuzumab from 2009 to 2013. Pathological complete response (pCR) was defined as the disappearance of invasive cancer cells regardless of the presence of in situ components. TILs were evaluated using pre-therapeutic needle biopsy specimens. We assessed the percentage of the breast stroma with TILs over the total intratumoral stroma and classified the specimens in three grades: TILs1+ < 30%, TILs2+ 30–50%, and TILs3+ > 50%.Results
Overall, 80.4% of the specimens were TILs1+, 15.5% were TILs2+ and 4.1% were TILs3+. The pCR rate was 44.9% (35/78) in the TILs1+ cases, 80.0% (12/15) in the TILs2+ cases and 75.0% (3/4) in the TILs3+ cases. TILs were significantly associated with pCR (P = 0.0228). Multivariate analysis using TILs, hormone receptor (HR), nuclear grade (NG) and age indicated that TILs (OR 4.32, 95% CI 1.04–23.33, P = 0.0436) and HR (OR 8.76, 95% CI 3.30–25.44, P < 0.0001) were independent predictors for pCR.Conclusion
TILs are associated with the efficacy of trastuzumab-based treatment in HER2-positive breast cancer.12.
Philip D. Poorvu Ines Vaz-Luis Rachel A. Freedman Nancy U. Lin William T. Barry Eric P. Winer Michael J. Hassett 《Breast cancer research and treatment》2018,168(3):727-737
Purpose
Prior studies have identified shortcomings in the quality of care for early-stage breast cancer. Guidelines recommend systemic therapy for metastatic breast cancer (MBC), but few studies have examined guideline concordance for these patients.Methods
We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify patients aged ≥ 66 diagnosed in 2010–2011 with de novo MBC who were continuously enrolled in fee-for-service Medicare. We described initial care (within 6 months of diagnosis) for hormone receptor (HR)-positive/human epidermal receptor-2 (HER2)-negative, HER2-positive, and triple-negative (TN) tumors. We identified factors independently associated with receiving no initial systemic therapy, and compared hospice and hospital utilization for treated versus untreated patients.Results
Among 446 patients, 65% were HR-positive, 21% were HER2-positive, and 14% were TN. Most patients (76.9%) received initial systemic treatment. Among treated HR-positive patients, 15% received chemotherapy as initial treatment; among treated HER2-positive patients, 34% did not receive HER2-targeted initial therapy. Factors independently associated with receiving no initial systemic therapy included older age (ORage continuous/year = 1.08, 95% CI 1.04–1.11), being not married (ORnot married vs. married = 2.87, 95% CI 1.42–5.81), and subtype (ORTN vs. HR+ = 4.95, 95% CI 2.53–9.71). Of patients who did not receive initial systemic therapy, 41.1% did not receive hospice services.Conclusions
In this population-based MBC cohort, almost one quarter did not receive initial systemic therapy and a substantial proportion of treated patients did not receive guideline-concordant first-line therapy. Further research should explore underuse of chemotherapy and HER2-targeted therapies, investigate whether patterns of care are consistent with patient preferences, and identify opportunities to optimize hospice utilization for patients not receiving treatment.13.
Soo Youn Bae Sei Joong Kim JungSun Lee Eun Sook Lee Eun-Kyu Kim Ho Young Park Young Jin Suh Hong Kyu Kim Ji-Young You Seung Pil Jung 《Breast cancer research and treatment》2018,172(1):113-121
Purpose
We analyzed the clinicopathologic characteristics and prognosis of pregnancy-associated breast cancer (PABC) according to clinical subtypes to better understand the characteristics of PABC.Methods
A total of 83,792 female patients between the ages of 20 and 49 were enrolled in the Korean Breast Cancer Society Registry database from January 1, 1996 to December 31, 2015. ‘PABC’ is defined as breast cancer diagnosed during pregnancy or within 1 year after delivery. Other patients were defined as ‘non-PABC’ patients.Results
In non-PABC patients, luminal A subtype was the most common (50.2%). In PABC patients, TNBC was the most common (40.4%) subtype, while luminal A comprised 21.2% and HER2 subtype comprised 17.3%. There was a significant difference in overall survival (OS). In non-PABC patients, TNBC had the highest HR (HR 2.3, 95% CI 2.1–2.6). In PABC patients, the luminal B subtype (HR+ HER2-high Ki67) had the highest HR at 7.0 (95% CI 1.7–29.1). In multivariate analysis of OS by subtypes, PABC patients had significantly higher HR than non-PABC patients in the HER2 subtype (HR 2.0, 95% CI 1.1–3.7) and luminal B subtype (HR+ HER2-high Ki67) (HR 4.4, 95% CI 1.6–12.3).Conclusion
PABC showed different biologic features than non-PABC. PABC had a particularly poor prognosis in the luminal B (HR+ HER2-highKi67) and HER2 subtypes. To improve the prognosis of PABC, treatment should be considered according to subtype. Development of drugs that can be used during pregnancy is needed.14.
María Elena Martínez Scarlett L. Gomez Li Tao Rosemary Cress Danielle Rodriguez Jonathan Unkart Richard Schwab Jesse N. Nodora Linda Cook Ian Komenaka Christopher Li 《Breast cancer research and treatment》2017,166(1):185-193
Purpose
To assess tumor subtype distribution and the relative contribution of clinical and sociodemographic factors on breast cancer survival between Hispanic and non-Hispanic whites (NHWs).Methods
We analyzed data from the California Cancer Registry, which included 29,626 Hispanic and 99,862 NHW female invasive breast cancer cases diagnosed from 2004 to 2014. Logistic regression was used to assess ethnic differences in tumor subtype, and Cox proportional hazard modeling to assess differences in breast cancer survival.Results
Hispanics compared to NHWs had higher odds of having triple-negative (OR = 1.29; 95% CI 1.23–1.35) and HER2-overexpressing tumors (OR = 1.19; 95% CI 1.14–1.25 [HR?] and OR = 1.39; 95% CI 1.31–1.48 [HR+]). In adjusted models, Hispanic women had a higher risk of breast cancer mortality than NHW women (mortality rate ratio [MRR] = 1.24; 95% CI 1.19–1.28). Clinical factors accounted for most of the mortality difference (MRR = 1.05; 95% CI 1.01–1.09); however, neighborhood socioeconomic status (SES) and health insurance together accounted for all of the mortality difference (MRR = 1.01; 95% CI 0.97–1.05).Conclusions
Addressing SES disparities, including increasing access to health care, may be critical to overcoming poorer breast cancer outcomes in Hispanics.15.
Rieko Nishimura Nami Okamoto Masakazu Satou Kenta Kojima Shinichi Tanaka Natsumi Yamashita 《Breast cancer (Tokyo, Japan)》2016,23(6):917-921
Background
HER2 testing for samples from recurrent or metastatic disease is recommended by the 2013 update of the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines and cytological analysis can be applied to several types of metastatic lesions. However, the practical method to assess the HER2 testing of breast cancer cytology specimens has yet to be resolved. Therefore, we conducted the bright-field HER2 dual in situ hybridization (DISH) assay on cell blocks (CBs) prepared from breast cancer cell samples as a validation study before clinical use.Methods
CBs were prepared from tumor cell samples collected from 54 surgically excised breast tumors. The cells were fixed in 10 % buffered formalin for 16–28 h, and embedded in paraffin. The INFORM HER2/neu Dual ISH DNA Probe Cocktail was used for the DISH assay on the Ventana BenchMark ULTRA (Roche Diagnostics).Results
Successful results were obtained in 51 of 54 CB specimens, and the results from the CB specimens were in agreement with those from the histological sections in 48 of the 51 cases (concordance rate, 94 %; kappa, 0.846). The intraclass correlation coefficient (ICC) between the CB and histological specimens in the continuous HER2/CEP17 signal count ratio was 0.89 (95 % CI 0.81–0.93), and the Pearson’s CC was 0.91 (95 % CI 0.85–0.94).Conclusion
The HER2 DISH assay, utilizing 10 % buffered formalin-fixed CB, would be a reliable and ideal method to assess the HER2 gene status of breast cancer cytological specimens.16.
Naoki Niikura Akihiko Shimomura Yumi Fukatsu Masataka Sawaki Rin Ogiya Hiroyuki Yasojima Tomomi Fujisawa Mitsugu Yamamoto Michiko Tsuneizumi Akira Kitani Junichiro Watanabe Akira Matsui Yuko Takahashi Seiki Takashima Tadatoshi Shien Kenji Tamura Shigehira Saji Norikazu Masuda Yutaka Tokuda Hhiroji Iwata 《Breast cancer research and treatment》2018,167(1):81-87
Purpose
Though advanced and metastatic epidermal growth factor receptor 2 (HER2)-positive disease is not curable, a small proportion of patients with HER2-positive metastatic breast cancer remain in prolonged complete remission with anti-HER2 treatment. We hypothesized that some cases of HER2-positive metastatic breast cancer may be curable. In this large, multicenter retrospective study, we aimed to assess the long-term outcomes for patients with a durable response to trastuzumab.Methods
We retrospectively evaluated the data of patients diagnosed with HER2-positive metastatic breast cancer who received trastuzumab for more than 2 years as the first-line treatment. Patients diagnosed between April 1, 2001 and December 31, 2014 at 19 institutions in Japan were included in the analysis. From 124 potential subjects, 16 were excluded and 108 were evaluated.Results
The median follow-up length was 7.7 years. Disease progression occurred in 44/108 (40.7%) patients and 13/108 (12%) patients died. The median progression-free survival was 11.2 years, and as more than 80% of patients were alive 10 years after metastatic breast cancer diagnosis. Of the 108 patients, 57 achieved a clinical complete response. Trastuzumab therapy was interrupted for 27 (47.4%) of these patients (based on the doctor’s recommendation for 19 patients, owing to adverse events for 4 patients, owing to unknown reasons for 3 patients, and at the request of 1 patient). Disease progression occurred in 4 of the 27 patients after the interruption of trastuzumab treatment. The median duration of trastuzumab therapy for all 27 patients was 5.1 years (0.9–9.3 years).Conclusion
We found that some patients showed no evidence of disease after the interruption of trastuzumab therapy. Discontinuation of maintenance trastuzumab in this patient population after a limited time should be explored cautiously while awaiting a global collaborative effort for a randomized trial.17.
Roberto Iacovelli Chiara Ciccarese Claudia Mosillo Davide Bimbatti Emanuela Fantinel Lisa Stefani Michele Simbolo Mario Romano Renzo Mazzarotto Matteo Brunelli Emilio Bria Aldo Scarpa Rita T. Lawlor Walter Artibani Giampaolo Tortora 《Targeted oncology》2018,13(5):649-655
Background
The CHAARTED and LATITUDE trials demonstrated improved outcomes with docetaxel or abiraterone plus androgen deprivation therapy in metastatic hormone sensitive prostate cancer (mHSPC) using two different prognostic scores.Objective
The aim of our study was to assess the concordance between the two scores and if these retained their prognostic value exclusively in de novo mHSPC.Patients and Methods
De novo mHSPC patients referring to our institution were retrospectively stratified according to the CHAARTED and LATITUDE classifications: high volume/high risk (HV/HR), low-volume/low-risk (LV/LR), and HVorHR (HV/LR and LV/HR). The Kaplan-Meier method and Cox proportional-hazard models were used to estimate hazard ratios for overall survival.Results
The study population included 106 patients. Concordance between the CHAARTED and LATITUDE classifications was observed in 86.8% of cases (65.1% HV/HR, 21.7% LV/LR), while 13.2% of patients fulfill the criteria of only one of the two classifications (HVorHR). When analyzed independently, the CHAARTED and LATITUDE classifications maintained their prognostic value (mOS 28.2 months in HV versus 60.9 months in LV, p?=?0.006; 28.2 months in HR versus 40.6 months in LR, p?=?0.017). The LR/LV population showed significantly longer mOS compared to the HR/HV group (72.6 months versus 26.3 months; p?=?0.005), and to HVorHR patients (35.1 months; p?=?0.003). No difference in OS was observed between HV/HR and HVorHR patients. ECOG PS?≥?1 and patient age improved the prognostic value of the two classifications with multivariate analysis.Conclusions
Our study showed a lack of complete concordance between the CHAARTED and LATITUDE classifications. The analysis confirmed the role of these prognostic scores to stratify de novo mHSPC patients in clinical practice.18.
Devika R. Jutagir Bonnie B. Blomberg Charles S. Carver Suzanne C. Lechner Kiara R. Timpano Laura C. Bouchard Lisa M. Gudenkauf Jamie M. Jacobs Alain Diaz Susan K. Lutgendorf Steve W. Cole Aaron S. Heller Michael H. Antoni 《Breast cancer research and treatment》2017,162(1):169-179
Purpose
The data of 589 metastatic breast cancer (MBC) patients in a single institution were reviewed to determine the outcomes of patients with brain metastasis (BM) and assess the efficacy of BM screening.Methods
The patients with BM among the 589 MBC patients who underwent treatment at Shizuoka Cancer Center (Shizuoka, Japan) from 09/2002 to 03/2014 were retrospectively analyzed.Results
During the study period, BM developed in 187 (31.7%) patients. The tumor subtypes were as follows: luminal (hormone receptor [HR]+, HER2?), 44.9%; luminal-HER2 (HR+, HER2+), 14.9%; HER2 (HR?, HER2+), 21.3%; and triple-negative (TN), 16.0%. BM was detected in 48.6% of the patients by screening MRI. While 137 of 187 patients underwent local therapy, whole-brain irradiation was the most frequently applied therapy (63.5%). The median overall survival from the diagnosis of BM was as follows: luminal, 7.0 months (M); luminal-HER2, 13.3 M; HER2, 17.7 M; TN, 4.2 M. The HER2 status (hazard ratio [HR]: 0.58, 95% confidence interval [CI] 0.38–0.88) and nonprogressive extracranial lesion(s) (HR: 0.45, 95% CI 0.29–0.71) were identified as prognostic factors in a multivariate analysis. When limited to HER2-overexpressed MBC patients, the multivariate analysis revealed that non-progressive extracranial lesion(s) (HR: 0.20, 95% CI 0.088–0.47) and stereotactic irradiation (STI) as an initial treatment (HR: 0.18, 95% CI 0.061–0.56) were prognostic factors.Conclusions
Our retrospective review showed that early detection of BM by screening MRI, followed by STI, improved the prognosis of HER2-overexpressed MBC patients with BM. A further prospective randomized study is needed to confirm our findings.19.
Background
Ipsilateral breast tumor recurrence (IBTR) after partial breast resection and contralateral breast tumor recurrence (CBTR) have been shown to occur relatively frequently in patients with ductal carcinoma in situ (DCIS). However, there is only limited data from Japanese institutes to support this.Methods
Of 301 consecutive DCIS patients, 179 patients underwent a mastectomy, and the other 122 underwent partial resection in the National Cancer Center Hospital, Tokyo, with a median follow-up period of 2,106 days. We reviewed clinicopathological parameters including age, menopausal status, body mass index, family history (FH) of breast cancer, tumor size, histological subtype, nuclear grade (NG), hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, treatment, and the surgical margin status of partially resected specimens. The risk associated with each of these parameters for IBTR in 122 patients who underwent partial resections, and for CBTR in a total of 301 patients were calculated using Cox proportional hazard general linear models.Results
Of the 122 patients who underwent partial breast resection, IBTR occurred in 7 (5.7 %). The risk of IBTR was higher or tended to be higher in younger patients or those with lower NG tumors, but did not change significantly with respect to margin status or irradiation. Amongst the entire cohort of 301 patients, CBTR occurred in 18 cases (6.0 %). CBTR occurred significantly more frequently in patients with a FH of breast cancer and with HR+/HER2? subtype tumors by univariate analyses, and tumor subtype was an independent risk factor for CBTR by multivariate analysis.Conclusions
The local recurrence rate was low following partial resection of DCIS. Younger age was a risk factor for IBTR, whereas the HR+/HER2? tumor subtype and a FH of breast cancer were risk factors for CBTR.20.
Wolfgang Janni Emilio Alba Thomas Bachelot Sami Diab Miguel Gil-Gil Thaddeus J. Beck Larisa Ryvo Rafael Lopez Michaela Tsai Francisco J. Esteva Pilar Zamora Auñón Zdenek Kral Patrick Ward Paul Richards Timothy J. Pluard Santosh Sutradhar Michelle Miller Mario Campone 《Breast cancer research and treatment》2018,169(3):469-479