HER2 positive breast cancer patients having HER2 loss after neoadjuvant chemotherapy should still be treated with adjuvant anti-HER2 treatment

Breast Cancer Research and Treatment -     

Cardiovascular mortality among patients with non‐Hodgkin lymphoma: Differences according to lymphoma subtype

Survival rates of patients with non‐Hodgkin lymphoma (NHL) have improved over the last decade. However, cardiotoxicities remain important adverse consequences of treatment with chemotherapy and radiation, although the burden of cardiovascular mortality (CVM) in such patients remains unknown. We conducted a retrospective cohort study of patients greater than or equal to 20 years of age diagnosed with diffuse large B‐cell lymphoma (DLBCL), follicular lymphoma (FL), and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) between 2000 and 2013 using data extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. Our primary endpoint was CVM. The association between NHL and CVM was evaluated using multivariable Cox regression analysis after adjusting for other patient characteristics. We calculated standardized mortality ratios (SMRs) for CVM, comparing NHL patients with the general population. We identified 153 983 patients who met the inclusion criteria (69 329 with DLBCL, 48 650 with CLL/SLL, and 36 004 with FL). The median follow‐up was 37 months (interquartile range, 10‐78 months); the mean patient age was 66.24 (±14.69) years; 84 924 (55.2%) were men; 134 720 (87.5%) were White, and 131 912 (85.7%) did not receive radiation therapy. Overall, 9017 patients (5.8%) died from cardiovascular disease, and we found that NHL patients had a higher risk of CVM than the general population, after adjusting for age (SMR 15.2, 95% confidence interval: 14.89‐15.52). The rates of CVM were 5.1%, 8%, and 4.4% in patients with DLBCL, CLL/SLL, and FL, respectively. Furthermore, across all NHL subtypes, older age, higher stage at the time of diagnosis (particularly stage 4), male sex, and living in the south were associated with higher risks of CVM. Our data suggest that risk assessment and careful cardiac monitoring are recommended for NHL patients, particularly those with the CLL/SLL subtypes.     

Increased pathologic complete response are expected in HER2-positive and triple-negative locally advanced breast cancers

To The Editor I want to congratulate Dr. Tan and colleagues for theirarticle entitled "Weekly taxane-anthracycline combinationregimen versus tri-weekly anthracycline-based regimenfor the treatment of locally advanced breast cancer:a randomized controlled trial" [1]. The pathologic completeresponse (pCR) rate was similar in the two arms(10.61% vs. 12.31%, P = 0.665). However, the authorsdid not stratify patients according to molecular subtypessuch as luminal A and B, human epidermal growth factorreceptor 2 (HER2)-positive and triple-negative breastcancers (TNBC). Rouzier et al. [2] reported that thepatients in TNBC and HER2-positive subgroups had thehighest rates of pCR (45% and 45%), whereas the patientswith luminal tumors had a pCR rate of 6% after neoadjuvantchemotherapy. Since HER2-positive and TNBCsubgroups of tumors are more sensitive to chemotherapy,pCR rates in these tumors are expected to be more than20%–25%. Taken all together, the evaluation of pCR ratesafter chemotherapy in locally advanced breast cancerpatients would be better evaluated according to molecularsubtypes.     

Phase II Study of Loading-Dose Ibandronate Treatment in Patients with Breast Cancer and Bone Metastases Suffering from Moderate to Severe Pain

Background: The aim of this study was to determine the efficacy and safety of loading-dose intravenous (i.v.) ibandronate in women with breast cancer and bone metastases. Patients and Methods: In this prospective, phase II, open-label study, 13 women with breast cancer, bone metastases, and moderate/severe bone pain received ibandronate 6 mg/day (i.v. loading-dose 15 min infusion over 3 consecutive days) with follow-up until day 14. Endpoints included pain response (primary), duration until pain response, analgesic use, Karnofsky index, safety (including hematologic, biochemical, and urine examinations), and adverse events. Results: Pain intensity decreased on days 7 and 14 versus day 1 (mean visual analogue scale score: 3.2 ± 2.2 and 3.0 ± 2.1 versus 6.1 ± 0.9, respectively; p < 0.01 for both). Mean time to pain response was 8.2 ± 3.3 days. Mean rate of analgesic use decreased (69.2%, 16.7% and 15.4% on days 1, 7 and 14, respectively). Mean Karnofsky index score increased (80.8 ± 13.1 and 80.8 ± 13.2, on days 7 and 14 versus 77.7 ± 11.7 on day 1; p < 0.05 on both days). Conclusion: Bone pain and analgesic use decreased in women with breast cancer and bone metastases following loadingdose i.v. ibandronate which was well-tolerated with no renal safety concerns.