Pub Date : 2024-08-24DOI: 10.1016/j.clbc.2024.08.013
Chirag Shah, Sheen Cherian
{"title":"Deintensification of Locoregional Therapy Following Neoadjuvant Chemotherapy for Breast Cancer: Where do We Go From Here?","authors":"Chirag Shah, Sheen Cherian","doi":"10.1016/j.clbc.2024.08.013","DOIUrl":"https://doi.org/10.1016/j.clbc.2024.08.013","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"18 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-24DOI: 10.1016/j.clbc.2024.08.018
Nengying Zhang , Liyi Pan , Tao Weng , Jiayang Li , Yuxiang Bao , Zhongliang Yan , Taolang Li , Xiaoming Cheng , Junyuan Lv
Both chemotherapy (CT) and endocrine therapy (ET) play important roles in the systemic treatment of breast cancer (BC). However, previous studies have shown an antagonistic effect when CT and ET are administered simultaneously. Therefore, sequential administration is more effective than combined administration. The current guidelines and consensus recommend a sequential schedule of CT and ET for patients with hormone receptor-positive (HR+) BC. However, with the continuous introduction of new endocrine drugs, the question of whether the simultaneous administration of CT and ET is superior to sequential therapy has surfaced again as a hot topic of clinical concern. Recent studies have shown that the combination of certain chemotherapeutic agents with endocrine drugs has a synergistic effect. This review aims to summarize the new advances achieved in recent years on the old topic of CT combined with ET in the treatment of BC.
化疗（CT）和内分泌治疗（ET）在乳腺癌（BC）的全身治疗中都发挥着重要作用。然而，以往的研究表明，同时使用 CT 和 ET 会产生拮抗作用。因此，序贯用药比联合用药更有效。目前的指南和共识建议对激素受体阳性（HR+）的乳腺癌患者按顺序使用 CT 和 ET。然而，随着新型内分泌药物的不断推出，CT 和 ET 同时使用是否优于序贯治疗的问题再次浮出水面，成为临床关注的热点话题。最新研究表明，某些化疗药物与内分泌药物联合使用具有协同作用。本综述旨在总结近年来在 CT 联合 ET 治疗 BC 这一老话题上取得的新进展。
{"title":"Chemotherapy Combined With Endocrine Therapy: Old Wine in a New Bottle?","authors":"Nengying Zhang , Liyi Pan , Tao Weng , Jiayang Li , Yuxiang Bao , Zhongliang Yan , Taolang Li , Xiaoming Cheng , Junyuan Lv","doi":"10.1016/j.clbc.2024.08.018","DOIUrl":"10.1016/j.clbc.2024.08.018","url":null,"abstract":"<div><div>Both chemotherapy (CT) and endocrine therapy (ET) play important roles in the systemic treatment of breast cancer (BC). However, previous studies have shown an antagonistic effect when CT and ET are administered simultaneously. Therefore, sequential administration is more effective than combined administration. The current guidelines and consensus recommend a sequential schedule of CT and ET for patients with hormone receptor-positive (HR+) BC. However, with the continuous introduction of new endocrine drugs, the question of whether the simultaneous administration of CT and ET is superior to sequential therapy has surfaced again as a hot topic of clinical concern. Recent studies have shown that the combination of certain chemotherapeutic agents with endocrine drugs has a synergistic effect. This review aims to summarize the new advances achieved in recent years on the old topic of CT combined with ET in the treatment of BC.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages e737-e747"},"PeriodicalIF":2.9,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1016/j.clbc.2024.08.012
Adil Ayub , Kazim Senol , Makris Eleftherios , Michael S. Cowher , Ronald R. Johnson , Kristin M. Lupinacci , Quratulain Sabih , Jennifer G. Steiman , Emilia J. Diego , Priscilla F. McAuliffe , Atilla Soran
Background
Sentinel lymph node biopsy (SLNB) for axillary staging in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy is debated due to low nodal positivity rate and risk of morbidity. Standard SLNB entails removing all lymph nodes (LN) that have a radioactive count > 10% of the most radioactive node, contain blue dye or are palpably suspicious. In this study, we hypothesize that judicious SLNB with attempt to remove only the node with the highest radioactive count provides sufficient pathologic information while minimizing morbidity.
Method
A single institution prospective database was retrospectively reviewed to identify women with DCIS who underwent mastectomy and SLNB between 2010 and 2022. Patient characteristics, number of SLNs retrieved, pathologic results and long-term upper extremity complications were analyzed.
Results
A total of 743 LNs were removed in 324 pts. Median (IQR) age was 62 (51-70) years. Dual tracer technique, with technetium-99m labeled radiocolloid and blue dye, was used in 311 (96%) pts, whereas single agent (radioisotope or blue dye alone) was utilized in 9 (2.8%) and 4 (1.2%) patients, respectively. Median (IQR) number of SLN removed was 2 (1-3) (range 1-9). In 99% of cases, the SLN with the highest radioactive count was identified among the first 3 dissected LNs. Final pathology revealed upstaging to invasive cancer in 27.5% (n = 89) of the breasts and nodal positivity in 1.9% (n = 6) of the patients. In all 6 cases, metastatic disease was identified in the LN with highest radioactive count among the LNs retrieved. No additional metastatic nodes were identified after > 3 SLN had been removed. At median follow-up of 57 (range 28-87) months, 8.3% (n = 27) of pts complained of long-term upper extremity symptoms. 7.1% (23 pts) were referred to physical therapy for symptoms such as swelling, fullness, heaviness, stiffness, or sensory discomfort in the upper extremity and/or axillary cording. Long-term upper extremity complications were higher when > 3 SLNs compared to ≤ 3 SLNs were removed (10.4% vs. 6.5%, P = .005).
Conclusion
In this cohort of patients with DCIS undergoing mastectomy who were upstaged on final pathology to node positive invasive cancers, the SLN with the highest radioactive count provided sufficient information for axillary staging. Acknowledging that the “hottest” LN is not always the first 1 removed, these data support an increased likelihood of developing long-term complications when more than 3 SLNs are removed. Rather than comprehensive removal of all SLNs meeting the standard “10% rule,” prioritizing the sequence of removal to the highest count provides the same prognostic information with reduced morbidity.
{"title":"De-Escalating the Extent of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma in Situ Undergoing Mastectomy","authors":"Adil Ayub , Kazim Senol , Makris Eleftherios , Michael S. Cowher , Ronald R. Johnson , Kristin M. Lupinacci , Quratulain Sabih , Jennifer G. Steiman , Emilia J. Diego , Priscilla F. McAuliffe , Atilla Soran","doi":"10.1016/j.clbc.2024.08.012","DOIUrl":"10.1016/j.clbc.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Sentinel lymph node biopsy (SLNB) for axillary staging in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy is debated due to low nodal positivity rate and risk of morbidity. Standard SLNB entails removing all lymph nodes (LN) that have a radioactive count > 10% of the most radioactive node, contain blue dye or are palpably suspicious. In this study, we hypothesize that judicious SLNB with attempt to remove only the node with the highest radioactive count provides sufficient pathologic information while minimizing morbidity.</div></div><div><h3>Method</h3><div>A single institution prospective database was retrospectively reviewed to identify women with DCIS who underwent mastectomy and SLNB between 2010 and 2022. Patient characteristics, number of SLNs retrieved, pathologic results and long-term upper extremity complications were analyzed.</div></div><div><h3>Results</h3><div>A total of 743 LNs were removed in 324 pts. Median (IQR) age was 62 (51-70) years. Dual tracer technique, with technetium-99m labeled radiocolloid and blue dye, was used in 311 (96%) pts, whereas single agent (radioisotope or blue dye alone) was utilized in 9 (2.8%) and 4 (1.2%) patients, respectively. Median (IQR) number of SLN removed was 2 (1-3) (range 1-9). In 99% of cases, the SLN with the highest radioactive count was identified among the first 3 dissected LNs. Final pathology revealed upstaging to invasive cancer in 27.5% (<em>n</em> = 89) of the breasts and nodal positivity in 1.9% (<em>n</em> = 6) of the patients. In all 6 cases, metastatic disease was identified in the LN with highest radioactive count among the LNs retrieved. No additional metastatic nodes were identified after > 3 SLN had been removed. At median follow-up of 57 (range 28-87) months, 8.3% (<em>n</em> = 27) of pts complained of long-term upper extremity symptoms. 7.1% (23 pts) were referred to physical therapy for symptoms such as swelling, fullness, heaviness, stiffness, or sensory discomfort in the upper extremity and/or axillary cording. Long-term upper extremity complications were higher when > 3 SLNs compared to ≤ 3 SLNs were removed (10.4% vs. 6.5%, <em>P</em> = .005).</div></div><div><h3>Conclusion</h3><div>In this cohort of patients with DCIS undergoing mastectomy who were upstaged on final pathology to node positive invasive cancers, the SLN with the highest radioactive count provided sufficient information for axillary staging. Acknowledging that the “hottest” LN is not always the first 1 removed, these data support an increased likelihood of developing long-term complications when more than 3 SLNs are removed. Rather than comprehensive removal of all SLNs meeting the standard “10% rule,” prioritizing the sequence of removal to the highest count provides the same prognostic information with reduced morbidity.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 716-720"},"PeriodicalIF":2.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1016/j.clbc.2024.08.011
Ru Yao , Fengzhou Du , Runzhu Liu , Linjuan Tan , Jie Lian , Lu Gao , Hailin Zhang , Li Huang , Bo Pan , Yidong Zhou , Qiang Sun , Jun Zhao , Xiao Long
Background
Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR).
Methods
The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared.
Results
Surgical training outcomes of BMR group (N = 52) were insignificantly improved compared to CPR group (N = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (P = .011) and surgery time (P < .001) was significantly reduced in BMR group (N = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (P < .001). The absolute PU values were significantly higher in BMR group (P = .002).
Conclusion
Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.
{"title":"Breast Modular Resection (BMR) in Nipple-Sparing Mastectomy (NSM) With Intraoperative Laser Speckle Contrast Imaging (LSCI) Monitoring Improved Surgical Training Outcome Among Fellows","authors":"Ru Yao , Fengzhou Du , Runzhu Liu , Linjuan Tan , Jie Lian , Lu Gao , Hailin Zhang , Li Huang , Bo Pan , Yidong Zhou , Qiang Sun , Jun Zhao , Xiao Long","doi":"10.1016/j.clbc.2024.08.011","DOIUrl":"10.1016/j.clbc.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR).</div></div><div><h3>Methods</h3><div>The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared.</div></div><div><h3>Results</h3><div>Surgical training outcomes of BMR group (<em>N</em> = 52) were insignificantly improved compared to CPR group (<em>N</em> = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (<em>P</em> = .011) and surgery time (<em>P</em> < .001) was significantly reduced in BMR group (<em>N</em> = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (<em>P</em> < .001). The absolute PU values were significantly higher in BMR group (<em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 705-715"},"PeriodicalIF":2.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1016/j.clbc.2024.08.010
Neda Stjepanovic , Sudhir Kumar , Katarzyna J. Jerzak , Maureen Trudeau , Ellen Warner , Xingshan Cao , Andrea Eisen , William Tran , Rossanna C. Pezo
Purpose
This study aimed to examine the impact of the level of HER2 overexpression on pathologic and clinical outcomes in HER2-positive breast cancer (BC) patients treated with neoadjuvant therapy (NAT).
Methods
Women with Stage II or III HER2-positive BC who received anthracycline-taxane-trastuzumab NAT regimens followed by curative-intent surgery were included. Patients were classified according to tumor HER2 expression into HER2-high (immunohistochemistry (IHC) 3+ or fluorescence in situ hybridization (FISH) HER2/CEP17 ratio ≥5 or HER2 copy number ≥10) and HER2-intermediate (IHC 2+ with HER2/CEP17 ratio ≥2 to <5 or copy number ≥4 to <10). Univariate and multivariate logistic regression analyses were performed using HER2 expression as a categorical variable. The primary outcome was pathological complete response (pCR). Estimated 3-year disease-free survival (DFS) and Overall Survival (OS) were secondary outcomes.
Results
Among 161 patients with HER2-positive BC, 139 (86%) and 22 (14%) were classified as HER2-high and HER2-intermediate, respectively; 105 (65.2%) had hormone receptor (HR)-positive tumors; 72 (45%) achieved a pCR. In the overall population, pCR rates of 18% and 49% were achieved in HER2-intermediate and HER2-high cases, respectively (odds ratio [OR] = 0.23 95% CI 0.07-0.72; P = .007). No pCRs were observed among HR-positive, HER2-intermediate cases. Estimated 3-year DFS was 97.1% versus 89.3% for patients achieving a pCR versus those with residual disease, respectively (P = .0011).
Conclusion
We found that patients with HER2-high disease were more likely to achieve pCR after NAT compared to patients with HER2-intermediate BC, a subgroup of patients that may benefit from more personalized NAT strategies.
{"title":"Analysis of Factors Associated With Pathological Complete Response in Patients With HER2-Positive Breast Cancer Receiving Neoadjuvant Chemotherapy","authors":"Neda Stjepanovic , Sudhir Kumar , Katarzyna J. Jerzak , Maureen Trudeau , Ellen Warner , Xingshan Cao , Andrea Eisen , William Tran , Rossanna C. Pezo","doi":"10.1016/j.clbc.2024.08.010","DOIUrl":"10.1016/j.clbc.2024.08.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to examine the impact of the level of HER2 overexpression on pathologic and clinical outcomes in HER2-positive breast cancer (BC) patients treated with neoadjuvant therapy (NAT).</div></div><div><h3>Methods</h3><div>Women with Stage II or III HER2-positive BC who received anthracycline-taxane-trastuzumab NAT regimens followed by curative-intent surgery were included. Patients were classified according to tumor HER2 expression into HER2-high (immunohistochemistry (IHC) 3+ or fluorescence in situ hybridization (FISH) HER2/CEP17 ratio ≥5 or HER2 copy number ≥10) and HER2-intermediate (IHC 2+ with HER2/CEP17 ratio ≥2 to <5 or copy number ≥4 to <10). Univariate and multivariate logistic regression analyses were performed using HER2 expression as a categorical variable. The primary outcome was pathological complete response (pCR). Estimated 3-year disease-free survival (DFS) and Overall Survival (OS) were secondary outcomes.</div></div><div><h3>Results</h3><div>Among 161 patients with HER2-positive BC, 139 (86%) and 22 (14%) were classified as HER2-high and HER2-intermediate, respectively; 105 (65.2%) had hormone receptor (HR)-positive tumors; 72 (45%) achieved a pCR. In the overall population, pCR rates of 18% and 49% were achieved in HER2-intermediate and HER2-high cases, respectively (odds ratio [OR] = 0.23 95% CI 0.07-0.72; <em>P</em> = .007). No pCRs were observed among HR-positive, HER2-intermediate cases. Estimated 3-year DFS was 97.1% versus 89.3% for patients achieving a pCR versus those with residual disease, respectively (<em>P</em> = .0011).</div></div><div><h3>Conclusion</h3><div>We found that patients with HER2-high disease were more likely to achieve pCR after NAT compared to patients with HER2-intermediate BC, a subgroup of patients that may benefit from more personalized NAT strategies.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages e723-e730"},"PeriodicalIF":2.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast cancer continues to pose a significant public health challenge, with its incidence and disproportionate impact on underserved populations in the United States. The relationship between obesity and clinicopathological characteristics at presentation remains a critical area of investigation. Safety-net hospitals caring for underserved communities provide a unique setting to explore these associations. This study seeks to explore a critical gap in knowledge on obesity and breast cancer characteristics in underserved populations in the United States.
Materials and Methods
In this retrospective study, 927 breast cancer patients were included. Analysis was conducted to assess the association between body mass index (BMI), age of diagnosis, tumor clinicopathologic characteristics, and molecular types stratified by menopausal status at diagnosis. Analysis was performed using the Statistical Package for Social Sciences version 29.
Results
A significant association was found between BMI and menopausal status (P < .05). Disease stage at presentation was significantly associated with BMI (P < .05). Further investigation into BMI categories and tumor characteristics revealed a significant correlation in postmenopausal women, with obesity linked to tumor size and lymph node status (P < .05). No significant associations were observed between HER-2 status, ER/PR status, and obesity in either premenopausal or postmenopausal groups.
Conclusion
This observational retrospective hypothesis-generating study revealed the association between obesity and disease stage and menopause status at diagnosis. In postmenopausal patients, obesity correlated with larger tumor size and advanced lymph node disease involvement. Additionally, ethnic variations were observed, with a higher prevalence of obesity among African American patients.
{"title":"Impact of Obesity on Breast Cancer Clinicopathological Characteristics in Underserved US Community Safety-Net Hospital: A Retrospective Single-Center Study","authors":"Ekaterina Proskuriakova , Barun Babu Aryal , Dhan Bahadur Shrestha , Stephanie Valencia , Iuliia Kovalenko , Megan Adams , Mubaraka Boxwala , Larissa Verda , Paramjeet Grewal Khosla","doi":"10.1016/j.clbc.2024.08.008","DOIUrl":"10.1016/j.clbc.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer continues to pose a significant public health challenge, with its incidence and disproportionate impact on underserved populations in the United States. The relationship between obesity and clinicopathological characteristics at presentation remains a critical area of investigation. Safety-net hospitals caring for underserved communities provide a unique setting to explore these associations. This study seeks to explore a critical gap in knowledge on obesity and breast cancer characteristics in underserved populations in the United States.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective study, 927 breast cancer patients were included. Analysis was conducted to assess the association between body mass index (BMI), age of diagnosis, tumor clinicopathologic characteristics, and molecular types stratified by menopausal status at diagnosis. Analysis was performed using the Statistical Package for Social Sciences version 29.</div></div><div><h3>Results</h3><div>A significant association was found between BMI and menopausal status (<em>P</em> < .05). Disease stage at presentation was significantly associated with BMI (<em>P</em> < .05). Further investigation into BMI categories and tumor characteristics revealed a significant correlation in postmenopausal women, with obesity linked to tumor size and lymph node status (<em>P</em> < .05). No significant associations were observed between HER-2 status, ER/PR status, and obesity in either premenopausal or postmenopausal groups.</div></div><div><h3>Conclusion</h3><div>This observational retrospective hypothesis-generating study revealed the association between obesity and disease stage and menopause status at diagnosis. In postmenopausal patients, obesity correlated with larger tumor size and advanced lymph node disease involvement. Additionally, ethnic variations were observed, with a higher prevalence of obesity among African American patients.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages e714-e722"},"PeriodicalIF":2.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.clbc.2024.08.001
Danielle M. File , Yara Abdou , Jeremy Force , Dominic T. Moore , Carey K. Anders , Katherine Reeder-Hayes , Lisa A. Carey , Hyman B. Muss , Charles M. Perou , P. Kelly Marcom , E. Claire Dees
Background
Alpelisib is an oral α-specific class I PI3K inhibitor approved in combination with fulvestrant for the treatment of PIK3CA-mutated hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer. The tolerability of this drug with the oral chemotherapy capecitabine is unknown.
Patients and Methods
This phase I trial evaluated the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of alpelisib (250 mg or 300 mg daily for 3-weeks) with capecitabine (1000 mg/m2 twice daily for 2-weeks followed by a 1-week rest period) in patients with metastatic HER2-negative breast cancer, regardless of PIK3CA mutation status.
Results
Eighteen patients were treated with alpelisib-capecitabine. Half of the patients had HR+ breast cancer, and 16 had prior systemic therapy for metastatic disease. The MTD of alpelisib was 250 mg daily in combination with capecitabine 1000 mg/m2 twice daily. DLTs included hyperglycemia, QTc prolongation, fatigue, and chest pain. The most common grade 3 adverse event (AE) was hyperglycemia (28%). No grade 4 AEs were observed. Three patients discontinued therapy due to an AE. One-third of patients required dose reduction of both alpelisib and capecitabine. Four patients experienced a partial response and 8 patients experienced stable disease. The median progression-free survival was 9.7 months (95% CI 2.8-13.5 months) and median overall survival was 18.2 months (95% CI 7.2-35.2 months). Twelve patients had PIK3CA mutation testing completed, of these 2 had known or likely deleterious PIK3CA mutation.
Conclusion
This study provides safety data for an oral combination therapy of alpelisib-capecitabine and defines tolerable doses for further study.
{"title":"A Phase I Trial of Alpelisib Combined With Capecitabine in Patients With HER2-Negative Metastatic Breast Cancer","authors":"Danielle M. File , Yara Abdou , Jeremy Force , Dominic T. Moore , Carey K. Anders , Katherine Reeder-Hayes , Lisa A. Carey , Hyman B. Muss , Charles M. Perou , P. Kelly Marcom , E. Claire Dees","doi":"10.1016/j.clbc.2024.08.001","DOIUrl":"10.1016/j.clbc.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Alpelisib is an oral α-specific class I PI3K inhibitor approved in combination with fulvestrant for the treatment of <em>PIK3CA</em>-mutated hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer. The tolerability of this drug with the oral chemotherapy capecitabine is unknown.</div></div><div><h3>Patients and Methods</h3><div>This phase I trial evaluated the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of alpelisib (250 mg or 300 mg daily for 3-weeks) with capecitabine (1000 mg/m<sup>2</sup> twice daily for 2-weeks followed by a 1-week rest period) in patients with metastatic HER2-negative breast cancer, regardless of <em>PIK3CA</em> mutation status.</div></div><div><h3>Results</h3><div>Eighteen patients were treated with alpelisib-capecitabine. Half of the patients had HR+ breast cancer, and 16 had prior systemic therapy for metastatic disease. The MTD of alpelisib was 250 mg daily in combination with capecitabine 1000 mg/m<sup>2</sup> twice daily. DLTs included hyperglycemia, QTc prolongation, fatigue, and chest pain. The most common grade 3 adverse event (AE) was hyperglycemia (28%). No grade 4 AEs were observed. Three patients discontinued therapy due to an AE. One-third of patients required dose reduction of both alpelisib and capecitabine. Four patients experienced a partial response and 8 patients experienced stable disease. The median progression-free survival was 9.7 months (95% CI 2.8-13.5 months) and median overall survival was 18.2 months (95% CI 7.2-35.2 months). Twelve patients had <em>PIK3CA</em> mutation testing completed, of these 2 had known or likely deleterious <em>PIK3CA</em> mutation.</div></div><div><h3>Conclusion</h3><div>This study provides safety data for an oral combination therapy of alpelisib-capecitabine and defines tolerable doses for further study.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 683-690"},"PeriodicalIF":2.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.clbc.2024.08.007
Hong Hou , Kun Fang , Ya-Lin Zhang , Qiang Mu , Jing Xia , Zhen-Feng Li
Objective
This study aimed to investigate the effect of a combination of functional exercise and psychological interventions on postoperative rehabilitation and intervention compliance in patients with breast cancer (BC).
Methods
This study involved 100 patients with BC who underwent a radical mastectomy in our hospital between April 2020 and April 2021. We assigned patients to a control group (with a functional exercise intervention for patients) and an observation group (where patients received psychological interventions based on functional exercise) using a random number table. We observed and recorded the general data, intervention compliance, range of motion (ROM) of the shoulder joint pre and postintervention, pre and postintervention quality of life scores, and anxiety and depression scores before and after the interventions.
Results
There were no significant differences in general data between the 2 groups (P > .05). Repeated measures analysis showed no preintervention differences in compliance, shoulder ROM, quality of life, or anxiety and depression scores (P > .05). Postintervention, compliance and shoulder ROM improved in both groups, with the observation group significantly outperforming the control group (P < .05). Quality of life scores improved significantly in both groups, with higher scores in the observation group at 1 and 3 months (P < .05). Anxiety and depression scores decreased in both groups, with the observation group showing lower scores than the control group (P < .05).
Conclusion
Combining functional exercise with psychological interventions improves treatment compliance, psychological status, postoperative shoulder ROM, and quality of life in breast cancer patients.
{"title":"Efficacy of a Combination of Functional Exercise and Psychological Interventions in Improving Postoperative Rehabilitation and Intervention Compliance in Patients With Breast Cancer","authors":"Hong Hou , Kun Fang , Ya-Lin Zhang , Qiang Mu , Jing Xia , Zhen-Feng Li","doi":"10.1016/j.clbc.2024.08.007","DOIUrl":"10.1016/j.clbc.2024.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the effect of a combination of functional exercise and psychological interventions on postoperative rehabilitation and intervention compliance in patients with breast cancer (BC).</div></div><div><h3>Methods</h3><div>This study involved 100 patients with BC who underwent a radical mastectomy in our hospital between April 2020 and April 2021. We assigned patients to a control group (with a functional exercise intervention for patients) and an observation group (where patients received psychological interventions based on functional exercise) using a random number table. We observed and recorded the general data, intervention compliance, range of motion (ROM) of the shoulder joint pre and postintervention, pre and postintervention quality of life scores, and anxiety and depression scores before and after the interventions.</div></div><div><h3>Results</h3><div>There were no significant differences in general data between the 2 groups (<em>P</em> > .05). Repeated measures analysis showed no preintervention differences in compliance, shoulder ROM, quality of life, or anxiety and depression scores (<em>P</em> > .05). Postintervention, compliance and shoulder ROM improved in both groups, with the observation group significantly outperforming the control group (<em>P</em> < .05). Quality of life scores improved significantly in both groups, with higher scores in the observation group at 1 and 3 months (<em>P</em> < .05). Anxiety and depression scores decreased in both groups, with the observation group showing lower scores than the control group (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>Combining functional exercise with psychological interventions improves treatment compliance, psychological status, postoperative shoulder ROM, and quality of life in breast cancer patients.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 699-704"},"PeriodicalIF":2.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.clbc.2024.07.012
Gordon R. Daly , Gavin P. Dowling , Mohammad Said , Yazan Qasem , Sandra Hembrecht , Gavin G. Calpin , Ma'en M. AlRawashdeh , Arnold D.K. Hill
In 2016 the Choosing Wisely guidelines advised against routine performance of a sentinel lymph node biopsy (SLNB) in women ≥ 70 years of age with clinically node negative (cN0), early-stage, oestrogen receptor positive/ human epidermal growth factor receptor 2 negative (ER+/HER2−), invasive breast cancer. The argument in favour of its continued performance is that it may serve as a useful guide for subsequent management. This systematic review was performed in accordance with the PRISMA guidelines. Studies reporting on rate of adjuvant chemotherapy, adjuvant radiotherapy and performance of completion axillary lymph node dissection (cALND) post SLNB in women aged ≥ 65 years with cN0, early-stage, ER+/HER2−, invasive breast cancer were included. A random effects meta-analysis was performed with summary estimates made using the Mantel–Haenszel method. Dichotomous outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Ten retrospective studies across 4 countries. Of 105,514 patients, 15,509 had a positive SLNB and 90,005 had a negative SLNB. On meta-analysis, a positive SLNB was significantly associated with receipt of adjuvant chemotherapy (OR 4.64 (95% CI 3.18, 6.77), P < .00001), adjuvant radiotherapy (1.71 (95% CI 1.18, 2.47), P = .005) and undergoing completion axillary lymph node dissection (OR 68.97 (95% CI, 7.47, 636.88), P = .0002). Adjuvant treatment decisions continue to be influenced by SLNB positivity in the era of the Choosing Wisely guidelines. The effects of a positive SLNB and subsequent treatments on outcomes remain inconclusive. However, it is likely clinicians are continuing to over-investigate and over-treat this cohort.
{"title":"Impact of Sentinel Lymph Node Biopsy on Management of Older Women With Clinically Node-Negative, Early-Stage, ER+/HER2−, Invasive Breast Cancer: A Systematic Review and Meta-Analysis","authors":"Gordon R. Daly , Gavin P. Dowling , Mohammad Said , Yazan Qasem , Sandra Hembrecht , Gavin G. Calpin , Ma'en M. AlRawashdeh , Arnold D.K. Hill","doi":"10.1016/j.clbc.2024.07.012","DOIUrl":"10.1016/j.clbc.2024.07.012","url":null,"abstract":"<div><div>In 2016 the Choosing Wisely guidelines advised against routine performance of a sentinel lymph node biopsy (SLNB) in women ≥ 70 years of age with clinically node negative (cN0), early-stage, oestrogen receptor positive/ human epidermal growth factor receptor 2 negative (ER+/HER2−), invasive breast cancer. The argument in favour of its continued performance is that it may serve as a useful guide for subsequent management. This systematic review was performed in accordance with the PRISMA guidelines. Studies reporting on rate of adjuvant chemotherapy, adjuvant radiotherapy and performance of completion axillary lymph node dissection (cALND) post SLNB in women aged ≥ 65 years with cN0, early-stage, ER+/HER2−, invasive breast cancer were included. A random effects meta-analysis was performed with summary estimates made using the Mantel–Haenszel method. Dichotomous outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Ten retrospective studies across 4 countries. Of 105,514 patients, 15,509 had a positive SLNB and 90,005 had a negative SLNB. On meta-analysis, a positive SLNB was significantly associated with receipt of adjuvant chemotherapy (OR 4.64 (95% CI 3.18, 6.77), <em>P</em> < .00001), adjuvant radiotherapy (1.71 (95% CI 1.18, 2.47), <em>P</em> = .005) and undergoing completion axillary lymph node dissection (OR 68.97 (95% CI, 7.47, 636.88), <em>P</em> = .0002). Adjuvant treatment decisions continue to be influenced by SLNB positivity in the era of the Choosing Wisely guidelines. The effects of a positive SLNB and subsequent treatments on outcomes remain inconclusive. However, it is likely clinicians are continuing to over-investigate and over-treat this cohort.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages e681-e688.e1"},"PeriodicalIF":2.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.clbc.2024.07.011
Jorge Henrique Cavalcanti Orestes Cardoso MS , Isabella Christina Amaral de Lara , Luis Eduardo Rodrigues Sobreira , Artur de Oliveira Macena Lôbo , Iasmin Isabelli Luiz Silvério , Maria Eduarda Cavalcanti Souza , Francisco Cezar Aquino de Moraes , Maria Cristina Figueroa Magalhães
Background
Breast cancer (BC) is a global problem, however, despite ALND is considered the standard treatment for early stage BC with node-positive, there is no sufficient data to determine which of these patients should undergo it. Thus, the aim of this systematic review was to clarify if there is any difference between NALND and ALND in terms of safety and prognosis of the patients.
Methods
A shearch was carried in PubMed, Embase and Cochrane databases for studies that compared NALND and ALND. The statistics was performed in R software, in which a restricted maximum likelihood estimator random-effect model were employed to compute risk ratios and hazard ratios with 95% CI. Heterogeneity was accessed with I2 statistics.
Results
There was 7 included studies, involving 7.338 patients, of whom 3.710 were randomized to omission of ALND. The follow-up period ranged from 5 to 10 years, with participant ages varying from 53 to 61 years. The analysis revealed significant increase in 10 years regional recurrence (RR 1.43; 95%CI 0.78 to 2.64; I²=0%) and a significant decrease in lymphedema (RR 0.35; 95% CI 0.23 to 0.53; I²=60%), however no significant result was found for last reported OS (HR 0.96; 95% CI 0.79 to 1.17; I2= 6%) or DFS (HR 1.002; 95% CI 0.960 to 1.045; I2=55%).
Conclusions
Our data suggest that while the NALND offers benefits in terms of preventing lymphedema, it was associated with a higher risk of 10 years regional recurrence. Thus, further studies are necessary to fully assess the role of these techniques in BC management.
{"title":"Omitting axillary lymph node dissection is associated with an increased risk of regional recurrence in early stage breast cancer: a systematic review and meta-analysis of randomized clinical trials","authors":"Jorge Henrique Cavalcanti Orestes Cardoso MS , Isabella Christina Amaral de Lara , Luis Eduardo Rodrigues Sobreira , Artur de Oliveira Macena Lôbo , Iasmin Isabelli Luiz Silvério , Maria Eduarda Cavalcanti Souza , Francisco Cezar Aquino de Moraes , Maria Cristina Figueroa Magalhães","doi":"10.1016/j.clbc.2024.07.011","DOIUrl":"10.1016/j.clbc.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer (BC) is a global problem, however, despite ALND is considered the standard treatment for early stage BC with node-positive, there is no sufficient data to determine which of these patients should undergo it. Thus, the aim of this systematic review was to clarify if there is any difference between NALND and ALND in terms of safety and prognosis of the patients.</div></div><div><h3>Methods</h3><div>A shearch was carried in PubMed, Embase and Cochrane databases for studies that compared NALND and ALND. The statistics was performed in R software, in which a restricted maximum likelihood estimator random-effect model were employed to compute risk ratios and hazard ratios with 95% CI. Heterogeneity was accessed with I<sup>2</sup> statistics.</div></div><div><h3>Results</h3><div>There was 7 included studies, involving 7.338 patients, of whom 3.710 were randomized to omission of ALND. The follow-up period ranged from 5 to 10 years, with participant ages varying from 53 to 61 years. The analysis revealed significant increase in 10 years regional recurrence (RR 1.43; 95%CI 0.78 to 2.64; I²=0%) and a significant decrease in lymphedema (RR 0.35; 95% CI 0.23 to 0.53; I²=60%), however no significant result was found for last reported OS (HR 0.96; 95% CI 0.79 to 1.17; I<sup>2</sup>= 6%) or DFS (HR 1.002; 95% CI 0.960 to 1.045; I<sup>2</sup>=55%).</div></div><div><h3>Conclusions</h3><div>Our data suggest that while the NALND offers benefits in terms of preventing lymphedema, it was associated with a higher risk of 10 years regional recurrence<strong>.</strong> Thus, further studies are necessary to fully assess the role of these techniques in BC management.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages e665-e680"},"PeriodicalIF":2.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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