Pub Date : 2022-10-01Epub Date: 2022-07-18DOI: 10.4048/jbc.2022.25.e33
Harim Kim, Eun Young Ko, Boo-Kyung Han, Ji-Yeon Kim, Byung Joo Chae, Hyunwoo Lee
Multicentric cancer of the pectoral and ectopic breasts is extremely rare, and diagnosing this malignancy remains challenging because axillary breast cancer is easily misdiagnosed as lymph node metastasis. Moreover, there are no established treatment guidelines for this disease. We present our experience with a multicentric breast cancer patient who showed different responses to neoadjuvant chemotherapy (NAC) and underwent surgical treatments that differed from those in previous studies. In our case, the preoperative imaging of both lesions and subsequent core needle biopsy of each lesion were crucial, as these procedures confirm the diagnosis and help decide the chemotherapy regimen based on the subtype. After NAC, the patient underwent right breast-conserving surgery, sentinel lymph node biopsy (SLNB), and excision of accessory breast tissue in the right axilla. SLNB should be the initial step in staging multicentric breast cancer, unless imaging scan shows evidence of lymph node metastasis.
{"title":"Multicentric Breast Cancer of the Axillary and Pectoral Breasts: A Case Report and Literature Review.","authors":"Harim Kim, Eun Young Ko, Boo-Kyung Han, Ji-Yeon Kim, Byung Joo Chae, Hyunwoo Lee","doi":"10.4048/jbc.2022.25.e33","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e33","url":null,"abstract":"<p><p>Multicentric cancer of the pectoral and ectopic breasts is extremely rare, and diagnosing this malignancy remains challenging because axillary breast cancer is easily misdiagnosed as lymph node metastasis. Moreover, there are no established treatment guidelines for this disease. We present our experience with a multicentric breast cancer patient who showed different responses to neoadjuvant chemotherapy (NAC) and underwent surgical treatments that differed from those in previous studies. In our case, the preoperative imaging of both lesions and subsequent core needle biopsy of each lesion were crucial, as these procedures confirm the diagnosis and help decide the chemotherapy regimen based on the subtype. After NAC, the patient underwent right breast-conserving surgery, sentinel lymph node biopsy (SLNB), and excision of accessory breast tissue in the right axilla. SLNB should be the initial step in staging multicentric breast cancer, unless imaging scan shows evidence of lymph node metastasis.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c5/df/jbc-25-436.PMC9629964.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40575913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji Yea Kim, Chan Sub Park, Se-Kyeong Jang, Hyesil Seol, Min-Ki Seong, Woo Chul Noh, In-Chul Park, Hyun-Ah Kim
Purpose: Phosphorylated AKT1 (p-AKT1) at Ser473 is a functional isoform of AKT and a key component of the PI3K/mTOR/AKT pathway. This study aimed to evaluate the prognostic significance of p-AKT1 (Ser473) based on the molecular subtypes of breast cancer.
Methods: To investigate the prognostic value of p-AKT1 (Ser473), we performed a retrospective chart review of patients with breast cancer. Data on p-AKT1 (Ser473) positivity, hormone receptor (HR) status, human epidermal growth factor receptor 2 (HER2) expression status, and other clinicopathological factors were obtained. Furthermore, the therapeutic effect of blocking p-AKT1 (Ser473) in breast cancer cells was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell apoptosis assay, apoptosis protein array, and western blot analysis.
Results: A total of 3,044 patients were evaluated, and the median follow-up time was 43 (range: 0-125) months. In patients with HR-positive and HER2-positive disease, the p-AKT1 (Ser473)-positive group had worse disease-free survival (DFS) than the p-AKT1 (Ser473)-negative group (hazard ratio, 1.9; 95% confidence interval, 1.1-3.5; p = 0.024). In the multivariate analysis, p-AKT1 (Ser473) remained a significantly worse prognostic factor in patients with HR-positive/HER2-positive breast cancer (p = 0.03). There was no difference in DFS according to p-AKT1 (Ser473) status among patients with other breast cancer subgroups. In vitro analysis showed that blocking p-AKT1 (Ser473) levels enhanced trastuzumab-induced cell death in HR-positive/HER2-positive and p-AKT1 (Ser473)-positive breast cancer cells.
Conclusion: p-AKT1 (Ser473) is a prognostic marker for poor outcomes in patients with HR-positive/HER2-positive breast cancer and may have a potential value as a therapeutic target.
{"title":"The Significance of p-AKT1 as a Prognostic Marker and Therapeutic Target in Patients With Hormone Receptor-Positive and Human Epidermal Growth Factor Receptor-2-Positive Early Breast Cancer.","authors":"Ji Yea Kim, Chan Sub Park, Se-Kyeong Jang, Hyesil Seol, Min-Ki Seong, Woo Chul Noh, In-Chul Park, Hyun-Ah Kim","doi":"10.4048/jbc.2022.25.e43","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e43","url":null,"abstract":"<p><strong>Purpose: </strong>Phosphorylated AKT1 (p-AKT1) at Ser473 is a functional isoform of AKT and a key component of the PI3K/mTOR/AKT pathway. This study aimed to evaluate the prognostic significance of p-AKT1 (Ser473) based on the molecular subtypes of breast cancer.</p><p><strong>Methods: </strong>To investigate the prognostic value of p-AKT1 (Ser473), we performed a retrospective chart review of patients with breast cancer. Data on p-AKT1 (Ser473) positivity, hormone receptor (HR) status, human epidermal growth factor receptor 2 (HER2) expression status, and other clinicopathological factors were obtained. Furthermore, the therapeutic effect of blocking p-AKT1 (Ser473) in breast cancer cells was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell apoptosis assay, apoptosis protein array, and western blot analysis.</p><p><strong>Results: </strong>A total of 3,044 patients were evaluated, and the median follow-up time was 43 (range: 0-125) months. In patients with HR-positive and HER2-positive disease, the p-AKT1 (Ser473)-positive group had worse disease-free survival (DFS) than the p-AKT1 (Ser473)-negative group (hazard ratio, 1.9; 95% confidence interval, 1.1-3.5; <i>p</i> = 0.024). In the multivariate analysis, p-AKT1 (Ser473) remained a significantly worse prognostic factor in patients with HR-positive/HER2-positive breast cancer (<i>p</i> = 0.03). There was no difference in DFS according to p-AKT1 (Ser473) status among patients with other breast cancer subgroups. In vitro analysis showed that blocking p-AKT1 (Ser473) levels enhanced trastuzumab-induced cell death in HR-positive/HER2-positive and p-AKT1 (Ser473)-positive breast cancer cells.</p><p><strong>Conclusion: </strong>p-AKT1 (Ser473) is a prognostic marker for poor outcomes in patients with HR-positive/HER2-positive breast cancer and may have a potential value as a therapeutic target.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/fd/jbc-25-387.PMC9629968.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-08-24DOI: 10.4048/jbc.2022.25.e37
Jee Suk Chang, Ji Hyun Chang, Nalee Kim, Yong Bae Kim, Kyung Hwan Shin, Kyubo Kim
Radiation therapy (RT) plays a critical role in breast cancer treatment. In the modern technological era, innovations and progress in breast RT and delivery techniques have greatly improved the clinical outcomes. Intensity-modulated RT (IMRT) is a modern RT technology that permits the modulation of RT beams, ensuring a more uniform dose distribution through the target tissue and better avoidance of underlying critical structures. Recently, several studies have been published on breast IMRT. However, the interpretation of these results can be challenging because of the wide diversity of patients and treatment. The purpose of this study was to review these studies, focusing on the impact of IMRT on reducing toxicity and increasing convenience, as well as addressing concerns regarding breast IMRT.
{"title":"Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy in the Treatment of Breast Cancer: An Updated Review.","authors":"Jee Suk Chang, Ji Hyun Chang, Nalee Kim, Yong Bae Kim, Kyung Hwan Shin, Kyubo Kim","doi":"10.4048/jbc.2022.25.e37","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e37","url":null,"abstract":"<p><p>Radiation therapy (RT) plays a critical role in breast cancer treatment. In the modern technological era, innovations and progress in breast RT and delivery techniques have greatly improved the clinical outcomes. Intensity-modulated RT (IMRT) is a modern RT technology that permits the modulation of RT beams, ensuring a more uniform dose distribution through the target tissue and better avoidance of underlying critical structures. Recently, several studies have been published on breast IMRT. However, the interpretation of these results can be challenging because of the wide diversity of patients and treatment. The purpose of this study was to review these studies, focusing on the impact of IMRT on reducing toxicity and increasing convenience, as well as addressing concerns regarding breast IMRT.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/40/d6/jbc-25-349.PMC9629965.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40646423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soo Yeon Baek, Sae Byul Lee, Yura Lee, Seockhoon Chung, Chang-Min Choi, Hui Jeong Lee, Min-Woo Jo, Sung-Cheol Yun, Jong Won Lee
Purpose: Physical activity (PA) in patients with breast cancer is associated with improved quality of life (QoL); however, many breast cancer survivors do not meet the recommended PA level. This study aims to evaluate the effect of digital health interventions using mobile apps to promote PA and QoL in patients with postoperative breast cancer. This study will also identify effective digital intervention methods and perform an economic analysis. The main hypothesis is that the use of mobile healthcare apps will improve health-related quality of life (HRQOL), promote PA, and reduce healthcare costs.
Methods: The Promotion of a better lifestyle (PA) with Precise and Practicable digital healthcare in postoperative CANCER patients through a Multi-Disciplinary Network (P4CancerMDnet) study is examined by a prospective 4-group randomized controlled trial with a concurrent cost-utility evaluation. Patients are randomly assigned to 3 different mobile app intervention groups or control groups in a 1:1:1:1 ratio. The intervention group is encouraged to use the assigned mobile app. The targeted outcomes are HRQOL, metabolic health markers, and quality-adjusted life-years. The outcomes will be measured at the 6- and 12-month follow-ups.
Discussion: This study will contribute towards a better lifestyle and HRQOL through digital healthcare for postoperative breast cancer patients. These findings are expected to provide evidence of the effectiveness of mobile apps for breast cancer survivors.
Trial registration: Clinical Research Information Service Identifier: KCT0005447.
{"title":"Effects of Mobile Healthcare Applications on the Lifestyle of Patients With Breast Cancer: A Protocol for a Randomized Clinical Trial.","authors":"Soo Yeon Baek, Sae Byul Lee, Yura Lee, Seockhoon Chung, Chang-Min Choi, Hui Jeong Lee, Min-Woo Jo, Sung-Cheol Yun, Jong Won Lee","doi":"10.4048/jbc.2022.25.e42","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e42","url":null,"abstract":"<p><strong>Purpose: </strong>Physical activity (PA) in patients with breast cancer is associated with improved quality of life (QoL); however, many breast cancer survivors do not meet the recommended PA level. This study aims to evaluate the effect of digital health interventions using mobile apps to promote PA and QoL in patients with postoperative breast cancer. This study will also identify effective digital intervention methods and perform an economic analysis. The main hypothesis is that the use of mobile healthcare apps will improve health-related quality of life (HRQOL), promote PA, and reduce healthcare costs.</p><p><strong>Methods: </strong>The Promotion of a better lifestyle (PA) with Precise and Practicable digital healthcare in postoperative CANCER patients through a Multi-Disciplinary Network (P4CancerMDnet) study is examined by a prospective 4-group randomized controlled trial with a concurrent cost-utility evaluation. Patients are randomly assigned to 3 different mobile app intervention groups or control groups in a 1:1:1:1 ratio. The intervention group is encouraged to use the assigned mobile app. The targeted outcomes are HRQOL, metabolic health markers, and quality-adjusted life-years. The outcomes will be measured at the 6- and 12-month follow-ups.</p><p><strong>Discussion: </strong>This study will contribute towards a better lifestyle and HRQOL through digital healthcare for postoperative breast cancer patients. These findings are expected to provide evidence of the effectiveness of mobile apps for breast cancer survivors.</p><p><strong>Trial registration: </strong>Clinical Research Information Service Identifier: KCT0005447.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/d2/jbc-25-425.PMC9629966.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jung Ho Park, Mi Jung Kwon, Jinwon Seo, Ho Young Kim, Soo Kee Min, Lee Su Kim
Few studies have reported on the clinical utility of targeted next-generation sequencing (NGS) for breast cancer in Korea. We retrospectively reviewed the targeted NGS data of 219 patients with breast cancer who underwent surgical resection between August 2018 and April 2021. Here, we described the mutational profiles of breast cancer and examined their prognostic implications. The most frequently mutated gene was PIK3CA (n = 97/219, 44.3%), followed by TP53 (n = 79/219, 36.1%), AKT1 (n = 23/219, 10.5%), and GATA3 (n = 20/219, 9.1%). TP53 mutations were associated with aggressive histologic features. We followed up for 31 (range, 1-39) months and observed 11 (5.0%) recurrences: nine were TP53 mutant and two were TP53 wild-type. Multivariable analysis revealed that TP53 mutation was an independent prognostic factor for recurrence (p = 0.012). Although no drug is currently available for TP53 mutations, it is valuable to know the mutational status of TP53 for the precise management of breast cancer.
{"title":"Somatic Mutations of <i>TP53</i> Identified by Targeted Next-Generation Sequencing Are Poor Prognostic Factors for Primary Operable Breast Cancer: A Single-Center Study.","authors":"Jung Ho Park, Mi Jung Kwon, Jinwon Seo, Ho Young Kim, Soo Kee Min, Lee Su Kim","doi":"10.4048/jbc.2022.25.e41","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e41","url":null,"abstract":"<p><p>Few studies have reported on the clinical utility of targeted next-generation sequencing (NGS) for breast cancer in Korea. We retrospectively reviewed the targeted NGS data of 219 patients with breast cancer who underwent surgical resection between August 2018 and April 2021. Here, we described the mutational profiles of breast cancer and examined their prognostic implications. The most frequently mutated gene was <i>PIK3CA</i> (n = 97/219, 44.3%), followed by <i>TP53</i> (n = 79/219, 36.1%), <i>AKT1</i> (n = 23/219, 10.5%), and <i>GATA3</i> (n = 20/219, 9.1%). <i>TP53</i> mutations were associated with aggressive histologic features. We followed up for 31 (range, 1-39) months and observed 11 (5.0%) recurrences: nine were <i>TP53</i> mutant and two were <i>TP53</i> wild-type. Multivariable analysis revealed that <i>TP53</i> mutation was an independent prognostic factor for recurrence (<i>p</i> = 0.012). Although no drug is currently available for <i>TP53</i> mutations, it is valuable to know the mutational status of <i>TP53</i> for the precise management of breast cancer.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d3/f9/jbc-25-379.PMC9629967.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10448057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-10-13DOI: 10.4048/jbc.2022.25.e40
Ju Yeon Kim, Min Jung Kim, Eun Bong Lee, Tae-Yong Kim, Kyung-Hun Lee, Seock-Ah Im, Jin Kyun Park
Purpose: Breast cancer patients often develop musculoskeletal pain, resembling that experienced by patients with rheumatoid arthritis (RA), during cancer treatment. This study aimed to investigate the causes of musculoskeletal pain, including RA, among breast cancer patients.
Methods: This retrospective study included breast cancer patients experiencing new-onset arthralgia during cancer treatment along with age- and sex-matched controls without breast cancer, who were evaluated at the Rheumatologic clinic between 2004 and 2017. The causes of musculoskeletal pain were compared between breast cancer patients and controls. The effects of cancer treatment on arthralgia and factors associated with RA were examined.
Results: A total of 146 breast cancer patients and 102 controls were included in the final analysis. The most common cause of arthralgia during breast cancer treatment was osteoarthritis (OA, 61.0%), followed by enthesopathy/tendinopathy (28.1%), which included tendinitis, adhesive capsulitis, and carpal tunnel syndrome. Overall, 50.0% of 72 breast cancer patients receiving aromatase inhibitors (AIs) satisfied the criteria of AI-induced musculoskeletal symptoms (AIMSS). The mean symptom duration (i.e., the time between pain onset and evaluation by a rheumatologist) was shorter in breast cancer patients than in controls (7.0 ± 12.1 vs. 14.8 ± 24.9 months, respectively; p = 0.004). RA was diagnosed in 3 (2.1%) breast cancer patients and 3 (2.9%) controls. All breast cancer patients with RA had an elevated erythrocyte sedimentation rate (ESR, 66.7 ± 25.0 mm/h), whereas those without RA had a normal ESR (20.4 ± 21.5 mm/h). Patients with breast cancer required more analgesics than the controls.
Conclusion: OA and enthesopathy/tendinopathy are the most common causes of arthralgia in breast cancer patients, which may concurrently manifest as AIMSS. Patients with breast cancer did not have a higher prevalence of RA than those without breast cancer.
{"title":"Musculoskeletal Pain and the Prevalence of Rheumatoid Arthritis in Breast Cancer Patients During Cancer Treatment: A Retrospective Study.","authors":"Ju Yeon Kim, Min Jung Kim, Eun Bong Lee, Tae-Yong Kim, Kyung-Hun Lee, Seock-Ah Im, Jin Kyun Park","doi":"10.4048/jbc.2022.25.e40","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e40","url":null,"abstract":"<p><strong>Purpose: </strong>Breast cancer patients often develop musculoskeletal pain, resembling that experienced by patients with rheumatoid arthritis (RA), during cancer treatment. This study aimed to investigate the causes of musculoskeletal pain, including RA, among breast cancer patients.</p><p><strong>Methods: </strong>This retrospective study included breast cancer patients experiencing new-onset arthralgia during cancer treatment along with age- and sex-matched controls without breast cancer, who were evaluated at the Rheumatologic clinic between 2004 and 2017. The causes of musculoskeletal pain were compared between breast cancer patients and controls. The effects of cancer treatment on arthralgia and factors associated with RA were examined.</p><p><strong>Results: </strong>A total of 146 breast cancer patients and 102 controls were included in the final analysis. The most common cause of arthralgia during breast cancer treatment was osteoarthritis (OA, 61.0%), followed by enthesopathy/tendinopathy (28.1%), which included tendinitis, adhesive capsulitis, and carpal tunnel syndrome. Overall, 50.0% of 72 breast cancer patients receiving aromatase inhibitors (AIs) satisfied the criteria of AI-induced musculoskeletal symptoms (AIMSS). The mean symptom duration (i.e., the time between pain onset and evaluation by a rheumatologist) was shorter in breast cancer patients than in controls (7.0 ± 12.1 vs. 14.8 ± 24.9 months, respectively; <i>p</i> = 0.004). RA was diagnosed in 3 (2.1%) breast cancer patients and 3 (2.9%) controls. All breast cancer patients with RA had an elevated erythrocyte sedimentation rate (ESR, 66.7 ± 25.0 mm/h), whereas those without RA had a normal ESR (20.4 ± 21.5 mm/h). Patients with breast cancer required more analgesics than the controls.</p><p><strong>Conclusion: </strong>OA and enthesopathy/tendinopathy are the most common causes of arthralgia in breast cancer patients, which may concurrently manifest as AIMSS. Patients with breast cancer did not have a higher prevalence of RA than those without breast cancer.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/41/jbc-25-404.PMC9629969.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40647937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-06-28DOI: 10.4048/jbc.2022.25.e30
Koung Jin Suh, Se Hyun Kim, Yu Jung Kim, Heechul Shin, Eunyoung Kang, Eun-Kyu Kim, Sejoon Lee, Ji Won Woo, Hee Young Na, Soomin Ahn, Bum-Sup Jang, In Ah Kim, So Yeon Park, Jee Hyun Kim
Purpose: Next-generation sequencing (NGS)-based tumor panel testing has been reimbursed by the Korean government since 2017. We evaluated the use of NGS-based tumor panel testing in real-world clinical practice, focusing on molecular profiling (MP)-guided breast cancer treatment.
Methods: A total of 137 breast cancer patients underwent NGS panel testing between December 2017 and July 2020 at Seoul National University Bundang Hospital (SNUBH). Samples from patients were profiled using an in-house SNUBH pan-cancer panel. Sixty-four patients were profiled on SNUBH Pan_Cancer v1.0, targeting 89 genes, while 73 patients were profiled on SNUBH Pan_Cancer v2.0, targeting 546 genes.
Results: Breast cancer subtypes included hormone receptor+/human epidermal growth factor receptor 2 (HER2)- (n = 87), triple-negative (n = 44), and HER2+ (n = 6). Most patients had locally advanced or metastatic cancers (92%). Approximately 92% (126/137) of the patients had significant genomic alterations (tiers I and II), and 62% (85/137) had targetable genomic alterations. The most common targetable genomic alterations were PIK3CA (39%) and ESR1 mutations (9%), followed by ERBB2 (7%), PTEN (7%), BRCA2 (6%), and BRCA1 mutations (4%). Of the 81 patients with locally advanced/metastatic breast cancer with targetable genomic alterations, 6 (7.4%) received MP-guided treatments, including PARP inhibitor (n = 4), ERBB2-directed therapy (n = 1), and PI3K inhibitor (n = 1). Among these 6 patients, 4 participated in clinical trials, 1 underwent treatment at their own expense, and 1 received drugs through an expanded access program. The remaining 66 patients (81%) with targetable genomic alteration did not receive MP-guided treatment due to lack of matched drugs and/or clinical trials, poor performance status, and/or financial burden.
Conclusion: NGS panel testing allowed MP-guided treatment in only 4.7% (6/127) of patients with advanced breast cancer in a real-world setting. The availability of matched drugs is critical for the realistic implementation of personalized treatment.
{"title":"Clinical Application of Next-Generation Sequencing in Patients With Breast Cancer: Real-World Data.","authors":"Koung Jin Suh, Se Hyun Kim, Yu Jung Kim, Heechul Shin, Eunyoung Kang, Eun-Kyu Kim, Sejoon Lee, Ji Won Woo, Hee Young Na, Soomin Ahn, Bum-Sup Jang, In Ah Kim, So Yeon Park, Jee Hyun Kim","doi":"10.4048/jbc.2022.25.e30","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e30","url":null,"abstract":"<p><strong>Purpose: </strong>Next-generation sequencing (NGS)-based tumor panel testing has been reimbursed by the Korean government since 2017. We evaluated the use of NGS-based tumor panel testing in real-world clinical practice, focusing on molecular profiling (MP)-guided breast cancer treatment.</p><p><strong>Methods: </strong>A total of 137 breast cancer patients underwent NGS panel testing between December 2017 and July 2020 at Seoul National University Bundang Hospital (SNUBH). Samples from patients were profiled using an in-house SNUBH pan-cancer panel. Sixty-four patients were profiled on SNUBH Pan_Cancer v1.0, targeting 89 genes, while 73 patients were profiled on SNUBH Pan_Cancer v2.0, targeting 546 genes.</p><p><strong>Results: </strong>Breast cancer subtypes included hormone receptor+/human epidermal growth factor receptor 2 (HER2)- (n = 87), triple-negative (n = 44), and HER2+ (n = 6). Most patients had locally advanced or metastatic cancers (92%). Approximately 92% (126/137) of the patients had significant genomic alterations (tiers I and II), and 62% (85/137) had targetable genomic alterations. The most common targetable genomic alterations were <i>PIK3CA</i> (39%) and <i>ESR1</i> mutations (9%), followed by <i>ERBB2</i> (7%), <i>PTEN</i> (7%), <i>BRCA2</i> (6%), and <i>BRCA1</i> mutations (4%). Of the 81 patients with locally advanced/metastatic breast cancer with targetable genomic alterations, 6 (7.4%) received MP-guided treatments, including PARP inhibitor (n = 4), ERBB2-directed therapy (n = 1), and PI3K inhibitor (n = 1). Among these 6 patients, 4 participated in clinical trials, 1 underwent treatment at their own expense, and 1 received drugs through an expanded access program. The remaining 66 patients (81%) with targetable genomic alteration did not receive MP-guided treatment due to lack of matched drugs and/or clinical trials, poor performance status, and/or financial burden.</p><p><strong>Conclusion: </strong>NGS panel testing allowed MP-guided treatment in only 4.7% (6/127) of patients with advanced breast cancer in a real-world setting. The availability of matched drugs is critical for the realistic implementation of personalized treatment.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/5d/jbc-25-366.PMC9629971.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40576510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-09-30DOI: 10.4048/jbc.2022.25.e38
Seung-Ah Choe, Minji Roh, Hye Ri Kim, Soohyeon Lee, Myung Ki, Domyung Paek, Mia Son
Purpose: This study aims to explore income-based disparities in breast cancer (BC) incidence and stage at presentation in a national population in South Korea, where a National Cancer Screening Program (NCSP) has been implemented.
Methods: In 2007, new patients with BC were identified using the Korea Central Cancer Registry database. We calculated adjusted odds ratios (aORs) to evaluate the association between individual income level and the risk of distant stage BC at presentation, adjusting for women's age, body mass index, disability registration, employment, region of residence, and year of diagnosis.
Results: The cumulative age-standardized incidence of BC in the 11 years was highest among women in the richest quintile (2,040 per 100,000 women for 11 years), whereas the proportion of distant stage at presentation was the highest (10.2%) among the medical aid beneficiaries. The aOR of distant stage diagnosis at presentation was higher for lower-income quintiles, and the risk was the highest in the medical aid beneficiaries (aOR, 2.25; 95% confidence interval, 1.97-2.58) than in the richest quintile. The income-based gradient in aORs for distant stage did not differ between younger (< 40 years) and older patients.
Conclusion: A higher risk of distant stage BC at presentation among the lower-income and medical aid groups in the context of a NCSP was observed. A more focused approach toward women in lower-income groups is necessary to alleviate the disparity in the risk of advanced BC.
{"title":"Income Disparity in Breast Cancer Incidence and Stage at Presentation: A National Population Study of South Korea.","authors":"Seung-Ah Choe, Minji Roh, Hye Ri Kim, Soohyeon Lee, Myung Ki, Domyung Paek, Mia Son","doi":"10.4048/jbc.2022.25.e38","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e38","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore income-based disparities in breast cancer (BC) incidence and stage at presentation in a national population in South Korea, where a National Cancer Screening Program (NCSP) has been implemented.</p><p><strong>Methods: </strong>In 2007, new patients with BC were identified using the Korea Central Cancer Registry database. We calculated adjusted odds ratios (aORs) to evaluate the association between individual income level and the risk of distant stage BC at presentation, adjusting for women's age, body mass index, disability registration, employment, region of residence, and year of diagnosis.</p><p><strong>Results: </strong>The cumulative age-standardized incidence of BC in the 11 years was highest among women in the richest quintile (2,040 per 100,000 women for 11 years), whereas the proportion of distant stage at presentation was the highest (10.2%) among the medical aid beneficiaries. The aOR of distant stage diagnosis at presentation was higher for lower-income quintiles, and the risk was the highest in the medical aid beneficiaries (aOR, 2.25; 95% confidence interval, 1.97-2.58) than in the richest quintile. The income-based gradient in aORs for distant stage did not differ between younger (< 40 years) and older patients.</p><p><strong>Conclusion: </strong>A higher risk of distant stage BC at presentation among the lower-income and medical aid groups in the context of a NCSP was observed. A more focused approach toward women in lower-income groups is necessary to alleviate the disparity in the risk of advanced BC.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/3a/jbc-25-415.PMC9629970.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40647936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-06-29DOI: 10.4048/jbc.2022.25.e31
Min Chong Kim, Min Hui Park, Jung Eun Choi, Su Hwan Kang, Young Kyung Bae
Purpose: The updated American Society of Clinical Oncology/College of American Pathologists guideline for estrogen receptor (ER) testing recommends that breast cancer with ER expression in 1-10% of tumor cells should be reported as ER-low positive (ERlow), although limited data are available on the overall benefits of endocrine therapy. We investigated the clinicopathological characteristics and clinical outcomes of ERlow breast cancer and to compare them with those of ER-negative (ERneg) and ER-high (> 10% of tumor cells, ERhigh) breast cancers.
Methods: Consecutive patients with invasive breast cancer who underwent curative surgery between November 2007 and December 2014 were included. Clinicopathological characteristics and disease-free survival (DFS) of ERlow tumors were compared with those of ERneg and ERhigh tumors.
Results: Of the 2,309 cases included, 46 (2%), 643 (27.8%), and 1,620 (70.2%) were ERlow, ERneg, and ERhigh, respectively. ERlow tumors were associated with no special type of histology (p = 0.011), advanced pT (p = 0.017), pN (p = 0.009) and anatomic stages (p < 0.001), high grade (p < 0.001), negative/low progesterone receptor (PR) status (p < 0.001), human epidermal growth factor receptor 2 positivity (p < 0.001), high Ki-67 (p < 0.001), and recurrence (p = 0.006) compared to ERhigh tumors. DFS was significantly dependent on ER status, and ERlow tumors showed poorer DFS than ERhigh tumors (p = 0.001), however, there was no significant survival difference between ERlow and ERneg tumors. Furthermore, DFS in ERhigh patients was affected by hormone therapy (p < 0.001), while it was not affected in ERlow patients.
Conclusion: Patients with ERlow breast cancer have clinicopathological characteristics that differ from those with ERhigh tumors. Although this study was limited by the small sample size of the ERlow group, no benefit from hormone therapy was observed in the ERlow group compared with the ERhigh group.
{"title":"Characteristics and Prognosis of Estrogen Receptor Low-Positive Breast Cancer.","authors":"Min Chong Kim, Min Hui Park, Jung Eun Choi, Su Hwan Kang, Young Kyung Bae","doi":"10.4048/jbc.2022.25.e31","DOIUrl":"https://doi.org/10.4048/jbc.2022.25.e31","url":null,"abstract":"<p><strong>Purpose: </strong>The updated American Society of Clinical Oncology/College of American Pathologists guideline for estrogen receptor (ER) testing recommends that breast cancer with ER expression in 1-10% of tumor cells should be reported as ER-low positive (ER<sup>low</sup>), although limited data are available on the overall benefits of endocrine therapy. We investigated the clinicopathological characteristics and clinical outcomes of ER<sup>low</sup> breast cancer and to compare them with those of ER-negative (ER<sup>neg</sup>) and ER-high (> 10% of tumor cells, ER<sup>high</sup>) breast cancers.</p><p><strong>Methods: </strong>Consecutive patients with invasive breast cancer who underwent curative surgery between November 2007 and December 2014 were included. Clinicopathological characteristics and disease-free survival (DFS) of ER<sup>low</sup> tumors were compared with those of ER<sup>neg</sup> and ER<sup>high</sup> tumors.</p><p><strong>Results: </strong>Of the 2,309 cases included, 46 (2%), 643 (27.8%), and 1,620 (70.2%) were ER<sup>low</sup>, ER<sup>neg</sup>, and ER<sup>high</sup>, respectively. ER<sup>low</sup> tumors were associated with no special type of histology (<i>p</i> = 0.011), advanced pT (<i>p</i> = 0.017), pN (<i>p</i> = 0.009) and anatomic stages (<i>p</i> < 0.001), high grade (<i>p</i> < 0.001), negative/low progesterone receptor (PR) status (<i>p</i> < 0.001), human epidermal growth factor receptor 2 positivity (<i>p</i> < 0.001), high Ki-67 (<i>p</i> < 0.001), and recurrence (<i>p</i> = 0.006) compared to ER<sup>high</sup> tumors. DFS was significantly dependent on ER status, and ER<sup>low</sup> tumors showed poorer DFS than ER<sup>high</sup> tumors (<i>p</i> = 0.001), however, there was no significant survival difference between ER<sup>low</sup> and ER<sup>neg</sup> tumors. Furthermore, DFS in ER<sup>high</sup> patients was affected by hormone therapy (<i>p</i> < 0.001), while it was not affected in ER<sup>low</sup> patients.</p><p><strong>Conclusion: </strong>Patients with ER<sup>low</sup> breast cancer have clinicopathological characteristics that differ from those with ER<sup>high</sup> tumors. Although this study was limited by the small sample size of the ER<sup>low</sup> group, no benefit from hormone therapy was observed in the ER<sup>low</sup> group compared with the ER<sup>high</sup> group.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/14/jbc-25-318.PMC9411025.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40576511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-07-08DOI: 10.4048/jbc.2022.25.e32
Xiaozhi Dang, Xin Zhang, Yi Gao, Hongping Song
Breast imaging techniques are used to assess the tumor response to neoadjuvant treatment (NAT), which is increasingly one of the preferred therapeutic options and increases the rate of breast conservation for breast cancer. Herein, we report a case in which a woman was diagnosed with invasive ductal carcinoma in the left breast and received NAT before surgery. Automated breast ultrasound (AB US) was regularly performed before and during the NAT to evaluate the tumor response to NAT by measuring diameter changes and volume reductions of the tumor. Images showed that the tumor size was significantly reduced and disappeared after 7 cycles of NAT, except for macrocalcification. Postoperative histopathological examination confirmed that there were no residual tumor cells. We found that AB US overcame the limitations of handheld US, such as operator dependence, poor reproducibility and limited field of view, and can be an alternative modality to assess the tumor response of NAT in the absence of magnetic resonance imaging (MRI) instruments.
乳腺成像技术用于评估肿瘤对新辅助治疗(NAT)的反应,新辅助治疗日益成为首选治疗方案之一,并提高了乳腺癌的保乳率。在此,我们报告了一例妇女被诊断为左乳腺浸润性导管癌并在手术前接受 NAT 治疗的病例。在接受 NAT 之前和期间定期进行了自动乳腺超声检查(AB US),通过测量肿瘤直径的变化和体积的缩小来评估肿瘤对 NAT 的反应。图像显示,经过7个周期的NAT治疗后,除大钙化外,肿瘤体积明显缩小并消失。术后组织病理学检查证实没有残留肿瘤细胞。我们发现 AB US 克服了手持 US 的局限性,如对操作者的依赖性、可重复性差和视野有限,可以作为在没有磁共振成像(MRI)仪器的情况下评估 NAT 的肿瘤反应的替代方式。
{"title":"Assessment of Neoadjuvant Treatment Response Using Automated Breast Ultrasound in Breast Cancer.","authors":"Xiaozhi Dang, Xin Zhang, Yi Gao, Hongping Song","doi":"10.4048/jbc.2022.25.e32","DOIUrl":"10.4048/jbc.2022.25.e32","url":null,"abstract":"<p><p>Breast imaging techniques are used to assess the tumor response to neoadjuvant treatment (NAT), which is increasingly one of the preferred therapeutic options and increases the rate of breast conservation for breast cancer. Herein, we report a case in which a woman was diagnosed with invasive ductal carcinoma in the left breast and received NAT before surgery. Automated breast ultrasound (AB US) was regularly performed before and during the NAT to evaluate the tumor response to NAT by measuring diameter changes and volume reductions of the tumor. Images showed that the tumor size was significantly reduced and disappeared after 7 cycles of NAT, except for macrocalcification. Postoperative histopathological examination confirmed that there were no residual tumor cells. We found that AB US overcame the limitations of handheld US, such as operator dependence, poor reproducibility and limited field of view, and can be an alternative modality to assess the tumor response of NAT in the absence of magnetic resonance imaging (MRI) instruments.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/5c/jbc-25-344.PMC9411026.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40575912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}