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Basra M, Patel H, Biglione A. Intra-arterial Chemotherapy in Patients With Metastatic Breast Cancer: A Scoping Review. Cureus 2024; 16:e58846. [PMID: 38784338 PMCID: PMC11112524 DOI: 10.7759/cureus.58846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Breast cancer is a common malignancy in women, and the survival rate for this cancer is low once it metastasized. Currently, chemotherapy is the first-line treatment for metastatic breast cancer (MBC). However, when liver metastases (LM) are present, the response to chemotherapy is poor. Regional intra-arterial chemotherapy (RIAC) delivers a high concentration of anticancer drugs to the malignant tissue, which improves the survival rate of patients with LM. It also decreases systemic side effects associated with chemotherapy. RIAC leads to higher remission rates because it directly targets the affected area. When RIAC is used alongside systemic chemotherapy, tumor resistance is decreased, increasing the rates of remission. This review aims to introduce the use of RIAC in patients with MBC. RIAC is a relatively new therapy in interventional oncology, and thus, limited research is currently available.
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Affiliation(s)
- Mahi Basra
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Hemangi Patel
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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2
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Deipolyi AR, Ward RC, Riaz A, Vogl TJ, Simmons RM, Pieper CC, Bryce Y. Locoregional Therapies for Primary and Metastatic Breast Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329454. [PMID: 37377360 DOI: 10.2214/ajr.23.29454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Minimally invasive locoregional therapies have a growing role in the multidisciplinary treatment of primary and metastatic breast cancer. Factors contributing to the expanding role of ablation for primary breast cancer include earlier diagnosis, when tumors are small, and increased longevity of patients whose condition precludes surgery. Cryoablation has emerged as the leading ablative modality for primary breast cancer owing to its wide availability, the lack of need for sedation, and the ability to monitor the ablation zone. Emerging evidence suggests that in patients with oligometastatic breast cancer, use of locoregional therapies to eradicate all disease sites may confer a survival advantage. Evidence also suggests that transarterial therapies-including chemoembolization, chemoperfusion, and radioembolization-may be helpful to some patients with advanced liver metastases from breast cancer, such as those with hepatic oligoprogression or those who cannot tolerate systemic therapy. However, the optimal modalities for treatment of oligometastatic and advanced metastatic disease remain unknown. Finally, locoregional therapies may produce tumor antigens that in combination with immunotherapy drive anti-tumor immunity. Although key trials are ongoing, additional prospective studies are needed to establish the inclusion of interventional oncology in societal breast cancer guidelines to support further clinical adoption and improved patient outcomes.
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Affiliation(s)
- Amy R Deipolyi
- Department of Surgery, Interventional Radiology, West Virginia University/Charleston Area Medical Center, 3200 MacCorkle Ave SE, Charleston, WV 25304
| | - Robert C Ward
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ahsun Riaz
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Rache M Simmons
- Department of Surgery, Weill Medical College of Cornell University, New York, NY
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Yolanda Bryce
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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3
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Intra-Arterial Therapies for Liver Metastatic Breast Cancer: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2021; 44:1868-1882. [PMID: 34322751 DOI: 10.1007/s00270-021-02906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Performing a systematic review and meta-analysis to assess the evidence of intra-arterial therapies in liver metastatic breast cancer (LMBC) patients. METHODS A systemic literature search was performed in PubMed, EMBASE, SCOPUS for studies regarding intra-arterial therapies in LMBC patients. Full text studies of LMBC patients (n ≥ 10) published between January 2010 and December 2020 were included when at least one outcome among response rate, adverse events or survival was available. Response rates were pooled using generalized linear mixed models. A weighted estimate of the population median overall survival (OS) was obtained under the assumption of exponentially distributed survival times. RESULTS A total of 26 studies (1266 patients) were included. Eleven articles reported on transarterial radioembolization (TARE), ten on transarterial chemoembolization (TACE) and four on chemo-infusion. One retrospective study compared TARE and TACE. Pooled response rates were 49% for TARE (95%CI 32-67%), 34% for TACE (95%CI 22-50%) and 19% for chemo-infusion (95%CI 14-25%). Pooled median survival was 9.2 months (range 6.1-35.4 months) for TARE, 17.8 months (range 4.6-47.0) for TACE and 7.9 months (range 7.0-14.2) for chemo-infusion. No comparison for OS was possible due to missing survival rates at specific time points (1 and 2 year OS) and the large heterogeneity. CONCLUSION Although results have to be interpreted with caution due to the large heterogeneity, the superior response rate of TARE and TACE compared to chemo-infusion suggests first choice of TARE or TACE in chemorefractory LMBC patients. Chemo-infusion could be considered in LMBC patients not suitable for TARE or TACE. LEVEL OF EVIDENCE 3a.
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4
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Rivera K, Jeyarajah DR, Washington K. Hepatectomy, RFA, and Other Liver Directed Therapies for Treatment of Breast Cancer Liver Metastasis: A Systematic Review. Front Oncol 2021; 11:643383. [PMID: 33842354 PMCID: PMC8033007 DOI: 10.3389/fonc.2021.643383] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background The liver is the second most common site of breast cancer metastasis. Liver directed therapies including hepatic resection, radiofrequency ablation (RFA), transarterial chemo- and radioembolization (TACE/TARE), and hepatic arterial infusion (HAI) have been scarcely researched for breast cancer liver metastasis (BCLM). The purpose of this review is to present the known body of literature on these therapies for BCLM. Methods A systematic review was performed with pre-specified search terms using PubMed, MEDLINE, EMBASE, and Cochrane Review resulting in 9,957 results. After review of abstracts and application of exclusion criteria, 51 studies were included in this review. Results Hepatic resection afforded the longest median overall survival (mOS) and 5-year survival (45 mo, 41%) across 23 studies. RFA was presented in six studies with pooled mOS and 5-year survival of 38 mo and 11–33%. Disease burden and tumor size was lower amongst hepatic resection and RFA patients. TACE was presented in eight studies with pooled mOS and 1-year survival of 19.6 mo and 32–88.8%. TARE was presented in 10 studies with pooled mOS and 1-year survival of 11.5 mo and 34.5–86%. TACE and TARE populations were selected for chemo-resistant, unresectable disease. Hepatic arterial infusion was presented in five studies with pooled mOS of 11.3 months. Conclusion Although further studies are necessary to delineate appropriate usage of liver directed therapies in BCLM, small studies suggest hepatic resection and RFA, in well selected patients, can result in prolonged survival. Longitudinal studies with larger cohorts are warranted to further investigate the effectiveness of each modality.
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Affiliation(s)
- Kevin Rivera
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Dhiresh Rohan Jeyarajah
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Kimberly Washington
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
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Abstract
Breast cancer is the most common cancer in women and breast cancer liver metastasis may be associated with poor outcomes. Emerging locoregional therapies can be given in outpatient settings or with short hospital stays, to provide local control, support quality of life, preserve liver function, and potentially prolong survival. This review discusses retrospective studies suggesting potential benefits of locoregional treatment of breast cancer liver metastasis. Future prospective studies are needed to demonstrate efficacy and optimize patient selection.
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Affiliation(s)
- Ariel N Liberchuk
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy R Deipolyi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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6
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Hsiao JH, Chang HT, Tseng YD, Chiang CL, Chen IS, Chen YC, Chang PM, Wang BW. Hepatic Arterial Infusion Chemotherapy Is a Feasible Treatment Option for Breast Cancer with Liver-predominant Metastatic Disease. In Vivo 2019; 32:1635-1641. [PMID: 30348727 DOI: 10.21873/invivo.11425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with liver metastasis from breast cancer (LMBC) are usually offered systemic therapy. However, for those with progressive liver disease and limited extra-hepatic conditions, local liver management becomes an option. Herein we present our experience with hepatic arterial infusion chemotherapy (HAIC). PATIENTS AND METHODS From 1999 to 2018, 42 patients with LMBC, who had progressive liver metastasis after systemic therapy, were treated with HAIC. A catheter was placed angiographically into the hepatic artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5-fluorouracil, folinic acid, and cisplatin. This treatment was repeated at monthly intervals. The medical records were reviewed and analyzed for hepatic tumor response, progression-free survival, overall survival and adverse effects. RESULTS Complete response was observed in two patients (5%), partial response in 18 patients (43%) and stable disease in eight patients (19%). Fourteen patients (33%) had progressive disease after HAIC. The median progression-free survival and overall survival were 8.4 and 19.3 months, respectively. There was no death related to HAIC. The patients with response to the treatment had a significant survival benefit (p<0.005). CONCLUSION HAIC can be an option for those with progressive liver disease who are heavily pretreated while their extra-hepatic conditions are minimal or stable.
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Affiliation(s)
- Jui-Hu Hsiao
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Hong-Tai Chang
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yen-Dun Tseng
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - I-Shu Chen
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yu-Chia Chen
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Po-Ming Chang
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Being-Whey Wang
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
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7
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Lindgaard SC, Brinch CM, Jensen BK, Nørgaard HH, Hermann KL, Theile S, Larsen FO, Jensen BV, Michelsen H, Nelausen KM, Holm VH, Ekblad L, Soerensen PG, Nielsen DL. Hepatic arterial therapy with oxaliplatin and systemic capecitabine for patients with liver metastases from breast cancer. Breast 2018; 43:113-119. [PMID: 30544058 DOI: 10.1016/j.breast.2018.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Hepatic arterial treatment (HAT) for liver metastases in patients with metastatic breast cancer (MBC) has only been investigated in few studies. MATERIALS AND METHODS Two phase II trials were initiated simultaneously to evaluate capecitabine in combination with oxaliplatin in patients with MBC and liver metastases. These two trials are reported together. Continuous capecitabine (1300 mg/m2) was combined with oxaliplatin (85 mg/m2) alternating between systemic treatment and HAT followed by degradable starch microspheres with EmboCept® S every second week. Four patients participated in a pharmacokinetic analysis of oxaliplatin. Each patient had samples taken when receiving oxaliplatin systemically and as HAT with and without EmboCept® S. RESULTS Totally, 52 patients received HAT: 14 with liver metastases only and 38 patients with additional limited metastatic disease. The patients had previously received a median of 2 (range 0-6) chemotherapeutic regimens for MBC. The response rate was 42.3% (95% confidence interval (CI) 28.7-56.8%) with 7.7% complete and 34.6% partial responses. Median progression free survival was 10.8 months (95% CI 6.9-14.7 months) and median overall survival 27.6 months (95% CI 20.4-34.8 months). The toxicity was moderate with hand-foot syndrome (15.4%), neuropathy (9.6%), fatigue (9.6%), and abdominal pain (9.6%) being the most common grade 3 adverse events. There was no clear difference between systemic blood concentrations of oxaliplatin when given systemic or as HAT. CONCLUSION HAT oxaliplatin in combination with capecitabine is safe and efficient in patients with MBC. The results are promising with high response rates and a long median progression free and overall survival.
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Affiliation(s)
- S C Lindgaard
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
| | - C M Brinch
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - B K Jensen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - H H Nørgaard
- Department of Radiology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - K L Hermann
- Department of Radiology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - S Theile
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - F O Larsen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - B V Jensen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - H Michelsen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - K M Nelausen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - V H Holm
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - L Ekblad
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology and Pathology, Box 117, SE-221 00 Lund, Sweden
| | - Peter G Soerensen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - D L Nielsen
- Department of Oncology, Herlev & Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
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8
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Wang S, Scharadin TM, Zimmermann M, Malfatti MA, Turteltaub KW, de Vere White R, Pan CX, Henderson PT. Correlation of Platinum Cytotoxicity to Drug-DNA Adduct Levels in a Breast Cancer Cell Line Panel. Chem Res Toxicol 2018; 31:1293-1304. [PMID: 30381944 DOI: 10.1021/acs.chemrestox.8b00170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Platinum drugs, including carboplatin and oxaliplatin, are commonly used chemotherapy drugs that kill cancer cells by forming toxic drug-DNA adducts. These drugs have a proven, but modest, efficacy against several aggressive subtypes of breast cancer but also cause several side effects that can lead to the cessation of treatment. There is a clinical need to identify patients who will respond to platinum drugs in order to better inform clinical decision making. Diagnostic microdosing involves dosing patients or patient samples with subtherapeutic doses of radiolabeled platinum followed by measurement of platinum-DNA adducts in blood or tumor tissue and may be used to predict patient response. We exposed a panel of six breast cancer cell lines to 14C-labeled carboplatin or oxaliplatin at therapeutic and microdose (1% therapeutic dose) concentrations for a range of exposure lengths and isolated DNA from the cells. The DNA was converted to graphite, and measurement of radiocarbon due to platinum-DNA adduction was quantified via accelerator mass spectrometry (AMS). We observed a linear correlation in adduct levels between the microdose and therapeutic dose, and the level of platinum-DNA adducts corresponded to cell line drug sensitivity for both carboplatin and oxaliplatin. These results showed a clear separation in adduct levels between the sensitive and resistant groups of cell lines that could not be fully explained or predicted by changes in DNA repair rates or mutations in DNA repair genes. Further, we were able to quantitate oxaliplatin-DNA adducts in the blood and tumor tissue of a metastatic breast cancer patient. Together, these data support the use of diagnostic microdosing for predicting patient sensitivity to platinum. Future studies will be aimed at replicating this data in a clinical feasibility trial.
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Affiliation(s)
- Sisi Wang
- Department of Internal Medicine, Division of Hematology and Oncology , University of California Davis , Sacramento , California 95817 , United States
| | - Tiffany M Scharadin
- Department of Internal Medicine, Division of Hematology and Oncology , University of California Davis , Sacramento , California 95817 , United States.,Accelerated Medical Diagnostics Incorporated , Berkeley , California 95618 , United States
| | - Maike Zimmermann
- Department of Internal Medicine, Division of Hematology and Oncology , University of California Davis , Sacramento , California 95817 , United States.,Accelerated Medical Diagnostics Incorporated , Berkeley , California 95618 , United States
| | - Michael A Malfatti
- Lawrence Livermore National Laboratory , Livermore , California 94550 , United States
| | - Kenneth W Turteltaub
- Lawrence Livermore National Laboratory , Livermore , California 94550 , United States
| | - Ralph de Vere White
- Lawrence Livermore National Laboratory , Livermore , California 94550 , United States
| | - Chong-Xian Pan
- Department of Internal Medicine, Division of Hematology and Oncology , University of California Davis , Sacramento , California 95817 , United States.,Department of Urology , University of California Davis Medical Center , Sacramento , California 95817 , United States.,VA Northern California Health Care System , Mather , California 95655 , United States
| | - Paul T Henderson
- Department of Internal Medicine, Division of Hematology and Oncology , University of California Davis , Sacramento , California 95817 , United States.,Accelerated Medical Diagnostics Incorporated , Berkeley , California 95618 , United States
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Mouli SK, Gupta R, Sheth N, Gordon AC, Lewandowski RJ. Locoregional Therapies for the Treatment of Hepatic Metastases from Breast and Gynecologic Cancers. Semin Intervent Radiol 2018; 35:29-34. [PMID: 29628613 DOI: 10.1055/s-0038-1636518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies.
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Affiliation(s)
- Samdeep K Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ramona Gupta
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Neil Sheth
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Andrew C Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
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10
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Ranieri G, Marech I, Porcelli M, Giotta F, Palmiotti G, Laricchia G, Fazio V, Gadaleta CD. Complete response in a patient with liver metastases from breast cancer employing hepatic arterial infusion 5-fluorouracil based chemotherapy plus systemic nab-paclitaxel. Oncotarget 2017; 9:8197-8203. [PMID: 29487726 PMCID: PMC5814293 DOI: 10.18632/oncotarget.23793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022] Open
Abstract
About half of patients with metastatic breast cancer (mBC) have unresectable liver metastases (LMs) or liver-predominant disease (LPD). Unfortunately systemic chemotherapy has limited tumor response due to LMs are supplied by hepatic artery. Hepatic intra-arterial (HAI) have antitumor activity in pretreated patients with LMs. Here we report the case of a 55-year-old woman affected by BCLPD and heavily pretreated. LMs responded to treatment based on HAI with 5-fluorouracil and nab-paclitaxel systemic chemotherapy, and they completely disappeared on a CT-scan. We conclude that this combination chemotherapy is safe and may be very useful for the treatment of patients with BCLPD. Therefore, this combination should be evaluated in a large study.
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Affiliation(s)
- Girolamo Ranieri
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Ilaria Marech
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Mariangela Porcelli
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Francesco Giotta
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Gennaro Palmiotti
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Giuseppe Laricchia
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Vito Fazio
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
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11
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Brozou V, Vadalouca A, Zis P. Pain in Platin-Induced Neuropathies: A Systematic Review and Meta-Analysis. Pain Ther 2017; 7:105-119. [PMID: 29196945 PMCID: PMC5993684 DOI: 10.1007/s40122-017-0092-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Platin-induced peripheral neuropathy (PIPN) is a common cause of PN in cancer patients. The aim of this paper is to systematically review the current literature regarding PIPN, with a particular focus on epidemiological and clinical characteristics of painful PIPN, and to discuss relevant management strategies. Methods A systematic computer-based literature search was conducted on the PubMed database. Results This search strategy resulted in the identification of 353 articles. After the eligibility assessment, 282 articles were excluded. An additional 24 papers were identified by scanning the reference lists. In total, 95 papers met the inclusion criteria and were used for this review. The prevalence of neuropathic symptoms due to acute toxicity of oxaliplatin was estimated at 84.6%, whereas PN established after chemotherapy with platins was estimated at 74.9%. Specifically regarding pain, the reported prevalence of pain due to acute toxicity of oxaliplatin was estimated at 55.6%, whereas the reported prevalence of chronic peripheral neuropathic pain in PIPN was estimated at 49.2%. Conclusion Peripheral neuropathy is a common complication in patients receiving platins and can be particularly painful. There is significant heterogeneity among studies regarding the method for diagnosing peripheral neuropathy. Nerve conduction studies are the gold standard and should be performed in patients receiving platins and complaining of neuropathic symptoms post-treatment.
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Affiliation(s)
| | | | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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12
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Wang M, Zhang J, Ji S, Shao G, Zhao K, Wang Z, Wu A. Transarterial chemoembolisation for breast cancer with liver metastasis: A systematic review. Breast 2017; 36:25-30. [PMID: 28915408 DOI: 10.1016/j.breast.2017.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/28/2017] [Accepted: 09/04/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is limited data on the impact of transarterial chemoembolisation (TACE) on survival in patients of breast cancer with liver metastasis (BCLM). METHODS A systematic review was conducted to assess TACE effect on BCLM patients. A search for clinical studies published since 1/1/2000 to 1/1/2017 was performed. Survival data from all studies were extracted to evaluate the efficacy of TACE, including overall survival, disease free survival and response rate. Toxic side effects data were also extracted to assess the safety of TACE. RESULTS A total of 10 studies with 519 BCLM patients were identified. 78.0% patients were treated with TACE, 9.9% were treated with TACE plus systematic chemotherapy and 12.1% were treated with systematic chemotherapy alone. Pooled median overall survival of patients who received TACE ranged from 7.3 to 47.0 months, median disease free survival ranged from 2.9 to 17.0 months and response rates ranged from 7.0 to 73.5%. Pooled Grade 3 and 4 side effects (blood toxicities, liver toxicity and post-embolization syndrome) ranged from 0.0 to 17.4%. CONCLUSIONS TACE is one of an effective treatment for BCLM and whether a specific patient is appropriate to receive TACE depends on a multiple disciplinary team discussion.
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Affiliation(s)
- Mengchuan Wang
- General Surgery Department, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, 510282, People's Republic of China
| | - Jian Zhang
- Breast Surgery Department, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Yuexiu District, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Shufeng Ji
- General Surgery Department, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, 510282, People's Republic of China
| | - Guoli Shao
- General Surgery Department, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, 510282, People's Republic of China
| | - Kankan Zhao
- General Surgery Department, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, 510282, People's Republic of China
| | - Zixiang Wang
- General Surgery Department, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, 510282, People's Republic of China
| | - Aiguo Wu
- General Surgery Department, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, 510282, People's Republic of China.
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Mohaghegh F, Solhi H, Kazemifar AM. Silymarin (Milk Thistle) can revoke liver enzyme changes during chemotherapy of breast cancer with Taxanes. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Seidensticker M, Garlipp B, Scholz S, Mohnike K, Popp F, Steffen I, Seidensticker R, Stübs P, Pech M, PowerskI M, Hass P, Costa SD, Amthauer H, Bruns C, Ricke J. Locally ablative treatment of breast cancer liver metastases: identification of factors influencing survival (the Mammary Cancer Microtherapy and Interventional Approaches (MAMMA MIA) study). BMC Cancer 2015; 15:517. [PMID: 26169362 PMCID: PMC4501116 DOI: 10.1186/s12885-015-1499-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/18/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Liver metastases from breast cancer (LMBC) are typically considered to indicate systemic disease spread and patients are most often offered systemic palliative treatment only. However, retrospective studies suggest that some patients may have improved survival with local treatment of their liver metastases compared to systemic therapy alone. In the absence of randomized trials, it is important to identify patient characteristics indicating that benefit from local treatment can be expected. METHODS 59 patients undergoing radiofrequency ablation (RFA), interstitial brachytherapy (BT), or radioembolization (RE) of LMBC as a salvage treatment were studied. Potential factors influencing survival were analyzed in a multivariate Cox model. For factors identified to have an independent survival impact, Kaplan-Meier analysis and comparison of overall survival (OS) using the log-rank test was performed. RESULTS Median OS following local interventional treatment was 21.9 months. Considering only factors evaluable at treatment initiation, maximum diameter of liver metastases (≥3.9 cm; HR: 3.1), liver volume (≥ 1376 mL; HR: 2.3), and history of prior chemotherapy (≥ 3 lines of treatment; HR: 2.5-2.6) showed an independent survival impact. When follow-up data were included in the analysis, significant factors were maximum diameter of liver metastases (≥ 3.9 cm; HR: 3.1), control of LMBC during follow-up (HR: 0.29), and objective response as best overall response (HR: 0.21). Neither the presence of any extrahepatic metastases nor presence of bone metastases only had a significant survival impact. Median OS was 38.7 vs. 16.1 months in patients with metastases < vs. ≥ 3.9 cm, 36.6 vs. 10.2 months for patients having objective response vs. stable/progressive disease, and 38.5 vs. 14.2 months for patients having controlled vs. non-controlled disease at follow-up. CONCLUSION Local control of LMBC confers a survival benefit and local interventional treatment for LMBC should be studied in a randomized trial. Patients with small metastases and limited history of systemic LMBC treatment are most likely to benefit from local approaches. Limited extrahepatic disease should not lead to exclusion from a randomized study and should not be a contraindication for local LMBC treatment as long as no randomized data are available.
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Affiliation(s)
- Max Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Benjamin Garlipp
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Sophia Scholz
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Konrad Mohnike
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Felix Popp
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Ingo Steffen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Ricarda Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Patrick Stübs
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Maciej Pech
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. .,Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Maciej PowerskI
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Peter Hass
- Institut für Strahlentherapie, Universitätsklinik Magdeburg, Magdeburg, Germany.
| | - Serban-Dan Costa
- Universitätsklinik Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany.
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Christiane Bruns
- International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. .,Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Jens Ricke
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
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