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Fiste O, Mavrothalassitis E, Apostolidou K, Trika C, Liontos M, Koutsoukos K, Kaparelou M, Dimitrakakis C, Gavriatopoulou M, Dimopoulos MA, Zagouri F. Cardiovascular complications of ribociclib in breast cancer patients. Crit Rev Oncol Hematol 2024; 196:104296. [PMID: 38395242 DOI: 10.1016/j.critrevonc.2024.104296] [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] [Received: 10/02/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors have unprecedentedly advanced hormone-dependent breast cancer treatment paradigm. In the metastatic setting, ribociclib has consistently demonstrated survival benefit in pre-, peri-, and postmenopausal patients, conjugating efficacy with health-related quality of life preservation. Accordingly, the emergence of cardiac and/or vascular adverse events related to this novel targeted agent is gaining significant interest. This narrative review provides an overview of the incidence and spectrum of cardiovascular toxicity, in both clinical trial framework and real-world evidence. The potential pathogenetic mechanism, along with the available diagnostic parameters including biomarkers, and proper management, are also summarized.
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Affiliation(s)
- Oraianthi Fiste
- Oncology Unit, Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens 11527, Greece.
| | | | - Kleoniki Apostolidou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Chrysanthi Trika
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Konstantinos Koutsoukos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Maria Kaparelou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Constantine Dimitrakakis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Meletios Athanasios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
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Bourbonne V, Lévy A, Khalifa J, Antoni D, Blais E, Darréon J, Le Péchoux C, Lerouge D, Giraud P, Marguerit A, Pourel N, Riet FG, Thureau S. Radiotherapy in the management of lung oligometastases. Cancer Radiother 2024; 28:36-48. [PMID: 38228422 DOI: 10.1016/j.canrad.2023.06.030] [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] [Received: 02/26/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 01/18/2024]
Abstract
In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, CHU de Brest, Brest, France; LaTim, Inserm, UMR 1101, université de Bretagne occidentale, Brest, France
| | - A Lévy
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopôle, Toulouse, France
| | - D Antoni
- Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - A Marguerit
- Department of Radiation Oncology, Institut de cancérologie de Montpellier, Montpellier, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, 35760 Saint-Grégoire, France
| | - S Thureau
- Radiotherapy Department, centre Henri-Becquerel, Rouen, France; QuantIF-Litis EA4108, université de Rouen, Rouen, France.
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Kubeczko M, Jarząb M, Gabryś D, Krzywon A, Cortez AJ, Xu AJ. Moderate adverse events and regional differences in CDK4/6 inhibitor treatment combined with palliative radiotherapy. Radiother Oncol 2023; 188:109908. [PMID: 37690666 DOI: 10.1016/j.radonc.2023.109908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Marcin Kubeczko
- Breast Cancer Center, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland.
| | - Michał Jarząb
- Breast Cancer Center, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Dorota Gabryś
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Alexander J Cortez
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Amy J Xu
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York City, United States
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Kubeczko M, Jarząb M, Gabryś D, Krzywon A, Cortez AJ, Xu AJ. Safety and feasibility of CDK4/6 inhibitors treatment combined with radiotherapy in patients with HR-positive/HER2-negative breast cancer. A systematic review and meta-analysis. Radiother Oncol 2023; 187:109839. [PMID: 37536378 DOI: 10.1016/j.radonc.2023.109839] [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] [Received: 05/01/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE The addition of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) to endocrine therapy in hormone receptor-positive (HR+) human epidermal growth factor 2-negative (HER2-) breast cancer has led to practice-changing improvements in overall survival. However, there are conflicting data concerning the safety of CDK4/6i combination with radiotherapy, and no consensus guidelines exist to guide practice. We conducted a meta-analysis to assess the safety and feasibility of CDK4/6i treatment with radiotherapy. MATERIALS AND METHODS A comprehensive search was performed in PubMed/MEDLINE, Web of Science, and Scopus, for studies in advanced/metastatic breast cancer receiving CDK4/6i and radiotherapy with the provided safety data on the occurrence of toxicity. The main outcomes were safety (grade 3-5 adverse events), CDK 4/6i dose reduction, and the discontinuation rate due to toxicity. RESULTS Fifteen studies comprising 1133 patients with HR+/HER2- breast cancer patients were included. Among them, 617 pts received CDK4/6i and radiotherapy; the median follow-up was 17.0 months (IQR 9.2 - 18.0), and the median age was 58.8 years (IQR 55.5---62.5). The pooled prevalence of severe hematologic toxicity was 29.4% (95% CI 14.0% - 47.4%; I2 = 93%; τ2 = 0.084; p < 0.01 and severe non-hematologic toxicity was 2.8% (95% CI 1.1% - 4.8%; I2 = 0%; τ2 = 0.0; p = 0.67). The pooled prevalence of CDK4/6i dose reduction was 24.0% (95% CI 11.1% - 39.4%; I2 = 90%; τ2 = 0.052; p < 0.01) with no difference between CDK4/6i plus RT vs. CDK4/6i (odds ratio of 0.934; 95% CI 0.66 - 1.33; I2 = 0%; τ2 = 0.0; p = 0.56). The pooled prevalence of CDK4/6i discontinuation due to toxicity was 2.3% (95% CI 0.4% - 5.2%; I2 = 23%; τ2 = 0.002; p = 0.24). CONCLUSION The findings of this study suggest that radiotherapy in addition to CDK4/6i treatment in breast cancer patients is generally safe and well tolerated and remains a viable treatment option.
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Affiliation(s)
- Marcin Kubeczko
- Breast Cancer Center, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland.
| | - Michał Jarząb
- Breast Cancer Center, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Dorota Gabryś
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Alexander J Cortez
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
| | - Amy J Xu
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York City, USA
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5
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Yoshimoto FH, de Sousa CFPM, Marta GN, Hanna SA. Integration of Postoperative Radiation Therapy with Cyclin-Dependent Kinase (CDK) Inhibitors. Curr Oncol Rep 2023; 25:1153-1159. [PMID: 37624551 DOI: 10.1007/s11912-023-01444-y] [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] [Accepted: 07/23/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW Sequential use of radiation therapy before cyclin-dependent kinase (CDK) inhibitors in women with early breast cancer seems reasonable and with a low toxicity rate. This study aimed to evaluate the possible interaction between RT and CDK inhibitors in the adjuvant setting for patients with positive hormone receptors and HER-2 negative, investigating toxicity and the treatment sequencing. RECENT FINDINGS CDK inhibitors have been studied in patients with localized breast cancer and can improve invasive disease-free survival outcomes. Regarding the time of RT, all trials used CDK inhibitors after the RT. Interruptions in the CDK inhibitors were performed in 27.1% in Pallas, 17.5% in Penelope-B, and 16.6% in Monarch-E trials due to adverse events. Data from the Natalee trial are still not reported. The main adverse event grade III was neutropenia, with good resolution of the symptoms over time. CDK inhibitors applied sequentially and after RT postoperative showed a low profile of acute toxicity and suitable oncological outcomes.
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Affiliation(s)
- Fernanda Hayashida Yoshimoto
- Department of Radiation Oncology, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil.
| | | | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil
| | - Samir Abdallah Hanna
- Department of Radiation Oncology, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil
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Beddok A, Mouren V, Cottu P, Laki F, Fourquet A, Kirova Y. Outcomes and toxicity of concurrent CDK4/6 inhibitor and locoregional radiotherapy for patients with de novo metastatic breast cancer. Int J Cancer 2023; 153:1386-1396. [PMID: 37381597 DOI: 10.1002/ijc.34562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
The objective of the present study was to assess the outcomes and toxicity of patients treated with concurrent administration of CDK4/6 inhibitors (CDK4/6i) and locoregional radiation therapy (RT), including the breast with a boost or the thoracic wall after mastectomy and the regional lymph node areas. We retrospectively analyzed data from 27 patients with hormone receptor-positive, HER2-negative de novo metastatic breast cancer treated with CDK4/6i and concomitant locoregional RT in 2017/2022. Survival rates were calculated by Kaplan-Meier method. Prognostic factors were tested with log-rank test. CDK4/6i was used as the first systemic metastatic treatment for all the patients, and the median overall treatment time was 26 months. The median time from initiation of CDK4/6i to the start of RT was 10 months (IQR: 7-14 months). The median duration of concomitant CDK4/6i and RT administration was 21 days (IQR: 14.5-23 days). After a median follow-up of 19 months (IQR: 14-36 months), 1 patient died, 11/27 had distant metastases and 1 patient had local recurrence, respectively. The 1- and 3-years progression-free survival (PFS) were 61.4% (95% CI: 45.1%-83.7%) and 53.7% (35.8%-80.5%), respectively. The acute toxicities most observed during RT were neutropenia (44%) and dermatitis (37%). Dermatitis was significantly more frequent in patients with large target volumes (CTV > 911 cc and PTV > 1285 cc). CDK4/6i had to be discontinued in five patients during RT (due to toxicity in three cases and disease progression in two cases). One patient has developed grade 2 late pulmonary fibrosis. Finally, our study demonstrated that concurrent administration of locoregional RT and CDK4/6i did not induce severe late toxicity for most patients.
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Affiliation(s)
- Arnaud Beddok
- Inserm LITO U1288, Institut Curie, PSL Research University, University Paris Saclay, Orsay, France
- Radiation Oncology Department, Institut Curie, PSL Research University, Paris, France
| | - Victoire Mouren
- Radiation Oncology Department, Institut Curie, PSL Research University, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Fatima Laki
- Department of Surgery, Institut Curie, Paris, France
| | - Alain Fourquet
- Radiation Oncology Department, Institut Curie, PSL Research University, Paris, France
| | - Youlia Kirova
- Radiation Oncology Department, Institut Curie, PSL Research University, Paris, France
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7
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Becherini C, Visani L, Caini S, Bhattacharya IS, Kirby AM, Nader Marta G, Morgan G, Salvestrini V, Coles CE, Cortes J, Curigliano G, de Azambuja E, Harbeck N, Isacke CM, Kaidar-Person O, Marangoni E, Offersen B, Rugo HS, Morandi A, Lambertini M, Poortmans P, Livi L, Meattini I. Safety profile of cyclin-dependent kinase (CDK) 4/6 inhibitors with concurrent radiation therapy: A systematic review and meta-analysis. Cancer Treat Rev 2023; 119:102586. [PMID: 37336117 DOI: 10.1016/j.ctrv.2023.102586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
The cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) have become the standard of care for hormone receptor-positive (HR + ) and human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer, improving survival outcomes compared to endocrine therapy alone. Abemaciclib and ribociclib, in combination with endocrine therapy, have demonstrated significant benefits in invasive disease-free survival for high-risk HR+/HER2- early breast cancer patients. Each CDK4/6i-palbociclib, ribociclib, and abemaciclib-exhibits distinct toxicity profiles. Radiation therapy (RT) can be delivered with a palliative or ablative intent, particularly using stereotactic body radiation therapy for oligometastatic or oligoprogressive disease. However, pivotal randomized trials lack information on concomitant CDK4/6i and RT, and existing preclinical and clinical data on the potential combined toxicities are limited and conflicting. As part of a broader effort to establish international consensus recommendations for integrating RT and targeted agents in breast cancer treatment, we conducted a systematic review and meta-analysis to evaluate the safety profile of combining CDK4/6i with palliative and ablative RT in both metastatic and early breast cancer settings.
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Affiliation(s)
- Carlotta Becherini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luca Visani
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Anna M Kirby
- Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Sutton, UK
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil; Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gilberto Morgan
- Division of Medical and Radiation Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Javier Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group & Medical Scientia Innovation Research (MedSIR), Barcelona, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato - Oncology (DIPO), University of Milan, Milan, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Clare M Isacke
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Reproductive (Maastro), Maastricht University, Maastricht, the Netherlands
| | - Elisabetta Marangoni
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, Paris, France
| | - Birgitte Offersen
- Department of Experimental Clinical Oncology, Danish Centre for Particle Therapy, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Andrea Morandi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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8
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Franco R, Cao JQ, Yassa M, Hijal T. Safety of CDK4/6 Inhibitors Combined with Radiotherapy in Patients with Metastatic Breast Cancer: A Review of the Literature. Curr Oncol 2023; 30:5485-5496. [PMID: 37366898 DOI: 10.3390/curroncol30060415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
Recent evidence suggests that cyclin-dependent kinase 4/6 (CDK4/6) inhibitors significantly improve progression-free survival and overall survival among metastatic breast cancer patients. However, given the effects on cell cycle arrest, there is potential for CDK4/6 inhibitors and radiotherapy (RT) to work synergistically, enhancing the effect and toxicities of RT. A comprehensive review of the literature on the combination of RT and CDK4/6 inhibitors was performed with 19 eligible studies included in the final analysis. A total of 373 patients who received radiotherapy combined with CDK4/6 inhibitors were evaluated across 9 retrospective studies, 4 case reports, 3 case series, and 3 letters to the editor. The CDK4/6 inhibitor used, RT target, and RT technique were assessed in terms of toxicities. This literature review demonstrates generally limited toxicities with the combination of CDK4/6 inhibitors and palliative radiotherapy to metastatic breast cancer patients. The current evidence is nonetheless limited, and further results of ongoing prospective clinical trials will help clarify whether these treatments can be safely combined.
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Affiliation(s)
- Rejane Franco
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Jeffrey Q Cao
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Michael Yassa
- Division of Radiation Oncology, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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9
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Das S, Mishra RK, Agrawal A. Prognostic factors affecting outcome of multifocal or multicentric glioblastoma: A scoping review. J Neurosci Rural Pract 2023; 14:199-209. [PMID: 37181186 PMCID: PMC10174113 DOI: 10.25259/jnrp_41_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022] Open
Abstract
It has been reported that patients with multiple lesions have shorter overall survival compared to single lesion in glioblastoma (GBM). Number of lesions can profoundly impact the prognosis and treatment outcome in GBM. In view of the advancement of imaging, multiple GBM (mGBM) lesions are increasingly recognized and reported. The scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for systematic review. Database was searched to collect relevant articles based on predefined eligibility criteria. Our observations suggest that multifocal/multicentric GBM has poorer outcome compared to GBM with singular lesion (sGBM). As the factors influencing the prognosis and outcome is poorly understood and there is no consensus in the existing literature, this review is clinically relevant. As patients with single lesion are more likely to undergo gross total excision, it is likely that further adjuvant treatment may be decided by extent of resection. This review will be helpful for design of further prospective randomized studies for optimal management of mGBM.
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Affiliation(s)
- Saikat Das
- Department of Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rakesh Kumar Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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10
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Incidence of and risk factors for non-hematologic toxicity with combined radiotherapy and CDK4/6 inhibitors in metastatic breast cancer using dose-volume parameters analysis: a multicenter cohort study. Breast Cancer 2023; 30:282-292. [PMID: 36528759 DOI: 10.1007/s12282-022-01422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a lack of data on combined radiotherapy (RT) and cyclin-dependent kinase 4 and 6 inhibitor (CDK4/6i) risk factors and toxicity. This study aimed to assess the incidence of and risk factors for non-hematologic toxicities in patients treated with combined RT and CDK4/6i using dose-volume parameter analysis. METHODS We conducted a retrospective multicenter cohort study of patients with metastatic breast cancer receiving RT within 14 days of CDK4/6i use. The endpoint was non-hematologic toxicities. Patient characteristics and RT treatment planning data were compared between the moderate or higher toxicities (≥ grade 2) group and the non-moderate toxicities group. RESULTS Sixty patients were included in the study. CDK4/6i was provided at a median daily dose of 125 mg and 200 mg for palbociclib and abemaciclib, respectively. In patients who received concurrent RT and CDK4/6i (N = 29), the median concurrent prescribed duration of CDK4/6i was 14 days. The median delivered RT dose was 30 Gy and 10 fractions. The rate of grade 2 and 3 non-hematologic toxicities was 30% and 2%, respectively. There was no difference in toxicity between concurrent and sequential use of CDK4/6i. The moderate pneumonitis group had a larger lung V20 equivalent dose of 2 Gy per fraction and planning target volume than the non-moderate pneumonitis group. CONCLUSIONS Moderate toxicities are frequent with combined RT and CDK4/6i. Caution is necessary concerning the combined RT and CDK4/6i. Particularly, reducing the dose to normal organs is necessary for combined RT and CDK4/6i.
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11
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Safety and Feasibility of Radiation Therapy Combined with CDK 4/6 Inhibitors in the Management of Advanced Breast Cancer. Cancers (Basel) 2023; 15:cancers15030690. [PMID: 36765648 PMCID: PMC9913652 DOI: 10.3390/cancers15030690] [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: 12/16/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i combination with radiotherapy (RT) are conflicting. A retrospective evaluation of 288 advanced breast cancer patients (pts) treated with CDK4/6i was performed, and 100 pts also received RT. Forty-six pts received 63 RT courses concurrently and fifty-four sequentially before CDK4/6i initiation (76 RT courses). Neutropenia was common (79%) and more frequent during and after concurrent RT than sequential RT (86% vs. 76%); however, CDK4/6i dose reduction rates were similar. In patients treated with CDK4/6i alone, the dose reduction rate was 42% (79 pts) versus 38% with combined therapy, and 5% discontinued treatment due to toxicity in the combined group. The risk of CDK4/6i dose reduction was correlated with neutropenia grade, RT performed within the first two CDK4/6i cycles, and more than one concurrent RT; a tendency was observed in concurrent bone irradiation. However, on multivariate regression analysis, only ECOG 1 performance status and severe neutropenia at the beginning of the second cycle were found to be associated with a higher risk of CDK4/6i dose reduction. This largest single-center experience published to date confirmed the acceptable safety profile of the CDK4/6i and RT combination without a significantly increased toxicity compared with CDK4/6i alone. However, one might delay RT for the first two CDK4/6i cycles, when myelotoxic AE are most common.
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Leblanc D, Cantin G, Desnoyers A, Dufresne J, Masucci GL, Panet-Raymond V, Poirier É, Soldera S, Gingras I. Management of Oligometastatic Breast Cancer: An Expert Committee's Opinion. Curr Oncol 2023; 30:1416-1425. [PMID: 36826069 PMCID: PMC9954938 DOI: 10.3390/curroncol30020108] [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] [Received: 12/06/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Patients with oligometastatic breast cancer (BC) are candidates of choice for metastasis-directed therapy (MDT). This paper summarizes the opinions of an expert committee about the management of oligometastatic BC. The experts could complete the questionnaire from 13 September 2021, to 10 October 2021, followed by a discussion. The experts were physicians working in the Province of Quebec (Canada) and specialized in BC care, including surgical oncologists, medical oncologists, and radiation oncologists. The experts provided their opinions about the context of the disease and therapeutic approach, local and systemic therapies, and the prognosis of oligometastatic BC. In addition to the expert panel's opinions about the management of oligometastatic disease per se, the experts stated that a prospective data registry should be implemented to collect data about oligometastatic BC to improve knowledge about oligometastatic BC and implement data-driven MDT. These data could also allow for the design of treatment algorithms. In conclusion, this paper presents the expert panel's opinions about the management of oligometastatic BC and highlights the needs to be met to improve the care of this condition.
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Affiliation(s)
- Dominique Leblanc
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence:
| | - Guy Cantin
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
| | - Alexandra Desnoyers
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
| | - Jean Dufresne
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | | | | | - Éric Poirier
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
| | - Sara Soldera
- Hôpital Charles-Le Moyne, Greenfield Park, QC J4V 2H1, Canada
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Visani L, Livi L, Ratosa I, Orazem M, Ribnikar D, Saieva C, Becherini C, Salvestrini V, Scoccimarro E, Valzano M, Cerbai C, Desideri I, Bernini M, Orzalesi L, Nori J, Bianchi S, Morandi A, Meattini I. Safety of CDK4/6 inhibitors and concomitant radiation therapy in patients affected by metastatic breast cancer. Radiother Oncol 2022; 177:40-45. [PMID: 36349599 DOI: 10.1016/j.radonc.2022.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) currently represent the standard of care for the initial treatment of patients with metastatic hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer. The aim of our study is to evaluate the safety of the use of concomitant radiation therapy (RT) in a consecutive series of HR+/HER2- patients treated in two academic institutions with CDK4/6i in the metastatic setting. METHODS AND MATERIALS From September 2017 to February 2020, we retrospectively collected and analysed data on a sequential series of patients treated with CDK4/6i, receiving RT or not, at two European institutions. Primary outcome of the study was the association between RT and any adverse events (AEs) ≥ G3. Secondary outcomes were the association between RT and any AEs (any grade), CDK4/6i dose reduction rate, and CDK4/6i treatment discontinuation rate. RESULTS We analysed a total of 132 consecutive women; RT was prescribed in 57 (43.2%) patients (70 irradiated lesions). The median age of the series was 52.1 years (range 32.3-78.2). Concomitant RT administration was not significantly related to higher AEs ≥ G3 (p = 0.19) and any grade AEs (p = 1.0); there was no association with RT and CDK4/6i dose reduction (p = 0.49) and discontinuation rates (p = 0.14). At a median follow-up of 18.8 months, the progression-free survival (PFS) rate was 35% and the overall survival (OS) rate was 38.7% in the whole group. The use of concomitant RT did not affect both PFS (p = 0.71) and OS rates (p = 0.55). CONCLUSIONS Our data are encouraging regarding the safety of this combination, showing that concurrent RT did not increase severe toxicity and did not have an impact on systemic treatment conduction.
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Affiliation(s)
- Luca Visani
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Orazem
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Domen Ribnikar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research Prevention and Clinical Network, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Erika Scoccimarro
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Morandi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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Al-Rashdan A, Quirk S, Roumeliotis M, Abedin T, Amaro CP, Barbera L, Lupichuk S, Cao JQ. Radiotherapy with Cyclin-Dependent Kinase 4/6 Inhibitors: A Multi-institutional Safety and Toxicity Study. Int J Radiat Oncol Biol Phys 2022; 114:399-408. [PMID: 35870712 DOI: 10.1016/j.ijrobp.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate radiotherapy (RT) toxicity when given with Cyclin-Dependent Kinase 4/6 inhibitors (CDK4/6i) compared to RT alone. METHODS AND MATERIALS We conducted a retrospective cohort study of patients with hormonal receptor-positive and human epidermal growth factor-2 negative metastatic breast cancer treated with RT at four cancer centers in Alberta, Canada between 2016 and 2020. Toxicity in patients treated with RT within 30 days of initiating to discontinuing CDK4/6i (RT+CDK4/6i) was compared to toxicity of RT in CDK4/6i naïve patients (RT alone). The primary outcome was acute grade (G) II or higher, non-hematological toxicity within 30 days of RT. We also explored toxicity based on the timing of RT (prior, concurrent, post) in relation to CDK4/6i. Propensity score matching was applied to create comparable cohorts. A generalized linear mixed model was used to evaluate factors associated with acute toxicity. RESULTS 132 patients (220 RT sites) in the RT+CDK4/6i and 53 patients (93 RT sites) in RT alone were eligible. The rate of acute GII or higher non-hematological toxicity was 11.5% vs. 7%, respectively (p=0.439), and acute GIII or higher non-hematological toxicity was 3.7% vs. 0%, respectively (p=0.151). Acute toxicity in RT+CDK4/6i group was mainly observed when RT was given concurrently (67%) with most of the GIII toxicity recorded. After propensity score matching, the association of acute toxicity with RT+CDK4/6i vs. RT alone was not significant on multivariable analysis, Odds Ratio 3.13 (95% confidence interval: 0.74 - 13.2; p=0.121). CONCLUSIONS We did not observe a significant association between CDK4/6i use and acute, GII or higher, non-hematological toxicity, in women with metastatic breast cancer receiving palliative RT. Given the findings of GIII toxicity, caution is advised whenever CDK4/6i is given concurrently with RT.
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Affiliation(s)
- Abdulla Al-Rashdan
- Dalhousie University School of Medicine, Dalhousie University, Halifax, NS, B3H 1V7, Canada; Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Sarah Quirk
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Michael Roumeliotis
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Tasnima Abedin
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Carla Paris Amaro
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Lisa Barbera
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Sasha Lupichuk
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Jeffrey Q Cao
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada.
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Guimond E, Tsai CJ, Hosni A, O'Kane G, Yang J, Barry A. Safety and Tolerability of Metastasis Directed Radiotherapy in the Era of Evolving Systemic, Immune and Targeted Therapies. Adv Radiat Oncol 2022; 7:101022. [PMID: 36177487 PMCID: PMC9513086 DOI: 10.1016/j.adro.2022.101022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022] Open
Abstract
AbstractPurpose Systemic, immune, and target therapies are growing in use in the management of metastatic cancers. The aim of this review was to describe up-to-date published data on the safety and tolerability of metastasis-directed hypofractionated radiation therapy (RT) when combined with newer systemic, immune, and targeted therapies and to provide suggested strategies to mitigate potential toxicities in the clinical setting. Methods and Materials A comprehensive search was performed for the time period between 1946 and August 2021 using predetermined keywords describing the use of noncentral nervous system palliative RT with commonly used targeted systemic therapies on PubMed and Medline databases. A total of 1022 articles were screened, and 130 met prespecified criteria to be included in this review. Results BRAF and MEK inhibitors are reported to be toxic when given concurrently with RT; suspension 3 days and 1 to 2 days, respectively, prior and post-RT is suggested. Cetuximab, erlotinib/gefitinib, and osimertinib were generally safe to use concomitantly with conventional radiation. But in a palliative/hypofractionated RT setting, suspending cetuximab during radiation week, erlotinib/gefitinib 1 to 2 days, and osimertinib ≥2 days pre- and post-RT is suggested. Vascular endothelial growth factor inhibitors such as bevacizumab reported substantial toxicities, and the suggestion is to suspend 4 weeks before and after radiation. Less data exist on sorafenib and sunitinib; 5 to 10 days suspension before and after RT should be considered. As a precaution, until further data are available, for cyclin-dependent kinase 4-6 inhibitors, consideration of suspending treatment 1 to 2 days before and after RT should be given. Ipilimumab should be suspended 2 days before and after RT, and insufficient data exist for other immunotherapy agents. Trastuzumab and pertuzumab are generally safe to use in combination with RT, but insufficient data exist for other HER2 target therapy. Conclusions Suggested approaches are described, using up-to-date literature, to aid clinicians in navigating the integration of newer targeted agents with hypofractionated palliative and/or ablative metastatic RT. Further prospective studies are required.
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Affiliation(s)
- Elizabeth Guimond
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
- Corresponding author: Elizabeth Guimond, MD, FRCPC
| | - Chiaojung Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
| | - Grainne O'Kane
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
| | - Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
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Guerini AE, Tucci A, Alongi F, Mataj E, Belotti A, Borghetti P, Triggiani L, Pegurri L, Pedretti S, Bonù M, Tomasini D, Imbrescia J, Donofrio A, Facheris G, Singh N, Volpi G, Tomasi C, Magrini SM, Spiazzi L, Buglione M. RR Myelo POINT: A Retrospective Single-Center Study Assessing the Role of Radiotherapy in the Management of Multiple Myeloma and Possible Interactions with Concurrent Systemic Treatment. Cancers (Basel) 2022; 14:cancers14092273. [PMID: 35565401 PMCID: PMC9099690 DOI: 10.3390/cancers14092273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background and purpose: Although chemotherapy, biological agents, and radiotherapy (RT) are cornerstones of the treatment of multiple myeloma (MM), the literature regarding the possible interactions of concurrent systemic treatment (CST) and RT is limited, and the optimal RT dose is still unclear. Materials and methods: We retrospectively analyzed the records of patients who underwent RT for MM at our institution from 1 January 2005 to 30 June 2020. The data of 312 patients and 577 lesions (treated in 411 accesses) were retrieved. Results: Most of the treated lesions involved the vertebrae (60%) or extremities (18.9%). Radiotherapy was completed in 96.6% of the accesses and, although biologically effective doses assuming an α/β ratio of 10 (BED 10) > 38 Gy and CST were significantly associated with higher rates of toxicity, the safety profile was excellent, with side effects grade ≥2 reported only for 4.1% of the accesses; CST and BED 10 had no impact on the toxicity at one and three months. Radiotherapy resulted in significant improvements in performance status and in a pain control rate of 87.4% at the end of treatment, which further increased to 96.9% at three months and remained at 94% at six months. The radiological response rate at six months (data available for 181 lesions) was 79%, with only 4.4% of lesions in progression. Progression was significantly more frequent in the lesions treated without CST or BED 10 < 15 Gy, while concurrent biological therapy resulted in significantly lower rates of progression. Conclusion: Radiotherapy resulted in optimal pain control rates and fair toxicity, regardless of BED 10 and CST; the treatments with higher BED 10 and CST (remarkably biological agents) improved the already excellent radiological disease control.
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Affiliation(s)
- Andrea Emanuele Guerini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Alessandra Tucci
- Department of Haematology, ASST-Spedali Civili Hospital, 25123 Brescia, Italy; (A.T.); (A.B.)
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar Di Valpolicella, Italy;
| | - Eneida Mataj
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Angelo Belotti
- Department of Haematology, ASST-Spedali Civili Hospital, 25123 Brescia, Italy; (A.T.); (A.B.)
| | - Paolo Borghetti
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
- Correspondence: ; Tel.: +39-0303995272
| | - Luca Triggiani
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Ludovica Pegurri
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Sara Pedretti
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Marco Bonù
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Davide Tomasini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Jessica Imbrescia
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Alessandra Donofrio
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Giorgio Facheris
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Navdeep Singh
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Giulia Volpi
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Cesare Tomasi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Public Health and Human Sciences, University of Brescia, 25123 Brescia, Italy;
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili Hospital, 25123 Brescia, Italy;
| | - Michela Buglione
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
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Zhang Z, Hu B, Joseph J, Wang Y, Mao J, Zhang H, Ma Q, Zhang Y, Wang J. Stable H-bond networks are crucial for selective CDK4 inhibition revealed from comprehensive in silico investigation. Comput Biol Chem 2022; 99:107699. [DOI: 10.1016/j.compbiolchem.2022.107699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
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18
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Meattini I, Livi L, Lorito N, Becherini C, Bacci M, Visani L, Fozza A, Belgioia L, Loi M, Mangoni M, Lambertini M, Morandi A. Integrating radiation therapy with targeted treatments for breast cancer: from bench to bedside. Cancer Treat Rev 2022; 108:102417. [PMID: 35623219 DOI: 10.1016/j.ctrv.2022.102417] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/02/2022]
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Multidisciplinary Treatment of Non-Spine Bone Metastases: Results of a Modified Delphi Consensus Process. Clin Transl Radiat Oncol 2022; 35:76-83. [PMID: 35620018 PMCID: PMC9127274 DOI: 10.1016/j.ctro.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/01/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
Evidence is emerging for new paradigms in the management of non-spine bone metastases. Consensus was feasible amongst physicians in both academic and community-based practice settings. Topics deemed of highest importance for consensus included referral for surgical stabilization and approach to peri-operative radiation, preferred radiation fractionation and appropriate use of stereotactic techniques, and clinical scenarios classified as potentially “complex” warranting multidisciplinary discussion.
Purpose Methods and Materials Results Conclusions
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20
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Radiotherapy as a tool to elicit clinically actionable signalling pathways in cancer. Nat Rev Clin Oncol 2022; 19:114-131. [PMID: 34819622 PMCID: PMC9004227 DOI: 10.1038/s41571-021-00579-w] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 02/03/2023]
Abstract
A variety of targeted anticancer agents have been successfully introduced into clinical practice, largely reflecting their ability to inhibit specific molecular alterations that are required for disease progression. However, not all malignant cells rely on such alterations to survive, proliferate, disseminate and/or evade anticancer immunity, implying that many tumours are intrinsically resistant to targeted therapies. Radiotherapy is well known for its ability to activate cytotoxic signalling pathways that ultimately promote the death of cancer cells, as well as numerous cytoprotective mechanisms that are elicited by cellular damage. Importantly, many cytoprotective mechanisms elicited by radiotherapy can be abrogated by targeted anticancer agents, suggesting that radiotherapy could be harnessed to enhance the clinical efficacy of these drugs. In this Review, we discuss preclinical and clinical data that introduce radiotherapy as a tool to elicit or amplify clinically actionable signalling pathways in patients with cancer.
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21
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Pesch AM, Hirsh NH, Michmerhuizen AR, Jungles KM, Wilder-Romans K, Chandler BC, Liu M, Lerner LM, Nino CA, Ward C, Cobain EF, Lawrence TS, Pierce LJ, Rae JM, Speers CW. RB expression confers sensitivity to CDK4/6 inhibitor-mediated radiosensitization across breast cancer subtypes. JCI Insight 2021; 7:154402. [PMID: 34932500 PMCID: PMC8855810 DOI: 10.1172/jci.insight.154402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Standard radiation therapy (RT) does not reliably provide locoregional control for women with multinode-positive breast cancer and triple-negative breast cancer (TNBC). We hypothesized that CDK4/6 inhibition (CDK4/6i) would increase the radiosensitivity not only of estrogen receptor–positive (ER+) cells, but also of TNBC that expresses retinoblastoma (RB) protein. We found that CDK4/6i radiosensitized RB WT TNBC (n = 4, radiation enhancement ratio [rER]: 1.49–2.22) but failed to radiosensitize RB-null TNBC (n = 3, rER: 0.84–1.00). RB expression predicted response to CDK4/6i + RT (R2 = 0.84), and radiosensitization was lost in ER+/TNBC cells (rER: 0.88–1.13) after RB1 knockdown in isogenic and nonisogenic models. CDK4/6i suppressed homologous recombination (HR) in RB WT cells but not in RB-null cells or isogenic models of RB1 loss; HR competency was rescued with RB reexpression. Radiosensitization was independent of nonhomologous end joining and the known effects of CDK4/6i on cell cycle arrest. Mechanistically, RB and RAD51 interact in vitro to promote HR repair. CDK4/6i produced RB-dependent radiosensitization in TNBC xenografts but not in isogenic RB1-null xenografts. Our data provide the preclinical rationale for a clinical trial expanding the use of CDK4/6i + RT to difficult-to-control RB-intact breast cancers (including TNBC) and nominate RB status as a predictive biomarker of therapeutic efficacy.
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Affiliation(s)
- Andrea M Pesch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Nicole H Hirsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Anna R Michmerhuizen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Kassidy M Jungles
- Department of Radiation Oncology, University of Michgan, Ann Arbor, United States of America
| | - Kari Wilder-Romans
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Benjamin C Chandler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Meilan Liu
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Lynn M Lerner
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Charles A Nino
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Connor Ward
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Erin F Cobain
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
| | - James M Rae
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Corey W Speers
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States of America
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22
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van Aken ESM, Beeker A, Houtenbos I, Pos FJ, Linn SC, Elkhuizen PHM, de Jong MC. Unexpected toxicity of CDK4/6 inhibitor palbociclib and radiotherapy. Cancer Rep (Hoboken) 2021; 5:e1470. [PMID: 34145976 PMCID: PMC8842704 DOI: 10.1002/cnr2.1470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023] Open
Abstract
Background Cyclin‐dependent kinase (CDK) 4/6 inhibitors have recently been approved for the treatment of hormone receptor–positive and HER2‐negative metastatic breast cancer in association with endocrine therapy in postmenopausal women. Data on the interaction of CDK4/6 inhibition and radiotherapy are scarce, but some studies show unexpected toxicity. Cases We report three cases of unexpected severe or prolonged soft tissue, skin, and gastrointestinal toxicity in patients treated with a combination of radiotherapy and the CDK4/6 inhibitor palbociclib. Conclusion These cases indicate a possible interaction between radiotherapy and palbociclib. Therefore, we recommend using radiotherapy cautiously when combined with CDK4/6 inhibitors.
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Affiliation(s)
- Evert S M van Aken
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Aart Beeker
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Ilse Houtenbos
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Paula H M Elkhuizen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Monique C de Jong
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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23
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Gagliano A, Prestifilippo A, Cantale O, Ferini G, Fisichella G, Fontana P, Sciacca D, Giuffrida D. Role of the Combination of Cyclin-Dependent Kinase Inhibitors (CDKI) and Radiotherapy (RT) in the Treatment of Metastatic Breast Cancer (MBC): Advantages and Risks in Clinical Practice. Front Oncol 2021; 11:643155. [PMID: 34221963 PMCID: PMC8247460 DOI: 10.3389/fonc.2021.643155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
Targeting cell cycle has become the gold standard for metastatic breast cancer (MBC), being cyclin-dependent kinase inhibitors (CDKIs) cornerstones of its treatment, alongside radiotherapy (RT). To date, no definite evidence regarding safety and efficacy of the combination of CDKIs plus radiotherapy (RT) is currently available. Purpose of this review is to collect data in favor or against the feasibility of the association of CDKIs + RT, describing its potential adverse events. Our review shows how CDKI + RT allows an overall satisfying disease control, proving to be effective and causing a grade of toxicity mainly influenced by the site of irradiation, leaning to favourable outcomes for sites as liver, spine or brain and to poorer outcomes for thoracic lesions or sites close to viscera; controversial evidence is instead for bone treatment. Toxicity also varies from patient to patient. To sum up, our contribution enriches and enlightens a still indefinite field regarding the feasibility of CDKIs + RT, giving cues for innovative clinical management of hormone-responsive MBC.
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Affiliation(s)
- Ambrogio Gagliano
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Angela Prestifilippo
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Ornella Cantale
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Gianluca Ferini
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Giacomo Fisichella
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Paolo Fontana
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Dorotea Sciacca
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Dario Giuffrida
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
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Barberi V, Pietragalla A, Franceschini G, Marazzi F, Paris I, Cognetti F, Masetti R, Scambia G, Fabi A. Oligometastatic Breast Cancer: How to Manage It? J Pers Med 2021; 11:532. [PMID: 34207648 PMCID: PMC8227505 DOI: 10.3390/jpm11060532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most frequent cancer among women and represents the second leading cause of cancer-specific death. A subset of patients with metastatic breast cancer (MBC) presents limited disease, termed 'oligometastatic' breast cancer (OMBC). The oligometastatic disease can be managed with different treatment strategies to achieve long-term remission and eventually cure. Several approaches are possible to cure the oligometastatic disease: locoregional treatments of the primary tumor and of all the metastatic sites, such as surgery and radiotherapy; systemic treatment, including target-therapy or immunotherapy, according to the biological status of the primary tumor and/or of the metastases; or the combination of these approaches. Encouraging results involve local ablative options, but these trials are limited by being retrospective and affected by selection bias. Systemic therapy, e.g., the use of CDK4/6 inhibitors for hormone receptor-positive (HR+)/HER-2 negative BC, leads to an increase of progression-free survival (PFS) and overall survival (OS) in all the subgroups, with favorable toxicity. Regardless of the lack of substantial data, this subset of patients could be treated with curative intent; the appropriate candidates could be mostly young women, for whom a multidisciplinary aggressive approach appears suitable. We provide a global perspective on the current treatment paradigms of OMBC.
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Affiliation(s)
- Vittoria Barberi
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy; (V.B.); (F.C.)
| | - Antonella Pietragalla
- Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.P.); (G.S.)
| | - Gianluca Franceschini
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.F.); (R.M.)
| | - Fabio Marazzi
- UOC Radiotherapy, Department of Imaging Diagnostic, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Cognetti
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy; (V.B.); (F.C.)
| | - Riccardo Masetti
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.F.); (R.M.)
| | - Giovanni Scambia
- Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.P.); (G.S.)
| | - Alessandra Fabi
- Unit of Precision Medicine in Breast Cancer, Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Mano MS, Oliveira LJC, Hanna SA. Integrating Adjuvant Radiation with Post-Neoadjuvant Therapies in Early Breast Cancer. Curr Oncol Rep 2021; 23:58. [PMID: 33770260 DOI: 10.1007/s11912-021-01050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Because of the strong prognostic value of pathologic complete response (pCR) in early breast cancer (EBC), patients who fail to achieve this outcome have increasingly been eligible to a new treatment modality, namely post-neoadjuvant systemic therapy (PNT). However, adjuvant radiation therapy (RT) retains a crucial role in EBC, and also needs to be timely administered to patients. To address how modern PNT optimally integrates with adjuvant RT is therefore the purpose of this review. RECENT FINDINGS How PNT administration optimally integrates with adjuvant RT has varied depending on the type of systemic therapy employed. The introduction of novel "targeted" agents has created new challenges, as for many of them limited information is available on the feasibility of concurrent systemic and RT administration or their optimal sequencing. PNT and RT are both of utmost importance to the management of EBC and need to be timely and safely administered to patients. The optimal strategy to integrate these modalities may vary according to the type of PNT agent and other factors.
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Affiliation(s)
- Max S Mano
- Centro Paulista de Oncologia (CPO) - Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil.
| | - Leandro Jonata C Oliveira
- Centro Paulista de Oncologia (CPO) - Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil
| | - Samir A Hanna
- Department of Radiation Oncology - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil
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