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Bozer A, Yilmaz C, Çetin Tunçez H, Kocatepe Çavdar D, Adıbelli ZH. MR Imaging Features Predictive of Pathologic Complete Response and Survival Outcomes for Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy. Magn Reson Med Sci 2025:mp.2024-0137. [PMID: 40090737 DOI: 10.2463/mrms.mp.2024-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2025] Open
Abstract
PURPOSE This study aims to evaluate the predictive value of MRI features for pathologic complete response (pCR) and survival outcomes in patients with breast cancer (BC) undergoing neoadjuvant chemotherapy (NAC). METHODS A retrospective analysis was conducted on 168 BC patients treated with NAC between 2018 and 2022. Pre-NAC breast MRI scans were evaluated for enhancement patterns, time-intensity curve (TIC), peritumoral edema, and background enhancement. Both pre- and post-NAC MRIs were assessed for Epeak %, mean apparent diffusion coefficient (ADC) value, and ADC ratio (mean ADC of lesion/contralateral normal breast parenchyma). Survival outcomes were analyzed using Kaplan-Meier and Cox regression models. RESULTS pCR was achieved in 34% of patients. MRI demonstrated a sensitivity of 74% and a specificity of 86% in predicting pCR, with an overall accuracy of 82%. The post-NAC percentage of initial peak enhancement (Epeak) was significantly lower in the pCR group (P < 0.001). Multivariate analysis identified a pre-NAC Epeak ≤ 96 (hazard ratio [HR]: 6.26, P < 0.001) and a post-NAC Epeak > 188 (HR: 18.40, P < 0.001) as independent risk factors for disease-free survival. Additionally, a lower pre-NAC ADC ratio (≤0.65) was associated with poorer overall survival (HR: 2.8, P: 0.041). Pre-NAC peritumoral edema, background enhancement, and TIC were not significant predictors of survival outcomes. CONCLUSION MRI features, including Epeak % and ADC ratio, are important predictors of pCR and survival outcomes in BC patients undergoing NAC. Incorporating these biomarkers into clinical practice may improve treatment planning and optimize patient outcomes.
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Affiliation(s)
- Ahmet Bozer
- Department of Radiology, Izmir City Hospital, Izmir, Turkey
| | - Cengiz Yilmaz
- Department of Medical Oncology, Izmir City Hospital, Izmir, Turkey
| | | | | | - Zehra Hilal Adıbelli
- Department of Radiology, Izmir City Hospital, Izmir, Turkey
- Department of Radiology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
- Department of Radiology, Bozyaka Education and Research Hospital, Izmir, Turkey
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Faur IF, Dobrescu A, Clim IA, Pasca P, Burta C, Tarta C, Brebu D, Neamtu AA, Braicu V, Duta C, Totolici B. Prognostic Significance of Peripheral Blood Parameters as Predictor of Neoadjuvant Chemotherapy Response in Breast Cancer. Int J Mol Sci 2025; 26:2541. [PMID: 40141182 PMCID: PMC11942583 DOI: 10.3390/ijms26062541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 03/07/2025] [Accepted: 03/09/2025] [Indexed: 03/28/2025] Open
Abstract
The standard treatment for breast cancer typically includes surgery, often followed by systemic therapy and individualized treatment regimens. However, there is growing interest in identifying pre-therapeutic biomarkers that can predict tumor response to neoadjuvant chemotherapy (NACT). This study systematically evaluated various analytical parameters, including age, TNM stage, histological type, molecular subtype, and several biomarker ratios, such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammatory index (SII), and prognostic nutritional index (PNI). We aimed to assess the predictive value of these parameters regarding the tumor's response rate to NACT. The analysis revealed a statistically significant association between the pathological complete response-pCR (absence of any detectable cancer cells in the tissue following neoadjuvant chemotherapy (NACT))-rate and NLR in the subgroup with values between 1 and 3 (p = 0.001). The optimal cut-off for PLR was determined to be 120.45, with 80.55% of patients achieving pCR showing PLR values below this threshold (p = 0.000). Similarly, the LMR cut-off was found to be 12.34, with 77.77% of patients with pCR having LMR values below this threshold (p = 0.002). Additionally, lower pre-therapeutic values of NLR (p < 0.001), PLR (p = 0.002), SII (p = 0.001), and LMR (p = 0.001) were significantly correlated with pCR compared to the non-pCR subgroup (p < 0.005). These findings highlight the predictive potential of these biomarkers for achieving pCR following NACT. Our study supports the hypothesis that pre-therapeutic values of NLR, PLR, SII, and LMR can serve as predictive biomarkers for pCR in breast cancer patients undergoing NACT. However, the PNI did not demonstrate predictive potential in relation to pCR. These biomarkers may provide valuable insights into patient prognosis and guide personalized treatment strategies.
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Affiliation(s)
- Ionut Flaviu Faur
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Multidisciplinary Doctoral School “Vasile Goldiș”, Western University of Arad, 310025 Arad, Romania
| | - Amadeus Dobrescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ioana Adelina Clim
- Doctoral School of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Paul Pasca
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cosmin Burta
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristi Tarta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Dan Brebu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Andreea-Adriana Neamtu
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Vlad Braicu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ciprian Duta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (A.D.); (P.P.); (C.T.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Bogdan Totolici
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
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Thomas J, Malla L, Shibwabo B. Advances in analytical approaches for background parenchymal enhancement in predicting breast tumor response to neoadjuvant chemotherapy: A systematic review. PLoS One 2025; 20:e0317240. [PMID: 40053513 PMCID: PMC11888135 DOI: 10.1371/journal.pone.0317240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 12/25/2024] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Breast cancer (BC) continues to pose a substantial global health concern, necessitating continuous advancements in therapeutic approaches. Neoadjuvant chemotherapy (NAC) has gained prominence as a key therapeutic strategy, and there is growing interest in the predictive utility of Background Parenchymal Enhancement (BPE) in evaluating the response of breast tumors to NAC. However, the analysis of BPE as a predictive biomarker, along with the techniques used to model BPE changes for accurate and timely predictions of treatment response presents several obstacles. This systematic review aims to thoroughly investigate recent advancements in the analytical methodologies for BPE analysis, and to evaluate their reliability and effectiveness in predicting breast tumor response to NAC, ultimately contributing to the development of personalized and effective therapeutic strategies. METHODS A comprehensive and structured literature search was conducted across key electronic databases, including Cochrane Database of Systematic Reviews, Google Scholar, PubMed, and IEEE Xplore covering articles published up to May 10, 2024. The inclusion criteria targeted studies focusing on breast cancer cohorts treated with NAC, involving both pre-treatment and at least one post-treatment breast dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI) scan, and analyzing BPE utility in predicting breast tumor response to NAC. Methodological quality assessment and data extraction were performed to synthesize findings and identify commonalities and differences among various BPE analytical approaches. RESULTS The search yielded a total of 882 records. After meticulous screening, 78 eligible records were identified, with 13 studies ultimately meeting the inclusion criteria for the systematic review. Analysis of the literature revealed a significant evolution in BPE analysis, from early studies focusing on single time-point BPE analysis to more recent studies adopting longitudinal BPE analysis. The review uncovered several gaps that compromise the accuracy and timeliness of existing longitudinal BPE analysis methods, such as missing data across multiple imaging time points, manual segmentation of the whole-breast region of interest, and over reliance on traditional statistical methods like logistic regression for modeling BPE and pathological complete response (pCR). CONCLUSION This review provides a thorough examination of current advancements in analytical approaches for BPE analysis in predicting breast tumor response to NAC. The shift towards longitudinal BPE analysis has highlighted significant gaps, suggesting the need for alternative analytical techniques, particularly in the realm of artificial intelligence (AI). Future longitudinal BPE research work should focus on standardization in longitudinal BPE measurement and analysis, through integration of deep learning-based approaches for automated tumor segmentation, and implementation of advanced AI technique that can better accommodate varied breast tumor responses, non-linear relationships and complex temporal dynamics in BPE datasets, while also handling missing data more effectively. Such integration could lead to more precise and timely predictions of breast tumor responses to NAC, thereby enhancing personalized and effective breast cancer treatment strategies.
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Affiliation(s)
- Julius Thomas
- School of Computing and Engineering Sciences, Strathmore University, Nairobi, Kenya
| | - Lucas Malla
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benard Shibwabo
- School of Computing and Engineering Sciences, Strathmore University, Nairobi, Kenya
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Gentile D, Canzian J, Barbieri E, Di Maria Grimaldi S, De Sanctis R, Tinterri C. Superior Survival and Lower Recurrence Outcomes with Breast-Conserving Surgery Compared to Mastectomy Following Neoadjuvant Therapy in 607 Breast Cancer Patients. Cancers (Basel) 2025; 17:766. [PMID: 40075614 PMCID: PMC11899183 DOI: 10.3390/cancers17050766] [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: 01/02/2025] [Revised: 02/16/2025] [Accepted: 02/19/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUNDS Neoadjuvant therapy (NAT) is a cornerstone in the management of breast cancer (BC), enabling tumor downstaging and improved surgical options. METHODS This study retrospectively analyzed 607 BC patients treated with NAT and surgery at IRCCS Humanitas Research Hospital, Milan, Italy, to compare long-term oncologic outcomes of breast-conserving surgery (BCS) versus mastectomy. Patient demographics, tumor characteristics, and treatment details were analyzed using descriptive statistics, logistic regression, and Cox proportional hazards models. RESULTS Of the 607 patients, 54.7% underwent BCS, and 45.3% had mastectomy. BCS was associated with significantly superior 10-year outcomes compared to mastectomy, including disease-free survival (DFS, 75.2% vs. 71.1%, p = 0.001), distant DFS (75.2% vs. 71.1%, p = 0.001), overall survival (OS, 82.9% vs. 78.1%, p = 0.002), and BC-specific survival (BCSS, 87.7% vs. 83.1%, p = 0.001). Pathologic complete response (pCR) emerged as a protective factor across all endpoints, while mastectomy was independently associated with worse BCSS (HR: 2.068, 95% CI: 1.016-4.210, p = 0.045). CONCLUSIONS Our findings demonstrate the oncologic safety and potential superiority of BCS over mastectomy in NAT-treated BC patients, highlighting the importance of individualized surgical decision-making to optimize survival outcomes.
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Affiliation(s)
- Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (E.B.); (S.D.M.G.); (C.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (J.C.); (R.D.S.)
| | - Jacopo Canzian
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (J.C.); (R.D.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Erika Barbieri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (E.B.); (S.D.M.G.); (C.T.)
| | - Simone Di Maria Grimaldi
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (E.B.); (S.D.M.G.); (C.T.)
| | - Rita De Sanctis
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (J.C.); (R.D.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (E.B.); (S.D.M.G.); (C.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (J.C.); (R.D.S.)
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Bozer A, Yilmaz C, Çetin Tunçez H, Kocatepe Çavdar D, Adıbelli ZH. Correlation of Histopathological and Radiological Response Patterns and Their Prognostic Implications in Breast Cancer After Neoadjuvant Chemotherapy. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:1005-1017. [PMID: 39759838 PMCID: PMC11699841 DOI: 10.2147/bctt.s495553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 12/13/2024] [Indexed: 01/07/2025]
Abstract
Purpose In breast cancer (BC), neoadjuvant chemotherapy (NAC) responses can be categorized as concentric shrinkage (CS), non-concentric shrinkage (non-CS), and complete response, influencing surgical planning and survival. This study evaluates the correlation between histopathological and radiological response patterns in BC patients after NAC and their impact on overall survival (OS) and disease-free survival (DFS). Patients and Methods This retrospective study analyzed 168 BC patients who received NAC between 2018 and 2022. Tumor response was evaluated radiologically using MRI and histopathologically after surgery. Radiological response patterns were categorized into CS, non-CS, and radiological complete response (rCR). Histopathologically, patients were classified into CS, non-CS, and pathological complete response (pCR). Concordance between radiological and histopathological classifications was assessed using the kappa statistic. Survival outcomes, including OS and DFS, were analyzed using Kaplan-Meier methods. Results Histopathological response patterns were distributed as CS (31.5%), non-CS (34.5%), and pCR (34%). Moderate agreement was observed between radiological and histopathological assessments (κ: 0.439, p < 0.001). Radiological evaluation identified 64% of CS, 50% of non-CS, and 74% of pCR cases accurately. Tumor molecular subtypes significantly correlated with both radiologic and histopathologic response patterns (p < 0.001). Subtype analysis revealed higher pCR rates in TN, HER2-enriched, and Luminal B-HER2(+) tumors, while non-CS was predominant in Luminal A tumors. No significant correlation was observed between histopathological or radiological patterns and OS (p: 0.291, p: 0.515) or DFS (p: 0.599, p: 0.899). However, patients achieving pCR tended to have better survival outcomes. Conclusion We observed moderate concordance between histopathological and radiological response patterns in BC patients after NAC, but discrepancies highlight the limitations of radiological evaluation alone. These patterns did not significantly correlate with prognosis. Higher pCR rates were associated with better outcomes, but response patterns alone may not predict survival, warranting further research in larger cohorts.
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Affiliation(s)
- Ahmet Bozer
- Department of Radiology, Izmir City Hospital, Izmir, Turkey
- Department of Radiology, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Cengiz Yilmaz
- Department of Medical Oncology, Izmir City Hospital, Izmir, Turkey
| | - Hülya Çetin Tunçez
- Department of Radiology, Izmir City Hospital, Izmir, Turkey
- Department of Radiology, Bozyaka Education and Research Hospital, Izmir, Turkey
| | | | - Zehra Hilal Adıbelli
- Department of Radiology, Izmir City Hospital, Izmir, Turkey
- Department of Radiology, Bozyaka Education and Research Hospital, Izmir, Turkey
- Department of Radiology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
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Adewale OO, Wińska P, Piasek A, Cieśla J. The Potential of Plant Polysaccharides and Chemotherapeutic Drug Combinations in the Suppression of Breast Cancer. Int J Mol Sci 2024; 25:12202. [PMID: 39596268 PMCID: PMC11594611 DOI: 10.3390/ijms252212202] [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: 09/26/2024] [Revised: 11/08/2024] [Accepted: 11/11/2024] [Indexed: 11/28/2024] Open
Abstract
Breast cancer is the most common cancer affecting women worldwide. The associated morbidity and mortality have been on the increase while available therapies for its treatment have not been totally effective. The most common treatment, chemotherapy, sometimes has dangerous side effects because of non-specific targeting, in addition to poor therapeutic indices, and high dose requirements. Consequently, agents with anticancer effects are being sought that can reduce the side effects induced by chemotherapy while increasing its cytotoxicity to cancer cells. This is possible using natural compounds that are safe and biologically active. There are many reports on plant polysaccharides due to their bioactive and anticancer properties. The use of plant polysaccharide together with a conventional cytotoxic drug may offer wide benefits in cancer therapy, producing synergistic effects, thereby reducing drug dose and, so, its associated side effects. In this review, we highlight an overview of the use of plant polysaccharides and chemotherapeutic drugs in breast cancer preclinical studies, including their mechanisms of anticancer activities. The findings emphasize the potential of plant polysaccharides to improve chemotherapeutic outcomes in breast cancer, paving the way for more effective and safer treatment strategies.
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Affiliation(s)
| | | | | | - Joanna Cieśla
- Chair of Drug and Cosmetics Biotechnology, Faculty of Chemistry, Warsaw University of Technology, 00-664 Warsaw, Poland; (O.O.A.); (P.W.); (A.P.)
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Yadav SK, Leon-Ferre RA. Current treatment paradigms for triple-negative breast cancer. Minerva Med 2024; 115:589-598. [PMID: 39016529 DOI: 10.23736/s0026-4806.24.09458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Triple negative breast cancer (TNBC) accounts for 15% of all breast cancers and is characterized by more aggressive biology, significant disease heterogeneity, and worse clinical outcomes. In recent years, improved understanding of TNBC tumor biology and its heterogeneity have led to the identification of new molecular targets, opening avenues for novel treatment strategies. Clinical trials evaluating immunotherapy, poly-ADP ribose polymerase (PARP) inhibitors, and antibody drug conjugates have shown improvement in clinical outcomes, leading to their incorporation to the treatment options available for patients with TNBC. This review aimed to provide the internal medicine specialist and primary care provider with a comprehensive overview of the current systemic therapy approaches for TNBC and introduce clinicians to novel therapies that have recently been added to the treatment armamentarium against this disease.
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Affiliation(s)
- Sumeet K Yadav
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA -
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Wu L, He C, Zhao T, Li T, Xu H, Wen J, Xu X, Gao L. Diagnosis and treatment status of inoperable locally advanced breast cancer and the application value of inorganic nanomaterials. J Nanobiotechnology 2024; 22:366. [PMID: 38918821 PMCID: PMC11197354 DOI: 10.1186/s12951-024-02644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024] Open
Abstract
Locally advanced breast cancer (LABC) is a heterogeneous group of breast cancer that accounts for 10-30% of breast cancer cases. Despite the ongoing development of current treatment methods, LABC remains a severe and complex public health concern around the world, thus prompting the urgent requirement for innovative diagnosis and treatment strategies. The primary treatment challenges are inoperable clinical status and ineffective local control methods. With the rapid advancement of nanotechnology, inorganic nanoparticles (INPs) exhibit a potential application prospect in diagnosing and treating breast cancer. Due to the unique inherent characteristics of INPs, different functions can be performed via appropriate modifications and constructions, thus making them suitable for different imaging technology strategies and treatment schemes. INPs can improve the efficacy of conventional local radiotherapy treatment. In the face of inoperable LABC, INPs have proposed new local therapeutic methods and fostered the evolution of novel strategies such as photothermal and photodynamic therapy, magnetothermal therapy, sonodynamic therapy, and multifunctional inorganic nanoplatform. This article reviews the advances of INPs in local accurate imaging and breast cancer treatment and offers insights to overcome the existing clinical difficulties in LABC management.
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Affiliation(s)
- Linxuan Wu
- School of Intelligent Medicine, China Medical University, Shenyang, 110122, China
| | - Chuan He
- Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Tingting Zhao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Tianqi Li
- School of Intelligent Medicine, China Medical University, Shenyang, 110122, China
| | - Hefeng Xu
- School of Intelligent Medicine, China Medical University, Shenyang, 110122, China
| | - Jian Wen
- Department of Breast Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China.
| | - Xiaoqian Xu
- School of Intelligent Medicine, China Medical University, Shenyang, 110122, China.
| | - Lin Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110022, China.
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Yang H, Ruan Y, Sun Y, Wang P, Qiao J, Wang C, Liu Z. Assessment of the impact of residual tumors at different sites post-neoadjuvant chemotherapy on prognosis in breast cancer patients and development of a disease-free survival prediction model. Ther Adv Med Oncol 2024; 16:17588359241249578. [PMID: 38736552 PMCID: PMC11085027 DOI: 10.1177/17588359241249578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Background Residual disease after neoadjuvant chemotherapy (NAC) in breast cancer patients predicts worse outcomes than pathological complete response. Differing prognostic impacts based on the anatomical site of residual tumors are not well studied. Objectives The study aims to assess disease-free survival (DFS) in breast cancer patients with different residual tumor sites following NAC and to develop a nomogram for predicting 1- to 3-year DFS in these patients. Design A retrospective cohort study. Methods Retrospective analysis of 953 lymph node-positive breast cancer patients with residual disease post-NAC. Patients were categorized into three groups: residual disease in breast (RDB), residual disease in lymph nodes (RDN), and residual disease in both (RDBN). DFS compared among groups. Patients were divided into a training set and a validation set in a 7:3 ratio. Prognostic factors for DFS were analyzed to develop a nomogram prediction model. Results RDB patients had superior 3-year DFS of 94.6% versus 85.2% for RDN and 81.8% for RDBN (p < 0.0001). Clinical T stage, N stage, molecular subtype, and postoperative pN stage were independently associated with DFS on both univariate and multivariate analyses. Nomogram integrating clinical tumor-node-metastasis (TNM) stage, molecular subtype, pathological response demonstrated good discrimination (C-index 0.748 training, 0.796 validation cohort), and calibration. Conclusion The location of residual disease has prognostic implications, with nodal residuals predicting poorer DFS. The validated nomogram enables personalized DFS prediction to guide treatment decisions.
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Affiliation(s)
- Hanzhao Yang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yuxia Ruan
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yadong Sun
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Peili Wang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jianghua Qiao
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Chengzheng Wang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Zhenzhen Liu
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou 450008, China
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Zavarykina TM, Lomskova PK, Pronina IV, Khokhlova SV, Stenina MB, Sukhikh GT. Circulating Tumor DNA Is a Variant of Liquid Biopsy with Predictive and Prognostic Clinical Value in Breast Cancer Patients. Int J Mol Sci 2023; 24:17073. [PMID: 38069396 PMCID: PMC10706922 DOI: 10.3390/ijms242317073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
This paper introduces the reader to the field of liquid biopsies and cell-free nucleic acids, focusing on circulating tumor DNA (ctDNA) in breast cancer (BC). BC is the most common type of cancer in women, and progress with regard to treatment has been made in recent years. Despite this, there remain a number of unresolved issues in the treatment of BC; in particular, early detection and diagnosis, reliable markers of response to treatment and for the prediction of recurrence and metastasis, especially for unfavorable subtypes, are needed. It is also important to identify biomarkers for the assessment of drug resistance and for disease monitoring. Our work is devoted to ctDNA, which may be such a marker. Here, we describe its main characteristics and potential applications in clinical oncology. This review considers the results of studies devoted to the analysis of the prognostic and predictive roles of various methods for the determination of ctDNA in BC patients. Currently known epigenetic changes in ctDNA with clinical significance are reviewed. The possibility of using ctDNA as a predictive and prognostic marker for monitoring BC and predicting the recurrence and metastasis of cancer is also discussed, which may become an important part of a precision approach to the treatment of BC.
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Affiliation(s)
- Tatiana M. Zavarykina
- N.M. Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow 119334, Russia;
- “B.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology of Ministry of Health of the Russian Federation, Moscow 117997, Russia; (S.V.K.); (G.T.S.)
| | - Polina K. Lomskova
- N.M. Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow 119334, Russia;
| | - Irina V. Pronina
- Institute of General Pathology and Pathophysiology, Moscow 125315, Russia;
| | - Svetlana V. Khokhlova
- “B.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology of Ministry of Health of the Russian Federation, Moscow 117997, Russia; (S.V.K.); (G.T.S.)
| | - Marina B. Stenina
- “N.N. Blokhin National Medical Research Center of Oncology of Ministry of Health of the Russian Federation, Moscow 115522, Russia;
| | - Gennady T. Sukhikh
- “B.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology of Ministry of Health of the Russian Federation, Moscow 117997, Russia; (S.V.K.); (G.T.S.)
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Qi X, Chen J, Wei S, Ni J, Song L, Jin C, Yang L, Zhang X. Prognostic significance of platelet-to-lymphocyte ratio (PLR) in patients with breast cancer treated with neoadjuvant chemotherapy: a meta-analysis. BMJ Open 2023; 13:e074874. [PMID: 37996220 PMCID: PMC10668253 DOI: 10.1136/bmjopen-2023-074874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Platelet-to-lymphocyte ratio (PLR), known as a key systemic inflammatory parameter, has been proved to be associated with response to neoadjuvant therapy in breast cancer (BC); however, the results remain controversial. This meta-analysis was carried out to evaluate the prognostic values of PLR in patients with BC treated with neoadjuvant chemotherapy (NACT). DESIGN Meta-analysis. DATA SOURCES Relevant literature published on the following databases: PubMed, Embase, Web of Science databases and the Cochrane Library. ELIGIBILITY CRITERIA All studies involving patients with BC treated with NACT and peripheral blood pretreatment PLR recorded were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted and evaluated HR/OR and its 95% CI of survival outcomes, pathological complete response (pCR) rate and clinicopathological parameters. RESULTS The last search was updated to 31 December 2022. A total of 22 studies with 5533 patients with BC treated with NACT were enrolled in the final meta-analysis. Our results demonstrate that elevated PLR value appears to correlate with low pCR rate (HR 0.77, 95% CI 0.67 to 0.88, p<0.001, I2=75.80%, Ph<0.001) and poor prognosis, including overall survival (OS) (HR 1.90, 95% CI 1.39 to 2.59, p<0.001; I2=7.40%, Ph=0.365) and disease-free survival (HR 1.97, 95% CI 1.56 to 2.50, p<0.001; I2=0.0%, Ph=0.460). Furthermore, PLR level was associated with age (OR 0.86, 95% CI 0.79 to 0.93, p<0.001, I2=40.60%, Ph=0.096), menopausal status (OR 0.83, 95% CI 0.76 to 0.90, p<0.001, I2=50.80%, Ph=0.087) and T stage (OR 1.05, 95% CI 1.00 to 1.11, p=0.035; I2=70.30%, Ph=0.005) of patients with BC. CONCLUSIONS This meta-analysis demonstrated that high PLR was significantly related to the low pCR rate, poor OS and disease-free survival (DFS) of patients with BC treated with NACT. Therefore, PLR can be used as a potential predictor biomarker for the efficacy of NACT in BC.
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Affiliation(s)
- Xue Qi
- Department of Oncology, Nantong Liangchun Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, China
| | - Jia Chen
- Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Sheng Wei
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jingyi Ni
- Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Li Song
- Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Conghui Jin
- Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Lei Yang
- Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xunlei Zhang
- Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China
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12
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Fan J, Tang Y, Wang K, Yang S, Ma B. Predictive miRNAs Patterns in Blood of Breast Cancer Patients Demonstrating Resistance Towards Neoadjuvant Chemotherapy. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:591-604. [PMID: 37593370 PMCID: PMC10427486 DOI: 10.2147/bctt.s415080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/22/2023] [Indexed: 08/19/2023]
Abstract
Objective The effect of chemotherapy in patients with breast cancer (BC) is uncertain. This study attempted to analyze serum microRNAs (miRNAs) in NAC resistant and sensitive BC patients and develop a miRNA-based nomogram model. To further help clinicians make treatment decisions for hormone receptor-positive patients. Methods A total of 110 BC patients with NAC were recruited and assigned in sensitive and resistant group, and 4 sensitive patients and 3 resistant patients were subjected to high-throughput sequencing. The functions of their target genes were analyzed by GO and KEGG. Five BC-related reported miRNAs were selected for expression pattern measurement by RT-qPCR and multivariate logistic analysis. The nomogram model was developed using R 4.0.1, and its predictive efficacy, consistency and clinical application value in development and validation groups were evaluated using ROC, calibration and decision curves. Results There were 44 differentially-expressed miRNAs in resistant BC patients. miR-3646, miR-4741, miR-6730-3p, miR-6831-5p and miR-8485 were candidate for resistance diagnosis in BC. Logistic multiple regression analysis showed that miR-4741 (or = 0.30, 95% CI = 0.08-0.63, P = 0.02) and miR-6831-5p (or = 0.48, 95% CI = 0.24-0.78, P = 0.01) were protective factors of BC resistance. The ROC curves showed a sensitivity of 0.884 and 0.750 for miR-4741 and miR-6831-5P as markers of resistance, suggesting that they can be used as independent risk factors for BC resistance. The other 3 miRNAs can be used as calibration factors to establish the risk prediction model of resistance in BC. In risk model, the prediction accuracy of resistance of BC is about 78%. 5-miRNA signature diagnostic models can help clinicians provide personalized treatment for NAC resistance BC patients to improve patient survival. Conclusion MiR-4741 and miR-6831-5p are independent risk factors for breast cancer resistance. This study constructed a nomogram model of NAC resistance in BC based on 5 differentially-expressed serum miRNAs.
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Affiliation(s)
- Jingjing Fan
- Department of Breast and Thyroid Surgery, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Yunjian Tang
- Department of Breast and Thyroid Surgery, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Kunming Wang
- Department of Breast and Thyroid Surgery, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Shu Yang
- Department of Breast and Thyroid Surgery, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Binlin Ma
- Department of Breast and Thyroid Surgery, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
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13
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Margolis R, Basavarajappa L, Li J, Obaid G, Hoyt K. Image-guided focused ultrasound-mediated molecular delivery to breast cancer in an animal model. Phys Med Biol 2023; 68:10.1088/1361-6560/ace23d. [PMID: 37369225 PMCID: PMC10439523 DOI: 10.1088/1361-6560/ace23d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/27/2023] [Indexed: 06/29/2023]
Abstract
Tumors become inoperable due to their size or location, making neoadjuvant chemotherapy the primary treatment. However, target tissue accumulation of anticancer agents is limited by the physical barriers of the tumor microenvironment. Low-intensity focused ultrasound (FUS) in combination with microbubble (MB) contrast agents can increase microvascular permeability and improve drug delivery to the target tissue after systemic administration. The goal of this research was to investigate image-guided FUS-mediated molecular delivery in volume space. Three-dimensional (3-D) FUS therapy functionality was implemented on a programmable ultrasound scanner (Vantage 256, Verasonics Inc.) equipped with a linear array for image guidance and a 128-element therapy transducer (HIFUPlex-06, Sonic Concepts). FUS treatment was performed on breast cancer-bearing female mice (N= 25). Animals were randomly divided into three groups, namely, 3-D FUS therapy, two-dimensional (2-D) FUS therapy, or sham (control) therapy. Immediately prior to the application of FUS therapy, animals received a slow bolus injection of MBs (Definity, Lantheus Medical Imaging Inc.) and near-infrared dye (IR-780, surrogate drug) for optical reporting and quantification of molecular delivery. Dye accumulation was monitored viain vivooptical imaging at 0, 1, 24, and 48 h (Pearl Trilogy, LI-COR). Following the 48 h time point, animals were humanely euthanized and tumors excised forex vivoanalyzes. Optical imaging results revealed that 3-D FUS therapy improved delivery of the IR-780 dye by 66.4% and 168.1% at 48 h compared to 2-D FUS (p= 0.18) and sham (p= 0.047) therapeutic strategies, respectively.Ex vivoanalysis revealed similar trends. Overall, 3-D FUS therapy can improve accumulation of a surrogate drug throughout the entire target tumor burden after systemic administration.
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Affiliation(s)
- Ryan Margolis
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Lokesh Basavarajappa
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Junjie Li
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Girgis Obaid
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
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14
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Zhang H, Barner JC, Moczygemba LR, Rascati KL, Park C, Kodali D. Comparing survival outcomes between neoadjuvant and adjuvant chemotherapy within breast cancer subtypes and stages among older women: a SEER-Medicare analysis. Breast Cancer 2023; 30:489-496. [PMID: 36842097 DOI: 10.1007/s12282-023-01441-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND This study aimed to compare survival outcomes of neoadjuvant (NAC) and adjuvant chemotherapy (AdC) within each breast cancer subtype and stage among older women. METHODS Older (≥ 66 years) women newly diagnosed with stage I-III invasive ductal breast cancer during 2010-2017 and treated with both chemotherapy and surgery within one year were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Analyses were performed within each of six groups, jointly defined based on subtype (hormone receptor [HR]-positive/human epidermal growth factor receptor 2 [HER2]-negative, HER2 + , and triple-negative) and stage (I-II and III). Kaplan-Meier curves and multivariable Cox models were used to compare overall and recurrence-free survival between NAC and AdC, with optimal full matching performed for confounding adjustment. RESULTS Among 8,495 included patients, 8,329 (20.6% received NAC) remained after matching. Before multiple testing adjustment, Cox models showed that NAC was associated with a lower hazard for death among stage III HER2 + patients (hazard ratio = 0.347, 95% confidence interval CI 0.161-0.745) but a higher hazard for death among triple-negative patients (stage I-II: hazard ratio = 1.558, 95% CI 1.024-2.370; stage III: hazard ratio = 2.453; 95% CI 1.254-4.797). A higher hazard for death/recurrence was associated with NAC among stage I-II HR + /HER2- patients (hazard ratio = 1.305, 95% CI 1.007-1.693). No significant difference remained after multiple testing adjustment. CONCLUSIONS The opposite trends (before multiple testing adjustment) of survival comparisons for advanced HER2 + and triple-negative disease warrant further research. Caution is needed due to study limitations such as cancer stage validity.
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Affiliation(s)
- Hanxi Zhang
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Jamie C Barner
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
| | | | - Karen L Rascati
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Chanhyun Park
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Dhatri Kodali
- Texas Oncology, Deke Slayton Cancer Center, Webster, TX, USA
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15
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Dutta R, Guruvaiah P, Reddi KK, Bugide S, Reddy Bandi D, Edwards YJK, Singh K, Gupta R. UBE2T promotes breast cancer tumor growth by suppressing DNA replication stress. NAR Cancer 2022; 4:zcac035. [PMID: 36338541 PMCID: PMC9629447 DOI: 10.1093/narcan/zcac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Breast cancer is a leading cause of cancer-related deaths among women, and current therapies benefit only a subset of these patients. Here, we show that ubiquitin-conjugating enzyme E2T (UBE2T) is overexpressed in patient-derived breast cancer samples, and UBE2T overexpression predicts poor prognosis. We demonstrate that the transcription factor AP-2 alpha (TFAP2A) is necessary for the overexpression of UBE2T in breast cancer cells, and UBE2T inhibition suppresses breast cancer tumor growth in cell culture and in mice. RNA sequencing analysis identified interferon alpha-inducible protein 6 (IFI6) as a key downstream mediator of UBE2T function in breast cancer cells. Consistently, UBE2T inhibition downregulated IFI6 expression, promoting DNA replication stress, cell cycle arrest, and apoptosis and suppressing breast cancer cell growth. Breast cancer cells with IFI6 inhibition displayed similar phenotypes as those with UBE2T inhibition, and ectopic IFI6 expression in UBE2T-knockdown breast cancer cells prevented DNA replication stress and apoptosis and partly restored breast cancer cell growth. Furthermore, UBE2T inhibition enhanced the growth-suppressive effects of DNA replication stress inducers. Taken together, our study identifies UBE2T as a facilitator of breast cancer tumor growth and provide a rationale for targeting UBE2T for breast cancer therapies.
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Affiliation(s)
- Roshan Dutta
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Praveen Guruvaiah
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Kiran Kumar Reddi
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Suresh Bugide
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Dhana Sekhar Reddy Bandi
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Yvonne J K Edwards
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Kamaljeet Singh
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI 02912, USA
| | - Romi Gupta
- Department of Biochemistry and Molecular Genetics, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
- O’Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
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16
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Li Z, Xiao H, Li J, Yang Z, Jiang J, Ji J, Peng C, He Y. Graphene Oxide-Based Highly Sensitive Assay of Circulating MicroRNAs for Early Prediction of the Response to Neoadjuvant Chemotherapy in Breast Cancer. Anal Chem 2022; 94:16254-16264. [DOI: 10.1021/acs.analchem.2c04117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zhijia Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Hongtao Xiao
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Junjie Li
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Zhongzhu Yang
- State Key Laboratory of Southwestern Chinese Medicine Resources, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jun Jiang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Juan Ji
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Cheng Peng
- State Key Laboratory of Southwestern Chinese Medicine Resources, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yang He
- State Key Laboratory of Southwestern Chinese Medicine Resources, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
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Bagdasaryan AA, Chubarev VN, Smolyarchuk EA, Drozdov VN, Krasnyuk II, Liu J, Fan R, Tse E, Shikh EV, Sukocheva OA. Pharmacogenetics of Drug Metabolism: The Role of Gene Polymorphism in the Regulation of Doxorubicin Safety and Efficacy. Cancers (Basel) 2022; 14:5436. [PMID: 36358854 PMCID: PMC9659104 DOI: 10.3390/cancers14215436] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Breast cancer (BC) is the prevailing malignancy and major cause of cancer-related death in females. Doxorubicin is a part of BC neoadjuvant and adjuvant chemotherapy regimens. The administration of anthracycline derivates, such as doxorubicin, may cause several side effects, including hematological disfunction, gastrointestinal toxicity, hepatotoxicity, nephrotoxicity, and cardiotoxicity. Cardiotoxicity is a major adverse reaction to anthracyclines, and it may vary depending on individual differences in doxorubicin pharmacokinetics. Determination of specific polymorphisms of genes that can alter doxorubicin metabolism was shown to reduce the risk of adverse reactions and improve the safety and efficacy of doxorubicin. Genes which encode cytochrome P450 enzymes (CYP3A4 and CYP2D6), p-glycoproteins (ATP-binding cassette (ABC) family members such as Multi-Drug Resistance 1 (MDR1) protein), and other detoxifying enzymes were shown to control the metabolism and pharmacokinetics of doxorubicin. The effectiveness of doxorubicin is defined by the polymorphism of cytochrome p450 and p-glycoprotein-encoding genes. This study critically discusses the latest data about the role of gene polymorphisms in the regulation of doxorubicin's anti-BC effects. The correlation of genetic differences with the efficacy and safety of doxorubicin may provide insights for the development of personalized medical treatment for BC patients.
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Affiliation(s)
- Alina A. Bagdasaryan
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Vladimir N. Chubarev
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Elena A. Smolyarchuk
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Vladimir N. Drozdov
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Ivan I. Krasnyuk
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Junqi Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Ruitai Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Edmund Tse
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Evgenia V. Shikh
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Olga A. Sukocheva
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
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Kripa E, Rizzo V, Galati F, Moffa G, Cicciarelli F, Catalano C, Pediconi F. Do body composition parameters correlate with response to targeted therapy in ER+/HER2- metastatic breast cancer patients? Role of sarcopenia and obesity. Front Oncol 2022; 12:987012. [PMID: 36212446 PMCID: PMC9538503 DOI: 10.3389/fonc.2022.987012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the association between body composition parameters, sarcopenia, obesity and prognosis in patients with metastatic ER+/HER2- breast cancer under therapy with cyclin-dependent kinase (CDK) 4/6 inhibitors. Methods 92 patients with biopsy-proven metastatic ER+/HER2- breast cancer, treated with CDK 4/6 inhibitors between 2018 and 2021 at our center, were included in this retrospective analysis. Visceral Adipose Tissue (VAT), Subcutaneous Adipose Tissue (SAT) and Skeletal Muscle Index (SMI) were measured before starting therapy with CDK 4/6 inhibitors (Palbociclib, Abemaciclib or Ribociclib). Measurements were performed on a computed tomography-derived abdominal image at third lumbar vertebra (L3) level by an automatic dedicated software (Quantib body composition®, Rotterdam, Netherlands). Visceral obesity was defined as a VAT area > 130 cm2. Sarcopenia was defined as SMI < 40 cm2/m2. Changes in breast lesion size were evaluated after 6 months of treatment. Response to therapy was assessed according to RECIST 1.1 criteria. Spearman’s correlation and χ2 analyses were performed. Results Out of 92 patients, 30 were included in the evaluation. Of the 30 patients (mean age 53 ± 12 years), 7 patients were sarcopenic, 16 were obese, while 7 patients were neither sarcopenic nor obese. Statistical analyses showed that good response to therapy was correlated to higher SMI values (p < 0.001), higher VAT values (p = 0.008) and obesity (p = 0.007); poor response to therapy was correlated to sarcopenia (p < 0.001). Moreover, there was a significant association between sarcopenia and menopause (p = 0.021) and between sarcopenia and the persistence of axillary lymphadenopathies after treatment (p = 0.003), while the disappearance of axillary lymphadenopathies was associated with obesity (p = 0.028). Conclusions There is a growing interest in body composition, especially in the field of breast cancer. Our results showed an interesting correlation between sarcopenia and progression of disease, and demonstrated that VAT can positively influence the response to targeted therapy with CDK 4/6 inhibitors. Larger-scale studies are needed to confirm these preliminary results. Clinical Relevance Sarcopenia and obesity seem to predict negative outcomes in many oncologic entities. Their prevalence and impact in current breast cancer care are promising but still controversial.
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19
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Zhang H, Barner JC, Moczygemba LR, Rascati KL, Park C, Kodali D. Neoadjuvant chemotherapy use trends among older women with breast cancer: 2010-2017. Breast Cancer Res Treat 2022; 193:695-705. [PMID: 35449473 DOI: 10.1007/s10549-022-06604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study assessed chemotherapy use trends before (neoadjuvant chemotherapy [NAC]) or after surgery (adjuvant chemotherapy [AdC]) among older women with breast cancer and examined factors related to NAC receipt. METHODS Women (> 65 years) diagnosed with stage I-III breast cancer during 2010-2017 who received NAC or AdC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. All patients were stratified into six strata based on subtype (hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR + /HER2-], HER2 + , and triple-negative breast cancer [TNBC]) and stage (I-II and III). Cochran-Armitage tests were performed to test temporal trends of NAC use in each stratum. Multivariable logistic regression analyses were performed to identify factors (sociodemographic and clinical) related to NAC use. RESULTS Among included older (mean ± standard deviation: 72.3 ± 5.2 years) women (N = 8,495) with stage I-III breast cancer, NAC use increased from 11.7% (2010) to 32.6% (2017). Significant increases in NAC were found in all strata (p < .0001) with more substantial increases in HER2 + disease and TNBC compared to HR + /HER2- disease. Multivariable logistic regressions identified the youngest age category (66-69 years) and later stage as significant (p < 0.05) predictors of NAC receipt in most strata, in addition to diagnosis year. CONCLUSION Similar to the overall breast cancer population, NAC use increased among a population of older women. NAC was received by most patients with stage III HER2 + disease or TNBC in more recent years and was more common among younger elderly women and those in stage III.
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Affiliation(s)
- Hanxi Zhang
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Jamie C Barner
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA.
| | - Leticia R Moczygemba
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Karen L Rascati
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Chanhyun Park
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Dhatri Kodali
- Texas Oncology, Deke Slayton Cancer Center, Webster, TX, USA
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20
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Rebmann V, Schwich E, Michita RT, Grüntkemeier L, Bittner AK, Rohn H, Horn PA, Hoffmann O, Kimmig R, Kasimir-Bauer S. Systematic Evaluation of HLA-G 3'Untranslated Region Variants in Locally Advanced, Non-Metastatic Breast Cancer Patients: UTR-1, 2 or UTR-4 are Predictors for Therapy and Disease Outcome. Front Immunol 2022; 12:817132. [PMID: 35095919 PMCID: PMC8790528 DOI: 10.3389/fimmu.2021.817132] [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: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Despite major improvements in diagnostics and therapy in early as well as in locally advanced breast cancer (LABC), metastatic relapse occurs in about 20% of patients, often explained by early micro-metastatic spread into bone marrow by disseminated tumor cells (DTC). Although neoadjuvant chemotherapy (NACT) has been a successful tool to improve overall survival (OS), there is growing evidence that various environmental factors like the non-classical human leukocyte antigen-G (HLA-G) promotes cancer invasiveness and metastatic progression. HLA-G expression is associated with regulatory elements targeting certain single-nucleotide polymorphisms (SNP) in the HLA-G 3’ untranslated region (UTR), which arrange as haplotypes. Here, we systematically evaluated the impact of HLA-G 3’UTR polymorphisms on disease status, on the presence of DTC, on soluble HLA-G levels, and on therapy and disease outcome in non-metastatic LABC patients. Although haplotype frequencies were similar in patients (n = 142) and controls (n = 204), univariate analysis revealed that the UTR-7 haplotype was related to patients with low tumor burden, whereas UTR-4 was associated with tumor sizes >T1. Furthermore, UTR-4 was associated with the presence of DTC, but UTR-3 and UTR-7 were related to absence of DTC. Additionally, increased levels of soluble HLA-G molecules were found in patients carrying UTR-7. Regarding therapy and disease outcome, univariate and multivariate analysis highlighted UTR-1 or UTR-2 as a prognostic parameter indicative for a beneficial course of disease in terms of complete response towards NACT or progression-free survival (PFS). At variance, UTR-4 was an independent risk factor for a reduced OS besides already known parameters. Taken into account the most common HLA-G 3’UTR haplotypes (UTR-1–UTR-7, UTR-18), deduction of the UTR-1/2/4 haplotypes to specific SNPs revealed that the +3003C variant, unique for UTR-4, seemed to favor a detrimental disease outcome, while the +3187G and +3196G variants, unique for UTR-1 or UTR-2, were prognostic parameters for a beneficial course of disease. In conclusion, these data suggest that the HLA-G 3’UTR variants +3003C, +3187G, and +3196G are promising candidates for the prediction of therapy and disease outcome in LABC patients.
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Affiliation(s)
- Vera Rebmann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Esther Schwich
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rafael Tomoya Michita
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Medicine, Baylor College of Medicine (BCMC), Houston, TX, United States
| | - Lisa Grüntkemeier
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ann-Kathrin Bittner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hana Rohn
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sabine Kasimir-Bauer
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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21
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Bhardwaj D, Dasgupta A, DiCenzo D, Brade S, Fatima K, Quiaoit K, Trudeau M, Gandhi S, Eisen A, Wright F, Look-Hong N, Curpen B, Sannachi L, Czarnota GJ. Early Changes in Quantitative Ultrasound Imaging Parameters during Neoadjuvant Chemotherapy to Predict Recurrence in Patients with Locally Advanced Breast Cancer. Cancers (Basel) 2022; 14:cancers14051247. [PMID: 35267555 PMCID: PMC8909335 DOI: 10.3390/cancers14051247] [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: 12/29/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study was conducted to explore the use of quantitative ultrasound (QUS) in predicting recurrence for patients with locally advanced breast cancer (LABC) early during neoadjuvant chemotherapy (NAC). METHODS Eighty-three patients with LABC were scanned with 7 MHz ultrasound before starting NAC (week 0) and during treatment (week 4). Spectral parametric maps were generated corresponding to tumor volume. Twenty-four textural features (QUS-Tex1) were determined from parametric maps acquired using grey-level co-occurrence matrices (GLCM) for each patient, which were further processed to generate 64 texture derivatives (QUS-Tex1-Tex2), leading to a total of 95 features from each time point. Analysis was carried out on week 4 data and compared to baseline (week 0) data. ∆Week 4 data was obtained from the difference in QUS parameters, texture features (QUS-Tex1), and texture derivatives (QUS-Tex1-Tex2) of week 4 data and week 0 data. Patients were divided into two groups: recurrence and non-recurrence. Machine learning algorithms using k-nearest neighbor (k-NN) and support vector machines (SVMs) were used to generate radiomic models. Internal validation was undertaken using leave-one patient out cross-validation method. RESULTS With a median follow up of 69 months (range 7-118 months), 28 patients had disease recurrence. The k-NN classifier was the best performing algorithm at week 4 with sensitivity, specificity, accuracy, and area under curve (AUC) of 87%, 75%, 81%, and 0.83, respectively. The inclusion of texture derivatives (QUS-Tex1-Tex2) in week 4 QUS data analysis led to the improvement of the classifier performances. The AUC increased from 0.70 (0.59 to 0.79, 95% confidence interval) without texture derivatives to 0.83 (0.73 to 0.92) with texture derivatives. The most relevant features separating the two groups were higher-order texture derivatives obtained from scatterer diameter and acoustic concentration-related parametric images. CONCLUSIONS This is the first study highlighting the utility of QUS radiomics in the prediction of recurrence during the treatment of LABC. It reflects that the ongoing treatment-related changes can predict clinical outcomes with higher accuracy as compared to pretreatment features alone.
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Affiliation(s)
- Divya Bhardwaj
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
| | - Archya Dasgupta
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Daniel DiCenzo
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
| | - Stephen Brade
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
| | - Kashuf Fatima
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
| | - Karina Quiaoit
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
| | - Maureen Trudeau
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (M.T.); (S.G.); (A.E.)
- Department of Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sonal Gandhi
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (M.T.); (S.G.); (A.E.)
- Department of Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (M.T.); (S.G.); (A.E.)
- Department of Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Frances Wright
- Department of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.W.); (N.L.-H.)
- Department of Surgery, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nicole Look-Hong
- Department of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.W.); (N.L.-H.)
- Department of Surgery, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
- Department of Medical Imaging, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Lakshmanan Sannachi
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
| | - Gregory J. Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (D.B.); (A.D.); (D.D.); (S.B.); (K.F.); (K.Q.); (L.S.)
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada
- Correspondence: ; Tel.: +416-480-6128
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Stege H, Haist M, Nikfarjam U, Schultheis M, Heinz J, Pemler S, Loquai C, Grabbe S. The Status of Adjuvant and Neoadjuvant Melanoma Therapy, New Developments and Upcoming Challenges. Target Oncol 2021; 16:537-552. [PMID: 34554353 PMCID: PMC8484171 DOI: 10.1007/s11523-021-00840-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
The global incidence of malignant melanoma, the leading cause of skin cancer death, has steadily increased in recent years. Surgical excision is the treatment of choice for early-stage melanoma. However, 40-60% of patients with high-risk melanoma or with nodal involvement eventually experience loco-regional relapse or tumor progression. Adjuvant therapy aims to reduce the rate of recurrence in radically operated high-risk patients with melanoma and thus improves survival. Interferon-α has long been the only approved drug for adjuvant melanoma therapy, despite an unclear survival benefit. The landmark success of immune-checkpoint inhibitors and BRAF/MEK-directed targeted therapies in the treatment of patients with stage IV melanoma led to the initiation of clinical trials in the adjuvant setting. These trials demonstrated the efficacy of immune-checkpoint inhibitors and targeted therapies for the adjuvant treatment of high-risk patients with melanoma, as shown both by an increase in recurrence-free survival and the emergence of long-term survivors, finally resulting in the approval of the cytotoxic T-lymphocyte antigen 4 inhibitor ipilimumab, PD1 inhibitors (nivolumab, pembrolizumab), and BRAF/MEK inhibitors for adjuvant melanoma therapy. This review aims to delineate the advances in adjuvant melanoma therapy, issuing particularly recent results from clinical trials. Moreover, we also discuss pending issues and future challenges, which comprise the adequate selection of adjuvant regimens for patient subgroups and the identification of markers likely to predict the individual response to adjuvant treatments. Last, we outline the role of emerging neoadjuvant approaches, which may complement adjuvant strategies and are currently investigated in clinical trials.
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Affiliation(s)
- Henner Stege
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Maximilian Haist
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ulrike Nikfarjam
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jaqueline Heinz
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Saskia Pemler
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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23
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Magbanua MJM, Li W, Wolf DM, Yau C, Hirst GL, Swigart LB, Newitt DC, Gibbs J, Delson AL, Kalashnikova E, Aleshin A, Zimmermann B, Chien AJ, Tripathy D, Esserman L, Hylton N, van 't Veer L. Circulating tumor DNA and magnetic resonance imaging to predict neoadjuvant chemotherapy response and recurrence risk. NPJ Breast Cancer 2021; 7:32. [PMID: 33767190 PMCID: PMC7994408 DOI: 10.1038/s41523-021-00239-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
We investigated whether serial measurements of circulating tumor DNA (ctDNA) and functional tumor volume (FTV) by magnetic resonance imaging (MRI) can be combined to improve prediction of pathologic complete response (pCR) and estimation of recurrence risk in early breast cancer patients treated with neoadjuvant chemotherapy (NAC). We examined correlations between ctDNA and FTV, evaluated the additive value of ctDNA to FTV-based predictors of pCR using area under the curve (AUC) analysis, and analyzed the impact of FTV and ctDNA on distant recurrence-free survival (DRFS) using Cox regressions. The levels of ctDNA (mean tumor molecules/mL plasma) were significantly correlated with FTV at all time points (p < 0.05). Median FTV in ctDNA-positive patients was significantly higher compared to those who were ctDNA-negative (p < 0.05). FTV and ctDNA trajectories in individual patients showed a general decrease during NAC. Exploratory analysis showed that adding ctDNA information early during treatment to FTV-based predictors resulted in numerical but not statistically significant improvements in performance for pCR prediction (e.g., AUC 0.59 vs. 0.69, p = 0.25). In contrast, ctDNA-positivity after NAC provided significant additive value to FTV in identifying patients with increased risk of metastatic recurrence and death (p = 0.004). In this pilot study, we demonstrate that ctDNA and FTV were correlated measures of tumor burden. Our preliminary findings based on a limited cohort suggest that ctDNA at surgery improves FTV as a predictor of metastatic recurrence and death. Validation in larger studies is warranted.
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Affiliation(s)
- Mark Jesus M Magbanua
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Denise M Wolf
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christina Yau
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Gillian L Hirst
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Lamorna Brown Swigart
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - David C Newitt
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Gibbs
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Amy L Delson
- Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - A Jo Chien
- Division of Hematology Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Esserman
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nola Hylton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Laura van 't Veer
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.
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24
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Systemic Immune-Inflammation Index Is Superior to Neutrophil to Lymphocyte Ratio in Prognostic Assessment of Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7961568. [PMID: 33381583 PMCID: PMC7762645 DOI: 10.1155/2020/7961568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
Results SII, NLR, and PLR did not define patient groups with distinct clinicopathological characteristics. SII, NLR, and PLR cut-off values were 547, 2.13, and 88.23, as determined by ROC analysis; the corresponding areas under the curve (AUCs) were 0.625, 0.555, and 0.571, respectively. Cox regression models identified SII as independently associated with OS. Patients with low SII had prolonged OS (65 vs. 41 months, P = 0.017, HR: 3.24, 95% CI: 1.23-8.55). In the Z test, the difference in AUC between SII and NLR was statistically significant (Z = 2.721, 95% CI: 0.0194-0.119, P = 0.0065). Conclusion Our study suggests that the pretreatment SII value is significantly correlated with OS in breast cancer patients undergoing NAC and that the prognostic utility of SII is superior to that of NLR and PLR.
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Al-Saleh K, Aldiab A, Salah T, Arafah M, Husain S, Al-Rikabi A, El-Aziz NA. Prognostic Significance of HER2 Expression Changes Following Neoadjuvant Chemotherapy in Saudi Patients With Locally Advanced Breast Cancer. Clin Breast Cancer 2020; 21:e362-e367. [PMID: 33419688 DOI: 10.1016/j.clbc.2020.11.015] [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: 07/06/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Progesterone receptor (PR), estrogen receptor (ER), and human epidermal growth factor receptor 2 (HER2) significantly influence disease prognosis and therapeutic response in patients with breast cancer. Neoadjuvant chemotherapy (NACT) can change the receptor status, affecting the disease characteristics. PATIENTS AND METHODS A retrospective chart review was carried out at a single tertiary care hospital in Riyadh, Kingdom of Saudi Arabia, from December 2008 to December 2014, where 91 adult female patients diagnosed with locally advanced breast cancer planning to receive NACT were included. Original pathology and surgical histopathology reports were assessed, and patients were followed up to recurrence, death, or until December 2019. An expression for the ER, PR, and HER2 was carried out in pre and post NACT specimens by an experienced pathologist, and all HER2 with 2+ immunohistochemistry was sent for fluorescence in situ hybridization as per American Society of Clinical Oncology guidelines. RESULTS ER pre- and postoperatively changed from positive to negative in 17.6% of patients and from negative to positive in 1.1% of patients (P < .001). ER status remained stable in 81.3% of patients. PR changed from positive to negative in 13.2% of patients, and from negative to positive in 3.3% of patients (P < .001), whereas it remained stable in 83.5% of patients. HER2 changed from positive to negative in 11% of patients, and from negative to positive in 5.5% of patients (P < .001), and it remained stable in 83.5% of patients. No significant association was found between overall survival and disease-free-survival with HER2 expression change. CONCLUSION NACT can induce changes in the ER, PR, and HER2 status, which should be evaluated post-NACT to choose the optimal treatment regimens.
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Affiliation(s)
- Khalid Al-Saleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdurrahman Aldiab
- Division of Hematology-Oncology, Oncology Center, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Tareq Salah
- Division of Radiation Oncology, Oncology Center, King Saud University, Riyadh, Kingdom of Saudi Arabia; Clinical Oncology, Nuclear Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Maria Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sufia Husain
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ammar Al-Rikabi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nashwa Abd El-Aziz
- Division of Hematology-Oncology, Oncology Center, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia; Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
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Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival. Ann Oncol 2020; 32:229-239. [PMID: 33232761 PMCID: PMC9348585 DOI: 10.1016/j.annonc.2020.11.007] [Citation(s) in RCA: 268] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/29/2020] [Accepted: 11/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is strongly associated with favorable outcome. We examined the utility of serial circulating tumor DNA (ctDNA) testing for predicting pCR and risk of metastatic recurrence. PATIENTS AND METHODS Cell-free DNA (cfDNA) was isolated from 291 plasma samples of 84 high-risk early breast cancer patients treated in the neoadjuvant I-SPY 2 TRIAL with standard NAC alone or combined with MK-2206 (AKT inhibitor) treatment. Blood was collected at pretreatment (T0), 3 weeks after initiation of paclitaxel (T1), between paclitaxel and anthracycline regimens (T2), or prior to surgery (T3). A personalized ctDNA test was designed to detect up to 16 patient-specific mutations (from whole-exome sequencing of pretreatment tumor) in cfDNA by ultra-deep sequencing. The median follow-up time for survival analysis was 4.8 years. RESULTS At T0, 61 of 84 (73%) patients were ctDNA positive, which decreased over time (T1: 35%; T2: 14%; and T3: 9%). Patients who remained ctDNA positive at T1 were significantly more likely to have residual disease after NAC (83% non-pCR) compared with those who cleared ctDNA (52% non-pCR; odds ratio 4.33, P = 0.012). After NAC, all patients who achieved pCR were ctDNA negative (n = 17, 100%). For those who did not achieve pCR (n = 43), ctDNA-positive patients (14%) had a significantly increased risk of metastatic recurrence [hazard ratio (HR) 10.4; 95% confidence interval (CI) 2.3-46.6]; interestingly, patients who did not achieve pCR but were ctDNA negative (86%) had excellent outcome, similar to those who achieved pCR (HR 1.4; 95% CI 0.15-13.5). CONCLUSIONS Lack of ctDNA clearance was a significant predictor of poor response and metastatic recurrence, while clearance was associated with improved survival even in patients who did not achieve pCR. Personalized monitoring of ctDNA during NAC of high-risk early breast cancer may aid in real-time assessment of treatment response and help fine-tune pCR as a surrogate endpoint of survival.
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Hong J, Wu J, Huang O, He J, Zhu L, Chen W, Li Y, Chen X, Shen K. Early response and pathological complete remission in Breast Cancer with different molecular subtypes: a retrospective single center analysis. J Cancer 2020; 11:6916-6924. [PMID: 33123282 PMCID: PMC7591996 DOI: 10.7150/jca.46805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose: To evaluate the association of clinical early response and pathological complete remission (pCR) in breast cancer patients with different molecular subtypes. Materials and methods: Breast cancer patients who received neoadjuvant treatment (NAT) with clinical early response assessment from October 2008 to October 2018 were retrospectively analyzed. Clinical early response was defined as tumor size decreasing ≥30% evaluated by ultrasound after two cycles of NAT. Chi-square test was used to compare the pCR rates between the responder and non-responder groups with different molecular subtypes. Multivariate logistic regression was used to identify independent factors associated with the pCR. Results: A total of 328 patients were included: 100 responders and 228 non-responders. The progesterone receptor (PR) expression was an independent factor associated with clinical early response (OR=2.39, 95%CI=1.41-4.05, P=0.001). The pCR rate of breast was 50.0% for responders and 18.0% for non-responders (P<0.001). Regarding different molecular subtypes, responders had higher pCR rates than non-responders for patients with HER2 overexpression (OR=10.66, 95%CI=2.18-52.15, P=0.001), triple negative (OR=3.29, 95%CI=1.23-8.84, P=0.016) and Luminal (HER2-) subtypes (OR=8.58, 95%CI=3.05-24.10, P<0.001) respectively. Moreover, pCR rate can be achieved as high as 88.2% in HER2 overexpression patients with early clinical response, which was significantly higher than patients without early response (41.3%, P=0.001). Multivariate analysis showed that clinical early response was an independent factor associated with the pCR rate (OR=4.87, 95%CI=2.72-8.72, P<0.001). Conclusions: Early response was significantly associated with a higher pCR rate in breast cancer patients receiving NAT, especially for patients with HER2 overexpression subtype, which warrants further clinical evaluation.
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Affiliation(s)
- Jin Hong
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Jianrong He
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Li Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Weiguo Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Yafen Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
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Mandish SF, Gaskins JT, Yusuf MB, Amer YM, Eldredge-Hindy H. The effect of omission of adjuvant radiotherapy after neoadjuvant chemotherapy and breast conserving surgery with a pathologic complete response. Acta Oncol 2020; 59:1210-1217. [PMID: 32716227 DOI: 10.1080/0284186x.2020.1797161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE(S) Neoadjuvant chemotherapy (NAC) is a standard of care for locally advanced breast cancers. Adjuvant radiotherapy (RT) after NAC is an area of active research. We hypothesize overall survival (OS) is not altered by omitting RT in women with a pathologic complete response (pCR) to NAC after breast conserving survery (BCS). METHODS Patients from the National Cancer Database who underwent NAC, BCS, and had a pCR were included. Inflammatory disease, <6 months follow up, and unknown variables were excluded. Descriptive statistics characterized the retained cohort. Logistic regression analyzed the influence of variables on the rate of RT omission. Cox proportional hazard modeling analyzed the influence of prognostic variables on OS. RESULTS Of 5383 women included, 364 (7%) omitted RT. 5-year OS was 94.1% with RT, 93% without. RT omission was most likely in women >70yo (adjusted OR2.4, 95%CI 1.58-3.65, p < .0001;reference 40-49 yo), Hispanic (AOR 1.73, 95%CI 1.19-2.52, p = .0044; reference non-Hispanic), ≥20 miles from treatment facility (20-49 miles; AOR 1.45, 95%CI 1.09-1.93, p = .0109: >50 miles; AOR 2.02, 95%CI 1.42-2.87, p < .0001;reference 0-19 miles), grade 1 (AOR 4.29, 95%CI 2.16-8.51, p < .0001; reference grade 3), and clinical T4 disease (AOR 3.17, 95%CI 1.74-5.79, p = .0002; reference T0/1). Women ≥60yo (60-69: AHR 2.33, 95%CI 1.41-3.83, p = .0009:70+:AHR 2.4, 95%CI 1.24-4.62, p = .0092; reference 40-49) and with N1 and N3 disease (N1: AHR 1.67, 95% CI 2.28-3.24, p = .0034; N3: AHR3.37,95%CI2.01-5.65,p < .0001) showed increased death. Triple-positive (AHR 0.18, 95%CI 0.07-0.43, p = .0002) and HER2+ patients (AHR 0.44, 95%CI 0.30-0.64, p < .0001) had improved OS compared to triple-negative disease. No survival difference was seen with omission of RT (log-rank test: p = .1783; Cox model AHR 1.33, 95%CI 0.76-2.31, p = .3181). CONCLUSION Women ≥70, of Hispanic origin, living ≥20 miles from treatment facility, and grade 1 disease were more likely to omit RT. HER2+ patients had favorable OS, while older age and N3 disease were negative prognostic factors. Omitting RT after a pCR to NAC and BCS was not found to affect OS.
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Affiliation(s)
- Steven F. Mandish
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
| | - Jeremy T. Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Mehran B. Yusuf
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
| | - Yomna M. Amer
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Harriet Eldredge-Hindy
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
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Ai X, Liao X, Li J, Tang P, Jiang J. Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database. Cancer Manag Res 2020; 12:5331-5343. [PMID: 32753951 PMCID: PMC7342555 DOI: 10.2147/cmar.s246162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Although stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated. Material and Methods Data from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes. Results In our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001). Conclusion Breast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.
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Affiliation(s)
- Xiang Ai
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Xin Liao
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Junyan Li
- Department of Breast Surgery, People's Hospital of DeYang City, Deyang 618000, People's Republic of China
| | - Peng Tang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
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Hong WX, Haebe S, Lee AS, Westphalen CB, Norton JA, Jiang W, Levy R. Intratumoral Immunotherapy for Early-stage Solid Tumors. Clin Cancer Res 2020; 26:3091-3099. [PMID: 32071116 PMCID: PMC7439755 DOI: 10.1158/1078-0432.ccr-19-3642] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/07/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
The unprecedented benefits of immunotherapy in advanced malignancies have resulted in increased interests in exploiting immune stimulatory agents in earlier-stage solid tumors in the neoadjuvant setting. However, systemic delivery of immunotherapies may cause severe immune-related side-effects and hamper the development of combination treatments. Intratumoral delivery of neoadjuvant immunotherapy provides a promising strategy in harnessing the power of immunotherapy while minimizing off-target toxicities. The direct injection of immune stimulating agents into the tumor primes the local tumor-specific immunity to generate a systemic, durable clinical response. Intratumoral immunotherapy is a highly active area of investigation resulting in a plethora of agents, for example, immune receptor agonists, non-oncolytic and oncolytic viral therapies, being tested in preclinical and clinical settings. Currently, more than 20 neoadjuvant clinical trials exploring distinct intratumoral immune stimulatory agents and their combinations are ongoing. Practical considerations, including appropriate timing and optimal local delivery of immune stimulatory agents play an important role in safety and efficacy of this approach. Here, we discuss promising approaches in drug delivery technologies and opportunity for combining intratumoral immunotherapy with other cancer treatments and summarize the recent preclinical and clinical evidences that highlighted its promise as a part of routine oncologic care.
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Affiliation(s)
- Wan Xing Hong
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Sarah Haebe
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
- Department of Medicine III, University Hospital, LMU, Munich, Germany
| | - Andrew S Lee
- Department of Pathology, Stanford University School of Medicine, Stanford, California
- Shenzhen Bay Laboratory, Cancer Research Institute, Shenzhen, China
| | - C Benedikt Westphalen
- Department of Medicine III, University Hospital, LMU, Munich, Germany
- Comprehensive Cancer Center Munich, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site, Munich, Germany
| | - Jeffrey A Norton
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ronald Levy
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California.
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Chronaiou I, Giskeødegård GF, Goa PE, Teruel J, Hedayati R, Lundgren S, Huuse EM, Pickles MD, Gibbs P, Sitter B, Bathen TF. Feasibility of contrast-enhanced MRI derived textural features to predict overall survival in locally advanced breast cancer. Acta Radiol 2020; 61:875-884. [PMID: 31744303 DOI: 10.1177/0284185119885116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prognosis for women with locally advanced breast cancer (LABC) is poor and there is a need for better treatment stratification. Gray-level co-occurrence matrix (GLCM) texture analysis of magnetic resonance (MR) images has been shown to predict pathological response and could become useful in stratifying patients to more targeted treatments. PURPOSE To evaluate the ability of GLCM textural features obtained before neoadjuvant chemotherapy to predict overall survival (OS) seven years after diagnosis of patients with LABC. MATERIAL AND METHODS This retrospective study includes data from 55 patients with LABC. GLCM textural features were extracted from segmented tumors in pre-treatment dynamic contrast-enhanced 3-T MR images. Prediction of OS by GLCM textural features was assessed and compared to predictions using traditional clinical variables. RESULTS Linear mixed-effect models showed significant differences in five GLCM features (f1, f2, f5, f10, f11) between survivors and non-survivors. Using discriminant analysis for prediction of survival, GLCM features from 2 min post-contrast images achieved a classification accuracy of 73% (P < 0.001), whereas traditional prognostic factors resulted in a classification accuracy of 67% (P = 0.005). Using a combination of both yielded the highest classification accuracy (78%, P < 0.001). Median values for features f1, f2, f10, and f11 provided significantly different survival curves in Kaplan-Meier analysis. CONCLUSION This study shows a clear association between textural features from post-contrast images obtained before neoadjuvant chemotherapy and OS seven years after diagnosis. Further studies in larger cohorts should be undertaken to investigate how this prognostic information can be used to benefit treatment stratification.
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Affiliation(s)
- Ioanna Chronaiou
- Department of Circulation and Medical Imaging, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro Fanneløb Giskeødegård
- Department of Circulation and Medical Imaging, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Erik Goa
- Department of Physics, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Jose Teruel
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - Roja Hedayati
- Cancer clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Steinar Lundgren
- Cancer clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Else Marie Huuse
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Martin D Pickles
- Radiology Department, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Peter Gibbs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beathe Sitter
- Department of Circulation and Medical Imaging, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Frost Bathen
- Department of Circulation and Medical Imaging, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
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Berko YA, Akala EO. Computer Optimization of Stealth Biodegradable Polymeric Dual-loaded Nanoparticles for Cancer Therapy Using Central Composite Face-centered Design. Pharm Nanotechnol 2020; 8:108-132. [PMID: 32091350 DOI: 10.2174/2211738508666200224110410] [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: 12/07/2019] [Revised: 01/03/2020] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Combination chemotherapy capable of overcoming cancer drug resistance can be facilitated by nanotechnology. OBJECTIVE Synthesis, characterization, statistical experimental design, analysis and optimization of stealth pH-sensitive polymeric nanoparticles suitable as a platform for simultaneous delivery of paclitaxel and 17-AAG in breast cancer therapy were investigated. METHODS An acetal crosslinker and a poly(ɛ)caprolactone macromonomer were synthesized and characterized. The statistical experimental design used was the response surface method (RSM). We used the central composite face-centered design (CCF) in three independent factors and seventeen runs. Nanoparticles were fabricated by dispersion polymerization techniques. Response variables evaluated were: particle size, drug loading, encapsulation efficiency, and in vitro availability. RESULTS Scanning electron micrographs showed the formation of spherical nanoparticles. Computer software was used for the analysis of variance with a 95% confidence level and Q2 (goodness of prediction) to select an appropriate model for each of the response variables. Each term in each of the models was tested for the significance of the regression coefficients. The computer software optimizer was used for optimization to select factor combination to minimize particle size, time (h) for maximum release of paclitaxel and 17-AAG, to maximize paclitaxel and 17-AAG loading efficiency and to maximize paclitaxel and 17-AAG encapsulation efficiency. CONCLUSION The optimization was successful, as shown by the validation data which lie within the confidence intervals of predicted values of the response variables. The selected factor combination is suitable for the in vivo evaluation of the nanoparticles loaded with paclitaxel and 17-AAG.
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Affiliation(s)
- Yvonne A Berko
- Center for Drug Research and Development, Department of Pharmaceutical Sciences, College of Pharmacy, Howard University, 2300 4th Street, NW, Washington, DC 20059, United States
| | - Emmanuel O Akala
- Center for Drug Research and Development, Department of Pharmaceutical Sciences, College of Pharmacy, Howard University, 2300 4th Street, NW, Washington, DC 20059, United States
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Chen L, Kong X, Wang Z, Wang X, Fang Y, Wang J. Pre-treatment systemic immune-inflammation index is a useful prognostic indicator in patients with breast cancer undergoing neoadjuvant chemotherapy. J Cell Mol Med 2020; 24:2993-3021. [PMID: 31989747 PMCID: PMC7077539 DOI: 10.1111/jcmm.14934] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022] Open
Abstract
The systemic immune‐inflammation index (SII = N × P/L) based on neutrophil (N), platelet (P) and lymphocyte (L) counts is used to predict the survival of patients with malignant tumours and can fully reflect the balance between host inflammatory and immune status. This study is conducted to explore the potential prognostic significance of SII in patients with breast cancer undergoing neoadjuvant chemotherapy (NACT). A total of 262 patients with breast cancer received NACT were enrolled in this study. According to the receiver operating characteristic curve, the optimal cut‐off value of SII was divided into two groups: low SII group (<602 × 109/L) and high SII group (≥602 × 109/L). The associations between breast cancer and clinicopathological variables by SII were determined by chi‐squared test or Fisher's exact test. The Kaplan‐Meier plots and log‐rank test were used to determine clinical outcomes of disease‐free survival (DFS) and overall survival (OS). The prognostic value of SII was analysed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by National Cancer Institute Common Toxicity Criteria (NCICTC). According to univariate and multivariate Cox regression survival analyses, the results showed that the value of SII had prognostic significance for DFS and OS. The patients with low SII value had longer DFS and OS than those with high SII value (31.11 vs 40.76 months, HR: 1.075, 95% CI: 0.718‐1.610, P = .006; 44.47 vs 53.68 months, HR: 1.051, 95% CI: 0.707‐1.564, P = .005, respectively). The incidence of DFS and OS in breast cancer patients with low SII value was higher than that in those patients with high SII value in 3‐, 5‐ and 10‐year rates. The common toxicities after NACT were haematological and gastrointestinal reaction, and there were no differences by SII for the assessment of side effects of neoadjuvant chemotherapy. Meanwhile, the results also proved that breast cancer patients with low SII value and high Miller and Payne grade (MPG) survived longer than those breast cancer with high SII value and low MPG grade. In patients without lymph vessel invasion, these breast cancer patients with low SII value had better prognosis and lower recurrence rates than those with high SII value. Pre‐treatment SII with the advantage of reproducible, convenient and non‐invasive was a useful prognostic indicator for breast cancer patients undergoing neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.
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Affiliation(s)
- Li Chen
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fisusi FA, Akala EO. Drug Combinations in Breast Cancer Therapy. Pharm Nanotechnol 2019; 7:3-23. [PMID: 30666921 PMCID: PMC6691849 DOI: 10.2174/2211738507666190122111224] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/27/2018] [Accepted: 01/15/2019] [Indexed: 12/13/2022]
Abstract
Breast cancer therapy involves a multidisciplinary approach comprising surgery, radiotherapy, neoadjuvant and adjuvant therapy. Effective therapy of breast cancer requires maximum therapeutic efficacy, with minimal undesirable effects to ensure a good quality of life for patients. The carefully selected combination of therapeutic interventions provides patients with the opportunity to derive maximum benefit from therapy while minimizing or eliminating recurrence, resistance and toxic effects, as well as ensuring that patients have a good quality of life. This review discusses therapeutic options for breast cancer treatments and various combinations that had been previously exploited. The review will also give an insight into the potential application of the nanotechnology platform for codelivery of therapeutics in breast cancer therapy.
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Affiliation(s)
- Funmilola A Fisusi
- Center for Drug Research and Development, Department of Pharmaceutical Sciences, College of Pharmacy, Howard University, Washington, DC, United States.,Drug Research and Production Unit, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Emmanuel O Akala
- Center for Drug Research and Development, Department of Pharmaceutical Sciences, College of Pharmacy, Howard University, Washington, DC, United States
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López-Muñoz E, Corres-Molina M, García-Hernández N. Correlation of the protein expression of GRP78 and BIK/NBK with prognostic markers in patients with breast cancer and neoadjuvant chemotherapy. J OBSTET GYNAECOL 2019; 40:419-426. [DOI: 10.1080/01443615.2019.1652886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Eunice López-Muñoz
- Medical Research Unit in Reproductive Medicine, Unidad Médica de Alta Especialidad (UMAE) Hospital de Gineco Obstetricia No. 4, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Corres-Molina
- Service of Oncology, Hospital Juárez de México, Mexico City, Mexico
- Service of Oncologic Surgery, Hospital General Naval de Alta Especialidad, Secretaría de Marina (SEMAR), Mexico City, Mexico
| | - Normand García-Hernández
- Medical Research Unit in Human Genetics, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría, Dr. Silvestre Frenk Freund, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Debik J, Euceda LR, Lundgren S, Gythfeldt HVDL, Garred Ø, Borgen E, Engebraaten O, Bathen TF, Giskeødegård GF. Assessing Treatment Response and Prognosis by Serum and Tissue Metabolomics in Breast Cancer Patients. J Proteome Res 2019; 18:3649-3660. [DOI: 10.1021/acs.jproteome.9b00316] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Steinar Lundgren
- Department of Oncology, St. Olav’s University Hospital, 7006 Trondheim, Norway
| | | | - Øystein Garred
- Department of Tumor Biology, Oslo University Hospital, 0424 Oslo, Norway
| | - Elin Borgen
- Department of Tumor Biology, Oslo University Hospital, 0424 Oslo, Norway
| | - Olav Engebraaten
- Department of Oncology, Oslo University Hospital, 0424 Oslo, Norway
- Department of Tumor Biology, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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Ahmed SH. Safety of neoadjuvant chemotherapy for the treatment of breast cancer. Expert Opin Drug Saf 2019; 18:817-827. [DOI: 10.1080/14740338.2019.1644318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Katyan A, Mittal MK, Mani C, Mandal AK. Strain wave elastography in response assessment to neo-adjuvant chemotherapy in patients with locally advanced breast cancer. Br J Radiol 2019; 92:20180515. [PMID: 31045431 DOI: 10.1259/bjr.20180515] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The study was conducted to study the role of strain wave elastography in evaluating the response to neo-adjuvant chemotherapy (NACT) in patients with locally advanced breast cancer (LABC). METHODS In this Institutional review board approved study, 86 patients of LABC were investigated with strain wave elastography. Females receiving NACT had the affected breast scanned by strain wave elastography before each cycle of chemotherapy and immediately before surgery by two independent observers. Changes in elastographic parameters (size ratio, strain ratio) were documented and then compared to clinical and pathologic tumor response as evaluated after mastectomy. RESULTS Elastographic strain ratio parameters demonstrated high sensitivity and moderate specificity for determining response even after the first cycle of neo-adjuvant chemotherapy [97.7% sensitivity (Sn), 68.7% specificity (Sp)]. Elastographic size ratio parameters showed moderate sensitivity and specificity for response detection after second and third cycle of neo-adjuvant chemotherapy (Sn, Sp: after second cycle of NACT Sn 83.3% Sp 80%; after third cycle of NACT Sn 77.8% Sp 100%). CONCLUSION Strain ratio is the earliest predictor of treatment response in patients of LABC. Serial imaging with elastography has the potential to predict treatment response early during the course of NACT, which may prove vital in management of patients with breast cancer. ADVANCES IN KNOWLEDGE Strain wave elastography is a powerful tool to predict chemoresponse early during the course of management, thereby providing an optimal window to change treatment protocols.
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Affiliation(s)
- Amit Katyan
- 1 Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi , India
| | - Mahesh Kumar Mittal
- 1 Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi , India
| | - Chinta Mani
- 2 Department of Surgery Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi , India
| | - Ashish Kumar Mandal
- 3 Department of Pathology Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi , India
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Vavadi H, Mostafa A, Zhou F, Uddin KMS, Althobaiti M, Xu C, Bansal R, Ademuyiwa F, Poplack S, Zhu Q. Compact ultrasound-guided diffuse optical tomography system for breast cancer imaging. JOURNAL OF BIOMEDICAL OPTICS 2018; 24:1-9. [PMID: 30350491 PMCID: PMC6197842 DOI: 10.1117/1.jbo.24.2.021203] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/19/2018] [Indexed: 05/02/2023]
Abstract
Near-infrared diffuse optical tomography (DOT) has demonstrated a great potential as an adjunct modality for differentiation of malignant and benign breast lesions and for monitoring treatment response in patients with locally advanced breast cancers. The path toward commercialization of DOT techniques depends upon the improvement of robustness and user-friendliness of this technique in hardware and software. In this study, we introduce our recently developed ultrasound-guided DOT system, which has been improved in system compactness, robustness, and user-friendliness by custom-designed electronics, automated data preprocessing, and implementation of a new two-step reconstruction algorithm. The system performance has been tested with several sets of solid and blood phantoms and the results show accuracy in reconstructed absorption coefficients as well as blood oxygen saturation. A clinical example of a breast cancer patient, who was undergoing neoadjuvant chemotherapy, is given to demonstrate the system performance.
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Affiliation(s)
- Hamed Vavadi
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - Atahar Mostafa
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Feifei Zhou
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - K. M. Shihab Uddin
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Murad Althobaiti
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - Chen Xu
- New York City College of Technology, Brooklyn, New York, United States
| | - Rajeev Bansal
- University of Connecticut, BME and ECE Departments, Connecticut, United States
| | - Foluso Ademuyiwa
- Washington University School of Medicine, Department of Medical Oncology, St. Louis, Missouri, United States
| | - Steven Poplack
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
| | - Quing Zhu
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
- Address all correspondence to: Quing Zhu, E-mail:
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Klein J, Lam WW, Czarnota GJ, Stanisz GJ. Chemical exchange saturation transfer MRI to assess cell death in breast cancer xenografts at 7T. Oncotarget 2018; 9:31490-31501. [PMID: 30140385 PMCID: PMC6101146 DOI: 10.18632/oncotarget.25844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/12/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose Detecting cell death and predicting tumor response early in a course of chemotherapy could help optimize treatment regimens and improve clinical outcomes. Chemical exchange saturation transfer (CEST) MRI was investigated in vivo to study properties that may be able to detect cancer death. Results Using a magnetization transfer ratio (MTR) cutoff of 0.12 at 1.8 ppm was able to differentiate between viable tumor and cell death regions. Comparison of MTR values at this frequency showed significant differences (p < 0.0001) between viable tumor and cell death regions, matching patterns seen on histology. Using this cutoff, the mean increase in cell death index (± standard error of the mean) after chemotherapy was 4 ± 4%, 10% ± 7%, 10 ± 8%, and 4 ± 9% at 4, 8, 12, and 24 h, respectively. Conclusions CEST MRI can detect cell death in MDA-231 xenografts but further work is needed to characterize the clinical applications of this finding. Maximum response to chemotherapy occurred at 8-12 h after chemotherapy injection in this in vivo tumor model. Materials and Methods Breast cancer xenografts (MDA-MB-231) were scanned using 7 T MRI before and after chemotherapy. As a measure of CEST effect at 0.5 µT saturation amplitude, MTR values at frequency offsets of 1.8 and -3.3 ppm were evaluated. CEST signals after chemotherapy treatment were compared to cell-death histopathology of tumors.
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Affiliation(s)
- Jonathan Klein
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wilfred W Lam
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Greg J Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
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Ascierto PA, Eggermont AMM. Neoadjuvant therapy in melanoma: the next step? Lancet Oncol 2018; 19:151-153. [PMID: 29361473 DOI: 10.1016/s1470-2045(18)30016-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Paolo A Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione "G Pascale", 80131 Napoli, Italy.
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Irmejs A, Loza P, Skuja E, Gardovskis J. Platinum-Based Chemotherapy Secures Effective Local Control for Very Advanced Hereditary Triple-Negative Breast Cancer with Life-Threatening Bleeding. Cureus 2017; 9:e1455. [PMID: 28929039 PMCID: PMC5590706 DOI: 10.7759/cureus.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Here we report the case of a noncompliant 50-year-old female patient with high-grade, triple-negative breast cancer (TNBC) and strong family cancer history. She only agreed to start treatment after being admitted to the hospital with advanced stage disease and severe anaemia resulting from bulky, ulcerated, and actively bleeding tumor. Therapy was promptly started with platinum-based chemotherapy, resulting in extremely rapid clinical remission and complete control of local symptoms. In conclusion, we hypothesise that even a single course of platinum-based chemotherapy could bring under control life-threatening complications in hereditary TNBC and, therefore, it should be administered without hesitation in emergency circumstances if the patient can tolerate one dose of the medication.
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Affiliation(s)
- Arvids Irmejs
- Institute of Oncology, Continuing Education, Riga Stradins University, Latvia
| | - Peteris Loza
- Breast Unit, Riga Stradins University Hospital, Riga Stradins University, Latvia
| | - Elina Skuja
- Institute of Oncology, Continuing Education, Riga Stradins University, Latvia
| | - Janis Gardovskis
- Chief of Surgical Department, Riga Stradins University Hospital, Riga Stradins University, Latvia
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