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Li X, Yan F. Predictive value of background parenchymal enhancement on breast magnetic resonance imaging for pathological tumor response to neoadjuvant chemotherapy in breast cancers: a systematic review. Cancer Imaging 2024; 24:35. [PMID: 38462607 PMCID: PMC10926651 DOI: 10.1186/s40644-024-00672-0] [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: 07/19/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES This review aimed to assess the predictive value of background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) as an imaging biomarker for pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT). METHODS Two reviewers independently performed a systemic literature search using the PubMed, MEDLINE, and Embase databases for studies published up to 11 June 2022. Data from relevant articles were extracted to assess the relationship between BPE and pCR. RESULTS This systematic review included 13 studies with extensive heterogeneity in population characteristics, MRI follow-up points, MRI protocol, NACT protocol, pCR definition, and BPE assessment. Baseline BPE levels were not associated with pCR, except in 1 study that reported higher baseline BPE of the younger participants (< 55 years) in the pCR group than the non-pCR group. A total of 5 studies qualitatively assessed BPE levels and indicated a correlation between reduced BPE after NACT and pCR; however, among the studies that quantitatively measured BPE, the same association was observed only in the subgroup analysis of 2 articles that assessed the status of hormone receptor and human epidermal growth factor receptor 2. In addition, the predictive ability of early BPE changes for pCR was reported in several articles and remains controversial. CONCLUSIONS Changes in BPE may be a promising imaging biomarker for predicting pCR in breast cancer. Because current studies remain insufficient, particularly those that quantitatively measure BPE, prospective and multicenter large-sample studies are needed to confirm this relationship.
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Affiliation(s)
- Xue Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China
- Graduate School of Peking, Union Medical College, Beijing, PR China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
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Dimitrov G, Shousha S, Troianova P. CD10 expression as a potential predictor of pathological complete response in ER-negative and triple-negative breast cancer patients treated with anthracycline-based neoadjuvant chemotherapy. Exp Mol Pathol 2024; 135:104885. [PMID: 38281565 DOI: 10.1016/j.yexmp.2024.104885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NCT) can induce a pathological complete response (pCR) in breast cancer patients, leading to improved outcomes. However, predicting which patients will achieve pCR remains a challenge. CD10, a myoepithelial marker, has shown diagnostic and prognostic value in metastatic tumors. Its potential as a predictor of chemosensitivity to anthracycline-based NCT in breast cancer is unknown. AIM This retrospective study aimed to investigate the potential of CD10 cancer cell expression as a predictive marker of chemosensitivity in breast cancers treated with anthracycline-based neoadjuvant chemotherapy. METHODS We analyzed 130 patients with invasive ductal carcinoma who received anthracycline-based NCT. CD10 expression was assessed by immunohistochemistry on pre-treatment biopsies. Statistical analysis evaluated the association between CD10 expression and pCR rates. RESULTS Univariate analysis revealed that ER-positive and CD10-negative tumors had lower pCR rates [OR 7.4830 (95% CI 2.7762-20.1699); p = 0.0001]. Multivariate analysis confirmed ER status as a strong predictor of poor response [OR 0.085 (95% CI 0.024-0.30); p < 0.001] and CD10 expression as a predictor of a favourable response [OR 0.11 (0.8-0.19); p = 0.049]. CD10 expression significantly predicted pCR in ER-negative cases [OR 0.1098 (0.0268-0.4503); p = 0.0022] and triple-negative breast cancer [OR 0.0966 (95% CI 0.0270-0.3462); p = 0.0003]. Concordance was observed between core biopsies and excised samples. CONCLUSION Positive CD10 cancer cell expression may predict increased response to anthracycline-based neoadjuvant chemotherapy in ER-negative and triple-negative breast cancer cases. Further research is needed to validate these findings in larger cohorts and determine the clinical utility of CD10 as a predictive marker.
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Affiliation(s)
- George Dimitrov
- Medical University of Sofia, Boulevard "Akademik Ivan Evstratiev Geshov " 15, 1431 Sofia Center, Sofia, Bulgaria; Department of Medical Oncology, Tsaritsa Yoanna Hospital, Byalo More 8, 1527 Sofia, Bulgaria.
| | - Sami Shousha
- Department of Histopathology, Imperial College London, Charing Cross Hospital Campus, St Dunstan's Road, London W6 8RP, United Kingdom
| | - Petranka Troianova
- Medical University of Sofia, Boulevard "Akademik Ivan Evstratiev Geshov " 15, 1431 Sofia Center, Sofia, Bulgaria; Department of Medical Oncology, Tsaritsa Yoanna Hospital, Byalo More 8, 1527 Sofia, Bulgaria
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3
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Kodali A, Gadi VK. Preoperative Systemic Therapy for Breast Cancer. Surg Clin North Am 2022; 103:201-217. [DOI: 10.1016/j.suc.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fan Y, Wang Y, He L, Imani S, Wen Q. Clinical features of patients with HER2-positive breast cancer and development of a nomogram for predicting survival. ESMO Open 2021; 6:100232. [PMID: 34392135 PMCID: PMC8371219 DOI: 10.1016/j.esmoop.2021.100232] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background Different estrogen receptor (ER) and progesterone receptor (PR) expression patterns have important biological and therapeutic implications in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, little is known about hormone receptor (HR)-positive and triple-positive subtypes, making therapy selection and survival prognosis difficult. This study investigated the clinical characteristics and nomogram-predicted survival of patients with HER2-positive breast cancer. Materials and methods Data on patients with HER2-positive breast cancer were retrieved from the Surveillance, Epidemiology, and End Results database. Comparisons were carried out between single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram-based model of predicted outcomes was developed. Results This cohort study included 34 819 patients with breast cancer (34 606 women and 213 men). Single HR-positive and double HR-positive/double HR-negative subtypes showed distinct clinicopathological characteristics. Multivariable Cox regression analysis showed that patients with ER-positive/PR-negative/HER2-positive [hazard ratio (HR) = 1.24; 95% confidence interval (CI): 1.14-1.39], ER-negative/PR-positive/HER2-positive (HR = 1.56; 95% CI: 1.23-1.97), and ER-negative/PR-negative/HER2-positive (HR = 1.56; 95% CI: 1.43-1.70) subtypes had worse breast cancer-specific survival than patients with the triple-positive subtype. Thirteen clinical parameters were included as prognostic factors in the nomogram: age, sex, race, grade, histology type, bone, brain, liver, and lung metastasis, TNM (tumor–node–metastasis) staging, and molecular subtype. The C-index was 0.853 (95% CI: 0.845-0.861). Calibration plots indicated that the nomogram-predicted survival was consistent with the recorded 3-year and 5-year prognoses. Conclusions Significant differences in survival rates were observed between single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram accurately predicted survival. Different treatment strategies may be required for HER2-positive patients with single HR-positive and double HR-positive tumors to ensure optimal treatment and benefits. Significant differences in survival were observed in single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram based on molecular subtypes of HER2-positive breast cancer accurately predicted breast cancer-specific survival. Different treatment strategies may be required for HER2-positive breast cancer to ensure optimal treatment and benefits.
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Affiliation(s)
- Y Fan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, P. R. China; Academician (Expert) Workstation of Sichuan Province, Luzhou, P. R. China.
| | - Y Wang
- Health Management Department, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
| | - L He
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, P. R. China; Academician (Expert) Workstation of Sichuan Province, Luzhou, P. R. China
| | - S Imani
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, P. R. China; Academician (Expert) Workstation of Sichuan Province, Luzhou, P. R. China
| | - Q Wen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, P. R. China; Academician (Expert) Workstation of Sichuan Province, Luzhou, P. R. China
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5
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Evans A, Sim YT, Whelehan P, Savaridas S, Jordan L, Thompson A. Are baseline mammographic and ultrasound features associated with metastasis free survival in women receiving neoadjuvant chemotherapy for invasive breast cancer? Eur J Radiol 2021; 141:109790. [PMID: 34091135 DOI: 10.1016/j.ejrad.2021.109790] [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: 03/10/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify associations between baseline ultrasound (US) and mammographic features and metastasis free survival (MFS) in women receiving neo-adjuvant chemotherapy (NACT) for breast cancer. METHODS The data were collected as part of an ethically approved prospective study. Women with invasive breast cancer receiving NACT who were metastasis free at diagnosis were included. Baseline US and mammography were performed. Imaging was assessed by an experienced breast radiologist who was blinded to outcomes. US imaging features documented included posterior effect, skin thickening, size and stiffness using shear wave elastography (SWE). The mammographic features documented were spiculation and microcalcification. The development of metastatic disease was ascertained from computer records. Statistical analysis was performed using Kaplan Meier survival curves and Receiver Operator Characteristic (ROC) analysis. RESULTS 171 women with 172 cancers were included in the study and 55 developed metastatic disease. Mean follow-up was 6.0 years. Women with mammographic calcification had significantly poorer metastasis free survival (MFS) compared to women without calcification (p = 0.043, 6 yr MFS 50 % vs 69 %). Women bearing cancer with distal shadowing had poorer MFS than women without shadowing (p = 0.025, 6 yr MFS 47 % vs. 73 %). Women with US skin thickening had poorer MFS compared to women without skin thickening (p = 0.032, 6 yr MFS 52 % vs. 68 %). Mammographic spiculation, US size and stiffness at SWE had no significant association with MFS. CONCLUSION We have identified mammographic and US features associated with MFS in women receiving NACT. Such information may be useful when counselling patients about the benefits and risks of NACT.
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Affiliation(s)
- Andy Evans
- Mail Box 4, Ninewells Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom.
| | - Yee Ting Sim
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Patsy Whelehan
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Sarah Savaridas
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Lee Jordan
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Alastair Thompson
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, United States
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Arafah MA, Ouban A, Ameer OZ, Quek KJ. KI-67 LI Expression in Triple-Negative Breast Cancer Patients and Its Significance. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211016977. [PMID: 34158798 PMCID: PMC8186110 DOI: 10.1177/11782234211016977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022]
Abstract
Purpose: Triple-negative breast cancer (TNBC) is a subset of breast cancer which is known to carry a poor prognosis because of lack of targets for hormonal therapy. Research efforts have focused in recent years on discovering biomarkers of management in TNBCs. KI-67 Labelling Index (LI) is a nuclear protein which has proven to play diagnostic and prognostic roles in many cancers. Materials and methods: We analysed the expression of KI-67 LI by immunohistochemistry in TNBC cases from the University hospital. This expression was cross-checked against clinical-pathological criteria of TNBC patients and against Vimentin expression in TNBC patients with significant KI-67 expression. Results: KI-67 LI was significantly expressed in the majority of TNBC cases. This expression was significantly correlated with lymph node metastases, tumour invasion, high tumour nuclear grade, clinical stage, adverse survival outcome, and failure to achieve pathological complete response. TNBCs’ KI-67 LI expression was also correlated with Vimentin expression, the mesenchymal chief marker of the EMT phenomenon. Conclusion: Collectively, our study presents a strong argument for the use of KI-67 LI as a biomarker of aggressive, metastatic TNBC disease with poor outcome. This study, along with mounting evidence in the scientific literature, presents a case for the use of this nuclear protein in diagnosis, prognosis, and follow-up of patients with this difficult diagnosis.
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Affiliation(s)
- Maria A Arafah
- Department of Pathology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abderrahman Ouban
- Department of Pathology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Omar Z Ameer
- Department of Pharmaceutical Sciences, College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ko Jin Quek
- Faculty of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
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Zhang J, Xiao L, Pu S, Liu Y, He J, Wang K. Can We Reliably Identify the Pathological Outcomes of Neoadjuvant Chemotherapy in Patients with Breast Cancer? Development and Validation of a Logistic Regression Nomogram Based on Preoperative Factors. Ann Surg Oncol 2021; 28:2632-2645. [PMID: 33095360 PMCID: PMC8043913 DOI: 10.1245/s10434-020-09214-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pathological responses of neoadjuvant chemotherapy (NCT) are associated with survival outcomes in patients with breast cancer. Previous studies constructed models using out-of-date variables to predict pathological outcomes, and lacked external validation, making them unsuitable to guide current clinical practice. OBJECTIVE The aim of this study was to develop and validate a nomogram to predict the objective remission rate (ORR) of NCT based on pretreatment clinicopathological variables. METHODS Data from 110 patients with breast cancer who received NCT were used to establish and calibrate a nomogram for pathological outcomes based on multivariate logistic regression. The predictive performance of this model was further validated using a second cohort of 55 patients with breast cancer. Discrimination of the prediction model was assessed using an area under the receiver operating characteristic curve (AUC), and calibration was assessed using calibration plots. The diagnostic odds ratio (DOR) was calculated to further evaluate the performance of the nomogram and determine the optimal cut-off value. RESULTS The final multivariate regression model included age, NCT cycles, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and lymphovascular invasion. A nomogram was developed as a graphical representation of the model and showed good calibration and discrimination in both sets (an AUC of 0.864 and 0.750 for the training and validation cohorts, respectively). Finally, according to the Youden index and DORs, we assigned an optimal ORR cut-off value of 0.646. CONCLUSION We developed a nomogram to predict the ORR of NCT in patients with breast cancer. Using the nomogram, for patients who are operable and whose ORR is < 0.646, we believe that the benefits of NCT are limited and these patients can be treated directly using surgery.
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Affiliation(s)
- Jian Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Linhai Xiao
- School of Public Health, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Shengyu Pu
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Yang Liu
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China.
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China.
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Savaridas SL, Sim YT, Vinnicombe SJ, Purdie CA, Thompson AM, Evans A. Are baseline ultrasound and mammographic features associated with rates of pathological completes response in patients receiving neoadjuvant chemotherapy for breast cancer? Cancer Imaging 2019; 19:67. [PMID: 31639053 PMCID: PMC6802305 DOI: 10.1186/s40644-019-0251-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/10/2019] [Indexed: 12/23/2022] Open
Abstract
Background Increasing numbers of breast cancer patients receive neoadjuvant chemotherapy (NACT). We seek to investigate whether baseline mammographic and ultrasound features are associated with complete pathological response (pCR) after NACT. Methods A database of NACT patients was reviewed. Baseline imaging parameters assessed were ultrasound: posterior effect; echo pattern; margin and lesion diameter; mammography: spiculation and microcalcification. Core biopsy grade and immunophenotype were documented. Data were analysed for the whole study group and by immunophenotype. Results Of the 222 cancers, 83 (37%) were triple negative (TN), 61 (27%) ER positive/HER-2 negative and 78 (35%) HER-2 positive. A pCR occurred in 46 of 222 cancers (21%). For the whole group, response was associated with high core biopsy grade (grade 3 vs. grade 1 or 2) (26% vs. 9%, p = 0.0044), absence of posterior shadowing on ultrasound (26% vs. 10%, p < 0.001) and the absence of mammographic spiculation (26 vs. 6%, p < 0.001). Within the HER-2 positive group; the absence of shadowing and spiculation remained highly associated with pCR, in addition to small ultrasound size (AUC = 0.71, p < 0.001) and the absence of microcalcification (39% vs. 21%, p < 0.02). On multivariable analysis absence of spiculation and core grade remained significant for the whole cohort, size and absence of spiculation remained significant for HER-2 positive tumours. No feature predicted pCR in TN tumours. Conclusion A pCR is less likely when there is mammographic spiculation. Small ultrasound size is associated with pCR in HER-2 positive tumours. These findings may be helpful when discussing NACT and surgical options with patients. Trial registration UK Clinical Trials Gateway: registration number 16712.
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Affiliation(s)
| | | | | | | | | | - Andy Evans
- University of Dundee, Dundee, UK.,Ninewells Hospital, Dundee, UK
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Bayarmaa B, Wu Z, Peng J, Wang Y, Xu S, Yan T, Yin W, Lu J, Zhou L. Association of LncRNA MEG3 polymorphisms with efficacy of neoadjuvant chemotherapy in breast cancer. BMC Cancer 2019; 19:877. [PMID: 31488093 PMCID: PMC6727505 DOI: 10.1186/s12885-019-6077-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 08/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy in women, and neoadjuvant chemotherapy has been recommended to the patients with locally advanced breast cancer as the initial treatments. Long non-coding RNA (lncRNA) MEG3, an identified tumor suppressor, has been implicated in the development of various cancers. However, there is no data to evaluate the effect of MEG3 polymorphisms on neoadjuvant treatment in the breast cancer. METHODS Genotyping was performed using Nanodispenser Spectro CHIP chip spotting and Mass ARRAY Compact System. Univariate and multivariate logistic regression analyses were used to analyze the associations between the MEG3 polymorphisms and the pathological complete response (pCR). The disease-free survival (DFS) was estimated by the Kaplan-Meier method, and multivariate Cox proportional hazards models were used to calculate the hazard ratios (HRs) with a 95% confidential interval (CI). RESULTS A total of 144 patients with available pretreatment blood species were enrolled in the SHPD002 clinic trial of neoadjuvant chemotherapy for breast cancer. MEG3 rs10132552 were significantly associated with good response (Adjusted OR = 2.79, 95% CI 1.096-7.103, p = 0.031) in dominant model. Median follow-up time was 20 months. In multiple regression analysis, rs10132552 TC + CC (adjusted HR = 0.127, 95% CI 0.22-0.728, p = 0.02) and rs941576 AG + GG (adjusted HR = 0.183, 95% CI 0.041-0.807, p = 0.025) were significantly associated with good DFS. MEG3 rs7158663 (OR = 0.377, 95% CI 0.155-0.917, p = 0.032) were associated with a low risk of hemoglobin decrease in dominant models. CONCLUSIONS LncRNA MEG3 polymorphisms were associated with the chemotherapy response and toxicity of paclitaxel and cisplatin. The result indicates that MEG3 polymorphisms can be considered as the predictive and prognostic markers for the breast cancer patients. TRIAL REGISTRATION Retrospectively registered (ClinicalTrials. Gov identifier: NCT02221999 ); date of registration: Aug 20th, 2014.
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Affiliation(s)
- Battseren Bayarmaa
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Ziping Wu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Jing Peng
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Yan Wang
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Shuguang Xu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Tingting Yan
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Wenjin Yin
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Jinsong Lu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China.
| | - Liheng Zhou
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, People's Republic of China.
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Yang H, Zhou L, Wang S, Cao Y, Tong F, Liu P, Zhou B, Cheng L, Liu M, Liu H, Xie F, Guo J, Wang S, Peng Y. Retrospective analysis of concurrent docetaxel and epirubicin neoadjuvant versus adjuvant chemotherapy: Which leads to better outcomes for different subtype breast cancer patients? Medicine (Baltimore) 2018; 97:e12690. [PMID: 30290661 PMCID: PMC6200491 DOI: 10.1097/md.0000000000012690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Different biological subtype breast cancers respond differently to neoadjuvant chemotherapy, but it is unknown whether neoadjuvant or adjuvant chemotherapy leads to different long-term survival in each specific subtype although equal outcomes have been reported in general population. This study sought to clarify whether the selection of either neoadjuvant or adjuvant chemotherapy was linked to a differential survival benefit based on breast cancer subtypes.A prospectively maintained breast cancer database was queried from 2000 to 2008. All patients with a diagnosis of stage II and III breast cancer who received neoadjuvant or adjuvant chemotherapy were identified, only patients receiving docetaxel and epirubicin (TA) regimen were included. Patients were divided according to the administration of neoadjuvant or adjuvant chemotherapy. The biological subtypes were determined by immunohistochemical tests. The outcomes between neoadjuvant and adjuvant chemotherapy were compared in each different subtype. Kaplan-Meier curves were generated, and the Cox model was used to estimate the association between death risk and chemotherapy timing while adjusting for potentially confounding factors. P values < .05 were considered statistically significant.Of the 406 patients included, 201 (49.5%) received neoadjuvant chemotherapy, and 205 (50.5%) received an adjuvant TA regimen. Patients with the HER2+ and TNBC subtypes showed significantly higher pCR rates than patients with luminal types (P < .05). In general population, the neoadjuvant and adjuvant chemotherapy groups showed little survival variance (HR=1.15, 95% confidence interval (CI) .69-1.91, P=.60). In luminal B-like patients, neoadjuvant chemotherapy led to worse overall survival (OS) than adjuvant therapy (HR=2.92, 95%CI 1.20 to 8.31, P = .02). In patients with the HER2+ subtype, neoadjuvant treatment corresponded to better OS (HR = .10, 95%CI .02-.58, P = .01). In contrast, patients with luminal A-like (HR = 1.14, 95%CI .53-2.43, P = .74) and TNBC disease (HR = 1.00, 95%CI .27-3.73, P = >.99) who underwent neoadjuvant chemotherapy showed equivalent OS when compared to patients undergoing adjuvant therapy.Neoadjuvant versus adjuvant chemotherapy results in a disparate impact on overall survival among patients with variant subtype breast cancer. When neoadjuvant chemotherapy was given, luminal B-like patients showed worse outcome, while patients with HER2+ disease had better OS. Prospective studies are necessary to determine and optimize the timing of chemotherapy for breast cancers with different molecular backgrounds.
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Affiliation(s)
- Houpu Yang
- Peking University People's Hospital Breast Center
| | - Lixin Zhou
- Department of Thoracic Surgery, Peking University People's Hospital
| | - Shu Wang
- Peking University People's Hospital Breast Center
| | - Yingming Cao
- Peking University People's Hospital Breast Center
| | - Fuzhong Tong
- Peking University People's Hospital Breast Center
| | - Peng Liu
- Peking University People's Hospital Breast Center
| | - Bo Zhou
- Peking University People's Hospital Breast Center
| | - Lin Cheng
- Peking University People's Hospital Breast Center
| | - Miao Liu
- Peking University People's Hospital Breast Center
| | - Hongjun Liu
- Peking University People's Hospital Breast Center
| | - Fei Xie
- Peking University People's Hospital Breast Center
| | - Jiajia Guo
- Peking University People's Hospital Breast Center
| | - Siyuan Wang
- Peking University People's Hospital Breast Center
| | - Yuan Peng
- Peking University People's Hospital Breast Center
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Shi J, Chen Y, Chen W, Tang C, Zhang H, Chen Y, Yang X, Xu Z, Wei J, Chen J. Isobavachalcone sensitizes cells to E2-induced paclitaxel resistance by down-regulating CD44 expression in ER+ breast cancer cells. J Cell Mol Med 2018; 22:5220-5230. [PMID: 30179299 PMCID: PMC6201375 DOI: 10.1111/jcmm.13719] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/13/2018] [Indexed: 12/16/2022] Open
Abstract
Oestrogen receptor (ER) is expressed in approximately 60%‐70% of human breast cancer. Clinical trials and retrospective analyses have shown that ER‐positive (ER+) tumours are more tolerant to chemotherapeutic drug resistance than ER‐negative (ER−) tumours. In addition, isobavachalcone (IBC) is known as a kind of phytoestrogen with antitumour effect. However, the underlying mechanism of IBC in ER+ breast cancer needs to be elucidated further. Our in vitro experiments showed that IBC could attenuate 17β‐estradiol (E2)‐induced paclitaxel resistance and that E2 could stimulate CD44 expression in ER+ breast cancer cells but not in ER− cells. Meanwhile, E2 could promote ERα expression to render ER+ breast cancer cells resistant to paclitaxel. Furthermore, we established paclitaxel‐resistant breast cancer cell lines and determined the function of ERα in the enhancement of paclitaxel resistance via the regulation of CD44 transcription. IBC down‐regulated ERα and CD44 expression and thus inhibited tumour growth in paclitaxel‐resistant xenograft models. Overall, our data demonstrated for the first time that IBC could decrease CD44 expression level via the ERα pathway and make ER+ breast cancer cells sensitive to paclitaxel treatment.
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Affiliation(s)
- Junfeng Shi
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China.,Clinical Research Center, Xuyi People's Hospital, Xuyi, China
| | - Yi Chen
- Department of Oncology, Nanjing Pukou Central Hospital, Nanjing, China
| | - Wenxing Chen
- School of pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cuiju Tang
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China
| | - Honghong Zhang
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China
| | - Yuetong Chen
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China
| | - Xiuwei Yang
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Zhi Xu
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China
| | - Jingsun Wei
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China
| | - Jinfei Chen
- Department of Oncology, Nanjing First Hospital, NanJing Medical University, Nanjing, China.,Clinical Research Center, Xuyi People's Hospital, Xuyi, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
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12
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Wu YT, Xu Z, Arshad B, Wu JS, Zhang K, Wu H, Li X, Li H, Li YC, Wang ZL, Wu KN, Kong LQ. Significantly higher pathologic complete response (pCR) after the concurrent use of trastuzumab and anthracycline-based neoadjuvant chemotherapy for HER2-positive breast cancer: Evidence from a meta-analysis of randomized controlled trials. J Cancer 2018; 9:3168-3176. [PMID: 30210640 PMCID: PMC6134822 DOI: 10.7150/jca.24701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/21/2018] [Indexed: 12/23/2022] Open
Abstract
Objectives: To investigate the effect of the concurrent use of trastuzumab and anthracycline-based neoadjuvant chemotherapy (NAC) for HER2-positive breast cancer in terms of pCR and cardiotoxicity. Methods: We systematically searched Pubmed, Embase, Cochrane and SinoMed databases from inception until 1 July 2017 for relevant articles of randomized controlled studies. After identified all relevant studies that reported the concurrent use of trastuzumab and anthracycline-based NAC for HER2-positive locally advanced breast cancer, five eligible randomized studies were extracted relevant data and assessed for design and quality, and the meta-analysis was conducted to evaluate the risk ratio (RR) of pCR and other interesting outcomes, such as left ventricular ejection fraction (LVEF) decrease more than 10%, responses, recurrence free survival (RFS) and overall survival (OS). Results: A total of five randomized controlled studies were included in the meta-analysis, including 232 HER2-positive locally advanced breast cancer patients received the concurrent use of trastuzumab and anthracycline-based NAC. The results showed that the pCR rate was significantly higher in the group received the concurrent use of trastuzumab and anthracycline-based NAC (48%) than that in the non-concurrent use of trastuzumab and anthracycline-based NAC group (26%) (RR: 1.76, 95%CI: 1.37-2.26, p<0.0001). Besides, higher rate of RFS (RR: 1.14, 95%CI: 1.03-1.26, p=0.009) was observed in the concurrent use of trastuzumab and anthracycline-based NAC group. No significant differences in LVEF decreased more than 10% (p=0.50) between both groups. Conclusions: Our meta-analysis of randomized controlled studies showed that pCR rates are significantly higher in the concurrent use of trastuzumab and anthracycline-based NAC compared with the non-concurrent use of trastuzumab and anthracycline-based NAC for certain HER2-positive breast cancer, meanwhile without significant increase of the cardiotoxicity.
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Affiliation(s)
- Yu-Tuan Wu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhou Xu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bilal Arshad
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jiu-Song Wu
- Department of General Surgery, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - Ke Zhang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - He Wu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin Li
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hao Li
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ying-Cun Li
- Department of General Surgery, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - Zhong-Liang Wang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - Kai-Nan Wu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ling-Quan Kong
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Gonzalez-Conchas GA, Rodriguez-Romo L, Hernandez-Barajas D, Gonzalez-Guerrero JF, Rodriguez-Fernandez IA, Verdines-Perez A, Templeton AJ, Ocana A, Seruga B, Tannock IF, Amir E, Vera-Badillo FE. Epidermal growth factor receptor overexpression and outcomes in early breast cancer: A systematic review and a meta-analysis. Cancer Treat Rev 2018; 62:1-8. [DOI: 10.1016/j.ctrv.2017.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 01/09/2023]
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Tao M, Chen S, Zhang X, Zhou Q. Ki-67 labeling index is a predictive marker for a pathological complete response to neoadjuvant chemotherapy in breast cancer: A meta-analysis. Medicine (Baltimore) 2017; 96:e9384. [PMID: 29390540 PMCID: PMC5758242 DOI: 10.1097/md.0000000000009384] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) is a strong indicator of the benefit of therapy and presents an early surrogate for a favorable long-term outcome. It remains unclear whether Ki-67, a marker for tumor proliferation, can function as a predictor of the response to NCT in breast cancer. The objective of this meta-analysis was to compare the pCR rate and clinical outcomes in breast cancer patients with different Ki-67 labeling indexes (Ki-67 LI) who received NCT. METHODS Clinical studies were retrieved from the electronic databases of PubMed, Embase, Clinical Trials, Wanfang, and the Chinese National Knowledge Infrastructure, from their inception to July 31, 2017. Meta-analysis was performed on pool eligible studies to determine whether Ki-67 LI was associated with the pCR rate and clinical outcomes of breast cancer patients who were treated with NCT. Pooled analyses were performed using fixed effects models. Two reviewers screened all titles and abstracts and independently assessed all articles. RESULTS A total of 36 studies involving 6793 patients were included in the meta-analysis. Pooled analysis results revealed that patients with high Ki-67 LI exhibited significantly higher pCR rates (odds ratio [OR] = 3.94, 95% confidence interval [CI]: 3.33-4.67, P <.001) but poorer relapse-free survival (OR = 1.99, 95% CI: 1.39-2.85, P <.001) than those with low Ki-67 LI, but there was no significant difference in objective tumor response rate. CONCLUSION The meta-analysis reported here demonstrates that pretherapeutic Ki-67 LI is associated with pCR in breast cancer patients undergoing NCT. More phase III randomized clinical trials will be required to confirm our findings.
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Affiliation(s)
| | | | - Xianquan Zhang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zhou
- Fuling Center Hospital of Chongqing City
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15
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Kawashima H, Miyati T, Ohno N, Ohno M, Inokuchi M, Ikeda H, Gabata T. Differentiation Between Luminal-A and Luminal-B Breast Cancer Using Intravoxel Incoherent Motion and Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Acad Radiol 2017; 24:1575-1581. [PMID: 28778511 DOI: 10.1016/j.acra.2017.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to investigate whether intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can differentiate luminal-B from luminal-A breast cancer MATERIALS AND METHODS: Biexponential analyses of IVIM and DCE MRI were performed using a 3.0-T MRI scanner, involving 134 patients with 137 pathologically confirmed luminal-type invasive breast cancers. Luminal-type breast cancer was categorized as luminal-B breast cancer (LBBC, Ki-67 ≧ 14%) or luminal-A breast cancer (LABC, Ki-67 < 14%). Quantitative parameters from IVIM (pure diffusion coefficient [D], perfusion-related diffusion coefficient [D*], and fraction [f]) and DCE MRI (initial percentage of enhancement and signal enhancement ratio [SER]) were calculated. The apparent diffusion coefficient (ADC) was also calculated using monoexponential fitting. We correlated these data with the Ki-67 status. RESULTS The D and ADC values of LBBC were significantly lower than those of LABC (P = 0.028, P = 0.037). The SER of LBBC was significantly higher than that of LABC (P = 0.004). A univariate analysis showed that a significantly lower D (<0.847 x 10-3 mm2/s), lower ADC (<0.960 × 10-3 mm2/s), and higher SER (>1.071) values were associated with LBBC (all P values <0.01), compared to LABC. In a multivariate analysis, a higher SER (>1.071; odds ratio: 3.0099, 95% confidence interval: 1.4246-6.3593; P = 0.003) value and a lower D (<0.847 × 10-3 mm2/s; odds ratio: 2.6878, 95% confidence interval: 1.0445-6.9162; P = 0.040) value were significantly associated with LBBC, compared to LABC. CONCLUSION The SER derived from DCE MRI and the D derived from IVIM are associated independently with the Ki-67 status in patients with luminal-type breast cancer.
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Affiliation(s)
- Hiroko Kawashima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan; Department of Breast Oncology, Kanazawa University Hospital, Kanazawa, Japan.
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan
| | - Masako Ohno
- Radiology Division, Kanazawa University Hospital, Kanazawa, Japan
| | - Masafumi Inokuchi
- Department of Breast Oncology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroko Ikeda
- Division of Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
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16
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Wang S, Li W, Wang F, Niu Y, Hao C, Wang X, He L, Tong Z. 36 cases adenoid cystic carcinoma of the breast in China: Comparison with matched grade one invasive ductal carcinoma-not otherwise specified. Pathol Res Pract 2017; 213:310-315. [PMID: 28222936 DOI: 10.1016/j.prp.2017.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinicopathological characteristic of adenoid cystic carcinoma (ACC). MATERIALS AND METHODS The clininopathological features, along with relapse free survival(RFS) and overall survival(OS) of 36 patients with ACC were retrospectively investigated and compared with those of 108 grade 1 invasive ductal carcinoma not-otherwise-specified (G1-IDC-NOS) patients. RESULTS Most cases of ACC were ER, PR and HER-2 negative which was classified as triple-negative subtype. Five cases were concomitant with other pathological types of cancer. Axillary lymph node dissection(ALND) was performed in 31 patients and 2 of them with lymph nodes metastasis. Two patients died of lung metastases at 46 and 116 months after the surgery respectively. Compared with G1-IDC-NOS, ACC showed lower Ki-67 index, less lymph nodes metastasis, lower P53 expression, and higher proportion in location of upper outer quadrant of breast. There was no difference of OS and RFS between ACC and G1-IDC-NOS. CONCLUSIONS ACC of the breast was a rare disease with a good prognosis although most of them were classified as triple-negative subtype. And the value of axillary node dissection and adjuvant therapy needs to be further investigated.
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Affiliation(s)
- Shuling Wang
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Weidong Li
- Department of Breast Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Fang Wang
- Shandong Academy of Pharmaceutical Sciences, Ji Nan 250101, Shan Dong, China
| | - Yun Niu
- Department of Breast Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Chunfang Hao
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Xu Wang
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Lihong He
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Zhongsheng Tong
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China.
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17
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Chen X, He C, Han D, Zhou M, Wang Q, Tian J, Li L, Xu F, Zhou E, Yang K. The predictive value of Ki-67 before neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis. Future Oncol 2017; 13:843-857. [PMID: 28075166 DOI: 10.2217/fon-2016-0420] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM To review the predictive values of Ki-67 before neoadjuvant chemotherapy (NAC) for breast cancer patients. METHODS PubMed and EMBASE were searched. Random-effect model meta-analysis was conducted using Revman software. RESULTS High Ki-67 was associated with more pathological complete responses (pCRs) events (odds ratio: 3.10; 95% CI: 2.52-3.81; 53 studies, 10,848 patients) regardless of HR+, HER2+ and triple-negative breast cancer types, the definitions of pCR and cut-off points for Ki-67. Ki-67 could predict pCR in those who received anthracyclines plus taxanes, and anthracyclines only, and those from Asia and Europe. CONCLUSION High Ki-67 before NAC was a predictor for pCR in neoadjuvant setting for breast cancer patients.
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Affiliation(s)
- Xianyu Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao He
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Dongdong Han
- Department of Urology, the Second Hospital of Lanzhou University, Lanzhou, China
| | - Meirong Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Quan Wang
- Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Four Military Medical University, Xi'an, Shaanxi, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Lun Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Xu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Enxiang Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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Chung MJ, Lee JH, Kim SH, Suh YJ, Choi HJ. Simple Prediction Model of Axillary Lymph Node Positivity After Analyzing Molecular and Clinical Factors in Early Breast Cancer. Medicine (Baltimore) 2016; 95:e3689. [PMID: 27196477 PMCID: PMC4902419 DOI: 10.1097/md.0000000000003689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the association between pretreatment molecular and clinical factors and axillary lymph node metastases in early breast cancer. A total of 367 consecutive breast cancer patients with cT1-2NxM0 who underwent breast conserving surgery and axillary lymph node dissection followed by whole breast irradiation were enrolled. We evaluated the pathologic tumor and node status, tumor differentiation, calcification, and lymphovascular invasion, the status of estrogen receptor (ER), progesterone receptor (PR), epidermal growth factor receptor 1 (EGFR1), and human epidermal growth factor receptor 2 (HER2), the expression of E-cadherin, P53, and Ki-67 index. Totally, 108 (29.4%) of the 367 patients had positive axillary lymph nodes. An increased tumor size (P = 0.024), the presence of lymphovascular invasion (P < 0.001), and Ki-67 index of >20% (P = 0.038) were significantly associated with axillary lymph node metastases on the multivariate analysis. In our study, 86.2% of the patients with all the unfavorable factors had an involvement of axillary nodal metastases, and only 12.2% of the patients with all the favorable predictors had positive axillary nodes. The predictive power was significant on the receiver operating curve (P < 0.001). We found that several factors, such as tumor size, lymphovascular invasion, and the Ki-67 index, are independent factors that predict positive ALNM on multivariate analysis for the patients with cT1-2 breast cancer. Clinicians simply could predict the probability of ALNM after verifying the molecular and clinical factors in early breast cancer.
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Affiliation(s)
- Mi Joo Chung
- From the Department of Radiation Oncology (MJC), Kyung Hee University Hospital at Gangdong; Department of Radiation Oncology (JHL, SHK); Department of Surgery (YJS); and Department of Hospital Pathology (HJC), St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Semiglazov V. RECIST for Response (Clinical and Imaging) in Neoadjuvant Clinical Trials in Operable Breast Cancer. J Natl Cancer Inst Monogr 2016; 2015:21-3. [PMID: 26063880 DOI: 10.1093/jncimonographs/lgv021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although approximately 70% of breast cancer patients demonstrate a clinical response on neoadjuvant systemic therapy on physical examination or on anatomic radiographic imaging, only 3%-40% achieve a pathologic complete response (pCR). Magnetic resonance imaging (MRI) is superior to physical examination, ultrasound, and mammography in response evaluation during neoadjuvant systemic therapy. The accuracy of breast MRI to predict pCR has a moderate sensitivity, but high specificity. The accuracy of anatomic imaging to assess residual disease and predict pCR depended on anatomic radiographic imaging cancer subtypes. Response monitoring using breast is accurate in triple-negative or HER2-positive tumors. It was inaccurate in estrogen receptor-positive/HER2-negative subtype. Another approach currently under investigation is dynamic contrast-enhanced MRI and diffusion weighted-imaging, (18)F-fluorodeoxyglucose positron emission tomography, fluorodeoxyglucose positron emission tomography/computed tomography.
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20
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Luo J, Zhou Z, Yang Z, Chen X, Cheng J, Shao Z, Guo X, Tuan J, Fu X, Yu X. The Value of 18F-FDG PET/CT Imaging Combined With Pretherapeutic Ki67 for Early Prediction of Pathologic Response After Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer. Medicine (Baltimore) 2016; 95:e2914. [PMID: 26937935 PMCID: PMC4779032 DOI: 10.1097/md.0000000000002914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To evaluate the value of F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) and pretherapeutic Ki67 in predicting pathologic response in locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NAC).As a training set, total 301 LABC patients treated with NAC were retrospectively analyzed to evaluate the potential predictive value of pretherapeutic Ki67 for pathologic complete response (pCR) after NAC. Another 60 LABC patients were prospectively included as a validation set to evaluate the value of Ki67 combined PET/CT as pCR predictors. Ki67 was assessed in pretherapy core needle biopsy specimens and PET/CT scans were performed at baseline (before initiating NAC), after the 2nd, and 4th cycle of NAC. Maximum standardized uptake value (SUVmax) and its changes relative to baseline (ΔSUVmax%) were used as parameters of PEC/CT.In the training set, Ki67 was a predictor of pCR to NAC, with area under the curve (AUC) of 0.624 (P = 0.003) in receiver-operating characteristic (ROC) analysis. In the validation set, Ki67 alone did not show significant value in predicting pCR in the validation set. ΔSUVmax% after then 2nd or 4th course are predictors of pCR to NAC with the AUC of 0.774 (P = 0.002) and 0.791 (P = 0.002), respectively. When combined with ΔSUVmax% after the 2nd and 4th course NAC, Ki67 increased the value of ΔSUVmax% in predicting pCR with the AUC of 0.824 (P = 0.001). Baseline SUVmax and after 2nd, 4th course NAC had no predictive value for pCR, but SUVmax after the 2nd and 4th course showed remarkable predictive value for nonpathologic response (Grade 1 in Miller-Payne Grading System) with the AUC of 0.898 (P = 0.0001) and 0.801 (P = 0.003).Both PET/CT and Ki67 can predict pCR to NAC in LABC patients in the early phases of treatment. PET/CT combined Ki67 is a better pCR predictor for response to NAC. This helps the physician to predict the probability of pCR, and facilitates the optimization of individual treatment plan in case of ineffective and/or excessive chemotherapy.
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Affiliation(s)
- Jurui Luo
- From the Departments of Radiation Oncology (JL, ZZ, ZY, XC, XG, XF, XY), Nuclear Medicine (JC), and Breast Surgery (ZS), Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University (JL, ZZ, ZY, XC, XG, XF, XY, JC, ZS), Shanghai, China; and National Cancer Centre Singapore (JT), Singapore, Singapore
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Alba E, Lluch A, Ribelles N, Anton-Torres A, Sanchez-Rovira P, Albanell J, Calvo L, García-Asenjo JAL, Palacios J, Chacon JI, Ruiz A, De la Haba-Rodriguez J, Segui-Palmer MA, Cirauqui B, Margeli M, Plazaola A, Barnadas A, Casas M, Caballero R, Carrasco E, Rojo F. High Proliferation Predicts Pathological Complete Response to Neoadjuvant Chemotherapy in Early Breast Cancer. Oncologist 2016; 21:150-5. [PMID: 26786263 DOI: 10.1634/theoncologist.2015-0312] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/11/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the neoadjuvant setting, changes in the proliferation marker Ki67 are associated with primary endocrine treatment efficacy, but its value as a predictor of response to chemotherapy is still controversial. PATIENTS AND METHODS We analyzed 262 patients with centralized basal Ki67 immunohistochemical evaluation derived from 4 GEICAM (Spanish Breast Cancer Group) clinical trials of neoadjuvant chemotherapy for breast cancer. The objective was to identify the optimal threshold for Ki67 using the receiver-operating characteristic curve method to maximize its predictive value for chemotherapy benefit. We also evaluated the predictive role of the defined Ki67 cutoffs for molecular subtypes defined by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). RESULTS A basal Ki67 cutpoint of 50% predicted pathological complete response (pCR). Patients with Ki67 >50% achieved a pCR rate of 40% (36 of 91) versus a pCR rate of 19% in patients with Ki67 ≤ 50% (33 of 171) (p = .0004). Ki67 predictive value was especially relevant in ER-HER2- and ER-HER2+ patients (pCR rates of 42% and 64%, respectively, in patients with Ki67 >50% versus 15% and 45%, respectively, in patients with Ki67 ≤ 50%; p = .0337 and .3238, respectively). Both multivariate analyses confirmed the independent predictive value of the Ki67 cutpoint of 50%. CONCLUSION Basal Ki67 proliferation index >50% should be considered an independent predictive factor for pCR reached after neoadjuvant chemotherapy, suggesting that cell proliferation is a phenomenon closely related to chemosensitivity. These findings could help to identify a group of patients with a potentially favorable long-term prognosis. IMPLICATIONS FOR PRACTICE The use of basal Ki67 status as a predictive factor of chemotherapy benefit could facilitate the identification of a patient subpopulation with high probability of achieving pathological complete response when treated with primary chemotherapy, and thus with a potentially favorable long-term prognosis.
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Affiliation(s)
- Emilio Alba
- Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ana Lluch
- Valencia University Hospital, Valencia, Spain
| | - Nuria Ribelles
- Virgen de la Victoria University Hospital, Málaga, Spain
| | | | | | - Joan Albanell
- Hospital del Mar Medical Research Institute-Institut Hospital del Mar d'Investigacions Mediques and Pompeu Fabra University, Barcelona, Spain
| | - Lourdes Calvo
- A Coruña University Hospital Complex, A Coruña, Spain
| | | | | | | | - Amparo Ruiz
- Valencian Institute of Oncology, Valencia, Spain
| | | | | | | | - Mireia Margeli
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | | | - Maribel Casas
- GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain
| | | | - Eva Carrasco
- GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain
| | - Federico Rojo
- Fundación Jiménez Diaz University Hospital, Madrid, Spain
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Michishita S, Kim SJ, Shimazu K, Sota Y, Naoi Y, Maruyama N, Kagara N, Shimoda M, Shimomura A, Noguchi S. Prediction of pathological complete response to neoadjuvant chemotherapy by magnetic resonance imaging in breast cancer patients. Breast 2015; 24:159-65. [PMID: 25805427 DOI: 10.1016/j.breast.2015.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/14/2014] [Accepted: 01/01/2015] [Indexed: 01/12/2023] Open
Abstract
The purpose of this study was to evaluate whether the baseline breast MRI findings would be useful for the prediction for pathological complete response (pCR) by breast cancer patients to neoadjuvant chemotherapy. Primary breast cancer patients (stage II-III) preoperatively treated with sequential paclitaxel (12 cycles) and fluorouracil, epirubicin, and cyclophosphamide (4 cycles), followed by surgery were retrospectively enrolled, and 229 patients were eligible. Before chemotherapy, breast MRI studies were performed. Breast tumors were dichotomized into round + oval and irregular types based on MRI morphology. The round + oval tumors showed a significantly higher pCR rate than the irregular tumors (42.0% vs 17.3%; P < 0.001). In addition, PAM50 analysis revealed that basal and HER2-enriched tumors were significantly more prevalent among round + oval than irregular type tumors (P = 0.015). Baseline MRI morphology appears to be a significant predictor for pCR. The higher rate of the basal and HER2-enriched tumors among the round + oval tumors may explain their better chemo-sensitivity.
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Affiliation(s)
- Shintaro Michishita
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Seung Jin Kim
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshiaki Sota
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasuto Naoi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naomi Maruyama
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naofumi Kagara
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masafumi Shimoda
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Shimomura
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Vici P, Pizzuti L, Natoli C, Gamucci T, Di Lauro L, Barba M, Sergi D, Botti C, Michelotti A, Moscetti L, Mariani L, Izzo F, D'Onofrio L, Sperduti I, Conti F, Rossi V, Cassano A, Maugeri-Saccà M, Mottolese M, Marchetti P. Triple positive breast cancer: a distinct subtype? Cancer Treat Rev 2014; 41:69-76. [PMID: 25554445 DOI: 10.1016/j.ctrv.2014.12.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 01/23/2023]
Abstract
Breast cancer is a heterogeneous disease, and within the HER-2 positive subtype this is highly exemplified by the presence of substantial phenotypical and clinical heterogeneity, mostly related to hormonal receptor (HR) expression. It is well known how HER-2 positivity is commonly associated with a more aggressive tumor phenotype and decreased overall survival and, moreover, with a reduced benefit from endocrine treatment. Preclinical studies corroborate the role played by functional crosstalks between HER-2 and estrogen receptor (ER) signaling in endocrine resistance and, more recently, the activation of ER signaling is emerging as a possible mechanism of resistance to HER-2 blocking agents. Indeed, HER-2 positive breast cancer heterogeneity has been suggested to underlie the variability of response not only to endocrine treatments, but also to HER-2 blocking agents. Among HER-2 positive tumors, HR status probably defines two distinct subtypes, with dissimilar clinical behavior and different sensitivity to anticancer agents. The triple positive subtype, namely, ER/PgR/Her-2 positive tumors, could be considered the subset which most closely resembles the HER-2 negative/HR positive tumors, with substantial differences in biology and clinical outcome. We argue on whether in this subgroup the "standard" treatment may be considered, in selected cases, i.e., small tumors, low tumor burden, high expression of both hormonal receptors, an overtreatment. This article review the existing literature on biologic and clinical data concerning the HER-2/ER/PgR positive tumors, in an attempt to better define the HER-2 subtypes and to optimize the use of HER-2 targeted agents, chemotherapy and endocrine treatments in the various subsets.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Laura Pizzuti
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Clara Natoli
- Department of Experimental and Clinical Sciences, University "G. d'Annunzio", V dei Vestini, 29, 66100 Chieti, Italy.
| | - Teresa Gamucci
- Medical Oncology Unit ASL Frosinone, V Armando Fabi, 03100 Frosinone, Italy.
| | - Luigi Di Lauro
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Maddalena Barba
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Domenico Sergi
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Claudio Botti
- Department of Surgery, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, V Roma 67, 56126 Pisa, Italy.
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology, Belcolle Hospital, ASL Viterbo, Strada S. Martinese, 01100 Viterbo, Italy.
| | - Luciano Mariani
- Department of Gynecologic Oncology, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy; HPV Unit, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Fiorentino Izzo
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Loretta D'Onofrio
- Department of Medical Oncology, University Campus Bio-Medico, V Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Isabella Sperduti
- Biostatistics Unit, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Francesca Conti
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Valentina Rossi
- Division of Medical Oncology, Ospedale Civile di Saluzzo, V Spielberg 58, 12100 Saluzzo (CN), Italy.
| | - Alessandra Cassano
- Division of Medical Oncology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Marcella Mottolese
- Department of Pathology, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Paolo Marchetti
- Oncology Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, V Grottarossa 1035/1039, 00189 Rome, Italy.
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Dong MJ, Wang LB, Jiang ZN, Jin M, Hu WX, Shen JG. The transcription factor KLF4 as an independent predictive marker for pathologic complete remission in breast cancer neoadjuvant chemotherapy: a case-control study. Onco Targets Ther 2014; 7:1963-9. [PMID: 25368523 PMCID: PMC4216037 DOI: 10.2147/ott.s68340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To identify whether a stem cell biomarker, KLF4, may predict the pathologic tumor response to neoadjuvant chemotherapy for patients with locally advanced breast cancer. Methods Twelve locally advanced breast cancer patients who achieved pathologic complete remission (pCR) after neoadjuvant chemotherapy were identified and for each, three non-pCR breast cancer patients – matched for age, clinical tumor–node–metastasis stage, and neoadjuvant chemotherapy cycles – were selected. The relationship between KLF4 expression in the core needle biopsied cancer tissue and patient pCR rate was assessed using univariate and multivariate analysis. Results Receiver operating characteristic curve analysis showed that the patients with a histoscore of KLF4 expression >0.18 had a lower pCR rate. Multivariable analysis showed that higher KLF4 expression (odds ratio 0.013; 95% confidence interval 0.013–0.444; P=0.004) was independently correlated with a lower pCR rate after neoadjuvant chemotherapy. Conclusion KLF4 overexpression was associated with lower pCR in locally advanced breast cancer patients undergoing neoadjuvant chemotherapy. This study suggests that KLF4 may serve as a predictor for pCR in patients with breast cancer after neoadjuvant chemotherapy.
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Affiliation(s)
- Min Jun Dong
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Lin Bo Wang
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Zhi Nong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Mei Jin
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Wen Xian Hu
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Jian Guo Shen
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
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Khokher S, Qureshi MU, Mahmood S, Nagi AH. Association of immunohistochemically defined molecular subtypes with clinical response to presurgical chemotherapy in patients with advanced breast cancer. Asian Pac J Cancer Prev 2014; 14:3223-8. [PMID: 23803108 DOI: 10.7314/apjcp.2013.14.5.3223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Gene expression profiling (GEP) has identified several molecular subtypes of breast cancer, with different clinico-pathologic features and exhibiting different responses to chemotherapy. However, GEP is expensive and not available in the developing countries where the majority of patients present at advanced stage. The St Gallen Consensus in 2011 proposed use of a simplified, four immunohistochemical (IHC) biomarker panel (ER, PR, HER2, Ki67/Tumor Grade) for molecular classification. The present study was conducted in 75 newly diagnosed patients of breast cancer with large (>5cm) tumors to evaluate the association of IHC surrogate molecular subtype with the clinical response to presurgical chemotherapy, evaluated by the WHO criteria, 3 weeks after the third cycle of 5 flourouracil, adriamycin, cyclophosphamide (FAC regimen). The subtypes of luminal, basal-like and HER2 enriched were found to account for 36.0 % (27/75), 34.7 % (26/75) and 29.3% (22/75) of patients respectively. Ten were luminal A and 14 luminal B (8 HER2 negative and 6HER2 positive). The triple negative breast cancer (TNBC) was most sensitive to chemotherapy with 19% achieving clinical-complete-response (cCR) followed by HER2 enriched (2/22 (9%) cCR), luminal B (1/6 (7%) cCR) and luminal A (0/10 (0%) cCR). Heterogeneity was observed within each subgroup, being most marked in the TNBC although the most responding tumors, 8% developing clinical-progressive-disease. The study supports association of molecular subtypes with response to chemotherapy in patients with advanced breast cancer and the existence of further heterogeneity within subtypes.
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Mori N, Ota H, Mugikura S, Takasawa C, Ishida T, Watanabe G, Tada H, Watanabe M, Takase K, Takahashi S. Luminal-type breast cancer: correlation of apparent diffusion coefficients with the Ki-67 labeling index. Radiology 2014; 274:66-73. [PMID: 25203132 DOI: 10.1148/radiol.14140283] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the correlation between apparent diffusion coefficient ( ADC apparent diffusion coefficient ) values and the Ki-67 labeling index for luminal-type (estrogen receptor-positive) breast cancer not otherwise specified ( NOS not otherwise specified ) diagnosed by means of biopsy. MATERIALS AND METHODS The institutional review board approved this retrospective study, and the requirement for informed consent was waived. Between December 2009 and December 2012, 86 patients with 86 lesions with luminal-type invasive breast cancer NOS not otherwise specified underwent magnetic resonance imaging, including dynamic contrast material-enhanced imaging and diffusion-weighted imaging with b values of 0 and 1000 sec/mm(2). Conventional measurement of the minimum and mean ADC apparent diffusion coefficient s by placing regions of interest and histogram analysis of pixel-based ADC apparent diffusion coefficient data of the entire tumor were performed by two observers independently and correlated with the Ki-67 labeling index of surgical specimens. RESULTS For the interobserver reliability, interclass correlation coefficients for all parameters with the exception of the minimum ADC apparent diffusion coefficient exceeded 0.8, indicating almost perfect agreement. The minimum ADC apparent diffusion coefficient and mean ADC apparent diffusion coefficient and the 25th, 50th, and 75th percentiles of the histograms showed negative correlations with the Ki-67 labeling index (r = -0.49, -0.55, -0.54, -0.53, and -0.48, respectively). Receiver operating characteristic curve analysis for the differential diagnosis between the high-proliferation (Ki-67 ≥ 14; n = 44) and low-proliferation (Ki-67 < 14; n = 42) groups revealed that the most effective threshold for the mean ADC apparent diffusion coefficient was lower than 1097 × 10(-6) mm(2)/sec, with sensitivity and specificity of 82% and 71%, respectively. The area under the receiver operating characteristic curve (AUC) was 0.81 for the mean ADC apparent diffusion coefficient . There were no significant differences in the AUC among the parameters. CONCLUSION Considering convenience for routine practice, the authors suggest that the mean ADC apparent diffusion coefficient of the conventional method would be practical to use for estimating the Ki-67 labeling index.
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Affiliation(s)
- Naoko Mori
- From the Departments of Diagnostic Radiology (N.M., H.O., S.M., C.T., K.T., S.T.), Surgical Oncology (T.I., G.W., H.T.), and Pathology (M.W.), Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai 980-8574, Japan
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Fontein DBY, Charehbili A, Nortier JWR, Meershoek-Klein Kranenbarg E, Kroep JR, Putter H, van Riet Y, Nieuwenhuijzen GAP, de Valk B, Terwogt JMM, Algie GD, Liefers GJ, Linn S, van de Velde CJH. Efficacy of six month neoadjuvant endocrine therapy in postmenopausal, hormone receptor-positive breast cancer patients--a phase II trial. Eur J Cancer 2014; 50:2190-200. [PMID: 24970786 DOI: 10.1016/j.ejca.2014.05.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/24/2014] [Accepted: 05/08/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Neoadjuvant hormonal therapy (NHT) is playing an increasing role in the clinical management of breast cancer (BC) and may improve surgical outcomes for postmenopausal, oestrogen receptor (ER)-positive BC patients. However, there is currently no consensus on the optimal duration of NHT before surgery. Here, we present the outcomes of the TEAM IIA trial, a multicentre, phase II trial investigating the efficacy of six months of neoadjuvant exemestane in postmenopausal, strong ER-positive (ER+, ⩾50%) BC patients. METHODS 102 patients (stage T2-T4ac) were included in the study after exclusion of ineligible patients. Primary end-point was clinical response at 3 and 6 months as measured by palpation. Secondary end-point was radiological response as measured by magnetic resonance imaging (MRI), mammography and/or ultrasound. Linear mixed models (95% confidence interval (CI)) were used to compare changes in mean tumour size (in mm) between baseline, 3 and 6 months after the start of endocrine therapy. Conversion rates from mastectomy to breast conserving surgery (BCS) were evaluated. RESULTS Median age of all patients was 72 years (range 53-88). Overall response rate by clinical palpation was 64.5% in all patients with a final palpation measurement. Four patients had clinically progressive disease. 63 patients had both 3-month and >3-month palpation measurements. Overall response was 58.7% at 3 months and 68.3% at final palpation (>3 months). Mean tumour size by clinical palpation at T=0 was 39.1mm (95% CI 34.8-43.4mm), and decreased to 23.0mm (95% CI 18.7-27.2mm) and 16.7 mm (95% CI 12.6-20.8) at T=3 and T>3 months, respectively (p=0.001). Final radiological response rates at the end of treatment for MRI (n=37), ultrasound (n=77) and mammography (n=56) were 70.3%, 41.6% and 48.2%, respectively. Feasibility of BCS improved from 61.8% to 70.6% (McNemar p=0.012). CONCLUSION 6 months of neoadjuvant exemestane therapy helps reduce mean tumour size further in strongly ER-positive BC patients without significant side-effects compared to 3 months. Nevertheless, some patients still experience disease progression under exemestane. Feasibility of breast conservation rates improved by almost 10%.
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Affiliation(s)
- Duveken B Y Fontein
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ayoub Charehbili
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan W R Nortier
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Judith R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne van Riet
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | | | - Bart de Valk
- Department of Medical Oncology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands; Department of Medical Oncology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Gijs D Algie
- Department of Surgery, MC Zuiderzee, Lelystad, The Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Sabine Linn
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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The Levels of Ki-67 Positive are Positively Associated with Lymph Node Metastasis in Invasive Ductal Breast Cancer. Cell Biochem Biophys 2014; 70:1145-51. [DOI: 10.1007/s12013-014-0034-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Colleoni M, Munzone E. Extended adjuvant chemotherapy in endocrine non-responsive disease. Breast 2014; 22 Suppl 2:S161-4. [PMID: 24074780 DOI: 10.1016/j.breast.2013.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND AIMS There is a biological rationale for expecting benefit from longer duration therapy in the subpopulation of patients with endocrine non-responsive disease. Such tumors have a rapid cell proliferation and are associated with a high risk of relapse despite adjuvant chemotherapy. Moreover, prolonged duration of chemotherapy may be particularly relevant for patients with triple negative disease to inhibit the growth of tumors that are not susceptible to the effects of endocrine therapies due to lack of steroid hormone receptors, or to the effects of anti-HER2 target treatment. METHODS AND RESULTS The question of duration of adjuvant chemotherapy for breast cancer has been directly addressed in several trials herein presented. Most of these were small and, therefore, unsuitable for detecting differences of modest magnitude in intrinsic biological subtypes. In addition, a number of trials examine regimens which differ in duration of therapy, but also in the drugs given. In these trials the effects of duration and choice of drug are inextricably confounded. However incremental chemotherapy strategies, compared with less extensive therapies, were more effective in past studies particularly in patients with endocrine non-responsive disease. CONCLUSIONS The evidence resulting from past trials indicates that conventional-dose chemotherapy for 4-6 months is an adequate option in patients whose tumors present a low or no expression of steroid hormone receptors. These tumor subtypes are part of a highly heterogeneous subgroup (e.g., basal-like, molecular apocrine, claudin-low, HER-enriched). Tailored research through international cooperation is key to solidify consensus on how to treat individual patients with endocrine non-responsive breast cancer.
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Affiliation(s)
- Marco Colleoni
- Division of Medical Senology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Fei F, Du Y, Di G, Wu J, Shao Z. Are changes in circulating tumor cell (CTC) count associated with the response to neoadjuvant chemotherapy in local advanced breast cancer? A meta-analysis. Oncol Res Treat 2014; 37:250-4. [PMID: 24853784 DOI: 10.1159/000362378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/07/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Circulating tumor cells (CTCs) represent a biomarker for tumor progression and monitoring therapeutic effects. We evaluated the association between the changes in CTC count and the pathological response to neoadjuvant chemotherapy (NCT) for local advanced breast cancer (LABC) patients. METHODS PubMed, EBSCO, Web of Science, conference proceedings and key trials for the period 1998-2012 were searched. We used the hazard ratio (HR) to evaluate the variation in the number of CTCs to predict the response to NCT in LABC patients. All data from each study were investigated using either fixed- or random-effect models and were analyzed using Stata software. RESULTS There was no between-study heterogeneity in pathological complete response (pCR) (heterogeneity chi-squared = 0.02 (df = 1), I(2) = 0.0%, p = 0.877). Our meta-analysis showed that the change (decrease or increase) in CTC number in LABC patients during NCT was not correlated with pCR (HR = 0.918, 95% confidence interval 0.650-1.295; p = 0.877). CONCLUSION The results of the current meta-analysis indicate that there is no association between the decrease of CTC number and pCR after NCT. According to our results, a decrease in the CTC count after NCT in LABC patients did not indicate that they had an improved response to NCT. However, more randomized clinical trials are needed to confirm this conclusion.
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Affiliation(s)
- Fei Fei
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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Zhang G, Xie W, Liu Z, Lin C, Piao Y, Xu L, Guo F, Xie X. Prognostic Function of Ki-67 for Pathological Complete Response Rate of Neoadjuvant Chemotherapy in Triple-negative Breast Cancer. TUMORI JOURNAL 2014; 100:136-42. [DOI: 10.1177/030089161410000204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims and Background Triple-negative breast cancer (TNBC) has fluctuating pathological complete response (pCR) rates to neoadjuvant chemotherapy (NAC) according to published reports. Biomarkers predicting pCR rates of NAC would improve TNBC patients' outcomes. We conducted a meta-analysis to estimate the prognostic function of Ki-67 in relation to pCR rates of NAC in TNBC. Methods and Study Design Relevant publications in the literature from January 2006 to March 2013 were selected by searching PubMed, SpringerLink, Web of Science, Scopus and the Cochrane Library. The quality of prognostic studies was evaluated according to the standard reported by Hayden et al. Relative risk (RR) and 95% confidence interval (CI) were used to estimate the prognostic function of Ki-67 for pCR rates in TNBC. The fail-safe number was used to detect possible publication bias. Review Manager and MIX software was used to merge extracted data. Results The pCR rate of TNBC with high Ki-67 expression was 3.36 times that of low Ki-67 expression TNBC. The merged RR was 3.36 (95% CI: 1.61–7.02) and the fail-safe number was 34. No obvious publication bias but heterogeneity of the case series was detected. Conclusions Ki-67 was a predictor of pCR rates to NAC in TNBC.
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Affiliation(s)
- Guojing Zhang
- Oncology Diagnosis and Treatment Center, The General Hospital of Shenyang Military Region, Shenyang
| | - Wanqing Xie
- Molecular Biology Laboratory of Traditional Chinese Medicine, The Basic Medical College of Liaoning University of Traditional Chinese Medicine, Shenyang
| | - Zhaozhe Liu
- Oncology Diagnosis and Treatment Center, The General Hospital of Shenyang Military Region, Shenyang
| | - Chao Lin
- Department of Gynecology and Obstetrics, Zhejiang Chinese Medical University Affiliated Hospital of Wenzhou Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Ying Piao
- Oncology Diagnosis and Treatment Center, The General Hospital of Shenyang Military Region, Shenyang
| | - Long Xu
- Oncology Diagnosis and Treatment Center, The General Hospital of Shenyang Military Region, Shenyang
| | - Fang Guo
- Oncology Diagnosis and Treatment Center, The General Hospital of Shenyang Military Region, Shenyang
| | - Xiaodong Xie
- Oncology Diagnosis and Treatment Center, The General Hospital of Shenyang Military Region, Shenyang
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Petrelli F, Barni S. Response to neoadjuvant chemotherapy in ductal compared to lobular carcinoma of the breast: a meta-analysis of published trials including 1,764 lobular breast cancer. Breast Cancer Res Treat 2013; 142:227-35. [PMID: 24177758 DOI: 10.1007/s10549-013-2751-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/22/2013] [Indexed: 11/29/2022]
Abstract
Infiltrating lobular carcinoma (ILC) of the breast is associated with greater oestrogen receptor expression and poorer response to neoadjuvant chemotherapy, when compared to infiltrating ductal carcinoma (IDC). In order to compare the pathological complete response rate (pCR) and breast conserving surgery (BCS) in patients with ILC versus IDC treated with neoadjuvant chemotherapy, we performed a systematic review and meta-analysis of all published studies. A search of PubMed, EMBASE, the Web of Science, SCOPUS and the Cochrane Central Register of Controlled Trials was performed to identify studies that investigated pCR, clinical response and BCS in patients with ILC that were treated with neoadjuvant chemotherapy. Random-effect models were adopted to estimate the summary odds ratio (OR), and the publication bias was evaluated using a funnel plot and Egger's regression asymmetry test. Seventeen studies were included (one randomized controlled trial, three prospective series and 13 retrospective trials), for a total of 12,645 IDCs and 1,764 ILCs to be compared. Ductal carcinoma of the breast was associated with a better pCR (from 5.9 to 16.7 %; OR = 3.1, 95 % CI 2.48-3.87, P < 0.00001) and rate of BCS (from 35.4 to 54.8 %; OR = 2.1, 95 % CI 1.8-2.45, P < 0.00001) compared to ILC. The overall pCR rates and BCS decreased in the ILCs compared with IDC when treated with neoadjuvant chemotherapy.
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Affiliation(s)
- Fausto Petrelli
- Division of Medical Oncology, Department of Medical Oncology, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy,
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Kim HP, Han SW, Song SH, Jeong EG, Lee MY, Hwang D, Im SA, Bang YJ, Kim TY. Testican-1-mediated epithelial-mesenchymal transition signaling confers acquired resistance to lapatinib in HER2-positive gastric cancer. Oncogene 2013; 33:3334-41. [PMID: 23873022 DOI: 10.1038/onc.2013.285] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/26/2013] [Accepted: 05/28/2013] [Indexed: 12/17/2022]
Abstract
Human epidermal growth factor receptor 2 (HER2)-directed treatment using trastuzumab has shown clinical benefit in HER2-positive gastric cancer. Clinical trials using lapatinib in HER2-positive gastric cancer are also currently underway. As with other molecularly targeted agents, the emergence of acquired resistance to HER2-directed treatment is an imminent therapeutic problem for HER2-positive gastric cancer. In order to investigate the mechanisms of acquired resistance to HER2-directed treatment in gastric cancer, we generated lapatinib-resistant gastric cancer cell lines (SNU216 LR) in vitro by chronic exposure of a HER2-positive gastric cancer cell line (SNU216) to lapatinib. The resultant SNU216 LR cells were also resistant to gefitinib, cetuximab, trastuzumab, afatinib and dacomitinib. Interestingly, SNU216 LR cells displayed an epithelial-mesenchymal transition (EMT) phenotype and maintained the activation of MET, HER3, Stat3, Akt and mitogen-activated protein kinase signaling in the presence of lapatinib. Using gene expression arrays, we identified the upregulation of a variety of EMT-related genes and extracellular matrix molecules, such as Testican-1, in SNU216 LR cells. We showed that the inhibition of Testican-1 by small interfering RNA decreased Testican-1-induced, MET-dependent, downstream signaling, and restored sensitivity to lapatinib in these cells. Furthermore, treatment with XAV939 selectively inhibited β-catenin-mediated transcription and Testican-1-induced EMT signaling, leading to G1 arrest. Taken together, these data support the potential role of EMT in acquired resistance to HER2-directed treatment in HER2-positive gastric cancer, and provide insights into strategies for preventing and/or overcoming this resistance in patients.
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Affiliation(s)
- H-P Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S-W Han
- 1] Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea [2] Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S-H Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - E-G Jeong
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - M-Y Lee
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology(POSTECH), Pohang, Republic of Korea
| | - D Hwang
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology(POSTECH), Pohang, Republic of Korea
| | - S-A Im
- 1] Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea [2] Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Y-J Bang
- 1] Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea [2] Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - T-Y Kim
- 1] Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea [2] Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea [3] WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
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Demir L, Yigit S, Ellidokuz H, Erten C, Somali I, Kucukzeybek Y, Alacacioglu A, Cokmert S, Can A, Akyol M, Dirican A, Bayoglu V, Sari AA, Tarhan MO. Predictive and prognostic factors in locally advanced breast cancer: effect of intratumoral FOXP3+ Tregs. Clin Exp Metastasis 2013; 30:1047-62. [PMID: 23836289 DOI: 10.1007/s10585-013-9602-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/01/2013] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate the prognostic and predictive effect of FOXP3+ Tregs together with clinicopathologic factors in locally advanced breast cancer (LABC) patients. The medical records of 101 LABC patients who received neoadjuvant chemotherapy (NAC) between 2005 and 2012 were evaluated retrospectively. The density of intratumoral FOXP3+ lymphocytes in paraffin-embedded tissues was assessed by immunohistochemical analyses in appropriate cases. The relationship with clinicopathologic features, prognosis and chemotherapy response was investigated. HR(-) and HER2(+) tumors tended to have higher pre-chemotherapy Tregs than HR(+) tumors, and significantly higher pathologic complete response (PCR) rates were observed in these patients. Treg decline after NAC was associated with better pathological response rates. Lower intratumoral infiltration of FOXP3+ Tregs after NAC (<3.4/HPF) was significantly associated with higher PCR rates for breast, and close to the significance limit for total (or both for breast and axillary) PCR rates (PCR for breast: 25 vs. 2.9 % for low vs. high Treg, p = 0.001; PCR for breast + axillary tissue: 13.9 vs. 0 %, p = 0.05). Despite better PCR rates, patients with high intratumoral Treg infiltrates (≥11.5/HPF) before chemotherapy had significantly shorter overall survival than patients with low Treg infiltrates (<11.5/HPF). Cox multivariate regression analyses demonstrated that the density of Treg infiltration before chemotherapy was the strongest predictor for survival. This study established the predictive and prognostic effect of intratumoral FOXP3+ Tregs in LABC patients. To predict clinical outcome, evaluation of FOXP3+ Tregs in tumoral tissues before and after NAC should be considered for these high-risk patients.
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MESH Headings
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/immunology
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/secondary
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Axilla
- Breast Neoplasms/drug therapy
- Breast Neoplasms/immunology
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/immunology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/immunology
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/secondary
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/immunology
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/secondary
- Female
- Follow-Up Studies
- Forkhead Transcription Factors/metabolism
- Humans
- Immunoenzyme Techniques
- Lymphatic Metastasis
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/pathology
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Grading
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Risk Factors
- Survival Rate
- T-Lymphocytes, Regulatory/immunology
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Affiliation(s)
- Lutfiye Demir
- Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin Sitesi, Karabaglar, Izmir, Turkey, 35360,
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Lin Q, Liu Y, Chen H, Liu Y, Tang Q, Liu J, Chen H. Survivin, Ki-67 and tumor grade as predictors of response to docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer. Mol Clin Oncol 2013; 1:839-844. [PMID: 24649257 PMCID: PMC3915650 DOI: 10.3892/mco.2013.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/10/2013] [Indexed: 12/21/2022] Open
Abstract
The response rates to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) may vary and the risks may outweigh the benefits in poorly selected patients. This study investigated whether survivin expression, high-level Ki-67 expression, estrogen-receptor (ER) tumor status and high tumor grade are able to predict response to docetaxel-based NAC in LABC patients, in order to perform breast-conserving surgery. In this study, 68 patients (IIb-IIIb) completed 4–6 cycles of TAC (75 mg/m2 docetaxel, 60 mg/m2 pirarubicin and 500 mg/m2 cyclophosphamide, administered every 3 weeks). Tumor samples were obtained prior to chemotherapy. The response to chemotherapy was quantified clinically and pathologically and the histological and molecular tumor characteristics were determined. Association with response was assessed for all the parameters and the patients underwent breast-conserving surgery or radical mastectomy accordingly. A clinical complete response was observed in 21 (31%) and a partial response in 37 (54%) of the 68 patients. Thus, the overall clinical response rate (ORR) was 85%. A pathological complete response (pCR) was observed in 14 (20%) of the 68 patients and 37 patients (54%) underwent breast-conserving surgery. In the univariate analysis, survivin expression, high-level Ki-67 expression and high tumor grade (grade III) were significantly associated with ORR (P=0.007, 0.024 and 0.047, respectively). Survivin expression and high-level Ki-67 expression were significantly associated with pCR (P=0.029 and 0.048, respectively). In the multivariate analysis, survivin expression (P=0.030) and tumor grade (P=0.036), but not high-level Ki-67 and ER expression, were significantly associated with ORR and none of these factors was significantly associated with pCR. In conclusion, expression of survivin and high tumor grade were of predictive value for ORR to docetaxel-based NAC in LABC patients, leading to more patients successfully undergoing breast conserving-surgery. Immunohistochemistry of survivin and the Elston and Ellis criteria of tumor grade may provide a widely applicable, cost-effective method of patient selection for NAC.
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Affiliation(s)
- Qi Lin
- Department of General Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, P.R. China
| | - Yang Liu
- Department of Ultrasonography, Lianyungang First People's Hospital Affiliated to Xuzhou Medical College, Lianyungang, Jiangsu 222002, P.R. China
| | - Huiyu Chen
- Department of General Surgery, Lianyungang First People's Hospital Affiliated to Xuzhou Medical College, Lianyungang, Jiangsu 222002, P.R. China
| | - Yi Liu
- Department of Pathology, Lianyungang First People's Hospital Affiliated to Xuzhou Medical College, Lianyungang, Jiangsu 222002, P.R. China
| | - Qiang Tang
- Department of General Surgery, Lianyungang First People's Hospital Affiliated to Xuzhou Medical College, Lianyungang, Jiangsu 222002, P.R. China
| | - Jing Liu
- Department of General Surgery, Lianyungang First People's Hospital Affiliated to Xuzhou Medical College, Lianyungang, Jiangsu 222002, P.R. China
| | - Hao Chen
- Department of Pathology, Lianyungang First People's Hospital Affiliated to Xuzhou Medical College, Lianyungang, Jiangsu 222002, P.R. China
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Sánchez-Rovira P, Seguí MA, Llombart A, Aranda E, Antón A, Sánchez A, Lomas M, Jaén A, Fernández M, Porras I, Dalmau E, Morales S, de la Haba-Rodríguez J. Bevacizumab plus preoperative chemotherapy in operable HER2 negative breast cancer: biomarkers and pathologic response. Clin Transl Oncol 2013; 15:810-7. [PMID: 23397155 PMCID: PMC3776259 DOI: 10.1007/s12094-013-1006-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/13/2013] [Indexed: 12/31/2022]
Abstract
Purpose The primary aim of this trial was to assess the rate of pathologic complete responses (pCR) of doxorubicin/cyclophosphamide (AC) followed by bevacizumab/docetaxel (BT), as neoadjuvant therapy for breast cancer (BC). Furthermore, the association between biomarkers and the pCR was explored. Methods Patients with HER-negative operable stage II–III BC ≥2 cm were enrolled. Four cycles of AC (A 60 mg/m2 and C 600 mg/m2, every 3 weeks) followed by 4 cycles of BT (B 15 mg/kg and T 75 mg/m2, every 3 weeks), were planned. A core-biopsy was performed for biological markers assessment. Results Seventy-two women were included. Forty-three (63 %) patients were hormone receptor-positive. Sixty-four (89 %) completed the planned treatment, and 66 evaluable patients underwent surgery (92 %): a pCR was achieved in 16 of them (24, 95 % CI 15–36 %). pCR was significantly higher in tumors hormone receptor-negative, and in those with Angiotensin II type 1 receptor (AGTR1) protein overexpression. The overall clinical response rate was 86 % (95 % CI 76–93 %), including 42 complete responses. No unexpected toxicities or treatment-related deaths were observed. Conclusion This regimen showed a remarkable clinical and pathological activity: the suggested relation between pCR and AGTR1 overexpression should be confirmed in larger trials.
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Affiliation(s)
- P Sánchez-Rovira
- Servicio de Oncología Médica, Complejo Hospitalario de Jaén, Avda. del Ejército Español, 10, 23007, Jaén, Spain,
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37
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Olszewski AJ, Migdady Y, Boolbol SK, Klein P, Boachie-Adjei K, Sakr BJ, Sikov W, Shao T. Effects of adjuvant chemotherapy in HER2-positive or triple-negative pT1ab breast cancers: a multi-institutional retrospective study. Breast Cancer Res Treat 2013; 138:215-23. [DOI: 10.1007/s10549-013-2423-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
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38
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Jinno H, Matsuda S, Hayashida T, Takahashi M, Hirose S, Ikeda T, Kitagawa Y. Differential pathological response to preoperative chemotherapy across breast cancer intrinsic subtypes. Chemotherapy 2012. [PMID: 23207824 DOI: 10.1159/000343663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast cancer is a heterogeneous disease with a diversity of clinical behaviors. The purpose of this study was to evaluate the utility of breast cancer intrinsic subtypes in the prediction of pathological complete response (pCR) in a cohort of breast cancer patients receiving preoperative chemotherapy. METHODS Patients with stage II/III breast cancer received 4 cycles of XT (capecitabine and docetaxel) followed by 4 cycles of FEC (fluorouracil, epirubicin, and cyclophosphamide) as preoperative chemotherapy. Tumors were classified as luminal A, luminal B, luminal/HER2, HER2, basal-like, or non-basal-like triple negative by immunohistochemical analysis in core needle biopsy samples at baseline. RESULTS The overall pCR rate was 11.9% (12/101). Multivariate analysis showed that intrinsic subtype was an independent factor to predict pCR. With luminal A patients as the reference group, luminal B (OR = 16.39; 95% CI 1.44-185.88; p = 0.024), HER2 (OR = 14.73; 95% CI 1.19-180.84; p = 0.035), and basal-like (OR = 13.27; 95% CI 1.27-138.79; p = 0.031) patients had a significantly higher likelihood of pCR. CONCLUSION The present data indicate that intrinsic subtypes may be useful predictive biomarkers of pCR in breast cancer patients treated with preoperative chemotherapy.
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Affiliation(s)
- Hiromitsu Jinno
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
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39
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Heys SD, Stewart KN, McKenzie EJ, Miller ID, Wong SYC, Sellar G, Rees AJ. Characterisation of tumour-infiltrating macrophages: impact on response and survival in patients receiving primary chemotherapy for breast cancer. Breast Cancer Res Treat 2012; 135:539-48. [PMID: 22886449 DOI: 10.1007/s10549-012-2190-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/25/2012] [Indexed: 11/28/2022]
Abstract
The role of the tumour microenvironment and complex cellular interactions has attracted interest in responses to primary chemotherapy. Of particular interest are tumour-infiltrating T cells and tumour-infiltrating macrophages (TIMs). We evaluated TIMs and their key activation markers in patients with breast cancer undergoing primary chemotherapy related to response and survival. One hundred and ninety nine patients with large or locally advanced breast cancers received primary chemotherapy. Clinical data, histopathological responses to chemotherapy and survival were examined related to infiltrating cells in tumour microenvironments: cluster of differentiation (CD)3 (pan T cell); CD4 (helper T cells); CD8 (cytotoxic T cells); CD25 (activated T cells); CD68, suppressor of cytokine signalling (SOCS)1, SOCS3 (macrophages); and CD11c and CD205 (dendritic). In tumours demonstrating better responses to chemotherapy, there were significantly fewer CD4(+) T-helper cells than a poorer response (p < 0.05). There were increased numbers of SOCS3 expressing macrophages (pro-inflammatory) in tumours with complete pathological responses compared with no response to chemotherapy (p < 0.05). There was no association between SOCS1 expressing macrophages (anti-inflammatory) and tumour response. Multivariate analysis revealed that factors indicating better survival were receiving anthracycline plus docetaxel (ExpB = 1.166; p = 0.006), better pathological chemotherapy response (ExpB = 0.309; p = 0.009) and a low macrophage SOCS1 expression (ExpB = 13.465; p = 0.044). This study highlights the heterogeneity of TIMs and provides further insight into complex interactions within tumours. The results emphasise the importance of characterising activation status of infiltrating macrophages and provides proof of principle for using macrophage SOCS protein expression as a survival predictor. The apparent impact of macrophage subsets on overall survival underlines the therapeutic potential of manipulating macrophage activation in cancer.
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Affiliation(s)
- Steven D Heys
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK.
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Takada M, Sugimoto M, Ohno S, Kuroi K, Sato N, Bando H, Masuda N, Iwata H, Kondo M, Sasano H, Chow LWC, Inamoto T, Naito Y, Tomita M, Toi M. Predictions of the pathological response to neoadjuvant chemotherapy in patients with primary breast cancer using a data mining technique. Breast Cancer Res Treat 2012; 134:661-70. [PMID: 22689089 DOI: 10.1007/s10549-012-2109-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 05/22/2012] [Indexed: 11/30/2022]
Abstract
Nomogram, a standard technique that utilizes multiple characteristics to predict efficacy of treatment and likelihood of a specific status of an individual patient, has been used for prediction of response to neoadjuvant chemotherapy (NAC) in breast cancer patients. The aim of this study was to develop a novel computational technique to predict the pathological complete response (pCR) to NAC in primary breast cancer patients. A mathematical model using alternating decision trees, an epigone of decision tree, was developed using 28 clinicopathological variables that were retrospectively collected from patients treated with NAC (n = 150), and validated using an independent dataset from a randomized controlled trial (n = 173). The model selected 15 variables to predict the pCR with yielding area under the receiver operating characteristics curve (AUC) values of 0.766 [95 % confidence interval (CI)], 0.671-0.861, P value < 0.0001) in cross-validation using training dataset and 0.787 (95 % CI 0.716-0.858, P value < 0.0001) in the validation dataset. Among three subtypes of breast cancer, the luminal subgroup showed the best discrimination (AUC = 0.779, 95 % CI 0.641-0.917, P value = 0.0059). The developed model (AUC = 0.805, 95 % CI 0.716-0.894, P value < 0.0001) outperformed multivariate logistic regression (AUC = 0.754, 95 % CI 0.651-0.858, P value = 0.00019) of validation datasets without missing values (n = 127). Several analyses, e.g. bootstrap analysis, revealed that the developed model was insensitive to missing values and also tolerant to distribution bias among the datasets. Our model based on clinicopathological variables showed high predictive ability for pCR. This model might improve the prediction of the response to NAC in primary breast cancer patients.
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Affiliation(s)
- M Takada
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaracho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Pilot and feasibility study: comparative proteomic analysis by 2-DE MALDI TOF/TOF MS reveals 14-3-3 proteins as putative biomarkers of response to neoadjuvant chemotherapy in ER-positive breast cancer. J Proteomics 2012; 75:2745-52. [PMID: 22498883 DOI: 10.1016/j.jprot.2012.03.049] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/23/2012] [Accepted: 03/27/2012] [Indexed: 12/20/2022]
Abstract
Neoadjuvant chemotherapy is used to treat oestrogen receptor-positive breast cancer however chemo-resistance is a major obstacle in this molecular subtype. The ability to predict tumour response would allow chemotherapy administration to be directed towards patients who would most benefit, thus maximising treatment efficacy. We aimed to identify protein biomarkers associated with response to neoadjuvant chemotherapy, in a pilot study using comparative 2-DE MALDI TOF/TOF MS proteomic analysis of breast tumour samples. A total of 3 comparative proteomic experiments were performed, comparing protein expression between chemotherapy-sensitive and chemotherapy-resistant oestrogen receptor-positive invasive ductal carcinoma tissue samples. This identified a list of 132 unique proteins that were significantly differentially expressed (≥ 2 fold) in chemotherapy resistant samples, 57 of which were identified in at least two experiments. Ingenuity® Pathway Analysis was used to map the 57 DEPs onto canonical signalling pathways. We implicate several isoforms of 14-3-3 family proteins (theta/tau, gamma, epsilon, beta/alpha and zeta/delta), which have previously been associated with chemotherapy resistance in breast cancer. Extensive clinical validation is now required to fully assess the role of these proteins as putative markers of chemotherapy response in luminal breast cancer subtypes.
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Wang S, Li W, Liu N, Zhang T, Liu H, Liu J, Liu F, Zhang W, Gebreamlak EP, Niu Y. Clinicopathologic characteristics and prognosis for molecular subtypes in low-grade breast carcinoma: comparison with grade one invasive ductal carcinoma-not otherwise specified. Med Oncol 2012; 29:2556-64. [PMID: 22311262 DOI: 10.1007/s12032-012-0174-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/19/2012] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the clinicopathologic characteristics and prognosis value for molecular subtypes of low-grade breast carcinoma (LGBC) compared with grade one invasive ductal carcinoma-not otherwise specified (G1-IDC-NOS). A retrospective review of 688 LGBC and 1 037 G1-IDC-NOS patients was classified into four different molecular subtypes based on the IHC-based definitions for ER, PR, and c-erbB-2. In LGBC, lymph node metastasis, the percentage of III/IV TNM stages, the expression of Ki-67 and p53 in luminal A subtype were lower than in other subtypes (P<0.01). In addition, the variations of Ki-67 and p53 expression were observed in different subtypes of G1-IDC-NOS (P<0.01). Compared with G1-IDC-NOS, LGBC has higher proportion in the ER positive, PR positive, HER-2 negative, luminal A subtype, Ki-67 negative, and lymph nodes negative group (P<0.01). Furthermore, the overall survival of luminal A and luminal B is higher than triple-negative and HER-2/neu subtype both in LGBC and G1-IDC-NOS in 262 LGBC and 330 G1-IDC-NOS patients with proper follow-up. The classification of molecular subtype together with clinicopathologic factors can significantly improve the traditional prognosticators in predicting outcome for LGBC and G1-IDC-NOS. And it may contribute to guide the treatment for LGBC and G1-IDC-NOS in the future.
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Affiliation(s)
- Shuling Wang
- Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University, Cancer Institute and Hospital, Huan hu xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China
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Naoi Y, Tanei T, Kishi K, Tsunashima R, Tominaga N, Baba Y, Nakayama T, Shimazu K, Kim S, Tamaki Y, Noguchi S. 70-Gene classifier for differentiation between paclitaxel- and docetaxel-sensitive breast cancers. Cancer Lett 2012; 314:206-12. [DOI: 10.1016/j.canlet.2011.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/22/2011] [Accepted: 09/23/2011] [Indexed: 02/03/2023]
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Hodgkinson VC, ELFadl D, Agarwal V, Garimella V, Russell C, Long ED, Fox JN, McManus PL, Mahapatra TK, Kneeshaw PJ, Drew PJ, Lind MJ, Cawkwell L. Proteomic identification of predictive biomarkers of resistance to neoadjuvant chemotherapy in luminal breast cancer: a possible role for 14-3-3 theta/tau and tBID? J Proteomics 2011; 75:1276-83. [PMID: 22115752 DOI: 10.1016/j.jprot.2011.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/27/2011] [Accepted: 11/03/2011] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Chemotherapy resistance is a major obstacle in effective neoadjuvant treatment for estrogen receptor-positive breast cancer. The ability to predict tumour response would allow chemotherapy administration to be directed towards only those patients who would benefit, thus maximising treatment efficiency. We aimed to identify putative protein biomarkers associated with chemotherapy resistance, using fresh tumour samples with antibody microarray analysis and then to perform pilot clinical validation experiments. MATERIALS AND METHODS Chemotherapy resistant and chemotherapy sensitive tumour samples were collected from breast cancer patients who had received anthracycline based neoadjuvant therapy consisting of epirubicin with cyclophosphamide followed by docetaxel. A total of 5 comparative proteomics experiments were performed using invasive ductal carcinomas which demonstrated estrogen receptor positivity (luminal subtype). Protein expression was compared between chemotherapy resistant and chemotherapy sensitive tumour samples using the Panorama XPRESS Profiler725 antibody microarray containing 725 antibodies from a wide variety of cell signalling and apoptosis pathways. A pilot series of archival samples was used for clinical validation of putative predictive biomarkers. RESULTS AbMA analysis revealed 38 differentially expressed proteins which demonstrated at least 1.8 fold difference in expression in chemotherapy resistant tumours and 7 of these proteins (Zyxin, 14-3-3 theta/tau, tBID, Pinin, Bcl-xL, RIP and MyD88) were found in at least 2 experiments. Clinical validation in a pilot series of archival samples revealed 14-3-3 theta/tau and tBID to be significantly associated with chemotherapy resistance. CONCLUSIONS For the first time, antibody microarrays have been used to identify proteins associated with chemotherapy resistance using fresh breast cancer tissue. We propose a potential role for 14-3-3 theta/tau and tBID as predictive biomarkers of neoadjuvant chemotherapy resistance in breast cancer. Further validation in a larger sample series is now required.
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Affiliation(s)
- Victoria C Hodgkinson
- Cancer Biology Proteomics Group, Postgraduate Medical Institute of the University of Hull, Hull, UK
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Luporsi E, André F, Spyratos F, Martin PM, Jacquemier J, Penault-Llorca F, Tubiana-Mathieu N, Sigal-Zafrani B, Arnould L, Gompel A, Egele C, Poulet B, Clough KB, Crouet H, Fourquet A, Lefranc JP, Mathelin C, Rouyer N, Serin D, Spielmann M, Haugh M, Chenard MP, Brain E, de Cremoux P, Bellocq JP. Ki-67: level of evidence and methodological considerations for its role in the clinical management of breast cancer: analytical and critical review. Breast Cancer Res Treat 2011; 132:895-915. [PMID: 22048814 PMCID: PMC3332349 DOI: 10.1007/s10549-011-1837-z] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/12/2011] [Indexed: 01/22/2023]
Abstract
Clinicians can use biomarkers to guide therapeutic decisions in estrogen receptor positive (ER+) breast cancer. One such biomarker is cellular proliferation as evaluated by Ki-67. This biomarker has been extensively studied and is easily assayed by histopathologists but it is not currently accepted as a standard. This review focuses on its prognostic and predictive value, and on methodological considerations for its measurement and the cut-points used for treatment decision. Data describing study design, patients’ characteristics, methods used and results were extracted from papers published between January 1990 and July 2010. In addition, the studies were assessed using the REMARK tool. Ki-67 is an independent prognostic factor for disease-free survival (HR 1.05–1.72) in multivariate analyses studies using samples from randomized clinical trials with secondary central analysis of the biomarker. The level of evidence (LOE) was judged to be I-B with the recently revised definition of Simon. However, standardization of the techniques and scoring methods are needed for the integration of this biomarker in everyday practice. Ki-67 was not found to be predictive for long-term follow-up after chemotherapy. Nevertheless, high KI-67 was found to be associated with immediate pathological complete response in the neoadjuvant setting, with an LOE of II-B. The REMARK score improved over time (with a range of 6–13/20 vs. 10–18/20, before and after 2005, respectively). KI-67 could be considered as a prognostic biomarker for therapeutic decision. It is assessed with a simple assay that could be standardized. However, international guidelines are needed for routine clinical use.
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Affiliation(s)
- Elisabeth Luporsi
- INSERM, Centre d’Investigations Cliniques-9501, CHU Nancy & Nancy-Université, 54511 Vandoeuvre-les-Nancy, France
| | - Fabrice André
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Frédérique Spyratos
- Laboratory of Oncogenetics, Institut Curie—Hôpital René Huguenin, St-Cloud, France
| | | | | | - Frédérique Penault-Llorca
- Department of Pathology, Centre Jean Perrin and EA 4233, University of Auvergne, Clermont-Ferrand, France
| | | | | | - Laurent Arnould
- Department of Tumour Biology and Pathology, Centre Georges-François Leclerc, Dijon, France
| | - Anne Gompel
- Unit of Gynaecology, Université Paris Descartes, INSERM UMRS 938, Hôtel-Dieu, AP-HP, Paris, France
| | - Caroline Egele
- Département de Pathologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
| | - Bruno Poulet
- Institut de Pathologie de Paris, 49 rue du Ranelagh, 75016 Paris, France
| | - Krishna B. Clough
- Department of Surgery, L’Institut du Sein/Paris Breast Center, Paris, France
| | - Hubert Crouet
- Department of Surgical Oncology, Centre Francois Baclesse, Caen, France
| | - Alain Fourquet
- Department of Oncological Radiotherapy, Institut Curie, Paris, France
| | - Jean-Pierre Lefranc
- Department of Gynaecological and Breast Cancer Surgery, Pitié-Salpêtrière, AP-HP, Paris, France
| | - Carole Mathelin
- Department of Gynaecology & Obstetrics, University Hospital, Strasbourg, France
| | | | - Daniel Serin
- Department of Medical Oncology, Institute Sainte Catherine, Avignon, France
| | - Marc Spielmann
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Margaret Haugh
- MediCom Consult, 39 rue Clément Michut, 69100 Villeurbanne, France
| | - Marie-Pierre Chenard
- Département de Pathologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie—Hôpital René Huguenin, St-Cloud, France
| | | | - Jean-Pierre Bellocq
- Département de Pathologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
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Jacot W, Gutowski M, Azria D, Romieu G. Adjuvant early breast cancer systemic therapies according to daily used technologies. Crit Rev Oncol Hematol 2011; 82:361-9. [PMID: 22024387 DOI: 10.1016/j.critrevonc.2011.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/18/2011] [Accepted: 09/13/2011] [Indexed: 01/04/2023] Open
Abstract
Prognosis of early breast cancer patients is significantly improved with the use of adjuvant therapies. Various guidelines have been proposed to select patients who will derive the most benefit from such treatments. However, classifications have limited usefulness in subsets of patients such as those with node negative breast cancer. The 2007 St. Paul de Vence Clinical Practice Recommendations proposed to consider adjuvant therapy in accordance with the 10-year relapse-free survival reduction estimated by Adjuvant! Online. However, many limitations remain regarding the use of Adjuvant! Online. Among them, adverse prognostic and/or predictive factors such as vascular invasion, mitotic activity, progesterone receptor negativity, and HER-2 expression are not incorporated in the routine clinical decision process. Our group has therefore issued guidelines based on the consideration of both Adjuvant! Online calculations and the prognostic and/or predictive effects of these markers. In addition, web-accessible comprehensive tables summarizing these recommendations are provided.
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Affiliation(s)
- W Jacot
- Val d'Aurelle Comprehensive Cancer Centre, Montpellier, France.
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Osako T, Nishimura R, Okumura Y, Toyozumi Y, Arima N. Predictive significance of the proportion of ER-positive or PgR-positive tumor cells in response to neoadjuvant chemotherapy for operable HER2-negative breast cancer. Exp Ther Med 2011; 3:66-71. [PMID: 22969846 DOI: 10.3892/etm.2011.359] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 08/01/2011] [Indexed: 11/05/2022] Open
Abstract
Estrogen receptor (ER) and progesterone receptor (PgR) status are predictive factors for the clinical and pathological response to neoadjuvant chemotherapy for operable breast cancer. However, it remains unclear as to how the proportion of ER-positive or PgR-positive tumor cells affects the response to neoadjuvant chemotherapy. We examined the correlation of the proportion of ER-positive or PgR-positive tumor cells with the clinical and pathological response to neoadjuvant chemotherapy for operable human epidermal growth factor receptor 2 (HER2)-negative breast cancer. From April 2002 to October 2010, 103 patients received neoadjuvant chemotherapy containing epirubicin and taxane in our clinic. A clinical response was observed in 86 (83%) patients, and a pathological complete response (pCR) was observed in 16 (16%) patients. Fourteen (30%) of 46 patients with ER-negative tumors achieved pCR and 15 (26%) of 57 patients with PgR-negative tumors achieved pCR. Patients with more than 30% ER-positive tumor cells or more than 1% PgR-positive tumor cells did not achieve pCR. No significant correlation was observed between pCR and the menopausal status, tumor size, grade and Ki-67 expression. In univariate analysis, pCR was associated with the ER status (p=0.001), PgR status (p=0.0001) and chemotherapy regimens (p=0.03). Multivariate analysis revealed that ER and PgR status were significant factors for pCR, and patients with ER-negative tumors were 18.6 times more likely to achieve pCR than those with greater than or equal to 30% ER-positive tumor cells (p=0.006; 95% confidence interval 2.3-149.9). We demonstrated a predictive significance of the proportion of ER-positive or PgR-positive tumor cells in the response to neoadjuvant chemotherapy for operable HER2-negative breast cancer. ER-negativity (<1%) was a significant predictive factor for achieving pCR in multivariate analysis. Conversely, patients with more than 30% ER-positive tumor cells or more than 1% PgR-positive tumor cells may not achieve pCR.
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Rossi D, Pistilli B, Morale D, Baldelli, Casadei V, Benedetti G, Alessandroni P, Catalano V, Giordani P, Graziano F, Fedeli SL, Fiorentini G. "Short Course" of Nonpegylated Liposomal Doxorubicin Plus Paclitaxel and Trastuzumb as Primary Systemic Therapy for Operable and Locally-Advanced Breast Cancer: A Phase II Study (PacLiDox 07). World J Oncol 2011; 2:245-251. [PMID: 29147255 PMCID: PMC5649686 DOI: 10.4021/wjon393w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2011] [Indexed: 11/29/2022] Open
Abstract
Background Schedules with anthracyclines and taxanes are one of the best options for primary chemotherapy. The addition of trastuzumab showed an impressive percentage of pathological complete responses in Buzdar trial (66.7%). Recently, nonpegylated liposome-encapsulated doxorubicin (NLD) has been widely used in advanced breast cancer with high response rates (98.1 % in Cortes study). The aims of our study were to assess pathological responses and toxicity of NLD plus paclitaxel (and trastuzumab in patients with HER2 overexpression). Methods Thirty patients entered the study: 9 locally advanced and 21 operable. Median age was 58.5 years (range: 31-73). 23 patients without HER2 overexpression (or FISH not amplified) were treated with NLD 50 mg/m2 every three weeks for 3 courses and weekly paclitaxel 80 mg/m2 for 8 courses. 7 patients with HER2 overexpression or FISH amplified were treated with the same schedules plus trastuzumab (Herceptin) 4 mg/kg for the first administration and 2 mg/kg for the following 7 weekly administrations. Results Pathological complete response (pCR) was documented in 1 patient (treated with trastuzumab); no residual tumor (infiltrating or “in situ”) on breast was documented in other 2 patients. Objective clinical responses were documented in 22 patients (73.3%): 8 complete, 10 partial and 4 “minimal” responses. 7 patients have shown stable and 1 progressive disease. Clinical response in patients with HER2 overexpression treated with trastuzumab was 100% (4 complete and 3 partial responses). Conservative surgery was performed in 8 (38%) and mastectomy in 13 (62%) out of 21 operable patients; however, 7 out of 14 responding patients with operable disease underwent quadrantectomy (50%). Main toxicity was neutropenia: febrile in 2 patients (7%) and gr. 3-4 in 13 (43%). Other grade 3 toxicities were as follows: vomiting in 1 patient, asthenia in 1 patient, joint symptom in 1 patient. 3 patients were withdrawn from the study. No episodes of left ventricular ejection fraction (LVEF) < 50% were recorded (with a median reduction of 8%). Conclusions A “short course” of paclitaxel and NLD is active in terms of clinical response and conservative surgery for patients with potentially operable and locally advanced breast cancer; toxicity was manageable. High activity of the combination with trastuzumab has been confirmed. However, with this “short course” schedule, the result in term of clinical responses didn't turn into complete pathological responses.
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Affiliation(s)
- D Rossi
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - B Pistilli
- Oncolgy Unit, Macerata General Hospital, Italy
| | - D Morale
- Oncology Unit, Ascoli Piceno General Hospital, Italy
| | - Baldelli
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - V Casadei
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - G Benedetti
- Oncolgy Unit, Macerata General Hospital, Italy
| | - P Alessandroni
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - V Catalano
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - P Giordani
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - F Graziano
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - S Luzi Fedeli
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - G Fiorentini
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
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50
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Montemurro F, Rossi V, Cossu Rocca M, Martinello R, Verri E, Redana S, Adamoli L, Valabrega G, Sapino A, Aglietta M, Viale G, Goldhirsch A, Nolè F. Hormone-receptor expression and activity of trastuzumab with chemotherapy in HER2-positive advanced breast cancer patients. Cancer 2011; 118:17-26. [DOI: 10.1002/cncr.26162] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/09/2011] [Accepted: 03/07/2011] [Indexed: 01/24/2023]
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