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Amar ID, Franceschini G, Nero C, Pasqua I, Paris I, Orlandi A, Gori S, Fabi A, Garganese G, Scambia G, Villa P. Preventing Bone Loss in Breast Cancer Patients: Designing a Personalized Clinical Pathway in a Large-Volume Research Hospital. J Pers Med 2024; 14:371. [PMID: 38672998 PMCID: PMC11051440 DOI: 10.3390/jpm14040371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND We assess the impact of bone health clinical management in breast cancer (BC) patients receiving adjuvant endocrine therapy and design a personalized clinical pathway to reduce bone loss in an Italian research hospital. METHODS The primary endpoint was to assess (through the process improvement organizational method) the clinical pathway that post-surgical BC patients prescribed with endocrine therapy undergo to prevent bone loss. The secondary endpoint was to design a personalized clinical pathway for a prompt implementation of guidelines, to assess and possibly prescribe antiresorptive therapy. RESULTS During the first year of the execution of the new Diagnostic Therapeutic Assistance Pathway, a 60% increase in Dual-Energy X-ray Absorptiometry evaluations within 30 days and a 39.5% increase in antiresorptive therapy prescription within 90 days (since the prescription of endocrine therapy) were shown, thus increasing patients' compliance. CONCLUSION Case managers and bone health specialists in this context can improve patients' adherence to therapies and bone health, helping physicians to expand their collaboration.
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Affiliation(s)
- Inbal Dona Amar
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Gianluca Franceschini
- Onco-Plastic Surgery Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Camilla Nero
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Ilaria Pasqua
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Ida Paris
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Armando Orlandi
- Medical Oncology Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Stefania Gori
- Medical Oncology Unit, Department of Oncology, IRCCS Sacro Cuore “Don Calabria”, 37024 Negrar, Italy;
- Rete Oncologica Pazienti Italia (ROPI), 20121 Milan, Italy
- Associazione Italiana di Oncologia Medica (AIOM), 20133 Milan, Italy
| | - Alessandra Fabi
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Associazione Italiana di Oncologia Medica (AIOM), 20133 Milan, Italy
| | - Giorgia Garganese
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Paola Villa
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
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Hellinger JW, Schömel F, Buse JV, Lenz C, Bauerschmitz G, Emons G, Gründker C. Identification of drivers of breast cancer invasion by secretome analysis: insight into CTGF signaling. Sci Rep 2020; 10:17889. [PMID: 33087801 PMCID: PMC7578015 DOI: 10.1038/s41598-020-74838-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
An altered consistency of tumor microenvironment facilitates the progression of the tumor towards metastasis. Here we combine data from secretome and proteome analysis using mass spectrometry with microarray data from mesenchymal transformed breast cancer cells (MCF-7-EMT) to elucidate the drivers of epithelial-mesenchymal transition (EMT) and cell invasion. Suppression of connective tissue growth factor (CTGF) reduced invasion in 2D and 3D invasion assays and expression of transforming growth factor-beta-induced protein ig-h3 (TGFBI), Zinc finger E-box-binding homeobox 1 (ZEB1) and lysyl oxidase (LOX), while the adhesion of cell-extracellular matrix (ECM) in mesenchymal transformed breast cancer cells is increased. In contrast, an enhanced expression of CTGF leads to an increased 3D invasion, expression of fibronectin 1 (FN1), secreted protein acidic and cysteine rich (SPARC) and CD44 and a reduced cell ECM adhesion. Gonadotropin-releasing hormone (GnRH) agonist Triptorelin reduces CTGF expression in a Ras homolog family member A (RhoA)-dependent manner. Our results suggest that CTGF drives breast cancer cell invasion in vitro and therefore could be an attractive therapeutic target for drug development to prevent the spread of breast cancer.
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Affiliation(s)
- Johanna W Hellinger
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Franziska Schömel
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Judith V Buse
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Christof Lenz
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Bauerschmitz
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Günter Emons
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Carsten Gründker
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Systemic treatment of patients with early breast cancer: recent updates and state of the art. Breast 2020; 48 Suppl 1:S7-S20. [PMID: 31839166 DOI: 10.1016/s0960-9776(19)31115-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review is focused on trials generating results that potentially impacted clinical practice since the 2017 St. Gallen Consensus; the most impactful trial was KATHERINE, which revealed a 11.3% absolute iDFS improvement with T-DM1 (compared to trastuzumab) in HER2-positive breast cancer patients who presented invasive residual disease following neoadjuvant treatment. These results, if reinforced by a subsequent overall survival benefit, will consolidate neoadjuvant treatment as the standard-of-care for most HER2-positive breast cancer patients. The addition of pertuzumab to adjuvant trastuzumab (APHINITY) or extending anti-HER2 therapy with 1 year of neratinib (ExteNET) also improved outcomes, but in a more modest way. In triple-negative early breast cancer patients presenting invasive residual disease after neoadjuvant chemotherapy, the CREATE-X trial demonstrated the benefit of post-neoadjuvant capecitabine. In patients with luminal tumours, updated results of the SOFT/TEXT trials confirmed the benefit of aromatase inhibitors plus ovarian suppression in high-risk premenopausal patients, and the 12-year results of the BIG1-98 trial demonstrated a sustained trend in favour of letrozole compared to tamoxifen in the adjuvant treatment of postmenopausal patients. The TAILOR-X study showed that, overall, patients with an intermediate recurrence risk score (11-25) in the OncotypeDX 21-gene assay did not benefit from adjuvant chemotherapy. A meta-analysis performed by the EBCTCG demonstrated that extended adjuvant aromatase inhibitors modestly reduced breast cancer recurrence risks, with a more pronounced benefit in patients previously treated with tamoxifen. Finally, an EBCTCG meta-analysis including patients with all breast cancer subtypes showed that dose-dense chemotherapy improved survival when compared to conventionally-timed chemotherapy.
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Recine F, Bongiovanni A, Foca F, Mercatali L, Fausti V, Calpona S, Riva N, De Vita A, Liverani C, Spadazzi C, Miserocchi G, Di Menna G, Gurrieri L, Cocchi C, Debonis SA, Vespignani R, Ibrahim T. BOne HEalth ManagEment in Patients with Early Breast Cancer: A Retrospective Italian Osteoncology Center "Real-Life" Experience (BOHEME Study). J Clin Med 2019; 8:jcm8111894. [PMID: 31698876 PMCID: PMC6912302 DOI: 10.3390/jcm8111894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background: We assessed the real-life clinical impact of bone health management in patients with breast cancer (BC) receiving adjuvant endocrine therapy at an Italian Osteoncology Center. Methods: Pre- and post-menopausal women undergoing adjuvant endocrine therapy for early-stage BC who came to our institute for their first bone health evaluation from January 2011 to June 2016 were considered in this retrospective observational study. Results: 1125 pre- and post-menopausal early-stage BC patients (209 and 916, respectively) were evaluated. Median age was 61 years (range 26–88). In the pre-menopausal group, spinal x-ray revealed that 10 patients (4.7%) had a morphometric vertebral fracture. Higher age (OR: 1.14; 95% CI: 1.01–1.29) and bone mineral density (BMD) ≤ −2.5 (OR: 14.45; 95% CI: 1.70–122.67) were associated with a higher risk of bone fracture. The overall frequency of bone fracture was 17.6% (n = 161) in post-menopausal patients and a lower risk for bone fractures was associated with tamoxifen or other treatments (OR: 0.25; 95% CI: 0.12–0.53), presence of back pain (OR: 1.65; 95% CI: 1.16–2.36), lower BMD (OR: 2.09 in patients with T-score ≤ 2.5; 95% CI: 1.21–3.59) and lower vitamin D levels (OR: 1.57 in patients with ≤ 10 ng/mL; 95% CI: 1.05–2.34) in univariate analysis. Conclusion: Our findings confirm that bone health management should be an integral part of long-term cancer care.
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Affiliation(s)
- Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
- Correspondence: ; Tel.: +39-0543-739140; Fax: +39-0543-739151
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Sebastiano Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Alessandro De Vita
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Giandomenico Di Menna
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Lorena Gurrieri
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Claudia Cocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Silvia Angela Debonis
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Roberto Vespignani
- IT Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
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Conforti F, Pala L. Exemestane Plus Ovarian Function Suppression Is the Best Adjuvant Treatment of Premenopausal Women With Endocrine-Responsive Breast Cancer at Higher Risk of Relapse and With HER2-Negative Tumors. J Clin Oncol 2019; 37:1838-1840. [PMID: 31173554 DOI: 10.1200/jco.19.00559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fabio Conforti
- Fabio Conforti, MD and Laura Pala, MD, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laura Pala
- Fabio Conforti, MD and Laura Pala, MD, European Institute of Oncology, IRCCS, Milan, Italy
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Lambertini M, Demeestere I, Viglietti G, de Azambuja E. Oncofertility counselling in premenopausal women with HER2-positive breast cancer. Oncotarget 2019; 10:926-929. [PMID: 30847021 PMCID: PMC6398182 DOI: 10.18632/oncotarget.26565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/31/2022] Open
Abstract
A complete oncofertility counselling should be offered to all premenopausal patients before the administration of anticancer treatments. This important discussion is a crucial step for allowing them to take fully informed decisions about the proposed therapy and its potential long-term consequences as well as on their need and interest of accessing the available strategies for ovarian function and/or fertility preservation. In premenopausal women with HER2-positive early breast cancer, limited evidence exists to counsel them about the potential added gonadotoxicity of targeted agents beyond the damage already caused by chemotherapy. In addition, the prognostic role of treatment-induced amenorrhea in this setting was unknown. In our exploratory analysis within the ALTTO (BIG 2-06) trial, we have recently described the rates of treatment-induced amenorrhea after chemotherapy plus trastuzumab and/or lapatinib and the prognostic value of developing this side effect according to the hormone receptor status of their tumours. We observed similar rates of treatment-induced amenorrhea in the four anti-HER2 treatment arms. The lack of an increased rate of treatment-induced amenorrhea in the dual anti-HER2 blockade arm suggests the possible gonadal safety of these agents. In addition, women with HER2-positive/hormone receptor-positive tumours showed significantly better survival outcomes if they developed treatment-induced amenorrhea, while no difference was observed for those with HER2-positive/hormone receptor-negative disease. Future research efforts are needed to address the gonadotoxicity of the new available targeted agents as well as to elucidate which is the best adjuvant endocrine therapy in premenopausal women with HER2-positive/hormone receptor-positive disease.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium.,Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Viglietti
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
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