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Cummins DD, Garcia JH, Nguyen MP, Saggi S, Chung JE, Goldschmidt E, Berger MS, Theodosopoulos PV, Chang EF, Daras M, Hervey-Jumper SL, Aghi MK, Morshed RA. Association of CDKN2A alterations with increased postoperative seizure risk after resection of brain metastases. Neurosurg Focus 2023; 55:E14. [PMID: 37527678 PMCID: PMC11128027 DOI: 10.3171/2023.5.focus23133] [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: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Seizures are common and significantly disabling for patients with brain metastases (BMs). Although resection can provide seizure control, a subset of patients with BMs may continue to suffer seizures postoperatively. Genomic BM characteristics may influence which patients are at risk for postoperative seizures. This work explores correlations between genomic alterations and risk of postoperative seizures following BM resection. METHODS All patients underwent BM resection at a single institution, with available clinical and sequencing data on more than 500 oncogenes. Clinical seizures were documented pre- and postoperatively. A random forest machine learning classification was used to determine candidate genomic alterations associated with postoperative seizures, and clinical and top genomic variables were correlated with postoperative seizures by using Cox proportional hazards models. RESULTS There were 112 patients with BMs who underwent 114 surgeries and had at least 1 month of postoperative follow-up. Seizures occurred preoperatively in 26 (22.8%) patients and postoperatively in 25 (21.9%). The Engel classification achieved at 6 months for those with preoperative seizures was class I in 13 (50%); class II in 6 (23.1%); class III in 5 (19.2%), and class IV in 2 (7.7%). In those with postoperative seizures, only 8 (32.0%) had seizures preoperatively, and preoperative seizures were not a significant predictor of postoperative seizures (HR 1.84; 95% CI 0.79-4.37; p = 0.156). On random forest classification and multivariate Cox analysis controlling for factors including recurrence, extent of resection, and number of BMs, CDKN2A alterations were associated with postoperative seizures (HR 3.22; 95% CI 1.27-8.16; p = 0.014). Melanoma BMs were associated with higher risk of postoperative seizures compared with all other primary malignancies (HR 5.23; 95% CI 1.37-19.98; p = 0.016). Of 39 BMs with CDKN2A alteration, 35.9% (14/39) had postoperative seizures, compared to 14.7% (11/75) without CDKN2A alteration. The overall rate of postoperative seizures in melanoma BMs was 42.9% (15/35), compared with 12.7% (10/79) for all other primary malignancies. CONCLUSIONS CDKN2A alterations and melanoma primary malignancy are associated with increased postoperative seizure risk following resection of BMs. These results may help guide postoperative seizure prophylaxis in patients undergoing resection of BMs.
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Affiliation(s)
- Daniel D. Cummins
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Joseph H. Garcia
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Minh P. Nguyen
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Satvir Saggi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jason E. Chung
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Ezequiel Goldschmidt
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Mariza Daras
- Department of Neurological Surgery, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | | | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Ramin A. Morshed
- Department of Neurological Surgery, University of California, San Francisco, California
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Cheng X, Huang Z, Pan A, Long D. ORLNC1 Suppresses Cell Growth in HER2-Positive Breast Cancer via miRNA-296 Sponging. Curr Mol Med 2023; 23:289-299. [PMID: 35658886 DOI: 10.2174/1566524022666220603113550] [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: 02/23/2022] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Accumulating research has demonstrated that aberrant levels of long noncoding RNAs (LncRNAs) are related to cancer progression. The effects of ORLNC1 in HER2+ breast cancer have yet to be explored. METHODS Real-time PCR was used to examine the expression of LncRNA ORLNC1 in HER+ breast cancer. CCK-8, wound healing and cell invasion assays were used to examine the effect of LncRNA ORLNC1 on HER+ breast cancer cells. Luciferase reporter assay was utilized to determine the regulatory relationship between LncRNA ORLNC1 and miR-296. Western blotting was used to measure the expression of PTEN. Xenograft mouse model was used to examine the effect of LncRNA ORLNC1 on tumor progression in vivo. RESULTS In this study, our findings revealed downregulation of ORLNC1 in HER2+ breast cancer specimens and cell lines. Low levels of ORLNC1 were related to poor prognosis and advanced cancer stage. Using gain- and loss-of-function assays, the ability of these tumor cells to proliferate was found to be inhibited by ORLNC1 in vitro and in vivo. Further analyses revealed that miR-296/PTEN axis is directly targeted by ORLNC1. Consequently, over-expression of miR-296 efficiently abrogated the upregulation of PTEN induced by ORLNC1, suggesting that ORLNC1 positively regulates PTEN expression by competitively binding to miR-296. CONCLUSION Our results indicate that lncRNA ORLNC1 acts as a tumor suppressor by regulating the miR-296/PTEN axis in HER2+ breast cancer.
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Affiliation(s)
- Xueyuan Cheng
- Department of General Surgery, Beihai People's Hospital, Beihai, Guangxi, 536000, China
| | - Zhong Huang
- Department of General Surgery, Beihai People's Hospital, Beihai, Guangxi, 536000, China
| | - Anchao Pan
- Department of Gastrointestinal Surgery, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
| | - Di Long
- Department of Gastrointestinal Surgery, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, China
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Batista MFFV, Eiriz I, Fitzpatrick A, Le Du F, Braga S, Alpuim Costa D. Refining Therapy in Patients with HER2-Positive Breast Cancer with Central Nervous System Metastasis. Breast Care (Basel) 2022; 17:524-532. [PMID: 36590149 PMCID: PMC9801402 DOI: 10.1159/000526431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background Brain metastasis (BM) is a major clinical problem in metastatic breast cancer (MBC), occurring in 50% of patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Historically omitted from clinical trials, recent studies of novel HER2-targeted agents have focused on HER2+ BM patients, addressing stable but also progressing BM and leptomeningeal carcinomatosis (LMC). Summary This review aimed to summarize the most relevant data on treating patients with HER2+ BM and LMC. Key Messages The treatment paradigm for patients with HER2+ MBC has changed. Local therapies play an important role, but accumulating evidence on the intracranial activity and clinical benefit of anti-HER2 targeting therapies might lead to a shift in the paradigm on treating BM in the next few years towards more widespread use of systemic therapy.
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Affiliation(s)
| | - Inês Eiriz
- Oncology Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
| | - Amanda Fitzpatrick
- Oncology Department, Guy's and St Thomas' Hospital, London, UK
- Oncology Department, The Institute of Cancer Research, London, UK
| | - Fanny Le Du
- Oncology Department, CRLCC Eugène Marquis, Rennes, France
| | - Sofia Braga
- Oncology Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal
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Erythroblastic oncogene B-2 status and intracranial metastatic disease in patients with gastrointestinal cancer: a systematic review. J Neurooncol 2022; 160:735-742. [PMID: 36372832 DOI: 10.1007/s11060-022-04195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE The incidence of intracranial metastatic disease (IMD) in patients with gastrointestinal (GI) cancers is rising. Expression of the erythroblastic oncogene B-2 (ERBB2) is associated with an in increased risk of IMD in patients with breast cancer. The implications of ERBB2 expression for IMD risk in patients with GI cancers is less clear. The objective of this systematic review was to determine the incidence of IMD and OS in patients with ERBB2+ gastrointestinal cancers. METHODS A literature search of MEDLINE, EMBASE, CENTRAL, and grey literature sources was conducted from date of database inception to July 2021. Included studies reported outcomes on patients with IMD secondary to ERBB2 GI cancers. RESULTS Fourteen cohort studies met inclusion criteria, of which thirteen were retrospective. Eleven studies reported on gastric, esophageal, or gastroesophageal junction cancers. Three studies directly compared incidence of IMD based on ERBB2 status and among these, ERBB2+ patients had a higher incidence of IMD. One study indicated that ERBB2+ patients had significantly longer OS from the times of primary cancer (P = .015) and IMD diagnosis (P = .01), compared with patients with ERBB2- disease. CONCLUSIONS In this systematic review, patients with ERBB2+ GI cancer were more likely to develop IMD. Future study is required on the prognostic and predictive value of ERBB2 status in patients with GI cancers.
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Omidi Y, Mobasher M, Castejon A, Mahmoudi M. Recent advances in nanoscale targeted therapy of HER2-positive breast cancer. J Drug Target 2022; 30:687-708. [PMID: 35321601 DOI: 10.1080/1061186x.2022.2055045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Breast cancer is the second leading cause of death among women with high mortality rates worldwide. The exceptionally fast rate of metastasis, the emergence of drug-resistant mechanisms, and the occurrence of inadvertent side effects by cytotoxic chemotherapies often make conventional chemotherapy and immunotherapy treatments ineffective. Similar to other solid tumors, breast cancer can develop unique cellular and molecular characteristics forming an atypical permissive tumor microenvironment (TME). Due to the unique features of TME, cancer cells can further proliferate and coadapt with the stromal cells and evade immunosurveillance. aberrantly abundantly express various pieces of molecular machinery (the so-called oncomarkers) in favor of their survival, progression, metastasis, and further invasion. Such overexpressed oncomarkers can be exploited in the targeted therapy of cancer. Among breast cancer oncomarkers, epidermal growth factor receptors, particularly HER2, are considered as clinically valid molecular targets not only for the thorough diagnosis but also for the targeted therapy of the disease using different conventional and advanced nanoscale treatment modalities. This review aims to elaborate on the recent advances in the targeted therapy of HER2-positive breast cancer, and discuss various types of multifunctional nanomedicines/theranostics, and antibody-/aptamer-drug conjugates.
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Affiliation(s)
- Yadollah Omidi
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Maha Mobasher
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Ana Castejon
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Morteza Mahmoudi
- Department of Radiology, College of Medicine, Michigan State University, East Lansing, Michigan, USA
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Intracranial Response Rate in Patients with Breast Cancer Brain Metastases after Systemic Therapy. Cancers (Basel) 2022; 14:cancers14040965. [PMID: 35205723 PMCID: PMC8869862 DOI: 10.3390/cancers14040965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary For many years, patients with breast cancer and brain metastases were excluded from participation in clinical trials. It was believed that anticancer drugs could not cross the blood–brain barrier. However, recent evidence strongly suggests that some drugs can act against brain metastases, with the greatest intracranial response rate reported in the case of capecitabine, neratinib plus capecitabine, trastuzumab deruxtecan and tucatinib plus trastuzumab and capecitabine. In this article, we discuss the achievements in systemic therapy of breast cancer patients with brain metastases. We stress on the newest clinical trial results which indicate tremendous progress in HER2-positive breast cancer. On the other hand, in patients with triple-negative breast cancer or hormone-receptor-positive brain metastases, much fewer compounds were discovered. Based on the presented results, patients with active brain metastases should be routinely included in clinical trials with novel agents. Abstract Brain metastases are detected in 5% of patients with breast cancer at diagnosis. The rate of brain metastases is higher in HER2-positive and triple-negative breast cancer patients (TNBC). In patients with metastatic breast cancer, the risk of brain metastases is much higher, with up to 50% of the patients having two aggressive biological breast cancer subtypes. The prognosis for such patients is poor. Until recently, little was known about the response to systemic therapy in brain metastases. The number of trials dedicated to breast cancer with brain metastases was scarce. Our review summarizes the current knowledge on this topic including very significant results of clinical trials which have been presented very recently. We focus on the intracranial response rate of modern drugs, including new antibody–drug conjugates, HER2- targeted tyrosine kinase inhibitors and other targeted therapies. We highlight the most effective and promising drugs. On the other hand, we also suggest that further efforts are needed to improve the prognosis, especially patients with TNBC and brain metastases. The information contained in this article can help oncologists make treatment-related decisions.
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Umemneku-Chikere CM, Ayodele O, Soares M, Khan S, Abrams K, Owen R, Bujkiewicz S. Comparative review of pharmacological therapies in individuals with HER2-positive advanced breast cancer with focus on hormone receptor subgroups. Front Oncol 2022; 12:943154. [PMID: 36059633 PMCID: PMC9433866 DOI: 10.3389/fonc.2022.943154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Breast cancer is the fifth leading cause of cancer-related deaths worldwide. The randomized controlled trials (RCTs) of targeted therapies in human epidermal receptor 2 (HER2)-positive advanced breast cancer (ABC) have provided an evidence base for regulatory and reimbursement agencies to appraise the use of cancer therapies in clinical practice. However, a subset of these patients harbor additional biomarkers, for example, a positive hormone receptor status that may be more amenable to therapy and improve overall survival (OS). This review seeks to explore the reporting of evidence for treatment effects by the hormone receptor status using the RCT evidence of targeted therapies for HER2-positive ABC patients. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed to identify published RCTs. Extracted data were synthesized using network meta-analysis to obtain the relative effects of HER2-positive-targeted therapies. We identified a gap in the reporting of the effectiveness of therapies by the hormone receptor status as only 15 out of 42 identified RCTs reported hormone receptor subgroup analyses; the majority of which reported progression-free survival but not OS or the overall response rate. In conclusion, we recommend that future trials in ABC should report the effect of cancer therapies in hormone receptor subgroups for all outcomes.
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Affiliation(s)
| | - Olubukola Ayodele
- University Hospital Leicester National Health Service (NHS) Trust, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Marta Soares
- Centre for Health Economics, University of York, York, United Kingdom
| | - Sam Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Keith Abrams
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Rhiannon Owen
- Medical School, Swansea University, Swansea, United Kingdom
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Dai MS, Feng YH, Chen SW, Masuda N, Yau T, Chen ST, Lu YS, Yap YS, Ang PCS, Chu SC, Kwong A, Lee KS, Ow S, Kim SB, Lin J, Chung HC, Ngan R, Kok VC, Rau KM, Sangai T, Ng TY, Tseng LM, Bryce R, Bebchuk J, Chen MC, Hou MF. Analysis of the pan-Asian subgroup of patients in the NALA Trial: a randomized phase III NALA Trial comparing neratinib+capecitabine (N+C) vs lapatinib+capecitabine (L+C) in patients with HER2+metastatic breast cancer (mBC) previously treated with two or more HER2-directed regimens. Breast Cancer Res Treat 2021; 189:665-676. [PMID: 34553296 PMCID: PMC8505315 DOI: 10.1007/s10549-021-06313-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Neratinib, an irreversible pan-HER tyrosine kinase inhibitor, has demonstrated systemic efficacy and intracranial activity in various stages of HER2+breast cancer. NALA was a phase III randomized trial that assessed the efficacy and safety of neratinib+capecitabine (N+C) against lapatinib+capecitabine (L+C) in HER2+ metastatic breast cancer (mBC) patients who had received ≥ 2 HER2-directed regimens. Descriptive analysis results of the Asian subgroup in the NALA study are reported herein. METHODS 621 centrally assessed HER2+ mBC patients were enrolled, 202 of whom were Asian. Those with stable, asymptomatic brain metastases (BM) were eligible for study entry. Patients were randomized 1:1 to N (240 mg qd) + C (750 mg/m2 bid, day 1-14) with loperamide prophylaxis or to L (1250 mg qd) + C (1000 mg/m2 bid, day 1-14) in 21-day cycles. Co-primary endpoints were centrally assessed progression-free survival (PFS) and overall survival (OS). Secondary endpoints included time to intervention for central nervous system (CNS) disease, objective response rate, duration of response (DoR), clinical benefit rate, and safety. RESULTS 104 and 98 Asian patients were randomly assigned to receive N+C or L+C, respectively. Median PFS of N+C and L+C was 7.0 and 5.4 months (P = 0.0011), respectively. Overall cumulative incidence of intervention for CNS disease was lower with N+C (27.9 versus 33.8%; P = 0.039). Both median OS (23.8 versus 18.7 months; P = 0.185) and DoR (11.1 versus 4.2 months; P < 0.0001) were extended with N+C, compared to L+C. The incidences of grade 3/4 treatment emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation were mostly comparable between the two arms. Diarrhea and palmar-plantar erythrodysesthesia were the most frequent TEAEs in both arms, similar to the overall population in incidence and severity. CONCLUSION Consistent with the efficacy profile observed in the overall study population, Asian patients with HER2+ mBC, who had received ≥ 2 HER2-directed regimens, may also benefit from N+C. No new safety signals were noted. CLINICAL TRIAL REGISTRATION NCT01808573.
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Affiliation(s)
- Ming Shen Dai
- Department of Hematology-Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yin Hsun Feng
- Department of Hematology-Oncology, Chi Mei Medical Center-Yongkang Branch, Tainan, Taiwan
| | - Shang Wen Chen
- Department of Hematology-Oncology, Chi Mei Medical Center-LiouYing Branch, Tainan, Taiwan
| | - Norikazu Masuda
- Department of Surgery and Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Thomas Yau
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shou Tung Chen
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen Shen Lu
- Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Peter C S Ang
- Department of Medical Oncology, OncoCare Cancer Centre, Singapore, Singapore
| | - Sung Chao Chu
- Department of Hematology-Oncology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang-si, South Korea
| | - Samuel Ow
- Department of Haematology and Oncology, National University Cancer Institute, Singapore, Singapore
| | - Sung Bae Kim
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - Johnson Lin
- Department of Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hyun Cheol Chung
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Roger Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
| | - Kun Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ling Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Judith Bebchuk
- Department of Biostatistics, Puma Biotechnology Inc., Los Angeles, USA
| | - Mei Chieh Chen
- Clinical Development and Medical Affairs, CANbridge Pharmaceuticals Inc., Taipei, Taiwan
| | - Ming Feng Hou
- Division of Breast Oncology and Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.
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