Locally advanced breast cancer

Evaluation of early cardiotoxicity in HER2-positive breast cancer patients receiving radiotherapy and concurrent trastuzumab

BACKGROUND

Overexpression of human epidermal growth factor receptor 2 (HER-2) is associated with aggressive disease in breast cancer. Trastuzumab and radiotherapy are standard treatments for patients with HER-2 + breast cancer, but they may increase the risk of cardiotoxicity.

AIM

This study aimed to assess early cardiotoxicity in patients receiving radiotherapy (RT) and concurrent trastuzumab.

METHOD

The study included 116 patients with HER-2 + breast cancer who received concurrent treatment with trastuzumab and RT (52 right-side; 64 left-side). Five left ventricular ejection fraction (LVEF) measurements were performed: one before treatment and four subsequent measurements taken at three-month intervals. LVEF was also assessed before (preRT-EF) and after (postRT-EF) radiotherapy.

RESULTS

The baseline LVEF was 62.27 ± 5.5%, while the 12-month LVEF was 59.8 ± 5.8% (p < 0.05). In subgroups, post-RT LVEF values ​​were significantly lower than pre-RT LVEF values (p < 0.05). No significant difference was found between the reduction in LVEF for patients receiving 50 Gy and 60 Gy doses. Moreover, the contribution of regional lymph node irradiation to the decrease in LVEF could not be demonstrated. A positive correlation was found between the total trastuzumab dose and the decrease in LVEF from preRT to postRT. Additionally, a positive correlation was observed between the total taxane dose and the reduction in LVEF from baseline to 9 months, both in the overall group and in the left breast cancer group.

CONCLUSION

In our study,it was found that not only trastuzumab but also taxane-based agents could be cardiotoxic. However, no connection was found between RT doses and the decrease in LVEF.

Pre-operative systemic therapy in locally advanced breast cancer: a single institution experience

BACKGROUND

Locally advanced breast cancer (LABC) is common in developing countries and it frequently affects younger women. Patients do very poorly when treated by locoregional therapy alone; therefore, pre-operative systemic therapy (PST) is commonly used.

MATERIALS AND METHODS

Medical records of 64 Saudi patients with LABC treated with PST in a single institution were retrospectively reviewed.

RESULTS

At diagnosis, most patients were young (median age 41 years), and had poor clinicopathological characteristics. Following surgery, complete pathologic response (pCR) in the breast was achieved in 13 patients (20%). Of 62 patients with known nodal status, 22 (34%) had negative axillary nodes. Presence of oestrogen receptor (ER) negative tumour was the only dependent variable that predicted pCR in the breast (p = 0.03). At a median follow-up of 42 months, the median progression-free survival (PFS) was 48 months (95% CI, 20-76 months) and the projected five-year overall survival (OS) was 68%. The recently published scoring system (Jeruss et al (2008) J Clin Oncol26 2 246-52), was the only variable that independently influenced PFS, while ER negative tumours and presence of lymphovascular space invasion were the only factors that adversely affected OS.

CONCLUSIONS

despite the use of standard multi-modality approach in the management of patients with LABC, prognosis remains guarded.