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Zhou J, Mo H, Hu D, Zhao X, Zhou H, Pan J. Association of ctDNA detection and recurrence assessment in patients with neoadjuvant treatment. Cancer Med 2023; 12:19794-19806. [PMID: 37746916 PMCID: PMC10587978 DOI: 10.1002/cam4.6544] [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: 05/12/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The utilization of neoadjuvant therapy is progressively expanding in various clinical settings. However, the absence of a clinically validated biomarker to evaluate the treatment response remains a significant challenge in the field. Circulating tumor DNA (ctDNA) detection, a novel and emerging monitoring approach in the field of oncology, holds promise as a potential prognostic biomarker for patients with cancer. This meta-analysis investigated the clinical significance of ctDNA detection as a predictive tool for cancer recurrence in patients receiving neoadjuvant treatment. METHODS A comprehensive systematic literature search was conducted using public databases to identify relevant studies that investigated the association between ctDNA detection and cancer recurrence in patients receiving neoadjuvant treatment. Hazard ratios (HRs) and their corresponding 95% confidence intervals (95% CI) were calculated to assess the relationship between cancer recurrence and relevant factors. Cancer recurrence was considered the primary outcome. RESULTS A total of 23 studies encompassing 1590 patients across eight different cancer types were included in the final analysis. Positive ctDNA detection was significantly associated with higher cancer recurrence, especially at post-neoadjuvant treatment and post-surgery time points. The risk values for the different cancer categories and geographic areas also differed significantly. CONCLUSION Our comprehensive meta-analysis revealed a significant positive correlation between ctDNA detection and a higher risk of cancer recurrence in patients receiving neoadjuvant treatment. In addition, the risk of recurrence was influenced by variations in cancer type, timing of detection, and geographic region. These findings highlight the promising clinical applicability of ctDNA as a prognostic marker and monitoring approach for patients with cancer. However, the precise mechanism is unknown and more evidence is needed for further research.
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Affiliation(s)
- Jiaxin Zhou
- General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- International School, Jinan University, Guangzhou, China
| | - Haocong Mo
- Department of Physiology, School of Medicine, Jinan University, Guangzhou, China
| | - Dahai Hu
- General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaoxu Zhao
- General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Jinan University, Heyuan, China
| | - Hong Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jinghua Pan
- General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Neoadjuvant Chemotherapy in Synchronous Bilateral Breast Cancer With Different HER2 Types. Am J Ther 2021; 28:e769-e772. [PMID: 34757968 DOI: 10.1097/mjt.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Turkistani S, Sugita BM, Fadda P, Marchi R, Afsari A, Naab T, Apprey V, Copeland RL, Campbell MC, Cavalli LR, Kanaan Y. A panel of miRNAs as prognostic markers for African-American patients with triple negative breast cancer. BMC Cancer 2021; 21:861. [PMID: 34315420 PMCID: PMC8317413 DOI: 10.1186/s12885-021-08573-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To investigate the global expression profile of miRNAs, their impact on cellular signaling pathways, and their association with poor prognostic parameters in African-American (AA) patients with triple negative breast cancer (TNBC). METHODS Twenty-five samples of AA TNBC patients were profiled for global miRNA expression and stratified considering three clinical-pathological parameters: tumor size, lymph node (LN), and recurrence (REC) status. Differential miRNA expression analysis was performed for each parameter, and their discriminatory power was determined by Receiver Operating Characteristic (ROC) curve analysis. KMplotter was assessed to determine the association of the miRNAs with survival, and functional enrichment analysis to determine the main affected pathways and miRNA/mRNA target interactions. RESULTS A panel of eight, 23 and 27 miRNAs were associated with tumor size, LN, and REC status, respectively. Combined ROC analysis of two (miR-2117, and miR-378c), seven (let-7f-5p, miR-1255b-5p, miR-1268b, miR-200c-3p, miR-520d, miR-527, and miR-518a-5p), and three (miR-1200, miR-1249-3p, and miR-1271-3p) miRNAs showed a robust discriminatory power based on tumor size (AUC = 0.917), LN (AUC = 0.945) and REC (AUC = 0.981) status, respectively. Enrichment pathway analysis revealed their involvement in proteoglycans and glycan and cancer-associated pathways. Eight miRNAs with deregulated expressions in patients with large tumor size, positive LN metastasis, and recurrence were significantly associated with lower survival rates. Finally, the construction of miRNA/mRNA networks based in experimentally validated mRNA targets, revealed nodes of critical cancer genes, such as AKT1, BCL2, CDKN1A, EZR and PTEN. CONCLUSIONS Altogether, our data indicate that miRNA deregulated expression is a relevant biological factor that can be associated with the poor prognosis in TNBC of AA patients, by conferring to their TNBC cells aggressive phenotypes that are reflected in the clinical characteristics evaluated in this study.
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Affiliation(s)
- Safaa Turkistani
- grid.257127.40000 0001 0547 4545Department of Microbiology, Howard University Cancer Center, Howard University, Washington DC, USA
| | - Bruna M. Sugita
- Research Institute Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, PR Brazil
| | - Paolo Fadda
- grid.261331.40000 0001 2285 7943Genomics Shared Resource, Comprehensive Cancer Center, The Ohio State University, Columbus, OH USA
| | - Rafael Marchi
- Research Institute Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, PR Brazil
| | - Ali Afsari
- grid.411399.70000 0004 0427 2775Department of Pathology, Howard University Hospital, Washington DC, USA
| | - Tammey Naab
- grid.411399.70000 0004 0427 2775Department of Pathology, Howard University Hospital, Washington DC, USA
| | - Victor Apprey
- grid.257127.40000 0001 0547 4545Department of Community and Family Medicine, Howard University, Washington DC, USA
| | - Robert L. Copeland
- grid.257127.40000 0001 0547 4545Department of Pharmacology, College of Medicine and Cancer Center, Howard University, Washington DC, USA
| | - Michael C. Campbell
- grid.257127.40000 0001 0547 4545Department of Biology, Howard University, Washington DC, USA
| | - Luciane R. Cavalli
- Research Institute Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, PR Brazil ,grid.213910.80000 0001 1955 1644Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Yasmine Kanaan
- grid.257127.40000 0001 0547 4545Department of Microbiology, Howard University Cancer Center, Howard University, Washington DC, USA
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Raiter A, Lipovetzki J, Lubin I, Yerushalmi R. GRP78 expression in peripheral blood mononuclear cells is a new predictive marker for the benefit of taxanes in breast cancer neoadjuvant treatment. BMC Cancer 2020; 20:333. [PMID: 32306920 PMCID: PMC7168854 DOI: 10.1186/s12885-020-06835-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 04/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer treatment is tailored to the specific cancer subtype. Often, systemic treatment is given prior to surgery. Chemotherapy induces significant endoplasmic reticulum (ER) stress-mediated cell death and upregulation of 78-kDa glucose-regulated protein (GRP78). We hypothesized that chemotherapy induces ER stress not only in the tumor tissue but also in immune cells, which may affect the response to anti-cancer treatment. METHODS We determined the surface expression of GRP78 on 15 different peripheral blood mononuclear cell (PBMC) subpopulations in 20 breast cancer patients at three time points of the neoadjuvant treatment, i.e., at baseline, after anthracycline treatment, and after taxanes treatment. For this purpose, we performed flow cytometric analyses and analyzed the data using ANOVA and the Tukey test. Serum cytokine levels were also evaluated, and their levels were correlated with response to treatment using the t-test after log transformation and Mann-Whitney U Wilcoxon W test. RESULTS A significant increase in GRP78 expression in PBMCs was documented during the taxane phase, only in patients who achieved pathological complete response (pCR). GRP78-positive clones correlated with increased serum levels of interferon gamma (IFNγ). CONCLUSIONS The presence of GRP78-positive clones in certain PBMC subpopulations in pCR patients suggests a dynamic interaction between ER stress and immune responsiveness. The correlation of GRP78-positive clones with increased levels of IFNγ supports the idea that GRP78 expression in PBMCs might serve as a new predictive marker to identify the possible benefits of taxanes in the neoadjuvant setting.
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Affiliation(s)
- Annat Raiter
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.
| | - Julia Lipovetzki
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel
| | - Ido Lubin
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel
| | - Rinat Yerushalmi
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.
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Mazari FAK, Sharma N, Dodwell D, Horgan K. Human Epidermal Growth Factor 2-positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy. Radiology 2018; 288:366-374. [PMID: 29786482 DOI: 10.1148/radiol.2018170960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Purpose To determine the relationship between the presence or absence of mammographic calcifications in human epidermal growth factor receptor 2 (HER2)-positive breast cancers and pathologic complete response (pCR) to neoadjuvant chemotherapy and to determine other tumor and clinical characteristics that may be predictive of such a response. Materials and Methods A database of all patients with HER2-positive breast cancer who underwent neoadjuvant chemotherapy between 2007 and 2015 was retrospectively reviewed. Patient demographic characteristics, mammographic appearance, molecular subtype of cancer (luminal or nonluminal), radiologic response (based on breast magnetic resonance images), surgery, and pathologic response to treatment were recorded. Inter- and subgroup comparison was performed for presence of mammographic microcalcification and cancer subtype by using Mann-Whitney and χ2 tests and logistic regression. Results A total of 111 patients with a median age of 49 years (interquartile range, 40-57 years) were evaluated. Of these, 64.9% (72 of 111) had mammographic microcalcifications, 63.1% (70 of 111) had luminal B cancer, and 36.9% (41 of 111) had nonluminal HER2-positive cancer. Radiologic response to neoadjuvant chemotherapy was observed in 70.3% (78 of 111) of patients. Surgery was performed in 97.3% (108 of 111) of patients, and 30.6% (34 of 111) of patients underwent breast conservation. pCR was observed in 33.3% (37 of 111) of patients; 16.2% (18 of 111) showed residual ductal carcinoma in situ and 50.5% (56 of 111) had residual invasive disease. The pCR rate was the same (P = .21) in patients with mammographic microcalcification (29.2% [21 of 72]) as in those without calcification (41.0% [16 of 39]). The pCR rate in patients with nonluminal HER2-positive cancers (46.3% [19 of 41]) was higher (P = .01) than in those with luminal B cancers (25.7% [18 of 70]). pCR was associated with nonluminal HER2-positive subtype (odds ratio, 5.4; 95% confidence interval: 1.8, 16.0; P = .01) and complete radiologic response (odds ratio, 20.4; 95% confidence interval: 3.3, 126.6; P = .01). Conclusion Patients with HER2-positive cancer and mammographic microcalcification can achieve pCR after neoadjuvant chemotherapy. Nonluminal HER2-positive subtype and complete radiologic response are predictors of pCR.
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Affiliation(s)
- Fayyaz A K Mazari
- From the Leeds Breast Unit (F.A.K.M., K.H.) and the Departments of Radiology (N.S.) and Oncology (D.D.), Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds LS9 7TF, England
| | - Nisha Sharma
- From the Leeds Breast Unit (F.A.K.M., K.H.) and the Departments of Radiology (N.S.) and Oncology (D.D.), Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds LS9 7TF, England
| | - David Dodwell
- From the Leeds Breast Unit (F.A.K.M., K.H.) and the Departments of Radiology (N.S.) and Oncology (D.D.), Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds LS9 7TF, England
| | - Kieran Horgan
- From the Leeds Breast Unit (F.A.K.M., K.H.) and the Departments of Radiology (N.S.) and Oncology (D.D.), Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds LS9 7TF, England
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Zhang D, Zhang Q, Suo S, Zhuang Z, Li L, Lu J, Hua J. Apparent diffusion coefficient measurement in luminal breast cancer: will tumour shrinkage patterns affect its efficacy of evaluating the pathological response? Clin Radiol 2018; 73:909.e7-909.e14. [PMID: 29970246 DOI: 10.1016/j.crad.2018.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022]
Abstract
AIM To determine which region of interest (ROI) placement method of apparent diffusion coefficient (ADC) measurement has the best performance for predicting pathological complete response (PCR) at two cycles of neoadjuvant chemotherapy (NAC) according to different tumour shrinkage patterns of luminal breast cancer and to assess the evaluative accuracy of ADC value combined with other clinicopathological indicators. MATERIALS AND METHODS Sixty-one patients who underwent NAC for histopathologically confirmed breast cancer were enrolled in this retrospective study. The ADC values of different shrinkage patterns (concentric shrinkage, nest or dendritic shrinkage, and mixed shrinkage) for tumours shown by diffusion-weighted imaging (DWI) were measured independently using three ROI placement methods (single-round, three-round, and freehand). Intraclass correlation coefficients (ICCs) were used to assess the interobserver variability in the ADC values. Multivariate logistic regression analysis was performed to identify the independent predictors of PCR. RESULTS The best placement method found was single-round ROI in all the patients (AUC=0.863). When analysed separately, the effectiveness results differed: the single-round method was optimal for concentrically shrinking tumours (AUC=0.970); the freehand method was optimal for nest or dendritically shrinking tumours (AUC=0.714); and the three-round method was optimal for mixed shrinking tumours (AUC=0.975). Multivariate logistic analysis showed that oestrogen receptor (ER), ΔADC% and tumour diameter reduction (ΔD%) were independent factors in evaluating the PCR. CONCLUSION The methods for measuring ADC values vary across different shrinkage patterns of luminal tumours. ΔADC%, ER and ΔD% were independent factors for evaluating the PCR.
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Affiliation(s)
- D Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China
| | - Q Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China
| | - S Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China
| | - Z Zhuang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China
| | - L Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China
| | - J Lu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China.
| | - J Hua
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Rd, Shanghai 200127, People's Republic of China.
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Li F, Ma L, Geng C, Liu C, Deng H, Yue M, Ding Y, Wang X, Liu Y. Analysis of the relevance between molecular subtypes and efficacy of neoadjuvant chemotherapy in breast cancer as well as its prognostic factors. Pathol Res Pract 2018; 214:1166-1172. [PMID: 29945816 DOI: 10.1016/j.prp.2018.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/03/2018] [Accepted: 06/16/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate pathological assessment of breast specimens after NACT is crucial. It is beneficial to determine the treatment efficacy and predict prognosis. So we should explore the relevance between molecular subtypes and efficacy of neoadjuvant chemotherapy in breast cancer as well as its prognostic factors, which about survival analysis and disease free survival involved, which was one part of contributing for evaluating in terms of global survival and disease free survival. METHODS Medical records of 264 patients with breast cancer who received neoadjuvant chemotherapy in Breast Center, the Fourth Hospital of Hebei Medical University, between January 2008 and May 2013. The relationship between molecular subtypes and neoadjuvant chemotherapy, and clinical pathological features were analyzed. RESULTS The total pCR rate was 12.50% (33/264). The rate of pCR were 3.03% (1/33), 9.40% (14/149), 17.39%(8/46), 27.78% (10/36) in Luminal A type, Luminal B type, HER2 overexpression type, and Triple negative type, respectively. Which was predicted that The pCR rate associated with breast cancer molecular subtypes (P < 0.05). The pCR rate in Triple negative type was highest, HER2 overexpression type was showed higher pCR rate than Luminal A and Luminal B type. Multiple factors analysis results showed that: the independent impact factors of 5-year overall survival rate in neoadjuvant chemotherapy breast cancer patients were clinical stage, tumor size, chemotherapy regimens, lymph node metastasis, estrogen receptor status and pathological remission; the independent impact factors of 5-year disease free survival rate were tumor size, chemotherapy regimens, estrogen receptor status, progesterone receptor status and pathological remission (P < 0.05). Triple negative type of breast cancer had shorter overall survival and disease-free survival (P < 0.05). CONCLUSIONS The pCR was more frequently observed in HER2 overexpression type and Triple negative type of breast cancer. That could achieve a higher rate of pCR on paclitaxel class joint anthracycline-based chemotherapy. But Triple negative type showed worse prognosis, due to residual tumor after neoadjuvant chemotherapy, which could be in combination or sequential, at the neoadjuvant / adjuvant setting (NCCN 2016 Breast cancer, chemotherapy regimens), So how to choose a more appropriate neoadjuvant chemotherapy regimens, we should need further research.
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Affiliation(s)
- Fang Li
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Li Ma
- Department of Surgery, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Cuizhi Geng
- Department of Surgery, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Chang Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Huiyan Deng
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Meng Yue
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Yan Ding
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Xiaolin Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China; Department of Surgery, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, China, No.12, Jiankang Road, Shijiazhuang, 050011, PR China.
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Riethdorf S, Müller V, Loibl S, Nekljudova V, Weber K, Huober J, Fehm T, Schrader I, Hilfrich J, Holms F, Tesch H, Schem C, von Minckwitz G, Untch M, Pantel K. Prognostic Impact of Circulating Tumor Cells for Breast Cancer Patients Treated in the Neoadjuvant "Geparquattro" Trial. Clin Cancer Res 2017; 23:5384-5393. [PMID: 28679772 DOI: 10.1158/1078-0432.ccr-17-0255] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/03/2017] [Accepted: 06/26/2017] [Indexed: 11/16/2022]
Abstract
Purpose: This study aimed to evaluate the prognostic impact of circulating tumor cells (CTC) detected in patients with operable or locally advanced breast cancer before and after neoadjuvant therapy (NT) within the clinical trial GeparQuattro.Experimental Design: Data on CTCs enumerated with the CellSearch system were available for 213 and 207 patients before and after NT, respectively. Associations of CTCs with disease-free survival (DFS) and overall survival (OS) were analyzed by nonparametric Kaplan-Meier estimates and parametric Cox regression.Results: After a median follow-up of 67.1 months, the detection of ≥1 CTC/7.5 mL and ≥2 CTCs/7.5 mL before NT was associated with reduced DFS (P = 0.031 and P < 0.0001, respectively) and OS (P = 0.0057 and P < 0.0001, respectively), whereas CTCs detected after NT did not correlate with DFS or OS. In parametric univariate and multivariate Cox models, ≥1 CTC/7.5 mL, ≥2 CTCs/7.5 mL, and absolute CTC numbers before NT revealed to be independent prognostic parameters of DFS and OS. CTC-negative patients with pathologic complete response (pCR) exhibited the best prognosis, whereas those with CTCs and less tumor response were at high risk of tumor relapse. In HER2 (ERBB2)-positive and triple-negative patients, ≥2 CTCs/7.5 mL detected before NT also were significantly associated with worse DFS and OS.Conclusions: Detection of CTCs before NT is an independent prognostic factor of impaired clinical outcome, and combined with pCR, it could be helpful to stratify breast cancer patients for therapeutic interventions. Clin Cancer Res; 23(18); 5384-93. ©2017 AACR.
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Affiliation(s)
- Sabine Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Jens Huober
- Department of Gynecology and Obstetrics, University Medical Center, Ulm, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University Medical Center, Düsseldorf, Germany
| | | | | | - Frank Holms
- Department of Obstetrics and Gynecology, St. Barbara-Klinik, Hamm-Heessen, Germany
| | | | - Christian Schem
- Department of Gynecology and Obstetrics, University Medical Center, Kiel, Germany
| | | | - Michael Untch
- Department of Obstetrics and Gynecology, Heliosklinik Buch, Berlin, Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ballesio L, Gigli S, Di Pastena F, Giraldi G, Manganaro L, Anastasi E, Catalano C. Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: Correlation with tumor biological subtypes and pathological response after therapy. Tumour Biol 2017; 39:1010428317694540. [PMID: 28347225 DOI: 10.1177/1010428317694540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The objective of this study is to analyze magnetic resonance imaging shrinkage pattern of tumor regression after neoadjuvant chemotherapy and to evaluate its relationship with biological subtypes and pathological response. We reviewed the magnetic resonance imaging studies of 51 patients with single mass-enhancing lesions (performed at time 0 and at the II and last cycles of neoadjuvant chemotherapy). Tumors were classified as Luminal A, Luminal B, HER2+, and Triple Negative based on biological and immunohistochemical analysis after core needle biopsy. We classified shrinkage pattern, based on tumor regression morphology on magnetic resonance imaging at the II cycle, as concentric, nodular, and mixed. We assigned a numeric score (0: none; 1: low; 2: medium; 3: high) to the enhancement intensity decrease. Pathological response on the surgical specimen was classified as complete (grade 5), partial (grades 4-3), and non-response (grades 1-2) according to Miller and Payne system. Fisher test was used to relate shrinkage pattern with biological subtypes and final pathological response. Seventeen patients achieved complete response, 25 partial response, and 9 non-response. A total of 13 lesions showed nodular pattern, 20 concentric, and 18 mixed. We found an association between concentric pattern and HER2+ (p < 0.001) and mixed pattern and Luminal A lesions (p < 0.001). We observed a statistical significant correlation between concentric pattern and complete response (p < 0.001) and between mixed pattern and non-response (p = 0.005). Enhancement intensity decrease 3 was associated with complete response (p < 0.001). Shrinkage pattern and enhancement intensity decrease may serve as early response indicators after neoadjuvant chemotherapy. Shrinkage pattern correlates with tumor biological subtypes.
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Affiliation(s)
- Laura Ballesio
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Silvia Gigli
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Francesca Di Pastena
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Guglielmo Giraldi
- 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Lucia Manganaro
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Emanuela Anastasi
- 3 Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
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Halfter K, Mayer B. Bringing 3D tumor models to the clinic - predictive value for personalized medicine. Biotechnol J 2017; 12. [PMID: 28098436 DOI: 10.1002/biot.201600295] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 12/17/2022]
Abstract
Current decision-guiding algorithms in cancer drug treatment are based on decades of research and numerous clinical trials. For the majority of patients, this data is successfully applied for a systemic disease management. For a number of patients however, treatment stratification according to clinically based risk criteria will not be sufficient. The most effective treatment options are ideally identified prior to the start of clinical drug therapy. This review will discuss the implementation of three-dimensional (3D) cell culture models as a preclinical testing paradigm for the efficacy of clinical cancer treatment. Patient tumor-derived cells in 3D cultures duplicate the individual tumor microenvironment with a minimum of confounding factors. Clinical implementation of such personalized tumor models requires a high quality of methodological and clinical validation comparable to other biomarkers. A non-systematic literature search demonstrated the small number of prospective studies that have been conducted in this area of research. This may explain the current reluctance of many physicians and insurance providers in implementing this type of assay into the clinical diagnostic routine despite potential benefit for patients. Achieving valid and reproducible results with a high level of evidence is central in improving the acceptance of preclinical 3D tumor models.
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Affiliation(s)
| | - Barbara Mayer
- SpheroTec GmbH, Martinsried, Germany.,Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
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Sheppard VB, Cavalli LR, Dash C, Kanaan YM, Dilawari AA, Horton S, Makambi KH. Correlates of Triple Negative Breast Cancer and Chemotherapy Patterns in Black and White Women With Breast Cancer. Clin Breast Cancer 2017; 17:232-238. [PMID: 28189497 DOI: 10.1016/j.clbc.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Triple negative breast cancer (TNBC) tumors are estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor-negative. TNBC is responsive to chemotherapy, but chemotherapy might be underused in some patient subgroups. The goal of the present study was to characterize the patterns of chemotherapy use (uptake and completion) in TNBC patients. PATIENTS AND METHODS Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Data were collected using a standardized telephone survey that captured sociocultural and health care process factors. Clinical data were abstracted from the medical records. We used χ2 tests to access the association between the receipt of chemotherapy use (initiation and completion) and categorical variables, and t tests were used for continuous variables. Logistic regression models were used to evaluate the factors associated with chemotherapy uptake. RESULTS Women with TNBC (16% of sample) were more likely to be black than white (68% vs. 32%; P < .05). Among women with TNBC, 60% underwent chemotherapy. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and in women without (vs. with) healthcare discrimination (35% vs. 25%; P = .04). In multivariable models, only race was associated with the receipt of chemotherapy. Black women were more likely to receive chemotherapy than were white women. The odds ratio of receiving chemotherapy by race was 4.1 (95% confidence interval, 1.3-13.1). Each 1-year increase in age was associated with a lower likelihood of chemotherapy completion (odds ratio, 0.9; 95% confidence interval, 0.826-0.981; P = .02). Women with at least some college were less likely to complete chemotherapy than were those with other education levels (P = .02). CONCLUSION A substantial number of TNBC patients failed to receive and/or complete chemotherapy. Differences in chemotherapy uptake by race and sociocultural factors diminished in multivariable models but age and stage remained significant. Suboptimal treatment among women with TNBC could contribute to adverse outcomes. Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted.
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Affiliation(s)
| | | | | | - Yasmine M Kanaan
- Department of Microbiology, Howard University College of Medicine, Washington, DC
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Loibl S, Majewski I, Guarneri V, Nekljudova V, Holmes E, Bria E, Denkert C, Schem C, Sotiriou C, Loi S, Untch M, Conte P, Bernards R, Piccart M, von Minckwitz G, Baselga J. PIK3CA mutations are associated with reduced pathological complete response rates in primary HER2-positive breast cancer: pooled analysis of 967 patients from five prospective trials investigating lapatinib and trastuzumab. Ann Oncol 2016; 27:1519-25. [PMID: 27177864 PMCID: PMC6279074 DOI: 10.1093/annonc/mdw197] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The predictive value of PIK3CA mutations in HER2 positive (HER2+) breast cancer treated with neoadjuvant anti-HER2 and chemotherapy has been reported, but the power for subgroup analyses was lacking. PATIENTS AND METHODS We combined individual patient data from five clinical trials evaluating PIK3CA mutations and associations with pathological complete response (pCR), disease-free survival (DFS) and overall survival (OS). Patients received either trastuzumab (T), lapatinib (L) or the combination T/L in addition to a taxane-based chemotherapy. PIK3CA was genotyped in tumour biopsies taken before therapy. RESULTS A total of 967 patients were included in this analysis; the median follow-up is 47 months. Overall, the pCR rate was significantly lower in the PIK3CA mutant compared with the wild-type group (16.2% versus 29.6%; P < 0.001). Within the hormone-receptor positive (HR+) subgroup, the PIK3CA mutant group had a pCR rate of only 7.6% compared with 24.2% in the wild-type group (P < 0.001). In contrast, in the HER2+/HR- group, there was no difference in pCR (27.2% versus 36.4%; P = 0.125) according to PIK3CA mutation status (interaction test P = 0.036). According to treatment arm, the pCR rate for mutant versus wild-type was 20.3% versus 27.1% for T (P = 0.343), 11.3% versus 16.9% for L (P = 0.369) and 16.7% versus 39.1% for T/L (P < 0.001). In the HR+ T/L group, the pCR rate was 5.5% versus 33.9% (interaction between HR and PIK3CA genotype P = 0.008). DFS and OS were not significantly different by mutation status, though the incidence rate of events was low. However, HR+/PIK3CA mutant patients seemed to have significantly worse DFS {hazard ratio (HR) 1.56 [95% confidence interval (CI) 1.00-2.45], P = 0.050; Pinteraction = 0.021}. T/L tended to improve DFS compared with T in the wild-type cohort, especially in the HR- group [HR 0.72, 95% CI (0.41-1.25), P = 0.242]. CONCLUSION Overall PIK3CA mutant/HER2+ tumours had significantly lower pCR rates compared with wild-type tumours, however mainly confined to the HR+/PIK3CA mutant population. No definite conclusions can be drawn regarding survival.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - I Majewski
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - E Holmes
- Frontier Science Scotland, Kincraig, UK
| | - E Bria
- Department of Medical Oncology, University of Verona, Verona, Italy
| | - C Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, and German Cancer Consortium (DKTK), Berlin
| | - C Schem
- Department of Obstetrics and Gynecology, University Hospital Kiel, Kiel, Germany
| | - C Sotiriou
- Institut Jules Bordet, Université Libre de Bruxelles, Brussel, Belgium
| | - S Loi
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - M Untch
- Department of Obstetrics and Gynecology, Helios-Klinikum, Berlin-Buch, Germany
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - R Bernards
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussel, Belgium
| | | | - J Baselga
- Memorial Sloan-Kettering Cancer Center, New York, USA
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The path to personalized medicine in women's cancers: challenges and recent advances. Curr Opin Obstet Gynecol 2014; 27:45-7. [PMID: 25517359 DOI: 10.1097/gco.0000000000000149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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