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Cuniolo L, Gipponi M, Murelli F, Depaoli F, Cornacchia C, Franchelli S, Pesce M, Ronda E, Picardi S, Diaz R, Poggio F, Friedman D, De Cian F, Fregatti P. Multidisciplinary and Tailored Treatment of Locally Advanced Breast Cancer in Progression during Neoadjuvant Chemotherapy: Case Report. Curr Oncol 2024; 31:2856-2866. [PMID: 38785498 PMCID: PMC11119312 DOI: 10.3390/curroncol31050217] [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: 04/14/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Locally advanced breast cancer (LABC) is a complex disease that requires a multidisciplinary approach. Neoadjuvant chemotherapy (NAC) is usually performed in order to achieve loco-regional radical resection; although its importance in the multidisciplinary approach to LABC is well recognized, a small number of patients show Progressive Disease (PD). No standard salvage treatment (ST) has been defined and different strategies can be adopted, such as second-line systemic therapies, radiation therapy, and surgery. Herein, a case of LABC in PD during NAC is reported with a literature review, with the aim of highlighting the importance of a tailored multidisciplinary treatment for each patient.
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Affiliation(s)
- Letizia Cuniolo
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Marco Gipponi
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Federica Murelli
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Francesca Depaoli
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Chiara Cornacchia
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Simonetta Franchelli
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Marianna Pesce
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Elena Ronda
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Stefano Picardi
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Raquel Diaz
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Daniele Friedman
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Franco De Cian
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
- Breast Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.G.)
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Stukan AI, Khachmamuk ZK, Antipova VV, Dzagashtokova AV. Significance and possible causes of hormone receptor expression loss in metastatic breast cancer. Phenotypic evolution of luminal <i>BRCA1</i>-associated breast cancer to triple negative subtype in lung metastasis and PARP inhibition strategy in early-line therapy. TUMORS OF FEMALE REPRODUCTIVE SYSTEM 2022. [DOI: 10.17650/1994-4098-2022-18-3-78-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Current clinical recommendations indicate the need for a biopsy of a metastatic focus in metastatic breast cancer (BC), but the optimal frequency of additional molecular analysis remains unclear. The discordance of hormonal receptors (HR) between the primary tumor and metastatic foci has prognostic significance, while the transition from HR-positive BC to a triple negative phenotype is associated with a worse clinical prognosis. Acquisition of HR expression in primary triple negative BC is more favorable due to the wide range of options for HR-positive BC treatment. Over the past few years, PARP inhibitors have become an important therapeutic option for the treatment of various tumor types, including BC and luminal surrogate subtypes. However, some questions still remain unresolved, the most important of which are: what is the optimal sequence of the use of CDK4 / 6 inhibitors as part of combined hormone therapy and PARP inhibitors in luminal types of BRCA-associated BC and how effective is the strategy of PARP inhibition after the use of combined hormone therapy with CDK4 / 6 inhibitors? It is obvious that the answers to the questions can be partially obtained by performing a biopsy of the most clinically significant metastatic focus and selecting therapy according to the phenotypic surrogate subtype. A clinical case of the phenotypic evolution of HR-positive BRCA1-associated BC into a triple negative phenotype during metastasis to the lungs and the luminal phenotype of tumor metastasis in soft tissues is presented. Biopsy of the most clinically significant metastatic lesion in the lungs in this case changed the strategy of early-line therapy for estrogen-receptor-positive disease, when in the absence of a biopsy, a combined hormone therapy regimen with CDK4 / 6 inhibitors could be applied. At the same time, the strategy of using PARP inhibitor talazoparib, which has shown efficacy in all surrogate subtypes, should certainly be prescribed in the early line of therapy for BRCA-associated disease with loss of estrogen receptor expression. Despite the luminal phenotype of metastasis in the soft tissues of the back and the unknown status of bone metastases, the drug demonstrates efficacy in these cases as well. It should be noted that partial response according on RECIST 1.1 months with an improvement in the quality of life and the disappearance of pain syndrome was evaluated after 10 weeks of treatment. The response duration was an unprecedented 10 months.
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Affiliation(s)
- A. I. Stukan
- Clinical Oncology Dispensary No. 1, Ministry of Health of Krasnodar Region; Kuban State Medical University; N.N. Petrov National Medical Research Center of Onclology, Ministry of Health of Russia
| | - Z. K. Khachmamuk
- Clinical Oncology Dispensary No. 1, Ministry of Health of Krasnodar Region
| | - V. V. Antipova
- Clinical Oncology Dispensary No. 1, Ministry of Health of Krasnodar Region
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Guo J, Wang BH, He M, Fu P, Yao M, Jiang T. Contrast-enhanced ultrasonography for early prediction of response of neoadjuvant chemotherapy in breast cancer. Front Oncol 2022; 12:1026647. [PMID: 36531048 PMCID: PMC9753903 DOI: 10.3389/fonc.2022.1026647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 07/29/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) is widely accepted as a primary treatment for inoperable or locally advanced breast cancer before definitive surgery. However, not all advanced breast cancers are sensitive to NAC. Contrast-enhanced ultrasonography (CEUS) has been considered to assess tumor response to NAC as it can effectively reflect the condition of blood perfusion and lesion size. Therefore, this study aimed to evaluate the diagnostic performance of CEUS to predict early response in different regions of interest in breast tumors under NAC treatment. This prospective study included 82 patients with advanced breast cancer. Parameters of TIC (time-intensive curve) between baseline and after the first cycle of NAC were calculated for the rate of relative change (Δ), including Δpeak, ΔTTP (time to peak), ΔRBV (regional blood volume), ΔRBF (regional blood flow) and ΔMTT (mean transit time). The responders and non-responders were distinguished by the Miller-Payne Grading (MPG) system and parameters from different regions of tumors were compared in these two groups. For ROI 1(the greatest enhancement area in the central region of the tumor), there were significant differences in Δpeak1, ΔRBV1 and ΔRBF1 between responders and non-responders. For ROI 2 (the greatest enhancement area on edge of the tumor), there were significant differences in Δpeak2 and ΔRBF2 between the groups. The Δpeak1 and ΔRBF2 showed good prediction (AUC 0.798-0.820, p ≤ 0.02) after the first cycle of NAC. When the cut-off value was 0.115, the ΔRBF2 had the highest diagnostic accuracy and the maximum NPV. Quantitative TIC parameters could be effectively used to evaluate early response to NAC in advanced breast cancer.
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Affiliation(s)
- Jiabao Guo
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bao-Hua Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mengna He
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peifen Fu
- Department of Breast Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Minya Yao
- Department of Breast Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tian’an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Gerwing M, Hoffmann E, Kronenberg K, Hansen U, Masthoff M, Helfen A, Geyer C, Wachsmuth L, Höltke C, Maus B, Hoerr V, Krähling T, Hiddeßen L, Heindel W, Karst U, Kimm MA, Schinner R, Eisenblätter M, Faber C, Wildgruber M. Multiparametric MRI enables for differentiation of different degrees of malignancy in two murine models of breast cancer. Front Oncol 2022; 12:1000036. [PMID: 36408159 PMCID: PMC9667047 DOI: 10.3389/fonc.2022.1000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Objective The objective of this study was to non-invasively differentiate the degree of malignancy in two murine breast cancer models based on identification of distinct tissue characteristics in a metastatic and non-metastatic tumor model using a multiparametric Magnetic Resonance Imaging (MRI) approach. Methods The highly metastatic 4T1 breast cancer model was compared to the non-metastatic 67NR model. Imaging was conducted on a 9.4 T small animal MRI. The protocol was used to characterize tumors regarding their structural composition, including heterogeneity, intratumoral edema and hemorrhage, as well as endothelial permeability using apparent diffusion coefficient (ADC), T1/T2 mapping and dynamic contrast-enhanced (DCE) imaging. Mice were assessed on either day three, six or nine, with an i.v. injection of the albumin-binding contrast agent gadofosveset. Ex vivo validation of the results was performed with laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS), histology, immunhistochemistry and electron microscopy. Results Significant differences in tumor composition were observed over time and between 4T1 and 67NR tumors. 4T1 tumors showed distorted blood vessels with a thin endothelial layer, resulting in a slower increase in signal intensity after injection of the contrast agent. Higher permeability was further reflected in higher Ktrans values, with consecutive retention of gadolinium in the tumor interstitium visible in MRI. 67NR tumors exhibited blood vessels with a thicker and more intact endothelial layer, resulting in higher peak enhancement, as well as higher maximum slope and area under the curve, but also a visible wash-out of the contrast agent and thus lower Ktrans values. A decreasing accumulation of gadolinium during tumor progression was also visible in both models in LA-ICP-MS. Tissue composition of 4T1 tumors was more heterogeneous, with intratumoral hemorrhage and necrosis and corresponding higher T1 and T2 relaxation times, while 67NR tumors mainly consisted of densely packed tumor cells. Histogram analysis of ADC showed higher values of mean ADC, histogram kurtosis, range and the 90th percentile (p90), as markers for the heterogenous structural composition of 4T1 tumors. Principal component analysis (PCA) discriminated well between the two tumor models. Conclusions Multiparametric MRI as presented in this study enables for the estimation of malignant potential in the two studied tumor models via the assessment of certain tumor features over time.
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Affiliation(s)
- Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
- *Correspondence: Mirjam Gerwing,
| | - Emily Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Katharina Kronenberg
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany
| | - Uwe Hansen
- Institute for Musculoskeletal Medicine, University of Münster, Münster, Germany
| | - Max Masthoff
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Anne Helfen
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Christiane Geyer
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Lydia Wachsmuth
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Carsten Höltke
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Bastian Maus
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Verena Hoerr
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Heart Center Bonn, Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Tobias Krähling
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Lena Hiddeßen
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany
| | - Walter Heindel
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany
| | - Melanie A. Kimm
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Michel Eisenblätter
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Department of Diagnostic and Interventional Radiology, University of Freiburg, Freiburg, Germany
| | - Cornelius Faber
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
| | - Moritz Wildgruber
- Clinic of Radiology, University of Münster, Münster, Germany
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
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Han X, Yang H, Jin S, Sun Y, Zhang H, Shan M, Cheng W. Prediction of pathological complete response to neoadjuvant chemotherapy in patients with breast cancer using a combination of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging. Cancer Med 2022; 12:1389-1398. [PMID: 35822639 PMCID: PMC9883403 DOI: 10.1002/cam4.5019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to evaluate the value of dynamic contrast-enhanced ultrasound (CEUS) combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting pathological complete response (pCR) in patients with breast cancer receiving neoadjuvant chemotherapy (NAC). Fifty-seven female patients with breast cancer (mean age, 50.46 years; range, 32-66 years) scheduled for NAC were recruited. CEUS and DCE-MRI were performed before and after NAC. Imaging features and their changes were compared with postoperative pathological results. After the clinical differences were balanced using propensity score matching, univariate and multiple logistic regression analyses were used to derive the characteristics independently associated with pCR. Receiver operating characteristic curve analysis was performed to assess diagnostic performance. After six to eight cycles of NAC, 24 (42.1%) patients achieved pCR, while 33 (57.9%) did not. Multivariate analysis showed that enhancement order on CEUS and DCE-MRI before NAC, reduction in diameter and enhancement shape on CEUS, maximum diameter on DCE-MRI, and the type of progressive dynamic contrast enhancement after NAC were independently associated with pCR after NAC. The area under the receiver operating characteristic curve for CEUS+DCE-MRI was 0.911 (95% confidence interval, 0.826-0.997), and the specificity and positive predictive values were 87.0% and 87.5%. CEUS and DCE-MRI have the potential for assessing the pathological response to NAC in patients with breast cancer; their combination showed the best diagnostic performance. CEUS+DCE-MRI has proved beneficial for comprehensive assessment and personalizing treatment strategies for patients with breast cancer.
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Affiliation(s)
- Xue Han
- Department of UltrasoundHarbin Medical University Cancer HospitalHarbinChina
| | - Huajing Yang
- Department of UltrasoundHarbin Medical University Cancer HospitalHarbinChina
| | - Shiyang Jin
- Department of Breast SurgeryHarbin Medical University Cancer HospitalHarbinChina
| | - Yunfeng Sun
- Imaging CenterHarbin Medical University Cancer HospitalHarbinChina
| | - Hongxia Zhang
- Imaging CenterHarbin Medical University Cancer HospitalHarbinChina
| | - Ming Shan
- Department of Breast SurgeryHarbin Medical University Cancer HospitalHarbinChina
| | - Wen Cheng
- Department of UltrasoundHarbin Medical University Cancer HospitalHarbinChina
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Liu Y, Kang Y, Li J, Zhang Y, Jia S, Sun Q, Ma Y, Zhang J, Wang Z, Cao Y, Shen Y. Estrogen Receptor and Claudin-6 Might Play Vital Roles for Long-Term Prognosis in Patients With Luminal A Breast Cancer Who Underwent Neoadjuvant Chemotherapy. Front Oncol 2022; 12:630065. [PMID: 35847894 PMCID: PMC9280129 DOI: 10.3389/fonc.2022.630065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/26/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose It is well-known that the pathological complete response (pCR) rate in patients with luminal A cancer (LAC) is lower than those of other subtypes of breast cancer. The phenotype of cancer often alters after neoadjuvant chemotherapy (NAC) which may be related to hypoxia, and the latter might induce the drift of the estrogen receptor (ER). The phenotype drift in local advanced LAC after NAC might influence the long-term prognosis. Methods The oxygen concentration of cancer tissues during NAC was recorded and analyzed (n = 43). The expression of ER and claudin-6 was detected in pre- and post-NAC specimens. Results NAC might induce the cycling intracanceral hypoxia, and the pattern was related to NAC response. The median follow-up time was 61 months. Most of the patients (67%) with stable or increased ER and claudin-6 expression exhibited perfect prognosis (DFS = 100%, 61 months). About 20% of patients with decreased claudin-6 would undergo the poor prognosis (DFS = 22.2%, 61 months). The contrasting prognosis (100% vs. 22.2%) had nothing to do with the response of NAC in the above patients. Only 13% patients had stable claudin-6 and decreased ER, whose prognosis might relate to the response of NAC. Conclusion NAC might induce cycling intracanceral hypoxia to promote the phenotype drift in local advanced LAC, and the changes in ER and claudin-6 after NAC would determine the long-term prognosis.
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Affiliation(s)
- Yushi Liu
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianyi Li
- Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, China
- *Correspondence: Jianyi Li,
| | - Yang Zhang
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Shi Jia
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Qiang Sun
- Department of Breast Surgery, Benxi Iron and Steel Co. General Hospital, Benxi, China
| | - Yan Ma
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Zhenrong Wang
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yanan Cao
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yang Shen
- Department of Breast Surgery, ShengJing Hospital of China Medical University, Shenyang, China
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Boca (Bene) I, Dudea SM, Ciurea AI. Contrast-Enhanced Ultrasonography in the Diagnosis and Treatment Modulation of Breast Cancer. J Pers Med 2021; 11:jpm11020081. [PMID: 33573122 PMCID: PMC7912589 DOI: 10.3390/jpm11020081] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this paper is to highlight the role of contrast-enhanced ultrasound in breast cancer in terms of diagnosis, staging and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) is successfully used to diagnose multiple pathologies and has also clinical relevance in breast cancer. CEUS has high accuracy in differentiating benign from malignant lesions by analyzing the enhancement characteristics and calculating the time-intensity curve’s quantitative parameters. It also has a significant role in axillary staging, especially when the lymph nodes are not suspicious on clinical examination and have a normal appearance on gray-scale ultrasound. The most significant clinical impact consists of predicting the response to neoadjuvant chemotherapy, which offers the possibility of adjusting the therapy by dynamically evaluating the patient. CEUS is a high-performance, feasible, non-irradiating, accessible, easy-to-implement imaging method and has proven to be a valuable addition to breast ultrasound.
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Zattarin E, Leporati R, Ligorio F, Lobefaro R, Vingiani A, Pruneri G, Vernieri C. Hormone Receptor Loss in Breast Cancer: Molecular Mechanisms, Clinical Settings, and Therapeutic Implications. Cells 2020; 9:cells9122644. [PMID: 33316954 PMCID: PMC7764472 DOI: 10.3390/cells9122644] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
Hormone receptor-positive breast cancer (HR+ BC) accounts for approximately 75% of new BC diagnoses. Despite the undisputable progresses obtained in the treatment of HR+ BC in recent years, primary or acquired resistance to endocrine therapies still represents a clinically relevant issue, and is largely responsible for disease recurrence after curative surgery, as well as for disease progression in the metastatic setting. Among the mechanisms causing primary or acquired resistance to endocrine therapies is the loss of estrogen/progesterone receptor expression, which could make BC cells independent of estrogen stimulation and, consequently, resistant to estrogen deprivation or the pharmacological inhibition of estrogen receptors. This review aims at discussing the molecular mechanisms and the clinical implications of HR loss as a result of the therapies used in the neoadjuvant setting or for the treatment of advanced disease in HR+ BC patients.
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Affiliation(s)
- Emma Zattarin
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
| | - Rita Leporati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
| | - Francesca Ligorio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
| | - Riccardo Lobefaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
| | - Andrea Vingiani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
| | - Giancarlo Pruneri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
- Department of Oncology and Haematology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; (E.Z.); (R.L.); (F.L.); (R.L.); (A.V.); (G.P.)
- IFOM, The FIRC Institute of Molecular Oncology, Via Adamello 16, 20139 Milan, Italy
- Correspondence: ; Tel.: +39-02-2390-3650
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9
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The beginning of the end for conventional RECIST - novel therapies require novel imaging approaches. Nat Rev Clin Oncol 2019; 16:442-458. [PMID: 30718844 DOI: 10.1038/s41571-019-0169-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Owing to improvements in our understanding of the biological principles of tumour initiation and progression, a wide variety of novel targeted therapies have been developed. Developments in biomedical imaging, however, have not kept pace with these improvements and are still mainly designed to determine lesion size alone, which is reflected in the Response Evaluation Criteria in Solid Tumors (RECIST). Imaging approaches currently used for the evaluation of treatment responses in patients with solid tumours, therefore, often fail to detect successful responses to novel targeted agents and might even falsely suggest disease progression, a scenario known as pseudoprogression. The ability to differentiate between responders and nonresponders early in the course of treatment is essential to allowing the early adjustment of treatment regimens. Various imaging approaches targeting a single dedicated tumour feature, as described in the hallmarks of cancer, have been successful in preclinical investigations, and some have been evaluated in pilot clinical trials. However, these approaches have largely not been implemented in clinical practice. In this Review, we describe current biomedical imaging approaches used to monitor responses to treatment in patients receiving novel targeted therapies, including a summary of the most promising future approaches and how these might improve clinical practice.
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10
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Wang B, Jiang T, Huang M, Wang J, Chu Y, Zhong L, Zheng S. Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast-enhanced ultrasonography and ultrasound elastography. Exp Ther Med 2019; 17:3655-3663. [PMID: 30988749 PMCID: PMC6447770 DOI: 10.3892/etm.2019.7353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 02/20/2019] [Indexed: 02/06/2023] Open
Abstract
The purpose of the present study was to investigate whether contrast-enhanced ultrasonography (CEUS) in combination with ultrasound elastography (UE) is able to accurately predict the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer patients. A total of 65 breast cancer patients who received NAC at the First Affiliated Hospital of Zhejiang University (Hangzhou, China) between February 2016 and August 2017 and were recruited for the present study. Prior to and after NAC, examination by CEUS, UE or their combination was performed. Pathological results were obtained at the end of each chemotherapy cycle, based on which 41 cases were assigned to the response group and 24 to the non-response group. Kappa values were 0.710, 0.434 and 0.836 for CEUS, UE and CEUS+UE, respectively. The area under the receiver operating characteristic curves for CEUS, UE and CEUS+UE for determining the response to NAC was 0.864 [95% confidence interval (CI), 0.765–0.964], 0.715 (95% CI, 0.579–0.850) and 0.910 (95% CI, 0.826–0.993), respectively. It was identified that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS+UE were higher than those of CEUS and US individually. The prediction accuracy was 89.2, 90.8 and 100% for CEUS, UE and their combination, respectively. CEUS and UE have their own advantages in evaluating the clinical efficacy of NAC in breast cancer, and a higher accuracy was achieved when the two techniques were applied in combination. Therefore, a combination of CEUS and UE may be a preferred method for the clinical assessment of the efficacy of NAC in breast cancer patients.
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Affiliation(s)
- Baohua Wang
- Department of Ultrasound Medicine, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Tian'An Jiang
- Department of Ultrasound Medicine, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Min Huang
- Department of Ultrasound Medicine, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jing Wang
- Department of Ultrasound Medicine, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yanhua Chu
- Department of Ultrasound Medicine, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Liyun Zhong
- Department of Ultrasound Medicine, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Shusen Zheng
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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