Use of aromatase inhibitors and bisphosphonates as an anticancer therapy in postmenopausal breast cancer

The impact of geriatric characteristics and comorbidities on distant metastases and other cause mortality in older women with non-metastatic breast cancer treated with primary endocrine therapy

INTRODUCTION

In recent years, primary surgical treatment of older women with non-metastatic breast cancer has decreased in favor of primary endocrine therapy (PET). PET can be considered in women with a remaining life expectancy of less than five years. The aim of this study was to (1) assess the risk of distant metastases and other cause mortality over ten years in women aged 65 and older with stage I-III breast cancer treated with PET, (2) whether this was associated with geriatric characteristics and comorbidities and to (3) describe the reasons on which the choice for PET was made.

METHODS

Women were included from the retrospective FOCUS cohort, which comprises all incident women diagnosed with breast cancer aged 65 or older between January 1997 and December 2004 in the Comprehensive Cancer Center Region West in the Netherlands. We selected women (N = 257) with stage I-III breast cancer and treated with PET from this cohort. Patient characteristics (including comorbidity, polypharmacy, walking, cognitive and sensory impairment), treatment and tumor characteristics were retrospectively extracted from charts. Outcomes were distant metastasis and other cause mortality. Cumulative incidences were calculated using the Cumulative Incidence for Competing Risks method (CICR); and subdistribution hazard ratios (SHR) were tested between groups based on age, geriatric characteristics and comorbidity with the Fine and Gray model.

RESULTS

Women treated with PET were on average 84 years old and 41% had one or more geriatric characteristics. Other cause mortality exceeded the cumulative incidence of distant metastasis over ten years (83 versus 5.6%). The risk of dying from another cause further increased in women with geriatric characteristics (SHR 2.06, p < 0.001) or two or more comorbidities (SHR 1.72, p < 0.001). Often the reason for omitting surgery was not recorded (52.9%), but if recorded surgery was omitted mainly at the patient's request (18.7%).

DISCUSSION

This study shows that the cumulative incidence of distant metastasis is much lower than other cause mortality in older women with breast cancer treated with PET, especially in the presence of geriatric characteristics or comorbidities. This confirms the importance of assessment of geriatric characteristics to aid counseling of older women.

Carbon nanospheres conjugated bisphosphonates: synthesis, characterization and in vitro antimalarial activity

About 40% of the world's population lives in malaria zones where it presents a challenging health problem. Malaria treatment and prevention have been hindered by drug resistance. Bisphosphonates have been found to be active against Trypanosoma cruzi and Plasmodium falciparum that cause Chaga's disease and malaria respectively. However, bisphosphonates have a shortcoming of being rapidly removed from the bloodstream through the kidneys before reaching the target sites due to their low molecular weight. In the current study, increased bisphosphonates' efficacy for malaria treatment was attempted by conjugating bisphosphonates onto carbon nanospheres (CNSs). The synthesis of the target compounds was confirmed by SEM, TEM, EDX, FTIR, Raman and TGA. The target CNSs containing bisphosphonates were evaluated for antimalarial activity against a chloroquine-resistant strain of P. falciparum. From the free bisphosphonates to the conjugates, the results obtained revealed that there were improvements in percentage parasite kill (from -10.71% to 18%, -18.93% to 28.09% and 10.47% to 28.33% for alendronate, pamidronate and neridronate, respectively). The haemolysis assays revealed that the synthesized compound did not have a toxic impact on healthy red blood cells. The results indicate that bisphosphonates conjugated CNSs are said to be promising P. falciparum blood stage inhibitors.

Pathways to breast cancer recurrence

Breast cancer remains a deadly disease, even with all the recent technological advancements. Early intervention has made an impact, but an overwhelmingly large number of breast cancer patients still live under the fear of “recurrent” disease. Breast cancer recurrence is clinically a huge problem and one that is largely not well understood. Over the years, a number of factors have been studied with an overarching aim of being able to prognose recurrent disease. This paper attempts to provide an overview of our current knowledge of breast cancer recurrence and its associated challenges. Through a survey of the literature on cancer stem cells (CSCs), epithelial-mesenchymal transition (EMT), various signaling pathways such as Notch/Wnt/hedgehog, and microRNAs (miRNAs), we also examine the hypotheses that are currently under investigation for the prevention of breast cancer recurrence.