1
|
Ge I, Berner K, Mathis M, Hensgen C, Mayer S, Erbes T, Juhasz-Böss I, Asberger J. Real-World Data Analysis of CDK4/6 Inhibitor Therapy-A Patient-Centric Single Center Study. Cancers (Basel) 2024; 16:1760. [PMID: 38730711 PMCID: PMC11083990 DOI: 10.3390/cancers16091760] [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: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The quest to comprehend the real-world efficacy of CDK4/6 inhibitors (CDKis) in breast cancer continues, as patient responses vary significantly. METHODS This single-center retrospective study evaluated CDKi use outside the trial condition from November 2016 to May 2020. Progression-free survival (PFS), time-to-treatment failure (TTF), short-term and prolonged treatment benefit (≥4 and ≥10 months), as well as prognostic and predictive markers were assessed with Kaplan-Meier and multivariate regression analyses. RESULTS Out of 86 identified patients, 58 (67.4%) had treatment failure of which 40 (46.5%) were due to progression. Median PFS and TTF were 12 and 8.5 months, respectively. A total of 57 (66.3%) and 42 (48.8%) patients experienced short-term and prolonged treatment benefit. Independent, significant predictors for PFS were progesterone receptor expression (HR: 0.88), multiple metastatic sites (HR: 2.56), and hepatic metastasis (HR: 2.01). Significant predictors for TTF were PR expression (HR: 0.86), multiple sites (HR: 3.29), adverse events (HR: 2.35), and diabetes (HR: 2.88). Aside from tumor biology and adverse events, treatment modifications like pausing and switching of CDKi were predictive for short-term (OR: 6.73) and prolonged (OR: 14.27) therapeutic benefit, respectively. CONCLUSIONS These findings emphasize the importance of tailored treatment strategies, highlighting the role of PR expression, metastatic burden, and therapeutic adjustments in optimizing patient outcomes in real-world breast cancer management.
Collapse
Affiliation(s)
- Isabell Ge
- Department of Gynecology and Obstetrics, University Hospital Basel, 4031 Basel, Switzerland;
- Breast Center, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Kai Berner
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Gyneaecology and Obstetrics, Diako Mannheim, 68163 Mannheim, Germany
| | - Marlene Mathis
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Catherine Hensgen
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sebastian Mayer
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Gynaecology and Obstetrics, Hospital Krumbach, 86381 Krumbach, Germany
| | - Thalia Erbes
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Gyneaecology and Obstetrics, Diako Mannheim, 68163 Mannheim, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Jasmin Asberger
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| |
Collapse
|
2
|
Wang X, Zhao S, Xin Q, Zhang Y, Wang K, Li M. Recent progress of CDK4/6 inhibitors' current practice in breast cancer. Cancer Gene Ther 2024:10.1038/s41417-024-00747-x. [PMID: 38409585 DOI: 10.1038/s41417-024-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
Dysregulated cellular proliferation represents a hallmark feature across all cancers. Aberrant activation of the cyclin-dependent kinase 4 and 6 (CDK4/6) pathway, independent of mitogenic signaling, engenders uncontrolled breast cancer cell proliferation. Consequently, the advent of CDK4/6 inhibition has constituted a pivotal milestone in the realm of targeted breast cancer therapy. The combination of CDK4/6 inhibitors (CDK4/6i) with endocrine therapy (ET) has emerged as the foremost therapeutic modality for patients afflicted with hormone receptor-positive (HR + )/HER2-negative (HER2-) advanced breast cancer. At present, the Food and Drug Administration (FDA) has sanctioned various CDK4/6i for employment as the primary treatment regimen in HR + /HER2- breast cancer. This therapeutic approach has demonstrated a substantial extension of progression-free survival (PFS), often amounting to several months, when administered alongside endocrine therapy. Within this comprehensive review, we systematically evaluate the utilization strategies of CDK4/6i across various subpopulations of breast cancer and explore potential therapeutic avenues following disease progression during application of CDK4/6i therapy.
Collapse
Affiliation(s)
- Xueqing Wang
- Department of Oncology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Shanshan Zhao
- Department of Oncology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Qinghan Xin
- Department of Breast Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Yunkun Zhang
- Department of Pathology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Kainan Wang
- Department of Oncology, the Second Hospital of Dalian Medical University, Dalian, China.
| | - Man Li
- Department of Oncology, the Second Hospital of Dalian Medical University, Dalian, China.
| |
Collapse
|
3
|
Brufsky A, Liu X, Li B, McRoy L, Chen C, Layman RM, Rugo HS. Palbociclib Combined with an Aromatase Inhibitor in Patients with Breast Cancer with Lung or Liver Metastases in US Clinical Practice. Cancers (Basel) 2023; 15:5268. [PMID: 37958441 PMCID: PMC10649131 DOI: 10.3390/cancers15215268] [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: 10/05/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
A cyclin-dependent kinase 4/6 inhibitor combined with endocrine therapy is the standard of care for patients with hormone receptor-positive/human epidermal growth factor 2-negative (HR+/HER2-) metastatic breast cancer (mBC), but real-world effectiveness data for patients with lung or liver metastases are limited. This retrospective study included data from the US Flatiron Health database of patients with HR+/HER2- mBC and lung or liver metastases treated with first-line palbociclib (PAL) plus an aromatase inhibitor (AI) or an AI alone in routine clinical practice. Overall survival (OS) and real-world progression-free survival (rwPFS) were assessed. A total of 891 patients were included (622 with lung metastasis, 376 with liver metastasis, and 107 with both lung and liver metastasis). After stabilized inverse probability of treatment weighting to balance patient characteristics, PAL + AI versus AI alone was associated with significantly prolonged OS (HR = 0.62; p < 0.001) and rwPFS (HR = 0.55; p < 0.001) in patients with lung metastases and numerically longer OS (HR = 0.73; p = 0.056) and significantly longer rwPFS (HR = 0.57, p < 0.001) for those with liver metastases. Overall, PAL + AI versus AI alone was associated with prolonged OS and rwPFS in routine clinical practice, supporting the use of first-line PAL + AI for patients with HR+/HER2- mBC with lung and/or liver metastases.
Collapse
Affiliation(s)
- Adam Brufsky
- UPMC Hillman Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Xianchen Liu
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Benjamin Li
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Lynn McRoy
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Connie Chen
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Rachel M. Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Hope S. Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA;
| |
Collapse
|
4
|
Yang R, Lu G, Lv Z, Jia L, Cui J. Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study. Front Oncol 2022; 12:1048781. [PMID: 36330468 PMCID: PMC9623315 DOI: 10.3389/fonc.2022.1048781] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Breast cancer visceral crisis (VC) is caused by excessive tumor burden leading to severe organ dysfunction with poor prognosis. Traditional chemotherapy reduces the quality of life of patients without significantly improving survival. The aim of this study was to investigate the clinical characteristics of patients with VC and the prognosis by using different treatment options. Methods According to the 5th European School of Oncology (ESO)–European Society for Medical Oncology (ESMO) international consensus guidelines for advanced breast cancer guidelines (ABC 5), patients who were treated in the First Hospital of Jilin University from 2018 to 2022 and diagnosed with breast cancer VC were retrospectively analyzed. The analysis focused on the characteristics of the patients, the treatment regimens, and prognosis. Results A total of 133 patients were included in this study. As for metastasis breast cancer subtype, 92 (69.18%) were hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER-2) negative, 20 (15.04%) had HER-2 overexpression, and 21 (15.78%) were triple negative. All patients had an mOS of 11.2 months (range, 1.1–107.8 months). In different types of VC, the median overall survival (mOS) of bone marrow metastasis (BMM) was 18.0 months (range, 2.0–107.8 months), that of diffuse liver metastasis (DLM) was 8.1 months (range, 1.3–30.2 months), and that of meningeal metastasis (MM) was 9.0 months (range, 1.2–53.8 months). In 92 HR+, Her-2− patients using different treatment regimens, mOS was 6.2 months (range, 1.2–29.8 months) in the chemotherapy group while it was 24.3 months (range, 3.1–107.8 months) in the endocrine therapy (ET) group. Multivariate Cox regression analysis suggested that Eastern Cooperative Oncology Group (ECOG) scores and type of VC were associated with survival. Conclusion Prognosis varied in different types of VC. Patients with BMM had the best prognosis, and DLM had the worst. As treatment options continue to progress, our retrospective study showed a significant prolongation of overall survival (OS) in patients with VC compared to previous studies.
Collapse
Affiliation(s)
| | | | | | - Lin Jia
- *Correspondence: Lin Jia, ; Jiuwei Cui,
| | | |
Collapse
|
5
|
Cardi M, Pocard M, Dico RL, Fiorentini G, Valle M, Gelmini R, Vaira M, Pasqual EM, Asero S, Baiocchi G, Di Giorgio A, Spagnoli A, Di Marzo F, Sollazzo B, D'Ermo G, Biacchi D, Iafrate F, Sammartino P. Selected Patients With Peritoneal Metastases From Breast Cancer May Benefit From Cytoreductive Surgery: The Results of a Multicenter Survey. Front Oncol 2022; 12:822550. [PMID: 35646687 PMCID: PMC9132044 DOI: 10.3389/fonc.2022.822550] [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: 11/25/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Even though breast cancer is the most frequent extra-abdominal tumor causing peritoneal metastases, clear clinical guidelines are lacking. Our aim is to establish whether cytoreductive surgery (CRS) could be considered in selected patients with peritoneal metastases from breast cancer (PMBC) to manage abdominal spread and allow patients to resume or complete other medical treatments. Methods We considered patients with PMBC treated in 10 referral centers from January 2002 to May 2019. Clinical data included primary cancer characteristics (age, histology, and TNM) and data on metastatic disease (interval between primary BC and PM, molecular subtype, other metastases, and peritoneal spread). Overall survival (OS) was estimated using the Kaplan–Meier method. Univariate and multivariable data for OS were analyzed using the Cox proportional hazards model. Results Of the 49 women with PMBC, 20 were treated with curative aim (CRS with or without HIPEC) and 29 were treated with non-curative procedures. The 10-year OS rate was 27%. Patients treated with curative intent had a better OS than patients treated with non-curative procedures (89.2% vs. 6% at 36 months, p < 0.001). Risk factors significantly influencing survival were age at primary BC, interval between BC and PM diagnosis, extra-peritoneal metastases, and molecular subtype. Conclusions The improved outcome in selected cases after a multidisciplinary approach including surgery should lead researchers to regard PMBC patients with greater attention despite their scarce epidemiological impact. Our collective efforts give new information, suggest room for improvement, and point to further research for a hitherto poorly studied aspect of metastatic BC.
Collapse
Affiliation(s)
- Maurizio Cardi
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Marc Pocard
- University of Paris, Unité Mixte de Recherche (UMR) 1275 CArcinose et pathologies du Péritoine (CAP) Paris Tech Carcinomatosis Peritoneum Paris Technology, Digestive and Hepato-Biliary Surgery Department, Pitié Salpetrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rea Lo Dico
- University of Paris, Unité Mixte de Recherche (UMR) 1275 CArcinose et pathologies du Péritoine (CAP) Paris Tech Lariboisière Carcinomatosis Peritoneum Paris Technology, Digestive and Oncological Surgery Department, Saint Louis Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gianmaria Fiorentini
- Department of Oncology, Azienda Ospedaliera (AO) Ospedali Marche Nord, Pesaro, Italy
| | - Mario Valle
- Peritoneal Tumors Unit, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Roberta Gelmini
- Department of Surgery, General and Oncologic Surgery Unit, Azienda Ospedaliera Universitaria (AOU) Modena, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
| | - Marco Vaira
- Surgical Oncology Unit, Istituto Tumori di Candiolo, Turin, Italy
| | - Enrico Maria Pasqual
- Advanced Oncologic Surgery Unit, Dipartimento Area Medica (DAME) University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) Udine, Italy
| | - Salvatore Asero
- Department of Oncology, Surgical Oncology Unit, Azienda Ospedaliera di Rilievo e di Alta Specializzazione Garibaldi, Catania, Italy
| | - Gianluca Baiocchi
- Clinical and Experimental Sciences Department, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Cremona, Italy
| | - Andrea Di Giorgio
- Surgery of Peritoneum and Retroperitoneum Unit, Istituti Ricerca e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alessandra Spagnoli
- Public Health and Infectious Diseases Department, Statistics Unit, Sapienza University of Rome, San Donato, Italy
| | - Francesco Di Marzo
- General Surgery Department, Ospedale Valtiberina, Unità Sanitaria Locale (USL) Toscana Sud-Est, Sansepolcro, Italy
| | - Bianca Sollazzo
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Franco Iafrate
- Department of Radiology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Paolo Sammartino
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
6
|
Ribociclib plus letrozole in subgroups of special clinical interest with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: Subgroup analysis of the phase IIIb CompLEEment-1 trial. Breast 2022; 62:75-83. [PMID: 35131646 PMCID: PMC9073296 DOI: 10.1016/j.breast.2022.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/10/2023] Open
Abstract
Background The phase IIIb CompLEEment-1 study evaluated ribociclib plus letrozole in patients with hormone receptor–positive (HR+), human epidermal growth factor receptor 2–negative (HER2–) advanced breast cancer (ABC). Outcomes were investigated in the following subgroups: central nervous system (CNS) metastases, prior chemotherapy for advanced disease, Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2, and visceral metastases plus prior chemotherapy for advanced disease or ECOG PS 2. Patients and methods Patients with HR+, HER2– ABC without prior hormonal treatment for advanced disease received oral ribociclib (600 mg once daily, 3 weeks on/1 week off) plus letrozole (2.5 mg once daily, continuous). Primary endpoint was safety/tolerability, assessed via occurrence of adverse events (AEs); key secondary endpoints included time to progression (TTP), overall response rate, and clinical benefit rate. Results 51 patients had CNS metastases, 194 received prior chemotherapy for advanced disease, 112 had ECOG PS 2, 146 had visceral metastases plus prior chemotherapy, and 77 had visceral metastases plus ECOG PS 2. Safety results were consistent with those in the overall CompLEEment-1 population; no new safety concerns were identified. The AE profile was manageable with low rates of discontinuations due to AEs. TTP in patients with CNS metastases was consistent with the overall study population and shorter for other patient subgroups. Each patient subgroup achieved meaningful clinical benefit from treatment, consistent with the overall population. Conclusion These findings confirm the clinical benefit of ribociclib plus endocrine therapy in high-risk patient subgroups of clinical interest commonly underrepresented in clinical trials. CompLEEment-1 evaluated ribociclib plus letrozole in patients with HR+, HER2– ABC. Outcomes were evaluated in 5 patient subgroups with traditionally poor prognosis. The AE profile was manageable; there were low rates of discontinuations due to AEs. Patients in each subgroup achieved meaningful clinical benefit from treatment.
Collapse
|
7
|
Hui V, Brazee R, Rosenzweig M, Lee YJ. The Association Between Hormone Receptor Status and End-of-Life Care Among Patients With Metastatic Breast Cancer. Clin J Oncol Nurs 2022; 26:198-203. [PMID: 35302550 DOI: 10.1188/22.cjon.198-203] [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: 11/17/2022]
Abstract
BACKGROUND In metastatic breast cancer (MBC), positive estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status allow for more long-term, sequential treatment options compared to ER-negative and HER2-negative diseases. It is unclear if end-of-life care (timely integration of palliative care, discontinuation of chemotherapy, and enrollment into hospice) in MBC is now tailored to the ER and HER2 status. OBJECTIVES This article explores the association between ER and HER2 status and the quality of end-of-life care received among patients with MBC. METHODS A 20-year MBC clinical database captured demographics, tumor characteristics, and treatment histories of deceased patients with MBC (N = 1,258) at a tertiary hospital located in Pittsburgh, Pennsylvania. Descriptive and inferential statistics were used. FINDINGS Patients with ER-positive MBC had greater odds of receiving quality end-of-life care than those with ER-negative MBC. HER2 status was not associated with differences in the quality of end-of-life care.
Collapse
|
8
|
Zhang L, Song G, Shao B, Xu L, Xiao Y, Wang M, Sumou IK, Zhang Y, Liang X, Jiang H, Li H. The efficacy and safety of palbociclib combined with endocrine therapy in patients with hormone receptor-positive HER2-negative advanced breast cancer: a multi-center retrospective analysis. Anticancer Drugs 2022; 33:e635-e643. [PMID: 34371506 PMCID: PMC8670355 DOI: 10.1097/cad.0000000000001210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 07/24/2021] [Indexed: 11/26/2022]
Abstract
To explore the efficacy and safety of palbociclib combined with endocrine therapy (ET) in advanced breast cancer (ABC). We conducted a retrospective study involving patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) ABC who received palbociclib combined with ET in the first- to third-line at three centers in China between January 2018 and October 2020. A total of 151 patients were included in this study. The median age of the patients at palbociclib initiation was 56 years (range 30-86 years) with a median follow-up of 10.9 months (range 2.0-41.2 months). Among these patients, 88 patients received palbociclib combined with ET as first-line therapy, and achieved a median progression-free survival (mPFS) of 19.8 months and an objective response rate (ORR) of 40.9%, meanwhile, in the first-line setting, 62 patients received palbociclib at an initial dose of 125 mg, achieving a mPFS of 20.9 months and an ORR of 46.8%. There were 39 and 24 patients who received palbociclib combined with ET as second- and third-line therapy, the mPFS were 10.0 months and 6.1 months, respectively. The most common and serious adverse events (AEs) were leukopenia and neutropenia. A total of 64 patients (42.4%) underwent palbociclib dose reduction due to AEs. Palbociclib combined with ET is an effective therapeutic regimen for HR+/HER2- ABC, particularly in the first-line setting with palbociclib initial dose of 125 mg, and AEs were manageable.
Collapse
Affiliation(s)
- Linhui Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| | - Bin Shao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| | - Ling Xu
- Department of Breast Disease Center, Peking University First Hospital, Xi Cheng District
| | - Yu Xiao
- Department of Tumor Chemotherapy and Radiation Sickness, Peking University Third Hospital, Hai-Dian District, Beijing, China
| | - Mopei Wang
- Department of Tumor Chemotherapy and Radiation Sickness, Peking University Third Hospital, Hai-Dian District, Beijing, China
| | - Ingrid Karmane Sumou
- Department of Oncology, Centro Hospitalar Conde de São Januário (CHCSJ), Macao Special Administrative Region of China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| | - Xu Liang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| | - Hanfang Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Hai-Dian District
| |
Collapse
|
9
|
Manohar PM, Davidson NE. Updates in endocrine therapy for metastatic breast cancer. Cancer Biol Med 2021; 19:j.issn.2095-3941.2021.0255. [PMID: 34609096 PMCID: PMC8832960 DOI: 10.20892/j.issn.2095-3941.2021.0255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Endocrine therapy (ET) remains the mainstay of treatment for steroid hormone receptor-positive, human epidermal growth factor 2 (HER2)-negative metastatic breast cancer (MBC). Tumor resistance to hormone therapy has led to the development of novel endocrine drug combinations, transforming the landscape of MBC management. The options for ET are expanding, with promising agents in the pipeline. Although MBC remains incurable, many patients can enjoy years of survival with good quality of life by cycling through the many available agents. With the plethora of available agents and rapid approvals, clinicians look to evidence-based guidelines to assist in treatment selection to maximize patient well-being. In this review, we provide a contemporary review of the advances in ET and a suggested algorithm to guide clinicians in daily management of patients with hormone receptor-positive, HER2-negative MBC. We will discuss landmark trials and highlight their impact in reshaping treatment approaches. Finally, we will provide a glimpse into advances on the horizon and the promise they bring to improve outcomes in patients with advanced breast cancer.
Collapse
Affiliation(s)
- Poorni M. Manohar
- University of Washington/Seattle Cancer Care Alliance, Seattle 98109, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle 98109, WA, USA
| | - Nancy E. Davidson
- University of Washington/Seattle Cancer Care Alliance, Seattle 98109, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle 98109, WA, USA
| |
Collapse
|
10
|
Yamamura J, Miyamura Y, Kamigaki S, Fujita J, Osato H, Manabe H, Tanaka Y, Shinzaki W, Hahimot Y, Ito T, Komoike Y. Relationship between endocrine resistance and the periods of adjuvant endocrine treatment for hormone receptor-positive, HER2-negative breast cancer. Breast Dis 2021; 41:109-114. [PMID: 34420939 DOI: 10.3233/bd-210027] [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: 11/15/2022]
Abstract
BACKGROUND Current guidelines define primary and secondary endocrine resistance according to the periods of adjuvant endocrine therapy (adj-ET); however, the relationship between adj-ET period and endocrine resistance remains unclear. OBJECTIVE We examined progression-free survival (PFS) after primary ET for recurrent hormone receptor-positive/HER2-negative breast cancer, and evaluated the relationship between endocrine resistance and the periods of adj-ET. METHODS We assessed PFS among 183 patients who received ET as primary treatment for the first recurrence, according to the period of adj-ET (adj-ET < 1 year, 1-2 years, ≥2 years, and completion). RESULTS Patients who relapsed during the first year of adj-ET had the significantly shortest PFS. PFS did not significantly differ between patients who relapsed at 1-2 years of adj-ET and patients who relapsed while on adj-ET but after the first 2 years. CONCLUSIONS Relapse at 1-2 years after adj-ET initiation might be better classified as secondary endocrine resistance rather than primary endocrine resistance.
Collapse
Affiliation(s)
- Jun Yamamura
- Department of Surgery, Sakai City Medical Center, Osaka, Japan.,Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yukiko Miyamura
- Department of Surgery, Sakai City Medical Center, Osaka, Japan
| | - Shunji Kamigaki
- Department of Surgery, Sakai City Medical Center, Osaka, Japan
| | - Junya Fujita
- Department of Surgery, Sakai City Medical Center, Osaka, Japan
| | - Hiroki Osato
- Department of Surgery, Sakai City Medical Center, Osaka, Japan
| | - Hironobu Manabe
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yumiko Tanaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Wataru Shinzaki
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yukihiko Hahimot
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toshikazu Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshifumi Komoike
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| |
Collapse
|
11
|
Yamamura J, Kamigaki S, Fujita J, Osato H, Manabe H, Tanaka Y, Shinzaki W, Hashimoto Y, Komoike Y. New insights into patterns of first metastatic sites influencing survival of patients with hormone receptor-positive, HER2-negative breast cancer: a multicenter study of 271 patients. BMC Cancer 2021; 21:476. [PMID: 33926418 PMCID: PMC8086318 DOI: 10.1186/s12885-021-08219-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background The initial therapeutic strategy for hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer is based on the first metastatic site; however, little evidence is available regarding the influence of metastatic distribution patterns of first metastatic sites on prognosis. In this study, we aimed to identify the metastatic distribution patterns of first metastatic sites that significantly correlate with survival after recurrence. Methods We performed a retrospective review of records from 271 patients with recurrent metastatic HR+/HER2- breast cancer diagnosed between January 2000 and December 2015. We assessed survival after recurrence according to the metastatic distribution patterns of the first metastatic sites and identified significant prognostic factors among patients with single and multiple metastases. Results Prognosis was significantly better in patients with a single metastasis than in those with multiple metastases (median overall survival after recurrence: 5.86 years vs. 2.50 years, respectively, p < 0.001). No metastatic organ site with single metastasis was significantly associated with prognostic outcome, although single metastasis with diffuse lesions was an independent risk factor for worse prognosis (HR: 3.641; 95% CI: 1.856–7.141) and more easily progressing to multiple metastases (p = 0.002). Multiple metastases, including liver metastasis (HR: 3.145; 95% CI: 1.802–5.495) or brain metastasis (HR: 3.289; 95% CI: 1.355–7.937), were regarded as significant independent poor prognostic factors; however, multiple metastases not involving liver or brain metastasis were not significantly related to prognosis after recurrence. Conclusions Single metastases with diffuse lesions could more easily disseminate systemically and progress to multiple metastases, leading to a poor prognosis similar to multiple metastases. Our findings indicate that the reconsideration of the determinant factors of therapeutic strategies for first recurrence in HR+/HER2- breast cancer may be needed.
Collapse
Affiliation(s)
- Jun Yamamura
- Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan. .,Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigasi, Sayama City, Osaka, 589-8511, Japan.
| | - Shunji Kamigaki
- Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Junya Fujita
- Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Hiroki Osato
- Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Hironobu Manabe
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigasi, Sayama City, Osaka, 589-8511, Japan
| | - Yumiko Tanaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigasi, Sayama City, Osaka, 589-8511, Japan
| | - Wataru Shinzaki
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigasi, Sayama City, Osaka, 589-8511, Japan
| | - Yukihiko Hashimoto
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigasi, Sayama City, Osaka, 589-8511, Japan
| | - Yoshifumi Komoike
- Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigasi, Sayama City, Osaka, 589-8511, Japan
| |
Collapse
|
12
|
Robertson JFR, Di Leo A, Johnston S, Chia S, Bliss JM, Paridaens RJ, Lichfield J, Bradbury I, Campbell C. Meta-analyses of visceral versus non-visceral metastatic hormone receptor-positive breast cancer treated by endocrine monotherapies. NPJ Breast Cancer 2021; 7:11. [PMID: 33579962 PMCID: PMC7881093 DOI: 10.1038/s41523-021-00222-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Endocrine therapy (ET) is recommended as first-line therapy for the majority of patients with hormone receptor-positive (HR+), human epidermal growth factor 2-negative advanced breast cancer (ABC); however, the efficacy of ET in patients with visceral metastases (VM) versus patients whose disease is limited to non-visceral metastases (non-VM) is debated. Meta-analyses including available data from randomised controlled trials of first- and second-line endocrine monotherapies for patients with HR+ ABC were performed to address this question. In one and two-stage meta-analyses, progression-free survival (PFS), overall survival (OS), clinical benefit rate (CBR) and duration of clinical benefit (DoCB) outcomes were analysed. In the first-line meta-analysis (seven trials; n = 1988) tamoxifen and fulvestrant significantly improved PFS, OS and CBR for patients with non-VM versus those whose disease included VM. The most substantial hazard ratios were observed for fulvestrant 500 mg; 0.56 (95% confidence interval [CI] 0.45-0.70) and 0.55 (95% CI 0.42-0.72) for PFS and OS, respectively. In the second-line meta-analysis (seven trials; n = 2324), all ET combined was more effective (in terms of PFS, OS and DoCB) for non-VM versus VM. In both meta-analyses, patients with non-liver VM had better clinical outcomes than patients with liver VM for all types of ET. Patients whose disease included non-VM sites had better clinical outcomes with endocrine monotherapy compared with patients whose disease included VM. These findings may facilitate better informed treatment decision-making.
Collapse
Affiliation(s)
- John F R Robertson
- Graduate Entry Medicine, University of Nottingham, School of Medicine, Nottingham, UK.
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Unit, Department of Oncology, Hospital of Prato, Instituto Toscano Tumori, Prato, Italy
| | | | - Stephen Chia
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Robert J Paridaens
- Department of Oncology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - Jasmine Lichfield
- Global Medicines Development, AstraZeneca, Cambridge, UK
- Eisai, Hatfield, UK
| | - Ian Bradbury
- Biostatistics, Frontier Science, Kincraig, Scotland, UK
| | | |
Collapse
|
13
|
Finn RS, Cristofanilli M, Ettl J, Gelmon KA, Colleoni M, Giorgetti C, Gauthier E, Liu Y, Lu DR, Zhang Z, Bartlett CH, Slamon DJ, Turner NC, Rugo HS. Treatment effect of palbociclib plus endocrine therapy by prognostic and intrinsic subtype and biomarker analysis in patients with bone-only disease: a joint analysis of PALOMA-2 and PALOMA-3 clinical trials. Breast Cancer Res Treat 2020; 184:23-35. [PMID: 32783178 PMCID: PMC7568717 DOI: 10.1007/s10549-020-05782-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023]
Abstract
Purpose This analysis evaluated the relationship between treatment-free interval (TFI, in PALOMA-2)/disease-free interval (DFI, in PALOMA-3) and progression-free survival (PFS) and overall survival (OS, in PALOMA-3), treatment effect in patients with bone-only disease, and whether intrinsic subtype affects PFS in patients receiving palbociclib. Methods Data were from phase 3, randomized PALOMA-2 and PALOMA-3 clinical studies of hormone receptor‒positive/human epidermal growth factor receptor 2‒negative (HR+ /HER2−) advanced breast cancer (ABC) patients receiving endocrine therapy plus palbociclib or placebo. Subpopulation treatment effect pattern plot (STEPP) analysis evaluated the association between DFI and PFS and OS. PFS by luminal subtype and cyclin-dependent kinase (CDK) 4/6 or endocrine pathway gene expression levels were evaluated in patients with bone-only disease; median PFS and OS were estimated by the Kaplan–Meier method. Results Median durations of TFI were 37.1 and 30.9 months (PALOMA-2) and DFI were 49.2 and 52.0 months (PALOMA-3) in the palbociclib and placebo groups, respectively. Among the PALOMA-2 biomarker population (n = 454), 23% had bone-only disease; median PFS was longer with palbociclib versus placebo (31.3 vs 11.2 months; hazard ratio, 0.41; 95% CI 0.25‒0.69). The interaction effect of bone-only versus visceral disease subgroups on median PFS with palbociclib was not significant (P = 0.262). Among the PALOMA-3 biomarker population (n = 302), 27% had bone-only disease. STEPP analyses showed that palbociclib PFS benefit was not affected by DFI, and that palbociclib OS effect may be smaller in patients with short DFIs. Among patients who provided metastatic tumor tissues (n = 142), regardless of luminal A (hazard ratio, 0.23; 95% CI 0.11‒0.47; P = 0.0000158) or luminal B (hazard ratio, 0.26; 95% CI 0.12‒0.56; P = 0.000269) subtype, palbociclib improved PFS versus placebo. Conclusions These findings support palbociclib plus endocrine therapy as standard of care for HR+ /HER2− ABC patients, regardless of baseline TFI/DFI or intrinsic molecular subtype, including patients with bone-only disease. Trial registration Pfizer (clinicaltrials.gov:NCT01740427, NCT01942135).
Collapse
Affiliation(s)
- Richard S Finn
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd, Suite 200, Santa Monica, CA, USA.
| | - Massimo Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, 710 N Fairbanks Ct, Suite 8-250A, Chicago, IL, USA
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Karen A Gelmon
- British Columbia Cancer Agency, 675 West 10th Ave, Vancouver, BC, Canada
| | - Marco Colleoni
- IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | | | - Eric Gauthier
- Pfizer Inc, 525 Market Street, San Francisco, CA, USA
| | - Yuan Liu
- Pfizer Inc, 10646 Science Center Dr, La Jolla, San Diego, CA, USA
| | - Dongrui R Lu
- Pfizer Inc, 10646 Science Center Dr, La Jolla, San Diego, CA, USA
| | - Zhe Zhang
- Pfizer Inc, 10646 Science Center Dr, La Jolla, San Diego, CA, USA
| | | | - Dennis J Slamon
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd, Suite 200, Santa Monica, CA, USA
| | - Nicholas C Turner
- Royal Marsden Hospital and Institute of Cancer Research, Fulham Rd, London, SW3 6JJ, UK
| | - Hope S Rugo
- University of California San Francisco Comprehensive Center, 1600 Divisadero St, San Francisco, CA, USA
| |
Collapse
|
14
|
Rugo HS, Bardia A, Tolaney SM, Arteaga C, Cortes J, Sohn J, Marmé F, Hong Q, Delaney RJ, Hafeez A, André F, Schmid P. TROPiCS-02: A Phase III study investigating sacituzumab govitecan in the treatment of HR+/HER2- metastatic breast cancer. Future Oncol 2020; 16:705-715. [PMID: 32223649 DOI: 10.2217/fon-2020-0163] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with HR+/HER2- metastatic breast cancer (MBC) whose cancers have progressed despite conventional therapies represent an unmet clinical need. Trop-2, a transmembrane calcium signal transducer, is highly expressed in MBC and plays a role in tumor growth and progression. Sacituzumab govitecan (SG) is a novel antibody-drug conjugate comprising an Trop-2 antibody coupled to SN-38, the active metabolite of irinotecan, via a unique hydrolyzable linker. SG has demonstrated promising activity in a Phase I/II IMMU-132-01 basket study in heavily pretreated solid tumors, including HR+/HER2- MBC. We describe the registrational Phase III TROPiCS-02 study (NCT03901339), evaluating SG versus treatment of physician's choice in HR+/HER2- MBC. Trial registration number: NCT03901339.
Collapse
Affiliation(s)
- Hope S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94115, USA
| | - Aditya Bardia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Carlos Arteaga
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Javier Cortes
- Medical Oncology Department, IOB Institute of Oncology, Quirosalud Group, Madrid & Barcelona, Spain and Senior clinical Researcher, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, University Hospital Mannheim, Germany
| | - Quan Hong
- Immunomedics, Morris Plains, NJ 07950, USA
| | | | | | - Fabrice André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, UK
| |
Collapse
|
15
|
Komorowski AS, Warner E, MacKay HJ, Sahgal A, Pritchard KI, Jerzak KJ. Incidence of Brain Metastases in Nonmetastatic and Metastatic Breast Cancer: Is There a Role for Screening? Clin Breast Cancer 2019; 20:e54-e64. [PMID: 31447286 DOI: 10.1016/j.clbc.2019.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/24/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines recommend against screening breast cancer patients for asymptomatic brain metastases. Because brain metastases are a major cause of morbidity and mortality from breast cancer, we undertook a literature review to ascertain whether there might be a role for brain metastases screening in high-risk patient subgroups. MATERIALS AND METHODS A literature search was conducted on the OvidSP platform in the MedLine database, using MeSH terms and subject headings related to breast cancer, brain metastases, and incidence. The search was conducted without language or publication restrictions, and included articles indexed from January 1, 2006 to June 10, 2018. Experimental and observational studies that reported the incidence of brain metastases in patients with nonmetastatic or metastatic breast cancer were included. RESULTS One hundred seventy studies were identified, with 33 included in the final analysis. Among nonmetastatic breast cancer patients, incidence of brain metastases as site of first recurrence per year of median follow-up ranged from 0.1% to 3.2%. Although incidence of brain metastases was much higher among the metastatic breast cancer population overall, it was particularly high among metastatic HER2-overexpressing (HER2+) and triple-negative populations, ranging between 22% and 36% for the former, and 15%-37% for the latter in the absence of screening. CONCLUSION In patients with nonmetastatic breast cancer, screening for asymptomatic brain metastases cannot currently be justified. However, due to the high incidence of brain metastases among patients with metastatic HER2+ and triple-negative breast cancer, studies to determine the value of screening for brain metastases should be undertaken in these subgroups.
Collapse
Affiliation(s)
- Adam S Komorowski
- Division of Medical Microbiology, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Warner
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Helen J MacKay
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen I Pritchard
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Katarzyna J Jerzak
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
16
|
Turner NC, Finn RS, Martin M, Im SA, DeMichele A, Ettl J, Diéras V, Moulder S, Lipatov O, Colleoni M, Cristofanilli M, Lu DR, Mori A, Giorgetti C, Iyer S, Bartlett CH, Gelmon KA. Clinical considerations of the role of palbociclib in the management of advanced breast cancer patients with and without visceral metastases. Ann Oncol 2019; 29:669-680. [PMID: 29342248 PMCID: PMC5888946 DOI: 10.1093/annonc/mdx797] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This report assesses the efficacy and safety of palbociclib plus endocrine therapy (ET) in women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (ABC) with or without visceral metastases. Patients and methods Pre- and postmenopausal women with disease progression following prior ET (PALOMA-3; N = 521) and postmenopausal women untreated for ABC (PALOMA-2; N = 666) were randomized 2 : 1 to ET (fulvestrant or letrozole, respectively) plus palbociclib or placebo. Progression-free survival (PFS), safety, and patient-reported quality of life (QoL) were evaluated by prior treatment and visceral involvement. Results Visceral metastases incidence was higher in patients with prior resistance to ET (58.3%, PALOMA-3) than in patients naive to ET in the ABC setting (48.6%, PALOMA-2). In patients with prior resistance to ET and visceral metastases, median PFS (mPFS) was 9.2 months with palbociclib plus fulvestrant versus 3.4 months with placebo plus fulvestrant [hazard ratio (HR), 0.47; 95% confidence interval (CI), 0.35–0.61], and objective response rate (ORR) was 28.0% versus 6.7%, respectively. In patients with nonvisceral metastases, mPFS was 16.6 versus 7.3 months, HR 0.53; 95% CI 0.36–0.77. In patients with visceral disease and naive to ET in the advanced disease setting, mPFS was 19.3 months with palbociclib plus letrozole versus 12.9 months with placebo plus letrozole (HR 0.63; 95% CI 0.47–0.85); ORR was 55.1% versus 40.0%; in patients with nonvisceral disease, mPFS was not reached with palbociclib plus letrozole versus 16.8 months with placebo plus letrozole (HR 0.50; 95% CI 0.36–0.70). In patients with prior resistance to ET with visceral metastases, palbociclib plus fulvestrant significantly delayed deterioration of QoL versus placebo plus fulvestrant, whereas patient-reported QoL was maintained with palbociclib plus letrozole in patients naive to endocrine-based therapy for ABC. Conclusions Palbociclib plus ET prolonged mPFS in patients with visceral metastases, increased ORRs, and in patients previously treated for ABC, delayed QoL deterioration, presenting a standard treatment option among patients with visceral metastases amenable to endocrine-based therapy. Clinical trial registration NCT01942135, NCT01740427
Collapse
Affiliation(s)
- N C Turner
- Toby Robins Breast Cancer Research Centre, Institute of Cancer Research and Royal Marsden Hospital, London, UK.
| | - R S Finn
- Department of Medicine, David Geffen School of Medicine, Los Angeles, USA
| | - M Martin
- Department of Medicine, Hospital Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - A DeMichele
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - J Ettl
- Klinik und Poliklinik fuer Frauenheilkunde Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - V Diéras
- Department of Clinical Research, Institut Curie, Paris, France
| | - S Moulder
- Department of Breast Medical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, USA
| | - O Lipatov
- State Budget Medical Institution Republican Clinical Oncology Dispensary, Ufa, Russia
| | - M Colleoni
- European Institute of Oncology, Milan, Italy
| | - M Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Chicago
| | - D R Lu
- Pfizer Inc, La Jolla, USA
| | - A Mori
- Pfizer S.r.l, Milan, Italy
| | | | - S Iyer
- Pfizer Inc, New York, USA
| | | | - K A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency-Vancouver Centre, Vancouver, Canada
| |
Collapse
|
17
|
Fumet JD, Wickre M, Jacquot JP, Bizollon MH, Melis A, Vanoli A, Viel E. Successfully treatment by eribulin in visceral crisis: a case of lymphangitic carcinomatosis from metastatic breast cancer. BMC Cancer 2018; 18:839. [PMID: 30126360 PMCID: PMC6102904 DOI: 10.1186/s12885-018-4725-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) rest an incurably disease associated with bad prognosis and a median overall survival of 23-31 months. There are several treatment options including chemotherapy and sometimes endocrine therapy. Currently, there is no standard treatment for patients with MBC who have already benefited from anthracyclines and taxanes therapy. Many drugs like capecitabine, eribulin, gemcitabine, vinorelbin and liposomal doxorubicin are conventionally used as monotherapy. One important complication from MBC is life threating visceral crisis that needs a fast-effective treatment. CASE PRESENTATION We report here a case of an evolution of metastatic breast cancer with lymphangitic carcinomatosis after taxane based chemotherapy and endocrine therapy. This 37-year-old woman was referred to our hospital with complaints of dyspnea and dry cough. There was clinical concern for visceral crisis and a chemotherapy with eribulin was initiated. Pulmonary lymphangitic carcinomatosis disappeared and the patient achieved a good partial response. CONCLUSION We reported a case of rapid, positive treatment response using eribulin on metastatic breast cancer with visceral crisis and we could quoted others. Therefore, eribulin may be an appropriate chemotherapeutic option in instances requiring rapid symptom control.
Collapse
Affiliation(s)
- Jean-David Fumet
- Department of Oncology, Centre Georges François Leclerc, 1 rue Professeur Marion, 21000, Dijon, France.
| | - Mark Wickre
- Department of Radiology, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Jean-Philippe Jacquot
- Department of Pathology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
| | - Marie-Helene Bizollon
- Department of Pathology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
| | - Adrien Melis
- Department of Oncology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
- Department of Oncology, Chalon-sur-Saône and Institut de Cancérologie de Bourgogne, 4 allées St Jean des Vignes, 71100, Chalon sur Saône, France
| | - André Vanoli
- Department of Oncology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
- Department of Oncology, Chalon-sur-Saône and Institut de Cancérologie de Bourgogne, 4 allées St Jean des Vignes, 71100, Chalon sur Saône, France
| | - Erika Viel
- Department of Oncology, Ramsay Général de Santé, Hopital Privé Sainte Marie, 4 Allée de Saint-Jean-des-Vignes, 71100, Chalon-sur-Saône, France
- Department of Oncology, Chalon-sur-Saône and Institut de Cancérologie de Bourgogne, 4 allées St Jean des Vignes, 71100, Chalon sur Saône, France
| |
Collapse
|
18
|
CDK4/6 inhibitors in advanced hormone receptor-positive/HER2-negative breast cancer: a systematic review and meta-analysis of randomized trials. Breast Cancer Res Treat 2018; 172:9-21. [DOI: 10.1007/s10549-018-4901-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
|
19
|
Health-related quality of life from the FALCON phase III randomised trial of fulvestrant 500 mg versus anastrozole for hormone receptor-positive advanced breast cancer. Eur J Cancer 2018; 94:206-215. [DOI: 10.1016/j.ejca.2018.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/19/2022]
|
20
|
Jiang Y, Wu Q, Yang X, Zhao J, Jin Y, Li K, Ma Y, Chen X, Tian F, Zhao S, Xu J, Lu J, Yin X, Liu K, Dong Z. A method for establishing a patient-derived xenograft model to explore new therapeutic strategies for esophageal squamous cell carcinoma. Oncol Rep 2015; 35:785-92. [PMID: 26718633 DOI: 10.3892/or.2015.4459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 10/10/2015] [Indexed: 11/05/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is the predominant histological type of esophageal carcinoma in China. The overall 5-year survival rate of ESCC patients is in the low range of 15-25%. One important reason for the poor prognosis is that the underlying molecular mechanisms are unclear. Furthermore, the development of effective therapeutic strategies to improve patient outcome is needed. Animal models can be beneficial to analyze the molecular mechanisms as well as specific clinical therapeutic strategies for esophageal cancer. In recent years, patient-derived xenografts (PDXs) have been widely used in numerous types of cancers to investigate the basic mechanisms and to conduct preclinical research. Accumulating evidence indicates that the PDX model is an important tool for basic and clinical research. Herein, we successfully established 14 ESCC PDXs. These PDX models preserved the patient pathological characteristics and effectively reflected the patient biological heterogeneity. Cancers exhibit diverse growth rates and tumor texture, even more, they have different signaling pathways. The PDX model is a superior strategy for understanding the underlying molecular mechanisms of ESCC and for screening new therapeutic strategies for ESCC patients.
Collapse
Affiliation(s)
- Yanan Jiang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Qiong Wu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Xiawen Yang
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Jimin Zhao
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Yuxi Jin
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Ke Li
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Yihui Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xinhuan Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Fang Tian
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Song Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jinglong Xu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Jing Lu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Xueshan Yin
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Kangdong Liu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Ziming Dong
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| |
Collapse
|