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Sahraoui G, Rahoui N, Driss M, Mrad K. Inflammatory breast cancer: An overview about the histo-pathological aspect and diagnosis. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 384:47-61. [PMID: 38637099 DOI: 10.1016/bs.ircmb.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Inflammatory Breast Cancer (IBC) is a rare and aggressive form of locally advanced breast cancer, classified as stage T4d according to the tumor-node-metastasis staging criteria. This subtype of breast cancer is known for its rapid progression and significantly lower survival rates compared to other forms of breast cancer. Despite its distinctive clinical features outlined by the World Health Organization, the histopathological characteristics of IBC remain not fully elucidated, presenting challenges in its diagnosis and treatment. Histologically, IBC tumors often exhibit a ductal phenotype, characterized by emboli composed of pleomorphic cells with a high nuclear grade. These emboli are predominantly found in the papillary and reticular dermis of the skin overlaying the breast, suggesting a primary involvement of the lymphatic vessels. The tumor microenvironment in IBC is a complex network involving various cells such as macrophages, monocytes, and predominantly T CD8+ lymphocytes, and elements including blood vessels and extracellular matrix molecules, which play a pivotal role in the aggressive nature of IBC. A significant aspect of IBC is the frequent loss of expression of hormone receptors like estrogen and progesterone receptors, a phenomenon that is still under active investigation. Moreover, the overexpression of ERBB2/HER2 and TP53 in IBC cases is a topic of ongoing debate, with studies indicating a higher prevalence in IBC compared to non-inflammatory breast cancer. This overview seeks to provide a comprehensive understanding of the histopathological features and diagnostic approaches to IBC, emphasizing the critical areas that require further research.
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Affiliation(s)
- Ghada Sahraoui
- Department of histopathology, Salah Azaiez Cancer Institute, Tunisia.
| | - Nabil Rahoui
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - Maha Driss
- Department of histopathology, Salah Azaiez Cancer Institute, Tunisia
| | - Karima Mrad
- Department of histopathology, Salah Azaiez Cancer Institute, Tunisia
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Boussen H, Berrazaga Y, Sherif Kullab, Manai M, Berrada N, Mejri N, Siala I, Levine PH, Cristofanilli M. Inflammatory breast cancer: Epidemiologic data and therapeutic results. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 384:1-23. [PMID: 38637094 DOI: 10.1016/bs.ircmb.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Since the early description more than a century ago, inflammatory breast cancer (IBC) remains an aggressive disease, with a different geographic repartition, with the highest ones incidence reported in the North of Africa (Tunisia, Algeria, Morocco, and Egypt), and the lowest incidence in Western countries (USA, Europe…). In this study, we reviewed the literature using the Surveillance, Epidemiology, and End Results (SEER) database compared to other published series. We observed that in the high incidence areas (North of Africa) when compared to "classical" breast cancer, IBC was associated to younger age (less than 50 years) with rapid evolution of signs and symptoms (in less than 3 up to 6 months), and more aggressive clinical and histopathological-molecular parameters, due to the predominance of triple-negative and HER2+ subtypes in around 60% of cases. An epidemiologic trend was observed in both high and low incidence areas since the eighties are towards reduction of IBC prevalence. Concerning Tunisia, in comparison with the historical series of the 1980s, the incidence decreased in part by applying more stringent diagnostic criteria but also probably due to a slight improvement of the socio-economic level (SEL). This trend was also observed in the US, due to the efforts of collaborative IBC groups from MD Anderson Cancer Center (MDACC), Duke and IBC patient advocacy groups. Therapeutic results are slightly better due to the standardization of a multidisciplinary approach and the use of combined primary chemotherapy and/or targeted therapies (especially in HER2 positive patients), followed by mastectomy plus radiotherapy. The 5-year overall and disease-free survival is at more than 60%, related to an IBC mortality decrease observed in the cohorts of patients treated in the last decade.
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Affiliation(s)
- Hamouda Boussen
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia; Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States.
| | - Yosra Berrazaga
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia
| | | | - Maroua Manai
- Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States; Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Pasteur Institute of Tunis, 13, place Pasteur, BP74, 1002 Tunis-Belvédère, University of Tunis El Manar, Tunis, Tunisia; Department of Medicine, Hematology/Oncology division, Weill Cornell Medicine, New York, NY, United States
| | | | - Nesrine Mejri
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia
| | | | - Paul H Levine
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Massimo Cristofanilli
- Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States; Department of Medicine, Hematology/Oncology division, Weill Cornell Medicine, New York, NY, United States
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Mighri N, Mejri N, Boujemaa M, Berrazega Y, Rachdi H, El Benna H, Labidi S, Benna F, Boubaker S, Boussen H, Abdelhak S, Hamdi Y. Association between epidemiological and clinico-pathological features of breast cancer with prognosis, family history, Ki-67 proliferation index and survival in Tunisian breast cancer patients. PLoS One 2022; 17:e0269732. [PMID: 36094928 PMCID: PMC9467370 DOI: 10.1371/journal.pone.0269732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
Breast cancer has different epidemio-clinical characteristics in Middle East and North-African populations compared to those reported in the Western countries. The aim of this study is to analyze the epidemiological and clinico-pathological features of breast cancer in Tunisia and to determine prognostic factors with special interest to family history, Ki-67 proliferation index and comorbidity. We retrospectively reviewed epidemiological and clinico-pathological data from patients’ medical records, treated in the Medical Oncology Department at Abderrahmane Mami Hospital, in the period 2011–2015. Data has been collected on 602 breast cancer patients and analyzed using SPSS software V.23.0. Our study showed high fractions of young breast cancer patients and cases with dense breasts. The most prevalent comorbidities observed in the studied cohort were cardiovascular diseases and diabetes. Familial breast cancer was found in 23.3% of cases and was associated with younger age at diagnosis (p<0.001) and advanced stage (p = 0.015). Ki-67 index >20% was significantly associated with early age at diagnosis, lymph node involvement (p = 0.002), advanced tumor grade (p<0.001) and high risk of relapse (p = 0.007). Ki-67 cut-off 30% predicted survival in luminal cases. Survival was worse in patients with triple negative breast cancer compared to non-triple negative breast cancer, inflammatory breast cancer compared to non-inflammatory breast cancer, moderately to poorly differentiated tumors compared to well-differentiated tumors and with positive lymph nodes compared to pN0 (p<0.05). Our study showed new insights into epidemiological and clinico-pathological characteristics of breast cancer that are not well explored in Tunisian population. Considering our findings along with the implementation of electronic health record system may improve patient health care quality and disease management.
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Affiliation(s)
- Najah Mighri
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nesrine Mejri
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Maroua Boujemaa
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Berrazega
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Haifa Rachdi
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Houda El Benna
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Soumaya Labidi
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Farouk Benna
- Department of Radiation Oncology, University of Tunis, Tunis, Tunisia
| | - Samir Boubaker
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Hamouda Boussen
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sonia Abdelhak
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia
- * E-mail:
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Fecal Metabolic Profiling of Breast Cancer Patients during Neoadjuvant Chemotherapy Reveals Potential Biomarkers. Molecules 2021; 26:molecules26082266. [PMID: 33919750 PMCID: PMC8070723 DOI: 10.3390/molecules26082266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
Breast cancer (BC) is the most common form of cancer among women worldwide. Despite the huge advancements in its treatment, the exact etiology of breast cancer still remains unresolved. There is an increasing interest in the role of the gut microbiome in modulating the anti-cancer therapeutic response. It seems that alteration of the microbiome-derived metabolome potentially promotes carcinogenesis. Taken together, metabolomics has arisen as a fascinating new omics field to screen promising metabolic biomarkers. In this study, fecal metabolite profiling was performed using NMR spectroscopy, to identify potential biomarker candidates that can predict response to neoadjuvant chemotherapy (NAC) for breast cancer. Metabolic profiles of feces from patients (n = 8) following chemotherapy treatment cycles were studied. Interestingly, amino acids were found to be upregulated, while lactate and fumaric acid were downregulated in patients under the second and third cycles compared with patients before treatment. Furthermore, short-chain fatty acids (SCFAs) were significantly differentiated between the studied groups. These results strongly suggest that chemotherapy treatment plays a key role in modulating the fecal metabolomic profile of BC patients. In conclusion, we demonstrate the feasibility of identifying specific fecal metabolic profiles reflecting biochemical changes that occur during the chemotherapy treatment. These data give an interesting insight that may complement and improve clinical tools for BC monitoring.
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Manai M, Finetti P, Mejri N, Athimni S, Birnbaum D, Bertucci F, Rahal K, Gamoudi A, Chaffanet M, Manai M, Boussen H. Inflammatory breast cancer in 210 patients: A retrospective study on epidemiological, anatomo-clinical features and therapeutic results. Mol Clin Oncol 2019; 10:223-230. [PMID: 30680198 PMCID: PMC6327217 DOI: 10.3892/mco.2018.1773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 10/01/2018] [Indexed: 11/05/2022] Open
Abstract
To report epidemiological and anatomo-clinical features within a retrospective series of inflammatory breast cancer and to evaluate prognostic factors. This retrospective study included 210 Tunisian patients presenting a clinically diagnosed IBC, treated at the Institute Salah Azaiez (ISA) of Tunis, Tunisia, from 2008 to 2013. We collected data on epidemiology, anatomo-clinical and biological features and histologic response to neoadjuvant therapy. Overall and disease-free survivals were calculated by Kaplan-Meier method and compared by log-rank tests and Cox's models were used to identify prognostic factors impacting survival. The 210 IBC patients had a median age of 42 years (24-62) and 15% of them were aged less than 35 years. Mean age at menarche was 13 years and 45% had their 1st childbirth before 23 years. On histology, grades III represented 42% of cases, hormone receptors were negative in 59%, HER2 over-expressed in 32, 25% of our IBC cases had a triple negative profile and Ki-67 was >20% in 53% of cases. High pathological grade III was significantly correlated to TN subtype (58%) (Fisher's exact test, P=7.5×10-3). Further, high Ki-67 expression (>20%) was evident in the TN subtype (84%) (Fisher's exact test, P=3.7×10-4). After neoadjuvant therapy (and trastuzumab in 88 and 69% of HER2+ patients, respectively), we observed 49% of objective clinical responses and 35% of pathological complete response (pCR) and >3 axillary lymph nodes were invaded on a resected tumor in 55% of cases. Overall survival (OS) was associated with age at menarche (Wald-test, P=2.2×10-2) and metastases at diagnosis (Wald-test, P=2.4×10-2). Reaching a pCR was correlated with a better metastasis-free survival (MFS), (Fisher's exact test, P=3.6×10-2).
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Affiliation(s)
- Maroua Manai
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, Tunis 1006, Tunisia.,Medical Oncology Service, University Hospital Abderrahmane Mami, Ariana 2080, Tunisia.,Laboratory of Biochemistry and Molecular Biology, Department of Biology, Faculty of Sciences, University of Tunis El Manar, Ariana 2092, Tunisia.,Predictive Oncology Τeam, Marseille Cancer Research Center (INSERM UMR1068; IFR137), Paoli-Calmettes Institute, 13009 Marseille, France
| | - Pascal Finetti
- Predictive Oncology Τeam, Marseille Cancer Research Center (INSERM UMR1068; IFR137), Paoli-Calmettes Institute, 13009 Marseille, France
| | - Nesrine Mejri
- Medical Oncology Service, University Hospital Abderrahmane Mami, Ariana 2080, Tunisia
| | - Salma Athimni
- Medical Oncology Service, University Hospital Abderrahmane Mami, Ariana 2080, Tunisia
| | - Daniel Birnbaum
- Predictive Oncology Τeam, Marseille Cancer Research Center (INSERM UMR1068; IFR137), Paoli-Calmettes Institute, 13009 Marseille, France
| | - François Bertucci
- Predictive Oncology Τeam, Marseille Cancer Research Center (INSERM UMR1068; IFR137), Paoli-Calmettes Institute, 13009 Marseille, France.,UFR of Medicine, Aix Marseille University, 13009 Marseille, France.,Department of Medical Oncology, Marseille Cancer Research Center (INSERM UMR1068; IFR137), Paoli-Calmettes Institute, Aix Marseille University, 13009 Marseille, France
| | - Khaled Rahal
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, Tunis 1006, Tunisia
| | - Amor Gamoudi
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, Tunis 1006, Tunisia
| | - Max Chaffanet
- Predictive Oncology Τeam, Marseille Cancer Research Center (INSERM UMR1068; IFR137), Paoli-Calmettes Institute, 13009 Marseille, France
| | - Mohamed Manai
- Laboratory of Biochemistry and Molecular Biology, Department of Biology, Faculty of Sciences, University of Tunis El Manar, Ariana 2092, Tunisia
| | - Hamouda Boussen
- Medical Oncology Service, University Hospital Abderrahmane Mami, Ariana 2080, Tunisia.,Laboratory of Biochemistry and Molecular Biology, Department of Biology, Faculty of Sciences, University of Tunis El Manar, Ariana 2092, Tunisia.,Oncology Radiotherapy Association for the Mediterranean, 75014 Paris, France
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Slaoui M, Zoure AA, Mouh FZ, Bensouda Y, El Mzibri M, Bakri Y, Amrani M. Outcome of inflammatory breast cancer in Moroccan patients: clinical, molecular and pathological characteristics of 219 cases from the National Oncology Institute (INO). BMC Cancer 2018; 18:713. [PMID: 29976157 PMCID: PMC6034251 DOI: 10.1186/s12885-018-4634-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 06/25/2018] [Indexed: 01/04/2023] Open
Abstract
Background Usually misdiagnosed, Inflammatory Breast Cancer (IBC) is the most aggressive form of non-metastatic breast cancer. This orphan disease is more frequent in North Africa. Despite intensive treatment, the survival rate remains very low. Methods We have retrospectively studied all breast cancer cases diagnosed at the National Oncology Institute (INO), Rabat between 2005 and 2010. We have collected 219 cases of women with metastatic and non-metastatic IBC. Data have been obtained from patients’ personal medical files over a follow-up period of 5 years. We have described IBC’s clinicopathological features and analyzed its clinical outcome using SPSS software. HR (hazard Ratio) was calculated using Cox regression analysis. Results The frequency of IBC cases is 4.05%. The majority of our patients (65.3%) were under 50 years old. The most prevalent molecular subtype was Luminal A (38.7%) followed by Luminal B HER2+ (27.9%) and Triple negative (21.6%). During the follow-up period, 72 patients (32.9%) had recurrence and 40 patients (18.3%) died. The 3-year OS (Overall Survival) and EFS (Event Free Survival) of non-metastatic patients were 70.4 and 46.5% respectively, while in the metastatic disease, the 3-year OS was only 41.9%. In non-metastatic women, we observed a higher rate of EFS associated to Selective estrogen receptor modulation treatment (p = 0.01), and a lower rate EFS in triple negative breast cancer patients (p = 0.02). In univariate analysis, we found that EFS rate is lower in patients presenting Triple Negative tumors when compared to other molecular subtypes (HR: 3.54; 95%CI: 1.13–11.05; p = 0.02). We also found that Selective estrogen receptor modulation treatment is associated with higher EFS rate (HR: 0.48; 95%CI: 0.07–0.59; p = 0.01). Conclusions IBC in Morocco shows similar characteristics to those in North African countries; however, survival rates are still the highest when compared with neighboring countries. Collaborative studies with prospective aspects are warranted to establish the epidemiological profile and understand the high frequencies of IBC in North Africa. More studies on molecular markers are also needed to improve IBC patients’ management and eventually their survival rate.
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Affiliation(s)
- Meriem Slaoui
- Equipe de recherche ONCOGYMA, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, Avenue Mohammed Belarbi El Alaoui - Souissi - BP, 6203, Rabat, Morocco. .,Unité de Biologie et Recherche Médicale, Centre National de l'Energie, des Sciences et des Techniques Nucléaires, Rabat, Morocco.
| | - Abdou Azaque Zoure
- Pietro Annigoni Biomolecular Research Center (CERBA)/LABIOGENE, University of Ouaga 1 Joseph KI ZERBO, UFR/SVT, Ouagadougou, Burkina Faso.,Laboratory of Biochemistry and Immunology, Faculty of Sciences, University of Mohammed V-Rabat, Rabat, Morocco.,Institute of Health Sciences Research, (IRSS)/ Department of Biomedical and Public Health, Ouagadougou, Burkina Faso
| | - Fatima Zahra Mouh
- Equipe de recherche ONCOGYMA, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, Avenue Mohammed Belarbi El Alaoui - Souissi - BP, 6203, Rabat, Morocco.,Unité de Biologie et Recherche Médicale, Centre National de l'Energie, des Sciences et des Techniques Nucléaires, Rabat, Morocco
| | - Youssef Bensouda
- Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, Avenue Mohammed Belarbi El Alaoui - Souissi - BP, 6203, Rabat, Morocco
| | - Mohammed El Mzibri
- Unité de Biologie et Recherche Médicale, Centre National de l'Energie, des Sciences et des Techniques Nucléaires, Rabat, Morocco
| | - Youssef Bakri
- Biochemistry-Immunology Laboratory, Faculty of Sciences Rabat, University Mohammed V - Agdal, Rabat, Morocco
| | - Mariam Amrani
- Equipe de recherche ONCOGYMA, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, Avenue Mohammed Belarbi El Alaoui - Souissi - BP, 6203, Rabat, Morocco
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Mejri N, Benna HE, M'ghirbi F, Labidi S, Daoud N, Boussen H. Biological features of inflammatory breast cancer in North Africa: burden and research priorities. BREAST CANCER MANAGEMENT 2018. [DOI: 10.2217/bmt-2018-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We aimed to review all published literature reporting biological data about inflammatory breast cancer (IBC) in populations from North Africa. Methods: We reviewed all studies that evaluated biological features of IBC in six North African countries between 1990 and 2017. Among 118 screened studies, 13 were included, none about Mauritania/Libya. Results: Across the studies, hormonal receptors were positive in 46–69% of cases, reaching 83% in Algeria. HER2 was overexpressed in 25–39% of cases. Recombinant human C protein expression was the highest in Egyptian patients (87%) compared with other North African populations. Using mRNA expression recombinant human C protein was expressed in 83% of Tunisian patients. WISP3 gene expression showed positive immunohistochemistry staining in 17% and mRNA expression in 26.8% of IBC. Conclusion: Biological aspects of IBC across North Africa show important similarities and differences.
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Affiliation(s)
- Nesrine Mejri
- Medical Oncology Department, Abderrahman Mami Hospital, University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Houda El Benna
- Medical Oncology Department, Abderrahman Mami Hospital, University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Fehmi M'ghirbi
- Medical Oncology Department, Abderrahman Mami Hospital, University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Soumaya Labidi
- Medical Oncology Department, Abderrahman Mami Hospital, University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Nouha Daoud
- Medical Oncology Department, Abderrahman Mami Hospital, University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Hamouda Boussen
- Medical Oncology Department, Abderrahman Mami Hospital, University of Medicine, University Tunis El Manar, Tunis, Tunisia
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Goh G, Schmid R, Guiver K, Arpornwirat W, Chitapanarux I, Ganju V, Im SA, Kim SB, Dechaphunkul A, Maneechavakajorn J, Spector N, Yau T, Afrit M, Ahmed SB, Johnston SR, Gibson N, Uttenreuther-Fischer M, Herrero J, Swanton C. Clonal Evolutionary Analysis during HER2 Blockade in HER2-Positive Inflammatory Breast Cancer: A Phase II Open-Label Clinical Trial of Afatinib +/- Vinorelbine. PLoS Med 2016; 13:e1002136. [PMID: 27923043 PMCID: PMC5140058 DOI: 10.1371/journal.pmed.1002136] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/22/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer associated with HER2 amplification, with high risk of metastasis and an estimated median survival of 2.9 y. We performed an open-label, single-arm phase II clinical trial (ClinicalTrials.gov NCT01325428) to investigate the efficacy and safety of afatinib, an irreversible ErbB family inhibitor, alone and in combination with vinorelbine in patients with HER2-positive IBC. This trial included prospectively planned exome analysis before and after afatinib monotherapy. METHODS AND FINDINGS HER2-positive IBC patients received afatinib 40 mg daily until progression, and thereafter afatinib 40 mg daily and intravenous vinorelbine 25 mg/m2 weekly. The primary endpoint was clinical benefit; secondary endpoints were objective response (OR), duration of OR, and progression-free survival (PFS). Of 26 patients treated with afatinib monotherapy, clinical benefit was achieved in 9 patients (35%), 0 of 7 trastuzumab-treated patients and 9 of 19 trastuzumab-naïve patients. Following disease progression, 10 patients received afatinib plus vinorelbine, and clinical benefit was achieved in 2 of 4 trastuzumab-treated and 0 of 6 trastuzumab-naïve patients. All patients had treatment-related adverse events (AEs). Whole-exome sequencing of tumour biopsies taken before treatment and following disease progression on afatinib monotherapy was performed to assess the mutational landscape of IBC and evolutionary trajectories during therapy. Compared to a cohort of The Cancer Genome Atlas (TCGA) patients with HER2-positive non-IBC, HER2-positive IBC patients had significantly higher mutational and neoantigenic burden, more frequent gain-of-function TP53 mutations and a recurrent 11q13.5 amplification overlapping PAK1. Planned exploratory analysis revealed that trastuzumab-naïve patients with tumours harbouring somatic activation of PI3K/Akt signalling had significantly shorter PFS compared to those without (p = 0.03). High genomic concordance between biopsies taken before and following afatinib resistance was observed with stable clonal structures in non-responding tumours, and evidence of branched evolution in 8 of 9 tumours analysed. Recruitment to the trial was terminated early following the LUX-Breast 1 trial, which showed that afatinib combined with vinorelbine had similar PFS and OR rates to trastuzumab plus vinorelbine but shorter overall survival (OS), and was less tolerable. The main limitations of this study are that the results should be interpreted with caution given the relatively small patient cohort and the potential for tumour sampling bias between pre- and post-treatment tumour biopsies. CONCLUSIONS Afatinib, with or without vinorelbine, showed activity in trastuzumab-naïve HER2-positive IBC patients in a planned subgroup analysis. HER2-positive IBC is characterized by frequent TP53 gain-of-function mutations and a high mutational burden. The high mutational load associated with HER2-positive IBC suggests a potential role for checkpoint inhibitor therapy in this disease. TRIAL REGISTRATION ClinicalTrials.gov NCT01325428.
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Affiliation(s)
- Gerald Goh
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, United Kingdom
- Bill Lyons Informatics Centre, UCL Cancer Institute, London, United Kingdom
| | - Ramona Schmid
- Boehringer Ingelheim Pharma GmbH & Co.KG, Biberach, Germany
| | - Kelly Guiver
- Boehringer Ingelheim Ltd, Bracknell, United Kingdom
| | | | | | | | - Seock-Ah Im
- Seoul National University Hospital, Seoul, South Korea
| | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | | | - Neil Spector
- Duke University Medical Center, Durham, North Carolina, United States of America
| | | | | | | | | | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co.KG, Biberach, Germany
| | | | - Javier Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, London, United Kingdom
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
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