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Püsküllüoğlu M, Swiderska K, Konieczna A, Streb J, Grela-Wojewoda A, Rudzinska A, Dobrzańska J, Pacholczak-Madej R, Mucha-Malecka A, Kunkiel M, Mitus JW, Jarząb M, Ziobro M. Clinical analysis of metaplastic breast carcinoma with distant metastases: A multi‑centre experience. Oncol Lett 2024; 27:198. [PMID: 38516685 PMCID: PMC10955678 DOI: 10.3892/ol.2024.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/23/2024] Open
Abstract
Metaplastic breast cancer (BC-Mp), which includes a range of epithelial and mixed epithelial-mesenchymal tumours, are rare malignancies with an unfavourable prognosis. The limited literature on BC-Mp focuses mainly on retrospective data for radically treated patients. Notably absent are studies dedicated to the palliative treatment of BC-Mp with distant metastases. The present retrospective study investigated treatment modalities and prognosis in a multi-centre cohort of 31 female participants diagnosed with distant metastatic BC-Mp, including 7 patients with de novo metastatic disease. The median age of the patients was 61 years (range, 33-87 years), with 38.7% presenting local lymph node involvement. Lungs were the most common site for the metastatic disease (61.3%). Median Ki-67 index was 50% (range, 35-70%), and 80.7% of cases were classified as grade 3. Human epidermal growth factor receptor 2 (HER2)+ and estrogen receptor+ were detected in 12.9 and 6.5% of cases, respectively. A total of 62.4% of patients received first-line palliative systemic treatment. The 1- and 2-year overall survival (OS) were 38.5 and 19.2%, respectively. Receiving ≥1 line of palliative treatment was significantly associated with improved OS (P<0.001). Factors such as age, Ki-67 index, HER2 or hormonal status, presence of specific epithelial or mesenchymal components, location of metastases or chemotherapy regimen type did not influence OS. The present study provided insights into the clinicopathological profile, systemic treatment experience, prognostic factors and OS data of BC-Mp with distant metastases, emphasizing the imperative for clinical trials in this population.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Katarzyna Swiderska
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Aleksandra Konieczna
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Oncology, University Hospital, 30-688 Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Agnieszka Rudzinska
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | | | - Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
- Department of Chemotherapy, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Anna Mucha-Malecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Kunkiel
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Jerzy W. Mitus
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Jarząb
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
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Püsküllüoğlu M, Świderska K, Konieczna A, Rudnicki W, Pacholczak-Madej R, Kunkiel M, Grela-Wojewoda A, Mucha-Małecka A, Mituś JW, Stobiecka E, Ryś J, Jarząb M, Ziobro M. Discrepancy between Tumor Size Assessed by Full-Field Digital Mammography or Ultrasonography (cT) and Pathology (pT) in a Multicenter Series of Breast Metaplastic Carcinoma Patients. Cancers (Basel) 2023; 16:188. [PMID: 38201615 PMCID: PMC10778481 DOI: 10.3390/cancers16010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Metaplastic breast cancer (BC-Mp) presents diagnostic and therapeutic complexities, with scant literature available. Correct assessment of tumor size by ultrasound (US) and full-field digital mammography (FFDM) is crucial for treatment planning. METHODS A retrospective cohort study was conducted on databases encompassing records of BC patients (2012-2022) at the National Research Institutes of Oncology (Warsaw, Gliwice and Krakow Branches). Inclusion criteria comprised confirmed diagnosis in postsurgical pathology reports with tumor size details (pT) and availability of tumor size from preoperative US and/or FFDM. Patients subjected to neoadjuvant systemic treatment were excluded. Demographics and clinicopathological data were gathered. RESULTS Forty-five females were included. A total of 86.7% were triple-negative. The median age was 66 years (range: 33-89). The median pT was 41.63 mm (6-130), and eight patients were N-positive. Median tumor size assessed by US and FFDM was 31.81 mm (9-100) and 34.14 mm (0-120), respectively. Neither technique demonstrated superiority (p > 0.05), but they both underestimated the tumor size (p = 0.002 for US and p = 0.018 for FFDM). Smaller tumors (pT1-2) were statistically more accurately assessed by any technique (p < 0.001). Only pT correlated with overall survival. CONCLUSION The risk of underestimation in tumor size assessment with US and FFDM has to be taken into consideration while planning surgical procedures for BC-Mp.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (A.G.-W.); (M.Z.)
| | - Katarzyna Świderska
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Aleksandra Konieczna
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Wojciech Rudnicki
- Department of Electroradiology, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, 31-008p Kraków, Poland; (R.P.-M.)
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
- Department of Chemotherapy, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Michał Kunkiel
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (A.G.-W.); (M.Z.)
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Jerzy W. Mituś
- Department of Anatomy, Jagiellonian University Medical College, 31-008p Kraków, Poland; (R.P.-M.)
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Ewa Stobiecka
- Department of Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Janusz Ryś
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Michał Jarząb
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (A.G.-W.); (M.Z.)
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Pacholczak-Madej R, Kosałka-Węgiel J, Kuszmiersz P, Mituś JW, Püsküllüoğlu M, Grela-Wojewoda A, Korkosz M, Bazan-Socha S. Immune Checkpoint Inhibitor Related Rheumatological Complications: Cooperation between Rheumatologists and Oncologists. Int J Environ Res Public Health 2023; 20:4926. [PMID: 36981837 PMCID: PMC10049070 DOI: 10.3390/ijerph20064926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
In cancer, immune checkpoint inhibitors (ICIs) improve patient survival but may lead to severe immune-related adverse events (irAEs). Rheumatic irAEs are a distinct entity that are much more common in a real-life than in clinical trial reports due to their unspecific symptoms and them being a rare cause of hospitalization. This review focuses on an interdisciplinary approach to the management of rheumatic irAEs, including cooperation between oncologists, rheumatologists, and immunologists. We discuss the immunological background of rheumatic irAEs, as well as their unique clinical characteristics, differentiation from other irAEs, and treatment strategies. Importantly, steroids are not the basis of therapy, and nonsteroidal anti-inflammatory drugs should be administered in the front line with other antirheumatic agents. We also address whether patients with pre-existing rheumatic autoimmune diseases can receive ICIs and how antirheumatic agents can interfere with ICIs. Interestingly, there is a preclinical rationale for combining ICIs with immunosuppressants, particularly tumor necrosis factor α and interleukin 6 inhibitors. Regardless of the data, the mainstay in managing irAEs is interdisciplinary cooperation between oncologists and other medical specialties.
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Affiliation(s)
- Renata Pacholczak-Madej
- Department of Clinical Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
| | - Joanna Kosałka-Węgiel
- Department of Rheumatology and Immunology, Jagiellonian University Medical Kraków, 30-688 Krakow, Poland
- Division of Rheumatology and Immunology Clinical, University Hospital, 30-688 Kraków, Poland
| | - Piotr Kuszmiersz
- Department of Rheumatology and Immunology, Jagiellonian University Medical Kraków, 30-688 Krakow, Poland
- Division of Rheumatology and Immunology Clinical, University Hospital, 30-688 Kraków, Poland
| | - Jerzy W. Mituś
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Department of Surgical Oncology, National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Mirosława Püsküllüoğlu
- Department of Clinical Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical Kraków, 30-688 Krakow, Poland
- Division of Rheumatology and Immunology Clinical, University Hospital, 30-688 Kraków, Poland
| | - Stanisława Bazan-Socha
- Department of Internal Medicine, Jagiellonian University Medical College, 30-688 Kraków, Poland
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Ziobro M, Grela-Wojewoda A. Shifting Treatment Paradigms: Improvements in HR-Positive, HER-2- Negative Breast Cancer Care in Poland from a Clinical Perspective. Biomedicines 2023; 11:biomedicines11020510. [PMID: 36831045 PMCID: PMC9953114 DOI: 10.3390/biomedicines11020510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Patients with hormone-receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer constitute about 70% of the breast cancer population. About 35% of these patients develop distant metastases and their treatment will be palliative. Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors were shown to significantly improve the outcomes of these patients. In combination with endocrine therapy, they have become the standard first-line treatment for HR-positive, HER2-negative breast cancer. In Poland, treatment with CDK4/6 inhibitors is reimbursed only for patients participating in the drug program of the Ministry of Health. However, fulfilling the eligibility criteria for the program may be challenging both for patients and for clinicians. This may lead to a delay in treatment with CDK4/6 inhibitors or a decision to use older and less effective drugs that are more widely available. The aim of this review was to compare the efficacy of first-line therapies in patients with HR-positive, HER2-negative metastatic breast cancer depending on the use of CDK4/6 inhibitors. We compared the efficacy of previous standard therapies with that of ribociclib, a CDK4/6 inhibitor, based on the median progression-free survival (PFS) as an outcome. Median PFS is not affected by the efficacy of subsequent treatment lines and is easy to interpret both for clinicians and for patients. The first-line treatment with chemotherapy or endocrine therapy (without CDK4/6 inhibitors) prolongs median PFS by several months and even to over a dozen months. The first-line treatment with endocrine therapy plus CDK4/6 inhibitors provides an opportunity to achieve a median PFS of more than 25 months and to prolong it by about 9 to 14 months.
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Grela-Wojewoda A, Püsküllüoğlu M, Sas-Korczyńska B, Zemełka T, Pacholczak-Madej R, Wysocki WM, Wojewoda T, Adamczyk A, Lompart J, Korman M, Mucha-Małecka A, Ziobro M, Konduracka E. Biomarkers of Trastuzumab-Induced Cardiac Toxicity in HER2- Positive Breast Cancer Patient Population. Cancers (Basel) 2022; 14:cancers14143353. [PMID: 35884413 PMCID: PMC9313458 DOI: 10.3390/cancers14143353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Trastuzumab administered as a (neo)adjuvant therapy in radically treated Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer patients improves overall survival. This study aimed to assess if factors commonly thought to play a role as biomarkers of trastuzumab-induced cardiotoxicity (TIC) are pathognomonic for this injury. Data obtained for 130 HER2-positive breast cancer patients do not support an influence of N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), or myoglobin on the frequency of TIC. Suggestions for trastuzumab therapy include: close cooperation between cardiologists and oncologists; not using NT-proBNP, CK-MB, or myoglobin as standard TIC predictive markers; organizing prospective studies assessing the role of these parameters as TIC predictive markers in the case of HER2 blockage in conjunction with doublet immunotherapy or other anti-HER2 agents. Abstract Trastuzumab-induced cardiotoxicity (TIC) can lead to early treatment discontinuation. The aim of this study was to evaluate: N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), myoglobin, and selected biochemical and clinical factors as predictors of TIC. One hundred and thirty patients with HER2-positive BC receiving adjuvant trastuzumab therapy (TT) were enrolled. Measurement of cardiac markers and biochemical tests as well as echocardiography were performed prior to TT initiation and every three months thereafter. Cardiotoxicity leading to treatment interruption occurred in 24 patients (18.5%). While cardiotoxicity caused early treatment discontinuation in 14 patients (10.8%), the TIC resolved in 10 (7.7%) and TT was resumed. The most common complication was a decrease in left ventricular ejection fraction of more than 10% from baseline or below 50% (7.7%). In patients with TIC, there was no increase in the levels of NT-proBNP, myoglobin, and CK-MB. BMI, hypertension, ischemic heart disease, diabetes, age, cancer stage, type of surgery, use of radiotherapy, chemotherapy, and hormone therapy were shown to not have an effect on TIC occurrence. NT-proBNP, myoglobin, and CK-MB are not predictors of TIC. There is an ongoing need to identify biomarkers for TIC.
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Affiliation(s)
- Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (M.P.); (T.Z.); (R.P.-M.); (J.L.); (M.Z.)
- Correspondence: ; Tel.: +48-12-63-48-228
| | - Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (M.P.); (T.Z.); (R.P.-M.); (J.L.); (M.Z.)
| | - Beata Sas-Korczyńska
- Department of Oncology, Radiotherapy and Translational Medicine, Institute of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Tomasz Zemełka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (M.P.); (T.Z.); (R.P.-M.); (J.L.); (M.Z.)
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (M.P.); (T.Z.); (R.P.-M.); (J.L.); (M.Z.)
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Wojciech M. Wysocki
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland; (W.M.W.); (T.W.)
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-006 Kraków, Poland
- The Maria Skłodowska-Curie National Research Institute of Oncology, Scientific Editorial Office, Wawelska 15/B, 02-781 Warszawa, Poland
| | - Tomasz Wojewoda
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland; (W.M.W.); (T.W.)
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-006 Kraków, Poland
| | - Agnieszka Adamczyk
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland;
| | - Joanna Lompart
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (M.P.); (T.Z.); (R.P.-M.); (J.L.); (M.Z.)
| | - Michał Korman
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland;
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (M.P.); (T.Z.); (R.P.-M.); (J.L.); (M.Z.)
| | - Ewa Konduracka
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, John Paul the Second Hospital, 31-008 Kraków, Poland;
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Pacholczak-Madej R, Grela-Wojewoda A, Lompart J, Żuchowska-Vogelgesang B, Ziobro M. Effective Treatment of a Melanoma Patient with Hemophagocytic Lymphohistiocytosis after Nivolumab and Ipilimumab Combined Immunotherapy. Prague Med Rep 2022; 123:35-42. [PMID: 35248163 DOI: 10.14712/23362936.2022.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Immune checkpoint inhibitors have significantly improved the prognosis of melanoma patients. However, these therapies may trigger unexpected immune-related adverse events (irAEs), which are challenging in making the proper diagnosis and providing treatment. Hematological toxicities are possible irAEs, but were poorly evaluated in clinical trials and treatment recommendations of this specific complications are limited. We present a stage IV melanoma patient who developed an extremely rare toxicity - hemophagocytic lymphohistiocytosis (HLH) after the 4th course of combined immunotherapy with nivolumab and ipilimumab. The patient was steroid resistant and only the treatment with various immunosuppressive agents provided control of the disease and finally melanoma regression. In this report, we evaluated the methods of HLH treatment and described our modification of available protocols. Immediate immunosuppression can be life-saving and due to rarity of this condition as well as lack of specific recommendations, every report is valuable for clinicians, especially when treatment was effective.
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Affiliation(s)
- Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Clinical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Cracow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Cracow, Poland
| | - Joanna Lompart
- Department of Clinical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Cracow, Poland
| | - Beata Żuchowska-Vogelgesang
- Department of Clinical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Cracow, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Cracow, Poland.
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7
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Grela-Wojewoda A, Pacholczak-Madej R, Adamczyk A, Korman M, Püsküllüoğlu M. Cardiotoxicity Induced by Protein Kinase Inhibitors in Patients with Cancer. Int J Mol Sci 2022; 23:ijms23052815. [PMID: 35269958 PMCID: PMC8910876 DOI: 10.3390/ijms23052815] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
Kinase inhibitors (KIs) represent a growing class of drugs directed at various protein kinases and used in the treatment of both solid tumors and hematologic malignancies. It is a heterogeneous group of compounds that are widely applied not only in different types of tumors but also in tumors that are positive for a specific predictive factor. This review summarizes common cardiotoxic effects of KIs, including hypertension, arrhythmias with bradycardia and QTc prolongation, and cardiomyopathy that can lead to heart failure, as well as less common effects such as fluid retention, ischemic heart disease, and elevated risk of thromboembolic events. The guidelines for cardiac monitoring and management of the most common cardiotoxic effects of protein KIs are discussed. Potential signaling pathways affected by KIs and likely contributing to cardiac damage are also described. Finally, the need for further research into the molecular mechanisms underlying the cardiovascular toxicity of these drugs is indicated.
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Affiliation(s)
- Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (R.P.-M.); (M.P.)
- Correspondence: ; Tel.: +48-1263-48350
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (R.P.-M.); (M.P.)
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Agnieszka Adamczyk
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland;
| | - Michał Korman
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Garncarska 11, 31-115 Kraków, Poland; (R.P.-M.); (M.P.)
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8
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Püsküllüoğlu M, Tomaszewski KA, Grela-Wojewoda A, Pacholczak-Madej R, Ebner F. Effects of Transcutaneous Electrical Nerve Stimulation on Pain and Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58020284. [PMID: 35208610 PMCID: PMC8876365 DOI: 10.3390/medicina58020284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is the usage of a mild electrical current through electrodes that stimulate nerves. Patients with malignancies experience pain and chemotherapy-induced peripheral neuropathy. A systematic review was performed to find research evaluating the effect of TENS on these two common symptoms decreasing the quality of life in cancer patients. PubMed, the Cochrane Central Register of Controlled Trials and EMBASE were searched. Original studies, namely randomized controlled trials, quasi-randomized controlled trials and controlled clinical trials, published between April 2007 and May 2020, were considered. The quality of the selected studies was assessed. Seven papers were incorporated in a qualitative synthesis, with 260 patients in total. The studies varied in terms of design, populations, endpoints, quality, treatment duration, procedures and follow-up period. Based on the results, no strict recommendations concerning TENS usage in the cancer patient population could be issued. However, the existing evidence allows us to state that TENS is a safe procedure that may be self-administered by the patients with malignancy in an attempt to relieve different types of pain. There is a need for multi-center, randomized clinical trials with a good methodological design and adequate sample size.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
- Labcorp (Polska) Sp. z o.o., 05-825 Warsaw, Poland
- Correspondence:
| | - Krzysztof A. Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland;
- Scanmed St. Raphael Hospital, 30-693 Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
- Department of Anatomy, Medical College, Jagiellonian University, 31-008 Krakow, Poland
| | - Florian Ebner
- Helios Amper-Klinikum Dachau, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, 85221 München, Germany;
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9
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Grela-Wojewoda A, Niemiec J, Sas-Korczyńska B, Zemełka T, Puskulluoglu M, Wysocki WM, Wojewoda T, Pacholczak-Madej R, Adamczyk A, Mucha-Małecka A, Ziobro M, Konduracka E. Adjuvant combined therapy with trastuzumab in patients with HER2-positive breast cancer and cardiac alterations: implications for optimal cardio-oncology care. Pol Arch Intern Med 2022; 132. [PMID: 35089680 DOI: 10.20452/pamw.16204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Recently, the prognosis of patients with HER2-positive breast cancer (BC) has improved significantly owing to the use of combined treatment modalities. However, systemic treatment is associated with increased risk of cardiotoxicity. OBJECTIVES We aimed to assess subclinical cardiac alterations during the final stage of adjuvant combined therapy, that is, trastuzumab therapy (TT), as potential predictors of late cardiac complications in patients with HER2-positive BC. PATIENTS AND METHODS We enrolled 251 patients with HER2-positive BC treated with radical local therapy, adjuvant chemotherapy (anthracyclines or anthracyclines+taxanes), and immunotherapy (trastuzumab). Patients underwent 6 echocardiographic examinations: at baseline, during TT, and after TT, with assessment of left ventricular ejection fraction (LVEF), degree of valvular regurgitation, cardiac chamber diameters. RESULTS Valvular fibrosis (28.4% of patients) was associated with older age, hypertension at baseline, and a higher degree of regurgitation during TT. Reduced LVEF, greater regurgitation, and larger cardiac chamber diameters were noted during TT. Patients who received higher anthracycline doses showed a greater degree of aortic insufficiency and a larger right ventricular diameter. Reduced LVEF during TT was associated with radiotherapy or chemotherapy and degree of valvular regurgitation. Significantly larger diameters were observed in older patients and in those with comorbidities at baseline, high body mass index, and regurgitation. CONCLUSIONS Asymptomatic subclinical cardiac alterations during TT may predict late cardiac complications; however, longer follow-up is necessary to confirm this hypothesis. Patients with HER2-positive BC should be closely monitored for possible cardiac alterations during and after therapy to ensure optimal care and guide therapeutic decision-making.
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Affiliation(s)
- Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland.
| | - Joanna Niemiec
- Institute of Medical Studies, University of Rzeszow, Rzeszów, Poland
| | - Beata Sas-Korczyńska
- Department of Oncology, Radiotherapy and Translational Medicine, Institute of Medical Studies, University of Rzeszow, Rzeszów, Poland
| | - Tomasz Zemełka
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
| | - Mirosława Puskulluoglu
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
| | - Wojciech M Wysocki
- Department of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Krakow, Kraków, Poland
- Maria Skłodowska-Curie National Research Institute of Oncology, Scientific Editorial Office, Kraków, Poland
| | - Tomasz Wojewoda
- Department of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Krakow, Kraków, Poland
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Adamczyk
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
| | - Ewa Konduracka
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
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10
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Biesaga B, Janecka-Widła A, Kołodziej-Rzepa M, Mucha-Małecka A, Słonina D, Ziobro M, Wysocka J, Adamczyk A, Majchrzyk K, Niemiec J, Ambicka A, Grela-Wojewoda A, Harazin-Lechowska A. Low frequency of HPV positivity in breast tumors among patients from south-central Poland. Infect Agent Cancer 2021; 16:67. [PMID: 34838092 PMCID: PMC8626918 DOI: 10.1186/s13027-021-00405-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Some studies suggest that Human Papilloma Virus (HPV) infection is important factor in carcinogenesis of breast tumors. This study’ objective was to analyze HPV prevalence in breast cancers of patients from south-central Poland. Materials and methods The study was performed based on archival paraffin embebbed and formalin fixed blocks in the group of 383 patients with breast cancer. HPV prevalence and its genotype were assessed, respectively by: nested PCR (with two groups of primers: PGMY09/PGMY11 and GP5+/GP6+), quantitative PCR (qPCR). Tumors were classified as HPV positive in case of at least one positive result in nested PCR and positive results in genotyping procedure. For all HPV positive tissues P16 immunostaining was applied in order to confirm active viral infection. Results In the group of 383 breast cancers, HPV positivity was found in 17 samples (4.4%) in nested PCR. All these samples were subjected to HPV genotyping. This analysis revealed presence of HPV type 16 into two tumors (0.5%). In these two cancers, P16 overexpression was reported. Conclusion In breast tumors of patients from south-central Poland in Poland, HPV positivity is demonstrated in very low percentage of cases.
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Affiliation(s)
- Beata Biesaga
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland. .,Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland.
| | - Anna Janecka-Widła
- Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Marta Kołodziej-Rzepa
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital, Cracow, Poland
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Dorota Słonina
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Joanna Wysocka
- Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Agnieszka Adamczyk
- Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Kaja Majchrzyk
- Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Joanna Niemiec
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.,Department Laboratory of Medical Diagnostics, Cytogenetics and Flow Cytometry Specialist Hospital, Brzozow, Poland
| | - Aleksandra Ambicka
- Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
| | - Agnieszka Harazin-Lechowska
- Department of Tumor Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Gliwice, Poland
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11
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Gawin M, Kurczyk A, Niemiec J, Stanek-Widera A, Grela-Wojewoda A, Adamczyk A, Biskup-Frużyńska M, Polańska J, Widłak P. Intra-Tumor Heterogeneity Revealed by Mass Spectrometry Imaging Is Associated with the Prognosis of Breast Cancer. Cancers (Basel) 2021; 13:4349. [PMID: 34503159 PMCID: PMC8431441 DOI: 10.3390/cancers13174349] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Intra-tumor heterogeneity (ITH) results from the coexistence of genetically distinct cancer cell (sub)populations, their phenotypic plasticity, and the presence of heterotypic components of the tumor microenvironment (TME). Here we addressed the potential association between phenotypic ITH revealed by mass spectrometry imaging (MSI) and the prognosis of breast cancer. Tissue specimens resected from 59 patients treated radically due to the locally advanced HER2-positive invasive ductal carcinoma were included in the study. After the on-tissue trypsin digestion of cellular proteins, peptide maps of all cancer regions (about 380,000 spectra in total) were segmented by an unsupervised approach to reveal their intrinsic heterogeneity. A high degree of similarity between spectra was observed, which indicated the relative homogeneity of cancer regions. However, when the number and diversity of the detected clusters of spectra were analyzed, differences between patient groups were observed. It is noteworthy that a higher degree of heterogeneity was found in tumors from patients who remained disease-free during a 5-year follow-up (n = 38) compared to tumors from patients with progressive disease (distant metastases detected during the follow-up, n = 21). Interestingly, such differences were not observed between patients with a different status of regional lymph nodes, cancer grade, or expression of estrogen receptor at the time of the primary treatment. Subsequently, spectral components with different abundance in cancer regions were detected in patients with different outcomes, and their hypothetical identity was established by assignment to measured masses of tryptic peptides identified in corresponding tissue lysates. Such differentiating components were associated with proteins involved in immune regulation and hemostasis. Further, a positive correlation between the level of tumor-infiltrating lymphocytes and heterogeneity revealed by MSI was observed. We postulate that a higher heterogeneity of tumors with a better prognosis could reflect the presence of heterotypic components including infiltrating immune cells, that facilitated the response to treatment.
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Affiliation(s)
- Marta Gawin
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.G.); (A.K.); (A.S.-W.); (M.B.-F.)
| | - Agata Kurczyk
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.G.); (A.K.); (A.S.-W.); (M.B.-F.)
| | - Joanna Niemiec
- Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (J.N.); (A.G.-W.); (A.A.)
- Medical College of Rzeszow University, 35-959 Rzeszów, Poland
| | - Agata Stanek-Widera
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.G.); (A.K.); (A.S.-W.); (M.B.-F.)
- Faculty of Medicine, University of Technology in Katowice, 40-555 Katowice, Poland
| | - Aleksandra Grela-Wojewoda
- Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (J.N.); (A.G.-W.); (A.A.)
| | - Agnieszka Adamczyk
- Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (J.N.); (A.G.-W.); (A.A.)
| | - Magdalena Biskup-Frużyńska
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.G.); (A.K.); (A.S.-W.); (M.B.-F.)
| | | | - Piotr Widłak
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.G.); (A.K.); (A.S.-W.); (M.B.-F.)
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12
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Abstract
Last decade brought new achievements in the melanoma research, which resulted in an important changes in the clinical management of stage III melanoma. The article summarizes recent updates with particular focus on practical aspects. Results from surgical studies, Multicenter Selective Lymphadenectomy Trial II (MSLT-II) and German Dermatologic Cooperative Oncology Group (DeCOG-SLT) proved that surgical dogmatic approach that all sentinel node melanoma metastasis warrants completion lymphadenectomy is no longer valid; omission of completion lymphadenectomy in large proportion of sentinel node positive melanoma patients has no negative impact on survival rates. Moreover oncological trials (COMBI-AD, EORTC 1325/KEYNOTE-054 and CheckMate 238) showed that in stage III melanoma patients' chances of recurrence-free survival can be improved by 10-20% by modern immunotherapy and/or molecular targeted therapy. These findings led to fall of another dogma in oncology: lack of effective adjuvant therapy for stage III melanoma at acceptable toxicity. At the end of the day in 2021 modern multidisciplinary approach incorporating newest findings offer stage III melanoma patients less surgical complications of better tailored surgery and longer survival in result of efficient adjuvant therapy.
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Affiliation(s)
- Wojciech M Wysocki
- Department of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland; Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, Kraków, Poland; Scientific Editorial Office, National Research Institute of Oncology Maria Skłodowska-Curie Memorial in Warsaw, Warsaw, Poland.
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, National Institute of Oncology Maria Skłodowska-Curie Memorial, Kraków Branch, Kraków, Poland
| | - Michał Jankowski
- Department of Surgical Oncology, Oncology Center – Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland,Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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13
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Adamczyk A, Kruczak A, Harazin-Lechowska A, Ambicka A, Grela-Wojewoda A, Domagała-Haduch M, Janecka-Widła A, Majchrzyk K, Cichocka A, Ryś J, Niemiec J. Relationship between HER2 gene status and selected potential biological features related to trastuzumab resistance and its influence on survival of breast cancer patients undergoing trastuzumab adjuvant treatment. Onco Targets Ther 2018; 11:4525-4535. [PMID: 30122944 DOI: 10.2147/ott.s166983] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The aim of the study was to investigate if parameters associated with human epidermal growth factor receptor type 2 (HER2) status (HER2 gene copy number, HER2/CEP17 ratio or polysomy of chromosome 17) are related to various biological features potentially responsible for trastuzumab resistance (PTEN, IGF-1R, MUC4, EGFR, HER3, HER4, and mutation status of PIK3CA) as well as their influence on survival of HER2-positive breast cancer patients treated with adjuvant chemotherapy and trastuzumab. Patients and methods The investigated group consisted of 117 patients with invasive ductal breast cancer (T≥1, N≥0, M0) with overexpression of HER2, who underwent radical surgery between 2007 and 2014. Status of ER, PR, and HER2 expression was retrieved from patients' files. HER2 gene copy number was investigated by fluorescence in situ hybridization using PathVysion HER-2 DNA Probe Kit II. Expression of PTEN, IGF-1R, MUC4, EGFR, HER3, and HER4 was assessed immunohistochemically on formalin-fixed paraffin-embedded tissue sections. PIK3C mutation status was determined by qPCR analysis. Results Overexpression of HER2 protein (IHC 3+) and ER negativity corresponded to higher HER22 copy number and HER2/CEP17 ratio (.<0.001). Tumors with polysomy were characterized by higher HER22 gene copy number but lower HER2/CEP17p ratio (p<0.026, p<0.001). Patients with tumors featuring HER3 immunonegativity or low HER2/CEP17 ratio (#4) were characterized by 100% metastasis-free survival (.=0.018, p=0.062). Conclusion Presence of both unfavorable factors, ie, HER3 expression and high HER2/CEP17 ratio, allowed to distinguish a group of patients with worse prognosis (.=0.001).
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Affiliation(s)
| | | | | | | | - Aleksandra Grela-Wojewoda
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Małgorzata Domagała-Haduch
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
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14
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Niemiec J, Adamczyk A, Harazin-Lechowska A, Ambicka A, Grela-Wojewoda A, Majchrzyk K, Kruczak A, Sas-Korczyńska B, Ryś J. Podoplanin-positive Cancer-associated Stromal Fibroblasts in Primary Tumor and Synchronous Lymph Node Metastases of HER2-overexpressing Breast Carcinomas. Anticancer Res 2018; 38:1957-1965. [PMID: 29599311 DOI: 10.21873/anticanres.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 11/10/2022]
Abstract
We compared the status of stromal podoplanin-positive cancer-associated fibroblasts (ppCAFs) between primary tumors and paired synchronous lymph node metastases (LNMs) and analyzed the prognostic significance of tumoral ppCAFs in 203 patients with human epidermal growth factor receptor 2-positive breast carcinoma. ppCAFs were found in 167/203 and in 35/87 tumors and LNM, respectively. ppCAFs were most frequently found in tumors and corresponding LNM (n=52, 59.8%; p=0.001). However, for all LNMs (n=12) without ppCAFs, their paired tumors also lacked ppCAFs. In both tumors and LNMs, ppCAFs were α-smooth muscle actin-positive and cluster of differentiation 21 protein-negative, suggesting them not to be resident lymph node cells. Moreover, in our series, the presence of ppCAFs in tumors was borderline related to poor disease-free survival (p=0.058). These results speak in favor of a hypothesis suggesting ppCAFs accompany metastatic cancer cells migrating from tumor to LNMs.
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Affiliation(s)
- Joanna Niemiec
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Agnieszka Adamczyk
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Agnieszka Harazin-Lechowska
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Aleksandra Ambicka
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Kaja Majchrzyk
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Anna Kruczak
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Beata Sas-Korczyńska
- The Oncology Clinic, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Janusz Ryś
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Center and Institute of Oncology, Cracow Branch, Cracow, Poland
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15
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Duchnowska R, Sperinde J, Czartoryska-Arłukowicz B, Myśliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziółkowska B, Dębska-Szmich S, Merdalska M, Grela-Wojewoda A, Żawrocki A, Biernat W, Huang W, Jassem J. Predictive value of quantitative HER2, HER3 and p95HER2 levels in HER2-positive advanced breast cancer patients treated with lapatinib following progression on trastuzumab. Oncotarget 2017; 8:104149-104159. [PMID: 29262628 PMCID: PMC5732794 DOI: 10.18632/oncotarget.22027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/21/2017] [Indexed: 12/27/2022] Open
Abstract
Lapatinib is a HER1 and HER2 tyrosine kinase inhibitor (TKI) approved in second line treatment of advanced or metastatic breast cancer following progression on trastuzumab-containing therapy. Biomarkers for activity of lapatinib and other TKIs are lacking. Formalin-fixed, paraffin-embedded primary tumor samples were obtained from 189 HER2-positive patients treated with lapatinib plus capecitabine following progression on trastuzumab. The HERmark® Breast Cancer Assay was used to quantify HER2 protein expression. HER3 and p95HER2 protein expression was quantified using the VeraTag® technology. Overall survival (OS) was inversely correlated with HER2 (HR = 1.9/log; P = 0.009) for patients with tumors above the cut-off positivity level by the HERmark assay. OS was significantly shorter for those with above median HER2 levels (HR = 1.7; P = 0.015) and trended shorter for those below the cut-off level of positivity by the HERmark assay (HR = 1.7; P = 0.057) compared to cases with moderate HER2 overexpression. The relationship between HER2 protein expression and OS was best captured with a U-shaped parabolic function (P = 0.004), with the best prognosis at moderate levels of HER2 protein overexpression. In a multivariate model including HER2, increasing p95HER2 expression was associated with longer OS (HR = 0.35/log; P = 0.027). Continuous HER3 did not significantly correlate with OS. Patients with moderately overexpressed HER2 levels and high p95HER2 expression may have best outcomes while receiving lapatinib following progression on trastuzumab. Further study is warranted to explore the predictive utility of quantitative HER2 and p95HER2 in guiding HER2-directed therapies.
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Affiliation(s)
| | - Jeff Sperinde
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | | | - John Winslow
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | - Christos Petropoulos
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | | | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | | | | | | | - Weidong Huang
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
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16
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Niemiec JA, Adamczyk A, Ambicka A, Mucha-Małecka A, Wysocki WM, Biesaga B, Ziobro M, Cedrych I, Grela-Wojewoda A, Domagała-Haduch M, Wysocka J, Ryś J, Sas-Korczyńska B. Prognostic role of lymphatic vessel density and lymphovascular invasion in chemotherapy-naive and chemotherapy-treated patients with invasive breast cancer. Am J Transl Res 2017; 9:1435-1447. [PMID: 28386369 PMCID: PMC5376034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/01/2017] [Indexed: 06/07/2023]
Abstract
It is assumed that the spread of breast cancer cells via the lymphatic system might be influenced by inflammatory reactions and/or the application of chemotherapy or molecularly targeted therapy. Therefore, we analysed survival according to lymphatic vessel density (LVD), lymphovascular invasion (LVI) (both assessed using podoplanin as immunohistochemical marker of lymphatic endothelium) and well-established clinico-pathological features in a group of 358 patients with invasive ductal breast cancer: 139 chemotherapy-naïve (pT1-2/pN0/M0) and 219 treated with chemotherapy (pT1-4/pN1-3/M0). Univariate analysis revealed that high LVD was related to unfavourable disease-free survival (DFS) in pN0/chemotherapy/trastuzumab-naïve patients (P = 0.028). Conversely, in pN+/chemotherapy-treated individuals high LVD was related to favourable DFS (P = 0.019). LVI was a significant indicator of survival (P = 0.005) only in pN0/chemotherapy/trastuzumab-naïve patients. The following parameters were significant independent adverse prognostic factors for DFS: (i) in pN0/chemotherapy/trastuzumab-naïve patients: high LVD (LVD > 7 vessels/mm2; RR = 2.7, P = 0.039), LVI (RR = 3.3, P = 0.046) and high tumor grade (G3 vs. G1 + G2; RR = 2.6, P = 0.030); (ii) in pN+/chemotherapy/trastuzumab-treated patients: low LVD (RR = 1.8, P = 0.042), the number of involved lymph nodes (pN3 vs. pN1-2; RR = 2.3, P = 0.012) and the breast cancer subtype (expression of steroid receptors together with HER2 immunonegativity and high proliferation index vs. other breast cancer immunophenotypes; RR = 3.0, P < 0.001). High LVD may identify high progression risk in pN0/chemotherapy/trastuzumab-naïve patients, and low progression risk in pN+/chemotherapy-treated patients. This phenomenon might be explained by potential involvement of lymphangiogenesis in two processes related to cancer eradication: a chemotherapy-stimulated activity of the immune system against cancer cells, or increased tumour drainage influencing the efficacy of cytotoxic drugs.
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Affiliation(s)
- Joanna A Niemiec
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Agnieszka Adamczyk
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Aleksandra Ambicka
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Anna Mucha-Małecka
- Department of The Oncology Clinic, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Wojciech M Wysocki
- Department of Surgical Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Beata Biesaga
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Marek Ziobro
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Ida Cedrych
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Małgorzata Domagała-Haduch
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Joanna Wysocka
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Janusz Ryś
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
| | - Beata Sas-Korczyńska
- Department of The Oncology Clinic, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyKrakow Branch, Krakow, Poland
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17
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Duchnowska R, Sperinde J, Czartoryska-Arlukowicz B, Mysliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziólkowska B, Debska-Szmich S, Merdalska M, Grela-Wojewoda A, Zawrocki A, Biernat W, Huang W, Jassem J. Abstract P2-05-21: Predictive value of quantitative HER2 and HER3 levels combined with downstream signaling markers in HER2-positive advanced breast cancer patients treated with lapatinib. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Clinical correlates of lapatinib resistance have not been well defined. Previous studies implicated genes regulated by the estrogen receptor (ER) and activation or mutation of proteins downstream from HER family receptors. In the current study, HER2 and HER3 expression levels were quantitatively measured using a VeraTag® fluorescence-based assay, in addition to seven downstream signaling proteins determined by IHC. All biomarkers were correlated with overall survival (OS) in patients treated with lapatinib.
Methods: Formalin-fixed, paraffin-embedded samples were obtained from the primary tumor of 191 patients treated with lapatinib plus capecitabine following progression on trastuzumab. The HERmark® Breast Cancer Assay (Monogram Biosciences, South San Francisco) was used to quantify HER2 protein expression levels. HER3 protein expression was quantified using the VeraTag® technology (Monogram Biosciences). Expression of ER, PTEN, Cyclin E, HIF-2alpha, p-p70S6K, p-AMPK and p-MAPK were determined by IHC (Duchnowska et al., Oncotarget 2016; 7:550). OS analyses of HER2 and HER3 were stratified by key clinical variables, including stage and presence of a brain metastasis prior to lapatinib-based therapy.
Results: Among the downstream signaling molecules, HIF-2alpha (r = -0.23; p = 0.047) and ER (r = -0.27; p = 0.005) were negatively correlated with HER2 expression after adjustment for multiple testing. PTEN appeared to correlate with HER3, but was not significant after adjustment for multiple testing. OS was significantly shorter for both those below the cut-off level of positivity by the HERmark assay (HR = 1.8; p = 0.029), and those with above median HER2 levels (HR = 1.7; p = 0.009), as compared to cases with in between levels. The relationship between HER2 and OS is also captured by a U-shaped, parabolic function in HER2 (p = 0.005). Elevated HER3 showed a trend toward a correlation with longer OS (HR = 0.66/log; p = 0.16), somewhat stronger in the ER-negative subset (HR = 0.55/log; p = 0.085) and in the subset with above-median HER2 (0.48/log; p = 0.10), where inhibiting HER2 activation of HER3 may be more important. In multivariate Cox models, HER2 (parabola, intermediate HER2 best, p = 0.001), presence of brain metastases (HR = 2; p < 0.001), ER (HR = 0.60; p = 0.009) and either p-p70S6K (HR = 0.66; p = 0.018) or p-AMPK (HR = 0.67; p = 0.022) were significantly associated with OS (p-p70S6K and p-AMPK were mutually correlated).
Conclusions: Patients with moderately increased HER2 levels may have best outcomes while receiving lapatinib following progression on trastuzumab. This supports recent findings of a less benefit from lapatinib in patients with high HER2 expression (Nunciforo et al., SABCS 2015, P3-07-08). HER3 levels do not seem to substantially impact the prognosis. Further studies are warranted to explore the predictive utility of quantitative HER2 and HER3 in guiding HER2-directed therapies.
Citation Format: Duchnowska R, Sperinde J, Czartoryska-Arlukowicz B, Mysliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziólkowska B, Debska-Szmich S, Merdalska M, Grela-Wojewoda A, Zawrocki A, Biernat W, Huang W, Jassem J. Predictive value of quantitative HER2 and HER3 levels combined with downstream signaling markers in HER2-positive advanced breast cancer patients treated with lapatinib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-21.
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Affiliation(s)
- R Duchnowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Sperinde
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Czartoryska-Arlukowicz
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - P Mysliwiec
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Winslow
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Radecka
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - C Petropoulos
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - R Demlova
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - M Orlikowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Kowalczyk
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - I Lang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Ziólkowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - S Debska-Szmich
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - M Merdalska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Grela-Wojewoda
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Zawrocki
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - W Biernat
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - W Huang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Jassem
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
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18
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Adamczyk A, Grela-Wojewoda A, Domagała-Haduch M, Ambicka A, Harazin-Lechowska A, Janecka A, Cedrych I, Majchrzyk K, Kruczak A, Ryś J, Niemiec J. Proteins Involved in HER2 Signalling Pathway, Their Relations and Influence on Metastasis-Free Survival in HER2-Positive Breast Cancer Patients Treated with Trastuzumab in Adjuvant Setting. J Cancer 2017; 8:131-139. [PMID: 28123607 PMCID: PMC5264049 DOI: 10.7150/jca.16239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
Aim: Resistance to trastuzumab (which is a standard therapy for breast cancer patients with HER2 overexpression) is associated with higher risk of progression or cancer death, and might be related to activation of signalling cascades (PI3K/AKT/mTOR, Ras/Raf/MAPK) and decreased level of their inhibitors. Material and methods: Formalin-fixed paraffin-embedded tumour specimens from 118 HER2-overexpressing breast cancer patients treated with radical local therapy and trastuzumab in adjuvant setting were used for the assessment of: (1) PIK3CA gene mutations (p.H1047R and p.E545K) by qPCR, and (2) expression of Ki-67, EGFR, MUC4, HER3 and PTEN by immunohistochemistry. Results: Lower Ki-67LI was observed in EGFR-immunonegative and in PTEN-immunopositive tumours. MUC4-immunonegative tumours more frequently were PTEN- and HER3-immunonegative. Favourable metastasis-free survival was observed in patients with tumours characterized by Ki-67LI≤50% (p=0.027), HER3 immunonegativity or PTEN immunopositivity (vs. tumours with HER3 expression and lack of PTEN expression, p=0.043), additionally, the trend was observed for patients with pN0+pN1 pathological tumour stage (vs. pN2+pN3) (p=0.086). Cox model revealed that independent negative prognostic factors were: (i) Ki-67LI>50% (p=0.014, RR=4.6, 95% CI 1.4-15.4), (ii) HER3 immunopositivity together with PTEN immunonegativity (p=0.034, RR=3.7, 95% CI 1.1-12.5). Conclusion: The results of our study suggest that combined analysis of HER3 and PTEN expression might bring information on trastuzumab sensitivity in the group of HER2-positive breast cancer patients treated with trastuzumab in adjuvant setting.
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Affiliation(s)
- Agnieszka Adamczyk
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Małgorzata Domagała-Haduch
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Aleksandra Ambicka
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Agnieszka Harazin-Lechowska
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Anna Janecka
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Ida Cedrych
- Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Kaja Majchrzyk
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Anna Kruczak
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Janusz Ryś
- Department of Tumour Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Joanna Niemiec
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
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Abstract
Treatment of the malignant ovarian tumors remains challenging. Some of the reasons are as follows: lack of effective screening technique, usually asymptomatic early stages of the disease, which effects in detecting the disease in advanced stage, and eventually poor prognosis. Treatment of the relapse remains palliative. Inventing new drugs - like PARP inhibitors - gives hope for improvement of the treatment outcomes. This review paper presents actual knowledge on PARP inhibitors in the ovarian cancer therapy.
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Affiliation(s)
- Maksymilian Artur Kruczała
- Centrum Onkologii Instytut im. Marii Skłodowskiej-Curie Oddział w Krakowie. Klinika Nowotworów Układowych i Uogólnionych..
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Grela-Wojewoda A, Niemiec J, Sas-Korczyńska B, Cedrych I, Domagała-Haduch M, Adamczyk A, Ambicka A, Kołacz J, Jakubowicz J. Prognostic Role of Nodal Status and Clinically Asymptomatic Valvular Insufficiency in Patients with HER2-positive Breast Cancer Treated with Chemotherapy, Radiotherapy and Trastuzumab in an Adjuvant Setting. Anticancer Res 2015; 35:4063-4072. [PMID: 26124356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of the present study was to assess metastasis-free survival of 134 patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with chemotherapy, radiotherapy and trastuzumab in an adjuvant setting, according to sub-clinical cardiac side-effects (parameters not tested previously) evaluated before, during and after trastuzumab therapy, as well as selected clinicopathological parameters. RESULTS In our series, left ventricular ejection fraction decreased significantly from 68.1% before trastuzumab treatment to 66.7% after therapy (p<0.001). Further analysis revealed that this decrease was significant only in patients who received radiotherapy and developed valve insufficiency during or after (but not before) trastuzumab therapy (p<0.001). Cox multivariate analysis revealed that both pN2a tumor stage and valve regurgitation during/after trastuzumab therapy (vs. lack of valve insufficiency or insufficiency before trastuzumab therapy) were significant independent factors for a negative prognosis. CONCLUSION Valve insufficiency diagnosed during or after trastuzumab application might be cancer-unrelated indicator of decreased sensitivity to trasuzumab.
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Affiliation(s)
- Aleksandra Grela-Wojewoda
- Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | - Joanna Niemiec
- Department of Applied Radiobiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | - Beata Sas-Korczyńska
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | - Ida Cedrych
- Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | - Małgorzata Domagała-Haduch
- Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | - Agnieszka Adamczyk
- Department of Applied Radiobiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | - Aleksandra Ambicka
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
| | | | - Jerzy Jakubowicz
- The Oncology Unit, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland
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21
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Wojewoda T, Mitus J, Grela-Wojewoda A, Wysocki W. 193. The correlation between breast cancer stage and anticancer therapy and the risk of lymphoedema. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Ziobro M, Rolski J, Grela-Wojewoda A, Zygulska A, Niemiec M. Effects of palliative treatment with temozolomide in patients with high-grade gliomas. Neurol Neurochir Pol 2008; 42:210-215. [PMID: 18651326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to assess the results of treatment with temozolomide in patients with high-grade gliomas who no longer benefit from surgical treatment and radiotherapy. MATERIAL AND METHODS The retrospective analysis included 51 patients treated between 2001 and 2007 in the Centre of Oncology in Kraków. Glioblastoma multiforme was histologically diagnosed in 24 (47%) patients; anaplastic astrocytomas and other grade III gliomas (according to WHO classification) were diagnosed in 27 (53%) patients. Patients received 1-11 cycles of treatment with temozolomide - 210 cycles were given in total. Forty-five patients were eligible for efficacy assessment because 6 patients received only one chemotherapy cycle (due to rapid progression of the glioma). RESULTS According to the radiological assessment, 6 patients (13%) had an objective response and a further 16 patients (36%) had stabilization of the glioma. Subjective improvement was noted in 26 patients (58%), and neurological improvement was observed in 14 patients (31%). The median survival in the whole group was 41 weeks (40 weeks in patients with glioblastoma multiforme and 54 weeks in patients with anaplastic gliomas). One-year overall survival in the above-mentioned groups was 40.7%, 22%, and 50%, respectively. Two-year overall survival was 16%, 8%, and 20.9%, respectively. Adverse events were observed during 73 (35%) cycles of treatment and prompted a dose reduction in 12 (24.5%) patients. The most frequent adverse events were: thrombocytopenia, leukopenia, nausea and vomiting. Adverse events did not lead to treatment withdrawal in any patient. CONCLUSIONS Objective benefit from the temozolomide treatment (stabilization or objective remission) was observed in 49% of patients irrespective of histological diagnosis. Tolerability of treatment with temozolomide in patients with high-grade gliomas is good.
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Affiliation(s)
- Marek Ziobro
- Klinika Nowotworów Układowych i Uogólnionych, Centrum Onkologii Oddział w Krakowie, ul. Garncarska 11, 31-115 Kraków.
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