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Peters AL, Hall PS, Jordan LB, Soh FY, Hannington L, Makaranka S, Urquhart G, Vallet M, Cartwright D, Marashi H, Elsberger B. Enhancing clinical decision support with genomic tools in breast cancer: A Scottish perspective. Breast 2024; 75:103728. [PMID: 38657322 PMCID: PMC11061332 DOI: 10.1016/j.breast.2024.103728] [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: 10/28/2023] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The Oncotype DX Breast RS test has been adopted in Scotland and has been the subject of a large population-based study by a Scottish Consensus Group to assess the uptake of the recurrence score (RS), evaluate co-variates associated with the RS and to analyse the effect it may have had on clinical practice. MATERIALS & METHODS Pan-Scotland study between August 2018-August 2021 evaluating 833 patients who had a RS test performed as part of their diagnostic pathway. Data was extracted retrospectively from electronic records and analysis conducted to describe change in chemotherapy administration (by direct comparison with conventional risk assessment tools), and univariate/multivariate analysis to assess relationship between covariates and the RS. RESULTS Chemotherapy treatment was strongly influenced by the RS (p < 0.001). Only 30 % of patients received chemotherapy treatment in the intermediate and high risk PREDICT groups, where chemotherapy is considered. Additionally, 55.5 % of patients with a high risk PREDICT had a low RS and did not receive chemotherapy. There were 17 % of patients with a low risk PREDICT but high RS who received chemotherapy. Multivariate regression analysis showed the progesterone receptor Allred score (PR score) to be a strong independent predictor of the RS, with a negative PR score being associated with high RS (OR 4.49, p < 0.001). Increasing grade was also associated with high RS (OR 3.81, p < 0.001). Classic lobular pathology was associated with a low RS in comparison to other tumour pathology (p < 0.01). Nodal disease was associated with a lower RS (p = 0.012) on univariate analysis, with menopausal status (p = 0.43) not influencing the RS on univariate or multivariate analysis. CONCLUSIONS Genomic assays offer the potential for risk-stratified decision making regarding the use of chemotherapy. They can help reduce unnecessary chemotherapy treatment and identify a subgroup of patients with more adverse genomic tumour biology. A recent publication by Health Improvement Scotland (HIS) has updated guidance on use of the RS test for NHS Scotland. It suggests to limit its use to the intermediate risk PREDICT group. Our study shows the impact of the RS test in the low and high risk PREDICT groups. The implementation across Scotland has resulted in a notable shift in practice, leading to a significant reduction in chemotherapy administration in the setting of high risk PREDICT scores returning low risk RS. There has also been utility for the test in the low risk PREDICT group to detect a small subgroup with a high RS. We have found the PR score to have a strong independent association with high risk RS. This finding was not evaluated by the key RS test papers, and the potential prognostic information provided by the PR score as a surrogate biomarker is an outstanding question that requires more research to validate.
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Affiliation(s)
- A L Peters
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, 1053 Great Western Rd, Glasgow G12 0YN, UK; Cancer Research UK (CRUK) Scotland Institute, Switchback Road, Bearsden, Glasgow G61 1BD, UK.
| | - P S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - L B Jordan
- Ninewells Hospital & Medical School, NHS Tayside, Department of Pathology, Dundee, DD1 9SY, UK
| | - F Y Soh
- Raigmore Hospital, NHS Highland, Department of Oncology, Inverness IV2 3UJ, UK
| | - L Hannington
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, 1053 Great Western Rd, Glasgow G12 0YN, UK
| | - S Makaranka
- Aberdeen Royal Infirmary, NHS Grampian, Department of Breast Surgery, Aberdeen AB25 2ZN, UK
| | - G Urquhart
- Aberdeen Royal Infirmary, NHS Grampian, Department of Oncology, Aberdeen AB25 2ZN, UK
| | - M Vallet
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - D Cartwright
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, 1053 Great Western Rd, Glasgow G12 0YN, UK; Cancer Research UK (CRUK) Scotland Institute, Switchback Road, Bearsden, Glasgow G61 1BD, UK
| | - H Marashi
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, 1053 Great Western Rd, Glasgow G12 0YN, UK
| | - B Elsberger
- Aberdeen Royal Infirmary, NHS Grampian, Department of Breast Surgery, Aberdeen AB25 2ZN, UK
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Hartup SM, Morgan JL, Cheng VWT, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hogan B, Horgan K, Kirwan CC, McIntosh SA, O’Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: protocol for a prospective, multicentre cohort study. Int J Surg Protoc 2024; 28:20-26. [PMID: 38433867 PMCID: PMC10905491 DOI: 10.1097/sp9.0000000000000018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 03/05/2024] Open
Abstract
Background Despite a UK 5-year breast cancer survival rate of 86.6%, patients may develop breast cancer recurrence within the same breast after breast conserving surgery, as well as in the remaining skin or chest wall after mastectomy or in the ipsilateral lymph glands. These recurrences, collectively termed locoregional recurrence (LRR), occur in around 8% of patients within 10 years of their original diagnosis. Currently, there is a lack of robust information on the presentation and prevalence of LRR with no UK-specific clinical guidelines available for the optimal management of this patient group. Additionally, there is a need to identify patterns of LRR presentation and their progression, which will enable prognostic factors to be determined. This will subsequently enable the tailoring of treatment and improve patient outcome. Methods The MARECA study is a prospective, multicentre cohort study recruiting patients diagnosed with breast cancer LRR +/- associated distant metastases. Over 50 UK breast units are participating in the study with the aim of recruiting at least 500 patients over a recruitment period of 24 months. The data collected will detail the tumour pathology, imaging results, surgical treatment, radiotherapy and systemic therapy of the primary and recurrent breast cancer. Study follow-up will be for up to 5 years following LRR diagnosis to determine subsequent oncological outcomes and evaluate potential prognostic factors. Discussion This study will address the current knowledge gap and identify subgroups of patients who have less successful treatment outcomes. The results will determine the current management of LRR and the prognosis of patients diagnosed with breast cancer LRR +/- distant metastases in the UK, with the aim of establishing best practice and informing future national guidelines. The results will direct future research and inform the design of additional interventional trials and translational studies.
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Affiliation(s)
- Sue M. Hartup
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Jenna L. Morgan
- Division of Clinical Medicine, University of Sheffield School of Medicine and Population Health, Beech Hill Road, Sheffield
| | - Vinton WT Cheng
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Peter A. Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, Surrey
- The Institute of Cancer Research
| | - Ellen Copson
- Somers Cancer Research Building, University of Southampton and University Hospital Southampton, Southampton
| | - Ramsey I. Cutress
- Somers Cancer Research Building, University of Southampton and University Hospital Southampton, Southampton
| | - Rajiv Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital
| | - Beatrix Elsberger
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen
| | | | - Brian Hogan
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Kieran Horgan
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Cliona C. Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Manchester
| | - Stuart A. McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast
| | - Rachel L. O’Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, Surrey
- The Institute of Cancer Research
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust
| | - Shelley Potter
- Translational Health Sciences, Bristol Medical School, Learning and Research Building, Southmead Hospital
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol
| | - Tim Rattay
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary
- Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester
| | - Lisa Sheehan
- Wessex Deanery, Southern House, Otterbourne, Winchester, UK
| | - Lynda Wyld
- Division of Clinical Medicine, University of Sheffield School of Medicine and Population Health, Beech Hill Road, Sheffield
| | - Baek Kim
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
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Gamble DT, Ross J, Khan H, Unger A, Cheyne L, Rudd A, Saunders F, Srivanasan J, Kamya S, Horgan G, Hannah A, Baliga S, Tocchetti CG, Urquhart G, Linke WA, Masannat Y, Mustafa A, Fuller M, Elsberger B, Sharma R, Dawson D. Impaired Cardiac and Skeletal Muscle Energetics Following Anthracycline Therapy for Breast Cancer. Circ Cardiovasc Imaging 2023; 16:e015782. [PMID: 37847761 PMCID: PMC10581415 DOI: 10.1161/circimaging.123.015782] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Anthracycline-related cardiac toxicity is a recognized consequence of cancer therapies. We assess resting cardiac and skeletal muscle energetics and myocyte, sarcomere, and mitochondrial integrity in patients with breast cancer receiving epirubicin. METHODS In a prospective, mechanistic, observational, longitudinal study, we investigated chemotherapy-naive patients with breast cancer receiving epirubicin versus sex- and age-matched healthy controls. Resting energetic status of cardiac and skeletal muscle (phosphocreatine/gamma ATP and inorganic phosphate [Pi]/phosphocreatine, respectively) was assessed with 31P-magnetic resonance spectroscopy. Cardiac function and tissue characterization (magnetic resonance imaging and 2D-echocardiography), cardiac biomarkers (serum NT-pro-BNP and high-sensitivity troponin I), and structural assessments of skeletal muscle biopsies were obtained. All study assessments were performed before and after chemotherapy. RESULTS Twenty-five female patients with breast cancer (median age, 53 years) received a mean epirubicin dose of 304 mg/m2, and 25 age/sex-matched controls were recruited. Despite comparable baseline cardiac and skeletal muscle energetics with the healthy controls, after chemotherapy, patients with breast cancer showed a reduction in cardiac phosphocreatine/gamma ATP ratio (2.0±0.7 versus 1.1±0.5; P=0.001) and an increase in skeletal muscle Pi/phosphocreatine ratio (0.1±0.1 versus 0.2±0.1; P=0.022). This occurred in the context of increases in left ventricular end-systolic and end-diastolic volumes (P=0.009 and P=0.008, respectively), T1 and T2 mapping (P=0.001 and P=0.028, respectively) but with preserved left ventricular ejection fraction, mass and global longitudinal strain, and no change in cardiac biomarkers. There was preservation of the mitochondrial copy number in skeletal muscle biopsies but a significant increase in areas of skeletal muscle degradation (P=0.001) in patients with breast cancer following chemotherapy. Patients with breast cancer demonstrated a reduction in skeletal muscle sarcomere number from the prechemotherapy stage compared with healthy controls (P=0.013). CONCLUSIONS Contemporary doses of epirubicin for breast cancer treatment result in a significant reduction of cardiac and skeletal muscle high-energy 31P-metabolism alongside structural skeletal muscle changes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04467411.
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Affiliation(s)
- David T. Gamble
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - James Ross
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Hilal Khan
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Andreas Unger
- Institute of Physiology II, University of Münster, Germany (A.U., W.A.L.)
| | - Lesley Cheyne
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Amelia Rudd
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Fiona Saunders
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Janaki Srivanasan
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Sylvia Kamya
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Graham Horgan
- Biomathematics and Statistics Scotland, Aberdeen (G.H.)
| | - Andrew Hannah
- Department of Cardiology National Health Service (NHS) Grampian (A.H.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Santosh Baliga
- Department of Trauma and Orthopaedic Surgery (S.B.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy (C.G.T.)
| | - Gordon Urquhart
- Department of Oncology NHS Grampian (G.U., R.S.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Wolfgang A. Linke
- Institute of Physiology II, University of Münster, Germany (A.U., W.A.L.)
| | - Yazan Masannat
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Ahmed Mustafa
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Mairi Fuller
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Beatrix Elsberger
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Ravi Sharma
- Department of Oncology NHS Grampian (G.U., R.S.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Dana Dawson
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
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Dave RV, Elsberger B, Taxiarchi VP, Gandhi A, Kirwan CC, Kim B, Camacho EM, Coles CE, Copson E, Courtney A, Horgan K, Fairbrother P, Holcombe C, Kirkham JJ, Leff DR, McIntosh SA, O'Connell R, Pardo R, Potter S, Rattay T, Sharma N, Vidya R, Cutress RI. Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study. Breast Cancer Res Treat 2023; 199:265-279. [PMID: 37010651 PMCID: PMC10068712 DOI: 10.1007/s10549-023-06893-4] [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: 11/09/2022] [Accepted: 02/11/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. METHODS This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb-July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. RESULTS 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32-81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7-8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months' treatment duration; median of 4 mm [IQR - 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month's duration of BrET. DISCUSSION This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.
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Affiliation(s)
- Rajiv V Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4BX, UK.
| | - Beatrix Elsberger
- Aberdeen Royal Infirmary/University of Aberdeen, Breast Unit, Foresterhill Road, Aberdeen, AB25 2ZN, UK
| | - Vicky P Taxiarchi
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Ashu Gandhi
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4BX, UK
| | - Cliona C Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4BX, UK
| | - Baek Kim
- Department of Breast Surgery, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Elizabeth M Camacho
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | | | - Ellen Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Alona Courtney
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Kieran Horgan
- Department of Breast Surgery, St. James's University Hospital, Leeds, LS9 7TF, UK
| | | | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - Jamie J Kirkham
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Stuart A McIntosh
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK
| | - Rachel O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Ricardo Pardo
- Bolton NHS Foundation Trust, Minerva Rd, Farnworth, Bolton, BL4 0JR, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, Whatley Road, Bristol, BS8 2PS, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
| | - Tim Rattay
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester, LE2 2LX, UK
| | - Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James's Hospital, Leeds, LS9 7TF, UK
| | - Raghavan Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
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Goyal A, Nicholls S, Marshall A, Hammonds N, Wheatley D, Elsberger B, Rose J, Edwards HT, Butt R, Shaaban A, Puri S, Ahmed S, Homer T, Vale L, Bruce J, Gasson SJ, Higgins H, Dunn JA. Abstract OT1-09-02: ATNEC: A multicentre, randomized trial investigating whether axillary treatment can be avoided in T1-3N1M0 breast cancer patients with no residual cancer in the axillary lymph nodes after neoadjuvant chemotherapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot1-09-02] [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: 03/06/2023]
Abstract
Abstract
Background: For patients who are node positive at presentation and are found to have a complete nodal tumour response (ypN0) post-neoadjuvant chemotherapy (NACT), we do not yet know whether local axillary therapy can be modified based on the response to NACT. ATNEC addresses whether axillary treatment can be de-escalated, post-surgery, in T1-3N1M0 breast cancer patients who have no residual nodal disease post-NACT. Methods: Design: ATNEC is a phase III, randomized (1:1), multi-centre trial, with embedded economic evaluation. Patients with proven axillary node metastases on needle biopsy receive NACT followed by sentinel node biopsy (SNB). If the sentinel nodes have converted to ypN0, ATNEC randomizes patients to axillary treatment (nodal radiotherapy [ART] or axillary nodal clearance [ANC]) vs. no further axillary treatment. Stratification: Institution, type of surgery (breast conserving surgery vs mastectomy), receptor status (triple negative vs HER2 positive vs ER positive and/or PR positive and HER2 negative). Inclusion criteria: • Age ≥ 18 • Male or female • T1-3N1M0 breast cancer at diagnosis (pre-NACT) • FNA or core biopsy confirmed axillary nodal metastases at presentation • ER and HER2 status evaluated on primary tumour • Received standard NACT as per local guidelines • Imaging of the axilla to assess response to NACT • Dual tracer SNB post-NACT and at least 3 nodes removed (sentinel nodes and marked node). o If a single tracer is used, the patient is eligible if the involved node is marked pre-NACT and at least 3 nodes removed (including the marked node) o If axillary node sampling is performed following failed localization of sentinel nodes, patient is eligible if at least 3 nodes removed (including the marked node). o If node is not marked, or marked node is not removed, patient is eligible if the histology report shows evidence of down-staging with complete pathological response in at least one node of the 3 removed nodes. • No evidence of nodal metastases post-NACT (ypN0) Exclusion criteria: • Bilateral invasive breast cancer • SNB prior to NACT • Previous ipsilateral axillary nodal surgery • Previous cancer within last 5 years or concomitant malignancy Aims: To assess whether omitting further axillary treatment (ART or ANC) for patients with early stage breast cancer and axillary nodal metastases on needle biopsy - who post NACT have no residual nodal disease on SNB (ypN0) - is non-inferior to axillary treatment in terms of disease-free survival, and whether lymphoedema is reduced at 5 years. Statistical methods: All analyses will be carried out on an intention-to-treat basis to preserve randomization, avoid bias from exclusions and preserve statistical power. Radiotherapy Quality Assurance: ATNEC has in-built radiotherapy QA coordinated by National Radiotherapy Trials QA (RTTQA) group. The RTQA monitors trial protocol compliance ensuring clinical outcomes reflect differences in randomization schedules rather than departures from the protocol. ATNEC is the only trial in the UK that offers QA for IMC radiotherapy. Screening Data: ATNEC collects screening data to monitor acceptance rates and reasons why patients decline the trial to identify ways to improve recruitment. Screening data until 30-Jun-22 shows that 69% of eligible patients were approached (244/354) and, of those approached, 45% were consented (109/244). For the 81 patients who declined, the most common reasons were; preference for axillary treatment (31%), preference for no axillary treatment (10%), no reason documented (23%) and ineligibility (21%). ClinicalTrials.gov: NCT04109079 Target accrual: 1900 Target sites: 100 Trial Status: Recruiting. As of 30-Jun-22: 52 sites open, 158 patients enrolled, 54 randomised. ATNEC is open to new sites and international collaboration.
Citation Format: Amit Goyal, Sophie Nicholls, Andrea Marshall, Natalie Hammonds, Duncan Wheatley, Beatrix Elsberger, Janice Rose, Helen-Teresa Edwards, Roeum Butt, Abeer Shaaban, Shama Puri, Samreen Ahmed, Tara Homer, Luke Vale, Julie Bruce, Sophie J. Gasson, Helen Higgins, Janet A. Dunn. ATNEC: A multicentre, randomized trial investigating whether axillary treatment can be avoided in T1-3N1M0 breast cancer patients with no residual cancer in the axillary lymph nodes after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-09-02.
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Affiliation(s)
| | | | - Andrea Marshall
- 3Warwick Clinical Trials Unit, University of Warwick, Coventry, England, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Janet A. Dunn
- 18University of Warwick, Coventry, England, United Kingdom
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Chatterji S, Krzoska E, Thoroughgood CW, Saganty J, Liu P, Elsberger B, Abu-Eid R, Speirs V. Defining genomic, transcriptomic, proteomic, epigenetic, and phenotypic biomarkers with prognostic capability in male breast cancer: a systematic review. Lancet Oncol 2023; 24:e74-e85. [PMID: 36725152 DOI: 10.1016/s1470-2045(22)00633-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 02/02/2023]
Abstract
Although similar phenotypically, there is evidence that male and female breast cancer differ in their molecular landscapes. In this systematic review, we consolidated all existing prognostic biomarker data in male breast cancer spanning genetics, transcriptomics, proteomics, and epigenetics, and phenotypic features of prognostic value from articles published over a 29-year period (March 16, 1992, to May 1, 2021). We identified knowledge gaps in the existing literature, discussed limitations of the included studies, and outlined potential approaches for translational biomarker discovery and validation in male breast cancer. We also recognised STC2, DDX3, and DACH1 as underexploited markers of male-specific prognostic value in breast cancer. Finally, beyond describing the cumulative knowledge on the extensively researched markers oestrogen receptor-α, progesterone receptor, HER2, androgen receptor, and BRCA2, we highlighted ATM, CCND1, FGFR2, GATA3, HIF1-α, MDM2, TP53, and c-Myc as well studied predictors of poor survival that also aligned with several hallmarks of cancer.
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Affiliation(s)
- Subarnarekha Chatterji
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK; Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Emma Krzoska
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - John Saganty
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Peng Liu
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK; Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Rasha Abu-Eid
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK; Institute of Dentistry, University of Aberdeen, Aberdeen, UK
| | - Valerie Speirs
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK; Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
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7
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Bruce E, Makaranka S, Urquhart G, Elsberger B. The Gut Microbiome: A novel player in response to systemic treatment for Breast Cancer. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.228] [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: 02/23/2023]
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8
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Gamble D, Khan H, Ross J, Cheyne L, Rudd A, Horgan G, Hannah A, Urquhart G, Masannat Y, Elsberger B, Sharma R, Dawson D. Energetic and myocellular pathways in cardiac and skeletal muscle following anthracycline chemotherapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anthracycline-related cardiac dysfunction is a recognised consequence of cancer therapies. Here we assess resting cardiac and skeletal muscle energic status as an early mechanistic pathway of myocyte derangement and explore molecular targets of skeletal myocyte metabolism, protein synthesis/degradation and mitochondrial biogenesis signalling.
Methods
We conducted a prospective, mechanistic, observational, longitudinal study of chemotherapy-naive breast cancer patients undergoing anthracycline-based chemotherapy, compared to a healthy control group. 31P-Magnetic Resonance spectroscopy in cardiac and skeletal muscle (phosphocreatine/gamma adenosine triphosphate (PCr/yATP) and inorganic phosphate/phosphocreatine (Pi/PCr) ratios respectively), cardiac magnetic resonance (CMR) imaging inclusive of T1 and T2 mapping, echocardiography-derived global longitudinal strain function, serum NT-pro-BNP and skeletal muscle biopsies from the right vastus lateralis were assessed before and after 3 cycles of Flurouracil, Epirubicin and Cyclophosphamide followed by 3 cycles of Docetaxel. Statistical significance was set at p<0.05.
Results
Twenty-five female breast cancer patients (median age 53 years, range 32–74 years) receiving a mean epirubicin dose 307 mg/m2) and twenty-eight controls (median age 44 years, range 23–65) were recruited. All study assessments in breast cancer patients at pre-chemotherapy stage were comparable to the matched healthy controls. However, following chemotherapy, breast cancer patients demonstrated a small but significant reduction in cardiac function (global longitudinal strain −22.9±3.9 vs −19.1±3.3%, p=0.01 and CMR-derived ejection fraction 65±5 vs 62±4%, p=0.047), a mild increase in CMR-derived indexed left ventricular volumes (end diastolic 65±10 vs 74±11 ml/m2, p=0.014 and end systolic 23±5 vs 28±5 ml/m2, p=0.01) as well as an increase in left ventricular T1 and T2-mapping (1289±29 vs 1321±31 ms, p=0.004 and 50±4 vs 55±7 ms, p=0.027, respectively) and serum NT-Pro-BNP (49±25 vs 108±84 pg/m, p=0.008). After epirubicin, there was significant reduction in cardiac PCr/yATP ratio (2.0±0.7 vs 1.2±0.6, p=0.007) and a significant increase in skeletal muscle Pi/PCr ratio (0.13±0.04 vs 0.22±0.2, p=0.008) – Figure 1.
Following chemotherapy, there was significant upregulation of skeletal myocyte protein synthesis (mammalian target of rapamycin, 0.44±0.4 vs 0.53±0.2, p<0.001) and degradation (Calcium/calmodulin dependent protein kinase II, 1.4±0.7 vs 2.7±1.1, p<0.001), metabolism (peroxisome proliferator-activated receptor gamma, 0.35±0.2 vs 0.60±0.1, p<0.001) and muscle mass regulator myostatin-2 (0.16±0.1 vs 0.24±0.1, p<0.001).
Conclusion
Contemporary doses of epirubicin for breast cancer result in significant reduction of cardiac and skeletal muscle high energy 31P-metabolism alongside skeletal myocellular alterations of protein synthesis and metabolic regulation pathways.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Tenovus ScotlandNHS Grampian Endowment fund
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Affiliation(s)
- D Gamble
- University of Aberdeen , Aberdeen , United Kingdom
| | - H Khan
- University of Aberdeen , Aberdeen , United Kingdom
| | - J Ross
- University of Aberdeen , Aberdeen , United Kingdom
| | - L Cheyne
- University of Aberdeen , Aberdeen , United Kingdom
| | - A Rudd
- University of Aberdeen , Aberdeen , United Kingdom
| | - G Horgan
- University of Aberdeen , Aberdeen , United Kingdom
| | - A Hannah
- Aberdeen Royal Infirmary, cardiology , Aberdeen , United Kingdom
| | - G Urquhart
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - Y Masannat
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - B Elsberger
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - R Sharma
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - D Dawson
- University of Aberdeen , Aberdeen , United Kingdom
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9
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Morgan JL, Cheng V, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hartup S, Hogan B, Horgan K, Kirwan CC, McIntosh SA, O'Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National practice questionnaire of United Kingdom multi-disciplinary decision making. Eur J Surg Oncol 2022; 48:1510-1519. [PMID: 35410760 DOI: 10.1016/j.ejso.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evidence based guidelines for the optimal management of breast cancer locoregional recurrence (LRR) are limited, with potential for variation in clinical practice. This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding LRR management. METHODS UK breast units were invited to take part in the MARECA study MDT NPQ. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy. RESULTS 822 MDT members across 42 breast units (out of 144; 29%) participated in the NPQ (February-August 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%). For patients previously treated with breast conserving surgery (BCS) and radiotherapy, few units (7%) always/usually offered repeat BCS. However, in the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with isolated local recurrence following previous BCS and SLNB (sentinel lymph node biopsy), most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure. For ER positive, HER2 negative, node negative local recurrence, 10% of units always/usually offered chemotherapy. For ER positive, HER2 negative, node positive local recurrence, this recommendation increased to 64%. For triple negative breast cancer local recurrence, 90% of units always/usually offered chemotherapy. CONCLUSION This survey has highlighted where consistencies and variations exist in the multidisciplinary management of breast cancer LRR. However, further research is required to determine how these management patterns influence patient outcomes, which will further refine optimal treatment pathways.
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Affiliation(s)
- Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - Vinton Cheng
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Peter A Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Ellen Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Rajiv Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Beatrix Elsberger
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | | | - Sue Hartup
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Brian Hogan
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Kieran Horgan
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Cliona C Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4BX, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK
| | - Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
| | - Shelley Potter
- Translational Health Sciences, Bristol Medical School, Canynge Hall, Whatley Road, Bristol, BS8 2PS, UK
| | - Tim Rattay
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 2LX, UK
| | - Lisa Sheehan
- Wessex Deanery, Southern House, Otterbourne, Winchester, SO21 2RU, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Baek Kim
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
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10
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McClurg DP, Urquhart G, McGoldrick T, Chatterji S, Miedzybrodzka Z, Speirs V, Elsberger B. Analysis of the Clinical Advancements for BRCA-Related Malignancies Highlights the Lack of Treatment Evidence for BRCA-Positive Male Breast Cancer. Cancers (Basel) 2022; 14:3175. [PMID: 35804947 PMCID: PMC9264767 DOI: 10.3390/cancers14133175] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
Male breast cancer (MBC) is a rare disease that accounts for less than 1% of all breast cancers and male malignancies. Despite recognised clinico-pathological and molecular differences to female breast cancer (FBC), the clinical management of MBC follows established FBC treatment strategies. Loss of function mutations in the DNA damage response genes BRCA1 and BRCA2, have been strongly implicated in the pathogenesis of MBC. While there have been extensive clinical advancements in other BRCA-related malignancies, including FBC, improvements in MBC remain stagnant. Here we present a review that highlights the lack of treatment evidence for BRCA-related MBC and the required national and global collaborative effort to address this unmet need. In doing so, we summarise the transformative clinical advancements with poly(ADP-ribose) polymerase (PARP) inhibitors in other BRCA-related cancers namely, FBC and prostate cancer.
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Affiliation(s)
- Dylan P. McClurg
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Gordan Urquhart
- Aberdeen Royal Infirmary, Department of Oncology, Foresterhill Road, Aberdeen AB25 2ZN, UK; (G.U.); (T.M.)
| | - Trevor McGoldrick
- Aberdeen Royal Infirmary, Department of Oncology, Foresterhill Road, Aberdeen AB25 2ZN, UK; (G.U.); (T.M.)
| | - Subarnarekha Chatterji
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Zosia Miedzybrodzka
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Valerie Speirs
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Beatrix Elsberger
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
- Aberdeen Royal Infirmary, Breast Unit, Foresterhill Road, Aberdeen AB25 2ZN, UK
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11
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Gamble D, Khan H, Ross J, Cheyne L, Rudd A, Horgan G, Hannah A, Urquhart G, Masannat Y, Elsberger B, Sharma R, Dawson DK. 142 Cardiac and skeletal muscle energetic pathways following anthracycline chemotherapy for breast cancer. IMAGING 2022. [DOI: 10.1136/heartjnl-2022-bcs.142] [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: 11/04/2022] Open
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12
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Goyal A, Cramp S, Marshall A, Hammonds N, Wheatley D, Elsberger B, Puri S, Homer T, Vale L, Butt R, Nabi Z, Rose J, Edwards HT, Ahmed S, Shaaban A, Bruce J, Gasson S, Higgins H, Dunn J. ATNEC: A multicenter, randomized trial investigating whether axillary treatment can be avoided in patients with T1-3N1M0 breast cancer with no residual cancer in the lymph glands after neoadjuvant chemotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps615] [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: 11/20/2022] Open
Abstract
TPS615 Background: Neoadjuvant chemotherapy (NACT) results in eradication of cancer in the axillary nodes in 40-70% of patients. This raises questions about the benefit of further axillary treatment in patients with no evidence of residual nodal disease (ypN0) post NACT. Methods: Design: ATNEC is a phase 3, randomized (1:1), multi-center UK trial, with embedded economic evaluation. Patients with proven axillary node metastases on needle biopsy receive NACT followed by sentinel node biopsy (SNB). If the sentinel nodes have converted to benign (ypN0), ATNEC randomly assigns patients to axillary treatment (nodal radiotherapy [ART] or axillary nodal clearance [ALND]) vs no further axillary treatment. Stratification: Institution, type of surgery (breast conserving surgery vs mastectomy), receptor status (triple negative vs HER2 positive vs ER positive and/or PR positive and HER2 negative).Inclusion criteria: Age ≥ 18; Male or female; T1-3N1M0 breast cancer at diagnosis (pre-NACT); FNA or core biopsy confirmed axillary nodal metastases at presentation; ER and HER2 status evaluated on primary tumor; Received standard NACT as per local guidelines; Imaging of the axilla to assess response to NACT;Dual tracer SNB post-NACT and at least 3 nodes removed (sentinel nodes and marked node): If a single tracer is used, the patient is eligible if the involved node is marked pre-NACT and at least 3 nodes removed (including the marked node), If axillary node sampling is performed following failed localization of sentinel nodes, patient is eligible if at least 3 nodes removed (including the marked node), If node is not marked, or marked node is not removed, patient is eligible if the histology report shows evidence of down-staging with complete pathological response in at least one node and at least 3 nodes removed; No evidence of nodal metastases post NACT (ypN0). Exclusion criteria: Bilateral invasive breast cancer; SNB prior to NACT; Previous ipsilateral axillary nodal surgery; Previous cancer within last 5 years or concomitant malignancy. Aims: To assess whether omitting further axillary treatment (ALND & ART) for patients with early-stage breast cancer and axillary nodal metastases on needle biopsy - who after NACT have no residual nodal disease on SNB (ypN0) - is non-inferior to axillary treatment in terms of disease-free survival, and reduces lymphoedema at 5 years. Statistical methods: All analyses will be carried out on an intention-to-treat basis to preserve randomization, avoid bias from exclusions and preserve statistical power. Radiotherapy Quality Assurance: Study has in-built radiotherapy QA program that will be coordinated by National Radiotherapy Trials QA (RTTQA) group. Target accrual: 1,900 Status: Recruiting. As of 11-Feb-2022, 39 sites open, 87 patients enrolled, 31 randomized. Clinical trial information: NCT04109079.
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Affiliation(s)
- Amit Goyal
- Royal Derby Hospital, Derby, United Kingdom
| | - Sophie Cramp
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | | | | | | | | | - Shama Puri
- Royal Derby Hospital, Derby, United Kingdom
| | - Tara Homer
- Newcastle University, Newcastle University, United Kingdom
| | - Luke Vale
- Newcastle University, Newcastle, United Kingdom
| | - Roeum Butt
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Zohal Nabi
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Janice Rose
- NCRI Breast Clinical Studies Group, London, United Kingdom
| | | | - Samreen Ahmed
- University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Abeer Shaaban
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Julie Bruce
- University of Warwick, Coventry, United Kingdom
| | - Sophie Gasson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Helen Higgins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
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13
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Macnab MR, Slater G, Fuller M, Elsberger B, Lovell L, Staff R, Masannat Y. Redo-sentinel lymph node biopsy in patients with prior ipsilateral breast cancer surgery. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.057] [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: 10/18/2022]
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14
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Morgan J, Cheng V, Barry P, Copson E, Cutress R, Dave R, Elsberger B, Fairbrother P, Hartup S, Hogan B, Horgan K, Kirwan C, McIntosh S, O'Connell R, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National practice questionnaire of United Kingdom multi-disciplinary decision making. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Makaranka S, Bruce E, Urquhart G, Elsberger B. Gut microbiome environment and its relevance in breast cancer therapy. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2022.03.201] [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: 11/24/2022] Open
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16
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Peters A, Marashi H, Jordan LB, Hannington L, Vallet M, Cartwright D, Yi-Soh F, Makaranka S, Urquhart G, Hall P, Elsberger B. Steroid receptor positivity and tumour type are influencing Oncotype DX recurrence score and subsequent treatment delivery in Scotland. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.221] [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: 10/18/2022]
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Pawloy K, Urquhart G, Brown D, Daltrey I, Soh FY, Anderson LA, Elsberger B. Not all small HER2 positive breast cancers have the same clinical outcome in the North-East of Scotland. Cancer Treat Res Commun 2022; 31:100549. [PMID: 35325763 DOI: 10.1016/j.ctarc.2022.100549] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
HER2-positive breast cancers, representing up to 20% of all breast cancers, are more aggressive and have poorer outcomes. Systemic therapy has been proven to prevent disease recurrence and improve survival. Existing literature provides only limited evidence to support this in smaller HER2-positive tumors. The study aimed to evaluate HER-2 positive breast cancer management and treatment of all T1N0 tumors in the North of Scotland, diagnosed 2012-2019. Clinical-pathological details, comorbidities, treatments and clinical events were retrieved from the Scottish North Cancer Alliance audit database and analyzed using univariate and multivariate analysis including cox-regression and log-rank testing (SPSSv23).Overall, 299 patients (41% screen detected/ 56.9% symptomatic /2.1% other), median age 63 years and median tumor size 13 mm, were included. Most cancers were grade 2/3 (43.1%/ 55.5%). Most patients (59.5%) received treatment with trastuzumab (tT); 40.8% concurrent with chemotherapy and endocrine therapy. 7.7% of patients received neo adjuvant chemotherapy. Median follow-up time was 2.6 years, with recurrence on average occurring 2.9 years after diagnosis. Patients receiving trastuzumab were younger, had a higher grade and larger size tumor. 78.5% of patients in the untreated group (non-tT) were ER positive compared to 65.2% in the treated group (tT). Trastuzumab significantly lowered breast cancer recurrence (Tt=3.4% versus non-Tt=8.3%, p = 0.022 HR= 0.096, 95% CI 0.025-0.361). In conclusion, receiving anti-HER2 treatment significantly improved clinical outcome in this T1N0 patient group. Consideration, at the very least informed discussions with patients, should be undertaken to treat these early stage HER2-positive breast cancers.
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Affiliation(s)
- Karola Pawloy
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, United Kingdom.
| | - Gordon Urquhart
- Aberdeen Royal Infirmary, NHS Grampian, Department of Oncology, Aberdeen, AB25 2ZN, United Kingdom
| | - Douglas Brown
- Ninewells Hospital, NHS Tayside, Department of Breast Surgery, Dundee, DD1 9SY, United Kingdom
| | - Ian Daltrey
- Raigmore Hospital, NHS Highland, Department of Breast Surgery, Inverness, IV2 3UJ, United Kingdom
| | - Feng-Yi Soh
- Raigmore Hospital, NHS Highland, Department of Oncology, Inverness, IV2 3UJ, United Kingdom
| | - Lesley Ann Anderson
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, United Kingdom; University of Aberdeen, Aberdeen Centre for Health Data Science, Aberdeen, AB25 2ZD, United Kingdom
| | - Beatrix Elsberger
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, United Kingdom; Aberdeen Royal Infirmary, NHS Grampian, Department of Breast Surgery, Aberdeen, AB25 2ZN, United Kingdom
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18
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Goyal A, Cramp S, Marshall A, Wheatley D, Hammonds N, Puri S, Homer T, Vale L, Butt R, Mir R, Rose J, Edwards HT, Ahmed S, Shaaban A, Elsberger B, Bruce J, Gasson S, Speirs V, Shaw J, Higgins H, Dunn J. Abstract OT1-04-01: ATNEC: A multi-centre, randomised trial investigating whether axillary treatment can be avoided in T1-3N1M0 breast cancer patients with no residual cancer in the lymph glands after neoadjuvant chemotherapy (clinicaltrials.gov: nct04109079). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot1-04-01] [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: For patients who are node positive to start at presentation and are found to have a complete nodal tumour response (ypN0) post neoadjuvant chemotherapy (NACT), we do not yet know whether local axillary therapy can be modified based on the response to NACT. ATNEC randomised trial specifically address axillary management following NACT in patients with proven axillary node metastases. Methods: Design: ATNEC is a phase III, randomised (1:1), multi-centre trial, with embedded economic evaluation. Patients with proven axillary node metastases on needle biopsy receive NACT followed by sentinel node biopsy (SNB). If the sentinel nodes have converted to benign (ypN0), ATNEC randomly assigns patients to axillary treatment (nodal radiotherapy or axillary nodal clearance) vs. no axillary treatment (without further surgery). Aims: To assess whether, omitting further axillary treatment (ALND and ART) for patients with early stage breast cancer and axillary nodal metastases on needle biopsy - who after NACT have no residual nodal disease on SNB - is non-inferior to axillary treatment in terms of disease free survival, and reduces the risk of lymphoedema at 5 years. Stratification: Institution, type of surgery (breast conserving surgery [BCS] vs mastectomy), receptor status (triple negative vs HER2 positive vs ER status positive and/or PR status positive and HER2 negative). Inclusion criteria:. • Age ≥ 18. • Male or female. • T1-3N1M0 breast cancer at diagnosis (pre-NACT). • FNA or core biopsy confirmed axillary nodal metastases at presentation. • ER and HER2 status evaluated on primary tumour. • Received standard NACT as per local guidelines. • Imaging assessment of the axilla at completion of NACT. • Dual tracer SNB after NACT and at least 3 nodes removed (sentinel nodes and marked node). o If a single tracer is used, the patient is eligible if the involved node is marked before NACT and at least 3 nodes removed (including the marked node). o If axillary node sampling is performed following failed localisation of sentinel nodes, patient is eligible if at least 3 nodes removed (including the marked node). o If node is not marked, or marked node is not removed, patient is eligible if the histology report shows evidence of down-staging with complete pathological response in at least one node and at least 3 nodes removed. • No evidence of nodal metastases post NACT (ypN0). Exclusion criteria:. • Bilateral invasive breast cancer. • SNB prior to NACT. • Previous ipsilateral axillary nodal surgery. • Previous cancer within last 5 years or concomitant malignancy. Radiotherapy Quality Assurance: ATNEC has in-built radiotherapy QA programme that is coordinated by National Radiotherapy Trials QA (RTTQA) group. Target accrual: 1900 Number of sites: 100 Trial Status: Recruiting. Trial is open to new sites. Disclaimer: This study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (Reference - HTA NIHR128311). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Citation Format: Amit Goyal, Sophie Cramp, Andrea Marshall, Duncan Wheatley, Natalie Hammonds, Shama Puri, Tara Homer, Luke Vale, Roeum Butt, Romaana Mir, Janice Rose, Helen Teresa Edwards, Samreen Ahmed, Abeer Shaaban, Beatrix Elsberger, Julie Bruce, Sophie Gasson, Valerie Speirs, Jacqui Shaw, Helen Higgins, Janet Dunn. ATNEC: A multi-centre, randomised trial investigating whether axillary treatment can be avoided in T1-3N1M0 breast cancer patients with no residual cancer in the lymph glands after neoadjuvant chemotherapy (clinicaltrials.gov: nct04109079) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-04-01.
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Affiliation(s)
- Amit Goyal
- Royal Derby Hospital, Derby, United Kingdom
| | | | | | | | | | - Shama Puri
- Royal Derby Hospital, Derby, United Kingdom
| | - Tara Homer
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Luke Vale
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Roeum Butt
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Romaana Mir
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Janice Rose
- NCRI Breast Clinical Studies Group, London, United Kingdom
| | | | - Samreen Ahmed
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Abeer Shaaban
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Julie Bruce
- University of Warwick, Coventry, United Kingdom
| | | | | | - Jacqui Shaw
- University of Leicester, Leicester, United Kingdom
| | | | - Janet Dunn
- University of Warwick, Coventry, United Kingdom
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Macnab MRF, Slater G, Fuller M, Elsberger B, Lovell L, Staff RT, Masannat Y. The role of redo-Sentinel Lymph Node Biopsy in patients with prior ipsilateral breast cancer surgery. Clin Breast Cancer 2022; 22:e674-e679. [DOI: 10.1016/j.clbc.2022.01.012] [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] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 12/24/2022]
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Alnumani H, Lip G, Fuller M, Elsberger B, Mustafa A, Smyth E, Muhammad Gowdh N, Arcot Ragupathy SK, Nandakumar A, Greiskalna D, Masannat Y. Radiofrequency Tag Localisation for Breast Lesions, A single center experience. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.399] [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: 11/16/2022]
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Frixou M, Makaranka S, Urquhart G, Elsberger B. 362 Comparison of PREDICT Score to Oncotype Dx Score in Early Invasive Breast Cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.204] [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: 11/13/2022]
Abstract
Abstract
Aim
The PREDICT score is used to help define decisions about benefits of chemotherapy in early invasive breast cancer. With a PREDICT score of 5% or more chemotherapy should be considered, 3% to 4% is a borderline decision and less than 3% chemotherapy is not pursued. We set out to compare the PREDICT score to Oncotype Dx recurrence score (RS), which predicts chemotherapy benefit based on 21-gene breast cancer assay.
Method
Data for patient and tumour characteristics, and treatment choice was collected from electronic patient records of 98 patients who had an RS score done between February 2017-September 2020. This data was then compared to the patients’ PREDICT scores.
Results
98 patients were analysed with 2 excluded due to having nodal macro-metastases. Mean patient age was 53 years with an average tumour size of 27mm. 31/96 (32%) patients had a PREDICT score ≥5%, with 21/31 (68%) having a low RS score (<26). 57/96 (59%) patients had a PREDICT score of 3-4%, with 40/57 (70%) having a low RS score. 8/96 (8%) patients had a PREDICT score of < 3%, with 7/8 (88%) having a low RS score. Additionally, 7/8 (88%) patients in this group were pre-menopausal.
Conclusions
68% of patients in the ≥5% PREDICT group had a low RS score and so have avoided chemotherapy. In the 3-4% group, approximately 1 in 3 tested were shown to have a chemotherapy benefit. In the <3% group most patients were pre-menopausal, and chemotherapy was safely avoided. A bigger dataset and comparison to other health boards is required.
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Affiliation(s)
- M Frixou
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - S Makaranka
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - G Urquhart
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - B Elsberger
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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Bruce E, Makaranka S, Urquhart G, Elsberger B. Does the gut microbiome environment influence response to systemic breast cancer treatment? Exploration of Targeted Anti-tumor Therapy 2021; 2:374-384. [PMID: 36046753 PMCID: PMC9400737 DOI: 10.37349/etat.2021.00051] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
The gut microbiome is a novel player in the pathogenesis and treatment of breast cancer. The term “microbiome” is used to describe the diverse community of micro-organisms existing within the gastrointestinal tract. The gut microbiome plays an important role in oestrogen metabolism through its ability to deconjugate oestrogens within the gut resulting in their reabsorption. Therefore, it is not unsurprising that “dysbiosis”, the disruption of normal gut microbiota composition, is now thought to play a role in the development of the disease, as women with breast cancer have been shown to have altered gut microbiota and this has been correlated with tumour characteristics. There is emerging evidence to suggest that the gut microbiota may also impact on breast cancer treatment, by mediating both drug efficacy and toxicity. The present review will discuss the influence of the gut microbiota on systemic treatments for breast cancer, including chemotherapy, anti-human epidermal growth factor receptor 2 (HER2) therapy, endocrine therapy and immunotherapy as well as other targeted treatments.
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Affiliation(s)
- Eilidh Bruce
- Department of Breast Surgery, Aberdeen Royal Infirmary, NHS Grampian, AB25 2ZN Aberdeen, Scotland, UK; University of Aberdeen, AB25 2ZN Aberdeen, Scotland, UK
| | - Stanislau Makaranka
- Department of Breast Surgery, Aberdeen Royal Infirmary, NHS Grampian, AB25 2ZN Aberdeen, Scotland, UK
| | - Gordon Urquhart
- Department of Oncology, Aberdeen Royal Infirmary, NHS Grampian, AB25 2ZN Aberdeen, Scotland, UK
| | - Beatrix Elsberger
- Department of Breast Surgery, Aberdeen Royal Infirmary, NHS Grampian, AB25 2ZN Aberdeen, Scotland, UK; University of Aberdeen, AB25 2ZN Aberdeen, Scotland, UK
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Strickland J, Elsberger B, Lip G, Fuller M, Masannat Y. Impalpable Breast Cancer and Service Delivery During the COVID-19 Pandemic – the Role of Radiofrequency Tag localization. Arch Breast Cancer 2021. [DOI: 10.32768/abc.202183247-250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Radiofrequency tags are used to localize breast lesions for surgery. During the Covid-19 pandemic, these offered the flexibility of inserting the Tags days or weeks before surgery. This made logistics of planning theatres lists easier, especially with most of the lists having been moved off site.Methods: In the 7 weeks following the first lockdown in the UK, we reviewed all planned admissions for breast surgery looking at the types of surgery offered, type of localization used and assessed which cases would not have been able to go ahead had radiofrequency tags not been available.Results: Out of 85 planned admission, 83 had surgery, 11 were for re-excision of margins and 72 for their first breast surgery excision (mastectomy or breast conservation). Out of the 54 that had breast conserving surgery, 40 needed localization, out of whom 27 had radiofrequency tags. Looking at theatre order list and location of surgery, 20 out of the 27 would not have had their surgery had radiofrequency tags not been available, which is 50% of the patients needing localization.Conclusion: Radiofrequency tags are new devices used for breast lesion localization that offer a much-needed flexibility especially as seen during the Covid-19 pandemic.
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Goyal A, Cramp S, Wheatley D, Marshall A, Puri S, Hammonds N, Homer T, Vale L, Mir R, Rose J, Edwards HT, Ahmed S, Shaaban A, Elsberger B, Bruce J, Gasson S, Speirs V, Shaw J, Higgins H, Dunn J. Axillary management in T1-3N1M0 breast cancer patients with needle biopsy proven nodal metastases at presentation after neoadjuvant chemotherapy (ATNEC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps600] [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: 11/20/2022] Open
Abstract
TPS600 Background: Neoadjuvant chemotherapy (NACT) results in eradication of cancer in the axillary nodes in 40% to 70% of patients. This raises questions about the benefit of further axillary treatment in those patients with no evidence of residual nodal disease (ypN0) after NACT. Methods: Design: ATNEC is a phase 3, randomised (1:1), multi-centre trial, with embedded economic evaluation, comparing standard axillary treatment (axillary lymph node dissection [ALND] or axillary radiotherapy [ART]) with no further axillary treatment in T1-3N1M0 breast cancer patients with needle biopsy proven axillary nodal metastases, who after NACT have no residual nodal disease (ypN0) on dual tracer sentinel node biopsy (SNB) and removal of at least 3 nodes (sentinel nodes and marked involved node). Stratification: Institution, type of surgery (breast conserving surgery vs mastectomy), receptor status (triple negative vs HER2 positive vs ER positive and/or PR positive and HER2 negative). Inclusion criteria are: Age ≥ 18, Male or female, T1-3N1M0 breast cancer at diagnosis (pre-NACT), FNA or core biopsy confirmed axillary nodal metastases at presentation, ER and HER2 status evaluated on primary tumour, received standard NACT as per local guidelines, ultrasound of the axilla at completion of NACT, dual tracer SNB after NACT and at least 3 nodes removed (sentinel nodes and marked node), no evidence of nodal metastases post NACT (ypN0). Exclusion criteria are: bilateral invasive breast cancer, SNB prior to NACT, marked node not removed except where at least one node removed shows evidence of down-staging with complete pathological response e.g. fibrosis/scarring and at least 3 nodes removed, previous ipsilateral axillary surgery, previous cancer within last 5 years or concomitant malignancy except basal or squamous cell carcinoma of the skin, in situ carcinoma of the cervix, in situ or stage 1 melanoma, contra- or ipsilateral in situ breast cancer. Aims: To assess whether, omitting further axillary treatment (ALND and ART) for patients with early stage breast cancer and axillary nodal metastases on needle biopsy - who after NACT have no residual nodal disease on SNB (ypN0) - is non-inferior to axillary treatment in terms of disease free survival, and reduces the risk of lymphoedema at 5 years. Statistical methods: All analyses will be carried out on an intention-to-treat basis to preserve randomisation, avoid bias from exclusions and preserve statistical power. Radiotherapy quality assurance: Study has in-built radiotherapy QA programme that will be co-ordinated by National Radiotherapy Trials QA (RTTQA) group. Target accrual: 1900. Trial status: Recruiting. Number of sites: 100. Clinical trial information: NCT04109079.
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Affiliation(s)
- Amit Goyal
- Royal Derby Hospital, Derby, United Kingdom
| | | | | | | | - Shama Puri
- Royal Derby Hospital, Derby, United Kingdom
| | | | - Tara Homer
- Newcastle University, Newcastle University, United Kingdom
| | - Luke Vale
- Newcastle University, Newcastle, United Kingdom
| | - Romaana Mir
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Janice Rose
- NCRI Breast Clinical Studies Group, London, United Kingdom
| | | | - Samreen Ahmed
- University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Abeer Shaaban
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Julie Bruce
- University of Warwick, Coventry, United Kingdom
| | | | | | - Jacqui Shaw
- University of Leicester, Leicester, United Kingdom
| | | | - Janet Dunn
- University of Warwick, Coventry, United Kingdom
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Makaranka S, Frixou M, Urquhart G, Elsberger B. P057. The implementation of oncotype DX score on MDT decision making - A service evaluation. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.061] [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: 11/29/2022] Open
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Strickland J, Elsberger B, Lip G, Fuller M, Masannat Y. P062. The use of radiofrequency tag localization of impalpable breast cancers during the COVID-19 pandemic. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.066] [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: 10/21/2022] Open
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Goyal A, Cramp S, Wheatley D, Marshall A, Puri S, Homer T, Vale L, Mir R, Nabi Z, Rose J, Edwards HT, Ahmed S, Shaaban A, Elsberger B, Bruce J, Gasson S, Speirs V, Shaw J, Higgins H, Dunn J. Abstract OT-04-01: Axillary management in T1-3N1M0 breast cancer patients with needle biopsy proven nodal metastases at presentation after neoadjuvant chemotherapy - ATNEC (ClinicalTrials.gov NCT04109079). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-04-01] [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: Neoadjuvant chemotherapy (NACT) results in eradication of cancer in the axillary lymph nodes in 40% to 70% of patients. This has raised questions about the benefit of further axillary treatment in these patients with no evidence of residual disease in the lymph nodes. Trial design: A multi-centre phase III randomised controlled trial with embedded economic evaluation in which participants will be randomised in a 1:1 ratio. Study participants: T1-3N1M0 breast cancer patients aged 18 years or older, with needle biopsy proven nodal metastases, who after NACT have no residual cancer in the lymph nodes on dual tracer sentinel node biopsy and removal of at least 3 lymph nodes (sentinel nodes and marked involved node). Intervention: Participants in the experimental group will not receive further axillary treatment (axillary lymph node dissection [ALND] or axillary radiotherapy [ART]), after NACT and surgery. Participants in the control group will receive further axillary treatment (ALND or ART) after NACT and surgery, as per local guidelines. Stratification: Institution, type of breast surgery (breast conserving surgery (BCS) vs mastectomy), receptor status (triple negative vs HER2 positive vs ER status positive and/or PR status positive and HER2 negative) Eligible participants will be/should have:•Age ≥ 18•Male or female •T1-3N1M0 breast cancer at diagnosis (prior to NACT) •FNA or core biopsy confirmed axillary nodal metastases at presentation •Oestrogen receptor and HER2 status evaluated on primary tumour •Received standard NACT as per local guidelines (Patients undergoing neoadjuvant endocrine therapy as part of another clinical trial are eligible) •Ultrasound of the axilla at completion of NACT •Undergo dual tracer sentinel node biopsy after NACT and at least 3 nodes removed (sentinel nodes and marked node). If axillary node sampling is performed following failed localisation of sentinel nodes, patient will be eligible if at least 3 nodes removed (including the marked node) •No evidence of nodal metastases post NACT (isolated tumour cells, micro or macro metastasis) Participants will be excluded if they have any one of the following:•Bilateral invasive breast cancer•Sentinel node biopsy prior to NACT•Marked node not removed except where at least one node removed showsoevidence of down-staging with complete pathological response e.g. fibrosis or scarring and at least 3 nodes removed•Previous axillary surgery on the same body side as the scheduled targeted sampling•Any previous cancer within last 5 years or concomitant malignancy except basal or squamous cell carcinoma of the skin, in situ carcinoma of the cervix oin situ or stage 1 melanoma, contra- or ipsilateral in situ breast cancer Specific aims: To assess whether, omitting further axillary treatment (ALND and ART) for patients with early stage breast cancer and axillary nodal metastases on needle biopsy, who after NACT have no residual cancer in the lymph nodes on sentinel node biopsy, is non-inferior to axillary treatment in terms of disease free survival (DFS), and reduces the risk of lymphoedema at 5 years.Statistical methods: All analyses will be carried out on an intention-to-treat basis to preserve randomisation, avoid bias from exclusions and preserve statistical power.
Target accrual: 1900, Number of sites: ~100 ClinicalTrials.gov: NCT04109079 Contact information: atnec@warwick.ac.uk Disclaimer: This study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (Reference - HTA NIHR128311). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Citation Format: Amit Goyal, Sophie Cramp, Duncan Wheatley, Andrea Marshall, Shama Puri, Tara Homer, Luke Vale, Romaana Mir, Zohal Nabi, Janice Rose, Helen Teresa Edwards, Samreen Ahmed, Abeer Shaaban, Beatrix Elsberger, Julie Bruce, Sophie Gasson, Valerie Speirs, Jacqui Shaw, Helen Higgins, Janet Dunn. Axillary management in T1-3N1M0 breast cancer patients with needle biopsy proven nodal metastases at presentation after neoadjuvant chemotherapy - ATNEC (ClinicalTrials.gov NCT04109079) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-04-01.
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Affiliation(s)
- Amit Goyal
- 1Royal Derby Hospital, Derby, United Kingdom
| | - Sophie Cramp
- 2University of Warwick, Coventry, United Kingdom
| | - Duncan Wheatley
- 3Royal Cornwall Hospitals NHS Trust, Cornwall, United Kingdom
| | | | - Shama Puri
- 1Royal Derby Hospital, Derby, United Kingdom
| | - Tara Homer
- 4Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Luke Vale
- 4Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Romaana Mir
- 5Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Zohal Nabi
- 5Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Janice Rose
- 6NCRI Breast Clinical Studies Group, London, United Kingdom
| | | | - Samreen Ahmed
- 8University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Abeer Shaaban
- 9University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Julie Bruce
- 2University of Warwick, Coventry, United Kingdom
| | | | | | - Jacqui Shaw
- 12University of Leicester, Leicester, United Kingdom
| | | | - Janet Dunn
- 2University of Warwick, Coventry, United Kingdom
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Strickland J, Elsberger B, Lip G, Fuller M, Masannat Y. The use of Radiofrequency Tag Localization of impalpable breast cancers during the COVID-19 pandemic. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.268] [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: 10/22/2022] Open
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Puri S, Sharma N, Newcombe R, Kaushik M, Al-Attar M, Pascaline S, Hajaj M, Wallis M, Elsberger B, Goyal A. Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes. Clin Radiol 2018; 73:391-395. [DOI: 10.1016/j.crad.2017.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022]
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Tang SSK, Kaptanis S, Haddow JB, Mondani G, Elsberger B, Tasoulis MK, Obondo C, Johns N, Ismail W, Syed A, Kissias P, Venn M, Sundaramoorthy S, Irwin G, Sami AS, Elfadl D, Baggaley A, Remoundos DD, Langlands F, Charalampoudis P, Barber Z, Hamilton-Burke WLS, Khan A, Sirianni C, Merker LAMG, Saha S, Lane RA, Chopra S, Dupré S, Manning AT, St John ER, Musbahi A, Dlamini N, McArdle CL, Wright C, Murphy JO, Aggarwal R, Dordea M, Bosch K, Egbeare D, Osman H, Tayeh S, Razi F, Iqbal J, Ledwidge SFC, Albert V, Masannat Y. Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland. Eur J Cancer 2017; 84:315-324. [PMID: 28865259 DOI: 10.1016/j.ejca.2017.07.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates. METHODS A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies. RESULTS A total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70-900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0-41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin. CONCLUSION There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Consensus
- Female
- Guideline Adherence/standards
- Healthcare Disparities/standards
- Humans
- Ireland
- Margins of Excision
- Mastectomy, Segmental/adverse effects
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/standards
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Prospective Studies
- Quality Indicators, Health Care/standards
- Reoperation
- Treatment Outcome
- United Kingdom
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Affiliation(s)
- Sarah Shuk-Kay Tang
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England SW17 0QT, UK.
| | - Sarantos Kaptanis
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - James B Haddow
- Queen Mary University of London, Garrod Building, Turner Street, London, England E1 2AD, UK.
| | | | - Beatrix Elsberger
- Ninewells Hospital, James Arrott Drive, Dundee, Scotland DD1 9SY, UK.
| | | | - Christine Obondo
- Stobhill Hospital, 133 Balornock Road, Glasgow, Scotland G21 3UW, UK.
| | - Neil Johns
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh, Scotland EH42XU, UK.
| | - Wisam Ismail
- Bradford Royal Infirmary, Duckworth Lane, Bradford, England BD9 6RJ, UK.
| | - Asim Syed
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Mary Venn
- Ipswich Hospital, Heath Road, Ipswich, England IP4 5PD, UK.
| | | | - Gareth Irwin
- Ulster Hospital, Upper Newtownards Road, Belfast, Northern Ireland BT16 1RH, UK.
| | - Amtul S Sami
- Lincoln County Hospital, Greetwell Road, Lincoln, England LN2 5QY, UK.
| | - Dalia Elfadl
- Royal Marsden Hospital, Downs Road, Sutton, England SM2 5PT, UK.
| | - Alice Baggaley
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Fiona Langlands
- Castle Hill Hospital, Castle Road, Cottingham, Hull, England HU16 5JQ, UK.
| | | | - Zoe Barber
- Neville Hall Hospital, Brecon Road, Abergavenny, Wales NP7 7EG, UK.
| | | | - Ayesha Khan
- Royal Surrey County Hospital, Egerton Road, Guildford, England GU2 7XX, UK.
| | - Chiara Sirianni
- Betsi Cadwaladr University Local Health Board, Town Hall Newry Street, Holyhead, Wales LL65 1HN, UK.
| | | | - Sunita Saha
- Broomfield Hospital, Court Road, Chelmsford, England CM1 7ET, UK.
| | - Risha Arun Lane
- Darent Valley Hospital, Darenth Wood Road, Dartford, England DA2 8DA, UK.
| | - Sharat Chopra
- Abertawe Bro Morgannwg University Health Board, 1 Talbot Gateway, Port Talbot, Wales SA12 7BR, UK.
| | - Sophie Dupré
- Guy's Hospital, Great Maze Pond, London, England SE1 9RT, UK.
| | - Aidan T Manning
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Edward R St John
- Charing Cross Hospital, Fulham Palace Road, London, England W6 8RF, UK.
| | - Aya Musbahi
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Nokwanda Dlamini
- James Paget Hospital, Lowestoft Road, Great Yarmouth, England NR31 6LA, UK.
| | | | - Chloe Wright
- Bolton Breast Unit, Royal Bolton Hospital, Farnworth, Bolton, England BL4 0JR, UK.
| | - James O Murphy
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Ravi Aggarwal
- Hillingdon Hospital, Pield Heath Road, Uxbridge, England UB8 3NN, UK.
| | - Matei Dordea
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Karen Bosch
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Donna Egbeare
- Cardiff and Vale University Health Board, Heath Park, Cardiff, Wales CF14 4XW, UK.
| | - Hisham Osman
- Frimley Park Hospital, Portsmouth Road, Camberley, England GU16 7UJ, UK.
| | - Salim Tayeh
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - Faraz Razi
- North Hampshire Hospital, Aldermaston Road, Basingstoke, England RG24 9NA, UK.
| | - Javeria Iqbal
- Diana Princess of Wales Hospital, Scartho Road, Grimsby, England DN33 2BA, UK.
| | | | - Vanessa Albert
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK
| | - Yazan Masannat
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK; University of Aberdeen, Aberdeen, Scotland AB24 3FX, UK; University of East Anglia, Norwich, England NR4 7TJ, UK
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Ong SM, Hamady Z, Elsberger B. Surgical interventions for breast cancer liver metastases – Results of a UK survey. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.02.234] [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: 10/22/2022] Open
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Elsberger B, Brown D, Purdie C, Jordan L, Evans A, Macaskill EJ. Is the size of sentinel lymph node macrometastasis predictive for further positive axillary nodes on surgical clearance? Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.02.122] [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: 11/24/2022] Open
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Elsberger B. Translational evidence on the role of Src kinase and activated Src kinase in invasive breast cancer. Crit Rev Oncol Hematol 2014; 89:343-51. [DOI: 10.1016/j.critrevonc.2013.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 12/04/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022] Open
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Elsberger B, Roxburgh CS, Horgan PG. Is there a role for surgical resections of hepatic breast cancer metastases? Hepatogastroenterology 2014; 61:181-186. [PMID: 24895817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Breast cancer accounts for over 12,000 deaths in the UK annually; 12% of women develop hepatic metastases receiving systemic therapy as standard treatment. Hepatic resection has been proposed as a potentially curative alternative. Current literature was reviewed and evaluated for hepatic resection on breast cancer liver metastases by conducting a literature search across Ovid Medline, Embase and PubMed. Twenty-one studies were included in the review. All were retrospective, single centre case series. Eighteen studies reported results for ten or more patients. Only three studies reported results for over 50 patients. The time-span for the individual series ranged from 9-20 years. Generally, liver resection for breast cancer liver metastases is a safe procedure with only two post-operative deaths reported. Median time to recurrence was low (10-36 months). Overall 5-year survival ranged from 12-75%. Poorer prognosis correlated with increasing size and number of metastases, extrahepatic spread and short time span from primary surgery to the development of further metastases. Current literature does not establish clearly, who should undergo a hepatic resection for breast cancer metastasis. But it seems that hepatic resection should be considered as a therapeutic option for limited volume liver metastasis in high-risk breast cancer patients. However, prospective cohort studies are required to establish the role of hepatic resection for breast cancer metastasis.
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Elsberger B, Romsauerova A, Vinnicombe S, Whelehan P, Brown DC, Dewar JA, Thompson AM, Evans A. Comparison of mammographic findings after intraoperative radiotherapy or external beam whole breast radiotherapy. Eur J Surg Oncol 2013; 40:163-7. [PMID: 24332581 DOI: 10.1016/j.ejso.2013.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 11/14/2013] [Revised: 11/14/2013] [Accepted: 11/15/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The TARGIT (TARGeted Intraoperative Radiotherapy) trial was designed to compare local recurrence and complication rates in breast cancer patients, prospectively randomised to either EBRT (external beam whole breast radiotherapy) or a single dose of IORT (intraoperative radiotherapy). The aim of our study was to compare follow-up mammographic findings, ultrasound and biopsy rates in each group. METHODS Follow-up imaging and breast biopsies of women from one centre participating in the TARGIT-A trial were independently reviewed by two radiologists blinded to the radiotherapy treatment received. RESULTS The cohort consisted of 141 patients (EBRT n = 80/IORT n = 61). There was no significant difference in the patient or disease characteristics of the two groups. The number of follow-up mammograms and length of follow-up was similar (EBRT/IORT n = 2.0/2.4; 4.3yr/5.1yr; p = 0.386 χ(2) test). There were no significant differences in mammographic scar or calcification appearances of the post-operative site. Generalised increase in breast density and skin thickening were more common in the EBRT compared to the IORT group (p = 0.002; p = 0.030, χ(2) test respectively). A trend towards additional ultrasound at follow-up was observed in the IORT group (15 of 61 [24.6%] versus 11 of 80 [13.8%]), however this was not statistically significant (p = 0.100 χ(2) test). No disease recurrence was demonstrated on any of the breast biopsies taken. Only one biopsy was reported as fat necrosis in the IORT group. CONCLUSIONS Mammographic changes were more common following EBRT, although more additional follow-up ultrasounds were performed in the IORT group. IORT is not detrimental to subsequent radiological follow up.
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Affiliation(s)
- B Elsberger
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | - A Romsauerova
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - S Vinnicombe
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - P Whelehan
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - D C Brown
- Breast Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - J A Dewar
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - A M Thompson
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - A Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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Elsberger B, Romsauerova A, Brown D, Dewar J, Vinnicombe S, Whelehan P, Evans A. Mammographic findings and rates of ultrasound and biopsy following wide local excision for breast cancer in patients treated with intraoperative radiotherapy (IORT) versus external beam whole breast radiotherapy (EBRT). Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.01.146] [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: 11/17/2022] Open
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Elsberger B, Paravasthu D, Tovey S, Edwards J. Expression of SRC Kinase Family Members in Tamoxifen Treated ER Positive Breast Cancer and Association with Clinical Outcome. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt084.16] [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: 11/15/2022] Open
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Ohotski J, Long JS, Orange C, Elsberger B, Mallon E, Doughty J, Pyne S, Pyne NJ, Edwards J. Erratum: Expression of sphingosine 1-phosphate receptor 4 and sphingosine kinase 1 is associated with outcome in oestrogen receptor negative breast cancer. Br J Cancer 2012. [PMCID: PMC3419969 DOI: 10.1038/bjc.2012.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ohotski J, Edwards J, Elsberger B, Watson C, Orange C, Mallon E, Pyne S, Pyne NJ. Identification of novel functional and spatial associations between sphingosine kinase 1, sphingosine 1-phosphate receptors and other signaling proteins that affect prognostic outcome in estrogen receptor-positive breast cancer. Int J Cancer 2012; 132:605-16. [DOI: 10.1002/ijc.27692] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/11/2012] [Indexed: 12/14/2022]
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Elsberger B, Paravasthu DM, Tovey SM, Edwards J. Shorter disease-specific survival of ER-positive breast cancer patients with high cytoplasmic Src kinase expression after tamoxifen treatment. J Cancer Res Clin Oncol 2011; 138:327-32. [PMID: 22134837 DOI: 10.1007/s00432-011-1096-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 11/07/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Src kinase, a non-receptor tyrosine kinase, is overexpressed and highly activated in a number of human cancers and appears to show a significant relationship with breast cancer progression. Recent in vitro studies have suggested that Src kinase may be involved in tamoxifen resistance. METHODS Immunohistochemistry was performed on 392 resected breast cancers using an antibody to c-Src. Expression was assessed using the weighted histoscore method. RESULTS Forty-five percentage of breast tumours exhibited nuclear, 46% cytoplasmic and 7% membrane expression. Lymph node positivity correlated with cytoplasmic c-Src tumour expression levels (P < 0.001). Nuclear c-Src correlated negatively with cytoplasmic and membrane c-Src expression (P < 0.001, P = 0.005). High expression levels of cytoplasmic c-Src was associated with worse disease-specific survival (P = 0.026) after completing 5 years of tamoxifen therapy. However, high expression of c-Src at any cellular location did not show any association with de novo relapse on tamoxifen (c-Src nuc P = 0.906, c-Src cyto P = 0.735 and c-Src memb P = 0.791). CONCLUSIONS No translational evidence was found in this study to support a role for Src kinase in developing de novo tamoxifen resistance. However, based on our findings on late clinical outcome, patients with high cytoplasmic c-Src may be selected for continuing endocrine therapy to prevent worsening prognosis.
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Affiliation(s)
- B Elsberger
- Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Western Infirmary, McGregor Building, Dumbarton Road, Glasgow, G11 6NT, UK
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Elsberger B, Lankston L, Orange C, Underwood MA, Edwards J. Expression of hypoxia inducible factor-1 alpha in matched hormone naive and castrate resistant prostate cancer specimens. Cancer Biomark 2011; 8:1-9. [DOI: 10.3233/dma-2011-0805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Beatrix Elsberger
- Western Infirmary, Department of Pathology, McGregor Building, Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Dumbarton Road, Glasgow, UK
| | - Louise Lankston
- Western Infirmary, Department of Pathology, McGregor Building, Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Dumbarton Road, Glasgow, UK
| | - Clare Orange
- Western Infirmary, Department of Pathology, McGregor Building, Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Dumbarton Road, Glasgow, UK
| | | | - Joanne Edwards
- Western Infirmary, Department of Pathology, McGregor Building, Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Dumbarton Road, Glasgow, UK
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Elsberger B, Stewart B, Tatarov O, Edwards J. Is Src a viable target for treating solid tumours? Curr Cancer Drug Targets 2011; 10:683-94. [PMID: 20578988 DOI: 10.2174/156800910793605802] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/03/2010] [Indexed: 11/22/2022]
Abstract
Src was the first proto-oncogene to be discovered. Since then the role of Src has been extensively studied in vitro. Src is a key regulator of multiple signal transduction pathways and plays a significant part in cellular transformation. Dysfunction of Src, through overexpression or increased activation, has profound effects on basic cellular functions. Elevated Src expression and/or activation is evident across a wide range of solid tumour types, highlighting its place in carcinogenesis and making it an attractive therapeutic target. In this review, we discuss in vitro and in vivo data examining the role of Src in the different cellular processes involved in oncogenesis and metastasis, covering the association of Src with increased cell proliferation and survival, decreased cellular adhesion, increased cell motility and invasiveness, accelerated/advanced angiogenesis and pathogenic bone activity. We also review evidence gathered from human tumour tissue and translational research studies that further substantiates the role of Src in oncogenesis. A summary of Src inhibitors currently being developed and trialled as therapeutic agents is provided to underline Src as a potential molecular target for solid tumour therapy. Further clinical data are needed to conclusively demonstrate that Src inhibitors have clinical utility in the treatment of solid tumors.
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Affiliation(s)
- B Elsberger
- Glasgow Western Infirmary, Section of Surgery, Division of Cancer Sciences and Molecular Pathology, Faculty of Medicine, Level 2, McGregor Building, Dumbarton Road, Glasgow G11 0NT, Scotland, UK
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Elsberger B, Lankston L, McMillan DC, Underwood MA, Edwards J. Presence of tumoural C-reactive protein correlates with progressive prostate cancer. Prostate Cancer Prostatic Dis 2011; 14:122-8. [PMID: 21358753 DOI: 10.1038/pcan.2011.5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
C-reactive protein (CRP) is an acute phase protein implicated in the progression of cancer. A positive correlation between tumour stage and plasma CRP levels was demonstrated in prostate cancer, indicating a relationship between raised CRP levels and more aggressive disease, suggesting a role for inflammatory response in tumour progression. Aim of this study was to assess the tumoural presence and cellular location of CRP and establish if these are linked to clinicopathological features of the cohort and patient survival. Tissue microarray technology was employed to analyse 50 matched pairs of hormone sensitive and refractory prostate cancers. Immunohistochemistry was performed using antibody to CRP. CRP was assessed using the weighted histoscore method. CRP presence was observed in the cytoplasm and nucleus of selected tumours. Cytoplasmic CRP correlated positively with metastases at diagnosis (P=0.039), whereas nuclear CRP presence correlated with metastases at relapse (P=0.006). A trend towards an increase in cytoplasmic and nuclear CRP presence from hormone sensitive to hormone refractory tumours was noticed. No significant association between tumoural CRP presence, time to biochemical relapse or disease-specific survival was observed. Tumoural CRP is likely to have a role in progression of prostate cancer, as it is associated with increased presence of metastases at the time of diagnosis and time of relapse. A larger powered study is necessary to establish if CRP presence is associated with disease-specific survival.
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Affiliation(s)
- B Elsberger
- Department of Pathology, Western Infirmary, McGregor Building, Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Elsberger B, Tan BA, Brown SF, Mallon EA, Edwards J. Abstract P6-08-10: Disease Specific Survival of Breast Cancer Patients Is Not Associated with Expression of Inactive or Even Partially Activated Src Kinase. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-08-10] [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: c-Src is implicated as a regulator of cell proliferation and survival (1). Recent work has demonstrated that c-Src and fully activated Y419Src expression in breast cancer specimens was associated with poor clinical outcome of breast cancer patients (2). c-Src is activated by a number of pathways. Known as the classical activation pathway, dephosphorylation of Y530 is needed to initiate a configuration change of the protein allowing full activation by autophosphorylation of tyrosine site 419. Phosphorylation of the tyrosine residual 530 on the c-terminal tail by Csk tyrosine kinase acts as a negative regulatory protein binding site, keeping Src kinase in a closed confirmation (3).
The aim of this translational study was to assess associations between inactivate and partially activated Src expression to clinic-pathological features of the cohort and if different stages of c-Src activation equally influences breast cancer patients’ disease specific survival. Methods: Tissue microarray technology was used to analyse tissue taken from 165 breast cancer patients taken at time of surgical resection. Immunohistochemistry was performed using anti-Clone 28 and Clone 28 antibody. To investigate those different stages of Src kinase activation, Clone 28 antibody was employed to recognise the semi-active form of Src. To evaluate protein expression of inactive Src kinase, anti-Src family negative regulatory [pY] site (anti-Clone 28= AC28) antibody was utilised for detecting phosphorylated tyrosine site 530. Expression was assessed using the weighted histoscore method by two independent scorers. Results: Using those antibodies, 50% of AC28 and Clone28 expression was observed in the nucleus and 44% AC28 and 46% Clone28 expression in the cytoplasm. Only 3.6% of AC28 was detected in the membrane, compared to Clone28 with 53% in the membrane and 55 % perinuclear. Nuclear expression of AC28 correlated negatively with ER status (chi square P<0.001), whereas cytoplasmic AC28 and Clone28 correlated negatively with membrane c-Src expression (chi square p=0.008, chi square P<0.001). On univariate and multivariate analysis there was no significant association noticed between AC28 and Clone28 expression and disease specific survival at any cellular location.
Conclusions: ER negative breast cancers patients were more likely to express inactive Src in the nucleus. Breast cancer patients with higher cytoplasmic expression of inactive or partially activated Src were more likely not to express c-Src at the membrane (site of activation). Inactive and partially activated Src are not associated with patients’ survival. References:
1) Frame MC. Biochim Biophys Acta 2002; 1602: 114-130.
2) Elsberger B, et. al: Am J Path (2009);175(4):1389-97.
3) Roskoski R Jr. Biochem Biophys Res Commun. 2005 May 27;331(1):1- 14.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-08-10.
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Affiliation(s)
- B Elsberger
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - BA Tan
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - SF Brown
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - EA Mallon
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - J. Edwards
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
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Elsberger B, Tannahill C, Orange C, Mallon EA, Wilson C, Doughty JC, Edwards J. Abstract P6-08-06: C-Reactive Protein Expression and Its Association with Disease Specific Survival and Disease Recurrence in ER Negative Breast Cancer Patients. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-08-06] [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: The systemic inflammatory response, as evidenced by elevated serum C-reactive protein (CRP) has been reported to be predictive of poor survival, independent of tumour stage, in a variety of solid tumours (1). Previous studies suggest that systemic elevated serum CRP did not predict relapse-free, cancer-specific (DSS) nor overall survival (2). Aim of this study was to examine the relationship between expression of CRP within ER negative breast cancers and patients’ clinical outcome. Methods: Tissue microarray technology was employed to analyse tissue taken from 171 ER negative breast cancer patients at time of surgery. Immunohistochemistry was performed using an antibody to CRP. Expression was assessed using the weighted histoscore method by two independent scorers.
Results: Cohort's median age was 56 years and tumour size was 20mm, 22% were pathologically graded G2 and 74% G3 and 46% were lymph node positive. 60% underwent a mastectomy, 56% received radiotherapy and 67% chemotherapy. 33% had recurrence after a median time of 5.6 years. 47/171 patient were deceased at time of analysis. There was a definitive trend noticed between high nuclear and cytoplasmic CRP expression and DSS (p=0.078 and p=0.173, figure 1a and 1b) and recurrence (p=0.133, p=0.253, figure 2a and 2b). There was a significant association seen with high CRP expression in the surrounding tumoural stroma and DSS (p=0.007) as well as recurrence (p=0.016). Conclusion: Due to small patient numbers only trends indicating that high CRP expression within and surrounding the tumour play an important role in ER negative patients regards poorer survival and earlier recurrence. We are currently expanding our cohort further. References:
(1) Roxburgh CSD (2009). Future Oncol. 2010 Jan;6(1):149-63
(2) Al Murri AM (2007) British Journal of Cancer, 96, 891-895 Figure available in online version.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-08-06.
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Affiliation(s)
- B Elsberger
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - C Tannahill
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - C Orange
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - EA Mallon
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - C Wilson
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - JC Doughty
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
| | - J. Edwards
- University of Glasgow, Scotland, United Kingdom; NHS Greater Glasgow, Scotland, United Kingdom
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Edwards J, Tannahill C, Obondo C, Elsberger B, Mallon E, Wilson C, Doughty J. O-14 Expression and activation of Akt and NFkB in breast cancer patients. EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.015] [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: 11/28/2022] Open
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Elsberger B, Stewart B, Tatarov O, Edwards J. Is Src a Viable Target for Treating Solid Tumours? Curr Cancer Drug Targets 2010. [DOI: 10.2174/1568210205789880096] [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: 11/22/2022]
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Elsberger B, Zino S, Jordan F, Fullerton R, Mitchell T, Shiels P, Edwards J. Src Kinase Family Members Expression in Human Breast Tissue and Their Association to Clinical Outcome of Breast Cancer Patients. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-6130] [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: There is a paucity in the literature about expression levels of Src kinase family members (SKFMs) in human breast tissue. The aim of this study was to assess m-RNA SKFM expression levels in human breast specimens and to assess protein expression of the most significant SKFMs in invasive breast cancer to establish their association to clinical outcome.Material and Methods: m-RNA expression of eight SKFMs (Src, Lck, Lyn, Fgr, Fyn, Hck, Blk, Yes) was assessed by quantitative real time PCR. IHC was performed using antibodies to c-Src, Y419Src, Lck and Lyn. Expression was assessed using the weighted histoscore method.Results: Cohort one consisted of 52 invasive breast cancers (M), 36 non-malignant (NM) and 10 normal (N) breast tissue samples. Median age of the patients was 60 years. Median size of breast cancer was 25mm (IQR 20-40mm). ER status was not significantly different between tissue types (p=0.50). Every SKFM expression was quantified in all tissue samples. Fyn was the most expressed SKFM in normal tissue and Lyn in the NM breast tissue. Blk was the least expressed SKFM in all breast tissues. In malignant breast tissue Src and Lyn were most expressed. Higher expression levels of Lck were observed in invasive breast cancers compared to NM and N (p=<0.001). SKFMs Lck and Lyn were higher expressed in ER negative compared to ER positive tumours. c-Src (p=0.01) and Fyn (p=0.03) were expressed at higher levels in lobular compared to ductal carcinomas. There were no correlations observed between c-Src and SKFMs in N breast tissue. However in NM and M tissue, all seven SKFMs correlated with c-Src expression; strongest correlation observed was with Lyn (p<0.001, c.c 0.805) and least with Yes (p=0.003, c.c.=0.489). No association was noticed between SKFM expression, tumour grade, size and LN positivity.Cohort two consisted of 320 patients with median follow-up of 6.3 years. Median age was 58 years (IQR 24-90). Median tumour size was 20mm (IQR 15-30mm). In both cohorts majority of the cancer specimens were pathologically graded as G2 and G3. 49% of the patients were axillary lymph node positive. High cytoplasmic Src and membrane Y419Src kinase expression levels were significantly associated with decreased disease specific survival (p=0.028, p=0.023). Lyn was not associated with survival at any cellular location. High membrane Lck expression was significantly associated with improved survival (p=0.039).Patient Cohort 2 Patient NumbersP valueAge<50 yrs810.351 >50 yrs239 Tumour typeDuctal2980.714 Lobular18 Others6 Grade1220.014 2152 3146 Size<20mm126<0.001 20-50mm173 >50mm21 ER statusPositive212<0.001 Negative108 PR statusPositive1520.006 Negative168 HER2 statusPositive550.010 Negative265 c-Src cytoplasmPositive1410.023 Negative179 Y419Src membranePositive1540.028 Negative166 Lck membranePositive140.039 Negative266 Discussion: All eight SKFMs are expressed in different breast tissues. In invasive breast cancer Src kinase is highest expressed and seems to have a negative impact on disease specific survival. Whereas, high membrane expression of Lck provides better clinical outcome in those breast cancer patients. Further investigations are required to determine underlying mechanisms for this observation.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6130.
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Affiliation(s)
- B. Elsberger
- 1University of Glasgow, Strathclyde, United Kingdom
| | - S. Zino
- 1University of Glasgow, Strathclyde, United Kingdom
| | - F. Jordan
- 2Division of Developmental Medicine, Strathclyde, United Kingdom
| | - R. Fullerton
- 1University of Glasgow, Strathclyde, United Kingdom
| | - T. Mitchell
- 1University of Glasgow, Strathclyde, United Kingdom
| | - P. Shiels
- 1University of Glasgow, Strathclyde, United Kingdom
| | - J. Edwards
- 1University of Glasgow, Strathclyde, United Kingdom
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Elsberger B, Tan BA, Mitchell TJ, Brown SBF, Mallon EA, Tovey SM, Cooke TG, Brunton VG, Edwards J. Is expression or activation of Src kinase associated with cancer-specific survival in ER-, PR- and HER2-negative breast cancer patients? Am J Pathol 2009; 175:1389-97. [PMID: 19762712 DOI: 10.2353/ajpath.2009.090273] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to assess the expression levels of c-Src and phosphorylated Src kinase in human breast cancers and to establish if these are linked to oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status or patient survival. Tissue microarray technology was used to analyze 314 breast cancer specimens. Immunohistochemistry was performed using antibodies to c-Src, Y419Src, and Y215Src, and expression was assessed using the weighted histoscore method. High cytoplasmic c-Src kinase and high membrane phosphorylated activated Y419Src kinase was associated with decreased disease-specific survival. In contrast, phosphorylated activated nuclear and cytoplasmic Y215Src kinase expression levels were significantly associated with improved disease-specific survival. When the cohort was subdivided according to ER/PR/HER2 status, the ER-negative subgroup (105 patients) was associated with improved disease-specific survival and was found to be independent by multivariate analysis with a hazard ratio of 0.4 (interquartile range 0.2-0.8). High cytoplasmic c-Src expression was associated with decreased survival; high expression of activated c-Src (Y215) was associated with improved survival. This was potentiated in the ER/HER2-negative subgroup. Hence, administration of Src kinase inhibitors aiming to decrease phosphorylation should be approached with caution, especially in ER-negative patients. It is therefore essential to appropriately identify with the correct biomarkers which patients are most likely to respond to Src inhibitors.
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Affiliation(s)
- Beatrix Elsberger
- Section of Surgery, Division of Cancer Sciences and Molecular Pathology, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
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Elsberger B, Zino S, Fullerton R, Mitchell T, Shiels P, Edwards J. 1023 Are expression levels of Src kinase family members in human breast tissue related to clinical outcome of breast cancer patients? EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70316-7] [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: 10/20/2022] Open
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