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Azim HA, Loutfy SA, Azim HA, Kamal NS, Abdel Fattah NF, Elberry MH, Abdelaziz MR, Abdelsalam M, Aziz M, Shohdy KS, Kassem L. The Landscape of BRCA Mutations among Egyptian Women with Breast Cancer. Oncol Ther 2023; 11:445-459. [PMID: 37731153 PMCID: PMC10673778 DOI: 10.1007/s40487-023-00240-9] [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: 02/01/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Deleterious germline mutations in BRCA1 and BRCA2 genes are associated with a high risk of breast and ovarian cancer. In many developing countries, including Egypt, the prevalence of BRCA1/2 mutations among women with breast cancer (BC) is unknown. AIM We aimed to determine the prevalence of deleterious germline BRCA mutations in Egyptian patients with breast cancer. METHODS We report the results of a cohort study of 81 Egyptian patients with breast cancer who were tested for germline BRCA1/2 mutations during routine clinical practice, mostly for their young age of presentation, BC subtype, or presence of family history. In addition, we searched five databases to retrieve studies that reported the prevalence of BRCA1/2 mutation status in Egyptian women with BC. A systematic review of the literature was performed, including prospective and retrospective studies. RESULTS In our patient cohort study, 12 patients (14.8%) were positive for either BRCA1/2 deleterious mutations. Moreover, 13 (16.1%) patients had a variant of unknown significance (VUS) of BRCA1/2 genes. Twelve studies were eligible for the systematic review, including 610 patients. A total of 19 deleterious germline mutations in BRCA1/2 were identified. The pooled prevalence of BRCA1/2 mutations was 40% (95% confidence interval 1-80%). CONCLUSION The reported prevalence was highly variable among the small-sized published studies that adopted adequate techniques. In our patient cohort, there was a high incidence of VUS in BRCA1/2 genes. Accordingly, there is an actual demand to conduct a prospective well-designed national study to accurately estimate the prevalence of BRCA1/2 mutations among patients with BC in Egypt.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt
| | - Samah A Loutfy
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
- Nanotechnology Research Center, BUE, Cairo, Egypt
| | - Hatem A Azim
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt
| | - Nermin S Kamal
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt
| | - Nasra F Abdel Fattah
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa H Elberry
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | - Madonna Aziz
- Clinical Research Unit, Cairo Oncology Center, Cairo, Egypt
| | - Kyrillus S Shohdy
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt.
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Arecco L, Blondeaux E, Bruzzone M, Latocca MM, Mariamidze E, Begijanashvili S, Sokolovic E, Gentile G, Scavone G, Ottonello S, Boutros A, Vaz-Luis I, Saura C, Anderson RA, Demeestere I, Azim HA, de Azambuja E, Peccatori FA, Del Mastro L, Partridge AH, Lambertini M. Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis. ESMO Open 2023; 8:102031. [PMID: 37879234 PMCID: PMC10774870 DOI: 10.1016/j.esmoop.2023.102031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer. MATERIALS AND METHODS A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232). RESULTS Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n = 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P = 0.781). In the six studies (n = 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05). CONCLUSIONS This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.
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Affiliation(s)
- L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova. https://twitter.com/Lucarecco
| | - E Blondeaux
- U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Bruzzone
- U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M M Latocca
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital, Tbilisi, Georgia
| | - E Sokolovic
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - G Gentile
- Medical Oncology Unit B, Department of Radiology, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome
| | - G Scavone
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - S Ottonello
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - A Boutros
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Vaz-Luis
- Unit 981-Molecular Predictors and New Targets in Oncology, Interdisciplinary Department for the Organization of Patient Pathways (DIOPP), INSERM and Institut Gustave Roussy, Paris, France
| | - C Saura
- Breast Cancer Unit, Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - R A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - I Demeestere
- Research Laboratory on Human Reproduction, Fertility Clinic (HUB-Erasme), Brussels, Belgium
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - E de Azambuja
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - F A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova.
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3
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Aboelhassan R, Sobeih ME, El-Din MA, Ghali RR, El-Din IS, Khorshid O, Mokhtar M, Rabea AM, Belal A, Azim HA, Abdullah M, Elnahas T, Tawfik H, Abdelwahab S, Elsaid AA, Hashem T, Mancy M, Farag H. Real-world treatment patterns and clinical outcomes in patients with stage III non-small cell lung cancer: results of KINDLE-Egypt cohort. Ther Adv Med Oncol 2023; 15:17588359231212182. [PMID: 38028146 PMCID: PMC10666716 DOI: 10.1177/17588359231212182] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Stage III non-small cell lung cancer (NSCLC) being highly heterogeneous requires multimodal therapeutic strategies for optimal management. We present findings on treatment patterns and their associated survival outcomes in patients with stage III NSCLC from the Egypt subset of the KINDLE global real-world study conducted across countries from Asia, Middle East, Africa, and Latin America. Method Retrospective data from the Egypt subset (21 centers) of adult patients diagnosed with stage III NSCLC between January 2013 and December 2017 were analyzed. Descriptive and inferential statistics summarized treatment modalities, progression-free survival (PFS), and overall survival (OS). Results Of 421 patients enrolled (median age: 59.0 years), 77.9% were males, 53.5% had stage IIIA disease, 60.8% had adenocarcinoma, 78.4% had an unresectable disease, and 81.5% had Eastern Cooperative Oncology Group performance status ⩽1. Overall, chemotherapy alone (40.4%) was predominantly used in the initial line, whereas definite radiotherapy was used in only 5.0% of patients. In resectable patients, chemotherapy plus surgery (33.8%), surgery alone (20.6%), or other surgery (20.6%) were the top three modalities used in initial line of treatment. Chemotherapy alone was most preferred (48.8%) in unresectable patients, followed by sequential chemoradiotherapy (CRT) (17.6%) and concurrent CRT (9.3%). The overall median PFS was 10.3 months [95% confidence interval (CI), 9.43-12.02], whereas the median OS was 18.5 months (95% CI, 16.46-21.88). Overall, female gender, adenocarcinoma histology, and radical therapy as surgery or CRT predicted significantly longer OS (all p < 0.05). Conclusion KINDLE-Egypt cohort revealed wide heterogeneities in the treatment patterns of stage III NSCLC. Although deemed resectable, few patients did not undergo surgery, probably due to high smoking rates leading to poor lung function. Lower survival outcomes than other published real-world studies highlight the need for timely approval and availability of novel targeted and immunotherapies to enhance patient outcomes. Trial registration NCT03725475.
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Affiliation(s)
| | | | | | | | | | - Ola Khorshid
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | | | | | | | | | | | | | | | - Tarek Hashem
- Menofia University, Shebin EL-koum, Cairo, Egypt
- Armed Forces College of Medicine, Heliopolis, Cairo, Egypt
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Loibl S, Azim HA, Bachelot T, Berveiller P, Bosch A, Cardonick E, Denkert C, Halaska MJ, Hoeltzenbein M, Johansson ALV, Maggen C, Markert UR, Peccatori F, Poortmans P, Saloustros E, Saura C, Schmid P, Stamatakis E, van den Heuvel-Eibrink M, van Gerwen M, Vandecaveye V, Pentheroudakis G, Curigliano G, Amant F. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023; 34:849-866. [PMID: 37572987 DOI: 10.1016/j.annonc.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
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Affiliation(s)
- S Loibl
- GBG c/o GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Frankfurt; Goethe University Frankfurt, Frankfurt am Main, Frankfurt, Germany.
| | - H A Azim
- Breast Cancer Center, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - T Bachelot
- Department of medical oncology, Centre Léon Bérard, Lyon, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy; UMR 1198 - BREED, INRAE, Paris Saclay University, RHuMA, Montigny-Le-Bretonneux, France
| | - A Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - E Cardonick
- Cooper Medical School at Rowan University, Camden, USA
| | - C Denkert
- Philipps-University Marburg and Marburg University Hospital (UKGM), Marburg, Germany
| | - M J Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University in Prague and Universital Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - M Hoeltzenbein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway
| | - C Maggen
- Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - U R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Iridium Netwerk, Antwerp; University of Antwerp, Antwerp, Belgium
| | - E Saloustros
- Department of Oncology, University General Hospital of Larissa, Larissa, Greece
| | - C Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Cancer Institute, Queen Mary University London, London, UK
| | - E Stamatakis
- Department of Anesthesiology, 'Alexandra' General Hospital, Athens, Greece
| | | | - M van Gerwen
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Amant
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Division Gynaecologic Oncology, UZ Leuven, Belgium
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Azim HA, Elghazawy H, Ghazy RM, Abdelaziz AH, Abdelsalam M, Elzorkany A, Kassem L. Clinicopathologic Features of Breast Cancer in Egypt-Contemporary Profile and Future Needs: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2023; 9:e2200387. [PMID: 36888929 PMCID: PMC10497263 DOI: 10.1200/go.22.00387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/11/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE Breast cancer (BC) is the most common cancer among Egyptian females. No current national cancer database is available in Egypt to provide reliable data on the specific clinicopathologic features of BC in this population. Herein, we investigated the clinical profile of BC among Egyptian women. METHODS A systematic review of studies on BC published from inception until December 2021 was performed. We explored pooled estimated proportions of different stages of BC at presentation in Egypt and other clinicopathologic features including age, menopausal status, tumor (T) and lymph node (N) stages, and biological subtypes. Data analysis was performed using meta package (R). RESULTS Twenty-six studies were eligible for our systematic review and meta-analysis, including 31,172 BC cases. In 12 studies, including 15,067 patients with BC, the estimated mean age was 50.46 years (95% CI, 48.7 to 52.1; I2, 99%), with a pooled proportion of premenopausal/perimenopausal women of 57% (95% CI, 50 to 63; I2, 98%). Among 9,738 patients with BC, pooled proportions of stage I, II, III, and IV were 6% (95% CI, 4 to 8; I2, 90%), 37% (95% CI, 31 to 43; I2, 93%), 45% (95% CI, 42 to 49; I2, 78%), and 11% (95% CI, 9 to 15; I2, 87%), respectively. The pooled proportions of patients with T3 and T4 tumors were 21% (95% CI, 14 to 31; I2, 99%) and 8% (95% CI, 5 to 12; I2, 96%), respectively, while those with positive lymph nodes were 70% (95% CI, 59 to 79; I2, 99%). CONCLUSION Dominance of advanced stage and young age at diagnosis represented the two main features of BC among Egyptian women. Our data may serve to guide the policymakers in Egypt as well as other countries with lower resources to prioritize the diagnostic and therapeutic needs in this context.
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Affiliation(s)
- Hamdy A. Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
- Cairo Oncology Center, Cairo, Egypt
| | - Hagar Elghazawy
- Cairo Oncology Center, Cairo, Egypt
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Ramy M. Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | | | - Amira Elzorkany
- Training and Biostatistics Administration, Ministry of Health and Population, Alexandria, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
- Cairo Oncology Center, Cairo, Egypt
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Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Gentilini O, Harbeck N, Kaufman B, Kim SB, Liu Q, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Sirohi B, Spanic T, Sulosaari V, Peccatori F, Pagani O. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5). Ann Oncol 2022; 33:1097-1118. [PMID: 35934170 DOI: 10.1016/j.annonc.2022.07.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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: 03/03/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 12/31/2022] Open
Abstract
We dedicate this manuscript in memory of a dear friend and colleague Bella Kaufman. The fifth International Consensus Symposium for Breast Cancer in Young Women (BCY5) took place virtually in October 2020, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY4 with incorporation of new evidence to inform the guidelines. Areas of research priorities as well as specificities in different geographic and minority populations were identified. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Affiliation(s)
- S Paluch-Shimon
- Hadassah University Hospital & Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | | | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - M J Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | | | - N Harbeck
- Breast Center, Department of OB&GYN and CCCMunich, LMU University Hospital, Munich, Germany
| | - B Kaufman
- Sheba Medical Center, Ramat Gan, Israel
| | - S B Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Q Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - P Poortmans
- Iridium Netwerk, Department of Radiation Oncology & University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - B Sirohi
- Max Institute of Cancer Care, New Delhi and Gurgaon, India
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Sulosaari
- European Oncology Nursing Society (EONS) and Turku University of Applied Sciences, Turku, Finland
| | - F Peccatori
- European Institute of Oncology IRCCS, Milan; European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Vaud, Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Lugano, Switzerland
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Azim HA, Shohdy KS, Elghazawy H, Salib MM, Almeldin D, Kassem L. Programmed death-ligand 1 (PD-L1) expression predicts response to neoadjuvant chemotherapy in triple-negative breast cancer: A systematic review and meta-analysis. Biomarkers 2022; 27:764-772. [PMID: 35980714 DOI: 10.1080/1354750x.2022.2112614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Background: In patients with metastatic triple-negative breast cancer (TNBC), PD-L1 expression has been demonstrated to predict response to immunotherapy. It is unclear whether PD-L1 expression measured with currently available validated assays can predict chemotherapy response in patients with non-metastatic TNBC.Methods: We conducted a systematic review and meta-analysis of clinical studies to assess the PD-L1 expression as a predictor of response to chemotherapy in non-metastatic TNBC using validated assays. The primary endpoint was pathological complete response (pCR) rate to neoadjuvant chemotherapy. Secondary endpoints included the prevalence of PD-L1 expression in non-metastatic TNBC and its impact on disease-free survival (DFS) and overall survival (OS). Moreover, RNA sequence data from the TCGA breast cancer cohort was used to define the relationship between PDCD1 and response to chemotherapy and prognosis.Results: Nineteen studies were eligible for the meta-analysis with a total of 2403 patients with non-metastatic TNBC disease. The PD-L1-positive cohort had a significantly higher likelihood of achieving pCR with neoadjuvant chemotherapy (pooled odds ratio =1.95; 95% CI= 1.39-2.73, p <0.0001). In studies which reported long-term outcomes, PD-L1 positivity was associated with significantly better DFS and OS compared to PD-L1 negative patients (pooled hazard ratio= 0.51; 95% CI= 0.35-0.74, p< 0.0001 and 0.51; 95% CI= 0.27-0.94, p = 0.031, respectively). Transcriptomic data suggested that PD-L1 expression is a surrogate marker for the upregulation of key immune-related genes that mediate response to chemotherapy in TNBC.Conclusion: This analysis clearly shows that patients with PD-L1 positive TNBC respond better to neoadjuvant chemotherapy and are associated with better survival outcomes compared to patients with PD-L1 negative tumors. The newly distinct quadruple negative breast cancer (QNBC) subtype should be defined as the BC subtype with the poorest outcome in the non-metastatic setting, highlighting the need for more aggressive therapy approaches.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Cairo University, Cairo, Egypt
| | - Kyrillus S Shohdy
- Clinical Oncology Department, Cairo University, Cairo, Egypt.,Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Hagar Elghazawy
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Monica M Salib
- Clinical Oncology Department, Cairo University, Cairo, Egypt
| | - Doaa Almeldin
- Clinical Oncology Department, Cairo University, Cairo, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Cairo University, Cairo, Egypt
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Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Di Meglio A, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Graffeo R, Dieci MV, Pérez-Fidalgo JA, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Safety of assisted reproductive techniques in young women harboring germline pathogenic variants in BRCA1/2 with a pregnancy after prior history of breast cancer. ESMO Open 2021; 6:100300. [PMID: 34775302 PMCID: PMC8593447 DOI: 10.1016/j.esmoop.2021.100300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knowledge is growing on the safety of assisted reproductive techniques (ART) in cancer survivors. No data exist, however, for the specific population of breast cancer patients harboring germline BRCA1/2 pathogenic variants. PATIENTS AND METHODS This is a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤40 years with stage I-III breast cancer, between January 2000 and December 2012, harboring known germline BRCA1/2 pathogenic variants. Patients included in this analysis had a post-treatment pregnancy either achieved through use of ART (ART group) or naturally (non-ART group). ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection, and embryo transfer under hormonal replacement therapy. RESULTS Among the 1424 patients registered in the study, 168 were eligible for inclusion in the present analysis, of whom 22 were in the ART group and 146 in the non-ART group. Survivors in the ART group conceived at an older age compared with those in the non-ART group (median age: 39.7 versus 35.4 years, respectively). Women in the ART group experienced more delivery complications compared with those in the non-ART group (22.1% versus 4.1%, respectively). No other apparent differences in obstetrical outcomes were observed between cohorts. The median follow-up from pregnancy was 3.4 years (range: 0.8-8.6 years) in the ART group and 5.0 years (range: 0.8-17.6 years) in the non-ART group. Two patients (9.1%) in the ART group experienced a disease-free survival event (specifically, a locoregional recurrence) compared with 40 patients (27.4%) in the non-ART group. In the ART group, no patients deceased compared with 10 patients (6.9%) in the non-ART group. CONCLUSION This study provides encouraging safety data on the use of ART in breast cancer survivors harboring germline pathogenic variants in BRCA1/2, when natural conception fails or when they opt for ART in order to carry out preimplantation genetic testing.
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Affiliation(s)
- M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - A Grinshpun
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A S Hamy
- Department of Medical Oncology, Institut Curie, Paris, France
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - S Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - P D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - C Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - C Senechal
- Cancer Genetics Unit, Bergonie Institute, Bordeaux, France
| | - L Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Siena, Siena, Italy
| | - R Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - L De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - K Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - C Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - O Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - L Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - F Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - R Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - F P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - F Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - E Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - T Peretz-Yablonski
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - O Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Saule
- Department of Genetics, Institut Curie, Paris, France
| | - L Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - J Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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De Laurentiis M, Borstnar S, Campone M, Warner E, Bofill JS, Jacot W, Dent S, Martin M, Ring A, Cottu P, Lu J, Ciruelos E, Azim HA, Chatterjee S, Zhou K, Wu J, Menon-Singh L, Zamagni C. Correction to: Full population results from the core phase of CompLEEment-1, a phase 3b study of ribociclib plus letrozole as first-line therapy for advanced breast cancer in an expanded population. Breast Cancer Res Treat 2021; 191:223-224. [PMID: 34625861 PMCID: PMC8758655 DOI: 10.1007/s10549-021-06374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Michelino De Laurentiis
- Division of Breast Medical Oncology, Department of Breast and Thoracic Oncology Director, Istituto Nazionale Tumori IRCCS "Fondazione Pascale", Napoli, Italy.
| | | | | | - Ellen Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Susan Dent
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Miguel Martin
- Gregorio Marañón General University Hospital, GEICAM, Universidad Complutense, CIBERONC, Madrid, Spain
| | - Alistair Ring
- Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | | | - Janice Lu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eva Ciruelos
- University Hospital 12 de Octubre, Clara Campal Comprehensive Cancer Center (HM CIOCC), Madrid, Spain
| | - Hamdy A Azim
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Katie Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Claudio Zamagni
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italia
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10
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De Laurentiis M, Borstnar S, Campone M, Warner E, Bofill JS, Jacot W, Dent S, Martin M, Ring A, Cottu P, Lu J, Ciruelos E, Azim HA, Chatterjee S, Zhou K, Wu J, Menon-Singh L, Zamagni C. Full population results from the core phase of CompLEEment-1, a phase 3b study of ribociclib plus letrozole as first-line therapy for advanced breast cancer in an expanded population. Breast Cancer Res Treat 2021; 189:689-699. [PMID: 34414532 PMCID: PMC8505291 DOI: 10.1007/s10549-021-06334-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE CompLEEment-1 is a phase 3b trial in an expanded patient population with hormone receptor-positive (HR +), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancer (ABC), the largest current trial of cyclin-dependent kinase 4 and 6 inhibitors in ABC. METHODS Patients treated with ≤ 1 line of prior chemotherapy and no prior endocrine therapy for ABC received ribociclib 600 mg/day (3-weeks-on/1-week-off) plus letrozole 2.5 mg/day and additionally monthly goserelin/leuprolide in men and pre-/perimenopausal women. Eligibility criteria allowed inclusion of patients with stable CNS metastases and an Eastern Cooperative Oncology Group performance status of 2. Primary objectives were safety and tolerability, and secondary objectives were efficacy and quality of life (QoL). RESULTS Overall, 3,246 patients were evaluated (median follow-up 25.4 months). Rates of all-grade and grade ≥ 3 treatment-related adverse events (AEs) were 95.2% and 67.5%, respectively. Treatment-related discontinuations due to all grade and grade ≥ 3 AEs occurred in 12.9% and 7.3% of patients, respectively. Rates of all-grade AEs of special interest (AESI) were as follows: neutropenia (74.5%), increased alanine aminotransferase (16.2%), increased aspartate aminotransferase (14.1%), and QTcF prolongation (6.7%); corresponding values for grade ≥ 3 AESI were 57.2%, 7.7%, 5.7%, and 1.0%, respectively. Median time to progression was 27.1 months (95% confidence interval, 25.7 to not reached). Patient QoL was maintained during treatment. CONCLUSION Safety and efficacy data in this expanded population were consistent with the MONALEESA-2 and MONALEESA-7 trials and support the use of ribociclib plus letrozole in the first-line setting for patients with HR + , HER2- ABC. TRIAL REGISTRATION linicalTrials.gov NCT02941926.
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Affiliation(s)
- Michelino De Laurentiis
- Division of Breast Medical Oncology, Department of Breast and Thoracic Oncology Director, Istituto Nazionale Tumori IRCCS "Fondazione Pascale", Napoli, Italy.
| | | | | | - Ellen Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Susan Dent
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Miguel Martin
- Gregorio Marañón General University Hospital, GEICAM, Universidad Complutense, CIBERONC, Madrid, Spain
| | - Alistair Ring
- Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | | | - Janice Lu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eva Ciruelos
- University Hospital 12 de Octubre, Clara Campal Comprehensive Cancer Center (HM CIOCC), Madrid, Spain
| | - Hamdy A Azim
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Katie Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Claudio Zamagni
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italia
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11
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Elghazaly H, Rugo HS, Azim HA, Swain SM, Arun B, Aapro M, Perez EA, Anderson BO, Penault-Llorca F, Conte P, El Saghir NS, Yip CH, Ghosn M, Poortmans P, Shehata MA, Giuliano AE, Leung JWT, Guarneri V, Gligorov J, Gulluoglu BM, Abdel Aziz H, Frolova M, Sabry M, Balch CM, Orecchia R, El-Zawahry HM, Al-Sukhun S, Abdel Karim K, Kandil A, Paltuev RM, Foheidi M, El-Shinawi M, ElMahdy M, Abulkhair O, Yang W, Aref AT, Bakkach J, Bahie Eldin N, Elghazawy H. Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer. Cancers (Basel) 2021; 13:2262. [PMID: 34066769 PMCID: PMC8125909 DOI: 10.3390/cancers13092262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Hope S. Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Hamdy A. Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza 12613, Egypt; (H.A.A.); (H.M.E.-Z.)
| | - Sandra M. Swain
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, MedStar Health, Washington, DC 20007, USA;
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Matti Aapro
- Breast Center, Clinique de Genolier, 1272 Genolier, Switzerland;
| | - Edith A. Perez
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98195, USA;
| | - Frederique Penault-Llorca
- Department of Pathology, Clermont Auvergne University, INSERM U1240 “Molecular Imaging and Theranostic Strategies”, Center Jean Perrin, Montalembert, 63000 Clermont-Ferrand, France;
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy; (P.C.); (V.G.)
| | - Nagi S. El Saghir
- Department of Internal Medicine, Division of Hematology Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Kuala Lumpur 47500, Malaysia;
| | - Marwan Ghosn
- Hematology and Oncology Department, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Philip Poortmans
- Iridium Kankernetwerk and Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk-Antwerp, Belgium;
| | - Mohamed A. Shehata
- Clinical oncology Department, Menoufia University, Shebin Elkom 51132, Egypt;
| | - Armando E. Giuliano
- Department of Surgery, Surgical Oncology Division, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Jessica W. T. Leung
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy; (P.C.); (V.G.)
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie AP-HP. Sorbonne Université, INSERM U938, 75013 Paris, France;
| | - Bahadir M. Gulluoglu
- Breast & Endocrine Surgery Unit, Marmara University School of Medicine, University Hospital, Istanbul 34722, Turkey;
| | - Hany Abdel Aziz
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Mona Frolova
- Federal State Budgetary Institution “NN Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 127994 Moscow, Russia;
| | - Mohamed Sabry
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Charles M. Balch
- Surgical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Roberto Orecchia
- Scientific Directorate, IRCCS European Institute of Oncology (IEO), and University of Milan, 20122 Milan, Italy;
| | - Heba M. El-Zawahry
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza 12613, Egypt; (H.A.A.); (H.M.E.-Z.)
| | | | - Khaled Abdel Karim
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Alaa Kandil
- Department of Clinical Oncology, Alexandria School of Medicine, Alexandria 21131, Egypt;
| | - Ruslan M. Paltuev
- Russian Association of Oncological Mammology, Department of Breast Tumours of Federal State Budgetary Institution “Petrov Research Institute of Oncology”, 197758 Saint Petersburg, Russia;
| | - Meteb Foheidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 22384, Saudi Arabia;
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
- Vice President of Galala University, Galala University, Suez 435611, Egypt
| | - Manal ElMahdy
- Department of Pathology, Ain shams University, Cairo 11566, Egypt;
| | - Omalkhair Abulkhair
- Oncology Department, Alfaisal university, Alhabib Hospital, Riyad 11533, Saudi Arabia;
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;
| | - Adel T. Aref
- The School of Public Health, University of Adelaide, Adelaide 5005, Australia;
| | - Joaira Bakkach
- Biomedical Genomics & Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdel Malek Essaadi University, Tangier 90000, Morocco;
| | - Nermean Bahie Eldin
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Hagar Elghazawy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
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12
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Azim HA, Kandil A, El Zawahry H, Abdel-Razeq H, Elghazaly H, Kharusi SA, Abdelwahab MM, Fayaz S, Saadeddin A, Alabdulkarim HA, Aboelhassan R, Errihani H, Al Rubai T, Al Bader SB, Aziz NMA, El Saghir N, Attinà G, Yosry A, El Leithy M, Kassem L, Ghosn M. Abstract PS7-65: Triple negative breast cancer prospective registry in middle East and Africa (TRIPOLI) study: Interim analysis of the patients’ characteristics. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-65] [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:Globally, triple-negative breast cancer (TNBC) is responsible for approximately 15% of all invasive Breast cancer and has been typically associated with poor prognosis. Some retrospective studies have suggested a relatively higher incidence of TNBC in the Middle East and North African Arab countries. Nevertheless, there is complete lack of prospective data, on TNBC in the region, including clinico-pathologic characteristics, treatment patterns and disease outcomes. The TRIPOLI study aims to bridge this information gap.Methods:TRIPOLI is an ongoing prospective multinational, disease registry, designed to recruit 700 newly diagnosed TNBC patients, from 15 institutions within 9 Arab countries: Egypt, Jordon, Morocco, Kingdom of Saudi Arabia, Lebanon, Oman, Kuwait, Qatar and Iraq. This interim analysis includes the patients’ characteristics and treatment approaches of the first 449 cases included in the study from December 2017 to September 2019.Results:All the 449 TNBC patients were females, with a median age of 49 years (range 23.8 - 93.6 years). Premenopausal status was reported in 54.7%, while a positive family history of BC was stated in 25.2% of these cases. 0.2% of patients were below normal (BMI<18.5), 17.2% had normal weight (18.5≤BMI<25), and 30.5% were overweight (25≤BMI<30). Obesity (BMI ≥ 30) was present in 52% of these patients, while a parity of ≥3 children was present in 254 patients (59.8%) Sixty-six patients (14.7%) had tumours smaller than 2cm. 159 patients (35.4%) had node negative disease. The majority of patients had invasive duct carcinoma (87.1%) with 5 patients (1.1%) grade I, 181 (40.3%) grade II and 234 (52.1%) grade III tumours (29 (6.5%) had unknown histological grade). Thirty-four patients (7.6%) presented with stage I disease, 203 patients (45.2%) with stage II, 161 patients (35.9%) with stage III and 50 patients (11.1%) presented with stage IV disease.Out of the 387 patients with non-metastatic disease who started treatment, 217 patients (56.1%) had upfront surgery and 170 patients (43.9%) started with neoadjuvant chemotherapy. Compared to patients > 40 years, patients ≤ 40 years were less likely to be obese (39.4% versus 60.6%; p=0.002), more likely to have grade III tumours (62.3% versus 53.5%; p=0.116), more likely to have T3 or T4 tumours (41.4% versus 32.7%; p=0.038).Conclusion:In this interim analysis, Arab women with TNBC had high parity (≥ 3) and high BMI, compared to existing literature based on western population. High tumor grade, younger age and advanced stages at presentation are in line with similar world-wide reports. Younger women in the Arab region (≤40 years) presented with poor prognostic features, which will be further elucidated in subsequent reports.
Citation Format: Hamdy A. Azim, Alaa Kandil, Heba El Zawahry, Hikmat Abdel-Razeq, Hesham Elghazaly, Suad Al Kharusi, Manal M. Abdelwahab, Salah Fayaz, Ahmed Saadeddin, Huda A. Alabdulkarim, Rasha Aboelhassan, Hassan Errihani, Tahseen Al Rubai, Salha Bujassoum Al Bader, Nashwa Mohamed Abdel Aziz, Nagi El Saghir, Giulia Attinà, Ahmed Yosry, Mohamed El Leithy, Loay Kassem, Marwan Ghosn. Triple negative breast cancer prospective registry in middle East and Africa (TRIPOLI) study: Interim analysis of the patients’ characteristics [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 PS7-65.
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Affiliation(s)
- Hamdy A. Azim
- 1Clinical Oncology Department, Cairo University Hospital, Cairo University/AMCI (Africa Middle East Cancer Intergroup), Cairo, Egypt
| | - Alaa Kandil
- 2Alexandria School of Medicine (Alexandria Clinical Research Center), Alexandria University, Alexandria, Egypt
| | | | | | | | | | | | - Salah Fayaz
- 8Kuwait Cancer Control Center, Kuwait, Kuwait
| | - Ahmed Saadeddin
- 9King Abdullah Specialized Children’s Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Huda A. Alabdulkarim
- 10The Comprehensive Cancer Center at King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Hassan Errihani
- 12National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | | | | | - Nashwa Mohamed Abdel Aziz
- 15Division of Hematology-Oncology, Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Nagi El Saghir
- 16American University of Beirut Medical Center, Beirut, Lebanon
| | - Giulia Attinà
- 17MSD International Business GmbH, Luzern, Switzerland
| | | | | | - Loay Kassem
- 20Clinical Oncology Department, Cairo University Hospital, Cairo University, Cairo, Egypt
| | - Marwan Ghosn
- 21Faculty of Medicine, Saint Joseph University/AMCI (Africa Middle East Cancer Intergroup), Beirut, Lebanon
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13
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Azim HA, Kassem L, Azim H. Integrating PARP inhibitors into the management of breast cancer: where are we? Chin Clin Oncol 2021; 10:50. [PMID: 33440946 DOI: 10.21037/cco-19-230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 10/19/2020] [Indexed: 11/06/2022]
Abstract
During the last 2 decades, extensive research has focused on the molecular functions of BRCA1 and BRCA2 genes. This has led to the development of Poly(ADP-ribose) polymerase inhibitors (PARPi), as effective target therapies, based on their preferential cytotoxicity in tumor cells harboring germline BRCA1 and BRCA2 mutations. At the present time, 2 PARPi (Olaparib and Talazoparib) are approved as single agent for the treatment of patients with metastatic HER2-ve breast cancer, who have BRCA germline mutations. The clinical benefit of these agents might be also anticipated in patients harboring germline mutations in some additional genes involved in the process of homologous recombination repair (HRR) other than BRCA1/BRCA2. In this review, we summarize the molecular rational for the therapeutic development of PARPi and the clinical evidence supporting their use as anticancer drugs in breast cancer patients with BRCA1/BRCA2 germline mutations. We also discuss the role of platinum-based chemotherapy and how it compares with PARPi in the management of these patients. We will go through some relevant clinical trials of various combinations of PARPi with cytotoxic or immunotherapeutic agents, which may potentially provide better treatment results, compared to what is already achieved with their use as monotherapy.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, KasrAlainy School of Medicine, Cairo University, Cairo, Egypt
| | - Loay Kassem
- Clinical Oncology Department, KasrAlainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hatem Azim
- Department of Medicine, Division of Hematology-Oncology, American University of Beirut, Beirut, Lebanon
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14
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Azim HA, Shohdy KS, Kaldas DF, Kassem L, Azim HA. Adjuvant ovarian function suppression and tamoxifen in premenopausal breast cancer patients: A meta-analysis. Curr Probl Cancer 2020; 44:100592. [PMID: 32527567 DOI: 10.1016/j.currproblcancer.2020.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The benefit of adding ovarian function suppression (OFS) to tamoxifen in the adjuvant treatment of premenopausal women with breast cancer is uncertain. We conducted a meta-analysis of randomized controlled trials that addressed this question. METHODS Systematic search of PubMed, the web of science, and the meeting library of ASCO, ESMO, and SABCS was conducted using the following keywords: tamoxifen, ovarian suppression, and breast cancer. Eligible studies were those recruiting patients with breast cancer randomized to receive adjuvant tamoxifen and OFS versus tamoxifen alone. Pooled hazard ratio [HR]) for disease-free (DFS) and overall survival (OS) with 95% confidence interval (CI) were calculated using the fixed effect model. RESULTS We searched a total of 845 records, of which 5 clinical trials, including 7557 patients, were eligible for our analysis. Adding OFS to tamoxifen improved DFS with pooled HR: 0.88 (95% CI: 0.80-0.96, P= 0.004) and OS (pooled HR: 0.87 {95% CI: 0.77-0.98, P= 0.02}) compared to tamoxifen alone. The benefit of the addition of OFS to tamoxifen was mostly observed in patients younger than 40 years where the pooled HRs of DFS was 0.76 (95% CI: 0.63-0.91; P= 0.004), and in those who received adjuvant chemotherapy with pooled HRs of DFS 0.80 (95% CI: 0.65-0.99, P= 0.042). There was an increase in the incidence of all grade musculoskeletal symptoms and high-grade hot flushes with the addition of OFS with risk ratios of 1.12 (95% CI: 1.07-1.17, P< 0.001) and 2.14 (95% CI: 1.01-4.51, P= 0.047) respectively. CONCLUSION Our analysis indicates that the addition of OFS to tamoxifen improves DFS and OS. This strategy could be considered in patients in which tamoxifen alone is not deemed sufficient or in case of poor tolerance to OFS with aromatase inhibitors.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Kyrillus S Shohdy
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt; Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY.
| | - David F Kaldas
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Hatem A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
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15
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Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Harbeck N, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Spanic T, Stearns V, Wengström Y, Peccatori F, Pagani O. ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol 2020; 31:674-696. [PMID: 32199930 DOI: 10.1016/j.annonc.2020.03.284] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [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: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022] Open
Abstract
The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were also identified. This article summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Affiliation(s)
| | - F Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
| | | | - M-J Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Nova Medical School Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | - N Harbeck
- Breast Center, Dept. OB&GYN, University of Munich (LMU), Munich, Germany
| | | | - P Poortmans
- Institut Curie, Department of Radiation Oncology & Paris Sciences & Lettres - PSL University, Paris, France
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - Y Wengström
- Department of Neurobiology Cancer Science and Society, Karolinska Institute and Theme Cancer Karolinska University Hospital, Sweden
| | - F Peccatori
- European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona, Switzerland
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16
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De Laurentiis M, Borstnar S, Campone M, Warner E, Salvador Bofill J, Jacot W, Dent SF, Martin M, Ring AE, Cottu PH, Lu JM, Ciruelos E, Azim HA, Chatterjee S, Zhou K, Wu J, Ankrah N, Zamagni C. Updated results from the phase IIIb complement-1 study of ribociclib (RIB) plus letrozole (LET) in the treatment of HR+, HER2-advanced breast cancer (ABC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1055 Background: Real-world evidence is important as it complements data from randomized controlled trialse report updated results from CompLEEment-1, a Phase IIIb trial evaluating RIB+LET in an expanded population, the largest CDK4/6i trial in ABC to date. Methods: Patients (pts) with HR+, HER2– ABC, ≤ 1 line of prior CT and no prior ET for ABC received RIB+LET. Study design has been reported previously (De Laurentiis, et al. ASCO 2019). Primary endpoints were safety and tolerability. Results: 3,246 pts received ≥ 1 dose of study treatment. Median duration of follow-up was 25.4 months (mos) (15 additional mos since interim analysis [De Laurentiis, et al. ABC5 2019]). Median treatment exposure was 17.8 mos. Baseline characteristics indicated a diverse population, including men (1.2%), premenopausal women (22.2%), and pts aged ≥ 70 years (19.5%); 112 (3.5%) pts had an ECOG PS of 2, 194 (6.0%) pts received prior CT for ABC, and 51 (1.6%) pts had stable CNS lesions. The most common adverse events (AEs) were neutropenia (61.1%), nausea (35.9%), and fatigue (23.4%). Grade 3/4 hematologic abnormalities ( > 5.0 %) were decreased neutrophils (54.8%), leukocytes (25.9%), and lymphocytes (12.6%). Grade 3/4 biochemical abnormalities ( > 5.0 %) were increased ALT (9.1%) and AST (6.7%). An increase of > 60 ms in QTcF interval from baseline occurred in 189 (5.9%) pts, while post-baseline QTcF of > 480 to ≤ 500 ms and > 500 ms occurred in 59 (1.8%) and 42 (1.3%) pts, respectively. Treatment-related AEs led to treatment discontinuation in 418 (12.9%) pts. Of 74 (2.3%) on treatment deaths, 38 (1.2%) were due to breast cancer. Median time to progression was 27.1 mos (95% CI, 25.7-NE), overall response rate was 43.6% (95% CI, 41.5-45.8%), and clinical benefit rate was 69.1% (95% CI, 67.1-71.1%) for pts with measurable disease at baseline. Conclusions: This analysis confirms the safety and efficacy of RIB+LET in a large, diverse cohort of pts with HR+, HER2– ABC (with no previous ET for ABC), closely resembling real-world clinical practice. Safety and efficacy data were consistent with those observed in the MONALEESA trials, supporting the use of RIB+LET in the first-line setting. NCT02941926. Clinical trial information: NCT02941926 .
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Affiliation(s)
| | | | | | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Javier Salvador Bofill
- Virgen Del Rocío University Hospital, Institute of Biomedicine of Seville, Seville, Spain
| | | | | | - Miguel Martin
- Gregorio Marañón General University Hospital, Madrid, Spain
| | | | | | - Janice M. Lu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Eva Ciruelos
- Univeristy Hospital 12 de Octubre, Clara Campal Comprehensive Cancer Center (HM CIOCC), Madrid, Spain
| | | | | | - Katie Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Nii Ankrah
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Claudio Zamagni
- Bologna University Hospital, St Orsola-Malpighi Polyclinic, Bologna, Italy
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17
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Azim HA, Ghosn M, Oualla K, Kassem L. Personalized treatment in metastatic triple-negative breast cancer: The outlook in 2020. Breast J 2019; 26:69-80. [PMID: 31872557 DOI: 10.1111/tbj.13713] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022]
Abstract
Compared with other breast cancer subtypes, patients with triple-negative breast cancer (TNBC), and irrespective to their disease stage, were always recognized to have the worst overall survival data. Although this does not seem different at the present time, yet the last few years have witnessed many breakthrough genomic and molecular findings, that could dramatically improve our understanding of the biological complexity of TNBC. Based on genomic analyses, it was consistently evident that TNBC comprises a heterogeneous group of cancers, which have numerous diverse molecular aberrations. This-in return-has provided a platform for a new generation of clinical trials using many innovative therapies, directed against such novel targets. At the present time, two PARP inhibitors and one anti-PD-L1 monoclonal antibody (in combination with chemotherapy) have been approved in certain subpopulations of metastatic TNBC (mTNBC) patients, which have finally brought this disease into the era of personalized medicine. In the current review, we will explore the genomic landscape of TNBC, through which many actionable targets were graduated. We will also discuss the results of the key-practice changing-clinical studies, and some upcoming personalized treatment options for patients with mTNBC, that may be clinically adopted in the near future.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.,Clinical Oncology Department, Cairo Oncology Center, Cairo, Egypt
| | - Marwan Ghosn
- Hotel Dieu de France University Hospital and Saint Joseph University, Beirut, Lebanon
| | - Karima Oualla
- Medical Oncology Department, Hassan II University Hospital, Fes, Morocco
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.,Clinical Oncology Department, Cairo Oncology Center, Cairo, Egypt
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18
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Azim HA, Dawood S, El-Saghir N, Kassem L, Azim HA. Understanding the benefits and challenges of first-line cyclin-dependent kinases 4 and 6 inhibitors in advanced breast cancer among postmenopausal women. Breast J 2019; 26:630-642. [PMID: 31709685 DOI: 10.1111/tbj.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023]
Abstract
Endocrine therapy (ET) has been regarded for many years as the standard treatment for patients with hormone receptor-positive (ER+), HER2-negative (HER2-) advanced breast cancer (ABC) without visceral crisis. However, the efficacy of single-agent ET is constrained by the development of resistance, attributed to alterations in several intracellular signaling pathways, including those related to cell cycle dysregulation. The cyclin-dependent kinases 4 and 6 (CDK4/6) are principal regulators of cell cycle progression from the G1-phase into the DNA synthesis (S)-phase. In vitro inhibition of CDK4/6 activity has potent antiproliferative properties against luminal breast cancer cell lines, which are enhanced when combined with traditional ET. This has led to a substantial interest in targeting this pathway to overcome endocrine resistance in the clinic. Three selective CDK4/6 inhibitors (palbociclib, ribociclib, and abemaciclib) have been approved as first-line therapy in combination with an aromatase inhibitor, or fulvestrant in the case of ribociclib in patients with ER+/HER2- ABC. To date, there is no clue as to which subgroup of patients might benefit most from these combinations. Here, we outline some of the established approaches to overcome endocrine resistance, with special emphasis on the unique mechanism of action of CDK4/6 inhibitors.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Cairo Oncology Centre, Cairo, Egypt
| | - Shaheenah Dawood
- Department of Medical Oncology, Mediclinic City Hospital, Comprehensive Cancer Center, Dubai Health Care City, Dubai, UAE
| | - Nagi El-Saghir
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Loay Kassem
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Cairo Oncology Centre, Cairo, Egypt
| | - Hatem A Azim
- American University of Beirut Medical Center, Beirut, Lebanon
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19
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DeLaurentiis M, Borstnar S, Campone M, Warner E, Bofill S, Jacot W, Dent SF, Martin M, Ring AE, Cottu PH, Lu JM, Ciruelos E, Azim HA, Chatterjee S, Zhou K, Wu J, Ankrah N, Zamagni C. Interim results from the full population of the phase 3b CompLEEment-1 study of ribociclib (RIBO) plus letrozole (LET) in the treatment of HR+/HER2– advanced breast cancer (ABC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
1041 Background: RIBO, an oral, selective inhibitor of CDK4/6 (CDK4/6i), is approved for use in combination with endocrine therapy (ET) in women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) ABC in multiple countries worldwide. Here we report interim safety and efficacy results from CompLEEment-1, a phase 3b trial evaluating RIBO+LET in an expanded patient (pt) population and the largest CDK4/6i trial in ABC to date. Methods: Pts with HR+, HER2– ABC, ≤1 line of prior chemotherapy (CT), and no prior ET for ABC received RIBO+LET. Treatment regimens and study endpoints have been reported previously (De Laurentiis, et al. ASCO 2018. Poster 1056). Results: Overall, 3,246 pts, who received ≥1 dose of study treatment, were evaluated (cut-off date, August 8, 2018). Median duration of RIBO exposure was 8.1 months (min, 0.0; max, 22.4). Demographic and baseline characteristics indicated a diverse population including men (1.2%), premenopausal women (22.2%), and patients aged ≥70 years (19.5%). Pts were well represented in terms of age, race, and disease history; 5.9% of pts received prior CT for ABC. The only non-hematologic any-cause grade ≥3 AEs ≥5% were increased alanine (7.3%) and aspartate (5.3%) aminotransferase. Treatment-related AEs (any grade) led to discontinuation in 11.4% of pts. Of the 51 (1.6%) on-treatment deaths, 26 were due to study indication and 25 to other reasons. The median time to progression was not estimable (NE) (95% confidence interval [CI], 17.1-NE). Overall response rate was 20.5% (95% CI, 19.1%-21.9%) and clinical benefit rate was 66.1% (95% CI, 64.4%-67.7%). Consistent mean change from baseline in Functional Assessment of Cancer Therapy – Breast Cancer questionnaire scores indicated that pts maintained their quality of life throughout treatment. Conclusions: This interim analysis demonstrates the safety, tolerability, and efficacy of RIBO+LET in a large, diverse cohort of pts with HR+, HER2– ABC who had not previously received ET for ABC. Safety results were consistent with those observed in RIBO pivotal studies and no new safety signals were observed. Clinical trial information: NCT02941926.
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Affiliation(s)
- Michelino DeLaurentiis
- National Cancer Institute “Fondazione Pascale,” Department of Breast and Thoracic Oncology, Naples, Italy
| | | | - Mario Campone
- Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - William Jacot
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañón, Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | | | - Eva Ciruelos
- Breast Cancer Unit, University Hospital, Madrid, Spain
| | | | | | - Katie Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Nii Ankrah
- Novartis Pharmaceuticals, East Hanover, NJ
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20
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Lambertini M, Goldrat O, Ferreira AR, Dechene J, Azim HA, Desir J, Delbaere A, t'Kint de Roodenbeke MD, de Azambuja E, Ignatiadis M, Demeestere I. Reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients. Ann Oncol 2019; 29:237-243. [PMID: 29045555 DOI: 10.1093/annonc/mdx639] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Preclinical evidence suggests a possible negative impact of deleterious BRCA mutations on female fertility. However, limited and rather conflicting clinical data are available. This study assessed the reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients. Patients and methods This was a retrospective analysis of two prospective studies investigating oocyte cryopreservation and ovarian tissue cryopreservation in newly diagnosed early breast cancer patients. In the current analysis, baseline anti-Mullerian hormone (AMH) and performance of cryopreservation strategies were compared between patients with or without germline deleterious BRCA mutations. Results Out of 156 patients included, 101 had known BRCA status of whom 29 (18.6%) were BRCA-mutated and 72 (46.1%) had no mutation. Median age in the entire cohort was 31 years [interquartile range (IQR) 28-33). Median AMH levels were 1.8 μg/l (IQR 1.0-2.7) and 2.6 µg/l (IQR 1.5-4.1) in the BRCA-positive and BRCA-negative cohorts, respectively (P = 0.109). Among patients who underwent oocyte cryopreservation (N = 29), women in the BRCA-positive cohort tended to retrieve (6.5 versus 9; P = 0.145) and to cryopreserve (3.5 versus 6; P = 0.121) less oocytes than those in the BRCA-negative cohort. Poor response rate (i.e. retrieval of ≤4 oocytes) was 40.0% and 11.1% in the BRCA-positive and BRCA-negative cohorts, respectively (P = 0.147). Among patients who underwent ovarian tissue cryopreservation (N = 72), women in the BRCA-positive cohort tended to have a numerically lower number of oocytes per fragment (0.08 versus 0.14; P = 0.193) and per square millimeter (0.33 versus 0.78; P = 0.153) than those in the BRCA-negative cohort. Two BRCA-mutated patients were transplanted after chemotherapy and one delivered at term a healthy baby. No difference between BRCA1- and BRCA2-mutated patients was observed in any of the above-mentioned outcomes. Conclusion A consistent trend for reduced reproductive potential and performance of cryopreservation strategies was observed in BRCA-mutated breast cancer patients. Independent validation of these results is needed.
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Affiliation(s)
- M Lambertini
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.,Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - O Goldrat
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A R Ferreira
- Hospital de Santa Maria and Instituto de Medicina Molecular, Faculdade de Medicina, Universiade de Lisboa, Lisbon, Portugal
| | - J Dechene
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - H A Azim
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
| | - J Desir
- Medical Genetics Department, CUB-Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A Delbaere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M-D t'Kint de Roodenbeke
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Ignatiadis
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - I Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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21
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Ring A, Borstnar S, Ferreira A, Azim HA, Cottu P, Lu J, Martin M, Zamagni C, Beck JT, Zhou K, Wu J, Menon L, De Laurentiis M. Abstract P6-18-16: Ribociclib (RIBO) + letrozole (LET) in older patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC): Preliminary subgroup results from the phase 3b CompLEEment-1 trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-16] [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 cyclin-dependent kinase (CDK)4/6 inhibitor RIBO is approved in combination with an aromatase inhibitor (AI) for HR+, HER2– ABC in postmenopausal women with no prior therapy for ABC, based on the MONALEESA-2 trial (Hortobagyi et al. NEJM 2016). Although a high proportion of patients with HR+, HER2– ABC are >65 years of age, older patients are often under-represented in clinical trials. Furthermore, treatment decisions may be complicated by comorbidities, functional status, and concurrent medications. Here, we report early safety results for patients ≥65 years of age enrolled in CompLEEment-1, an open-label, phase 3b trial evaluating RIBO+LET as first-line endocrine-based therapy in an expanded patient population.
Methods: Patients with HR+, HER2– ABC, ≤1 line of prior chemotherapy (CT), and no prior endocrine therapy for ABC received RIBO (600 mg/day, 3 weeks on/1 week off) + LET (2.5 mg/day); men and premenopausal women received concomitant goserelin (3.6-mg subcutaneous implant every 28 days). The primary outcome was safety and tolerability. A pre-planned interim analysis was conducted ˜15 months after first patient first visit.
Results: Of the first 1,008 patients enrolled who completed 56 days of follow-up or discontinued before the data cut-off date, 377 were ≥65 years of age. Of these, 157 (41.6%) were 65-<70 years, 107 (28.4%) were 70-<75 years, and 113 (30%) were ≥75 years. The majority of patients (94.4%) had an Eastern Cooperative Oncology Group performance status ≤1; 33.2% presented with stage IV disease at diagnosis; 9 patients were male. The most common sites of metastasis were bone (70.0%), lung (44.8%), and lymph nodes (29.7%). The most common all-grade adverse events (AEs) were neutropenia (58.4%), nausea (31.8%), and fatigue (24.1%). The most common grade 3/4 AEs were neutropenia (37.7%) and alanine aminotransferase increase (4.2%). QT prolongation events were mild (majority grade 1/2) and occurred in 6.1% of patients (0.5% grade 3/4). Dose reduction or interruption due to AEs occurred in 54.5% of patients; 6.9% of patients had AEs leading to treatment discontinuation. In the overall patient population, the most frequent grade 3/4 AEs were neutropenia (42.8%), leukopenia (3.4%), and increased alanine aminotransferase (2.9%); QT prolongation occurred in 5.4% of patients (0.5% grade 3/4).
Conclusions: Initial safety results from CompLEEment-1, from the first 56 days of follow-up, demonstrate the tolerability of RIBO+LET in older patients, consistent with the overall patient population. NCT02941926.
Citation Format: Ring A, Borstnar S, Ferreira A, Azim HA, Cottu P, Lu J, Martin M, Zamagni C, Beck JT, Zhou K, Wu J, Menon L, De Laurentiis M. Ribociclib (RIBO) + letrozole (LET) in older patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC): Preliminary subgroup results from the phase 3b CompLEEment-1 trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-16.
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Affiliation(s)
- A Ring
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - S Borstnar
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - A Ferreira
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - HA Azim
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - P Cottu
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - J Lu
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - M Martin
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - C Zamagni
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - JT Beck
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - K Zhou
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - J Wu
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - L Menon
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - M De Laurentiis
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
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Pagani O, Partridge AH, Peccatori F, Azim HA, Colleoni M, Saura C, Kroep JR, Warner E, Gombos A, Sætersdal AB, Ruggeri M, Gelber RD, Sun Z. Abstract OT1-01-06: POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-01-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Young patients with breast cancer (BC) are often diagnosed with the disease before completing their families. The best available retrospective evidence suggests that pregnancy after BC does not negatively impact disease outcomes in patients with endocrine responsive BC and is safe for the offspring. However, given the possibility of extended adjuvant endocrine therapy (ET) (5-10 years), it is not feasible for many of these women to delay pregnancy until completion of therapy and thus there is a need to study the safety of interrupting ET to allow pregnancy. To date, no prospective study has been conducted in BC survivors attempting future pregnancy.
Trial Design
Young patients with endocrine responsive early BC who desire pregnancy will interrupt ET for up to 2 yrs to attempt pregnancy. As resumption of menses and conception depends on many factors (e.g. patient's age and adjuvant treatment received), the 2-yr interruption period is approximate, intended to include treatment wash-out (3 mos), conception (˜3-6 mos), delivery (˜9 mos), and breast feeding (˜6 mos). Patients will be strongly advised to resume ET as soon as pregnancy attempts/deliveries are concluded, and to complete the planned 5-10 yrs of ET.
Major Eligibility Criteria
- Histologically-proven stage I-III endocrine-responsive BC.
- Patient's wish to become pregnant.
- Age ≥ 18 and ≤ 42 years at enrollment.
- Adjuvant ET (selective estrogen receptor modulator [SERM] alone, GnRH analogue plus SERM or aromatase inhibitor) for ≥18 months but ≤30 months, stopped within 1 month prior to enrollment.
- Premenopausal status at BC diagnosis.
Specific Aim
To assess the risk of BC relapse associated with the interruption of ET to permit pregnancy, and to evaluate pregnancy success rate and offspring outcome.
Statistical Methods
With 500 pts enrolled and followed for a median of 3 years, the statistical design is based on the 95% CI for the 3-year BC recurrence rate. Interim monitoring assumes a 2% BC recurrence risk/yr with continuous ET and a recommendation to stop the study early if the BC risk exceeds 4%/yr with ET interruption.
Translational Research will investigate various ovarian function and uterine parameters and circulating tumour DNA. Fresh frozen paraffin embedded tissue of the primary tumour will be collected to evaluate parameters related to the biology of BC in young women. All material will be banked centrally.
Psycho-oncological Companion Study (POCS) will evaluate fertility concerns, psychological well-being and decisional conflict. It is mandatory in North America and open to interested centers elsewhere.
Accrual: Target: 500; Actual: 262 (30 June 2018)
Psycho-oncological Companion Study Accrual: Target: 200; Actual: 138 (30 June 2018)
Citation Format: Pagani O, Partridge AH, Peccatori F, Azim HA, Colleoni M, Saura C, Kroep JR, Warner E, Gombos A, Sætersdal AB, Ruggeri M, Gelber RD, Sun Z. POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-01-06.
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Affiliation(s)
- O Pagani
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - AH Partridge
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - F Peccatori
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - HA Azim
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - M Colleoni
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - C Saura
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - JR Kroep
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - E Warner
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - A Gombos
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - AB Sætersdal
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - M Ruggeri
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - RD Gelber
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - Z Sun
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
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Azim HA, Omar A, Atef H, Zawahry H, Shaker MK, Abdelmaksoud AK, EzzElarab M, Abdel-Rahman O, Ismail M, Kassem L, Waked I. Sorafenib plus tegafur-uracil (UFT) versus sorafenib as first line systemic treatment for patients with advanced stage HCC: a Phase II trial (ESLC01 study). J Hepatocell Carcinoma 2018; 5:109-119. [PMID: 30510922 PMCID: PMC6250115 DOI: 10.2147/jhc.s169285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Phase II trials found that tegafur–uracil (UFT) is an effective drug in hepatocellular carcinoma (HCC), while preclinical data suggested that its combination with sorafenib may have a promising activity. Our Phase II randomized trial aimed to evaluate efficacy and tolerability of sorafenib plus UFT vs sorafenib in advanced HCC. Methods Patients with advanced HCC, with no prior systemic therapy, were randomized to receive either UFT at 125 mg/m2 twice daily for 4 out of 5 weeks plus sorafenib at 400 mg twice daily (arm 1) or single agent sorafenib at 400 mg twice daily (arm 2). Primary end point was time to progression (TTP). Results Between March 2012 and March 2014, 76 eligible patients – out of 143 preplanned – were randomized. The study was terminated early because of futility. This is the final analysis of the study, after a median follow-up of 10.2 months and death of 86% of randomized patients (n=64). Median TTP was 7.5 months and 8.2 months in arms 1 and 2 respectively (HR: 1.07; 95% CI, 0.52–2.22; P=0.855), while the median overall survival was 8.2 months and 10.5 months respectively (HR: 1.58; 95% CI: 0.90–2.76, P=0.112). Nine patients (25%) in the combination arm discontinued treatment because of toxicity vs eight patients (21.1%) in the sorafenib monotherapy arm (P=0.899). Conclusion In patients with advanced HCC, adding UFT to sorafenib is feasible, but it did not improve efficacy outcome over sorafenib monotherapy.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt, ,
| | - Ashraf Omar
- Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Atef
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt, ,
| | - Heba Zawahry
- Department of Medical Oncology, National Cancer Institute, Cairo, Egypt
| | - Mohamed K Shaker
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed EzzElarab
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Ismail
- Clinical Oncology Department, Cairo Oncology Center, Cairo, Egypt
| | - Loay Kassem
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt, ,
| | - Imam Waked
- Institute of Liver Disease, Menoufiya University, Menoufiya, Egypt
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Jung KH, Ataseven B, Verrill M, Pivot X, De Laurentiis M, Al-Sakaff N, Lauer S, Shing M, Gligorov J, Azim HA. Adjuvant Subcutaneous Trastuzumab for HER2-Positive Early Breast Cancer: Subgroup Analyses of Safety and Active Medical Conditions by Body Weight in the SafeHer Phase III Study. Oncologist 2018; 23:1137-1143. [PMID: 30018134 PMCID: PMC6263135 DOI: 10.1634/theoncologist.2018-0065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/01/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This SafeHer subgroup analysis assessed the safety of fixed-dose subcutaneous trastuzumab (H SC) as an adjuvant therapy in HER2-positive early breast cancer (EBC) by body weight. PATIENTS AND METHODS Patients with HER2-positive EBC not previously treated with anti-HER2 therapy received H SC 600 mg (every 3 weeks for 18 cycles), with neoadjuvant or adjuvant chemotherapy or without adjuvant chemotherapy. Adverse events (AEs) were assessed throughout treatment and at final follow-up (28 ±5 days after last treatment). Subgroups were categorized by body weight, Asian origin, and chemotherapy administration. All analyses were descriptive. RESULTS Of 2,577 patients enrolled, 2,573 received ≥1 dose of study medication and were included in this safety analysis. Median body weight at baseline was 67.0 kg (range 33.6-150.0 kg). Any-grade AEs occurred in 88.7% (2,282/2,573) of the overall population, versus 87.1% (590/677) of the lowest bodyweight quartile (≤59 kg), 90.0% (561/623) of the highest quartile (>77 kg), and 86.5% (327/378) of the Asian population. Grade ≥3 AEs occurred in 23.2% (596/2,573) of the overall population, 17.9% (121/677) of the lowest bodyweight quartile, 26.8% (167/623) of the highest quartile, and 15.3% (58/378) of the Asian population. The highest bodyweight quartile had the highest incidence of medical conditions at baseline (highest quartile, 75.6%; lowest quartile, 56.1%). CONCLUSION These data support the use of fixed-dose H SC as an adjuvant therapy in HER2-positive EBC and confirm the comparable safety profile of H SC in patients with low body weight or of Asian origin versus the overall population in SafeHer. ClinicalTrials.gov: NCT01566721. IMPLICATIONS FOR PRACTICE The safety profile of fixed-dose subcutaneous trastuzumab (H SC) was comparable between patients in the lowest bodyweight subgroup and the overall patient population, and also between patients of Asian origin (of whom a higher proportion often fall within the lower bodyweight quartiles) and the overall population. The safety data from this SafeHer subgroup analysis therefore support the use of fixed-dose H SC 600 mg administered every 3 weeks as an adjuvant therapy for patients with HER2-positive early breast cancer across different bodyweight subgroups and in the Asian patient population.
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Affiliation(s)
- Kyung Hae Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beyhan Ataseven
- Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Mark Verrill
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Xavier Pivot
- Centre Paul Strauss, I'Institut Régional du Cancer, Strasbourg, France
| | | | | | | | - Mona Shing
- Genentech, Inc., South San Francisco, California, USA
| | | | - Hamdy A Azim
- Oncology Department, School of Medicine, Cairo University, Cairo, Egypt
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Azim HA, Lasheen S, Kassem L. Treatment of HER2-positive early breast cancer: How to best balance efficacy and toxicity? Breast J 2018; 24:459-461. [DOI: 10.1111/tbj.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Hamdy A. Azim
- The Department of Clinical Oncology; School of Medicine; Cairo University; Cairo Egypt
| | - Shaimaa Lasheen
- The Department of Clinical Oncology; School of Medicine; Cairo University; Cairo Egypt
| | - Loay Kassem
- The Department of Clinical Oncology; School of Medicine; Cairo University; Cairo Egypt
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26
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DeLaurentiis M, Neven P, Jerusalem GHM, Bachelot TD, Jacot W, Dent SF, Colleoni M, Prat A, Martin M, Ring AE, Cottu PH, Lu JM, Azim HA, Zhou K, Wu J, Zarate JP, Zamagni C. Ribociclib (RIBO) + letrozole (LET) in patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC) with no prior endocrine therapy (ET) for ABC: Preliminary results from the phase 3b CompLEEment-1 trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - William Jacot
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain
| | | | | | | | | | - Katie Zhou
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Nguyen B, Venet D, Desmedt C, Pruneri G, Peccatori F, Mardis ER, Azim HA, Rothé F, Sotiriou C. Abstract P2-05-01: Whole genome sequencing reveals enrichment of mutations in mucin gene family in breast cancer diagnosed during pregnancy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-05-01] [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
Pregnancy is known to modulate breast cancer (BC) risk. Different reproductive behaviors have been shown to impact not only the risk of developing BC but also the phenotypes of these tumors. Breast cancer diagnosed during pregnancy (BCP) is a rare disease but could serve as a good model to understand how pregnancy modulates BC biology. In this project, we aim to interrogate the effect of pregnancy on the biology of BC by performing whole genome sequencing (WGS) using a unique series of BC patients diagnosed during pregnancy (BCP).
Method
Whole genome sequencing was performed for 35 BCP and 20 non-pregnant controls matched for age and stage with available clinic-pathological data. DNA extracted from primary tumor and matched adjacent normal FFPE tissues was assessed using WGS on Illumina HiSeqXTen platform targeting 60x and 30x coverage for tumor and normal DNA respectively. Briefly, 2x150bp paired end sequence data were generated, cleaned, trimmed and aligned to the reference genome (hg19) using bwa-mem. Somatic mutations were detected using Strelka and annotated using SnpEff. Mutational signatures were extracted using deconstructSigs. Differences on mutational profiles between BCP and case controls were assessed using Wilcoxon test for continuous variables and Fisher exact test for categorical variables.
Result
No difference in clinic-pathological features was observed between BCP and control patients. A median of 10084 and 13829 SNVs and of 26 and 21 indels were identified in the BCP and controls respectively, no significant difference between the two groups being observed (p = 0.703 and p = 0.851). Of interest, a significantly higher number of mutations was found in the BCP as compared to the control group when considering only mutations associated with a deleterious effect (median: 20 vs. 12, p = 0.027). As expected, TP53 and PIK3CA were the most frequently mutated genes both in BCP and control cases without any significant difference between the groups (34.3% vs. 22.2%, p = 0.53 and 20.0% vs. 16.7%, p = 1, respectively). Interestingly, there was a significant enrichment of non-silent mutations in the mucin genes family (MUC2, MUC4, MUC12, MUC16, MUC17, MUC20) in the BCP group: 45.7% of BCP vs. 11.1% of control cases had at least one such mutation (p = 0.015). A similar significant result (45.7% vs. 23.1%, p = 0.034) was found when comparing BCP with BC control cases from the TCGA dataset (selected to have similar age, ER and PR distribution, N = 56). When comparing the distribution of the twelve BC mutational signatures, a borderline significant enrichment with a signature depicting mismatch-repair deficiency (signature 20) was observed in the BCP patients (p = 0.059).
Conclusion
This is the first study reporting the mutational landscape of breast cancer diagnosed during pregnancy using WGS. We found that BCP are associated with a higher number of putative driver mutations including mutations in mucin genes, shown to be implicated in tumorigenesis. Furthermore, BCP were enriched with a mismatch-repair deficiency signature. These results could open new avenues for the development of targeted therapeutic approaches for patients diagnosed with breast cancer during pregnancy.
Citation Format: Nguyen B, Venet D, Desmedt C, Pruneri G, Peccatori F, Mardis ER, Azim HA, Rothé F, Sotiriou C. Whole genome sequencing reveals enrichment of mutations in mucin gene family in breast cancer diagnosed during pregnancy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-05-01.
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Affiliation(s)
- B Nguyen
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - D Venet
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - C Desmedt
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - G Pruneri
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - F Peccatori
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - ER Mardis
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - HA Azim
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - F Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
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Kassem L, Ismail M, Azim HA. Capecitabine and Vinorelbine Combination More Effective as the First Line Treatment of Advanced ER Positive Breast Cancer. Breast 2017. [DOI: 10.1016/s0960-9776(17)30704-x] [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] Open
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29
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Pagani O, Partridge AH, Azim HA, Peccatori F, Ruggeri M, Sun Z. Abstract OT3-02-01: POSITIVE: A study evaluating pregnancy and disease outcome and safety of interrupting endocrine therapy for young women with endocrine-responsive breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot3-02-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
Young breast cancer (BC) patients often face the disease before completing their family planning. The best available retrospective evidence suggests that pregnancy after BC does not negatively impact disease outcomes in patients with endocrine-responsive BC and is safe for offspring. However, given the possibility of prolonged adjuvant endocrine therapy (ET) (5-10 yrs), it is not feasible to wait until completion of therapy in many of these women and thus there is a need to explore the safety of temporary interruption of ET to allow pregnancy. To date, no prospective study has been conducted in young women attempting future pregnancy.
Trial Design
Young patients with endocrine-responsive early BC and pregnancy desire will interrupt ET for up to 2 yrs to attempt pregnancy. As resumption of menses and conception depends on many factors, e.g. patient's age and adjuvant treatment received, the 2-yr interruption period is approximate, intended to include treatment wash-out (3 mos) conception (∼3-6 mos), delivery (∼9 mos), breast feeding (∼6 mos). Patients will be strongly advised to resume ET as soon as pregnancy attempts are concluded and to complete the planned 5-10 yrs ET.
Major Eligibility Criteria
* Histologically-proven stage I-III endocrine-responsive BC.
* Age ≥ 18 and ≤ 42 years at enrollment.
* Adjuvant ET (SERM alone, GnRH analogue plus SERM or AI) for ≥18 mos but ≤30 mos, stopped within 1 mo prior to enrollment.
* Patient wishes to become pregnant.
* Premenopausal status at BC diagnosis.
Specific Aim
To assess the risk of BC relapse associated with temporary interruption of ET to permit pregnancy and to evaluate pregnancy success and offspring outcome.
Statistical Methods
A true risk of BC recurrence of 2% per year is assumed for patients who do not interrupt ET. With 500 patients enrolled in 4.0 yrs and an additional 1.6 yrs of follow up, there will be approximately 1600 patient-yrs of follow up and a median follow up of approximately 3 yrs at the time of the primary analysis, anticipated to occur 5.6 yrs after enrolment of the first patient. If the true risk of BC recurrence is 2% per yr, we anticipate 31 BC recurrences and an estimated 3-yr breast cancer free interval (BCFI) event of 5.6% (95% CI 4.0% to 7.9%).
Translational Research will investigate different ovarian function and uterine parameters; and circulating tumour DNA. FFPE tissue of the primary tumour will be collected to integrate different parameters related to biology of BC arising in young women. All material will be banked centrally.
Psycho-oncological Companion Study on fertility concerns, psychological well-being and decisional conflicts is mandatory in the US and open to interested centers elsewhere.
Accrual: Target: 500; Actual: 39 (30 Apr 2016)
Psycho-oncological Companion Study Accrual: Target: 200; Actual: 29 (30 Apr 2016)
Contact Information
POSITIVE is conducted and sponsored by the International Breast Cancer Study Group. The Alliance for Clinical Trials in Oncology is the US sponsor for NCTN network. Contact Monica Ruggeri, IBCSG Coordinating Center, monica.ruggeri@ibcsg.org, or Trial Coordinators at ibcsg48_positive@fstrf.org.
Citation Format: Pagani O, Partridge AH, Azim Jr. HA, Peccatori F, Ruggeri M, Sun Z. POSITIVE: A study evaluating pregnancy and disease outcome and safety of interrupting endocrine therapy for young women with endocrine-responsive breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-02-01.
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Affiliation(s)
- O Pagani
- International Breast Cancer Study Group, Bern, Switzerland
| | - AH Partridge
- International Breast Cancer Study Group, Bern, Switzerland
| | - HA Azim
- International Breast Cancer Study Group, Bern, Switzerland
| | - F Peccatori
- International Breast Cancer Study Group, Bern, Switzerland
| | - M Ruggeri
- International Breast Cancer Study Group, Bern, Switzerland
| | - Z Sun
- International Breast Cancer Study Group, Bern, Switzerland
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Nguyen B, Brown DN, Rothé F, Desmedt C, Majjaj S, Pruneri G, Peccatori F, Azim HA, Sotiriou C. Abstract P1-05-17: Interrogating the impact of pregnancy on breast cancer biology using DNA copy number profiling. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-17] [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
Epidemiological evidence indicates a clear relationship between pregnancy and breast cancer (BC) risk. However, little is known regarding the impact of pregnancy on BC biology. DNA copy number aberrations (CNAs) play an important role in breast carcinogenesis. BC during pregnancy is a rare disease but yet could serve as a good model to study the impact of pregnancy on BC biology.
Methods
We retrospectively included 54 pregnant and 113 non-pregnant BC patients matched for age and stage with complete clinico-pathological, gene expression and 5-year follow-up data. CNAs were assessed using Affymetrix OncoScan FFPE arrays. We identified the CNAs associated with pregnancy using a multivariate logistic regression adjusted for classical clinico-pathological features. We further evaluated their impact on gene expression.
Results
After quality control, CNA profiles were obtained for 38 pregnant and 87 non-pregnant BC patients. We identified 13 regions with copy number gains, 11 of which were more frequently gained in pregnant compared to non-pregnant controls and 5 regions with copy number loss, 3 of which were more frequently lost in pregnant patients (p≤0.05). Of interest, we identified 4 genes previously identified as driver event associated with CNAs in breast cancer (S. Nik-Zainal et al, Nature 2016). AKT1 and CDKN2A/B were more frequently gained in the pregnant compared to the non-pregnant (23.7% vs. 8.0%, p=0.068 and 18.4% vs. 4.6% p=0.036) and ARID1B was less frequently gained in the pregnant cohort (2.6% vs. 13.8%, p=0.02). Interestingly, PAPPA which had been previously identified as a pregnancy-dependent oncogene (Takabatake Y. et al, EMBO Mol Med. 2016) was also more frequently gained in the pregnant compared to the non-pregnant patients (21.1% vs 5.8%, p=0.03). We next evaluated the effect of these CNAs on their own gene expression levels and found that AKT1 and CDKN2A/B CNAs were affected by gene-dosage effect.
Conclusions
In this study, we were able to identify several genomic alterations associated with pregnancy that could further elucidate the impact of pregnancy on BC risk. Moreover, by combining CNAs with gene expression, we were able to identify genes whose expression were associated with CNAs and therefore could be considered potential drivers of this rare disease.
Citation Format: Nguyen B, Brown DN, Rothé F, Desmedt C, Majjaj S, Pruneri G, Peccatori F, Azim Jr HA, Sotiriou C. Interrogating the impact of pregnancy on breast cancer biology using DNA copy number profiling [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-17.
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Affiliation(s)
- B Nguyen
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - DN Brown
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - F Rothé
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - C Desmedt
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - S Majjaj
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - G Pruneri
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - F Peccatori
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - HA Azim
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
| | - C Sotiriou
- Jules Bordet Institute, Brussels, Belgium; European Institute of Oncology, Milan, Italy
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Azim HA, Kassem L, Treilleux I, Wang Q, El Enein MA, Anis SE, Bachelot T. Analysis of PI3K/mTOR Pathway Biomarkers and Their Prognostic Value in Women with Hormone Receptor-Positive, HER2-Negative Early Breast Cancer. Transl Oncol 2016; 9:114-123. [PMID: 27084427 PMCID: PMC4833894 DOI: 10.1016/j.tranon.2016.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 11/27/2015] [Revised: 12/28/2015] [Accepted: 01/04/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND: The PI3K/AKT/mTOR pathway alterations have been shown to play significant roles in the development, progression, and metastatic spread of breast cancer. Furthermore, they have been implicated in the process of drug resistance, especially endocrinal therapies. In this study, we aimed to define the correlation between the PI3K mutations and the expression of the phosphorylated forms of different downstream molecules in women with estrogen receptor (ER)–positive, human epidermal growth factor receptor 2–negative (luminal) early breast cancer treated at Cairo university hospitals. METHODS: Next-generation sequencing was used to detect mutations in the PIK3CA hotspots (in exons 9 and 20). Immunohistochemistry was performed on tissue microarray blocks prepared from samples of 35 Egyptian luminal breast cancer patients in the pathology department of Centre Léon Bérard (CLB). The intensity and the percentage of stained tumor cells were integrated to define high versus low biomarker expression. The cytoplasmic and nuclear stainings were graded separately. Patients were followed for a median of 4.7 years (2.1 to 6.9 years). Correlation was done between PI3K mutations and the immunohistochemistry expression of pAKT, LKB1, p4EBP1, and pS6 ribosomal protein (pS6RP) with the clinicopathologic features and disease free survival (DFS) of the patients. RESULTS: Median age at diagnosis was 51.3 years (range, 25 to 82 years). Tumors were larger than 20 mm in 79.2% of the cases, whereas 57.9% had axillary lymph node deposits. Only 12.3% of the patients had SBR grade I tumors, 50.8% had grade II, and 36.8% had grade III. ERs were negative in 6 patients (17%) after pathology review. Thirty-two cases were assessable for LKB1 and pAKT, 33 for p4EBP1 and pS6RP, and 24 for PI3K mutations. Nuclear LKB1, cytoplasmic LKB1, nuclear pAKT, cytoplasmic pAKT, nuclear p4EBP1, and cytoplasmic pS6RP expression was high in 65.6%, 62.5%, 62.5%, 68.8%, 42.4%, and 57.6%, respectively. PIK3CA mutations were found in 7 patients (29.2%). PI3K mutations were correlated with nuclear localization of pAKT (i.e., decreased cytoplasmic pAKT, P = .04; and increased nuclear pAKT, P = .10). There was a tendency toward an inverse correlation between PI3K mutations and the expression of pS6RP (P = .10) and p4EBP1 (P = .19). Nuclear LKB1 expression was a marker of good prognosis. It was associated with smaller tumors (P = .05), more ER (P = .08) and progesteron receptor (PgR) positivity (P = .002). In the Kaplan Meier (KM) model, patients with high nuclear LKB1 had longer DFS (hazard ratio = 0.36; 95% confidence interval, 0.15-1.10; P = .08). Nuclear pAKT high expression also carried a tendency toward longer DFS (hazard ratio = 0.51; 95% confidence interval, 0.11-1.16; P = .13). The expression of p4EBP1, pS6RP, and the PI3K mutational status did not show any prognostic significance in our cohort. CONCLUSION: Among the studied biomarkers, only nuclear expression of LKB1 and pAKT tended to predict better survival in breast cancer patients. PI3K mutation was correlated with the expression of nuclear pAKT but not pS6RP or p4EBP1.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Cairo University Hospital, Cairo, Egypt.
| | - Loay Kassem
- Department of Clinical Oncology, Cairo University Hospital, Cairo, Egypt.
| | | | - Qing Wang
- Genomic Platform-Translational Research Laboratory, Centre Léon Bérard, Lyon, France
| | - Mona Abu El Enein
- Department of Clinical Oncology, Cairo University Hospital, Cairo, Egypt
| | - Shady E Anis
- Department of Pathology, Cairo University Hospital, Cairo, Egypt
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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Gingras I, Sonnenblick A, de Azambuja E, Paesmans M, Delaloge S, Aftimos P, Piccart MJ, Sotiriou C, Ignatiadis M, Azim HA. The current use and attitudes towards tumor genome sequencing in breast cancer. Sci Rep 2016; 6:22517. [PMID: 26931736 PMCID: PMC4773754 DOI: 10.1038/srep22517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 10/28/2015] [Accepted: 02/09/2016] [Indexed: 12/24/2022] Open
Abstract
There is increasing availability of technologies that can interrogate the genomic landscape of an individual tumor; however, their impact on daily practice remains uncertain. We conducted a 28-item survey to investigate the current attitudes towards the integration of tumor genome sequencing in breast cancer management. A link to the survey was communicated via newsletters of several oncological societies, and dedicated mailing by academic research groups. Multivariable logistic regression modeling was carried out to determine the relationship between predictors and outcomes. 215 physicians participated to the survey. The majority were medical oncologists (88%), practicing in Europe (70%) and working in academic institutions (66%). Tumor genome sequencing was requested by 82 participants (38%), of whom 21% reported low confidence in their genomic knowledge, and 56% considered tumor genome sequencing to be poorly accessible. In multivariable analysis, having time allocated to research (OR 3.37, 95% CI 1.84–6.15, p < 0.0001), working in Asia (OR 5.76, 95% CI 1.57 – 21.15, p = 0.01) and having institutional guidelines for molecular sequencing (OR 2.09, 95% 0.99–4.42, p = 0.05) were associated with a higher probability of use. In conclusion, our survey indicates that tumor genome sequencing is sometimes used, albeit not widely, in guiding management of breast cancer patients.
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Affiliation(s)
- I Gingras
- Department of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - A Sonnenblick
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - E de Azambuja
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - M Paesmans
- Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - S Delaloge
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Philippe Aftimos
- Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - M J Piccart
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - M Ignatiadis
- Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - H A Azim
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
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Pagani O, Partridge A, Azim HA, Peccatori FA, Ruggeri M, Sun Z. Abstract OT2-01-08: POSITIVE: A study evaluating pregnancy and disease outcome and safety of interrupting endocrine therapy for young women with endocrine responsive breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot2-01-08] [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
Young breast cancer (BC) patients often face the disease before completing their family planning. The best available retrospective evidence suggests that pregnancy after BC does not negatively impact disease outcome in patients with endocrine sensitive BC and is safe for the offspring. However, given the need for prolonged adjuvant endocrine therapy for 5-10 years, it is not feasible to wait until completion of therapy in most of these women and thus there is a need to explore the safety of temporary interruption of endocrine therapy to allow pregnancy. To date, no definitive prospective study has been conducted in young women desiring future pregnancy.
Trial Design
Young patients with endocrine responsive early BC and pregnancy desire will interrupt endocrine treatment for up to 2 yrs to attempt pregnancy. As resumption of menses and conception depends on many factors, e.g. patient's age and adjuvant treatment received, the 2-yr interruption period is approximate, intended to include treatment wash-out (3 mos) conception (∼3-6 mos), delivery (∼9 mos), breast feeding (∼6 mos). Patients will be strongly advised to resume ET as soon as pregnancy attempts are concluded, and to complete 5-10 yrs ET at the local investigator discretion.
Major Eligibility Criteria
-Histologically-proven stage I-III endocrine-responsive BC.
-Age ≥ 18 and ≤ 42 years at enrollment.
-Adjuvant endocrine therapy (SERM alone, GnRH analogue plus SERM or AI) for ≥18 months but ≤30 months, stopped within 1 month prior to enrollment.
-Patient wishes to become pregnant.
-Premenopausal status at BC diagnosis.
Specific Aim
To assess the risk of BC relapse associated with temporary interruption of ET to permit pregnancy and to evaluate pregnancy success.
Statistical Methods
A true risk of BC recurrence of 2% per year is assumed for patients who do not interrupt endocrine treatment. With 500 patients enrolled in 4.0 yrs and an additional 1.6 yrs of follow up, there will be approximately 1600 patient-yrs of follow up and a median follow up of approximately 3 yrs at the time of the primary analysis, anticipated to occur 5.6 yrs after enrollment of the first patient. If the true risk of BC recurrence is 2% per yr, we anticipate 31 BC recurrences and an estimated 3-yr breast cancer free interval (BCFI) failure of 5.6% (95% CI 4.0% to 7.9%).
Translational Research will investigate different ovarian function parameters; uterine evaluation; and circulating tumor DNA. FFPE tissue of the primary tumor will be collected to integrate different parameters related to biology of BC arising in young women. All material will be banked centrally.
Psycho-oncological Companion Study on fertility concerns, psychological well-being and decisional conflicts is mandatory in the United States and open to interested centers elsewhere.
Accrual: Target: 500; Actual: 4 (31 May 2015)
Contact Information
POSITIVE is conducted and sponsored by the International Breast Cancer Study Group. Alliance for Clinical Trials in Oncology is US sponsor for NCTN network. Contact Trial Coordinators at ibcsg48_positive@fstrf.org.
Citation Format: Pagani O, Partridge A, Azim Jr HA, Peccatori FA, Ruggeri M, Sun Z. POSITIVE: A study evaluating pregnancy and disease outcome and safety of interrupting endocrine therapy for young women with endocrine responsive breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-01-08.
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Affiliation(s)
- O Pagani
- International Breast Cancer Study Group, Bern, Switzerland; Dana-Farber Cancer Insitute and Alliance for Clinical Trials in Oncology, Boston, MA
| | - A Partridge
- International Breast Cancer Study Group, Bern, Switzerland; Dana-Farber Cancer Insitute and Alliance for Clinical Trials in Oncology, Boston, MA
| | - HA Azim
- International Breast Cancer Study Group, Bern, Switzerland; Dana-Farber Cancer Insitute and Alliance for Clinical Trials in Oncology, Boston, MA
| | - FA Peccatori
- International Breast Cancer Study Group, Bern, Switzerland; Dana-Farber Cancer Insitute and Alliance for Clinical Trials in Oncology, Boston, MA
| | - M Ruggeri
- International Breast Cancer Study Group, Bern, Switzerland; Dana-Farber Cancer Insitute and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Z Sun
- International Breast Cancer Study Group, Bern, Switzerland; Dana-Farber Cancer Insitute and Alliance for Clinical Trials in Oncology, Boston, MA
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Azim HA, Sonnenblick A, Agbor-Tarh D, Bradbury I, Daly F, Huang Y, Dueck AC, Pritchard K, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Perez E, Piccart M, de Azambuja E. Abstract PD5-07: The impact of early lapatinib-induced rash on disease-free and overall survival in patients treated within the ALTTO phase III randomized trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd5-07] [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: We have previously shown in a phase III neoadjuvant trial that early development of lapatinib-induced rash (i.e. within 6 weeks after lapatinib initiation) is independently associated with a higher chance of obtaining a pathological complete response (Azim et al; JCO 2013). In the current study, we aimed to investigate whether early lapatinib-induced rash is associated with improved survival in the context of a large phase III adjuvant trial.
Methods: This analysis is based on the ALTTO trial (BIG 2-06, Alliance N063D), in which patients with HER2-positive early breast cancer were randomized to adjuvant trastuzumab, lapatinib, their sequence or their combination for a total duration of 1 year. In this sub-study, we evaluated whether the development of rash (any grade) within 6 weeks of lapatinib initiation was associated with disease-free (DFS) and overall survival (OS). All analyses were tested in a multivariate model adjusted for treatment arm, treatment completion and trial stratification factors.
Results: A total of 6,098 lapatinib-treated patients were included in the current analysis; of whom 2,006 patients (32.9%) developed early lapatinib-induced rash, 1,025 (16.8%) developed rash after 6 weeks and 3,067 (50.3%) did not develop rash. No differences in patient characteristics were observed between the three groups apart from a higher frequency of younger patients (≤ 50) in the early rash group (54% vs. 47% and 44%, p<0.0001). At a median follow-up of 4.5 years, 876 (14.37%) and 377 (6.18%) patients in the lapatinib containing arms experienced a DFS and OS event, respectively. In a multivariate analysis confined to patients randomized to the lapatinib containing arms, the development of early rash was associated with improved DFS (HR: 0.80; 95%CI: 0.69-0.93, p=0.004) and OS (HR: 0.61; 95%CI: 0.48 - 0.78, p<0.001) compared to patients who did not develop early rash, with no interaction according to patient's age (p=0.9). No significant association was observed between the development of rash after 6 weeks of lapatinib initiation and survival. Compared to patients randomized to the trastuzumab alone arm (n=2,076), patients who developed early rash in the sequence (n=580) or combination (n=704) arms of trastuzumab/lapatinib had superior DFS (Sequence: HR 0.75 [95% CI: 0.58 – 0.98], p=0.034; Combination: HR 0.69 [95% CI: 0.54 – 0.89], p=0.005) and OS (Sequence: HR 0.57 [95%CI: 0.36 – 0.88], p=0.012; Combination: HR 0.59 [95% CI: 0.39 – 0.89], p=0.011). On the other hand, patients randomized to the lapatinib only arm who developed early rash (n=722) still had inferior DFS (HR 1.28 [95% CI: 1.04 – 1.59], p=0.02) with no difference in OS (HR: 0.95; 95%CI: 0.67 – 1.35, p=0.79) compared to patients randomized to the trastuzumab alone arm.
Conclusions: The results support our previous findings in the neoadjuvant setting that early development of skin rash within the first 6 weeks can identify patients who derive superior benefit of lapatinib treatment.
Citation Format: Azim Jr HA, Sonnenblick A, Agbor-Tarh D, Bradbury I, Daly F, Huang Y, Dueck AC, Pritchard K, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Perez E, Piccart M, de Azambuja E. The impact of early lapatinib-induced rash on disease-free and overall survival in patients treated within the ALTTO phase III randomized trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD5-07.
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Affiliation(s)
- HA Azim
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - A Sonnenblick
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - D Agbor-Tarh
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - I Bradbury
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - F Daly
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - Y Huang
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - AC Dueck
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - K Pritchard
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - AC Wolff
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - C Jackisch
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - I Lang
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - M Untch
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - I Smith
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - F Boyle
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - B Xu
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - H Gomez
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - E Perez
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - M Piccart
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - E de Azambuja
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
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Gingras I, Sonnenblick A, Dolci S, de Azambuja E, Paesmans M, Delaloge S, Piccart MJ, Sotiriou C, Michail I, Azim HA. Abstract P6-04-13: The role of precision medicine in "real-life" management of breast cancer patients: A survey assessing the current use and attitudes towards tumor molecular sequencing in clinical practice. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-04-13] [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: Personalized medicine is a rising paradigm in cancer care. The identification of pathways involved in carcinogenesis along with the development of targeted therapies has revolutionized cancer treatment. There is increasing availability of technologies that can interrogate the genomic landscape of the tumor; however, it is still uncertain whether such platforms are used in clinical practice.
Methods: We conducted a 28-item survey to investigate the current use of tumor molecular sequencing in the management of breast cancer patients. A link to the online survey was communicated via various platforms such as the European Society for Medical Oncology (ESMO) and European School of Oncology (ESO) newsletter, and via a dedicated mailing by the Breast International Group (BIG) and other academic groups. Descriptive statistical analysis and Fisher's exact tests were applied to explore potential association between the demographic characteristics and responses.
Results: A total of 211 physicians from 35 countries participated to the study between the 9 March and 3 June 2015, with 92% fully completed questionnaires. The mean age of the participants was 45 years (range 27-77). The majority of responders were medical oncologists (88%), practicing in Europe (69%) and working in academic institutions (66%). 62% (130/211) of participants had never requested tumor molecular sequencing for breast cancer patients. Working in academic institutions and having more time allocated to research were associated with the use of tumor molecular sequencing (p = 0.007 and 0.009, respectively). For the 81 participants that used tumor molecular sequencing in the past (Table 1), there was a significant association between accessibility and frequency of use (p=0.02). 92% (181/211) of participants claimed that they would probably use tumor molecular sequencing more often if it was more accessible. Lack of funding and lack of access to the technology were the main reasons for poor endorsement. 89% of participants believe that tumor molecular sequencing will play a major role in the management of breast cancer patients in the future. Current weak evidence and poor access to matched targeted therapy are the main concerns against a wider use of these platforms in clinical practice.
Table 1. Summary of replies from the 81 participants that used tumor molecular sequencing for breast cancer patientsQuestionResponseN (%)In what percentage of your breast cancer patients has tumor molecular sequencing been performed at least once?≤5%55 (68%) >5%26 (32%)How often do the results lead to enrollment in a clinical trial?≤10%53 (65%) >10%28 (35%)How confident are you in interpreting tumor sequencing results?Not at all/A little17 (21%) Somewhat/Highly64 (79%)Do you consider molecular sequencing platforms accessible?Not at all/A little45 (55%) Somewhat/Highly36 (45%)
Conclusion: Our survey indicates that molecular sequencing platforms are sometimes used, albeit not widely in guiding management of breast cancer patients. Poor accessibility may contribute to the low frequency of use, but lack of evidence and poor access to matched targeted therapy are also major concerns.
Citation Format: Gingras I, Sonnenblick A, Dolci S, de Azambuja E, Paesmans M, Delaloge S, Piccart MJ, Sotiriou C, Michail I, Azim Jr HA. The role of precision medicine in "real-life" management of breast cancer patients: A survey assessing the current use and attitudes towards tumor molecular sequencing in clinical practice. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-04-13.
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Affiliation(s)
- I Gingras
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - A Sonnenblick
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - S Dolci
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - E de Azambuja
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - M Paesmans
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - S Delaloge
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - MJ Piccart
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - C Sotiriou
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - I Michail
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
| | - HA Azim
- Institut Jules Bordet, Brussels, Belgium; Institut Gustave-Roussy, Paris, France
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Ahmed Farag AF, Elbarmelgi MY, Azim HA, Abozeid AA, Mashhour AN. TNMF versus TNM in staging of colorectal cancer. Int J Surg 2016; 27:147-150. [PMID: 26836283 DOI: 10.1016/j.ijsu.2016.01.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
AIM TNM staging and histological grading of rectal cancer has undergone no or minimal changes during the past 20 years despite their major impact on planning, reporting and outcome of the disease. The addition of category 'F' to the 'TNM' staging of colorectal cancer, which becomes TNMF will accommodate the expanding list of risk factors that may affect the management and thus avoid squeezing them into the TNM categories. METHODS Reporting of the following risk factors was traced in 730 (664 retrospective and 66 prospective) cases of colorectal cancer: age, Tumor location, preoperative CEA, intraoperative tumor perforation and blood transfusion, quality of TME, tumor grade, non nodal T.Ds, Lymphovascular invasion, lymph node ratio, circumferential tumor margins, apical lymph nodes, infiltrating or pushing and K-ras gene mutation. RESULTS The reporting of most risk factors was inadequate; also there is marked improvement in reporting in the prospective cases in preoperative CEA, intra operative blood transfusion and tumor perforation, quality of TME, tumor grade and non-nodal T.Ds (P-value <0.0001). CONCLUSION The addition of category 'F' to the TNM staging system to become TNMF may avoid ignoring already established risk factors due to our inability to accommodate them in the inhospitable TNM categories.
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Affiliation(s)
| | | | - Hamdy A Azim
- Medical Oncology Department, Cairo University, Egypt.
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Elbarmelgi MY, Farag A, Azim HA, Abozeid AA, Mashour AN, Mikhail HMS. Reporting of the circumferential tumour margin involvement and preoperative levels of carcinoembryonic antigen as prognostic risk factors in colorectal cancer patients. Arab J Gastroenterol 2015; 16:113-5. [PMID: 26526512 DOI: 10.1016/j.ajg.2015.09.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/10/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND STUDY AIMS The two very important prognostic risk factors of colorectal cancer are circumferential tumour margin (CTM) involvement and preoperative levels of carcinoembryonic antigen (CEA). The aim of this study is to monitor the frequency of reporting of the CTM in the postoperative pathology reports after colorectal cancer resection in addition to monitoring the frequency of reporting of preoperative levels of CEA and exploring the possibility of improving the frequency of reporting of both. PATIENTS AND METHODS Reports of the CTM and preoperative level of CEA were found in 730 (664 retrospective and 66 prospective) patients with colorectal cancer. The possibility of improving the incidence of reporting was estimated by comparing the reporting frequency of both (retrospective and prospective) groups. RESULTS The percentage of reporting the involvement of the CTM was 46.08% and 81.81% for the retrospective group and the prospective group, respectively. The percentage of reporting the preoperative CEA levels was 40.9% and 68.7% for the retrospective and the prospective groups, respectively. There was a statistically significant difference in reporting both CTMs and the preoperative level of CEA between retrospective and prospective groups to the side of prospective group in which the p-value was <0.0001 for both groups. CONCLUSION There was inadequate reporting of both the CTM involvement and preoperative levels of CEA in the retrospective patients with statistically significant improvement of this reporting in patients in the prospective group. This may point to the unawareness of the importance of both in the prognosis of colorectal cancer, which may be because both are not involved in the widely used tumour, node, metastasis (TNM) staging system.
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Affiliation(s)
| | - Ahmed Farag
- General Surgery Department, Cairo University, Cairo, Egypt.
| | - Hamdy A Azim
- Medical Oncology Department, Cairo University, Cairo, Egypt.
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Abdel-Rahman O, Azim HA, Mikhail S, Salem ME. New hope on the horizon for patients with metastatic colorectal cancer. Colorectal Cancer 2015. [DOI: 10.2217/crc.15.28] [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: 11/21/2022]
Abstract
Colorectal cancer is the second leading cause of cancer death in the USA. It is estimated that approximately 132,700 patients are diagnosed with, and more than 49,700 are expected to die of colorectal cancer each year. For many years, 5-fluorouracil was the only treatment option for patients with metastatic colorectal cancer but, over the last decade, the introduction and the US FDA approval of irinotecan, oxaliplatin and several monoclonal antibodies that target the VEGF and EGF receptor have markedly changed the therapeutic landscape. Most recently, regorafenib, ramucirumab and the novel orally active TAS-102 have also become available, presenting even more therapeutic options. In this review, we focus on emerging systemic therapy options for the management of advanced/metastatic colorectal cancer, particularly in the second-line/salvage settings, highlighting existing scientific evidence for the activity of, as well as future perspectives on, these more novel treatments.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hamdy A Azim
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sameh Mikhail
- The Ohio State University Comprehensive Cancer Center–James Cancer Hospital, Columbus, OH 43210, USA
| | - Mohamed E Salem
- Department of Medicine, Division of Hematology and Oncology, Georgetown University, Washington, DC 20057, USA
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, USA
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Lambertini M, Ceppi M, Poggio F, Peccatori FA, Azim HA, Ugolini D, Pronzato P, Loibl S, Moore HCF, Partridge AH, Bruzzi P, Del Mastro L. Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: a meta-analysis of randomized studies. Ann Oncol 2015; 26:2408-19. [PMID: 26347105 DOI: 10.1093/annonc/mdv374] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [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: 07/07/2015] [Accepted: 09/01/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The role of temporary ovarian suppression with luteinizing hormone-releasing hormone agonists (LHRHa) in the prevention of chemotherapy-induced premature ovarian failure (POF) is still controversial. Our meta-analysis of randomized, controlled trials (RCTs) investigates whether the use of LHRHa during chemotherapy in premenopausal breast cancer patients reduces treatment-related POF rate, increases pregnancy rate, and impacts disease-free survival (DFS). METHODS A literature search using PubMed, Embase, and the Cochrane Library, and the proceedings of major conferences, was conducted up to 30 April 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) for POF (i.e. POF by study definition, and POF defined as amenorrhea 1 year after chemotherapy completion) and for patients with pregnancy, as well hazard ratios (HRs) and 95% CI for DFS, were calculated for each trial. Pooled analysis was carried out using the fixed- and random-effects models. RESULTS A total of 12 RCTs were eligible including 1231 breast cancer patients. The use of LHRHa was associated with a significant reduced risk of POF (OR 0.36, 95% CI 0.23-0.57; P < 0.001), yet with significant heterogeneity (I(2) = 47.1%, Pheterogeneity = 0.026). In eight studies reporting amenorrhea rates 1 year after chemotherapy completion, the addition of LHRHa reduced the risk of POF (OR 0.55, 95% CI 0.41-0.73, P < 0.001) without heterogeneity (I(2) = 0.0%, Pheterogeneity = 0.936). In five studies reporting pregnancies, more patients treated with LHRHa achieved pregnancy (33 versus 19 women; OR 1.83, 95% CI 1.02-3.28, P = 0.041; I(2) = 0.0%, Pheterogeneity = 0.629). In three studies reporting DFS, no difference was observed (HR 1.00, 95% CI 0.49-2.04, P = 0.939; I(2) = 68.0%, Pheterogeneity = 0.044). CONCLUSION Temporary ovarian suppression with LHRHa in young breast cancer patients is associated with a reduced risk of chemotherapy-induced POF and seems to increase the pregnancy rate, without an apparent negative consequence on prognosis.
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Affiliation(s)
- M Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova
| | - M Ceppi
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genova
| | - F Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova
| | - F A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy
| | - H A Azim
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - D Ugolini
- Department of Internal Medicine, University of Genoa, Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genova, Italy
| | - P Pronzato
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova
| | - S Loibl
- German Breast Group (GBG), Neu-Isenburg Sana-Klinikum Offenbach, Offenbach am Main, Germany
| | - H C F Moore
- Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - P Bruzzi
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genova
| | - L Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy
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Abstract
AIM To illustrate the differences between invasive lobular and ductal carcinomas (ILCs and IDCs) in terms of baseline demographics, pathologic features and recurrence in Egyptian breast cancer patients. PATIENTS & METHODS Retrospective analysis of breast cancer patients diagnosed and treated between 2000 and 2008 was performed. RESULTS 176 (8.5%) and 1758 (85%) cases were diagnosed with ILC and IDC, respectively. Compared with IDC, ILC was less observed in patients under 35 years of age (3.4 vs 9.3%; p = 0.009), and was associated with more bilaterality (p = 0.001), advanced tumor stage (p = 0.027) and nodal involvement (p = 0.004). On the other hand, IDC was significantly associated with more luminal B-like phenotype (16.9 vs 8.1%; p < 0.001) and more HER2-enriched disease (11.5 vs 2.7%; p < 0.001). At a median follow-up time of 64 months, ILC histology was independently associated with better disease-free survival (hazard ratio: 0.58; 95% CI: 0.36-0.93; p = 0.023). Bone and peritoneal relapses were more common in ILC, while lung relapses were more common in IDC. CONCLUSION ILC has distinct biologic and prognostic features that may warrant different therapeutic approaches.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Cairo University Hospital, Cairo, Egypt
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42
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Affiliation(s)
- H A Azim
- Breast Cancer Translational Research Laboratory (BCTL), Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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43
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Fouad TM, de Azambuja E, Azim HA. Duration of endocrine therapy and its impact on the results of adjuvant trials in premenopausal breast cancer patients. Ann Oncol 2015; 26:1511. [PMID: 25899784 DOI: 10.1093/annonc/mdv193] [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: 11/13/2022] Open
Affiliation(s)
- T M Fouad
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - E de Azambuja
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - H A Azim
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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44
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Azim HA, Saadeldeen A. Commentary on "aTTom": long-term effects of continuing adjuvant Tamoxifen to 10 years. Chin Clin Oncol 2015; 3:7. [PMID: 25842085 DOI: 10.3978/j.issn.2304-3865.2013.12.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/01/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Hamdy A Azim
- Oncology Department, School Of Medicine, Cairo University, Egypt.
| | - Ahmed Saadeldeen
- Medical Oncology Department, Nation Guard Hospital, Kingdom of Saudi Arabia
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45
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Zagouri F, Liakou P, Bartsch R, Peccatori FA, Tsigginou A, Dimitrakakis C, Zografos GC, Dimopoulos MA, Azim HA. Discrepancies between ESMO and NCCN breast cancer guidelines: An appraisal. Breast 2015; 24:513-23. [PMID: 25818651 DOI: 10.1016/j.breast.2015.02.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 10/21/2014] [Revised: 01/12/2015] [Accepted: 02/22/2015] [Indexed: 11/29/2022] Open
Abstract
An ever growing number of medical organizations, societies, working groups and governmental agencies issue algorithms i.e. guidelines, of decision making flowcharts in diagnosis and treatment in a variety of diseases. In the field of evidence-based diagnosis and treatment of breast cancer, a large number of guidelines are available both from medical associations and national health departments. Among the most appreciated and utilized comprehensive guides is the European Society for Medical Oncology (ESMO) Breast Cancer Guidelines and from the other side of the Atlantic the National Comprehensive Cancer Network (NCCN) Guidelines in Breast Cancer. Although there is much concordance between the guidelines from these two organizations, it is intriguing to locate their discrepancies also. The aim of this report is to present a number of different points between ESMO and NCCN in the whole spectrum of breast cancer management, from prevention and diagnosis to treatment and follow up. This systematic review was performed in accordance with the PRISMA guidelines using a predefined search strategy and summarizes in detail, the differences between ESMO and NCCN guidelines regarding genetic risk evaluation and screening, surgery, chemotherapy, endocrine treatment, targeted biological agents, radiotherapy, pregnancy and fertility and follow-up.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Greece
| | - Paraskevi Liakou
- 1st Propaedeutic Surgical Dept, Hippocrateio Hospital, Medical School, University of Athens, Athens, Greece
| | - Rupert Bartsch
- Clinical Division of Oncology, Medical University of Vienna, Austria
| | - Fedro A Peccatori
- Department of Obstetrics and Gynecology, Medical School, University of Athens, Greece
| | - Alexandra Tsigginou
- Fertility and Procreation Unit, Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - Constantine Dimitrakakis
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - George C Zografos
- 1st Propaedeutic Surgical Dept, Hippocrateio Hospital, Medical School, University of Athens, Athens, Greece
| | | | - H A Azim
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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46
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Criscitiello C, Azim HA, de Azambuja E, Rubio IT. Factors affecting surgical management following neoadjuvant therapy in patients with primary HER2-positive breast cancer: results from the NeoALTTO phase III trial. Ann Oncol 2014; 25:910-911. [PMID: 24667722 DOI: 10.1093/annonc/mdu034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Criscitiello
- Department of Medical Oncology, Istituto Europeo di Oncologia, Milan, Italy.
| | - H A Azim
- BrEAST Data Centre and Department of Medicine, Clinical Oncology, Brussels, Belgium
| | - E de Azambuja
- BrEAST Data Centre and Department of Medicine, Clinical Oncology, Brussels, Belgium
| | - I T Rubio
- Breast Surgical Onclogy Unit, Universitario Vall D'Hebron, Barcelona, Spain
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47
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Affiliation(s)
- Hamdy A Azim
- 1 Clinical Oncology Department, Faculty of Medicine, Cairo University, Egypt ; 2 Epidemiology Department, National Cancer Institute, Cairo University, Egypt
| | - Amal S Ibrahim
- 1 Clinical Oncology Department, Faculty of Medicine, Cairo University, Egypt ; 2 Epidemiology Department, National Cancer Institute, Cairo University, Egypt
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48
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Azim HA, Bahr SA, Kamal NS, Koura MA, Tolba R, Gad HA, Morsy A, Attia HM, Iskander I, Hammad A, Hemed MF, Abdallah MF, Sadek KA, Taha AH. One for the road! A study to assess the efficacy of single low-dose regimen of rasburicase in controlling hyperuricaemia in patients with tumour lysis syndrome due to haematological malignancies. Ecancermedicalscience 2013; 7:378. [PMID: 24324529 PMCID: PMC3855003 DOI: 10.3332/ecancer.2013.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/12/2013] [Indexed: 11/20/2022] Open
Abstract
We conducted a retrospective audit of six patients with various haematological malignancies (two acute lymphoblastic leukaemia, one acute myeloid leukaemia, and three non-Hodgkin lymphoma); these patients were eligible to receive rasburicase, being at high risk of development of tumour lysis syndrome (TLS). They received a fixed single low-dose regimen of rasburicase (7.5 mg) mainly due to financial restriction, as patients were not supported by the National Health Service and did not have health insurance. We compared uric acid, creatinine levels, and electrolytes (i.e. phosphate, potassium, and calcium) before and after rasburicase administration and also assessed the need for renal replacement therapy after treatment. All six patients had a significant reduction in uric acid levels on the first day, achieving a response rate of 100% (p = 0.008994); creatinine, phosphate, and potassium were reduced significantly as well, with the p values of 0.0439, 0.014326, and 0.002008, respectively; only one patient needed renal replacement therapy in the form of haemodialysis, due to concerns about hyperphosphataemia. Financial difficulties faced either because patients lacked insurance or because of the restricted National Health Service budget in Egypt have resulted in the unavailability of certain modalities of treatment in cancer care and the need to consider more economic yet efficient approaches. Our experience suggests that a single low-dose rasburicase injection (7.5 mg) is an efficient and cost-effective method to control hyperuricaemia in patients with a high risk of developing TLS when compared with the more expensive and extended standard regimen and doses recommended.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt ; Clinical Oncology and Bone Marrow Transplantation Unit, Manial Specialized University Hospital, Cairo University, Cairo, Egypt
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49
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Peccatori FA, Azim HA, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, Pentheroudakis G. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi160-70. [PMID: 23813932 DOI: 10.1093/annonc/mdt199] [Citation(s) in RCA: 461] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- F A Peccatori
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology, Milan, Italy
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50
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Azim HA, Kamal NS, Malak RA. Bisphosphonates in the adjuvant treatment of young women with breast cancer: the estrogen rich is a poor candidate! J Thorac Dis 2013; 5 Suppl 1:S27-35. [PMID: 23819025 PMCID: PMC3695537 DOI: 10.3978/j.issn.2072-1439.2013.06.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/03/2013] [Indexed: 01/06/2023]
Abstract
During the last 2 decades the role of bisphosphonates (BPs) to reduce skeletal-related events from bone metastases in breast cancer has been well defined. Several preclinical studies have strongly suggested that BPs may also provide an anti-cancer effect in early breast cancer. Indeed, the use of adjuvant BPs represents a unique approach that attempts at eradicating occult tumor micro-metastases residing in the bone marrow via targeting the bone microenvironment to render it less favorable for cancer cell growth. Although, this concept has been tested clinically for more than 15 years, no final consensus has been reached as for the routine use of BPs in the adjuvant phase of breast cancer, owing to conflicting results of randomized studies. Nevertheless, accumulating evidence from recent trials has indicated a therapeutic benefit of adjuvant BPs-particularly zoledronic acid-in women with established menopause, with no or perhaps detrimental effects in premenopausal women. Indeed, this hypothesis has opened a new chapter on the role of estrogen-poor microenvironment as a potential pre-requisite for the anti-tumor effects of BPs in the adjuvant phase of breast cancer. In this review, we will emphasize the biological rational of using BPs to target bone microenvironment in patients with early breast cancer and we will explore mechanistic differences; related to bisphosphonates effects in premenopausal versus postmenopausal women and how the endocrine environment would influence the anticancer potential of these compounds.
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Affiliation(s)
- Hamdy A Azim
- The Department of Clinical Oncology, Cairo University, Giza, Egypt
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