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Monteiro MR, Nunes NCC, Junior AADS, Fêde ABDS, Bretas GDO, Souza CDP, Mano M, da Silva JL. Antibody-Drug Conjugates in Breast Cancer: A Comprehensive Review of How to Selectively Deliver Payloads. Breast Cancer (Dove Med Press) 2024; 16:51-70. [PMID: 38434801 PMCID: PMC10909371 DOI: 10.2147/bctt.s448191] [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] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
Antibody-drug conjugates (ADCs) have surfaced as a promising group of anticancer agents employing the precise targeting capacity of monoclonal antibodies to transport highly effective cytotoxic payloads. Compared to conventional chemotherapy, they aim to selectively eradicate cancer cells while minimizing off-target toxicity on healthy tissues. An increasing body of evidence has provided support for the efficacy of ADCs in treating breast cancer across various contexts and tumor subtypes, resulting in significant changes in clinical practice. Nevertheless, unlocking the full potential of these therapeutic agents demands innovative molecular designs to address complex clinical challenges, including drug resistance, tumor heterogeneity, and treatment-related adverse events. This thorough review provides an in-depth analysis of the clinical data on ADCs, offering crucial insights from pivotal clinical trials that assess the efficacy of ADCs in diverse breast cancer settings. This aids in providing a comprehensive understanding of the current state of ADCs in breast cancer therapy, while also providing valuable perspectives for the future.
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Affiliation(s)
| | | | | | | | | | | | - Max Mano
- Grupo Oncoclínicas, São Paulo, Brazil
| | - Jesse Lopes da Silva
- Grupo Oncoclínicas, Rio de Janeiro, Brazil
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
- Hospital da Força Aérea do Galeão, Rio de Janeiro, Brazil
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Monteiro MR, Nunes NCC, Crespo J, Abrahão ABK, Buscacio G, Lerner LCC, Sermoud L, Arakelian R, Piotto G, Lemos C, Campos R, Victorino D, Andrade PM, Ferreira TAV, Pecoraro JP, Meton F, Gaui MF, Araujo LH. Patient-centered Outcomes in Breast Cancer: Description of EQ-5D-5L and EORTC-QLQ-BR23 Measurements in Real-world Data and Their Association With Survival. Clin Oncol (R Coll Radiol) 2022; 34:608-616. [PMID: 35667940 DOI: 10.1016/j.clon.2022.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
AIMS In recent years, major improvements in breast cancer treatments have led to a significant increase in survival. Despite that, this population's quality of life (QoL) information is lacking, especially real-world data. MATERIALS AND METHODS This was a prospective, multicentre, observational study of female breast cancer patients, without prior systemic treatment, treated between 2012 and 2019 in private health care in Brazil. QoL was assessed by two questionnaires, the EQ-5D-5L and the EORTC-QLQ-BR23. Additional data were retrospectively collected. RESULTS The study comprised 1372 patients, most with early-stage disease (80.2% stages 0-II). At a median follow-up of 25.6 months, the estimated 3-year overall survival was 93.6%. Patients with locally advanced and metastatic breast cancer had the lowest visual analogue scale scores and the highest symptom burden in all dimensions of EQ-5D-5L, but with the most significant improvement after treatment. With the EORTC-QLQ-BR23 questionnaire, patients undergoing lumpectomy had a better perception of body image. Axillary dissection led to greater arm symptoms after 12 months, radiotherapy enhanced breast symptoms and patients treated with chemotherapy had significant worsening in the effects of systemic therapy compared with endocrine or HER2 therapy. Staging and immunohistochemical subtype correlated with survival and with several QoL parameters, but overall survival was not independently affected by patient-reported outcomes in this cohort. CONCLUSION Our results show that early diagnosis and access to treatments with fewer side-effects, such as endocrine or targeted therapy, and less aggressive surgeries are the best strategies to achieve a better QoL for breast cancer patients.
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Affiliation(s)
- M R Monteiro
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil.
| | - N C C Nunes
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - J Crespo
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - A B K Abrahão
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - G Buscacio
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - L C C Lerner
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - L Sermoud
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - R Arakelian
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - G Piotto
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - C Lemos
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - R Campos
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - D Victorino
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - P M Andrade
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - T A V Ferreira
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - J P Pecoraro
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - F Meton
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - M F Gaui
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
| | - L H Araujo
- COI Institute, Clinical Research Department, Americas Oncology Cancer Center, São Paulo, Brazil
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da Silva JL, Cardoso Nunes NC, Izetti P, de Mesquita GG, de Melo AC. Triple negative breast cancer: A thorough review of biomarkers. Crit Rev Oncol Hematol 2019; 145:102855. [PMID: 31927455 DOI: 10.1016/j.critrevonc.2019.102855] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [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: 08/14/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 02/08/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is defined as a type of breast cancer with lack of expression of estrogen receptor (ER), progesterone receptor (PR) and HER2 protein. The tumorigenesis is not likely to be driven by hormonal or HER2 pathway. In comparison to other types of breast cancer, TNBC stands out for its aggressive behavior, more prone to early recurrence. Historically, TNBC has been considered a disease with poor response to molecular target therapy, requiring better validation of biomarkers. Recent issues related to tumor heterogeneity have been widely discussed suggesting the subdivision of TNBC into different molecular subtypes. Through a complete research on the main published trials databases and platforms of ongoing clinical studies, the current manuscript was carried out in order to present a critical view of the role of immunohistochemical and molecular biomarkers for the prognosis and response prediction of TNBC to traditional therapy and new molecular target agents.
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da Silva JL, Dos Santos ALS, Nunes NCC, de Moraes Lino da Silva F, Ferreira CGM, de Melo AC. Cancer immunotherapy: the art of targeting the tumor immune microenvironment. Cancer Chemother Pharmacol 2019; 84:227-240. [PMID: 31240384 DOI: 10.1007/s00280-019-03894-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/14/2019] [Indexed: 01/07/2023]
Abstract
For many decades, cancer treatment has been strongly directed toward the development of cytotoxic and cytostatic drugs, quite often leading to disappointing results due to the inter- and intra-tumoral heterogeneity. Lately, this intra-cellular look has given way to the understanding of the tumor microenvironment, thus enabling modification of the immunological dynamics between tumor cells and their host. An era of new drugs aiming to unlock the host immune system against tumor cells is steadily increasing. Strategies involving adoptive cell therapy, therapeutic vaccines, immune checkpoint inhibitors and so on have provided spectacular clinical responses and increased survival in previously refractory settings and "hard-to-treat" cancers. Based on a comprehensive search in the main scientific databases, annals of recent renowned oncology congresses and platforms of ongoing trials, the clinical pharmacology characteristics of the main classes of immunotherapeutic agents, as well as the new treatment strategies related to immunotherapy in solid tumors, are carefully discussed throughout this review.
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Affiliation(s)
- Jesse Lopes da Silva
- Clinic Oncomed, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil.
- Oncomed Clinic Oncologica, Niterói, Rio de Janeiro, 24220-300, Brazil.
| | | | - Natalia Cristina Cardoso Nunes
- Clinic Oncomed, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Oncoclinicas Institute for Research and Education, Sao Paulo, Brazil
| | | | | | - Andreia Cristina de Melo
- Clinic Oncomed, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Oncoclinicas Institute for Research and Education, Sao Paulo, Brazil
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