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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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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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3
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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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4
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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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5
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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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Lu YS, Malwinder S, Azim H, Eralp Y, Im SA, Yap Y, Delgar Alfaro T, Gao M, El Saghir N. Ribociclib plus goserelin with hormonal therapy versus physician choice chemotherapy in pre-/perimenopausal patients with HR+, HER2– inoperable locally advanced breast cancer (ABC): RIGHT choice study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz417.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bagot M, Porcu P, Marie-Cardine A, Battistella M, Bensussan A, Paturel C, Bonnafous C, Sicard H, Azim H, Kim Y. 091 IPH4102 (an anti-KIR3DL2 antibody) in refractory cutaneous T cell lymphoma. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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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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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, El Sheshtawy W, Lasheen S, Ismail M, El Khishin D, Azim H. Clinical and biological factors associated with higher rates of locoregional recurrences in Egyptian patients with early breast cancer. Breast 2017. [DOI: 10.1016/s0960-9776(17)30400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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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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15
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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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16
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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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17
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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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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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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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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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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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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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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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Abdelrhman O, Abdelmalek R, Kassem L, Azim H. More Frequent Screening of the Contralateral Breast is Warranted After Treatment of Primary Node-Positive Breast Cancer. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt078.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Del Pup L, Peccatori FA, Azim HA, Michieli M, Moioli M, Giorda G, Tirelli U, Berretta M. Obstetrical, fetal and postnatal effects of gestational antiblastic chemotherapy: how to counsel cancer patients. Int J Immunopathol Pharmacol 2013; 25:33S-46S. [PMID: 23092518 DOI: 10.1177/03946320120250s203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregnancy increases, numbers are growing. If chemotherapy cannot be postponed, both doctors and patients face complex medical and ethical issues. There is a conflict between optimal maternal therapy and fetal wellbeing. Treatment during the first trimester increases the risk of congenital malformations, spontaneous abortions and fetal death. Second and third trimester exposure is less risky, but it can cause intrauterine growth retardation and low birth weight. Other effects on pregnancy after the first trimester include premature birth, stillbirth, impaired functional development, myocardial toxicity and myelosuppression. Counseling and management of these cases are difficult, because literature is mostly represented by case reports or retrospective series while randomized prospective studies or guidelines are lacking. Moreover, personal experience is often scanty due to the rarity of the condition. This article reviews the available data regarding the different aspects of systemic treatment of cancer during pregnancy to help oncologist and obstetricians in counseling their patients and treat them accordingly.
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Affiliation(s)
- L Del Pup
- Division of Gynecological Oncology, National Cancer Institute, Aviano (PN), Italy.
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Criscitiello C, Azim HA, Agbor-tarh D, de Azambuja E, Piccart M, Baselga J, Eidtmann H, Di Cosimo S, Bradbury I, Rubio IT. Factors associated with surgical management following neoadjuvant therapy in patients with primary HER2-positive breast cancer: results from the NeoALTTO phase III trial. Ann Oncol 2013; 24:1980-5. [PMID: 23567146 DOI: 10.1093/annonc/mdt129] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 11/13/2022] Open
Abstract
BACKGROUND The NeoALTTO trial showed that dual HER2 blockade nearly doubles the rate of pathologic complete response (pCR) in patients with primary HER2-positive breast cancer. However, this did not translate into a higher rate of breast-conserving surgery (BCS). PATIENTS AND METHODS In NeoALTTO, patients with HER2-positive breast cancer were randomly assigned to either trastuzumab, lapatinib or their combination with paclitaxel before surgery with pCR as the primary end point. We investigated the association between the surgery type and clinicopathological factors and response to treatment, adjusting for the treatment arm. RESULTS Four hundred and twenty-nine patients were subjected to breast surgery. Two hundred and forty-two (56%) and 187 (44%) patients underwent mastectomy and BCS, respectively. In a logistic regression model, negative estrogen receptor (ER), multicentricity and the presence of a palpable mass before surgery were significantly associated with a low chance of BCS. Conversely, patients with small tumors and those eligible for BCS at diagnosis were managed more with BCS, independent of the treatment arm. Radiological response was not associated with the surgical decision. CONCLUSIONS Tumor characteristics before neoadjuvant therapy play a main role in deciding the type of surgery calling for a clear consensus on the role of BCS in patients responding to neoadjuvant therapy.
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Affiliation(s)
- C Criscitiello
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
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Abstract
Greater understanding of the biology of triple-negative breast cancer (TNBC) is needed to discern the roughly 60% of node-negative patients who are already cured with locoregional therapy from the 40% who need adjuvant systemic therapy to be cured. Recent evidence suggests that patients with TNBC whose tumours have an activated immune response gene signature have a more favourable outcome than TNBC patients without this signature. For the group who needs additional systemic therapy, the challenge remains to choose the right systemic drug combination for the right TNBC sub-type. Significant heterogeneity exists within the TNBC class that is exemplified by differing chemotherapeutic sensitivity observed for some sub-types. This heterogeneity establishes the need for identifying differentiating molecular markers within the overall class of TNBC disease, which may help refine therapeutic management. In this review, we discuss some of these promising predictive molecular markers for tailoring therapy. In addition, several gene expression profiling and functional studies employing genetic screens that help to establish TNBC sub-groups with varying sensitivities to a variety of targeted therapies currently under clinical investigation are conferred. It is anticipated that a greater understanding of the biology of TNBC and its complex heterogeneity will reveal novel targets or identify markers around which clinical trials in molecularly well-defined sub-groups can be designed.
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Affiliation(s)
- C Criscitiello
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
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Azim HA, Michiels S, Zagouri F, Delaloge S, Filipits M, Namer M, Neven P, Symmans WF, Thompson A, André F, Loi S, Swanton C. Utility of prognostic genomic tests in breast cancer practice: The IMPAKT 2012 Working Group Consensus Statement. Ann Oncol 2013; 24:647-54. [PMID: 23337633 DOI: 10.1093/annonc/mds645] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We critically evaluated the available evidence on genomic tests in breast cancer to define their prognostic ability and likelihood to determine treatment benefit. DESIGN Independent evaluation of six genomic tests [Oncotype Dx™, MammaPrint(®), Genomic Grade Index, PAM50 (ROR-S), Breast Cancer Index, and EndoPredict] was carried out by a panel of experts in three parameters: analytical validity, clinical validity, and clinical utility based on the principles of the EGAPP criteria. PANEL STATEMENTS: The majority of the working group members found the available evidence on the analytical and clinical validity of Oncotype Dx™ and MammaPrint(®) to be convincing. None of the genomic tests demonstrated robust evidence of clinical utility: it was not clear from the current evidence that modifying treatment decisions based on the results of a given genomic test could result in improving clinical outcome. CONCLUSIONS The IMPAKT 2012 Working Group proposed the following recommendations: (i) a need to develop models that integrate clinicopathologic factors along with genomic tests; (ii) demonstration of clinical utility should be made in the context of a prospective randomized trial; and (iii) the creation of registries for patients who are subjected to genomic testing in the daily practice.
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Affiliation(s)
- H A Azim
- Breast Cancer Translational Research Laboratory BCTL, J.C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Piccart MJ, Azim HA. Abstract CS1-2: Small Tumor – Aggressive Biology: When They Collide! Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-cs1-2] [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
Historically, tumor stage was the main stay in determining the prognosis and the need for adjuvant therapy in patients with operable breast cancer (BC). Patients with a tumor size < 1cm (pT1a, b) and negative nodal involvement (pN0) were regarded to have very favorable prognosis. This in turn was reflected in the way these patients were managed. Since a decade or more, it became obvious that BC is not a single disease, but a group of molecularly distinct subtypes. The appreciation of the biological diversity of BC subtypes has urged the question on the relevance of tumor stage in the decision-making, nowadays. In other words, should patients with early-stage disease continue to receive “milder” or even no systemic therapy being historically known to have favorable prognosis, even if they are of aggressive nature?
Evidence in this regards mainly rely on retrospective data as these patients are often excluded from randomized trials. Data based on analyzing untreated cohorts have shown that the 5-year relapse-free survival of patients with pT1a, b pN0 disease is rather favorable, in the range of 90%. However, obvious differences in outcome were observed according to BC subtype. Patients with ER-positive disease often have an even more favorable outcome reaching up to 95% unlike those with HER2 and t tumors in which 5-year RFS ranges around 75–80%. This calls for integrating biological information in managing these patients.
Patients with ER-positive disease are composed of at least two subtypes, luminal-A and luminal-B.; the latter being more aggressive. It is unlikely that this differs in patients with pN0 disease. This was demonstrated by the Mammaprint®, which separate pT1a, b patients into two distinct groups with different outcome.
Few data suggested that the addition of trastuzumab particularly in patients with pT1b is worthwhile. This is further endorsed by guidelines like NCCN and St Gallen. However, it is important to note that the exact magnitude of benefit of trastuzumab in these patients is unknown. It is plausible to assume that the relative risk reduction on relapse will be similar to that in patients with more advanced tumors, which is in the range of 50%. On the basis that these patients have an absolute risk of relapse in the range of 20–25%, it appears reasonable to consider trastuzumab, particularly in patients with pT1b, which were shown to experience more BC-related events compared to patients with pT1a.
A similar argument exists on the added value of chemotherapy for patients with TN disease. Based on the recent EBCTCG overview, the relative risk reduction on the risk of relapse by administering chemotherapy does not exceed 30%. Acknowledging the absolute risk of relapse of the pT1a, b pN0 patients, the absolute benefit from offering chemotherapy appears to be modest; especially for those with pT1a.
Hence, the appreciation of BC heterogeneity on the molecular level is vital and should be considered in managing patients with very small tumors. As these patients have “relatively” low risk of relapse, it is important to consider absolute risk reductions that are foreseen by the addition of chemotherapy ± trastuzumab. This would help refining management strategies and hence improve counseling of patients diagnosed with these relatively indolent, yet challenging tumors.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr CS1-2.
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Affiliation(s)
- MJ Piccart
- Institut Jules Bordet, Brussels, Belgium
| | - HA Azim
- Institut Jules Bordet, Brussels, Belgium
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Azim H, Kroman N, Ameye L, Rotmensz N, Gelber S, Cordoba O, Pinto A, Jensen M, de Azambuja E, Peccatori F. 21 Pregnancy Following Estrogen Receptor-Positive Breast Cancer is Safe – Results From a Large Multi-center Case-control Study. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70089-8] [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: 10/28/2022]
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Peccatori FA, Giovannetti E, Pistilli B, Bellettini G, Codacci-Pisanelli G, Losekoot N, Curigliano G, Azim HA, Goldhirsch A, Peters GJ. "The only thing I know is that I know nothing": 5-fluorouracil in human milk. Ann Oncol 2012; 23:543-544. [PMID: 22275286 DOI: 10.1093/annonc/mdr582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
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Azim HA, Metzger-Filho O, de AE, Loibl S, Focant F, Gresko E, Procter M, Piccart-Gebhart M. P1-12-01: Pregnancy during and Following Adjuvant Trastuzumab in Patients with HER2−Positive Breast Cancer: An Analysis from the HERA Trial (BIG 01-01). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-12-01] [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: 1-year of adjuvant trastuzumab (T) is the standard of care in managing patients (pts) with early HER2−positive breast cancer (BC). As T is not known to alter fertility, pts with childbearing potential could become pregnant during or following treatment with T. Cases of oligohydramnios, some associated with fatal pulmonary hypoplasia of the fetus have been reported in women receiving T during pregnancy (preg). Here we report the outcome of preg in all pts enrolled in the HERA trial.
Methods: Pregnancies in the HERA trial are reported on a distinct “pregnancy form” for up to 10 years following T completion. The form includes information on approximate date of conception, preg course & outcome, fetal measurements at birth, and congenital anomalies. Any missing data were retrieved from the study site, if available. For this analysis, pts were grouped into 3 groups: 1) preg during and up to 3 months after T, 2) preg > 3 months of last T dose, and 3) preg with no prior exposure to T.
Results: By March 2010, 70 preg were reported in 58 out of 5102 pts randomized. Five, 30 and 7 completed preg were reported in groups 1, 2 & 3 respectively.
As per protocol, all pts on T were required to use adequate contraceptive measures, yet 16 pts became pregnant during the course of T and up to 3 months thereafter. The percentage of completed preg was lowest in group 1, with 4 spontaneous and 7 induced abortions. In group 2, preg occurred at a mean of 29 months following completion of T, with 6 spontaneous and 4 induced abortions. In group 3, abortion was induced in 3 pts and no spontaneous abortions reported. Across all 3 groups, all but 1 spontaneous abortion occurred during the 1st trimester. Two congenital anomalies were reported; a Down's syndrome in a 43 year old pt >5 years after completing T for which abortion was induced, and one with partial fusion of the 2nd and 3rd toe born to a pt in group 3.
Conclusions: Unintentional exposure to T during preg may be associated with spontaneous abortion, yet the numbers remain low to draw firm conclusions (spontaneous abortion rate in general population is up to 20%). No oligohydramnios or anomalies were observed in group 1. While an increased risk of oligohydramnios has been reported when T is administered after the 1st trimester, T administered to Cynomolgus monkeys during organogenesis did not cause fetal harm (Pentsuk et al; 2009). Nevertheless, women of childbearing potential should be advised to use effective contraception during and up to 6 months after treatment with T. On the other hand, prior exposure to T did not appear to affect the preg course or outcome. We are planning to collect information from the other T adjuvant trials to confirm our findings.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-01.
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Affiliation(s)
- HA Azim
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - O Metzger-Filho
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - Azambuja E de
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - S Loibl
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - F Focant
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - E Gresko
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - M Procter
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
| | - M Piccart-Gebhart
- 1Institut Jules Bordet, Brussels, Belgium; German Breast Group, Frankfurt, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science, Kincraig, United Kingdom
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Azim HA, Santoro L, Russell-Edu W, Pentheroudakis G, Pavlidis N, Peccatori FA. P4-11-03: Prognosis of Pregnancy-Associated Breast Cancer: A Meta-Analysis Involving 39,415 Patients. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-03] [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-associated breast cancer (PABC), defined as breast cancer diagnosed during pregnancy or one year after is a relatively rare disease and hence considerable controversy exists regarding its prognosis compared to non-pregnancy-related breast cancer.
Methods: Two of the authors independently performed a literature search on MEDLINE and Cochrane Library with no date or language restrictions. Eligible studies were control-matched, population-based and hospital-based studies that have addressed the outcome of patients diagnosed during pregnancy or one-year afterwards. The control group was defined as patients diagnosed with breast cancer not related to pregnancy. The primary and secondary end-points were overall and disease-free survival respectively. Pooling of data was done using the random effect model. To control for potential differences between the two groups in systemic treatment and clinico-pathological features (e.g. tumor size, nodal status, ER, etc …) that could affect prognosis, we performed a sensitivity analysis by pooling the hazard ratios (HRs) of the adjusted multivariate models within each study. We also analyzed differences according to time of diagnosis (during pregnancy or post-partum), type of study and year of reporting the study. Finally, we communicated with the authors of the eligible studies to collect unpublished statistics relevant to our analysis to further refine our findings.
Results: 29 studies were included in this meta-analysis (2903 cases and 36, 512 controls). Women diagnosed with PABC had a significantly higher risk of death compared to those diagnosed with non-pregnancy-related breast cancer (pooled hazard ratio (pHR): 1.47 [95% CI: 1.30−1.65]). A sensitivity analysis including 11 studies (1222 PABC cases, 19231 controls) adjusted for differences in tumor size, nodal status and systemic treatment showed the same result (pHR: 1.44 [95% CI: 1.17−1.77]). These findings were consistent in patients diagnosed either during pregnancy (pHR: 1.30 [95% CI: 1.01−1.67]) or in the post-partum period (pHR: 1.56 [95% CI: 1.08−2.26]) with no heterogeneity observed (p=0.43). Sensitivity analyses according to the type and year of study showed the same findings. Regarding the secondary end-point, only ten studies (531 cases, 1842 controls) provided sufficient information to estimate disease-free survival, and indeed PABC patients had a higher risk of relapse compared to breast cancer controls [pHR: 1.59 (95%CI: 1.23−2.07)]. Collection of unpublished data is currently ongoing and further analyses will be presented at the meeting.
Conclusion: To the best of our knowledge, this is the largest analysis addressing the prognosis of PABC. Our results confirm that PABC is independently associated with a worse prognosis whether diagnosis is made during pregnancy or in the post-partum period. This underscores the possible impact of pregnancy on breast cancer biology. In this regard, we are currently interrogating potential biological differences between PABC patients and matched breast cancer controls at the gene expression level to elucidate the biology of this relatively rare, yet very challenging disease.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-03.
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Affiliation(s)
- HA Azim
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - L Santoro
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - W Russell-Edu
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - G Pentheroudakis
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - N Pavlidis
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
| | - FA Peccatori
- 1Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Ioannina, Ioannina, Greece
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Huober J, Fasching PA, Barsoum M, Petruzelka L, Wallwiener D, Thomssen C, Reimer T, Paepke S, Azim HA, Ragosch V, Kubista E, Baumgärtner AK, Beckmann MW, May C, Nimmrich I, Harbeck N. Higher efficacy of letrozole in combination with trastuzumab compared to letrozole monotherapy as first-line treatment in patients with HER2-positive, hormone-receptor-positive metastatic breast cancer - results of the eLEcTRA trial. Breast 2011; 21:27-33. [PMID: 21862331 DOI: 10.1016/j.breast.2011.07.006] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/07/2011] [Accepted: 07/22/2011] [Indexed: 02/07/2023] Open
Abstract
The eLEcTRA trial compared efficacy and safety of letrozole combined with trastuzumab to letrozole alone in patients with HER2 and hormone receptor (HR) positive metastatic breast cancer (MBC). Patients were randomized to either letrozole alone (arm A, n = 31) or letrozole plus trastuzumab (arm B, n = 26) as first-line treatment. Additional 35 patients with HER2 negative and HR positive tumors received letrozole alone (arm C). Median time to progression in arm A was 3.3 months compared to 14.1 months in arm B (hazard ratio 0.67; p = 0.23) and 15.2 months in arm C (hazard ratio 0.71; p = 0.03). Clinical benefit rate was 39% for arm A compared to 65% in arm B (odds ratio 2.99, 95% CI 1.01-8.84) and 77% in arm C (odds ratio 5.34, 95% CI 1.83-15.58). The eLEcTRA trial showed that the combination of letrozole and trastuzumab is a safe and effective treatment option for patients with HER2 positive and HR positive MBC.
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Affiliation(s)
- J Huober
- Breast Center, Kantonsspital St. Gallen, Switzerland.
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Azim HA, de Azambuja E, Colozza M, Bines J, Piccart MJ. Long-term toxic effects of adjuvant chemotherapy in breast cancer. Ann Oncol 2011; 22:1939-1947. [PMID: 21289366 DOI: 10.1093/annonc/mdq683] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Breast cancer is the most common malignant tumor affecting women. Adjuvant systemic therapies have been shown to have a significant impact on reducing the risk for breast cancer recurrence and overall mortality. Chemotherapy remains an important and frequently used treatment option in the adjuvant setting, and the associated short-term adverse events are very well described. However, there is insufficient information regarding the long-term sequelae of most chemotherapeutic agents. In this review, we describe different potential long-term adverse events associated with adjuvant chemotherapy in breast cancer, with a particular focus on long-term cardiac toxicity, secondary leukemia, cognitive function, and neurotoxicity. In addition, we discuss the effect of adjuvant chemotherapy on fertility and sexual function of young breast cancer patients. These adverse events are frequently overshadowed by the well-demonstrated clinical efficacy and/or reassuring short-term safety profiles of the different chemotherapy regimens commonly used today. We believe that a proper understanding and appreciation of these adverse events will enable us to refine our strategies for managing breast cancer. The fact that adjuvant chemotherapy is often given to patients who might not really need it urges us to consider the whole spectrum of chemotherapy risks versus benefits to maximize benefit without compromising quality of life.
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Affiliation(s)
- H A Azim
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - E de Azambuja
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - M Colozza
- Department of Oncology, Terni Hospital, Terni, Italy
| | - J Bines
- Department of Clinical Oncology, University Hospital of Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M J Piccart
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium.
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Azim HA, Santoro L, Bociek RG, Gandini S, Malek RA, Azim HA. High dose intensity doxorubicin in aggressive non-Hodgkin's lymphoma: a literature-based meta-analysis. Ann Oncol 2009; 21:1064-71. [PMID: 19850640 DOI: 10.1093/annonc/mdp425] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aggressive non-Hodgkin's lymphoma (NHL) represents approximately 60% of lymphomas in the West and even more in the developing world. cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) is recognized as the standard chemotherapy regimen and the addition of rituximab to B-cell subtypes has been shown to significantly improve treatment outcomes. Nevertheless, still a significant fraction of patients is not offered rituximab due to economic reasons. Thus, CHOP is still offered to these patients as well as those with T-cell subtypes. Data from the early 1990s have indicated that the dose intensity (DI) of doxorubicin is a key factor in predicting survival. METHODS A Medline and Cochrane library search was carried out using the search terms 'CHOP', 'lymphoma' and 'randomized trials'. Eligible trials had CHOP as a control arm and any regimen administering doxorubicin at a higher DI (16.6 mg/m(2)/week) as the investigational arm. Pooling of data was carried out using the mixed effect model. RESULTS Eight trials were eligible. Patients receiving DI doxorubicin-based regimens had a significantly better overall survival [summary hazard ratio (SHR) 0.82; 95% confidence interval (CI) 0.71-0.96], event-free survival (SHR 0.86; 95% CI 0.75-0.99) and higher complete response rate (summary odds ratio 0.91; 95% CI 0.67-0.97). CONCLUSION High DI doxorubicin based should be considered in patients with aggressive NHL.
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Affiliation(s)
- H A Azim
- Department of Clinical Oncology, Cairo University Hospital, Cairo, Egypt
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Abbas N, Fattah R, Malek R, Azim H. 3027 Actual or adjusted surface area which shall we choose? EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Azim HA, Malek RA, Elattar I, Elkheshen D, Azim H. The relation between hormone receptor status and disease-free survival in adjuvant breast cancer: A multivariate analysis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Azim HA, Ganti AK, Elattar I, Azim H, Loberiza FR. Triplets vs. doublets in the management of advanced non-small cell lung cancer (NSCLC) using third generation chemotherapeutic agents: A meta-analysis. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7580] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Abstract
7580 Background: A platinum-based doublet is the current standard of care in the management of NSCLC. Addition of a third agent to the doublet has not shown to improve outcomes in a previous meta-analysis. Since one of the reasons for this may have been the inclusion of trials utilizing agents inferior to the currently used, we conducted a meta-analysis to evaluate the benefit of adding a third generation cytotoxic chemotherapeutic agent to a platinum doublet in terms of response rate, survival, and toxicity in patients with advanced NSCLC. Methods: Randomized controlled trials for advanced NSCLC, published as full papers in English, comparing doublets to triplets restricted to platinum salts and third-generation cytotoxic chemotherapeutic agents (vinorelbine, gemcitabine, docetaxel, paclitaxel) were analyzed. A Medline search was performed using the search terms “lung cancer” and “randomized trials”. Manual searches were also performed in the Journal of Clinical Oncology and Annals of Oncology. Pooled odds ratios (ORs) for the objective response and toxicity rates were calculated using the Mantel-Haenszel estimate. Pooled median ratios for median survival were calculated using the weighted sum of the log-ratio of median ratios of individual study. Results: Eight trials (2,107 patients) published between 2000 and 2006 were eligible. Patients receiving triplet therapy had a significantly increased response rate (OR 1.86; 95% CI, 1.53 –2.26; P<0.001) and median survival (41.9 weeks vs. 37.05 weeks; OR: 1.14, 95% CI: 1.00–1.31; P=0.047), at the expense of higher grade III/IV hematological and neurological toxicity (P<0.001) ( Table ). Conclusions: The addition of a third-generation cytotoxic agent to a platinum-based doublet was associated with improved response rate and survival, but with increased hematological and neurological toxicity. Thus, triplet therapy may be considered in selected good performance status patients with advanced NSCLC. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- H. A. Azim
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - A. K. Ganti
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - I. Elattar
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - H. Azim
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - F. R. Loberiza
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
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Giles FJ, Shan J, Advani SH, Akan H, Aydogdu I, Aziz Z, Azim HA, Bapsy PP, Buyukkececi F, Chaimongkol B, Chen PM, Cheong SK, Ferhanoglu B, Hamza R, Khalid HM, Intragumtornchai T, Kim SW, Kim SY, Koc H, Kumar L, Kumar R, Lei KI, Lekhakula A, Muthalib A, Patel M, Poovalingam VP, Prayoonwiwat W, Rana F, Reksodiputro AH, Ruff P, Sagar TG, Schwarer AP, Song HS, Suh CW, Suharti C, Supindiman I, Tee GY, Thamprasit T, Villalon AH, Wickham NR, Wong JE, Yalcin A, Jootar S. A prospective randomized study of Chop versus Chop plus alpha-2B interferon in patients with intermediate and high grade non-Hodgkin's lymphoma: the International Oncology Study Group NHL1 Study . Leuk Lymphoma 2000; 40:95-103. [PMID: 11426633 DOI: 10.3109/10428190009054885] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED The addition of a brief alpha interferon regimen to each CHOP induction cycle, plus one year of alpha interferon thrice weekly maintenance therapy, has no early effect on response rates or survival in patients with Intermediate or High grade cell NHL. BACKGROUND The CHOP (Cyclophosphamide, Adriamycin. Vincristine, Prednisone) regimen is the most widely used first-line therapy for patients with Intermediate or High Grade (IG/HG) non-Hodgkin's lymphoma (NHL). Alpha 2b interferon (INF) enhances response rates and improves survival in low-grade NHL. The International Oncology Study Group (IOSG) conducted a prospective randomized study comparing CHOP alone or combined with INF in patients with IG/HG-NHL. The primary study aim was to compare the objective response rates in these patient cohorts. PATIENTS AND METHODS Patients with a confirmed diagnosis of measurable NHL of International Working Formulation (IWF) groups D to H histology were randomized to receive CHOP alone or CHOP with 5Mu INF s.c. for 5 days on days 22 to 26 of each 28 day cycle with INF 5 million units (Mu) given three times per week subcutaneously for 52 weeks in those patients who responded to CHOP plus INF. RESULTS The overall response rates were equivalent in both groups: CHOP alone (214 patients) 81% (complete 55%, partial 26%); CHOP plus INF (221 patients) 80% (complete 54%, partial 26%). At 36 months, the actuarial survival rate was equivalent in both groups. CONCLUSIONS There is no apparent early advantage in terms of response or survival conferred by adding the study INF regimen to CHOP therapy for patients with IG/HG-NHL.
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Affiliation(s)
- F J Giles
- International Oncology Study Group, Houston, Texas, USA.
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Kolivakis T, Azim H, Kingstone E. A double-blind comparison of pimozide and chlorpromazine in the maintenance care of chronic schizophrenic outpatients. Curr Ther Res Clin Exp 1974; 16:998-1004. [PMID: 4214674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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