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Meng J, Tan JYT, Joseph CR, Ye J, Lim JCT, Goh D, Xue Y, Lim X, Koh VCY, Wee F, Tay TKY, Chan JY, Ng CCY, Iqbal J, Lau MC, Lim HE, Toh HC, Teh BT, Dent RA, Tan PH, Yeong JPS. The Prognostic Value of CD39 as a Marker of Tumor-Specific T Cells in Triple-Negative Breast Cancer in Asian Women. J Transl Med 2024; 104:100303. [PMID: 38103870 DOI: 10.1016/j.labinv.2023.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Triple-negative breast cancer (TNBC) has a poor prognosis with limited therapeutic options available for affected patients. Efforts are ongoing to identify surrogate markers for tumor-specific CD8+ T cells that can predict the response to immune checkpoint inhibitor (ICI) therapies, such as programmed cell death protein 1 or programmed cell death ligand-1 blockade. We have previously identified tumor-specific CD39+CD8+ T cells in non-small cell lung cancer that might help predict patient responses to programmed cell death protein 1 or programmed cell death ligand-1 blockade. Based on this finding, we conducted a comparative interrogation of TNBC in an Asian cohort to evaluate the potential of CD39 as a surrogate marker of tumor-specific CD8+ T cells. Using ICI-treated TNBC mouse models (n = 24), flow cytometric analyses of peripheral blood mononuclear cells and tumor-infiltrating lymphocytes revealed that >99% of tumor-specific CD8+ T cells also expressed CD39. To investigate the relationship between CD39+CD8+ T-cell density and CD39 expression with disease prognosis, we performed multiplex immunohistochemistry staining on treatment-naive human TNBC tissues (n = 315). We saw that the proportion of CD39+CD8+ T cells in human TNBC tumors correlated with improved overall survival, as did the densities of other CD39+ immune cell infiltrates, such as CD39+CD68+ macrophages. Finally, increased CD39 expression on CD8+ T cells was also found to predict the response to ICI therapy (pembrolizumab) in a separate cohort of 11 TNBC patients. These findings support the potential of CD39+CD8+ T-cell density as a prognostic factor in Asian TNBC patients.
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Affiliation(s)
- Jia Meng
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Jing Ying Tira Tan
- Duke-NUS Medical School, Singapore, Republic of Singapore; National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Craig Ryan Joseph
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Jiangfeng Ye
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Jeffrey Chun Tatt Lim
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Denise Goh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Yuezhen Xue
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Xinru Lim
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Valerie Cui Yun Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Felicia Wee
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Timothy Kwang Yong Tay
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Republic of Singapore
| | | | | | - Jabed Iqbal
- Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Anatomical Pathology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Mai Chan Lau
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Hsuen Elaine Lim
- National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Han Chong Toh
- National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Bin Tean Teh
- National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Rebecca Alexandra Dent
- Duke-NUS Medical School, Singapore, Republic of Singapore; National Cancer Centre Singapore, Singapore, Republic of Singapore.
| | - Puay Hoon Tan
- KK Women's and Children's Hospital, Singapore, Republic of Singapore; Luma Women's Imaging Centre/Medical Centre, Singapore, Republic of Singapore.
| | - Joe Poh Sheng Yeong
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore; National Cancer Centre Singapore, Singapore, Republic of Singapore; Department of Anatomical Pathology, Singapore General Hospital, Singapore, Republic of Singapore.
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2
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Yeong J, Goh D, Tan TJ, Tan B, Sivaraj H, Koh V, Tatt Lim JC, Joseph CR, Ye J, Yong Tay TK, Chan Lau M, Chan JY, Ng C, Iqbal J, Teh BT, Dent RA, Tan PH. Early Triple-Negative Breast Cancers in a Singapore Cohort Exhibit High PIK3CA Mutation Rates Associated With Low PD-L1 Expression. Mod Pathol 2023; 36:100056. [PMID: 36788078 DOI: 10.1016/j.modpat.2022.100056] [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: 07/20/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
Mutations in the PI3K pathway, particularly PIK3CA, were reported to be intimately associated with triple-negative breast cancer (TNBC) progression and the development of treatment resistance. We profiled PIK3CA and other genes on 166 early-stage TNBC tumors from Singapore for comparison to publicly available TNBC cohorts. These tumors were profiled transcriptionally using a NanoString panel of immune genes and multiplex immunohistochemistry, then manually scored for PD-L1-positivity using 2 clinically relevant clones, SP142 and 22C3. We discovered a higher rate of PIK3CA mutations in our TNBC cohort than in non-Asian cohorts, along with TP53, BRCA1, PTPN11, and MAP3K1 alterations. PIK3CA mutations did not affect overall or recurrence-free survival, and when compared with PIK3CAWT tumors, there were no differences in immune infiltration. Using 2 clinically approved antibodies, PIK3CAmut tumors were associated with PD-L1 negativity. Analysis of comutation frequencies further revealed that PIK3CA mutations tended to be accompanied by MAP kinase pathway mutation. The mechanism and impact of PIK3CA alterations on the TNBC tumor immune microenvironment and PD-L1 positivity warrant further study.
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Affiliation(s)
- Joe Yeong
- Division of Pathology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore; Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Denise Goh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tira J Tan
- Duke-NUS Medical School, Singapore; National Cancer Centre Singapore, Singapore
| | - Benedict Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | | | - Valerie Koh
- Division of Pathology, Singapore General Hospital, Singapore
| | - Jeffrey Chun Tatt Lim
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Craig Ryan Joseph
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Jiangfeng Ye
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | | | - Mai Chan Lau
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A∗STAR), Singapore
| | | | - Cedric Ng
- National Cancer Centre Singapore, Singapore
| | - Jabed Iqbal
- Division of Pathology, Singapore General Hospital, Singapore
| | | | | | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore; Luma Women's Imaging Centre/Medical Centre, Singapore.
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3
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Pusztai L, Denkert C, O'Shaughnessy J, Cortes J, Dent RA, McArthur HL, Kuemmel S, Bergh JCS, Park YH, Hui R, Harbeck N, Takahashi M, Untch M, Fasching PA, Cardoso F, Zhu Y, Pan W, Tryfonidis K, Schmid P. Event-free survival by residual cancer burden after neoadjuvant pembrolizumab + chemotherapy versus placebo + chemotherapy for early TNBC: Exploratory analysis from KEYNOTE-522. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
503 Background: KEYNOTE-522 (NCT03036488) tested the benefit from adding pembrolizumab (pembro) to chemotherapy (chemo) in patients (pts) with early TNBC. The primary results showed statistically significant and clinically meaningful improvements in pCR and EFS with pembro.Prior studies have shown the prognostic value of the residual cancer burden (RCB) method to quantify the extent of residual disease after neoadjuvant chemo. In this exploratory analysis, we assessed EFS by RCB in KEYNOTE-522. Methods: 1174 pts with previously untreated, nonmetastatic, stage T1c/N1-2 or T2-4/N0-2 TNBC were randomized 2:1 to pembro 200 mg Q3W or placebo (pbo) given with 4 cycles of paclitaxel + carboplatin, then 4 cycles of doxorubicin or epirubicin + cyclophosphamide. After definitive surgery, pts received pembro or pbo for 9 cycles or until recurrence or unacceptable toxicity. Dual primary endpoints are pCR and EFS. RCB was assessed by the local pathologist at the time of surgery. The association between RCB categories (RCB-0, -1, -2, -3, corresponding to increasingly larger residual cancer) and EFS was assessed based on a Cox regression model with treatment as a covariate. Results: Median follow-up was 39.1 months at data cutoff (23 MAR 2021). Pembro shifted RCB to lower categories across the entire spectrum (Table). The HRs (95% CI) for EFS were 0.70 (0.38 - 1.31) for RCB-0 (equivalent to pCR), 0.92 (0.39 - 2.20) for RCB-1, 0.52 (0.32 - 0.82) for RCB-2, and 1.24 (0.69 - 2.23) for RCB-3. The most common EFS event in both arms was distant recurrence, which occurred in fewer pts in the pembro arm in all RCB categories. Conclusions: Increased RCB score was associated with worse EFS. Pts with residual disease had lower RCB values in the pembro arm, including fewer pts with RCB-3. Pembro + chemo prolonged EFS vs chemo alone in the RCB-0, -1, and -2 categories; the small sample size limits interpretation in the RCB-3 category. The small subset of pts with extensive residual disease (RCB-3) in both arms, 5.1% and 6.7%, respectively, had a poor prognosis. These results highlight the importance of neoadjuvant treatment with pembro for improving survival in pts with early TNBC, and identified a subset of pts for whom additional therapies will be needed. Clinical trial information: NCT03036488. [Table: see text]
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Affiliation(s)
- Lajos Pusztai
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg, Germany
| | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology Network, Dallas, TX
| | - Javier Cortes
- International Breast Cancer Center, Quironsalud Group, Barcelona, Spain and Universidad Europea de Madrid, Madrid, Spain
| | - Rebecca Alexandra Dent
- National Cancer Center Singapore, Duke–National University of Singapore Medical School, Singapore, Singapore
| | | | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany and Charité – Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Jonas C. S. Bergh
- Department of Oncology-Pathology, Karolinska Institutet and Breast Cancer Centre, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Yeon Hee Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Rina Hui
- Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Nadia Harbeck
- Breast Center, LMU University Hospital, Munich, Germany
| | | | - Michael Untch
- Breast Cancer Center, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Peter A. Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - Yalin Zhu
- Oncology, Merck & Co., Inc., Kenilworth, NJ
| | - Wilbur Pan
- Oncology, Merck & Co., Inc., Kenilworth, NJ
| | | | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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4
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Seet AOL, Tan AC, Tan TJ, Ng MCH, Tai DWM, Lam JYC, Tan GS, Gogna A, Too CW, Tan BS, Takano A, Lim A, Lim TH, Lim ST, Dent RA, Ang MK, Yap YS, Tan IBH, Choo SP, Toh CK, Lim EH, Farid M, Skanderup AJ, Iyer NG, Lim WT, Tan EH, Lim TKH, Tan DSW. Individualized Molecular Profiling for Allocation to Clinical Trials Singapore Study-An Asian Tertiary Cancer Center Experience. JCO Precis Oncol 2021; 5:PO.20.00261. [PMID: 34250396 DOI: 10.1200/po.20.00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Precision oncology has transformed the management of advanced cancers through implementation of advanced molecular profiling technologies to identify increasingly defined subsets of patients and match them to appropriate therapy. We report outcomes of a prospective molecular profiling study in a high-volume Asian tertiary cancer center. PATIENTS AND METHODS Patients with advanced cancer were enrolled onto a prospective protocol for genomic profiling, the Individualized Molecular Profiling for Allocation to Clinical Trials Singapore study, at the National Cancer Center Singapore. Primary objective was to identify molecular biomarkers in patient's tumors for allocation to clinical trials. The study commenced in February 2012 and is ongoing, with the results of all patients who underwent multiplex next-generation sequencing (NGS) testing until December 2018 presented here. The results were discussed at a molecular tumor board where recommendations for allocation to biomarker-directed trials or targeted therapies were made. RESULTS One thousand fifteen patients were enrolled with a median age of 58 years (range 20-83 years). Most common tumor types were lung adenocarcinoma (26%), colorectal cancer (15%), and breast cancer (12%). A total of 1,064 NGS assays were performed, on fresh tumor tissue for 369 (35%) and archival tumor tissue for 687 (65%) assays. TP53 (39%) alterations were most common, followed by EGFR (21%), KRAS (14%), and PIK3CA (10%). Of 405 NGS assays with potentially actionable alterations, 111 (27%) were allocated to a clinical trial after molecular tumor board and 20 (4.9%) were enrolled on a molecularly matched clinical trial. Gene fusions were detected in 23 of 311 (7%) patients tested, including rare fusions in new tumor types and known fusions in rare tumors. CONCLUSION Individualized Molecular Profiling for Allocation to Clinical Trials Singapore demonstrates the feasibility of a prospective broad molecular profiling program in an Asian tertiary cancer center, with the ability to develop and adapt to a dynamic landscape of precision oncology.
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Affiliation(s)
- Amanda O L Seet
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Aaron C Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Tira J Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Matthew C H Ng
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - David W M Tai
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Justina Y C Lam
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Gek San Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Angela Takano
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Alvin Lim
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Tse Hui Lim
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | | | - Mei Kim Ang
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Yoon-Sim Yap
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Iain B H Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Su Pin Choo
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Chee Keong Toh
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Elaine H Lim
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | | | - N Gopalakrishna Iyer
- Division of Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Wan Teck Lim
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Eng Huat Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Tony K H Lim
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Daniel S W Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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5
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Finkelstein EA, Baid D, Cheung YB, Schweitzer ME, Malhotra C, Volpp K, Kanesvaran R, Lee LH, Dent RA, Ng Chau Hsien M, Bin Harunal Rashid MF, Somasundaram N. Hope, bias and survival expectations of advanced cancer patients: A cross-sectional study. Psychooncology 2021; 30:780-788. [PMID: 33739561 DOI: 10.1002/pon.5675] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/27/2021] [Accepted: 03/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self-deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced cancer patients and quantifies the extent to which hope exacerbates these biases. METHODS A cross-sectional survey was administered to 200 advanced cancer patients with physician-estimated prognoses of one year or less. Hope was measured using the Herth Hope Index (HHI). Hypotheses were tested using linear and logistic regressions and a structural-equation model. RESULTS Results are consistent with the presence of optimism bias, illusion of superiority, self-deception, and misattribution. All of these biases are amplified by higher levels of hope. Each 1-point higher HHI is associated with a 6% (OR: 1.06; 95% CI: 1.01-1.11) greater odds of believing their illness is curable, a 0.33-year (95% CI: 0.17-0.49) longer expected survival, a 6% (OR: 1.06; 95% CI: 1.02-1.11) higher probability of believing that survival outcomes are better than the average patient, a 5% higher odds of believing primary intent of treatment is curative (OR: 1.05; 95% CI: 1.00-1.10), and a 12% (OR: 1.12; 95% CI: 1.05-1.17) higher odds of believing they are well-informed. Mediation analyses revealed that hope significantly mediates the effect of mental-well-being and loneliness on expected survival. CONCLUSIONS Results suggest advanced cancer patients succumb to several cognitive biases which are exacerbated by greater levels of hope. As a result, they are susceptible to possible over-treatment and regret.
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Affiliation(s)
- Eric A Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Drishti Baid
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Maurice E Schweitzer
- Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Kevin Volpp
- Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lai Heng Lee
- Department of Haematology, Singapore General Hospital, Singapore
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6
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Kee GJ, Tan RYC, Rehena S, Lee JJX, Zaw MWW, Lian WX, Yeong J, Tan SM, Lim SH, Tan BKT, Yap YS, Dent RA, Wong FY, Lee GE. Human epidermal growth factor receptor 2 positive rates in invasive lobular breast carcinoma: The Singapore experience. World J Clin Oncol 2020; 11:283-293. [PMID: 32728531 PMCID: PMC7360517 DOI: 10.5306/wjco.v11.i5.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/16/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Invasive lobular carcinomas (ILC) form 5%-10% of breast cancer and rarely show overexpression of human epidermal growth factor receptor 2 (HER2).
AIM To describe the prevalence and prognostic factors of HER2 positive (HER2+) ILC in an Asian population.
METHODS A retrospective review of patients with ILC seen between January 1985 and March 2018 at various SingHealth medical institutions was conducted. Demographic and clinical data were collected from medical records. We examined clinicopathological characteristics and survival in relation to HER2 status.
RESULTS A total of 864 patients were included. Prevalence of HER2 positivity was 10.1% (87 patients). Compared with HER2 negative (HER2-) ILC, HER2+ ILC was associated with a higher proportion of estrogen receptor negative (24.4% vs 5.9%, P < 0.001), progesterone receptor negative (PR-) (40.2% vs 24%, P = 0.002) and grade 3 tumours (Grade 3, 29.0% vs 10.2%, P < 0.001). Overall survival rate was poorer in patients with HER2+ compared to HER2- ILC (56.7% vs 72.9% alive at 10 years; hazard ratio 1.87, 95% confidence interval: 1.21-2.90, P = 0.004). Based on multivariate analysis, negative prognostic factors for overall survival included HER2 positivity, PR negativity, older age, Indian ethnicity and higher tumour stage.
CONCLUSION Prevalence of HER2+ ILC was 10.1%. HER2+ ILC was more likely to have poorer prognostic features such as estrogen receptor negative, PR- and higher tumour grade, and have a poorer survival.
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Affiliation(s)
- Ga-Jing Kee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Ryan Ying-Cong Tan
- Division of Medical Oncology, National Cancer Centre, Singapore 169610, Singapore
| | - Sultana Rehena
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Joycelyn Jie-Xin Lee
- Division of Medical Oncology, National Cancer Centre, Singapore 169610, Singapore
| | - Ma Wai-Wai Zaw
- Department of Anaesthesiology, Singapore General Hospital, Singapore 169608, Singapore
| | - Wei-Xiang Lian
- Division of Radiation Oncology, National Cancer Centre, Singapore 169610, Singapore
| | - Joe Yeong
- Division of Pathology, Singapore General Hospital, Singapore 169608, Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Changi General Hospital, Singapore, 529889, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore 169610, Singapore
| | - Swee-Ho Lim
- SingHealth Duke-NUS Breast Centre, Singapore 169610, Singapore
- Kandang Kerbau Breast Centre, Kandang Kerbau Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Benita Kiat-Tee Tan
- SingHealth Duke-NUS Breast Centre, Singapore 169610, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yoon-Sim Yap
- Division of Medical Oncology, National Cancer Centre, Singapore 169610, Singapore
| | | | - Fuh-Yong Wong
- Division of Radiation Oncology, National Cancer Centre, Singapore 169610, Singapore
| | - Guek-Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore 169610, Singapore
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7
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Gianni L, Mansutti M, Anton A, Calvo L, Bisagni G, Bermejo B, Semiglazov V, Thill M, Chacon JI, Chan A, Morales S, Alvarez I, Plazaola A, Zambetti M, Redfern AD, Dittrich C, Dent RA, Magazzù D, De Fato R, Valagussa P, Tusquets I. Comparing Neoadjuvant Nab-paclitaxel vs Paclitaxel Both Followed by Anthracycline Regimens in Women With ERBB2/HER2-Negative Breast Cancer-The Evaluating Treatment With Neoadjuvant Abraxane (ETNA) Trial: A Randomized Phase 3 Clinical Trial. JAMA Oncol 2019; 4:302-308. [PMID: 29327055 DOI: 10.1001/jamaoncol.2017.4612] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Studies of neoadjuvant chemotherapy regimens using anthracyclines followed by taxanes have reported a doubling of pathological complete remission (pCR) rates compared with anthracycline-based regimens alone. A reverse sequence did not reduce activity. Nab-paclitaxel is an albumin-bound nanoparticle of paclitaxel that allows for safe infusion without premedication, and its use led to a significantly higher rate of pCR in the GeparSepto trial. Objective To determine whether nab-paclitaxel improves the outcomes of early and locally advanced human epidermal growth factor receptor 2 (ERBB2/HER2)-negative breast cancer compared with paclitaxel when delivered in a neoadjuvant setting. Design, Setting, and Participants In this multicenter, open-label study, in collaboration with Grupo Español de Investigación en Cáncer de Mama (GEICAM) and Breast Cancer Research Center-Western Australia (BCRC-WA), patients with newly diagnosed and centrally confirmed ERBB2/HER2-negative breast cancer were recruited. Participants were randomly allocated to paclitaxel, 90 mg/m2 (349 patients), or nab-paclitaxel, 125 mg/m2 (346 patients). The 2 drugs were given on weeks 1, 2, and 3 followed by 1 week of rest for 4 cycles before 4 cycles of an anthracycline regimen per investigator choice. Main Outcomes and Measures The primary end point was the rate of pCR, defined as absence of invasive cells in the breast and axillary nodes (ie, ypT0/is ypN0) at the time of surgery. A secondary end point was to assess tolerability and safety of the 2 regimens. Results From May 2013 to March 2015, 814 patients were registered to the study; 695 patients met central confirmation eligibility and were randomly allocated to receive either paclitaxel (349), or nab-paclitaxel (346) (median age, 50 years; range, 25-79 years). The intention-to-treat analysis of the primary end point pCR revealed that the improved pCR rate after nab-paclitaxel (22.5%) was not statistically significant compared with paclitaxel (18.6%; odds ratio [OR], 0.77; 95% CI, 0.52-1.13; P = .19). Overall, 38 of 335 patients (11.3%) 11.3% of patients had at least 1 serious adverse event in the paclitaxel arm and 54 of 337 patient (16.0%) in the nab-paclitaxel arm. Peripheral neuropathy of grade 3 or higher occurred in 6 of 335 patients (1.8%) and in 15 of 337 (4.5%), respectively. Conclusions and Relevance The improved rate of pCR after nab-paclitaxel was not statistically significant. The multivariate analysis revealed that tumor subtype (triple-negative vs luminal B-like) was the most significant factor (OR, 4.85; 95% CI, 3.28-7.18) influencing treatment outcome. Trial Registration clinicaltrials.gov Identifier: NCT01822314.
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Affiliation(s)
- Luca Gianni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milano, Italy
| | - Mauro Mansutti
- Department of Oncology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Antonio Anton
- Department of Medical Oncology, Miguel Servet University Hospital, Aragón Health Research Institute, Zaragoza, Spain
| | - Lourdes Calvo
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Giancarlo Bisagni
- IRCCS Arcispedale Santa Maria Nuova Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - Begoña Bermejo
- Department of Medical Oncology, Hospital Clinico Universitario Valencia, Valencia, Spain
| | | | - Marc Thill
- Agaplesion Markus Krankenhaus, Klinik für Gynäkologie und Geburtshilfe, Frankfurt am Main, Germany
| | | | - Arlene Chan
- Breast Cancer Research Centre, Western Australia & Curtin University, Perth, Australia
| | - Serafin Morales
- Department of Medical Oncology, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | - Isabel Alvarez
- Department of Oncology, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Milvia Zambetti
- Department of Medical Oncology, San Raffaele Scientific Institute, Milano, Italy
| | - Andrew D Redfern
- Department of Medical Oncology, Royal Perth Hospital, Perth, Australia
| | - Christian Dittrich
- Applied Cancer Research-Institution for Translational Research Vienna (ACR-ITR VIEnna) & Kaiser Franz Josef-Spital, Vienna, Austria
| | | | | | | | | | - Ignacio Tusquets
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
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Sammons S, Tan TJY, Traina TA, Kim SB, Im YH, Bachelder C, Marcom PK, Dent RA. Dora: A randomized phase II multicenter maintenance study of olaparib alone or olaparib in combination with durvalumab in platinum responsive advanced triple-negative breast cancer (aTNBC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps1113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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
TPS1113 Background: PARP inhibition (PARPi) with olaparib is approved in HER2-negative germline BRCA mutant (g BRCAm) metastatic breast cancer. Maintenance PARPi in relapsed platinum-sensitive ovarian cancer improves median PFS regardless of gBRCA mutation status. Preclinical work has shown that platinum response strongly correlates with olaparib response in breast cancer models; hence, maintenance therapy trials are underway in aTNBC. PARPi modulates immune responses and enhances immunogenicity in many preclinical models. We hypothesize that olaparib either alone or in combination with the PD-L1 inhibitor durvalumab will have clinical efficacy as maintenance therapy in aTNBC subjects who have responded to platinum-based chemotherapy. Methods: DORA is a randomized, international, multicenter, phase II study designed to explore the efficacy of olaparib or olaparib in combination with durvalumab as maintenance therapy in platinum-sensitive aTNBC. 60 subjects will be enrolled following a minimum of 3 cycles of treatment with platinum-based (cisplatin or carboplatin) chemotherapy as a single agent or combination therapy in the first or second-line setting. Subjects deriving clinical benefit (CR / PR / SD) from platinum-based therapy will be eligible and randomized in a 1:1 ratio. Patients in arm 1 will receive olaparib orally 300mg BID continuously and in arm 2 will receive olaparib orally 300mg BID continuously in combination with durvalumab 1500mg IV every 4 weeks. Assessment of tumor response will be done every 8 weeks. Primary endpoint: progression-free survival. Secondary endpoints: overall survival, clinical benefit rate, safety. Correlative analyses: pre-treatment archival/fresh biopsy samples are mandated. Post-treatment tissue biopsy is requested. Serial ctDNA will be collected at baseline, staging, and progression to correlate with response and track emerging genomic alterations in a platinum sensitive cohort under the pressure of PARP inhibition. Whole exome DNA sequencing, IHC for PDL-1 and TILs will be performed on tissue samples. ClincalTrials.gov Identifier: NCT03167619. (Moore K, et al "SOLO-1: Phase III trial of maintenance olaparib following platinum-based chemotherapy in newly diagnosed patients with advanced ovarian cancer and a BRCA1/2 mutation" ESMO 2018; Abstract LBA7-PR). Clinical trial information: NCT03167619.
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Affiliation(s)
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Sung-Bae Kim
- University of Ulsan College of Medicine, Seoul, South Korea
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9
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Gianni L, Mansutti M, Anton A, Calvo Martínez L, Bisagni G, Bermejo B, Semiglazov V, Thill M, Chacon JI, Chan A, Morales S, Alvarez I, Lahuerta A, Zambetti M, Redfern AD, Dent RA, Barlera S, Valagussa P, Tusquets I. Event-free survival analysis of the prospectively randomized phase III ETNA study with neoadjuvant nab-paclitaxel (nab-P) versus paclitaxel (P) followed by anthracycline regimens in women with HER2-negative high-risk breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
515 Background: The ETNA study showed that substituting P with nab-P did not significantly increase the overall rate of pathological complete response (pCR) (P 18.6%, nab-P 22.5%, p = 0.19). The multivariate analysis revealed that tumor subtype (triple negative vs luminal B-like) was the most significant factor (OR 4.85) influencing treatment outcome (Gianni L et al, JAMA Oncol 2018). Methods: This multicenter open label study (NCT01822314) in collaboration with GEICAM and BCRC-WA randomized 695 patients with centrally-confirmed HER2-negative breast cancer to nab-P 125 mg/m2 (346 patients) or P 90 mg/m2 (349 patients). The two drugs were given on weeks 1, 2 and 3 followed by 1-week rest for 4 cycles before 4 cycles of an anthracycline regimen as per investigator choice. The primary endpoint was pCR (absence of invasive cells in breast and nodes). A secondary endpoint is event-free survival (EFS) defined as the time from randomization to the first date of disease progression while on primary therapy or disease recurrence (local, regional, distant, invasive contralateral breast cancer) after surgery or death due to any cause. Results: The ITT analysis of the secondary endpoint EFS at 5 years is reported below: Clinical trial information: NCT01822314. Overall 5-year survival was 84.8% after P and 87.3% for nab-P. No serious adverse events were documented during the follow-up. Conclusions: The improved 5-year EFS after nab-P failed to reach statistical significance (unadjusted P = 0.245). In the analysis by subgroup the numerical improvement was almost exclusively observed in luminal B and not in TN tumors. So far the data do not support substitution of P with nab-P in the schedule and doses adopted in the ETNA trial. Additional analyses will be based on ongoing molecular studies.[Table: see text]
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Affiliation(s)
| | - Mauro Mansutti
- Department of Oncology-ASUI Udine University Hospital, Udine, Italy
| | - Antonio Anton
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | | | - Giancarlo Bisagni
- Oncologia Medica Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Vladimir Semiglazov
- "National Medical Research Center of Oncology na N.N. Petrov" Ministry of Healthcare of Russian Federation, St Petersburg, Russian Federation
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Jose Ignacio Chacon
- Hospital Virgen de la Salud, GEICAM Spanish Breast Cancer Group, Toledo, Spain
| | - Arlene Chan
- Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
| | - Serafin Morales
- Medical Oncology Department, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | - Isabel Alvarez
- Hospital Donostia, GEICAM Spanish Breast Cancer Group, San Sebastian, Spain
| | | | | | | | | | | | | | - Ignasi Tusquets
- Hospital del Mar, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Barcelona, Spain
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Abstract
The immune system plays a complex role in the recognition/prevention, early eradication as well as progression of cancer. Recently, we have witnessed great momentum in the field of immuno-oncology. Checkpoint inhibitors and chimeric antigen receptor T cell therapy have now entered the clinic, with impressive and durable clinical responses seen across a broad array of tumor types. There are several lines of evidence supporting the development of an immune targeted approach in breast cancer. Emerging data of early clinical trials evaluating monotherapy checkpoint inhibition have shown modest activity in breast cancer, in particular high grade and aggressive subtypes such as triple negative, human epidermal growth factor receptor 2 (HER2)-positive and luminal B breast cancers. A considerable amount of effort is currently underway in exploring the use of combinatory strategies where therapies with distinct and potentially complementary mechanisms of actions may further enhance the immune response broadening out the group of breast cancer patients who would benefit from this strategy of cancer treatment. In this review, we discuss approaches to targeting the immune system in breast cancer adopted through understanding why the host immune system has failed in natural tumor suppression as well as the processes evolved by the tumor to circumvent an active immune system.
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Affiliation(s)
- Tira J Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jack J Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Sulastri Kamis
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
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11
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De Guzman R, Malik M, Lopes GDL, Dent RA, Dawood S. ASCO Leadership Development Program: International Perspectives. J Glob Oncol 2018; 4:1-3. [PMID: 30241270 PMCID: PMC6223475 DOI: 10.1200/jgo.18.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Roselle De Guzman
- Roselle De Guzman, St Lukes Medical Center, Quezon City, Philippines; Monica Malik, Nizam's Institute of Medical Sciences, Hyderabad, India; Gilberto de Lima Lopes Jr, Sylvester Comprehensive Cancer Center, Miami, FL; Rebecca Alexandra Dent, National Cancer Centre Singapore, Singapore; and Shaheenah Dawood, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Monica Malik
- Roselle De Guzman, St Lukes Medical Center, Quezon City, Philippines; Monica Malik, Nizam's Institute of Medical Sciences, Hyderabad, India; Gilberto de Lima Lopes Jr, Sylvester Comprehensive Cancer Center, Miami, FL; Rebecca Alexandra Dent, National Cancer Centre Singapore, Singapore; and Shaheenah Dawood, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Gilberto de Lima Lopes
- Roselle De Guzman, St Lukes Medical Center, Quezon City, Philippines; Monica Malik, Nizam's Institute of Medical Sciences, Hyderabad, India; Gilberto de Lima Lopes Jr, Sylvester Comprehensive Cancer Center, Miami, FL; Rebecca Alexandra Dent, National Cancer Centre Singapore, Singapore; and Shaheenah Dawood, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Rebecca Alexandra Dent
- Roselle De Guzman, St Lukes Medical Center, Quezon City, Philippines; Monica Malik, Nizam's Institute of Medical Sciences, Hyderabad, India; Gilberto de Lima Lopes Jr, Sylvester Comprehensive Cancer Center, Miami, FL; Rebecca Alexandra Dent, National Cancer Centre Singapore, Singapore; and Shaheenah Dawood, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Shaheenah Dawood
- Roselle De Guzman, St Lukes Medical Center, Quezon City, Philippines; Monica Malik, Nizam's Institute of Medical Sciences, Hyderabad, India; Gilberto de Lima Lopes Jr, Sylvester Comprehensive Cancer Center, Miami, FL; Rebecca Alexandra Dent, National Cancer Centre Singapore, Singapore; and Shaheenah Dawood, Mediclinic City Hospital, Dubai, United Arab Emirates
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12
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Schmid P, Cortes J, Bergh JCS, Pusztai L, Denkert C, Verma S, McArthur HL, Kummel S, Ding Y, Karantza V, Dang T, Dent RA. KEYNOTE-522: Phase III study of pembrolizumab (pembro) + chemotherapy (chemo) vs placebo + chemo as neoadjuvant therapy followed by pembro vs placebo as adjuvant therapy for triple-negative breast cancer (TNBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps602] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Peter Schmid
- Barts Cancer Institute, Centre for Experimental Cancer Medicine, London, United Kingdom
| | | | | | - Lajos Pusztai
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | - Carsten Denkert
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sunil Verma
- Tom Baker Cancer Centre, Alberta Health Services, and University of Calgary, Calgary, AB, Canada
| | | | | | - Yu Ding
- Merck & Co., Inc., Kenilworth, NJ
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13
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Dawood SS, Sirohi B, Mainwaring P, Dent RA. Effect of breast tumor subtype and site of distant metastatic disease on prognostic outcome among patients with brain metastases and stage IV denovo breast cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Yap YS, Kwok LL, Syn N, Chay WY, Chia JWK, Tham CK, Wong NS, Lo SK, Dent RA, Tan S, Mok ZY, Koh KX, Toh HC, Koo WH, Loh M, Ng RCH, Choo SP, Soong RCT. Predictors of Hand-Foot Syndrome and Pyridoxine for Prevention of Capecitabine-Induced Hand-Foot Syndrome: A Randomized Clinical Trial. JAMA Oncol 2017; 3:1538-1545. [PMID: 28715540 DOI: 10.1001/jamaoncol.2017.1269] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hand-foot syndrome (HFS) is a common adverse effect of capecitabine treatment. Objective To compare the incidence and time to onset of grade 2 or greater HFS in patients receiving pyridoxine vs placebo and to identify biomarkers predictive of HFS. Design, Setting, and Participants This single-center, randomized double-blind, placebo-controlled phase 3 trial conducted at National Cancer Centre Singapore assessed whether oral pyridoxine could prevent the onset of grade 2 or higher HFS in 210 patients scheduled to receive single-agent capecitabine chemotherapy for breast, colorectal, and other cancers. Interventions Patients were randomized to receive concurrent pyridoxine (200 mg) or placebo daily for a maximum of 8 cycles of capecitabine, with stratification by sex and use in adjuvant or neoadjuvant vs palliative setting. Patients were withdrawn from the study on development of grade 2 or higher HFS or cessation of capecitabine. Main Outcomes and Measures Primary end point was the incidence of grade 2 or higher HFS in patients receiving pyridoxine. Secondary end points included the time to onset (days) of grade 2 or higher HFS and identification of biomarkers predictive of HFS, including baseline folate and vitamin B12 levels, as well as genetic polymorphisms with genome-wide arrays. Results In this cohort of 210 patients (median [range] age, 58 [26-82] years; 162 women) grade 2 or higher HFS occurred in 33 patients (31.4%) in the pyridoxine arm vs 39 patients (37.1%) in the placebo arm (P = .38). The median time to onset of grade 2 or higher HFS was not reached in both arms. In univariate analysis, the starting dose of capecitabine (odds ratio [OR], 1.99; 95% CI, 1.32-3.00; P = .001), serum folate levels (OR, 1.27; 95% CI, 1.10-1.47; P = .001), and red blood cell folate levels (OR, 1.25; 95% CI, 1.08-1.44; P = .003) were associated with increased risk of grade 2 or higher HFS. In multivariate analyses, serum folate (OR, 1.30; 95% CI, 1.12-1.52; P < .001) and red blood cell folate (OR, 1.28; 95% CI, 1.10-1.49; P = .001) were the only significant predictors of grade 2 or higher HFS. Grade 2 or higher HFS was associated with 300 DNA variants at genome-wide significance (P < 5 × 10-8), including a novel DPYD variant (rs75267292; P = 1.57 × 10-10), and variants in the MACF1 (rs183324967, P = 4.80 × 10-11; rs148221738, P = 5.73 × 10-10) and SPRY2 (rs117876855, P < 1.01 × 10-8; rs139544515, P = 1.30 × 10-8) genes involved in wound healing. Conclusions and Relevance Pyridoxine did not significantly prevent or delay the onset of grade 2 or higher HFS. Serum and red blood cell folate levels are independent predictors of HFS. Trial Registration clinicaltrials.gov Identifier: NCT00486213.
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Affiliation(s)
- Yoon-Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Li-Lian Kwok
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Chee Kian Tham
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Nan Soon Wong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Soo Kien Lo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Sili Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Zuan Yu Mok
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - King Xin Koh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Han Chong Toh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wen Hsin Koo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Marie Loh
- Translational Laboratory in Genetic Medicine (TLGM), Agency for Science, Technology, and Research, Singapore.,Department of Epidemiology and Biostatistics of the School of Public Health, Imperial College London, London, United Kingdom
| | | | - Su Pin Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Richie Chuan Teck Soong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Pathology, National University of Singapore, Singapore
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15
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Paluch-Shimon S, Pagani O, Partridge AH, Abulkhair O, Cardoso MJ, Dent RA, Gelmon K, Gentilini O, Harbeck N, Margulies A, Meirow D, Pruneri G, Senkus E, Spanic T, Sutliff M, Travado L, Peccatori F, Cardoso F. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast 2017; 35:203-217. [DOI: 10.1016/j.breast.2017.07.017] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
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16
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Dorajoo SR, NG T, Chae JW, Yeo HLA, Shwe M, Gan YX, Foo KM, Loh WJK, Koo SL, Chay WY, Tan TJY, Beh SY, Lim EH, Lee GE, Dent RA, Yap YS, Ng RC, Chan A. A web-based tool to predict chemotherapy-associated cognitive impairment during survivorship. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21609] [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: 11/20/2022] Open
Abstract
e21609 Background: Chemotherapy-associated cognitive impairment (CACI) experienced during survivorship can dramatically impair quality of life, particularly among patients receiving treatment with curative intent. We construct a web-based tool to predict the risk of self-perceived CACI at 15 months post-chemotherapy initiation among early stage breast cancer patients, to facilitate screening and early intervention. Methods: We recruited patients receiving chemotherapy for early-stage breast cancer between 2011 and 2014. Subjective cognitive function was assessed using FACT-Cog before, during and at 15 months after initiating chemotherapy. Based on a previously established minimal clinically important difference, an 11-point reduction in FACT-Cog score relative to that at baseline was considered as clinically significant CACI. Factors evaluated as potential predictors of CACI included clinical, laboratory and demographic factors, behavioural symptom and quality of life assessments (EORTC-QLQ-C30). Logistic regression was used to construct a model predicting CACI. Validation was performed on an external cohort recruited between 2015 and 2016. Model discrimination and calibration were evaluated using the receiver operating curve (ROC) and Hosmer-Lemeshow goodness-of-fit, respectively. The model was implemented as a web-based tool. Results: A total of 131 patients were recruited for model development. The model consisted of baseline EORTC-QLQ-C30 fatigue subscale percentage [effect size (95% confidence interval), 5.0% (2.0% to 7.0%), p < 0.001] and the change in FACT-Cog score after 2 cycles of chemotherapy, relative to baseline [-4.0% (-7.0% to -1.0%), p = 0.007]. The model was validated on an external cohort of 33 patients, with an ROC of 0.60, Hosmer-Lemeshow goodness-of-fit statistic of 5.86 (p = 0.44), sensitivity of 57.1% and specificity of 76.9%. The web application is accessible at http://bit.ly/CognitiveRisk Conclusions: A web application to predict CACI risk has been developed and externally validated. The tool facilitates early screening for patients at high risk for CACI and allows timely interventions to prevent or minimize the impact of CACI during survivorship.
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Affiliation(s)
| | - Terence NG
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Jung-Woo Chae
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, K.K. Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- National Cancer Centre Singapore, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Elaine H. Lim
- Singapore Oncology Consultants, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond C.H. Ng
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
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17
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Chae JW, Chua PS, NG T, Yeo HLA, Shwe M, Gan YX, Dorajoo SR, Foo KM, Loh KWJ, Koo SL, Chay WY, Tan TJY, Beh SY, Lim HE, Lee GE, Dent RA, Yap YS, Ng RC, Ho HK, Chan A. Mitochondrial DNA content in peripheral blood as a biomarker for cancer-related fatigue in early-stage breast cancer patients: A prospective cohort study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10018] [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: 11/20/2022] Open
Abstract
10018 Background: Cancer-related fatigue (CRF) is reported to be associated with mitochondrial dysfunction. Hence, mitochondrial DNA (mtDNA) content, a biomarker of mitochondrial dysfunction, is hypothesized to correlate with the onset of CRF. This study aimed to evaluate the association between peripheral blood mtDNA content and CRF in patients receiving chemotherapy. Methods: This was a prospective cohort study. Early-stage breast cancer patients (Stages I to III) receiving anthracycline or taxane-based chemotherapy were recruited. CRF was assessed using the validated Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) at two time points: baseline (T1; prior to treatment) and 6 weeks after initiation of treatment (T2). Worsening of CRF was defined as ≥10% increase in the overall MFSI-SF score at T2. Peripheral blood mtDNA content was measured at both time points using real-time quantitative polymerase chain reaction. Multiple logistic regression was utilized to evaluate the association between mtDNA reduction and worsening of CRF, adjusting for age, anxiety, insomnia and other clinically important covariates. Results: A total of 91 patients [mean age (±SD): 51.3 (9.2) years; 81.3% Chinese; 63.3% receiving anthracycline-based chemotherapy] were recruited. Proportions of patients with worsening of CRF increased from the lower to the upper quartiles of mtDNA reduction (26.1%, 30.4%, 52.2%, and 59.1% in quartiles 1, 2, 3, and 4, respectively, P = 0.010 for trend). Reduction of mtDNA content was significantly greater among those with worsening of CRF compared to those without CRF [mean reduction (±SD): 16.3 (23.5) vs 6.0 (17.3), P = 0.018]. After adjusting for covariates, every 1-unit reduction of the mtDNA content was associated with a 4% increase risk for worsening of CRF (95% CI, 1%-8%; P = 0.016). Conclusions: This is the first study to show that reduction of mtDNA content in peripheral blood is associated with onset of CRF in patients receiving chemotherapy. Further validation studies are required to confirm the findings.
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Affiliation(s)
- Jung-Woo Chae
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Peh Siang Chua
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Terence NG
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Koon Mian Foo
- Department of Pharmacy, K.K. Women’s and Children’s Hospital, Singapore, Singapore
| | - Kiley Wei Jen Loh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Hsuen Elaine Lim
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond C.H. Ng
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
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18
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NG T, Yeo HLA, Shwe M, Gan YX, Foo KM, Loh WJK, Koo SL, Chay WY, Tan TJY, Beh SY, Lim HE, Lee GE, Dent RA, Yap YS, Ng RC, Chu PYP, Khor CC, Ho HK, Chan A. A genome-wide association study (GWAS) meta-analysis of chemotherapy-associated cognitive impairment (CACI) in Asian early-stage breast cancer patients (ESBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10096] [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: 11/20/2022] Open
Abstract
10096 Background: Genetic variations among genes regulating neuronal function, neurotransmission and plasticity may contribute to varying risk of CACI. In order to fully elucidate the complex genetic structure underlying CACI, a GWAS meta-analysis was performed to identify genetic variants associated with CACI among ESBC patients. Methods: A GWAS meta-analysis of two independent cohorts totaling 266 chemotherapy-receiving ESBC patients (mean age: 51.0 ± 9.2 years; 80.8% Chinese) was performed. Patients’ self-perceived cognitive function was assessed using the validated FACT-Cog (v.3). Genome-wide genotyping was performed using the Illumina HumanOmniExpress-24 version 1.1 BeadChips kits. Each beadchip contains over 700,000 genetic markers. Covariates included in the meta-analysis were the first two dimensions of the multi-dimensional scaling. Results: After applying stringent quality control measures and removing four population outliers, data from 546,399 SNPs were available for 84 cases and 170 controls. In the meta-analysis, two SNPs (rs6443264 and rs4686371) exceeded the suggestive threshold of P < 1×10-5 (Table). Following adjustment for the first two MDS dimensions in the meta-analysis, both SNPs remained as top two SNPs with P < 1×10-4. Both rs6443264 and rs4686371 are located in chromosome 3p25 and lie in the intronic regions encoding OGG1 and ARPC4 genes, respectively. Alteration of the OGG1 gene could compromise the functions of downstream neuronal genes, and modification of the ARPC4 gene could affect the formation of the actin-related protein 2/3 complex and impair memory formation. Conclusions: To the best of our knowledge, this is the first GWAS meta-analysis to identify two loci, namely rs6443264 and rs4686371 that are suggestive of genome-wide association with CACI among Asian ESBC patients. [Table: see text]
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Affiliation(s)
- Terence NG
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, K.K. Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Hsuen Elaine Lim
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond C.H. Ng
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | | | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
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19
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Dent RA, Kim SB, Im SA, Espie M, Blau S, Tan AR, Isakoff S, Oliveira M, Saura C, Wongchenko M, Kapp AV, Chan WY, Singel SM, Maslyar DJ, Baselga J. LOTUS (NCT02162719): A double-blind placebo (PBO)-controlled randomized phase II trial of first-line ipatasertib (IPAT) + paclitaxel (P) for metastatic triple-negative breast cancer (TNBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1009] [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: 11/20/2022] Open
Abstract
1009 Background: The oral Akt inhibitor IPAT is being evaluated in cancers with a high prevalence of PI3K/Akt pathway activation, including TNBC. Methods: Eligible patients (pts) had measurable inoperable locally advanced/metastatic TNBC previously untreated with systemic therapy. Pts were stratified by prior (neo)adjuvant therapy, chemotherapy-free interval and tumor PTEN status, and randomized 1:1 to P 80 mg/m2 (d1, 8 & 15) with either IPAT 400 mg or PBO (d1–21) q28d until progression or unacceptable toxicity. Co-primary endpoints were progression-free survival (PFS) in the ITT population and pts with PTEN-low tumors by IHC. Secondary endpoints included objective response rate (ORR), duration of response (DoR) and overall survival in the ITT and IHC PTEN-low populations, efficacy in pts with PIK3CA/AKT1/PTEN-altered tumors by next-generation sequencing (NGS), and safety. Results: Baseline characteristics were generally balanced between arms. Efficacy is shown below. The most common grade ≥3 AEs (grouped terms) were diarrhea (23% IPAT+P vs 0% PBO+P; no grade 4 or colitis in either arm), neutropenia (18% vs 8%), asthenia (5% vs 6%), peripheral neuropathy (5% vs 5%) and pneumonia (5% vs 0%). More pts receiving IPAT+P than PBO+P had an AE leading to dose reduction of IPAT/PBO (21% vs 6%) or P (38% vs 11%) but median cumulative dose intensity was similar (IPAT/PBO: 99% vs 100%; P: 100% vs 100%). AEs led to IPAT/PBO discontinuation in 13% vs 11% of pts, respectively; 2 pts (3%) discontinued IPAT for grade 3 diarrhea. Conclusions: Adding IPAT to P for TNBC modestly improved PFS in the ITT pts. The effect was more pronounced in the prespecified subgroup with PIK3CA/AKT1/PTEN alterations, warranting further evaluation of IPAT in these pts. AEs were manageable. Clinical trial information: NCT02162719. [Table: see text]
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Affiliation(s)
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seock-Ah Im
- Seoul National University, Seoul, Republic of Korea
| | - Marc Espie
- Hospital Saint Louis, Breast Disease Center, Paris, France
| | - Sibel Blau
- Northwest Medical Specialties, Puyallup, WA
| | | | | | - Mafalda Oliveira
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Saura
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
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20
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Lee JJX, Wong FY, Tan B, Lim SH, Tan SH, Ngeow JYY, Dent RA. Clinicopathological characteristics and treatment outcomes in patients with stage I-III invasive lobular carcinoma of the breast (ILC) treated at the National Cancer Centre Singapore. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joycelyn Jie Xin Lee
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Fuh-Yong Wong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Benita Tan
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Swee Ho Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Joanne YY Ngeow
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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21
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NG T, Chian MT, Yeo HLA, Shwe M, Gan YX, Loh WJK, Koo SL, Jain A, Lee GE, Dent RA, Yap YS, Ng RC, Cham MT, Lee JA, Chu PYP, Khor CC, Ho HK, Chan A. DNA methyltransferase 1 (DNMT1) polymorphism and chemotherapy-associated cognitive impairment in early-stage breast cancer patients (ESBC): A prospective, longitudinal study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Terence NG
- National University of Singapore, Singapore, Singapore
| | | | | | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Si-Lin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- National Cancer Center Singapore, Singapore, Singapore
| | | | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Mooi Tai Cham
- K.K. Women's and Children's Hospital, Singapore, Singapore
| | - Jung Ah Lee
- K.K. Women's and Children's Hospital, Singapore, Singapore
| | - Pak Yan Pa Chu
- Singapore Cord Blood Bank, K.K. Women's and Children's Hospital, Singapore, Singapore
| | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
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22
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Chan A, NG T, Oh SK, Eyob T, Shwe M, Gan YX, Chan R, Dent RA, Ng RC, Tan M, Goh B, Tan YP, Fan G. A culturally adapted, multidisciplinary psychoeducation program for early-stage breast cancer survivors in Asia: A randomized, controlled trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Terence NG
- National University of Singapore, Singapore, Singapore
| | - Suan Kai Oh
- National University of Singapore, Singapore, Singapore
| | - Tewodros Eyob
- National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond Chan
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Mabel Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Brandon Goh
- National Cancer Centre Singapore, Singapore, Singapore
| | - Yee Pin Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Gilbert Fan
- National Cancer Centre Singapore, Singapore, Singapore
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23
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Gianni L, Mansutti M, Anton A, Calvo L, Bisagni G, Bermejo B, Semiglazov V, Thill M, Chacon JI, Chan A, Morales S, Alvarez I, Plazaola A, Zambetti M, Redfern AD, Dittrich C, Dent RA, Magazzu' D, Valagussa P, Tusquets I. ETNA (Evaluating Treatment with Neoadjuvant Abraxane) randomized phase III study comparing neoadjuvant nab-paclitaxel (nab-P) versus paclitaxel (P) both followed by anthracycline regimens in women with HER2-negative high-risk breast cancer: A MICHELANGO study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Luca Gianni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milano, Italy
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Antonio Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Lourdes Calvo
- Complejo Hospitalario Universitario de A Coruña, A Coruna, Spain
| | - Giancarlo Bisagni
- Arcispedale S. Maria Nuova Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - Begoña Bermejo
- Hospital Clinico Universitario Valencia, Valencia, Spain
| | | | - Marc Thill
- Agaplesion Markus Krankenhaus, Klinik für Gynäkologie und Geburtshilfe, Frankfurt am Main, Germany
| | | | - Arlene Chan
- Breast Cancer Research Centre - WA & Curtin University, Perth, Australia
| | - Serafin Morales
- Medical Oncology Department, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | | | | | | | | | - Christian Dittrich
- Ludwig Boltzmann Institute for Applied Cancer Research (LBI-ACR VIEnna), Kaiser Franz Josef-Spital, Vienna, Austria, Vienna, Austria
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24
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Dawood SS, Gupta S, Mainwaring PN, Nag SM, Dent RA. Effect of progesterone receptor on outcome of women with breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Dawood SS, Ngeow Yuen Yie J, Mainwaring PN, Gupta S, Cortes J, Sirohi B, Dent RA. Association of male breast cancer and prostate cancer: A large population based study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Joanne Ngeow Yuen Yie
- National Cancer Center Singapore, Duke-National University Singapore, Singapore, Singapore
| | | | | | - Javier Cortes
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
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26
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Matsumoto H, Thike AA, Li H, Yeong J, Koo SL, Dent RA, Tan PH, Iqbal J. Increased CD4 and CD8-positive T cell infiltrate signifies good prognosis in a subset of triple-negative breast cancer. Breast Cancer Res Treat 2016; 156:237-47. [PMID: 26960711 DOI: 10.1007/s10549-016-3743-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [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: 12/08/2015] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
Tumour-infiltrating lymphocytes (TILs) signify immune response to tumour in a variety of cancers including breast cancer. However, earlier studies examining the clinical significance of TILs in breast cancers have generated mixed results. There are only a few that address the relationship between TILs and clinical outcomes in triple-negative breast cancers (TNBC). The aim of this study is to evaluate the clinical significance of TILs that express CD4 + and CD8 + , in TNBC. Immunohistochemical staining of CD4 and CD8 was performed on tissue microarrays of 164 cases of TNBC. TILs were counted separately as intratumoral when within the cancer cell nests (iTILs) and as stromal when within cancer stroma (sTILs). High CD8 + iTILs and sTILs, and CD4 + iTILs correlated with histologic grade. On Kaplan-Meier analysis, a significantly better survival rate was observed in high CD8 + iTIL (disease-free survival, DFS: P = 0.004, overall survival, OS: P = 0.02) and both high CD4 + iTILs (DFS: P = 0.025, OS: P = 0.023) and sTILs (DFS: P = 0.01, OS: P = 0.002). In multivariate analysis, CD8 + iTILs (DFS: P = 0.0095), CD4 + sTILs (DFS: P = 0.0084; OS: P = 0.0118), and CD4 (high) CD8 (high) CD8 iTILs (DFS: P = 0.0121; OS: P = 0.0329) and sTILs (DFS: P = 0.0295) showed significantly better survival outcomes. These results suggest that high levels of both CD8 + iTILs and CD4 + sTILs as well as CD4 (high) CD8 (high) iTILs and sTILs are independent prognostic factors in TNBC.
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Affiliation(s)
| | - Aye Aye Thike
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Singapore, 169856, Singapore
| | - Huihua Li
- Division of Research, Singapore General Hospital, Singapore, Singapore
| | - Joe Yeong
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Singapore, 169856, Singapore.,Singapore Immunology Network, Agency of Science, Technology and Research, Singapore, Singapore
| | - Si-Lin Koo
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Singapore, 169856, Singapore
| | - Jabed Iqbal
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Singapore, 169856, Singapore.
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27
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Molinero L, Yu J, Li C, Deurloo R, Dent RA, Bell R, Brown J, Parmar M, Toi M, Suter T, Steger G, Pivot X, Mackey J, Jackisch C, Hall P, Hegde P, Bais C, Cameron D. Abstract S1-01: Analysis of molecular prognostic factors associated with tumor immune and stromal microenvironment in BEATRICE, an open-label phase 3 trial in early triple-negative breast cancer (eTNBC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s1-01] [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: 11/16/2022]
Abstract
Abstract
Background: TNBC is a mutationally complex heterogeneous breast cancer subtype. In BEATRICE, adding bevacizumab to standard adjuvant chemotherapy for eTNBC improved neither invasive disease-free survival (IDFS; primary endpoint) nor overall survival (OS) [Cameron 2013; Bell SABCS 2014]. We explored prognostic effects of tumor-associated immune and stromal gene signatures.
Methods: Gene expression (RNA) was assessed in pretreatment archival tumor tissue using an 800-gene nanostring platform. Given the low event rates and lack of bevacizumab effect in BEATRICE, treatment arms were pooled. The biomarker-evaluable population (BEP; all patients with an evaluable biomarker sample and ≥1 postbaseline efficacy assessment) was dichotomized using median gene expression level as the cutoff. Prognostic associations between IDFS/OS and prespecified candidate gene sets/de novo identified clusters were assessed using univariate Cox proportional hazards models.
Results: Baseline characteristics and efficacy were similar in the BEP (988/2591 randomized pts; 38%) and the overall study population. In hierarchical cluster analysis based exclusively on immune gene expression, immune genes were enriched in 33% of samples, intermediate in 38%, and weak in 28%. Further characterization suggested differential prognostic value of distinct immune and stromal cell gene sets (Table). A significant prognostic effect for IDFS and OS was seen for CD8 effector T cell (Teff) and regulatory T cell (Treg) gene signatures, but not for the Teff:Treg ratio. A less pronounced positive prognostic effect was seen for other gene sets representing immune cells, including macrophages, CD4 T cells, and B cells (data not shown). Activated T helper (Th)-1 cell-derived chemokines and negative immune modulators of T cell activity (eg PD-L1) were highly prognostic for IDFS and OS. Both the cytokine IL-8 and ESM1 (target of VEGF-A pathway activation) were associated with worse IDFS and OS. No association was seen between outcome and markers for classic microvasculature (CD31, CD34), cancer-associated fibroblasts (FAP, BGN, DCN), VEGF-A, or VEGF-C.
IDFSOSGene signatureHR (95% CI)Interaction p-valueHR (95% CI)Interaction p-valueTeff0.40 (0.28-0.57)7.2x10-70.29 (0.17-0.49)4.2x10-6Treg0.38 (0.26-0.54)1.6x10-70.23 (0.13-0.40)2.9x10-7Teff:Treg ratio0.80 (0.58-1.12)0.20.89 (0.57-1.39)0.6Th10.45 (0.31-0.64)8.1x10-60.43 (0.27-0.70)5.8x10-4PD-L10.42 (0.29-0.60)1.8x10-60.24 (0.14-0.41)3.4x10-7IL-81.48 (1.06-2.08)0.0221.89 (1.18-3.01)0.0076ESM11.73 (1.23-2.43)0.00172.22 (1.38-3.58)0.001
Conclusions: These molecular gene signature analyses in eTNBC confirm that markers of cytotoxic CD8 T cells are associated with good prognosis. This is the first report of a positive prognostic effect of regulatory T cell markers, immune checkpoint modulators, and macrophage-associated markers in the adjuvant TNBC setting. High VEGF-A activity, but not its expression, was associated with worse prognosis. The strong prognostic effect of immune checkpoint modulators suggests equilibrium between cytotoxic T cells and their inhibitors in eTNBC, supporting further exploration of immune checkpoint inhibitors in this therapeutic context.
Citation Format: Molinero L, Yu J, Li C, Deurloo R, Dent RA, Bell R, Brown J, Parmar M, Toi M, Suter T, Steger G, Pivot X, Mackey J, Jackisch C, Hall P, Hegde P, Bais C, Cameron D. Analysis of molecular prognostic factors associated with tumor immune and stromal microenvironment in BEATRICE, an open-label phase 3 trial in early triple-negative breast cancer (eTNBC). [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 S1-01.
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Affiliation(s)
- L Molinero
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - J Yu
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - C Li
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - R Deurloo
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - RA Dent
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - R Bell
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - J Brown
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - M Parmar
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - M Toi
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - T Suter
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - G Steger
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - X Pivot
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - J Mackey
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - C Jackisch
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - P Hall
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - P Hegde
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - C Bais
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
| | - D Cameron
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; National Cancer Center, Singapore, Singapore; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada; Deakin University, Geelong, Australia; Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; Kyoto University, Kyoto, Japan; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Medical University of Vienna, Vienna, Austria; University Hospital Jean Minjoz, Besançon, France; Cross Center Institute, Edmonton, Canada; Klinikum Offenbach, Offenbach, Germany; Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, United Kingdom
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Kim SB, Tan AR, Im SA, Villanueva R, Valero V, Saura C, Oliveira M, Isakoff SJ, Singel SM, Dent RA. LOTUS: A randomized, phase II, multicenter, placebo-controlled study of ipatasertib (Ipat, GDC-0068), an inhibitor of Akt, in combination with paclitaxel (Pac) as front-line treatment for patients (pts) with metastatic triple-negative breast cancer (TNBC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps1111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Seock-Ah Im
- Seoul National University College of Medicine, Seoul, South Korea
| | - Rafael Villanueva
- Institut Català D'Oncologia. ICO Duran i Reinals, Hospitalet Del Llobregat, Spain
| | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cristina Saura
- Vall d'Hebron University Hospital/SOLTI, Barcelona, Spain
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NG T, Teo SMJ, Yeo HLA, Shwe M, Gan YX, Cheung YT, Tan YP, Yong WS, Madhukumar P, Loh KWJ, Koo SL, Jain A, Lee GE, Wong M, Dent RA, Yap YS, Ng RC, Khor CC, Ho HK, Chan A. Evaluation of brain-derived neurotrophic factor (BDNF) genetic polymorphism (rs6265) on chemotherapy-associated cognitive impairment in early-stage breast cancer (ESBC) patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Terence NG
- National University of Singapore, Singapore, Singapore
| | | | | | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Yee Pin Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Si-Lin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- National Cancer Center Singapore, Singapore, Singapore
| | - Mabel Wong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | | | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
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30
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NG T, Yap SY, Shwe M, Gan YX, Cheung YT, Fan G, Yong WS, Madhukumar P, Loh KWJ, Koo SL, Jain A, Lee GE, Wong M, Dent RA, Yap YS, Ng RC, Ho HK, Chan A. Evaluation of pro-inflammatory cytokines and anxiety symptoms in early-stage breast cancer (ESBC) patients: A prospective, longitudinal study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Terence NG
- National University of Singapore, Singapore, Singapore
| | - Shi Yin Yap
- National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Gilbert Fan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Si-Lin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- National Cancer Center Singapore, Singapore, Singapore
| | - Mabel Wong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
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31
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Dent RA, Mainwaring PN, Tan TJY, Barbier S, Cortes J, Blackwell KL, Dawood SS. Survival in triple-negative breast cancer (TNBC): Evidence from the SEER database 2010-2011. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12075] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Tira Jing Ying Tan
- Experimental Cancer Therapeutics Unit, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Dawood SS, Lei X, Mainwaring PN, Gupta S, Sirohi B, Cortes J, Dent RA. Impact of locoregional therapy among women 70 years or older with early stage hormone receptor positive breast cancer: A population based study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Xiudong Lei
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sudeep Gupta
- Tata Memorial Centre, Mumbai, Maharashtra, India
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Cheung YT, Ng T, Shwe M, Ho HK, Foo KM, Cham MT, Lee JA, Fan G, Tan YP, Yong WS, Madhukumar P, Loo SK, Ang SF, Wong M, Chay WY, Ooi WS, Dent RA, Yap YS, Ng R, Chan A. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol 2015; 26:1446-51. [PMID: 25922060 PMCID: PMC4478978 DOI: 10.1093/annonc/mdv206] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/20/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Existing evidence suggests that proinflammatory cytokines play an intermediary role in postchemotherapy cognitive impairment. This is one of the largest multicentered, cohort studies conducted in Singapore to evaluate the prevalence and proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. PATIENTS AND METHODS Chemotherapy-receiving breast cancer patients (stages I-III) were recruited. Proinflammatory plasma cytokines concentrations [interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, interferon-γ and tumor necrosis factor-α] were evaluated at 3 time points (before chemotherapy, 6 and 12 weeks after chemotherapy initiation). The FACT-Cog (version 3) was utilized to evaluate patients' self-perceived cognitive disturbances and a computerized neuropsychological assessment (Headminder) was administered to evaluate patients' memory, attention, response speed and processing speed. Changes of cognition throughout chemotherapy treatment were compared against the baseline. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations on self-perceived cognitive disturbances and each objective cognitive domain. RESULTS Ninety-nine patients were included (age 50.5 ± 8.4 years; 81.8% Chinese; mean duration of education = 10.8 ± 3.3 years). Higher plasma IL-1β was associated with poorer response speed performance (estimate: -0.78; 95% confidence interval (CI) -1.34 to -0.03; P = 0.023), and a higher concentration of IL-4 was associated with better response speed performance (P = 0.022). Higher concentrations of IL-1β and IL-6 were associated with more severe self-perceived cognitive disturbances (P = 0.018 and 0.001, respectively). Patients with higher concentrations of IL-4 also reported less severe cognitive disturbances (P = 0.022). CONCLUSIONS While elevated concentrations of IL-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment. This study is important because cytokines would potentially be mechanistic mediators of chemotherapy-associated cognitive changes.
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Affiliation(s)
- Y T Cheung
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - T Ng
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - M Shwe
- Department of Pharmacy, National University of Singapore, Singapore
| | - H K Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - M T Cham
- Breast Centre, KK Women's and Children's Hospital, Singapore
| | - J A Lee
- Breast Centre, KK Women's and Children's Hospital, Singapore
| | - G Fan
- Departments of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Y P Tan
- Departments of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - W S Yong
- Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - P Madhukumar
- Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - S K Loo
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - S F Ang
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - M Wong
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W Y Chay
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W S Ooi
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - R A Dent
- Medical Oncology, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Y S Yap
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - R Ng
- Medical Oncology, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - A Chan
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
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Lee GE, Ow MY, Lie D, Dent RA. Barriers and facilitators for clinical trial participation among diverse Asian patients with breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
108 Background: Recruitment rates for breast cancer trials are low for racial/ethnic minorities. Little is known about factors influencing trial recruitment in Asian patients. Our aim is to examine the barriers and facilitators for participation in trials among multi-ethnic Asian women with breast cancer. Methods: We recruited a convenience sample from consecutive women seen at a National Cancer Centre. Two experienced bilingual (English and Chinese) moderators conducted focus groups to theme saturation. The question guide incorporated open-ended questions soliciting opinions about trial participation and knowledge. Women were first asked if they were willing, unwilling, or still open to participate in future trials. Sessions were audiotaped and transcribed. Transcripts were independently coded for emergent themes. Results: Sixteen of 103 women approached participated in five focus groups. Chinese, Malay and Indian participants aged 29 to 69 represented different cancer stages. Five had no prior knowledge of trials. We identified three major areas consisting of 24 minor themes for barriers and facilitators. Major themes fell into: 1) individual- or patient-related, 2) trial-related and and 3) sociocultural factors. When analysis was stratified by willingness to join trials, we found that women willing to join trials expressed themes representing facilitators (better test therapy, cost-effective profile, or trust in doctors and local systems). Women unwilling to participate expressed themes associated with barriers, while women still open to participation expressed themes representing both facilitators and barriers. Malay women were more likely to express themes related to ‘fatalism’ as a barrier. Conclusions: We found that facilitators and barriers to trial participation among Asian women were similar to those previously reported in Western women. Knowledge of trials is limited among women receiving breast cancer treatment. Unique sociocultural factors suggest that approaches customised to local and community beliefs are needed to improve trial participation in minority groups.
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Affiliation(s)
- Guek Eng Lee
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Mandy Y.L. Ow
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Desiree Lie
- Duke-NUS Graduate Medical School, Singapore, Singapore
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Clemons MJ, Cochrane B, Pond GR, Califaretti N, Chia SKL, Dent RA, Song X, Robidoux A, Parpia S, Warr D, Rayson D, Pritchard KI, Levine MN. Randomised, phase II, placebo-controlled, trial of fulvestrant plus vandetanib in postmenopausal women with bone only or bone predominant, hormone-receptor-positive metastatic breast cancer (MBC): the OCOG ZAMBONEY study. Breast Cancer Res Treat 2014; 146:153-62. [PMID: 24924416 DOI: 10.1007/s10549-014-3015-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/27/2014] [Indexed: 12/20/2022]
Abstract
Biomarkers of bone turnover, including urine N-telopeptide (uNTx), have been used as surrogate measures of response to bone-targeted therapies. Vascular endothelial growth factor (VEGF) levels correlate with extent of bone metastases. We assessed whether vandetanib, an inhibitor of VEGF, epidermal growth factor receptor and RET signalling, improved uNTx response when added to fulvestrant (F) in breast cancer patients with bone metastases. Postmenopausal patients with bone predominant, hormone-receptor-positive metastatic breast cancer were randomised to F (500 mg IM days 1, 15, 29, then monthly) with either vandetanib (100 mg PO OD) (FV) or placebo (FP). The primary objective was uNTx response. Secondary objectives included PFS, OS, RECIST response, pain scores and toxicity. Sixty-one patients were allocated to FV and 68 to FP. Out of 127 analyzable patients, an uNTx response occurred in 66 % for FV and 54 % for FP (p = 0.21). No difference was detected between groups for PFS; HR = 0.95 (95 % CI 0.65-1.38) or OS HR = 0.69 (95 % CI 0.37-1.31). For the 62 patients with measurable disease, clinical benefit rates were 41 and 43 %, respectively (p = 0.47). Serious adverse events were similar, 3.3 % for FV versus 5.9 % for FP. Elevated baseline uNTx (>65 nM BCE/mmol Cr) was prognostic for PFS, HR = 1.55 (95 % CI 1.04-2.30) and for OS, HR = 2.32 (95 % CI 1.25-4.33). The addition of vandetanib to fulvestrant did not improve biomarker response, PFS or OS in patients with bone metastases. Baseline bone turnover was prognostic for PFS and OS.
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Affiliation(s)
- Mark J Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute and University of Ottawa, Box 912, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada,
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Abstract
Abstract
Background
While breast cancer is relatively rare in young women under the age of 40, its incidence is increasing and accounts for up to 40% of all female cancers. Young age at diagnosis is associated with a poorer prognosis in early breast cancers; however little is known about the natural history of young women with metastatic breast cancer. We aim to evaluate the effect of age on breast-cancer specific survival (BCS) and overall survival (OS) for patients with de novo metastatic breast cancer using data from the SEER registry.
Methods
We retrospectively analyzed 14155 patients with de novo metastatic breast cancer from the SEER registry between 2000 and 2009. Young women were defined as 50 years and below and further subdivided into three groups: 20-34, 35-39, and 40-49 years. Age 50-69 years served as a comparison group. Unadjusted overall survival (OS) and breast cancer specific survival (BCS) were accessed using Kaplan-Meier plots and compared across groups using log-rank tests. Cox proportional hazards models were then fitted to determine the association between survival end point and age after adjusting for patient and tumor characteristics.
Results
546 (3.9%) patients were age 20-34 years, 750 (5.3%) were 35-39 years, 3049 (21.5%) were 40-49 years and 9810 (69.3%) patients were 50-69 years. Median BCS among patients age 20-34, 35-39, 40-49 and 50-69 years was 30, 33, 35, 28 months respectively (P<0.0001). Median BCS among patients with estrogen receptor positive disease who were age 20-34, 35-39, 40-49 and 50-69 years was 43, 42, 51, 37 months respectively (P<0.0001). Similarly median BCS among patients with estrogen receptor negative disease who were age 20-34, 35-39, 40-49 and 50-69 years was 21, 18, 18, 17 months respectively (P<0.0001). In the multivariable model compared to patients who were age 50 -69 years those aged 20-34 years (HR 0.88, 95% CI 0.78-0.99), 35-39 years (HR 0.82, 95% CI 0.74-0.91) and 40-49 years (HR 0.84, 95% CI 0.79-0.89) had a significantly decreased risk of death from breast cancer. Similar results were obtained for OS.
Conclusion
Younger patients defined by age less than 50 years had a better BCS and OS when compared against older age group in the setting of de novo metastatic breast cancer. This may be explained by lack of important comorbidities, relatively good performance status as well as ability to tolerate more lines of chemotherapies.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-16.
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Affiliation(s)
- GE Lee
- National Cancer Centre Singapore, Singapore, Singapore; Dubai Health Authority, Dubai, United Arab Emirates; DUKE-NUS Graduate Medical School, Singapore, Singapore; University of Malaya, Kuala Lumpur, Malaysia
| | - S Dawood
- National Cancer Centre Singapore, Singapore, Singapore; Dubai Health Authority, Dubai, United Arab Emirates; DUKE-NUS Graduate Medical School, Singapore, Singapore; University of Malaya, Kuala Lumpur, Malaysia
| | - BA Haaland
- National Cancer Centre Singapore, Singapore, Singapore; Dubai Health Authority, Dubai, United Arab Emirates; DUKE-NUS Graduate Medical School, Singapore, Singapore; University of Malaya, Kuala Lumpur, Malaysia
| | - PS Tan
- National Cancer Centre Singapore, Singapore, Singapore; Dubai Health Authority, Dubai, United Arab Emirates; DUKE-NUS Graduate Medical School, Singapore, Singapore; University of Malaya, Kuala Lumpur, Malaysia
| | - N Bhoo-Pathy
- National Cancer Centre Singapore, Singapore, Singapore; Dubai Health Authority, Dubai, United Arab Emirates; DUKE-NUS Graduate Medical School, Singapore, Singapore; University of Malaya, Kuala Lumpur, Malaysia
| | - RA Dent
- National Cancer Centre Singapore, Singapore, Singapore; Dubai Health Authority, Dubai, United Arab Emirates; DUKE-NUS Graduate Medical School, Singapore, Singapore; University of Malaya, Kuala Lumpur, Malaysia
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Chan A, Foo YL, Ham Guo MS, Kee YC, Tan YP, Yong WS, Madhukumar P, Ooi WS, Chay WY, Dent RA, Ang SF, Lo SK, Yap YS, Ng RC, Cheung YT. Minimal clinically important difference (MCID) for the functional assessment of cancer therapy: Cognitive function (FACT-Cog) in breast cancer patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6589 Background: Establishing the Minimal Clinically Important Difference (MCID) is essential for interpreting the clinical relevance of patient reported outcomes. This is the first study to date to determine the MCID of FACT-Cog, a 37-item validated subjective neuropsychological instrument designed to evaluate cancer patients’ perceived cognitive deterioration on their quality of life. Methods: This prospective, observational study involved 220 breast cancer patients who have completed FACT-Cog and EORTC-QLQ-C30 at two time points: baseline and at least 3 months following chemotherapy. The MCID was computed using 3 approaches: 1) an anchor-based approach utilized the validated EORTC-QLQ-C30-Cognitive Functioning scale (CF) as the anchor for patients who showed a minimal deterioration on the CF (defined as a one-step deterioration on the CF scale); 2) a Receiver Operating Characteristic (ROC) curve was used to identify an optimal MCID cut-off point for deterioration; 3) a distribution-based approach utilized the 0.33 SD, 0.5 SD and one standard error of measurement (SEM) of the total FACT-Cog score (148 points) to estimate the MCID. Results: There was moderate correlation between the mean change scores of FACT-Cog and CF (rp= 0.43, p<0.001). The CF-anchored MCID was 9.6 points (95% CI 4.4 - 14.8). MCID derived from the ROC method was 7.5 points (AUC: 0.75; sensitivity: 75.6%; specificity: 68.8%). Using the distribution-based approach, MCID corresponding to effect sizes of 0.33SD to 0.5SD of the total FACT-Cog score ranged from 6.9 – 10.3 points and one-SEM criterion resulted in a MCID estimate of 10.6 points. Combining results from all approaches, the MCID identified for FACT-Cog ranged from 6.9 – 10.6 points (4.7% to 7.2% of total score). Conclusions: A 6.9 to 10.6 points reduction of the FACT-Cog score corresponds to the smallest clinically-relevant perceived cognitive deterioration. These estimates are important as they can facilitate the interpretation of patient-reported cognitive changes and sample size estimation in future studies.
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Affiliation(s)
| | - Yu Lee Foo
- National University of Singapore, Singapore, Singapore
| | | | | | - Yee Pin Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Wei Seong Ooi
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Soo Fan Ang
- National Cancer Centre Singapore, Singapore, Singapore
| | - Soo Kien Lo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
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Ng T, Cheung YT, Ham Guo MS, Kee YC, Ho HK, Fan G, Yong WS, Madhukumar P, Ooi WS, Chay WY, Ng RC, Ng QS, Ang SF, Lo SK, Yap YS, Dent RA, Chan A. Plasma vascular endothelial growth factor level and cognitive changes in breast cancer patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e20566] [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: 11/20/2022] Open
Abstract
e20566 Background: It is suggested that vascular endothelial growth factor (VEGF) induces neurogenesis in the brain and provides neuroprotectiveeffects. This study was designed to examine the relation between plasma VEGF level and cognitive functioning in breast cancer patients who have received chemotherapy. Methods: Early-stage breast cancer patients (stage I to III) who received anthracycline- and/or taxane-based chemotherapy were prospectively recruited at a single center. Perceived cognitive functioning (FACT-Cog) and computerized neuropsychological assessment (Headminder) were used to evaluate patients’ cognitive function at three time points: prior to chemotherapy (T1), at midpoint (T2), and end of chemotherapy (T3). Headminder evaluated four cognitive domains: Attention, Memory, Processing, and Response speed. Impairment in each domain were defined as a >2.5 reduction of the Z score from baseline, as calculated by the reliable change index for repeated cognitive measurements. Plasma VEGF levels were analyzed at each time point using the multiplex immunoassay. Spearman Correlation (rs) was utilized to correlate the change in plasma VEGF and neurocognitive functioning. Results: Thirty-six patients were recruited (median age: 51.5; Chinese: 80.6%; post-menopausal: 58.3%). Median plasma VEGF levels were T1: 19.2 pg/ml; T2: 26.5 pg/ml; T3: 21.9 pg/ml. Weak correlations were observed between the change in VEGF level and the change in FACT-Cog and Headminder scores for individual cognitive domain (Table). Conclusions: Results suggest a weak correlation between plasma VEGF level and cognitive functioning in the domains of attention, concentration, functional interferences, mental acuity and response speed. Larger sample size and longer follow up are required to further explore the findings. [Table: see text]
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Affiliation(s)
- Terence Ng
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
| | - Gilbert Fan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Wei Seong Ooi
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Quan Sing Ng
- National Cancer Centre Singapore, Singapore, Singapore
| | - Soo Fan Ang
- National Cancer Centre Singapore, Singapore, Singapore
| | - Soo Kien Lo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
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Clemons MJ, Cochrane B, Califaretti N, Chia SKL, Dent RA, Song X, Robidoux A, Pond GR, Parpia S, Pritchard KI, Levine MN. Randomized phase II placebo-controlled trial of fulvestrant plus vandetanib in postmenopausal women with bone only or bone predominant, hormone receptor-positive metastatic breast cancer (MBC): OCOG Zamboney study—NCT00811369. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
574 Background: Biomarkers of bone turnover, including urine N-telopeptide (uNTx) and serum C-telopeptide (sCTx) reflect tumor-related bone breakdown and have been used as surrogate measures of response to therapy in trials. Vascular endothelial growth factor (VEGF) levels correlate with extent of bone metastases (BM). We assessed whether vandetanib, an inhibitor of VEGF, epidermal growth factor receptor and RET signalling, improved uNTx response when added to fulvestrant (F) in patients with BM. Methods: Postmenopausal patients with bone only, or bone predominant, hormone receptor positive MBC were randomised to F (500mg IM day 1, 14, 28, then monthly) with either vandetanib (100mg PO OD) (FV) or placebo (FP) until progression. The primary objective was uNTx response (>30% reduction from baseline). uNTx was collected at baseline, weekly to wk 4, at wk 12 and then every 12 wks. Secondary objectives included PFS, OS, RECIST response, pain and toxicity. Results: 61 patients were allocated to FV and 68 to FP. Median age was 59. 18% had received 1 prior chemotherapy regime and 73% prior endocrine therapy for MBC. uNTx response (n=124 pts) was 64% for FV vs. 52% for FP (p=0.20). No difference was detected between groups for median PFS; 6 months for FV vs. 4.8 months for FP, HR=0.93 (95% CI: 0.64 to 1.36). 16 patients died in FV arm vs. 21 in the FP arm, HR=0.71 (95% CI: 0.37 to 1.36). For those patients with measurable disease, clinical benefit rates were 41% and 43%, respectively, p=1.00. Serious adverse events were similar, 3.3% for FV vs. 5.9% for FP. Elevated baseline uNTx (>65 nM BCE/mmol Cr) was prognostic for PFS, HR=1.62 (95% CI: 1.08 to 2.43 and for mortality, HR= 2.4 (95% CI: 1.2 to 4.6). In an exploratory analysis uNTx was predictive of responsiveness to FV for PFS, HR=0.60 when uNTx >65 vs. HR=1.37 when uNTx <65, P = 0.025 for interaction. Conclusions: The addition of vandetanib to F did not improve biomarker response, PFS or OS compared to F alone in patients with bone predominant disease. Exploratory analyses confirmed that baseline bone turnover markers are prognostic for PFS and OS. Clinical trial information: NCT00811369.
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Affiliation(s)
- Mark J. Clemons
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | - Xinni Song
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, ON, Canada
| | - Andre Robidoux
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Sameer Parpia
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
| | - Kathleen I. Pritchard
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Mark Norman Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
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Cheung YT, Ham Guo MS, Kee YC, Chui WK, Ho HK, Fan G, Yong WS, Madhukumar P, Ooi WS, Chay WY, Dent RA, Ang SF, Lo SK, Yap YS, Ng RC, Chan A. Association of pro-inflammatory biomarkers and post-chemotherapy cognitive changes in Asian breast cancer patients: A prospective cohort study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9506 Background: Although existing evidence suggests that cytokines play an intermediary role in the development of post-chemotherapy cognitive changes, specific cytokines associated with this neurotoxic sequela of chemotherapy are still unknown. This study was designed to identify pro-inflammatory biomarkers that are associated with memory and attention impairment in Asian patients receiving chemotherapy. Methods: This is a prospective, cohort study conducted at the National Cancer Centre Singapore. Early-stage Asian breast cancer patients (Stage I to III), who received anthracycline and/or taxane-based chemotherapy were recruited. Computerized neuropsychological assessments (Headminder) were administered to evaluate patients’ memory and attention performances and a panel of pro-inflammatory plasma cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, GM-CSF, IFN-γ and TNF-α) was evaluated using multiplex immunoassay at three time points: prior to chemotherapy (T1), at midpoint (T2), and end of chemotherapy (T3). Memory and attention impairment were defined as a >2.5 reduction of the Zscore from baseline, as calculated by the reliable change index for repeated cognitive measurements. Results: Thirty-six patients were included (mean age 49.7±9.0 years; 80.6% Chinese). Comparing to T1, 50.0% and 36.1% of the patients suffered memory and attention impairment at T3, respectively. Comparing patients with intact memory to those who suffered impairment from T2 to T3, they had higher levels of circulating IL-1β [median (IQR): 0.44 (0.1-0.5) vs 0.56 (0.4-0.7) pg/ml, p=0.069], IL-4 [0.41 (0.0-0.8) vs 0.85 (0.2-1.5) pg/ml, p=0.067) and TNF-α [1.78 (1.3-2.2) vs 3.01 (1.3-3.5) pg/ml, p=0.069]. At T3, reduction of attention scores were associated with higher levels of IL-1β (rs= -0.37, p=0.023) and IL-6 (rs= -0.33, p=0.045). No significant associations were identified with IL-2, IL-8, IL-10, GM-CSF and IFN-γ. Conclusions: These findings suggest that an increase in the post-chemotherapy levels of TNF-α, IL-1β, IL-4 and IL-6 may have an association with the manifestations of memory and attention impairment in Asian breast cancer patients.
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Affiliation(s)
| | | | | | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
| | - Gilbert Fan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Wei Seong Ooi
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Soo Fan Ang
- National Cancer Centre Singapore, Singapore, Singapore
| | - Soo Kien Lo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
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Cheung YT, Shwe M, Chui WK, Chay WY, Ang SF, Dent RA, Yap YS, Lo SK, Ng RCH, Chan A. Effects of chemotherapy and psychosocial distress on perceived cognitive disturbances in Asian breast cancer patients. Ann Pharmacother 2012; 46:1645-55. [PMID: 23249868 DOI: 10.1345/aph.1r408] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is conflicting evidence on the effect of chemotherapy and psychosocial distress on perceived cognitive changes in cancer patients. OBJECTIVE To compare the severity of perceived cognitive disturbance in Asian breast cancer patients receiving chemotherapy and those not receiving chemotherapy, and identify clinical characteristics associated with perceived cognitive disturbances. METHODS A cross-sectional, observational study was conducted at the largest cancer center in Singapore. Breast cancer patients receiving chemotherapy and not receiving chemotherapy completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30), and Beck Anxiety Inventory to assess their perceived cognitive functioning, health-related quality of life, and anxiety, respectively. Multiple regression was conducted to delineate the factors associated with perceived cognitive disturbances. RESULTS A total of 85 breast cancer patients receiving chemotherapy and 81 not receiving chemotherapy were recruited. Chemotherapy patients experienced more fatigue (QLQ-C30 fatigue scores: 33.3 vs 22.2 points; p = 0.005) and moderate-to-severe anxiety (21.9% vs 8.6%; p = 0.002) compared to non-chemotherapy patients. Non-chemotherapy patients reported better perceived cognitive functioning than those who received chemotherapy (FACT-Cog scores: 124 vs 110 points, respectively; p < 0.001). Chemotherapy and endocrine therapy were strongly associated with perceived cognitive disturbances (p < 0.001 and 0.021, respectively). The interacting effect between anxiety and fatigue was moderately associated with perceived cognitive disturbances (β = -0.29; p = 0.037). CONCLUSIONS Chemotherapy and endocrine treatment were associated with significant cognitive disturbances among Asian breast cancer patients. Psychosocial factors could be used to identify cancer patients who are more susceptible to cognitive disturbances in the clinical setting.
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Cheung YT, Ham Guo MS, Chui WK, Dent RA, Yap YS, Lo SK, Ng RC, Chan A. Effect of chemotherapy and psychosocial distress parameters on perceived cognitive disturbances in Asian breast cancer patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9041 Background: A qualitative study has revealed that Asian breast cancer patients attributed their post-chemotherapy cognitive disturbances to psychosocial distress. To validate this claim, we aim to examine perceived cognitive disturbances, anxiety and quality of life (QoL) in Asian breast cancer patients and to identify clinical and psychosocial factors associated with perceived cognitive disturbances. Methods: A prospective, observational study was held at the largest cancer center in Singapore. Chemotherapy (CT) and non-chemotherapy (non-CT) receiving breast cancer patients completed self- reported questionnaires to assess the following domains: patients’ perceived impact of chemotherapy on cognitive disturbances (FACT-Cog), health-related QoL (EORTC QLQ-C30) and anxiety (Beck Anxiety Inventory). Multiple regression was conducted to delineate factors associated with perceived cognitive impairment. Results: A total of 166 (1:1 CT/non-CT) patients were recruited (age: 54.1±10.2 years; 78.9% Chinese; 53.6% post-menopausal). Most of the CT patients received anthracycline-based chemotherapy (93.1%) and anti-hormonal therapy (69.4%). Comparing to non-CT patients, CT patients experienced more fatigue (QLQ-C30 fatigue scores: 22.2 vs 33.3 points; p=0.005), more significant anxiety (8.6% vs 21.9%; p=0.002), and more cognitive disturbances (FACT-Cog scores: 110 vs 124 points; p<0.0001). Regression model identified chemotherapy, anti-hormonal therapy, emotional functioning and global health status to be strongly associated with cognitive disturbances in Asian breast cancer patients. The interacting effect between anxiety and fatigue, comparing to fatigue alone, was more associated with cognitive disturbances (β=-0.212; p=0.032 vs β=-0.07; p=0.25, respectively). Conclusions: This is the first study to demonstrate that Asian breast cancer patients experiencing both fatigue and anxiety are more predisposed to cognitive disturbances. Post-chemotherapy cognitive changes are observed in our patients, and our results suggest that psychosocial factors are impactful to identify cancer patients who are more susceptible to cognitive disturbances.
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Affiliation(s)
| | | | | | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Soo Kien Lo
- National Cancer Centre Singapore, Singapore, Singapore
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Dawood SS, Dent RA, Gupta S, Litton JK, Mustafa R, Cortes J, Mittendorf EA, Gonzalez-Angulo AM, Buchholz TA. Impact of surgery and radiation of the primary among women with de novo stage IV breast cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1032 Background: The aim of this retrospective study was to determine the impact of surgery(S) and radiation(R) therapy to the primary tumor among patients (pts) with stage IV denovo breast cancer. Methods: The SEER registry was used to identify pts with denovo stageIV breast cancer diagnosed between 1988 and 2008. Pts were divided into 4 groups based on type of treatment to primary tumor: both S+R, S alone, R alone, or no treatment of primary (no S/R). Breast cancer specific survival (BCS) was calculated from the date of diagnosis of breast cancer to the date of death from breast cancer or last follow up. Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the association between treatment of primary and survival after adjusting for potential confounders (e.g age, grade, hormone receptor and race). Results: 25903 pts were identified; 4640 (17.9%) S+R, 6556 (25.3%) S, 4467 (17.2%) R, and 10240 (39.5%) no S/R. 1183 (4.6%) had surgery to sites other than the primary. Median age was 63 years. Median follow-up was 14 months. Median BCS was 23 months. Median BCS among pts who underwent S+R, S, R and no S/R was 36 months, 31 months, 18 months and 15 months respectively (p<0.0001). Among pts who underwent S+R, median BCS among pts who did and did not have surgery to sites other than primary was 50 months and 41 months respectively (p=0.029). Of the pts treated with S+R 10-year BCS was 18%. In the multivariable model compared to women who were in the no S/R group those who underwent S (HR= 0.59, 95%CI 0.55- 0.62,p<0.0001) and S+R (HR=0.51, 95%CI 0.47-0.55,p<0.0001) had decreased risk of death from breast cancer and those who underwent R (HR=1.13, 95% CI 1.04-1.21, p=0.002) had an increased risk of death from breast cancer. Pts who had surgery to sites other than the primary tumor had decreased risk of death from breast cancer compared to those who did not (HR=0.80, 95%CI 0.72-0.89,p<0.0001). Conclusions: Our results indicate that S+R of the primary breast tumor among pts with denovo stage IV breast cancer maybe associated with a decreased risk of death from breast cancer. A select subgroup of pts who undergo S+R may also benefit from surgery to sites other than the primary which may afford them maximum survival advantage.
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Affiliation(s)
| | | | | | | | | | - Javier Cortes
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Byrski T, Gronwald J, Huzarski T, Dent RA, Zuziak D, Wiśniowski R, Marczyk E, Blecharz P, Szurek O, Cybulski C, Dębniak T, Górski B, Lubiński J, Narod S. Neoadjuvant therapy with cisplatin in BRCA1-positive breast cancer patients. Hered Cancer Clin Pract 2011. [PMCID: PMC3108169 DOI: 10.1186/1897-4287-9-s2-a4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nasim S, Sousa BA, Dent RA, Pritchard KI. Abstract P6-12-01: A Meta Analysis of Risk of Cardiovascular Events in Patients with Metastatic Breast Cancer (MBC) Treated with Anti Vascular Endothelial Growth Factor (VEGF) Therapy — Bevacizumab. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-12-01] [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 and objectives: Bevacizumab, used in combination with chemotherapy has demonstrated efficacy in randomized trials in MBC. Hypertension, congestive heart failure and cardiomyopathy have been reported in trials of bevacizumab in breast cancer. The aim of this systematic review and meta analysis is to determine the overall risk of grade 3-4 hypertension (HTN), left ventricular dysfunction (LVD) and venous (VT) and arterial thromboembolic events (ATE) related to Bevacizumab in patients with MBC.
Methods: We selected randomized phase III trials which compared chemotherapy with or without bevacizumab in MBC as first or second line therapy. Data extraction was carried out from results published in the literature or from conference proceedings of the selected studies. For the analysis, we used a fixed-effects and random effects models to calculate the pooled event-based relative risk ratios (RR) with 95% confidence interval (CI). The Cochran's Q statistic and I2 statistics were first calculated to assess the heterogeneity among the proportions of the included trials. We collected all grade 3-4 events reported in these trials in relation to cardiovascular events: HTN, LVD, congestive heart failure, cardiomyopathy, VT and ATE.
Results: Five trials were included in the meta-analysis: E2100, AVADO, RIBBON-1, RIBBON-2 and Miller et al study (capecitabine alone or plus bevacizumab in previously treated MBC). In total 2126 patients received chemotherapy in combination with bevacizumab and 1444 chemotherapy alone. When there was tendency for heterogeneity, random-effects models were used. Thromboembolic events were pooled together as VT and ATE as information was not clear in some of the reported studies. CHF and cardiomyopathy were considered for LVD events in the Miller study as LVD was not reported. Patients treated with bevacizumab-containing regimens had a RR for HTN of 10.32 (95% CI, 4.23- 24.79; p<.0001), RR for LVD 2.58 (95% CI, 1.06 - 6.32; p=0.04) and RR for VT and ATE of 1.71 (95% CI, 0.81- 3.60; p=0.16) as shown in figure 1.
Conclusion: HTN is a recognized side effect of bevacizumab therapy. The risk of LVD is also significantly higher with bevacizumab therapy (RR 2.58) as shown in this pooled analysis, but the risk of thrombotic events is not increased.
Figure available in online version.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-12-01.
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Affiliation(s)
- S Nasim
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - BA Sousa
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - RA Dent
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - KI. Pritchard
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada
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