Current status and controversial issues concerning endocrine therapy for patients with recurrent breast cancer in Japan

The objective is to report a case of recurrent breast cancer in a poor CYP2D6 metabolizer male patient on tamoxifen, and how pharmacogenomic (PGx) testing can play an important role in selecting appropriate adjuvant endocrine therapy. The case examined here is a 60-year-old white male diagnosed with recurrence of breast cancer. The patient was prescribed tamoxifen four years prior as adjuvant endocrine therapy after initial treatment with surgery. PGx testing ordered at the time of recurrence revealed patient is a poor metabolizer of CYP2D6, which may decrease the efficacy of tamoxifen. The results prompted a change in therapy to an aromatase inhibitor (AI). This case illustrates the potential benefits of preemptive PGx testing in a male breast cancer patient to assist in selecting appropriate adjuvant therapy based on how the patient metabolizes medications. In addition, PGx testing encourages patient involvement by emphasizing the association of genetics in determining treatment. The ultimate goal in performing these tests is to individualize treatment to improve safety and efficacy while minimizing adverse drug reactions. Article Type: Case Study

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Factors associated with overall survival after recurrence in patients with ER-positive/HER2-negative breast cancer: An ad-hoc analysis of the JBCRG-C06 Safari study

10.21203/rs.3.rs-190374/v1 ◽

2021 ◽

Author(s):

Hidetoshi Kawaguchi ◽

Yutaka Yamamoto ◽

Shigehira Saji ◽

Norikazu Masuda ◽

Takahiro Nakayama ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Endocrine Therapy ◽

Ad Hoc ◽

Recurrent Breast Cancer ◽

University Hospital ◽

Patient Factors ◽

Long Time ◽

Recurrent Breast ◽

The Relationship

Abstract Background The Safari study (UMIN 000015168) was a retrospective, multicenter study in which 1072 consecutive cases of estrogen receptor-positive (ER+) advanced breast cancer (ABC) treated using 500 mg fulvestrant were registered. We previously reported the relationship between the patient factors and overall survival (OS) after the diagnosis using the same cases and the same factors for the analysis of time to treatment failure (TTF) in patients with ER + ABC. The current study is an ad-hoc analysis that focused on the relationship between the patient factors and OS after recurrence by adding factors generally associated with OS after recurrence. Methods The OS after recurrence in patients with ER + human epidermal growth factor receptor 2 negative (HER2−) recurrent breast cancer was analyzed via univariate and multivariate analyses with a Cox proportional hazards model. Results A total of 598 cases were used for the analysis of OS after recurrence. Multivariate analysis revealed that favorable OS (median, 6.4 years) was significantly correlated with long time from recurrence to fulvestrant use (≥ 3 years), low nuclear or histological grade (G3 vs. G1), long TTF of initial palliative endocrine therapy (≥ 12 months), and long time to initial palliative chemotherapy (≥ 2 years). Conclusion In patients with ER + HER2 − recurrent breast cancer who received endocrine therapy as the primary palliative treatment, the low proliferation activity of the tumor at the first diagnosis, sensitivity to initial endocrine therapy after the recurrence, and long time to the initiation of chemotherapy might be correlated with the favorable OS after recurrence. Trial registration: University Hospital Medical Information Network: UMIN 000015168, 2014/09/16

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Neoadjuvant pegylated liposomal doxorubicin in combination with cisplatin and infusional fluoruracil (CCF) with and without endocrine therapy in locally advanced primary or recurrent breast cancer

The Breast ◽

10.1016/j.breast.2010.06.005 ◽

2011 ◽

Vol 20 (1) ◽

pp. 34-38 ◽

Cited By ~ 5

Author(s):

Rosalba Torrisi ◽

Emilia Montagna ◽

Eloise Scarano ◽

Silvia Dellapasqua ◽

Giuseppe Cancello ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Liposomal Doxorubicin ◽

Locally Advanced ◽

Pegylated Liposomal Doxorubicin ◽

Recurrent Breast Cancer ◽

Recurrent Breast

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Loss of estrogen receptor in recurrent breast cancer is associated with poor response to endocrine therapy.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.9.2584 ◽

1996 ◽

Vol 14 (9) ◽

pp. 2584-2589 ◽

Cited By ~ 219

Author(s):

T Kuukasjärvi ◽

J Kononen ◽

H Helin ◽

K Holli ◽

J Isola

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Hormone Receptor ◽

Poor Response ◽

Recurrent Breast Cancer ◽

Hormone Receptor Status ◽

Primary Tumors ◽

Er Positive ◽

Recurrent Breast ◽

Er Expression

PURPOSE Up to 30% to 40% of metastases from hormone receptor-positive primary breast cancer do not respond to endocrine therapy. We studied how often hormone receptor status changes between primary and recurrent tumors and whether such a change might explain unresponsiveness to endocrine therapy. PATIENTS AND METHODS Primary breast cancer samples and matched asynchronous recurrences were studied from 50 patients who had not received any adjuvant therapy. Estrogen receptor (ER) and progesterone receptor (PR) status was determined immunohistochemically from histologically representative formalin-fixed paraffin-embedded tumor samples. ER status was ascertained by mRNA in situ hybridization. RESULTS Thirty-five (70%) of 50 primary tumors were positive for ER and 30 (60%) for PR. Hormone receptor status of the recurrent tumor differed from that of the primary tumor in 18 cases (36%). Discordant cases were due to the loss of ER (n = 6), loss of PR (n = 6), or loss of both receptors (n = 6). Receptor-negative primary tumors were always accompanied by receptor-negative recurrences. Among 27 patients with ER-positive primary tumors, loss of ER was a significant predictor (P = .0085) of poor response to subsequent endocrine therapy. Only one of eight patients (12.5%) with lost ER expression responded to tamoxifen therapy, whereas the response rate was 74% (14 of 19) for patients whose recurrent tumors retained ER expression. CONCLUSION Loss of ER expression in recurrent breast cancer should be considered as a cause for poor response to endocrine therapy in primarily ER-positive patients. We conclude that analysis of recurrent tumor samples may improve the predictive value of ER and PR assays.

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