scholarly journals Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer

2018 ◽  
Vol 129 ◽  
pp. 54-66 ◽  
Author(s):  
Ilaria Trestini ◽  
Luisa Carbognin ◽  
Sara Monteverdi ◽  
Sara Zanelli ◽  
Alessandro De Toma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Composition ◽  
Metastatic Breast Cancer ◽  
Clinical Implication ◽  
Early Stage ◽  
Metastatic Breast

Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer.

1995 ◽  
Vol 13 (4) ◽  
pp. 858-868 ◽  
Author(s):  
R P McQuellon ◽  
H B Muss ◽  
S L Hoffman ◽  
G Russell ◽  
B Craven ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Metastatic Breast Cancer ◽  
Life Expectancy ◽  
Metastatic Disease ◽  
Patient Preferences ◽  
Early Stage ◽  
Metastatic Breast ◽  
High Dose

PURPOSE The purpose of this study was to elicit preferences for the treatment of metastatic breast cancer in women with early-stage breast cancer who were given hypothetical treatment scenarios. We predicted that quality of life, demographic, and treatment variables would have an impact on patient preferences. PATIENTS AND METHODS One hundred fifteen patients with stage 1-IIIA breast cancer were interviewed. All patients had either mastectomy or lumpectomy plus radiotherapy as primary treatment. Sixty-seven (58%) had prior adjuvant chemotherapy. Patients were given four clinical scenarios that described a woman with metastatic breast cancer who was stated to have a life expectancy of 18 months. Side effects of the treatment options were systematically varied from low (hormonal therapy) to life-threatening (high-dose experimental therapy) and were consistent with common clinical situations. Patients were asked to select which treatment, with its associated toxicity, they would accept and prefer for a 50% chance of specified increments in life expectancy, ie, 5 years, 18 months, 1 year, 6 months, 1 month, and 1 week. RESULTS Quality of life at the time of interview, previous chemotherapy treatment, and degree of difficulty of previous treatments did not predict patient preferences. The greater the toxicity potential of the treatment, the less likely patients were to accept the treatment, although approximately 15% of patients would prefer high-risk treatment for as little as 1 month of added life expectancy. Between 34% and 82% of patients would prefer different therapies for a 6-month addition to life expectancy, whereas almost all patients would accept treatment for a 5-year increase in length of survival. Younger patients were more willing to assume the risks of treatment for a small increase in life expectancy. Of note, between 54% and 78% of patients would elect to start the different treatments even without symptoms related to metastatic disease. Moreover, 76% of patients would prefer standard treatment or an experimental agent to reduce symptoms or pain, even if such treatment did not prolong life. Additionally, only 10% of patients would allow randomization to a clinical trial comparing high-dose with standard chemotherapy. Participation in the study was not distressing to most patients. CONCLUSION Patients showed clear preferences for specific treatments for metastatic disease when given hypothetical scenarios. There was a wide range of patient preferences for treatment based on risk-benefit assessment, but a substantial percentage of patients would accept the risk of major toxicity for minimal increase in overall survival.

What is the evidence for rechallenging with anthracyclines or taxanes in metastatic breast cancer? A review of the data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1072-1072
Author(s):  
J. Krell ◽  
C. Harper-Wynne ◽  
D. Miles ◽  
V. Misra ◽  
S. Cleator ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Safety Data ◽  
Metastatic Breast ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Sequence ◽  
Pubmed Database ◽  
Current Evidence Base

1072 Background: Anthracyclines and taxanes are widely used in the adjuvant setting for high risk, early stage breast cancer. This raises the issue of what is the optimal therapy for those patients who relapse, and what the potential role, if any, there is for rechallenge with these agents. The current evidence base for rechallenging with anthracyclines/anthracediones and taxanes in metastatic breast cancer (MBC) is examined in this study. Methods: Medline/Pubmed database searches were performed upto October 2008 to identify studies in which patients (pts) were rechallenged with anthracyclines/anthracediones or taxanes in MBC. Results: The efficacy data, as well as the safety data relating to neurotoxicity and cardiotoxicity from these studies, are summarized in the Table. Twenty-seven studies were identified (20=anthracycline/anthracedione, 7= taxane) of which only two were prospective studies. Both were small (n= 74 & 51) and related to anthracycline rechallenging. Conclusions: Evidence exists to support rechallenging with anthracyclines and taxanes. However, there are few prospective data on reexposure to taxanes and no data comparing anthracyclines versus taxanes following adjuvant exposure to both agents, supporting the need for clinical trials in this area. Such trials should ideally incorporate a cross-over design at treatment failure, which would shed light on the optimal sequence in which these agents should be administered. [Table: see text] No significant financial relationships to disclose.

scholarly journals It doesn’t make sense, but we do: framing disease in an online metastatic breast cancer support community

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ariane B. Anderson
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Late Stage ◽  
Illness Perceptions ◽  
Early Stage ◽  
Metastatic Breast ◽  
Peer To Peer ◽  
Online Discussions ◽  
Breast Cancer Patients ◽  
Cancer Support

Using Weick’s sensemaking as a conceptual framework to investigate online discussions between members of a Facebook group of metastatic breast cancer patients, and using thematic analysis to examine textual threads between group members, this research examines participants’ framing of cancer survivorship. Participants in peer-to-peer disease support groups, which are not led by medical experts, communicate differently among themselves in order to cope with chronic and terminal illness. Perceptions of survivorship of late stage patients versus early stage patients differ for a variety of reasons, with late stage patients understanding their illness trajectory more often as chronic and declining. This analysis identified three properties of sensemaking used by members to manage their disease: identity, retrospective, and enactment. Results indicate that peer-to-peer online support group communication engenders distinct framing logics that members draw upon for group support as they manage a chronic and terminal disease.

Use of comprehensive next-generation sequencing to identify pathogenic germline variants with therapeutic relevance in metastatic breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10527-10527
Author(s):  
Nicole Margo Grogan ◽  
Yi-Mi Wu ◽  
Dan R. Robinson ◽  
James M. Rae ◽  
Norah Lynn Henry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Genetic Testing ◽  
Early Stage ◽  
Metastatic Breast ◽  
Exome Capture ◽  
Sample Collection ◽  
Direct Role ◽  
Early Stage Disease ◽  
Therapeutic Relevance

10527 Background: Among patients with early-stage breast cancer, approximately 6-10% have a pathogenic germline variant (PGV) conferring inherited cancer predisposition. In contrast, few studies have explored the frequency and types of PGVs identified in patients with metastatic breast cancer (MBC); therefore, additional data is needed. Methods: From 2011-2020, 278 patients with MBC underwent fresh tumor biopsy and blood sample collection for paired tumor/normal DNA (targeted exome capture with analysis of 1700 genes) and RNA (tumor transcriptome) sequencing through the Michigan Oncology Sequencing (Mi-ONCOSEQ) program. Somatic and germline alterations were annotated and classified according to degree of clinical actionability with results returned to treating oncologists. Retrospective chart review was performed to determine if: 1) a PGV was identified prior to Mi-ONCOSEQ testing, 2) patients met National Comprehensive Cancer Network (NCCN) guideline criteria for genetic testing on the basis of personal or family cancer history and 3) patients received subsequent therapy informed by a PGV. Results: Forty-eight of the 278 patients (17.3%) had at least one PGV identified, with a total of 50 PGVs identified in this cohort. Only twelve of these PGVs (24%) had been identified prior to Mi-ONCOSEQ testing. The most frequent PGVs identified were in CHEK 2 (n = 9, 18%), MUTYH (n = 6, 12%), BRCA 1 (n = 5, 10%), BRCA2 (n = 5, 10%), ATM (n = 4, 8%) and PALB2 (n = 4, 8%). Somatic loss of heterozygosity events (LOH) occurred in 30 of the 50 cases with PGVs identified (60%). LOH events were observed in 83.3% of BRCA1, BRCA2, ATM and PALB2 PGVs, but were less frequently observed with CHEK2 (33.3%) and MUTYH (66.7%). Two hundred sixteen out of 278 patients (77.7%) in this cohort met NCCN criteria for genetic testing, although six patients with a PGV identified (CHEK2: n = 5; MUTYH: n = 1) did not meet NCCN criteria. Twenty-nine PGVs identified (58%) had potential therapeutic relevance and 11 patients (22.9%) received targeted therapy based on the PGV. Conclusions: The frequency of PGVs identified in this cohort is nearly double the frequency reported for patients with early-stage disease, suggesting that certain PGVs may confer worse prognosis. CHEK2, the most frequently identified PGV, was less likely to have an identifiable LOH event. The direct role of CHEK2 PGVs in tumor pathogenesis is uncertain, but other mechanisms of silencing the wild type allele must be considered. Despite the majority of patients meeting NCCN criteria for genetic testing, those with PGVs in CHEK2 were less reliably identified by this mechanism. The majority of PGVs identified were of potential therapeutic relevance, supporting the recommendation for genetic testing in all patients with MBC.

scholarly journals The EPICURE study: a pilot prospective cohort study of heterogeneous and massive data integration in metastatic breast cancer patients

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathilde Colombié ◽  
Pascal Jézéquel ◽  
Mathieu Rubeaux ◽  
Jean-Sébastien Frenel ◽  
Frédéric Bigot ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Metastatic Breast ◽  
Heterogeneous Data ◽  
Biological Data ◽  
Biological Database ◽  
Breast Cancer Patients ◽  
Survival Status ◽  
Data Investigation

Abstract Background Breast cancer is the most common cancer in women and the first cancer concerning mortality. Metastatic breast cancer remains a disease with a poor prognosis and about 30% of women diagnosed with an early stage will have a secondary progression. Metastatic breast cancer is an incurable disease despite significant therapeutic advances in both supportive cares and targeted specific therapies. In the management of a metastatic patient, each clinician follows a highly complex and strictly personal decision making process. It is based on a number of objective and subjective parameters which guides therapeutic choice in the most individualized or adapted manner. Methods/design The main objective is to integrate massive and heterogeneous data concerning the patient’s environment, personal and familial history, clinical and biological data, imaging, histological results (with multi-omics data), and microbiota analysis. These characteristics are multiple and in dynamic interaction overtime. With the help of mathematical units with biological competences and scientific collaborations, our project is to improve the comprehension of treatment response, based on health clinical and molecular heterogeneous big data investigation. Discussion Our project is to prove feasibility of creation of a clinico-biological database prospectively by collecting epidemiological, socio-economic, clinical, biological, pathological, multi-omic data and to identify characteristics related to the overall survival status before treatment and within 15 years after treatment start from a cohort of 300 patients with a metastatic breast cancer treated in the institution. Trial registration ClinicalTrials.gov identifier (NCT number): NCT03958136. Registration 21st of May, 2019; retrospectively registered.

scholarly journals Receptor Discordance of Metastatic Breast Cancer Depending on the Molecular Subtype

Breast Care ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. 648-654
Author(s):  
Iris Holzer ◽  
Alex Farr ◽  
Yen Tan ◽  
Christine Deutschmann ◽  
Carmen Leser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Bone Metastases ◽  
Metastatic Disease ◽  
Primary Tumor ◽  
Molecular Subtype ◽  
Early Stage ◽  
Metastatic Breast ◽  
Her2 Status ◽  
Receptor Status

<b><i>Introduction:</i></b> Almost 30% of all women with early-stage breast cancer develop metastases. Treatment of metastatic disease is often based on the immunohistochemical information of the primary tumor, despite possible discordance of the hormone and Her2 receptor status. <b><i>Objectives:</i></b> The aim of this study was to compare the receptor status of the primary tumor with the metastasis, and to evaluate for receptor discordance with regard to the molecular subtype, receptor status, and the localization of the metastases. <b><i>Methods:</i></b> We retrospectively analyzed the data of all consecutive women with metastatic breast cancer, who underwent treatment at the Medical University Vienna between 2009 and 2016. Associations were calculated using the χ<sup>2</sup>or Fisher’s exact test; years from primary diagnosis to metastatic disease were calculated using the Kaplan-Meier method. <b><i>Results:</i></b> We identified 213 metastatic breast cancer patients, of whom 67 (31.5%) showed a discordant receptor status. Out of 32 patients with luminal A subtype, 14 (43.8%) had a switch of at least one receptor; 27 of 53 patients (50.9%) with luminal B subtype and 21 of 32 patients (65.6%) with Her2+ subtype showed receptor discordance; for triple-negative disease, 5 of 19 patients (36.3%) had a switch of at least one receptor. In 63 samples of bone metastases, 13 (20.6%) had discordant estrogen receptor status (<i>p</i> = 0.04). In 55 samples of bone metastases, 35 (63.3%) had discordant Her2 status (<i>p</i> = 0.002). <b><i>Conclusions:</i></b> Our data show high rates of receptor discordance in metastatic breast cancer. Apart from the primary tumor, the immunohistochemical receptor status of the metastasis needs to be verified. This can lead to a change in treatment and prognosis.

scholarly journals Monitoring the progression of metastatic breast cancer on nanoporous silica chips

2012 ◽  
Vol 370 (1967) ◽  
pp. 2433-2447 ◽  
Author(s):  
Jia Fan ◽  
Xiaoyong Deng ◽  
James W. Gallagher ◽  
Haiyu Huang ◽  
Yi Huang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Physiological State ◽  
Metastatic Breast ◽  
Effective Therapy ◽  
Nanoporous Silica ◽  
Breast Cancer Patients ◽  
Tumour Metastasis ◽  
Small Proteins

Breast cancer accounted for 15 per cent of total cancer deaths in female patients in 2010. Although significant progress has been made in treating early-stage breast cancer patients, there is still no effective therapy targeting late-stage metastatic breast cancers except for the conventional chemotherapy interventions. Until effective therapy for later-stage cancers emerges, the identification of biomarkers for the early detection of tumour metastasis continues to hold the key to successful management of breast cancer therapy. Our study concentrated on the low molecular weight (LMW) region of the serum protein and the information it contains for identifying biomarkers that could reflect the ongoing physiological state of all tissues. Owing to technical difficulties in harvesting LMW species, studying these proteins/peptides has been challenging until now. In our study, we have recently developed nanoporous chip-based technologies to separate small proteins/peptides from the large proteins in serum. We used nanoporous silica chips, with a highly periodic nanostructure and uniform pore size distribution, to isolate LMW proteins and peptides from the serum of nude mice with MDA-MB-231 human breast cancer lung metastasis. By matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and biostatistical analysis, we were able to identify protein signatures unique to different stages of cancer development. The approach and results reported in this study possess a significant potential for the discovery of proteomic biomarkers that may significantly enhance personalized medicine targeted at metastatic breast cancer.

scholarly journals A Gastric Metastatic Lesion That Resembled Early-Stage Gastric Cancer on Endoscopy during Treatment for Recurrent Breast Cancer: A Case Report

2021 ◽  
pp. 1719-1724
Author(s):  
Yukino Watanabe ◽  
Yoshiya Horimoto ◽  
Yuka Takahashi ◽  
Fumi Murakami ◽  
Masaki Yamada ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gastric Cancer ◽  
Metastatic Breast Cancer ◽  
Metastatic Disease ◽  
Gastric Lesion ◽  
Early Stage ◽  
Metastatic Breast ◽  
Endoscopic Findings ◽  
Systemic Treatments

Breast cancer metastasis to the gastrointestinal tract is relatively rare. Patients with such disease often develop gastrointestinal symptoms, but it is sometimes asymptomatic. Endoscopic findings of gastric metastasis from breast cancer markedly vary from benign to malignant, and even in suspected malignant cases, it is often difficult to differentiate between primary and metastatic disease. We experienced a case in which an endoscopic examination performed during the treatment for metastatic breast cancer resembled an early-stage gastric cancer. A 71-year-old woman underwent curative surgery for right breast cancer 16 years previously. She underwent endoscopic submucosal dissection for early-stage gastric cancer 5 years ago. Two years ago, she developed metastatic disease in the lungs and mediastinal lymph nodes, and endocrine therapy was administered. At the same time, a follow-up endoscopy revealed a new elevated lesion, suspected to be an early-stage gastric cancer. However, histological diagnosis of the biopsy was metastasis of breast cancer. One and a half years later, a follow-up endoscopy revealed a gastric lesion that had reduced in size. She is still alive, having received a variety of systemic treatments. Patients with metastatic breast cancer are experiencing prolonged survival. Thus, follow-up endoscopy should be considered after the diagnosis of gastrointestinal metastasis considering the risk of lethal conditions, such as gastrointestinal bleeding and perforation. Our case serves as a reminder to clinicians how difficult it is to determine whether a gastric lesion is primary or metastatic based on endoscopic findings and the importance of communication with endoscopists and pathologists.

Neuregulin Expression Modulates Clinical Response to Trastuzumab in Patients With Metastatic Breast Cancer

2007 ◽  
Vol 25 (19) ◽  
pp. 2656-2663 ◽  
Author(s):  
Enrique de Alava ◽  
Alberto Ocaña ◽  
Mar Abad ◽  
Juan Carlos Montero ◽  
Azucena Esparís-Ogando ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Metastatic Breast ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Event Free Survival ◽  
Mcf7 Cells ◽  
Free Survival ◽  
Her 2

Purpose Human epidermal growth factor receptor 2 (HER-2) overexpression has been associated with the genesis and progression of a subset of breast cancers. The function of HER-2 may be upregulated by overexpression or by the availability of neuregulins (NRGs), a group of transmembrane growth factors. Transmembrane NRGs strongly activated HER-2 and cell proliferation in breast cancer cells that did not overexpress HER-2, and treatment with trastuzumab prevented the proliferative action of transmembrane NRG. This raised the relevant clinical question of whether patients considered as HER-2 negative, but expressing transmembrane NRG, may benefit from treatment with trastuzumab. Patients and Methods MCF7 cells expressing transmembrane NRG (MCF7-NRGα2c) were injected into mice, and their sensitivity to trastuzumab was assessed. A retrospective study of 124 patients with early-stage or metastatic breast cancer was conducted. Expression of transmembrane NRG was evaluated by immunohistochemistry. In 11 patients, Western blot for NRGs was also carried out. Statistics were performed to analyze possible correlations between NRG expression and response to trastuzumab-based therapies, event-free survival, and overall survival (OS). Results Trastuzumab inhibited tumor growth in mice injected with MCF7-NRGα2c cells. Transmembrane NRG was frequently expressed in breast cancer patients. Overexpression of transmembrane NRG significantly correlated with a longer event-free survival and OS in patients with low or normal HER-2 expression who were treated with trastuzumab-based therapies but not in patients with HER-2 overexpression. Conclusion We suggest that the spectrum of patients who may benefit from trastuzumab-based therapies may be widened to include patients with metastatic breast cancer without HER-2 amplification but who express transmembrane NRGs.

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