318 PUBLICATION Antisense chemoradioimmunotherapy inhibit the endothelin axis with subsequent induction of type I, type II PCD and metastatization in advanced breast cancer characterised by hypermethylated oncosuppressor promoter CpG islands and overexpression of oncogenes

e11590 Background: Primary systemic therapy (PST) has become a standard therapy for locally advanced breast cancer (LABC). The aim of this study was to evaluate the activity and toxicity of EC (epirubicin/cyclophosphamide) followed by weekly paclitaxel with/without trastuzumab as PST in LABC. Methods: Primary endpoint was pathologic complete response (pCR) rate in the breast and axilla, and secondary endpoints were breast conserving rate and toxicities. Patients with histologically diagnosed invasive breast cancer by core needle biopsy of the T2–4 (>3 cm) or N1–3 were included in this study. Eligible patients were age >20 years, had a performance status of 0 to 1, and had adequate organ functions. It was determined that the expected rate of pCR in the trial was 25%, and the sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The target enrollment was estimated to be 40 evaluable patients. Treatment: Patients received epirubicin (100 mg/m2) and cyclophosphamide (600mg/m2 ) every 3 weeks for four cycles followed by paclitaxel (80 mg/m2 ) every week for 12 cycles. Trastuzumab (2mg/kg) was added to paclitaxel in HER2-positive patients. Results: Forty-three patients were enrolled into this study and 3 patients withdrew. pCR were observed in 8 patients and pCR rate was 20.0% (95% confidence interval, 7.6- 32.4). Twenty-four patients (60.0%) underwent breast conserving surgery. In particular, patients with HER2 positive tumor had significantly higher rate of pCR than the others (62.5% vs. 8.6%; p=0.0014). Grade 4 neutropenia was recorded in 27.5% of the patients, and febrile neutropenia occurred in 4 patients (10.0%). No heart failure was seen. Conclusions: EC followed by weekly paclitaxel with/without trastuzumab was an active and well-tolerated treatment for LABC. No significant financial relationships to disclose.

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A CASE OF ADVANCED BREAST CANCER WITH SEVERE FUNNEL CHEST AND OPERATED AORTIC DISSECTION (TYPE I)

The journal of the Japanese Practical Surgeon Society ◽

10.3919/ringe1963.51.2641 ◽

1990 ◽

Vol 51 (12) ◽

pp. 2641-2644

Author(s):

Shigeru HOSAKA ◽

Osamu SUZUKI ◽

Shunji MUTOU ◽

Takatoshi FURUYA ◽

Masaru IWASAKI ◽

...

Keyword(s):

Breast Cancer ◽

Aortic Dissection ◽

Advanced Breast Cancer ◽

Advanced Breast ◽

Type I ◽

Funnel Chest

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Epirubicin/cyclophosphamide followed by docetaxel as the primary systemic therapy for locally advanced breast cancer: The final analysis of a phase II study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e12026 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e12026-e12026

Author(s):

Akira Hirano ◽

Mari Kamimura ◽

Kaoru Ogura ◽

Akinori Hattori ◽

Fumie Okubo ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Systemic Therapy ◽

Triple Negative ◽

Locally Advanced Breast Cancer ◽

Objective Response ◽

Locally Advanced ◽

Advanced Breast ◽

Type I ◽

Primary Systemic Therapy

e12026 Background: The aim of this study was to evaluate the efficacy and safety of epirubicin/cyclophosphamide (EC) followed by docetaxel as the primary systemic therapy for locally advanced breast cancer. We previously reported pathological and objective response of patients receiving this treatment (Anticancer Res 28:4137-42, 2008). Another follow-up period of 5 years (5y) has since passed, and 5y overall survival (OS) and relapse-free survival (RFS) rates were determined. Methods: The primary endpoints were pathological and objective response in the breast and axilla, and toxicities. The secondary endpoints were the rate of breast-conserving surgery and the 5y OS and RFS rates. Patients with histologically diagnosed invasive breast cancer of T2-4 (>3 cm) or N1-3 were included in this study. The expected rate of pCR was 25%, and the sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The target enrollment was estimated to be 40 evaluable patients. pCR was defined as no evidence of residual invasive cancer, either in the breast or axilla. Patients received E (90 mg/m2) and C (600 mg/m2) every 3 weeks for 4 cycles followed by docetaxel (70 mg/m2) every 3 weeks for 4 cycles. Trastuzumab was not added to the regimen. Results: Forty-six patients were enrolled in this study. pCR were observed in 6 patients and the pCR rate was 13.0% (95% confidence interval, 3.4-22.7%). In particular, patients with HER2 positive tumor had a significantly higher rate of pCR than others (40.0% vs. 5.6%; p=0.0096). Overall, 5y OS was 93.2% and 5y RFS was 72.9%. According to ER, PgR, HER2 status, the following 4 subtypes were classified: luminal (ER and/or PgR+, HER2-; n=28), luminal-HER2 (ER and/or PgR+, HER2+; n=3), HER2 (ER and PgR-, HER2+; n=7) and triple negative (ER, PgR and HER2-; n=8). 5y OS and RFS were 96.4% and 70.6% in luminal type, 100% and 50% in luminal-HER2, 71.4% and 57.1% in HER2, 100% and 100% in triple negative, respectively. Conclusions: EC followed by docetaxel was an effective and well-tolerated treatment, and it is suggested that this treatment provides survival benefit especially for patients with triple-negative breast cancer.

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Correlation between MRI morphological response patterns and histopathological tumor regression after neoadjuvant endocrine therapy in locally advanced breast cancer: a randomized phase II trial

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06343-z ◽

2021 ◽

Author(s):

Joana Reis ◽

Owen Thomas ◽

Maryam Lahooti ◽

Marianne Lyngra ◽

Hossein Schandiz ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Tumor Regression ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Advanced Breast ◽

Response Patterns ◽

Type Ii ◽

Morphological Response ◽

Type Iv

Abstract Purpose To correlate MRI morphological response patterns with histopathological tumor regression grading system based on tumor cellularity in locally advanced breast cancer (LABC)-treated neoadjuvant with third-generation aromatase inhibitors. Methods Fifty postmenopausal patients with ER-positive/HER-2-negative LABC treated with neoadjuvant letrozole and exemestane given sequentially in an intra-patient cross-over regimen for at least 4 months with MRI response monitoring at baseline as well as after at least 2 and 4 months on treatment. The MRI morphological response pattern was classified into 6 categories: 0/complete imaging response; I/concentric shrinkage; II/fragmentation; III/diffuse; IV/stable; and V/progressive. Histopathological tumor regression was assessed based on the recommendations from The Royal College of Pathologists regarding tumor cellularity. Results Following 2 and 4 months with therapy, the most common MRI pattern was pattern II (24/50 and 21/50, respectively). After 4 months on therapy, the most common histopathological tumor regression grade was grade 3 (21/50). After 4 months an increasing correlation is observed between MRI patterns and histopathology. The overall correlation, between the largest tumor diameter obtained from MRI and histopathology, was moderate and positive (r = 0.50, P-value = 2e-04). Among them, the correlation was highest in type IV (r = 0.53). Conclusion The type II MRI pattern “fragmentation” was more frequent in the histopathological responder group; and types I and IV in the non-responder group. Type II pattern showed the best endocrine responsiveness and a relatively moderate correlation between sizes obtained from MRI and histology, whereas type IV pattern indicated endocrine resistance but the strongest correlation between MRI and histology.

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