Radioembolization of Secondary Hepatic Malignancies

2021 ◽  
Vol 38 (04) ◽  
pp. 445-452
Author(s):  
Barbara Manchec ◽  
Nima Kokabi ◽  
Govindarajan Narayanan ◽  
Andrew Niekamp ◽  
Constantino Peña ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Metastases ◽  
Hepatic Metastasis ◽  
Patient Management ◽  
Metastatic Breast ◽  
Primary Malignancy ◽  
Transarterial Radioembolization ◽  
Hepatic Malignancies

AbstractCancer has become the leading cause of mortality in America, and the majority of patients eventually develop hepatic metastasis. As liver metastases are frequently unresectable, the value of liver-directed therapies, such as transarterial radioembolization (TARE), has become increasingly recognized as an integral component of patient management. Outcomes after radioembolization of hepatic malignancies vary not only by location of primary malignancy but also by tumor histopathology. This article reviews the outcomes of TARE for the treatment of metastatic colorectal cancer, metastatic breast cancer, and metastatic neuroendocrine tumors, as well as special considerations when treating metastatic disease with TARE.

scholarly journals Eribulin, Child-Pugh score, and liver-function tests: lessons from pivotal breast cancer studies 301 and 305

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Iain R. Macpherson ◽  
Yaohua He ◽  
Carlo Palmieri
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Function ◽  
Liver Metastases ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Hepatic Impairment ◽  
Metastatic Breast ◽  
Dose Modifications ◽  
Group D

Abstract Background The recommended starting dose of eribulin in patients with hepatic impairment is based on the Child-Pugh score, largely informed by a pharmacokinetic study of 18 patients. In the pivotal studies of eribulin in metastatic breast cancer (Study 301 and Study 305 [EMBRACE]), entry criteria and dose modifications were based on liver-function test (LFT) results rather than Child-Pugh score. In populations such as patients with metastatic breast cancer, in which metastatic infiltration is the predominant cause of hepatic impairment, using Child-Pugh score may be problematic; in clinical practice, it has been more common for oncologists to make dosing decisions based on LFTs. To address this, the effects of abnormal baseline LFT results on eribulin efficacy and safety were investigated. Methods In this pooled post hoc analysis, 1062 patients who were randomized to receive eribulin in Studies 301 and 305 were divided into 4 groups: (A) no elevated LFT results (no liver impairment); (B) increased levels of aspartate aminotransferase and/or alanine aminotransferase; (C) decreased albumin and/or increased levels of aspartate aminotransferase and/or alanine aminotransferase but not increased bilirubin; and (D) increased bilirubin. Patients were subcategorized by presence of liver metastasis. Drug exposure, dose intensity, and treatment-emergent adverse events (TEAEs) were analyzed. Results Eribulin mesylate mean dosage was 0.82 (group A)–0.65 mg/m2/week (group D). Group D had shorter treatment, more dose reductions/delays, more TEAEs leading to dose modifications, and numerically lower objective response rates and clinical benefit rates versus groups A–C. TEAE rates leading to dose modification were similar between group D (45.5%) and groups A–C (range, 43.5–54.9%) in the absence of liver metastases, but higher in group D (91.3%) compared with groups A–C (range, 41.7–54.3%) if liver metastases were present. Conclusions Mild elevations in bilirubin levels were associated with increased toxicity and a greater requirement for dose modifications. Based both on these study data and existing recommendations, we propose a novel scheme to guide initial dose selection in patients with metastatic breast cancer and hepatic impairment that is based on LFTs rather than Child-Pugh score.

scholarly journals Metastatic breast cancer patients with lung or liver metastases should be distinguished before being treated with fulvestrant

2019 ◽  
Vol 8 (14) ◽  
pp. 6212-6220
Author(s):  
Min He ◽  
Jun‐Jie Li ◽  
Wen‐Jia Zuo ◽  
Lei Ji ◽  
Yi‐Zhou Jiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Breast Cancer Patients

Association between single nucleotide polymorphism (SNPs) of CYP3A4 and SLC28A3 and clinical outcome in metastatic breast cancer (MBC) patients receiving paclitaxel plus gemcitabine (PG) chemotherapy as first-line treatment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1088-1088
Author(s):  
Seock-Ah Im ◽  
Yeon Hee Park ◽  
Soo-Youn Lee ◽  
Sook Young Woo ◽  
Seonwoo Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Clinical Outcome ◽  
Hepatic Metastasis ◽  
Metastatic Breast ◽  
First Line ◽  
Single Nucleotide ◽  
Receptor Status ◽  
Hormonal Receptor Status ◽  
Line Chemotherapy

1088 Background: Paclitaxel and gemcitabine (PG) combination chemotherapy is an effective regimen in metastatic breast cancer (MBC) patients as first-line chemotherapy. The primary purpose of our study was to investigate the association of the single nucleotide polymorphisms (SNPs) and clinical outcome in MBC patients treated with PG chemotherapy. Methods: A total of 324 MBC patients were enrolled in this prospective multicenter trial as the first-line chemotherapy. Eighty five of 324 patients were available for SNP analysis. Germline DNA from peripheral blood (PB) mononuclear cells was extracted. SNPs in 15 genes (27 SNPs) from pathways that may influence cellular sensitivity to paclitaxel and gemcitabine were genotyped from PB sample. Results: Median progression free survival (PFS) and overall survival (OS) of all 324 patients was 8.7 months (95% CI: 7.5-9.6 mo.) and 26.9 months (95% CI: 23.6-30.1 mo.), respectively. Among clinical parameters, young age (p = 0.047, HR 1.03 [95% CI, 1-1.07]), positive hormonal receptor status (p = 0.0004, HR 0.26 [95% CI, 0.12-0.54]), and hepatic metastasis (p = 0.046, HR 2.30 [95% CI, 1.02-5.18]) were identified predictive factors for OS in Cox-regression analysis. SLC28A3 SNP which participates in transcription showed correlation with OS. OS of the patients with CC and CT genotypes in SLC28A3 was significantly longer than the OS of the patients with TT genotype (median OS: 31 vs. 37 vs. 21 months, p = 0.027, HR 2.6 [95% CI, 1.1-6.3]). OS of the patients with TT genotype in CYP3A4 was significantly longer than the OS of the patients with TC genotype (median OS: 37 vs. 19 months, p = 0.021, HR 5.8 [95% CI, 1.3-25.7]). After adjusting hormonal receptor status, age, and hepatic metastasis, prognostic value of SLC28A3 remained significant (HR 2.9, p = 0.047). Other SNPs were not significantly associated with PFS, OS, or toxicities. Conclusions: SLC28A3 SNP can predict with the clinical outcome of MBC patients treated with PG chemotherapy. Further studies for functional mechanism of germline polymorphisms in SLC28A are warranted.

scholarly journals Patient Management with Eribulin in Metastatic Breast Cancer: A Clinical Practice Guide

2016 ◽  
Vol 19 (1) ◽  
pp. 8 ◽  
Author(s):  
Jungsil Ro ◽  
Fiona Tsui-Fen Cheng ◽  
Virote Sriuranpong ◽  
Antonio Villalon ◽  
B. K Smruti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Clinical Practice ◽  
Patient Management ◽  
Metastatic Breast ◽  
Practice Guide

Prognostic factors influencing the selection of bevacizumab combined with chemotherapy in patients with HER2-negative metastatic breast cancer in routine clinical practice: Oncosur-Avalox—Observational cross-sectional study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12020-e12020
Author(s):  
Luis Manso ◽  
Andres Garcia-Palomo ◽  
Ramon Perez-Carrion ◽  
Jose Ignacio Chacon ◽  
Xabier Mielgo Rubio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Metastases ◽  
Clinical Benefit ◽  
Disease Free Survival ◽  
Metastatic Breast ◽  
First Line ◽  
Cross Sectional ◽  
Patient Decision ◽  
Selection Of

e12020 Background: Combining bevacizumab (BEV) with chemotherapy (CT) improves survival in HER2-negative metastatic breast cancer (MBC). We investigated the influence of age, ECOG, hormonal status, number of sites, location of metastases and patient decision on the selection of BEV combined with CT in MBC. Methods: Observational cross-sectional multicenter study in patients with HER2- negative MBC who have received first-line CT with BEV. Results: 219 patients were included: median age 51(44-63) yr; ECOG: 0=53%; 60.4% pre-menopausic; 23.9% triple-negative (TN);76.2 % hormone receptor positive (HR+).Metastatic disease: ≥3 sites=39.2% (TN: 22%; HR+: 43.9%); location: 45.2% bone, 37.4% liver, 30.1% lung. Most frequent BEV combinations were paclitaxel/BEV(60.7%) and docetaxel/BEV(12.8%); median no. of CT cycles: 6 (5- 8). A disease-free survival (DFS) ≥12 months was achieved by 82.8%; TN: 78.9%; HR+: 83.3%. Overall response rate (ORR) was 62.7%: 53.6% partial response (PR), 9.1% complete response (CR); 25.4% stable disease (SD) and 7.2% disease progression (4.8% non evaluated). TN:ORR 54.2% (47.9% PR), clinical benefit 80% (27.1% SD); HR+:ORR 65.8% (55.7% PR), clinical benefit 89.9% (24.1% SD). 66.2% presented at least one toxicity, mainly grade 1-2; 32% BEV-related: only 3 grade 3 toxicities; no grade 4. Receiving adjuvant hormonal therapy was associated to DFS ≥12 months (p<0.05). ER+ tumors (OR:0.326;95%CI:0.16-0.65;p=0.002) and patient decision after consider doctor opinion (OR:0.026;95%CI:0.01-0.74; p=0.085) were independent factors associated with the selection of paclitaxel-BEV in the overall population (TN or HR+). Liver metastases were significantly related to paclitaxel-BEV administration (p<0.01). Conclusions: First-line CT with BEV is an effective and safe scheme for patients with TN and HR+ MBC. ER+ tumors and patient decision after consider doctor opinion were identified as independent factors for the selection of paclitaxel-BEV therapy. The presence of liver metastases was significantly associated to the administration of a paclitaxel-BEV regimen.

scholarly journals STUDY ON ADHERENCE TO CAPECITABINE AMONG PATIENTS WITH COLORECTAL CANCER AND METASTATIC BREAST CANCER

2014 ◽  
Vol 51 (3) ◽  
pp. 186-191 ◽  
Author(s):  
Adiel Goes de FIGUEIREDO JUNIOR ◽  
Nora Manoukian FORONES
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Colon Cancer ◽  
Metastatic Breast Cancer ◽  
Oral Treatment ◽  
Metastatic Breast ◽  
Oral Drug ◽  
Metastatic Colon Cancer ◽  
Oral Capecitabine ◽  
Chemotherapy Drugs

Context Capecitabine, an oral drug, is as effective as traditional chemotherapy drugs. Objectives To investigate the adhesion to treatment with oral capecitabine in breast and colorectal cancer, and to determine any correlation with changes in patient’s quality of life. Methods Patients with colorectal cancer or breast cancer using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. The QLQ-C30 questionnaire was applied at the first visit and 8-12 weeks after treatment. Results Thirty patients were evaluated. Adherence was 88.3% for metastatic colon cancer, 90.4% for non-metastatic colon cancer, 94.3% for rectal cancer and 96.2% for metastatic breast cancer. No strong correlation between adherence and European Organisation for Research and Treatment of Cancer QLQ-C30 functional or symptom scale rates had been found. There was no statistically significant correlation between compliance and the functional and symptom scales of the questionnaire before and after chemotherapy, with the exception of dyspnea. Conclusions Although no absolute adherence to oral capecitabine treatment had been observed, the level of adherence was good. Health professionals therefore need a greater focus in the monitoring the involvement of patients with oral treatment regimens. Patients with lesser degrees of dyspnea had greater compliance.

scholarly journals Overall survival analysis in patients with metastatic breast cancer and liver or lung metastases treated with eribulin, gemcitabine, or capecitabine

2020 ◽  
Vol 184 (2) ◽  
pp. 559-565
Author(s):  
Shayma Kazmi ◽  
Debanjana Chatterjee ◽  
Dheeraj Raju ◽  
Rob Hauser ◽  
Peter A. Kaufman
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Liver Metastases ◽  
Real World ◽  
Lung Metastases ◽  
Metastatic Breast ◽  
Line Therapy ◽  
Third Line Therapy ◽  
Third Line

Abstract Purpose The purpose of this study was to estimate the overall survival (OS) in real-world clinical practice in patients with metastatic breast cancer (MBC) and visceral metastases (liver or lung) treated in the third-line setting with eribulin, gemcitabine or capecitabine overall and in the major clinical categories of MBC (TNBC, HR+/HER2−, and HER2+). Methods A retrospective, observational study was conducted with de-identified patient electronic health records from the Cancer Treatment Centers of America (CTCA). Patients with a diagnosis of metastatic breast with lung or liver metastases, and treated with eribulin, gemcitabine, or capecitabine as third-line therapy were included in the analysis. Landmark survival was calculated as percentage of patients alive at 6, 12, 24, and 36 months. Overall survival was compared between treatment arms within TNBC and HR+/HER2− using log-rank analysis. Cox regression analyses was performed to estimate hazard ratios for comparison of treatments within TNBC and HR+/HER2− subtype. Results 443 patients with liver or lung metastases received third-line therapy with eribulin (n = 229), gemcitabine (n = 134), or capecitabine (n = 80). Eribulin patients had a higher percentage of patients alive at all landmark timepoints vs. gemcitabine, and a higher percentage of patients alive until 36 months vs. capecitabine. Median survival times showed that overall, and within the TNBC and HR+/HER2− subtype, patients receiving eribulin had a numerically higher median overall survival. Conclusions This real-world evidence study is consistent with randomized clinical trial data and demonstrates consistency of eribulin effectiveness in MBC patients with lung or liver metastases overall and in TNBC and HR+/HER2− disease.

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