scholarly journals Clinical Outcome of Neoplastic Meningitis Associated with Breast Cancer

2022 ◽  
Author(s):  
Anju Anna Abraham ◽  
Anoop T.M ◽  
Rona Joseph P. ◽  
Arun Vasudevan ◽  
Bhavya S. Kumar
Keyword(s):  
Breast Cancer ◽  
Clinical Outcome ◽  
Clinical Symptoms ◽  
Single Agent ◽  
Unmet Need ◽  
Neoplastic Meningitis ◽  
Intrathecal Methotrexate ◽  
Breast Cancer Patients ◽  
Csf Cytology ◽  
Carcinoma Breast

Abstract Background Neoplastic meningitis (NM) is considered as a terminal event with poor prognosis. Its impact in clinical oncology is growing. Objective To analyze the clinical outcome of patients with carcinoma breast diagnosed with NM. Materials and Methods This study was an observational study in breast cancer patients diagnosed with NM. Patients with typical clinical symptoms and signs with either presence of cerebrospinal fluid (CSF) cytology positive for neoplastic cells or typical radiological features of leptomeningeal involvement in the presence of neurological symptoms or signs were taken as leptomeningeal metastasis (LM) or NM. The estimation of survival was done by Kaplan–Meier method. Results Out of 1,200 patients diagnosed with carcinoma breast during the study period, 15 developed NM. The median age of study population was 51 (range: 44–55) years. Most common presentations were headache (47%), vomiting (47%), diplopia (20%), seizure (20%), and cerebellar signs (7%). Seven (46%) patients were hormone receptor positive, four (30%) were HER2 (Human epidermal growth factor receptor 2) positive and seven (46%) were triple-negative breast cancer. Median time to develop LM from the time of diagnosis of breast cancer was 6 (range: 3–8) months. Nine patients (90%) had features of NM in CSF cytology. Thirteen patients received palliative whole brain radiotherapy (20 Gy in five fractions). Nine out of 12 patients received single-agent Capecitabine as first-line chemotherapy after palliative radiation therapy (RT). Intrathecal methotrexate was given for seven patients. The median overall survival was 3 (range: 0.5–4) months. Conclusion LM is a very aggressive metastatic disease with poor outcome. There is an unmet need for proper guidelines and an overwhelming necessity for a better focus on research for new modalities of disease in this scenario.

Survival of a cohort of 25 breast cancer patients with neoplastic meningitis treated with intrathecal liposomal cytarabine

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1109-1109
Author(s):  
E. Le Rhun ◽  
F. Zairi ◽  
M. Baranzelli ◽  
M. Faivre-Pierret ◽  
P. Devos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Supportive Care ◽  
Cancer Patients ◽  
Systemic Chemotherapy ◽  
Neurological Status ◽  
Neoplastic Meningitis ◽  
Liposomal Cytarabine ◽  
Breast Cancer Patients ◽  
Csf Cytology ◽  
Median Delay

1109 Background: Neoplastic meningitis (NM) occurs in 5% of the patients with breast cancer; if untreated the median duration of survival is 5 weeks. Combination of intrathecal (IT), systemic chemotherapy, and supportive care may increase overall survival (OS) to 5 months (Chamberlain, 2005). Methods: 30 consecutive female breast cancer patients diagnosed with NM, on the basis of cerebrospinal fluid (CSF) cytology and/or cerebrospinal MRI with clinical symptoms, have been prospectively treated for 19 months. Three patients did not receive any treatment because of a poor neurological status at diagnosis; 2 patients stopped treatment because of the lack of improvement after 1.5 months. The aim was to report clinico-pathological characteristics and OS in patients treated with IT liposomal cytarabine and supportive care with or without systemic chemotherapy. Statistical analyses were performed in the 25 treated patients. Correlations between tumor characteristics and OS were analyzed using usual statistical methods (Kaplan Meier, Log-rank, Cox). Results: Median age at NM diagnosis was 56 years. Median Karnofsky Performance Status (KPS) was 75. Breast cancers were invasive ductal carcinoma in 75%. Estrogen and progesterone receptors were detected in respectively 64 and 40%. HER-2 hyperexpression was observed in 33.5%. Tumors were triple negative in 17%. At the time of NM diagnosis CSF cytology and cerebrospinal MRI were positive in respectively 64% and 87.5%. Brain metastases were present in 64% of the patients, 36% had whole brain radiotherapy. Median delay between first symptoms and diagnosis was 16 days. Median delay between NM diagnosis and first IT was 17 days. Systemic chemotherapy was given in 56.5% at the discretion of the referring oncologist. All patients had supportive care. After 5 IT a clinical stabilization or improvement was observed in 56.5%. A CSF response was observed in 36%. Median OS of treated patients was 7 months. KPS at diagnosis (≥80), neurological status after 5 IT were significantly correlated with OS. A trend was also observed between association with systemic chemotherapy and OS. Conclusions: Our results confirm that the association of IT, systemic treatment and supportive care treatment may be useful in treating this cancer complication. No significant financial relationships to disclose.

scholarly journals Clinical CYP2D6 Genotyping to Personalize Adjuvant Tamoxifen Treatment in ER-Positive Breast Cancer Patients: Current Status of a Controversy

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 771
Author(s):  
Tessa A. M. Mulder ◽  
Mirjam de With ◽  
Marzia del Re ◽  
Romano Danesi ◽  
Ron H. J. Mathijssen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Plasma Concentrations ◽  
Tamoxifen Treatment ◽  
Current Status ◽  
Endocrine Treatment ◽  
Breast Cancer Patients ◽  
Er Positive ◽  
Positive Breast Cancer

Tamoxifen is a major option for adjuvant endocrine treatment in estrogen receptor (ER) positive breast cancer patients. The conversion of the prodrug tamoxifen into the most active metabolite endoxifen is mainly catalyzed by the enzyme cytochrome P450 2D6 (CYP2D6). Genetic variation in the CYP2D6 gene leads to altered enzyme activity, which influences endoxifen formation and thereby potentially therapy outcome. The association between genetically compromised CYP2D6 activity and low endoxifen plasma concentrations is generally accepted, and it was shown that tamoxifen dose increments in compromised patients resulted in higher endoxifen concentrations. However, the correlation between CYP2D6 genotype and clinical outcome is still under debate. This has led to genotype-based tamoxifen dosing recommendations by the Clinical Pharmacogenetic Implementation Consortium (CPIC) in 2018, whereas in 2019, the European Society of Medical Oncology (ESMO) discouraged the use of CYP2D6 genotyping in clinical practice for tamoxifen therapy. This paper describes the latest developments on CYP2D6 genotyping in relation to endoxifen plasma concentrations and tamoxifen-related clinical outcome. Therefore, we focused on Pharmacogenetic publications from 2018 (CPIC publication) to 2021 in order to shed a light on the current status of this debate.

The elevated preoperative derived neutrophil-to-lymphocyte ratio predicts poor clinical outcome in breast cancer patients

Tumor Biology ◽  
2015 ◽  
Vol 37 (1) ◽  
pp. 361-368 ◽  
Author(s):  
Sabine Krenn-Pilko ◽  
Uwe Langsenlehner ◽  
Tatjana Stojakovic ◽  
Martin Pichler ◽  
Armin Gerger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Neutrophil To Lymphocyte Ratio ◽  
Breast Cancer Patients ◽  
Poor Clinical Outcome ◽  
Lymphocyte Ratio

scholarly journals Targeting CD82/KAI1 for Precision Therapeutics in Surmounting Metastatic Potential in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4486
Author(s):  
Maximillian Viera ◽  
George Wai Cheong Yip ◽  
Han-Ming Shen ◽  
Gyeong Hun Baeg ◽  
Boon Huat Bay
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Therapeutic Approach ◽  
Traditional Approach ◽  
Unmet Need ◽  
Great Promise ◽  
Metastasis Suppressor ◽  
Precision Oncology ◽  
Breast Cancer Patients

Metastasis is the main cause of mortality in breast cancer patients. There is an unmet need to develop therapies that can impede metastatic spread. Precision oncology has shown great promise for the treatment of cancers, as the therapeutic approach is tailored to a specific group of patients who are likely to benefit from the treatment, rather than the traditional approach of “one size fits all”. CD82, also known as KAI1, a glycoprotein belonging to the tetraspanin family and an established metastasis suppressor, could potentially be exploited to hinder metastases in breast cancer. This review explores the prospect of targeting CD82 as an innovative therapeutic approach in precision medicine for breast cancer patients, with the goal of preventing cancer progression and metastasis. Such an approach would entail the selection of a subset of breast cancer patients with low levels of CD82, and instituting an appropriate treatment scheme tailored towards restoring the levels of CD82 in this group of patients. Proposed precision treatment regimens include current modalities of treating breast cancer, in combination with either clinically approved drugs that could restore the levels of CD82, CD82 peptide mimics or non-coding RNA-based therapeutics.

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