Occult Breast Carcinoma Presenting as Scalp Metastasis

Breast cancer is the most common tumor among women, and approximately 6% of the patients have de novo metastatic breast cancer. Occult breast cancer accounts for only 0.1–0.8% of the cases and most commonly presents with axillary lymphadenopathy. Scalp metastases are rare and have been described as a sign of progression or widespread metastatic disease. Here, we describe a rare case of de novo metastatic breast cancer to the scalp as the single site of spread and without an identifiable primary breast tumor.

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Complete Excision of Primary Breast Tumor Improves Survival of Patients With Metastatic Breast Cancer at Diagnosis

Journal of Clinical Oncology ◽

10.1200/jco.2005.04.2226 ◽

2006 ◽

Vol 24 (18) ◽

pp. 2743-2749 ◽

Cited By ~ 245

Author(s):

Elisabetta Rapiti ◽

Helena M. Verkooijen ◽

Georges Vlastos ◽

Gerald Fioretta ◽

Isabelle Neyroud-Caspar ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Primary Tumor ◽

Breast Tumor ◽

Metastatic Breast ◽

Surgical Margins ◽

Primary Breast Tumor ◽

Complete Excision ◽

Risk Of Death ◽

The Impact

Purpose Surgery of the primary tumor usually is not advised for patients with metastatic breast cancer at diagnosis because the disease is considered incurable. In this population-based study, we evaluate the impact of local surgery on survival of patients with metastatic breast cancer at diagnosis. Methods We included all 300 metastatic breast cancer patients recorded at the Geneva Cancer Registry between 1977 and 1996. We compared mortality risks from breast cancer between patients who had surgery of the primary breast tumor to those who had not and adjusted these risks for other prognostic factors. Results Women who had complete excision of the primary breast tumor with negative surgical margins had a 40% reduced risk of death as a result of breast cancer (multiadjusted hazard ratio [HR], 0.6; 95% CI, 0.4 to 1.0) compared with women who did not have surgery (P = .049). This mortality reduction was not significantly different among patients with different sites of metastasis, but in the stratified analysis the effect was particularly evident for women with bone metastasis only (HR, 0.2; 95% CI, 0.1 to 0.4; P = .001). Survival of women who had surgery with positive surgical margins was not different from that of women who did not have surgery. Conclusion Complete surgical excision of the primary tumor improves survival of patients with metastatic breast cancer at diagnosis, particularly among women with only bone metastases.

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Epidemiology of De Novo Metastatic Breast Cancer

Clinical Breast Cancer ◽

10.1016/j.clbc.2021.01.017 ◽

2021 ◽

Author(s):

Karen Daily ◽

Emily Douglas ◽

Paul A Romitti ◽

Alexandra Thomas

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

De Novo ◽

Metastatic Breast

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Locoregional Therapy for the Primary Tumour in Women with a De Novo Diagnosis of Metastatic Breast Cancer

Current Breast Cancer Reports ◽

10.1007/s12609-021-00408-0 ◽

2021 ◽

Author(s):

Katie Miller ◽

Kieran Horgan ◽

David Dodwell

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

De Novo ◽

Primary Tumour ◽

Metastatic Breast ◽

Locoregional Therapy

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Real-world Indian scenario of CDK4/6 inhibitors (palbociclib and ribociclib) with endocrine therapy in upfront hormone positive metastatic breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13028 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13028-e13028

Author(s):

Ajay Gogia ◽

Shalabh Arora ◽

Priyanshu Choudhary ◽

Rakesh Kumar ◽

Sanjay Thulkar ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Endocrine Therapy ◽

Real World ◽

De Novo ◽

Metastatic Breast ◽

Common Side Effect ◽

Drug Discontinuation ◽

Grade 3 ◽

Visceral Disease

e13028 Background: CDK4/6 inhibitors (CDKi), in combination with endocrine therapy (ET), has become the standard of care in the treatment of hormone positive (HR+)/ HER2 neu negative metastatic breast cancer (MBC) patients. We evaluated clinical outcomes and toxicity in MBC patients, who have received ET with two CDKi, namely palbociclib and ribociclib. Methods: This is an ambispective, single institutional analysis of de-novo HR+ MBC patients treated with CDKi (palbociclib 125 mg and ribociclib 600 mg once a day for 21 days /28 days cycle) from November 2016- October 2020 at AIIMS, New Delhi, India. The primary endpoint was progression-free survival (PFS) and the secondary endpoint was response rate and toxicity. A total of 157 female patients were recruited in this study however the response and toxicity data were available in 120 cases. All premenopausal women received ovarian suppression or ovarian ablation. Results: A total of 120 patients were included in this study with a median age of 57 years (35-75) and 93 (77.5%) cases were postmenopausal. Twenty-three (19.1%) patients had a bone-only disease, 49 (40.9%) had bone and visceral disease and 48 (40%) had only visceral disease. In this study 91 (75.9%) patients received palbociclib and 29 (24.2%) received ribociclib. The median PFS was 18 months (4-36). Twenty four (20%) patients achieved a complete response, 69 (57.5%) patients attained partial response, 18(15%) patients had stable disease and 9 (7.5%) had disease progression. Grade 3–4 neutropenia, thrombocytopenia, and anaemia were observed in 18(15%), 8 (6.7%), and 4 (3.3%) cases respectively. None of the patients developed febrile neutropenia. Cutaneous, renal, hepatic, and gastrointestinal toxicity was observed in 1,1,3,4 cases respectively. Prolonged QTc was observed in one case. Grade 3 fatigue was observed in 7 cases. Dose interruption/delay (mean dose delay of 7 days), dose modification, and drug discontinuation were observed in 24 (20%), 12 (10%), and 10 (8.3%) of cases respectively. Conclusions: This is one of the largest real-world Indian data on CDK4/6 inhibitors on upfront HR+ MBC. Side effects are less than published literature with similar efficacy. Neutropenia was the most common side effect which was managed by brief dose interruption.

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Changes in Overall Survival Over Time for Patients With de Novo Metastatic Breast Cancer

10.20944/preprints202105.0093.v1 ◽

2021 ◽

Author(s):

Toshiaki Iwase ◽

Tushaar Vishal Shrimanker ◽

Ruben Rodriguez-Bautista ◽

Onur Sahin ◽

Anjali James ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Metastatic Breast Cancer ◽

De Novo ◽

Metastatic Breast ◽

Locoregional Therapy ◽

Cancer Center ◽

Her2 Positive ◽

Time Periods ◽

Over Time

The purpose of this study was to determine the change in overall survival (OS) for patients with de novo metastatic breast cancer (dnMBC) over time. We conducted a retrospective cohort study with 1981 patients with dnMBC diagnosed between January 1995 and December 2017 at The University of Texas MD Anderson Cancer Center. OS was measured from the date of diagnosis of dnMBC. OS was compared between patients diagnosed during different time periods: 5-year periods and periods defined according to when key agents were approved for clinical use. The median OS was 3.4 years. The 5- and 10-year OS rates improved over time across both types of time periods. A subgroup analysis showed that OS improved significantly over time for the estrogen-receptor-positive/HER2-positive (ER+/HER2+) subtype, and exhibited a tendency toward improvement over time for the ER-negative (ER-)/HER2+ subtype. Median OS was significantly longer in patients with non-inflammatory breast cancer (P = .02) and in patients with ER+ disease, progesterone-receptor-positive disease, HER2+ disease, lower nuclear grade, locoregional therapy, and metastasis to a single organ (all P &lt;.0001). These findings showed that OS at 5 and 10 years after diagnosis in patients with dnMBC improved over time. The significant improvements in OS over time for the ER+/HER2+ subtype and the tendency toward improvement for ER-/HER2+ subtype suggest the contribution of HER2-targeted therapy to survival.

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Early Locoregional Breast Surgery and Survival in de novo Metastatic Breast Cancer in the Multicenter National ESME Cohort

Annals of Surgery ◽

10.1097/sla.0000000000004767 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Judicaël Hotton ◽

Amélie Lusque ◽

Léa Leufflen ◽

Mario Campone ◽

Christelle Levy ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

De Novo ◽

Breast Surgery ◽

Metastatic Breast

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The First-Two Lines of Chemotherapy for de Novo Metastatic Breast Cancer: Efficacy Study between Anthracyclines and Non-Anthracyclines

Annals of Oncology ◽

10.1016/s0923-7534(20)31961-x ◽

2012 ◽

Vol 23 ◽

pp. xi17-xi18

Author(s):

W.-W. Chen ◽

D.-Y. Chang ◽

C.-H. Lin ◽

C. Hsu ◽

A.-L. Cheng ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

De Novo ◽

Metastatic Breast ◽

Efficacy Study

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Survival impact of primary tumor resection in de novo metastatic breast cancer patients (GEICAM/El Alamo Registry)

Scientific Reports ◽

10.1038/s41598-019-55765-9 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Sara Lopez-Tarruella ◽

M. J. Escudero ◽

Marina Pollan ◽

Miguel Martín ◽

Carlos Jara ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Cancer Patients ◽

Primary Tumor ◽

Cox Regression ◽

De Novo ◽

Histological Grade ◽

Tumor Resection ◽

Metastatic Breast ◽

Breast Cancer Patients

AbstractThe debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. We explored this approach’s outcomes in patients included in a retrospective registry, named El Álamo, of breast cancer patients diagnosed in Spain (1990–2001). In this analysis we only included de novo MBC patients, 1415 of whom met the study’s criteria. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Median age was 63.1 years, 49.2% of patients had single-organ metastasis (skin/soft tissue [16.3%], bone [33.8%], or viscera [48.3%]). PT surgery (S) was performed in 44.5% of the cases. S-group patients were younger, had smaller tumors, higher prevalence of bone and oligometastatic disease, and lower prevalence of visceral involvement. With a median follow-up of 23.3 months, overall survival (OS) was 39.6 versus 22.4 months (HR = 0.59, p < 0.0001) in the S- and non-S groups, respectively. The S-group OS benefit remained statistically and clinically significant regardless of metastatic location, histological type, histological grade, hormone receptor status and tumor size. PT surgery (versus no surgery) was associated with an OS benefit suggesting that loco-regional PT control may be considered in selected MBC patients. Data from randomized controlled trials are of utmost importance to confirm these results.

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