scholarly journals Difficulty Diagnosing a Brain Tumor during Clinical Maintenance of a Complete Response to anti-HER2 Treatments for Metastatic Breast Cancer: A Case Report

2020 ◽  
Vol 13 (3) ◽  
pp. 1311-1316
Author(s):  
Ryoko Semba ◽  
Yoshiya Horimoto ◽  
Atsushi Arakawa ◽  
Yoko Edahiro ◽  
Tomoiku Takaku ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Tumor ◽  
Ductal Carcinoma ◽  
Metastatic Breast ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Her2 Positive ◽  
Stage Iv Breast Cancer ◽  
The Right

A 46-year-old woman with erythema of the right breast presented to our hospital and was diagnosed with stage IV breast cancer (HER2-positive invasive ductal carcinoma). She received 4 courses of anthracycline-based regimens and 4 courses of trastuzumab + pertuzumab + docetaxel (Tmab + Pmab + DTX). Since she responded well to these therapies, only Tmab + Pmab was continued thereafter. Twenty-three months after starting treatment, she developed a headache. A tumor was identified in the right temporal lobe. Craniotomy was performed for definitive diagnosis. Intraoperative pathological assessment suggested the tumor to be brain metastasis of breast cancer. However, the final pathological diagnosis was diffuse large B-cell lymphoma of central nervous system (DLBCL-CNS) based on re-assessment with immunohistochemical examinations. Therefore, the Tmab + Pmab was discontinued, and 6 courses of high-dose methotrexate therapy were administered. This case highlights the importance of considering rare entities, such as DLBCL, when diagnosing a solitary brain tumor in a patient with a primary cancer, based on imaging and pathological findings.

QOL-enhancing surgery for patients with HER2-positive metastatic breast cancer

2018 ◽  
Vol 9 (2) ◽  
pp. 151-154
Author(s):  
Masaya Kai ◽  
Makoto Kubo ◽  
Hitomi Kawaji ◽  
Kanako Kurata ◽  
Hitomi Mori ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Primary Tumour ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Her2 Positive ◽  
Tumour Control ◽  
Her2 Positive Breast Cancer ◽  
Stage Iv Breast Cancer ◽  
Positive Breast Cancer

The role of the resection of primary tumour in stage IV breast cancer is unclear. Systemic therapy is recommended to prolong the survival and improve the quality of life (QOL). However, even if the systemic therapy is effective to control distant metastasis, sometimes the local lesion worsens, especially in the aggressive subtypes such as HER2-positive breast cancer. In uncontrollable tumours, the wound bed can bleed, weep and get infected, leading to dismal QOL. Our study describes two cases of patients with HER2-positive stage IV breast cancer who underwent palliative mastectomy which resulted in improvement of QOL. Local tumour control through palliative mastectomy can be beneficial for symptomatic aggressive patients with HER2-positive breast cancer to improve their QOL.

High-dose consolidation therapy with autologous stem-cell rescue in stage IV breast cancer: follow-up report.

1992 ◽  
Vol 10 (11) ◽  
pp. 1743-1747 ◽  
Author(s):  
S F Williams ◽  
T Gilewski ◽  
R Mick ◽  
J D Bitran
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Median Time ◽  
Metastatic Breast ◽  
Stage Iv ◽  
High Dose ◽  
Dose Intensification ◽  
Stem Cell Rescue ◽  
Stage Iv Breast Cancer ◽  
Time To Treatment Failure

PURPOSE Fifty-nine patients with newly diagnosed metastatic breast cancer were treated with induction chemotherapy followed by high-dose intensification and autologous stem-cell rescue (ASCR) to determine therapeutic efficacy. PATIENTS AND METHODS Induction consisted of cyclophosphamide, doxorubicin, vincristine, and methotrexate with leucovorin rescue (LOMAC) in 27 patients, or fluorouracil, cisplatin, doxorubicin, and cyclophosphamide (FCAP) in 32 patients. Intensification after LOMAC was cyclophosphamide and thiotepa (CyTepa) with ASCR, and after FCAP it was cyclophosphamide, thiotepa, and carmustine (BCNU) in all but eight patients who received CyTepa. RESULTS Median survival from study entry for the entire group was 13.3 months. Median time to progression from reinfusion for the 45 patients who underwent intensification was 7.5 months. After LOMAC and intensification, there were 12 complete responses (CR) (nine partial responses [PRs] after induction converted to CRs). Responses after FCAP and intensification were eight CRs (two PRs after induction converted to CRs). Median time to treatment failure from reinfusion was 5.4 months for LOMAC and intensification, and was 10.5 months for FCAP and intensification. Median survival from study entry was 15.1 months for all 27 LOMAC patients and 9.3 months for all 32 FCAP patients. Median time to treatment failure from reinfusion for 11 patients who were CRs at intensification has not been reached and is more than 13 months compared with a median of 5.5 months for the 23 patients in partial remission at intensification. CONCLUSIONS High-dose intensification therapy has led to increased CR rates in metastatic breast cancer. The role of such therapy in the treatment of stage IV breast cancer requires further refinement.

The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy

2020 ◽  
Vol 27 (8) ◽  
pp. 2711-2720 ◽  
Author(s):  
Ross Mudgway ◽  
Carlos Chavez de Paz Villanueva ◽  
Ann C. Lin ◽  
Maheswari Senthil ◽  
Carlos A. Garberoglio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Stage Iv ◽  
Tumor Surgery ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Stage Iv Breast Cancer ◽  
The Impact

scholarly journals Local Resection of Primary Tumor in Upfront Stage IV Breast Cancer

Breast Care ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. 411-417 ◽  
Author(s):  
Thomas Kolben ◽  
Theresa M. Kolben ◽  
Isabelle Himsl ◽  
Tom Degenhardt ◽  
Jutta Engel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Local Therapy ◽  
Stage Iv ◽  
Organ System ◽  
Asymptomatic Patients ◽  
Local Surgery ◽  
Stage Iv Breast Cancer

Background: This study aimed to identify the association of local surgery of the primary tumor in metastatic breast cancer (MBC) patients with overall survival (OS) and prognostic factors. Patients and Methods: Patients with primary MBC (1990-2006) were included in our retrospective analysis (n = 236). 83.1% had surgery for the primary tumor. OS was evaluated using Kaplan-Meier estimates. Predictive factors for OS were determined. Results: Median follow-up was 123 months for all patients still alive at the time of analysis. In univariate analysis, patients with surgery of the primary tumor had significantly prolonged OS (28.9 vs. 23.9 months). Within the surgery group, patients with MBC limited to 1 organ system had a better outcome (39.3 vs. 24.9 months), as did asymptomatic patients. Independent risk factors for shorter OS were hormone receptor negativity, symptoms, and involvement of ≥ 1 organ system. Conclusion: Patient selection for local therapy was confounded by a more favorable profile and a lesser tumor burden before surgery, which might implicate a bias. Nevertheless, our univariate results indicate that local surgery of the primary tumor in MBC patients could be considered as part of the therapeutic regimen in selected patients. However, larger patient numbers are needed to prove these findings in the multivariate model.

Relationships among patients’ ability to identify their cancer stage, knowledge of care options, and management of transitions.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 224-224
Author(s):  
Jenna Hinchey ◽  
Jessica Goldberg ◽  
Sarah Linsky ◽  
Rebecca Linsky ◽  
Sangchoon Jeon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Depression Scale ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Stage I ◽  
Self Management ◽  
Future Research ◽  
Cancer Stage ◽  
Younger Age ◽  
Stage Iv Breast Cancer

224 Background: Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage. We explored women’s ability to correctly identify their stage of breast cancer among a sample of women recently diagnosed with nonmetastatic (Stage I-III) disease. Methods: As part of a cancer self-management study, we asked women with non-metastatic breast cancer to identify their stage of disease. Participants’ responses were compared to their electronic medical record (EMR) for validation. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes (Control Preferences Scale- CPS, Knowledge of Care Options Test- KOCO, Measurement of Transitions Scale- MOT, Medical Communication Competence Scale- MCCS, Chronic Disease Self-Efficacy Scale- CDSE, Uncertainty in Illness Scale- MUIS-C, and Hospital Anxiety and Depression Scale- HADS). Results: Participants (n= 100) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19%) had Stage I breast cancer, 57 (57%) had Stage II, and 24 (24%) had Stage III. Twenty-nine participants (29%) were unable to correctly identify their stage of cancer. Of this group, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 7 (25%) did not know/want to know their stage. Younger age (p=.0412) and earlier cancer stage (p=.0136) were predictive of correctly identifying cancer stage. Participants who at baseline had a greater knowledge of care options were more likely to correctly identify their cancer stage (KOCO, p=.0482). Those who correctly identified their cancer stage were better able to manage transitions over time (MOT, p=.0564) than those unable to identify their stage. Conclusions: Women who cannot correctly identify their cancer stage may neither understand its implications nor effectively participate in cancer self-management. Conversations about cancer stage should be revisited to ensure patients’ understanding. Future research should include women with Stage IV breast cancer to more completely investigate ability to identify cancer stage.

Prognostic Model for Relapse After High-Dose Chemotherapy With Autologous Stem-Cell Transplantation for Stage IV Oligometastatic Breast Cancer

2002 ◽  
Vol 20 (3) ◽  
pp. 707-718 ◽  
Author(s):  
Yago Nieto ◽  
Samia Nawaz ◽  
Roy B. Jones ◽  
Elizabeth J. Shpall ◽  
Pablo J. Cagnoni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Metastatic Breast ◽  
Local Therapy ◽  
Stage Iv ◽  
High Dose Chemotherapy ◽  
Long Term Results ◽  
High Dose ◽  
Nodal Ratio ◽  
Her 2

PURPOSE: To study prognostic factors after high-dose chemotherapy (HDC) for patients with stage IV oligometastatic breast cancer. PATIENTS AND METHODS: Sixty patients with minimal metastatic disease amenable to local therapy enrolled onto a prospective HDC trial were analyzed for potential prognostic factors. Tumor blocks were retrospectively collected from referring institutions. RESULTS: Median follow-up was 62 months (range, 4 to 120 months). Median relapse-free survival (RFS) and overall survival (OS) times were 52 and 80 months, respectively. Five-year RFS and OS rates were 52% (95% confidence interval [CI], 39% to 64%) and 62% (95% CI, 49% to 74%), respectively. HER-2 expression, number of tumor sites, primary axillary nodal ratio (number of positive nodes divided by number of sampled nodes), number of positive axillary nodes, and delivery or omission of radiotherapy to metastases correlated with RFS. HER-2 overexpression and more than one site were independent adverse risk factors for RFS. HER-2 and the axillary nodal ratio were independent predictors of OS. The following prognostic categories for RFS were established (RFS rate, median RFS): good risk, no factors (77%, 80 months); intermediate risk, one factor (41%, 28 months); and poor risk, both factors (10%, 10 months). CONCLUSION: Long-term results in patients with oligometastatic breast cancer are encouraging but need validation in prospective randomized studies. HER-2 expression, number of sites, and primary nodal ratio are independent outcome predictors. Confirmation of these observations in this selected population would imply the need for reevaluation of the current tenet that early detection of metastatic breast cancer recurrence is of no benefit.

Primary operation in synchroneous metastasized invasive breast cancer patients: First oncologic outcomes of the prospective randomized phase III ABCSG 28 POSYTIVE trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 557-557 ◽  
Author(s):  
Florian Fitzal ◽  
Marija Balic ◽  
Vesna Bjelic-Radisic ◽  
Michael Hubalek ◽  
Christian F. Singer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Median Survival ◽  
Systemic Therapy ◽  
Stage Iv ◽  
Phase Iii ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Primary Systemic Therapy ◽  
Stage Iv Breast Cancer

557 Background: The ABCSG 28 Posytive trial compared primary surgery versus primary systemic therapy without surgery in stage IV breast cancer patients. The primary aim was to investigate whether immediate resection of the primary tumor followed by standard systemic therapy improves median survival compared with no surgical resection (NCT01015625). The trial had to be stopped early due insufficient recruitment. Methods: Untreated stage IV breast cancer patients with the primary in situ were randomly assigned to either surgery of the primary versus no surgery followed by systemic therapy between 2011 and 2015 in 15 breast health centers in Austria. Systemic therapy included endocrine therapy or chemotherapy. Patients were routinely followed every 3-6 months. Primary endpoint was median survival. Results: 90 patients (45 with surgery, 45 with primary systemic therapy without surgery) were randomized. Stratification criteria were age, endocrine responsiveness, her2 expression, planned first line therapy and bone only versus other metastases. Patients in the surgery arm had more cT3 breast cancer (22% versus 7%) and more cN2 staging (16% versus 4%) as well as more her2 positive breast cancer cases (27% versus 18%). The median follow up was 37.5 months and immunohistochemical subtype analysis showed 9% basal like, 22% her2 positive, 51% luminal A and 13% luminal B cancers. Both groups were well balanced regarding first line treatment (endocrine versus chemotherapy) however, there were more taxane treated patients in the no surgery group (24.4 versus 15.6%). The median survival in the surgery arm was 34.6 months versus 54.8 months in the no surgery arm without statistical significance (HR 0.691 CI 0.358 – 1.333; p=0.267). Time to distant progression was insignificantly longer in the no surgery arm (surgery arm 13.9 versus no surgery arm 29.0 months). Conclusions: This first analysis of the prospective randomized phase III trial POSYTIVE-ABCSG-28 demonstrated no benefit in overall survival for immediate surgery of the primary in de novo stage IV breast cancer patients. Clinical trial information: NCT01015625.

Sign in / Sign up

Export Citation Format

Share Document