scholarly journals Hormone Receptor Positive/HER2 Negative Breast Cancer With Isolated Bladder Metastasis: A Rare Case

2021 ◽  
Vol 9 ◽  
pp. 232470962110221
Author(s):  
Noman Ahmed Jang Khan ◽  
Mahmoud Abdallah ◽  
Maria Tria Tirona
Keyword(s):  
Breast Cancer ◽  
Urinary Bladder ◽  
Metastatic Disease ◽  
Hormone Receptor ◽  
Rare Case ◽  
Bladder Wall ◽  
Locally Advanced ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer ◽  
Bladder Metastasis

Breast cancer is the most common cancer diagnosed in women in North America. Hormone receptor positive (HR+) and HER2 negative (HER2−) breast cancers account for at least 60% to 70% of all breast cancer cases. They usually metastasize to lymph nodes, bones, liver, lungs, and brain. Urinary bladder is a very unusual site for metastatic HR+/HER2− breast cancer and occurs in only 2% of all metastatic disease. In this article, we present a case of a 63-year-old female with locally advanced breast cancer who underwent mastectomy, adjuvant chemotherapy, radiation, and hormonal therapy. She was in remission for almost 17 years and subsequently presented with hematuria and lower abdominal pain. Cystoscopy was performed, which showed evidence of bladder wall thickening. Histopathology showed metastatic HR+/HER2− breast cancer consistent with her history of breast primary. Imaging studies did not show any other evidence of metastatic disease. She was started on cyclin D kinase 4/6 inhibitor, palbociclib, in combination with an aromatase inhibitor, letrozole. This is an exceedingly rare case of HR+ and HER2− breast cancer with metastasis to the urinary bladder. The late onset of recurrence with bladder metastasis makes this case very unique and to our knowledge only few similar cases have been reported in the literature.

A phase II randomized study to compare abemaciclib plus trastuzumab with or without fulvestrant to standard of care chemotherapy plus trastuzumab in hormone receptor positive, HER2-positive advanced breast cancer (monarcHER).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS1109-TPS1109 ◽  
Author(s):  
Sara M. Tolaney ◽  
Nawel Bourayou ◽  
Shom Goel ◽  
Anwar Hossain ◽  
Fabrice Andre
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Hormone Receptor ◽  
Single Agent ◽  
Objective Response ◽  
Locally Advanced ◽  
Metastatic Breast ◽  
Advanced Breast ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer

TPS1109 Background: Inhibition of CDK4 in preclinical models, demonstrated efficacy in HER2+ breast cancer and enhanced activity of HER2-targeted therapy suggesting a crosstalk between HER2 signaling and the cyclin D/CDK4 signaling pathway in which CDK4 & CDK6 inhibitors may re-sensitize resistant tumors to HER2 blockade.Abemaciclib is a selective inhibitor of CDK4 & CDK6 inhibitor that demonstrates single-agent anti-tumor activity on a continuous dosing schedule in women with hormone receptor positive (HR+) advanced breast cancer. Triple regimens with abemaciclib have been tolerable. Methods: monarcHER is an ongoing Phase 2, open-label, study in postmenopausal women with HR+, HER2+ locally advanced or metastatic breast cancer. Eligible patients (pts) are those previously treated with ≥2 HER2-directed therapies in advanced disease setting; T-DM1 and a taxane in any disease setting; no prior treatment with fulvestrant or any CDK4 & CDK6 inhibitor or with ECOG PS ≤1; LVEF ≥50%; no visceral crisis and no CNS metastases that are untreated, symptomatic or requiring steroids. Pts are randomized 1:1:1 to Arm A (abemaciclib [150mg PO Q12H] plus trastuzumab [IV infusion Q3 weeks] plus fulvestrant [IM injection on D1, 15, 29 then Q4 weeks]), Arm B (abemaciclib plus trastuzumab), or Arm C (trastuzumab plus SOC single-agent chemotherapy of physician’s choice); stratified based on number of prior systemic regimens (excluding single agent endocrine therapy) and disease status (measurable vs nonmeasurable). The primary objective evaluates investigator-assessed progression-free survival (PFS). Secondary objectives include overall survival, objective response rate, duration of response, disease control rate, clinical benefit rate, safety and tolerability, efficacy, health outcomes and pharmacokinetics. Analysis is planned at 165 PFS events, providing ≥80% power to detect superiority of Arm A and Arm B over Arm C, assuming a hazard ratio of 0.67 at a one-sided alpha of 0.10. First pt visit occurred in May 2016; with a target enrollment of 225 pts. Contact information: 1-877-CTLILLY (1-877-285-4559) Clinical trial information: NCT02675231.

scholarly journals Olaparib in hormone receptor-positive, HER2-negative metastatic breast cancer with a somatic BRCA2 mutation

2021 ◽  
Vol 13 ◽  
pp. 175883592110069
Author(s):  
Lee S. Schwartzberg ◽  
Lesli A. Kiedrowski
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Clinical Response ◽  
Hormone Receptor ◽  
Brca2 Mutation ◽  
Locally Advanced ◽  
Susceptibility Gene ◽  
Metastatic Breast ◽  
Breast Cancer Susceptibility Gene ◽  
Hormone Receptor Positive

The oral poly(adenosine diphosphate-ribose) polymerase inhibitor olaparib is approved for the treatment of patients with human epidermal growth factor 2-negative (HER2−) metastatic breast cancer (mBC) and a germline breast cancer susceptibility gene (BRCA) mutation who have been treated with chemotherapy. This case report describes a 63-year-old postmenopausal woman with somatic BRCA2-mutated mBC who responded to olaparib treatment following multiple prior lines of therapy. The patient presented in January 2012 with locally advanced, hormone receptor-positive (HR+), HER2− BC which, despite initial response to neoadjuvant chemotherapy, recurred as bone disease in February 2014, and subsequently skin (June 2016) and liver (October 2016) metastases. A comprehensive 592-gene next-generation sequencing panel (Caris Life Sciences), performed on a skin biopsy, detected a pathogenic frameshift mutation in BRCA2 (H3154fs, c.9460delC), which was not identified in a 28-gene hereditary cancer germline analysis (Myriad Genetics, Inc.), and was therefore considered to be a somatic mutation. In January 2017, cell-free DNA (cfDNA) analysis (Guardant Health, Inc.) confirmed the BRCA2 H3154fs mutation in plasma. After several lines of chemotherapy and endocrine therapy, deriving clinical benefit from eribulin and capecitabine, the disease progressed by October 2017, and olaparib (300 mg orally twice daily) was initiated in January 2018. By April 2018, the liver lesions had shrunk by 80% and a >90% response in multiple skin lesions was noted. Clinical response was maintained for 8 months, followed by progression in the skin in September 2018. Biopsy of recurrent lesions revealed a novel BRCA2 mutation, E3152del (c.9455_9457delAGG), predicted to restore the open reading frame and presumably the mechanism of resistance to olaparib. Further likely resistance mutations were noted in subsequent cfDNA analyses. This case demonstrated a clinical response with olaparib as a later-line therapy for HR+, HER2− mBC with a somatic BRCA2 mutation.

scholarly journals Top 3 abstracts concerning hormone-receptor-positive early breast cancer

2021 ◽  
Author(s):  
Simon Peter Gampenrieder ◽  
Gabriel Rinnerthaler ◽  
Richard Greil
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
Menopausal Status ◽  
Pathologic Complete Response ◽  
Oncotype Dx ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer

SummaryThe three top abstracts at the 2020 virtual San Antonio Breast Cancer Symposium regarding hormone-receptor-positive early breast cancer, from our point of view, were the long-awaited results from PenelopeB and RxPONDER as well as the data from the ADAPT trial of the West German Study Group. PenelopeB failed to show any benefit by adjuvant palbociclib when added to standard endocrine therapy in patients without pathologic complete response after neoadjuvant chemotherapy. RxPONDER demonstrated that postmenopausal patients with early hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2−) breast cancer, 1–3 positive lymph nodes and an Oncotype DX Recurrence Score of less than 26 can safely be treated with endocrine therapy alone. In contrast, in premenopausal women with positive nodes, adjuvant chemotherapy plays still a role even in case of low genomic risk. Whether the benefit by chemotherapy is mainly an indirect endocrine effect and if ovarian function suppression would be similarly effective, is still a matter of debate. The HR+/HER2− part of the ADAPT umbrella trial investigated the role of a Ki-67 response to a short endocrine therapy before surgery in addition to Oncotype DX—performed on the pretreatment biopsy—to identify low-risk patients who can safely forgo adjuvant chemotherapy irrespective of menopausal status.

scholarly journals Immune microenvironment and intrinsic subtyping in hormone receptor-positive/HER2-negative breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Gaia Griguolo ◽  
Maria Vittoria Dieci ◽  
Laia Paré ◽  
Federica Miglietta ◽  
Daniele Giulio Generali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Gene Expression Data ◽  
Hormone Receptor ◽  
Tumor Biology ◽  
Expression Data ◽  
Immune Microenvironment ◽  
Immune Infiltrate ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer

AbstractLittle is known regarding the interaction between immune microenvironment and tumor biology in hormone receptor (HR)+/HER2− breast cancer (BC). We here assess pretreatment gene-expression data from 66 HR+/HER2− early BCs from the LETLOB trial and show that non-luminal tumors (HER2-enriched, Basal-like) present higher tumor-infiltrating lymphocyte levels than luminal tumors. Moreover, significant differences in immune infiltrate composition, assessed by CIBERSORT, were observed: non-luminal tumors showed a more proinflammatory antitumor immune infiltrate composition than luminal ones.

Predictive factors associated with a pathologic complete response in a Mexican HER2+ breast cancer population.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12630-e12630
Author(s):  
Raul Alejandro Andrade Moreno ◽  
José Fabián Martínez-Herrera ◽  
Geovani Amador ◽  
Raquel Gerson Cwilich ◽  
Juan Alberto Serrano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Predictive Factors ◽  
Hormone Receptor ◽  
Locally Advanced ◽  
Complete Response ◽  
Receptor Expression ◽  
Proliferation Index ◽  
Comprehensive Cancer Center ◽  
Lymph Node Status ◽  
Her2 Breast Cancer

e12630 Background: The current standard of treatment for locally advanced and early HER2+ breast cancer is the use of neoadjuvant chemotherapy (NAC) in combination with trastuzumab and pertuzumab. Mexican reports about its efficacy and predictive factors leading to pathological complete response (pCR) are scarce and few statistics are known. Methods: We performed a retrospective review of medical records of locally advanced and early HER2+ breast cancer patients who were treated with NAC in association with pertuzumab and trastuzumab. pCR was defined as the absence of residual invasive cancer cells in the breast and lymph nodes (ypT0/ypN0). Other histopathological features included Tumor type, estrogen, and progesterone receptor expression, HER2 status and Ki67. Clinical data included age, body mass index and number of metastatic nodes. Results: Thirty-five patients with early or locally advanced HER2+ breast cancer diagnosed and treated in a Comprehensive Cancer Center between January 2014 to June 2020 were included. The median age in the population was 47 years (range 28-79) with 20 patients under 50 years (57% of the total population). 40% of the patients were classified as overweight or obese at the time of diagnosis. The predominant histology was infiltrating ductal carcinoma (91%). The most frequent clinical stages were IIA, (34.2%) IIB (31.4%) and IIIA (22.8%). The population included patients with N0 (21.7%), N1 (56.5%), N2 (13%) and N3 (8.7%). Most tumors were larger than 2 centimeters at the time of diagnosis. T1 (17.4%), T2 (60.9%), T3 (17.4%) and T4 (4.3%). Most of the patients (77%) had a high proliferation index (Ki67 > 20). A total of 12 patients (34.3%) were hormone receptor (HR) negative and the rest (65.7%) were categorized as Triple Positive. The chemotherapy schemes used for NAC treatment were AC/THP (57.5%), THP (22.8%), TCHP (17.1%) and FEC/THP (2.7%) pCR was achieved in 60% of the patients. Patients with HR (-) achieved a pCR in 83% of the cases (10/12 patients) against 47.8% (11/23 patients) of the triple positive population. The Odds ratio (OR) for residual disease was 6.6 (95%CI 1.17-37.02) in the HR+ population. HR-/HER2+ tumors (p = 0.49) were independent predictors of pCR at multivariate logistic regression. No other variables including Ki67, BMI, age, tumor size, type of chemotherapy administered, and lymph node status were statistically significant. Conclusions: In this Mexican population there is a significant difference between the percentage of patients who achieve pCR in relation to the status of hormone receptors, favoring those patients with hormone receptor negative tumors. Nevertheless, most of the population achieves this benefit regardless of their hormone status, as HER2+ tumors showed sensitivity to chemotherapy and to the humanized anti-HER2 therapies. No other clinical or pathological variables were associated with pCR.

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