Hepatic intra-arterial chemotherapy in patients with metastatic breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10581-10581
Author(s):  
N. Fazio ◽  
M. Medici ◽  
M. Colleoni ◽  
A. Rocca ◽  
R. Torrisi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Metastases ◽  
Mitomycin C ◽  
Epigastric Pain ◽  
Hepatic Metastases ◽  
Metastatic Breast ◽  
Hepatic Arterial Infusion ◽  
Patient Treatment ◽  
Arterial Infusion

10581 Background: Hepatic intra-arterial chemotherapy has been reported to produce higher response rate than systemic in patients (pts) with metastatic colorectal cancer. In breast cancer the liver is involved in up to 60% of cases and often conditions the prognosis. Nevertheless, only rare hepatic arterial infusion studies were published. Therefore, based on our previous experience in hepatic metastatic colorectal malignancies, we evaluated efficacy and toxicity of hepatic intra-arterial chemotherapy in pts with metastatic breast cancer. Methods: A three-day continuous arterial infusion (CAI) of fluorouracil 1000 mg/m2 q 24 hrs, with cisplatin 10 mg/m2 twice daily, and mitomycin-c 1 mg/m2 twice daily, was performed through a percutaneous radiological temporary trans-subclavicular catheter. Pts with responsive disease received up to four cycles every six weeks. Pts still responding could carry on with cisplatin and fluorouracil, without mitomycin-c. Pts were hospitalized and the catheter was removed upon end of infusion. Results: From 9.2000 to 6.2005, 25 pts with progressive liver metastases from breast cancer were treated. Nine had more than 50% of liver involvement. Fifteen had also extra-hepatic metastases. All had received antracyclines and 22/25 taxanes. Pts had a median of five previous chemotherapy lines. Median time from diagnosis of liver metastases to first CAI was 33 months (range: 7–110). Sixty-four total courses were administered, with a median of 2 (range: 1–7) per pts. Epigastric pain was the main clinical toxicity (54%) and iatrogenic gastro-duodenal ulcer, the main complication (28%). No relevant catheter-related complications occurred. Fifteen partial responses (60%) and eight stable diseases (32%) were observed. Response duration was 5.4 months (range: 2 - 27), time to progression 5.1 months (range: 2.5–29+), and median overall survival 13 months (range: 3.5+–32+). Conclusions: Hepatic arterial infusion of chemotherapy in heavily pre-treated pts with metastatic breast cancer is feasible and effective. A specific evaluation of quality of life should be performed to verify a real clinical benefit. An earlier timing during course of liver disease, and a shift to radiological implanted arterial port (allowing out-patient treatment), will be investigated. No significant financial relationships to disclose.

scholarly journals Sequential intra-arterial infusion of 90Y-resin microspheres and mitomycin C in chemo refractory liver metastatic breast cancer patients: a single centre pilot study

2020 ◽  
Vol 54 (1) ◽  
pp. 33-39
Author(s):  
Brigitte Maximiliana Aarts ◽  
Elisabeth Geneviève Klompenhouwer ◽  
Raphaëla Carmen Dresen ◽  
Christophe Michel Albert Louis Omer Deroose ◽  
Regina Gien Hoa Beets-Tan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Pilot Study ◽  
Mitomycin C ◽  
Progressive Disease ◽  
Metastatic Breast ◽  
Response To Treatment ◽  
Breast Cancer Patients ◽  
Arterial Infusion ◽  
Resin Microspheres

AbstractBackgroundThe aim of the study was to evaluate the safety and feasibility of intra-arterial mitomycin C (MMC) infusion after selective internal radiation therapy (SIRT) using Yttrium-90 (90Y) resin microspheres in liver metastatic breast cancer (LMBC) patients.Patients and methodsThe prospective pilot study included LMBC patients from 2012–2018. Patients first received infusion of 90Y resin microspheres, after 6–8 weeks response to treatment was assessed by MRI, 18F-FDG PET/CT and laboratory tests. After exclusion of progressive disease, MMC infusion was administrated 8 weeks later in different dose cohorts; A: 6 mg in 1 cycle, B: 12 mg in 2 cycles, C: 24 mg in 2 cycles and D: maximum of 72 mg in 6 cycles. In cohort D the response was evaluated after every 2 cycles and continued after exclusion of progressive disease. Adverse events (AE) were reported according to CTCAE version 5.0.ResultsSixteen patients received 90Y treatment. Four patients were excluded for MMC infusion, because of extra hepatic disease progression (n = 3) and clinical and biochemical instability (n = 1). That resulted in the following number of patient per cohort; A: 2, B: 1, C: 3 and D: 6. In 4 of the 12 patients (all cohort D) the maximum dose of MMC was adjusted due biochemical toxicities (n = 2) and progressive disease (n = 2). One grade 3 AE occurred after 90Y treatment consisting of a gastrointestinal ulcer whereby prolonged hospitalization was needed.ConclusionsSequential treatment of intra-arterial infusion of MMC after 90Y SIRT was feasible in 75% of the patients when MMC was administrated in different escalating dose cohorts. However, caution is needed to prevent reflux after 90Y SIRT in LMBC patients.

Intrahepatic mitomycin C as treatment of breast cancer hepatic metastasis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10690-10690
Author(s):  
W. Demey ◽  
H. Wildiers ◽  
G. Maleux ◽  
P. Clement ◽  
S. Heye ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Mitomycin C ◽  
Systemic Treatment ◽  
Therapeutic Option ◽  
Metastatic Breast ◽  
University Hospital ◽  
The Right

10690 Background: Because of increasing survival due to improving systemic treatment, liver metastasis represents a major and increasing cause of death in women with metastatic breast cancer. Regional treatment is an attractive option in the treatment of liver metastases. We reviewed the tolerability and efficacy of intrahepatic administration of mitomycin C (MMC) performed in our institution. Patients with only or predominant liver metastasis were eligible, independent of previous chemotherapy for metastatic breast cancer. Methods: In a unicentric protocol we reviewed retrospectively all patients (n = 11) who received intrahepatic MMC for liver metastasis of breast cancer between January 2000 and July 2005 in the University Hospital Leuven. MMC was administered as a bolus of 6 mg in 50 ml saline directly into the right and left hepatic arteries by transcatheter technique. The procedure was performed by an interventional radiologist. Patients were hospitalised for 24 hours. In patients with severe liver function disturbances or more than six administrations of MMC a dose reduction was applied. Results: All treated patients were reviewed. The median age was 52 years (range, 36–61). Most patients were heavily pre-treated with a median of 4 systemic chemotherapy regimens (range, 1–5). Treatment was well tolerated, no grade 3 or 4 adverse events were reported. Only one patient had persistent thrombocytopenia for which interruption of treatment was required. One patient had fatigue. There were no procedure-related complications. Six patients received only 1 or 2 administrations because of rapid disease progression within the first two months. Among the remainders, 4 patients had 6 and 1 had 11administrations. When evaluatde by RECIST criteria one patient had a complete remisson, two patients had a partial remission and 2 patients remained stable for at least 6 months. Conclusions: In this retrospective analysis intrahepatic administration of MMC was well tolerated and provided clincal benefit (respons or at least disease stabilization for 6 months) in 45% of heavily pre-treated patients. This treatment represents a valid therapeutic option for patients with predominant liver metastases of breast cancer after failure of standard systemic treatment. No significant financial relationships to disclose.

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

Combination of capecitabine and mitomycin C as first-line treatment in patients with metastatic breast cancer

Neoplasma ◽  
2011 ◽  
Vol 58 (2) ◽  
pp. 172-178 ◽  
Author(s):  
E. VRDOLJAK ◽  
M. BOBAN ◽  
T. OMRCEN ◽  
D. HREPIC ◽  
V. FRIDL-VIDAS ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Mitomycin C ◽  
Metastatic Breast ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Examining patient choices for metastatic breast cancer drugs.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6053-6053
Author(s):  
Mary Lou Smith ◽  
Carol B White ◽  
Elda Railey ◽  
Anna Maria Storniolo ◽  
George W. Sledge
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Online Survey ◽  
Metastatic Breast ◽  
Treatment Decision ◽  
Patient Treatment ◽  
Treatment Preferences ◽  
Trade Offs ◽  
Advocacy Network ◽  
Individualization Of Therapy

6053 Background: Patients with metastatic breast cancer face difficult drug decisions. Our previous research (ASCO Proc 2011, abstr 6044) focused on general benefit and toxicity showed that conjoint analysis (CA) allows patients to express preferences; our current research quantifies patient preference for specific drug profiles (capecitabine and paclitaxel). Methods: Research Advocacy Network and CBWhite conducted research using CA for DOD Center of Excellence for Individualization of Therapy in Breast Cancer. An online survey was sent by four breast cancer organizations (N=641). Questions elicited views on trade-offs between benefit and type/severity/duration of toxicity. CA questions present pairs of hypothetical treatments and ask respondents their preferred alternative; a follow-up question asks whether the person would take the treatment if it were the only option available. Analysis of response patterns allows study of treatment preferences for combinations of benefit and described toxicity. Results: See table. Preferences show much greater attention to benefit than to toxicity. When CA is used to examine impact of biomarkers, focus on benefit continues. Paclitaxel profile (IV) set with moderate PN lasting 1 year post treatment: with 33% benefit LH, 6% of respondents change treatment decision if biomarker predicts 27% vs 60% toxicity likelihood; with 27% toxicity LH, 22% of respondents change treatment decision if biomarker predicts 20% vs 50% benefit likelihood. Conclusions: For patients with metastatic disease, CA shows much greater attention to benefit than toxicity, and high likelihood to take treatment with at least 30% chance of benefit for any toxicity tested here. These results suggest biomarkers (for the profiled drugs) predicting benefit are more likely to be used to affect patient treatment decisions than biomarkers for toxicity. [Table: see text]

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