Impact of FDG-PET scan on follow-up care in nonmetastatic breast cancer

e11611 Background: Fluorine-18-FDG positron emission tomography (FDG-PET) role in the follow up care of non-metastatic breast cancer is not defined. Methods: We retrospectively analyzed 177 patients with stage I-III breast cancer between November 2004 and June 2006. IRB approval was obtained for this study. Patients were divided into two groups. Group A consisted of patients who had one or more FDG-PET scans as part of their clinical follow up (N=68), and Group B consisted of patients who did not (N=109). Clinical, radiological and pathology data were obtained from patients’ records. Results: Median follow-up is 35 months. Mean age 53 years for group A and 57 years for group B. Group A patients were more likely to have had higher stages (29% stage I, 53% stage II, and 18% stage III) compared with group B (64 % stage I, 31% stage II and 4% stage III). The two groups did not differ significantly in ER+ status (69% vs. 78% p=0.21), or Her2neu status (19% vs. 17%; p=0.6). Group A patients had more clinic visits (18 vs. 11; p=0.009), their tumor marker was checked more often (13 vs. 9 times; p=0.0001), had more radiological studies (10 studies vs. 5; p=0.0001), and had more biopsies (0.88 vs. 0.48 biopsy per patient; p=0.05). These differences were significant even after controlling for stage and chemotherapy. 9/68 patients in group A had tumor recurrence compared to 1/109 in group B (p=0.0003). PET scan indications were as follows: 29 (43%) for asymptomatic follow up evaluation [2 recurred]; 18 (26%) concerning symptoms [0 recurred]; 10 (15%) elevated tumor marker [2 recurred]; 7 (10%) other abnormal imaging studies [1 recurred]; 4 (6%) metastatic workup. Conclusions: While FDG-PET might aid in detecting recurrence in some patients with non-metastatic breast cancer, its use was associated with more clinic visits, blood tests, biopsies, and radiological tests. No significant financial relationships to disclose.

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Treatment Strategy for Patients with HR-Positive HER2-Negative Metastatic Breast Cancer That Progressed on CDK4/6 Inhibitors

Breast Care ◽

10.1159/000515729 ◽

2021 ◽

pp. 1-8

Author(s):

Shouko Hayama ◽

Rikiya Nakamura ◽

Toshiko Miyaki ◽

Makiko Itami ◽

Naohito Yamamoto

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Treatment Option ◽

Metastatic Breast ◽

Mtor Inhibitors ◽

Subsequent Treatment ◽

Rank Test ◽

Significant Difference ◽

Group A ◽

Group B

Background/Aims: The study aim was to evaluate if mTOR inhibitors can be considered as a treatment option for HR+ HER2− metastatic breast cancer (MBC) after progression on CDK4/6 inhibitors in clinical practice. Methods: We retrospectively collected the clinicopathological data of patients with HR+ HER2− MBC treated with CDK4/6 inhibitors and subsequent therapies at our institution between 2014 and 2020. The patients were divided into 3 groups according to the type of subsequent treatment: (A) exemestane plus everolimus, (B) endocrine monotherapy, and (C) chemotherapy. Overall survival (OS) was estimated by using the Kaplan-Meier method and compared by using the log-rank test. The efficacy and adverse events (AEs) of each subsequent treatment were assessed by using Fisher’s exact tests. Results: Eighty-six patients (34 in group A, 20 in group B, 32 in group C) were included. The most common endocrine therapy in group B was fulvestrant (40%). The major chemotherapy regimen in group C was eribulin (25%). The median OS times after stopping CDK4/6 inhibitors were 34.5 months (95% confidence interval, 17.2 to NA), 13.6 months (3.9 to NA), and 19.5 months (18.8 to NA) in group A, group B, and group C, respectively. The only significant difference in OS was observed between group A and group B (20.9 months; p = 0.003). There was no difference in the incidence of grade 3 AEs between groups A and C or in the frequency of treatment discontinuation because of AEs among the 3 groups. Conclusion: Our study shows that mTOR inhibitors might be an effective treatment option for patients with HR+ HER2− MBC previously treated with CDK4/6 inhibitors.

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Trastuzumab use and CNS metastasis in Medicare patients diagnosed with metastatic breast cancer (MBC)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.1123 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 1123-1123

Author(s):

R. Griffiths ◽

D. Lalla ◽

M. Brammer ◽

R. Herbert ◽

J. Doan ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Initial Treatment ◽

Index Date ◽

Metastatic Breast ◽

Stage Iv ◽

Distant Recurrence ◽

Group A ◽

Group B ◽

Mean Time

1123 Background: While trastuzumab was approved in 1998 for treating patients with HER-2-positive MBC, there is little information on its use in the Medicare setting. Methods: We used SEER-Medicare data to examine patterns of trastuzumab use in women diagnosed with MBC . An index date was defined as either the date of diagnosis (stage IV) or of first distant recurrence (stage 0-III). Included patients were diagnosed in 2000–2002, and had their first claim for trastuzumab between their index date and December 31, 2005, the end of the observation period. Patients were divided into those who received trastuzumab as part of their first treatment following their index date (Group A), and those who began trastuzumab after at least one course of chemotherapy (Group B). Chemotherapy agents were grouped into antimicrotubule (vinorelbine, docetaxel, paclitaxel, vincristine), anthracycline (doxorubicin, epirubicin), cyclophosphamide, other, and unknown. Results: 281 patients met the inclusion criteria. Overall, the median (mean) time from the index date to initial chemotherapy and/or trastuzumab treatment was 35 (94) days (range 1–1,587 days). The average duration of trastuzumab use (first to last administration) was 371 days (median 239), during which patients averaged 2.3 trastuzumab claims per month. There were 192 (68%) patients in Group A. The median (mean) time from diagnosis to initial treatment in Group A was 34 (94) days. 64 (33%) received trastuzumab alone, and 121 (63%) received trastuzumab with an antimicrotubule. In Group B (89 patients), the median (mean) time to initial chemotherapy was 41 (92) days. 36 (40%) received anthracycline and/or cyclophosphamide based therapy, 22 (25%) received an antimicrotubule without either an anthracycline or cyclophosphamide. The median (mean) time from initial chemotherapy to initial trastuzumab therapy was 233 (368) days. At that time, 29 (33%) received trastuzumab alone, and 54 (61%) received trastuzumab plus an antimicrotubule. Conclusions: To our knowledge, this is the first study to describe patterns of trastuzumab use in Medicare. When used for metastatic breast cancer, trastuzumab was most often provided soon after diagnosis as part of initial treatment, and usually with an antimicrotubule agent. [Table: see text]

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A pilot study of weekly versus 3-week docetaxel in combination with capecitabine in patients with anthracycline-pretreated metastatic breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10771 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10771-10771

Author(s):

Z. Jiang ◽

S. Zhang ◽

X. Xie ◽

J. Liu ◽

J. Ren ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Response Rate ◽

Pilot Trial ◽

Metastatic Breast ◽

Therapeutic Index ◽

Clinical Response Rate ◽

Oral Capecitabine ◽

Group A ◽

Group B

10771 Background: Capecitabine in combination with docetaxel given every 3 weeks has shown a high degree of activity in anthracycline-pretreated metastatic breast cancer (MBC), but with high toxicities. To improve the therapeutic index, we performed a clinical pilot trial to evaluate the efficacy and safety of weekly or 3-week docetaxel in combination with capecitabine given for 14 days every 21 days. Methods: Patients with at least one measurable lesion were randomized to receive the treatment arms: docetaxel 75mg/m2 on days 1, oral capecitabine 950 mg/m2 twice daily on days 1–14 (Arm A); docetaxel 37.5mg/m2 on days 1 and 8, oral capecitabine 950 mg/m2 twice daily on days 1–14 (arm B). Each cycle was repeated every 3 weeks. Patients remained on study for a maximum 6 cycles or until tumor progression or unacceptable toxicity occurred, response assessments were scheduled every two cycles. Results: 64 pts were enrolled, 62 eligible for safety and tumor assessment. Key baseline variables were well balanced. Dominant site of disease was visceral in 66.1%; 24.2% had ≥3 organ sites of disease; all patients had previously received anthracyclines, 24.2% for MBC. 43. 6% were ER negative and 46.8% were HER-2 overexpress. The overall clinical response rate of all groups was 59.7% (37/62). There was no progressive disease (PD) after two cycles. Efficacy outcomes were similar in the two arms. The response rate of group A and B were 60% (18/30) and 59.4% (19/32) respectively. There were no drug-related deaths observed. Neutropenia was the most common toxicity. In all, the frequence of Grade 3/4 neutropenia were similar in two arm, but Grade 4 neutropenia of Group A 66.7% (20/30) was higher than Group B 34.4% (11/32), P = 0.021. Conclusions: The study confirmed the superior activity of docetaxe-capecitabine combination therapy in anthracycline resistant MBC, and comparing with 3-week schedule, weekly docetaxel plus capecitabine has same high efficacy with a favourable safety profile. No significant financial relationships to disclose.

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Association between tumor stage of first non-metastatic breast cancer and second contralateral breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.260 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 260-260

Author(s):

Akshara Raghavendra ◽

Arup Kumar Sinha ◽

Limin Hsu ◽

Modesto Patangan ◽

Huong T. Le-Petross ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Contralateral Breast Cancer ◽

Metastatic Breast ◽

Tumor Stage ◽

Contralateral Breast ◽

Stage I ◽

Stage Ii ◽

Md Anderson

260 Background: Female breast cancer survivors have an average lifetime risk of 4-8% to develop a contralateral breast cancer (CBC).It is unclear if the tumor stage of the first breast cancer is associated with the development of a second CBC. Methods: We performed a retrospective analysis of women who had a presenting diagnosis of non–metastatic breast cancer treated at MD Anderson Cancer Center between January 1997 and December 2013. Demographic, clinical, pathologic and treatment information were obtained from an institutional database. We excluded male patients, those treated outside MD Anderson, patients who underwent bilateral mastectomy, and those with unknown tumor characteristics. The primary endpoint was the development of CBC. The time to CBC was measured from the date of diagnosis of the first breast cancer. Patients who did not develop CBC were censored at death, or if alive, at the most recent follow-up visit. Index tumor stages were categorized as 0, I, II and III. Results: We analyzed 8,770 patients (median follow-up of 5.4 years), among whom 259 (3.0%) developed a CBC. The median follow-up time for stages 0-III was 4.9, 7.2, 5.2 and 3.9 years, respectively. The proportion of patients who developed a CBC by the stage of the index breast cancer was: stage 0: 0/403 (0.0%); stage I: 115/2,143 (5.4%); stage II: 110/4,220 (2.6%); stage III: 34/2,004 (1.7%). The overall median [quartile (Q) 1, Q3] time to the development of CBC was 3.2 (1.2, 6.3) years (stage 0: 0 (0.0, 0.0); stage I: 3.0 (1.2, 6.3); stage II: 4.4 (1.3, 6.9); stage III: 1.6 (0.8, 5.1) years). Conclusions: Patients with stage 0 breast cancer appear to have lower risk of developing a second CBC compared to women presenting with invasive disease. A more detailed analysis of this observation, including incorporation of hormone receptor status and receipt of endocrine therapy, is warranted to determine whether this observation suggests differing biologic risks or treatment/selection bias.

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Survival of premenopausal women with metastatic breast cancer. Long-term follow-up of eastern cooperative group and cancer and leukemia group B studies

Cancer ◽

10.1002/1097-0142(19901001)66:7<1621::aid-cncr2820660729>3.0.co;2-g ◽

1990 ◽

Vol 66 (7) ◽

pp. 1621-1629 ◽

Cited By ~ 41

Author(s):

Geoffrey Falkson ◽

Rebecca S. Gelman ◽

Louis Leone ◽

Carla I. Falkson

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Metastatic Breast ◽

Premenopausal Women ◽

Cooperative Group ◽

Long Term Follow Up ◽

Group B ◽

Leukemia Group

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The role of F-18 FDG PET/CT and breast MRI in the management of breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10778 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10778-10778

Author(s):

A. Iagaru ◽

R. Masamed ◽

H. Silberman ◽

S. Keesara ◽

P. S. Conti

Keyword(s):

Breast Cancer ◽

High Risk ◽

Fdg Pet ◽

Breast Mri ◽

Pet Ct ◽

Group A ◽

Group B ◽

Fdg Pet Ct ◽

Work Up

10778 Background: F-18 FDG PET/CT combines functional and morphologic information in a single study, thus becoming a powerful imaging tool for diagnosis, staging and establishing the response to therapy in various malignancies, including breast cancer (BC). Breast MRI (BMRI) is gaining a major role in the management of high risk BC patients (pts), demonstrating high sensitivity and specificity for detection of small lesions. It is not clear whether to request both studies prior to therapy or opt only for one. We were therefore prompted to review our experience with PET/CT and BMRI in BC. Methods: This is a retrospective study of 21 pts with BC, 30–76 years old (average: 52±13.5), who had BMRI and PET/CT from June 2002 to May 2005. 6 pts (group A) had BMRI and PET/CT in the preoperative period (3–78 days, average: 25) and 15 pts (group B) had BMRI and PET/CT as follow-up after surgery (4–175 days, average: 51.3). The interval between the PET/CT and BMRI ranged 2–188 days (average: 52.7). Specificities and sensitivities for BC and metastases detection using PET/CT and MRI were calculated using pathology (17 pts) or clinical follow-up (4 pts) as gold standard. Results: In group A, BMRI identified BC in 4 pts, while PET/CT did so in 5 pts. All were proven to be malignancy on pathology. In group B, BMRI detected recurrent BC in 8 pts, with 88.9% sensitivity (95% CI: 56.5–98) and 83.3% specificity (95% CI: 43.6–96.9). In the same patient population, PET/CT was 33.3% sensitive and 91.7% specific. As a whole body exam, PET/CT revealed metastases in 6 pts (100% sensitive and 90% specific). Overall, sensitivities and specificities for BC detection were 85.7% (95% CI: 60.1–95.9) and 85.7% (95% CI: 48.7–97.4) for breast MRI, and 75% (95% CI: 40.9–92.8) and 92.3% (95% CI: 66.7–98.6) for PET/CT. Conclusions: BMRI is more sensitive than PET/CT for detection of breast lesions. However, PET/CT detected distant metastases in 6 of the 21 pts (100% sensitive, 90% specific). Larger prospective studies, with the addition of dedicated breast PET and dual time imaging are needed to define the sequence of studies during initial work-up. Our study suggests that PET/CT and BMRI should be considered complimentary imaging tools in the pre- and perioperative work-up of pts diagnosed with BC and at high risk for metastatic disease. No significant financial relationships to disclose.

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The Incidence of Brain Metastases Among Patients with Metastatic Breast Cancer: A Systematic Review and Meta-Analysis

Neuro-Oncology ◽

10.1093/neuonc/noaa285 ◽

2020 ◽

Author(s):

Markus Kuksis ◽

Yizhuo Gao ◽

William Tran ◽

Christianne Hoey ◽

Alex Kiss ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Metastatic Breast Cancer ◽

Brain Metastases ◽

Triple Negative ◽

Screening Program ◽

Meta Analysis ◽

Metastatic Breast ◽

Breast Cancer Brain Metastasis

Abstract Background Patients with metastatic breast cancer (MBC) are living longer, but development of brain metastases often limits their survival. We conducted a systematic review and meta-analysis to determine the incidence of brain metastases in this patient population. Methods Articles published from January 2000 to January 2020 were compiled from four databases using search terms related to: breast cancer, brain metastasis, and incidence. The overall and per patient-year incidence of brain metastases were extracted from studies including patients with HER2+, triple negative, and hormone receptor (HR)+/HER2- MBC; pooled overall estimates for incidence were calculated using random effects models. Results 937 articles were compiled, and 25 were included in the meta-analysis. Incidence of brain metastases in patients with HER2+ MBC, triple negative MBC, and HR+/HER2- MBC was reported in 17, 6, and 4 studies, respectively. The pooled cumulative incidence of brain metastases was 31% for the HER2+ subgroup (median follow-up: 30.7 months, IQR: 24.0 – 34.0), 32% for the triple negative subgroup (median follow-up: 32.8 months, IQR: 18.5 – 40.6), and 15% among patients with HR+/HER2- MBC (median follow-up: 33.0 months, IQR: 31.9 – 36.2). The corresponding incidences per patient-year were 0.13 (95% CI: 0.10 – 0.16) for the HER2+ subgroup, 0.13 (95%CI: 0.09 – 0.20) for the triple negative subgroup, and only 0.05 (95%CI: 0.03 – 0.08) for patients with HR+/HER2- MBC. Conclusion There is high incidence of brain metastases among patients with HER2+ and triple negative MBC. The utility of a brain metastases screening program warrants investigation in these populations.

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Staging Investigations in Asymptomatic Early Breast Cancer Patients at the Cancer Centre of Southeastern Ontario

Current Oncology ◽

10.3390/curroncol28030203 ◽

2021 ◽

Vol 28 (3) ◽

pp. 2190-2198

Author(s):

Dalia Kamel ◽

Veronica Youssef ◽

Wilma M. Hopman ◽

Mihaela Mates

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Adjuvant Chemotherapy ◽

Early Breast Cancer ◽

Triple Negative ◽

Metastatic Breast ◽

Receptor Status ◽

Cancer Centre ◽

Radiological Staging

Background: In 2012, the American Society for Clinical Oncology (ASCO) identified five key opportunities in oncology to improve patient care, recommending against imaging tests for the staging of patients with early breast cancer (EBC) at low risk for metastases. Similarly, the European Society of Medical Oncology (ESMO) guideline does not support radiological staging in asymptomatic EBC (aEBC). The purpose of this study was to assess local practice and outcomes of staging investigations (SIs) in aEBC at the Cancer Centre of Southeastern Ontario (CCSEO). Methods: A retrospective electronic and paper chart review was undertaken to identify all aEBC patients treated at our institution between January 2012 and December 2014. Patients with pathological staging of T1-T2 and N0-1 with any receptor status were included. We collected patient demographics, treatment and pathologic tumor characteristics. The use and outcomes of initial and follow-up SIs were recorded. Data were analyzed to determine associations between the use of SIs and clinical characteristics (chi-square tests, independent samples t-tests and Mann–Whitney U tests). Results: From 2012 to 2014, 295 asymptomatic EBC patients were identified. The mean age was 64, 81% were postmenopausal and 76% had breast conserving surgery. Stage distribution was as follows: stage I 42%, stage IIA 37% and stage IIB 21%. Receptor status was as follows: ER+ 84%, HER2+ 13% and triple negative 12%. Adjuvant chemotherapy was received by 36%, Trastuzumab by 10% and endocrine therapy by 76% of patients. Baseline SIs were performed in 168 patients (57%) for a total of 332 tests. Overt metastatic disease was found in five patients (one bone scan and four CT scans). Seventy-one out of the 168 patients (42%) who received initial staging imaging underwent 138 follow-up imaging tests, none of which were diagnostic for metastases. Nine patients with suspicious CT findings underwent biopsies, of which four were malignant (one metastatic breast cancer and three new primaries). Factors significantly associated with SI were as follows: younger age (p = 0.001), premenopausal status (p = 0.01), T2 stage (p < 0.001), N1 stage (p < 0.001), HER2 positive (p < 0.001), triple negative status (p = 0.007) and use of adjuvant chemotherapy (p < 0.001). Conclusions: Over a 3-year period at our institution, more than 50% of aEBC patients underwent a total of 470 initial and follow-up staging tests, yielding a cancer diagnosis (metastatic breast cancer or second primary cancer) in four patients. We, therefore, conclude that routine-staging investigations in aEBC patients have low diagnostic value, supporting current guidelines that recommend against the routine use of SI in this population.

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