The persistence of disseminated tumor cells after systemic therapy and their influence on prognosis in early breast cancer patients.

1030 Background: Detection of disseminated tumor cells (DTC) in the bone marrow (BM) of early breast cancer (EBC) patients before the administration of systemic therapy is associated with poor outcome. The aim of this study was to evaluate the impact of DTC on overall survival (OS) and disease free survival (DFS) in a large cohort of EBC patients after the administration of systemic therapy. Methods: EBC patients receiving systemic therapy (endocrine therapy and/or chemotherapy +/- HER2-directed treatment) either prior to surgery (neoadjuvant systemic therapy, NST) or after surgery (adjuvant systemic therapy, AST) at Tuebingen University Hospital, Germany between 01/2003 and 06/2012 were available for this analysis. BM aspirates were collected during surgery / one year after surgery in patients receiving NST / AST. DTC were identified by immunocytochemistry (pancytokeratin antibody A45/B3) and cytomorphology. Survival was analyzed using univariate (log-rank test) and multivariate analysis (cox regression). Results: DTC were detected in 201 of 608 (35%) patients. 175 of 419 (42%) patients treated with NST and 35 of 189 (19%) patients treated with AST were DTC-positive. Chemotherapy / endocrine therapy was administered prior to BM aspiration in 399 (96%) / 19 (5%) of the patients receiving NST and in 99 (52%) / 158 (84%) of the patients receiving AST. On univariate analysis, the detection of DTC was a significant predictor of poor DFS (HR: 2.27, 95% CI: 1.48 – 3.48, p<0.001) and poor OS (HR: 1.89, 95% CI: 1.19 – 3.00, p=0.007). On multivariate analysis (considering all clinicopathological factors and the DTC-status), independent factors for DFS were DTC-status (negative vs. positive), grading (G2-3 vs. G3), nodal-status (negative vs. positive), and the ER-status (negative vs. positive). Independent factors for OS were grading, PR-status (negative vs. positive) and nodal-status. Conclusions: The persistence of DTC in the BM of EBC patients after systemic treatment is a strong and independent marker of poor prognosis. Determination of the DTC-status is thus promising to monitor the effect of systemic therapy and to identify patients that are in need of additional adjuvant therapy.

Download Full-text

Presence of apoptotic and nonapoptotic disseminated tumor cells reflects the response to neoadjuvant systemic therapy in breast cancer

Breast Cancer Research ◽

10.1186/bcr1611 ◽

2006 ◽

Vol 8 (5) ◽

Cited By ~ 36

Author(s):

Tanja Fehm ◽

Sven Becker ◽

Graziella Becker-Pergola ◽

Karl Sotlar ◽

Gerhard Gebauer ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Cells ◽

Systemic Therapy ◽

Disseminated Tumor Cells ◽

Neoadjuvant Systemic Therapy

Download Full-text

The impact of adjuvant endocrine therapy in early breast cancer on quality-of-life: an overview of prospective trials

Expert Review of Quality of Life in Cancer Care ◽

10.1080/23809000.2016.1157002 ◽

2016 ◽

Vol 1 (2) ◽

pp. 111-120 ◽

Cited By ~ 1

Author(s):

Eleonora Mioranza ◽

Cristina Falci ◽

Maria Vittoria Dieci ◽

Valentina Guarneri ◽

Pierfranco Conte

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Endocrine Therapy ◽

Early Breast Cancer ◽

Adjuvant Endocrine Therapy ◽

Prospective Trials ◽

The Impact

Download Full-text

Genomic and expression profiling reveal molecular heterogeneity of disseminated tumor cells in bone marrow of early breast cancer

npj Breast Cancer ◽

10.1038/s41523-018-0083-5 ◽

2018 ◽

Vol 4 (1) ◽

Cited By ~ 6

Author(s):

Mark Jesus M. Magbanua ◽

Hope S. Rugo ◽

Louai Hauranieh ◽

Ritu Roy ◽

Janet H. Scott ◽

...

Keyword(s):

Breast Cancer ◽

Bone Marrow ◽

Tumor Cells ◽

Early Breast Cancer ◽

Expression Profiling ◽

Disseminated Tumor Cells ◽

Molecular Heterogeneity

Download Full-text

Primary systemic therapy does not eradicate disseminated tumor cells in breast cancer patients

Breast Cancer Research and Treatment ◽

10.1007/s10549-006-9484-5 ◽

2007 ◽

Vol 106 (2) ◽

pp. 239-243 ◽

Cited By ~ 38

Author(s):

Sven Becker ◽

Erich Solomayer ◽

Graziella Becker-Pergola ◽

Diethelm Wallwiener ◽

Tanja Fehm

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Tumor Cells ◽

Systemic Therapy ◽

Disseminated Tumor Cells ◽

Breast Cancer Patients ◽

Primary Systemic Therapy

Download Full-text

Adjuvant chemotherapy for early female breast cancer: A systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline

Current Oncology ◽

10.3747/co.22.2321 ◽

2014 ◽

Vol 22 ◽

pp. 82 ◽

Cited By ~ 12

Author(s):

S. Gandhi ◽

G.G. Fletcher ◽

A. Eisen ◽

M. Mates ◽

O.C. Freedman ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Endocrine Therapy ◽

Early Breast Cancer ◽

Systemic Therapy ◽

Cancer Care ◽

Cytotoxic Chemotherapy ◽

Evidence Based ◽

Inclusion Criteria ◽

Meta Analyses

BackgroundThe Program in Evidence-Based Care (PEBC) of Cancer Care Ontario (CCO) has recently created an evidence-based consensus guideline on the systemic treatment of early breast cancer. The evidence for this guideline was compiled using a systematic review to answer the question: “What is the optimal systemic therapy for patients with early-stage, operable breast cancer, when patient and disease factors are considered?” This question was addressed in three parts: cytotoxic chemotherapy, endocrine treatment, and human epidermal growth factor receptor 2 (HER2) directed therapy.MethodsA systematic review was performed using the MEDLINE and EMBASE databases for the period January 2008 to May 2014. The SAGE Directory of Cancer Guidelines and websites of major oncology guideline organizations were also searched. The basic search terms were “breast cancer” and “systemic therapy” (chemotherapy, endocrine therapy, targeted agents, ovarian suppression), and was limited to randomized controlled trials (RCTs), guidelines, systematic reviews, and meta-analyses. ResultsSeveral hundred documents were retrieved that met the inclusion criteria; the Early Breast Cancer Trialists Collaborative Group (EBCTCG) meta-analyses encompassed many of the RCTs found. Several additional studies which met the inclusion criteria were included, as well as other guidelines and systematic reviews. Chemotherapy was largely reviewed as three classes of agents: anti-metabolite based regimens (e.g., CMF), anthracyclines, and taxane-based regimens. Single-agent chemotherapy in general is not recommended for the adjuvant treatment of breast cancer in any patient population. Anthracycline and taxane-based polychemotherapy regimens are overall considered superior to earlier generation regimens, with the most significant impact on patient survival outcomes. Various regimens with disparate anthracycline and taxane doses and schedules are options; in general, paclitaxel given every 3 weeks is inferior. Evidence does not support the use of bevacizumab in the adjuvant setting; other systemic therapy agents such as metformin and vaccines remain under investigation. Adjuvant bisphosphonates for menopausal women will be discussed in later work. ConclusionThe results of this systematic review represent a comprehensive compilation of high-level evidence which was the basis for the 2014 PEBC CCO guideline on systemic therapy for early breast cancer. The use of cytotoxic chemotherapy is presented here; the results addressing endocrine therapy and HER-2 targeted treatment, as well as the final clinical practice recommendations, are published separately in this issue.

Download Full-text

To Look or Not to Look? Yes to Nodal US!

Journal of Breast Imaging ◽

10.1093/jbi/wbab079 ◽

2021 ◽

Author(s):

Gaiane M Rauch ◽

Henry M Kuerer ◽

Maxine S Jochelson

Keyword(s):

Breast Cancer ◽

Systemic Therapy ◽

Tumor Biology ◽

Significant Proportion ◽

Nodal Status ◽

Newly Diagnosed ◽

Breast Cancer Patients ◽

Axillary Surgery ◽

Appropriate Treatment ◽

Neoadjuvant Systemic Therapy

Abstract Knowledge of axillary nodal status is highly important for correct staging and treatment planning in patients with breast cancer. Axillary US is a recognized highly specific and cost-effective tool for assessing nodal status and guiding appropriate treatment. Axillary US imaging with US-guided biopsy is routinely performed throughout the world. However, because of recent developments in the surgical management of the axilla in patients with newly diagnosed breast cancer (American College of Surgeons Oncology Group [ACOSOG] Z0011 trial) and in patients with breast cancer receiving neoadjuvant systemic therapy (ACOSOG Z1071, SENTinel NeoAdjuvant [SENTINA] and Sentinel Node biopsy aFter NeoAdjuvant Chemotherapy [SN FNAC] trials), some have questioned the utility of axillary US for nodal staging. Here, we review the evidence to date supporting the additional value of axillary US for patients with breast cancer. Nodal US in patients with newly diagnosed breast cancer is useful for staging; in a significant proportion of patients, nodal US identifies additional axillary level II or level III nodal disease, which allows for appropriate treatment of disease. Furthermore, ongoing clinical trials may show that axillary surgery can be omitted in patients with negative findings on axillary US. In patients with lymph node–positive disease undergoing neoadjuvant systemic therapy, nodal US can guide the approach to axillary surgery. A more personalized patient approach, taking into the account tumor biology, among other factors, may help to mitigate the controversy surrounding the role of axillary US in breast cancer patients.

Download Full-text