Prognosis of pT1a,bN0 breast cancer: Perception from the French oncology community—Results from the EURISTIC survey.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11607-e11607
Author(s):  
Marc Spielmann ◽  
David Azria ◽  
Jean Marc Classe ◽  
Florence Dalenc ◽  
Clarisse Dromain ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Size ◽  
Perceived Risk ◽  
Triple Negative ◽  
Early Stage ◽  
Tumour Size ◽  
Tumor Biology ◽  
Her2 Positive ◽  
Triple Negative Tumor ◽  
Negative Tumor

e11607 Background: Although most early-stage breast tumors have a favourable outcome, some subgroups carry a higher recurrence risk. The objective of the EURISTIC Survey was to evaluate the perception French physicians have of the prognostic risk associated with the biopathological characteristics of tumors in pT1a,b N0 breast cancer. Methods: This 38 item postal survey was developed by an expert panel. 2,000 physicians involved in breast cancer treatment were contacted. Specialities involved were medical and radiation oncologists, surgeons, radiologists and pathologists. Results: The survey was conducted between September and December 2012. A total of 663 physicians responded (response rate = 33%). They stated treating an average of 50 breast cancer patients per month. 58% of physicians reported that tumour size was not considered a major parameter in this clinical setting. In the absence of an adjuvant treatment, the prognosis of T1a,bN0 carcinoma was perceived better if HR-positive rather than HER2-positive or triple-negative with a "positive" prognosis perception rated by 83%, 21% and 8% of physicians respectively. For pT1a,bN0 tumors, the criteria with the highest perceived prognostic risk were ranked as follows: HER2+ (29%), HR- (20%) elevated tumor grade (20%) and triple negative tumor (14%). The average size threshold for a "negative" prognostic rated tumor was 18 mm. This threshold was scaled up for HR-positive carcinoma (22 mm) and scaled down for HER2-positive (10mm) or triple negative carcinoma (7mm). Between 4 and 17 mm, there was a linear correlation between tumor size and perceived risk of recurrence with HER2-positive tumors always carrying a worse prognostic than HR-positive tumor (Table). Conclusions: French physicians have the perception that HER2-positivity and triple negative tumor biology strongly impact the prognosis of pT1a,b N0 carcinoma, independent of tumor size. [Table: see text]

Population-based outcomes of patients (pt) with early-stage HER2-positive breast cancer treated with adjuvant trastuzumab (T).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11079-e11079
Author(s):  
Krista Noonan ◽  
Joy S. McCarthy
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Early Stage ◽  
Tumour Size ◽  
Disease Free Survival ◽  
Clinical Effectiveness ◽  
Population Based ◽  
The Body ◽  
Phase Iii ◽  
Her2 Positive

e11079 Background: Phase III trials have shown clinical efficacy of T when combined with chemotherapy in HER2-positive early stage breast cancer, decreasing recurrence by 50% and increasing survival by 30%. 15-20% of early stage breast cancers demonstrate amplification of the HER2 gene, which is associated with a poor prognosis. The aims of this study were to evaluate the clinical effectiveness of T, and explore potential prognostic factors. Methods: Pts with stage I-III breast cancer overexpressing HER2 from 2005 to 2010, assessed in Newfoundland and Labrador’s cancer centre were retrospectively identified from the Provincial Tumour Registry. Pt, treatment, and tumour characteristics were extracted. Kaplan-Meier curves were used for survival analysis, and Cox Proportional Hazards Models were used to identify prognostic factors and evaluate their impact on outcomes. Results: A total of 148 pts were identified. The median age was 56 years, and 76% received T. At a median follow-up of 25 months, overall survival (OS) was 97% (p=0.0002), and disease-free survival was 96% (p<0.00) for pts receiving T. Younger age, smaller tumour size, and lymph node negativity were favorable prognostic factors. There was an 83% decrease in risk of breast cancer recurrence in the patients receiving T. Discontinuation of T occurred in 6.2% of patients due to a decreased ejection fraction. Conclusions: This population-based analysis demonstrates T’s favorable impact on 25-month DFS, OS, and safety. This adds to the body of literature, showing clinical effectiveness and tolerability of T. [Table: see text]

scholarly journals Suboptimal Therapy Following Breast Conserving Surgery in Triple Negative and HER2-Postive Breast Cancer Patients

2021 ◽  
Author(s):  
Jeffrey E. Johnson ◽  
Paula D Strassle ◽  
Guilherme C de Oliveira ◽  
Chris B. Agala ◽  
Philip M. Spanheimer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Triple Negative ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Optimal Therapy ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

Abstract Purpose To assess potential disparities in guideline-concordant care delivery among women with early stage triple-negative and HER2-positive breast cancer treated with breast conserving therapy. Methods Women ≥40 years old diagnosed with pT2N0M0 triple-negative or HER2-positive breast cancer treated with primary surgery and axillary staging between 2012 and 2017 were identified using the National Cancer Database (NCDB). The primary outcome was receipt of adjuvant systemic therapy and radiation concordant with current guidelines. Multivariable log binomial regression was used to assess the prevalence of optimal therapy use across patient and cancer characteristics. Kaplan-Meier curves were used to assess 5-year overall survival. Multivariable Cox proportional hazards regression was used to compare the impact of optimal therapy on 5-year mortality. Results 11,785 women were included with 7,843 receiving optimal therapy. Receipt of optimal therapy decreased with age even after adjusting for comorbidities and cancer characteristics; other sociodemographic factors were not associated with differences in receipt of optimal therapy. Among patients who did not receive adjuvant systemic therapy, most were not offered the treatment (49%) or refused (40%). Overall 5-year survival was higher among women who received optimal therapy (89% [95% CI 88.0-89.3] vs. 66% [95% CI 62.9-68.5]). Patients who received suboptimal therapy were over twice as likely to die within 5-years of their diagnosis (adjusted HR 2.44, 95% CI 2.12-2.82). Conclusion Age is the primary determinant of the likelihood of a woman to receive optimal adjuvant therapies in high-risk early stage breast cancer. Patients who did not receive optimal therapy had significantly diminished survival.

scholarly journals Lobular Breast Cancer: Histomorphology and Different Concepts of a Special Spectrum of Tumors

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3695
Author(s):  
Matthias Christgen ◽  
Gábor Cserni ◽  
Giuseppe Floris ◽  
Caterina Marchio ◽  
Lounes Djerroudi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Special Treatment ◽  
Molecular Characteristics ◽  
Lobular Breast Cancer ◽  
Her2 Positive ◽  
Comprehensive Overview ◽  
Invasive Lobular Breast Cancer

Invasive lobular breast cancer (ILC) is the most common special histological type of breast cancer (BC). This review recapitulates developments in the histomorphologic assessment of ILC from its beginnings with the seminal work of Foote and Stewart, which was published in 1941, until today. We discuss different concepts of ILC and their implications. These concepts include (i) BC arising from mammary lobules, (ii) BC growing in dissociated cells and single files, and (iii) BC defined as a morpho-molecular spectrum of tumors with distinct histological and molecular characteristics related to impaired cell adhesion. This review also provides a comprehensive overview of ILC variants, their histomorphology, and differential diagnosis. Furthermore, this review highlights recent advances which have contributed to a better understanding of the histomorphology of ILC, such as the role of the basal lamina component laminin, the molecular specificities of triple-negative ILC, and E-cadherin to P-cadherin expression switching as the molecular determinant of tubular elements in CDH1-deficient ILC. Last but not least, we provide a detailed account of the tumor microenvironment in ILC, including tumor infiltrating lymphocyte (TIL) levels, which are comparatively low in ILC compared to other BCs, but correlate with clinical outcome. The distinct histomorphology of ILC clearly reflects a special tumor biology. In the clinic, special treatment strategies have been established for triple-negative, HER2-positive, and ER-positive BC. Treatment specialization for patients diagnosed with ILC is just in its beginnings. Accordingly, ILC deserves greater attention as a special tumor entity in BC diagnostics, patient care, and cancer research.

scholarly journals REVIEW ON POTENTIAL TARGETED THERAPY FOR TRIPLE NEGATIVE BREAST CANCER

2020 ◽  
Vol 5 (2) ◽  
pp. 55-60
Author(s):  
Nurul Issttifa Aminuddin ◽  
Raihana Edros ◽  
Rajaletchumy Veloo Kutty
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Targeted Therapies ◽  
Triple Negative ◽  
Treatment Options ◽  
Molecular Targets ◽  
Single Type ◽  
Triple Negative Tumor ◽  
Negative Tumor ◽  
Potential Opportunity

Triple negative breast cancer (TNBC) is a very aggressive type of cancer.  TNBC is not just a single type of disease to be cured, but it consists of 6 subtypes which are basal-like 1 and 2, immunomodulatory, mesenchymal, mesenchymal stem- like and luminar androgen receptor. These subtypes has diverse characteristics, which hold potential opportunity for targeted treatment. Lack of molecular targets for triple negative tumor lead to limited targeted therapies for TNBC.  Therefore, effective targeted therapies are urgently needed for TNBC. This paper will highlight on the potential targets in TNBC and treatment options that are currently under clinical application.  

Retrospective comparisons of nanoparticle albumin-bound paclitaxel and docetaxel neoadjuvant regimens for breast cancer

Nanomedicine ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. 391-400
Author(s):  
Yan Li ◽  
Xiang Chen ◽  
Qiannan Zhu ◽  
Rui Chen ◽  
Lu Xu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Pathological Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Neoadjuvant Systemic Therapy ◽  
Triple Negative Tumor ◽  
Negative Tumor ◽  
Dose Dense ◽  
Peripheral Sensory

Aim: To compare the efficacy and safety of 2-weekly nanoparticle albumin-bound paclitaxel (nP) and 3-weekly docetaxel regimens as neoadjuvant systemic therapy (NST) for breast cancer. Materials & methods: Patients (n = 201) received NST comprising either dose-dense epirubicin and cyclophosphamide followed by 2-weekly nP (n = 104) or 3-weekly courses of epirubicin and cyclophosphamide followed by docetaxel (n = 97). Results: Higher pathological complete response rates were achieved by the nP group. Subgroup analysis showed that the nP-based regimen achieved higher pathological complete response rates in patients with triple-negative tumor cells and high Ki67 levels. However, grades 3–4 peripheral sensory neuropathies were more frequent in the nP group. Conclusion: The 2-weekly nP-based regimen might be a better choice of NST for patients with breast cancer.

scholarly journals Recurrence in Stage I and II Triple-Negative Breast Cancer: Analysis of Clinicopathologic and Imaging Factors

2019 ◽  
Author(s):  
Hye Joung Eom ◽  
Joo Hee Cha ◽  
Woo Jung Choi ◽  
Eun Young Chae ◽  
Hee Jung Shin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Tumor Size ◽  
Triple Negative ◽  
Early Stage ◽  
Nodal Status ◽  
Stage I ◽  
Factors Associated ◽  
Clinicopathologic Factors

Abstract Background To describe the outcomes of patients with early stage triple-negative breast cancer (TNBC) and to investigate whether certain imaging and clinicopathologic factors were associated with recurrence in patients with early stage TNBC. Methods We identified stage I and II TNBC patients treated between 2009 and 2011. Data included patient and tumor characteristics, time of recurrence, and findings on mammography, ultrasonography, and magnetic resonance imaging (MRI). Kaplan-Meier method was used to estimate recurrence free survival and Cox proportional hazards model was used to determine the association between imaging and clinicopathologic factors and recurrence. Results The study included 702 patients with mean age of 49.0 years (range, 24–82 years) and mean follow-up of 61 months (range, 6 - 93 months). Overall, 115 (115/702, 16.4%) had recurrence. Clinicopathologic factors associated with recurrence included increasing tumor size, positive nodal status, ki-67 index more than 14, presence of lymphovascular invasion (LVI), mastectomy, and neoadjuvant or adjuvant chemotherapy. Imaging factors associated with recurrence included moderate or marked background parenchymal enhancement on MRI. After controlling for all potential confounders, tumor size, nodal status, LVI, and adjuvant chemotherapy were independently associated with recurrence. Conclusion Sixteen percent of patients with early stage TNBC experienced recurrence, with 3 and 5 year recurrence rates being 12.4% and 15.3%, respectively. Tumor size, nodal status, LVI, and adjuvant chemotherapy were independently associated with recurrence, while none of the imaging factors showed association.

Different Prognostic Value of Cytokeratin-19 mRNA–Positive Circulating Tumor Cells According to Estrogen Receptor and HER2 Status in Early-Stage Breast Cancer

2007 ◽  
Vol 25 (33) ◽  
pp. 5194-5202 ◽  
Author(s):  
Michail Ignatiadis ◽  
Nikos Xenidis ◽  
Maria Perraki ◽  
Stella Apostolaki ◽  
Eleni Politaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Prognostic Value ◽  
Triple Negative ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Cytokeratin 19 ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Er Positive

Purpose To examine the prognostic value of cytokeratin-19 (CK-19) mRNA–positive circulating tumor cells (CTCs) in early-stage breast cancer patients focusing on clinically relevant subgroups based on estrogen receptor (ER) and HER2 expression. Patients and Methods CK-19 mRNA–positive CTCs were detected by real-time reverse transcriptase polymerase chain reaction in the blood of 444 consecutive, stage I-III, breast cancer patients before initiation of adjuvant chemotherapy. The association between detection of CK-19 mRNA–positive CTCs and clinical outcome was analyzed for patients with ER-positive, ER-negative, triple-negative, HER2-positive, and ER-positive/HER2-negative tumors. Results CK-19 mRNA–positive CTCs were detected in 181 (40.8%) of 444 patients; 109 (41.9%) of 260 patients with ER-positive tumors; 71 (40.6%) of 175 patients with ER-negative tumors; 27 (35%) of 77 patients with triple-negative tumors; 35 (39.8%) of 88 patients with HER2-positive tumors; and 82 (44.1%) of 186 patients with ER-positive/HER2-negative tumors. After a median follow-up of 53.5 months, patients with CK-19 mRNA–positive CTCs experienced reduced disease-free survival (DFS; P < .001) and overall survival (OS; P < .001); this was mainly observed in patients with ER-negative (P < .001 and P < .001, respectively) but not ER-positive tumors (P = .172 and P = .425, respectively) and in patients with triple-negative (P = .008 and P = .001, respectively) and HER2-positive (P = .023 and P = .040, respectively) but not ER-positive/HER2-negative tumors (P = .210 and P = .578, respectively). In multivariate analysis, the interaction between CK-19 mRNA–positive CTCs and ER status was the strongest independent prognostic factor for reduced DFS (hazard ratio [HR], 3.808; 95% CI, 2.415 to 6.003; P < .001) and OS (HR, 4.172; 95% CI, 2.477 to 9.161; P < .001). Conclusion Detection of CK-19 mRNA–positive CTCs before adjuvant chemotherapy predicts poor clinical outcome mainly in patients with ER-negative, triple-negative, and HER2-positive early-stage breast cancer.

scholarly journals Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

2021 ◽  
Vol 28 (2) ◽  
pp. 1338-1347
Author(s):  
Tabitha Tse ◽  
Sandeep Sehdev ◽  
Jean Seely ◽  
Denis H. Gravel ◽  
Mark Clemons ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Practice Change ◽  
Her2 Positive ◽  
Local Conditions ◽  
Early Stage Disease ◽  
Cancer Management

Practice and behaviour change in healthcare is complex, and requires a set of critical steps that would be needed to implement and sustain the change. Neoadjuvant chemotherapy for breast cancer is traditionally used for locally advanced disease and is primarily advantageous for surgical downstaging purposes. However, it does also offer patients with certain biologic subtypes such as the triple negative or Her2 positive breast cancers the opportunity to improve survival, even in early stage disease. During the height of the pandemic, an opportunity and motivation for the increased use of neoadjuvant therapy in breast cancer was identified. This paper describes the conditions that have supported this practice change at the provider and institutional levels. We also include our own institutional algorithm based on tumor biology and extent of disease that have guided our decisions on breast cancer management during the pandemic. Our processes can be adapted by other institutions and breast oncology practices in accordance with local conditions and resources, during and beyond the pandemic.

The impact of screening mammography in women age 40-49 as a function of tumor biology.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 113-113
Author(s):  
John C. Ruckdeschel ◽  
William V. Rees ◽  
Brett T Parkinson ◽  
Thomas Belnap ◽  
Braden D. Rowley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Large Scale ◽  
Triple Negative ◽  
Tumor Biology ◽  
Screening Mammography ◽  
Her2 Status ◽  
Screening Mammogram ◽  
Interval Cancers ◽  
Her2 Positive ◽  
The Impact

113 Background: Mammographic screening for women 40-49 years of age remains controversial based on results from earlier large scale, controlled mammography trials. Methods: From 2002-2006, 871 women aged 40-49 were diagnosed with breast cancer at Intermountain. The charts of all patients without a record of a screening mammogram at Intermountain (n= 436) were reviewed to confirm that they had not had a screening mammogram in the prior two years at any facility (Interval Cancers) and their survival was compared to 435 women who had their cancer diagnosed on a screening exam (Screen Detected). All patients were followed for at least 5 years via the tumor registry. Results: Stage distribution for Screen Detected/Interval cancers was 25.3/6.4% stage 0, 36.8/24.8% stage I, 24.6/35.6% stage II, 6.9/20.4% stage III and 0.5/3.4% stage IV. Overall, 67 patients (7.7%) did not have complete staging data. Overall survival was significantly better (p<.0001) for 40-49 year old women with Screen Detected compared to those with Interval cancers. 702 (79.6%) had ER/PR status recorded (83.5% ER/PR positive). Women with DCIS or LCIS did not have tissue sent for markers. 679 patients (76.9%) had HER2 status recorded (78.8% HER2 neg). Of the patients with both HER2 and ER/PR status recorded 10.4% were “triple negative.” Survival following screening mammography was significantly enhanced for women who were ER/PR positive (p<0.0001), HER2 negative (p=0.0065), or HER2 positive (p=0.0013). Survival was not improved by screening mammography for women who were ER/PR negative (p=0.3818) or for women who were triple negative (p=0.416). Conclusions: A minority of women age 40-49 who develop breast cancer (13%) have biologic features suggestive of aggressive disease and, after 5 years of follow up, they are not benefitted by screening mammography. The remaining 87% are clearly benefitted by screening mammography. Our results suggest that the discrepancies noted in the screening mammography trials in 40-49 year old women may have resulted from population variations in the proportion of women with unfavorable biology. Based in part on these results, we continue to recommend regular screening in the 40-49 year old cohort.

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