scholarly journals Giant Metastatic Breast Phyllodes Tumour with an Elusive Diagnosis: A Case Report and Literature Review

2021 ◽  
Author(s):  
Raquel Basto ◽  
Tatiana Cunha Pereira ◽  
Luís Rei ◽  
Fábio Rêgo Salgueiro ◽  
Joana Correia Magalhães ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Metastatic Disease ◽  
Palliative Chemotherapy ◽  
Treatment Options ◽  
Metastatic Breast ◽  
Standard Of Care ◽  
Residual Tumour ◽  
Recurrence Rates ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Background: The term phyllodes tumours, which account for less than 1% of breast neoplasms, describes a spectrum of heterogenous tumours with different clinical behaviours. Less than 30% present as metastatic disease. Complete surgical resection is the standard of care so that recurrence rates are reduced. The role of adjuvant chemotherapy or radiation therapy is controversial. Patients with metastatic disease have a median overall survival of around 30 months. Case description: The authors present the case of a 57-year-old woman with an exuberant left malignant phyllodes tumour with bilateral involvement, as well as lung and axillar metastasis. The patient underwent haemostatic radiation therapy and started palliative chemotherapy with doxorubicin, achieving partial response with significant improvement in quality of life. A posterior simple mastectomy revealed a small residual tumour. Discussion: Metastatic malignant phyllodes tumours are rare, so therapeutic strategies rely on small retrospective studies and guidelines for soft tissue sarcoma. Palliative chemotherapy protocols include anthracycline-based regimens, either as monotherapy with doxorubicin or doxorubicin together with ifosfamide. With few treatment options, management of these patients must rely on a continuum of care

scholarly journals PHYLLOIDES TUMOUR: REVIEW OF AN UNCOMMON BREAST PATHOLOGY AT A SPECIALIZED CANCER CENTRE

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Samiullah K Niazi ◽  
Raza Sayyed ◽  
Zulkernain Chaudary ◽  
Amina I Khan ◽  
Huma M Khan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Breast Tumours ◽  
Cancer Centre ◽  
Increased Risk ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Purpose: Phyllodes tumours are rare breast tumours that comprise almost 1% of breast tumours. The outcome for these tumours is generally considered better than breast cancers. We review the cases of phyllodes tumour presenting to a specialised cancer centre over a 14 year period. Materials and Methods: All case records with the diagnosis of phyllodes tumour between 1999 and 2012 were retrieved from the cancer registry. Patient demographics, tumour site, size, axillary lymph node status, whether primary or recurrent, metastatic status, histological type, type of surgery, any complication, margin positivity, post-operative radiation therapy, local or distant recurrence, morality and follow-up duration were recorded. Data were analysed using SPSS. Results: A total of 77 cases of phyllodes tumour were seen between 1999 and 2012. All patients were female with a mean age of 39.9 years. All patients presented with a breast lump with median duration of 8 months. Almost two-thirds (65%) of the patients presented with primary tumour compared to 10% recurrent tumours and the rest were referred after surgery outside. Median size on histopathology was 5 cm (IQR 3.5–8.5 cm). Over a median follow-up duration of 31 months (IQR 9–48 months), 69 patients (89.6%) were alive, while 3 patients (3.9%) did not survive and 5 patients (6.4%) were lost to follow-up. Recurrence was seen in 10 (13%) patients with median time to recurrence of 12 months (IQR 7–24). Involved axillary lymph nodes and borderline or malignant histopathology were found to be signi cantly associated with recurrence (P = 0.04), while margin positivity, post operative radiation therapy and histopathology were not signi cantly associated with recurrence. Conclusion: Phyllodes tumour is an uncommon breast tumour that is predominantly treated with surgical excision. Although survival with these tumours is better compared to breast cancers, involvement of axillary nodes and borderline or malignant histopathology confer an increased risk of recurrence in these patients. Key words: Breast cancer, phyllodes tumours, survival 

scholarly journals Emerging treatment strategies for breast cancer brain metastasis: from translational therapeutics to real-world experience

2020 ◽  
Vol 12 ◽  
pp. 175883592093615 ◽  
Author(s):  
Ding Ren ◽  
Hao Cheng ◽  
Xin Wang ◽  
Monika Vishnoi ◽  
Bin S. Teh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Metastatic Breast ◽  
Standard Of Care ◽  
Difficult Problem ◽  
Therapeutic Strategies ◽  
Her2 Positive ◽  
Whole Brain Radiation ◽  
Breast Cancer Brain Metastasis

Systemic therapies for primary breast cancer have made great progress over the past two decades. However, oncologists confront an insidious and particularly difficult problem: in those patients with metastatic breast cancer, up to 50% of human epidermal growth factor 2 (HER2)-positive and 25–40% of triple-negative subtypes, brain metastases (BM) kill most of them. Fortunately, standard- of-care treatments for BM have improved rapidly, with a decline in whole brain radiation therapy and use of fractionated stereotactic radiosurgery as well as targeted therapies and immunotherapies. Meanwhile, advances in fundamental understanding of the basic biological processes of breast cancer BM (BCBM) have led to many novel experimental therapeutic strategies. In this review, we describe the most recent clinical treatment options and emerging experimental therapeutic strategies that have the potential to combat BCBM.

scholarly journals Immune checkpoint inhibitors in genitourinary malignancies

2019 ◽  
Vol 27 (S2) ◽  
Author(s):  
M. Thana ◽  
L. Wood
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Urothelial Carcinoma ◽  
Metastatic Disease ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Standard Of Care ◽  
Current Evidence ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours

Although immune-mediated therapies have been used in genitourinary (gu) malignancies for decades, recent advances with monoclonal antibody checkpoint inhibitors (cpis) have led to a number of promising treatment options. In renal cell carcinoma (rcc), cpis have been shown to have benefit over conventional therapies in a number of settings, and they are the standard of care for many patients with metastatic disease. Based on recent data, combinations of cpis and antiangiogenic therapies are likely to become a new standard approach in rcc. In urothelial carcinoma, cpis have been shown to have a role in the second-line treatment of metastatic disease, and a number of clinical trials are actively investigating cpis for other indications. In other gu malignancies, such as prostate cancer, results to date have been less promising. Immunotherapies continue to be an area of active study for all gu disease sites, with several clinical trials ongoing. In this review, we summarize the current evidence for cpi use in rcc, urothelial carcinoma, prostate cancer, testicular germ-cell tumours, and penile carcinoma. Ongoing clinical trials of interest are highlighted, as are the challenges that clinicians and patients will potentially face as immune cpis become a prominent feature in the treatment of gu cancers.

scholarly journals Choice of treatment options for metastatic hormone-sensitive prostate cancer

2020 ◽  
pp. 90-99
Author(s):  
R. A. Gafanov ◽  
A. G. Dzidzaria ◽  
I. B. Kravtsov ◽  
S. V. Fastovets
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Treatment Options ◽  
Standard Of Care ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
The Past ◽  
Choice Of Treatment ◽  
Hormone Sensitive ◽  
The Impact

The arsenal of available treatments and treatments for metastatic hormone-sensitive prostate cancer (mHRPC) has increased significantly over the past 5 years. Although androgen-preferential therapy (ADT) remains the mainstay of treatment, the addition of docetaxel, abiraterone, enzalutamide, apalutamide, or local external beam radiation therapy improves the outcome of patients with mHRPC and becomes the standard of care. Choosing a therapy to improve treatment outcomes for patients with mHRPC is becoming increasingly challenging as there are different options for this stage of the disease. This article provides an overview of clinical trials that included ADT in combination with chemotherapy, new hormonal therapy, and radiation therapy. We will also consider recent advances in the choice of treatment for men diagnosed with mHPCR and the impact of previous therapy on the subsequent biology of the disease. Options include chemohormone therapy, androgen receptor (AR) targeted therapy in addition to ADT or, less commonly, ADT alone. The choice of treatment should be based on a consideration of the clinical characteristics and characteristics of the disease, as well as taking into account the patient’s preferences, territorial constraints and financial resources.

scholarly journals The Evolution of Radiation Therapy in Metastatic Breast Cancer: From Local Therapy to Systemic Agent

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jessica M. S. Jutzy ◽  
Jeffrey M. Lemons ◽  
Jason J. Luke ◽  
Steven J. Chmura
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Metastatic Breast Cancer ◽  
Metastatic Disease ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Metastatic Breast ◽  
Local Therapy ◽  
Metastatic Setting

Radiation therapy is a mainstay of treatment in early and locally advanced breast cancer but is typically reserved for palliation of symptomatic lesions in patients with metastatic breast cancer. With new advances in the field of tumor biology and immunology, the role of radiation in the metastatic setting is evolving to harness its immune-enhancing properties. Through the release of tumor antigens, tumor DNA, and cytokines into the tumor microenvironment, radiation augments the antitumoral immune response to affect both the targeted lesion and distant sites of metastatic disease. The use of immunotherapeutics to promote antitumoral immunity has resulted in improved treatment responses in patients with metastatic disease and the combination of radiation therapy and immunotherapy has become an area of intense investigation. In this article, we will review the emerging role of radiation in the treatment of metastatic disease and discuss the current state of the science and clinical trials investigating the combination of radiation and immunotherapy.

scholarly journals Stereotactic Body Radiation Therapy after Chemotherapy for Unresectable Perihilar Cholangiocarcinoma: The STRONG Trial, a Phase I Safety and Feasibility Study

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 3991
Author(s):  
Rogier Baak ◽  
François E. J. A. Willemssen ◽  
Yvette van Norden ◽  
Ferry A. L. M. Eskens ◽  
Maaike T. W. Milder ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Palliative Chemotherapy ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Local Control Rate ◽  
Stereotactic Body Radiation ◽  
Common Grade ◽  
Grade 3

Background: In unresectable pCCA, the standard of care is palliative chemotherapy. We investigated the feasibility and safety of adding stereotactic body radiation therapy (SBRT) after chemotherapy. Methods: Patients with unresectable pCCA, stage T1-T4N0-N1M0, ECOG 0-1, having finished 6–8 cycles of cisplatin and gemcitabine without disease progression were eligible. SBRT was planned in 15 fractions of 3.0–4.5 Gy. The primary endpoints were feasibility (defined as completing SBRT as planned) and toxicity, evaluated within 3 months after SBRT (CTCAE v4.03). A conventional “3 + 3” design was used, corresponding to a sample size of 6 patients. Dose-limiting toxicity (DLT) was defined as grade ≥ 4 hepatobiliary or grade ≥ 3 gastrointestinal toxicity. The secondary endpoints, measured from the start of radiotherapy, were local control, progression-free survival, overall survival, and quality of life (QoL). ClinicalTrials.gov identifier: NCT03307538. Results: Six patients were enrolled between November 2017 and March 2020. SBRT was delivered as planned. All patients were treated with 60Gy (15 × 4.0Gy). No SBRT-related DLT was observed. The most common grade ≥ 3 toxicity was cholangitis (n = 5). The median follow-up was 14 months. The 12-month local control rate was 80%. We observed no substantial changes in QoL. Conclusion: In patients with unresectable pCCA with stable disease after palliative chemotherapy, adding SBRT is feasible and safe. The observed local control merits an additional evaluation of effectiveness.

Using real-world cohorts to assess the generalizability and relevance of randomized clinical trials (RCTs).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6540-6540 ◽  
Author(s):  
Caroline Savage Bennette ◽  
Nathan Coleman Nussbaum ◽  
Melissa D. Curtis ◽  
Neal J. Meropol
Keyword(s):  
Clinical Trials ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Treatment Options ◽  
Metastatic Breast ◽  
Standard Of Care ◽  
Real World Data ◽  
Eligibility Criteria ◽  
Relevance Score ◽  
World Data

6540 Background: RCTs are the gold standard for understanding the efficacy of new treatments, however, patients (pts) in RCTs often differ from those treated in the real-world. Further, selecting a standard of care (SOC) arm is challenging as treatment options may evolve during the course of a RCT. Our objective was to assess the generalizability and relevance of RCTs supporting recent FDA approvals of anticancer therapies. Methods: RCTs were identified that supported FDA approvals of anticancer therapies (1/1/2016 - 4/30/2018). Relevant pts were selected from the Flatiron Health longitudinal, EHR-derived database, where available. Two metrics were calculated: 1) a trial’s pt generalizability score (% of real-world pts receiving treatment consistent with the control arm therapy for the relevant indication who actually met the trial's eligibility criteria) and 2) a trial’s SOC relevance score (% of real-world pts with the relevant indication and meeting the trial's eligibility criteria who actually received treatment consistent with the control arm therapy). All analyses excluded real-world pts treated after the relevant trial’s enrollment ended. Results: 14 RCTs across 5 cancer types (metastatic breast, advanced non-small cell lung cancer, metastatic renal cell carcinoma, multiple myeloma, and advanced urothelial) were included. There was wide variation in the SOC relevance and pt generalizability scores. The median pt generalizability score was 63% (range 35% - 88%), indicating that most real-world pts would have met the RCT eligibility criteria. The median SOC relevance score was 37% (range 15% - 74%), indicating that most RCT control arms did not reflect the way trial-eligible real-world pts in the US were actually treated. Conclusions: There is great variability across recent RCTs in terms of pt generalizability and relevance of SOC arms. Real-world data can be used to inform selection of control arms, predict impact of inclusion/exclusion criteria, and also assess the generalizability of the results of completed trials. Incorporating real-world data in planning and interpretation of prospective clinical trials could improve accrual and enhance relevance of RCT outcomes.

scholarly journals Evidence-based review of the surgical management of vertebral column metastatic disease

2003 ◽  
Vol 15 (5) ◽  
pp. 1-10 ◽  
Author(s):  
Timothy C. Ryken ◽  
Kurt M. Eichholz ◽  
Peter C. Gerszten ◽  
William C. Welch ◽  
Ziya L. Gokaslan ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Vertebral Column ◽  
English Language ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Standard Of Care ◽  
Appropriate Treatment ◽  
The Subject ◽  
Guidelines And Recommendations

Object Significant controversy exists over the most appropriate treatment for patients with metastatic disease of the vertebral column. Treatment options include surgical intervention, radiotherapy, or a combination of the two; nevertheless, a standard of care that yields the best survival, outcome, and quality of life has not been established. The purpose of this review was to determine the foundation in the literature of views favoring surgical intervention for spinal metastatic disease. Methods A search of the English-language literature published between 1964 and 2003 was performed for the subject of spinal metastatic disease. Papers were selected based on the inclusion criteria described, and evidentiary information was compiled and graded using previously described methods. Conclusions Although there is insufficient evidence to support a standard for surgical treatment in patients with metastatic spinal disease, the authors present guidelines and recommendations based on the evidence provided by the current literature.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

scholarly journals Hypoxia-inducible Factor 2α: A Key Player in Tumorigenesis and Metastasis of Pheochromocytoma and Paraganglioma?

2021 ◽  
Author(s):  
Nicole Bechmann ◽  
Graeme Eisenhofer
Keyword(s):  
Extracellular Matrix ◽  
Signaling Pathways ◽  
Metastatic Disease ◽  
Therapeutic Intervention ◽  
Treatment Options ◽  
Hypoxia Inducible Factor ◽  
Germline Mutations ◽  
Driver Mutations ◽  
Mesenchymal Transition ◽  
Therapeutic Relevance

AbstractGermline or somatic driver mutations linked to specific phenotypic features are identified in approximately 70% of all catecholamine-producing pheochromocytomas and paragangliomas (PPGLs). Mutations leading to stabilization of hypoxia-inducible factor 2α (HIF2α) and downstream pseudohypoxic signaling are associated with a higher risk of metastatic disease. Patients with metastatic PPGLs have a variable prognosis and treatment options are limited. In most patients with PPGLs, germline mutations lead to the stabilization of HIF2α. Mutations in HIF2α itself are associated with adrenal pheochromocytomas and/or extra-adrenal paragangliomas and about 30% of these patients develop metastatic disease; nevertheless, the frequency of these specific mutations is low (1.6–6.2%). Generally, mutations that lead to stabilization of HIF2α result in distinct catecholamine phenotype through blockade of glucocorticoid-mediated induction of phenylethanolamine N-methyltransferase, leading to the formation of tumors that lack epinephrine. HIF2α, among other factors, also contributes importantly to the initiation of a motile and invasive phenotype. Specifically, the expression of HIF2α supports a neuroendocrine-to-mesenchymal transition and the associated invasion-metastasis cascade, which includes the formation of pseudopodia to facilitate penetration into adjacent vasculature. The HIF2α-mediated expression of adhesion and extracellular matrix genes also promotes the establishment of PPGL cells in distant tissues. The involvement of HIF2α in tumorigenesis and in multiple steps of invasion-metastasis cascade underscores the therapeutic relevance of targeting HIF2α signaling pathways in PPGLs. However, due to emerging resistance to current HIF2α inhibitors that target HIF2α binding to specific partners, alternative HIF2α signaling pathways and downstream actions should also be considered for therapeutic intervention.

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