Actualities on Diagnosis, Targeting and Treating Bone Metastases in Breast Cancer with Radiotherapy and New Drugs

The standard of care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment in case of symptomatology onset. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive disease presentations are even more common, leading to a change of paradigm of focal treatments. In fact, acknowledgement of behaviour of disease in these setting of patients is carrying aim of radiotherapy towards modalities with radical intent. The aim of this literature review is to analyse available clinical data regarding disease behaviour, imaging, radiotherapy and chemo-radiotherapy integration outcomes for understanding bone metastasis from breast cancer and the potential impact of targeting it.

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GLPG0187 inhibits progression of established bone metastasis and achieves maximum efficacy when combined with standard-of-care metastatic breast cancer treatments

Bone ◽

10.1016/j.bone.2010.10.127 ◽

2011 ◽

Vol 48 (1) ◽

pp. S45 ◽

Cited By ~ 2

Author(s):

P. Clément-Lacroix ◽

E. Berrocal ◽

B. Heckmann ◽

P. Wigerinck ◽

G. Lorenzon ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Bone Metastasis ◽

Metastatic Breast ◽

Standard Of Care ◽

Cancer Treatments

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Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians

Cancers ◽

10.3390/cancers12092390 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2390

Author(s):

Fabio Marazzi ◽

Armando Orlandi ◽

Stefania Manfrida ◽

Valeria Masiello ◽

Alba Di Leone ◽

...

Keyword(s):

Breast Cancer ◽

Bone Metastases ◽

Standard Care ◽

Metastatic Breast ◽

Paradigm Change ◽

Local Approach ◽

Breast Cancer Radiotherapy ◽

Focal Treatment ◽

Target Therapies ◽

Systemic Therapies

The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive settings are even more common—paving the way to a paradigm change of focal treatments role. In fact, according to immunophenotype, radiotherapy can be considered with radical intent in these settings of patients. The aim of this literature review is to analyze available clinical data on prognosis of bone metastases from breast cancer and benefits of available treatments for developing a practical guide for clinicians.

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Breast Cancer with Bone Metastasis: Molecular Insights and Clinical Management

Cells ◽

10.3390/cells10061377 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1377

Author(s):

Konstantinos Venetis ◽

Roberto Piciotti ◽

Elham Sajjadi ◽

Marco Invernizzi ◽

Stefania Morganti ◽

...

Keyword(s):

Breast Cancer ◽

Bone Metastasis ◽

Clinical Management ◽

Bone Destruction ◽

Metastatic Breast ◽

Breast Cancer Patients ◽

Incurable Condition ◽

Skeletal Related Events ◽

Relevant Topic ◽

Systemic Therapies

Despite the remarkable advances in the diagnosis and treatment of breast cancer patients, the presence or development of metastasis remains an incurable condition. Bone is one of the most frequent sites of distant dissemination and negatively impacts on patient’s survival and overall frailty. The interplay between tumor cells and the bone microenvironment induces bone destruction and tumor progression. To date, the clinical management of bone metastatic breast cancer encompasses anti-tumor systemic therapies along with bone-targeting agents, aimed at slowing bone resorption to reduce the risk of skeletal-related events. However, their effect on patients’ survival remains controversial. Unraveling the biology that governs the interplay between breast neoplastic cells and bone tissue would provide means for the development of new therapeutic agents. This article outlines the state-of-the art in the characterization and targeting the bone metastasis in breast cancer, focusing on the major clinical and translational studies on this clinically relevant topic.

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Karakteristik Klinikopatologik Pasien Kanker Payudara dengan Metastasis Tulang di RSUP Sanglah pada Tahun 2014 - 2018

e-CliniC ◽

10.35790/ecl.v8i1.27814 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Putu Krishna B. S. Putra ◽

I Wayan J. Sumadi ◽

Ni Putu Sriwidyani ◽

IG Budhi Setiawan

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Bone Metastasis ◽

Cancer Patients ◽

Invasive Carcinoma ◽

Molecular Subtype ◽

Metastatic Breast ◽

Breast Cancer Patients ◽

Luminal B ◽

Histopathological Type

Abstract: Breast cancer is the most common cancer in woman. Metastasis often occurs especially to the bones. This study was aimed to determine the characteristics of breast cancer patients with bone metastasis. This was a descriptive study with a cross-sectional design. Samples were 46 breast cancer patients with bone metastasis recorded at Sanglah Hospital from 2014 until 2018. Data of pathological examination archives of Oncology Surgery Division Medical Faculty of Udayana University/Sanglah General Hospital were used to obtain the clinicopathological characteristics of metastatic breast cancer patients based on age, lateralization, histopathological type, and tumor molecular subtype. The results showed that most cases of metastatic breast cancer were aged 40-49 years as many 21 patients (45.7%), minimal difference in lateralization between right breast as many 22 patients (47.8%) and left breast 23 patients (50%). The most common histopathological type was invasive carcinoma of no special type as many 34 patients (73.9%). The most common tumor subtype was the luminal B subtype as many 21 patients (45.7%). In conclusion, most patients of breast cancer with bone metastasis were 40-49 years old, invasive carcinoma of no special type, molecular subtype of luminal B, and no significant difference between lateralization to the right and left breast.Keywords: breast cancer, bone, metastasis, clinicopathological caharacteristics Abstrak: Kanker payudara merupakan jenis kanker yang paling sering dijumpai pada wanita. Metastasis sering terjadi terutama pada tulang. Penelitian ini bertujuan untuk mengetahui karakteristik pasien kanker payudara dengan metastasis tulang di RSUP Sanglah Denpasar. Jenis penelitian ialah deskriptif dengan desain potong lintang. Sampel penelitian ialah 46 pasien kanker payudara dengan metastasis tulang yang tercatat di RSUP Sanglah tahun 2014-2018. Data diambil dari arsip hasil pemeriksaan patologi di Subdivisi Bedah Onkologi, Departemen/Kelompok Staf Medis (KSM) Bedah Fakultas Kedokteran Universitas Udayana (FK UNUD)/RSUP Sanglah untuk mendapatkan karakteristik klinikopatologi pasien kanker payudara metastasis tulang berdasarkan usia, lateralisasi, tipe histopatologik, dan subtipe molekuler tumor. Hasil penelitian menunjukkan kasus terbanyak terjadi pada rentang usia 40-49 tahun sebanyak 21 orang (45,7%), dengan lateralisasi tidak jauh berbeda antara payudara kanan sebanyak 22 orang (47,8) dan kiri sebanyak 23 orang (50%). Tipe histopatologik yang lebih sering ditemukan yaitu invasive carcinoma of no special type sebanyak 34 orang (73,9%). Subtipe molekuler yang paling banyak ditemukan ialah subtipe luminal B sebanyak 21 orang (45,7%). Simpulan penelitian ini pasien kanker payudara dengan metastasis tulang berada pada rentang usia 40-49 tahun, invasive carcinoma of no special type, subtipe molekuler luminal B. dan lateralisasi payudara kanan dan kiri tidak jauh berbeda.Kata kunci: kanker payudara, metastasis, tulang, karakteristik klinikopatologik

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Metastatic Breast Cancer at a Glance: Scenarios of BC Brain- and BC Bone-Metastasis by Illustrations

Cancer Genetics and Psychotherapy ◽

10.1007/978-3-319-64550-6_22 ◽

2017 ◽

pp. 1029-1070

Author(s):

Parvin Mehdipour

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Bone Metastasis ◽

Metastatic Breast

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Neuroendocrine differentiation in metastatic breast cancer following CDK 4/6 inhibitors.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13029 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13029-e13029

Author(s):

Sakina Sekkate ◽

Laure Ladrat ◽

Christelle Pouliquen ◽

Celine Callens ◽

Jean Francois Geay ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Aromatase Inhibitor ◽

Neuroendocrine Differentiation ◽

Metastatic Breast ◽

Standard Of Care ◽

Proliferation Index ◽

Castration Resistant Prostate Cancer ◽

Metastatic Tumors ◽

Ki 67

e13029 Background: First-line treatment with a CDK4/6 inhibitor in combination with an aromatase inhibitor for HR+/HER2- postmenopausal metastatic breast cancer (mBC) is considered as a standard of care based on the compelling data across all landmark trials. Methods: We report our experience about two cases with metastatic breast cancer treated by CDK4/6 inhibitor in combination with an aromatase inhibitor, which develop neuroendocrine differentiation. After observing an unusual massive progression, a biopsy of the metastasis was performed in both patients. Both histological analysis confirmed a lobular breast cancer with small cell neuroendocrine features and a high proliferation index (KI 67 90%). An NGS (Next generation sequencing) profile was realized on primary and metastatic tumors to detect new acquired genomic alterations. Results: The comparative analysis of the NGS results of primary and metastatic tumors revealed the occurrence of several events in both patients under treatment. For one patient, we identified new mutations in the genes CDH1, FANCG, PIK3CA, PTEN and TP53, which did not exist initially. For the second patient, we found an amplification of the segment containing FGFR1, CCND1, FGF4, FGF3, FADD genes and the deletion of the segment containing RB1 andTP53 genes. Such events were not observed on the primary tumor. Conclusions: Prostate adenocarcinoma may develop neuroendocrine features in later stages of castration-resistant prostate cancer but neuroendocrine differentiation is atypical in breast carcinoma. In case of unusual rapidly progressive disease after CDK4/6 inhibitor, biopsy of new metastases should be recommanded to search neuroendocrine differentiation, or druggable mutations to guide the treatment.

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Two may be better than one: PD-1/PD-L1 blockade combination approaches in metastatic breast cancer

npj Breast Cancer ◽

10.1038/s41523-019-0130-x ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 5

Author(s):

David B. Page ◽

Harry Bear ◽

Sangeetha Prabhakaran ◽

Margaret E. Gatti-Mays ◽

Alexandra Thomas ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Clinical Practice ◽

Clinical Data ◽

Targeted Therapies ◽

Metastatic Breast ◽

Programmed Death ◽

Programmed Death 1 ◽

Better Than ◽

Systemic Therapies

Abstract Antibodies blocking programmed death 1 (anti-PD-1) or its ligand (anti-PD-L1) are associated with modest response rates as monotherapy in metastatic breast cancer, but are generally well tolerated and capable of generating dramatic and durable benefit in a minority of patients. Anti-PD-1/L1 antibodies are also safe when administered in combination with a variety of systemic therapies (chemotherapy, targeted therapies), as well as with radiotherapy. We summarize preclinical, translational, and preliminary clinical data in support of combination approaches with anti-PD-1/L1 in metastatic breast cancer, focusing on potential mechanisms of synergy, and considerations for clinical practice and future investigation.

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