scholarly journals Is Surgery Justifiable in Residual Locally Advance Breast Cancer After Neo-Adjuvant Systemic Treatment?

2020 ◽  
Keyword(s):  
Breast Cancer ◽  
Recurrence Rate ◽  
Triple Negative ◽  
Residual Disease ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Radical Mastectomy ◽  
Her2 Status ◽  
Systemic Recurrence ◽  
Time To Recurrence

Background: Management of locally advanced disease is a challenge. In women with significant residual disease after neoadjuvant therapy when subjected to surgery wounds cannot be closed primarily and require myo-cutaneous flap, Latismus dorsi being the easiest one. The purpose of this study is to look at the recurrence rate, time to recurrence and is surgery needed in this group of patients. Material and Methods: This is a hospital-based retrospective study conducted at Liaquat National Hospital and Medical College, Karachi. Pakistan. From 2006 to 2015, 15 patients with locally advanced breast cancer, who still had significant residual disease after adequate neo-adjuvant therapy that after Modified radical mastectomy wound could not be closed and latismus dorsi flap was used to close the defect. The age, histopathology report, margin of clearance, ER, PR, Her2 status and ki67 was noted. These patients were followed up to look for any local or systemic recurrence and time to recurrence and local or site of any systemic recurrence was recorded. Results: A total of 15 female patients with a mean age of 42.73±9.66 years with a mean follow up of 33.93±26.78 months were seen. In all patients, margins were histologically negative. Mean nodes removed and involved were 12.53±8.04 and 5.46±7.15 respectively. Meantime to recurrence was 16.00±14.92 months. In our study, recurrence was observed in 11 (73.3%) patients with 7(64 %) local and 4(36%) systemic recurrence. All 5 triple-negative and 4 patients stage IV 4 had local recurrence. Patients with poor prognostic markers like higher residual nodal involvement, large tumor size, higher Ki 67, aggressive tumor biology (triple-negative and HER2 Positive tumors) had a high and early recurrence. Conclusion: In patients with high residual tumor burden and aggressive biology has high chances of disease recurrence. Surgery in these patients should be offered to keep quality of life, disease biology and recurrence rate in mind.

scholarly journals Immunohistochemistry profile and its relation with prognosis in locally advanced breast cancer

2019 ◽  
Vol 6 (12) ◽  
pp. 4507
Author(s):  
Naseef Kannanavil ◽  
Nabeel Thommil Padinjarenalakath ◽  
Ahsan Vilayapoyilil ◽  
Abidali Karatparambil
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Response To Therapy ◽  
Advanced Breast ◽  
Age Group ◽  
Modified Radical Mastectomy ◽  
Number Of Patients ◽  
Related Mortality

Background: Breast cancer is one of the most common malignancy and leading cause of cancer related deaths in women worldwide. Immunohistochemistry (IHC) is done to characterize intracellular proteins or cell-surface antigens and is used to assess tumour subtypes, confirm diagnosis, predict prognosis and response to therapy. The aim of the present study was to evaluate the relationship of IHC profile- ER, PR and HER2 neu and prognosis of patients who underwent modified radical mastectomy for locally advanced breast cancer.Methods: A retrospective cohort study was conducted at MES Medical College Hospital from October 2015 to November 2017 in patients who underwent modified radical mastectomy for locally advanced breast carcinoma. A total of 65 women were enrolled in the study. 5 years survival was taken as the prognostic indicator.Results: Majority of the patients belong to the age group of 40-49 years with 40% patients followed by 33.84% patients in the age group of 50-59 years. Maximum number of patients was found in 2B stage of tumour. Maximum patients belonged to the ER/PR+, HER2- subgroup (27), followed by triple negative (ER/PR-, HER2) subgroup (16). There was no disease related mortality in ER/PR+, HER2+ and ER/PR+, HER2- subgroups. There were 1 and 2 disease related mortality in ER/PR-, HER2+ and triple negative subgroups respectively.Conclusions: In the present study the worst prognosis was observed in triple negative (ER/PR-,HER2-) IHC subgroup followed by the HER2 enriched (ER/PR-, HER2+) subgroup. 

scholarly journals 210 Prognosis of Breast Cancer in Very Young Age (Less Than 30 Years)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Abid ◽  
R Bano ◽  
M Salim ◽  
A I Khan ◽  
M Z Chaudhry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Triple Negative ◽  
Molecular Subtype ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Histopathological Diagnosis ◽  
Distant Relapse ◽  
Associated Family ◽  
Age Range

Abstract Background Breast cancer diagnosed at younger age has aggressive biology being triple negative and high grade and associated with poor prognosis. Method Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 was reviewed. Demographics studied were age at diagnosis, gender, pregnancy, or lactation associated, family history, histopathological diagnosis, stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, survival. Results One patient was male. Age range 20 -30 years, single patient had bilateral involvement. half 50.4%(n = 61) patients had locally advanced disease at presentation. Pregnancy/ lactation associated breast cancer was seen in 29.8%(n = 36). Most common stage was stage III (52.1%) & stage II (33.9%). IDC was the most common histology 94.2% (n = 114) Triple negative was most common molecular subtype present in 46.3%(56). After 5 years follow up, local recurrence was observed in 12.4%(n = 15), cancer related deaths were 42.1%(n = 51). Conclusions Breast cancer in very young has very aggressive tumor biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy, furthermore there is need to identify possible environmental factors which may contribute in the rising incidence in this age group.

scholarly journals PROGNOSIS OF BREAST CANCER IN VERY YOUNG AGE (LESS THAN 30 YEARS)

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Razia Bano ◽  
Mariam Salim ◽  
Amina Iqbal Khan ◽  
Akif Zaidi
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Triple Negative ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Histopathological Diagnosis ◽  
Single Patient ◽  
Tumour Biology

Purpose: Breast cancer diagnosed at a younger age has aggressive biology being triple negative and high grade and is associated with poor prognosis.Materials and Methods: Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 were reviewed. Data were extracted from the cancer registry department of the institute. Demographics studied were the age at diagnosis, gender, pregnancy or lactation association, family history of breast cancer, histopathological diagnosis, and stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, and survival. Results: A total of 121 patients with age 30 years or less were included. An only a single patient was male. The age range was from 20 to 30 years; bilateral involvement was seen in a single patient. Almost half 50.4% (n = 61) patients had locally advanced disease at presentation. Pregnancy/lactation-associated breast cancer was seen in 29.8% (n = 36). The most common stage was Stage III (52.1%) and Stage II (33.9%). Invasive ductal carcinoma was the most common histology 94.2% (n = 114) of patients; triple negative was the most common molecular subtype present in 46.3% (n = 56). Chemotherapy was received by 92.6% (n = 112), 88.4% (n = 107) patients received radiation therapy. Modi ed radical mastectomy was performed in 57% (n = 69), breast conservation surgery in 35.5% (n = 43), follow- up period was 5 years, local recurrence was observed in 12.4% (n = 15) and cancer related deaths were 42.1% (n = 51). Conclusions: Breast cancer in very young has very aggressive tumour biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy. Key words: Breast cancer, pregnancy-associated aggressive tumour biology, triplenegative, young 

Đánh giá kết quả điều trị tân bổ trợ ung thư vú tại Bệnh viện Ung bướu Đà Nẵng

2020 ◽  
Author(s):  
Tinh Bui Thanh
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative ◽  
Ductal Carcinoma ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Her2 Status ◽  
Breast Cancer Patients

Background: Neoadjuvant chemotherapy for breast cancer was used to downstaging tumours to facilitate breast-conserving surgery. Methods: A descriptive retrospective study of 93 breast cancer patients at Da Nang Oncology Hospital from January 2017 to December 2019. Patients diagnosed with locally advanced breast cancer cT2-4N0- 3M0. Exclude cases of Ductal carcinoma in situ from breast or previously treated. Results: an average age of 48, an average tumor size of 6.0 cm, the majority were Invasive ductal carcinoma (97.8%) and grade 2 ( 85.6%). Hormon receptor positive in 57%, HER-2 positive in 38.7% and 18.3% triple negative Breast cancer. The combination chemotherapy regimen Anthacycline and Taxane accounted for 94.7%, Trastuzumab-based regimen accounted for 25%. There was 8.3% progression of disease during neoadjuvant chemotherapy. About Surgery: Breast- conserving surgery in 20.5%, Breast reconstruction in 6.8%, Mastectomy in 71.6%, Sentinel lymph node biopsy in 4.3%. Her2 status was significantly different between the groups with and without pCR.. Endocrine receptors are negative, Ki67 is high, and Triple negative has a higher rate of pCR but not statistically significant. Conclusion: Neoadjuvant chemotherapy helps to downstaging tumours to facilitate breast-conserving surgery. Her2 status is correlated with the rate of complete pathological response (pCR).

HER2 expression on circulating tumor cells (CTC) in patients with early HER2-positive breast cancer: Results of the German SUCCESS B trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10540-10540
Author(s):  
Bernadette Anna Sophia Jaeger ◽  
Brigitte Kathrin Rack ◽  
Julia Katharina Neugebauer ◽  
Ulrich Andergassen ◽  
Carola Anna Melcher ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Primary Tumor ◽  
Residual Disease ◽  
Tumor Biology ◽  
Phase Iii ◽  
Her2 Status ◽  
Axillary Lymph ◽  
Her2 Expression ◽  
Her2 Positive

10540 Background: Recent reports showed a discrepancy in the Her2-status of metastases or minimal residual disease in blood and bone marrow compared to the primary tumor in patients with breast cancer. The Her2-status of CTC was prospectively evaluated in the German multicenter SUCCESS B study. Methods: The SUCCESS B trial is a randomized Phase III study comparing FEC-Docetaxel (Doc) vs. FEC-Docetaxel-Gemcitabine (Doc-G) as well as Her2 targeted therapy with Trastuzumab as adjuvant treatment in patients with early, Her2 positive, node positive or high risk node negative primary breast cancer. As part of the translational research program, 23ml of peripheral blood were drawn before adjuvant chemotherapy. In 638 samples CTC and Her2-status were assessed using the CellSearch System (Veridex, USA). After immunomagnetic enrichment with an anti-Epcam-antibody, cells were labeled with anti-CK8/18/19, anti-CD45 antibodies as well as a fluorescein conjugate antibody for Her2 phenotyping. Cutoff for CTC-positivity was ≥1 CTC and for Her2 ≥1 CTC with strong Her2-staining (+++). Results: 40.2% of pts (n=257) were positive for CTC (mean 4.52; range 0-1689). The number of detected CTC was distributed as follows: 1 CTC (n=112; 43.6%), 2 CTC (n=65; 25.3%), 3 CTC (n=36; 14.0%), 4 CTC (n=12; 4.7%) and ≥5 CTC (n=31; 12.1%). Her2 status on CTC was negative or weak in 12.5% (n=32) and 8.9% (n=23) of CTC positive patients respectively and therefore categorized as Her2 negative. In 21.4% (n=55) we detected moderate and in 57.2% (n=147) strong Her2-staining of ≥1 CTC per sample. Therefore 57.2% of CTC-positive samples were diagnosed as Her2 positive and 21.4% as questionable. No association was found between the detection of CTC or the Her2-status on CTC with tumor size, histopathological grading, hormone receptor status or axillary lymph node involvement. Conclusions: The data of this trial confirms the frequent discordance of Her2 expression on CTC compared to the primary tumor. Survival data within the Success B trial will give further insight into the tumor biology of Her2 positive disease and the role of the Her2-status on CTC to predict treatment efficacy.

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.

Triple negative breast cancer: An Indian problem— Experience from a tertiary care oncology centre.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12583-e12583
Author(s):  
Sameer Gupta ◽  
Jeetendra Paryani ◽  
Arun Chaturvedi ◽  
Vijay Kumar ◽  
Naseem Akhtar
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Indian Population ◽  
Triple Negative ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Radical Mastectomy ◽  
Free Survival ◽  
Disease Free

e12583 Background: Breast cancer is a heterogeneous disease with distinct biological subtypes as determined by gene expression profiling studies. Breast cancer is most common cancer in Indian females and is believed to be biologically different from west, notably in terms of high prevalence of Triple negative subtype (TNBC). Reliable data on clinical and epidemiological profile of TNBC in Indian population is scarce. Aim of this study was to analyze the epidemiological and clinical profile of TNBCs Methods: Data of 355 patients of breast cancer registered in our department between 2013 and 2015 and followed up until December 2016 was collected and reviewed for epidemiological and clinical features Results: Of total 355 patients analysed, TNBC group was most common (n = 152) (43%) followed by Luminal A (25%). Median age at disease presentation in TNBC was 42.4 years compared to overall age of 45.3 years (24–73 years). In TNBC subgroup, 48% patients presented in locally advanced and 15% in metastatic stage, more commonly in pre-menopausal patients. Overall 268 (76%) patients underwent surgery with Modified radical mastectomy being preferred surgical option (86%), followed by adjuvant chemotherapy. TNBC subgroup demonstrated low response rate to neoadjuvant chemotherapy with only 9% of patients having complete response and 25% patients having progressive disease. Median followup was 34 months (6 50 months). Of the total recurrences (n = 19), nearly 2/3rd (n = 13) were documented in TNBC subgroup. Disease free survival (DFS) of TNBC subgroup was lower than of other luminal subtypes (p = .043) Conclusions: TNBC was the most common breast cancer subtype (43%) in Indian population which is nearly twice the rate reported in Western countries. This finding has significant clinical relevance as it may contribute to poor outcomes in Indian patients. Our study also corraborated this fact with higher prevalence of premenopausal breast cancer, poor response to neoadjuvant chemotherapy, high recurrence rates and decreased disease free survival. Additional research is needed to understand the determinants of TNBC in India as it is a prognostic group with aggressive behaviour that commonly lack the benefit of any specific targeted therapy

scholarly journals Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Maitri Kalra ◽  
Yan Tong ◽  
David R. Jones ◽  
Tom Walsh ◽  
Michael A. Danso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Neoadjuvant Therapy ◽  
Triple Negative ◽  
Residual Disease ◽  
Disease Free Survival ◽  
Parp Inhibition ◽  
High Risk Population ◽  
Risk Population ◽  
The Impact

AbstractPatients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

scholarly journals Practical classification of triple-negative breast cancer: intratumoral heterogeneity, mechanisms of drug resistance, and novel therapies

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Antonio Marra ◽  
Dario Trapani ◽  
Giulia Viale ◽  
Carmen Criscitiello ◽  
Giuseppe Curigliano
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Residual Disease ◽  
Therapeutic Approaches ◽  
Minimal Residual Disease Monitoring ◽  
Anticancer Treatment ◽  
Immune Contexture

Abstract Triple-negative breast cancer (TNBC) is not a unique disease, encompassing multiple entities with marked histopathological, transcriptomic and genomic heterogeneity. Despite several efforts, transcriptomic and genomic classifications have remained merely theoretic and most of the patients are being treated with chemotherapy. Driver alterations in potentially targetable genes, including PIK3CA and AKT, have been identified across TNBC subtypes, prompting the implementation of biomarker-driven therapeutic approaches. However, biomarker-based treatments as well as immune checkpoint inhibitor-based immunotherapy have provided contrasting and limited results so far. Accordingly, a better characterization of the genomic and immune contexture underpinning TNBC, as well as the translation of the lessons learnt in the metastatic disease to the early setting would improve patients’ outcomes. The application of multi-omics technologies, biocomputational algorithms, assays for minimal residual disease monitoring and novel clinical trial designs are strongly warranted to pave the way toward personalized anticancer treatment for patients with TNBC.

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