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Akihiko Ozaki ◽  
Yudai Kaneda ◽  
Yuki Senoo ◽  
Masahiro Wada ◽  
Tomohiro Kurokawa ◽  

We experienced an advanced breast cancer patient who failed to receive diagnostic imaging despite regular video conferences with her physician during the COVID-19 pandemic, resulting in delayed liver metastasis detection. Recognizing shortcomings of telemedicine and collaboration among medical institutions for uninterrupted cancer care is imperative during the pandemic.

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5271
Renée. S. J. M. Schmitz ◽  
Sandra. M. E. Geurts ◽  
Khava. I. E. Ibragimova ◽  
Dominique. J. P. Tilli ◽  
Vivianne C. G. Tjan-Heijnen ◽  

New treatment options in cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). From the Southeast Netherlands Breast cancer (SONABRE) registry, we selected all deceased patients diagnosed with ABC in Maastricht University Medical Center between January 2007 and October 2017. Frequency of health care use in the last six months of life was described and predictors for health care use were assessed. Of 203 patients, 76% were admitted during the last six months, 6% to the intensive care unit (ICU) and 2% underwent cardiopulmonary resuscitation (CPR). Death in hospital occurred in 25%. Nine percent of patients received a new line of chemotherapy ≤30 days before death, which was associated with age <65 years and <1 year survival since diagnosis of metastases. In these patients, the hospital admission rate was 95%, of which 79% died in the hospital, mostly due to progressive disease (80%). In conclusion, the frequency of ICU-admission, CPR or a new line of chemotherapy ≤ 30 days before death was low. Most patients receiving a new line of chemotherapy ≤ 30 days before death, died in the hospital.

Breast Cancer ◽  
2021 ◽  
Masato Takahashi ◽  
Eriko Tokunaga ◽  
Joji Mori ◽  
Yoshinori Tanizawa ◽  
Jan-Stefan van der Walt ◽  

Abstract Background This was a Japanese subpopulation analysis of MONARCH 3, a randomized, double-blind, placebo-controlled phase 3 study of abemaciclib plus nonsteroidal aromatase inhibitors (NSAIs) for initial therapy for advanced breast cancer (ABC). Methods Eligibility included postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative ABC who had no prior systemic therapy in the advanced disease setting. Patients (N = 493) were randomized 2:1 to receive abemaciclib or placebo (150 mg) plus either 1 mg anastrozole or 2.5 mg letrozole (physician’s choice). The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), pharmacokinetics (PK), safety, and health-related quality of life (HRQoL). Results In Japan, 53 patients were randomized (abemaciclib, n = 38; placebo, n = 15). At final PFS analysis (November 3, 2017), median PFS was 29.1 and 14.9 months in the abemaciclib and placebo groups, respectively (hazard ratio 0.537; 95% confidence interval 0.224–1.289). ORR in measurable disease was 62.1 and 50.0% in the abemaciclib and placebo groups, respectively. The Japanese PK profile was comparable to that of the overall population. Consistent with prior studies, the most frequent adverse events reported were diarrhea (abemaciclib: any grade, 94.7%; grade ≥ 3, 10.5%; placebo: any grade, 46.7%; grade ≥ 3, 0%) and neutropenia (abemaciclib: any grade, 68.4%; grade ≥ 3, 21.1%; placebo: any grade, 0%). HRQoL outcomes were generally similar between treatments except for the diarrhea score, which favored placebo. Conclusions Consistent with findings in the overall population, abemaciclib plus NSAI was an effective initial treatment in the Japanese subpopulation, with a manageable safety profile. Clinical trial registration NCT02246621; U.S. National Library of Medicine:

Irina Niță ◽  
Cornelia Nițipir ◽  
Ștefania Andreea Toma ◽  
Alexandra Maria Limbău ◽  
Edvina Pirvu ◽  

Background and aims. Our aim is to examine the relationship between the level of education, background, tumor size and lymph node status on the treatment outcome in a group of patients with early and locally advanced breast cancer (BC) by using the restricted mean survival time (RMST), which summarizes treatment effects in terms of event-free time over a fixed period of time. Methods. We evaluated the prognostic values in 143 patients treated for early BC at Elias University Emergency Hospital, Bucharest, Romania and followed up for a maximum of 36 months. The protocol was amended to include the levels of education (gymnasium, high school, or university), the background (urban or rural) and the clinical stage (primary tumor (T) and regional nodes (N)). The methodology consisted in using a Kaplan–Meier analysis and RMST for the entire sample and Cox regression, for the variables with statistical influence. The principal endpoints of the study were overall survival (OS) and progression free survival (PFS). Results. The level of education had impact both on RMST OS (35.30 vs. 26.70) and death HR (hazard ratio) in the group of patients with general school level, compared with those with graduated university. In this study, the urban or rural background did not impact the outcome, probably because in this study we included predominantly patients from urban areas (83%). Although clinical tumor size measurements did not impact the outcome, the clinical staged lymph node influenced both OS (p=0.0500) and PFS (p=0.0006) for the patients with palpable or imaging proof of lymph node involvement of station 2 or 3. Conclusions. RMST provides an intuitive and explicit way to express the effect of those risk factors on OS and PFS in a cohort of early breast cancer patients. Low level of education and high-grade clinical lymph node status negatively influences the outcome of this cohort of BC patients.

2021 ◽  
Vol 11 ◽  
Zhichao Gao ◽  
Junnan Xu ◽  
Yan Wang ◽  
Jie Wu ◽  
Tao Sun

The prognosis for female patients with locally advanced breast cancer (LABC) has improved with the emergence of novel drugs, especially for those who have HER2 overexpression or ERBB-2 amplification. Trastuzumab-based regimen has been the paradigm in guidelines as first-line therapy, whereas many patients got progressive disease after several cycles of treatment or rapidly progress because of primary resistance. Point mutations of ERBB2 gene occur in both HER2-amplication and non-amplification patients, with a 2% ratio in HER2 non-amplification cohort and 1.48% in HER2 amplication population. The acquired mutation ratio of ERBB2 substantially raised to 16.7%–17.7% in patients prior to trastuzumab treatment. ERBB2 mutation may be a critical reason of resistance and disease progression among the patients treated with anti-HER2 monoclonal trastuzumab or dual anti-HER2 antibodies with trastuzumab and pertuzumab, or tyrosine-kinase inhibitor. ERBB-2 mutation with L755S and V842I indicates resistance to trastuzumab, while that with L755S and K753I indicates resistance to lapatinib; these mutations maybe sensitive to pan-HER tyrosine-kinase inhibitors. A 48-year woman diagnosed with HER2-positive LABC developed trastuzumab resistance after three lines of trastuzumab cross-line treatment with partial response (PR) as the best response. The tissue was performed by next-generation sequencing (NGS), and the results discovered L755S in ERBB2 gene. Then, she received effective treatment with pyrotinib plus capecitabine and underwent mastectomy after six cycles of combined treatment with PR. Subsequently, breast mastectomy was performed, and she took pyrotinib plus capecitabine for 1 year and pyrotinib monotherapy for another 1 year as adjuvant therapy and achieved a long-term clinical benefit. In conclusion, pyrotinib is a potential neoadjuvant agent for patients who are heavily pretreated and harbor both ERBB2 amplification and ERBB2 mutant in locally advanced breast cancer.

2021 ◽  
Vol 10 (41) ◽  
pp. 3577-3581
Nonam Chellappan ◽  
Smitha G. Raj

BACKGROUND Breast cancer is a systemic disease that requires treatment with surgery, chemotherapy, radiation, endocrine therapy and biological therapy. Neoadjuvant chemotherapy is the recent treatment of locally advanced breast cancer. The purpose of this study was to assess the acute toxicity of paclitaxel-based dose-dense and conventional neoadjuvant chemotherapy in locally advanced female breast cancer patients. METHODS In this study, neoadjuvant paclitaxel was given to a hundred locally advanced breast malignancies of female patients. Three weekly paclitaxel 200 mg/m2 ( 4 courses) was given for fifty patients and weekly paclitaxel 80 mg/m2 (10 courses) was given for fifty patients along with four-course of three weekly doxorubicin 50 mg/m2 given in both arms. Chemotherapy-induced acute toxicities in both arms were assessed weekly. RESULTS There was a significant increase in the incidence of anaemia in weekly chemotherapy patients at 7th week (28 % verse 10 %, P - value 0.022) and neutropenic infection at 11th week (28 % verse 10 %, P - value 0.022). There was a non-statistically significant increase in the incidence of leukopenia, thrombocytopenia and paraesthesia and myalgia in the weekly arm. There was a significant increase in the incidence of gastrointestinal toxicity like grade 3 stomatitis (at 4th - week), nausea and vomiting (at 4th, 7th, and 11th week ) in three weekly chemotherapy patients. CONCLUSIONS In this study, acute neurological and haematological toxicities were more in the weekly neoadjuvant chemotherapy arm and acute gastrointestinal toxicities were more in the three weekly neoadjuvant chemotherapy arm. KEYWORDS Acute Toxicity, Neoadjuvant Paclitaxel Chemotherapy, Locally Advanced Breast Malignancy.

Leiping Wang ◽  
Jun Cao ◽  
Chunlei Li ◽  
Xiaodong Wang ◽  
Yannan Zhao ◽  

SummaryPurpose. This trial aimed to evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection (Lipo-MIT) in advanced breast cancer (ABC). Methods. In this randomized, open-label, active-controlled, single-center, phase II clinical trial, eligible patients were randomized in a ratio of 1:1 to receive Lipo-MIT or mitoxantrone hydrochloride injection (MIT) intravenously. The primary endpoint was objective response rate (ORR). The secondary endpoints were disease control rate (DCR), progression-free survival (PFS), and safety outcomes. Results. Sixty patients were randomized to receive Lipo-MIT or MIT. The ORR was 13.3% (95% confidence interval (CI): 3.8–30.7%) for Lipo-MIT and 6.7% (95% CI: 0.8–22.1%) for MIT. The DCR was 50% (95% CI: 31.3–68.7%) with Lipo-MIT vs. 30% (95% CI: 14.7–49.4%) with MIT. The median PFS was 1.92 months (95% CI: 1.75–3.61) for Lipo-MIT and 1.85 months (95% CI: 1.75–2.02) for MIT. The most common toxicity was myelosuppression. Lipo-MIT resulted in an incidence of 86.7% of leukopenia and 80.0% of neutropenia, which was marginally superior to MIT (96.7% and 96.7%, respectively). Lipo-MIT showed a lower incidence of cardiovascular events (13.3% vs. 20.0%) and increased cardiac troponin T (3.3% vs. 36.7%); but higher incidence of anemia (76.7% vs. 46.7%), skin hyperpigmentation (66.7% vs. 3.3%), and fever (23.3% vs. 10.0%) than MIT. Conclusions The clinical benefit parameters of Lipo-MIT and MIT were comparable. Lipo-MIT provided a different toxicity profile, which might be associated with the altered distribution of the drug. Additional study is needed to elucidate the potential benefit of Lipo-MIT in ABC. Clinical trial registration. This study is registered with (No. NCT02596373) on Nov 4, 2015.

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