scholarly journals Metastatic Breast Cancer as a Chronic Disease: Evidence-Based Data on a Theoretical Concept

Breast Care ◽  
2019 ◽  
Vol 15 (3) ◽  
pp. 281-288
Author(s):  
Constanze Elfgen ◽  
Giacomo Montagna ◽  
Seraina Margaretha Schmid ◽  
Walter Bierbauer ◽  
Uwe Güth
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Chronic Disease ◽  
Progressive Disease ◽  
Case Fatality ◽  
Metastatic Breast ◽  
Theoretical Concept ◽  
First Year ◽  
Evidence Based ◽  
Entire Cohort

Background: We challenge the concept of metastatic breast cancer (MBC) as a chronic disease. Methods: We analyzed an unselected cohort of 367 patients who were diagnosed with MBC over a 22-year period (1990–2011). Results: In order to create a “chronic disease subgroup”, we separated those patients from the entire cohort in whom systemic therapy was not applied after the diagnosis of MBC (n = 53; 14.4%). Three hundred fourteen patients (85.6%) comprised the “chronic disease subgroup”. The vast majority of those patients (89.8%) died of progressive disease after a median metastatic disease survival (MDS) of 25 months. Twenty patients (6.4%) died of non-MBC-related causes (MDS 38.5 months). Approximately 1 in 4 patients (26.8%) died within the first year after the MBC diagnosis. The 3- and 5-year MDS rates were 35.4 and 16.2%, respectively. Only 12 patients (3.8%) were exceptional survivors (MDS >10 years). Conclusion: The term “chronic disease” might be appropriate in selected MBC cases, bringing MBC into alignment with “classical” chronic diseases such as diabetes and hypertension. However, most cases display fundamental differences with regard to temporal progression and above all the case fatality rate. More than 90% of patients in the “chronic disease subgroup” died of the disease with a MDS of 2–3 years (even those who underwent systemic palliative therapies). Doctors and patients might understand the term “chronic disease” differently. The term must be used sparingly and explained carefully in order to create a common level of communication based on a shared understanding which avoids awakening false hopes and fostering misleading expectations.

Paclitaxel activity in heavily pretreated breast cancer: a National Cancer Institute Treatment Referral Center trial.

1995 ◽  
Vol 13 (8) ◽  
pp. 2056-2065 ◽  
Author(s):  
J S Abrams ◽  
D A Vena ◽  
J Baltz ◽  
J Adams ◽  
M Montello ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Progressive Disease ◽  
Overall Response Rate ◽  
Metastatic Breast ◽  
Investigational Drug ◽  
Single Institution ◽  
Doxorubicin Treatment ◽  
Heavily Pretreated ◽  
Pretreated Patients

PURPOSE To provide paclitaxel, an investigational drug at the inception of this study, to women with chemotherapy-refractory metastatic breast cancer and to evaluate response and toxicity in these patients. PATIENTS AND METHODS Two hundred sixty-seven patients with progressive disease (PD) following at least two chemotherapy regimens for metastatic breast cancer and a contraindication to further doxorubicin treatment received paclitaxel either at 175 mg/m2 intravenously (IV) over 24 hours or at 135 mg/m2 if they had prior irradiation to 30% of marrow-bearing bone or a cumulative dose of mitomycin > or = 20 mg/m2. RESULTS In a subgroup of patients (n = 172) with measurable disease, four complete responses (CRs) and 36 partial responses (PRs) occurred, for an overall response rate of 23% (95% confidence interval [CI], 17% to 30%). No differences in response rates were noted according either to the number of prior chemotherapy regimens received or to whether patients were considered refractory to doxorubicin. The dose and schedule used in this trial resulted in febrile neutropenia in 45% of patients and a hospitalization rate of 49%. CONCLUSION Paclitaxel's activity in this multiinstitutional trial in heavily pretreated patients confirms the encouraging results attained in single-institution trials. Although at this dose and schedule paclitaxel may be considered too myelosuppressive for palliative care, supportive measures such as colony-stimulating factors and antibiotics were not used prophylactically. Current research efforts are focusing on whether paclitaxel's activity against breast cancer is dose- and/or schedule-dependent, and on what role it has in patients with less advanced disease.

scholarly journals Sequential intra-arterial infusion of 90Y-resin microspheres and mitomycin C in chemo refractory liver metastatic breast cancer patients: a single centre pilot study

2020 ◽  
Vol 54 (1) ◽  
pp. 33-39
Author(s):  
Brigitte Maximiliana Aarts ◽  
Elisabeth Geneviève Klompenhouwer ◽  
Raphaëla Carmen Dresen ◽  
Christophe Michel Albert Louis Omer Deroose ◽  
Regina Gien Hoa Beets-Tan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Pilot Study ◽  
Mitomycin C ◽  
Progressive Disease ◽  
Metastatic Breast ◽  
Response To Treatment ◽  
Breast Cancer Patients ◽  
Arterial Infusion ◽  
Resin Microspheres

AbstractBackgroundThe aim of the study was to evaluate the safety and feasibility of intra-arterial mitomycin C (MMC) infusion after selective internal radiation therapy (SIRT) using Yttrium-90 (90Y) resin microspheres in liver metastatic breast cancer (LMBC) patients.Patients and methodsThe prospective pilot study included LMBC patients from 2012–2018. Patients first received infusion of 90Y resin microspheres, after 6–8 weeks response to treatment was assessed by MRI, 18F-FDG PET/CT and laboratory tests. After exclusion of progressive disease, MMC infusion was administrated 8 weeks later in different dose cohorts; A: 6 mg in 1 cycle, B: 12 mg in 2 cycles, C: 24 mg in 2 cycles and D: maximum of 72 mg in 6 cycles. In cohort D the response was evaluated after every 2 cycles and continued after exclusion of progressive disease. Adverse events (AE) were reported according to CTCAE version 5.0.ResultsSixteen patients received 90Y treatment. Four patients were excluded for MMC infusion, because of extra hepatic disease progression (n = 3) and clinical and biochemical instability (n = 1). That resulted in the following number of patient per cohort; A: 2, B: 1, C: 3 and D: 6. In 4 of the 12 patients (all cohort D) the maximum dose of MMC was adjusted due biochemical toxicities (n = 2) and progressive disease (n = 2). One grade 3 AE occurred after 90Y treatment consisting of a gastrointestinal ulcer whereby prolonged hospitalization was needed.ConclusionsSequential treatment of intra-arterial infusion of MMC after 90Y SIRT was feasible in 75% of the patients when MMC was administrated in different escalating dose cohorts. However, caution is needed to prevent reflux after 90Y SIRT in LMBC patients.

scholarly journals AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2019

Breast Care ◽  
2019 ◽  
Vol 14 (4) ◽  
pp. 247-255 ◽  
Author(s):  
Marc Thill ◽  
Christian Jackisch ◽  
Wolfgang Janni ◽  
Volkmar Müller ◽  
Ute-Susann Albert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Medical Oncology ◽  
Locally Advanced ◽  
Metastatic Breast ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Scientific Validity ◽  
Gynäkologische Onkologie ◽  
Radiologic Diagnostics

Every year the Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO), a group of gynecological oncologists specialized in breast cancer and interdisciplinary members specialized in pathology, radiologic diagnostics, medical oncology, and radiation oncology, prepares and updates evidence-based recommendations for the diagnosis and treatment of patients with early and metastatic breast cancer. Every update is performed according to a documented rule-fixed algorithm, by thoroughly reviewing and scoring the recent publications for their scientific validity and clinical relevance. This current publication presents the 2019 update on the recommendations for metastatic breast cancer.

scholarly journals Use of Sickness Benefits by Patients With Metastatic Breast Cancer – A Swedish Cohort Study

2021 ◽  
Author(s):  
Renske Altena ◽  
Sofie A.M. Gernaat ◽  
Ulla Wilking ◽  
Narsis A. Kiani ◽  
Aina Johnsson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Well Being ◽  
First Year ◽  
Study Population ◽  
Sickness Benefits ◽  
Second Year ◽  
New Diagnosis

Abstract Background Advances in the treatment of metastatic breast cancer (mBC) have led to improved life expectancy. Many cancer survivors desire to return to paid work to enhance their sense of well-being. For patients with mBC, little is known about how the diagnosis impacts ability to work or the factors that increase the need for sickness benefits. Patients and methods Data were collected from two Swedish national registers, for females ages 18 to 63 years in the Stockholm-Gotland healthcare region with a new diagnosis of mBC from 1997 through 2011. Type of first-line palliative treatment was identified in medical records of a subset of the study population. Use of sickness absence (SA) and disability pension (DP) by these patients during the year before and one and two years after mBC diagnosis was determined from a third register. Regression analysis was performed to ascertain which covariate factors were associated with long-term (> 30 days) SA. Results A total of 1,240 patients were evaluated the year before and the first year after mBC diagnosis; only 805 patients were still alive and evaluated the second year after diagnosis. The proportions of patients having SA and DP were 56.0% and 24.8% the year before, 69.9% and 28.9% the first year after, and 64.0% and 34.7% the second year after diagnosis, respectively. Adjusted odds of having long-term SA were significantly higher at 1 and 2 years after diagnosis for patients with age < 45 years (AOR = 3.43 and AOR = 1.70, respectively), early calendar year of diagnosis (AOR = 1.72 and AOR = 1.79, respectively), metachronous mBC (AOR = 4.85 and AOR = 4.52, respectively), and SA ≥ 90 days the year before diagnosis (AOR = 3.44 and AOR = 1.98, respectively). Odds were also significantly higher the second after diagnosis for patients treated with chemotherapy (AOR = 1.81) or radiotherapy (AOR = 2.23), compared to those treated with hormonal therapy, Conclusions Rates of SA and DP increase after a diagnosis of mBC. Women who are younger, develop metachronous mBC, use SA heavily before mBC, and receive chemotherapy or radiotherapy have a greater need for sickness benefits after an mBC diagnosis.

Ifosfamide and vinorelbine as first-line chemotherapy for metastatic breast cancer.

1996 ◽  
Vol 14 (11) ◽  
pp. 2993-2999 ◽  
Author(s):  
B A Leone ◽  
C T Vallejo ◽  
A O Romero ◽  
J E Perez ◽  
M A Cuevas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Peripheral Neuropathy ◽  
Progressive Disease ◽  
Metastatic Breast ◽  
Survival Duration ◽  
First Line ◽  
Half Dose ◽  
Time To Treatment Failure ◽  
Line Chemotherapy

PURPOSE To evaluate the efficacy and toxicity of the combination of ifosfamide (IFX) and vinorelbine (VNB) as first-line chemotherapy in metastatic breast cancer (MBC). PATIENTS AND METHODS Between August 1993 and August 1995, 45 patients with untreated MBC received a regimen that consisted of IFX 2 g/m2 by 1-hour intravenous (i.v.) infusion on days 1 to 3, mesna 400 mg/m2 by i.v. bolus at hours 0 and 4 and 800 mg/m2 orally at hour 8 on days 1 to 3, and VNB 35 mg/m2 by 20-minute i.v. infusion on days 1 and 15. Courses were repeated every 28 days. During the first course only, half-dose VNB (17.5 mg/m2) was administered on days 8 and 22. The median age was 53 years and 30 patients (67%) were postmenopausal. Dominant sites of disease were soft tissue in nine patients, bone in seven, and visceral in 29. RESULTS Objective responses (ORs) were recorded in 25 of 43 assessable patients (58%; 95% confidence interval, 43% to 73%). Complete remissions (CRs) occurred in six patients (14%) and partial remissions (PRs) in 19 (44%). No change (NC) was recorded in 10 patients (23%) and progressive disease (PD) in eight patients (19%). The median time to treatment failure was 12 months and the median survival duration 19 months. Myelosuppression was the limiting toxicity, mainly leukopenia in 32 patients (74%). In contrast, anemia and thrombocytopenia were mild. Other significant toxicities included peripheral neuropathy in nine patients (21%), constipation in 15 (35%), and myalgias in 11 (26%). CONCLUSION IFX/VNB is an active combination against MBC with moderate toxicity and deserves further evaluation.

Phase II Evaluation of Thalidomide in Patients With Metastatic Breast Cancer

2000 ◽  
Vol 18 (14) ◽  
pp. 2710-2717 ◽  
Author(s):  
Said M. Baidas ◽  
Eric P. Winer ◽  
Gini F. Fleming ◽  
Lyndsay Harris ◽  
James M. Pluda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Progressive Disease ◽  
Single Agent ◽  
Metastatic Breast ◽  
Complete Response ◽  
Pharmacokinetic Studies ◽  
Angiogenic Growth Factors ◽  
Heavily Pretreated ◽  
Dose Levels

PURPOSE: To determine the efficacy, safety, pharmacokinetics, and effect on serum angiogenic growth factors of two dose levels of thalidomide in patients with metastatic breast cancer. PATIENTS AND METHODS: Twenty-eight patients with progressive metastatic breast cancer were randomized to receive either daily 200 mg of thalidomide or 800 mg to be escalated to 1,200 mg. Fourteen heavily pretreated patients were assigned to each dose level. Each cycle consisted of 8 weeks of treatment. Pharmacokinetics and growth factor serum levels were evaluated. RESULTS: No patient had a true partial or complete response. On the 800-mg arm, 13 patients had progressive disease at or before 8 weeks of treatment and one refused to continue treatment. The dose was reduced because of somnolence to 600 mg for five patients and to 400 mg for two and was increased for one to 1,000 mg and for four to 1,200 mg. On the 200-mg arm, 12 patients had progressive disease at or before 8 weeks and two had stable disease at 8 weeks, of whom one was removed from study at week 11 because of grade 3 neuropathy and the other had progressive disease at week 16. Dose-limiting toxicities included somnolence and neuropathy. Adverse events that did not require dose or schedule modifications included constipation, fatigue, dry mouth, dizziness, nausea, anorexia, arrhythmia, headaches, skin rash, hypotension, and neutropenia. Evaluation of circulating angiogenic factors and pharmacokinetic studies failed to provide insight into the reason for the lack of efficacy. CONCLUSION: Single-agent thalidomide has little or no activity in patients with heavily pretreated breast cancer. Further studies that include different patient populations and/or combinations with other agents might be performed at the lower dose levels.

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