Tailoring Chemotherapy in Early-Stage Breast Cancer: Based on Tumor Biology or Tumor Burden?

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_159077 ◽

2016 ◽

pp. e31-e38 ◽

Cited By ~ 3

Author(s):

Domen Ribnikar ◽

Fatima Cardoso

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Predictive Value ◽

Cancer Biology ◽

Early Stage ◽

Tumor Biology ◽

Tumor Burden ◽

Early Stage Breast Cancer ◽

Gene Signatures ◽

New Biomarkers

The question of whether to offer adjuvant chemotherapy to patients with early-stage breast cancer has always been challenging to answer. It is well known that a substantial proportion of patients with early-stage breast cancer are over treated, especially when staging and hormonal and HER2 receptors are solely taken into consideration. The advances in our knowledge of breast cancer biology and its clinical implications were the basis for the discovery of additional reliable prognostic markers to aid decision making for adjuvant treatment. Gene expression profiling is a molecular tool that more precisely defines the intrinsic characteristics of each individual tumor. The application of this technology has led to the development of gene signatures/profiles with relevant prognostic—and some predictive—value that have become important tools in defining which patients with early-stage breast cancer can be safely spared from chemotherapy. However, the exact clinical utility of these tools will only be determined after the results of two large prospective randomized trials, MINDACT and TailorX, evaluating their role become available. Notwithstanding the existence of these genomic tools, tumor burden (defined as tumor size and nodal status) still has independent prognostic value and must be incorporated in decision making. In addition, these gene signatures have limited predictive value, and new biomarkers and new targets are needed. Therefore close collaboration between clinicians and scientists is crucial. Lastly, issues of cost-effectiveness, reimbursement, and availability are crucial and widely variable around the globe.

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Preoperative Axillary Ultrasound in the Selection of Patients With a Heavy Axillary Tumor Burden in Early-Stage Breast Cancer: What Leads to False-Positive Results?

Journal of Ultrasound in Medicine ◽

10.1002/jum.14545 ◽

2018 ◽

Vol 37 (6) ◽

pp. 1357-1365 ◽

Cited By ~ 7

Author(s):

Ying Zhu ◽

Wei Zhou ◽

Xiao-hong Jia ◽

Ou Huang ◽

Wei-wei Zhan

Keyword(s):

Breast Cancer ◽

False Positive ◽

Early Stage ◽

Tumor Burden ◽

Early Stage Breast Cancer ◽

Axillary Ultrasound ◽

Positive Results ◽

Selection Of Patients ◽

Selection Of

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Contemporary Locoregional Recurrence Rates in Young Patients With Early-Stage Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2015.64.3536 ◽

2016 ◽

Vol 34 (18) ◽

pp. 2107-2114 ◽

Cited By ~ 26

Author(s):

Kim C. Aalders ◽

Emily L. Postma ◽

Luc J. Strobbe ◽

Margriet van der Heiden-van der Loo ◽

Gabe S. Sonke ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Early Stage ◽

Tumor Biology ◽

Young Patients ◽

Early Stage Breast Cancer ◽

Her2 Positive ◽

Entire Study ◽

Netherlands Cancer Registry ◽

Increased Risk

Purpose The aim of this study was to evaluate contemporary rates of local recurrence (LR) and regional recurrence (RR) in young patients with breast cancer in relation to tumor biology as expressed by biomarker subtypes. Patients and Methods Women < 35 years of age who underwent surgery for primary unilateral invasive breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. Patients were categorized according to biomarker subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year risks of developing LR and regional lymph node recurrence were estimated by using Kaplan-Meier statistics. Results A total of 1,000 patients were identified, of whom 59% had a known subtype: 39% HR-positive/HER2-negative; 17% HR-positive/HER2-positive; 10% HR-negative/HER2-positive; and 34% HR-negative/HER2-negative (triple negative). Overall 5-year LR and RR rates were 3.5% and 3.7%, respectively. A decreasing trend for both rates was observed over time and was accompanied by a significant decrease in the risk of distant metastases (DM). LR occurred in 4.2%, RR in 6.1%, and DM in 17.8% of patients in 2003, and in 3.2%, 4.4%, and 10.0%, respectively, in 2008. LR and RR rates varied with biomarker subtype. These differences were borderline significant when analyzed for the entire study period (P = .056 and P = .014, respectively) and leveled off after the introduction of trastuzumab after 2005 (P = .24 and P = .42, respectively). Patients with lymph node metastases at the time of diagnosis had an increased risk of RR. The type of surgery performed—breast-conserving or mastectomy—did not influence rates of LR and RR. Conclusion Overall, the rates of LR and RR in young patients with early-stage breast cancer were relatively low and varied by biomarker subtype.

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