scholarly journals Maintaining treatment of locally advanced breast cancer

2003 ◽  
Vol 11 (3) ◽  
pp. 145-147
Author(s):  
Ljubomir Muzikravic ◽  
Dragutin Donat ◽  
Jasna Pesic ◽  
Jasna Trifunovic
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Regional Lymph Node ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Developed Countries ◽  
Advanced Breast ◽  
Postoperative Treatment ◽  
Primary Tumors ◽  
Number Of Patients

Locally advanced breast cancer is a specific clinic entity, comprising various degrees of breast cancer local and regional extension. This term is applied to nonmetastatic large primary tumors (including inflammatory breast carcinoma), with or without extensive regional lymph node involvement, with a rapid or slow evolution, and usually with poor prognosis. This clinical presentation of mammary carcinoma is common in developing countries (30% to 60%), but also with a remarkable incidence in developed countries (10% to 20%). During many decades patients were treated with radical surgery or radiation therapy and with their combination, but always with poor results. The inclusion of neoadjuvant chemotherapy in the treatment enabled more favorable treatment results. The mortality from disseminated disease is the main problem in these patients, inducing the question of need for additional postoperative adjuvant systemic therapy. For steroid receptor positive patients hormonotherapy is a convenient choice of maintaining treatment. In endocrine non-responsive tumors, the role of postoperative chemotherapy is doubtful, having in mind preoperative chemotherapy and cumulative toxic effects. New trials including the large number of patients are necessary to obtain the definite answer whether the maintaining chemotherapy is useful but today it seems that additive postoperative treatment is not more efficient than preoperative alone.

scholarly journals The Effect of External Radiotherapy to the Left Ventricle Systolic Function in Locally Advanced Breast Cancer Patients

2021 ◽  
Vol 8 (11) ◽  
pp. 350-356
Author(s):  
Helmy Fahada ◽  
Desak Agung Suprabawati ◽  
Dyah Erawati
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Cancer Patients ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Left Ventricular ◽  
Advanced Breast ◽  
External Radiation ◽  
Breast Cancer Patients ◽  
Number Of Patients

Background: Locoregional management in breast cancer patients includes surgery and radiation. Radiation increases the risk of the decreasing of cardiac ventricular performance and known as cardiotoxicity. This study aims to analyze the relationship between radiation exposure in locally advanced breast cancer patients with the left ventricular systolic function. Methods: The subjects in this study were patients with locally advanced breast cancer who underwent external radiation therapy after surgery procedure at Dr. Soetomo General Hospital in January 2021 – April 2021. Examination of left ventricular performance parameters was carried out using an invasive method, the transthoracic echocardiography. The performance parameters examined were left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Results: A total of 45 patients were recruited in this study. Twenty-two patients (22/45; 48.9%) underwent radiation therapy from the left side and 23 patients (23/45; 51.1%) from the right side. After external radiation, the number of patients with left ventricular dilatation were increased. On the left side, there were 6 patients (6/22; 27.6%) who experienced dilatation compared to before radiation (3 patients), while on the right side of the body there were 8 patients (8/22; 34.8%) who experienced dilatation compared to before radiation (6 patients). There was an increase in the number of patients who experienced a decrease in EFT and EFB after radiation, although the association was not significant. Almost all patients experienced a decrease in GLS values ​​after radiation (44/45; 97.8%). Conclusion: There was an increase in the number of patients with left ventricular dilatation and decrease in EFT and EFB values after external radiation. Decreased GLS values ​​were found in almost all patients who underwent external radiation in this study. Keywords: Radiation, locally advanced breast cancer, LVID, ejection fraction, GLS.

Overexpression of chemokine receptor CXCR4 in cancer specimens following neoadjuvant chemotherapy predicts outcome in patients with locally advanced breast cancer (LABC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10578-10578 ◽  
Author(s):  
N. T. Holm ◽  
K. Byrnes ◽  
M. MacDonald ◽  
F. Abreo ◽  
F. Ampil ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Chemokine Receptor ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Cancer Recurrence ◽  
Advanced Breast ◽  
Western Blots ◽  
Number Of Patients

10578 Background: Despite significant advances made in the treatment of locally advanced breast cancer (LABC) with neoadjuvant chemotherapy, a significant number of patients continue to die. A molecular predictor to identify those who are at an increased risk for relapse is sorely needed. CXCR4 is a chemokine receptor that has been linked to breast cancer invasion and metastasis. We postulate that CXCR4 overexpression levels in cancer specimens following neoadjuvant chemotherapy predict cancer outcome in patients with LABC. Methods: 54 patients with LABC were prospectively accrued and analyzed. All had neoadjuvant chemotherapy, followed by definitive surgical and adjuvant chemo-radiation therapy. Study homogeneity was maintained by standardized treatment, surveillance, and compliance protocols. A 1 cm 3 cancer from the surgical specimens of each patient was retrieved for analysis. CXCR4 levels were detected using Western blots and results were quantified against 1 μg of HeLa cells (positive controls). CXCR4 expression was defined as low (<6.6 fold) or high (= 6.6 fold). Primary endpoints were cancer recurrence and death. Statistical analysis performed included Kaplan-Meier survival analysis, log-rank test, and Cox proportional hazard model. Results: With a median follow-up of 30 months, patients whose tumors had high CXCR4 overexpression (= 6.6 fold) had a statistically significantly higher incidence of recurrence (p= 0.0009) and cancer-related death (p= 0.0168) than those in the low CXCR4 group (< 6.6 fold). After adjusting for tumor size, nodal status, ER, PR and HER-2 status, the relative risk for recurrence and death in the high CXCR4 group was 27.3-fold (p=0.001; 95% CI: 6.2 to 120.8) and 4.8-fold (p=0.0076; 95% CI: 1.5 to 15.0) higher than those in the low CXCR4 group, respectively. Conclusion: High CXCR4 overexpression in cancer specimens following neoadjuvant chemotherapy was highly predictive of cancer recurrence and cancer death in patients with LABC. No significant financial relationships to disclose.

Efficacy and safety of neoadjuvant chemotherapy of sequential doublets and dose dense plus trastuzumab in HER2-positive locally advanced breast cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11089-11089
Author(s):  
E. Grande ◽  
A. Sanchez-Muñoz ◽  
A. García-Tapiador ◽  
A. Ortega-Granados ◽  
A. Jaén-Morago ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Cancer Patients ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Chemotherapeutic Agents ◽  
Advanced Breast ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Number Of Patients

11089 Background: Neoadjuvant therapy for breast cancer constitutes an excellent test to evaluate the sensitivity to chemotherapeutic agents and/or new biological agents against specific targets as trastuzumab and Her2. Furthermore, pathologic complete response (pCR) is a surrogate marker for disease-free and overall survival. Methods: The objective was to determine the efficacy in terms of pCR rates and the safety profile of the doublets plus trastuzumab schedule administered for the neoadjuvant setting of locally advanced breast cancer patients. A total of 20 patients with histologically confirmed locally invasive Her2-positive breast carcinoma were included. The median age was 43. Mean tumour size was 5.1 cm. Treatment consisted of a first sequence with epirubicin 90 mg/m2 and cyclophophamide 600 mg/m2 for 3 cycles, and a second sequence with paclitaxel 150 mg/m2 and gemcitabine 2500 mg/m2 for six cycles. All drugs were administered on day 1, every two weeks with prophylactic growth factor supports. Weekly trastuzumab was administered at a dose of 2mg/kg (4 mg/kg loading dose), concomitantly with paclitaxel and gemcitabine. Subsequently, patients underwent surgery and received radiotherapy and/or adjuvant hormonal therapy according to institutional practice Results: Objective clinical response was achieved in all patients. 10 (50%) pCR were obtained. With a median follow up of 18.2 months (3–38), 17 patients (85%) are alive without disease progression, and 3 (15%) showed recurrence and 1 of whom died. Treatment was well tolerated, 1 patient experienced 1 episode of grade 4 neutropenia and 2 patients had grade 3 neutropenia. 1 patient discontinued the treatment due to hypersensitivity reaction to paclitaxel. Asymptomatic decrease in cardiac ejection fraction with subsequent normalization was seen in 1 case. Conclusions: Despite of the small number of patients, results have shown a high pCR rate in this group of breast cancer patients with poor prognostic. The schedule seems to be feasible and tolerable and further studies with the doublet sequences plus trastuzumab are warranted on the neoadjuvant Her2 positive breast cancer patients No significant financial relationships to disclose.

Circulating tumor cells (CTCs) detection in a randomized phase II trial of neoadjuvant chemotherapy for large operable and locally advanced breast cancer (REMAGUS 02): Preliminary results

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10637-10637 ◽  
Author(s):  
J. Y. Pierga ◽  
C. Mathiot ◽  
J. M. Extra ◽  
P. Tresca ◽  
J. Asselah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Randomized Phase Ii ◽  
Number Of Patients

10637 Background: The presence of CTCs in blood from metastatic breast cancer patients before first line chemotherapy and persistence of CTCs after initiation of treatment, are predictive of shorter overall survival (Cristofanilli M; et al, 2005, J Clin Oncol 23:1420–1430). CTCs could be used as a surrogate marker. The aim of this study was to determine if CTC were present in the blood of patients who received neoadjuvant chemotherapy (CT) for large operable and locally advanced breast cancer, before initiation of CT (preCT) and at the end of CT before surgery (postCT). Methods: 7.5 ml of blood were obtained on CellSave tube from patients included in an ongoing randomized phase II trial. All patients received 4 cycles of Epirubicin-Cyclophosphamide every 3 weeks followed by 4 cycles of docetaxel associated with or not trastuzumab for HER2 positive patients and with or not celecoxib for HER2 negative patients. CTCs were immunomagnetically separated and fluorescently stained with the CellSearch kit. Cells were classified using the CellSpotter Analyzer as CTCs if they stained positive for DAPI (nuclear dye), and cytokeratin 8, 18 and 19, and if they stained negative for the leucocyte-specific antibody CD45. Results: From 10/2004 to 12/2005, preCT blood samples were obtained in 60 patients, analyzed in 56 for technical reasons. At least one CTC was detected in 15/56 (27%, CI 95%: 15.5–38.5%), 1 to 17 cells per sample (median 1.5). With a threshold of 2 cells, 8/56 (14%, CI 95%: 5–23%) patients were classified positive. At time of analysis, pre CT and post CT samples from the same patient were available for 19 patients. Six had >1 CTC/sample before CT (31.5%) and only one (1/6, 17%) remained positive after CT. Thirteen were negative for CTC before CT and 2/13 (15%) became positive after CT, with only one cell per sample. Conclusions: CTCs can be detected in blood of patients with large operable or locally advanced breast cancer before initiation of neoadjuvant CT and can be monitored during treatment. Longer follow-up and a larger number of patients are expected before correlating these data with tumor response and survival. No significant financial relationships to disclose.

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