CDK4/6 inhibitors combined with endocrine therapy have significantly improved treatment outcomes for metastatic hormone receptor-positive (HR+) breast cancer patients. However, the impact of low HER2 ...expression on treatment response and progression-free survival (PFS) remains unclear.
This multicenter retrospective study included 204 HR+ breast cancer patients treated with a combination of CDK4/6 inhibitor and endocrine therapy. HER2-zero disease was detected in 138 (68%) and HER2-low disease in 66 (32%) patients. Treatment-related characteristics and clinical outcomes were analyzed, with a median follow-up of 22 months.
The objective response rate (ORR) was 72.7% in the HER2 low group and 66.6% in the HER2 zero group (p = 0.54). Median PFS was not significantly different between the HER2-low and HER2 zero groups (19 months vs.18 months, p = 0.89), although there was a trend toward longer PFS in the HER2-low group for first-line treatment (24 months progression-free survival rate 63% vs 49%). In recurrent disease, the median PFS was 25 months in the HER2-low group and 12 months in the HER2-zero group (p = 0.08), while in de novo metastatic disease, the median PFS was 18 months in the HER2-low group and 27 months in the HER2-zero group (p = 0.16). The order of CDK4/6 inhibitor use and the presence of visceral metastasis were identified as independent variables affecting PFS.
Low HER2 expression did not significantly impact treatment response or PFS in HR+ breast cancer patients treated with a CDK4/6 inhibitor and endocrine therapy. Because of the conflicting results in the literature, further prospective studies are needed to evaluate the clinical significance of HER2 expression in HR+ breast cancer.
•Combination therapy with CDK4/6 inhibitors and endocrine therapy achieves impressive objective response rates in metastatic hormone-positive breast cancer patients regardless of HER2 status.•Low HER2 expression did not significantly affect survival in hormone-positive metastatic breast cancer patients receiving CDK4/6 inhibitors and endocrine therapy.•The order of CDK4/6 inhibitor use and the presence of visceral metastasis were identified as independent factors influencing progression-free survival.
Chordoma is a rare malignant tumor of the skull base and axial skeleton, with an incidence of less than 0.1/100,000 per year. Patients with advanced chordoma have a poor prognosis due to locoregional ...recurrence with infiltration and destruction of surrounding bone and soft tissue. Cytotoxic chemotherapy or other systemic therapies have not been proven to be effective for these diseases. Therefore, several molecularly targeted therapies have been proposed as potentially beneficial, including tyrosine kinase inhibitors such as imatinib, sorafenib, lapatinib, and others.
We present three cases of advanced chordoma treated with molecular targeted therapies: a 52-year-old Caucasian man, a 72-year-old Caucasian woman, and a 38-year-old Caucasian woman.
Chordoma has few systemic treatment options and they have limited benefit. Randomized trials with large patient numbers are unfeasible in this rare disease. Targeted therapy might be a reasonable alternative treatment for chordoma. Still, new treatment strategies are needed for this rare disease.
Cancer is a significant health problem for refugees and host countries. Breast cancer is the most common cancer among refugees. The subject of our study is to examine the clinical and pathological ...features of Syrian refugees with breast cancer and compare them with Turkish patients with breast cancer.
Data of patients with breast cancer between January 2018 and December 2020 were retrospectively reviewed. The clinical and histological features, treatment modalities and overall survival were collected and analyzed.
A total number of 338 women with breast cancer were included in this study. Ninety-nine of the 338 (29.3%) patients were Syrian refugees and 239 patients (70.7%) were Turkish. The median follow-up time was significantly lower in Syrian patients (
<0.001). Median OS was 146 months in Turkish and 116 months in Syrian group (
=0.022). Independent risk factors associated with long survival were receiving adjuvant chemotherapy (HR 0.465; 95% CI 0.234-0.926;
=0.029), adjuvant radiotherapy (HR 0.372 95% CI 0.182-0.758;
=0.007), and adjuvant hormonotherapy (HR 0.367; 95% CI 0.201-0.669;
=0.001). The rates of receiving adjuvant chemotherapy, adjuvant radiotherapy, and adjuvant hormonal therapy were significantly lower in the Syrian group (
=0.023,
=0.005,
=0.002, respectively).
Syrian refugees with breast cancer are more likely to receive suboptimal treatments. They have inferior survival compared to local patients. Our findings highlight the need for the provision of cancer therapy in such vulnerable populations. We suggest that more attention should be paid to breast cancer, as it is the most common cancer among refugees.
Aim: DR-70 is a newly developed immunoassay that detects fibrin degradation products in blood. We aimed to evaluate ability of DR-70 in monitoring treatment response in advanced gastrointestinal (GI) ...cancers.
Materials and Methods: We prospectively enrolled patients with advanced GI cancers treated with different lines of systemic therapies. Imaging studies, DR-70 and conventional tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 were analyzed at baseline and on the third month of treatment.
Results: A total of 142 patients diagnosed with colorectal (52.1%), esophago-gastric (32.4%) and pancreaticobiliary cancer (15.5%) were enrolled. Most patients were getting first-line treatment (56.3%). Second blood sampling was performed in 57% of patients. Among patients with esophago-gastric cancer, DR-70 response correlated well with treatment response (p=0.007) and low baseline DR-70 level was significantly associated with longer overall survival (p=0.02). There was a positive but weak correlation between pre-treatment DR-70 and CEA levels (p=0.03, r=0.244) in patients with colorectal cancer, while a moderate positive correlation was present between pre-treatment DR-70 and CA 19-9 levels in esophago-gastric and pancreaticobiliary cancers (p=0.01, r=0.402 and p=0.04, r=0.515, respectively). More than 25% reduction in DR-70 concentration was associated with better overall and progression-free survival.
Conclusion: DR-70 is a strong predictor of treatment response and survival, particularly in esophago-gastric cancer.
Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our ...results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC.
In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging.
Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002).
Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging.
Introduction
Male breast cancer, comprising approximately 1% of all breast cancer cases, often leads to the exclusion of male patients as a criterion in clinical trials. While the efficacy of ...Cyclin-dependent kinases 4 and 6 (CDK 4/6) inhibitors has been established in metastatic hormone receptor-positive (HR +) and human epidermal growth factor receptor 2-negative (HER2 −) breast cancer in women, limited data exist on their effectiveness in male patients.
We aimed to evaluate the efficacy and safety of palbociclib or ribociclib in male patients with breast cancer.
Methods
This study is a multicenter, retrospective study. We included male patients with HR + and HER2-metastatic breast cancer who received palbociclib or ribociclib as first-line treatment. Our primary endpoints were progression-free survival (PFS), overall response rates (ORR), and drug-related adverse effects.
Results
A total of 46 male patients from 27 institutions were enrolled. The median age at initiation of CDK 4/6 inhibitors was 63.64 ± 13.69 years, with a median follow-up of 21.33 (95% CI 14.92–27.74) months. The ORR were 84% for palbociclib and 76.2% for ribociclib. The mPFS for the entire cohort was 28.06 months (95% CI 18.70–37.42). No significant difference in PFS was observed between palbociclib and ribociclib (mPFS: 24.46 months (95% CI 11.51–37.42) vs 28.33 months (95% CI 14.77–41.88), respectively,
p
= 0.211). No new adverse events were reported.
Discussion
This study demonstrates that palbociclib and ribociclib are effective and safe options for first-line treatment in male patients with HR + /HER2 − metastatic breast cancer. However, further prospective studies are warranted to establish their efficacy in this population.
OBJECTIVE This study aims to evaluate the predictive impacts of cigarette smoking on treatment outcomes of EGFR tyrosine kinase inhibitors (TKIs) in Non-Small Cell Lung Cancer (NSCLC) patients with ...activating EGFR mutations. METHODS We retrospectively evaluated the data of 46 patients with metastatic NSCLC (adenocarcinoma) and EGFR mutation (exon 19 deletion, exon 21 mutation, and exon 18 activating mutation) treated with EGFR-TKI between 2012 and 2017. RESULTS Median age was 61 (range 30-80), and 56.5% (26/46) was female. Median follow-up was 39 months. The rate of smoking was 41.3% (19/46). The EGFR mutations were present in the patients, exon 19 deletion in 29 patients (64%), exon 21 mutation in 13 patients (28%) and exon 18 activating mutations in four patients (8%). Progression-free survival (PFS) was 21 months in smokers, whereas it was 25 months in non-smokers (p=0.330). Median PFS was 21 months for patients using EGFR TKI in the first-line (35 patients), and 13 months in the second-line setting (11 patients). CONCLUSION There were no statistically significant PFS differences between the smoker and non-smoker groups. Smokers should be tested for EGFR mutations, as some patients may benefit from EGFR TKI treatment for longer than reported in the literature.
The optimal surgical strategy for treating colorectal cancer with synchronous liver metastases is subject to debate. The current study sought to evaluate the outcomes of simultaneous colorectal ...cancer and liver metastases resection in a single center. Prospectively collected data on all patients with synchronous colorectal liver metastases who underwent simultaneous resection with curative intent were analyzed retrospectively. Patient outcomes were compared depending on the primary tumor location and type of liver resection (major or minor). Between January 2005 and August 2016, 108 patients underwent simultaneous resection of primary colorectal cancer and liver metastases. The tumor was localized to the right side of the colon in 24 patients (22%), to the left side in 40 (37%), and to the rectum in 44 (41%). Perioperative mortality occurred in 3 patients (3%). Postoperative complications were noted in 32 patients (30%), and most of these complications (75%) were grade 1 to 3 according to the Clavien-Dindo classification. Neither perioperative mortality nor the rate of postoperative complications after simultaneous resection differed among patients with cancer of the right side of the colon, those with cancer of the left side of the colon, and those with rectal cancer (4%, 2.5%, and 2%, respectively, p = 0.89) and (17%, 33%, and 34%, respectively; p = 0.29). The 5-year overall survival of the entire sample was 54% and the 3-year overall survival was 67 %. In conclusion, simultaneous resection for primary colorectal cancer and liver metastases is a safe procedure and can be performed without excess morbidity in carefully selected patients regardless of the location of the primary tumor and type of hepatectomy.
Current evaluation of response to neoadjuvant chemotherapy (NAC) shows that it could achieve pathological complete response (pCR). The purpose of this study was to assess the consistency of maximum ...uptake values (SUVmax) changes and pCR in hormone-positive locally advanced breast cancer (LABC).
Ninety hormone-positive LABC patients treated at Marmara University Medical Oncology Clinic, Istanbul, Turkey, between 2009 and 2015 were retrospectively studied. All eligible patients (n=5) received NAC (4-8 cycles) and were evaluated for pCR. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG- PET/CT) scan was performed before and after the completion of NAC. The relative changes of SUVmax both in the primary tumor and the axilla were assessed for consistency with pCR.
The patient median age was 46 years (range 26- 76). The patients 13.7% achieved pCR. Values of >50% (n=40) and <50% (n=11) SUVmax changes were not associated with pCR (15% and 18% respectively) (p=1.00). Patients with >75% SUVmax changes could achieve pCR of 20%. Interestingly, most patients with complete metabolic response did not achieve pCR (81%). The difference of the Ki67 levels before and after NAC, tumor localization, HER- 2 positivity, menopausal status, grade of differentiation, lymphovascular and perineural invasion were not associated with pCR.
SUVmax changes in later cycles of NAC as commonly practised in oncology clinics were not consistent with pCR (p=1.0). Complete metabolic response may not be associated with pCR in hormone-positive LABC. However, almost 80% of patients had >50% decrease in SUVmax and may still have a chance for conservative surgery and less postoperative morbidity. Therefore, 18F-FDG-PET/CT may still have a role to evaluate the tumor response with a need of larger studies and analysis for cost-effectiveness.
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