Consumption of herbs, food used as medicine and dietary supplements (HFDSs) is common in cancer patients. Herbs and food-drug interactions (HFDIs) can lead to serious adverse effects and can be ...prevented. We previously reviewed cytochrome P-450 (CYP)-mediated HFDI for 261 HFDSs and we classified the risk of CYP inhibition and induction on a level of evidence scale from 1 (high evidence, supported by several clinical studies) to 5 (low evidence, only limited preclinical data).
We conducted a prospective, non-interventional study (NCT04128865) to assess whether self-assessment of patients could detect HFDI classified as ‘probable’ (i.e. level 1, 2 or 3 of the scale) in a population of cancer patients. Patients were invited through a tablet application to report their consumption of herbs, regular CYP-interacting food consumption and dietary supplements, as well as some clinical data and cancer treatments. The patient’s completion of the survey could be supervised by a health care professional or not. A prespecified threshold of 5% of HFDIs classified as ‘probable’ detected with the application was deemed relevant.
Between 29 March 2018 and 22 June 2018, 143 patients completed the survey. Ninety-five patients (66%) reported at least one current systemic cancer treatment and were included in the analyses. Seventy-four patients reported an intake of at least one HFDS (77.9%), while 21 patients reported no HFDS (22.1%). Twenty-two HFDIs classified as ‘probable’ were found in 16 patients (16.8%) with the application, which was significantly superior to the prespecified threshold (P = 0.02). The interactions were reported with food (n = 19, 86%) more frequently than with herbs (n = 3, 14%) or with dietary supplements (no interaction reported).
Self-assessment of HFDS interaction with cancer treatment with an application is feasible and should be considered in daily routine. Prospective interventional studies should be conducted to better assess the clinical benefits of this approach.
•HFDSs are commonly used by cancer patients and can interact with treatments.•This clinical study aimed to demonstrate that self-reporting with a tablet application could detect potential interactions.•By self-reporting with a tablet we could detect 16.8% of patients with potentially clinically relevant HFDS–drug interactions.
Inflammatory breast cancers (IBC) particularly triple negative (TN) subtype have poor prognosis.
Between January 2010 and December 2016, all patients with TNIBC seen at breast cancer disease center, ...St Louis hospital, Paris, France, were treated with neoadjuvant dose dense Cyclophophamide (1.2g/m2 d1) - Epirubicin (75mg/m2 d1) q2w (SIM regimen) followed with 12 injections of paclitaxel (80mg/m2) qw or 4 injections of docetaxel (100mg/m2) q3w. All patients have histologically proven TN tumors and no evidence of metastases. Mastectomy and axillary clearance was performed after chemotherapy. pCR was defined as no residual invasive tumor in breast and lymph nodes. TIL and lymphovascular invasion were evaluated pre and post NAC by 2 independent anatomopathologists dedicated to breast cancer. Delta TIL was defined as the difference between post chemotherapy and pre chemotherapy TIL.
Thirty TNIBC patients were treated, 28 underwent surgery and 2 progressed during chemotherapy. Median follow-up was 45 months (8 – 103). 9/30 patients (30%) achieved pCR. Median disease free survival was not reached. Median TIL infiltration at diagnosis was 11% (0-60) and dropped to 1% after chemotherapy (0 – 80). On univariate analysis, LVI after chemotherapy (HR=2.1 95% CI, 1.1–3.6, p=0.02), TIL on mastectomy (HR=1.8 95% CI, 1.1–3.1, p=0.03), delta TIL (HR=2.2 95% CI, 1.4–3.5, p=0,001) were associated with DFS but no pCR (p=0,051). On multivariate analysis, only delta TIL remainedstatistically significant (HR=1.9 95% CI, 1.1–3.4, p=0.03).
We showed in this retrospective series of 30 TNIBC that dose dense dose intense chemotherapy is efficient in this population. Delta TIL is a strong prognostic factor associated with DFS. We show that a positive Delta TILis, among others, a strong and independent predictor of DFS: in TNIBC contrary to the results obtained in TN non inflammatory breast cancers, an increase in TIL after chemotherapy is associated with a decrease in DFS.The exact impact of LVI must be further investigated.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.
Abstract
Background
Inflammatory breast cancers (IBC) particularly triple negative (TN) subtype have poor prognosis.
Methods
Between January 2010 and December 2016, all patients with TNIBC seen at ...breast cancer disease center, St Louis hospital, Paris, France, were treated with neoadjuvant dose dense Cyclophophamide (1.2g/m2 d1) - Epirubicin (75mg/m2 d1) q2w (SIM regimen) followed with 12 injections of paclitaxel (80 mg/m2) qw or 4 injections of docetaxel (100 mg/m2) q3w. All patients have histologically proven TN tumors and no evidence of metastases. Mastectomy and axillary clearance was performed after chemotherapy. pCR was defined as no residual invasive tumor in breast and lymph nodes. TIL and lymphovascular invasion were evaluated pre and post NAC by 2 independent anatomopathologists dedicated to breast cancer. Delta TIL was defined as the difference between post chemotherapy and pre chemotherapy TIL.
Results
Thirty TNIBC patients were treated, 28 underwent surgery and 2 progressed during chemotherapy. Median follow-up was 45 months (8 – 103). 9/30 patients (30%) achieved pCR. Median disease free survival was not reached. Median TIL infiltration at diagnosis was 11% (0-60) and dropped to 1% after chemotherapy (0 – 80). On univariate analysis, LVI after chemotherapy (HR = 2.1 95% CI, 1.1–3.6, p = 0.02), TIL on mastectomy (HR = 1.8 95% CI, 1.1–3.1, p = 0.03), delta TIL (HR = 2.2 95% CI, 1.4–3.5, p = 0,001) were associated with DFS but no pCR (p = 0,051). On multivariate analysis, only delta TIL remainedstatistically significant (HR = 1.9 95% CI, 1.1–3.4, p = 0.03).
Conclusions
We showed in this retrospective series of 30 TNIBC that dose dense dose intense chemotherapy is efficient in this population. Delta TIL is a strong prognostic factor associated with DFS. We show that a positive Delta TILis, among others, a strong and independent predictor of DFS: in TNIBC contrary to the results obtained in TN non inflammatory breast cancers, an increase in TIL after chemotherapy is associated with a decrease in DFS.The exact impact of LVI must be further investigated.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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