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Aromatase inhibitors (AIs) directly applies to postmenopausal breast cancer patients. Patients underwent bilateral ovariectomy or ≥60 years were acknowledged as postmenopausal.Alternatively, for <60 years breast cancer patients, sex hormone detection to evaluate menopause is recommended by National Comprehensive Cancer Network (NCCN) guideline, textbooks, and AIs clinical trials.However, series of clinical trial found that, a broad overlap region of follicle stimulating hormone and estradiol appeared between premenopausal and postmenopausal patients, which unable to determine the menopause even with sensitivity promotion of detection equipment or manners.We have abandon this detection in clinical treatment, and decision making was only according to the relapse risk and disease status. We recommend bilateral ovariectomy resection accompanied with AIs for breast cancer patients with high recurrence risk (e.g. T3-4 or LNM≥4) or patients with advanced metastatic disease.However, patients with low or moderate recurrence risk can be treated with tamoxifen.
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Objective To explore the effect of prognosis of consolidation radiotherapy for patients after R0 resection of local recurrence after radical mastectomy. Methods Totally 110 breast cancer patients with local recurrence receiving R0 resection were admitted and treated in our hospital from January 1st, 2003 to November 30th, 2015 were retrospectively analyzed. Results The median local progression time of 74 patients receiving consolidation radiotherapy ( 67.3％) was remarkably better than that of those without radiotherapy(36 patients, 32.7％), and the difference was statistically significant (χ2 =8. 526, P<0.05). Meanwhile, there was no statistically significant difference (P>0.05) of distance disease-free survival and overall survival between the radiotherapy group and the non-radiotherapy group. Multifactor analysis indicated that pseudo-adjuvant endocrine therapy (χ2 =7.541,95％CI:27.1％ -80.4％, P <0.05), DDFS(≥2 years vs. <2 years,χ2 =4.068,95％CI:101.4％ -267％,P<0. 05) and pseudo-adjuvant radiotherapy(χ2 =14.126, 95％CI:21.7％ -80.4％, P <0. 05 ) were the independent risk factors affecting the OS of patients with local recurrence after R0 resection. Conclusions For the patients with local recurrence after R0 resection of local recurrence, it is recommended that consolidation radiotherapy should be done and the radiation field should include the same side of the chest wall and clavicle area lymphatic drainage area.
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Osteoblastic metastasis of breast cancer is relatively rare, but there are cases of misdiagnosis and mistreatment in clinical treatment. They can only be diagnosed by X ray or CT bone scan and must be identified from bone repair after effective treatment in patients with osteolytic or mixed bone metastases. Bone metastasis is often seen in the disease-free condition of breast cancer, and very few can occur in stage Ⅳ lesions prior to surgery. Based on the analysis of clinical phenomena, we questioned the evaluation criteria of the therapeutic effect on bone metastasis of breast cancer created by the World Health Organization and the MD Anderson Cancer Center and concluded the formation mechanism of bone metastasis. For patients with simple osteoblastic bone metastasis, we broke through the recommendations of the National Comprehensive Cancer Network guideline and advocated the concept of "noninterference" . Patients with positive hormone receptor can be treated with traditional endocrine therapy. Hormone receptor negative and/or human epidermal growth factor receptor 2 positive patients can be observed first, followed by chemotherapy and/or targeted therapy when there is osteolytic bone metastasis or visceral metastasis. Furthermore, bisphosphonates are not required since osteoblastic bone metastasis is generally not associated with the risk of bone related events. The active treatment of primary lesion should be taken into account in stage Ⅳ patient before operation.
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Skeleton is one of the most common metastatic organs for breast cancer, which has a better prognosis than visceral metastases. Bone-only metastasis was defined"non-measurable" in the RECIST (Response Evaluation Criteria in Solid Tumors) criteria, and was excluded by clinical trials. However, patients with bone-only metastasis are also in need of effective treatment to prolong survival. Endocrine therapy is the most important treatment for bone metastatic patients. Tumor response of bone metastases can be determined objectively by bone-window CT. Effective treatment should be continued if the symptoms are relieved or osteogenesis is observed. Osteoblastic change in bone-window CT is a sign of improvement after treatment. Endocrine therapy is proper for ER-positive patients. The patients with initial osteoblastic metastasis should not be treated with salvage chemotherapy or anti-HER2 treatment, only if osteolytic metastasis or visceral metastasis is observed. Bishosphonates are just auxiliary drugs in bone metastasis, which should not be abused.
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Objective To analysis the relationships between bone markers, bone-specific alkaline phosphatase (BAP) and cross-linked telopeptide of type Ⅰ collage (ICTP), and bone metastasis of breast cancer.Methods A total of 217 patients' serum were collected.The 217 cases were divided into two groups:109 cases with bone metastasis, 108 cases without bone metastasis. Serum BAP and ICTP was measured by ELISA. The relationships between factors of bone metastasis and serum levels of BAP, ICTP were analyzed.Results The levels of serum BAP and ICTP in bone metastases group were significantly higher than those in non-bone metastasis group[BAP:24.8 μg/L(7.60-213.70 μg/L) vs 21.2 μg/L(7.3～68.8 μg/L),ICTP:7.0μg/L(1.4～32.4 μg/L) vs 4.1 μg/L(0.0～15.8 μg/L) (P=0.003,P=0.000)].The level of serum BAP and ICTP in patients with multiple bone metastasis was significantly higher than that in patients with single bone metastasis[BAP:32.3 μg/L(9.A～213.7 μg/L) vs 18.1 μg/L(7.6～60.0 μg/L),ICTP:7.6 μg/L(1.4～32.4 μg/L) vs 4.9 μg/L(1.8～10.5 μg/L),(P=0.001,P=0.010)].The sensibility of BAP and ICTP was 45.0 ％ (49/109)and 46.8 ％ (51/109),respectively.The specificity of ICTP and BAP was 83.3 ％ (90/108)and 84.3 ％ (91/108),respectively.Joint detection of BAP and ICTP had improved sensibility in the diagnosis of bone metastasis in breast cancer patients. Conclusion Joint detection of serum bone biochemical markers ICTP and BAP have a little values for diagnosing bone metastasis in breast cancer patients.
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Anti-angiogenesis drug has become an important method and a hot research field for treating cancers.Drugs such as bevacizumab,sunitinib,sorafenib,lapatinib,achieved good clinical effect in treating breast cancers,but they also brought a lot of problems that need to be concerned.
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Objective To analyze the clinic characteristics, lifetime and prognostic factors of young female breast cancer patients. MethodsClinical data of 155 patients under 35 years of age with breast cancer were retrospectively reviewed and followed up.ResultsThe positive rate of hormone receptors was 61.6 % (77/125) in all cases who had been detected receptor status. The median survival time in hormone receptors positive and negative group were 119.0 and 51.3 months (P＜0.01), and 5-year survival rates were 68 % and 33 %, respectively. For patients who had been treated with adjuvant tamoxifen (47.1%), the median survival time was 182 months which longer than without tamoxifen (P ＜0.05). The median disease-free survival time and median survival time were 24 and 91 months in all cases. The overall 3-, 5- and 10-year survival rates were 79 %, 60 % and 51%, respectively. Multifactor analysis with the COX model indicated that tumor size, axillary metastatic status, tamoxifen treatment and overexpression of Her-2 were independent prognostic factors. While clinic stage and hormone receptors status might be referenced prognostic factors. ConclusionYoung women breast cancer patient may have good prognosis if multimodality treatment is conducted. Tumor size, axillary metastatic status, adjuvant endocrine therapy and overexpression of Her-2 are independent prognostic factors.
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Cardiotoxicity associated with anthracyclines and trastuzumab is discussed from clinical manifestations, pathogenesis, risk factors, monitoring methods, prevention and treatment.
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Metastatic breast cancer (MBC) is a heterogeneous disease that has a variety of different clinical scenarios. There are few recognized therapeutic standards for MBC. Combining recent international guidelines and consensus recommendations with our clinical practice experience, the article will introduce and comment many sides about the treatment for MBC patients.
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<p><b>OBJECTIVE</b>To evaluate the response rate and adverse reactions of xeloda, an analogue of 5-fluorouracil, in the treatment of relapsed and metastatic breast cancer.</p><p><b>METHODS</b>Twenty-two breast cancer patients who had recurrent and metastatic measurable foci were treated from Dec. 1999 to Feb. 2000. Xeloda was given, as a single drug, at a dose of or 2,510 mg/m2/d, bid, for two weeks followed by one week rest as one cycle, at least for one cycle in each patient.</p><p><b>RESULTS</b>Among these 22 patients, there was no complete response. Rates of partial response 8(36.4%), stable disease 10(45.5%), progressive disease 4(18.2%), and clinical benefit response (CR + PR + SD) 18(81.8%). The response rate in patients who had failed in previous chemotherapy of taxanes and/or anthracycline was 30.0%-33.3%. The common adverse reactions were hand-foot syndrome, skin pigmentation, nausea, vomiting, anorexia and fatigue. Mild-moderate anemia and leukopenia were observed in 36.4% of patients. Stomatitis, dizziness, diarrhea and chest distress were present in some. One patient developed degree IV myelosuppression. Total bilirubin and alanine transaminase (ALAT) mild elevation occurred in a few patients.</p><p><b>CONCLUSION</b>Xeloda is an effective drug in the treatment of patients with relapsed and metastatic breast cancer, especially for those who have failed in chemotherapy with taxanes and/or anthracycline. Xeloda is well tolerated but has mild adverse reactions.</p>
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Antimetabolites, Antineoplastic , Therapeutic Uses , Breast Neoplasms , Drug Therapy , Pathology , Capecitabine , Deoxycytidine , Therapeutic Uses , Fluorouracil , Neoplasm Metastasis , RecurrenceABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy and adverse effects of lentaron for postmenopausal patients with recurrent and metastatic breast cancer.</p><p><b>METHODS</b>Thirty-four patients with recurrent and metastatic breast cancer received 250 mg lentaron by intramuscular injection every 2 weeks for at least one month.</p><p><b>RESULTS</b>In 34 patients who were evaluable for efficacy and toxicity, the complete response rate (CR), partial response rate (PR), disease stabilization rate (SD) and progressive disease rate (PD) were 0%, 14.7%, 58.8% and 26.5%. The clinical benefit rate (CR + PR + SD >/= 6 months) was 50.0%. (17/34) with 12 patients (35.3%) having SD for at least 6 months. The response rates for bone, soft tissue and visceral metastasis were 28.6% (3/14), 13.6% (3/22) and 5.3% (1/19), respectively. There were no severe adverse effects in the treatment bylentaron.</p><p><b>CONCLUSION</b>Lentaron is a well tolerated agent with reasonable efficacy but low toxicity for postmenopausal patients with recurrent and metastatic breast cancer.</p>
Subject(s)
Female , Humans , Androstenedione , Therapeutic Uses , Antineoplastic Agents , Therapeutic Uses , Breast Neoplasms , Drug Therapy , Pathology , Disease Progression , Neoplasm Metastasis , Neoplasm Staging , Postmenopause , Treatment OutcomeABSTRACT
Objective To investigate the expression of tumor suppressor gene PTEN in breast carcinomas and its significance. Methods Immunohistochemical method was used to detect the expression of PTEN gene in 146 cases of breast carcinoma and 10 specimens of normal breast tissue closely adjacent to carcinoma. Results It was showed that PTEN gene was expressed in all 10 specimens of breast tissue closely adjacent to carcinoma. Expression of PTEN was localized in cytoplasm and nuclei of epithelial cells of lobular acini and epithelial cells of ducts. The rate of PTEN expression was 57.5% (84/146) in breast carcinoma. Expression of PTEN was related to tumor size, pathological stage, and the expression of ER and PR of breast cancer. The 2-year disease free survival of PTEN high expression breast cancer patients was superior to those with low expression (P
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Objective To detect the mutation frequency and mutation type of tumor suppressor PTEN in sporadic breast carcinoma tissues, and to investigate the association of PTEN gene mutation and sporadic breast cancer. Methods Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) was used to amplify 9 exons of PTEN and to analyze the conformation polymorphism, then DNA sequencing methods was used to detect point mutation of PTEN gene nine exons of abnormal single strand conformation in breast carcinoma. Results One of 45 cases showed 24th condon A→C missense mutation in the exon2 of PTEN gene, and this mutation made Met to change to Ala in PTEN protein structure. Conclusion These data indicated the existence of PTEN mutation in sporadic breast cancer, but PTEN gene mutation rate is very low.
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To evaluate the effect of mobilization of peripheral blood stem cells (PBSC) with high dose cyclophosphamide combination chemotherapy and G-CSF in breast cancer patients, a new mobilization protocol was designed on the basis of standard combination chemotherapy regimen, in which the dose of cyclophosphamide was raised to 2 to 4 times, and G-CSF began to be used at the dose of 150 micro g twice everyday when white blood cell (WBC) decreased below 1.0 x 10(9)/L. PBSC collection was performed while WBC increased over 5.0 x 10(9)/L during bone marrow recovering. The PBSC mobilization protocol was completed in 10 patients, the median nadir of WBC was 0.8 (0.4 - 1.0) x 10(9)/L, the median time of PBSC collection was 2 (2 - 4), the median number of collected CD34(+) cells was 6.43 (1.99 - 8.75) x 10(6)/kg. The results showed that the protocol, high dose cyclophosphamide combination chemotherapy, was an optimal PBSC mobilization regimen in breast cancer patients.
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How to select endocrine agents for patients with ER-positive/ Her-2 -positive breast cancer has been a difficult question. Increasing evidences shows a consistent results that an association between Her-2 overexpression and poor response of endocrine treatment, tamoxifen and the third generation aromatase inhibitors has the similar poor efficacy. The treatment strategy for such patients should prefer chemotherapy alone or in combination with trastuzumab, and endocrine therapy combining with trastuzumab may be the development strategy.
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Taxol is one of the most active agent in metastatic breast cancer. Taxol is also an excellent choice for combination therapy by its unique mechanism of action and favorable toxicity profile. Numerous phase II clinical studies have combined taxol with other active agents such as the anthracyclines, gemcitabine, carboplatin and Herceptin. In the adjuvant chemotherapy for early stage breast cancer, two large international clinical trials demonstrated the role of taxol in early breast cancer. CALGB 9344 demonstrated the addition of four cycles of taxol after the completion of a standard course of CA improves the disease-free and overall survival of patients with early breast cancer. CALGB 9741 showed dose density chemotherapy of taxol improves clinical outcomes significantly, while sequential chemotherapy is as effective as concurrent chemotherapty.