Efficacy and safety analysis of paclitaxel liposome and docetaxel for the neoadjuvant chemotherapy of breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to analyze the efficacy and safety of paclitaxel liposomal and docetaxel for neoadjuvant chemotherapy of breast cancer.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 188 operable patients with breast cancer who received neoadjuvant chemotherapy. According to the treatment regimens, they were divided into the group of paclitaxel liposome (86 patients) and group of docetaxel (102 patients) treatment. All the patients received a combination therapy with epirubicin and cyclophosphamide, i.e. neoadjuvant chemotherapy with three drugs, 21 days as a cycle, and a total of 6 cycles. Surgery was carried out three weeks after the end of chemotherapy, and the chemotherapy efficacy and adverse reaction of both groups were evaluated.</p><p><b>RESULTS</b>Pathological complete response (pCR) rate in the paclitaxel liposome group and docetaxel group was 10.5% and 9.8%, respectively, the objective response rate (ORR) was 80.2% and 79.4%, respectively, and the disease control rate (DCR) was 95.3% and 93.1%, respectively, showing a non-significant difference in therapy efficacy between the two groups (P > 0.05). Safety analysis indicated that all the occurrence rates of skin and nail toxic reaction, body fluid retention, oral mucositis, allergic reaction (such as facial blushing, chest distress, palpitation, dyspnea. etc.), and grade III-IV leukopenia and neutropenia in the paclitaxel liposome group were significantly lower than that of the docetaxel group (all P < 0.05).</p><p><b>CONCLUSIONS</b>Compared with docetaxel, paclitaxel liposome has the same anti-tumor efficacy, but causes fewer and milder adverse reactions with a higher safety in the neoadjuvant chemotherapy for breast cancer.</p>

Prognostic significance of Ki-67 expression before and after neoadjuvant chemotherapy in different biological breast cancer phenotypes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>This study was conducted to analyze the Ki-67 expression before and after neoadjuvant chemotherapy and clinicopathological characteristics of different biological breast cancer phenotypes. The significance and prognostic predictive value of the changes of Ki-67 expression in different biological breast cancer phenotypes were analyzed.</p><p><b>METHODS</b>A regression analysis was performed on 178 patients with invasive breast carcinoma who accepted neoadjuvant chemotherapy at Tianjin Medical University Cancer Institute and Hospital from August 2007 to August 2008. These patients were subtyped by hormone receptor status and HER-2 status. The Ki-67 index (percentage of Ki-67-positive cancer cell nuclei) was determined by immunohistochemistry. The prognostic value of Ki-67 index for disease-free survival (DFS) in different biological breast cancer phenotypes was analyzed using Kaplan-Meier survival and multivariable Cox regression.</p><p><b>RESULTS</b>The overall pathologic CR (pCR) rate, defined as no invasive residuals in the breast and axilla, was 15.2%. The highest pCR rate of 25.0% was observed in the TNBC patients, which was 14.3%, 10.3% and 18.2% in the luminal A, luminal B and HER2 overexpressing patients, respectively (P = 0.040). The changes of Ki-67 expression in pre-NAC and post-NAC patients showed a prognostic significance in luminal A and TNBC (P = 0.019 and P = 0.022, respectively) cases. Clinical stage, the efficacy of NAC, and changes of Ki-67 expression between pre- and post-NAC were independent prognostic factors in TNBC patients who did not achieve pCR.</p><p><b>CONCLUSIONS</b>The Ki-67 expression after neoadjuvant chemotherapy is an independent prognostic factor affecting the disease-free survival (DFS) in TNBC patients who have not achieved pCR.</p>

Clinicopathologic characteristics and prognostic analysis of luminal B breast cancer patients with diabetes / 中国肿瘤临床

Objective:To investigate the clinical, pathological, and prognostic characteristics of luminal B breast cancer patients with diabetes. Methods:A total of 479 luminal B breast cancer patients with diabetes and 3 392 luminal B breast cancer patients without diabetes who were treated between January 2002 and December 2006 were enrolled in this study. The luminal B breast cancer patients were further divided into the luminal B (high ki67) and luminal B (Her-2/neu+) subgroups. Each subgroup was further grouped into metformin-treated, non-metformin-treated, and non-diabetic groups. The indicators included cancer-specific mortality, clinical, pathological stage, lymph node status, chemotherapy, and endocrine therapy. The survival analysis of each group was performed using the Kaplan-Meier method, and the significance was determined using the logrank test. Cox proportional hazard model was used to examine the correlation between each factor and the prognosis. Results:The Kaplan-Meier analysis results revealed that the breast cancer mortality rates in the metformin-treated, non-metformin-treated, and non-diabetic groups were significantly different in both luminal B (high ki67) and luminal B (Her-2/neu+) subgroups (logrank test:P<0.001, P=0.035), and the respective five-year survival rates were 93.5%, 81%, and 89%for the luminal B (high ki67) subgroup and 84%, 77%, and 83%for the luminal B (Her-2/neu+) subgroup. The Cox multifactorial regression analysis results showed that compared with the metformin-treated group, the non-metformin-treated group was associated with a significantly increased risk of mortality (P<0.001, P=0.044) in the two subgroups. Meanwhile, the non-diabetic group was associated with an increased risk of mortality (P=0.038) in the luminal B (high ki67) subgroup only. The percentage of elderly (P<0.001), menopausal (P<0.001), obese (P<0.001), and patients with cardio-cerebrovascular complications (P<0.001) tended to be higher in the metformin-treated and non-metformin-treated groups than in the diabetic group. Moreover, the metformin-and non-metformin-treated groups in the luminal B (high ki67) subgroup were associated with high percentages of T3/4 pathological stage (P<0.001), lymph node metastasis (P=0.001). The non-metformin-treated group was associated with a lower percentage of invasive ductal carcinoma (P=0.001) compared with the other two groups. Conclusion:The non-metformin-treated group resulted in worse clinical outcomes in both subgroups compared with the metformin-treated group. Meanwhile, the non-diabetic group resulted in the worst prognosis among the three groups in the luminal B (high ki67) subgroup. These findings suggest that the choice of different anti-diabetic drugs may influence the prognosis of luminal B breast cancer patients with diabetes.

A comparative study on invasive micropapillary carcinoma and invasive ductal carcinoma of the breast / 中华普通外科杂志

Objective To elucidate the differences between invasive micropapillary carcinoma (IMPC) and invasive ductal carcinoma(IDC),and explore the clinicopathological and immunohistochemistry characteristics of invasive micropapillary carcinoma of the breast.Methods Invasive micropapillary carcinoma was identified in 51 patients by retrospective review of database from October 2004 to November 2007.Data were compared with 102 patients identified as invasive ductal carcinoma available in this hospital during the same period.Results Significant differences were observed in mammilla invasion,lymphatic vessel invasion,positivity of lymph node,lymph node metastatic level,extranodal extension,estrogen receptor,progestin receptor,triple negative between the two groups; while there was no significant differences between the two groups as to amenorrhea status,lesion laterality,number of metastatic lymph nodes,human epidermal growth factor receptor-2,local recurrence and distant organ metastasis.The median follow-up time of the invasive micropapillary carcinoma group were 46 months ( 16 - 75 months),and the 3-year overall survival and disease free survival was 90.2％ and 84.3％,respectively.Conclusions Invasive micropapillary carcinoma is a unique subtype of breast cancer which manifests an aggressive behavior tending to involve lymph node and extranodal soft tissues.Invasive micropapillary carcinoma of the breast had high expression of hormonal receptors,and triple negative breast cancer is less common in this type of breast cancer.

Clinical Effect of Neoadjuvant Chemotherapy Combined with PA-MSHA Injection on Breast Cancer / 中国肿瘤临床

Objective: To evaluate the effect and safety of neoadjuvant chemotherapy combined with PA-MSHA injection for breast cancer patients. Methods: An open randomized controlled clinical trial was con-ducted. Fourty patients with breast cancer were randomly assigned to neoadjuvant chemotherapy group (the control group, n=20) and neoadjuvant chemotherapy combined with PA-MSHA injection group (the experi-ment group, n=20). The evaluation of therapeutic effect was carried out when the treatment was completed. Kamofsky score was recorded before and after therapy. Venous blood was drawn before and after therapy and immune function (IFN-γ, IL-2, IL-4, and IL-10) and other indicators (Caspase-3, VEGF, MMP-2 and MMP-9) were measured by double antibody ELISA test. Adverse effects of PA-MSHA during therapy were ob-served and recorded. Results: The overall response rate (RR) in the experiment group was significantly higher than that in the control group (P<0.05). No significant difference was found in the pathologic complete remis-sion (pCR) between the experiment group and the control group (P>0.05). In the experimental group, pCR was significantly different before and after therapy (P<0.01). The score in the experimental group was signifi-cantly higher than that in the control group after therapy (P<0.01). With the treatment of chemotherapy and PA-MSHA injection, IFN-γ and IL-2 levels were significantly higher while IL-4 and IL-10 levels were significant-ly lower in the experiment group (P<0.05). A significant increase in serum Caspase-3 and a significant de-crease in serum VEGF, MMP-2 and MMP-9 (P<0.05) after therapy were also observed in the experimental group. The level of serum MMP-9 was decreased significantly (P=<0.05) after therapy in the control group. Con-clusion: Neoadjuvant chemotherapy combined with PA-MSHA injection can significantly improve the RR of breast cancer patients, enhance their cellular immune function, induce the apoptosis and restrain the metasta-sis of breast cancer cells. The PA-MSHA has been proved to be an ideal supplementary therapy for breast cancer.

Aromatase inhibitors and TAM in the treatment of post-menopausal Luminal B breast cancer patients / 中华普通外科杂志

Objective To evaluate a therapeutic strategy using aromatase inhibitors and TAM in postmenopausal Luminal B breast cancer patients. Methods The clinical data of 733 primary breast cancer cases receiving postoperative endocrine thempy from July 2002 to Mar 2005 in Tianjin Cancer Hospital were retrospectively analyzed.Diagnosis was confirmed by pathology in all the cases.All patients were post-menopausal and ER-positive.501 patients were given tamoxifen(TAM 2.5 mg qd,po),232 patients were given aromatase inhibitors(Letrozole 10 mg bid,po).The follow-up time ranged from 36 to 90 months.Median follow-up time was 46 months.Results The disease-free-survival(DFS)rate of Luminal B breast cancer patients in aromatase inhibitors(AIS)group was higherthan that in TAM group(90.6% vs.88.6%,P=0.038).In TAM group,subgroup analysis showed 3-year DFS of node-positive with HER2(+)is lower than that of node-positive with Her-2-negative(88.2% vs.90.4%,P=0.037);3-year DFS of ER+/PR+ group in HER2(+) patients was higher than that of ER+/PR-group(90.8% vs.89.5%.P=0.032).In AIs group,in spite of the axillary lymph node status,there was no significant difference of 3-year DFS between HER2(+)patients and HER2(-)ones(P>0.05).3-year DFS of ER+/PR+with HER2(+) patients was higher than that of ER+/PR-ones with HER2(+)(91.9% vs.90.5%,P=0.029).Hot flush,vaginal bleeding and thromboembolics in AIS group is less frequent,but muscle pain and bone fracture is more common than that in TAM group(P<0.05).Conclusion Compared to TAM, AIs is more effective and safer with postmenopausal Luminal B patients,and the effect is independent on node stams.