ABSTRACT
Anti-aromatase therapy is important in the treatment of breast cancer in postmenopausal women. Cyclooxygenase-2 (COX-2) inhibitors have been shown to be effective in chemoprevention in animal and clinical studies. A proof of principle study was performed to investigate the efficacy of combing anti-aromatase therapy (exemestane) and COX-2 inhibitors neoadjuvantly in hormone-sensitive postmenopausal breast cancers. The initial results are reported. The patients were randomly assigned to receive exemestane 25 mg daily and celecoxib 400 mg twice daily (group A), exemestane 25 mg daily (group B) and letrozole 2.5 mg daily (group C). The analysis was based on 20 patients who received at least one cycle of treatment. Fourteen patients completed two cycles and 12 patients three cycles. All groups showed clinical response and there was decrease in tumor area in each group. However, complete clinical response was only observed for group A patients. There was also progressive decline in blood CEA and CA15.3 levels but the differences between the three groups were not significant. The results of the preliminary analysis are encouraging but definitive conclusion could only be drawn after the completion of the study.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Aromatase Inhibitors , Breast Neoplasms/drug therapy , Sulfonamides/therapeutic use , Androstadienes/administration & dosage , Antigens, Neoplasm/blood , Breast Neoplasms/enzymology , Breast Neoplasms/pathology , Carcinoembryonic Antigen/blood , Celecoxib , Enzyme Inhibitors/pharmacology , Enzyme Inhibitors/therapeutic use , Female , Humans , Letrozole , Middle Aged , Neoadjuvant Therapy , Nitriles/administration & dosage , Postmenopause , Pyrazoles , Sulfonamides/administration & dosage , Treatment Outcome , Triazoles/administration & dosageABSTRACT
BACKGROUND: Screening for breast cancer has resulted in an increasing number of mammographically detected lesions that require further management. The Advanced Breast Biopsy Instrumentation system is a recently added biopsy technique for the management of such lesions. The present paper will review the authors' experience in the use of this procedure in Chinese patients whose breast volume was smaller than that of Caucasians. METHODS: Ninety-three patients were listed for the procedure and 78 (84%) underwent the procedure successfully. Ninety-two lesions were biopsied. Advanced Breast Biopsy Instrumentation (ABBI) was performed for clustered microcalcifications or abnormal mass/density. Minimally Invasive Breast Biopsy (MIBB), a suction-assisted core biopsy device, was employed for more scattered lesions. For small volume breasts, it may be required to bring the hand through the aperture to get the targeted lesions onto the digital image or, in the case of ABBI, to excise just beyond the deep margin of the lesion rather than the recommended depth. RESULTS: The ABBI was performed for 43 (46.7%) lesions and MIBB for 49 (53.3%) lesions. Nine (9.8%) were diagnosed to have ductal carcinoma in situ, two (2.2%) had ductal carcinoma in situ with microinvasion and eight (8.7%) had invasive ductal carcinoma. All the malignant lesions required further management. In addition, 19 (20.7%) were found to have atypical hyperplasia. Patients' satisfaction and cosmetic outcome are good. CONCLUSION: The ABBI and MIBB procedures can be applied satisfactorily for biopsy of mammographic lesions with good -cosmetic outcome in Chinese patients.
