Hormonálně dependentní HER2 negativní karcinom prsu je nejčastějším podtypem tohoto onemocnění. Kombinace hormonální léčby s inhibitory cyklin-dependentních kináz 4 a 6 (CDK 4/6) je v případě metastazujícího onemocnění jednoznačně preferovaným postupem v iniciálních fázích terapie, a to jak u premenopauzálních, tak postmenopauzálních pacientek. Díky této terapii došlo k výraznému zlepšení prognózy pacientek, a to jak ve smyslu prodloužení doby bez známek progrese onemocnění, tak celkového přežívání. Charakteristiky a chování onemocnění u premenopauzálních pacientek se liší od profilu onemocnění u pacientek postmenopauzálních; častěji se jedná o agresivnější onemocnění (vyšší proliferace, nižní exprese hormonálních receptorů, vyšší nádorový grade) s postižením viscerálních orgánů a s výraznějšími symptomy onemocnění. I v těchto případech je preferována kombinace hormonální léčby s inhibitory CDK 4/6 před chemoterapií. Předkládáme kazuistiku mladé premenopauzální pacientky s metastazujícím karcinomem prsu s postižením plic, hrudní dutiny a skeletu, s iniciálně výrazně symptomatickým a agresivním onemocněním, u které bylo dosaženo pomocí kombinace inhibitoru aromatázy a ribociklibu rychlé a dlouhodobé stabilizace onemocnění s výrazným zlepšením kvality života.
Hormone-dependent HER2-negative breast cancer is the most common subtype of this disease. Combination of hormonal therapy with cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors is clearly the preferred approach for metastatic disease in the initial phases of therapy in both premenopausal and postmenopausal patients. This therapy has significantly improved the prognosis of patients, both in terms of prolonged progression-free survival and overall survival. The characteristics and behavior of the disease in premenopausal patients differ from the disease profile in postmenopausal patients; more often it is a more aggressive disease (higher proliferation, lower hormone receptor expression, higher tumor grade) with visceral involvement and more pronounced symptoms. Even in these cases, the combination of hormonal therapy with CDK 4/6 inhibitors is preferred over chemotherapy. We present a case report of a young premenopausal patient with metastatic breast cancer involving the lung, thoracic cavity and skeleton, with initially highly symptomatic and aggressive disease, in whom a combination of aromatase inhibitor and ribociclib achieved rapid and long-term disease stabilization with significant improvement in quality of life.
Zařazení anti-HER2 terapie do léčebného algoritmu metastazujícího karcinomu prsu s pozitivitou receptoru 2 pro lidský epidermální růstový faktor (human epidermal growth factor receptor 2, HER2) je dlouhodobým standardem, díky kterému došlo k výraznému zlepšení prognózy pacientek s tímto agresivním podtypem onemocnění. V současné době je k léčbě metastazujícího HER2 pozitivního karcinomu prsu využíváno několik přípravků, jejichž spektrum se neustále rozšiřuje. K novějším přípravkům řadíme trastuzumab deruxtekan, zástupce lékové skupiny konjugátů monoklonální protilátky a cytostatika, který prokázal výraznou aktivitu u pacientek s HER2 pozitivním karcinomem a nověji také u pacientek s HER2-1ow karcinomem prsu. Předložená kazuistika dokládá vysokou účinnost tohoto přípravku u pacientky s metastazujícím HER2 pozitivním karcinomem prsu s dosažením dlouhodobé kompletní remise onemocnění.
The inclusion of anti-HER2 therapy in the treatment algorithm of metastatic breast cancer with human epidermal growth factor receptor 2 (HER2) positivity is a long-term standard that has significantly improved the prognosis of patients with this aggressive subtype of the disease. Currently, several agents are used to treat metastatic HER2-positive breast cancer, and the spectrum is continually expanding. Newer agents include trastuzumab deruxtecan, a representative of the monoclonal antibody-cytostatic drug conjugate class, which has shown significant activity in patients with HER2-positive cancer and, more recently, in patients with HER2-1ow breast cancer. The present case report demonstrates the high efficacy of this agent in a patient with metastatic HER2-positive breast cancer achieving long-term complete remission of the disease.
Neoadjuvant chemotherapy (NAC) is the preferred treatment option in locally advanced breast cancer (BC). The administration of NAC is associated with a wide range of adverse effects. This pilot observational prospective study examined the effect of NAC using anthracycline + cyclophosphamide (AC) followed by paclitaxel (PTx) on a portfolio of 22 plasma and urinary amino acids, plasma proteins (albumin, prealbumin, transferrin), and products of nitrogen metabolism (urea, creatinine, uric acid) in plasma and urine. Plasma and 24-h urine samples were obtained from ten patients with early breast cancer (N1-3 N0-2 M0), at the following time points: before the start of NAC and during the AC/PTx treatment period (a total of 8 measurements at three-weekly intervals). Amino acids were analyzed using ion exchange chromatography. There were no significant differences in the measured parameters in plasma and urine between pre-NAC and during AC- and PTx-treatment. No trend was detected. A significant difference in the portfolio of plasma and urinary amino acids was found only in the pre-treatment period compared to the control group. Levels of eight plasma amino acids (8/22) were significantly reduced and those of nine urine amino acids were increased (9/22). Nitrogenous catabolites in plasma and urine were not indicative of increased protein catabolism during the anthracycline and taxane treatment periods. A slightly positive nitrogen balance was accompanied by an average weight gain of 3.3 kg (range 0-6 kg). The AC/PTx treatment regimen did not cause significant changes in the monitored laboratory parameters.
- MeSH
- aminokyseliny * moč krev MeSH
- antracykliny terapeutické užití aplikace a dávkování MeSH
- cyklofosfamid * terapeutické užití MeSH
- dospělí MeSH
- dusík * moč MeSH
- kreatinin moč krev MeSH
- krevní proteiny * metabolismus analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu * farmakoterapie krev moč MeSH
- neoadjuvantní terapie * MeSH
- paclitaxel * terapeutické užití aplikace a dávkování MeSH
- pilotní projekty MeSH
- prospektivní studie MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
PURPOSE: Male breast cancer (MBC) is a rare, but increasingly common disease, and lacks prospective studies. Collaborative efforts are needed to understand and address MBC, including its prognosis, in different countries. METHODS: We retrospectively reviewed the clinical, histopathological, and molecular-genetic characteristics, treatments, and survival outcomes of MBC diagnosed between 2007 and 2017 in the Czech Republic. Prognostic factors of overall survival (OS), recurrence-free interval (RFi), and breast cancer-specific mortality (BCSM) were analyzed and indirectly compared to international data. RESULTS: We analyzed 256 patients with MBC (median age 66 years), including 12% with de novo metastatic (M1). Of 201 non-metastatic (M0) patients, 6% were <40 years old, 29% had stage I, 55% were cN0, and 54% underwent genetic testing. Overall, 97% of tumors had estrogen receptor expression ≥10%, 61% had high Ki67 index, 40% were high-grade (G3), and 68% were luminal B-like (HER2-negative). Systemic therapies included endocrine therapy (90%) and chemotherapy (53%). Few (5%) patients discontinued adjuvant endocrine therapy for reasons other than disease relapse or death. Patients treated with aromatase inhibitors alone had significantly shorter RFi (P < .001). OS, RFi, and BCSM were associated with disease stage, T stage, N stage, progesterone receptor expression, grade, and Ki67 index. Median OS reached 122 and 42 months in M0 and de novo M1 patients, respectively. CONCLUSION: Due to the rarity of MBC, this study highlights important findings from real clinical practice. Although the number of patients with MBC with unfavorable features was higher in this Czech dataset than in international studies, the prognosis remains consistent with real-world evidence.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu u mužů * patologie mortalita terapie farmakoterapie MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: The aim of this retrospective study is to analyze a consecutive cohort of brain metastasis (BM) patients treated off clinical trials through combination of surgery and radiotherapy over the last 15 years in a tertiary neurooncology center. MATERIALS AND METHODS: All BM patients operated between 2007-2019 received adjuvant linac-based radiotherapy categorized to whole brain radiotherapy (WBRT) and tumor bed stereotactic radiotherapy. Survival outcomes and local control was analyzed. RESULTS: In total, 118 patients were enrolled, those with stereotactic radiotherapy (41%) had better baseline characteristics mirrored in longer overall survival (OS) [18 vs. 7.1 months, p < 0.001; hazard ratio (HR) 0.47, p = 0.004] with median follow-up of 58 months. Cumulative incidence for local, distant, and extracranial control was not significantly different between groups, with 12-month cumulative control of 22% vs. 18%, 44% vs. 29%, and 35% vs. 32% for stereotactic and WBRT group, respectively. WBRT was an independent factor for better distal brain control. CONCLUSIONS: Real world data demonstrating significantly better overall survival in patients treated with postoperative targeted radiotherapy compared with postoperative WBRT is presented, with no significant difference in cumulative incidence for local or distant brain control. The majority of patients with targeted radiotherapy had a fractionated dose schedule with outcomes comparable to single-dose radiation trials of postoperative targeted radiotherapy.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. METHODS: Early breast cancer patients after partial mastectomy were equally randomized into two arms- external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. RESULTS: The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21-45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. CONCLUSION: External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. TRIAL REGISTRATION: NCT06007118.
- MeSH
- kojenec MeSH
- kombinovaná terapie MeSH
- kvalita života MeSH
- lidé MeSH
- mastektomie MeSH
- nádory prsu * radioterapie chirurgie patologie MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- segmentální mastektomie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
K dosažení co nejlepších léčebných výsledků a snížení rizika nadléčení u pacientek s časným hormonálně dependentním karcinomem prsu s negativním receptorem 2 pro lidský epidermální růstový faktor (human epidermal growth factor receptor 2, HER2) je zásadní výběr optimálního adjuvantního léčebného postupu. I v rámci tohoto podtypu se jedná o heterogenní onemocnění, s odlišným biologickým chováním, léčebnou odpovědí a prognózou. V naprosté většině případů je u této skupiny pacientek volena v adjuvantní léčbě hormonální terapie. Adjuvantní chemoterapie je u pacientek s hormonálně dependentním / HER2 negativním karcinomem volena podle standardně dostupných klinicko-patologických charakteristik, na jejichž základě lze stanovit riziko relapsu onemocnění a přibližně určit benefit adjuvantní chemoterapie. Nověji můžeme využít ke zhodnocení prognózy (ve smyslu rizika relapsu onemocnění) a benefitu adjuvantní chemoterapie multigenové testy, ke kterým patří i vyšetření MammaPrint a BluePrint.
The choice of optimal adjuvant therapy is essential to achieve the best possible treatment outcomes and reduce the risk of overtreatment in patients with early hormone receptor-dependent human epidermal growth factor receptor 2 negative (HER2-negative) breast cancer. Even within this subtype, it is a heterogeneous disease, with different biological behavior, treatment response, and prognosis. In the vast majority of cases, hormone therapy is chosen in the adjuvant treatment of this group of patients. Adjuvant chemotherapy in patients with hormone-dependent / HER2-negative breast cancer is selected according to standard clinicopathological characteristics, which can be used to determine the risk of disease relapse and to approximate the benefit of adjuvant chemotherapy. More recently, multigene tests, including MammaPrint and BluePrint, can be used to assess prognosis (in terms of risk of disease relapse) and benefit of adjuvant chemotherapy.
