BACKGROUND: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. METHODS: A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical-pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records. RESULTS: ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) (n = 8, 18.2%). CONCLUSIONS: Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC.
- Publikační typ
- časopisecké články MeSH
- MeSH
- lidé MeSH
- lokální recidiva nádoru diagnóza prevence a kontrola MeSH
- neoadjuvantní terapie metody MeSH
- radikální mastektomie metody MeSH
- retrospektivní studie MeSH
- segmentální mastektomie * metody MeSH
- triple-negativní karcinom prsu * chirurgie diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- souhrny MeSH
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.
- Klíčová slova
- HER2 pozitivní karcinom prsu, trastuzumab deruxtecan,
- MeSH
- dospělí MeSH
- epidermální růstový faktor MeSH
- imunokonjugáty aplikace a dávkování farmakologie terapeutické užití MeSH
- indukce remise MeSH
- inhibitory topoisomerasy I farmakologie terapeutické užití MeSH
- lidé MeSH
- metastázy nádorů * MeSH
- monoklonální protilátky farmakologie terapeutické užití MeSH
- nádory prsu * chirurgie farmakoterapie imunologie klasifikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
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 protinádorové 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
