Systemic Chemotherapy For Breast Cancer Research Articles

Body composition and chemotherapy toxicity among women treated for breast cancer: a systematic review.

Toxicity is a significant problem among women receiving systemic chemotherapy for breast cancer, with up to 60% experiencing hematologic and 14% experiencing non-hematologic toxicity. Chemotherapy is dosed using body surface area, which does not account for heterogeneity in lean body mass (LBM) and adipose tissue (AT). This systematic review, registered with the PROSPERO International Prospective Register of Systematic Reviews (#CRD42021279874), evaluates associations between body composition and chemotherapy-related toxicity during breast cancer treatment. Scientific literature databases (PubMed, Scopus, CINAHL, and CENTRAL) were systematically searched in November 2021 for studies evaluating associations between body composition (assessed using computed tomography or dual x-ray absorptiometry) and chemotherapy-related toxicity among women receiving breast cancer treatment. Eligibility was not limited by year or country of publication. Article screening and data abstraction was conducted using the Covidence Systematic Review Management System. Predetermined criteria were used to evaluate rigor of participant recruitment, representativeness of the population, and use of validated measures of body composition and toxicity. An inverse association between LBM and toxicity was reported in seven of the eight included studies, although definitions of low LBM differed across studies. Three studies evaluated the association between AT and chemotherapy toxicity with inconsistent findings. Heterogeneity in body composition measures/definitions and treatment regimens precluded the ability to perform meta-analyses. Low LBM appears to be a risk factor for chemotherapy toxicity, but the role of AT is unclear. Further research that accounts for guideline concordance in chemotherapy prescriptions and the use of supportive care medications is needed.

Cerebral Perfusion and Gray Matter Changes Associated With Chemotherapy-Induced Peripheral Neuropathy

To investigate the longitudinal relationship between chemotherapy-induced peripheral neuropathy (CIPN) symptoms (sx) and brain perfusion changes in patients with breast cancer. Interaction of CIPN-sx perfusion effects with known chemotherapy-associated gray matter density decrease was also assessed to elucidate the relationship between CIPN and previously reported cancer treatment-related brain structural changes. Patients with breast cancer treated with (n = 24) or without (n = 23) chemotherapy underwent clinical examination and brain magnetic resonance imaging at the following three time points: before treatment (baseline), 1 month after treatment completion, and 1 year after the 1-month assessment. CIPN-sx were evaluated with the self-reported Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity four-item sensory-specific scale. Perfusion and gray matter density were assessed using voxel-based pulsed arterial spin labeling and morphometric analyses and tested for association with CIPN-sx in the patients who received chemotherapy. Patients who received chemotherapy reported significantly increased CIPN-sx from baseline to 1 month, with partial recovery by 1 year (P < .001). CIPN-sx increase from baseline to 1 month was significantly greater for patients who received chemotherapy compared with those who did not (P = .001). At 1 month, neuroimaging showed that for the group that received chemotherapy, CIPN-sx were positively associated with cerebral perfusion in the right superior frontal gyrus and cingulate gyrus, regions associated with pain processing (P < .001). Longitudinal magnetic resonance imaging analysis in the group receiving chemotherapy indicated that CIPN-sx and associated perfusion changes from baseline to 1 month were also positively correlated with gray matter density change (P < .005). Peripheral neuropathy symptoms after systemic chemotherapy for breast cancer are associated with changes in cerebral perfusion and gray matter. The specific mechanisms warrant further investigation given the potential diagnostic and therapeutic implications.

288 Changes in Estrogen Receptor (ER), Progesterone Receptor (PgR) and HER2/neu Status During Primary Systemic Chemotherapy in Breast Cancer

288 Changes in Estrogen Receptor (ER), Progesterone Receptor (PgR) and HER2/neu Status During Primary Systemic Chemotherapy in Breast Cancer

307 Ki-67 as Predictive Biomarker for Systemic Chemotherapy in Breast Cancer

307 Ki-67 as Predictive Biomarker for Systemic Chemotherapy in Breast Cancer

P243 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) is useful for selecting optimal patients suited for sentinel lymph node biopsy after primary systemic chemotherapy in breast cancer

P243 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) is useful for selecting optimal patients suited for sentinel lymph node biopsy after primary systemic chemotherapy in breast cancer

Gray matter reduction associated with systemic chemotherapy for breast cancer: a prospective MRI study

Brain gray matter alterations have been reported in cross-sectional magnetic resonance imaging (MRI) studies of breast cancer patients after cancer treatment. Here we report the first prospective MRI study of women undergoing treatment for breast cancer, with or without chemotherapy, as well as healthy controls. We hypothesized that chemotherapy-associated changes in gray matter density would be detectable 1 month after treatment, with partial recovery 1 year later. Participants included breast cancer patients treated with (CTx+, N = 17) or without (CTx-, N = 12) chemotherapy and matched healthy controls (N = 18). MRI scans were acquired at baseline (after surgery but before radiation, chemotherapy, and/or anti-estrogen treatment), 1 month after completion of chemotherapy (M1), and 1 year later (Y1). Voxel-based morphometry (VBM) was used to evaluate gray matter density differences between groups and over time. There were no between-group gray matter differences at baseline. Group-by-time interactions showed declines from baseline to M1 in both cancer groups relative to controls. Within-group analyses indicated that at M1 relative to baseline the CTx+ group had decreased gray matter density in bilateral frontal, temporal, and cerebellar regions and right thalamus. Recovery was seen at Y1 in some regions, although persistent decreases were also apparent. No significant within-group changes were found in the CTx- or control groups. Findings were not attributable to recency of cancer surgery, disease stage, psychiatric symptoms, psychotropic medication use, or hormonal treatment status. This study is the first to use a prospective, longitudinal approach to document decreased brain gray matter density shortly after breast cancer chemotherapy and its course of recovery over time. These gray matter alterations appear primarily related to the effects of chemotherapy, rather than solely reflecting host factors, the cancer disease process, or effects of other cancer treatments.

Concomitant gemcitabine, cisplatin, anastrazole, and zoledronic acid in HER2-negative metastatic breast cancer in postmenopausal women.

1129 Background: There is no preclinical or clinical evidence against the concomitant use of aromatase inhibitors with systemic chemotherapy in breast cancer. Despite this fact it is rarely used in clinical practice today. Aromatase inhibitors have the significant therapeutic contribution in the management of hormone responsive disease in postmenopausal women and ideally their use shall not be delayed till the completion of chemotherapy. Therefore, we have designed this study to evaluate the efficacy and toxicity of concomitant gemcitabine, cisplatin, anastrazole, and zoledronic acid. Methods: Patients with visceral or visceral and bone metastases were included. Postmenopausal, ER-/PR-positive and HER2neu-negative patients with a KPS of > 70, adequate marrow, hepatic, and renal function were enrolled. Metastatic brain disease and bone as the only site of disease was excluded. Gemcitabine 1,250 mg/m2 was given on day 1 and 8, with cisplatin 70 mg/m2 on day one of three weekly cycles. Anastrazole 1 mg was g...

The Effect of Anthracycline-Based (Epirubicin) Adjuvant Chemotherapy on Plasma TAFI and PAI-1 Levels in Operable Breast Cancer

An increased incidence of thromboembolic events has been described in women receiving systemic chemotherapy for breast cancer. The effect of anthracycline-based adjuvant chemotherapy regimens on fibrinolytic system markers of plasminogen activator inhibitor-1 (PAI-1) and thrombin activitable fibrinolysis inhibitor (TAFI) was investigated in patients with operable breast cancer. Twenty-four patients with operable breast cancer (median age, 54.5 years; range, 37-72 years) enrolled in our study. Stage I-II and stage IIIA cases received EC (Epirubicin 90 mg/m(2)/d1, I.V. and cyclophosphamide 600 mg/m(2)/d1, I.V.) and FEC (5-fluorouracil 500 mg/m(2)/d1, I.V., epirubicin 100 mg/m(2)/d1, I.V., and cyclophosphamide 500 mg/m(2)/d1, I.V.) as an adjuvant chemotherapy regimen, respectively. Each group consisted of 12 patients. Blood samples were obtained at baseline and just before the third cycle of EC and fourth cycle of FEC chemotherapy regimens. Plasma TAFI antigen and PAI-1 levels did not disclose any statistical difference between basal and postchemotherapy levels within each group and between two groups. Although postchemotherapy D-dimer levels were statistically higher in the FEC group than in the EC group, results in both groups were within normal ranges. More studies concerning the role of fibrinolytic system in breast cancer patients receiving chemotherapy, probably including cases with advanced stage and with different chemotherapy regimens and dose intensities, are needed.

乳癌術前化学療法の効果判定における画像診断われわれが経験した病理判定と画像診断の不一致症例について

乳癌術前化学療法の効果判定における画像診断われわれが経験した病理判定と画像診断の不一致症例について

Secondary hematological malignancies after breast cancer chemotherapy

According to several reports, the 10 year incidence of secondary acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) after systemic chemotherapy is approximately 1.5%. The cumulative risk increases by 0.25--1% for the first 8 years after treatment. We have reported only 6 cases of hematological malignancies (0.3%) after breast cancer chemotherapy in our institute. We detected 2 cases of secondary AML and 1 case of MDS, 19, 52 and 12 months, respectively, after systemic chemotherapy for breast cancer. Published data on the occurrence of secondary hematological malignancies other than AML or MDS in this setting are scarce. We encountered diffuse large B-cell lymphoma, angioimmunoblastic lymphoma and mantle cell lymphoma as secondary hematological malignancies after systemic chemotherapy for breast cancer.

Tumor M2-Pk as predictive factor in primary systemic chemotherapy in breast cancer

891 Background: The isoenzyme tumor M2 of pyruvate kinase (M2-Pk) in glycolysis is overexpressed in solid tumors. This has given rise to the hypothesis that the concentration of M2-Pk is greater, the more malignant a tumor is. When one treats a locally advanced breast cancer with primary systemic chemotherapy one needs valid parameters for monitoring the treatment. We investigated whether M2-Pk would be useful as a monitoring parameter. Methods: Over a period of 12 months 18 patients suffering from locally advanced breast cancer received a primary systemic chemotherapy under study conditions (Gepartrio). Following surgery a complete histological investigation was carried out. The ELISA test (ScheBo, Tech GmbH) was used on blood samples taken before every chemotherapy cycle to determine the level of M2-Pk. The statistical evaluation was by means of the Mann-Whitney test and the chi-square test. Results: 4 of the 18 patients had a complete remission. Comparison of the M2-Pk baseline values with the known pr...

Surgical procedure following primary systemic chemotherapy for breast cancer

Die Indikation zur Durchfuhrung einer primar systemischen Chemotherapie (PST) wurde vom lokal fortgeschrittenen und inflammatorischen auf operable Mammakarzinome erweitert. Die Vorteile liegen in der In-vivo-Testung des Tumoransprechens und in der erhohten Rate an brusterhaltenden Operationen, ohne die onkologischen Zielparameter zu kompromittieren. Ubereinstimmend wird die lokale R0-Exzision des Karzinoms in den „neuen“, d. h. in den durch die PST reduzierten Grenzen empfohlen. Die zuverlassigste Bildgebung nach PST erreicht offensichtlich die Kernspintomographie der Mamma. Onkoplastische Techniken im Rahmen der brusterhaltenden Therapie oder die nach notwendiger Mastektomie durchgefuhrten Verfahren der Rekonstruktion scheinen sicher. Die Axilladissektion bleibt der Goldstandard, die Sentinel-Node-Biopsie nach PST ist Gegenstand der klinischen Forschung.

Gene expression profiles derived from fine needle aspiration correlate with response to systemic chemotherapy in breast cancer.

Drug resistance in breast cancer is a major obstacle to successful chemotherapy. In this study we used cDNA microarray technology to examine gene expression profiles obtained from fine needle aspiration (FNA) of primary breast tumors before and after systemic chemotherapy. Our goal was to determine the feasibility of obtaining representative expression array profiles from limited amounts of tissue and to identify those expression profiles that correlate with treatment response. Repeat presurgical FNA samples were taken from six patients who were to undergo primary surgical treatment. Additionally, a group of 10 patients who were to receive neoadjuvant chemotherapy underwent two FNAs before chemotherapy (adriamycin 60 mg/m2 and cyclophosphamide 600 mg/m2) followed by another FNA on day 21 after the first cycle. Total RNA was amplified with T7 Eberwine's procedure and labeled cDNA was hybridized onto a 7600-feature glass cDNA microarray. We identified candidate gene expression profiles that might distinguish tumors with complete response to chemotherapy from tumors that do not respond, and found that the number of genes that change after one cycle of chemotherapy was 10 times greater in the responding group than in the non-responding group. This study supports the suitability of FNA-derived cDNA microarray expression profiling of breast cancers as a comprehensive genomic approach for studying the mechanisms of drug resistance. Our findings also demonstrate the potential of monitoring post-chemotherapy changes in expression profiles as a measure of pharmacodynamic effect and suggests that these approaches might yield useful results when validated by larger studies.

Lack of effect of adjuvant chemotherapy on the elimination of single dormant tumor cells in bone marrow of high-risk breast cancer patients.

There is an urgent need for markers that can predict the efficacy of adjuvant chemotherapy in patients with solid tumors. This study was designed to evaluate whether monitoring of micrometastases in bone marrow can predict the response to systemic chemotherapy in breast cancer. Bone marrow aspirates of 59 newly diagnosed breast cancer patients with either inflammatory (n = 23) or advanced (> four nodes involved) disease (n = 36) were examined immunocytochemically with the monoclonal anticytokeratin (CK) antibody A45-B/B3 (murine immunoglobulin G(1); Micromet, Munich, Germany) before and after chemotherapy with taxanes and anthracyclines. Of 59 patients, 29 (49.2%) and 26 (44.1%) presented with CK-positive tumor cells in bone marrow before and after chemotherapy, respectively. After chemotherapy, less than half of the previously CK-positive patients (14 of 29 patients; 48.3%) had a CK-negative bone marrow finding, and 11 (36. 7%) of 30 previously CK-negative patients were CK-positive. At a median follow-up of 19 months (range, 6 to 39 months), Kaplan-Meier analysis of 55 assessable patients revealed a significantly reduced overall survival (P =.011; log-rank test) if CK-positive cells were detected after chemotherapy. In multivariate analysis, the presence of CK-positive tumor cells in bone marrow after chemotherapy was an independent predictor for reduced overall survival (relative risk = 5.0; P =.016). The cytotoxic agents currently used for chemotherapy in high-risk breast cancer patients do not completely eliminate CK-positive tumor cells in bone marrow. The presence of these tumor cells after chemotherapy is associated with poor prognosis. Thus, bone marrow monitoring might help predict the response to systemic chemotherapy.

P71 Epirubicin (EPI) and vinorelbine (VNR): A new promising combination for primary systemic chemotherapy for breast cancer

P71 Epirubicin (EPI) and vinorelbine (VNR): A new promising combination for primary systemic chemotherapy for breast cancer