1.Breast panel biomarker changes after neoadjuvant chemotherapy in breast cancer
Kris Raychelle Godoy ; Manuelito Madrid
Philippine Journal of Pathology 2024;9(1):17-20
Objectives:
The aim of this study is to evaluate the breast panel biomarker changes and tumor intrinsic subtype after neoadjuvant chemotherapy among patients with residual invasive breast carcinoma whose breast specimens were processed at St. Luke’s Medical Center - Quezon City SLMC-QC) from 1 January 2017 to 30 June 2023.
Methodology:
Cases of residual invasive breast carcinoma status post neoadjuvant systemic therapy were identified by retrospective review of cases. The baseline characteristics, type of biopsy and resection procedures, pre – and post–neoadjuvant ER, PR and HER2 status and pre – and post–neoadjuvant tumor intrinsic subtype were analyzed using frequency and percentage. The comparison of the changes in pre- and post-neoadjuvant breast panel biomarkers were analyzed by using McNemar test while the changes in the intrinsic tumor subtype was done using Wilcoxon signed-rank test.
Results:
This study encompassed a total of 43 cases of residual invasive breast carcinoma following neoadjuvant systemic therapy. The data disclosed shifts in the breast molecular profile and intrinsic subtype post-administration of neoadjuvant systemic therapy. The alterations in hormone receptor status, ER and PR, were observed in 11.6% of cases, while HER-2 status exhibited changes in 2.3%. A 14% change in the tumor intrinsic subtype is observed. Among the initial 18 Luminal A cases, 1 transitioned to Luminal B, and among the 6 Luminal B cases, 2 become HER2 enriched subtypes. Furthermore, among the initial 12 HER2 enriched cases, three shifted to Luminal B, while all triple-negative cases remained unchanged after chemotherapy.
Conclusion
Based on our findings, alterations in the molecular profile of breast tumors, including shifts in intrinsic subtype after neoadjuvant chemotherapy (NAC), could impact patient prognosis. While the data generated from this study may not exhibit statistical significance, its clinical relevance is noteworthy. In summary, retesting of breast biomarkers in the resection specimen is recommended to accurately ascertain the appropriate use of targeted therapy.
Neoadjuvant Therapy
2.Novel use of GnRH agonist as neoadjuvant treatment for giant endometrial polyps
Diana J. Cupino-Arcinue ; Regina Paz Tan-Espiritu
Philippine Journal of Reproductive Endocrinology and Infertility 2018;15(2):29-36
Endometrial polyp, being one of the most common causes of abnormal uterine bleeding, is
formed from localized overgrowths of endometrial tissue brought about by increased estrogen
levels. Sizes of polyps usually are less than 2cm, while those >4 cm are labeled as giant polyps.
Such polyps can even occupy the entire endometrial cavity, making complete hysteroscopic
removal difficult and prone to failure and morbidity. Limited literature regarding use of GnRH
agonist in endometrial polyps are published, but given the idea that it induces a state of
hypoestrogenism, it could be a promising approach for neoadjuvant treatment in such cases.
In this paper, 3 cases of giant endometrial polyps with fertility problems were given GnRH
agonists prior to resection. All cases have shown significant decrease in size of their polyps,
making complete and successful hysteroscopic removal feasible.
Neoadjuvant Therapy
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Polyps
3.Pattern and predictors of locoregional failure in locally advanced breast cancer following neoadjuvant chemotherapy and modified radical mastectomy with or without radiotherapy: Retrospective cohort analysis of patients in a Tertiary Hospital Breast Center
Shiela S. Macalindong ; Sigfred B. Lajara ; Jhoanne C. Ynion ; Michele S. Hernandez-Diwa ; Arturo S. Dela Peñ ; a
Acta Medica Philippina 2020;54(2):117-127
Objective:
The study aimed to identify the pattern and clinicopathologic factors associated with locoregional failure (LRF) in locally-advanced breast cancer (LABC) patients who received neoadjuvant chemotherapy (NAC) and modified radical mastectomy (MRM) with or without adjuvant radiotherapy (RT).
Methods:
Retrospective cohort analysis of LABC patients who developed LRF following NAC and MRM with or without RT in the Breast Care Center, Philippine General Hospital from 2007-2010 was done. Clinicopathologic and treatment factors were compared between patients who developed and did not develop recurrence using Student's t-tests and Chi-square tests and logistic regression analysis, with p values ≤0.05 considered significant.
Results:
A total of 63 patients were included, 34 with locoregional recurrence (LR) and 29 without. Two-year locoregional recurrence rate (LRR) was 54% with mean time to recurrence at 263 days and chest wall as most common site. Simple logistic regression analysis showed age distribution, pathologic nodal status (pN), percentage positive pathologic lymph nodes, pathologic stage, lymphovascular invasion, and adjuvant RT to be predictors of LR. Furthermore, pN (OR 1.31, CI 1.07-1.59, p=0.01) and adjuvant RT (OR 0.14, CI 0.04-0.53, p=0.004) were independent predictors of LR on multiple logistic regression analysis. In the subset of patients without adjuvant RT, no independent predictor of LR was found on multiple logistic regression analysis.
Conclusion
Among patients with LABC who received NAC and MRM, locoregional recurrence occurred frequently, usually in the chest wall and within a year of treatment. The absence of adjuvant radiotherapy and increased number of positive pathologic lymph nodes were predictive of locoregional recurrence.
Neoadjuvant Therapy
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Recurrence
4.Systemic adjuvant therapy in breast cancer.
Jin Hee AHN ; Sung Bae KIM ; Woo Kun KIM
Korean Journal of Medicine 2005;69(3):243-254
No abstract available.
Breast Neoplasms*
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Breast*
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Drug Therapy
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Neoadjuvant Therapy
5.Precaution of over or under treatment for colorectal cancer.
Chinese Journal of Gastrointestinal Surgery 2011;14(8):573-574
Insufficient treatment and overtreatment in the management of colorectal cancer greatly influence patients' outcome. The clinicopathological stage of carcinoma located in colon and rectum is different for anatomical differences. The indication of adjuvant chemotherapy varies in colon or rectal cancer. Locally advanced rectal cancer should receive neoadjuvant treatment, however, the optimal regimen is still controversial.
Colorectal Neoplasms
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therapy
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Humans
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Neoadjuvant Therapy
8.The guideline for neoadjuvant therapy of pancreatic cancer in China (2020 edition).
Chinese Journal of Surgery 2020;58(9):657-667
In order to improve the overall treatment level of pancreatic cancer in China, Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association have formulated the guideline for neoadjuvant therapy of pancreatic cancer in China (2020 edition). Based on the GRADE system, the guideline has conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis and surgery strategy, etc. This guideline has quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in the neoadjuvant therapy of pancreatic cancer. The guideline has highlighted the role of multiple disciplinary team and represented the conversion of treatment concept in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of the part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice and improve the survival of patients.
China
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Humans
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Neoadjuvant Therapy
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Pancreatic Neoplasms
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therapy
9.Guidelines for the diagnosis and treatment of pancreatic cancer in China(2021).
Chinese Journal of Surgery 2021;59(7):561-577
The incidence of pancreatic cancer has been rising worldwide,while its clinical diagnosis and treatment remain a great challenge. To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years, Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association updated "Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)" based on the Guideline of Management of Pancreatic Cancer in China which had been published in 2014. This updated guideline was formulated after reviewing evidence-based and problem-oriented literatures published from 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer. Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system. This guideline aims to improve the ability of clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and furtherly improve the prognosis of pancreatic cancer patients.
China
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Humans
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Neoadjuvant Therapy
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Pancreatic Neoplasms/therapy*
10.Clinical and pathologic tumor response following response-guided neoadjuvant chemotherapy for locally-advanced breast cancer in a Tertiary Hospital Breast Center in the Philippines
Shiela S. Macalindong ; Ralph Lazarus R. Rapacon
Philippine Journal of Surgical Specialties 2024;79(1):42-53
Rationale/Objective:
Neoadjuvant chemotherapy (NAC) is
recommended for locally-advanced breast cancer (LABC) to improve
resectability and provide in-vivo tumor response assessment. This
study aimed to describe the clinical and pathologic tumor response
of LABC patients after response-guided NAC.
Methods:
This is a retrospective cohort analysis of 128 LABC patients
who underwent NAC using sequential doxorubicin/cyclophosphamide
(AC) – docetaxel (T) regimen at the Philippine General Hospital
Breast Care Center. Clinical and pathologic response rates were
analyzed according to clinicopathologic variables including tumor
intrinsic subtype.
Results:
Objective clinical response (complete and partial) was
observed in 88% (111/128) of patients with 11% (14/128) achieving
pathologic complete response (pCR). The hormone receptor-negative/
Her2-enriched (HR-/Her2+) subtype had the highest pCR rate (23.5%)
followed by triple negative subtype (HR-/Her2-) at 19%. The hormone
receptor-positive/Her2-positive (HR+/Her2+) subtype had the lowest
pCR (4.7%). Two patients with initial poor response to AC but had
good response upon shifting to T achieved pCR. Twelve patients
(9.4%) had poor response to AC and T chemotherapy. Patients who
were pre-menopausal (p=0.04), had ductal histology (p=0.03), with
a HR-/Her2- (p=0.002) or HR+/Her2+ subtype (p=0.03) had good
response to AC. Intrinsic subtype was not significantly associated
with treatment response in those who received docetaxel. There was
strong association between the pathologic and clinical responses
(Spearman’s Rho score 0.69, p-value <0.0001).
Conclusion
Clinical and pathologic response to NAC was highly
dependent on tumor subtype. Clinical response was predictive of
pathologic response. Response-guided NAC allowed direct and early
evaluation of tumor treatment response that allowed for treatment
modifications.
Breast Neoplasms
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Neoadjuvant Therapy
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Drug Therapy