PURPOSE: The combination of gemcitabine and cisplatin (GP) has been shown to be safe and efficacious for patients with metastatic breast cancer (MBC), pretreated with anthracyclines and taxanes. We assessed the efficacy and safety of weekly low-dose GP in patients with MBC. METHODS: We collected clinicopathological data from MBC patients who had been treated with gemcitabine, 800 mg/m2 plus cisplatin, 30 mg/m2 intravenously, on days 1 and 8 every 3 weeks, between January 2001 and November 2011 in Korea. RESULTS: The analysis included 294 patients previously treated anthracycline-xand taxane-based chemotherapies prior to GP (median age, 48 years [range, 28-78 years]; median follow-up duration, 63.9 months). Seventeen patients (5.8%) discontinued GP because of toxicities. The median progression-free survival (PFS) was 3.9 months (95% confidence interval [CI], 3.394.4 months) and the median overall survival (OS) was 27.7 months (95% CI, 17.6-37.8 months) months. Statistically significant factors for PFS were performance status (Eastern Cooperative Oncology Group, > or =2 vs. <2; hazard ratio [HR], 1.37; 95% CI, 1.02-1.85; p=0.037), distant disease-free interval (DDFI; < or =2 years vs. >2 years; HR, 1.66; 95% CI, 1.28-1.95, p<0.001), time interval from the diagnosis of metastasis to GP therapy (< or =1 year vs. >1 year; HR, 1.48; 95% CI, 1.13-1.95, p<0.001), and presence of brain metastasis (HR, 1.47; 95% CI, 1.03-2.10; p=0.031). Similarly, DDFI (< or =2 years vs. >2 years; HR, 2.07; 95% CI, 1.36-3.14; p<0.001) and the presence of brain metastasis (HR, 2.14; 95% CI, 1.27-3.61; p=0.004) were important factors for OS after GP treatment. CONCLUSION: Weekly low-dose GP chemotherapy appears safe and effective for heavily pretreated MBC patients.
Anthracyclines ; Brain ; Breast Neoplasms* ; Cisplatin ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Korea ; Neoplasm Metastasis ; Taxoids

PURPOSE: The aim of study was to evaluate the usefulness of serum HER2 as a therapeutic response indicator in patients with HER2 positive metastatic breast cancer (MBC). MATERIALS AND METHODS: The levels of serum HER2 and CA15.3 were assayed in 148 serial serum samples from 50 HER2 positive MBC patients at both the baseline and follow-ups. The changes in the levels of serum HER2 and CA15.3 in relation to the tumor responses to the various chemotherapy regimens were monitored. RESULTS: The levels of serum HER2 and CA15.3 were elevated in 82% and 62% of tissue HER2 positive patients, respectively, prior to therapies, with the changes in both tumor markers showing statistical significance in relation to the tumor responses (p<0.01) in patients with elevated baseline serum markers. CONCLUSION: The level of serum HER2 could be a valuable response indicator, not only for trastuzumab containing therapy, but also for other common MBC chemotherapeutic agents. Also, as it is more frequently elevated, the serum level of HER2 may also be a more useful tumor marker than CA15.3 in HER2 positive MBC.
Biomarkers ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Follow-Up Studies ; Humans ; Biomarkers, Tumor ; Trastuzumab

PURPOSE: Inflammation within the tumor microenvironment has been reported to show an association with poor prognosis in breast cancer. However, the associations may differ according to breast cancer subtype. In this study, we investigated the association between inflammation-related markers and breast cancer recurrence according to patients' tumor subtypes. MATERIALS AND METHODS: This prospective study included 240 patients who underwent surgery for management of newly diagnosed breast cancer. Levels of inflammation-related markers (interleukin [IL]-1beta, IL-6, IL-8, monocyte chemoattractant protein-1 [MCP-1], leptin, and adiponectin) were measured at diagnosis, and the associations between these markers and breast cancer recurrence during a six-year follow-up period were examined using the Kaplan-Meier statistical method. RESULTS: Overall, inflammation-related markers showed no association with breast cancer recurrence. However, when data were stratified by tumor subtype, higher levels of some mediators showed an association with poor prognosis among patients with particular subtypes. Compared to patients without recurrence, patients with recurrence had higher levels of circulating IL-6 (p=0.024) and IL-8 (p=0.016) only among those with HER2- tumors and had higher levels of leptin (p=0.034) only among those with estrogen receptor (ER)+/progesterone receptor (PR)+ tumors. Results of survival analyses revealed an association of high levels of IL-6 (p=0.016) and IL-8 (p=0.022) with poor recurrence-free survival in patients with HER2- tumors. In addition, higher leptin levels indicated shorter recurrence-free survival time only among patients with ER+/PR+ tumors (p=0.022). CONCLUSION: We found that certain cytokines could have a differential prognostic impact on breast cancer recurrence according to breast cancer subtype. Conduct of additional large studies will be required in order to elucidate the precise roles of these cytokines in breast cancer progression.
Breast ; Breast Neoplasms ; Chemokine CCL2 ; Cytokines ; Estrogens ; Follow-Up Studies ; Humans ; Inflammation ; Interleukin-6 ; Interleukin-8 ; Leptin ; Prognosis ; Prospective Studies ; Receptors, Estrogen ; Receptors, Progesterone ; Recurrence ; Tumor Microenvironment

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare, malignancy-related complication that causes marked pulmonary hypertension, right heart failure, and death. We report on a patient with locally advanced breast cancer whose course was complicated by fatal PTTM based on clinical and laboratory findings.
Breast ; Breast Neoplasms ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Thrombotic Microangiopathies

Acral metastasis to the finger is a very rare phenomenon. We report herein a case of cutaneous acrometastasis to the right 5th finger tip in a 36-year-old woman with metastatic breast cancer. The patient underwent a right modified radical mastectomy for T3N3 invasive ductal carcinoma and received adjuvant chemotherapy and radiotherapy. After 2 years, she developed metastasis to the brain, bones, and lungs. She was found to have a growing tender mass on the tip of right 5th finger. A well-demarcated, soft tissue mass was identified on sonography. Under the clinical impression of a possible benign process, the nodule was surgically removed. The pathologic finding was consistent with metastatic breast cancer. Immunohistochemical staining for estrogen receptor, progesterone receptor, and HER2 were all negative, as in the primary tumor. Radiation was given to the finger tip and systemic chemotherapy with capecitabine was tried for systemic metastatic disease.
Adult ; Brain ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Chemotherapy, Adjuvant ; Deoxycytidine ; Estrogens ; Female ; Fingers ; Fluorouracil ; Humans ; Lung ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Receptors, Progesterone ; Capecitabine

OBJECTIVE: Breast cancer represents themost frequently diagnosed cancer in women. In order to reduce mortality, early detection of breast cancer is important, because diagnosis is more likely to be successful in the early stages of the disease. On the average, the reader's sensitivity can be increased by 10%with the assistance of computer-aided diagnosis (CAD) system. This paper presents a CAD system for the automatic detection of clustered micro-calcifications in digitized mammograms. METHODS: The proposed system consists of three main steps. First, breast region is segmented from original mammogram using contrast property of grey level co-occurrence matrix(GLCM). Second, potential micro-calcification pixels in the mammograms are detected by foveal method. Third, in order to reduce false-positive rate, individual micro-calcifications are detected by a set of 8 features extracted from the potential individual micro-calcification objects. RESULTS: In the result, Specificity and sensitivity are used to evaluate the detection performance of micro-calcifications.(sensitivity : 93.1%, specificity : 87.5%). CONCLUSION: This study could be a useful method for diagnosis of breast cancer as a CAD system.
Breast ; Breast Neoplasms ; Diagnosis ; Female ; Humans ; Mortality ; Sensitivity and Specificity

Eribulin, an antimicrotubule chemotherapeutic agent, is approved for the treatment of pretreated metastatic breast cancer (mBC) based on the positive outcomes of phase II and phase III clinical trials, which enrolled mainly Western patients. Eribulin has recently been approved in an increasing number of Asian countries; however, there is limited clinical experience in using the drug in certain countries. Therefore, we established an Asian working group to provide practical guidance for eribulin use based on our clinical experience. This paper summarizes the key clinical trials, and the management recommendations for the reported adverse events (AEs) of eribulin in mBC treatment, with an emphasis on those that are relevant to Asian patients, followed by further elaboration of our eribulin clinical experience. It is anticipated that this clinical practice guide will improve the management of AEs resulting from eribulin treatment, which will ensure that patients receive the maximum treatment benefit.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Humans

PURPOSE: The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT. MATERIALS AND METHODS: A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database. RESULTS: At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE. CONCLUSION: LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.
Arm ; Breast Neoplasms ; Breast* ; Chemotherapy, Adjuvant ; Drug Therapy* ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Lymphedema* ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Risk Factors

PURPOSE: The aim of this study is to evaluate stage IV breast cancer at the initial presentation by the review of a single institute' data. We also tried to figure out the factors to predict stage IV breast cancer. METHODS: We reviewed the prospectively collected database of 1,424 consecutive patients with primary breast cancer at the National Cancer Center in Korea from October 2000 to January 2005. RESULTS: The proportion of stage IV breast cancer was 2.7% (38/1,424). The median tumor size of the stage IV patients was 4.1 cm. The most common metastatic site was bone (47.4%) followed by lung (44.7%) and liver (36.8%). Metastases were found in 0.9% (6/672) of the T1 tumors, 2.4% (13/535) of the T2 tumors, 8.3% (4/48) of the T3 tumors, and 27.1% (13/48) of the T4 tumors (p<0.001). On multivariate analysis, the statistically significant predictors of distant metastasis were tumor size (> or =2 cm) (p=0.026), positive lymph node status (p<0.001), alkaline phosphatase (>104 IU/L) (p=0.013), aspartate transferase (>40 IU/L) (p=0.003) and CA15-3 (>32 U/mL) (p=0.025). CONCLUSION: Our study showed that the factors to predict distant metastasis of breast cancer were large size of tumor, positive lymph node status, elevated alkaline phosphatase, aspartate transferase and CA15-3. Therefore breast cancer patients with those clinical characteristics should be carefully evaluated to detect distant metastasis.
Alkaline Phosphatase ; Aspartic Acid ; Breast Neoplasms* ; Breast* ; Humans ; Korea ; Liver ; Lung ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prospective Studies ; Transferases

PURPOSE: Preoperative chemotherapy has been used to increase the rate of breast conserving surgery (BCS) in Caucasian women. However, whether it would also increase the rate of BCS in Korean women has not been verified. The aim of this study was to determine the effectiveness of preoperative chemotherapy to make BCS possible in Korean women who have locally advanced cancer without any increase of locoregional recurrence according to operation methods (BCS vs. mastectomy). METHODS: From August 2002 to April 2005, 205 patients with stage II or III breast cancer were enrolled in a phase III randomized trial of preoperative chemotherapy. Surgeons decided on the type of surgery (mastectomy or BCS) at initial diagnosis. By randomization, patients received four cycles of either docetaxel/capecitabine or doxorubicin/cyclophosphamide followed by surgery and crossover to the other treatment as postoperative chemotherapy. RESULTS: The mean tumor size was 3.29 cm and the mean breast volume was 489 cc at diagnosis. After preoperative chemotherapy, clinical response was shown in 76.0% of the patients. Of the 71 patients planned for a mastectomy at initial diagnosis, 27 patients underwent BCS (38.0%). Clinical T stage after preoperative chemotherapy, pathologic T size and lymphatic invasion were correlated with conversion to BCS. In multivariate analysis, only lymphatic invasion showed statistical significance. Locoregional disease-free survival did not statistically differ between the two operation methods for the patients who were planned for a mastectomy at the initial exam. CONCLUSION: This study showed that preoperative chemotherapy also increased the rate of BCS, while avoiding any increase of locoregional recurrence in Korean women with locally advanced breast cancer.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Female ; Humans ; Mastectomy ; Mastectomy, Segmental ; Multivariate Analysis ; Neoadjuvant Therapy ; Random Allocation ; Recurrence