Breast Care最新文献

{"title":"Insights from ASCO 2023","authors":"Andreas Hartkopf, Wolfgang Janni, Maggie Banys-Paluchowski, Francois-Clement Bidard, Christoph Thomssen","doi":"10.1159/000533788","DOIUrl":"https://doi.org/10.1159/000533788","url":null,"abstract":"","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135721929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimbursement in the context of precision oncology approaches in metastatic breast cancer: challenges and experiences","authors":"Constantin Pixberg, Markus Schulze, Lars Buschhorn, Jan Philip Suppelna, Andreas Mock, Mario Hlevnjak, Sabine Heublein, Eva Schumacher-Wulf, Andreas Schneeweiss","doi":"10.1159/000533902","DOIUrl":"https://doi.org/10.1159/000533902","url":null,"abstract":"Background: Precision oncology programs using Next Generation Sequencing (NGS) to detect predictive biomarkers are extending therapeutic options for patients with metastatic breast cancer (mBC). Regularly, based on the recommendations in the interdisciplinary molecular tumor board (iMTB), an inclusion in a clinical trial is not possible. In this case, the German health-insurance system allows for the application of reimbursement for an off-label drug use. Here we describe the current challenges and our experience with reimbursement of molecular therapies in mBC. Methods: A total of 100 applications for reimbursement of off-label therapies recommended by an iMTB were filed for patients with mBC, of which 89 were evaluable for this analysis. The approval rate was correlated with the molecular level of evidence of the respective therapy according to the NCT and ESCAT classification as well as with pretreatment therapy lines. Findings: Overall, 53.9% (48/89) of reimbursement applications were approved. Applications for therapies based on level of evidence m1 (NCT classification), tier I and II (ESCAT classification) had a significantly and clinically relevant increased chance of reimbursement, while a greater number of previous treatment lines had no significantly increased chance of approval, though a trend of approval towards higher treatment lines was detectable. Interpretation: Currently, the German jurisdiction seems to aggravate the clinical implementation of clinically urgently needed molecular therapies.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136378841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine Therapy: From Ovarian Ablation to individualized therapy and signal inhibition","authors":"Christian Jackisch, Athanasios Argyriadis","doi":"10.1159/000534154","DOIUrl":"https://doi.org/10.1159/000534154","url":null,"abstract":"<b><i>Background:</i></b> At the end of the 19th century, Sir George Thomas Beatson first discovered the positive influence of a bilateral oophorectomy on the development of breast cancer lesions in women with advanced disease. Since then, endocrine therapy has been a key component of the treatment of both early (EBC) and advanced-stage (MBC) hormone receptor (HR)-positive breast cancer. <b><i>Summary:</i></b> This review discusses the evolution of this therapeutic approach from the introduction of high-dose estrogen therapy leading to the development of several antiestrogen therapies. Recently, the new generation of drugs includes selective estrogen receptor modulators, orally administered selective estrogen receptor degraders (SERDs), as well as more unique agents such as complete estrogen receptor antagonists, proteolysis targeting chimeric, and selective estrogen receptor covalent antagonists. These drugs are under evaluation in various levels of randomized clinical trials (RCTs) being evaluated in both early and metastatic settings. As of today, the options in EBC are ranging from short-term neoadjuvant endocrine therapy to monitor the responsiveness of Ki-67 to combined endocrine therapy in MBC, introducing the combination of endocrine therapy and CDK4/6 inhibition as well as PARP inhibition in patients with luminal breast cancer presenting with germline BRCA1/2 mutations. The results of global RCTs are settled in global and local guidelines to optimize the individual therapy of our patients with luminal EBC. <b><i>Key Messages:</i></b> Endocrine intervention in hormone-sensitive breast cancer remains one of the most important options in all settings of early and metastatic breast cancer.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135109431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strict versus Liberal use of Sentinel Node Biopsy in Breast Cancer Surgery. Any clinical outcome difference? A 20-year experience.","authors":"Israel Barco, Marc García-Font, Antonio García-Fdez, Manel Fraile, Elena Vallejo, MCarmen Vidal, Sonia González, Clarisa González, Claudia Beatriz Mitru, Oriol Porta, Carolina Chabrera Sanz","doi":"10.1159/000533731","DOIUrl":"https://doi.org/10.1159/000533731","url":null,"abstract":"<b><i>Introduction:</i></b> As applied to early breast cancer (BC) patients, sentinel node biopsy (SNB) has undergone major changes over the years, especially concerning the widening of indication criteria or skipping systematic axillary lymph node dissection (ALND) after a positive SN. We aimed to ascertain whether a strict versus a more liberal use of SNB resulted in different clinical outcomes in our clinical experience. <b><i>Methods:</i></b> We studied consecutive BC patients undergoing SNB between January 1, 2000, and March 31, 2020. There were 1,587 patients and 1,634 SNB procedures. Cases were divided into two study groups: the “strict” SNB group (unifocal tumors up to 35 mm in which ALND was always performed for a positive SN, amounting to 1,183 SNBs), and the “liberal” SNB group (extended tumor size up to selected T3 cases, as well as multifocal or bilateral disease, and patients with previous contralateral BC, not always followed by ALND after a positive SN, amounting to 451 SNBs). Patients were closely followed up to the end of the study. <b><i>Results:</i></b> Clinico-pathological variables were strikingly different between study groups, with the liberal group showing a higher risk profile. Cox regression analysis for disease recurrence did not show significant differences in axillary, lymph node, or locoregional recurrence rates or distant relapse. There were no differences in survival between groups. <b><i>Conclusion:</i></b> It seems reasonable to adopt the liberal SNB approach, as the goal of surgical management in early BC patients must be attaining optimal locoregional disease control, no matter the differences in distant metastatic spread rates across different BC risk profiles.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135352999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate Intensity Exercise Reduces Side Effects of Cancer Therapy and Maintains Cardiorespiratory Fitness in Male Breast Cancer Patients: Findings from the BRECA Male Crossover Study","authors":"Eva B. Schultz, Damir Zubac, Wilhelm Bloch, Hansjörg Baurecht, Jana Rickert, Freerk T. Baumann","doi":"10.1159/000534090","DOIUrl":"https://doi.org/10.1159/000534090","url":null,"abstract":"<b><i>Introduction:</i></b> There is growing evidence that aerobic exercise mitigates cancer therapy-related side effects and improves cardiorespiratory fitness (CRF). However, to the best of our knowledge, no exercise study has been conducted in male breast cancer (MBC) patients. The aim of this study was to investigate the feasibility and efficacy of different exercise intensities on CRF and self-reported questionnaire items in MBC patients. <b><i>Methods:</i></b> Twenty-two MBC patients (60 ± 9 years) participated in this randomized crossover study. After completion of medical treatment, MBC patients were randomly assigned to either moderate (40–50% of heart rate [HR] max. and self-perceived exertion: 11) or vigorous (70–80% of HR max. and self-perceived exertion: 15) exercise intensity during the first 3 months of the study. After a 1-month washout period, participants switched group assignments. Primary endpoints were CRF and questionnaire items. <b><i>Results:</i></b> We observed a dropout rate of 36% over 7 months, with the number of participants decreasing from 22 to 14. The results showed significant improvements in “Physical Function” (<i>p</i> = 0.037) and “Social Function” (<i>p</i> = 0.016) after moderate training. A non-significant improvement was also observed in “Breast Symptoms” (<i>p</i> = 0.095), but there was no change in “Fatigue” (<i>p</i> = 0.306). There were no differences observed in cardiovascular fitness (V̇O₂ peak) between the treatment groups. <b><i>Conclusion:</i></b> This study emphasizes the effectiveness of exercise intervention for an exceedingly rare cancer, highlighting the vital role of moderate intensity aerobic exercise in mitigating treatment side effects. Despite minimal peak V̇O₂ differences, both exercise protocols adequately sustain CRF. Future studies are imperative to design optimized, sex-specific rehabilitation strategies tailored to the unique requirements of MBC patients, advancing our understanding of this under explored realm.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134973085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locoregional Therapy: From Mastectomy to Reconstruction, Targeted Surgery, and Ultra-Hypofractionated Radiotherapy","authors":"Maggie Banys-Paluchowski, Steffi Hartmann, Nina Ditsch, Natalia Krawczyk, Thorsten Kühn, Jana de Boniface, Joanna Banys-Kotomska, Achim Rody, David Krug","doi":"10.1159/000533748","DOIUrl":"https://doi.org/10.1159/000533748","url":null,"abstract":"<b><i>Background:</i></b> The past 3 decades have seen an unprecedented shift toward treatment de-escalation in surgical therapy of breast cancer. <b><i>Summary:</i></b> Radical mastectomy has been replaced by breast-conserving and oncoplastic approaches in most patients, and full axillary lymph node dissection by less radical staging procedures, such as sentinel lymph node biopsy and targeted axillary dissection. Further, attempts have been made to spare healthy tissue while increasing the probability of removing the tumor with clear margins, thus improving cosmetic results and minimizing the risk of local recurrence. In this context, modern probe-guided localization techniques have been introduced to guide surgical excision. This progress was accompanied by the development of targeted systemic therapies. At the same time, radiotherapy for breast cancer has undergone significant changes. The use of hypofractionation has decreased the typical length of a treatment course from 5–6 weeks to 1–3 weeks. Partial breast irradiation is now a valid option for de-escalation in patients with low-risk features. Axillary radiotherapy achieves similar recurrence rates and decreases the risk of lymphedema in patients with limited sentinel node involvement. <b><i>Key Messages:</i></b> Taken together, these advances are important steps toward individualization of locoregional management strategies. This highlights the importance of interdisciplinary approaches for de-escalation of locoregional therapies.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135787223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Follow-Up of High-Risk Breast Lesions at Vacuum-Assisted Biopsy without Subsequent Surgical Resection","authors":"Constanze Elfgen, Zsuzsanna Varga, Katrin Breitling, Eliane Pauli, Daniela Schwegler-Guggemos, Gert Kampmann, Rahel A. Kubik-Huch, Cornelia Leo, Domenico Lepori, Martin Sonnenschein, Christoph Tausch, Simone Schrading","doi":"10.1159/000533673","DOIUrl":"https://doi.org/10.1159/000533673","url":null,"abstract":"<b><i>Introduction:</i></b> B3-lesions of the breast are a heterogeneous group of neoplasms, associated with a higher risk of breast cancer. Recent studies show a low upgrade rate into malignancy after subsequent open surgical excision (OE) of most B3-lesions when proven by vacuum-assisted biopsy (VAB). However, there is a lack of long-term follow-up data after VAB of high-risk lesions. The primary aim of this study was to demonstrate whether follow-up of B3 lesions is a beneficial and reliable alternative to OE in terms of long-term outcome. The secondary aim was to identify patient and lesion characteristics of B3 lesions for which OE is still necessary. <b><i>Methods:</i></b> This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the <i>t</i> test and Fisher’s exact test. A <i>p</i> value of &amp;lt;0.05 was considered statistically significant. <b><i>Results:</i></b> The median follow-up interval was 59 months (range: 24–143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31–119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up (<i>p</i> &amp;lt; 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient (<i>p</i> &amp;gt; 0.12). <b><i>Conclusion:</i></b> With a low risk of &amp;lt;6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6–7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (&amp;gt;10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135098992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ongoing Necessity of Sentinel Lymph Node Biopsy for cT1–2N0 Breast Cancer Patients","authors":"Wenjun Jia, Xiao Chen, Xinyu Wang, Jianzhong Zhang, Tong Tang, Jianing Shi","doi":"10.1159/000532081","DOIUrl":"https://doi.org/10.1159/000532081","url":null,"abstract":"<b><i>Background:</i></b> Recent clinical trials attempt to determine whether it is appropriate to omit axillary lymph node surgery in patients with cT1–2N0 breast cancer. The study aimed to investigate the true extent of axillary node disease in patients with clinically negative nodes and explore the differences between negative axillary ultrasound (AUS-cN0) and suspicious axillary ultrasound with negative fine-needle aspiration (FNA-cN0). <b><i>Methods:</i></b> Pathologically identified T1–2 invasive breast cancer patients with clinically negative nodes were retrospectively analyzed at our center between January 2019 and December 2022. Patients who received any systematic treatment before surgery were excluded from this study. <b><i>Results:</i></b> A total of 538 patients were enrolled in this study. 134 (24.9%) patients had pathologically positive nodes, and 404 (75.1%) patients had negative nodes. Univariate analysis revealed that tumor size, T stage, Ki67 level, and vascular invasion (VI) were strongly associated with pathological axillary lymph node positivity. In multivariate analysis, VI was the only independent risk factor for node positivity in patients with cT1–2N0 disease (OR: 3.723, confidence interval [CI]: 2.380–5.824, <i>p</i> &amp;lt; 0.001). Otherwise, pathological node positivity was not significantly different between AUS-cN0 and FNA-cN0 groups (23.4% vs. 28.8%, <i>p</i> = 0.193). However, the rate of high nodal burden (≥3 positive nodes) was significantly higher in FNA-cN0 group. Further investigation revealed that FNA-cN0 and VI were independently associated with a high nodal burden (OR: 2.650, CI: 1.081–6.496, <i>p</i> = 0.033; OR: 3.521, CI: 1.249–9.931, <i>p</i> = 0.017, respectively). <b><i>Conclusions:</i></b> cT1–2 breast cancer patients with clinically negative axillary lymph nodes may have pathologically positive lymph nodes and even a high nodal burden. False negatives in AUS and AUS-guided FNA should not be ignored, and sentinel lymph node biopsy remains an ongoing necessity for cT1–2N0 breast cancer patients.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136337633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacituzumab govitecan: Trop-2 als Target","authors":"","doi":"10.1159/000533368","DOIUrl":"https://doi.org/10.1159/000533368","url":null,"abstract":"information@karger.com www.karger.com der sogenannte «Bystander-Effekt»: Durch die Hydrolyse liegt SN-38 auch extrazellulär vor. Es reichert sich in der Mikroumgebung des Tumors an und induziert nach Permeation der Zellmembran auch in benachbarten Tumorzellen die Apoptose – auch wenn diese kein Trop-2 exprimieren [2, 6]. «Durch die Anreicherung des Wirkstoffs im Tumor sowie in der Mikroumgebung der Tumorzellen scheint Sacituzumab govitecan auch für Tumoren mit heterogenen Oberflächenantigenmustern eine effektive Therapiestrategie darzustellen», erklärte Prof. Dr. Christian Schem, Hamburg. Sg ist indiziert als Monotherapie zur Behandlung von erwachsenen Patient*innen mit nicht resezierbarem oder metastasiertem TNBC, die zuvor zwei oder mehr systemische Therapien erhalten haben, darunter mindestens eine gegen die fortgeschrittene Erkrankung [1]. Eine Testung auf Trop-2 ist nicht erforderlich (mehr dazu im Interview).","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"18 1","pages":"318 - 319"},"PeriodicalIF":2.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42355145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PharmaNews","authors":"","doi":"10.1159/000531327","DOIUrl":"https://doi.org/10.1159/000531327","url":null,"abstract":"Inhibitoren der Cyclin-abhängigen Kinasen 4 und 6 (CDK4/6) sind der Goldstandard für die Erstund Zweitlinientherapie des metastasierten HR+/HER2– Mammakarzinoms (HR = Hormonrezeptor, HER2 = humaner epidermaler Wachstumsfaktorrezeptor 2). Palbociclib hat sich dabei in klinischen und Real-World-Studien als wirksam erwiesen. Das Handling ist einfach, einen Effektivitätsverlust infolge einer Dosisanpassung gibt es nicht.","PeriodicalId":9310,"journal":{"name":"Breast Care","volume":"18 1","pages":"228 - 230"},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46663521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}