Publications (14) View all
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Article: Locoregional recurrence in patients with HER2 positive breast cancer
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ABSTRACT: Literature shows that HER2/neu positive breast cancer cells are more sensitive to radiation-induced apoptosis by targeting the epidermal growth factor receptor family tyrosine kinase. We selected 466 patients with pT1-2 HER2/neu positive tumors who received adjuvant trastuzumab for primary invasive breast cancer. Patients were divided into three groups [Quadrantectomy followed by conventional radiotherapy vs Quadrantectomy followed by Intra-operative radiotherapy with electrons vs Mastectomy without radiotherapy]. After a median follow-up of 52 months, the 5-year cumulative incidence of locoregional recurrence (LRR) was 1.9%, 11.5% and 5.0% respectively (p < 0.01). At the multivariate analysis, extensive perivascular invasion, Luminal B HER2/Progesterone Receptor (PgR) negative status and Quadrantectomy followed by Intra-operative radiotherapy with electrons have significantly increased the risk of LRR. Our results suggest that HER2/neu positive breast cancer might have better outcomes when treated simultaneously with external radiotherapy and trastuzumab. Moreover, we underline the importance of PgR and further new stratification of risk among luminal subtypes.The Breast 05/2013; · 2.49 Impact Factor -
Article: Locoregional recurrence in patients with HER2 positive breast cancer.
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ABSTRACT: Literature shows that HER2/neu positive breast cancer cells are more sensitive to radiation-induced apoptosis by targeting the epidermal growth factor receptor family tyrosine kinase. We selected 466 patients with pT1-2 HER2/neu positive tumors who received adjuvant trastuzumab for primary invasive breast cancer. Patients were divided into three groups [Quadrantectomy followed by conventional radiotherapy vs Quadrantectomy followed by Intra-operative radiotherapy with electrons vs Mastectomy without radiotherapy]. After a median follow-up of 52 months, the 5-year cumulative incidence of locoregional recurrence (LRR) was 1.9%, 11.5% and 5.0% respectively (p < 0.01). At the multivariate analysis, extensive perivascular invasion, Luminal B HER2/Progesterone Receptor (PgR) negative status and Quadrantectomy followed by Intra-operative radiotherapy with electrons have significantly increased the risk of LRR. Our results suggest that HER2/neu positive breast cancer might have better outcomes when treated simultaneously with external radiotherapy and trastuzumab. Moreover, we underline the importance of PgR and further new stratification of risk among luminal subtypes.Breast (Edinburgh, Scotland) 04/2013; · 2.09 Impact Factor -
Article: HER2 signaling pathway and trastuzumab cardiotoxicity.
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ABSTRACT: Romond EH, Perez EA, Bryant J et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N. Engl. J. Med. 353(16), 1673-1684 (2005). Trastuzumab-induced cardiotoxicity may induce reversible damage that is usually transitory and improves with trastuzumab withdrawal. In clinical trials with trastuzumab in the adjuvant setting patients with cardiac risks were not included. Subgroup analysis identified subpopulations that were most likely to experience cardiac damage upon trastuzumab exposure. Although there is a risk of cardiac toxicity with adjuvant trastuzumab, the improvement of outcome in patients treated with this drug outweighs this. It is essential, therefore, to properly assess cardiac function prior to, during and after trastuzumab therapy in all patients. The incidence of congestive heart failure in older patients treated with trastuzumab is expected to be higher than in the overall population evaluated in large clinical trials. Therefore, cardiac risk assessment, breast cancer recurrence risk, and discussion between cardiologists and oncologists should take place prior to deciding which adjuvant treatment is appropriate for a woman with early breast cancer. A longer follow-up period is recommended in order to verify whether cardiac reversibility remains and, accordingly, whether the short-term risk is exaggerated or understated. With the NSABP-B31 trial regimen, the benefit of trastuzumab definitely outweighs the risk; indeed, the occurrence of late congestive heart failure after adding trastuzumab to chemotherapy is fairly unusual. In the era of personalized medicine, efforts are needed to promote strategies for risk detection and management to avoid dangerous toxicities that may impede the development of and patient access to new agents.Future Oncology 02/2013; 9(2):179-81. · 3.16 Impact Factor -
Article: Highlights from the 13th St Gallen International Breast Cancer Conference 2013. Access to innovation for patients with breast cancer: how to speed it up?
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ABSTRACT: The recognition that early breast cancer is a spectrum of diseases each requiring a specific systemic therapy guided the 13th St Gallen International Breast Cancer Consensus Conference [1]. The meeting assembled 3600 participants from nearly 90 countries worldwide. Educational content has been centred on the primary and multidisciplinary treatment approach of early breast cancer. The meeting culminated on the final day, with the St Gallen Breast Cancer Treatment Consensus, established by 40-50 of the world's most experienced opinion leaders in the field of breast cancer treatment. The major issue that arose during the consensus conference was the increasing gap between what is theoretically feasible in patient risk stratification, in treatment, and in daily practice management. We need to find new paths to access innovations to clinical research and daily practice. To ensure that continued innovation meets the needs of patients, the therapeutic alliance between patients and academic-led research should to be extended to include relevant pharmaceutical companies and drug regulators with a unique effort to bring innovation into clinical practice. We need to bring together major players from the world of breast cancer research to map out a coordinated strategy on an international scale, to address the disease fragmentation, to share financial resources, and to integrate scientific data. The final goal will be to improve access to an affordable, best standard of care for all patients in each country.ecancermedicalscience 01/2013; 7:299. -
Article: Targeted therapies in breast cancer: are heart and vessels also being targeted?
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ABSTRACT: The concept of 'targeted' therapies implies that such drugs only act on cells that specifically express the particular target, therefore giving rise to a low incidence of side effects. However, targeted therapies currently approved for the treatment of breast cancer have demonstrated a relatively high incidence of cardiovascular events. The anti-HER2 agents trastuzumab and lapatinib may cause left ventricular dysfunction or even congestive heart failure. Bevacizumab, an antiangiogenic drug, has been shown to increase the risk of hypertension, cardiovascular dysfunction and thromboembolic events. In addition, several anti-human epidermal growth factor receptor 2 (HER2) and antiangiogenic agents plus their combinations are currently being developed and evaluated for the treatment of breast cancer. In this review, we aim to assess the incidence of cardiac adverse events associated with targeted therapies designed to block HER2 and angiogenic pathways.Breast cancer research: BCR 06/2012; 14(3):209. · 5.24 Impact Factor
