Can we approach zero relapse in breast cancer?
Female; Humans; Gene Expression Profiling; Prognosis; Recurrence; Disease-Free Survival; Lymph Nodes/pathology; Neoadjuvant Therapy; Aromatase Inhibitors/therapeutic use; Breast Neoplasms/mortality/pathology/*prevention & control/*therapy; Antineoplastic Agents; Adjuvant; Chemotherapy; Hormonal/*therapeutic use
Adjuvant hormonal therapy and adjuvant chemotherapy have contributed significantly to the falling rates of breast cancer mortality. The introduction of taxanes and aromatase inhibitors in the adjuvant setting represents recent important improvements. More recently, the demonstration of significant benefit in the adjuvant setting with novel molecular targeted therapies (such as trastuzumab [Herceptin; Genentech, Inc., South San Francisco, CA, http://www.gene.com]) is already beginning to have a substantial impact on the adjuvant treatment of patients with certain tumor characteristics (i.e., HER-2 positivity). Neoadjuvant treatment represents an approach that offers an intermediate end point (i.e., pathologic complete response) that can be used as a marker of therapeutic activity. Furthermore, the use of genomic profiling is starting to replace the traditional prognostic and predictive factors currently used to estimate risks for recurrence and response to particular adjuvant therapies. These recent developments have demonstrated that the notion of approaching zero relapse in breast cancer patients is now within our reach.
Mamounas Eleftherios P
The oncologist
2005
2005-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1634/theoncologist.10-90002-9" target="_blank" rel="noreferrer noopener">10.1634/theoncologist.10-90002-9</a>
Facilitating breast-conserving surgery and preventing recurrence: aromatase inhibitors in the neoadjuvant and adjuvant settings.
Female; Humans; Neoadjuvant Therapy; Antineoplastic Agents/*administration & dosage; Aromatase Inhibitors/*administration & dosage; Breast Neoplasms/*drug therapy/*surgery; Neoplasm Recurrence; Segmental; *Mastectomy; Adjuvant; Chemotherapy; Local/*prevention & control
Breast-conserving surgery (BCS) is an attractive option for many patients with early-stage breast cancer, because it provides a better cosmetic outcome than modified radical mastectomy, while reducing surgical morbidity. In patients with large, operable breast tumors who are ineligible for BCS, neoadjuvant therapy is a useful option for reducing the tumor size and for increasing the proportion of candidates for BCS. In patients with endocrine-responsive tumors, neoadjuvant endocrine therapy with either tamoxifen or an aromatase inhibitor (AI; anastrozole, letrozole, or exemestane) provides an alternative to neoadjuvant chemotherapy. Clinical trials have demonstrated the superiority of neoadjuvant AIs over tamoxifen in achieving a clinical response and increasing the frequency of BCS. In addition, adjuvant endocrine therapy with AIs, whether used as initial therapy instead of tamoxifen, in a switching strategy after 2-3 years of tamoxifen, or as extended adjuvant therapy after 5 years of adjuvant tamoxifen, has been shown in several randomized clinical trials to improve disease-free survival, reduce distant metastases and, in some cases, improve overall survival. The availability of the AIs for effective and well-tolerated neoadjuvant and/or adjuvant endocrine therapy represents an important advance in breast cancer treatment, and surgeons should be familiar with these new therapeutic options.
Mamounas Eleftherios P
Annals of surgical oncology
2008
2008-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1245/s10434-007-9702-3" target="_blank" rel="noreferrer noopener">10.1245/s10434-007-9702-3</a>
Ipsilateral breast tumor recurrence after lumpectomy: is it time to take the bull by the horns?
Adult; Female; Prognosis; Combined Modality Therapy; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasm Recurrence; Lumpectomy; Breast Neoplasms – Pathology; Breast Neoplasms – Surgery; Breast Neoplasms – Therapy; Local – Pathology; Local – Surgery; Local – Therapy
Mamounas Eleftherios P; Mamounas E P
Journal of Clinical Oncology
2001
2001-09-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1200/jco.2001.19.18.3798" target="_blank" rel="noreferrer noopener">10.1200/jco.2001.19.18.3798</a>
Predicting locoregional recurrence after neoadjuvant chemotherapy in patients with breast cancer.
Female; Humans; Treatment Outcome; Prognosis; Clinical Trials as Topic; Research Design; Breast Neoplasms/*diagnosis/drug therapy/therapy; Neoadjuvant Therapy; Risk; *Neoplasm Recurrence; Local
Mamounas Terry P
Clinical advances in hematology & oncology : H&O
2013
2013-03
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Prediction of pathological complete response in breast cancer patients during neoadjuvant chemotherapy: Is shear wave elastography a useful tool in clinical routine?
2D shear wave imaging; Breast neoplasms; Elasticity imaging techniques; Neoadjuvant therapy
OBJECTIVE: To compare the validity of Shear Wave Elastography (SWE) for the preoperative assessment of pathological complete response (pCR) to standard clinical assessment in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: This prospective, consecutive clinical trial was conducted under routine clinical practice. Analysis included 134 patients. SWE served as index test, final pathology from surgical specimen as reference standard. PCR (ypT0) was defined as primary endpoint. Elasticity changes were compared for the pCR- vs. non-pCR group. To determine the validity of shear wave velocity (Vs), ROC analyses and diagnostic accuracy parameters were calculated and compared to the final standard clinical assessment by physical examination, mammography and B-mode ultrasound (ycT+vs. ycT0). RESULTS: Vs was significantly reduced in pCR and non-pCR groups during NACT (pCR: DeltaVs(abs)=3.90m/s, p<0.001; non-pCR: DeltaVs(abs)=3.10m/s, p<0.001). The pCR-group showed significant lower Vs for all control visits (t1,2,END: p<0.001). ROC analysis of Vs yielded moderate AUCs for the total population (t0: 0.613, t1: 0.745, t2: 0.685, tEND: 0.718). Compared to standard clinical assessment, Vs(tEND) (cut-off: </=3.35m/s) was superior in sensitivity (79.6 % vs. 54.5 %), NPV (86.4 % vs. 77.5 %), FNR (20.4 % vs. 45.5 %), inferior in specificity (58.6 % vs. 77.5 %), PPV (46.3 % vs. 54.5 %), FPR (41.4 % vs. 22.5 %). CONCLUSION: SWE measures significant differences in tumour elasticity changes in pCR vs. non-pCR cases. SWE shows improved sensitivity compared to standard clinical assessment, high NPV and low FNR, but failed in specificity in order to predict pCR under routine conditions.
Maier Anna Marie; Heil Jorg; Harcos Aba; Rauch Geraldine; Uhlmann Lorenz; Gomez Christina; Stieber Anne; Funk Annika; Barr Richard G; Hennigs Andre; Riedel Fabian; Schafgen Benedikt; Hug Sarah; Marme Frederik; Sohn Christof; Golatta Michael
European journal of radiology
2020
2020-05-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ejrad.2020.109025" target="_blank" rel="noreferrer noopener">10.1016/j.ejrad.2020.109025</a>
Present state and future prospects: a review of cooperative groups' adjuvant and neoadjuvant trials in breast cancer.
Female; Humans; Prognosis; Decision Making; Clinical Trials as Topic; Neoadjuvant Therapy; Tamoxifen/administration & dosage; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use; Breast Neoplasms/*drug therapy/surgery; Diphosphonates/therapeutic use; Ovary/drug effects/physiology; Taxoids/therapeutic use; Antineoplastic Agents; Adjuvant; Chemotherapy; Hormonal/*therapeutic use
In patients with operable breast cancer, adjuvant hormonal therapy and adjuvant chemotherapy result in significant and long-term reductions in the rates of disease recurrence and death. These reductions are evident in both patients with node-negative as well as in those with node-positive disease. However, several issues in the adjuvant treatment of breast cancer still remain unresolved. These issues were recently considered at the 2000 National Institutes of Health (NIH) Consensus Development Conference, which reviewed the current state of knowledge on adjuvant therapy and outlined strategies for future research. In the area of adjuvant hormonal therapy, tamoxifen is still the gold standard, and present evidence supports the use of tamoxifen for patients with estrogen receptor (ER)-positive tumors irrespective of age, menopausal status, nodal status, or tumor size. Optimal duration of tamoxifen therapy is about 5 years. Future research directions include evaluating the benefit of extending tamoxifen beyond 5 years, the contribution of ovarian ablation, and the role of hormonal manipulations involving selective ER modulators and aromatase inhibitors instead of or in addition to tamoxifen. In the area of adjuvant chemotherapy, polychemotherapy regimens have been consistently found to be superior to single agents, and anthracycline-containing regimens produce a small but statistically significant improvement in survival when compared with regimens not containing an anthracycline. High-dose adjuvant chemotherapy with stem cell support has not been proven superior to standard regimens. Neoadjuvant therapy offers the possibility of testing in vivo the sensitivity of individual tumors to particular cytotoxic regimens and, hence, of improving ultimate disease control, as well as reducing the extent of local therapy. The contribution and optimal integration of taxanes in the adjuvant setting are yet to be established but are the subject of intense research effort. Similarly, novel targeted therapies such as trastuzumab and bisphosphonates are currently being evaluated in adjuvant studies
Mamounas E P
Clinical breast cancer
2001
2001-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3816/cbc.2001.s.004" target="_blank" rel="noreferrer noopener">10.3816/cbc.2001.s.004</a>