Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study

Yang, Ruo-Han; Lu, Guanyu; Lv, Zheng; Jia, Lin; Cui, Jiuwei

doi:10.3389/fonc.2022.1048781

Cited by 13 publications

(31 citation statements)

References 31 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bone marrow replacement is another established type of VC, although cut-off values for haematopoietic dysfunction were often neither reported nor consistent. Some authors included carcinomatous meningitis in the definition of VC [ 16 , 18 , 19 ], Franzoi et al also considered symptomatic brain metastases. Other sporadically reported types include superior vena cava syndrome [ 5 , 8 , 9 ], peritoneal carcinomatosis with symptoms of bowel obstruction, cardiac tamponade and malignant hypercalcaemia [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other sporadically reported types include superior vena cava syndrome [ 5 , 8 , 9 ], peritoneal carcinomatosis with symptoms of bowel obstruction, cardiac tamponade and malignant hypercalcaemia [ 9 ]. The type of VC was found to be an independent prognostic factor for survival, with bone marrow and liver aetiology associated with the best and worst prognosis, respectively [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The heterogeneity of these studies lies not only in the definition and distribution of VC types but also in the clinicopathological characteristics of the patients (i.e., tumour molecular subtype, ECOG performance status at baseline, number and type of previous therapy lines and treatment received for VC). According to real-world epidemiology, HR+/HER2- ABC is the most common BC subtype; when included in the study, TBNC and HER2+ diseases do not represent more than 15–20% of the population each [ 16 , 17 , 19 ]. As expected, the patients with VC had a rather poor performance status compared to that observed in the general population of patients with ABC.…”

Section: Discussionmentioning

confidence: 99%

“…Most of them had an ECOG PS ≥ 2; in Yang’s series, even more than 40% of the patients had an ECOG PS of 3. Remarkably, poor ECOG PS was found to be an independent prognostic factor for survival in several studies [ 16 , 18 , 19 ]. From this series, it appears that the majority of VCs were diagnosed and treated in the first-line setting, although it is not uncommon for VC to occur after multiple lines of endocrine therapy and/or CT.…”

Section: Discussionmentioning

confidence: 99%

“…In multivariate analysis, ECOG PS and the type of VC were found to be independently associated with survival. A lower rate of adverse events (AEs), grade ≥ 3 AEs and dose reductions due to AEs were observed with ET and anti-HER2 therapy than with CT [ 19 ].…”

Section: The Clinical Management Of Visceral Crisismentioning

confidence: 99%

See 4 more Smart Citations

Clinical Review on the Management of Breast Cancer Visceral Crisis

et al. 2023

View full text Add to dashboard Cite

Visceral crisis is a life-threatening clinical condition requiring urgent treatment and accounts for 10–15% of new advanced breast cancer diagnoses, mainly hormone receptor-positive/human epidermal growth factor 2 negative. As its clinical definition is an open topic with nebulous criteria and much room for subjective interpretation, it poses a challenge for daily clinical practice. International guidelines recommend combined chemotherapy as first-line treatment for patients with visceral crisis, but with modest results and a very poor prognosis. Visceral crisis has always been a common exclusion criterion in breast cancer trials, and the available evidence mainly comes from limited retrospective studies which are not sufficient to draw solid conclusions. The outstanding efficacy of innovative drugs, such as CDK4/6 inhibitors, questions the role of chemotherapy in this setting. In the lack of clinical reviews, we aim to critically discuss the management of visceral crisis, advocating future treatment perspectives for this challenging condition.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Clinical Management Of Visceral Crisismentioning

confidence: 99%

See 3 more Smart Citations

Clinical Review on the Management of Breast Cancer Visceral Crisis

et al. 2023

View full text Add to dashboard Cite

show abstract

Efficacy of first‐line dual oral pyrotinib plus capetabine therapy in HER2‐positive metastatic breast cancer: A real‐world retrospective study

Dai,

Zhang,

Tan

et al. 2024

Cancer Medicine

View full text Add to dashboard Cite

BackgroundThe combination of dual‐targeted human epidermal growth factor receptor 2 (HER2) therapy and chemotherapy is the standard first‐line regimen for recurrent/metastatic breast cancer (mBC). However, the toxicity of such combination therapy can lead to some patients being unable to tolerate adverse events or bear treatment costs. As a novel irreversible pan‐ErbB receptor TKI (pyrotinib), can the dual oral administration of pyrotinib plus capetabine (PyroC) provide first‐line survival benefits and serve as a more affordable treatment option?MethodsThis real‐world retrospective study included patients diagnosed with HER2‐positive mBC who received PyroC as a first‐line treatment at West China Hospital between May 2018 and July 2023. The survival data and toxicity profiles were reported in this study.ResultsA total of 64 patients received PyroC as first‐line therapy. The median progression‐free survival (PFS) was 19.6 months (95% CI 15.0–27.2), while overall survival (OS) has not yet been reached. Kaplan–Meier analysis indicated that age (≥60, p = 0.03) and metastasis sites (p = 0.004) were related to poor efficacy of PyroC, while there was no relationship between effectiveness and menstrual status, hormone receptor (HR) status or previous treatment with anti‐HER2 therapy. Furthermore, the objective response rate (ORR) and disease control rate (DCR) were 79.7% and 98.4%, respectively. Of the patients, 78.1% reported treatment‐related adverse events (TRAEs). The predominant adverse events were diarrhea (n = 46, 71.9%) and hand‐foot syndrome (n = 10, 15.6%).ConclusionThe dual oral administration regimen (PyroC) has a promising ORR or PFS in HER2‐positive mBC patients, with an acceptable safety profile and convenience.

show abstract

CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2- advanced breast cancer with impending or established visceral crisis

Behrouzi

Armstrong

Howell

2023

Breast Cancer Res Treat

View full text Add to dashboard Cite

Purpose ER+/HER2- advanced breast cancer (ABC) with visceral crisis (VC) or impending VC (IVC) is commonly treated with chemotherapy instead of CDK4/6 inhibitors (CDK4/6i). However, there is little evidence to confirm which treatment is superior. This study compared outcomes of patients with ER+/HER2- ABC and IVC/VC treated with CDK4/6i or weekly paclitaxel. Methods Patients with ER+/HER2- ABC receiving first line treatment at a large tertiary UK cancer centre from 1-Mar-2017 to 30-Jun-2021 were retrospectively identified. Hospital records were screened for IVC/VC affecting the liver, lungs/mediastinum, gastrointestinal tract and/or bone marrow. Baseline demographics, clinical data and survival outcomes were recorded up to 30-Jul-2022. Results 27/396 (6.8%) patients with ABC who received CDK4/6i and 32/86 (37.2%) who received paclitaxel had IVC/VC. Median time to treatment failure (TTF), progression-free survival (PFS) and overall survival (OS) were significantly longer in the CDK4/6i compared to paclitaxel cohort: TTF 17.3 vs. 3.5 months (HR 0.33, 95%CI 0.17–0.61, p = 0.0002), PFS 17.8 vs. 4.5 months (HR 0.38, 95%CI 0.21–0.67, p = 0.002), OS 24.6 vs. 6.7 months (HR 0.37, 95%CI 0.20–0.68, p = 0.002). The median time to first improvement in IVC/VC was similar in patients receiving CDK4/6i compared to paclitaxel (3.9 vs. 3.6 weeks, p = 0.773). Disease control at 4 months was not significantly different in the CDK4/6i and paclitaxel cohorts (77.8% vs. 59.4%, p = 0.168). In multivariate analysis, treatment with CDK4/6i was independently associated with a longer PFS compared to paclitaxel (HR 0.31, 95%CI 0.12–0.78, p = 0.015). Conclusion In this retrospective study, patients with ER+/HER2- ABC and IVC/VC treated with CDK4/6i had a significantly better survival compared to those treated with weekly paclitaxel. Further prospective studies that minimise possible selection bias are recommended.

show abstract

Different treatment regimens in breast cancer visceral crisis: A retrospective cohort study

Cited by 13 publications

References 31 publications

Clinical Review on the Management of Breast Cancer Visceral Crisis

Clinical Review on the Management of Breast Cancer Visceral Crisis

Efficacy of first‐line dual oral pyrotinib plus capetabine therapy in HER2‐positive metastatic breast cancer: A real‐world retrospective study

CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2- advanced breast cancer with impending or established visceral crisis

Contact Info

Product

Resources

About