Background:Breast cancer metastases can be found in almost all organs in the body -but are most commonly found in the lungs, liver, bones, skin and brain.Metastatic breast cancer often occurs years or decades after initial diagnosis and treatment.In this case report, we will present a 62-year-old patient with metastasis of breast cancer which was originally described as primary colorectal cancer. Case presentation:In 2008, the patient was treated for hormone-sensitive HER2-negative breast cancer and was admitting letrozole as adjuvant therapy during the past 10 years.In the fall of 2018, she complained about abdominal cramps, nausea, vomiting and losing 20 kilograms.Tumor markers (ca15-3 63; ca125 107.8;CEA 20.6) and colonoscopy were performed, which raised the suspicion of tumor formation in the area of the ascending colon and terminal ileum that was then biopsy-confirmed.Concomitant PET-CT confirmed thickening of the ascending wall up to 7 cm in length with surrounding multiplied lymph nodes.Hemicolectomy on the right with an ileotransverse anastomosis was performed in December of 2018.and biopsy showed that it was grade 3 adenocarcinoma with seal ring-like cells.Postoperative tumor markers continued to be elevated (CEA 32; ca125 165; ca15-3 67.2), and control PET-CT revealed size progression and increased abdominal lymph node metabolism.A revision of the biopsy findings was made and then metastasis of breast cancer was suspected.Metastasis of the now triple-negative subtype of breast cancer has been confirmed and treatment has been started according to the protocol for metastatic disease. Conclusion:Despite the rare presentation of breast cancer metastasis to the colon, it must be carried in mind in patients with a history of breast cancer because it may be masked by the clinical picture of the second primary tumor.
Introduction Pandemic COVID-19 is an unexpected challenge for the oncological community, indicating potential detrimental effects on cancer patients. Our aim was to summarize the converging key points providing a general guidance in order to support decision making, pertaining to the oncologic care in the middle of a global outbreak. Methods We did an international online search in twenty five countries that have managed a surge in cancer patient numbers. We collected the recommendations from thirty one medical oncology societies. Results By synthesizing guidelines for a) oncology service delivery adjustments, b) general and specific treatment adaptations, and c) discrepancies from guidelines comparison, we present a clinical synopsis with the forty more crucial statements. A Covid-19 risk stratification base was also created in order to obtain a quick, objective patient assessment and a risk-benefit evaluation on a case-by-case basis. Conclusions In an attempt to face these complex needs and due to limited understanding of COVID-19, a variability of recommendations based on general epidemiological and infectious disease principles rather than definite cancer-related evidence has evolved. Additionally, the absence of an effective treatment or vaccine requires the development of cancer management guidance, capitalizing on comprehensive COVID-19 oncology experience globally.
Abstract BACKGROUND: According to immunohistochemistry (IHC) expression of HER2 receptor, breast cancer (BC) can be classified as either IHC score 0, 1+, 2+ or 3+. Until recently, two distinct BC subtypes were recognized depending on the HER2 IHC expression and in situ hybridization (ISH) score: HER2 positive (IHC 3+ or IHC 2+ ISH-amplified) and HER2 negative (IHC 0, 1+ or 2+ ISH negative). More recently a new BC entity termed HER2-low was acknowledged, defined as either HER2 IHC 1+ or 2+ ISH-negative. Given that no treatment benefit was observed in HER2-low group of patients in the pivotal trastuzumab studies, many years had to pass before the discovery of antibody-drug conjugates such as trastuzumab deruxtecan, that led to a significant improvement in the clinical outcome of HER2-low BC, compared to standard therapy options. It is still debated whether HER2-low BC represents a distinct biological subtype. The aim of this study was to determine whether there is an impact of HER2-low status on the effect of neoadjuvant chemotherapy (NACT) and its primary indicator - the rate of the pathologic complete response (pCR). METHODS: A retrospective study of 363 BC cases who received NACT between January 2020 and December 2022 at University Hospital Centre Zagreb, Croatia, was conducted with prior Ethics Committee approval. Histopathological characteristics of tumours available from the hospital information system (BIS), including hormone receptor status (ER, PR), HER2 status and Ki-67 at the time of diagnosis and after neoadjuvant treatment, as well as pCR rates, were analysed. pCR rates were calculated for HER2-low and HER2 0 cases. Chi square test was used to analyse association between pCR rate and HER2 status. RESULTS: After exclusion of HER2 positive BC cases, as well as cases with missing data, a total of 215 patients were included in the analysis. Of those, 101 (47%) were HER2-low, and 114 (53%) were HER2 negative. The majority of patients (N=151, 70.2%) had luminal BC, while 64 (29.8%) patients had triple negative BC (TNBC). In the luminal group, 86 cases (57%) were HER2-low, and 65 (43%) were HER2 0. In the TNBC group, 15 cases (23.4%) were HER2-low and 49 (76.6%) were HER2 0. The rate of pCR among luminal subtypes was 6.2% for HER2-low tumours, and 15.4% for HER2 0 tumours (p=.051559), approaching statistical significance. In the TNBC group, the pCR rate for HER2-low group was 60%, compared to 40% in the HER2 0 group, trending towards, but not reaching statistical significance (p=.191564). CONCLUSION: A trend toward higher pCR rates after neoadjuvant chemotherapy was observed in the luminal HER2 0 group compared to HER2-low luminal BC, almost reaching statistical significance. Interestingly, in TNBC there was a trend towards higher pCR rates among the HER2-low group, although a small number of patients precludes any definitive conclusions. Further trials that include novel targeted therapies are needed, as that might lead to significant changes in therapeutic approach, as well as clinical outcome of HER2-low BC patients. Citation Format: Dora Gudelj, Katarina Čular, Lea Toula, Marija Križić, Marina Popović, Natalija Dedić Plavetić, Ana Kelečić, Gordana Ivanac, Majana Soče, Iva Kukal Gjergjaj, Tajana Silovski. Clinical outcomes of neoadjuvant chemotherapy in HER2-low early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-02-09.
Abstract Introduction Breast cancer (BC) is a disease characterized by significant intra- and intertumoral heterogeneity. Hence, it is not surprising that new subtypes with distinct biological features are being discovered, even among previously well-defined BC groups. Recently, HER2-low BC emerged as a new entity with specific clinical behavior, response to treatment and prognosis. HER2-low is a subset of HER2-negative BC, with HER2 immunohistochemical (IHC) score of 1+ or 2+, without HER2 gene amplification measured by in situ hybridization (ISH). As new therapeutic options become available for HER2-low patients, the best treatment sequence is yet to be determined. Furthermore, it is important to distinguish whether there is a difference in the response to standard treatment lines, such as CDK 4/6 inhibitors in metastatic HR positive BC patients, depending on HER2-low status. Methods A retrospective study of 369 metastatic BC (mBC) cases who started CDK 4/6 inhibitor therapy from January 2018 through December 2022 at University Hospital Centre Zagreb was conducted, with prior Ethics Committee approval. All patients with HR positive HER2 negative mBC, determined by standard IHC and ISH, were included in the research. Patient demographics and clinical presentation, tumor characteristics and treatment information were collected. Progression-free survival (PFS) analysis was done with the final data cut-off date being June 1st, 2023. Type 1 right censoring was performed. The data was analyzed using the Kaplan-Meier method and Cox proportional-hazards regression for clinically relevant covariates (age, line of treatment, de novo metastatic disease, endocrine resistance, liver metastases, and detected PIK3CA mutation). Results Median follow-up was 23 months. Of the 283 patients included, 146 (51.59%) had HER2-low disease. A change in HER2 expression between primary tumor and metastasis was found in 16.96% (N=48) patients. Of them,10.25% (N=29) who were initially HER2-low, were found to be HER2-0 in metastatic disease. Meanwhile, 6.71% (N=19) of patients had a change in HER2 expression from 0 to low upon becoming metastatic. In the HER2-low group, 47.06% (N=45) patients had a PIK3CA mutation as opposed to 33.33% (N=30) in the HER2-0 group. Odds ratio for a PIK3CA mutation in HER2-low patients was 1.86 (95% confidence interval (CI): 1.01-3.43, p-value 0.046). Median PFS in the HER2-low group was 18 months (95% confidence interval (CI): 14-24) versus 23 (95% CI: 18-30) in the HER2-0 group. Using multivariable analysis an adjusted hazard ratio of 1.15 (95% CI:0.84-1.57; p-value 0.389) was calculated. Covariates associated with a statistically significant increased risk of disease progression were a higher line of therapy (HR 1.39, 95% CI 1.36-1.71, p-value 0.002) and the presence of liver metastases (HR 2.17, 95% CI 1.42-3.32, p-value 0.0004). A covariate associated with a statistically significant longer PFS was de novo metastatic disease (HR 0.63, 95% CI 0.41-0.97, p-value 0.034). Conclusion There was a trend toward worse PFS in HER2-low mBC that did not reach statistical significance. HER2-low patients were more likely to harbor PIK3CA mutations than HER2-0 patient group. Longer follow-up and a larger cohort are needed in order to make definitive conclusions. Citation Format: Katarina Čular, Kristina Kanceljak, Ana Magdalena Glas, Dora Gudelj, Marija Križić, Marina Popović, Natalija Dedić Plavetić, Maja Sirotković-Skerlev, Stjepko Pleština, Tajana Silovski. Characteristics and clinical outcome of patients with HR positive HER2 low metastatic breast cancer treated with CDK 4/6 inhibitors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-05-04.
e13078 Background: BC is the most common malignant disease and leading cancer-related cause of death in women. Despite significant achievements in the treatment, advanced BC (aBC) is still an incurable disease. HR+/HER2- subtype accounts for 70% of all BC. One of the most common mutations in BC is the PIK3CA gene mutation which can induce endocrine and chemo- resistance. In early BC, patients (pts) with PIK3CA mutations mostly have better, but in aBC worse prognosis. Standard first-line treatment for HR+/HER2- aBC is a combination of CDK4/6i and endocrine therapy. PIK3CA status is most often assessed in this group of pts and combination of alpelisib - PIK3CA inhibitor and fulvestrant is second-line treatment option in PIK3CA mutated pts. Methods: Medical records of HR+/HER2- aBC pts who started CDK4/6i therapy between 01.08.2018. and 01.10.2020. were analyzed with prior University Hospital Center Zagreb Ethics Committee approval. Demographics, tumor characteristics, clinical presentation and therapy information were collected. Molecular analysis of PIK3CA mutations was performed on tumor tissue samples. Time to treatment failure (TTF) was analyzed using the Kaplan-Meier method and the data cut-off was 31.12.2022. Results: Of the 103 pts with determined PIK3CA status, 45 (43.7%) had a detectable mutation. Median follow-up was 35 months. CDK4/6i were first line therapy in 31 (68.9%) pts with and 29 (50%) pts without PIK3CA mutation. Endocrine resistance, de novo metastatic disease and bone marrow infiltration were more common in PIK3CA mutated subgroup. The incidence of visceral metastases was similar in both groups, whereas liver metastases were more common in the unmutated group. Disease progression was observed in 69 (67%) pts, 28 (40.6%) of whom were PIK3CA mutated. Median TTF in mutated subgroup was 24 months (95% CI 21-33) and 25 months in unmutated subgroup (95% CI 19-36). During the follow-up period, 35 (34%) pts died, 14 (40%) of whom were PIK3CA mutated. Odds ratios in pts with a PIK3CA mutation. Conclusions: There was no relevant difference in TTF between two groups. However, PIK3CA mutated subgroup had more aggressive clinical features - more often presented with bone marrow infiltration and de novo aBC, statistically relevant OR 5.158 and 2.323 respectively, which is related to lower quality of life and highlights the importance of treatment improvement for this subgroup of pts. [Table: see text]
Background and Purpose: Breast cancer is the most common cancer in Croatian women. Due to improved diagnostic and treatment options women with breast cancer now live longer, which increases their risk of developing new primary malignancies. The aim of this study was to establish incidence of new primary non-breast malignancies after breast cancer diagnosis. Material and Methods: In the study cohort that included 215 consecutive patients treated for early breast cancer at University Hospital Center Zagreb, Croatia, 12 patients (5.58%) have developed new primary non-breast malignancy within nearly ten year follow-up. Results: Although the majority of studies found gynecological cancers to be the most common cancer site of new primary non- breast malignancies after breast cancer diagnosis, in our study most patients developed colorectal cancer. Conclusion: This is particularly interesting if you take into account that after breast cancer colorectal cancer is the second most common cancer in Croatian women. In order to stratify the risk for the development of new primary tumors it is necessary to further investigate the interaction of various factors that are thought to influence the evolvement of tumors.
Optimal management of patients with solid tumors, depending on the tumour type, includes measurement of serum tumour markers levels. Serum tumour markers are heterogeneous molecules with concentrations elevated in persons with solid tumours, but could also be found in small amounts in plasma of healthy individuals. Elevated plasma concentrations are caused by cell changes, necrosis, changed expression or secretion of different molecules. In some tumour types tumour cells by themselves could stimulate other cells to secrete particular molecules. There are several serum tumour markers in the routine clinical praxis: CEA, CA 19-9, CA15-3, CA 125, CYFRA, NSE, PSA, HCG, AFP, LDH, thyreoglobulin. There are also several serum tumour markers in experimental use, waiting to be included into the routine clinical use. National Academy of Clinical Biochemistry (NACB) practice guidelines for use of tumour markers in clinical practice are designated to encourage more appropriate use of serum tumour marker tests by general medicine practitioners, surgeons, oncologists, and other health care professionals giving care to patients with solid tumours.
Abstract Background Recent evidence brought by novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates is leading to significant changes in HER2-negative breast cancer (BC) best practices. A new targetable category termed ‘HER2-low’ has been identified in tumors previously classified as ‘HER2-negative’. Daily practice in pathology and medical oncology is expected to align to current recommendations, but patient access to novel anticancer drugs across geographies might be impeded due to local challenges. Materials and methods An expert meeting involving ten regional pathology and oncology opinion leaders experienced in BC management in four Central and Eastern Europe (CEE) countries (Bulgaria, Croatia, Serbia, Slovenia) was held. Herein we summarized the current situation of HER2-low metastatic BC (mBC), local challenges, and action plans to prevent delays in patient access to testing and treatment based on expert opinion. Results Gaps and differences at multiple levels were identified across the four countries. These included variability in the local HER2-low epidemiology data, certification of pathology laboratories and quality control, and reimbursement conditions of testing and anticancer drugs for HER2-negative mBC. While clinical decisions were aligned to international guidelines in use, optimal access to testing and innovative treatment was restricted due to significant delays in reimbursement or limitative reimbursement conditions. Conclusions Preventing delays in HER2-low mBC patient access to diagnosis and novel treatments is crucial to optimize outcomes. Multidisciplinary joint efforts and pro-active discussions between clinicians and decision makers are needed to improve care of HER2-low mBC patients in CEE countries.