Downloads
Abstract
Objectives: To explore the effect of fulvestrantbased therapy in recurrent on progressed breast cancer previously treated endocrine therapy.
Methods: A descriptive retrospective cohort study on 41 breast cancer patients at Oncology center - Hue Central Hospital, from June 2020 to June 2023. Inclusionary criteria consist breast cancers have progressed with first-line endocrine therapy. Statistics were collected by questionnaire survey, interview, and medical report. Statistical analysis was performed in SPSS 16.0 and Excel 2016.
Results: The mean age of patients was 51.24 ± 1.77 years and while the rate of local stages was 56.1%, the rate of advanced stage was 43.9%. As for the molecular classification, the high-grade tumor was 80.6% and the mean Ki67 index was 22.3 ± 3.7%. The number of ER+/PR+; ER+/PR-; ER-/PR+ and ER-/PR- were 61%; 26.8%; 9.8%; and 2.4%, respectively. Almost these patients (97.6%) with previous treatments had distant metastatic sites such as bone, lung, liver, and lymph nodes. Regarding the effect of Fulvestrant, the median progression - free survival (PFS) was 13.05 ± 4.27 months and the 2 - year DFS rates were 39%. Following this, risk factors that reduced PFS like non - bone metastatic sites and high Ki67 index (above 15%). Remarkably, the low Ki67 index was an independent prognostic factor on PFS (p = 0.004, HR = 0.155, 95% CI: 0.044 - 0.55). There were not side effects that graded from 2 - 4.
Conclusion: Fulvestrant is an effective therapy in recurrent or progressed breast cancers that were previously treated with first - line endocrine therapy. Their effectiveness is increased in cancer patients who have bone - only metastatic sites and/or low Ki67 Index (Below 15%). Moreover, fulvestrant is safe for these breast patients.
References
Lyngholm CD, Laurberg T, Alsner J, Damsgaard TE, Overgaard J, Failure pattern and survival after breast conserving therapy: Long-term results of the Danish Breast Cancer Group (DBCG) 89 TM cohort. Acta Oncol Stockh Oncol. 2016. 55(8): 983–992.
Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W et al, SEER Cancer Statistics Review 1975-2008. Bethesda, MD Natl. Cancer Inst. 2011.
Setiawan VW, Monroe KR, Wilkens LR, Breast cancer risk factors defined by estrogen and progesterone receptor status: the multiethnic cohort study. p. Am. J. Epidemiol. 2009. 169:1251-1259.
Cole MP, Jones CT, Todd ID, A new anti-oestrogenic agent in late breast cancer. An early clinical appraisal of ICI46474. Br J Cancer. 1971 Jun. 25(2):270-5.
Cheung KL, Robertson JF. Fulvestrant, Expert Opin Investig Drugs. 2002 Feb. 11(2):303-8.
Addo S, Yates RA, Laight A, A phase I trial to assess the pharmacology of the new oestrogen receptor antagonist fulvestrant on the endometrium in healthy postmenopausal volunteers. Br J Cancer. 2002 Dec 2. 87(12):1354-9.
AstraZeneca AB, Human medicine European public assessment report (EPAR): Faslodex. EPAR Product information. 2022. Annex I pages 2.
Walker AJ, Wedam S, Amiri-Kordestani L, Bloomquist E, Tang S, Sridhara R, Chen W et al, FDA Approval of Palbociclib in Combination with Fulvestrant for the Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer. Clin Cancer Res. 2016 Oct 15. 22(20):4968-4972.
Nishimura R, Osako T, Okumura Y, Hayashi M, Toyozumi Y, Arima N, Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer. Exp Ther Med. 2010 Sep. 1(5):747-754.
Nishimura R, Osako T, Nishiyama Y, Tashima R, Nakano M, Fujisue M, et al, Prognostic significance of Ki-67 index value at the primary breast tumor in recurrent breast cancer. Mol Clin Oncol. 2014 Nov. 2(6):1062-1068.
Bae, S.Y., Kim, S., Lee, J.H. et al. Poor prognosis of single hormone receptor- positive breast cancer: similar outcome as triple-negative breast cancer. BMC Cancer. 2015. Volumes 15, No 138.
Bs CKI Phan Thị Đỗ Quyên, Bs Nguyễn Việt Cường, Nguyễn Thị Thanh Huyền and Anh Thư, Nguyễn Sinh Nhật, Đánh giá mối liên quan giữa thang điểm tiên lượng Nottingham và phân loại nhóm phân tử của ung thư vú. Tạp chí Y học Lâm sàng. 5/2023. Trang 390.
Surveillance Research Program (SRP) in NCI’s Division of Cancer Control and Population Sciences (DCCPS), SEER 22: Percent of Female Breast Cases by Cancer Subtype 2016-2020. Nation Cancer Institute. 2020. 14. Bs CKI Phan Thị Đỗ Quyên và cs, Đặc điểm lâm sàng, cận lâm sàng, tình trạng chuyển đổi thụ thế ER, PR và Her-2 ở bệnh nhân ung thư vú tiến triển, tái phát và các yếu tố liên quan. Hội nghị Khoa học công nghệ Tp Hồ Chí Minh, 5/2022.
Di Leo A, Jerusalem G, Petruzelka L, Torres R, Bondarenko IN, Khasanov R et al, Results of the CONFIRM phase III trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptorpositive advanced breast cancer. J Clin Oncol. 2010 Oct 20. 28(30):4594-600.
He M, Li JJ, Zuo WJ, Ji L, Jiang YZ, Hu XC, Wang ZH, Shao ZM, Metastatic breast cancer patients with lung or liver metastases should be distinguished before being treated with fulvestrant. Cancer Med. 2019 Oct. 8(14):6212-6220.
Blancas I, Olier C, Conde V, Bayo JL, Herrero C, Zarcos-Pedrinaci I, et al, Real-world data of fulvestrant as first-line treatment of postmenopausal women with estrogen receptor-positive metastatic breast cancer. Sci Rep. 2021 Feb 19. 11(1):4274.
Kawaguchi H, Masuda N, Nakayama T, Aogi K, Anan K, Ito Y et al, Outcomes of fulvestrant therapy among japanese women with advanced breast cancer: a retrospective multicenter cohort study (JBCRG‑C06; Safari). p. Breast Cancer Res Treat. 2017. 163:545–54.
Tsuboi K, Kaneko Y, Nagatomo T, Fujii R, Hanamura T, Gohno T et al, Different epigenetic mechanisms of ERα implicated in the fate of fulvestrant-resistant breast cancer. J Steroid Biochem Mol Biol. 2017 Mar. 167:115-125.
Robertson JFR, Bondarenko IM, Trishkina E, Dvorkin M, Panasci L, Manikhas A, Shparyk Y et al, FALCON: A phase III randomised trial of fulvestrant 500 mg vs. anastrozole 1mg for hormone receptor-positive advanced breast cancer:
an international, randomised, double-blind, phase 3 trial. Lancet. 2016 Dec 17. 388(10063):2997-3005.
Graham J, Pitz M, Gordon V, Grenier D, Amir E, Niraula S. Clinical predictors of benefit from fulvestrant in advanced breast cancer: A Meta-analysis of randomized controlled trials. Cancer Treat Rev. 2016 Apr. 45:1-6.
E de Azambuja E, Cardoso F, de Castro G Jr, Colozza M, Mano MS, Durbecq V, et al, Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. Br J Cancer. 2007 May 2. 96(10):1504-13.
Polley MY, Leung SC, McShane LM, Gao D, Hugh JC, Mastropasqua MG et al, International Ki67 in Breast Cancer Working Group of the Breast International Group and North American Breast Cancer Group. An international Ki67 reproducibility study. J Natl Cancer Inst. 2013 Dec 18. 105(24):1897-906.
| Published | 26-12-2024 | |
| Fulltext |
|
|
| Language |
|
|
| Issue | No. 91 (2023) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.91.16 | |
| Keywords | Ung thư vú, giai đoạn tiến triển, thụ thể nội tiết dương tính, Fulvestrant, thời gian sống bệnh không tiến triển, tác dụng phụ Breast cancer, Advanced stages, Hormone receptor positive, Fulvestrant, Progression - free survival, Side effects |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Journal of Clinical Medicine Hue Central Hospital