Menu

A+ A A-

Download article

DOI: https://doi.org/10.22263/2312-4156.2018.4.64

Shliakhtunou Y.A., Semenov V.M.
Adjuvant cytostatic therapy of minimum residual disease in breast cancer
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus

Vestnik VGMU. 2018;17(4):64-71.

Abstract.
Objectives. To assess the effectiveness of adjuvant cytostatic breast cancer therapeutic regimens for eradication of CTCs and parameters of adjusted tumor-specific annual recurrence-free and overall survival.
Material and methods. The study involved 162 female patients with verified breast cancer of the I-IIIC stage at the age of 58.16 ± 9.98 years. All patients received adjuvant drug treatment in accordance with the available recommendations, taking into account risk groups stratification.
In all patients their peripheral blood was studied for the presence of CTCs. For the identification of CTCs the BIRC5 and HER2-neu genes expression was studied using real-time PCR.
Results. The therapy regimens CAF (CEF), AC (EC) AC-T lead to a significant decrease in the frequency of identification of CTCs expressing the BIRC5 and HER2-neu genes with regard to the baseline (p<0,05). The most effective influence on the decrease in the frequency of CTCs detection is provided by the therapeutic scheme of combining anthracyclines with the subsequent administration of taxanes, which reduces the incidence of minimal residual disease from 84.6% up to 30.8% (p=0,006). The most frequently used regimen of CAF (CEF) therapy was effective in eradicating CTCs expressing BIRC5 and HER2-neu genes in 29.6% of cases, and that of AC (EC) therapy – in 26,6% (p>0,05). The use of trastuzumab did not result in a significant decrease in CTCs expressing the target HER2-neu gene. Hormonotherapy did not lead to a significant decrease of target CTCs. The presence of BIRC5 and HER2-neu mRNAs positive CTCs prior to the initiation of treatment is an independent prognostic factor of the disease progression (RR=4,904 (95% CI: 1.207-19.929)). The preservation of BIRC5 and HER2-neu mRNA positive CTCs after systemic therapy is also an independent factor of the progression of breast cancer (RR = 3.590 (95% CI: 1.521-8.472)).
Conclusions. The most effective regimen for the treatment of minimal residual disease in breast cancer is the therapeutic scheme of combining anthracyclines with the subsequent administration of taxanes (paclitaxel, docetaxel).
Key words: minimal residual disease, breast cancer.

References

1. Hayes DF, Cristofanilli M, Budd GT, Ellis MJ, Stopeck A, Miller MC, et al. Circulating tumor cells at each follow-up time point during therapy of metastatic breast cancer patients predict progression-free and overall survival. Clin Cancer Res. 2006 Jul;12(14 Pt 1):4218-24. doi: http://dx.doi.org/10.1158/1078-0432.CCR-05-2821
2. Budd GT, Cristofanilli M, Ellis MJ, Stopeck A, Borden E, Miller MC, et al. Circulating tumor cells versus imaging- predicting overall survival in metastatic breast cancer. Clin Cancer Res. 2006 Nov;12(21):6403-9. doi: http://dx.doi.org/10.1158/1078-0432.CCR-05-1769
3. Liu MC, Shields PG, Warren RD, Cohen P, Wilkinson M, Ottaviano YL, et al. Circulating tumor cells: a useful predictor of treatment efficacy in metastatic breast cancer. J Clin Oncol. 2009 Nov;27(31):5153-9. doi: http://dx.doi.org/10.1200/JCO.2008.20.6664
4. Cristofanilli M, Broglio KR, Guarneri V, Jackson S, Fritsche HA, Islam R, et al. Circulating tumor cells in metastatic breast cancer: biologic staging beyond tumor burden. Clin Breast Cancer. 2007 Feb;7(6):471-9.
5. Sukonko OG, Krasnoy SA, red. Algorithms of diagnosis and treatment of malignant tumors: sb nauch st: vyp 2. Minsk, RB: Prof izd; 2012. 508 р. (In Russ.)
6. Semeglazov VF, Semeglazov VV, Krivorot’ko PV, Paltuev RM, Dashyan GA, Semiglazova TYu, i dr. Guidelines for the treatment of early breast cancer. Saint-Petersburg, RF: Kniga po Trebovaniiu; 2016. 154 р. (In Russ.)
7. Swain SM, Jeong JH, Wolmark N. Amenorrhea from breast cancer therapy – not a matter of dose. N Engl J Med. 2010 Dec;363(23):2268-70. doi: http://dx.doi.org/10.1056/NEJMc1009616
8. Peto R, Davies C, Godwin J, Gray R, Pan HC, Clarke M, et al; Early Breast Cancer Trialists' Collaborative Group. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 rаndomised trials. Lancet. 2012 Feb;379(9814):432-44. doi: http://dx.doi.org/10.1016/S0140-6736(11)61625-5
9. Tolaney SM, Barry WT, Dang CT, Yardley DA, Moy B, Marcom PK, et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. N Engl J Med. 2015 Jan;372(2):134-41. doi: http://dx.doi.org/10.1056/NEJMoa1406281
10. Viale G. A bad tumor biomarker is as bad as a bad drug: the gap between genomics data and phenotype to predict response. Breast. 2015 Nov;24 Suppl 2:S23-5. doi: http://dx.doi.org/10.1016/j.breast.2015.07.007

Information about authors:
Shliakhtunou Y.A. – Candidate of Medical Sciences, associate professor of the Chair of Oncology with the courses of Radiodiagnosis & Radiotherapy and the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
https://orcid.org/0000-0002-5906-5373
Semenov V.M. – Doctor of Medical Sciences, professor, head of the Chair of Infectious Diseases with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.

Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave, Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Oncology with the courses of Radiodiagnosis & Radiotherapy and the course of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yauheni A. Shliakhtunou.

Поиск по сайту