ABSTRACT
PURPOSE: The optimal treatment sequence for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) after progression on first-line cyclin-dependent kinase 4/6 inhibitor (CDKi) and endocrine therapy is unclear. Clinical and biological factors influencing treatment choices and outcomes in the second-line setting need to be elucidated. MATERIALS AND METHODS: This is a retrospective analysis of a real-world cohort including patients with HR+/HER2- ABC who received CDKi and endocrine therapy in the first-line setting and progressed, requiring second-line treatment. Clinical and biological factors were analyzed to evaluate their association with daily treatment decisions and the prognostic role of progression-free survival (PFS) in the second-line setting. RESULTS: Two hundred thirty-five patients were included. Second-line treatments were hormone therapy (HT) based in 60% and chemotherapy based in 40% of patients. The second-line median PFS was 6.6 months, with no difference between treatment types. In multivariable analysis, postmenopausal status, lower Ki-67 expression, and non-de novo stage IV disease were associated with improved second-line (2L) PFS. Menopausal status significantly interacted with treatment type, with reduced PFS in premenopausal patients receiving HT-based treatments (4.7 v 8.7 months, P = .00045). CONCLUSION: In our study, treatment decisions reflected the current algorithm incorporated in our clinical guidelines, and prior treatment response was the most relevant factor to determine 2L treatment decision. Menopausal status interacted with the subsequent therapy efficacy in this setting. Hence, we consider that menopausal status should be routinely evaluated in the subgroup analysis of clinical trials.
Subject(s)
Breast Neoplasms , Cyclin-Dependent Kinase 4 , Cyclin-Dependent Kinase 6 , Protein Kinase Inhibitors , Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Cyclin-Dependent Kinase 4/antagonists & inhibitors , Middle Aged , Cyclin-Dependent Kinase 6/antagonists & inhibitors , Retrospective Studies , Argentina/epidemiology , Aged , Adult , Protein Kinase Inhibitors/therapeutic use , Aged, 80 and over , Receptor, ErbB-2/metabolism , Progression-Free SurvivalABSTRACT
The Breast Cancer Revealed initiative was designed and conducted to know the status of breast cancer at each point of breast cancer care, through i) prevention, ii) detection, iii) diagnosis, iv) treatment, and iv) the capacity of our health systems. The expert panel from 11 Latin American countries identified several strategies and proposed high impact priorities, including implementation of prevention policies, improve primary healthcare capacity for breast cancer screening, have adequate infrastructure to make effective and timely diagnoses, have a multidisciplinary team in the treatment process, access to a variety of treatments for all types of patients, have a coordinated and articulated system from primary care to specialized hospital. In a region with limited resources, prioritization in high-impact strategies for breast cancer control could lead to improved clinical outcomes and quality of life for our patients.
Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Latin America/epidemiology , Quality of Life , Delivery of Health Care , Early Detection of CancerABSTRACT
El abordaje interhemisférico contralateral es una variante del abordaje interhemisférico transcalloso que permite optimizar el acceso a lesiones ubicadas en los ventrículos laterales o en sus paredes. La planificación del ángulo de entrada mediante neuronavegador nos permitió el manejo de un Cavernoma ubicado sobre el núcleo caudado e inmediato a la cápsula interna sin realizar callosotomía convencional ni comprometer las estructuras sensibles adyacentes.
Contralateral interhemispheric approach is a variant of the well-know interhemispheric transcallosal approach that allows to optimize the lateral wall ventricle lesions management. Neuronavigation planning allowed us to deal with a caudate nucleus cavernoma contiguous to internal capsule without conventional callosotomy and additional damage neither.
Subject(s)
Cerebrum , Cerebral Ventricles , Internal Capsule , NeuronavigationABSTRACT
BACKGROUND: Coronary artery perforation associated to cardiac tamponade is an uncommon life-threatening complication of percutaneous coronary intervention, and the occurrence of subepicardial or intramyocardial hematoma without hemopericardium is even rarer. CLINICAL CASE: We describe the case of a 72 year-old woman with a subepicardial hematoma after percutaneous coronary intervention, who required urgent left internal mammary artery graft to anterior descending artery surgery. CONCLUSIONS: Subepicardial or intramyocardial hematoma must be considered when a coronary perforation is suspected in absence of hemopericardium. Transthoracic echocardiogram or computed tomography may be used to decide a conservative or invasive approach.