Maria Tria Tirona

Prevention of Breast Cancer (Part I): Epidemiology, Risk Factors, and Risk Assessment Tools

ABSTRACT Advances in breast cancer research have led to declining death rates from this disease because of early detection through mammographic screening and improved therapy for breast cancer. The concept that breast cancer, in some cases, can be prevented has been explored over the last three decades. This article, part I of a two-part series, will focus on the epidemiology, the risk factors associated with breast cancer, and the available risk assessment tools, which can help define who should be considered for risk reduction strategies. Part II will focus on discussing risk reduction strategies.

Creating a Biomarker Panel for Early Detection of Chemotherapy Related Cardiac Dysfunction in Breast Cancer Patients

Cardiotoxicity is an important issue for breast cancer patients receiving anthracycline-trastuzumab therapy in the adjuvant setting. Studies show that 3-36% of patients receiving anthracyclines and/or trastuzumab experience chemotherapy related cardiac dysfunction (CRCD) and approximately 17% of patients must stop chemotherapy due to the consequences of CRCD. There is currently no standardized, clinically verified way to detect CRCD early, but common practices include serial echocardiography and troponin measurements, which can be timely, costly, and not always available in areas where health care resources are scarce. Furthermore, detection of CRCD, before there is any echocardiographic evidence of dysfunction or clinical symptoms present, would allow maximal benefit of chemotherapy and minimize cardiac complications. Creating a panel of serum biomarkers would allow for more specificity and sensitivity in the early detection of CRCD, which would be easy to implement and cost effective in places with limited health care. Based on a review of the literature, we propose creating a biomarker panel consisting of topoisomerase 2β, serum troponin T/I, myeloperoxidase, NT-proBNP, miR-208b, miR-34a, and miR-150 in breast cancer patients receiving anthracyclines and/or trastuzumab to detect CRCD before any signs of overt cardiotoxicity are apparent.

Prevention of Breast Cancer (Part II): Risk Reduction Strategies

ABSTRACT Until recently, the best protection against breast cancer mortality was early diagnosis through mammographic screening. However, the possibility that breast cancer in some cases can be prevented has come to light over the past 30 years. Various risk reduction strategies of breast cancer have been explored including lifestyle modification, prophylactic surgeries, and the use of chemopreventive agents. This article is the second portion of a two-part series on breast cancer prevention, and will focus its discussion on the available risk reduction interventions that have been shown to prevent breast cancer in women considered high risk for the disease. (See Part I in Cancer Investigation, 28:743750, 2010)

Prospect of the use of checkpoint inhibitors in hepatocellular cancer treatments

Hepatocellular cancer (HCC) is a very fatal disease due to limited therapeutic options as well as due to its association with underlying chronic liver disease in the majority of cases. The immune evasion in HCC signifies a major barrier to the delivery of effective immunotherapy. Sorafenib is the only Food and Drug Administration-approved drug available with an overall response rate of 2%–3% and overall survival of 2.8 months. Chemotherapy has not been used routinely because of the relative refractoriness of advanced HCC. The introduction of immune checkpoint inhibitors (cytotoxic T-lymphocyte antigen 4, programmed death 1, and programmed death-ligand 1) has opened a new horizon for cancer immunotherapy. Future direction in immunotherapy for HCC is to rationally combine it with other treatment modalities, including surgery, radiofrequency ablation, and cytotoxic agents, to maximize its therapeutic efficacy.

Bilateral Triple-Negative Invasive Breast Cancer with a BRCA2 Mutation, and Glioblastoma: A Case Report and Literature Review

Breast cancer is the second leading cause of death among women in North America. Glioblastoma is the most common primary malignant central nervous system tumor in adults. The majority of hereditary breast cancers are associated with deleterious mutations in the BRCA1 and BRCA2 genes. Although few case reports have described the incidence of glioblastoma in patients previously diagnosed with breast cancer, any association between BRCA2 mutations and glioblastoma has not been demonstrated to date. Herein, we report a woman who is a carrier of a familial BRCA2 mutation, and was previously diagnosed with triple-negative breast cancer (TNBC) and subsequently with a second primary TNBC and glioblastoma. Further investigation is required to define the possible relationship between these two aggressive malignances and the BRCA2 mutation, which might be critical for the proper management and treatment of this disease.

Abstract B78: Is race a prognostic factor for lung cancer?

Introduction: Lung cancer is the leading cause of cancer related deaths in the United States. Impact of race on prognosis of lung cancer has been controversial. We performed a retrospective study to evaluate if survival differences exist in patients of different races diagnosed with lung cancer and potential causes of these differences, if they exist. Methods: Data on patients diagnosed with lung cancer from 2003-2008 were collected from the Cancer Information Resource File (CIRF). Of 150,038 patients, complete data on age, gender, stage, histology, radiation therapy, chemotherapy, surgery and survival were available on 130,517 patients. Data were analyzed according to race and grouped into three categories: white, black, and other races (all non-white and non-black patients). Results: Of 130,517 patients evaluated, 91.4% were white, 6.5% were black, and 2.1% were other races. Within each race category, the percentage of patients less than 70 years of age were 54,67, and 59, and male patients were 55,58, and 56 in white, black, and other races, respectively. Non small cell lung cancer was found in 83.3,87.7, and 86.6%, small cell lung cancer was found in 16.3,12, and 12.9% and mixed histology lung cancer was found in 0.4,0.3, and 0.5% in white, black, and other races, respectively. The percentage of patients with stage I was 23,19, and 21; stage II was 7,6, and 5; stage III was 29,31, and 30; and stage IV was 41,44, and 44 in white, black, and other races, respectively. The percentage of patients receiving chemotherapy was 44, 43, and 45; radiation therapy was 49,52, and 45; and surgery was 28, 21, and 28 in white, black, and other races, respectively. Median overall survival (MOS) in months was 10.3,9.1, and 11.8 in white, black, and other races, respectively. On multivariate analysis, factors affecting overall survival were age greater than 70 [hazard ratio (HR) 1.3], male gender (HR 1.2), chemotherapy (HR 0.57), surgery (HR 0.37), radiation therapy (HR 0.9), and bronchoalveolar (BAL) histology (HR 0.69). Race was an independent risk factor for other races compared to white patients (HR 0.86, CI 0.83-0.90), but not for black compared to white patients (HR 1.01, CI 0.98-1.03). Conclusion: Race is not an independent prognostic factor for overall survival for black patients, but was a better prognostic factor for other races when compared to white patients. A higher percentage of black patients presented at a later stage and a lower percentage received surgery, and these factors may have contributed to a lower MOS compared to whites and other races. BAL histology had a favorable prognosis than other histologies. Prospective, randomized clinical trials are required to explore differences noted in MOS, stage, and histology according to race. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B78.