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The Optimal Timing and Duration of Daily G-CSF for the Primary Prevention of Febrile Neutropenia in Breast Cancer Patients Undergoing Adjuvant TAC Chemotherapy

Tue, 31 Dec 2024 15:00:00 GMT

Title: The Optimal Timing and Duration of Daily G-CSF for the Primary Prevention of Febrile Neutropenia in Breast Cancer Patients Undergoing Adjuvant TAC Chemotherapy All Author(s): Zisun Kim; Sung Mo Hur; Jong Eun Lee; Sun Wook Han; Hae Il Jung; Sung Yong Kim; Jihyoun Lee; Cheol Wan Lim Abstract: Aim: TAC chemotherapy is a standard adjuvant treatment for early-stage breast cancer, with G-CSF recommended for preventing febrile neutropenia (FN). This study investigates the optimal initiation timing for daily filgrastim to prevent FN in patients undergoing TAC chemotherapy, a subject not fully explored in existing guidelines. Methods: Sixty breast cancer patients receiving adjuvant TAC chemotherapy were randomly assigned to start daily filgrastim either on Day 2 (Day 2 group, n = 30) or Day 5 (Day 5 group, n = 30). The primary outcome was the incidence of FN. Secondary outcomes included the duration of neutropenia treatment and the neutropenia profile. Results: Patients underwent 349 cycles of TAC chemotherapy (173 cycles in Day 2 group and 176 cycles in Day 5 group). The incidence of FN was significantly lower in the Day 2 group (6.4%, 11/173) compared to the Day 5 group (22.2%, 39/176, p < 0.0001). Additionally, the mean ± SD duration of filgrastim treatment was longer (8 ± 1 vs. 6 ± 1 days, p < 0.0001), and the duration of severe neutropenia was shorter (3 ± 1 vs. 4 ± 1 days, p = 0.001) in the Day 2 group. Conclusion: Initiating filgrastim on Day 2 of TAC chemotherapy significantly enhances its effectiveness in preventing FN compared to starting on Day 5. These findings support early intervention and sustained treatment to optimize toxicity management in adjuvant TAC chemotherapy.

Prediction of menstrual recovery patterns in premenopausal women with breast cancer taking tamoxifen after chemotherapy: an ASTRRA Substudy

Sun, 31 Dec 2023 15:00:00 GMT

Title: Prediction of menstrual recovery patterns in premenopausal women with breast cancer taking tamoxifen after chemotherapy: an ASTRRA Substudy All Author(s): Young Joo Lee; Woo Chul Noh; Sungchan Gwark; Hyun-Ah Kim; Jai Min Ryu; Seung Il Kim; Eun-Gyeong Lee; Seock-Ah Im; Yongsik Jung; Min Ho Park; Kyong Hwa Park; Su Hwan Kang; Joon Jeong; Eunhwa Park; Sung Yong Kim; Min Hyuk Lee; Lee Su Kim; Woosung Lim; Seonok Kim; Hee Jeong Kim Abstract: Background: Chemo-endocrine therapy can lead to various side effects associated with ovarian dysfunction. Predicting menstrual recovery is necessary to discuss the treatment-related issues regarding fertility and premature menopause with patients. Methods: In the ASTRRA trial, patients who resumed ovarian function within 2 years after chemotherapy were randomized to receive tamoxifen for 5 years or OFS with tamoxifen for 2 years. With these 1298 patients, we developed a model that predicts when menstrual recovery will occur within a 3-year period after chemotherapy using variables including age, body mass index, chemotherapy regimen and duration, and serum estradiol and follicle-stimulating hormone levels. Results: The data of 957 patients were used to develop the prediction model, and those of 341 patients were used for validation. In the development group, menstruation resumed in 450 patients (47.0%) within 5 years. In multivariable analysis, younger age (< 35 vs. 45, HR 7.85, 95% CI 4.63-13.30, p < 0.0001), anthracycline-based chemotherapy without taxane (vs. with taxane, HR 1.81, 95% CI 1.37-2.38, p < 0.0001), and chemotherapy duration (≤ 90 days vs. > 90 days, HR 1.32, 95% CI 1.01-1.72, p = 0.045) correlated with menstrual recovery. Using combined age, regimen, and duration of chemotherapy, we developed a simplified scoring system to estimate recovery chances and used a concordance index of 0.679 overall and 0.744 at 3 years for validation. Conclusion: This model predicted timing and probability of menstrual recovery, based on their individual age, type and duration of chemotherapy in premenopausal women diagnosed with breast cancer who received tamoxifen after chemotherapy.

Peritumoral Adipose Tissue Features Derived from [(18)F]fluoro-2-deoxy-2-d-glucose Positron Emission Tomography/Computed Tomography as Predictors for Response to Neoadjuvant Chemotherapy in Breast Cancer Patients

Sun, 31 Dec 2023 15:00:00 GMT

Title: Peritumoral Adipose Tissue Features Derived from [(18)F]fluoro-2-deoxy-2-d-glucose Positron Emission Tomography/Computed Tomography as Predictors for Response to Neoadjuvant Chemotherapy in Breast Cancer Patients All Author(s): Jeong Won Lee; Yong Kyun Won; Hyein Ahn; Jong Eun Lee; Sun Wook Han; Sung Yong Kim; In Young Jo; Sang Mi Lee Abstract: This study investigated whether the textural features of peritumoral adipose tissue (AT) on [18F]fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) can predict the pathological response to neoadjuvant chemotherapy (NAC) and progression-free survival (PFS) in breast cancer patients. We retrospectively enrolled 147 female breast cancer patients who underwent staging FDG PET/CT and completed NAC and underwent curative surgery. We extracted 10 first-order features, 6 gray-level co-occurrence matrix (GLCM) features, and 3 neighborhood gray-level difference matrix (NGLDM) features of peritumoral AT and evaluated the predictive value of those imaging features for pathological complete response (pCR) and PFS. The results of our study demonstrated that GLCM homogeneity showed the highest predictability for pCR among the peritumoral AT imaging features in the receiver operating characteristic curve analysis. In multivariate logistic regression analysis, the mean standardized uptake value (SUV), 50th percentile SUV, 75th percentile SUV, SUV histogram entropy, GLCM entropy, and GLCM homogeneity of the peritumoral AT were independent predictors for pCR. In multivariate survival analysis, SUV histogram entropy and GLCM correlation of peritumoral AT were independent predictors of PFS. Textural features of peritumoral AT on FDG PET/CT could be potential imaging biomarkers for predicting the response to NAC and disease progression in breast cancer patients.

Clinical value of SUVpeak-to-tumor centroid distance on FDG PET/CT for predicting neoadjuvant chemotherapy response in patients with breast cancer

Sun, 31 Dec 2023 15:00:00 GMT

Title: Clinical value of SUVpeak-to-tumor centroid distance on FDG PET/CT for predicting neoadjuvant chemotherapy response in patients with breast cancer All Author(s): Sun-Pyo Hong; Sang Mi Lee; Ik Dong Yoo; Jong Eun Lee; Sun Wook Han; Sung Yong Kim; Jeong Won Lee Abstract: Background: Since it has been found that the maximum metabolic activity of a cancer lesion shifts toward the lesion edge during cancer progression, normalized distances from the hot spot of radiotracer uptake to tumor centroid (NHOC) and tumor perimeter (NHOP) have been suggested as novel F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters that can reflect cancer aggressiveness. This study aimed to investigate whether NHOC and NHOP parameters could predict pathological response to neoadjuvant chemotherapy (NAC) and progression-free survival (PFS) in breast cancer patients. Methods: This study retrospectively enrolled 135 female patients with breast cancer who underwent pretreatment FDG PET/CT and received NAC and subsequent surgical resection. From PET/CT images, normalized distances of maximum SUV and peak SUV-to-tumor centroid (NHOCmax and NHOCpeak) and -to-tumor perimeter (NHOPmax and NHOPpeak) were measured, in addition to conventional PET/CT parameters. Results: Of 135 patients, 32 (23.7%) achieved pathological complete response (pCR), and 34 (25.2%) had events during follow-up. In the receiver operating characteristic (ROC) curve analysis, NHOCmax showed the highest area under the ROC curve value (0.710) for predicting pCR, followed by NHOCpeak (0.694). In the multivariate logistic regression analysis, NHOCmax, NHOCpeak, and NHOPmax were independent predictors for pCR (p < 0.05). In the multivariate survival analysis, NHOCpeak (p = 0.026) was an independent predictor for PFS along with metabolic tumor volume, with patients having higher NHOCpeak showing worse PFS. Conclusion: NHOCpeak on pretreatment FDG PET/CT could be a potential imaging parameter for predicting NAC response and survival in patients with breast cancer.