Breast Cancer Treatment
Importance Breast cancer will be diagnosed in 12% of women in the United States over the course of their lifetimes and more than 250 000 new cases of breast cancer were diagnosed in the United States in 2017. This review focuses on current approaches and evolving strategies for local and systemic therapy of breast cancer.
Observations Breast cancer is categorized into 3 major subtypes based on the presence or absence of molecular markers for estrogen or progesterone receptors and human epidermal growth factor 2 (ERBB2; formerly HER2): hormone receptor positive/ERBB2 negative (70% of patients), ERBB2 positive (15%-20%), and triple-negative (tumors lacking all 3 standard molecular markers; 15%). More than 90% of breast cancers are not metastatic at the time of diagnosis. For people presenting without metastatic disease, therapeutic goals are tumor eradication and preventing recurrence. Triple-negative breast cancer is more likely to recur than the other 2 subtypes, with 85% 5-year breast cancer–specific survival for stage I triple-negative tumors vs 94% to 99% for hormone receptor positive and ERBB2 positive. Systemic therapy for nonmetastatic breast cancer is determined by subtype: patients with hormone receptor–positive tumors receive endocrine therapy, and a minority receive chemotherapy as well; patients with ERBB2-positive tumors receive ERBB2-targeted antibody or small-molecule inhibitor therapy combined with chemotherapy; and patients with triple-negative tumors receive chemotherapy alone. Local therapy for all patients with nonmetastatic breast cancer consists of surgical resection, with consideration of postoperative radiation if lumpectomy is performed. Increasingly, some systemic therapy is delivered before surgery. Tailoring postoperative treatment based on preoperative treatment response is under investigation. Metastatic breast cancer is treated according to subtype, with goals of prolonging life and palliating symptoms. Median overall survival for metastatic triple-negative breast cancer is approximately 1 year vs approximately 5 years for the other 2 subtypes.
Conclusions and Relevance Breast cancer consists of 3 major tumor subtypes categorized according to estrogen or progesterone receptor expression and ERBB2 gene amplification. The 3 subtypes have distinct risk profiles and treatment strategies. Optimal therapy for each patient depends on tumor subtype, anatomic cancer stage, and patient preferences.[1]
Reporting results of cancer treatment
On the initiative of the World Health Organization, two meetings on the Standardization of Reporting Results of Cancer Treatment have been held with representatives and members of several organizations. Recommendations have been developed for standardized approaches to the recording of baseline data relating to the patient, the tumor, laboratory and radiologic data, the reporting of treatment, grading of acute and subacute toxicity, reporting of response, recurrence and disease-free interval, and reporting results of therapy. These recommendations, already endorsed by a number of organizations, are proposed for international acceptance and use to make it possible for investigators to compare validly their results with those of others.[2]
Evaluation of Trends in the Cost of Initial Cancer Treatment
Background
Despite reports of increases in the cost of cancer treatment, little is known about how costs of cancer treatment have changed over time and what services have contributed to the increases.
Methods
We used data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database for 306 709 persons aged 65 and older and diagnosed with breast, lung, colorectal, or prostate cancer between 1991 and 2002 to assess the number of patients assigned to initial cancer care, from 2 months before diagnosis to 12 months after diagnosis, and mean annual Medicare payments for this care according to cancer type and type of treatment. Mutually exclusive treatment categories were cancer-related surgery, chemotherapy, radiation therapy, and other hospitalizations during the period of initial cancer care. Linear regression models were used to assess temporal trends in the percentage of patients receiving treatment and costs for those treated. We extrapolated our results based on the SEER data to the US Medicare population to estimate national Medicare payments by cancer site and treatment category. All statistical tests were two-sided.
Results
For patients diagnosed in 2002, Medicare paid an average of $39 891 for initial care for each lung cancer patient, $41 134 for each colorectal cancer patient, and $20 964 for each breast cancer patient, corresponding to inflation-adjusted increases from 1991 of $7139, $5345, and $4189, respectively. During the same interval, the mean Medicare payment for initial care for prostate cancer declined by $196 to $18261 in 2002. Costs for any hospitalization accounted for the largest portion of payments for all cancers. Chemotherapy use increased markedly for all cancers between 1991 and 2002, as did radiation therapy use (except for colorectal cancers). Total 2002 Medicare payments for initial care for these four cancers exceeded $6.7 billion, with colorectal and lung cancers being the most costly overall.
Conclusions
The statistically significant increase in costs of initial cancer treatment reflects more patients receiving surgery and adjuvant therapy and rising prices for these treatments. These trends are likely to continue in the near future, although more efficient targeting of costly therapies could mitigate the overall economic impact of this trend.[3]
Post Surgery Treatment with Topical Eye Drops of the Recurrent Conjunctival Melanoma
Conjunctival malignant melanoma (CMM) is rare and can be life threatening. Management of CMM is by surgical excision of the tumor. Non-surgical treatment consists of topical eye drops especially in diffuse and multifocal malignant melanoma. Interferon is reported as an effective agent of CMM treatment.
The purpose of this study is to evaluate the effect of Interferon alfa 2a in diffuse recurrent conjunctival melanoma and follow up of primary conjunctival melanoma after treatment with Interferon alfa 2a.
In this paper we are going to present a case of CMM in bulbar conjunctiva and 12 years of follow-up. Once the CMM was suspected, surgical removal of the affected area was performed and the subsequent biopsy resulted positive. Ten years later CMM reappeared in the same place and second surgery was performed. Two years later a second recurrence of the melanoma occurred at the same place as before. In order to avoid another surgery a treatment with topical interferon alpha 2 a 1 MIU/mL, 4 drops/day for 3 months was performed instead. Following 15 months of this treatment no sign of conjunctival melanoma came into sight.[4]
Rhoifolin; A Potent Antiproliferative Effect on Cancer Cell Lines
Aims: To investigate the cytotoxic activity of rhoifolin against different cancer cell lines.
Study Design: Isolation, identification and cytotoxic activity evaluation.
Place and Duration of Study: Faculty of Pharmacy, Ain Shams University and Al-Azhar University, between October, 2010 and January, 2011.
Methodology: Rhoifolin, Apigenin 7-O-β neohesperidoside was isolated in a copious amount from the leaves of Chorisia crispiflora (Bombaceae). Its identity was unambiguously confirmed via different spectroscopic methods (UV, 1HNMR, 13CNMR and HMBC) and viability assay test was used to evaluate its cytotoxic activity.
Results: It exhibited potent anticancer activities, nearly similar to that of vinblastine, when evaluated against human epidermoid larynex (Hep 2) and human cervical (HeLa) carcinoma cell lines. Promising activities were also obtained against hepatocellular (Hep G2), colon (HCT-116) and fetal human lung fibroblast (MRC-5) carcinoma cell lines. A unique effect of rhoifolin was in having no cytotoxic activity against healthy normal cells (Vero cells) which indicates a high selectivity of this compound.
Conclusion: The findings of this study showed that rhoifolin could be used as an ideal anticancer agent. It discriminates between cancerous and non cancerous cell as it kills only the former one. So the side effects which may appear during chemotherapy could be overcome.[5]
Reference
[1] Waks, A.G. and Winer, E.P., 2019. Breast cancer treatment: a review. Jama, 321(3), pp.288-300.
[2] Miller, A.B., Hoogstraten, B.F.A.U., Staquet, M.F.A.U. and Winkler, A., 1981. Reporting results of cancer treatment. cancer, 47(1), pp.207-214.
[3] Warren, J.L., Yabroff, K.R., Meekins, A., Topor, M., Lamont, E.B. and Brown, M.L., 2008. Evaluation of trends in the cost of initial cancer treatment. Journal of the National Cancer Institute, 100(12), pp.888-897.
[4] Pustina, B. and Salihu, N., 2016. Post Surgery Treatment with Topical Eye Drops of the Recurrent Conjunctival Melanoma. Journal of Advances in Medicine and Medical Research, pp.1-5.
[5] Eldahshan, O.A., 2013. Rhoifolin; a potent antiproliferative effect on cancer cell lines. Journal of Pharmaceutical Research International, pp.46-53.
