Hormone Receptor/Human Epidermal Growth Factor Receptor 2-positive breast cancer: Where we are now and where we are going

AbstractNear 75% of all breast cancers (BC) express estrogen receptors (ER) and/or progesterone receptors (PgR), while up to 20% of BC show an overexpression/amplification of Human Epidermal Growth Factor Receptor 2 (HER2). Around 50% of all HER2-overexpressing BC show the coexistence of both HER2 overexpression/amplification and ER and/or PgR overexpression. Numerous in vitro and in vivo studies suggest the existence of a cross-talk between their downstream pathways, which seem to affect the natural history, response to therapy and outcome of patients affected by this subset of BC. Meta-analyses or subgroup analysis of numerous neo-/adjuvant trials demonstrated significant clinical implications deriving from ER/HER2 co-existence, consisting in a different pattern of relapse and dissimilar outcome in response to anti-HER2 therapy. However, only two randomized trials in early disease and three in advanced disease specifically addressed the issue whether a combined approach with both hormonal and anti-HER2 therapy would have a better therapeutic impact in this subset of BC compared to the lone anti-HER2 or hormonal therapies (HT). None of these trials demonstrated improvements in overall survival, even though several efficacy end-points such as progression free survival, in advanced setting, or pCR rates in neoadjuvant setting, often favored the combined hormonal and anti-HER2 therapeutic approach. In the next few years, a certain number of ongoing randomized trials, both in neoadjuvant and advanced setting, will evaluate the efficacy of new anti-HER2 drugs, T-DM1 and pertuzumab, in combination with HT, helping to improve the therapeutic strategy for this specific subtype of breast tumors

Influence of chemical and mineralogical soil properties on the adsorption of sulfamethoxazole and diclofenac in Mediterranean soils

Abstract Background The irrigation with treated wastewaters can be a way for the introduction of organic contaminants in soils. However, their adsorption onto soils can allow a control of their bioavailability and leaching. The adsorption is influenced by properties of contaminants (water solubility, chemical structure) and soils (organic matter content, pH, mineralogy). This study aimed to investigate the effect of mineralogical composition, organic matter content and others parameters of soils on the adsorption of sulfamethoxazole (SMX) and diclofenac (DCF), two contaminants of emerging concerns (CECs), in real cases (Altamura, Sibari and Noci soils). Results The isotherms data showed that the adsorption of the two CECs closely matched the Freundlich model, even if the DCF could also fit the linear one. The only exception was the adsorption of SMX on the soil of Sibari, for which Langmuir's model fitted better. In all cases, the Kd values were the highest for Altamura soil according mainly to its content of organic carbon. Positive correlations were found between Kd value of DCF and the soil organic carbon and Al oxyhydroxides content, suggesting their roles in its adsorption, while SMX showed only a slight positive correlation with the soil organic carbon content. Finally, between the two CECs studied, DCF was more adsorbed than SMX also because of the lower water solubility of the former. Conclusions The good interaction between DCF and soil organic carbon suggests the organic amendment of soils before the application of treated watewaters. The low adsorption of SMX onto soils suggests greater leaching of this compound which is, therefore, potentially more dangerous than DCF. For this reason, the application of a filtration system with appropriate adsorbent materials before the application of wastewater to soils should be expected. Graphical Abstrac

Validation of a modified QuEChERS method for the extraction of multiple classes of pharmaceuticals from soils

Abstract Background The quick, easy, cheap, effective, rugged, and safe (QuEChERS) method can be employed for multi-residue analyses instead of traditional extraction methods due to its advantages in terms of extraction time and required equipment. A modified version of the QuEChERS method has been developed for quantifying eight pharmaceuticals belonging to different classes in three real soils with different chemical properties. Firstly, the soils have been polluted with all contaminants and the recoveries were determined by liquid chromatography tandem–mass spectrometry. Due to similar recoveries from the three soils, the validation of the method has been carried out only on a soil by determining linearity, recovery, precision, limit of detection (LOD) and limit of quantification (LOQ) values. A matrix-matched calibration for the soil has been adopted in order to avoid the matrix effect and three levels of fortification (50, 100 and 500 µg L−1) were used. Results The recovery of all pharmaceuticals, with the exception of tetracycline, from any soil was between 72 and 113%. In the validation procedure, recoveries of fortified samples ranged from 80 to 99%, the relative standard deviations ranged between 1.2 and 11.8%, and the LOQ between 20 and 36.9 μg kg−1. Conclusion The results of the present study confirmed the validity of the modified QuEChERS method for the extraction of pharmaceuticals from soils in the range 50–500 μg kg−1. Graphical Abstrac

CDK 4/6 inhibitors as single agent in advanced solid tumors

Cyclin-dependent kinases (CDK) 4/6 inhibitors, namely abemaciclib, palbociclib, and ribociclib, interfere with cell cycle progression, induce cell senescence and might promote cancer cell disruption by a cytotoxic T cells-mediated effect. Phase III randomized clinical trials have proven that CDK4/6 inhibitors (CDK4/6i) in combination with several endocrine agents improve treatment efficacy over endocrine agents alone for hormone receptor positive (HR+) HER2 negative (HER2-) metastatic breast cancer (MBC). Based on such results, these combinations have been approved for clinical use. Preclinical studies in cell cultures and mouse models proved that CDK4/6i are active against a broad spectrum of solid tumors other than breast cancer, including liposarcoma, rhabdomyosarcoma, non-small cell lung cancer, glioblastoma multiforme, esophageal cancer, and melanoma. The role of CDK4/6i in monotherapy in several solid tumors is currently under evaluation in phase I, II, and III trials. Nowadays, abemaciclib is the only of the three inhibitors that has received approval as single agent therapy for pretreated HR+ HER2- MBC. Here we review biological, preclinical and clinical data on the role of CDK4/6 inhibitors as single agents in advanced solid tumors

The role of dose-dense (DD) adjuvant chemotherapy (CT) in HER2-positive (HER2+) early breast cancer (BC) patients (pts) before and after the introduction of trastuzumab (T): Exploratory analysis of the GIM2 trial

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Potential of native and bioprocessed brewers' spent grains as organic soil amendments

IntroductionThe use of novel soil amendments and the exploitation of plant growth-promoting microorganisms are considered promising tools for developing a more sustainable agriculture in times when ensuring high-yield productions with limited resources is essential. MethodsIn this study, the potential of brewers' spent grain (BSG), the major by-product of the brewing industry, as organic soil amendment, was investigated. Bioprocessed BSG, obtained by an enzymatic treatment coupled with fermentation, together with native BSG, were used as amendments in a pot-trial. An integrated analytical approach aimed at assessing the modification of the physicochemical properties of a typical Mediterranean alkaline agricultural soil, and the plant growth-promoting effect on escarole (Cichorium endivia var. Cuartana), was carried out. ResultsThe use of biomasses led to soil organic content and total nitrogen content up to 72 and 42% higher, compared to the unamended soils. Moreover, the lower pH and the higher organic acids content doubled phosphorus availability. Although the number of leaves per plant in escaroles from pots amended with native and bioprocessed BSG did not show any difference compared to plants cultivated on unamended pots, the average fresh weight per escarole head, was higher in pots amended with bioprocessed BSG. DiscussionHence, the results collected so far encourage BSG application for agricultural purpose, while solving the problem of disposing of such abundant side stream.Peer reviewe

Techno-Economic Analysis of ZnO Nanoparticles Pretreatments for Biogas Production from Barley Straw

The aim of this study was to analyze the effect of ZnO nanoparticles (ZnO NPs) on the biogas production from mechanically treated barley straw and to perform a techno-economic analysis based on the costs assessment and on the results of biogas production. The structural changes of mechanically pretreated barley straw were observed using FTIR, XRD, TGA, and SEM. Additionally, both green ZnO NPs prepared from red alga (Antithamnion plumula) extract and chemically prepared ZnO NPs were characterized by FTIR, XRD, SEM, and TEM, surface area, and EDX. The results revealed that the biogas production was slightly improved by 14.9 and 13.2% when the barley straw of 0.4 mm was mechanically pretreated with 10 mg/L of both green and chemical ZnO NPs and produced 390.5 mL biogas/g VS and 385 mL biogas/g VS, respectively. On the other hand, the higher concentrations of ZnO NPs equal to 20 mg/L had an inhibitory effect on biogas production and decreased the biogas yield to 173 mL biogas/g VS, which was less than the half of previous values. It was also clear that the mechanically treated barley straw of 0.4 mm size presented a higher biogas yield of about 340 mL/g VS, in comparison to 279 mL biogas/g VS of untreated biomass. The kinetic study showed that the first order, modified Gompertz and logistic function models had the best fit with the experimental data. The results showed that the nanoparticles (NPs) of the mechanically treated barely straw are a suitable source of biomass for biogas production, and its yields are higher than the untreated barley straw. The results of the cost-benefit analysis showed that the average levelized cost of energy (LCOE), adopting the best treatments (0.4 mm + 10 mg/L ZnO), is 0.21 €/kWh, which is not competitive with the other renewable energy systems in the Egyptian energy market

Extended Adjuvant Endocrine Treatment in Luminal Breast Cancers in the Era of Genomic Tests

In patients with early-stage endocrine receptor-positive (ER+) breast cancer (BC), adjuvant endocrine therapy (ET) for 5 years is the standard of care. However, for some patients, the risk of recurrence remain high for up to 15 years after diagnosis and extended ET beyond 5 years may be a reasonable option. Nevertheless, this strategy significantly increases the occurrence of side effects. Here we summarize the available evidence from randomized clinical trials on the efficacy and safety profile of extended ET and discuss available clinical and genomic tools helpful to select eligible patients in daily clinical practice

Randomised phase 3 open-label trial of first-line treatment with gemcitabine in association with docetaxel or paclitaxel in women with metastatic breast cancer: a comparison of different schedules and treatments

BACKGROUND: This open-label study compared docetaxel/gemcitabine vs. paclitaxel/gemcitabine and a weekly (W) vs. 3-weekly (3 W) schedule in metastatic breast cancer (MBC). METHODS: Patients relapsed after adjuvant/neoadjuvant anthracycline-containing chemotherapy were randomized to: A) gemcitabine 1000 mg/m(2) Day 1,8 + docetaxel 75 mg/m(2) Day 1 q3W; B) gemcitabine 1250 mg/m(2) Day 1,8 + paclitaxel 175 mg/m(2) Day 1 q3W; C) gemcitabine 800 mg/m(2) Day 1,8,15 + docetaxel 30 mg/m(2) Day 1,8,15 q4W; D) gemcitabine 800 mg/m(2) Day 1,15 + paclitaxel 80 mg/m(2) Day 1,8,15 q4W. Primary endpoint was time-to-progression (TTP). Secondary endpoints were overall survival (OS) and overall response rate (ORR). RESULTS: Interim analysis led to accrual interruption (241 patients enrolled of 360 planned). Median TTP (months) was 8.33 (95% CI: 6.19-10.16) with W and 7.51 (95% CI: 5.93-8.33) with 3 W (p=0.319). No differences were observed in median TTP between docetaxel and paclitaxel, with 85.6% and 87.0% of patients progressing, respectively. OS did not differ between regimens/schedules. ORR was comparable between regimens (HR: 0.882; 95% CI: 0.523-1.488; p=0.639), while it was significantly higher in W than in the 3 W (HR: 0.504; 95% CI: 0.299-0.850; p=0.010) schedule. Grade 3/4 toxicities occurred in 69.2% and 71.9% of patients on docetaxel and paclitaxel, and in 65.8% and 75.2% in W and 3 W. CONCLUSIONS: Both treatment regimens showed similar TTP. W might be associated with a better tumour response compared with 3 W. TRIAL REGISTRATION: Clinicaltrial.gov ID NCT0023689

Endocrine‐based treatments in clinically‐relevant subgroups of hormone receptor‐positive/HER2‐negative metastatic breast cancer: systematic review and meta‐analysis

A precise assessment of the efficacy of first‐/second‐line endocrine therapies (ET) ± target therapies (TT) in clinically‐relevant subgroups of hormone receptor‐positive (HR+)/HER2‐negative metastatic breast cancer (MBC) has not yet been conducted. To improve our current knowledge and support clinical decision‐making, we thus conducted a systematic literature search to identify all first‐/second‐line phase II/III randomized clinical trials (RCT) of currently approved or most promising ET ± TT. Then, we performed a meta‐analysis to assess progression‐free (PFS) and/or overall survival (OS) benefit in several clinically‐relevant prespecified subgroups. Thirty‐five RCT were included (17,595 patients). Pooled results show significant reductions in the risk of relapse or death of 26–41% and 12–27%, respectively, depending on the clinical subgroup. Combination strategies proved to be more effective than single‐agent ET (PFS hazard ratio (HR) range for combinations: 0.60–0.65 vs. HR range for single agent ET: 0.59–1.37; OS HR range for combinations: 0.74–0.87 vs. HR range for single agent ET: 0.68–0.98), with CDK4/6‐inhibitors(i) + ET being the most effective regimen. Single agent ET showed comparable efficacy with ET+TT combinations in nonvisceral (p = 0.63) and endocrine sensitive disease (p = 0.79), while mTORi‐based combinations proved to be a valid therapeutic option in endocrine‐resistant tumors, as well as PI3Ki + ET in PIK3CA‐mutant tumors. These results strengthen international treatment guidelines and can aid therapeutic decision‐making