Efficacy and tolerability of trastuzumab emtansine in advanced human epidermal growth factor receptor 2–positive breast cancer

© 2018, Hong Kong Academy of Medicine Press. All rights reserved. Introduction: The management of human epidermal growth factor receptor 2 (HER2)–positive breast cancer has changed dramatically with the introduction and widespread use of HER2-targeted therapies. There is, however, relatively limited real-world information about the effectiveness and safety of trastuzumab emtansine (T-DM1) in Hong Kong Chinese patients. We assessed the efficacy and toxicity profiles among local patients with HER2-positive advanced breast cancer who had received T-DM1 therapy in the second-line setting and beyond. Methods: This retrospective study involved five local centres that provide service for over 80% of the breast cancer population in Hong Kong. The study period was from December 2013 to December 2015. Patients were included if they had recurrent or metastatic histologically confirmed HER2+ breast cancer who had progressed after at least one line of anti-HER2 therapy including trastuzumab. Patients were excluded if they received T-DM1 as first-line treatment for recurrent or metastatic HER2+ breast cancer. Patient charts including biochemical and haematological profiles were reviewed for background information, T-DM1 response, and toxicity data. Adverse events were documented during chemotherapy and 28 days after the last dose of medication. Results: Among 37 patients being included in this study, 28 (75.7%) had two or more lines of anti-HER2 agents and 26 (70.3%) had received two or more lines of palliative chemotherapy. Response assessment revealed that three (8.1%) patients had a complete response, eight (21.6%) a partial response, 11 (29.7%) a stable disease, and 12 (32.4%) a progressive disease; three patients could not be assessed. The median duration of response was 17.3 (95% confidence interval, 8.4-24.8) months. The clinical benefit rate (complete response + partial response + stable disease, ≥12 weeks) was 37.8% (95% confidence interval, 22.2%-53.5%). The median progression-free survival was 6.0 (95% confidence interval, 3.3-9.8) months and the median overall survival had not been reached by the data cut-off date. Grade 3 or 4 toxicities included thrombocytopaenia (13.5%), raised alanine transaminase (8.1%), anaemia (5.4%), and hypokalaemia (2.7%). No patient died as a result of toxicities. Conclusions: In patients with HER2-positive advanced breast cancer who have been heavily pretreated with anti-HER2 agents and cytotoxic chemotherapy, T-DM1 is well tolerated and provided a meaningful progression-free survival of 6 months and an overall survival that has not been reached. Further studies to identify appropriate patient subgroups are warranted.Link_to_subscribed_fulltex

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

A tribute to radiologists (and the multidisciplinary team) in combating liver cancer

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Women's imaging and Oncology

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Male breast cancer in Hong Kong: 15-year experience from a tertiary institution

© 2015 Hong Kong College of Radiologists. Objective: Male breast cancer (MBC) is a rare disease entity and few data are available for the Chinese population. This study aimed to report MBC data from a single institution in Hong Kong to supplement existing evidence of this disease in our local population. Methods: Patients with histologically confirmed MBC treated between July 1997 and February 2012 were retrospectively identified from an institutional patient database. Clinical, pathological, treatment, and survival data were collected and subsequently analysed. Results: Within the captioned period, 52 cases of MBC were identified. The median age was 63 years, with evenly distributed tumour laterality. The majority of patients had invasive ductal carcinoma (84.6%), most of which were histologically grade II (50.0%). Almost all patients demonstrated hormone receptor positivity (oestrogen receptor-positive 98.0%, progesterone receptor-positive 96.0%), and HER2 amplification rate was 25.0%. Patients tended to present at an early stage of disease: approximately 85% presented as a T1 or T2 tumour, and 56.1 % had axillary nodal involvement. Surgery with curative intent was performed in 48 patients, with 13 (27.1 %) received adjuvant chemotherapy, and 35 (72.9%) underwent adjuvant radiotherapy. Almost all hormone receptor-positive patients received adjuvant tamoxifen. The median time to tamoxifen discontinuation was 60 months (range, 2-61 months). Discontinuation rate before 60 months was 15.9%. For those who underwent radical surgery, none developed loco-regional recurrence, and 5- and 10-year disease-free survival was 89.6% and 85.1%, respectively. The median overall survival for the entire population was 14.3 years. Conclusion: Our single-institutional data indicate that a good long-term survival outcome can be achieved in MBC following a treatment protocol similar to that established for females with breast cancer. Prospective data will be helpfid to further evaluate optimal treatment strategies as well as treatment tolerance for MBC in the Asian population.Link_to_subscribed_fulltex

Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma

© 2015 Hong Kong College of Radiologists. Patients with early local recurrence of nasopharyngeal carcinoma with close proximity to the nearby carotid artery can be offered long-term control by endoscopic nasopharyngectomy which allows complete microscopic clearance of the recurrent tumour without damaging the carotid artery. This case report illustrates how this can be achieved without mutilating surgical procedures or further irradiation so that the patient can be spared of the associated morbidities.Link_to_subscribed_fulltex

Stereotactic body radiation therapy for hepatocellular carcinoma: Review of a local hospital

© 2017 Hong Kong College of Radiologists. Objective: To review the outcome and safety of stereotactic body radiation therapy (SBRT) for patients with hepatocellular carcinoma (HCC). Methods: Patients who underwent SBRT for HCC between January 2013 and March 2016 at Queen Elizabeth Hospital were reviewed retrospectively. Tumour response and toxicities were evaluated. Local control and overall survival rates were calculated using the Kaplan-Meier method. Results: 31 male and 8 female patients aged 54 to 90 (median, 72) years were included. 35 patients had Child- Pugh class A cirrhosis. 35 patients had viral hepatitis, of whom 33 were hepatitis B carriers. One patient was treatment native and underwent SBRT as bridging therapy prior to liver transplantation. The remaining 38 patients had received prior loco-regional therapies. The median tumour size was 1.9 cm. 29 patients had only one lesion. The SBRT doses ranged from 30 to 54 Gy in 6 to 7 fractions. After a median follow-up period of 17.8 months, 13 patients had died. The 1- and 2-year overall survival rates were 73.6% and 56.1%, respectively, and the median overall survival was 30.1 months. In 38 patients followed up at 3 months, 28.9%, 23.7%, and 42.1% had a complete response, partial response, and stable disease, respectively. The actuarial local control rate at 1 year was 82.8%. 21 patients had intrahepatic out-of-field recurrence, and four patients had distant metastasis. The 1-year intrahepatic recurrence-free survival was 50.5%, and the median intrahepatic recurrence-free survival was 15.4 months. 13 patients had grade 3 or above toxicity, of whom eight had thrombocytopaenia. One patient had grade 3 hepatic and renal toxicities and died after 2 months due to liver failure and hepatorenal syndrome. Conclusion: SBRT is effective and safe even in previously treated patients. It results in good local control with minimal severe adverse events but a relatively high intrahepatic (out-of-field) recurrence rate.Link_to_subscribed_fulltex

Primary squamous cell carcinoma of the breast in two Chinese women

Primary squamous cell carcinoma of the breast is a rare breast neoplasm. This report describes two Chinese women diagnosed with primary squamous cell carcinoma of the breast. The first patient was a 54-year-old woman with stage pT1cN0M0 triple-negative disease treated with wide local excision and axillary dissection followed by adjuvant chemotherapy with adriamycin and cyclophosphamide, and adjuvant radiotherapy. She was disease-free on follow-up at 19 months. The second patient was a 63-year-old woman presenting with a 10-cm right breast mass. She was given one cycle of neoadjuvant chemotherapy using docetaxel, cisplatin, and 5-fluorouracil without clinical response. Modified radical mastectomy with transverse rectus abdominis myocutaneous flap was performed. Pathology showed stage pT3N0M0 triple-negative disease. Adjuvant locoregional radiotherapy was given. She was disease-free on follow-up at 19 months. As reported in the literature, squamous cell carcinoma of the breast is mostly triple negative, of large size, and has infrequent nodal involvement at presentation. The disease runs a more aggressive clinical course. There is no consensus on the role and mode of adjuvant treatment. The choice of chemotherapy regimen for this histology remains to be defined. © 2012 Hong Kong College of Radiologists.Link_to_subscribed_fulltex

Coexistence of two Epstein-Barr virus-associated malignancies: Lymphoepithelioma-like cholangiocarcinoma in a patient with a history of undifferentiated nasopharyngeal carcinoma

© 2015 Hong Kong College of Radiologists. Undifferentiated nasopharyngeal carcinoma is particularly common in Southern China and is consistently associated with Epstein-Barr virus. In contrast, lymphoepithelioma-like carcinoma of the bile duct is a rare disease and not always associated with Epstein-Barr virus. We report the first case of coexisting Epstein-Barr virus-associated nasopharyngeal carcinoma and lymphoepithelioma-like carcinoma of the bile duct in a Chinese patient.Link_to_subscribed_fulltex

Primary mucoid adenocarcinoma of the larynx

Mucous gland carcinomas of the larynx are rare, with most being represented by 'non-specific' adenocarcinoma and adenoid cystic carcinoma. Here we report a unique case of mucoid adenocarcinoma of the larynx occurring in a 46-year-old woman. Despite the presence of regional lymph node metastasis, she remained well four years after surgery.Link_to_subscribed_fulltex