Initial experience with the Oncotype DX assay in decision-making for adjuvant therapy of early oestrogen receptor-positive breast cancer in Hong Kong

published_or_final_versio

Identification of serum miR-139-3p as a non-invasive biomarker for colorectal cancer

Aberrant levels of circulating microRNAs are potential biomarkers for the early detection of colorectal cancer. The aim of this study was to study miR-139-3p and miR-622 in serum as a non-invasive biomarker for colorectal cancer diagnosis. We applied quantitative polymerase chain reaction to determine the levels of miR-139-3p and miR-622 in 42 pairs of tumor and adjacent non-tumor tissues, and in serum samples of 117 patients and 90 control subjects. Our results showed that miR-139-3p was silenced whereas miR-622 was overexpressed in colorectal cancer. Similarly, serum miR-139-3p level was significantly lower in colorectal cancer patients than in control subjects whereas miR-622 was more frequently detectable in patients. ROC analysis showed that AUC of miR-139-3p was 0.9935, with a sensitivity of 96.6% and specificity of 97.8%. Serum miR-139-3p level showed high sensitivity and specificity for both early and late stage CRCs and proximal and distal CRCs. Detectable serum miR-622 showed a sensitivity of 87.5% and specificity of 63.5% for discriminating CRC patients, but the sensitivity dropped for late stage patients (72.7%). We also included analyses of the blood CEA level for comparing the diagnostic performance of these blood-based biomarkers. The median level in CRC patients (3.6 ng/ml) was significantly higher than that in control (1.8 ng/ml). The AUC value of CEA in diagnosing CRC patients was 0.7515. CEA showed a positive correlation with tumor stage and age of patients and its level was higher in male. Collectively, serum miR-139-3p has strong potential as a promising non-invasive biomarker in colorectal cancer detection.published_or_final_versio

Identification of serum miR-139-3p as a non-invasive biomarker for colorectal cancer

Aberrant levels of circulating microRNAs are potential biomarkers for the early detection of colorectal cancer. The aim of this study was to study miR-139-3p and miR-622 in serum as a non-invasive biomarker for colorectal cancer diagnosis. We applied quantitative polymerase chain reaction to determine the levels of miR-139-3p and miR-622 in 42 pairs of tumor and adjacent non-tumor tissues, and in serum samples of 117 patients and 90 control subjects. Our results showed that miR-139-3p was silenced whereas miR-622 was overexpressed in colorectal cancer. Similarly, serum miR-139-3p level was significantly lower in colorectal cancer patients than in control subjects whereas miR-622 was more frequently detectable in patients. ROC analysis showed that AUC of miR-139-3p was 0.9935, with a sensitivity of 96.6% and specificity of 97.8%. Serum miR-139-3p level showed high sensitivity and specificity for both early and late stage CRCs and proximal and distal CRCs. Detectable serum miR-622 showed a sensitivity of 87.5% and specificity of 63.5% for discriminating CRC patients, but the sensitivity dropped for late stage patients (72.7%). We also included analyses of the blood CEA level for comparing the diagnostic performance of these blood-based biomarkers. The median level in CRC patients (3.6 ng/ml) was significantly higher than that in control (1.8 ng/ml). The AUC value of CEA in diagnosing CRC patients was 0.7515. CEA showed a positive correlation with tumor stage and age of patients and its level was higher in male. Collectively, serum miR-139-3p has strong potential as a promising non-invasive biomarker in colorectal cancer detection.published_or_final_versio

The Impact of the Oncotype DX Breast Cancer Assay on Treatment Decisions for Women With Estrogen Receptor-Positive, Node-Negative Breast Carcinoma in Hong Kong

Background The Oncotype DX Breast Cancer Assay is validated to assess risk of distant recurrence and likelihood of chemotherapy (CT) benefit in estrogen receptor-positive ESBC in various populations. In Hong Kong, > 80% of breast cancers are early stage breast cancer (ESBC) and > 60% of these women receive CT. This prospective study measured changes in CT type and recommendations, as well as physician impression of assay impact in a homogenous Chinese population. Methods Consecutive patients with estrogen receptor-positive, T1-3 N0-1mi M0 ESBC were offered enrollment. After surgery, physicians discussed treatment options with patients, then ordered the assay, then reassessed treatment recommendation considering assay results. Changes in treatment recommendation, CT utilization, physician confidence, and physician rating of influence on their treatment recommendations were measured. Results A total of 146 evaluable patients received pre- and post-testing treatment recommendations. CT recommendations (including changes in intensity of CT) were changed for 34 of 146 patients (23.3%; 95% confidence interval, 16.7%-31.0%); change in intensity occurred in 7 of 146 (4.8%). There were 27 changes in treatment recommendations of adding or removing CT altogether (18.5% change; 95% confidence interval, 12.6%-25.8%). CT recommendations decreased from 52.1% to 37.7%, a net absolute reduction of 14.4% (P < .001; 27.6% net relative reduction). Pre-assay, 96% of physicians agreed/strongly agreed that they were confident in their treatment recommendation; post-assay, 90% of physicians agreed/strongly agreed with the same statement. Thirty percent of physicians agreed/strongly agreed that the test had influenced their recommendation, similar to the proportion of changed recommendations. Conclusions The Oncotype DX Assay appears to influence physician ESBC adjuvant treatment recommendations in Hong Kong.published_or_final_versio

Editorial to “Palbociclib and letrozole in advanced breast cancer”

link_to_subscribed_fulltex

Efficacy and safety of single-agent sunitinib in treating advanced hepatocelluar carcinoma patients after sorafenib failure: a prospective, open-label, phase II study

Poster abstract no. P-0216Background: This is an open label and single arm phase II study to assess the efficacy and tolerability of sunitinib for the treatment of sorafenib-refractory advanced hepatocellular carcinoma (HCC) patients. Methods: Between October, 2008 and October, 2010, eligible patients with advanced HCC and documented disease progression after sorafenib treatment received sunitinib 37.5 mg continuously at Queen Mary Hospital, Hong Kong. Response assessment was performed after every 8 weeks. The primary endpoint was time-to-progression (TTP) and the secondary endpoints were tumor response rate (RR), overall survival (OS) and safety. Results: At the time of analysis, 38 patients were recruited in the trial. The median age was 56 years (range, 27-80) and all patients were in ECOG Performance Status 0-1. Ninety-five percent of patients were chronic hepatitis B carriers with underlying Child- Pugh A and B cirrhosis in 70% and 30% of the enrolled patients, respectively. Ten (25%) patients had tumor vascular invasion and 32 (80%) patients had extra-hepatic metastasis. Among 35 evaluable patients, RR was 6% with 2 patients achieved partial response and another 12 (34%) patients achieved stable disease. Overall, 40% of patients derived clinical benefits from sunitinib treatment for at least 8 weeks. The median TTP was 2.9 months (0.5-15) and OS was 5.2 months (1-22.5). Malaise (60%), neutropenia (45%) and diarrhea (36%) were the most commonly encountered adverse events, with nearly 30% of patients experienced grade 3 or 4 toxicity. No treatmentrelated death was reported. Conclusions: Sunitinib has substantial anti-tumour activity with manageable toxicity profile in treating sorafenib-refractory advanced HCC population. These data may imply sunitinib inhibits signaling pathways involved in sorafenib resistance and support the hypothesis of sequential use of antiangiogenic tyrosine kinase inhibitors in treating advanced HCC patient

Advanced Pancreatic Cancer: Flourishing Novel Approaches in the Era of Biological Therapy

The progress in the development of systemic treatment for advanced pancreatic cancer (APC) has been slow. The main stream treatment remains using chemotherapy including gemcitabine, FOLFIRINOX, and nab-paclitaxel. Erlotinib is the only approved biological therapy with marginal benefit. Studies of agents targeting epidermal growth factor receptor, angiogenesis, and RAS signaling have not been satisfying, and the usefulness of targeted therapy in APC is uncertain. Understanding in molecular processes and tumor biology has opened the door for new treatment strategies such as targeting insulin-like growth factor 1 receptor, transforming growth factor β, phosphoinositide 3-kinase/AKT/mammalian target of rapamycin pathway, and Notch pathway. New directions also include the upcoming immunotherapy and many novel agents that act on the microenvironment. The practice of personalized medicine using predictive biomarkers and pharmacogenomics signatures may also enhance the effectiveness of existing treatment. Future treatment approaches may involve comprehensive genomic assessment of tumor and integrated combinations of multiple agents to overcome treatment resistance. ©AlphaMed Press 2014

Ki67 proliferation index in invasive lobular carcinoma of the breast: clinicopathologic correlation and prognostic significance

This journal supp. entitled: Abstract Book EBCC-8Poster 32

Comparison of clinicopathologic features of invasive lobular carcinoma of the breast with or without associated lobular carcinoma in-situ

This journal suppl. entitled: Abstract Book EBCC