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Current Oncology
Special Issues
Evolving Paradigm of Curative Intent Breast Cancer Management
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Evolving Paradigm of Curative Intent Breast Cancer Management

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Thoracic Oncology".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 28230

Special Issue Editors

Dr. Patricia Tang

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Guest Editor
Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
Interests: clinical trials; value of novel therapeutics
Dr. Jeffrey Cao

E-Mail Website1 Website2
Guest Editor
Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
Interests: leadership; breast cancer

Special Issue Information

Dear Colleagues, 

The care of breast cancer has evolved significantly over the past decade, with personalized medicine and biomarkers influencing decision-making in the curative setting. Within each breast cancer receptor subtype (hormone receptor positive, HER-2 positive, and triple-negative), recent advances are influencing the sequencing of curative therapy. Studies are assessing both escalation and de-escalation of treatment intensity in specific sub-groups of patients. Additional research suggests adjunct lifestyle interventions (such as exercise) also can play a significant role in improving treatment tolerance and compliance, while also impacting cancer outcomes.

This special issue will focus on the current status and challenges in treating breast cancer in the curative setting. It will encompass therapeutic advances in systemic therapy for breast cancer across the receptor subtypes as well as radiotherapy.  The role of adjunct lifestyle interventions (both during and after treatment), to help improve the care of breast cancer patients, will also be reviewed.

Dr. Patricia Tang
Dr. Jeffrey Cao
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Breast neoplasms
  • Carcinoma, ductal, breast
  • Carcinoma, lobular
  • Triple negative breast neoplasms
  • Estrogen antagonists
  • Estrogen receptor modulators
  • Exercise
  • Genomic testing
  • HER-2 positive breast cancer
  • Hormone-receptor positive breast cancer
  • Breast Surgery/Axillary Surgery
  • Radiotherapy

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Published Papers (7 papers)

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Research

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15 pages, 689 KiB  
Communication
Tailoring the Evidence for Exercise Oncology within Breast Cancer Care
by Chad W. Wagoner, Lauren C. Capozzi and S. Nicole Culos-Reed
Curr. Oncol. 2022, 29(7), 4827-4841; https://doi.org/10.3390/curroncol29070383 - 9 Jul 2022
Cited by 8 | Viewed by 3958
Abstract
Exercise is safe and effective for those living with and beyond breast cancer, with evidence supporting exercise guidelines, and position statements from international organizations. Despite the clearly recognized benefits of exercise for these individuals, many do not participate or maintain recommended exercise levels [...] Read more.
Exercise is safe and effective for those living with and beyond breast cancer, with evidence supporting exercise guidelines, and position statements from international organizations. Despite the clearly recognized benefits of exercise for these individuals, many do not participate or maintain recommended exercise levels throughout the breast cancer continuum, highlighting the lack of translation from research into practice. In addition, discerning how exercise can be tailored to address breast cancer-related impairments, so that individuals are able to participate safely and effectively, has also not been studied extensively. Thus, we propose that implementing exercise screening, triage, and referral pathways across the breast cancer continuum may allow for increased accessibility and adoption among those living with and beyond breast cancer. This paper provides an overview of exercise prescription tailoring for common breast cancer and treatment-related impairments, proposes a simplified screening tool for identifying physical activity and movement-related impairments, and considers how best to channel evidence into practice via proposed implementation pathways that may better connect individuals living with and beyond breast cancer with exercise oncology resources through screening, triage, and referral. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
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11 pages, 266 KiB  
Article
A Review of Trastuzumab Biosimilars in Early Breast Cancer and Real World Outcomes of Neoadjuvant MYL-1401O versus Reference Trastuzumab
by Charlie Yang, Raida Khwaja, Patricia Tang, Nancy Nixon, Karen King and Sasha Lupichuk
Curr. Oncol. 2022, 29(6), 4224-4234; https://doi.org/10.3390/curroncol29060337 - 11 Jun 2022
Cited by 8 | Viewed by 3063
Abstract
The reduced cost of trastuzumab biosimilars has led to increased adoption for HER2-positive breast cancer. This review of trastuzumab biosimilars encompasses this development and real world clinical data in early breast cancer. In addition, we present a retrospective study evaluating the total pathological [...] Read more.
The reduced cost of trastuzumab biosimilars has led to increased adoption for HER2-positive breast cancer. This review of trastuzumab biosimilars encompasses this development and real world clinical data in early breast cancer. In addition, we present a retrospective study evaluating the total pathological complete response (tpCR) rates (lack of residual invasive cancer in resected breast tissue and axillary nodes), of MYL-1401O to reference trastuzumab (TRZ) in the neoadjuvant setting for HER2+ early breast cancer (EBC) in Alberta, Canada. Neoadjuvant patients with HER2+ EBC treated with TRZ from November 2018–October 2019 and MYL-1401O from December 2019–September 2020 were identified. Logistic regression was used to control for variables potentially associated with tpCR: trastuzumab product, age, pre-operative T- and N-stage, grade, hormone receptor (HR)-status, HER2-status, chemotherapy regimen, and chemotherapy completion. tpCR was 35.6% in the MYL-1401O group (n = 59) and 40.3% in the TRZ (n = 77) group, p = 0.598. After controlling for clinically relevant variables, there was no significant difference in the odds of achieving tpCR in patients treated with TRZ versus MYL-1401O (OR 1.1, 95% CI 0.5–2.4, p = 0.850). tpCR rates were similar for patients treated with MYL-1401O compared to trastuzumab in our real world study of HER2+ neoadjuvant EBC and comparable to pivotal phase 3 trials. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)

Review

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11 pages, 853 KiB  
Review
Clinical Utility of Genomic Assay in Node-Positive Early-Stage Breast Cancer
by Mehrnoosh Pauls and Stephen Chia
Curr. Oncol. 2022, 29(7), 5139-5149; https://doi.org/10.3390/curroncol29070407 - 20 Jul 2022
Cited by 3 | Viewed by 3388
Abstract
Breast cancer (BC) is the most common malignancy among women in Canada. Adjuvant treatment in early BC can reduce the risk of BC recurrence. Historically, the decision for adjuvant chemotherapy for early BC was made only based on clinical and tumour characteristics. In [...] Read more.
Breast cancer (BC) is the most common malignancy among women in Canada. Adjuvant treatment in early BC can reduce the risk of BC recurrence. Historically, the decision for adjuvant chemotherapy for early BC was made only based on clinical and tumour characteristics. In recent years, there has been an effort toward developing genomic assays as a predictive and prognostic tool to improve precision in estimating disease recurrence, sensitivity to systemic treatment and ultimately with clinical utility for guidance regarding adjuvant systemic treatment(s). There are various commercial genomic tests available for early-stage ER+/HER-2 negative BC. This paper will review the Oncotype DX 21-gene Recurrence Score (RS), MammaPrint, EndoPredict, Prosigna®, and Breast Cancer Index (BCI) genomic assays. We will also focus on these genomic assays’ clinical application and utility in node-positive early-stage BC based on the most recent evidence and guidance recommendations. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
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14 pages, 1023 KiB  
Review
Appraising Adjuvant Endocrine Therapy in Hormone Receptor Positive HER2-Negative Breast Cancer—A Literature Review
by Danilo Giffoni de Mello Morais Mata, Carlos Amir Carmona, Andrea Eisen and Maureen Trudeau
Curr. Oncol. 2022, 29(7), 4956-4969; https://doi.org/10.3390/curroncol29070394 - 13 Jul 2022
Cited by 5 | Viewed by 3868
Abstract
Background: Approximately 75% of breast cancer (BC) is associated with luminal differentiation expressing endocrine receptors (ER). For ER+ HER2− tumors, adjuvant endocrine therapy (ET) is the cornerstone treatment. Although relapse events steadily continue, the ET benefits translate to dramatically lengthen life expectancy with [...] Read more.
Background: Approximately 75% of breast cancer (BC) is associated with luminal differentiation expressing endocrine receptors (ER). For ER+ HER2− tumors, adjuvant endocrine therapy (ET) is the cornerstone treatment. Although relapse events steadily continue, the ET benefits translate to dramatically lengthen life expectancy with bearable side-effects. This review of ER+ HER2− female BC outlines suitable adjuvant treatment strategies to help guide clinical decision making around appropriate therapy. Methods: A literature search was conducted in Embase, Medline, and the Cochrane Libraries, using ER+ HER−, ET BC keywords. Results: In low-risk patients: five years of ET is the standard option. While Tamoxifen remains the preferred selection for premenopausal women, AI is the choice for postmenopausal patients. In the high-risk category: ET plus/minus OFS with two years of Abemaciclib is recommended. Although extended ET for a total of ten years is an alternative, the optimal AI duration is undetermined; nevertheless an additional two to three years beyond the initial five years may be sufficient. In this postmenopausal group, bisphosphonate is endorsed. Conclusions: Classifying the risk category assists in deciding the treatment route and its optimal duration. Tailoring the breadth of ET hinges on a wide array of factors to be appraised for each individualized case, including weighing its benefits and harms. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
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18 pages, 802 KiB  
Review
Locoregional Management of Breast Cancer: A Chronological Review
by Abdulla Al-Rashdan, Melina Deban, May Lynn Quan and Jeffrey Q. Cao
Curr. Oncol. 2022, 29(7), 4647-4664; https://doi.org/10.3390/curroncol29070369 - 1 Jul 2022
Cited by 3 | Viewed by 3324
Abstract
Locoregional management of breast cancer is founded on evidence generated over a vast time period, much longer than the career span of many practicing physicians. Oncologists rely on specific patient and tumour characteristics to recommend modern-day treatments. However, some of this information may [...] Read more.
Locoregional management of breast cancer is founded on evidence generated over a vast time period, much longer than the career span of many practicing physicians. Oncologists rely on specific patient and tumour characteristics to recommend modern-day treatments. However, some of this information may not have been available during prior periods in which the evidence was generated. For example, the comprehensive Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analyses published in the 2000s typically included older trials accruing patients between the 1960s and 1980s. This raises some uncertainty about whether conclusions from studies conducted in prior eras are as relevant or applicable to modern-day patients and treatments. Reviewing the chronological order and details of the evidence can be beneficial to understanding these nuances. This review discusses the evolution of locoregional management through some key clinical trials. We aim to highlight the time period in which the evidence was generated and emphasize the 10-year outcomes for the comparability of results. Evidence supporting surgical management of the breast and axilla, as well as details of radiotherapy are discussed briefly for all stages of breast cancer. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
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13 pages, 692 KiB  
Review
Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective
by Sharon F. McGee, Mark Clemons and Marie-France Savard
Curr. Oncol. 2022, 29(6), 4125-4137; https://doi.org/10.3390/curroncol29060329 - 6 Jun 2022
Cited by 3 | Viewed by 3296
Abstract
The advent of HER2-targeted therapies has led to an important shift in the management of HER2-positive early breast cancer. However, initial treatment approaches apply uniform treatment regimens to all patients, with significant treatment-related and financial toxicities for both the patient and the health [...] Read more.
The advent of HER2-targeted therapies has led to an important shift in the management of HER2-positive early breast cancer. However, initial treatment approaches apply uniform treatment regimens to all patients, with significant treatment-related and financial toxicities for both the patient and the health care system. Recent data demonstrates that for many patients, the chemotherapy backbone, duration and nature (mono- versus dual-targeted therapy) of the HER2 blockade can be better targeted to an individual patient’s risk of recurrence. We will provide a review of current data supporting risk tailored therapy in early stage HER2-positive breast cancer along with key completed and ongoing Canadian and international risk tailored trials. Neoadjuvant systemic therapy should now be considered for patients with clinical stage 2 disease, with greater use of non-anthracycline based chemotherapy regimens. Patients with residual disease following neoadjuvant therapy should be considered for escalated treatment with adjuvant T-DM1. Patients with stage I disease can often be managed with upfront surgery and evidence-based de-escalated adjuvant chemotherapy regimens. The modest benefit of 12- versus 6 months of adjuvant HER2 therapy and/or dual adjuvant HER2 therapy should be carefully weighed against the toxicities. All patients with HER2-positive breast cancer should be enrolled in ongoing risk tailored treatment trials whenever possible. Increasing data supports risk tailored therapy in early stage HER2-positive breast cancer in place of the routine application of aggressive and toxic systemic therapy regimens to all patients. While much progress has been made towards treatment de-escalation in appropriate patients, more is needed, as we highlight in this review. Indeed, Canadian-led clinical trials are helping to lead these efforts. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
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Other

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11 pages, 264 KiB  
Commentary
Triple-Negative Breast Cancer: A Review of Current Curative Intent Therapies
by Isaiah MacDonald, Nancy A. Nixon and Omar F. Khan
Curr. Oncol. 2022, 29(7), 4768-4778; https://doi.org/10.3390/curroncol29070378 - 7 Jul 2022
Cited by 22 | Viewed by 5459
Abstract
Breast cancer is the most commonly diagnosed malignancy in women, with triple-negative breast cancer (TNBC) accounting for 10–20% of cases. Historically, fewer treatment options have existed for this subtype of breast cancer, with cytotoxic chemotherapy playing a predominant role. This article aims to [...] Read more.
Breast cancer is the most commonly diagnosed malignancy in women, with triple-negative breast cancer (TNBC) accounting for 10–20% of cases. Historically, fewer treatment options have existed for this subtype of breast cancer, with cytotoxic chemotherapy playing a predominant role. This article aims to review the current treatment paradigm for curative-intent TNBC, while also reviewing potential future developments in this landscape. In addition to chemotherapy, recent advances in the understanding of the molecular biology of TNBC have led to promising new studies of targeted and immune checkpoint inhibitor therapies in the curative-intent setting. The appropriate selection of TNBC patient subgroups with a higher likelihood of benefit from treatment is critical to identify the best treatment approach. Full article
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
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