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Innovations in the Integrated Management of Breast Cancer
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Innovations in the Integrated Management of Breast Cancer

A special issue of Journal of Personalized Medicine (ISSN 2075-4426).

Deadline for manuscript submissions: closed (25 January 2022) | Viewed by 44230

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Gianluca Franceschini

E-Mail Website
Guest Editor
Division of Breast Surgery, Rome Catholic University School of Medicine, Rome, Italy
Interests: breast cancer; breast pathology; breast reconstruction; breast surgery; cellulose; contralateral prophylactic mastectomy; mastectomy; oncoplastic surgery; surgical oncology
Special Issues, Collections and Topics in MDPI journals
Dr. Alejandro Martin Sanchez

E-Mail Website
Guest Editor
Alejandro Martin Sanchez, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Breast Cancer Center, Rome, Italy
Interests: breast surgery; surgery; surgical oncology; breast cancer management; breast cancer screening; senology; breast imaging; mammography; breast cancer; breast cancer stem cells
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Riccardo Masetti

E-Mail Website
Guest Editor
1. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Breast Cancer Center, Rome, Italy
2. Department of Surgery, Catholic University of Rome, Policlinico Agostino Gemelli Largo Agostino Gemelli, 8, 00168 Rome, Italy
Interests: breast cancer treatment

Special Issue Information

Dear Colleagues,

Breast cancer is acknowledged as an international priority in healthcare. It is currently the most common cancer in women worldwide, with demographic trends indicating a continuous increase in incidence. Over the years, increasing efforts and resources have been devoted to the search for a systematic and optimized strategy in breast cancer diagnosis and treatment. Today, the Breast Unit model is considered the gold standard in order to ensure optimal patient-centered and research-based clinical services through multidisciplinary and integrated management.

Surgical treatment has gradually evolved toward less aggressive approaches with the adoption of new therapeutic strategies. The evolution of evidence-based guidelines in such leading disciplines as radiation and medical oncology has led to a steady improvement in survival rates. This Special Issue will highlight innovations in the integrated management of breast cancer, their potential advantages, and the many open issues that are still required to be properly defined and addressed. 

Dr. Gianluca Franceschini
Dr. Alejandro Martin Sanchez
Prof. Dr. Riccardo Masetti
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. Journal of Personalized Medicine 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 2600 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 cancer treatment
  • oncoplastic surgery
  • conservative mastectomy
  • breast reconstruction
  • sentinel node biopsy
  • chemotherapy
  • radiotherapy
  • integrated therapies

Published Papers (14 papers)

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Editorial

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4 pages, 188 KiB  
Editorial
Innovations in the Integrated Management of Breast Cancer
by Gianluca Franceschini, Alejandro Martin Sanchez, Elena Jane Mason and Riccardo Masetti
J. Pers. Med. 2022, 12(4), 531; https://doi.org/10.3390/jpm12040531 - 28 Mar 2022
Viewed by 1578
Abstract
Breast cancer is commonly acknowledged as an international priority in healthcare [...] Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)

Research

Jump to: Editorial, Review, Other

14 pages, 1815 KiB  
Article
Adjuvant Radiotherapy Is Associated with an Increase in the Survival of Old (Aged over 80 Years) and Very Old (Aged over 90 Years) Women with Breast Cancer Receiving Breast-Conserving Surgery
by Chung-Chien Huang, Chia-Lun Chang, Mingyang Sun, Ming-Feng Chiang, Shao-Yin Sum, Jiaqiang Zhang and Szu-Yuan Wu
J. Pers. Med. 2022, 12(2), 287; https://doi.org/10.3390/jpm12020287 - 16 Feb 2022
Viewed by 1874
Abstract
This study is the first to examine the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM) in old (aged ≥80 years) and very old (aged ≥90 years) women with breast invasive [...] Read more.
This study is the first to examine the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM) in old (aged ≥80 years) and very old (aged ≥90 years) women with breast invasive ductal carcinoma (IDC) receiving breast-conserving surgery. After propensity score matching, adjuvant WBRT was associated with decreases in all-cause death, LRR, and DM in old and very old women with IDC compared with no use of adjuvant WBRT. Background: To date, no data on the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available for old (aged ≥80 years) and very old (≥90 years) women with breast invasive ductal carcinoma (IDC) receiving breast-conserving conservative surgery (BCS). Patients and Methods: We enrolled old (≥80 years old) and very old (≥90 years old) women with breast IDC who had received BCS followed by adjuvant WBRT or no adjuvant WBRT. We grouped them based on adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. To reduce the effects of potential confounders when comparing all-cause mortality between the groups, propensity score matching was performed. Results: Overall, 752 older women with IDC received BCS followed by adjuvant WBRT, and 752 with IDC received BCS with no adjuvant WBRT. In multivariable Cox regression analysis, the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) of all-cause death for adjuvant WBRT compared with no adjuvant WBRT in older women with IDC receiving BCS was 0.56 (0.44–0.70). The aHRs (95% CIs) of LRR and DM for adjuvant WBRT were 0.29 (0.19–0.45) and 0.45 (0.32–0.62), respectively, compared with no adjuvant WBRT. Conclusions: Adjuvant WBRT was associated with decreases in all-cause death, LRR, and DM in old (aged ≥80 years) and very old (aged ≥90 years) women with IDC compared with no adjuvant WBRT. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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9 pages, 1439 KiB  
Article
Conventional CT versus Dedicated CT Angiography in DIEP Flap Planning: A Feasibility Study
by Anna D’Angelo, Alessandro Cina, Giulia Macrì, Paolo Belli, Sara Mercogliano, Pierluigi Barbieri, Cristina Grippo, Gianluca Franceschini, Sabatino D’Archi, Elena Jane Mason, Giuseppe Visconti, Liliana Barone Adesi, Marzia Salgarello and Riccardo Manfredi
J. Pers. Med. 2021, 11(4), 277; https://doi.org/10.3390/jpm11040277 - 7 Apr 2021
Cited by 5 | Viewed by 2451
Abstract
The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study’s goal was to investigate the accuracy of conventional CT [...] Read more.
The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study’s goal was to investigate the accuracy of conventional CT (cCT), performed during disease staging, compared to CTa in preoperative DIEP flap planning. In this retrospective, single-center study, we enrolled patients scheduled for mastectomy and DIEP flap breast reconstruction, subjected to cCT within 24 months after CTa. We included 35 patients in the study. cCT accuracy was 95% (CI 0.80–0.98) in assessing the three largest perforators, 100% (CI 0.89–100) in assessing the dominant perforator, 93% (CI 0.71–0.94) in assessing the perforator intramuscular course, and 90.6% (CI 0.79–0.98) in assessing superficial venous communications. Superficial inferior epigastric artery (SIEA) caliber was recognized in 90% of cases (CI 0.84–0.99), with an excellent assessment of superficial inferior epigastric vein (SIEV) integrity (96% of cases, CI 0.84–0.99), and a lower accuracy in the evaluation of deep inferior epigastric artery (DIEA) branching type (85% of cases, CI 0.69–0.93). The mean X-ray dose spared would have been 788 ± 255 mGy/cm. Our study shows that cCT is as accurate as CTa in DIEP flap surgery planning. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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13 pages, 4309 KiB  
Article
Development of a Digital Research Assistant for the Management of Patients’ Enrollment in Oncology Clinical Trials within a Research Hospital
by Alfredo Cesario, Irene Simone, Ida Paris, Luca Boldrini, Armando Orlandi, Gianluca Franceschini, Filippo Lococo, Emilio Bria, Stefano Magno, Antonino Mulè, Angela Santoro, Andrea Damiani, Daniele Bianchi, Daniele Picchi, Guido Rasi, Gennaro Daniele, Alessandra Fabi, Paolo Sergi, Giampaolo Tortora, Riccardo Masetti, Vincenzo Valentini, Marika D’Oria and Giovanni Scambiaadd Show full author list remove Hide full author list
J. Pers. Med. 2021, 11(4), 244; https://doi.org/10.3390/jpm11040244 - 27 Mar 2021
Cited by 9 | Viewed by 3072
Abstract
Clinical trials in cancer treatment are imperative in enhancing patients’ survival and quality of life outcomes. The lack of communication among professionals may produce a non-optimization of patients’ accrual in clinical trials. We developed a specific platform, called “Digital Research Assistant” (DRA), to [...] Read more.
Clinical trials in cancer treatment are imperative in enhancing patients’ survival and quality of life outcomes. The lack of communication among professionals may produce a non-optimization of patients’ accrual in clinical trials. We developed a specific platform, called “Digital Research Assistant” (DRA), to report real-time every available clinical trial and support clinician. Healthcare professionals involved in breast cancer working group agreed nine minimal fields of interest to preliminarily classify the characteristics of patients’ records (including omic data, such as genomic mutations). A progressive web app (PWA) was developed to implement a cross-platform software that was scalable on several electronic devices to share the patients’ records and clinical trials. A specialist is able to use and populate the platform. An AI algorithm helps in the matchmaking between patient’s data and clinical trial’s inclusion criteria to personalize patient enrollment. At the same time, an easy configuration allows the application of the DRA in different oncology working groups (from breast cancer to lung cancer). The DRA might represent a valid research tool supporting clinicians and scientists, in order to optimize the enrollment of patients in clinical trials. User Experience and Technology The acceptance of participants using the DRA is topic of a future analysis. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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12 pages, 1284 KiB  
Article
Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer
by Andrea Bellieni, Domenico Fusco, Alejandro Martin Sanchez, Gianluca Franceschini, Beatrice Di Capua, Elena Allocca, Enrico Di Stasio, Fabio Marazzi, Luca Tagliaferri, Riccardo Masetti, Roberto Bernabei and Giuseppe Ferdinando Colloca
J. Pers. Med. 2021, 11(4), 243; https://doi.org/10.3390/jpm11040243 - 26 Mar 2021
Cited by 12 | Viewed by 2715
Abstract
Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, [...] Read more.
Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as “probably” sarcopenic; among these, 25 were sarcopenic and 17 “severely” sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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10 pages, 822 KiB  
Article
Liver Metastasectomy for Metastatic Breast Cancer Patients: A Single Institution Retrospective Analysis
by Armando Orlandi, Letizia Pontolillo, Caterina Mele, Mariangela Pasqualoni, Sergio Pannunzio, Maria Chiara Cannizzaro, Claudia Cutigni, Antonella Palazzo, Giovanna Garufi, Maria Vellone, Francesco Ardito, Gianluca Franceschini, Alejandro Martin Sanchez, Alessandra Cassano, Felice Giuliante, Emilio Bria and Giampaolo Tortora
J. Pers. Med. 2021, 11(3), 187; https://doi.org/10.3390/jpm11030187 - 8 Mar 2021
Cited by 6 | Viewed by 2131
Abstract
The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients [...] Read more.
The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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11 pages, 7881 KiB  
Article
The Assisi Think Tank Meeting Breast Large Database for Standardized Data Collection in Breast Cancer—ATTM.BLADE
by Fabio Marazzi, Valeria Masiello, Carlotta Masciocchi, Mara Merluzzi, Simonetta Saldi, Paolo Belli, Luca Boldrini, Nikola Dino Capocchiano, Alba Di Leone, Stefano Magno, Elisa Meldolesi, Francesca Moschella, Antonino Mulé, Daniela Smaniotto, Daniela Andreina Terribile, Luca Tagliaferri, Gianluca Franceschini, Maria Antonietta Gambacorta, Riccardo Masetti, Vincenzo Valentini, Philip M. P. Poortmans and Cynthia Aristeiadd Show full author list remove Hide full author list
J. Pers. Med. 2021, 11(2), 143; https://doi.org/10.3390/jpm11020143 - 19 Feb 2021
Cited by 2 | Viewed by 2600
Abstract
Background: During the 2016 Assisi Think Tank Meeting (ATTM) on breast cancer, the panel of experts proposed developing a validated system, based on rapid learning health care (RLHC) principles, to standardize inter-center data collection and promote personalized treatments for breast cancer. Material and [...] Read more.
Background: During the 2016 Assisi Think Tank Meeting (ATTM) on breast cancer, the panel of experts proposed developing a validated system, based on rapid learning health care (RLHC) principles, to standardize inter-center data collection and promote personalized treatments for breast cancer. Material and Methods: The seven-step Breast LArge DatabasE (BLADE) project included data collection, analysis, application, and evaluation on a data-sharing platform. The multidisciplinary team developed a consensus-based ontology of validated variables with over 80% agreement. This English-language ontology constituted a breast cancer library with seven knowledge domains: baseline, primary systemic therapy, surgery, adjuvant systemic therapies, radiation therapy, follow-up, and toxicity. The library was uploaded to the BLADE domain. The safety of data encryption and preservation was tested according to General Data Protection Regulation (GDPR) guidelines on data from 15 clinical charts. The system was validated on 64 patients who had undergone post-mastectomy radiation therapy. In October 2018, the BLADE system was approved by the Ethical Committee of Fondazione Policlinico Gemelli IRCCS, Rome, Italy (Protocol No. 0043996/18). Results: From June 2016 to July 2019, the multidisciplinary team completed the work plan. An ontology of 218 validated variables was uploaded to the BLADE domain. The GDPR safety test confirmed encryption and data preservation (on 5000 random cases). All validation benchmarks were met. Conclusion:BLADE is a support system for follow-up and assessment of breast cancer care. To successfully develop and validate it as the first standardized data collection system, multidisciplinary collaboration was crucial in selecting its ontology and knowledge domains. BLADE is suitable for multi-center uploading of retrospective and prospective clinical data, as it ensures anonymity and data privacy. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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10 pages, 1391 KiB  
Article
GENERATOR Breast DataMart—The Novel Breast Cancer Data Discovery System for Research and Monitoring: Preliminary Results and Future Perspectives
by Fabio Marazzi, Luca Tagliaferri, Valeria Masiello, Francesca Moschella, Giuseppe Ferdinando Colloca, Barbara Corvari, Alejandro Martin Sanchez, Nikola Dino Capocchiano, Roberta Pastorino, Chiara Iacomini, Jacopo Lenkowicz, Carlotta Masciocchi, Stefano Patarnello, Gianluca Franceschini, Maria Antonietta Gambacorta, Riccardo Masetti and Vincenzo Valentini
J. Pers. Med. 2021, 11(2), 65; https://doi.org/10.3390/jpm11020065 - 22 Jan 2021
Cited by 11 | Viewed by 3218
Abstract
Background: Artificial Intelligence (AI) is increasingly used for process management in daily life. In the medical field AI is becoming part of computerized systems to manage information and encourage the generation of evidence. Here we present the development of the application of AI [...] Read more.
Background: Artificial Intelligence (AI) is increasingly used for process management in daily life. In the medical field AI is becoming part of computerized systems to manage information and encourage the generation of evidence. Here we present the development of the application of AI to IT systems present in the hospital, for the creation of a DataMart for the management of clinical and research processes in the field of breast cancer. Materials and methods: A multidisciplinary team of radiation oncologists, epidemiologists, medical oncologists, breast surgeons, data scientists, and data management experts worked together to identify relevant data and sources located inside the hospital system. Combinations of open-source data science packages and industry solutions were used to design the target framework. To validate the DataMart directly on real-life cases, the working team defined tumoral pathology and clinical purposes of proof of concepts (PoCs). Results: Data were classified into “Not organized, not ‘ontologized’ data”, “Organized, not ‘ontologized’ data”, and “Organized and ‘ontologized’ data”. Archives of real-world data (RWD) identified were platform based on ontology, hospital data warehouse, PDF documents, and electronic reports. Data extraction was performed by direct connection with structured data or text-mining technology. Two PoCs were performed, by which waiting time interval for radiotherapy and performance index of breast unit were tested and resulted available. Conclusions: GENERATOR Breast DataMart was created for supporting breast cancer pathways of care. An AI-based process automatically extracts data from different sources and uses them for generating trend studies and clinical evidence. Further studies and more proof of concepts are needed to exploit all the potentials of this system. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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11 pages, 614 KiB  
Article
Palbociclib Plus Fulvestrant or Everolimus Plus Exemestane for Pretreated Advanced Breast Cancer with Lobular Histotype in ER+/HER2− Patients: A Propensity Score-Matched Analysis of a Multicenter Retrospective Patient Series
by Armando Orlandi, Elena Iattoni, Laura Pizzuti, Agnese Fabbri, Andrea Botticelli, Carmela Di Dio, Antonella Palazzo, Giovanna Garufi, Giulia Indellicati, Daniele Alesini, Luisa Carbognin, Ida Paris, Angela Vaccaro, Luca Moscetti, Alessandra Fabi, Valentina Magri, Giuseppe Naso, Alessandra Cassano, Patrizia Vici, Diana Giannarelli, Gianluca Franceschini, Paolo Marchetti, Emilio Bria and Giampaolo Tortoraadd Show full author list remove Hide full author list
J. Pers. Med. 2020, 10(4), 291; https://doi.org/10.3390/jpm10040291 - 18 Dec 2020
Cited by 4 | Viewed by 2889
Abstract
Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) show meaningful efficacy and tolerability in patients with metastatic breast cancer (MBC), but the optimal sequence of ET has not been established. It is not clear if patients with lobular breast carcinomas [...] Read more.
Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) show meaningful efficacy and tolerability in patients with metastatic breast cancer (MBC), but the optimal sequence of ET has not been established. It is not clear if patients with lobular breast carcinomas (LBC) derive the same benefits when receiving second line CDK4/6i. This retrospective study compared the efficacy of palbociclib plus fulvestrant (PALBO–FUL) with everolimus plus exemestane (EVE–EXE) as second-line ET for hormone-resistant metastatic LBC. From 2013 to 2018, patients with metastatic LBC positivity for estrogen and/or progesterone receptors and HER2/neu negativity, who had relapsed during adjuvant hormonal therapy or first-line hormonal treatment, were enrolled from six centers in Italy in this retrospective study. A total of 74 out of 376 patients (48 treated with PALBO–FUL and 26 with EVE–EXE) with metastatic LBC were eligible for inclusion. Progression-free survival (PFS) was longer in patients receiving EVE–EXE compared with PALBO–FUL (6.1 vs. 4.5 months, univariate HR 0.58, 95% CI 0.35–0.96; p = 0.025). On the propensity score (PS) analysis, PFS was confirmed to be significantly longer for patients treated with EVE–EXE compared to PALBO–FUL (6.0 vs. 4.6 months, p = 0.04). This retrospective analysis suggests that EVE–EXE is more effective than PALBO–FUL for second line ET of metastatic LBC, allowing us to speculate on the optimal therapeutic sequence. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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Review

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13 pages, 405 KiB  
Review
Oligometastatic Breast Cancer: How to Manage It?
by Vittoria Barberi, Antonella Pietragalla, Gianluca Franceschini, Fabio Marazzi, Ida Paris, Francesco Cognetti, Riccardo Masetti, Giovanni Scambia and Alessandra Fabi
J. Pers. Med. 2021, 11(6), 532; https://doi.org/10.3390/jpm11060532 - 9 Jun 2021
Cited by 8 | Viewed by 7067
Abstract
Breast cancer (BC) is the most frequent cancer among women and represents the second leading cause of cancer-specific death. A subset of patients with metastatic breast cancer (MBC) presents limited disease, termed ‘oligometastatic’ breast cancer (OMBC). The oligometastatic disease can be managed with [...] Read more.
Breast cancer (BC) is the most frequent cancer among women and represents the second leading cause of cancer-specific death. A subset of patients with metastatic breast cancer (MBC) presents limited disease, termed ‘oligometastatic’ breast cancer (OMBC). The oligometastatic disease can be managed with different treatment strategies to achieve long-term remission and eventually cure. Several approaches are possible to cure the oligometastatic disease: locoregional treatments of the primary tumor and of all the metastatic sites, such as surgery and radiotherapy; systemic treatment, including target-therapy or immunotherapy, according to the biological status of the primary tumor and/or of the metastases; or the combination of these approaches. Encouraging results involve local ablative options, but these trials are limited by being retrospective and affected by selection bias. Systemic therapy, e.g., the use of CDK4/6 inhibitors for hormone receptor-positive (HR+)/HER-2 negative BC, leads to an increase of progression-free survival (PFS) and overall survival (OS) in all the subgroups, with favorable toxicity. Regardless of the lack of substantial data, this subset of patients could be treated with curative intent; the appropriate candidates could be mostly young women, for whom a multidisciplinary aggressive approach appears suitable. We provide a global perspective on the current treatment paradigms of OMBC. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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16 pages, 258 KiB  
Review
Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments
by Marco Pappalardo, Marta Starnoni, Gianluca Franceschini, Alessio Baccarani and Giorgio De Santis
J. Pers. Med. 2021, 11(5), 402; https://doi.org/10.3390/jpm11050402 - 12 May 2021
Cited by 28 | Viewed by 4876
Abstract
Breast cancer-related lymphedema (BCRL) represents a global healthcare issue affecting the emotional and life quality of breast cancer survivors significantly. The clinical presentation is characterized by swelling of the affected upper limb, that may be accompanied by atrophic skin findings, pain and recurrent [...] Read more.
Breast cancer-related lymphedema (BCRL) represents a global healthcare issue affecting the emotional and life quality of breast cancer survivors significantly. The clinical presentation is characterized by swelling of the affected upper limb, that may be accompanied by atrophic skin findings, pain and recurrent cellulitis. Cardinal principles of lymphedema management are the use of complex decongestive therapy and patient education. Recently, new microsurgery procedures have been reported with interesting results, bringing in a new opportunity to care postmastectomy lymphedema. However, many aspects of the disease are still debated in the medical community, including clinical examination, imaging techniques, patient selection and proper treatment. Here we will review these aspects and the current literature. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
14 pages, 271 KiB  
Review
Is It Possible to Personalize the Diagnosis and Treatment of Breast Cancer during Pregnancy?
by Petra Tesarova, David Pavlista and Antonin Parizek
J. Pers. Med. 2021, 11(1), 18; https://doi.org/10.3390/jpm11010018 - 28 Dec 2020
Cited by 5 | Viewed by 2407
Abstract
The main goal of precision medicine in patients with breast cancer is to tailor the treatment according to the particular genetic makeup and the genetic changes in the cancer cells. Breast cancer occurring during pregnancy (BCP) is a complex and difficult clinical problem. [...] Read more.
The main goal of precision medicine in patients with breast cancer is to tailor the treatment according to the particular genetic makeup and the genetic changes in the cancer cells. Breast cancer occurring during pregnancy (BCP) is a complex and difficult clinical problem. Although it is not very common, both maternal and fetal outcome must be always considered when planning treatment. Pregnancy represents a significant barrier to the implementation of personalized treatment for breast cancer. Tailoring therapy mainly takes into account the stage of pregnancy, the subtype of cancer, the stage of cancer, and the patient’s preference. Results of the treatment of breast cancer in pregnancy are as yet not very satisfactory because of often delayed diagnosis, and it usually has an unfavorable outcome. Treatment of patients with pregnancy-associated breast cancer should be centralized. Centralization may result in increased experience in diagnosis and treatment and accumulated data may help us to optimize the treatment approaches, modify general treatment recommendations, and improve the survival and quality of life of the patients. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
10 pages, 240 KiB  
Review
Locoregional Surgery in Metastatic Breast Cancer: Do Concomitant Metabolic Aspects Have a Role on the Management and Prognosis in this Setting?
by Maria Ida Amabile, Federico Frusone, Alessandro De Luca, Domenico Tripodi, Giovanni Imbimbo, Silvia Lai, Vito D’Andrea, Salvatore Sorrenti and Alessio Molfino
J. Pers. Med. 2020, 10(4), 227; https://doi.org/10.3390/jpm10040227 - 13 Nov 2020
Cited by 10 | Viewed by 2052
Abstract
Although they cannot be considered curative, the new therapeutic integrated advances in metastatic breast cancer (MBC) have substantially improved patient outcomes. Traditionally, surgery was confined to palliation of symptomatic or ulcerating lumps. Data suggest, in some cases, a possible additive role for more [...] Read more.
Although they cannot be considered curative, the new therapeutic integrated advances in metastatic breast cancer (MBC) have substantially improved patient outcomes. Traditionally, surgery was confined to palliation of symptomatic or ulcerating lumps. Data suggest, in some cases, a possible additive role for more aggressive locoregional surgical therapy in combination with systemic treatments in the metastatic setting, although a low level of evidence has been shown in terms of improvement in overall survival in MBC patients treated with surgery and medical treatment compared to medical treatment alone. In this light, tumor heterogeneity remains a challenge. To effectively reshape the therapeutic approach to MBC, careful consideration of who is a good candidate for locoregional resection is paramount. The patient’s global health condition, impacting on cancer progression and morbidity and their associated molecular targets, have to be considered in treatment decision-making. In particular, more recently, research has been focused on the role of metabolic derangements, including the presence of metabolic syndrome, which represent well-known conditions related to breast cancer recurrence and distant metastasis and are, therefore, involved in the prognosis. In the present article, we focus on locoregional surgical strategies in MBC and whether concomitant metabolic derangements may have a role in prognosis. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)

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12 pages, 10121 KiB  
Case Report
Invasive Ductal Breast Cancer with Osteoclast-Like Giant Cells: A Case Report Based on the Gene Expression Profile for Changes in Management
by Azzurra Irelli, Maria Maddalena Sirufo, Gina Rosaria Quaglione, Francesca De Pietro, Enrica Maria Bassino, Carlo D’Ugo, Lia Ginaldi and Massimo De Martinis
J. Pers. Med. 2021, 11(2), 156; https://doi.org/10.3390/jpm11020156 - 23 Feb 2021
Cited by 2 | Viewed by 3096
Abstract
We report the case of a 49-year-old woman diagnosed with a rare histotype of early breast cancer (BC), invasive ductal carcinoma with osteoclast-like giant cells (OGCs), from the perspective of gene profile analysis tests. The patient underwent a quadrantectomy of the right breast [...] Read more.
We report the case of a 49-year-old woman diagnosed with a rare histotype of early breast cancer (BC), invasive ductal carcinoma with osteoclast-like giant cells (OGCs), from the perspective of gene profile analysis tests. The patient underwent a quadrantectomy of the right breast with removal of 2 cm neoplastic nodule and three ipsilateral sentinel lymph nodes. The Oncotype Dx gave a recurrence score (RS) of 23, and taking into account the patient’s age, an RS of 23 corresponds to a chemotherapy benefit of 6.5%. After a multidisciplinary collegial discussion, and in consideration of the patient’s age, the absence of comorbidity, the premenopausal state, the rare histotype and the Oncotype Dx report, the patient was offered adjuvant chemotherapy treatment followed by hormone therapy. This case may be an example of the utility of integrating gene expression profiling tests into clinical practice in the adjuvant treatment decision of a rare histotype BC. The Oncotype Dx test required to supplement the histological examination made us opt for the proposal of a combined treatment of adjuvant chemotherapy followed by adjuvant hormone therapy. It demonstrates the importance of considering molecular tests and, in particular, the Oncotype Dx, in estimating the risk of disease recovery at 10 years in order to identify patients who benefit from hormone therapy alone versus those who benefit from the addition of chemotherapy, all with a view toward patient-centered oncology. Here, we discuss the possible validity and limitations of the Oncotype Dx in a rare luminal A-like histotype with high infiltrate of stromal/inflammatory cells. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Breast Cancer)
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