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Digkas, E., Smith, D., Wennstig, A.-K., Matikas, A., Tegnelius, E. & Valachis, A. (2024). Incidence and risk factors of hypothyroidism after treatment for early breast cancer: a population-based cohort study. Breast Cancer Research and Treatment, 204, 79-87
Open this publication in new window or tab >>Incidence and risk factors of hypothyroidism after treatment for early breast cancer: a population-based cohort study
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2024 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 204, p. 79-87Article in journal (Refereed) Published
Abstract [en]

PURPOSE: An increased incidence of hypothyroidism among breast cancer survivors has been observed in earlier studies. The impact of the postoperative treatment modalities and their potential interplay on hypothyroidism development needs to be studied.

METHODS: We conducted a population- and registry-based study using the Breast Cancer Data Base Sweden (BCBaSe) including females diagnosed with breast cancer between 2006 and 2012. In total, 21,268 female patients diagnosed with early breast cancer between 2006 and 2012, with no previous prescription of thyroid hormones and no malignant diagnosis during the last ten years before breast cancer diagnosis, were included in the final analysis.

RESULTS: During the follow-up (median follow-up time 7.9 years), 1212 patients (5.7%) developed hypothyroidism at a median time of 3.45 years from the index date. No association of the systemic oncological treatment in terms of either chemotherapy or endocrine therapy and hypothyroidism development could be identified. A higher risk (HR 1.68;95% CI 1.42-1.99) of hypothyroidism identified among patients treated with radiation treatment of the regional lymph nodes whereas no increased risk in patients treated only with radiation therapy to the breast/chest wall was found (HR 1.01; 95% CI 0.86-1.19). The risk of hypothyroidism in the cohort treated with radiotherapy of the regional lymph nodes was present irrespective of the use of adjuvant chemotherapy treatment.

CONCLUSIONS: Based on the results of our study, the implementation of hypothyroidism surveillance among the breast cancer survivors treated with radiotherapy of the regional lymph nodes can be considered as reasonable in the follow-up program.

Place, publisher, year, edition, pages
Kluwer Academic Publishers, 2024
Keywords
Breast cancer, Chemotherapy, Endocrine therapy, Hypothyroidism, Population-based, Radiation therapy
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-110082 (URN)10.1007/s10549-023-07184-8 (DOI)38057688 (PubMedID)2-s2.0-85178910535 (Scopus ID)
Funder
Uppsala University
Available from: 2023-12-07 Created: 2023-12-07 Last updated: 2024-01-29Bibliographically approved
Schiza, A., Fredriksson, I., Sund, M. & Valachis, A. (2024). Treatment utilization and effectiveness of neoadjuvant chemotherapy comparing men and women diagnosed with breast cancer: a Swedish retrospective cohort study. Breast Cancer Research and Treatment, 203, 235-243
Open this publication in new window or tab >>Treatment utilization and effectiveness of neoadjuvant chemotherapy comparing men and women diagnosed with breast cancer: a Swedish retrospective cohort study
2024 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 203, p. 235-243Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Evidence supporting the use of neoadjuvant chemotherapy (NAC) in early breast cancer is based on studies mainly including women, whereas the utilization and effectiveness of NAC in men is less studied. The present study aimed to investigate the utilization and effectiveness of NAC in men and women with early breast cancer.

METHODS: Eligible patients were identified through the Swedish National Breast Cancer Quality Register, that includes all newly diagnosed breast cancer cases in Sweden from 2008 and onwards. For the treatment utilization analysis, all patients with stage I-III between 2008 and 2020 were included (n = 82,888), whereas for the effectiveness analysis the cohort was restricted to patients receiving NAC (n = 6487). For both analyses, multivariate logistic regression models were applied to investigate potential sex disparities in NAC utilization and effectiveness, adjusted for patient- and tumor characteristics.

RESULTS: In the NAC utilization analysis, 487 men and 82,401 women with stage I-III were included. No statistically significant difference between sexes in terms of NAC utilization was observed (adjusted Odds Ratio (adjOR): 1.135; 95% Confidence Interval (CI) 0.606-2.128) with an overall utilization rate of 4.9% in men compared to 7.8% in women. Among the 24 men and 6463 women who received NAC, the pathologic complete response (pCR) rates were 16.7% and 21.2%, respectively (adjOR: 1.141; 95% CI 0.141-9.238).

CONCLUSION: The present study did not find any sex disparities in NAC utilization or effectiveness in terms of pCR. This supports the current recommendations of treating men with breast cancer with the same indications for NAC as women.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2024
Keywords
Early breast cancer, Effectiveness of neoadjuvant chemotherapy, Men, Neoadjuvant chemotherapy, Pathologic complete response, Utilization of neoadjuvant chemotherapy
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-108883 (URN)10.1007/s10549-023-07129-1 (DOI)001079606100001 ()37812362 (PubMedID)2-s2.0-85173951164 (Scopus ID)
Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2024-01-29Bibliographically approved
Ohlsson-Nevo, E., Arvidsson Lindvall, M., Hellerstedt Börjesson, S., Hagberg, L., Hultgren Hörnquist, E., Valachis, A., . . . Duberg, A. (2023). A Digitally Distributed Yoga Intervention in Breast Cancer Rehabilitation (DigiYogaCaRe): Protocol for a Randomized Controlled Trial. In: : . Paper presented at Nordic Conference in Nursing Research, Reykjavik, Iceland, 2-4 October, 2023.
Open this publication in new window or tab >>A Digitally Distributed Yoga Intervention in Breast Cancer Rehabilitation (DigiYogaCaRe): Protocol for a Randomized Controlled Trial
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2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Nursing Physiotherapy Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-109650 (URN)
Conference
Nordic Conference in Nursing Research, Reykjavik, Iceland, 2-4 October, 2023
Available from: 2023-11-09 Created: 2023-11-09 Last updated: 2024-01-02Bibliographically approved
Pellat, A., Grinda, T., Prelaj, A., Cresta, P., Valachis, A., Zerdes, I., . . . Koopman, M. (2023). Comprehensive mapping review of real-world evidence publications focusing on targeted therapies in solid tumors: A collaborative work from ESMO real-world data and Digital Health Working Group. Paper presented at Annual Meeting of the European-Society-for-Medical-Oncology (ESMO), Barcelona, Spain, October 20-24, 2023. Annals of Oncology, 34(Suppl. 2), S925-S925, Article ID 16890.
Open this publication in new window or tab >>Comprehensive mapping review of real-world evidence publications focusing on targeted therapies in solid tumors: A collaborative work from ESMO real-world data and Digital Health Working Group
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2023 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 34, no Suppl. 2, p. S925-S925, article id 16890Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: A growing body of real-world evidence (RWE) aims to better reflect outcomes of cancer patients treated in real-world settings. We aimed to conduct a first comprehensive mapping review of the RWE produced over the past 3 years in terms of tumor type, treatment strategies, setting, and data sources, focusing on targeted therapies (TT) in solid tumors.

Methods: We conducted a systematic review in PubMed of RWE studies published between 01/2020 and 12/2022. We identified non-interventional studies using observational data, focusing on solid tumors exposure to targeted therapies, excluding immunotherapies. Abstract and full-text screening were performed by 11 independent reviewers.

Results: A total of 7,774 publications were retrieved with 1,251 considered eligible and extracted. The number of publications per year progressively increased during this period (328 in 2020; 421 in 2021; 502 in 2022). Most studies (50%) were performed in Asia, followed by Europe (25%) and North America (17%). Only 8% of studies had patients treated in more than one country. Treatment effectiveness and safety were assessed in 71% and 42% of studies respectively. Main data sources were medical records.

Conclusions: RWE publications on TT for solid tumors are heterogeneous and mostly rely on retrospective data such as medical records. Population-based and international studies are rare. Collaborative efforts towards international representativeness and the use of routinely collected and/or standardized data sources must be encouraged to increase the relevance and future quality of publications and their potential impact on oncology practice.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-110156 (URN)10.1016/j.annonc.2023.09.2643 (DOI)001087480202359 ()
Conference
Annual Meeting of the European-Society-for-Medical-Oncology (ESMO), Barcelona, Spain, October 20-24, 2023
Available from: 2023-12-11 Created: 2023-12-11 Last updated: 2023-12-11Bibliographically approved
Schiza, A., Fredriksson, I., Sund, M. & Valachis, A. (2023). De Novo metastatic breast cancer in males versus females: a Swedish, population-based cohort study. JNCI cancer spectrum, 7(4), Article ID pkad050.
Open this publication in new window or tab >>De Novo metastatic breast cancer in males versus females: a Swedish, population-based cohort study
2023 (English)In: JNCI cancer spectrum, E-ISSN 2515-5091, Vol. 7, no 4, article id pkad050Article in journal (Refereed) Published
Abstract [en]

Current evidence on de novo metastatic breast cancer (dnMBC) is based on data from women. This Swedish, population-based cohort study compared the incidence over time and prognosis of dnMBC between sexes using data from the National Quality register for Breast Cancer. Joinpoint regression analysis was used to compare incidence trends in all stages (104,733 women, 648 men) and multivariate Cox regression analysis to investigate potential sex disparities in dnMBC prognosis (6005 women, 41 men). For both sexes, increased trends were evident for stages I-II with a stabilizing trend at the later years for women while stage III incidence remained stable. An increased trend for dnMBC in women, and to less extent in men, was observed. No difference in dnMBC overall survival between sexes was observed (HR : 1.24; 95% CI : 0.85-1.81). The comparable features in terms of incidence and prognosis of dnMBC between sexes imply similarities supporting the adoption of common treatment strategies.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-107481 (URN)10.1093/jncics/pkad050 (DOI)001053100300001 ()37490458 (PubMedID)2-s2.0-85169931765 (Scopus ID)
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2023-12-08Bibliographically approved
Rosin, J., Svegrup, E., Valachis, A. & Zerdes, I. (2023). Discordance of PIK3CA mutational status between primary and metastatic breast cancer: a systematic review and meta-analysis. Breast Cancer Research and Treatment, 201(2), 161-169
Open this publication in new window or tab >>Discordance of PIK3CA mutational status between primary and metastatic breast cancer: a systematic review and meta-analysis
2023 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 201, no 2, p. 161-169Article, review/survey (Refereed) Published
Abstract [en]

INTRODUCTION: In light of the clinically meaningful results of the PI3K inhibitors in PIK3CA-mutated metastatic breast cancer (BC) patients, the reliable identification of PIK3CA mutations is of outmost importance. However, lack of evidence on the optimal site and timing of assessment, presence of temporal heterogeneity and analytical factors pose several challenges in clinical routine. We aimed to study the discordance rates of PIK3CA mutational status between primary and matched metastatic tumors.

METHODS: A systematic literature search was performed in three different databases (Embase, Pubmed, Web of Science) and-upon screening-a total of 25 studies reporting PIK3CA mutational status both on primary breast tumors and their matched metastases were included in this meta-analysis. The random-effects model was used for pooled analyses of discordance of PIK3CA mutational status.

RESULTS: The overall discordance rate of PIK3CA mutational status was 9.8% (95% CI, 7.0-13.0; n = 1425) and did not significantly differ within BC subtypes or metastatic sites. The change was bi-directional, more commonly observed from PIK3CA mutated to wild-type status (14.9%, 95% CI 11.8-18.2; n tumor pairs = 453) rather than the opposite direction (8.9%, 95% CI 6.1-12.1; n tumor pairs = 943).

CONCLUSIONS: Our results indicate the need of obtaining metastatic biopsies for PIK3CA-mutation analysis and the possibility of testing of the primary tumor, in case a re-biopsy deemed non-feasible.

Place, publisher, year, edition, pages
Kluwer Academic Publishers, 2023
Keywords
Breast cancer, Metastasis, Mutation, PIK3CA, Primary
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-106755 (URN)10.1007/s10549-023-07010-1 (DOI)001020148100001 ()37392328 (PubMedID)2-s2.0-85163781575 (Scopus ID)
Funder
Region Stockholm, FoUI-977295Iris, Stig och Gerry Castenbäcks Stiftelse för Cancerforskning
Note

Funding agency:

Swedish Society of Oncology postdoctoral grant

Available from: 2023-07-03 Created: 2023-07-03 Last updated: 2023-08-01Bibliographically approved
Castelo-Branco, L., Pellat, A., Martins-Branco, D., Valachis, A., Derksen, J. W., Suijkerbuijk, K. P., . . . Koopman, M. (2023). ESMO Guidance for Reporting Oncology real-World evidence (GROW). Annals of Oncology, 34(12), 1097-1112
Open this publication in new window or tab >>ESMO Guidance for Reporting Oncology real-World evidence (GROW)
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2023 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 34, no 12, p. 1097-1112Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Kluwer Academic Publishers, 2023
Keywords
ESMO-GROW, guidance, observational studies, oncology, real-world data, real-world evidence
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-109047 (URN)10.1016/j.annonc.2023.10.001 (DOI)001154463200001 ()37848160 (PubMedID)2-s2.0-85178337859 (Scopus ID)
Available from: 2023-10-18 Created: 2023-10-18 Last updated: 2024-02-14Bibliographically approved
Sund, M., Garmo, H., Andersson, A., Margolin, S., Ahlgren, J. & Valachis, A. (2023). Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk. Breast Cancer Research and Treatment, 198(2), 361-368
Open this publication in new window or tab >>Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk
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2023 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 198, no 2, p. 361-368Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The safety of local estrogen therapy in patients on adjuvant endocrine treatment is questioned, but evidence on the issue is scarce. This nested case-control registry-based study aimed to investigate whether estrogen therapy affects breast cancer mortality risk in women on adjuvant endocrine treatment.

METHODS: In a cohort of 15,198 women diagnosed with early hormone receptor (HR)-positive breast cancer and adjuvant endocrine treatment, 1262 women died due to breast cancer and were identified as cases. Each case was matched with 10 controls. Exposure to estrogen therapy with concurrent use of aromatase inhibitors (AIs), tamoxifen, or both sequentially, was compared between cases and controls.

RESULTS: No statistically significant difference in breast cancer mortality risk was seen in patients with exposure to estrogen therapy concurrent to endocrine treatment, neither in short-term or in long-term estrogen therapy use.

CONCLUSIONS: The study strengthens current evidence on local estrogen therapy use in breast cancer survivors, showing no increased risk for breast cancer mortality in patients on adjuvant AIs or tamoxifen.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Breast cancer, Endocrine therapy, Estrogen therapy, Survivors
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-104140 (URN)10.1007/s10549-023-06871-w (DOI)000932729800001 ()36773184 (PubMedID)2-s2.0-85147831911 (Scopus ID)
Funder
Örebro University
Note

Funding agency:

Bröstcancerförbundet and ALF Funding Region Örebro County

Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2023-05-19Bibliographically approved
Pantiora, E., Tasoulis, M. K., Valachis, A., Eriksson, S., Kühn, T., Karakatsanis, A. & Rubio, I. T. (2023). Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis. British Journal of Surgery, 110(4), 410-419
Open this publication in new window or tab >>Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis
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2023 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 110, no 4, p. 410-419Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Superparamagnetic iron oxide nanoparticles (SPIO) have been used as a tracer for sentinel lymph node (SLN) localization in breast cancer, demonstrating comparable performance to the combination of radioisotope (RI) and blue dye (BD).

METHODS: A systematic literature search and meta-analysis with subgroup and meta-regression analysis were undertaken to update the available evidence, assess technique evolution, and define knowledge gaps. Recommendations were made using the GRADE approach.

RESULTS: In 20 comparative studies, the detection rate was 97.5 per cent for SPIO and 96.5 per cent for RI ± BD (risk ratio 1.006, 95 per cent c.i. 0.992 to 1.019; P = 0.376, high-certainty evidence). Neoadjuvant therapy, injection site, injection volume or nodal metastasis burden did not affect the detection rate, but injection over 24 h before surgery increased the detection rate on meta-regression. Concordance was 99.0 per cent and reverse concordance 97.1 per cent (rate difference 0.003, 95 per cent c.i. -0.009 to 0.015; P = 0.656, high-certainty evidence). Use of SPIO led to retrieval of slightly more SLNs (pooled mean 1.96 versus 1.89) with a higher nodal detection rate (94.1 versus 83.5 per cent; RR 1.098, 1.058 to 1.140; P < 0.001; low-certainty evidence). In meta-regression, injection over 24 h before surgery increased the SPIO nodal yield over that of RI ± BD. The skin-staining rate was 30.8 per cent (very low-certainty evidence), and possibly prevented with use of smaller doses and peritumoral injection.

CONCLUSION: The performance of SPIO is comparable to that of RI ± BD. Preoperative injection increases the detection rate and nodal yield, without affecting concordance. Whether skin staining and MRI artefacts are reduced by lower dose and peritumoral injection needs to be investigated.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-103134 (URN)10.1093/bjs/znac426 (DOI)000901386400001 ()36560842 (PubMedID)2-s2.0-85151573684 (Scopus ID)
Available from: 2023-01-16 Created: 2023-01-16 Last updated: 2023-07-04Bibliographically approved
Wickberg, Å., Prag, C., Valachis, A., Karlsson, L. & Johansson, B. (2023). Intraoperative Radiation Therapy Delivered by Brachytherapy in Breast Cancer: An Interim Analysis of a Phase 2 Trial. Clinical Breast Cancer
Open this publication in new window or tab >>Intraoperative Radiation Therapy Delivered by Brachytherapy in Breast Cancer: An Interim Analysis of a Phase 2 Trial
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2023 (English)In: Clinical Breast Cancer, ISSN 1526-8209, E-ISSN 1938-0666Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Intraoperative breast cancer radiotherapy (IORT) offers an alternative to external beam radiotherapy (EBRT) after breast-conserving surgery (BCS). The Intraoperative brachytherapy (IOBT) trial applies high dose rate (HDR) brachytherapy with a new applicator prototype as IORT after BCS. In this interim analysis of the IOBT trial, we present the oncological safety and toxicity of the method.

METHODS: Eligible patients were women, ≥ 50 years old with an unifocal nonlobular, estrogen-receptor-positive, HER2-negative breast cancer, cN0, ≤ 3 cm, treated with BCS and sentinel node biopsy (SNB). Toxicity was registered according to the LENT-SOMA scale. Cumulative incidence of local (LR) and regional recurrence (RR) were calculated through cumulative incidence function whereas overall survival (OS) was illustrated through Kaplan-Meier curve.

RESULTS: Until February 2023, 155 women (median age 68 years) were included in the trial. Twenty-nine women (18.7%) received supplemental EBRT, mostly due to positive SNB. Three-year cumulative incidence of LR and RR were 1.0% (CI 95 % 0.1%-2.3%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five- year cumulative incidence of LR and RR were 3.9% (CI 95% 1.8%-6.4%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five-year OS was 96.3% (CI 95% 93.6%-98.4%). Side effects were limited, low grade, and transient.

CONCLUSION: Acknowledging the short median follow-up time at interim analysis, our initial results indicate that delivering IORT through HDR brachytherapy in carefully selected breast cancer patients is feasible and oncological safe so far. A long-term follow-up is essential to confirm the initial results.

Place, publisher, year, edition, pages
CIG Media Group, LP, 2023
Keywords
Breast-conserving surgery, Endocrine therapy, Intraoperative brachytherapy, Local recurrence, Partial breast irradiation
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-110611 (URN)10.1016/j.clbc.2023.12.006 (DOI)38185607 (PubMedID)2-s2.0-85181841972 (Scopus ID)
Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-02-05Bibliographically approved
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