Isolated thoracic perfusion in lung metastases from breast cancer: a retrospective observational study
- 34 Downloads
The median overall survival of metastatic breast cancer (MBC) patients is still approximately 2 years. This is even lower in triple-negative breast cancer (TNBC) patients with concomitant lung metastases. These patients are often not suitable for surgery and not responsive to systemic chemotherapy. Isolated thoracic perfusion (ITP) followed by chemofiltration has been used for palliation in selected specialised centres. A retrospective observational study evaluating 162 MBC patients who underwent 407 ITP procedures was performed. The primary objective was the evaluation of the feasibility, safety, tolerability and efficacy of ITP in the complete cohort of 162 patients with LM from breast cancer. The secondary objective of the study was the evaluation of responses and median survivals in 43 TNBC patients with LM. In the 162 patients, ITP appeared safe and well tolerated with MST from LM diagnosis to death or last contact of 19.5 months. In the subgroup of patients treated with systemic chemotherapy followed by ITP at progression, the MST from LM diagnosis to death or last contact was 29 months. In the subgroup of TNBC patients treated with systemic chemotherapy followed by ITP at progression, the MST from LM diagnosis to death or last contact was 19 months (ITP overall response rate was 65.52%). ITP followed by chemofiltration could be adopted in the sequential palliation treatments of BC patients with LM in progression after systemic chemotherapy, especially with TNBC. The present data allow interesting considerations about tolerability and responses, but do not allow robust conclusions about survival.
KeywordsBreast cancer Lung metastases Triple-negative status Isolated thoracic perfusion
We would like to thank Giancarlo Palumbo (University of L’Aquila, Italy) for pharmacokinetic analyses, Kornelia Aigner (Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany) and Gianni Lazzarin (University of L’Aquila, Italy) for data collection, Lucio Fumi (Wyfold Medical Consultancy, Oxford, UK) for English editing, and Società Italiana di Terapie Integrate Locoregionali in Oncologia (SITILO) for scientific support.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
Research involving human participants and/or animals
This retrospective observational study had been conducted in accordance with the ethical standards of the Committee on Human Experimentation, after approval of the Ethics Committee in L’Aquila (n.10/CE/2018), and according to all rules for good clinical practice included in the Declaration of Helsinki.
Informed consent was obtained from all individual participants included in this study.
- 7.Aigner KR, Guadagni S, Zavattieri G (2016) Regional chemotherapy for thoracic wall recurrence and metastasized breast cancer. In: Aigner KR, Stephens FO (eds) Induction chemotherapy. Systemic and locoregional. Springer-Verlag, Berlin, pp 173–186Google Scholar
- 8.Guadagni S, Clementi M, Valenti M et al (2006) Thoracic stop-flow perfusion in the treatment of refractory malignant pleural mesothelioma: a phase I-II evaluation/trial. In Vivo 20:715–718Google Scholar
- 11.Ruscitti C, Guadagni S, Russo F et al (2009) Thoracic stopflow perfusion for refractory lymphoma: a phase I-II evaluation trial. In Vivo 23:447–458Google Scholar
- 15.Guadagni S, Fiorentini G, Clementi M, Palumbo P, Mambrini A, Masedu F (2017) Mitomycin C hypoxic pelvic perfusion for unresectable recurrent rectal cancer: pharmacokinetic comparison of surgical and percutaneous techniques. Updates Surg 69:403–410. https://doi.org/10.1007/s13304-017-0480-6 CrossRefGoogle Scholar
- 19.Rugo HS, Barry WT, Moreno-Aspitia A et al (2015) Randomized phase III study of paclitaxel once per week compared with nanoparticle albumin-bound Nab-paclitaxel once per week or ixabepilone with bevacizumab as first-line chemotherapy for locally recurrent or metastatic breast cancer: CALGB 40502/NCCTG N063H (alliance). J Clin Oncol 33:2361–2369CrossRefGoogle Scholar
- 22.Wahba HA, El-Hadaad HA (2015) Current approaches in treatment of triple-negative breast cancer. Cancer Biol Med 12:106–116Google Scholar
- 23.Tutt A, Ellis P, Kilburn L, et al (2015) The TNT trial: A randomized phase III trial of carboplatin © compared with docetaxel (D) for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012) [abstract]. In: Proceedings of the thirty-seventh annual CTRC-AACR San Antonio breast cancer symposium: 2014 Dec 9–13; San Antonio, TX. Philadelphia (PA): AACR. Cancer Res 75 (9 Suppl): Abstract nr S3-01Google Scholar
- 24.Fiorentini G, Poddie DB, Cantore M et al (2004) Hepatic intra-arterial chemotherapy (HIAC) of high dose mitomycin and epirubicin combined with caval chemofiltration versus prolonged low doses in liver metastases from colorectal cancer: a prospective randomised study. J Chemother 16:51–54CrossRefGoogle Scholar