Author
Leticia Varella
Other affiliations: National Foundation for Cancer Research, Cornell University
Bio: Leticia Varella is an academic researcher from Cleveland Clinic. The author has contributed to research in topics: Breast cancer & Metastatic breast cancer. The author has an hindex of 6, co-authored 12 publications receiving 414 citations. Previous affiliations of Leticia Varella include National Foundation for Cancer Research & Cornell University.
Topics: Breast cancer, Metastatic breast cancer, Palbociclib, Medicine, Cancer
Papers
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Stanford University1, Intermountain Healthcare2, The Royal Marsden NHS Foundation Trust3, American Society of Clinical Oncology4, University of North Carolina at Chapel Hill5, St. Jude Medical Center6, University of Michigan7, University of Queensland8, University of Texas MD Anderson Cancer Center9, Harvard University10, Yale Cancer Center11, University of Saskatchewan12, Saskatchewan Health13, Cornell University14, European Institute of Oncology15, University of Milan16, Johns Hopkins University17
TL;DR: The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose.
Abstract: PURPOSETo update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen (ER) and progesterone receptor (PgR) testing in breast cancer guideline.M...
510 citations
Stanford University1, Intermountain Healthcare2, The Royal Marsden NHS Foundation Trust3, American Society of Clinical Oncology4, University of North Carolina at Chapel Hill5, St. Jude Medical Center6, University of Michigan7, University of Queensland8, University of Texas MD Anderson Cancer Center9, Harvard University10, Yale Cancer Center11, University of Saskatchewan12, Saskatchewan Health13, Cornell University14, European Institute of Oncology15, University of Milan16, Johns Hopkins University17
TL;DR: The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose.
Abstract: Purpose.— To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer...
175 citations
TL;DR: In a cohort of select patients with a limited tumor burden after treatment with targeted agents consolidative metastasectomy is feasible with acceptable morbidity and significant time off targeted therapy and long-term tumor-free status are possible with this approach.
105 citations
TL;DR: Among patients with HR-positive advanced breast cancer, the estimated PFS in patients treated with fulvestrant and palbociclib was comparable to a previously reported phase 3 trial, but the median PFS was shorter than previously reported data from phase 2 and 3 trials.
Abstract: Real-world data are critical to demonstrate the reproducibility of evidence and external generalizability of randomized clinical trials. Palbociclib is an oral small-molecule inhibitor of cyclin-dependent kinases 4 and 6 that has been shown to improve progression-free survival (PFS) when combined with letrozole or fulvestrant in phase 3 clinical trials. We evaluated real-world outcomes in metastatic breast cancer patients who received palbociclib in combination with endocrine therapy in routine clinical practice. Records of patients with advanced hormone receptor (HR)-positive breast cancer treated with palbociclib at the Cleveland Clinic health system from February, 2015 to December, 2017 were retrospectively reviewed. The primary end point was PFS. In this cohort, 411 women were included. The median age and follow-up times were 53.5 years and 10.2 months, respectively. The median PFS for palbociclib plus letrozole was 15.1 months for patients treated in first line, 10.5 months in second line, and 4.2 months in third line and beyond. For patients who received fulvestrant plus palbociclib, the median PFS in first, second, and third line and beyond were 11.6, 12.3, and 6.4 months, respectively. The most common adverse events were hematologic, with grade 3–4 neutropenia occurring in 58% of patients. Thirty-one (8%) patients permanently discontinued palbociclib due to adverse events. Among patients with HR-positive advanced breast cancer, the estimated PFS in patients treated with fulvestrant and palbociclib was comparable to a previously reported phase 3 trial. However, the median PFS with letrozole and palbociclib was shorter than previously reported data from phase 2 and 3 trials. Palbociclib toxicity was very manageable, with a low drug discontinuation rate.
43 citations
TL;DR: Clinical studies conducted to investigate the role of bevacizumab in the management of breast cancer, both in the early stage and in the metastatic disease settings are summarized.
16 citations
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TL;DR: RCC appears to be more common in patients with obesity, end-stage renal failure, acquired renal cystic disease and tuber-ous sclerosis, and severalautosomal dominant syndromes are described, each with a dis-tinct genetic basis and phenotype.
1,795 citations
Johns Hopkins University1, University of Utah2, Stanford University3, American Society of Clinical Oncology4, Ontario Institute for Cancer Research5, University of Sydney6, University of Nottingham7, St. Jude Medical Center8, University of Toronto9, Mayo Clinic10, University of Southern California11, Indiana University12, National Institutes of Health13, The Royal Marsden NHS Foundation Trust14
TL;DR: In this article, the authors updated key recommendations of the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) human epidermal growth factor receptor 2 (HER2) testing in breast cancer.
Abstract: Purpose.— To update key recommendations of the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) human epidermal growth factor receptor 2 (HER2) testing in breast ...
652 citations
TL;DR: The content featured in this issue focuses on the recommendations for overall management of ductal carcinoma in situ and the workup and locoregional management of early stage invasive breast cancer.
Abstract: The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied. These NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of ductal carcinoma in situ and the workup and locoregional management of early stage invasive breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.
187 citations
01 Nov 2015
TL;DR: Among patients with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who met established guidelines for the recommendation of adjuvant chemotherapy on the basis of clinicopathologic features, those with tumors that had a favorable gene-expression profile had very low rates of recurrence at 5 years with endocrine therapy alone.
Abstract: BACKGROUND
Prior studies with the use of a prospective-retrospective design including archival tumor samples have shown that gene-expression assays provide clinically useful prognostic information. However, a prospectively conducted study in a uniformly treated population provides the highest level of evidence supporting the clinical validity and usefulness of a biomarker.
METHODS
We performed a prospective trial involving women with hormone-receptor-positive, human epidermal growth factor receptor type 2 (HER2)-negative, axillary node-negative breast cancer with tumors of 1.1 to 5.0 cm in the greatest dimension (or 0.6 to 1.0 cm in the greatest dimension and intermediate or high tumor grade) who met established guidelines for the consideration of adjuvant chemotherapy on the basis of clinicopathologic features. A reverse-transcriptase-polymerase-chain-reaction assay of 21 genes was performed on the paraffin-embedded tumor tissue, and the results were used to calculate a score indicating the risk of breast-cancer recurrence; patients were assigned to receive endocrine therapy without chemotherapy if they had a recurrence score of 0 to 10, indicating a very low risk of recurrence (on a scale of 0 to 100, with higher scores indicating a greater risk of recurrence).
RESULTS
Of the 10,253 eligible women enrolled, 1626 women (15.9%) who had a recurrence score of 0 to 10 were assigned to receive endocrine therapy alone without chemotherapy. At 5 years, in this patient population, the rate of invasive disease-free survival was 93.8% (95% confidence interval [CI], 92.4 to 94.9), the rate of freedom from recurrence of breast cancer at a distant site was 99.3% (95% CI, 98.7 to 99.6), the rate of freedom from recurrence of breast cancer at a distant or local-regional site was 98.7% (95% CI, 97.9 to 99.2), and the rate of overall survival was 98.0% (95% CI, 97.1 to 98.6).
CONCLUSIONS
Among patients with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who met established guidelines for the recommendation of adjuvant chemotherapy on the basis of clinicopathologic features, those with tumors that had a favorable gene-expression profile had very low rates of recurrence at 5 years with endocrine therapy alone. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00310180.).
158 citations
TL;DR: Clinical trials in the management of TNBC are discussed as well as perspectives for potential future treatments and various new agents and combination strategies have been explored.
Abstract: Triple‑negative breast cancer (TNBC) accounts for 10‑15% of all breast cancer cases. TNBCs lack estrogen and progesterone receptors and express low levels of HER2, and therefore do not respond to hormonal or anti‑HER2 therapies. TNBC is a particularly aggressive form of breast cancer that generally displays poorer prognosis compared to other breast cancer subtypes. TNBC is chemotherapy sensitive, and this treatment remains the standard of care despite its limited benefit. Recent advances with novel agents have been made for specific subgroups with PD‑L1+ tumors or germline Brca‑mutated tumors. However, only a fraction of these patients responds to immune checkpoint or PARP inhibitors and even those who do respond often develop resistance and relapse. Various new agents and combination strategies have been explored to further understand molecular and immunological aspects of TNBC. In this review, we discuss clinical trials in the management of TNBC as well as perspectives for potential future treatments.
134 citations