The Survival of Patients with Triple Negative Breast Cancer Undergoing Chemotherapy Along with Lifestyle Change Interventions Survival of TNBC patients
Main Article Content
Triple negative breast cancer, Current chemotherapy, Physical exercise, Diet and lifestyle change
Background: The survival of patients with triple-negative breast cancer subtype undergoing chemotherapy along with weight management, physical activity, and diet was examined. In addition, the relationship between the Overall Survival (OS) of patients with expression P53 and Ki 67 was investigated.
Methods: The study was conducted on 110 patients admitted to oncology clinics between October 2009 and July 2018. The patients underwent five chemotherapy cycles, including Docetaxel, Epirubicin, and Cyclophosphamide once every 21 days followed by two cycles of Epirubicin, Cyclophosphamide, and 5-Fluorouracil. The patients also received guidelines for physical exercise, diet, and lifestyle change.
Results: The median and mean follow-ups were 52.3 and 45.6 months respectively. Eight patients were metastatic and 103 were under adjuvant therapy, 13 of whom had relapses. The median relapse-free survival and mean OS were 44.4 months and 49.2 months respectively. OS for P53-negative patients was 64.2 months, eight patients relapsed in the P53-positive group, and two relapsed in the P53-negative group. Survival was more favorable in the negative group (P=0.021). The mean DFS in the P53- negative group was 96.1% and 76.3% in the P53-positive group, suggesting a more favorable status in the P53-negative group. Out of 110 patients, 20 died and 90 are still alive.
Conclusion: Combining physical exercise, diet, and lifestyle change with chemotherapy increases the chance of a better response to treatment and a reduction in the rate of relapse during the first three years. The survival rate was better in p53-negative patients.
2. Martin J Larsen, Mads Thomassen, Anne-Marie Gerdes, and Torben A Kruse. Hereditary Breast Cancer: Clinical, Pathological and Molecular Characteristics. Breast Cancer (Auckl). 2014; 8: 145–155. doi: 10.4137/BCBCR.S18715.
3. Eunjung Lee, Roberta McKean-Cowdin, Huiyan Ma, Darcy V. Spicer, David Van Den Berg, Leslie Bernstein and et all. Characteristics of Triple-Negative Breast Cancer in Patients With a BRCA1 Mutation: Results From a Population-Based Study of Young Women. J Clin Oncol. 2011; 29 : 4373–4380. doi: 10.1200/JCO.2010.33.6446.
4. Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al: Triple-negative breast cancer: Clinical features and patterns of recurrence. Clin Cancer Res. 2007; 13:4429-34. doi: 10.1158/1078-0432.CCR-06-3045.
5. Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, et al: The triple negative paradox: Primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 2007, 13:2329-2334. doi: 10.1158/1078-0432.CCR-06-1109.
6. Boyle P: Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol 2012, 23:vi7-vi12. doi: 10.1093/annonc/mds187.
7. Jennifer A. Ligibel, Karen Basen-Engquist, and Jennifer W. Bea. Weight Management and Physical Activity for Breast Cancer Prevention and Control.10.1200/EDBK-237423. American Society of Clinical Oncology Book 39(May 17, 2019) e22-e33. doi: 10.1200/EDBK_237423.
8. Judith Hugh, John Hanson, Maggie Chon U. Cheang, Torsten O. Nielsen, Charles M. Perou, Charles Dumontet, et al. Breast cancer subtypes and response to docetaxel in node-positive breast cancer: Use of an immunohistochemical definition in the BCIRG 001 trial. J Clin Oncol. 2009;27:1168–1176. doi: 10.1200/JCO.2008.18.1024.
9. Katarzyna Pogoda, Anna Niwińska, Magdalena Murawska, and Tadeusz Pieńkowski. Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol. 2013; 30: 388. doi: 10.1007/s12032-012-0388-4.
10. Jones RL, Salter J, A'Hern R, Nerurkar A, Parton M and et al. The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer. Breast Cancer Res Treat. 2009; 116:53-68. doi: 10.1007/s10549-008-0081-7.
11. Rakha EA, El-Sayed ME, Green AR, Lee AH, Robertson JFand, et al. Prognostic markers in triple-negative breast cancer. Cancer. 2007; 109:25-32. doi: 10.1002/cncr.22381.
12. Jung SY, Han W, Lee JW, Ko E, Kim E, et all. Ki-67 expression gives additional prognostic information on St. Gallen 2007 and Adjuvant! Online risk categories in early breast cancer. Ann Surg Oncol. 2009; 16:1112-21. doi: 10.1245/s10434-009-0334-7.
13. Bhumsuk Keam, Seock-Ah Im, Kyung-Hun Lee, Sae-Won Han, Do-Youn Oh, Jee Hyun Kim and et all. Ki-67 can be used for further classification of triple-negative breast cancer into two subtypes with different responses and prognoses. Breast Cancer Res. 2011; 13: R22. doi: 10.1186/bcr2834.
14. Ping-Ping Bao, Gen-Ming Zhao, Xiao-Ou Shu, Peng Peng, Hui Cai, Wei Lu and et all. Modifiable lifestyle factors and triple-negative breast cancer survival: a population-based prospective study. Epidemiology. 2015; 26: 909–916. doi: 10.1097/EDE.0000000000000373.
15. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:242-274. doi: 10.3322/caac.21142.
16. Denlinger CS, Ligibel JA, Are M, Baker KS, Broderick G, Demark-Wahnefried W, et al. NCCN Guidelines insights: survivorship, version 1.2016. J Natl Compr Canc Netw. 2016;14:715-724. doi: 10.6004/jnccn.2016.0073.
17. Blanchard CM, Courneya KS, Stein K; American Cancer Society’s SCS-II. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008;26:2198-2204. doi: 10.1200/JCO.2007.14.6217.
18. Chan DSM, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25:1901-1914. doi: 10.1093/annonc/mdu042.
19. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010; 123:627-635. doi: 10.1007/s10549-010-0990-0.
20. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30-67. doi: 10.3322/caac.20140.
21. Chlebowski RT, Luo J, Anderson GL, Barrington W, Reding K, Simon MS, et al. Weight loss and breast cancer incidence in postmenopausal women. Cancer. 2019;125:205-212. doi: 10.1002/cncr.31687.
22. Janni W, Rack BK, Friedl TW, Müller V, Lorenz R, Rezai M, et al. Lifestyle intervention and effect on disease-free survival in early breast cancer pts: interim analysis from the randomized SUCCESS C study. Cancer Res.2019;79 (suppl; Abstr GS5-03). doi: 10.1158/1538-7445.SABCS18-GS5-03
23. Hildebrand JS, Gapstur SM, Campbell PT, Gaudet MM, Patel AV.Recreational physical activity and leisure-time sitting about postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev. 2013;22:1906-1912. doi: 10.1158/1055-9965.EPI-13-0407.
24. Cava, Edda, Paolo Marzullo, Deborah Farinelli, Alessandra Gennari, Chiara Saggia, Sergio Riso, and Flavia Prodam. 2022. "Breast Cancer Diet “BCD”: A Review of Healthy Dietary Patterns to Prevent Breast Cancer Recurrence and Reduce Mortality" Nutrients 14, no. 3: 476. doi: 10.3390/nu14030476
25. Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol.2002;20:1128-1143. doi: 10.1200/JCO.2002.20.4.1128.
26. Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after a breast cancer diagnosis. J Clin Oncol. 2005 Mar 1; 23:1370-8. doi: 10.1200/JCO.2005.01.079.
27. Loi S, Milne RL, Friedlander ML, McCredie MR, Giles GG, Hopper JL, et al. Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev.2005;14:1686-1691.doi: 10.1158/1055-9965.EPI-05-0042.
28. Cleveland RJ, Eng SM, Abrahamson PE, Britton JA, Teitelbaum SL, et al. Weight gain before diagnosis and survival from breast cancer. Cancer Epidemiol Biomarkers Prev.2007; 16: 1803-1811. doi: 10.1158/1055-9965.EPI-06-0889.
29. Dawood S, Broglio K, Gonzalez-Angulo AM, Kau SW, Islam R, et al. Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res. 2008;14:1718-1725. doi: 10.1158/1078-0432.CCR-07-1479.
30. Rose DP, Vona-Davis L. Influence of obesity on breast cancer receptor status and prognosis. Expert Rev Anticancer Ther. 2009;9:1091-1101. doi: 10.1586/era.09.71.
31. Hatse S, Lambrechts D, Verstuyf A, Smeets A, Brouwers B, Vandorpe T, et al. Vitamin D status at breast cancer diagnosis: correlation with tumor characteristics, disease outcome, and genetic determinants of vitamin D insufficiency. Carcinogenesis. 2012 Jul;33(7):1319-26. doi: 10.1093/carcin/bgs187.
32. Nechuta S, Lu W, Chen Z, Zheng Y, Gu K, Cai H, Zheng W, Shu XO. Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):262-71. doi: 10.1158/1055-9965.EPI-10-1072.
33. Nechuta S, Lu W, Chen Z, Zheng Y, Gu K, Cai H, Zheng W, Shu XO. Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):262-71. doi: 10.1158/1055-9965.EPI-10-1072.
34. Lappe J, Watson P, Travers-Gustafson D, Recker R, Garland C, Gorham E, et al. Effect of vitamin D and calcium supplementation on cancer incidence in older women: a randomized clinical trial. JAMA. 2017;317:1234–1243. doi: 10.1001/jama.2017.2115
35. Ordóñez-Mena JM, Schöttker B, Fedirko V, Jenab M, Olsen A, Halkjær J, et al. Pre-diagnostic vitamin D concentrations and cancer risks in older individuals: an analysis of cohorts participating in the CHANCES consortium. Eur J Epidemiol. 2016 Mar;31(3):311-23. doi: 10.1007/s10654-015-0040-7.
36. Peng C, Luo WP, Zhang CX. Fruit and vegetable intake and breast cancer prognosis: a meta-analysis of prospective cohort studies. Br J Nutr. 2017 Mar;117(5):737-749. doi: 10.1017/S0007114517000423.
37. Vucenik I, Stains JP. Obesity and cancer risk: evidence, mechanisms, and recommendations. Ann N Y Acad Sci. 2012 Oct;1271(1):37-43. doi: 10.1111/j.1749-6632.2012.06750.x.
38. Iyengar NM, Brown KA, Zhou XK, Gucalp A, Subbaramaiah K, Giri DD, et al. Metabolic Obesity, Adipose Inflammation and Elevated Breast Aromatase in Women with Normal Body Mass Index. Cancer Prev Res (Phila). 2017 Apr;10(4):235-243. doi: 10.1158/1940-6207.CAPR-16-0314
39. Li JP, Zhang XM, Zhang Z, Zheng LH, Jindal S, Liu YJ. Association of p53 expression with poor prognosis in patients with triple-negative breast invasive ductal carcinoma. Medicine (Baltimore). 2019 May;98(18):e15449. doi: 10.1097/MD.0000000000015449.
Article Statistics :Views : 139 | Downloads : 92 : 17