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Palbociclib and beyond for the treatment of HR + HER2- metastatic breast cancer: an Asian-Pacific perspective and practical management guide on the use of CDK4/6 inhibitors

Dawood S, Chiu JW, Huang CS, Nag S, Sookprasert A, Yap YS, et al.

Curr Med Res Opin, 2020 08;36(8):1363-1373.
PMID: 32544344 DOI: 10.1080/03007995.2020.1783646

Breast cancer is the most frequent cancer amongst women worldwide including in Asia where the incidence rate is rapidly increasing. Even with treatment, around 30% of patients with early breast cancer progress to metastatic disease, with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) breast cancer the most common phenotype. First-line endocrine therapy targeting the estrogen receptor signaling pathway provides a median progression-free survival or time to progression of 6-15 months in HR + HER2- metastatic breast cancer. Recently, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, combined with endocrine therapy, have achieved more than two years median progression-free survival in HR + HER2- metastatic breast cancer. However, the characteristics of the Asian breast cancer population differ from those of Western populations and need to be considered when selecting a suitable treatment. Breast cancer is diagnosed at a younger age in Asian populations and late stage at presentation is generally more common in low-/middle-income countries than high-income countries. Consequently, the proportion of premenopausal women with metastatic breast cancer is higher in Asian compared with Western populations. While CDK4/6 inhibitors have been approved in the USA (FDA) since 2015, experience with them in Asia is more limited. We review the experience with the CDK4/6 inhibitor palbociclib in Asian patients with HR + HER2- metastatic breast cancer and provide guidance on the use of palbociclib in these patients.

Matched MeSH terms: Breast Neoplasms/drug therapy*; Breast Neoplasms/mortality; Breast Neoplasms/pathology
Fulltext Dietary Changes and Its Impact on Quality of Life among Malay Breast and Gynaecological Cancer Survivors in Malaysia

Zainordin NH, Abd Talib R, Shahril MR, Sulaiman S, A Karim N

Asian Pac J Cancer Prev, 2020 Dec 01;21(12):3689-3696.
PMID: 33369469 DOI: 10.31557/APJCP.2020.21.12.3689

OBJECTIVE: Fear of cancer recurrent, side effects of treatment and belief in food taboos encourage cancer survivors to make changes in their dietary practices after diagnosis of cancer. The objective of this study was to determine the impact of dietary changes on quality of life (QoL) among Malay breast and gynaecological cancer survivors.
METHODS: Questionnaire of dietary changes was modified from WHEL study and adapted to typical Malay's food intake in Malaysia. A total of 23 items were listed and categorized by types of food and cooking methods. Four categories of changes "increased", "decreased", "no changes" or "stopped" were used to determine the changes in dietary practices. Score one (+1) is given to positive changes by reference to WCRF/AICR and Malaysia Dietary Guideline healthy eating recommendations. Malay EORTC QLQ-C30 were used to determine the QoL. Sociodemographic, clinical characteristics and anthropometric measurement were also collected.
RESULTS: The mean age of the subjects (n=77) was 50.7±7.8 years old with duration of survivorship 4.0±3.1 years. Subjects mean BMI was 27.8±4.9 kg/m2 which indicate subjects were 31.2% overweight and 32.5% obese. The percentage score of positive dietary changes was 34.7±16.4%. Positive dietary changes were increased intake of green leafy vegetable (49.4%), cruciferous vegetable (46.8%) and boiling cooking methods (45.5%). Subjects reduced their intake of red meat (42.9%), sugar (53.2%) and fried cooking method (44.2%). Subjects stopped consuming milk (41.6%), c 2008-5862 heese (33.8%) and sweetened condensed milk (33.8%). With increasing positive dietary changes, there was a significant improvement on emotional function (rs=0.27; p=0.016) and reduced fatigue symptoms (rs=-0.24; p=0.033).
CONCLUSION: Positive changes in dietary intake improved emotional function and reduced fatigue symptoms after cancer treatment. By knowing the trend of food changes after cancer treatment, enables the formation of healthy food intervention implemented more effective.

Matched MeSH terms: Breast Neoplasms/diet therapy*; Breast Neoplasms/physiopathology; Breast Neoplasms/psychology
Fulltext Dietary and lifestyle changes of Malaysian breast cancer survivors: a qualitative study

Redhwan, A.A., Md Idris, M.N., Robert, C.

Malaysian Journal of Community Health, 2008;14(1):24-31.
MyJurnal

Objective :This study was performed to determine changes in diet and lifestyle among breast cancer survivors in Malaysia.
Methods :This was a qualitative study done on fifteen survivors (8 Malays and 7 non-Malays) obtained from the Oncology and Surgery Department, National University of Malaysia Hospital. The study was conducted using a semi-structured interview format. The data obtained were sorted into various categories via content analysis.
Results :Majority of breast cancer survivors increased their fruit and vegetable intake following diagnosis. Some non-Malays changed to vegetarian whereas all the Malays remained on the same dietary pattern. As far as exercise was concerned, all Malays did not exercise before diagnosis, but did so after diagnosis, whereas most of non- Malays did not exercise either before or after diagnosis.
Conclusion : Some changes were noticed in dietary and lifestyle behaviors after diagnosis among some survivors. The differences were due to their different cultural and religious backgrounds.

Matched MeSH terms: Breast Neoplasms
Fulltext Radiation induced sarcoma: a risk that is almost forgotten

Ruhi Fadzlyana, J., Nani Harlina, M.L., Saladina Jaszle, J., Rohaizak, M.

Journal of Surgical Academia, 2014;4(1):67-69.
MyJurnal

Radiotherapy has been widely use as an adjuvant therapy in the breast cancer management. The usage has increased the incidence of radiation induce sarcoma. We here present a case of radiation induce sarcoma of the axilla following mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma.

Matched MeSH terms: Breast Neoplasms
Breast cancer screening: How knowledgeable are female staff of a public university?

Nor Afiah, M.Z., Hejar, A.R., Looi, Y.K., Lim, S.J., Ng, C.Y., Tong, C.Y.

International Medical Journal Malaysia, 2011;10(1):23-29.
MyJurnal

Introduction: Breast cancer is the most common cancer among women worldwide and in Malaysia. It has better cure rate if detected early. However, the practice of breast cancer screening in Malaysia is still low. The objective of this study is to determine the knowledge and its associated factors as well as sources of information on breast cancer and breast cancer screening among female staff in a public university in Malaysia. Materials and Methods: This was a cross sectional study conducted in 2005 involving 394 female staff including academic and non-academic staff, which was selected by cluster sampling. A self-administered questionnaire on socioeconomic characteristics and family history of breast cancer was used for data collection. Chi-square Test and Fisher’s Exact Test was used for testing an association using SPSS 12.0. Results: The response rate was 84.3%. Only 50.9% had high knowledge on breast cancer and breast cancer screening and this was significantly associated with occupational status, monthly family income and educational level (p

Matched MeSH terms: Breast Neoplasms
Fulltext A survey on physical factors and compressed breast thickness in voluntary mammography screening using ffdm system in malaysia: preliminary results

Noriah Jamal, Humairah Samad Cheung, Siti Kamariah Che Mohamad, Ellyda Muhamad Nordin

Jurnal Sains Nuklear Malaysia, 2013;25(1):29-34.
MyJurnal

This paper aims at presenting preliminary results of a survey on physical factors, namely tube
potential (kV), tube current exposure time product (mAs) and compressed breast thickness (CBT)
during voluntary mammography screening using Full-Field Digital Mammography (FFDM) System
in Malaysia. Retrospective data were collected from 1128 FFDM images of 282 women from three
major ethnic groups (Malay, Chinese and Indian) who underwent voluntary screening
mammography at Breast Centre, International Islamic University Malaysia from January to March
2008. Results from the present study were then compared with results from the previous study on
Screen-Film Mammography System (SFM) according to the ethnic group for both Cranio-caudal
(CC) and Mediol-Lateral (MLO) views. We found that the mean kV for CC view for the three ethnic
groups are Malay (28), Chinese (28) and Indian (28), and for MLO view are Malay (29), Chinese
(28) and Indian (29). These values are higher than the kV for SFM which were Malay (26), Chinese
(27) and Indian (26) for CC and Malay (26), Chinese (27) and Indian (26) for CC and MLO views
respectively. The mean mAs for CC and MLO views for FFDM were lower compared to SFM
systems. These values were Malay (104), Chinese (108) and Indian (91) for CC views and Malay
(106), Chinese (105), and Indian (94) for MLO views for the FFDM system. The values for SFM
system are for CC and MLO views were Malay (120), Chinese (106) and Indian (126), and Malay
(166), Chinese (132), Indian (183) respectively. The median CBT for CC and MLO views increased
by 27% and 7% respectively on the FFDM compared to the SFM system. In conclusion, the FFDM
operates with higher kV, lower mAs, and higher CBT when compared with SFM system. Median
CBT on CC and MLO view with FFDM system are 27% and 7% higher respectively compared to
the SFM. We are currently collecting data on mean glandular dose with FFDM systems to assess
how the change in local mammography practice influences this value. This will allow comparison
with related data from other parts of the world.

Matched MeSH terms: Breast
Fulltext Do elderly women in Malaysia go for mammogram screening?

Rahmah, M.A., Aniza, I., Che Engku Nor Bahiyah, C.E.M.

Malaysian Journal of Public Health Medicine, 2013;13(2):20-26.
MyJurnal

Despite the debates of the benefits of continuing mammography screening among elderly women, studies in Malaysia have shown that the prevalence of breast examination declines after age 45 years and for mammogram per se, the prevalence of examination increases until age of 64. This study aims to determine the prevalence of mammogram screening among elderly women in Hulu Langat, Selangor and its relationship with factors such as demographic factors, family history of breast cancer, perceived health status, perceived general psychological factor and lifestyle factors. Data used were from a cross sectional study of health status among community in Hulu Langat area by the Department of Community Health, Universiti Kebangsaan Malaysia carried out from the year 1998 till 2002. However this paper focused on the database involving elderly women age 60 and above. The sample population was 652. The mean (standard deviation) age was 67.17 (5.995). Only 8.3% of the elderly women claimed to ever had mammogram screening done. Hence, the prevalence of mammogram screening is still low among elderly women in Hulu Langat. Having family history of breast cancer (p < 0.001) and perceived positive psychological status (p=0.003) had shown significant associations with mammogram screening among them. It is therefore important for researcher to further look into the reasons behind this and qualitative exploration is highly recommended.

Matched MeSH terms: Breast Neoplasms
Fulltext State level variation of breast cancer cases in 2007 among Malaysian women

Kuan, Gary Low Kim, Papapreponis, Panayiotis, Hin, Yong Mun

Malaysian Journal of Public Health Medicine, 2015;15(1):0-0.
MyJurnal

Breast cancer is the commonest cancer in women worldwide. This study examined the use of spatial analysis and mapping to visualise the disease distribution. The geographic units used were the states of Malaysia. Breast cancer data was obtained from the National Cancer Registry Report 2007 and the female population data was obtained from the Malaysian Census 2010. A spatial analysis was used to analyse the data by indirect standardisation of the underlying female population of each state. Sarawak has a high standardised incidence ratio (SIR) of 16.81 compared to all other states of the country where the highest SIR was only up to 2.15. However, the age-standardised rate (ASR) does not reflect so. SIR could provide a comprehensive evaluation of the disease for further research and public health intervention.

Matched MeSH terms: Breast Neoplasms
Positron emission mammography is a useful adjunct in assessment of dense breasts

Kumar SK, Trujillo PB, Ucros GR

Med J Malaysia, 2017 04;72(2):138-140.
PMID: 28473683

Worldwide breast cancer remains as the most common malignancy in women and the numbers who form a subgroup with dense breast parenchyma are substantial. In addition to mammography, the adjuncts used for further evaluation of dense breasts have been anatomically based modalities such as ultrasound and magnetic resonance imaging. The practice of functionally based imaging of breasts is relatively new but has undergone rapid progress over the past few years with promising results. The value of positron emission mammography is demonstrated in patients with dense breasts and mammographically occult disease.

Matched MeSH terms: Breast Density
Fulltext Baseline adjustment for statistical efficiency on clinical controlled trial

Loh, S.Y.

JUMMEC, 2009;12(1):31-34.
MyJurnal

In a clinical controlled trial involving repeated measures of continuous outcomes such as quality of life, distress, pain, activity level at baseline and after treatment, the possibilities of analyzing these outcomes can be numerous with quite varied findings. This paper examined four methods of statistical analysis using data from an outcome study of a clinical controlled trial to contrast the statistical power on those with baseline adjustment. In this study, data from a CCT with women with breast cancer were utilized. The experiment (n=67) and control (n=74) were about equal ratio. Four method of analysis were utilized, two using ANOVA for repeated measures and two using ANCOVA. The multivariate between subjects of the combined dependents variables and the univariate between subjects test were examined to make a judgement of the statistical power of each method. The results showed that ANCOVA has the highest statistical power. ANOVA using raw data is the least power and is the worst method with no evidence of an intervention effect even when the treatment by time interaction is statistically significant. In conclusion, ANOVA using raw data is the worst method with the least power whilst ANCOVA using baseline as covariate has the highest statistical power to detect a treatment effect other than method. The second best method as shown in this study was in using change scores of the repeated measures.

Matched MeSH terms: Breast Neoplasms
Fulltext Counselling changes in sexual functioning for women with breast cancer

Loh, S.Y.

JUMMEC, 2010;13(1):33-37.
MyJurnal

As women with breast cancer are living longer, issues beyond survivorship like the much neglected sexual functioning and issue of quality of life have become increasingly important. Experiences of significant alterations in sexual functioning need to be addressed. However, these sexual issues are often not acknowledged in our traditional medical model of health care delivery. This paper briefly reviews the changes in sexual functioning after a diagnosis of breast cancer, with implication for clinical practice and medical curicula.

Matched MeSH terms: Breast Neoplasms
Fulltext Relationship Between Breast-feeding & Bottle-feeding To Craniofacial & Dental Development

Radzi, Z., Yahya, N.A.

Ann Dent, 2005;12(1):-.
MyJurnal

Breast-feeding offers many benefits to the baby and the mother. For instance, breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler. Even though breastfeeding is a natural process, it is not always easy. In certain situations, some mothers are unable to breastfeed their babies or the babies are unable to adapt to breastfeeding. This will lead to the use of bottle-feeding. The effect of breast-feeding and bottle-feeding on physical growth has been well established but less has been concentrated on the craniofacial growth and dental development. This review reveals the effects of breast-feeding and bottle-feeding on craniofacial growth and dentoalveolar development based on the available literature.

Matched MeSH terms: Breast Feeding
Comparative evaluation of cytotoxic effects of milk from various species on leukemia cell lines

Asmah Rahmat, Rozita Rosli, Tan, Mui Hoon, Nasir Umar-Tsafe, Abdul Manaf Ali, Mohd Fadzelly Abu Bakar

Malaysian Journal of Medicine and Health Sciences, 2006;2(1):1-10.
MyJurnal

Objective: Previous studies have shown milk to contain cancer inhibitors. In this context, this study was conducted to screen the potential cytotoxic properties of four different types of milk, namely cow's milk, goat's milk, mare's milk and human milk.
Methods: In evaluating the cytotoxic properties of milk, two different human leukemia cell lines namely, Raji and CEM-SS were used. The treated and untreated cells of milk were cultured at 37°C in 5% CO2 for 5 days according to standard guidelines. The CellTiter 96® Aqueous (MTS) assay was carried out on the first, third and fifth days to measure cell viability. The percentage of cell viability was determined by comparing the optical density of the treated cells against the untreated controls. One-way ANOYA at p

Matched MeSH terms: Breast
Fulltext Solitary adrenal metastasis from invasive infiltrating ductal carcinoma: A case report and review of literature

Sangeetha Poovaneswaran, Justin Zon Ern Lee, Whei Ying Lim, Navarasi S Raja Gopal, Fauziah Mohd Dali, Ibtisam Mohamad

International e-Journal of Science, Medicine & Education, 2013;7(1):33-36.
MyJurnal

Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.

Matched MeSH terms: Breast Neoplasms
Fulltext Psychometric properties of the Malay version of the inventory of socially supportive behaviour (ISSB)

Nasir Yusoff, Low, Wah Yun, Yip, Cheng Ha

ASEAN Journal of Psychiatry, 2014;15(1):23-29.
MyJurnal

Objective: This study validates The Malay Version of The Inventory of Socially Supportive Behaviour. Methods: The psychometric properties of the ISSB- Malay Version were examined on sixty-eight women who were Malay native speakers and diagnosed with breast cancer. Respondents answered the questionnaire at three weeks and ten weeks following surgery for breast cancer. Results: The Malay Version of ISSB showed excellent internal consistency (Cronbach’s alpha=0.96). Test-retest Intraclass Correlation Coefficient (ICC) was 0.03. Small mean differences were observed at test-retest measurement with Effect Size Index 0.18. Conclusion: The Malay Version of the ISSB could be an appropriate tool to measure the supportive behavior of the Malaysian population. ASEAN Journal of Psychiatry, Vol. 15 (1): January – June 2014: 23-29.

Matched MeSH terms: Breast Neoplasms
Fulltext Attenuation coefficients of Rhizophora spp. in the 11.22 to 28.43 keV photon energy range

Sabar Bauk, Abd. Aziz Tajuddin

Journal of Nuclear and Related Technologies, 2008;2008(1):11-19.
MyJurnal

The linear and the mass attenuation coefficients of Rhizophora spp. wood in the photon energy range of 11.22 - 28.43 keV were determined. This was done by studying the attenuation of x-ray fluorescent (XRF) photons from selenium, molybdenum, silver and tin targets. Both the Kα and Kβ peaks were utilised. The results were compared with theoretical values for average breast tissues for youngage, middle-age and old-age groups calculated by using a XCOM computer programme. The mass attenuation coefficient of Rhizophora spp. was found to be close to that of the calculated young-age breast in this photon energy range.

Matched MeSH terms: Breast
Fulltext Extraction and purification of Cytotoxic compounds from Premna Serratifolia L. (Bebuas) for human breast cancer treatment

Salih, G.A., Ahmad-Raus, R., Shaban, M.N., Abdullah, N.

International Food Research Journal, 2017;24(101):0-0.
MyJurnal

Breast cancer is considered as one of the most common cancers all over the world. A huge effort has been made to create a safe and cost effective breast cancer treatment. All of these features exist in the plants sources. In this study, the effect of local vegetable salad, Premna serratifolia (Bebuas) against MCF-7 cells (human breast adenocarcinoma) was determined. The optimum condition to extract breast cancer cytotoxic compound from the plant was investigated and the exact cytotoxic compound was identified as well. To determine the plant cytotoxicity effect against MCF-7 cells, MTT assay was used. Two important parameters in the sonication extraction method which are duration of time and temperature were optimized by carrying out a series of experiments which were designed by Face Centered Central Composite Design (FCCCD). The extraction efficiency of each experiment was determined by measuring the yield of extract and the half maximal inhibitory concentration (IC50) of the extract against MCF-7 cells. The results obtained from the experiments were fitted to the second order polynomial model to generate equation that was used to determine best extraction processing condition. Based on the generated equation, the best sonication processing condition to extract the cytotoxic compound is at 30oC for 67 min. Analysis of variance (ANOVA) showed that the duration of extraction time has great influence (p

Matched MeSH terms: Breast Neoplasms
Copper complex derived from S-benzyldithiocarbazate and 3-acetylcoumarin induced apoptosis in breast cancer cell

Foo JB, Low ML, Lim JH, Lor YZ, Zainol Abidin R, Eh Dam V, et al.

Biometals, 2018 08;31(4):505-515.
PMID: 29623473 DOI: 10.1007/s10534-018-0096-4

Copper complexes have been widely studied for the anti-tumour application as cancer cells are reported to take up greater amounts of copper than normal cells. Preliminary study revealed that the newly synthesised copper complex [Cu(SBCM)2] displayed marked anti-proliferative towards triple-negative MDA-MB-231 breast cancer cells. Therefore, Cu(SBCM)2 has great potential to be developed as an agent for the management of breast cancer. The present study was carried out to investigate the mode of cell death induced by Cu(SBCM)2 towards MDA-MB-231 breast cancer cells. The inhibitory and morphological changes of MDA-MB-231 cells treated with Cu(SBCM)2 was determined by using MTT assay and inverted light microscope, respectively. The safety profile of Cu(SBCM)2 was also evaluated towards human dermal fibroblast (HDF) normal cells. Confirmation of apoptosis and cell cycle arrest were determined by flow cytometry analysis. The expression of p53, Bax, Bcl-2 and MMP2 protein were detected with western blot analysis. Cu(SBCM)2 significantly inhibited the growth of MDA-MB-231 cells in a dose-dependent manner with GI50 18.7 ± 3.06 µM. Indeed, Cu(SBCM)2 was less toxic towards HDF normal cells with GI50 31.8 ± 4.0 µM. Morphological study revealed that Cu(SBCM)2-treated MDA-MB-231 cells experienced cellular shrinkage, membrane blebbing, chromatin condensation and formation of apoptotic bodies, suggesting that Cu(SBCM)2 induced apoptosis in the cells, which was confirmed by Annexin-V/PI flow cytometry analysis. It was also found that Cu(SBCM)2 induced G2/M phase cell cycle arrest towards MDA-MB-231 cells. The induction of apoptosis and cell cycle arrest in the present study is possibly due to the down-regulation of the mutant p53 and MMP2 protein. In conclusion, Cu(SBCM)2 can be developed as a targeted therapy for the treatment of triple-negative breast cancer.

Matched MeSH terms: Breast Neoplasms/drug therapy*; Breast Neoplasms/pathology; Breast Neoplasms/chemistry
Fulltext Cognizance and utilization about breast cancer screening among the health professional female students and staffs of University Kuala Lumpur, Royal College of Medicine Perak, Malaysia

Haque AT, Mohd Hisham MA, Ahmad Adzman NA, Azudin NA, Shafri NB, Haque M

Indian J Med Paediatr Oncol, 2016 Oct-Dec;37(4):286-292.
PMID: 28144097 DOI: 10.4103/0971-5851.195752

Breast cancer (BC) is a major life-threatening problem and a global concern including Malaysia. BC is an equal threat for both developing and developed countries. The aim of this study was to determine the relationship between sociodemographic factors with knowledge, attitude, and perception on BC screening among the females of University Kuala Lumpur, Royal College of Medicine Perak (UniKL RCMP).

Matched MeSH terms: Breast Neoplasms
Fulltext Mammary Paget's Disease of the Nipple: Relatively Common but Still Unknown to Many

Ooi PS, Draman N, Yusoff SSM, Zain WZW, Ganasagaran D, Chua HH

Korean J Fam Med, 2019 Jul;40(4):269-272.
PMID: 30486607 DOI: 10.4082/kjfm.17.0143

Mammary Paget's disease is clinically defined as skin inflammation of the nipple area and is an adenocarcinoma of the epidermis of the nipple. The pathogenesis of mammary Paget's disease is relatively unknown; nonetheless, there are two popular theories that support the underlying carcinoma and de novo carcinogenesis. For the attending medical practitioner, mammary Paget's disease poses a diagnostic and therapeutic dilemma, especially in the absence of a clinically palpable breast mass. We report a rare case of a 48-year-old Malay woman who presented at Hospital Universiti Sains Malaysia, Kelantan, Malaysia with the symptom of skin erosion on the left nipple and unresponsiveness to multiple topical treatments. A full evaluation and assessment of the patient were conducted, and mammary Paget's disease was diagnosed.

Matched MeSH terms: Breast Neoplasms

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