Sarcoma of the breast is a rare condition. The biological differences from other primary breast tumours necessitate a corresponding difference in approach to diagnostic and management strategies. The rarity of the condition has made clinicopathological study difficult, with most series limited to less than 50 patients. We review the current literature on the diagnosis and management of breast sarcoma, and highlight areas of likely future development.

Oncolytic reovirus is currently under active investigation in a range of tumour types. Early phase studies have shown that this agent has modest monotherapy efficacy and its future development is likely to focus on combination regimens with cytotoxic chemotherapy. Indeed, phase I/II clinical trials have confirmed that reovirus can be safely combined with cytotoxic drugs, including a platin—taxane doublet regimen, which is currently being tested in a phase III clinical trial in patients with relapsed/metastatic head and neck cancer. Therefore, we have tested this triple (reovirus, cisplatin, paclitaxel) combination therapy in a panel of four head and neck cancer cell lines. Using the combination index (CI) method, the triple therapy demonstrated synergistic cytotoxicity in vitro in both malignant and non-malignant cell lines. In head and neck cancer cell lines, this was associated with enhanced caspase 3 and 7 cleavage, but no increase in viral replication. In vitro analyses confirmed colocalisation of markers of reovirus infection and caspase 3. Triple therapy was significantly more effective than reovirus or cisplatin—paclitaxel in athymic nude mice. These data suggest that the combination of reovirus plus platin—taxane doublet chemotherapy has significant activity in head and neck cancer and underpin the current phase III study in this indication.

Melanoma is an aggressive skin cancer that carries an extremely poor prognosis when local invasion, nodal spread or systemic metastasis has occurred. Recent advances in melanoma biology have revealed that RAS-RAF-MEK-ERK signalling plays a pivotal role in governing disease progression and treatment resistance. Proof-of-concept clinical studies have shown that direct BRAF inhibition yields impressive responses in advanced disease but these are short-lived as treatment resistance rapidly emerges. Therefore, there is a pressing need to develop new targeted strategies for BRAF mutant melanoma.As such, oncolytic viruses represent a promising cancer-specific approach with significant activity in melanoma.This study investigated interactions between genetically-modified vaccinia virus (GLV1h68) and radiotherapy in melanoma cell lines with BRAF mutant, Ras mutant or wildtype genotype. Pre-clinical studies revealed that GLV-1h68 combined with radiotherapy significantly increased cytotoxicity and apoptosis relative to either single agent in V600D BRAF/ V600E BRAF mutant melanoma in vitro and in vivo. The mechanism of enhanced cytotoxicity with GLV-1h68/radiation was independent of viral replication and due to attenuation of JNK, p38 and ERK MAPK phosphorylation specifically in BRAF mutant cells. Further studies showed that JNK pathway inhibition sensitized BRAF mutant cells to GLV-1h68-mediated cell death, mimicking the effect of radiation. GLV1h68 infection activated MAPK signalling in V600D BRAF/ V600E BRAF mutant cell lines and this was associated with TNF-α secretion which, in turn, provided a prosurvival signal.Combination GLV-1h68/radiation (or GLV-1h68/JNK inhibition) caused abrogation of TNF-α secretion. These data provide a strong rationale for combining GLV-1h68 with irradiation in V600D/E BRAF mutant tumors.3

Please cite this article as: Pencavel T, Allan CP, Thomas M, Hayes A. Treatment for breast sarcoma: a large, single-centre series., European Journal of Surgical Oncology (2011Oncology ( ), doi: 10.1016Oncology ( / j.ejso.2011 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Breast sarcoma. Conflict of Interest:The authors are not aware of any competing or conflicting interest in the preparation of this manuscript. Synopsis:Breast sarcoma is a rare condition. This large series evaluates prognostic factors from the standpoint of a large tertiary referral centre. Previous breast irradiation emerges as the factor most strongly associated with poorer prognosis; other factors are also discussed. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT AbstractBackground