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McCann KE, Goldfarb SB, Traina TA, Regan MM, Vidula N, Kaklamani V. Selection of appropriate biomarkers to monitor effectiveness of ovarian function suppression in pre-menopausal patients with ER+ breast cancer. NPJ Breast Cancer 2024; 10:8. [PMID: 38242892 PMCID: PMC10798954 DOI: 10.1038/s41523-024-00614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024] Open
Abstract
Use of gonadotropin-releasing hormone (GnRH) agonists has been widely adopted to provide reversible ovarian function suppression for pre-menopausal breast cancer patients who are also receiving aromatase inhibitor or tamoxifen therapy based on results of 25 randomized trials representing almost 15,000 women demonstrating a survival benefit with this approach. Past clinical trials designed to establish the efficacy of GnRH agonists have monitored testosterone in the prostate cancer setting and estradiol in the breast cancer setting. We explore the merits of various biomarkers including estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) and their utility for informing GnRH agonist treatment decisions in breast cancer. Estradiol remains our biomarker of choice in ensuring adequate ovarian function suppression with GnRH agonist therapy among pre-menopausal women with breast cancer. We recommend future trials to continue to focus on estradiol levels as the primary endpoint, as they have in the past.
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Affiliation(s)
- Kelly E McCann
- University of California Los Angeles Medical Center, Los Angeles, CA, 90095, USA
| | - Shari B Goldfarb
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Tiffany A Traina
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meredith M Regan
- Dana Farber Cancer Institute / Harvard Medical School, Boston, MA, 02215, USA
| | | | - Virginia Kaklamani
- University of Texas Health Sciences Center San Antonio / MD Anderson Cancer Center, San Antonio, TX, 78229, USA.
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2
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Eckardt NK, Ignatov A, Meinecke AM, Burger E, Costa SD, Eggemann H. Tumor characteristics, therapy, and prognosis in young breast cancer patients ≤ 35 years. J Cancer Res Clin Oncol 2023; 149:709-719. [PMID: 36534272 DOI: 10.1007/s00432-022-04374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/18/2022] [Indexed: 12/23/2022]
Abstract
PURPOSES Young breast cancer patients aged 35 years and younger are a small group of women who tend to present at high-risk form of the disease. More analysis of the data on tumor characteristics, treatment, and survival is necessary to help improving treatment and outcome. METHODS In this retrospective study, we compared the clinical and tumor characteristics, the treatments, and the survival of 257 women aged ≤ 35 years, with 6566 women aged 50-69 years. We used a registry-based data of patients with invasive, non-metastatic breast cancer diagnosed between 2000 and 2015. RESULTS Young women showed lower rate of hormone receptor (HR) positivity. Their tumors were more often HER2-positive, which showed lower rate of differentiation and higher rate of Ki-67 expression compared to their older counterparts. Women aged 35 years and younger were more likely to undergo neoadjuvant therapy and mastectomy. Endocrine therapy was underrepresented in young patients. 5-Year disease-free survival (DFS) was significantly lower in the younger patient group (81.7% vs. 91.3%, p < 0.001), while 5-year overall survival (OS) was not impaired (91.4% vs. 91.1%, p = 0.847). CONCLUSION The unfavorable disease-free survival in the group of younger patients might be explained by their unfavorable tumor characteristics. The surgical treatment appears to be more aggressive in young breast cancer patients and is more frequently combined with chemotherapy and immunotherapy, either in a neoadjuvant or in an adjuvant setting.
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Affiliation(s)
- Naaja-Kristin Eckardt
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Anne-Marie Meinecke
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
| | - Elke Burger
- Cancer Registry Magdeburg, Magdeburg, Germany
| | - Serban-Dan Costa
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
| | - Holm Eggemann
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany.
- Department of Gynecology and Obstetrics, Klinikum Magdeburg gGmbH, Mageburg, Germany.
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Del Mastro L, Poggio F, Blondeaux E, De Placido S, Giuliano M, Forestieri V, De Laurentiis M, Gravina A, Bisagni G, Rimanti A, Turletti A, Nisticò C, Vaccaro A, Cognetti F, Fabi A, Gasparro S, Garrone O, Alicicco MG, Urracci Y, Mansutti M, Poletti P, Correale P, Bighin C, Puglisi F, Montemurro F, Colantuoni G, Lambertini M, Boni L, Venturini M, Abate A, Pastorino S, Canavese G, Vecchio C, Guenzi M, Lambertini M, Levaggi A, Giraudi S, Accortanzo V, Floris C, Aitini E, Fornari G, Miraglia S, Buonfanti G, Cherchi M, Petrelli F, Vaccaro A, Magnolfi E, Contu A, Labianca R, Parisi A, Basurto C, Cappuzzo F, Merlano M, Russo S, Mansutti M, Poletto E, Nardi M, Grasso D, Fontana A, Isa L, Comandè M, Cavanna L, Iacobelli S, Milani S, Mustacchi G, Venturini S, Scinto A, Sarobba M, Pugliese P, Bernardo A, Pavese I, Coccaro M, Massidda B, Ionta M, Nuzzo A, Laudadio L, Chiantera V, Dottori R, Barduagni M, Castiglione F, Ciardiello F, Tinessa V, Ficorella A, Moscetti L, Vallini I, Giardina G, Silva R, Montedoro M, Seles E, Morano F, Cruciani G, Adamo V, Pancotti A, Palmisani V, Ruggeri A, Cammilluzzi E, Carrozza F, D'Aprile M, Brunetti M, Gallotti P, Chiesa E, Testore F, D'Arco A, Ferro A, Jirillo A, Pezzoli M, Scambia G, Iacono C, Masullo P, Tomasello G, Gandini G, Zoboli A, Bottero C, Cazzaniga M, Genua G, Palazzo S, D'Amico M, Perrone D. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): end-of-study results from a randomised, phase 3 trial. Lancet Oncol 2022; 23:1571-1582. [DOI: 10.1016/s1470-2045(22)00632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
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Schlottmann F, Bucan V, Strauß S, Koop F, Vogt PM, Mett TR. Influence of Tamoxifen on Different Biological Pathways in Tumorigenesis and Transformation in Adipose-Derived Stem Cells, Mammary Cells and Mammary Carcinoma Cell Lines—An In Vitro Study. Cells 2022; 11:cells11172733. [PMID: 36078139 PMCID: PMC9454616 DOI: 10.3390/cells11172733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
Breast carcinoma is one of the most common malignant tumors in women. In cases of hormone-sensitive cells, tamoxifen as an anti-estrogenic substance is a first line medication in the adjuvant setting. The spectrum of autologous breast reconstructions ranges from fat infiltrations to complex microsurgical procedures. The influence of adipose-derived stem cells (ASC) on the tumor bed and a possibly increased recurrence rate as a result are critically discussed. In addition, there is currently no conclusive recommendation regarding tamoxifen-treated patients and autologous fat infiltrations. The aim of the present study was to investigate the effect of tamoxifen on the gene expression of a variety of genes involved in tumorigenesis, cell growth and transformation. Mammary epithelial cell line and mammary carcinoma cell lines were treated with tamoxifen in vitro as well as co-cultured with ASC. Gene expression was quantified by PCR arrays and showed increased expression in the mammary carcinoma cell lines with increasing time of treatment and concentration of tamoxifen. The data presented can be considered as an addition to the controversial discussion on the relationship between ASC and breast carcinoma cells. Further studies are needed to quantify the in vivo interaction of ASC and mammary carcinoma cells and to conclusively assess the impact of tamoxifen in reconstructive cases with fat grafting.
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Han B, Zhen F, Zheng XS, Hu J, Chen XS. Systematic analysis of the expression and prognostic value of ITPR1 and correlation with tumor infiltrating immune cells in breast cancer. BMC Cancer 2022; 22:297. [PMID: 35313846 PMCID: PMC8939201 DOI: 10.1186/s12885-022-09410-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ITPR1 is a key gene for autophagy, but its biological function is still unclear, and there are few studies on the correlation between ITPR1 gene expression and the occurrence and development of breast cancer. METHODS Analyze the expression of ITPR1 through online databases such as Oncomine and TIMER. Kaplan-Meier plotter and other databases were used to evaluate the impact of ITPR1 on clinical prognosis. The expression of ITPR1 in analysis of 145 cases of breast cancer and 30 cases of adjacent normal tissue was detected by Immunohistochemistry. Statistical analysis was used to evaluate the clinical relevance and prognostic significance of abnormally expressed proteins. And the Western Blot was used to detect the expression of ITPR1 between breast cancer tissues and cells. The TIMER database studied the relationship between ITPR1 and cancer immune infiltration. And used the ROC plotter database to predict the response of ITPR1 to chemotherapy, endocrine therapy and anti-HER2 therapy in patients with breast cancer. RESULTS Compared with normal breast samples, ITPR1 was significantly lower in patients with breast cancer. And the increased expression of ITPR1 mRNA was closely related to longer overall survival (OS), distant metastasis free survival (DMFS), disease specific survival (DSS) and relapse free survival (RFS) in breast cancer. And the expression level of ITPR1 was higher in patients treated with chemotherapy than untreated patients. In addition, the expression of ITPR1 was positively correlated with related gene markers of immune cells in different types of breast cancer, especially with BRCA basal tissue breast cancer. CONCLUSION ITPR1 was lower expressed in breast cancer. The higher expression of ITPR1 suggested favorable prognosis for patients. ITPR1 was related to the level of immune infiltration, especially in BRCA-Basal patients. All research results indicated that ITPR1 might affect breast cancer prognosis and participate in immune regulation. In short, ITPR1 might be a potential target for breast cancer therapy.
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Affiliation(s)
- Bing Han
- Department of Breast Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150040, China
| | - Fang Zhen
- Department of Breast Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150040, China
| | - Xiu-Shuang Zheng
- Department of Reproductive Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Harbin, 150001, China
| | - Jing Hu
- Department of Breast Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150040, China.
| | - Xue-Song Chen
- Department of Breast Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150040, China.
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Kuncman W, Orzechowska M, Kuncman Ł, Kordek R, Taran K. Intertumoral Heterogeneity of Primary Breast Tumors and Synchronous Axillary Lymph Node Metastases Reflected in IHC-Assessed Expression of Routine and Nonstandard Biomarkers. Front Oncol 2021; 11:660318. [PMID: 34804912 PMCID: PMC8595326 DOI: 10.3389/fonc.2021.660318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022] Open
Abstract
Breast cancer (BC) remains a significant healthcare challenge. Routinely, the treatment strategy is determined by immunohistochemistry (IHC)-based assessment of the key proteins such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67. However, it is estimated that over 75% of deaths result from metastatic tumors, indicating a need to develop more accurate protocols for intertumoral heterogeneity assessment and their consequences on prognosis. Therefore, the aim of this preliminary study was the identification of the expression profiles of routinely used biomarkers (ER, PR, HER2, Ki-67) and additional relevant proteins [Bcl-2, cyclin D1, E-cadherin, Snail+Slug, gross cystic disease fluid protein 15 (GCDFP-15), programmed death receptor 1 (PD-L1), and phosphatase of regenerating liver 3 (PRL-3)] in breast primary tumors (PTs) and paired synchronous axillary lymph node (ALN) metastases. A total of 67 tissue samples met the inclusion criteria for the study. The expression status of biomarkers was assessed in PTs and ALN metastases using tissue microarrays followed by IHC. In 11 cases, the shift of intrinsic molecular BC subtype was noticed between PTs and paired ALN metastases. Moreover, a significant disproportion in E-cadherin presence (p = 0.0002) was noted in both foci, and the expression status of all proteins except for HER2 demonstrated considerable variance (k = 1, p < 0.0001). Importantly, in around 30% of cases, the ALN metastases demonstrated discordance, i.e., loss/gain of expression, compared to the PTs. Intertumoral synchronous heterogeneity in both foci (primary tumor and node metastasis) is an essential phenomenon affecting the clinical subtype and characteristics of BC. Furthermore, a greater understanding of this event could potentially improve therapeutic efficacy.
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Affiliation(s)
- Wojciech Kuncman
- Department of Pathology, Medical University of Łódź, Łódź, Poland
| | | | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Łódź, Łódź, Poland
| | - Radzisław Kordek
- Department of Pathology, Medical University of Łódź, Łódź, Poland
| | - Katarzyna Taran
- Laboratory of Isotopic Fractionation in Pathological Processes, Department of Pathomorphology, Medical University of Łódź, Łódź, Poland
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Dose-Dense Docetaxel versus Weekly Paclitaxel following Dose-Dense Epirubicin and Cyclophosphamide as Adjuvant Chemotherapy in Node-Positive Breast Cancer Patients: A Retrospective Cohort Analysis. Int J Breast Cancer 2021; 2021:6653265. [PMID: 34594580 PMCID: PMC8478594 DOI: 10.1155/2021/6653265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Methods This study included patients from two prospective studies conducted in our institute from April 2007 to March 2009. Ninety-one women with axillary lymph node-positive breast cancer who had received four cycles of dose-dense epirubicin and cyclophosphamide were treated with either weekly paclitaxel (80 mg/m2) for 12 doses or biweekly docetaxel (75 mg/m2) for four cycles. Results After a median follow-up of 88 and 109 months, 11 (23.4%) and 10 (22.7%) patients had experienced disease recurrence (p = 0.16), while 10 (21.3%) and 5 (11.4%) patients had died in the paclitaxel and docetaxel arm, respectively (p = 0.56). No significant difference could be seen in 5-year DFS or OS among groups (HR: 0.58; 95% CI: 0.19–1.81, p = 0.35; HR: 0.58; 95% CI: 0.19–1.81, p = 0.35, respectively). Conclusion In conclusion, both evaluated adjuvant chemotherapy regimens have comparable effectiveness regarding DFS and OS.
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Mandó P, Hirsch I, Waisberg F, Ostinelli A, Luca R, Pranevicene B, Ferreyra Camacho A, Enrico D, Chacon M. Appraising the quality of meta-analysis for breast cancer treatment in the adjuvant setting: A systematic review. Cancer Treat Res Commun 2021; 27:100358. [PMID: 33957603 DOI: 10.1016/j.ctarc.2021.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast cancer is the tumor with highest incidence in women worldwide and adjuvant treatment is extremely important to achieve disease control. Given the relevance of systematic reviews, their rigor should be warranted to avoid biased conclusions. Our objective was to investigate the methodological quality of meta-analysis of early breast cancer adjuvant treatment. MATERIAL AND METHODS Comprehensive searches were performed using electronic databases from 1/1/2007 to 11/12/2018. All studies identified as a systematic review with meta-analysis investigating the efficacy of breast cancer adjuvant treatments were included. Two reviewers independently assessed titles and abstracts, then full-texts for eligibility. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) version 2 tool. RESULTS Of 950 citations retrieved, 66 studies (7.0%) were deemed eligible. Methodological quality was highly variable, median AMSTAR score 8.5 (IQR 7-9.5) and range 0-16. There was a weak positive correlation between journal impact factor and AMSTAR score (r = 0.17) and citation rate and AMSTAR score (r = 0.16). Cochrane Systematic Reviews were of higher quality than reviews from other journals. Overall confidence was critically low for 61 (92.4%) studies, and the least well-reported domains were the statement of conflict of interest and funding source for the included studies (4.6%), the report of a pre-defined study protocol (15.2%), and the description of details of excluded studies (6.1%). CONCLUSIONS Our findings reinforce concerns about the design, conduction and interpretation of meta-analysis in current literature. Methodological quality should be carefully considered and journal editors, decision makers and readers in general, must follow a critical approach to this studies.
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Affiliation(s)
- Pablo Mandó
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina; CEMIC, Galvan 4102, Ciudad de Buenos Aires, CP 1431, Argentina.
| | - Ian Hirsch
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina; Hospital General de Agudos Teodoro Álvarez, Juan Felipe Aranguren 2701, Ciudad de Buenos Aires, CP1406, Argentina
| | - Federico Waisberg
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina
| | - Alexis Ostinelli
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina; Instituto Alexander Fleming, Cramer 1180, Ciudad de Buenos Aires, CP1426, Argentina
| | - Romina Luca
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina
| | - Belen Pranevicene
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina
| | - Augusto Ferreyra Camacho
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina
| | - Diego Enrico
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina
| | - Matías Chacon
- Argentine Association of Clinical Oncology, Gorostiaga 2450, Ciudad de Buenos Aires, CP1426, Argentina; Instituto Alexander Fleming, Cramer 1180, Ciudad de Buenos Aires, CP1426, Argentina
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Four Cycles of Docetaxel-Cyclophosphamide versus Anthracycline-Taxane as Adjuvant Chemotherapy for HER2-Negative, Axillary Lymph Node Negative Breast Cancer: A Real-World Comparison of Alberta Patients Treated 2008-2012. Curr Oncol 2021; 28:1137-1142. [PMID: 33806441 PMCID: PMC8025747 DOI: 10.3390/curroncol28020109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
Uncertainty exists around the need to include an anthracycline if taxane-based adjuvant chemotherapy is being used for human epidermal growth factor receptor-2 (HER2) negative and axillary lymph node negative (LNN) breast cancer. We identified all patients who were diagnosed with HER2-negative, LNN breast cancer treated with docetaxel-cyclophosphamide for four cycles (DC4) or an anthracycline-taxane (AT) regimen following surgical resection in Alberta from 2008 through 2012. We used propensity score methods to match each patient treated with AT to up to four patients treated with DC4 on potentially confounding clinicopathologic and treatment variables. We compared the 10-year invasive disease free survival (iDFS), breast cancer specific-survival (BCSS) and overall survival (OS) and assessed the effect of the type of adjuvant chemotherapy on these outcomes using Cox regression. Of the 726 eligible patients, 657 (90.5%) were treated with DC4 and 69 (9.5%) were treated with AT. Matching created a group of 202 women treated with DC4 and eliminated differences in clinicopathologic and treatment factors. There was no statistically significant difference for the treatment effects of matched DC4 patients compared to the AT patients on iDFS (75.7% vs. 76.8%, p = 0.75; hazard ratio (HR) = 1.05, 95% CI = 0.65 to 1.8), BCSS (88.1% vs. 87%, p = 0.8; HR = 0.91, 95% CI = 0.42 to 1.9), or OS (87.1% vs. 86.9%, p= 0.96; HR = 0.98, 95% CI = 0.46 to 2.1). Four cycles of DC as compared with an AT regimen yielded similar 10-year iDFS, BCSS and OS amongst patients with HER2-negative, LNN breast cancer.
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van Dooijeweert C, Baas IO, Deckers IAG, Siesling S, van Diest PJ, van der Wall E. The increasing importance of histologic grading in tailoring adjuvant systemic therapy in 30,843 breast cancer patients. Breast Cancer Res Treat 2021; 187:577-586. [PMID: 33517555 PMCID: PMC8189961 DOI: 10.1007/s10549-021-06098-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
Purpose The large variation in histologic grading of invasive breast cancer (IBC) that has been reported likely influences tailoring adjuvant therapy. The role of grading in therapeutic decision-making in daily practice, was evaluated using the Dutch national guidelines for IBC-management. Methods Synoptic reports of IBC resection-specimens, obtained between 2013 and 2016, were extracted from the nationwide Dutch Pathology Registry, and linked to treatment-data from the Netherlands Cancer Registry. The relevance of grading for adjuvant chemotherapy (aCT) was quantified by identifying patients for whom grade was the determinative factor. In addition, the relation between grade and aCT-administration was evaluated by multivariate logistic regression for patients with a guideline-aCT-indication. Results 30,843 patients were included. Applying the guideline that was valid between 2013 and 2016, grade was the determinative factor for the aCT-indication in 7744 (25.1%) patients, a percentage that even increased according to the current guideline where grade would be decisive for aCT in 10,869 (35.2%) patients. Also in current practice, the indication for adjuvant endocrine therapy (aET) would be based on grade in 9173 (29.7%) patients. Finally, as patients with lower-grade tumors receive aCT significantly less often, grade was also decisive in tailoring aCT de-escalation. Conclusions In the largest study published so far we illustrate the increasing importance of histologic grade in tailoring adjuvant systemic breast cancer therapy. Next to playing a key-role in aCT-indication and de-escalation, the role of grading has expanded to the indication for aET. Optimizing histologic grading by pathologists is urgently needed to diminish the risk of worse patient outcome due to non-optimal treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06098-7.
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Affiliation(s)
- C van Dooijeweert
- Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - I O Baas
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I A G Deckers
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands), Houten, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Brezden-Masley C, Fathers KE, Coombes ME, Pourmirza B, Xue C, Jerzak KJ. A population-based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with hormone receptor-positive/HER2-negative breast cancer. Breast Cancer Res Treat 2021; 185:507-515. [PMID: 33064230 PMCID: PMC7867554 DOI: 10.1007/s10549-020-05960-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To update and expand on data related to treatment, resource utilization, and costs by cancer stage in Canadian patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC). METHODS We analyzed data for adult women diagnosed with invasive HR+/HER2- BC between 2012 and 2016 utilizing the publicly funded health care system in Ontario. Baseline characteristics, treatment received, and health care use were descriptively compared by cancer stage (I-III vs. IV). Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. RESULTS Our study included 21,360 patients with stage I-III plus 813 with stage IV HR+/HER2- BC. Surgery was performed on 20,510 patients with stage I-III disease (96.0%), with the majority having a lumpectomy, and radiation was received by 15,934 (74.6%). Few (n = 1601, 7.8%) received neoadjuvant and most (n = 15,655, 76.3%) received adjuvant systemic treatment. Seven hundred and fifty eight patients with metastatic disease (93.2%) received systemic therapy; 542 (66.7%) received endocrine therapy. Annual per patient health care costs were three times higher in the stage IV vs. stage I-III cohort with inpatient hospital services representing nearly 40% of total costs. CONCLUSION The costs associated with metastatic HR+/HER2- BC reflect a significant disease burden. Low endocrine treatment rates captured by the publicly funded system suggest guideline non-adherence or that a fair portion of Ontarian patients may be incurring out-of-pocket drug costs.
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Affiliation(s)
- Christine Brezden-Masley
- Division of Medical Oncology and Hematology, Faculty of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kelly E Fathers
- Department of Medical Affairs, Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | - Megan E Coombes
- Market Access and Pricing Department, Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | - Behin Pourmirza
- Department of Medical Affairs, Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | - Cloris Xue
- Department of Medical Affairs, Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | - Katarzyna J Jerzak
- Division of Medical Oncology and Hematology, Faculty of Medicine, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada.
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Yamaguchi T, Hozumi Y, Sagara Y, Takahashi M, Yoneyama K, Fujisawa T, Osumi S, Akabane H, Nishimura R, Mieno MN, Mukai H. The impact of neoadjuvant systemic therapy on breast conservation rates in patients with HER2-positive breast cancer: Surgical results from a phase II randomized controlled trial. Surg Oncol 2020; 36:51-55. [PMID: 33310293 DOI: 10.1016/j.suronc.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neoadjuvant systemic therapy (NST) induces tumor shrinkage and boosts the chance of breast-conserving thearpy (BCT) in patients with breast cancer. However, only a few trials have evaluated the effect of NST in conversion from BCT ineligibility to BCT eligibility in HER2-positive breast cancer. METHODS We conducted the surgical sub-study of a phase II randomized trial, which compared standard neoadjuvant treatment or an experimental treatment modified according to the interim Ki-67 evaluation in women with stage II or III HER2-positive breast cancer. The treating surgeons assessed eligibility for BCT before and after NST. We evaluated the change in BCT eligibility following NST. We also analyzed the type of surgery performed and the success rate of BCT. RESULTS Two hundred six patients were included in this study. Of these, 44.0% were considered BCT candidates at baseline, while 69.8% were deemed eligible for BCT after NST (P < 0.001). Among non-BCT candidates at baseline, 46% successfully converted to BCT candidates. Of 139 patients deemed eligible for BCT following NST, 84.2% attempted BCT, and successful BCT, defined as tumor-free at all surgical margins, was achieved in 96.8% of patients. Different treatment arms did not affect the rate of post-NST BCT eligibility (70.0% vs 69.7%). CONCLUSIONS This study demonstrated that NST resulted in an absolute increase of 25.8% in the rate of BCT eligibility in HER2-positive breast cancer. About a half of non-BCT candidates converted to BCT candidates. BCT was successful in most patients who attempted BCT. There were still patients who chose mastectomy even though they were deemed eligible for BCT. Patients considered BCT-ineligible due to large tumor size most likely converted to BCT-eligible with NST. On the other hand, NST had less impact on the surgical indication of patients with multicentric disease or probable poor cosmetic outcome.
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Affiliation(s)
- Takeshi Yamaguchi
- Medical Oncology, Japanese Red Cross Musashino Hospital. 1-26-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8610, Japan.
| | - Yasuo Hozumi
- Breast and Endocrine Surgery, University of Tsukuba Hospital/ Ibaraki Prefectural Central Hospital. 6528 Koibuchi, Kasama City, Ibaraki, 309-1793, Japan.
| | - Yasuaki Sagara
- Breast Oncology, Sagara Hospital, Hakuaikai Medical Corporation, 3-31 Matsubara-cho, Kagoshima-shi, Kagoshima, 343-0832, Japan.
| | - Masato Takahashi
- Breast Surgery, NHO Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo, Hokkaido, 003-0804, Japan.
| | - Kimiyasu Yoneyama
- Breast Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Tomomi Fujisawa
- Breast Oncology, Gunma Prefectural Cancer Center, 617-1 Takahayashinishi-cho, Ota-shi, Gunma, 373-8550, Japan.
| | - Shozo Osumi
- Breast Oncology, Shikoku Cancer Center, 160 Kou, Minamiumemoto-cho, Matsuyama, Ehime, 791-0280, Japan.
| | - Hiromitsu Akabane
- Breast Surgery, Asahikawa Kosei Hospital, 24-111, Ichi-jodori, Asahikawa-shi, Hokkaido, 078-8211, Japan
| | - Reiki Nishimura
- Breast Surgery, Kumamoto Shinto General Hospital, 3-2-65 Oe, Chuo-ku, Kumamoto-shi, Kumamoto, 862-8655, Japan.
| | - Makiko Naka Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University. 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Hirofumi Mukai
- Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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13
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Denduluri N, Somerfield MR, Chavez-MacGregor M, Comander AH, Dayao Z, Eisen A, Freedman RA, Gopalakrishnan R, Graff SL, Hassett MJ, King TA, Lyman GH, Maupin GR, Nunes R, Perkins CL, Telli ML, Trudeau ME, Wolff AC, Giordano SH. Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Guideline Update. J Clin Oncol 2020; 39:685-693. [PMID: 33079579 DOI: 10.1200/jco.20.02510] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this work is to update key recommendations of the ASCO guideline adaptation of the Cancer Care Ontario guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for breast cancer. METHODS An Expert Panel conducted a targeted systematic literature review guided by a signals approach to identify new, potentially practice-changing data that might translate into revised guideline recommendations. RESULTS The Expert Panel reviewed abstracts from the literature review and identified one article for inclusion that reported results of the phase III, open-label KATHERINE trial. In the KATHERINE trial, patients with stage I to III human epidermal growth factor receptor 2 (HER2)-positive breast cancer with residual invasive disease in the breast or axilla after completing neoadjuvant chemotherapy and HER2-targeted therapy were allocated to adjuvant trastuzumab emtansine (T-DM1; n = 743) or to trastuzumab (n = 743). Invasive disease-free survival was significantly higher in the T-DM1 group than in the trastuzumab arm (hazard ratio, 0.50; 95% CI, 0.39 to 0.64; P < .001), and risk of distant recurrence was lower in patients who received T-DM1 than in patients who received trastuzumab (hazard ratio, 0.60; 95% CI, 0.45 to 0.79). Grade 3 or higher adverse events occurred in 190 patients (25.7%) who received T-DM1 and in 111 patients (15.4%) who received trastuzumab. RECOMMENDATIONS Patients with HER2-positive breast cancer with pathologic invasive residual disease at surgery after standard preoperative chemotherapy and HER2-targeted therapy should be offered 14 cycles of adjuvant T-DM1, unless there is disease recurrence or unmanageable toxicity. Clinicians may offer any of the available and approved formulations of trastuzumab, including trastuzumab, trastuzumab and hyaluronidase-oysk, and available biosimilars.Additional information can be found at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | - Amy H Comander
- Massachusetts General Hospital Center at Newton-Wellesley, Newton, MA
| | | | - Andrea Eisen
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.,Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | | | | | - Tari A King
- Dana-Farber Cancer Institute, Boston, MA.,Brigham & Women's Cancer Center, Boston, MA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Raquel Nunes
- Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | - Maureen E Trudeau
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.,Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Antonio C Wolff
- Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
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14
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Batra A, Hannouf MB, Alsafar N, Lupichuk S. Four cycles of docetaxel and cyclophosphamide as adjuvant chemotherapy in node negative breast cancer: A real-world study. Breast 2020; 54:1-7. [PMID: 32861882 PMCID: PMC7475113 DOI: 10.1016/j.breast.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction The optimal number of cycles of adjuvant docetaxel and cyclophosphamide (DC) in patients with node negative breast cancer is not known. We aimed to analyse the survival outcomes of patients with node negative and human epidermal growth factor receptor (HER2)-negative breast cancer treated with four cycles of DC. Methods Patients with node negative and HER2-negative breast cancer treated with four cycles of DC after surgery in a large Canadian province from 2008 to 2012 were identified. We analysed the 4-year and 9-year invasive disease free survival (iDFS) and overall survival (OS). Cox regression models were constructed to examine the associations of clinical characteristics with survival outcomes. Results A total of 657 patients were eligible for the current analysis. The median age was 53 years and 71.2% of patients had hormone receptor-positive breast cancer. Approximately three-fourths of patients had grade III tumours. At a median follow-up of nine years, the 4-year iDFS and OS were 91.0% and 95.5% and the corresponding 9-year rates were 80.5% and 88.0%, respectively. On multivariable Cox regression analysis, grade III tumour predicted worse iDFS (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.09–4.21; P = 0.026) and OS (HR, 3.15; 95% CI, 1.18–8.45; P = 0.022). Conclusions Adjuvant chemotherapy with four cycles of DC in a select population of node negative breast cancer was associated with encouraging long-term survival. In the absence of a randomized comparison between four and six cycles of DC, this study presents real-world evidence to consider four cycles of DC as a reasonable option. Non-anthracycline adjuvant chemotherapy administered in node negative breast cancer. Not known if four or six cycles of docetaxel and cyclophosphamide is optimal. Long-term survival rates in this real-world study using four cycles are encouraging. In absence of randomized comparison, four cycles is a reasonable option.
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Affiliation(s)
- Atul Batra
- Department of Medical Oncology, Tom Baker Cancer Center, 1331 29 ST NW, Calgary, Alberta, T2N 4N2, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Malek B Hannouf
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Noura Alsafar
- Department of Medical Oncology, Tom Baker Cancer Center, 1331 29 ST NW, Calgary, Alberta, T2N 4N2, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Sasha Lupichuk
- Department of Medical Oncology, Tom Baker Cancer Center, 1331 29 ST NW, Calgary, Alberta, T2N 4N2, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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15
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Walsh EM, Smith KL, Stearns V. Management of hormone receptor-positive, HER2-negative early breast cancer. Semin Oncol 2020; 47:187-200. [PMID: 32546323 PMCID: PMC7374796 DOI: 10.1053/j.seminoncol.2020.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/24/2022]
Abstract
The majority of breast cancers are diagnosed at an early stage and are hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative. Significant advances have been made in the management of early stage HR-positive, HER2-negative breast cancer, resulting in improved survival outcomes. In this review, we discuss important factors to consider in the management of this disease. In particular, we discuss the role of adjuvant endocrine therapy, specific endocrine therapy agents, the duration of adjuvant endocrine therapy, treatment-related side effects, and the role of genomic assays and other biomarkers when considering treatment recommendations for individuals with HR-positive, HER2-negative early breast cancer. Finally, we address emerging data to individualize therapeutic decision-making and provide future considerations.
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Affiliation(s)
- Elaine M Walsh
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen L Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD.
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16
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Zekri J, Al-Foheidi M, Alata M, Zabani R, Rasmy A. Adjuvant Chemotherapy for Patients with Breast Cancer Based on Clinical and Evolving Oncotype DX Criteria. Breast Care (Basel) 2020; 15:642-647. [PMID: 33447239 DOI: 10.1159/000506389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Oncotype DX assay recurrence score (ODX-RS) cut-off values have recently changed after the publication of the TAILOR-X trial results. We aim to explore decisions for adjuvant chemotherapy (ACT) based on physicians' clinical assessment and the evolving ODX-RS. Methodology Patients who underwent ODX testing after curative surgical resection of estrogen receptor positive (ER+), Her2 non-overexpressed (Her2-) and lymph node-negative (LN-) breast cancer (BC) were eligible. Management of these patients was guided by the results of the old ODX-RS-1 (<18, 18-30, and ≥31) risk grouping. For the purpose of this study, treatment decisions were also assumed according to TAILOR-X results (ODX-RS-2). Decisions of 3 medical oncologists on ACT were solicited by blinding them to the RS to investigate concordance with ODXA RS-1 and 2 recommendations. Results Sixty-six consecutive patients were included. Median age was 50.5 (range: 21-73) years. There was 1 male patient, and 37/65 females (56.9%) were premenopausal. Among the 3 oncologists, recommendations for ACT based on clinical assessment were discrepant in 29 (43.9%) patients. Based on majority consensus (≥2 oncologists), ACT would have been recommended to 22/41 (53.7%) and 22/46 (47.82%) patients with low-risk tumors according to ODX-RS-1 and ODX-RS-2, respectively. Compared to ODX-RS-1, ODX-RS-2 identifies 12% (46 vs. 41) more low-risk patients and 66% (20 vs. 12 patients) more high-risk patients. Conclusion Overtreatment and discrepancies in the management of patients with ER+/Her2-/LN- early BC can be minimized by the implementation of ODX genomic assay. Some differences in ACT recommendations exist between ODX-RS-1 and ODX-RS-2.
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Affiliation(s)
- Jamal Zekri
- College of Medicine, Al-Faisal University, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Meteb Al-Foheidi
- Princess Noorah Oncology Center, King Saud bin Abdulaziz University, Jeddah, Saudi Arabia
| | - Maaz Alata
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Reem Zabani
- Ibn Sina National Medical College, Jeddah, Saudi Arabia
| | - Ayman Rasmy
- Medical Oncology Department, King Saud Medical City, Riyadh, Saudi Arabia.,Medical Oncology, Zagazig University Hospitals, Zagazig, Egypt
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17
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Gene Expression Profiling Tests for Early-Stage Invasive Breast Cancer: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-234. [PMID: 32284770 PMCID: PMC7143374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Breast cancer is a disease in which cells in the breast grow out of control. They often form a tumour that may be seen on an x-ray or felt as a lump.Gene expression profiling (GEP) tests are intended to help predict the risk of metastasis (spread of the cancer to other parts of the body) and to identify people who will most likely benefit from chemotherapy. We conducted a health technology assessment of four GEP tests (EndoPredict, MammaPrint, Oncotype DX, and Prosigna) for people with early-stage invasive breast cancer, which included an evaluation of effectiveness, safety, cost effectiveness, the budget impact of publicly funding GEP tests, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using either the Cochrane Risk of Bias tool, Prediction model Risk Of Bias ASsessment Tool (PROBAST), or Risk of Bias Assessment tool for Non-randomized Studies (RoBANS), depending on the type of study and outcome of interest, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also performed a literature survey of the quantitative evidence of preferences and values of patients and providers for GEP tests.We performed an economic evidence review to identify published studies assessing the cost-effectiveness of each of the four GEP tests compared with usual care or with one another for people with early-stage invasive breast cancer. We adapted a decision-analytic model to compare the costs and outcomes of care that includes a GEP test with usual care without a GEP test over a lifetime horizon. We also estimated the budget impact of publicly funding GEP tests to be conducted in Ontario, compared with funding tests conducted through the out-of-country program and compared with no funding of tests in any location.To contextualize the potential value of GEP tests, we spoke with people who have been diagnosed with early-stage invasive breast cancer. RESULTS We included 68 studies in the clinical evidence review. Within the lymph-node-negative (LN-) population, GEP tests can prognosticate the risk of distant recurrence (GRADE: Moderate) and may predict chemotherapy benefit (GRADE: Low). The evidence for prognostic and predictive ability (ability to indicate the risk of an outcome and ability to predict who will benefit from chemotherapy, respectively) was lower for the lymph-node-positive (LN+) population (GRADE: Very Low to Low). GEP tests may also lead to changes in treatment (GRADE: Low) and generally may increase physician confidence in treatment recommendations (GRADE: Low).Our economic evidence review showed that GEP tests are generally cost-effective compared with usual care.Our primary economic evaluation showed that all GEP test strategies were more effective (led to more quality-adjusted life-years [QALYs]) than usual care and can be considered cost-effective below a willingness-to-pay of $20,000 per QALY gained. There was some uncertainty in our results. At a willingness-to-pay of $50,000 per QALY gained, the probability of each test being cost-effective compared to usual care was 63.0%, 89.2%, 89.2%, and 100% for EndoPredict, MammaPrint, Oncotype DX, and Prosigna, respectively.Sensitivity analyses showed our results were robust to variation in subgroups considered (i.e., LN+ and premenopausal), discount rates, age, and utilities. However, cost parameter assumptions did influence our results. Our scenario analysis comparing tests showed Oncotype DX was likely cost-effective compared with MammaPrint, and Prosigna was likely cost-effective compared with EndoPredict. When the GEP tests were compared with a clinical tool, the cost-effectiveness of the tests varied. Assuming a higher uptake of GEP tests, we estimated the budget impact to publicly fund GEP tests in Ontario would be between $1.29 million (Year 1) and $2.22 million (Year 5) compared to the current scenario of publicly funded GEP tests through the out-of-country program.Gene expression profiling tests are valued by patients and physicians for the additional information they provide for treatment decision-making. Patients are satisfied with what they learn from GEP tests and feel GEP tests can help reduce decisional uncertainty and anxiety. CONCLUSIONS Gene expression profiling tests can likely prognosticate the risk of distant recurrence and some tests may also predict chemotherapy benefit. In people with breast cancer that is ER+, LN-, and human epidermal growth factor receptor 2 (HER2)-negative, GEP tests are likely cost-effective compared with no testing. The GEP tests are also likely cost-effective in LN+ and premenopausal people. Compared with funding GEP tests through the out-of-country program, publicly funding GEP tests in Ontario would cost an additional $1 million to $2 million annually, assuming a higher uptake of tests. GEP tests are valued by both patients and physicians for chemotherapy treatment decision-making.
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18
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Meloche M, Kwon HJ, Letarte N, Bussières JF, Vadnais B, Hurlimann T, Lavoie A, Beauchesne MF, de Denus S. Opinion, experience and educational preferences concerning pharmacogenomics: an exploratory study of Quebec pharmacists. Pharmacogenomics 2020; 21:235-245. [DOI: 10.2217/pgs-2019-0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: To evaluate the current opinion, experience and educational preferences of pharmacists in Quebec concerning pharmacogenomics. Method: A web-based survey containing 25 questions was sent to all Quebec pharmacists. Results: Most pharmacists were willing to advise patients (81%) and physicians (84%) on treatment choices based on pharmacogenomic test results after proper training. Only 31% had been previously exposed to pharmacogenomic test results, and 91% were favorable to pharmacogenomics training, with e-learning through interactive video sessions (69%). The preferred training session length was between 1 and 3 h (59%). Hospital pharmacists were more often exposed to pharmacogenomic tests (p < 0.0001) and more frequently advised patients on treatment choices (p < 0.001) than community pharmacists. Conclusion: Pharmacists remain favorable toward pharmacogenomics, but its use in clinical practice stays limited. Identifying the educational preferences of pharmacists may help in the development of educational programs to help them integrate pharmacogenomics in their clinical practice.
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Affiliation(s)
- Maxime Meloche
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Montreal Heart Institute, Montreal, Canada
| | - Hyuk J Kwon
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Nathalie Letarte
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Jean-François Bussières
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Department of Pharmacy, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Barbara Vadnais
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Department of Pharmacy, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Thierry Hurlimann
- Department of Social & Preventive Medicine, Bioethics Programs, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Annie Lavoie
- Department of Pharmacy, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie-Centre Hospitalier Universitaire de Sherbrooke, Installations Hôtel-Dieu et Fleurimont, Sherbrooke, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Montreal Heart Institute, Montreal, Canada
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19
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Masucci L, Torres S, Eisen A, Trudeau M, Tyono I, Saunders H, Chan KW, Isaranuwatchai W. Cost-utility analysis of 21-gene assay for node-positive early breast cancer. ACTA ACUST UNITED AC 2019; 26:307-318. [PMID: 31708649 DOI: 10.3747/co.26.4769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background For women with lymph node (ln)-positive, estrogen receptor-positive, and her2 (human epidermal growth factor receptor 2)-negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1-3 positive lns and a lower risk of recurrence. In the present study, we performed a cost-utility analysis comparing use of the 21-gene rs assay with current practice from the perspective of a Canadian health care payer. Methods A Markov model was developed to determine costs and quality-adjusted life-years (qalys) over a patient's lifetime. Patient outcomes in both study groups were examined based on published clinical trials. Costs were derived primarily from published Canadian sources. Costs and outcomes were discounted at 1.5% annually, and costs are reported in 2016 Canadian dollars. A probabilistic analysis was used, and the model parameters were varied in a sensitivity analysis. Results The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice. The probabilistic analysis revealed that 70% of the 10,000 simulated incremental cost-effectiveness ratios were in the southeast quadrant. The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice. Conclusions Use of the 21-gene rs assay could be a cost-effective strategy for Ontario patients with estrogen receptor-positive, her2-negative early bca and 1-3 positive lns.
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Affiliation(s)
- L Masucci
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - S Torres
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
| | - A Eisen
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Cancer Care Ontario, University of Toronto, Toronto, ON
| | - M Trudeau
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Cancer Care Ontario, University of Toronto, Toronto, ON
| | - I Tyono
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
| | - H Saunders
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - K W Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Cancer Care Ontario, University of Toronto, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, University of Toronto, Toronto, ON
| | - W Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, University of Toronto, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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20
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Dieckmeyer M, Ruschke S, Rohrmeier A, Syväri J, Einspieler I, Seifert-Klauss V, Schmidmayr M, Metz S, Kirschke JS, Rummeny EJ, Zimmer C, Karampinos DC, Baum T. Vertebral bone marrow fat fraction changes in postmenopausal women with breast cancer receiving combined aromatase inhibitor and bisphosphonate therapy. BMC Musculoskelet Disord 2019; 20:515. [PMID: 31694630 PMCID: PMC6836649 DOI: 10.1186/s12891-019-2916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Quantification of vertebral bone marrow (VBM) water–fat composition has been proposed as advanced imaging biomarker for osteoporosis. Estrogen deficiency is the primary reason for trabecular bone loss in postmenopausal women. By reducing estrogen levels aromatase inhibitors (AI) as part of breast cancer therapy promote bone loss. Bisphosphonates (BP) are recommended to counteract this adverse drug effect. The purpose of our study was to quantify VBM proton density fat fraction (PDFF) changes at the lumbar spine using chemical shift encoding-based water-fat MRI (CSE-MRI) and bone mineral density (BMD) changes using dual energy X-ray absorptiometry (DXA) related to AI and BP treatment over a 12-month period. Methods Twenty seven postmenopausal breast cancer patients receiving AI therapy were recruited for this study. 22 subjects completed the 12-month study. 14 subjects received AI and BP (AI+BP), 8 subjects received AI without BP (AI-BP). All subjects underwent 3 T MRI. An eight-echo 3D spoiled gradient-echo sequence was used for CSE-based water-fat separation at the lumbar spine to generate PDFF maps. After manual segmentation of the vertebral bodies L1-L5 PDFF values were extracted for each vertebra and averaged for each subject. All subjects underwent DXA of the lumbar spine measuring the average BMD of L1-L4. Results Baseline age, PDFF and BMD showed no significant difference between the two groups (p > 0.05). There was a relative longitudinal increase in mean PDFF (∆relPDFF) in both groups (AI+BP: 5.93%; AI-BP: 3.11%) which was only significant (p = 0.006) in the AI+BP group. ∆relPDFF showed no significant difference between the two groups (p > 0.05). There was no significant longitudinal change in BMD (p > 0.05). Conclusions Over a 12-month period, VBM PDFF assessed with CSE-MRI significantly increased in subjects receiving AI and BP. The present results contradict previous results regarding the effect of only BP therapy on bone marrow fat content quantified by magnetic resonance spectroscopy and bone biopsies. Future longer-term follow-up studies are needed to further characterize the effects of combined AI and BP therapy.
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Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroadiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Stefan Ruschke
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Rohrmeier
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan Syväri
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ingo Einspieler
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Vanadin Seifert-Klauss
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Monika Schmidmayr
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephan Metz
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroadiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroadiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroadiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Henry NL, Somerfield MR, Stearns V. Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage Breast Cancer: Update Summary of ASCO Cancer Care Ontario Guideline Endorsement. J Oncol Pract 2019. [DOI: 10.1200/jop.19.00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. Lynn Henry
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Vered Stearns
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD
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Zhou J, Luo LY, Dou Q, Chen H, Chen C, Li GJ, Jiang ZF, Heng PA. Weakly supervised 3D deep learning for breast cancer classification and localization of the lesions in MR images. J Magn Reson Imaging 2019; 50:1144-1151. [PMID: 30924997 DOI: 10.1002/jmri.26721] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The usefulness of 3D deep learning-based classification of breast cancer and malignancy localization from MRI has been reported. This work can potentially be very useful in the clinical domain and aid radiologists in breast cancer diagnosis. PURPOSE To evaluate the efficacy of 3D deep convolutional neural network (CNN) for diagnosing breast cancer and localizing the lesions at dynamic contrast enhanced (DCE) MRI data in a weakly supervised manner. STUDY TYPE Retrospective study. SUBJECTS A total of 1537 female study cases (mean age 47.5 years ±11.8) were collected from March 2013 to December 2016. All the cases had labels of the pathology results as well as BI-RADS categories assessed by radiologists. FIELD STRENGTH/SEQUENCE 1.5 T dynamic contrast-enhanced MRI. ASSESSMENT Deep 3D densely connected networks were trained under image-level supervision to automatically classify the images and localize the lesions. The dataset was randomly divided into training (1073), validation (157), and testing (307) subsets. STATISTICAL TESTS Accuracy, sensitivity, specificity, area under receiver operating characteristic curve (ROC), and the McNemar test for breast cancer classification. Dice similarity for breast cancer localization. RESULTS The final algorithm performance for breast cancer diagnosis showed 83.7% (257 out of 307) accuracy (95% confidence interval [CI]: 79.1%, 87.4%), 90.8% (187 out of 206) sensitivity (95% CI: 80.6%, 94.1%), 69.3% (70 out of 101) specificity (95% CI: 59.7%, 77.5%), with the area under the curve ROC of 0.859. The weakly supervised cancer detection showed an overall Dice distance of 0.501 ± 0.274. DATA CONCLUSION 3D CNNs demonstrated high accuracy for diagnosing breast cancer. The weakly supervised learning method showed promise for localizing lesions in volumetric radiology images with only image-level labels. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1144-1151.
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Affiliation(s)
- Juan Zhou
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 10071, People's Republic of China
| | - Lu-Yang Luo
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Qi Dou
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Hao Chen
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
- Imsight Medical Technology Co., Ltd., Nanshan, Shenzhen, 518000, People's Republic of China
| | - Cheng Chen
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Gong-Jie Li
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 10071, People's Republic of China
| | - Ze-Fei Jiang
- Department of Breast Cancer, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China, 100071
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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23
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Henry NL, Somerfield MR, Abramson VG, Ismaila N, Allison KH, Anders CK, Chingos DT, Eisen A, Ferrari BL, Openshaw TH, Spears PA, Vikas P, Stearns V. Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: Update of the ASCO Endorsement of the Cancer Care Ontario Guideline. J Clin Oncol 2019; 37:1965-1977. [DOI: 10.1200/jco.19.00948] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology endorsement of the Cancer Care Ontario recommendations on the Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer. METHODS Two phase III trials—the Trial Assigning Individualized Options for Treatment (TAILORx) in women with hormone receptor–positive, node-negative tumors and the Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy (MINDACT) trial—provided the evidence for this update. UPDATED RECOMMENDATIONS Shared decision making between clinicians and patients is appropriate for adjuvant systemic therapy for breast cancer. For patients older than age 50 years and whose tumors have Onco type DX recurrence scores less than 26, and for patients age 50 years or younger whose tumors have Onco type DX recurrence scores less than 16, there is little to no benefit from chemotherapy. Clinicians may offer endocrine therapy alone for these patients. For patients age 50 years or younger with recurrence scores of 16 to 25, clinicians may offer chemoendocrine therapy. Patients with recurrence scores greater than 30 should be considered candidates for chemoendocrine therapy. Based on informal consensus, the Panel recommends that oncologists may offer chemoendocrine therapy to patients with Onco type DX scores of 26 to 30. The MammaPrint assay could be used to guide decisions on withholding adjuvant systemic chemotherapy in patients with hormone receptor–positive lymph node–negative breast cancer and in select patients with lymph node–positive cancers. In both patients with node-positive and node-negative disease, evidence of clinical utility of the MammaPrint assay was only apparent in those determined to be at high clinical risk; the Panel thus did not recommend use of MammaPrint assay in patients determined to be at low clinical risk. Remaining recommendations from the 2016 ASCO guideline endorsement are unchanged. Additional information is available at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
- N. Lynn Henry
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | | | - Carey K. Anders
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Andrea Eisen
- Sunnybrook Odette Cancer Centre, Cancer Care Ontario, Toronto, Canada
| | | | | | - Patricia A. Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Praveen Vikas
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA
| | - Vered Stearns
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD
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24
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Hassett MJ, Banegas M, Uno H, Weng S, Cronin AM, O'Keeffe Rosetti M, Carroll NM, Hornbrook MC, Ritzwoller DP. Spending for Advanced Cancer Diagnoses: Comparing Recurrent Versus De Novo Stage IV Disease. J Oncol Pract 2019; 15:e616-e627. [PMID: 31107629 DOI: 10.1200/jop.19.00004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Spending for patients with advanced cancer is substantial. Past efforts to characterize this spending usually have not included patients with recurrence (who may differ from those with de novo stage IV disease) or described which services drive spending. METHODS Using SEER-Medicare data from 2008 to 2013, we identified patients with breast, colorectal, and lung cancer with either de novo stage IV or recurrent advanced cancer. Mean spending/patient/month (2012 US dollars) was estimated from 12 months before to 11 months after diagnosis for all services and by the type of service. We describe the absolute difference in mean monthly spending for de novo versus recurrent patients, and we estimate differences after controlling for type of advanced cancer, year of diagnosis, age, sex, comorbidity, and other factors. RESULTS We identified 54,982 patients with advanced cancer. Before diagnosis, mean monthly spending was higher for recurrent patients (absolute difference: breast, $1,412; colorectal, $3,002; lung, $2,805; all P < .001), whereas after the diagnosis, it was higher for de novo patients (absolute difference: breast, $2,443; colorectal, $4,844; lung, $2,356; all P < .001). Spending differences were driven by inpatient, physician, and hospice services. Across the 2-year period around the advanced cancer diagnosis, adjusted mean monthly spending was higher for de novo versus recurrent patients (spending ratio: breast, 2.39 [95% CI, 2.05 to 2.77]; colorectal, 2.64 [95% CI, 2.31 to 3.01]; lung, 1.46 [95% CI, 1.30 to 1.65]). CONCLUSION Spending for de novo cancer was greater than spending for recurrent advanced cancer. Understanding the patterns and drivers of spending is necessary to design alternative payment models and to improve value.
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Affiliation(s)
- Michael J Hassett
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Harvard Medical School, Boston, MA
| | | | - Hajime Uno
- 1 Dana-Farber Cancer Institute, Boston, MA.,2 Harvard Medical School, Boston, MA
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25
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Tervonen HE, Daniels B, Tang M, Preen DB, Pearson SA. Patterns of endocrine therapy in a national cohort of early stage HER2-positive breast cancer patients. Pharmacoepidemiol Drug Saf 2019; 28:812-820. [DOI: 10.1002/pds.4751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/26/2018] [Accepted: 01/20/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Hanna E. Tervonen
- Medicines Policy Research Unit, Centre for Big Data Research in Health; University of New South Wales; Sydney New South Wales Australia
| | - Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health; University of New South Wales; Sydney New South Wales Australia
| | - Monica Tang
- Medicines Policy Research Unit, Centre for Big Data Research in Health; University of New South Wales; Sydney New South Wales Australia
| | - David B. Preen
- School of Population and Global Health; University of Western Australia; Perth Western Australia Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health; University of New South Wales; Sydney New South Wales Australia
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26
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Ritzwoller DP, Fishman PA, Banegas MP, Carroll NM, O'Keeffe‐Rosetti M, Cronin AM, Uno H, Hornbrook MC, Hassett MJ. Medical Care Costs for Recurrent versus De Novo Stage IV Cancer by Age at Diagnosis. Health Serv Res 2018; 53:5106-5128. [PMID: 30043542 PMCID: PMC6232408 DOI: 10.1111/1475-6773.13014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To address the knowledge gap regarding medical care costs for advanced cancer patients, we compared costs for recurrent versus de novo stage IV breast, colorectal, and lung cancer patients. DATA SOURCES/STUDY SETTING Virtual Data Warehouse (VDW) information from three Kaiser Permanente regions: Colorado, Northwest, and Washington. STUDY DESIGN We identified patients aged ≥21 with de novo or recurrent breast (nde novo = 352; nrecurrent = 765), colorectal (nde novo = 1,072; nrecurrent = 542), and lung (nde novo = 4,041; nrecurrent = 340) cancers diagnosed 2000-2012. We estimated average total monthly and annual costs in the 12 months preceding, month of, and 12 months following the index de novo/recurrence date, stratified by age at diagnosis (<65, ≥65). Generalized linear repeated-measures models controlled for demographics and comorbidity. PRINCIPAL FINDINGS In the pre-index period, monthly costs were higher for recurrent than for de novo breast (<65: +$2,431; ≥65: +$1,360), colorectal (<65: +$3,219; ≥65: +$2,247), and lung cancer (<65: +$3,086; ≥65: +$2,260) patients. Conversely, during the index and post-index periods, costs were higher for de novo patients. Average total annual pre-index costs were five- to ninefold higher for recurrent versus de novo patients <65. CONCLUSIONS Cost differences by type of advanced cancer and by age suggest heterogeneous patterns of care that merit further investigation.
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Affiliation(s)
| | - Paul A. Fishman
- Department of Health ServicesUniversity of WashingtonSeattleWA
- Kaiser Permanente Washington Health Research InstituteSeattleWA
| | | | | | | | | | - Hajime Uno
- Dana‐Farber Cancer InstituteBostonMA
- Harvard Medical SchoolBostonMA
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27
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Wilson FR, Coombes ME, Brezden-Masley C, Yurchenko M, Wylie Q, Douma R, Varu A, Hutton B, Skidmore B, Cameron C. Herceptin® (trastuzumab) in HER2-positive early breast cancer: a systematic review and cumulative network meta-analysis. Syst Rev 2018; 7:191. [PMID: 30428932 PMCID: PMC6237027 DOI: 10.1186/s13643-018-0854-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/23/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Originator trastuzumab (Herceptin®; H) is an antibody-targeted therapy to treat patients with human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC). We investigated the overall survival (OS) advantage conferred by the addition of H to chemotherapy for HER2+ EBC patients and how the OS advantage changed over time. METHODS A systematic literature review (SLR) identified randomized controlled trials (RCTs) and non-randomized studies (NRSs) published from January 1, 1990 to January 19, 2017, comparing systemic therapies used in the neoadjuvant/adjuvant settings to treat HER2+ EBC patients. Bayesian cumulative network meta-analyses (cNMAs) of OS were conducted to assess the published literature over time. Heterogeneity was assessed through sensitivity and subgroup analyses. RESULTS The SLR identified 31 unique studies (28 RCTs, 3 NRSs) included in the OS analyses from 2008 to 2016. In the reference case cNMA (RCTs alone), initial evidence demonstrated an OS advantage for H/chemotherapy compared with chemotherapy alone in HER2+ EBC patients. As additional OS data were published, the precision around this survival benefit strengthened over time. Both H/anthracycline-containing chemotherapy and H/non-anthracycline-containing chemotherapy regimens provided similar OS advantages for HER2+ EBC patients. CONCLUSION This analysis represents the most comprehensive SLR/cNMA to date of published OS data in HER2+ EBC studies. These findings demonstrate why H/chemotherapy is now the established standard of care in HER2+ EBC. In the case of H, the benefits of early patient access far outweighed the risk of waiting for more precise information. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017055763.
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Affiliation(s)
- Florence R Wilson
- Cornerstone Research Group Inc., Suite 204, 3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | | | | | | | - Quinlan Wylie
- Cornerstone Research Group Inc., Suite 204, 3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | - Reuben Douma
- Cornerstone Research Group Inc., Suite 204, 3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | - Abhishek Varu
- Cornerstone Research Group Inc., Suite 204, 3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Public Health and Preventative Medicine, University of Ottawa School of Epidemiology, Ottawa, ON, Canada
| | | | - Chris Cameron
- Cornerstone Research Group Inc., Suite 204, 3228 South Service Road, Burlington, ON, L7N 3H8, Canada.
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28
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Bello DM, Russell C, McCullough D, Tierno M, Morrow M. Lymph Node Status in Breast Cancer Does Not Predict Tumor Biology. Ann Surg Oncol 2018; 25:2884-2889. [PMID: 29968028 PMCID: PMC6123264 DOI: 10.1245/s10434-018-6598-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVE The 21-gene Oncotype DX® Breast Recurrence Score® (RS) assay has been prospectively validated as prognostic and predictive in node-negative, estrogen receptor-positive (ER+)/HER2- breast cancer patients. Less is known about its prognostic role in node-positive breast cancer. We compared RS results among patients with lymph node-negative (N0), micrometastatic (N1mi), and macrometastatic (N+) breast cancer to determine if nodal metastases are associated with more aggressive biology, as determined by RS. METHODS Overall, 610,350 tumor specimens examined by the Genomic Health laboratory from February 2004 to August 2017 were studied. Histology was classified centrally, while lymph node status was determined locally. RS distribution (low: < 18; intermediate: 18-30; high: ≥ 31) was compared by nodal status. RESULTS Eighty percent (n = 486,013) of patients were N0, 4% (n = 24,325) were N1mi, 9% (n = 56,100) were N+, and 7% (n = 43,912) had unknown nodal status. Mean RS result was 18, 16.7, 17.3 and 18.9 in the N0, N1mi, N+, and unknown groups, respectively. An RS ≥ 31 was seen in 10% of N0 patients, 7% of N1mi patients, and 8.0% of N+ patients. The likelihood of an RS ≥ 31 in N1mi and N+ patients varied with tumor histology, with only 2% of patients with classic infiltrating lobular cancer having an RS ≥ 31, versus 7-9% of those with ductal carcinoma. CONCLUSIONS RS distribution among N0, N1mi, and N+ patients is similar, suggesting a spectrum of biology and potential chemotherapy benefit exists among node-negative and node-positive ER+/HER2- breast cancer patients. If RxPONDER does not show a chemotherapy benefit in N+ patients with a low RS result, our findings indicate that substantial numbers of patients could be spared the burden of chemotherapy.
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MESH Headings
- Aged
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/secondary
- Female
- Follow-Up Studies
- Gene Expression Profiling/methods
- Humans
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Prospective Studies
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
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Affiliation(s)
- Danielle M Bello
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lebert J, Lester R, Powell E, Seal M, McCarthy J. Advances in the systemic treatment of triple-negative breast cancer. Curr Oncol 2018; 25:S142-S150. [PMID: 29910657 PMCID: PMC6001760 DOI: 10.3747/co.25.3954] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Triple-negative breast cancer constitutes a heterogeneous group of malignancies that are often aggressive and associated with a poor prognosis. Molecular characterization, while not a standard of care, can further subtype triple-negative breast cancer and provide insight into prognostication and behaviour. Optimal chemotherapy regimens have yet to be established; however, there have been advances in the systemic treatment of triple-negative breast cancer in the neoadjuvant, adjuvant, and metastatic settings. In this review, we discuss evidence for the potential benefit of neoadjuvant platinum-based chemotherapy, adjuvant combination chemotherapy with weekly paclitaxel, and BRCA mutation-directed therapy in the metastatic setting. The role for adjuvant capecitabine in patients who do not achieve a pathologic complete response with neoadjuvant chemotherapy is reviewed. Future directions and data concerning novel targeted agents are reviewed, including the most recent data on parp [poly (adp-ribose) polymerase] inhibitors, antiandrogen agents, and immunotherapy.
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Affiliation(s)
- J.M. Lebert
- Memorial University of Newfoundland, Saint John’s, NL
| | - R. Lester
- Memorial University of Newfoundland, Saint John’s, NL
| | - E. Powell
- Memorial University of Newfoundland, Saint John’s, NL
| | - M. Seal
- Memorial University of Newfoundland, Saint John’s, NL
| | - J. McCarthy
- Memorial University of Newfoundland, Saint John’s, NL
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Abstract
Background A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability. Methods Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor-positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario's Program in Evidence Based Care (cco's pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool. Results The quality of the cpgs was greatest for the guidelines developed by asco and cco's pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory. Conclusions Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations-such as intrinsic guideline characteristics and the needs of end users-is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.
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Affiliation(s)
- N. Kumar Tyagi
- Division of Medical Oncology, Department of Oncology, McMaster University, Hamilton, ON
| | - S. Dhesy-Thind
- Division of Medical Oncology, Department of Oncology, McMaster University, Hamilton, ON
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31
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Torres S, Trudeau M, Gandhi S, Warner E, Verma S, Pritchard KI, Petrella T, Hew-Shue M, Chao C, Eisen A. Prospective Evaluation of the Impact of the 21-Gene Recurrence Score Assay on Adjuvant Treatment Decisions for Women with Node-Positive Breast Cancer in Ontario, Canada. Oncologist 2018; 23:768-775. [PMID: 29371476 DOI: 10.1634/theoncologist.2017-0346] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/14/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The 21-gene Recurrence Score (RS) assay is only reimbursed in Ontario for node-negative and micrometastatic node-positive (N+) early-stage breast cancer (EBC). We carried out a prospective study to evaluate the impact of the assay on treatment decisions for women with N+ EBC. SUBJECTS, MATERIALS, AND METHODS Women with estrogen receptor-positive, human epidermal growth receptor 2-negative EBC and one to three positive axillary lymph nodes, who were candidates for adjuvant chemotherapy in addition to hormonal treatment, but in whom the benefit of chemotherapy was uncertain, were eligible. The primary objective was to characterize how the results of the RS assay affected physicians' recommendations for adjuvant chemotherapy. Secondary objectives were to characterize changes in the physicians' and patients' level of confidence in treatment recommendations, to determine whether the results of the RS assay affected patients' treatment preferences, and to determine the final treatment administered. RESULTS Seventy-two patients were recruited; the mean age was 61. RS was <18 in 55%, between 18 and 30 in 36%, and ≥31 in 9% of patients. Treatment recommendations changed in 36% of all evaluable patients. The most significant change was in the group with a low RS. Physicians' and patients' confidence in treatment recommendations increased in 49% and 54% of cases, respectively. Upfront chemotherapy was recommended to 79% of patients before the assay; 42% ultimately received chemotherapy. CONCLUSION The RS assay resulted in a substantial decrease in the number of patients who received chemotherapy and in an increase in physicians' and patients' confidence in the adjuvant treatment recommendations. IMPLICATIONS FOR PRACTICE This is the first decision impact study to include exclusively women with ER-positive, HER2-negative, early-stage breast cancer with 1-3 positive lymph nodes, a population typically treated with adjuvant chemotherapy. This study provides evidence that, in these patients, the Oncotype Dx Recurrence Score assay influences systemic treatment decisions. Most of the changes in treatment recommendation resulted in withdrawal of chemotherapy or change in recommendation from a chemotherapy regimen with anthracyclines to a taxane-only regimen. If prospective studies confirm that these decisions result in good outcomes, a reduction in the use of chemotherapy might result in pharmacoeconomic savings.
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Affiliation(s)
- Sofia Torres
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maureen Trudeau
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sonal Gandhi
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ellen Warner
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sunil Verma
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Kathleen I Pritchard
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Teresa Petrella
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Hew-Shue
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Calvin Chao
- Genomic Health, Inc., Redwood City, California, USA
| | - Andrea Eisen
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Predicting Neoadjuvant Chemotherapy in Nonconcentric Shrinkage Pattern of Breast Cancer Using 1H-Magnetic Resonance Spectroscopic Imaging. J Comput Assist Tomogr 2018; 42:12-18. [DOI: 10.1097/rct.0000000000000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dalasanur Nagaprashantha L, Adhikari R, Singhal J, Chikara S, Awasthi S, Horne D, Singhal SS. Translational opportunities for broad-spectrum natural phytochemicals and targeted agent combinations in breast cancer. Int J Cancer 2017; 142:658-670. [PMID: 28975625 DOI: 10.1002/ijc.31085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
Breast cancer (BC) prevention and therapy in the context of life-style risk factors and biological drivers is a major focus of developmental therapeutics in oncology. Obesity, alcohol, chronic estrogen signaling and smoking have distinct BC precipitating and facilitating effects that may act alone or in combination. A spectrum of signaling events including enhanced oxidative stress and changes in estrogen-receptor (ER)-dependent and -independent signaling drive the progression of BC. Breast tumors modulate ERα/ERβ ratio, upregulate proliferative pathways driven by ERα and HER2 with a parallel loss and/or downregulation of tumor suppressors such as TP53 and PTEN which together impact the efficacy of therapeutic strategies and frequently lead to emergence of drug resistance. Natural phytochemicals modulate oxidative stress, leptin, integrin, HER2, MAPK, ERK, Wnt/β-catenin and NFκB signaling along with regulating ERα and ERβ, thereby presenting unique opportunities for both primary and combinatorial interventions in BC. In this regard, this article focuses on critical analyses of the evidence from multiple studies on the efficacy of natural phytochemicals in BC. In addition, areas in which the combinations of such effective natural phytochemicals with approved and/or developing anticancer agents can be translationally beneficial are discussed to derive evidence-based inference for addressing challenges in BC control and therapy.
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Affiliation(s)
| | | | - Jyotsana Singhal
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
| | - Shireen Chikara
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
| | - Sanjay Awasthi
- Texas Tech University Health Sciences Center, Lubbock, TX
| | - David Horne
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
| | - Sharad S Singhal
- Department of Molecular Medicine, City of Hope National Medical Center, Duarte, CA
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Sopik V, Sun P, Narod SA. The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients. Breast Cancer Res Treat 2017; 165:391-402. [DOI: 10.1007/s10549-017-4333-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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35
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Del Mastro L. Optimal Adjuvant Chemotherapy Regimens for Patients With Early-Stage Breast Cancer. J Clin Oncol 2017; 35:1137-1138. [DOI: 10.1200/jco.2016.68.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lucia Del Mastro
- Lucia Del Mastro, IRCCS AOU San Martino –IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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36
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Nyrop KA, Williams GR, Muss HB, Shachar SS. Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence? Breast Cancer Res Treat 2016; 158:203-17. [PMID: 27342454 DOI: 10.1007/s10549-016-3874-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022]
Abstract
Most breast cancer (BC) tumors are early stage and hormone receptor positive, where treatment generally includes adjuvant endocrine treatment (ET). Oncology providers and women about to start ET want to know about side effects, including potential weight gain. The aim of this study was a literature review to identify the independent effect of ET on post-diagnosis weight gain. Weight gain is of concern with regard to potential associations with BC recurrence, mortality, and quality of life in survivorship. We conducted a targeted review of the literature. Thirty-eight studies met our inclusion criteria. Patient-reported weight gain ranged widely from 18 to 52 % of patients in Year 1 and from 7 to 55 % in Year 5. Some studies reported categories of weight change: lost weight (9-17 %), stable weight (47-64 %), and gained weight (27-36 %). Most studies comparing ET with placebo or tamoxifen with AI reported no significant difference between the two groups. Wide-ranging and inconsistent results point to the need for further research to clarify annual weight change (loss, gain, stability) from BC diagnosis through 5 years of ET and beyond. There is also a need to explore weight change by type of ET and to explore risk factors for weight gain in women on ET, including tumor type, sociodemographic characteristics, and health behaviors. More specific information is needed to identify high-risk BC patients who could be targeted for weight management interventions.
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Affiliation(s)
- K A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.
| | - G R Williams
- School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - H B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - S S Shachar
- School of Medicine, University of North Carolina at Chapel Hill, Haifa, Israel
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Henry NL, Somerfield MR, Krop IE. Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: American Society of Clinical Oncology Endorsement of Cancer Care Ontario Guideline Recommendations Summary. J Oncol Pract 2016. [DOI: 10.1200/jop.2016.011205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and Dana-Farber Cancer Institute, Boston, MA
| | - Mark R. Somerfield
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and Dana-Farber Cancer Institute, Boston, MA
| | - Ian E. Krop
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and Dana-Farber Cancer Institute, Boston, MA
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38
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Denduluri N, Somerfield MR, Wolff AC. Selection of Optimal Adjuvant Chemotherapy Regimens for Early Breast Cancer and Adjuvant Targeted Therapy for HER2-Positive Breast Cancers: An American Society of Clinical Oncology Guideline Adaptation of the Cancer Care Ontario Clinical Practice Guideline Summary. J Oncol Pract 2016. [DOI: 10.1200/jop.2016.012344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Neelima Denduluri
- US Oncology Network, Virginia Cancer Specialists, Arlington; American Society of Clinical Oncology, Alexandria, VA; and Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Mark R. Somerfield
- US Oncology Network, Virginia Cancer Specialists, Arlington; American Society of Clinical Oncology, Alexandria, VA; and Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Antonio C. Wolff
- US Oncology Network, Virginia Cancer Specialists, Arlington; American Society of Clinical Oncology, Alexandria, VA; and Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Jablonska K, Grzegrzolka J, Podhorska-Okolow M, Stasiolek M, Pula B, Olbromski M, Gomulkiewicz A, Piotrowska A, Rys J, Ambicka A, Ong SH, Zabel M, Dziegiel P. Prolactin-induced protein as a potential therapy response marker of adjuvant chemotherapy in breast cancer patients. Am J Cancer Res 2016; 6:878-893. [PMID: 27293986 PMCID: PMC4889707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/29/2016] [Indexed: 06/06/2023] Open
Abstract
Many studies are dedicated to exploring the molecular mechanisms of chemotherapy-resistance in breast cancer (BC). Some of them are focused on searching for candidate genes responsible for this process. The aim of this study was typing the candidate genes associated with the response to standard chemotherapy in the case of invasive ductal carcinoma. Frozen material from 28 biopsies obtained from IDC patients with different responses to chemotherapy were examined using gene expression microarray, Real-Time PCR (RT-PCR) and Western blot (WB). Based on the microarray results, further analysis of candidate gene expression was evaluated in 120 IDC cases by RT-PCR and in 224 IDC cases by immunohistochemistry (IHC). The results were correlated with clinical outcome and molecular subtype of the BC. Gene expression microarray revealed Prolactin-Induced Peptide (PIP) as a single gene differentially expressed in BC therapy responder or non-responder patients (p <0.05). The level of PIP expression was significantly higher in the BC therapy responder group than in the non-responder group at mRNA (p=0.0092) and protein level (p=0.0256). Expression of PIP mRNA was the highest in estrogen receptor positive (ER+) BC cases (p=0.0254) and it was the lowest in triple negative breast cancer (TNBC) (p=0.0336). Higher PIP mRNA expression was characterized by significantly longer disease free survival (DFS, p=0.0093), as well as metastasis free survival (MFS, p=0.0144). Additionally, PIP mRNA and PIP protein expression levels were significantly higher in luminal A than in other molecular subtypes and TNBC. Moreover significantly higher PIP expression was observed in G1, G2 vs. G3 cases (p=0.0027 and p=0.0013, respectively). Microarray analysis characterized PIP gene as a candidate for BC standard chemotherapy response marker. Analysis of clinical data suggests that PIP may be a good prognostic and predictive marker in IDC patients. Higher levels of PIP were related to longer DFS and MFS but not with OS.
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Affiliation(s)
- Karolina Jablonska
- Department of Histology and Embryology, Wroclaw Medical UniversityWroclaw, Poland
| | - Jedrzej Grzegrzolka
- Department of Histology and Embryology, Wroclaw Medical UniversityWroclaw, Poland
| | | | - Mariusz Stasiolek
- Department of Neurology, Polish Mother’s Memorial Hospital-Research InstituteLodz, Poland
| | - Bartosz Pula
- Department of Histology and Embryology, Wroclaw Medical UniversityWroclaw, Poland
| | - Mateusz Olbromski
- Department of Histology and Embryology, Wroclaw Medical UniversityWroclaw, Poland
| | | | | | - Janusz Rys
- Department of Tumor Pathology, Centre of Oncology, Maria Sklodowska-Curie Memorial InstituteCracow Branch, Cracow, Poland
| | - Aleksandra Ambicka
- Department of Tumor Pathology, Centre of Oncology, Maria Sklodowska-Curie Memorial InstituteCracow Branch, Cracow, Poland
| | - Siew Hwa Ong
- Acumen Research Laboratories, National University of SingaporeSingapore
| | - Maciej Zabel
- Department of Histology and EmbryologyPoznan, Poland
| | - Piotr Dziegiel
- Department of Histology and Embryology, Wroclaw Medical UniversityWroclaw, Poland
- Department of Physiotherapy, University School of Physical EducationWroclaw, Poland
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40
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Denduluri N, Somerfield MR, Eisen A, Holloway JN, Hurria A, King TA, Lyman GH, Partridge AH, Telli ML, Trudeau ME, Wolff AC. Selection of Optimal Adjuvant Chemotherapy Regimens for Human Epidermal Growth Factor Receptor 2 (HER2) -Negative and Adjuvant Targeted Therapy for HER2-Positive Breast Cancers: An American Society of Clinical Oncology Guideline Adaptation of the Cancer Care Ontario Clinical Practice Guideline. J Clin Oncol 2016; 34:2416-27. [PMID: 27091714 DOI: 10.1200/jco.2016.67.0182] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A Cancer Care Ontario (CCO) guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer including adjuvant targeted therapy for human epidermal growth factor receptor 2 (HER2)-positive breast cancers was identified for adaptation. METHODS The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The CCO guideline was reviewed for developmental rigor and content applicability. RESULTS On the basis of the content review of the CCO guideline, the ASCO Panel agreed that, in general, the recommendations were clear and thorough and were based on the most relevant scientific evidence, and they presented options that will be acceptable to patients. However, for some topics addressed in the CCO guideline, the ASCO Panel formulated a set of adapted recommendations on the basis of local context and practice beliefs of the Panel members. RECOMMENDATIONS Decisions regarding adjuvant chemotherapy regimens should take into account baseline recurrence risk, toxicities, likelihood of benefit, and host factors such as comorbidities. In high-risk HER2-negative populations with excellent performance status, anthracycline- and taxane-containing regimens are the standard of care. Docetaxel and cyclophosphamide for four cycles is an acceptable non-anthracycline regimen. In high-risk HER2-positive disease, sequential anthracycline and taxanes administered concurrently with trastuzumab or docetaxel, carboplatin, and trastuzumab for six cycles are recommended. An alternative regimen in a lower-risk, node-negative, HER2-positive population is paclitaxel and trastuzumab once per week for 12 cycles. Trastuzumab should be given for 1 year. Platinum salts should not be routinely administered in the adjuvant triple-negative population until survival efficacy data become available.
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Affiliation(s)
- Neelima Denduluri
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Mark R Somerfield
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Andrea Eisen
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Jamie N Holloway
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Arti Hurria
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Tari A King
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Gary H Lyman
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Ann H Partridge
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Melinda L Telli
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Maureen E Trudeau
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Antonio C Wolff
- Neelima Denduluri, US Oncology Network, Virginia Cancer Specialists, Arlington; Jamie N. Holloway, Patient Representative, Arlington; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Andrea Eisen and Maureen E. Trudeau, Sunnybrook Health Sciences Centre, and Cancer Care Ontario, Toronto, Ontario, Canada; Arti Hurria, City of Hope, Duarte; Melinda L. Telli, Stanford University, Palo Alto, CA; Tari A. King, Dana-Farber/Brigham and Women's Cancer Center; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Adjuvant taxane-based chemotherapy for early stage breast cancer: a real-world comparison of chemotherapy regimens in Ontario. Breast Cancer Res Treat 2015; 152:137-145. [PMID: 26026467 DOI: 10.1007/s10549-015-3441-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to compare survival and risk of adverse events in women with early stage breast cancer (BC) treated with (1) doxorubicin (A), cyclophosphamide (C) + paclitaxel (P), (2) fluorouracil (F), epirubicin (E), cyclophosphamide (C) + docetaxel (D), or (3) dose-dense AC-P. Retrospective cohort study including 8462 women aged ≥18 years, with resected stage I-III BC, diagnosed between 2003 and 2009 in Ontario, identified through linkage of administrative databases. Primary outcome is overall survival (OS). Secondary outcomes are emergency room (ER) visits/hospitalizations, heart failure (HF), and leukemia. 4710 women were treated with FEC-D, 2065 with AC-P, and 1687 with dd AC-P. Adjusted 5-year OS was 92.1, 87.7, and 90.3 %, for each regimen, respectively (p = 0.0006). There was no difference in OS for FEC-D and dd AC-P in the propensity score-matched analyses (HR 1.24, 95 % CI 0.99-1.55). Five-year risk of HF was also similar (HR 1.09; 0.66-1.791.4 % for dd AC-P and 1.3 % for FEC-D and, p = 0.72). Treatment with FEC-D was significantly associated with ER visits and hospital admissions (p < 0.0001). The risks of leukemia were low and similar among the 3 groups (AC-P: 0.34 %, FEC-D: 0.08 %, dd AC-P: 0.12 %; p = 0.09). Although the efficacy of the three regimens was similar to that observed in randomized trials, we report higher toxicity with the use of these regimens in clinical practice. This was especially concerning for the docetaxel-containing regimen.
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