1
|
Basali D, Zabor EC, Houston N, Moore HCF. Abstract P5-14-13: Impact of race on time to treatment initiation and survival in breast cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-14-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Delays in cancer care can have a detrimental impact on breast cancer outcomes. Despite advances in breast cancer treatment and improvements in survival, disparities between racial groups persist. At our own institution, we observed worse breast cancer outcomes in Black versus White patients in spite of similar treatments received. Higher stage at diagnosis and differences in histology appeared to account for only part of the difference. In this study, we evaluate the impact of race on time to initiation of first oncology treatment and overall survival in a large cohort of breast cancer patients treated at our center. Methods: Women diagnosed with stage I-IV breast cancer between 2015 and 2020 at the Cleveland Clinic were identified from our local tumor registry. All women over the age of 18 who followed up at the Cleveland Clinic Main Campus and identified as either Black or White in the electronic medical record (EMR) were included in the initial query. Men and individuals who identified as a race other than Black or White were excluded due to small numbers. There were forty-nine patients in whom the date of first treatment was unknown. Clinical data were reviewed by author D.B. and data not available in the tumor registry were obtained from the EMR. Baseline characteristics, and time to first treatment initiation were reported. Time to treatment initiation was defined as the days from biopsy demonstrating cancer to the date of initiation of any breast cancer treatment modality (surgery, chemotherapy, endocrine therapy, or radiation therapy). Results: A total of 6095 patients were included in the analysis with a median follow-up of 2.7 years. Median age was 62 and Black patients were slightly older than White patients (63 years [range 21-98] versus 62 [range 21-99]; p=0.048). Fewer Black patients had private insurance (38% versus 51%) and more had Medicaid or Medicare compared to White patients (59% versus 45%) (p<0.001). Only 1% of patients had no insurance and this was similar for both Black and White patients. The time from diagnosis to treatment differed by race. Black patients had a median of 36 days from diagnosis to treatment and White patients had a median of 32 days from diagnosis to treatment (p<0.001). Three-year overall survival was 86% (95% CI: 83-89%) for Black patients and 92% (95%CI: 91%-93%) for White patients (p<0.0001). No difference was observed in breast cancer recurrence rates by race (p=0.56). Additional analyses will investigate the contribution of comorbidities, cancer stage, histology, and other patient related factors to racial disparities in overall survival and time to treatment. Conclusion:. Our study highlights real world data on racial disparities in breast cancer treatment initiation and overall survival. Further investigation will seek to identify the impact of patient related factors on these important outcomes. It is critically important for breast cancer treatment teams to be aware of these racial disparities to implement interventions that can attempt to limit them.
Citation Format: Diana Basali, Emily C. Zabor, Narcissa Houston, Halle CF Moore. Impact of race on time to treatment initiation and survival in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-13.
Collapse
Affiliation(s)
- Diana Basali
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Emily C. Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Narcissa Houston
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Halle CF Moore
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
2
|
Aleixo GFP, Wei W, Valente SA, Moore HCF. Abstract P1-08-04: The impact of sarcopenia and sarcopenic obesity detected by bioelectrical impedance analysis in patients with early breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Low muscle mass, known as sarcopenia, is associated with chemotherapy toxicity and reduced survival in women with breast cancer (BC). Sarcopenic obesity, a process in which patients lose muscle mass and increase body adipose mass, is associated with multiple comorbidities and worse outcomes in BC. Most studies to date used Computer Tomography (CT) to obtain the parameters necessary to calculate sarcopenia and sarcopenic obesity. However, CT scans are not routinely performed in women with early BC. Bioelectrical impedance analysis (BIA) is a noninvasive, easy to use tool to assess multiple body composition parameters; it does not expose patients to radiation, and gives results instantaneously. BIA can assess for both sarcopenia and sarcopenic obesity. Our study aims to evaluate the impact of BIA assessed sarcopenia and sarcopenic obesity on treatment-related adverse events in patients with early-stage BC who received (neo)adjuvant chemotherapy.Methods: From a cohort of 713 patients with stage I-III breast cancer who had undergone BIA analyses around the time of their initial cancer diagnosis and treatment, 361 were treated with chemotherapy. BIA was used to generate the Skeletal Muscle Area (SMA), Fat Mass (FM) and Fat-Free Mass (FFM). Skeletal Muscle Index (SMI) was calculated to assess for sarcopenia: SMI= (SMA, cm2)/(patient height, m2). Patients were divided into normal (SMI > 6.75 kg/m2), moderate sarcopenia (SMI between 6.75 and 5.76 kg/m2), and severe sarcopenia (SMI <5.75 kg/m2). Sarcopenic obesity is suggested by an elevated ratio of FM to FFM. Since there is no predefined cut-point for sarcopenic obesity, we compared patients with FM/FFM at or above the median to those below the median. Fisher's exact test was performed to associate patient characteristics and toxicity outcomes with sarcopenia and sarcopenic obesity status.Results: Median age was 60 years old (range: 26 to 88). Moderate Sarcopenia was present in 28% and severe sarcopenia in 6% of patients. The presence of sarcopenia was associated with higher rates of early chemotherapy termination at 17% and 38% among those with moderate or severe sarcopenia compared with 8% of those without sarcopenia (p=0.0006). Hospitalizations related to chemotherapy were higher in patients with moderate (17%) and severe sarcopenia (15%) compared with those without sarcopenia (8%; p=0.02). In addition, grade 3-4 neuropathy was more common in patients with moderate or severe sarcopenia (38% and 12%) compared to those without sarcopenia (9%; p=0.006). Similarly, patients with sarcopenic obesity had a significantly higher chance of early chemotherapy termination (16% versus 7%; p=0.004), hospitalization related to chemotherapy (15% versus 7%; p=0.008), and grade 3-4 neuropathy (17% versus 6%; p=0.0004). No significant differences were observed in rates of dose delay or dose reduction between the groups.Conclusion: Patients with early-stage breast cancer and baseline evidence of BIA assessed sarcopenia or sarcopenic obesity had poorer tolerance of (neo)adjuvant chemotherapy. Future studies should address whether body composition-based dosing strategies can improve patient outcomes.
Citation Format: Gabriel F. P. Aleixo, Wei Wei, Sephanie A Valente, Halle CF Moore. The impact of sarcopenia and sarcopenic obesity detected by bioelectrical impedance analysis in patients with early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-04.
Collapse
Affiliation(s)
| | - Wei Wei
- Cleveland Clinic Foundation, Cleveland, OH
| | | | | |
Collapse
|
3
|
Moore HCF, Barlow WE, Somlo G, Gralow JR, Schott AF, Hayes DF, Kuhn P, Hicks JB, Welter L, Dy PA, Yeon CH, Conlin AK, Balcueva E, Lew DL, Tripathy D, Pusztai L, Hortobagyi GN. A Randomized Trial of Fulvestrant, Everolimus, and Anastrozole for the Front-line Treatment of Patients with Advanced Hormone Receptor-positive Breast Cancer, SWOG S1222. Clin Cancer Res 2022; 28:611-617. [PMID: 34844978 PMCID: PMC9782801 DOI: 10.1158/1078-0432.ccr-21-3131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Metastatic hormone receptor (HR)-positive, HER2-negative breast cancer is an important cause of cancer mortality. Endocrine treatment with or without additional targeted therapies has been the mainstay of treatment. This trial was designed to evaluate the combination of fulvestrant plus everolimus versus fulvestrant, everolimus, and anastrozole compared with fulvestrant alone in the first-line treatment of advanced HR-positive, HER2-negative breast cancer. PATIENTS AND METHODS This randomized placebo-controlled trial included postmenopausal women with HR-positive, HER2-negative advanced breast cancer who had received no prior systemic therapy for metastatic disease. Participants were randomized to one of three treatment arms and the primary outcome was progression-free survival (PFS), comparing combinations of fulvestrant and everolimus with or without anastrozole with fulvestrant alone. Circulating tumor cells (CTC), as measured with two different methods, and circulating tumor DNA (ctDNA) were evaluated serially prior to treatment and the beginning of the second cycle of therapy. RESULTS Due in part to changes in clinical practice, the study was closed after accruing only 37 participants. There was no evidence that everolimus-containing combination treatment improved PFS or overall survival relative to fulvestrant alone. When modeled continuously, an association was observed of baseline CTC and ctDNA with poorer survival. CONCLUSIONS Although power of the study was limited, the findings were unable to support the routine use of everolimus combination endocrine therapy in the first-line treatment of advanced hormone-sensitive breast cancer. Prognostic impact of baseline ctDNA and copy-number variations in CTC was demonstrated.
Collapse
Affiliation(s)
| | | | | | - Julie R. Gralow
- University of Washington School of Medicine/Seattle Cancer Care Alliance, Seattle, WA
| | - Anne F. Schott
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Peter Kuhn
- University of Southern California, Los Angeles, CA
| | | | - Lisa Welter
- University of Southern California, Los Angeles, CA
| | - Philip A. Dy
- Crossroads Cancer Center (Cancer Care Specialists of Illinois), Heartland NCORP
| | | | | | | | - Danika L. Lew
- SWOG Statistics and Data Management Center, Seattle, WA
| | | | | | | |
Collapse
|
4
|
Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep J, Warner E, Borges VF, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Yamauchi H, Lee JE, Walshe JM, Borrego MR, Moore HCF, Saunders C, Cardoso F, Susnjar S, Bjelic-Radisic V, Smith KL, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Abstract PS12-17: Baseline characteristics of women enrolled in the POSITIVE trial (pregnancy outcome and safety of interrupting therapy for women with endocrine responsIVE breast cancer). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pregnancy is a major concern for young breast cancer (BC) survivors. Conception after BC in women with hormone receptor positive (HR+) disease is affected by the standard 5-10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may be waning. The POSITIVE Trial (IBCSG 48-14/BIG 8-13/Alliance A221405/NCT02308085) investigates the impact of temporary ET interruption to allow pregnancy.
Methods: POSITIVE enrolled premenopausal women with stage I-III HR+ early BC, ≤42 years of age, who had received adjuvant ET (SERM alone, ovarian function suppression (OFS) plus SERM or AI) for 18 to 30 months, and wished to interrupt ET to attempt pregnancy. An interruption of ET for up to 2 years was foreseen to allow pregnancy (after a 3-month ET washout period), delivery, and breastfeeding if desired/feasible. Resumption of ET to complete 5-10 years of treatment was planned as soon as pregnancy/breastfeeding was completed or after it was ensured conception was not possible. We report baseline characteristics of participants enrolled in POSITIVE by region of enrollment.
Results: From 12/2014 to 12/2019, 518 participants were enrolled at 116 centers in 20 countries across 4 continents. The table shows the baseline characteristics of the enrolled women.
Several differences were seen across regions: A higher proportion of participants <35 yrs (43%) enrolled in North America than in Europe (33%) or Asia (26%). Eighty-one percent of Asian women had no children at enrollment compared to 75% and 68% of European and North American women, respectively. Consistently, a greater percent of women in Asia (56%) had used fertility preservation measures, compared to Europe (53%) and North America (43%). Stage distribution was also different across continents: a greater percent of Asian participants had stage I, grade 1 and node-negative disease (51%, 29% and 76 %, respectively) compared to European (46%, 14% and 67%) and North American (43%, 16% and 55%) women. Only 19% of Asian women had either 1-3 positive nodes and grade 3 tumors, the proportion increased to 28% and 35% in Europe and to 41% and 38% in North America, respectively. North American women were more likely to have had mastectomy (60% vs. Asian (44%) and European (41%)); European women were more likely to have had chemotherapy (69% vs. North American (56%) and Asian (42%)). ET administration prior to enrollment differed substantially by region: Most North American women had SERM (T) alone (58%), and when OFS was added to oral ET, it was combined with AI in 19% and with T in 8% of participants, respectively. In Asia most women received T + OFS (55%), followed by T alone (36%), and AI + OFS (6%). In Europe, T + OFS was the most frequent treatment (40%), followed by T alone (37%) and AI + OFS (17%). Median duration of ET before enrollment was similar across regions (22-24 months).
Conclusion: Regional variation of baseline characteristics of women enrolled in the POSITIVE trial may provide important insights into different medical and sociocultural attributes and attitudes of the study participants and investigators from those regions.
Affiliation: POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group
CharacteristicRegion: Europe / North America / Asia-Pacific61% / 23% / 16%Median age at enrollment, yrs (IQR)37 (33-39)Caucasian race77%No children prior to enrollment74%Prior fertility preservation measures taken51%Stage I / II46% / 45%0 / 1 positive nodes65% / 21%Grade 2 / 348% / 33%HER2-negative74%Mastectomy46%Chemotherapy61%ET: SERM alone / SERM+OFS / AI+OFS41% / 35% / 16%Median duration of prior ET, mos (IQR)23 (20-27)
Citation Format: Ann H Partridge, Samuel M Niman, Monica Ruggeri, Fedro A Peccatori, Hatem A Azim, Jr, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna Barbro Sætersdal, Judith Kroep, Ellen Warner, Virginia F Borges, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Hideko Yamauchi, Jeong Eon Lee, Janice M Walshe, Manuel Ruíz Borrego, Halle CF Moore, Christobel Saunders, Fatima Cardoso, Snezana Susnjar, Vesna Bjelic-Radisic, Karen L Smith, Martine Piccart, Larissa A Korde, Aron Goldhirsch, Richard D Gelber, Olivia Pagani. Baseline characteristics of women enrolled in the POSITIVE trial (pregnancy outcome and safety of interrupting therapy for women with endocrine responsIVE breast cancer) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-17.
Collapse
Affiliation(s)
- Ann H Partridge
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Samuel M Niman
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Monica Ruggeri
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Fedro A Peccatori
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Hatem A Azim
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Marco Colleoni
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Cristina Saura
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Chikako Shimizu
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Anna Barbro Sætersdal
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Judith Kroep
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Ellen Warner
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Virginia F Borges
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Andrea Gombos
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Akemi Kataoka
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Christine Rousset-Jablonski
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Simona Borstnar
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Hideko Yamauchi
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Jeong Eon Lee
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Janice M Walshe
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Manuel Ruíz Borrego
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Halle CF Moore
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Christobel Saunders
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Fatima Cardoso
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Snezana Susnjar
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Vesna Bjelic-Radisic
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Karen L Smith
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Martine Piccart
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Larissa A Korde
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Aron Goldhirsch
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Richard D Gelber
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Olivia Pagani
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| |
Collapse
|
5
|
Thomas M, Li H, Abraham J, Moore HCF, Budd GT, Montero AJ, Kruse ML. Abstract P2-14-13: Comparison of survival outcomes between treatment with endocrine therapy and chemoendocrine therapy in patients with invasive lobular carcinoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-14-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Invasive lobular breast cancer (ILC) is the second most common histological type of invasive breast cancer and accounts for 10-15% of all breast cancer cases. It is commonly strongly hormone receptor positive and, in general, is considered to be less chemo-sensitive compared with invasive ductal carcinoma (IDC). The aim of this study was to compare survival outcomes among ILC patients treated with adjuvant endocrine therapy (ET) compared with chemoendocrine therapy (CET). We also sought to assess utilization of Oncotype Dx testing and distribution of Recurrence Score results among ILC patients treated at our institution.
Methods: We conducted an IRB approved retrospective study at Cleveland Clinic Taussig Cancer Institute of patients with non-metastatic ILC. Patient diagnosed with ILC and treated from January 2004 through December 2017 were identified from our tumor registry. Patient characteristics including demographics, pathologic features, hormone replacement therapy (HRT) use, Oncotype Dx recurrence score, treatment details and recurrence data were obtained through medical chart review. Recurrence-free and overall survival (OS) were compared between ET and CET using Kaplan-Meier method and Cox proportional hazard model with consideration of differences on age and prognostic factors. The outcomes between age and pathological stage propensity score matched treatment groups were also compared.
Results: A total of 638 patients (Mean age 61.9±11.7, 99.1% estrogen receptor positive, 82.6% progesterone receptor positive) were identified. 406 (63.6%) patients received ET and 232 (36.4%) patients received CET. Compared to ET, patients who received CET were significantly younger (Mean 56.3 vs 65.0 years) and more likely to be premenopausal (40.1% vs 14.6%), however they had significant worse prognostic features including pathological stage (stage III: 38.9% vs 2.1%), grade (≥ II: 69.0% vs 55.9%) and Oncotype Dx score (≥18: 72.4% vs 36.2%). Patients were followed for median (IQR) time of 4 (2.0, 6.4) years for survival outcomes. Although recurrence-free survival (local or distant) was worse in CET (5-year recurrence-free: 81.9% vs 96.5%), age and clinical prognostic features adjusted recurrence risk was similar as ET (Adjusted HR and 95% CI: 0.83, 0.36-1.92) and risk of death was also similar (Adjusted HR and 95% CI: 0.68, 0.31-1.50). Only 222 patients had Oncotype Dx score (35%), with 59% falling in the low risk range, 39% intermediate risk range and 2% high risk range. The Oncotype Dx recurrence score was not associated with recurrence or death. The recurrence-free (5-year: 97.4% vs 90.4%, p=0.37) and OS (At 5-year OS: 94.3% vs 89.4%, p=0.08) were also similar between age and pathological stage matched CET and ET groups.
Conclusion: Use of chemoendocrine therapy did not result in improved survival outcomes for patients with ILC compared to those treated with endocrine monotherapy in the adjuvant setting. The majority of ILC patients did not have Oncotype Dx testing sent however when it was ordered, most cases resulted in the low-intermediate risk range, suggesting limited benefit of chemotherapy as reflected by survival outcome results observed.
Citation Format: Mathew Thomas, Hong Li, Jame Abraham, Halle CF Moore, G Thomas Budd, Alberto J Montero, Megan L Kruse. Comparison of survival outcomes between treatment with endocrine therapy and chemoendocrine therapy in patients with invasive lobular carcinoma [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-13.
Collapse
Affiliation(s)
| | - Hong Li
- Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | |
Collapse
|
6
|
Gidding HF, McCallum L, Fathima P, Moore HC, Snelling TL, Blyth CC, Jayasinghe S, Giele C, de Klerk N, Andrews RM, McIntyre PB. Effectiveness of a 3 + 0 pneumococcal conjugate vaccine schedule against invasive pneumococcal disease among a birth cohort of 1.4 million children in Australia. Vaccine 2018; 36:2650-2656. [PMID: 29627233 DOI: 10.1016/j.vaccine.2018.03.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most studies use indirect cohort or case-control methods to estimate vaccine effectiveness (VE) of 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) against invasive pneumococcal disease (IPD). Neither method can measure the benefit vaccination programs afford the unvaccinated and many studies were unable to estimate dose-specific VE. We linked Australia's national immunisation register with health data from two states to calculate IPD incidence by vaccination status and VE for a 3 + 0 PCV schedule (doses at 2, 4, 6 months, no booster) among a cohort of 1.4 million births. METHODS Births records for 2001-2012 were probabilistically linked to IPD notifications, hospitalisations, deaths, and vaccination history (available until December 2013). IPD rates in vaccinated and unvaccinated children <2 years old were compared using Cox proportional hazards models (adjusting for potential confounders), with VE = (1 - adjusted hazard ratio) × 100. Separate models were performed for all-cause, PCV7, PCV13 and PCV13-non-PCV7 serotype-specific IPD, and for Aboriginal and non-Aboriginal children. RESULTS Following introduction of universal PCV7 in 2005, rates of PCV7 serotype and all-cause IPD in unvaccinated children declined 89.5% and 61.4%, respectively, to be similar to rates in vaccinated children. Among non-Aboriginal children, VEs for 3 doses were 94.2% (95%CI: 81.9-98.1) for PCV7 serotype-specific IPD, 85.6% (95%CI: 60.5-94.8) for PCV13-non-PCV7 serotype-specific IPD and 80.1% (95%CI: 59.4-90.3) for all-cause IPD. There were no statistically significant differences between the VEs for 3 doses and for 1 or 2 doses against PCV13 and PCV13-non-PCV7 serotype-specific IPD, or between Aboriginal and non-Aboriginal children. CONCLUSION Our population-based cohort study demonstrates that >90% coverage in the first year of a universal 3 + 0 PCV program provided high population-level protection, predominantly attributable to strong herd effects. The size of the cohort enabled calculation of robust dose-specific VE estimates for important population sub-groups relevant to vaccination policies internationally.
Collapse
Affiliation(s)
- H F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
| | - L McCallum
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - P Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - H C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - T L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; School of Public Health, Curtin University, Perth, WA, Australia.
| | - C C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, WA, Australia.
| | - S Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, Medical School, University of Sydney, Sydney, Australia.
| | - C Giele
- Communicable Disease Control Directorate, Department of Health Western Australia, Perth, WA, Australia.
| | - N de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - R M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
| | - P B McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, Medical School, University of Sydney, Sydney, Australia; School of Public Health, Medical School, University of Sydney, Sydney, Australia.
| | | |
Collapse
|
7
|
Tiwari SR, Sussman T, Kota K, Moore HC, Montero AJ, Budd GT, Puhalha S, Abraham J. Abstract P5-21-26: T-DM1 activity in metastatic HER2-positive breast cancer patients who have received prior trastuzumab and pertuzumab: NSABP B-005. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background :
The pivotal phase III EMILIA trial reported a progression free survival (PFS) rate of 9.6 months and an objective response rate of 43% with T-DM1 in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane. However, there is very limited data on the efficacy of T-DM1 in patients who have received prior pertuzumab either neoadjuvantly or as first line therapy in the metastatic setting. The primary goal of this study was to assess the clinical efficacy (tumor response rates and median duration on therapy) of T-DM1 in patients previously treated with pertuzumab and trastuzumab.
Methods:
After IRB approval, a cancer data registry and electronic pharmacy database were utilized to identify breast cancer patients receiving treatment with T-DM1 at Cleveland Clinic and University of Pittsburgh. Patients that received trastuzumab and pertuzumab, in either the neoadjuvant or metastatic setting, with baseline and follow up imaging available for review were identified. Patient charts were reviewed to collect accurate information about the treatment sequencing and outcomes. RECIST version 1.1 was utilized for tumor assessment and patients with measurable disease and non measurable disease were included in the study.
Results:
We identified a total of 23 patients with a median age of 55 years that met the inclusion criteria. 69% percent of patients received T-DM1 as first line or second line therapy and 31% received it as third line or later. All patients had at least 1 measurable lesion. Best overall response showed rates of complete response, partial response and stable disease of 17%, 26% and 22% respectively. 35% patients progressed on first assessment after start of treatment. The median duration on therapy was 5.3 months (range 3 weeks to 33 months) with 43% of patients receiving T-DM1 for greater than 6 months.
Conclusion:
Our results were comparable to those reported by EMILIA trial. T-DM1 has reasonable clinical efficacy in patients who have received prior treatment with pertuzumab and trastuzumab with an overall response rate of 43% and median duration on therapy of 5.3 months.
Citation Format: Tiwari SR, Sussman T, Kota K, Moore HC, Montero AJ, Budd GT, Puhalha S, Abraham J. T-DM1 activity in metastatic HER2-positive breast cancer patients who have received prior trastuzumab and pertuzumab: NSABP B-005 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-26.
Collapse
Affiliation(s)
- SR Tiwari
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - T Sussman
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - K Kota
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - HC Moore
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - AJ Montero
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - GT Budd
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - S Puhalha
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - J Abraham
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
8
|
Gidding HF, McCallum L, Fathima P, Snelling TL, Liu B, de Klerk N, Blyth CC, Sheppeard V, Andrews RM, Jorm L, McIntyre PB, Moore HC. Probabilistic linkage of national immunisation and state-based health records for a cohort of 1.9 million births to evaluate Australia's childhood immunisation program. Int J Popul Data Sci 2017; 2:406. [PMID: 32934996 PMCID: PMC7299480 DOI: 10.23889/ijpds.v2i1.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Several countries have developed national immunisation registers, but only the Nordic countries have linked their registers to other health data in order to comprehensively evaluate the `real world' effectiveness of vaccines. Nordic countries can link datasets deterministically using the national person identifier, but most countries, including Australia, don't have such an identifier to enable this type of linkage. Objectives To describe the process for assembling a linked study cohort that will enable the conduct of population-based studies related to immunisation and immunisation policy. Methods National death and immunisation databases along with state health data (notifications of vaccine preventable diseases, perinatal data, hospital admissions and emergency department presentations) up until December 2013 were probabilistically linked (using demographic details) for children born between 1996 and 2012 in two states: Western Australia and New South Wales (42% of Australia's population, combined). Results After exclusions there were 1.95 million children in the study cohort (live born children with both a birth and perinatal record which represents 97.5% of all live births in the state perinatal data collections - our source population) and 18.0 million person years of follow up (mean: 9.2 years per child). The characteristics of children in the cohort were generally similar to those only included in state perinatal databases and outcome measures were in keeping with expected figures from unlinked data sources. However, the lack of a dynamic national population register meant immigrants could not be included. Conclusions We have been able to develop a similarly comprehensive system to the Nordic countries based on probabilistic linkage methods. Our experience should provide encouragement to other countries with national immunisation registers looking to establish similar systems.
Collapse
Affiliation(s)
- H F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - L McCallum
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - P Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - T L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - B Liu
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - N de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - C C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Princess Margaret Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital, Perth, WA, Australia
| | - V Sheppeard
- Communicable Diseases, Health Protection NSW, NSW Ministry of Health, NSW, Australia
| | - R M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - L Jorm
- Centre for Big Data Research in Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - P B McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - H C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
9
|
Moore HC, Wood KM, Jackson MS, Lastowska MA, Hall D, Imrie H, Redfern CPF, Lovat PE, Ponthan F, O'Toole K, Lunec J, Tweddle DA. Histological profile of tumours from MYCN transgenic mice. J Clin Pathol 2008; 61:1098-103. [PMID: 18682419 DOI: 10.1136/jcp.2007.054627] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND MYCN is the most commonly amplified gene in human neuroblastomas. This proto-oncogene has been overexpressed in a mouse model of the disease in order to explore the role of MYCN in this tumour. AIMS To report the histopathological features of neuroblastomas from MYCN transgenic mice. METHODS 27 neuroblastomas from hemizygous transgenic mice and four tumours from homozygous mice were examined histologically; Ki67 and MYCN immunocytochemistry was performed in 24 tumours. RESULTS Tumours obtained from MYCN transgenic mice resembled human neuroblastomas, displaying many of the features associated with stroma-poor neuroblastoma, including heterogeneity of differentiation (but no overt ganglionic differentiation was seen), low levels of Schwannian stroma and a high mitosis karyorrhexis index. The tumours had a median Ki67 labelling index of 70%; all tumours expressed MYCN with a median labelling index of 68%. The most striking difference between the murine and human neuroblastomas was the presence of tingible body macrophages in the transgenic mouse tumours reflecting high levels of apoptosis. This has not previously been described in human or other murine neuroblastoma models. CONCLUSIONS These studies highlight the histological similarities between tumours from MYCN transgenic mice and human neuroblastomas, and reaffirm their role as a valuable model to study the biology of aggressive human neuroblastoma.
Collapse
Affiliation(s)
- H C Moore
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Many women now survive breast cancer, but find themselves at increased risk of menopausal complications. How to manage menopause after breast cancer is a complex issue, given that estrogen has a role in the development of breast cancer and valid concerns exist about estrogen replacement therapy in patients who have had breast cancer. This article explores the relationship between estrogens and breast cancer and discusses management options for a variety of menopausal complications in breast cancer survivors.
Collapse
Affiliation(s)
- H C Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland Clinic Foundation, OH 44195, USA.
| |
Collapse
|
11
|
Moore HC, Foster RS. Breast cancer and pregnancy. Semin Oncol 2000; 27:646-53. [PMID: 11130471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A diagnosis of breast cancer during pregnancy or the postpartum period is an unfortunate occurrence. Hormonal factors appear to play an important role early on in the development of breast cancer; however, pregnancy itself does not clearly influence the outcome of an established breast cancer. Diagnosis can be challenging in a pregnant woman and delays in diagnosis are common. Treatment decisions must take into consideration not only toxicity to the mother, but short- and long-term consequences for the fetus as well. Other special considerations with pregnancy-associated breast cancer include the timing of delivery, the potential for nursing, and concerns for future fertility. In general, management of pregnancy associated breast cancer follows the same principals as in non-pregnant patients of similar age. With thoughtful application of available therapies, outcome can be optimized for both the mother and her child.
Collapse
Affiliation(s)
- H C Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, OH 44195, USA
| | | |
Collapse
|
12
|
Abstract
Issues of long-term toxicity from treatment for breast cancer, including the induction of premature ovarian failure, appear to be of increasing importance for breast cancer survivors. The incidence of treatment-related amenorrhea is related to patient age and to the treatment regimen. Whereas the induction of ovarian failure may be advantageous with respect to breast cancer outcome, it is not clear that there is any advantage to permanent menopause over reversible hormonal manipulations. In addition, menopause may be associated with a variety of adverse health effects. Although nonhormonal therapies are available to manage many of the consequences of menopause, avoidance of chemotherapy-related ovarian toxicity may provide the best prospects for fertility after treatment. Pregnancy after breast cancer is a realistic consideration for some breast cancer survivors and is not clearly detrimental to either the mother or her offspring.
Collapse
Affiliation(s)
- H C Moore
- Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
13
|
Tsai DE, Schuster SJ, Matthies A, Moore HC, Alavi A, Juweid ME, Goldenberg DM, Stadtmauer EA. Progressive intermediate-grade non-Hodgkin's lymphoma after high-dose therapy and autologous peripheral stem-cell transplantation: changing the natural history with monoclonal antibody therapy. Clin Lymphoma 2000; 1:62-6. [PMID: 11707815 DOI: 10.3816/clm.2000.n.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prognosis of patients with progressive intermediate-grade non-Hodgkin's lymphoma (NHL) after high-dose chemotherapy and autologous peripheral stem-cell transplantation (PSCT) is poor, with survival measured in months. The advent of monoclonal antibody therapy for NHL has created new options for effective therapy with relatively mild side effects. We report on two patients with progressive intermediate-grade NHL after PSCT who were treated with monoclonal antibody therapy. Both patients initially received rituximab (unlabeled anti-CD20 monoclonal antibody) and were subsequently treated with (90)Y-epratuzumab (yttrium-90-labeled humanized anti-CD22 monoclonal antibody) at relapse. One patient received (90)Y-epratuzumab alone while the other was treated with higher doses in combination with autologous peripheral stem-cell infusion. Both patients achieved a rapid response to the radiolabeled antibody with minimal toxicity. Monoclonal antibody therapy may be an effective and tolerable treatment for progressive NHL after PSCT.
Collapse
Affiliation(s)
- D E Tsai
- Bone Marrow and Stem Cell Transplant Program, University of Pennsylvania Cancer Center, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Moore HC, Haller DG. Adjuvant therapy of colon cancer. Semin Oncol 1999; 26:545-55. [PMID: 10528903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Colon cancer is an important cause of cancer-related mortality. A series of clinical trials of adjuvant systemic therapy have been performed in attempt to establish means to improve outcome in this disease. By the early 1990s, a role for 5-fluorouracil (5-FU)-based chemotherapy in stage III colon cancer had been firmly established. The precise role for chemotherapy in stage II disease remains under investigation. Progress continues toward optimizing the schedule and duration of systemic therapy, allowing for maximal efficacy with a minimum of toxicity. It appears that approximately 6 months of 5-FU and leucovorin are as effective as more prolonged regimens. Levamisole does not appear to add to the benefit of 5-FU and leucovorin. Several newer agents such as the oral fluorinated pyrimidines, irinotecan (CPT-11) and oxaliplatin have demonstrated activity in metastatic colon cancer and hold promise as potentially effective drugs to be tested in the adjuvant setting.
Collapse
Affiliation(s)
- H C Moore
- University of Pennsylvania Cancer Center, Philadelphia, USA
| | | |
Collapse
|
15
|
Moore HC, Mick R, Solin LJ, Sickles C, Mangan PA, Luger SM, Fox KR, Schuchter LM, Loh E, Porter DL, Schuster S, Buzby GP, Glatstein E, Silberstein LE, Stadtmauer EA. Autologous stem-cell transplant after conventional dose adjuvant chemotherapy for high-risk breast cancer: impact on the delivery of local-regional radiation therapy. Ann Oncol 1999; 10:929-36. [PMID: 10509154 DOI: 10.1023/a:1008393204854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High-dose chemotherapy with autologous stem-cell transplantation is used increasingly in the treatment of poor-prognosis primary breast cancer. Because these patients may be cured with standard multimodality therapy, it is important to address both the efficacy of transplantation, and its effect on the delivery of standard treatments including local radiation therapy. PATIENTS AND METHODS Patients with high risk primary breast cancer were treated with high-dose cyclophosphamide and thiotepa and stem-cell transplant following surgery and conventional-dose adjuvant chemotherapy. Outcome, including sites of failure and delivery of local radiation therapy, was assessed for 103 patients. RESULTS Overall and disease-free survival rates at 18 months were 83% (+/- 4%) and 77% (+/- 4%) respectively. Twenty patients (19.4%) received radiation therapy prior to transplant. Of the remaining 83, 77 received radiation therapy after transplant. Overall, 5 (19.2%) of 26 first sites of recurrence were local alone. For patients receiving radiation prior to transplant, 3 of 7 (43%, 95% CI: 6%-80%) sites of first recurrence were local, while 2 of 19 (10.5%, 95% CI: 0%-24.5%) sites of first recurrence were local alone in patients receiving post-transplant radiation or no radiation. CONCLUSION Transplantation does not appear to significantly compromise the delivery or outcome of local radiation therapy for primary breast cancer.
Collapse
Affiliation(s)
- H C Moore
- Bone Marrow and Stem-Cell Transplant Program, University of Pennsylvania Cancer Center, Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
From 1973 to 1990, 392 mandibular subcondylar fractures were treated at the University of California, Davis, by the Otolaryngology Department. Of these, 17% were handled by open reduction and internal fixation. Twenty-one patients from this group were located for follow-up at an average interval of 64 months. Retrospective review shows the operation to be safe, with few complications and no permanent sequelae. Patient examination often revealed abnormalities of occlusion and mandibular function; however, these objective findings did not correlate well with patients' relative lack of subjective complaints. An 86% incidence of roentgenographic evidence of condylar disease after open reduction and internal fixation was found. We question the long-term efficacy of open reduction and internal fixation in restoring fracture alignment and maintaining mandibular height given the high rate (86%) of condylar disease in our patient population.
Collapse
Affiliation(s)
- C J MacArthur
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange 92668
| | | | | | | |
Collapse
|
17
|
Abstract
The role of auditory experience in the development of spongiform degeneration in the cochlear nuclei of Mongolian gerbils was studied by comparing results of animals exposed to either high or low levels of ambient noise. Gerbils reared in a typical vivarium experienced higher levels of ambient noise than animals reared in acoustic isolation chambers. Animals reared in the colony room showed a much greater number density and area density of spongiform lesions in the CN than did gerbils reared in acoustic isolation. The differences in the number and extent of spongiform lesions between the two groups of gerbils appeared to reflect their differences in exposure to ambient noise. These differences in lesion number and extent were most pronounced in the tonotopic regions of the PVCN which correspond to the greatest differences in the spectral characteristics of the ambient noise to which the animals were exposed. These results were compared with results previously obtained from gerbils with loss of hearing experimentally induced by a conductive block or by sensorineural damage. The lesion numbers and extent reflected the auditory experience of each group; in descending order, colony-reared, isolate, conductive-block, sensorineural loss. These results strongly support the hypothesis that this gerbilline encephalopathy is directly related to auditory functional activity.
Collapse
Affiliation(s)
- M D McGinn
- Department of Otolaryngology, School of Medicine, University of California, Davis 95616
| | | | | |
Collapse
|
18
|
Abstract
To investigate the role of acoustic stimulation in the development of spongiform degeneration in the cochlear nuclei of Mongolian gerbils, the right cochlea in 8 juvenile gerbils was chemically treated by placing sodium chloride (NaCl) crystals on the cochlear round window membrane. Sixty days after NaCl treatment there was extensive damage to the strial, sensorineural and supporting cells of the treated inner ear. The cochlear damage was accompanied by a dramatic decrease in the number and the extent of the spongioid lesions in the ipsilateral cochlear nuclei compared to the contralateral (control) cochlear nuclei. These results lend further support to the hypothesis that the progress of this disorder is related to auditory function.
Collapse
Affiliation(s)
- H C Moore
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, Davis 95616
| | | |
Collapse
|
19
|
Abstract
We report a 55-year-old man with coumarin necrosis. This drug eruption is sometimes a devastating gangrenous process in sites with abundant underlying adipose tissue. In our patient, however, it assumed an evanescent limited linear distribution on the skin, prompting this report.
Collapse
|
20
|
Abstract
The present observations confirm the value of suspending red blood cells in a low-ionic-strength medium in the first stage of the indirect antiglobulin test; that is, during the period of incubation with antibody-containing serum. The main advantage of this procedure is to shorten the time of incubation. In this respect a low-ionic-strength medium appears to be superior to albumin as a suspending medium for the red blood cells. A further advantage is to increase the uptake of certain antibodies; this effect was pronounced with selected Rh antibodies believed to be of low affinity.
Collapse
|
21
|
Abstract
Two cases are described in this report in which patients with anti-Chido in the serum were transfused with Chido-positive blood. Since there was evidence of normal survival of the transfused red blood cells, these findings do not support a suggestion that patients with anti-Chido may require transfusion with Chido-negative blood. In spite of the apparently normal survival of the Chido-positive blood, a previous report in which it was shown that weakly Chido-positive blood can stimulate the production of anti-Chido was confirmed.
Collapse
|
22
|
Breen KJ, Perkins KW, Schenker S, Dunkerley RC, Moore HC. Uncomplicated subsequent pregnancy after idiopathic fatty liver of pregnancy. Obstet Gynecol 1972; 40:813-5. [PMID: 4636910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
23
|
Moore HC, Borvendeg J, Wilson K. The effect of foetal removal on the blood pressure in steroid hypertensive rats. Acta Endocrinol (Copenh) 1971; 67:590-6. [PMID: 5108737 DOI: 10.1530/acta.0.0670590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ABSTRACT
In unilaterally nephrectomized hypertensive rats receiving DOCA, cortisone and saline the blood pressure falls after the removal of the foetuses as though the animals continued to be pregnant with the foetuses in situ. On the other hand, when the foetuses are removed from steroid hypertensive animals in which the maternal kidneys remain intact the blood pressure remains at hypertensive levels. The metrial gland part of the placenta appears histologically viable after foetal removal.
We conclude from the present and earlier experiments that the usual hypotensive effect of pregnancy in hypertensive animals is due to a vasodepressor agent produced by the foetuses and the metrial gland moiety of the placenta and that the activity of this agent is subject to maternal renal function.
A relation between these experiments and human pregnancy hypertension is not clear but we suggest that in human pregnancy, hypertension could be due either to failure of the foetoplacental vasodepressor or vasodilator agent or to destruction or excretion of this agent by the maternal kidney.
Collapse
|
24
|
Moore HC. More on dentistry and socialism ... Harb Dent Log 1971; 8:25. [PMID: 5277287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
25
|
Moore HC. Dentistry and socialism. Harb Dent Log 1970; 8:15-6. [PMID: 5275219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
26
|
|
27
|
Moore HC, Cserhati I, Wilson K. The duration of the fall of blood pressure following the induction of deciduomata and the administration of progesterone in steroid hypertensive rats. Acta Endocrinol (Copenh) 1970; 63:242-52. [PMID: 5468624 DOI: 10.1530/acta.0.0630242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ABSTRACT
Experimental deciduomata produce a protracted fall of blood pressure in steroid hypertensive rats. The fall begins at between 9 and 13 days of pseudopregnancy, lasts for between 8 and 14 days and is then followed by a restoration to higher levels between 17 and 24 days. The metrial gland of the deciduomata is thought to be responsible for the fall.
Parenteral progesterone has two main effects. It enhances the degree of the fall of blood pressure and also prolongs the survival of deciduomata to beyond 22 days of pseudopregnancy. Progesterone does not alter the time of onset nor the duration of the hypotensive episode and the return of the blood pressure to higher levels takes place even though the metrial gland of the deciduomata is still viable and progesterone still being administered.
It is considered that the duration of the hypotensive episode is determined either by a changed function of the metrial gland cells with duration or to an entirely different but unknown mechanism.
The present findings suggest that the hypotensive effect of pregnancy in hypertensive rats is a related phenomenon and is due in part to the function of metrial gland cells of the pregnancy decidua under the influence of progesterone.
Collapse
|
28
|
Moore HC, Cserhati I, Biliczki FP. The fall of blood pressure following induction of deciduomata in steroid hypertensive rats receiving progesterone. Acta Endocrinol (Copenh) 1968; 59:227-34. [PMID: 5754970 DOI: 10.1530/acta.0.0590227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
ABSTRACT
Experimental deciduomata and progesterone together lower the blood pressure in the steroid hypertensive rat from the 5th to 10th day of decidual growth i. e. from the 10th to 15th day of pseudopregnancy. This would suggest that the fall of blood pressure at an equivalent time of gestation in hypertensive pregnant rats could be due to the maternal decidua under the influence of progesterone. It is further considered that the metrial gland of the deciduoma is more likely to be responsible for the hypotensive effect and by comparison that the metrial gland is implicated in the hypotensive effect of pregnancy.
Progesterone alone also exerts a minor hypotensive effect in those animals in which a nephrectomy forms part of the hypertension regimen and indicates one way in which a maternal renal factor could influence blood pressure responses in hypertensive pregnant rats.
Collapse
|
29
|
Moore HC, Biliczki FP. Effect of the experimental deciduoma on steroid hypertension in the rat. Acta Endocrinol (Copenh) 1968; 58:177-82. [PMID: 5694739 DOI: 10.1530/acta.0.0580177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
ABSTRACT
Experimental deciduomas which are maintained for 5 to 6 days do not lower the blood pressure in steroid hypertensive rats. In animals maintained longer only the metrial gland of the deciduoma survives but this too does not have a hypotensive action.
It is concluded that the maternal decidual reaction in pregnant hypertensive rats is not responsible for the fall of blood pressure when this occurs at an equivalent time of gestation of up to 10 or 11 days and that the metrial gland is not responsible for the fall of blood pressure at whatever time the fall occurs during gestation.
Collapse
|
30
|
|
31
|
Moore HC, Lux SE, Malhotra OP, Bakerman S, Carter JR. Isolation and purification of bovine and canine prothrombin. Biochim Biophys Acta 1965; 111:174-80. [PMID: 5867320 DOI: 10.1016/0304-4165(65)90484-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
32
|
Moore HC, White R. A Study of the Alkaline and Neutral Permanganate Methods and Comparison of Results on Raw Materials and Fertilizer Mixtures. J AOAC Int 1927. [DOI: 10.1093/jaoac/10.2.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- H C Moore
- Armour Fertilizer Works, Chicago, Ill
| | | |
Collapse
|