1
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Anderson JJ, Ho FK, Niedzwiedz CL, Katikireddi SV, Celis-Morales C, Iliodromiti S, Welsh P, Pellicori P, Demou E, Hastie CE, Lyall DM, Gray SR, Forbes JF, Gill JMR, Mackay DF, Berry C, Cleland JGF, Sattar N, Pell JP. Remote history of VTE is associated with severe COVID-19 in middle and older age: UK Biobank cohort study. J Thromb Haemost 2021; 19:2533-2538. [PMID: 34242477 PMCID: PMC8420476 DOI: 10.1111/jth.15452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common, life-threatening complication of COVID-19 infection. COVID-19 risk-prediction models include a history of VTE. However, it is unclear whether remote history (>9 years previously) of VTE also confers increased risk of COVID-19. OBJECTIVES To investigate possible association between VTE and COVID-19 severity, independent of other risk factors. METHODS Cohort study of UK Biobank participants recruited between 2006 and 2010. Baseline data, including history of VTE, were linked to COVID-19 test results, COVID-19-related hospital admissions, and COVID-19 deaths. The risk of COVID-19 hospitalization or death was compared for participants with a remote history VTE versus without. Poisson regression models were run univariately then adjusted stepwise for sociodemographic, lifestyle, and comorbid covariates. RESULTS After adjustment for sociodemographic and lifestyle confounders and comorbid conditions, remote history of VTE was associated with nonfatal community (RR 1.61, 95% CI 1.02-2.54, p = .039), nonfatal hospitalized (RR 1.52, 95% CI 1.06-2.17, p = .024) and severe (hospitalized or fatal) (RR 1.40, 95% CI 1.04-1.89, p = .025) COVID-19. Associations with remote history of VTE were stronger among men (severe COVID-19: RR 1.68, 95% CI 1.14-2.42, p = .009) than for women (severe COVID-19: RR 1.07, 95% CI 0.66-1.74, p = .786). CONCLUSION Our findings support inclusion of remote history of VTE in COVID-19 risk-prediction scores, and consideration of sex-specific risk scores.
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Affiliation(s)
- Jana J Anderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Stamatina Iliodromiti
- Centre of Women's Health, Yvonne Carter Building, Queen Mary University of London, London, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claire E Hastie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - John F Forbes
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - John G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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2
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Hayes S, Forbes JF, Celis-Morales C, Anderson J, Ferguson L, Gill JMR, Gray S, Hastie C, Iliodromoti S, Lyall D, Pellicori P, Sattar N, Welsh CE, Pell J. Association Between Walking Pace and Stroke Incidence: Findings From the UK Biobank Prospective Cohort Study. Stroke 2020; 51:1388-1395. [PMID: 32299326 DOI: 10.1161/strokeaha.119.028064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Stroke incidence in younger and middle-aged people is growing. Despite this, its associations in this subset of the stroke population are unknown, and prevention strategies are not tailored to meet their needs. This study examined the association between self-reported walking pace and incident stroke. Methods- Data from the UK Biobank were used in a prospective population-based study. Three hundred and sixty-three thousand, one hundred and thirty-seven participants aged 37 to 73 years (52% women) were recruited. The associations of self-reported walking pace with stroke incidence over follow-up were investigated using Cox proportional-hazard models. Results- Among 363,137 participants, 2705 (0.7%) participants developed a fatal or nonfatal stroke event over the mean follow-up period of 6.1 years (interquartile range, 5.4-6.7). Slow walking pace was associated with a higher hazard for stroke incidence (hazard ratio [HR], 1.45 [95% CI, 1.26-1.66]; P<0.0001). Stroke incidence was not associated with walking pace among people <65 years of age. However, slow walking pace was associated with a higher risk of stroke among participants aged ≥65 years (HR, 1.42 [95% CI, 1.17-1.72]; P<0.0001). A higher risk for stroke was observed on those with middle (HR, 1.28 [95% CI, 1.01-1.63]; P=0.039) and higher (HR, 1.29 [95% CI, 1.05-1.69]; P=0.012) deprivation levels but not in the least deprived individuals. Similarly, overweight (HR, 1.30 [95% CI, 1.04-1.63]; P=0.019) and obese (HR, 1.33 [95% CI, 1.09-1.63]; P=0.004) but not normal-weight individuals had a higher risk of stroke incidence. Conclusions- Slow walking pace was associated with a higher risk of stroke among participants over 64 years of age in this population-based cohort study. The addition of the measurement of self-reported walking pace to primary care or public health clinical consultations may be a useful screening tool for stroke risk.
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Affiliation(s)
- Sara Hayes
- From the School of Allied Health, Ageing Research Centre (S.H.), Health Research Institute, University of Limerick, Ireland
| | - John F Forbes
- Graduate Entry Medical School (J.F.F.), Health Research Institute, University of Limerick, Ireland
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences (C.C.-M., L.F., J.M.R.G., S.G., S.I., N.S.), University of Glasgow, Scotland.,Centre for Research in Exercise Physiology, University Mayor, Santiago, Chile (C.C.-M.)
| | - Jana Anderson
- Institute of Health and Wellbeing (J.A., C.H., D.L., P.P., J.P.), University of Glasgow, Scotland
| | - Lyn Ferguson
- Institute of Cardiovascular and Medical Sciences (C.C.-M., L.F., J.M.R.G., S.G., S.I., N.S.), University of Glasgow, Scotland
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences (C.C.-M., L.F., J.M.R.G., S.G., S.I., N.S.), University of Glasgow, Scotland
| | - Stuart Gray
- Institute of Cardiovascular and Medical Sciences (C.C.-M., L.F., J.M.R.G., S.G., S.I., N.S.), University of Glasgow, Scotland
| | - Claire Hastie
- Institute of Health and Wellbeing (J.A., C.H., D.L., P.P., J.P.), University of Glasgow, Scotland
| | - Stamatina Iliodromoti
- Institute of Cardiovascular and Medical Sciences (C.C.-M., L.F., J.M.R.G., S.G., S.I., N.S.), University of Glasgow, Scotland
| | - Donald Lyall
- Institute of Health and Wellbeing (J.A., C.H., D.L., P.P., J.P.), University of Glasgow, Scotland
| | - Pierpaolo Pellicori
- Institute of Health and Wellbeing (J.A., C.H., D.L., P.P., J.P.), University of Glasgow, Scotland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (C.C.-M., L.F., J.M.R.G., S.G., S.I., N.S.), University of Glasgow, Scotland
| | - Claire E Welsh
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom (C.E.W.)
| | - Jill Pell
- Institute of Health and Wellbeing (J.A., C.H., D.L., P.P., J.P.), University of Glasgow, Scotland
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3
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Moseley A, Porter DJ, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow JR, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian LM, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Final Analysis of the Prevention of Early Menopause Study (POEMS)/SWOG Intergroup S0230. J Natl Cancer Inst 2020; 111:210-213. [PMID: 30371800 DOI: 10.1093/jnci/djy185] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022] Open
Abstract
Premature menopause is a serious long-term side effect of chemotherapy. We evaluated long-term pregnancy and disease-related outcomes for patients in S0230/POEMS, a study in premenopausal women with stage I-IIIA estrogen receptor-negative, progesterone receptor-negative breast cancer to be treated with cyclophosphamide-containing chemotherapy. Women were randomly assigned to standard chemotherapy with or without goserelin, a gonadotropin-releasing hormone agonist, and were stratified by age and chemotherapy regimen. All statistical tests were two-sided. Of 257 patients, 218 were eligible and evaluable (105 in the chemotherapy + goserelin arm and 113 in the chemotherapy arm). More patients in the chemotherapy + goserelin arm reported at least one pregnancy vs the chemotherapy arm (5-year cumulative incidence = 23.1%, 95% confidence interval [CI] = 15.3% to 31.9%; and 12.2%, 95% CI = 6.8% to 19.2%, respectively; odds ratio = 2.34; 95% CI = 1.07 to 5.11; P = .03). Randomization to goserelin + chemotherapy was associated with a nonstatistically significant improvement in disease-free survival (hazard ratio [HR] = 0.55; 95% CI = 0.27 to 1.10; P = .09) and overall survival (HR = 0.45; 95% CI = 0.19 to 1.04; P = .06). In this long-term analysis of POEMS/S0230, we found continued evidence that patients randomly assigned to receive goserelin + chemotherapy were not only more likely to avoid premature menopause, but were also more likely to become pregnant without adverse effect on disease-related outcomes.
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Affiliation(s)
| | - Joseph M Unger
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kelly-Anne Phillips
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Breast Cancer Trials Australia and New Zealand (BCT-ANZ), Newcastle, Australia.,International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | | | - Erika Hitre
- National Institute of Oncology, Budapest, Hungary
| | - Anna Moseley
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David J Porter
- Auckland Regional Cancer and Blood Service, Auckland, New Zealand
| | - Prudence A Francis
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Breast Cancer Trials Australia and New Zealand (BCT-ANZ), Newcastle, Australia.,International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | | | - Henry L Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | - Shaker R Dakhil
- Wichita NCORP, Wichita, KS.,Louisiana State University Health Sciences Center, New Orleans, LA
| | - Agustin A Garcia
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Julie R Gralow
- Seattle Cancer Care Alliance, and University of Washington, Seattle, WA
| | | | - John F Forbes
- Breast Cancer Trials Australia and New Zealand (BCT-ANZ), Newcastle, Australia.,Calvary Mater Hospital, Newcastle, Australia
| | | | - William E Barlow
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Frank L Meyskens
- University of California at Irvine Chao Family Comprehensive Cancer Center, Orange, CA
| | - Richard D Gelber
- IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health and Frontier Science and Technology Research Foundation, Boston, MA
| | | | - Kathy S Albain
- Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL
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4
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Cuzick J, Sestak I, Forbes JF, Dowsett M, Cawthorn S, Mansel RE, Loibl S, Bonanni B, Evans DG, Howell A. Use of anastrozole for breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial. Lancet 2020; 395:117-122. [PMID: 31839281 PMCID: PMC6961114 DOI: 10.1016/s0140-6736(19)32955-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Two large clinical trials have shown a reduced rate of breast cancer development in high-risk women in the initial 5 years of follow-up after use of aromatase inhibitors (MAP.3 and International Breast Cancer Intervention Study II [IBIS-II]). Here, we report blinded long-term follow-up results for the IBIS-II trial, which compared anastrozole with placebo, with the objective of determining the efficacy of anastrozole for preventing breast cancer (both invasive and ductal carcinoma in situ) in the post-treatment period. METHODS IBIS-II is an international, randomised, double-blind, placebo-controlled trial. Postmenopausal women at increased risk of developing breast cancer were recruited and were randomly assigned (1:1) to either anastrozole (1 mg per day, oral) or matching placebo daily for 5 years. After treatment completion, women were followed on a yearly basis to collect data on breast cancer incidence, death, other cancers, and major adverse events (cardiovascular events and fractures). The primary outcome was all breast cancer. FINDINGS 3864 women were recruited between Feb 2, 2003, and Jan 31, 2012. 1920 women were randomly assigned to 5 years anastrozole and 1944 to placebo. After a median follow-up of 131 months (IQR 105-156), a 49% reduction in breast cancer was observed for anastrozole (85 vs 165 cases, hazard ratio [HR] 0·51, 95% CI 0·39-0·66, p<0·0001). The reduction was larger in the first 5 years (35 vs 89, 0·39, 0·27-0·58, p<0·0001), but still significant after 5 years (50 vs 76 new cases, 0·64, 0·45-0·91, p=0·014), and not significantly different from the first 5 years (p=0·087). Invasive oestrogen receptor-positive breast cancer was reduced by 54% (HR 0·46, 95% CI 0·33-0·65, p<0·0001), with a continued significant effect in the period after treatment. A 59% reduction in ductal carcinoma in situ was observed (0·41, 0·22-0·79, p=0·0081), especially in participants known to be oestrogen receptor-positive (0·22, 0·78-0·65, p<0·0001). No significant difference in deaths was observed overall (69 vs 70, HR 0·96, 95% CI 0·69-1·34, p=0·82) or for breast cancer (two anastrozole vs three placebo). A significant decrease in non-breast cancers was observed for anastrozole (147 vs 200, odds ratio 0·72, 95% CI 0·57-0·91, p=0·0042), owing primarily to non-melanoma skin cancer. No excess of fractures or cardiovascular disease was observed. INTERPRETATION This analysis has identified a significant continuing reduction in breast cancer with anastrozole in the post-treatment follow-up period, with no evidence of new late side-effects. Further follow-up is needed to assess the effect on breast cancer mortality. FUNDING Cancer Research UK, the National Health and Medical Research Council Australia, Breast Cancer Research Foundation, Sanofi Aventis, and AstraZeneca.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | - John F Forbes
- Australia New Zealand Breast Cancer Trials Group Newcastle, University of Newcastle, Calvary Mater Hospital, Waratah, NSW, Australia
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden, London, UK
| | | | - Robert E Mansel
- University Department of Surgery, University of Wales College of Medicine, Cardiff, UK
| | | | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D Gareth Evans
- Prevent Breast Cancer Unit, Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anthony Howell
- Prevent Breast Cancer Unit, Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust, Manchester, UK
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5
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Smith JBE, Channon KM, Kiparoglou V, Forbes JF, Gray AM. Correction: A macroeconomic assessment of the impact of medical research expenditure: A case study of NIHR Biomedical Research Centres. PLoS One 2019; 14:e0216315. [PMID: 31022288 PMCID: PMC6483241 DOI: 10.1371/journal.pone.0216315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ackland SP, Gebski V, Zdenkowski N, Wilson A, Green M, Tees S, Dhillon H, Van Hazel G, Levi J, Simes RJ, Forbes JF, Coates AS. Dose intensity in anthracycline-based chemotherapy for metastatic breast cancer: mature results of the randomised clinical trial ANZ 9311. Breast Cancer Res Treat 2019; 176:357-365. [PMID: 31028610 DOI: 10.1007/s10549-019-05187-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The separate impacts of dose and dose intensity of chemotherapy for metastatic breast cancer remain uncertain. The primary objective of this trial was to compare a short, high-dose, intensive course of epirubicin and cyclophosphamide (EC) with a longer conventional dose regimen delivering the same total dose of chemotherapy. METHODS This open label trial randomised 235 women with metastatic breast cancer to receive either high-dose epirubicin 150 mg/m2 and cyclophosphamide 1500 mg/m2 with filgrastim support every 3 weeks for 3 cycles (HDEC) or standard dose epirubicin 75 mg/m2 and cyclophosphamide 750 mg/m2 every 3 weeks for 6 cycles (SDEC). Primary outcomes were time to progression, overall survival and quality of life. RESULTS In 118 patients allocated HDEC 90% of the planned dose was delivered, compared to 96% in the 117 participants allocated SDEC. There were no significant differences in the time to disease progression (5.7 vs. 5.8 months, P = 0.19) or overall survival (14.5 vs. 16.5 months, P = 0.29) between HDEC and SDEC, respectively. Patients on HDEC reported worse quality of life during therapy, but scores improved after completion to approximate those reported by patients allocated SDEC. Objective tumour response was recorded in 33 (28%) on HDEC and 42 patients (36%) on SDEC. HDEC produced more haematologic toxicity. CONCLUSION For women with metastatic breast cancer, disease progression, survival or quality of life were no better with high-dose intensity compared to standard dose EC chemotherapy. Australian Clinical Trials Registry registration number ACTRN12605000478617.
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Affiliation(s)
- Stephen P Ackland
- Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia. .,Breast Cancer Trials Ltd., Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia.
| | - V Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - N Zdenkowski
- Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia. .,Breast Cancer Trials Ltd., Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia.
| | - A Wilson
- Breast Cancer Trials Ltd., Newcastle, NSW, Australia
| | - M Green
- Royal Melbourne Hospital, Parkville, VIC, Australia
| | - S Tees
- Breast Cancer Trials Ltd., Newcastle, NSW, Australia
| | - H Dhillon
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - G Van Hazel
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - J Levi
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - R J Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - J F Forbes
- Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.,Breast Cancer Trials Ltd., Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
| | - A S Coates
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Smith JBE, Channon K, Kiparoglou V, Forbes JF, Gray AM. A macroeconomic assessment of the impact of medical research expenditure: A case study of NIHR Biomedical Research Centres. PLoS One 2019; 14:e0214361. [PMID: 30970015 PMCID: PMC6457483 DOI: 10.1371/journal.pone.0214361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/12/2019] [Indexed: 11/18/2022] Open
Abstract
Quantifying the value of investment in medical research can inform decision-making on the prioritisation of research programmes. Existing methodologies to estimate the rate of return of medical research are inappropriate for early-phase translational research due to censoring of health benefits and time lags. A strategy to improve the process of translational research for patient benefit has been initiated as part of the UK National Institute for Health Research (NIHR) investment in Biomedical Research Centres (BRCs) in England. By providing a platform for partnership between universities, NHS trusts and industry, successful BRCs should reduce time lags within translational research whilst also providing an impetus for local economic growth through industry collaboration. We present a novel contribution in the assessment of early-phase biomedical research by estimating the impact of the Oxford Biomedical Research Centre (OxBRC) on income and job creation following the initial NIHR investment. We adopt a macroeconomic assessment approach using Input-Output Analysis to estimate the value of medical research in terms of income and job creation during the early pathway towards translational biomedical research. Inter-industry linkages are assessed by building a model economy for the South East England region to estimate the return on investment of the OxBRC. The results from the input-output model estimate that the return on investment in biomedical research within the OxBRC is 46%. Each £1 invested in the OxBRC generates an additional £0.46 through income and job creation alone. Multiplicative employment effects following a marginal investment in the OxBRC of £98m during the period 2007-2017 result in an estimated additional 196 full time equivalent positions being created within the local economy on top of direct employment within OxBRC. Results from input-output analyses can be used to inform the prioritisation of biomedical research programmes when compared against national minimum thresholds of investment.
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Affiliation(s)
- Joel B. E. Smith
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith Channon
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John F. Forbes
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Alastair M. Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
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8
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Chua BH, Gray K, Krishnasamy M, Regan M, Zdenkowski N, Loi S, Mann B, Forbes JF, Wilcken N, Spillane A, Martin A, Badger H, Jafari S, Fong A, Mavin C, Corachan S, Arahmani A, Martinez JL, Francis P. Abstract OT2-04-03: Examining personalized radiation therapy (EXPERT): A randomised phase III trial of adjuvant radiotherapy vs observation in patients with molecularly characterized luminal A breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-03] [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
Radiation therapy (RT) after breast conserving surgery (BCS) is the current standard of care for patients with early stage breast cancer. However, individual absolute recurrence risks and hence benefits of RT vary substantially. A study showed significant association between local recurrence (LR) risk and PAM50-defined intrinsic subtypes and Risk of Recurrence scores (ROR).1
The objective of EXPERT, a co-lead study of Breast Cancer Trials-Australia & New Zealand (BCT-ANZ), and Breast International Group (BIG), is to optimize local therapy for early breast cancer through precise individualized quantification of LR risk to identify patients for whom RT after BCS may be safely omitted.
Trial design
This is a randomized, non-inferiority, phase III study of women who plan to receive adjuvant endocrine therapy for Prosigna (PAM50)-defined luminal A breast cancer with ROR ≤60 resected by BCS.
Women are randomized to receive adjuvant whole breast RT and endocrine therapy or endocrine therapy alone and followed-up for 10 years after randomization.
Major eligibility criteria
Females aged ≥50 years; histologically confirmed invasive breast carcinoma ≤2 cm, grade 1 or 2, ER and PgR ≥10%, HER2-negative and node-negative; treated by BCS with negative margins for invasive carcinoma and associated DCIS; Prosigna (PAM50)-defined Luminal A subtype and ROR ≤60; and plan to receive adjuvant endocrine therapy.
Specific aims
Primary: To determine if omission of RT is not inferior to RT in terms of LR-free interval after BCS.
Secondary: To evaluate the impact of omission of RT on regional, local-regional and distant recurrence-free interval; disease-free survival (DFS); invasive DFS; overall survival; salvage RT or mastectomy rate; toxicity; endocrine therapy adherence; patient reported outcomes; and health economic outcomes.
Statistical methods
An estimated 5-year LR rate in the target population is expected to be 1% with RT. A rate of 4% is considered non-inferior as a worthwhile trade-off against RT toxicity. Using O'Brien-Fleming boundary for rejecting non-inferiority, 29 LR events are required for final analysis expected 8 years after the first patient is randomized. Two interim analyses will be conducted after 10 and 21 events. If the stratified log-rank test statistic exceeds the upper boundary at interim or final analysis, the hypothesis of non-inferiority will be rejected and it will be concluded that no RT is inferior to RT.
Accrual: Target (1170), actual: 82 (June 2018)
The study was activated in Australia in August 2017, with global activation planned for Q4 2018. Recruitment is expected to be completed in 4.5 years.
Contact information
Professor Boon Chua, UNSW Sydney and Prince of Wales Hospital, NSW, Australia; email boon.chua@health.nsw.gov.au; T +61 2 49255239. Registration: NCT02889874
References
Fitzal F, Filipits M, Fesl C, et al. Predicting local recurrence using PAM50 in postmenopausal endocrine responsive breast cancer patients. JCO 2014;32(15 suppl):1008.
Citation Format: Chua BH, Gray K, Krishnasamy M, Regan M, Zdenkowski N, Loi S, Mann B, Forbes JF, Wilcken N, Spillane A, Martin A, Badger H, Jafari S, Fong A, Mavin C, Corachan S, Arahmani A, Martinez J-L, Francis P. Examining personalized radiation therapy (EXPERT): A randomised phase III trial of adjuvant radiotherapy vs observation in patients with molecularly characterized luminal A breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-03.
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Affiliation(s)
- BH Chua
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - K Gray
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - M Krishnasamy
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - M Regan
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - N Zdenkowski
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - S Loi
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - B Mann
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - JF Forbes
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - N Wilcken
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - A Spillane
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - A Martin
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - H Badger
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - S Jafari
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - A Fong
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - C Mavin
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - S Corachan
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - A Arahmani
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - J-L Martinez
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - P Francis
- Prince of Wales Hospital, Randwick, NSW, Australia; Dana-Farber Cancer Institute, Boston, MA; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The Mater Hospital, Sydney, NSW, Australia; Breast International Group, Brussels, Belgium; University of New South Wales, Sydney, NSW, Australia; University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
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Smith SG, Sestak I, Morris MA, Howell A, Forbes JF, Cuzick JM. Overweight and breast cancer risk in the International Breast Cancer Intervention studies I and II. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1560] [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: 11/20/2022] Open
Affiliation(s)
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | | | | | | | - Jack M. Cuzick
- Wolfson Institute of Preventive Medicine, London, United Kingdom
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Moseley A, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Abstract P1-15-01: Final analysis of SWOG S0230/Prevention of early menopause study (POEMS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-15-01] [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: The SWOG S0230/POEMS study demonstrated a 70% reduction in ovarian failure (OF) with goserelin coadministration during chemotherapy (CT) for ER-negative early breast cancer (BC; Moore H et al, NEJM 2015). Goserelin use was also associated with more pregnancies as well as favorable disease free survival (DFS) and overall survival (OS). Here we report the final analysis after 5 years of follow-up.
METHODS: Premenopausal women age <50 with stage I-IIIA ER/PR-negative BC to be treated with cyclophosphamide-containing CT were randomized to receive standard CT with or without monthly goserelin 3.6 mg SQ starting at least 1 week prior to the first CT dose. The primary endpoint was OF at 2-years, defined as amenorrhea for the prior 6 months and post-menopausal FSH. Secondary endpoints included pregnancies, disease free survival (DFS) and overall survival (OS). An unplanned analysis of rate of menses recovery at 2 years (presence of menses within 6 months of the 2 year time-point or pregnancy within the first 2 years) was also conducted. OF and pregnancy endpoints were analyzed using multivariable logistic regression adjusting for stratification factors (age and CT regimen); DFS and OS were examined using multivariable Cox regression, adjusting for stratification factors and stage. Two-sided p-values are reported unless otherwise specified in accordance with protocol design.
RESULTS: Among 257 randomized participants, 218 were eligible and evaluable. One hundred thirty-six eligible and evaluable patients had OF data and 186 had menstrual data. Median age was 37.7 years. Among the 136 patients with OF data, the odds ratio (OR) for OF at 2 years was 0.30 (95% CI 0.1-0.98; one-sided p=0.023) comparing CT with goserelin to standard CT alone. Among 186 patients with menstrual data, 80% recovered menses by 2 years in the goserelin arm compared with 70% in the standard arm (OR=1.74, 95% CI: 0.83-3.66, p=0.15). Pregnancies, DFS and OS are reported for all 218 eligible and evaluable patients. With a median follow-up of 5.1 years, 22% of patients in the goserelin group had at least one pregnancy compared with 12% in the standard group (OR 2.38, 95% CI 1.08-5.26, p=0.03). Cumulative incidence of pregnancy at 5 years is 23% in the goserelin arm compared with 12% in the standard group. Five-year Kaplan-Meier DFS estimates are 88% in the goserelin arm compared with 79% in the standard arm (HR=0.50, p=0.05). Five-year OS is 92% with goserelin versus 83% in the standard arm (HR=0.47, p=0.06). Including all 257 randomized patients, HR for DFS and OS are 0.67 and 0.48 (p=0.18 and p=0.05).
CONCLUSION: Ovarian suppression with goserelin during chemotherapy for hormone receptor-negative breast cancer reduces OF risk and, after 5 years of follow-up, continues to be associated with more pregnancies and improved survival compared with chemotherapy without goserelin.
SUPPORT: NIH/NCI grant awards CA189974, CA180888, CA180819, CA074362; AstraZeneca
Citation Format: Moore HCF, Unger JM, Phillips K-A, Boyle F, Hitre E, Moseley A, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Final analysis of SWOG S0230/Prevention of early menopause study (POEMS) [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 P1-15-01.
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Affiliation(s)
- HCF Moore
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JM Unger
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - K-A Phillips
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - F Boyle
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - E Hitre
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - A Moseley
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - D Porter
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - PA Francis
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - LJ Goldstein
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - HL Gomez
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - CS Vallejos
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - AH Partridge
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - SR Dakhil
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - AA Garcia
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - J Gralow
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JM Lombard
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JF Forbes
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - S Martino
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - WE Barlow
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - CJ Fabian
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - L Minasian
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - FL Meyskens
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - RD Gelber
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - GN Hortobagyi
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - KS Albain
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
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Sestak I, Smith SG, Howell A, Forbes JF, Cuzick J. Early participant-reported symptoms as predictors of adherence to anastrozole in the International Breast Cancer Intervention Studies II. Ann Oncol 2018; 29:504-509. [PMID: 29126161 PMCID: PMC5834118 DOI: 10.1093/annonc/mdx713] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Anastrozole reduces breast cancer risk in women at high risk, but implementing preventive therapy in clinical practice is difficult. Here, we evaluate adherence to anastrozole in the International Breast Cancer Intervention Study (IBIS)-II prevention and ductal carcinoma in situ (DCIS) trials, and its association with early symptoms. Patients and methods In the prevention trial, 3864 postmenopausal women were randomized to placebo versus anastrozole. A total of 2980 postmenopausal women with DCIS were randomized to tamoxifen versus anastrozole. Adherence to trial medication was calculated using the Kaplan-Meier method and all P-values were two-sided. Results In the prevention trial, adherence was 65.8% [anastrozole (65.7%) versus placebo (65.9%); HR = 0.97 (0.87-1.09), P = 0.6]. Adherence was lower for those reporting arthralgia in the placebo group (P = 0.02) or gynecological symptoms in the anastrozole group (P = 0.003), compared with those not reporting these symptoms at 6 months. In the DCIS study, adherence was 66.7% [anastrozole (67.5%) versus tamoxifen (65.8%); HR = 1.06 (0.94-1.20), P = 0.4]. Hot flashes were associated with greater adherence in the anastrozole arm (P = 0.02). In both studies, symptoms were mostly mild or moderately severe, and adherence decreased with increasing severity for most symptoms. Drop-outs were highest in the first 1.5 years of therapy in both trials. Conclusions In the IBIS-II prevention and DCIS trials, over two-thirds of women were adherent to therapy, with no differences by treatment groups. Participants who reported specific symptoms in the IBIS-II prevention trial had a small but significant effect on adherence, which strengthened as severity increased. Strategies to promote adherence should target the first year of preventive therapy.
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Affiliation(s)
- I Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - S G Smith
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - A Howell
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - J F Forbes
- Department of Surgical Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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12
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Bartlett JM, Ahmed I, Regan MM, Sestak I, Mallon EA, Dell'Orto P, Thürlimann B, Seynaeve C, Putter H, Van de Velde CJ, Brookes CL, Forbes JF, Viale G, Cuzick J, Dowsett M, Rea DW. HER2 status predicts for upfront AI benefit: A TRANS-AIOG meta-analysis of 12,129 patients from ATAC, BIG 1-98 and TEAM with centrally determined HER2. Eur J Cancer 2017; 79:129-138. [DOI: 10.1016/j.ejca.2017.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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13
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Cuzick J, Sestak I, Bianco A, Strobbe L, Bergh J, Hanusch C, Neven P, Dowsett M, Forbes JF, Buzdar A, Smith R, Howell A. Abstract P2-09-03: Long-term comparison of anastrozole versus tamoxifen: Results from LATTE/ATAC. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-09-03] [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: Previous reports from the Anastrozole Tamoxifen Alone or in Combination (ATAC) trial have shown significantly prolonged disease-free survival, lower rates of recurrence and distant recurrence, and reduced contralateral breast cancer in patients treated with anastrozole compared to tamoxifen (Cuzick et al., Lancet, 2010). Here, we compare the long-term effects of anastrozole versus tamoxifen in patients randomised to either monotherapy arm in the ATAC trial.
Methods: Postmenopausal women with hormone receptor positive breast cancer randomised to anastrozole or tamoxifen in the main ATAC trial were eligible for the LATTE observational study. The primary objective was to compare the long-term effects of tamoxifen and anastrozole on time to recurrence and death beyond 10 years after randomisation. Secondary objectives included time to distant recurrence, cancer-specific survival, new breast primaries, other cancers, fractures, and cardiac/cerebrovascular events. Cox proportional hazard methods were used to compute hazard ratios (95% CI) for recurrence from the time of last publication (10 years median follow-up).
Results: 2452 women from 11 countries were entered into the LATTE study. 40 women withdrew consent and 759 women died or had a recurrence within 10 years, which left 1653 women for analysis (838 anastrozole vs. 815 tamoxifen). A total of 118 breast events (69 anastrozole (8.2%) vs. 49 tamoxifen (6.0%)) were reported. No significant difference between the two treatment arms were observed (HR=1.36 (0.94-1.97), P=0.098). 57 women had a distant recurrence (33 (3.9%) vs. 24 (2.9%)), 41 reported a loco-regional recurrence (23 (2.7%) vs. 18 (2.2%)), and 26 contra-lateral breast cancer were recorded (17 (2.0%) vs. 9 (1.1%)). None of the treatment comparisons were statistically significant. 305 deaths were recorded (147 (17.5%) vs. 158 (19.4%)), of which 31 were due to breast cancer. Significantly fewer gynaecological cancers were recorded with anastrozole (7 vs. 16; OR=0.42 (0.15-1.09), P=0.05), but overall the effect on other cancers was not significant (54 (6.4%) vs. 64 (7.9%). Fractures, cardiovascular, and cerebrovascular events were evenly distributed between the treatment arms.
Conclusions: Although anastrozole was associated with significant fewer recurrences compared to tamoxifen in the first 10 years of follow-up, in this analysis, with limited number of patients, we could not find a significant difference between the two treatment arms.
Citation Format: Cuzick J, Sestak I, Bianco A, Strobbe L, Bergh J, Hanusch C, Neven P, Dowsett M, Forbes JF, Buzdar A, Smith R, Howell A. Long-term comparison of anastrozole versus tamoxifen: Results from LATTE/ATAC [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-03.
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Affiliation(s)
- J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - I Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - A Bianco
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - L Strobbe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - J Bergh
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - C Hanusch
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - P Neven
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - M Dowsett
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - JF Forbes
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - A Buzdar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - R Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - A Howell
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
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Faulkner S, Roselli S, Oldmeadow C, Attia J, Forbes JF, Walker MM, Hondermarck H. Abstract P6-03-03: Tropomyosin-related kinase A is overexpressed in HER2-positive breast cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-03-03] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- S Faulkner
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - S Roselli
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - C Oldmeadow
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - J Attia
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - JF Forbes
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - MM Walker
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - H Hondermarck
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute; School of Mathematical and Physical Sciences, The University of Newcastle, Callaghan, NSW, Australia; School of Public Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
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Thorat MA, Wagner S, Jones LJ, Levey PM, Bulka K, Hoff R, Sangale Z, Flake DD, Bundred NJ, Fentiman IS, Forbes JF, Lanchbury JS, Cuzick J. Abstract P1-09-06: Prognostic and predictive relevance of cell cycle progression (CCP) score in ductal carcinoma in situ: Results from the UK/ANZ DCIS trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-06] [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: The prognostic abilities of most gene expression signatures in breast cancer are often due to detection of proliferative activity measured from expression of genes regulated as a function of cell cycle progression. Cell Cycle Progression (CCP) score is an important prognostic factor in prostate cancer, and has shown promising results for renal and lung cancer; its role in ductal carcinoma in situ (DCIS) has not been explored. We investigated the prognostic and predictive relevance of CCP Score in DCIS using material from UK/ANZ DCIS trial.
Methods: Formalin-fixed paraffin embedded tissues were collected from patients enrolled in the UK/ANZ DCIS trial, a randomised 2X2 factorial design trial investigating role of tamoxifen, radiotherapy (RT) or both as adjuvant treatment in DCIS. mRNA expression of 25 S- and M-phase CCP genes was evaluated by reverse transcription followed by PCR on customized Taqman low-density arrays. CCP score is an un-weighted average of the expression values of CCP genes after normalisation with 14 housekeeping genes. CCP score was analysed as a continuous variable and also as an ordinal variable using tertile-based cut-offs. Exploratory analyses with subgroups defined by HER2 status by immunohistochemistry were performed.
Results: CCP scores were evaluable in 521 (134 recurrence events) of 704 available samples (DCIS absent or insufficient RNA in 51, assay failure in 132). Increase in CCP score (median 1.15; IQR 0.71-1.74) was associated with increased risk of ipsilateral breast event (IBE) [Hazard ratio (HR) = 1.28; 95% Confidence Interval (95%CI) 1.08-1.51; p = 0.0049]. CCP score however was not an independent predictor in multivariate analyses [HR = 1.16; 95%CI 0.95-1.42; p = 0.14].
CCP scores were categorised as CCP low (<0.87), CCP intermediate (>/= 0.87 to < 1.52) and CCP high (>/= 1.52) by tertiles. The benefit of RT in reducing IBE was significant when CCP score was low [HR = 0.35; 95%CI 0.14-0.87; p = 0.024] or intermediate [HR = 0.23; 95%CI 0.09-0.59; p = 0.0023], however, those with high CCP score did not derive significant RT benefit [HR = 0.59; 95%CI 0.31-1.13; p = 0.11].
In exploratory subgroup analyses, HER2 negative DCIS with high CCP score (20.9% of all DCIS cases) did not derive RT benefit and the largest RT benefit was seen for DCIS that expressed HER2 and did not have a high CCP score (23.2% of all DCIS cases).
Benefit of RT and 10-year IBE rates by CCP score (categorised) and HER2 status subgroups.SubgroupneventsHR (95%CI)p10-year IBE rates (%) - No RT10-year IBE rates (%) - RTCCP-high & HER2 neg106220.83 (0.35-1.97)0.6722.5 (14.0-35.0)20.0 (10.5-36.0)CCP-high & HER2 pos67210.43 (0.16-1.17)0.09840.6 (27.1-57.6)20.4 (8.9-42.9)CCP-non-High & HER2 neg217300.43 (0.18-0.99)0.04816.2 (10.7-24.0)8.1 (4.0-16.3)CCP- non-High & HER2 pos118330.14 (0.04-0.46)0.001239.5 (29.3-51.6)7.1 (2.3-20.4)CCP-non-High = low or intermediate CCP score
Conclusions: CCP score is not independently associated with the risk of IBE but appears to be a predictor of RT benefit. Exploratory analyses suggest that combined with HER2 status, it may help in identifying a large DCIS subgroup where RT is highly indicated and another large subgroup where mastectomy may be merited.
Citation Format: Thorat MA, Wagner S, Jones LJ, Levey PM, Bulka K, Hoff R, Sangale Z, Flake II DD, Bundred NJ, Fentiman IS, Forbes JF, Lanchbury JS, Cuzick J. Prognostic and predictive relevance of cell cycle progression (CCP) score in ductal carcinoma in situ: Results from the UK/ANZ DCIS trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-06.
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Affiliation(s)
- MA Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - S Wagner
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - LJ Jones
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - PM Levey
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - K Bulka
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - R Hoff
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - Z Sangale
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - DD Flake
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - NJ Bundred
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - IS Fentiman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - JF Forbes
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - JS Lanchbury
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
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Chirgwin JH, Giobbie-Hurder A, Coates AS, Price KN, Ejlertsen B, Debled M, Gelber RD, Goldhirsch A, Smith I, Rabaglio M, Forbes JF, Neven P, Láng I, Colleoni M, Thürlimann B. Treatment Adherence and Its Impact on Disease-Free Survival in the Breast International Group 1-98 Trial of Tamoxifen and Letrozole, Alone and in Sequence. J Clin Oncol 2016; 34:2452-9. [PMID: 27217455 DOI: 10.1200/jco.2015.63.8619] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To investigate adherence to endocrine treatment and its relationship with disease-free survival (DFS) in the Breast International Group (BIG) 1-98 clinical trial. METHODS The BIG 1-98 trial is a double-blind trial that randomly assigned 6,193 postmenopausal women with hormone receptor-positive early breast cancer in the four-arm option to 5 years of tamoxifen (Tam), letrozole (Let), or the agents in sequence (Let-Tam, Tam-Let). This analysis included 6,144 women who received at least one dose of study treatment. Conditional landmark analyses and marginal structural Cox proportional hazards models were used to evaluate the relationship between DFS and treatment adherence (persistence [duration] and compliance with dosage). Competing risks regression was used to assess demographic, disease, and treatment characteristics of the women who stopped treatment early because of adverse events. RESULTS Both aspects of low adherence (early cessation of letrozole and a compliance score of < 90%) were associated with reduced DFS (multivariable model hazard ratio, 1.45; 95% CI, 1.09 to 1.93; P = .01; and multivariable model hazard ratio, 1.61; 95% CI, 1.08 to 2.38; P = .02, respectively). Sequential treatments were associated with higher rates of nonpersistence (Tam-Let, 20.8%; Let-Tam, 20.3%; Tam 16.9%; Let 17.6%). Adverse events were the reason for most trial treatment early discontinuations (82.7%). Apart from sequential treatment assignment, reduced adherence was associated with older age, smoking, node negativity, or prior thromboembolic event. CONCLUSION Both persistence and compliance are associated with DFS. Toxicity management and, for sequential treatments, patient and physician awareness, may improve adherence.
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Affiliation(s)
- Jacquie H Chirgwin
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary.
| | - Anita Giobbie-Hurder
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Alan S Coates
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Karen N Price
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Bent Ejlertsen
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Marc Debled
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Richard D Gelber
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Aron Goldhirsch
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Ian Smith
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Manuela Rabaglio
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - John F Forbes
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Patrick Neven
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - István Láng
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Marco Colleoni
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
| | - Beat Thürlimann
- Jacquie H. Chirgwin and John F. Forbes, University of Newcastle; John F. Forbes, Calvary Mater Newcastle, Newcastle; Alan S. Coates, University of Sydney School of Public Health, Sydney, New South Wales; Jacquie H. Chirgwin, Box Hill Hospital; Jacquie H. Chirgwin, Maroondah Hospital; Jacquie H. Chirgwin, Monash University, Melbourne, Victoria, Australia; Anita Giobbie-Hurder, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute; Karen N. Price and Richard D. Gelber, Frontier Science and Technology Research Foundation; Richard D. Gelber, Harvard Medical School, Boston, MA; Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; Marc Debled, Institut Bergonié, Bordeaux, France; Aron Goldhirsch and Marco Colleoni, European Institute of Oncology, Milan, Italy; Ian Smith, The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Manuela Rabaglio, Inselspital, Bern; Beat Thürlimann, Kantonsspital, St. Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; István Láng, National Institute of Oncology, Budapest, Hungary
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17
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Phillips KA, Regan MM, Ribi K, Francis PA, Puglisi F, Bellet M, Spazzapan S, Karlsson P, Budman DR, Zaman K, Abdi EA, Domchek SM, Feng Y, Price KN, Coates AS, Gelber RD, Maruff P, Boyle F, Forbes JF, Ahles T, Fleming GF, Bernhard J. Adjuvant ovarian function suppression and cognitive function in women with breast cancer. Br J Cancer 2016; 114:956-64. [PMID: 27092785 PMCID: PMC4984913 DOI: 10.1038/bjc.2016.71] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Received: 09/23/2015] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 12/18/2022] Open
Abstract
Background: To examine the effect on cognitive function of adjuvant ovarian function suppression (OFS) for breast cancer. Methods: The Suppression of Ovarian Function (SOFT) trial randomised premenopausal women with hormone receptor-positive breast cancer to 5 years adjuvant endocrine therapy with tamoxifen+OFS, exemestane+OFS or tamoxifen alone. The Co-SOFT substudy assessed objective cognitive function and patient reported outcomes at randomisation (T0), and 1 year later (T1); the primary endpoint was change in global cognitive function, measured by the composite objective cognitive function score. Data were compared for the pooled tamoxifen+OFS and exemestane+OFS groups vs the tamoxifen alone group using the Wilcoxon rank-sum test. Results: Of 86 participants, 74 underwent both T0 and T1 cognitive testing; 54 randomised to OFS+ either tamoxifen (28) or exemestane (26) and 20 randomised to tamoxifen alone. There was no significant difference in the changes in the composite cognitive function scores between the OFS+ tamoxifen or exemestane groups and the tamoxifen group (mean±s.d., −0.21±0.92 vs −0.04±0.49, respectively, P=0.71, effect size=−0.20), regardless of prior chemotherapy status, and adjusting for baseline characteristics. Conclusions: The Co-SOFT study, although limited by small samples size, provides no evidence that adding OFS to adjuvant oral endocrine therapy substantially affects global cognitive function.
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Affiliation(s)
- Kelly-Anne Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.,Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), Platt Street, Waratah, NSW 2298, Australia.,International Breast Cancer Study Group, Bern CH-3008, Switzerland
| | - Meredith M Regan
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.,Harvard Medical School, Department of Medicine, Boston, MA 02115, USA
| | - Karin Ribi
- International Breast Cancer Study Group Coordinating Center, Effingerstrasse 40, Bern CH-3008, Switzerland
| | - Prudence A Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.,Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), Platt Street, Waratah, NSW 2298, Australia.,International Breast Cancer Study Group, Bern CH-3008, Switzerland
| | - Fabio Puglisi
- International Breast Cancer Study Group, Bern CH-3008, Switzerland.,Department of Medical Oncology, University Hospital of Udine, Piazzale S.M. Misericordia 15, Udine 33100, Italy.,School of Medical Oncology, The University of Udine, Udine 33100, Italy
| | - Meritxell Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona 08035, Spain.,SOLTI Group, Barcelona 08008, Spain
| | - Simon Spazzapan
- International Breast Cancer Study Group, Bern CH-3008, Switzerland.,CRO Aviano, IRCCS, National Cancer Institute, Via F. Gallini 2, Aviano 33081, Italy
| | - Per Karlsson
- International Breast Cancer Study Group, Bern CH-3008, Switzerland.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Röda stråket 16, Gothenburg 413 45, Sweden
| | - Daniel R Budman
- Monter Cancer Center of the North Shore-LIJ Health System, 450 Lakeville Road, Lake Success, NY 11042, USA.,NRG Oncology, Four Penn Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 19103, USA
| | - Khalil Zaman
- International Breast Cancer Study Group, Bern CH-3008, Switzerland.,Department of Oncology, Breast Center CHUV, Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - Ehtesham A Abdi
- Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), Platt Street, Waratah, NSW 2298, Australia.,International Breast Cancer Study Group, Bern CH-3008, Switzerland.,Tweed Heads Hospital, Tweed Heads, Griffith University, Gold Coast, Powell Street, Tweed Heads, NSW 2485, Australia
| | - Susan M Domchek
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA.,ECOG-ACRIN, 1818 Market Street, Suite 1100, Philadelphia, PA 19103, USA
| | - Yang Feng
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Karen N Price
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.,Frontier Science and Technology Research Foundation
| | - Alan S Coates
- Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), Platt Street, Waratah, NSW 2298, Australia.,International Breast Cancer Study Group, Bern CH-3008, Switzerland.,University of Sydney, Sydney, NSW 2006, Australia
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.,Frontier Science and Technology Research Foundation.,Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA 02115, USA
| | - Paul Maruff
- Cogstate Ltd, 2/255 Bourke Street, Melbourne, VIC 3000, Australia
| | - Frances Boyle
- Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), Platt Street, Waratah, NSW 2298, Australia.,International Breast Cancer Study Group, Bern CH-3008, Switzerland.,Mater Hospital, 40 Rocklands Road, North Sydney, NSW 2060, Australia
| | - John F Forbes
- International Breast Cancer Study Group, Bern CH-3008, Switzerland.,University of Newcastle, Calvary Mater Newcastle Hospital, Australia.,Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), NBN Telethon Mater Institute, Locked Bag 7 HRMC, Newcastle, NSW 2298, Australia
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave Fl 7, New York, NY 10022, USA.,Alliance for Clinical Trials in Oncology, Chicago, IL 60637, USA
| | - Gini F Fleming
- Alliance for Clinical Trials in Oncology, Chicago, IL 60637, USA.,The University of Chicago Medical Center, 5841 South Maryland Ave, MC 2115, Chicago, IL 60637, USA
| | - Jürg Bernhard
- International Breast Cancer Study Group Coordinating Center, Effingerstrasse 40, Bern CH-3008, Switzerland.,Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
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18
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Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones L, Ellis I, Cuzick J. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet 2016; 387:866-73. [PMID: 26686313 PMCID: PMC4769326 DOI: 10.1016/s0140-6736(15)01129-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Third-generation aromatase inhibitors are more effective than tamoxifen for preventing recurrence in postmenopausal women with hormone-receptor-positive invasive breast cancer. However, it is not known whether anastrozole is more effective than tamoxifen for women with hormone-receptor-positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole with that of tamoxifen in postmenopausal women with hormone-receptor-positive DCIS. METHODS In a double-blind, multicentre, randomised placebo-controlled trial, we recruited women who had been diagnosed with locally excised, hormone-receptor-positive DCIS. Eligible women were randomly assigned in a 1:1 ratio by central computer allocation to receive 1 mg oral anastrozole or 20 mg oral tamoxifen every day for 5 years. Randomisation was stratified by major centre or hub and was done in blocks (six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation and only the trial statistician had access to treatment allocation. The primary endpoint was all recurrence, including recurrent DCIS and new contralateral tumours. All analyses were done on a modified intention-to-treat basis (in all women who were randomised and did not revoke consent for their data to be included) and proportional hazard models were used to compute hazard ratios and corresponding confidence intervals. This trial is registered at the ISRCTN registry, number ISRCTN37546358. RESULTS Between March 3, 2003, and Feb 8, 2012, we enrolled 2980 postmenopausal women from 236 centres in 14 countries and randomly assigned them to receive anastrozole (1449 analysed) or tamoxifen (1489 analysed). Median follow-up was 7·2 years (IQR 5·6-8·9), and 144 breast cancer recurrences were recorded. We noted no statistically significant difference in overall recurrence (67 recurrences for anastrozole vs 77 for tamoxifen; HR 0·89 [95% CI 0·64-1·23]). The non-inferiority of anastrozole was established (upper 95% CI <1·25), but its superiority to tamoxifen was not (p=0·49). A total of 69 deaths were recorded (33 for anastrozole vs 36 for tamoxifen; HR 0·93 [95% CI 0·58-1·50], p=0·78), and no specific cause was more common in one group than the other. The number of women reporting any adverse event was similar between anastrozole (1323 women, 91%) and tamoxifen (1379 women, 93%); the side-effect profiles of the two drugs differed, with more fractures, musculoskeletal events, hypercholesterolaemia, and strokes with anastrozole and more muscle spasm, gynaecological cancers and symptoms, vasomotor symptoms, and deep vein thromboses with tamoxifen. CONCLUSIONS No clear efficacy differences were seen between the two treatments. Anastrozole offers another treatment option for postmenopausal women with hormone-receptor-positive DCIS, which may be be more appropriate for some women with contraindications for tamoxifen. Longer follow-up will be necessary to fully evaluate treatment differences. FUNDING Cancer Research UK, National Health and Medical Research Council Australia, Breast Cancer Research Fund, AstraZeneca, Sanofi Aventis.
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Affiliation(s)
- John F Forbes
- Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Waratah, NSW, Australia
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Nigel Bundred
- South Manchester University Hospital, Manchester, UK
| | | | | | | | - Patrick Neven
- Department of Oncology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Michael Stierer
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert E Coleman
- Department of Oncology and Metabolism, Weston Park Hospital, Sheffield, UK
| | - Louise Jones
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ian Ellis
- Department of Histopathology University of Nottingham, Nottingham, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
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19
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Cuzick J, Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones LJ, Ellis I. Abstract S6-03: Anastrozole versus tamoxifen for the prevention of loco-regional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in-situ (IBIS-II DCIS). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-03] [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: Third generation aromatase inhibitors are a more effective treatment option than tamoxifen for hormone receptor positive invasive breast cancer in postmenopausal women. However, it is not known whether anastrozole is more effective than tamoxifen in preventing the recurrence of breast cancer in women with hormone receptor (HR) positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole versus tamoxifen in postmenopausal women with HR positive DCIS.
Methods: A multi-centre randomised placebo-controlled trial of 1mg/day anastrozole (oral) vs. 20mg/day tamoxifen (oral) for five years was conducted in 2980 postmenopausal women with locally excised HR positive DCIS. The primary endpoint was to determine if anastrozole is at least as effective as tamoxifen in loco-regional control and prevention of contralateral disease. Secondary endpoints included breast cancer mortality, other cancers, cardiovascular disease, fractures, adverse events and non-breast cancer deaths. All analyses were done on an intention-to-treat basis and Cox proportional hazard were used to compute hazard ratios and corresponding confidence intervals for recurrence.
Results: Between 2003 and 2012, a total of 2980 postmenopausal women were recruited into the IBIS-II DCIS trial. 1471 women were randomly assigned to receive anastrozole and 1509 women tamoxifen. Median follow-up for this first analysis is 6.8 years and 131 breast cancer recurrences have been recorded. Median age was 60.3 years (56.1-64.6), median BMI was 26.7 (23.6-30.7), and 45.6% of women had used hormone replacement therapy (HRT) before joining the trial. Of the 131 women with recurrent disease, 77 had a loco-regional recurrence and 51 reported contralateral disease. A total of 61 deaths were recorded. We will present a comprehensive analysis of the efficacy of anastrozole and tamoxifen for preventing loco-regional/contralateral breast cancer and major adverse events by intention to treat (ITT).
Conclusions: To follow.
Citation Format: Cuzick J, Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones LJ, Ellis I. Anastrozole versus tamoxifen for the prevention of loco-regional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in-situ (IBIS-II DCIS). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-03.
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Affiliation(s)
- J Cuzick
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - JF Forbes
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - I Sestak
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - A Howell
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - B Bonanni
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - N Bundred
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - C Levy
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - G von Minckwitz
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - W Eiermann
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - P Neven
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - M Stierer
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - C Holcombe
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - RE Coleman
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - LJ Jones
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - I Ellis
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
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Thorat MA, Wagner S, Jones LJ, Levey PM, Bulka K, Hoff R, Sangale Z, Flake II DD, Bundred NJ, Fentiman IS, Forbes JF, Lanchbury JS, Cuzick J. Abstract P3-07-02: Prognostic and predictive relevance of HER2 status in ductal carcinoma in situ: Results from the UK/ANZ DCIS trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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:
As compared to invasive breast cancer (IBC), HER2 is much more frequently overexpressed in ductal carcinoma in situ (DCIS). Unlike IBC, the prognostic significance of HER2 overexpression remains to be established in DCIS and large studies to investigate its predictive role are lacking. We investigated the prognostic and predictive relevance of HER2 protein and ERBB2 mRNA expression in DCIS using material from UK/ANZ DCIS trial.
Methods:
Formalin-fixed paraffin embedded tissues (FFPETs) were collected from patients enrolled in the UK/ANZ DCIS trial, a randomised 2X2 factorial design trial investigating role of tamoxifen, radiotherapy or both as adjuvant treatment in DCIS. ERBB2 mRNA expression was evaluated by reverse transcription followed by PCR on customized Taqman low-density arrays. ERBB2 mRNA expression was analysed as a continuous variable and also as a binary variable using a cut-off to reproduce HER2 expression distribution similar to that observed with immunohistochemistry (IHC). HER2 protein expression was evaluated by IHC using HercepTest™ and scored as per ASCO-CAP 2013 recommendations; HER2 equivocal (IHC2+) were grouped with HER2 negative (IHC 0 or 1+) for main analyses. Additional analyses using binary ERBB2 mRNA expression as a reflex test for HER2 IHC2+ were also performed.
Results:
HER2 protein expression was evaluable in 713 (181 events) of 755 available samples (DCIS absent or lost during assay in 42). ERBB2 mRNA expression was evaluable in 521 (134 events) of 704 available samples (DCIS absent or insufficient RNA in 51, assay failure in 132). Both results were available in 508 cases (130 events). Increase in ERBB2 mRNA expression (median 0.62; range 0.07-36.76) was associated with increased risk of in situ ipsilateral breast event (DCIS-IBE) [Hazard ratio (HR) = 1.07; 95% Confidence Interval (95%CI) 1.04-1.10; p < 0.0001] but not with increased risk of invasive ipsilateral breast event (I-IBE) [HR = 1.03; 95%CI 0.97-1.10; p = 0.3209]. HER2 positivity by IHC was similarly associated with increased risk of DCIS-IBE [HR = 2.90; 95%CI 1.91-4.40; p < 0.0001] but not with increased risk of I-IBE [HR = 1.40; 95%CI 0. 0.81-2.42; p = 0.2313]. Reclassification of HER2 IHC2+ cases using binary ERBB2 mRNA expression (46 as negative, 16 as positive; 18 expression data unavailable) further improved prognostic discrimination of HER2 IHC [ΔX2 (1d.f.) 5.51; p = 0.0189] for any recurrence. The effect of radiotherapy (RT) for reducing I-IBE was greater in HER2 positive (by ERBB2 mRNA expression) cases [HR = 0.24; 95%CI 0.07-0.83; p = 0.0237] as compared with HER2 negative cases [HR = 0.60; 95%CI 0.23-1.55; p = 0.2925]. Kaplan-Meier estimates of 10-year I-IBE rates with and without RT were 4.5% (2.5%-1.4%) and 15.8% (9.6%-25.3%) in HER2 positive DCIS; rates in HER negative DCIS were 5.2% (2.1%-2.4%) and 7.3% (4.3%-12.2%) respectively. The differential benefit of RT by HER2 status was also seen for reduction in DCIS-IBE.
Conclusions:
HER2 overexpression is associated with increased risk of DCIS-IBE but not of I-IBE. HER2 status is predictive of radiotherapy response with larger reductions in both I-IBE and DCIS-IBE seen in HER2 positive DCIS.
Citation Format: Thorat MA, Wagner S, Jones LJ, Levey PM, Bulka K, Hoff R, Sangale Z, Flake II DD, Bundred NJ, Fentiman IS, Forbes JF, Lanchbury JS, Cuzick J. Prognostic and predictive relevance of HER2 status in ductal carcinoma in situ: Results from the UK/ANZ DCIS trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-02.
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Affiliation(s)
- MA Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - S Wagner
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - LJ Jones
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - PM Levey
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - K Bulka
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - R Hoff
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - Z Sangale
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - DD Flake II
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - NJ Bundred
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - IS Fentiman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - JF Forbes
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - JS Lanchbury
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Blizard Institute Core Pathology, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom; School of Medicine and Public Health, The University of Newcastle, Australia, Callaghan, New South Wales, Australia; Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT
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Bartlett JMS, Ahmed I, Regan MM, Sestak I, Mallon EA, Dell'Orto P, Thürlimann BJK, Seynaeve C, Putter H, Brookes CL, Forbes JF, Colleoni MA, Bayani J, van de Velde CJH, Viale G, Cuzick J, Dowsett M, Rea DW. Abstract S4-06: HER2 status as predictive marker for AI vs Tam benefit: A TRANS-AIOG meta-analysis of 12129 patients from ATAC, BIG 1-98 and TEAM with centrally determined HER2. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s4-06] [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
There is now significant evidence emerging from the pivotal trials of AIs versus Tamoxifen (AIOG) demonstrating the value of meta-analysis of key clinical questions. The "Trans-AIOG" group has been tasked with the exploration of key molecular/biomarker questions that are pertinent to meta-analyses of biomarkers (past/present/future) in AIOG trials. HER2 has been long proposed as a marker of endocrine "resistance". Data from three trials, before the era of HER-directed therapy, suggest a potential role for HER2 to select patients for treatment with upfront AIs. However the individual trials lack power to test treatment-by-HER2 interaction due to sample size and low HER2+ve rates. A meta-analysis of the predictive value of HER2 status, specifically within the first 3 years of endocrine therapy, has the potential to inform patient selection for upfront or sequential strategies with AIs. The pre-existing standardization of methodology for HER2 (IHC/FISH) facilitates analysis of existing data from BIG-1-98, TEAM and ATAC for this key marker.
Analysis plan: Following a prospectively-designed analysis plan, patient-level data from 3 randomized phase III trials (ATAC, BIG 1-98, TEAM) comparing AIs to tamoxifen during the first 2-3 years of adjuvant treatment were collected at the CRCTU (Birmingham UK), accounting for both the established time-dependency of relapse in HER2+ve, anti-endocrine treated patients and to address the clinical question of "upfront" vs "sequential" strategies for AIs. For each trial, covariate-adjusted Cox models estimated HER2-by-treatment (AI vs Tam) interaction on distant recurrence-free interval-censored at 2-2.75 years follow-up. A meta-analysis of the HER2-by-treatment interaction terms and of treatment effects according to HER2 status was performed.
Results: 12129 patients with centrally-confirmed ER and HER2 status, 1092 (9%) HER2+ve, with 473 (4%; 111 among HER2+ve) distant recurrences were analyzed. The meta-analysis estimated a pooled HER2-by-treatment interaction of 1.61 (95% CI 1.01,2.57), reflecting treatment effect hazard ratio(AI/Tam) of HR=1.13 (0.75,1.71) among HER2+ve and HR=0.70 (0.56,0.87) among HER2-ve. There was heterogeneity among interaction terms (I-squared=59%, p=.09) that resulted from treatment effect heterogeneity among HER2+ve subgroup (I2=71%, p=.03), not the HER2-ve subgroup (I2=0%). The results for disease-free survival were similar.
Conclusion: An individual patient data meta-analysis across 3 trials (ATAC, BIG 1-98, TEAM) conducted prior to standard use of HER2-directed adjuvant therapy demonstrated a marginally-significant interaction between HER2 status and treatment with AIs vs Tamoxifen in the 2-2.75 years prior to potential "switching" between Tamoxifen and AIs. Patients with HER2-ve cancers experienced improved outcomes when treated with AIs vs Tamoxifen whilst patients with HER+ve cancers fared no better, or slightly worse, during AI treatment. However, the small number of HER2+ve cancers and events even in this meta-analysis may explain a large degree of heterogeneity in the treatment effects within the HER2+ve subgroups across the 3 trials. Other causes, perhaps related to subtle differences between AIs, cannot be excluded.
Citation Format: Bartlett JMS, Ahmed I, Regan MM, Sestak I, Mallon EA, Dell'Orto P, Thürlimann BJK, Seynaeve C, Putter H, Brookes CL, Forbes JF, Colleoni MA, Bayani J, van de Velde CJH, Viale G, Cuzick J, Dowsett M, Rea DW, On Behalf of the Translational Aromatase Inhibitor Overview Group (Trans-AIOG). HER2 status as predictive marker for AI vs Tam benefit: A TRANS-AIOG meta-analysis of 12129 patients from ATAC, BIG 1-98 and TEAM with centrally determined HER2. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S4-06.
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Affiliation(s)
- JMS Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - I Ahmed
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - MM Regan
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - I Sestak
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - EA Mallon
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - P Dell'Orto
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - BJK Thürlimann
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - C Seynaeve
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - H Putter
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - CL Brookes
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - JF Forbes
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - MA Colleoni
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - J Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - CJH van de Velde
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - G Viale
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - J Cuzick
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - M Dowsett
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
| | - DW Rea
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Birmingham, Birmingham, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Queen Mary, University of London, London, United Kingdom; Western Infirmary, Glasgow, United Kingdom; Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland; Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands; The University of Newcastle, Newcastle, New South Wales, Australia; University of Milan, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; European Institute of Oncology, Milan, Italy
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Zdenkowski N, Forbes JF, Boyle FM, Kannourakis G, Gill PG, Bayliss E, Saunders C, Della-Fiorentina S, Kling N, Campbell I, Mann GB, Coates AS, Gebski V, Davies L, Thornton R, Reaby L, Cuzick J, Green M. Observation versus late reintroduction of letrozole as adjuvant endocrine therapy for hormone receptor-positive breast cancer (ANZ0501 LATER): an open-label randomised, controlled trial. Ann Oncol 2016; 27:806-12. [PMID: 26861603 DOI: 10.1093/annonc/mdw055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/29/2015] [Accepted: 01/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the effectiveness of adjuvant endocrine therapy in preventing breast cancer recurrence, breast cancer events continue at a high rate for at least 10 years after completion of therapy. PATIENTS AND METHODS This randomised open label phase III trial recruited postmenopausal women from 29 Australian and New Zealand sites, with hormone receptor-positive early breast cancer, who had completed ≥4 years of endocrine therapy [aromatase inhibitor (AI), tamoxifen, ovarian suppression, or sequential combination] ≥1 year prior, to oral letrozole 2.5 mg daily for 5 years, or observation. Treatment allocation was by central computerised randomisation, stratified by institution, axillary node status and prior endocrine therapy. The primary outcome was invasive breast cancer events (new invasive primary, local, regional or distant recurrence, or contralateral breast cancer), analysed by intention to treat. The secondary outcomes were disease-free survival (DFS), overall survival, and safety. RESULTS Between 16 May 2007 and 14 March 2012, 181 patients were randomised to letrozole and 179 to observation (median age 64.3 years). Endocrine therapy was completed at a median of 2.6 years before randomisation, and 47.5% had tumours of >2 cm and/or node positive. At 3.9 years median follow-up (interquartile range 3.1-4.8), 2 patients assigned letrozole (1.1%) and 17 patients assigned observation (9.5%) had experienced an invasive breast cancer event (difference 8.4%, 95% confidence interval 3.8% to 13.0%, log-rank test P = 0.0004). Twenty-four patients (13.4%) in the observation and 14 (7.7%) in the letrozole arm experienced a DFS event (log-rank P = 0.067). Adverse events linked to oestrogen depletion, but not serious adverse events, were more common with letrozole. CONCLUSION These results should be considered exploratory, but lend weight to emerging data supporting longer duration endocrine therapy for hormone receptor-positive breast cancer, and offer insight into reintroduction of AI therapy. CLINICAL TRIALS NUMBER Australian New Zealand Clinical Trials Registry (www.anzctr.org.au), ACTRN12607000137493.
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Affiliation(s)
- N Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Waratah School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Waratah School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - F M Boyle
- Australia and New Zealand Breast Cancer Trials Group, Waratah School of Medicine and Public Health, University of Newcastle, Callaghan, Australia Patricia Ritchie Centre for Cancer Care and Research, North Sydney
| | | | - P G Gill
- Department of Surgery, Royal Adelaide Hospital, Adelaide
| | - E Bayliss
- Department of Medical Oncology, Royal Perth Hospital, Perth
| | - C Saunders
- School of Surgery, University of Western Australia, Crawley
| | | | - N Kling
- Department of Surgery, St John of God Hospital, Bunbury, Australia
| | - I Campbell
- Breast Care Centre, Waikato Hospital, Hamilton, New Zealand
| | - G B Mann
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville
| | - A S Coates
- Australia and New Zealand Breast Cancer Trials Group, Waratah National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - V Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - L Davies
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - R Thornton
- Australia and New Zealand Breast Cancer Trials Group, Waratah
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Waratah
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - M Green
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville
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Colleoni M, Sun Z, Price KN, Karlsson P, Forbes JF, Thürlimann B, Gianni L, Castiglione M, Gelber RD, Coates AS, Goldhirsch A. Annual Hazard Rates of Recurrence for Breast Cancer During 24 Years of Follow-Up: Results From the International Breast Cancer Study Group Trials I to V. J Clin Oncol 2016; 34:927-35. [PMID: 26786933 DOI: 10.1200/jco.2015.62.3504] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Predicting the pattern of recurrence can aid in the development of targeted surveillance and treatment strategies. We identified patient populations that remain at risk for an event at a median follow-up of 24 years from the diagnosis of operable breast cancer. PATIENTS AND METHODS International Breast Cancer Study Group clinical trials I to V randomly assigned 4,105 patients between 1978 and 1985. Annualized hazards were estimated for breast cancer-free interval (primary end point), disease-free survival, and overall survival. RESULTS For the entire group, the annualized hazard of recurrence was highest during the first 5 years (10.4%), with a peak between years 1 and 2 (15.2%). During the first 5 years, patients with estrogen receptor (ER)--positive disease had a lower annualized hazard compared with those with ER-negative disease (9.9% v 11.5%; P = .01). However, beyond 5 years, patients with ER-positive disease had higher hazards (5 to 10 years: 5.4% v 3.3%; 10 to 15 years: 2.9% v 1.3%; 15 to 20 years: 2.8% v 1.2%; and 20 to 25 years: 1.3% v 1.4%; P < .001). Among patients with ER-positive disease, annualized hazards of recurrence remained elevated and fairly stable beyond 10 years, even for those with no axillary involvement (2.0%, 2.1%, and 1.1% for years 10 to 15, 15 to 20, and 20 to 25, respectively) and for those with one to three positive nodes (3.0%, 3.5%, and 1.5%, respectively). CONCLUSION Patients with ER-positive breast cancer maintain a significant recurrence rate during extended follow up. Strategies for follow up and treatments to prevent recurrences may be most efficiently applied and studied in patients with ER-positive disease followed for a long period of time.
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Affiliation(s)
- Marco Colleoni
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
| | - Zhuoxin Sun
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Karen N Price
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Per Karlsson
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - John F Forbes
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Beat Thürlimann
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Lorenzo Gianni
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Monica Castiglione
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Richard D Gelber
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Alan S Coates
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
| | - Aron Goldhirsch
- Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland
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24
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Spagnolo F, Sestak I, Howell A, Forbes JF, Cuzick J. Anastrozole-Induced Carpal Tunnel Syndrome: Results From the International Breast Cancer Intervention Study II Prevention Trial. J Clin Oncol 2016; 34:139-43. [PMID: 26598748 DOI: 10.1200/jco.2015.63.4972] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Indexed: 02/11/2024] Open
Abstract
PURPOSE Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist in the carpal tunnel. It has been suggested that hormonal risk factors may be involved in the pathogenesis of CTS, and a higher incidence of CTS has been reported in randomized clinical trials with aromatase inhibitors (AIs) compared with tamoxifen. PATIENTS AND METHODS This was an exploratory analysis of the International Breast Cancer Intervention Study II, a double-blind randomized clinical trial in which women at increased risk of breast cancer were randomly assigned to receive anastrozole or placebo. This is the first report of risk factors for and characteristics of CTS in women taking an AI in a placebo-controlled trial. RESULTS Overall, 96 participants with CTS were observed: 65 (3.4%) in the anastrozole arm and 31 (1.6%) in the placebo arm (odds ratio, 2.16 [1.40 to 3.33]; P < .001). Ten participants were reported as having severe CTS, of which eight were taking anastrozole (P = .08). Eighteen women (0.9%) in the anastrozole arm and six women (0.3%) in the placebo arm reported surgical intervention, which was significantly different (odds ratio, 3.06 [1.21 to 7.72], P = .018). Six women discontinued with the allocated treatment because of the onset of CTS. Apart from treatment allocation, a high body mass index and an a prior report of musculoskeletal symptoms after trial entry were the only other risk factors for CTS identified in these postmenopausal women. CONCLUSIONS The use of anastrozole was associated with a higher incidence of CTS but few participants required surgery. Further investigations are warranted into the risk factors and treatment of AI-induced CTS.
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Affiliation(s)
- Francesco Spagnolo
- Francesco Spagnolo, Ivana Sestak, and Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom; and John F. Forbes, Department of Surgical Oncology, University of Newcastle, Newcastle Mater Hospital, New South Wales, Australia
| | - Ivana Sestak
- Francesco Spagnolo, Ivana Sestak, and Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom; and John F. Forbes, Department of Surgical Oncology, University of Newcastle, Newcastle Mater Hospital, New South Wales, Australia
| | - Anthony Howell
- Francesco Spagnolo, Ivana Sestak, and Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom; and John F. Forbes, Department of Surgical Oncology, University of Newcastle, Newcastle Mater Hospital, New South Wales, Australia
| | - John F Forbes
- Francesco Spagnolo, Ivana Sestak, and Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom; and John F. Forbes, Department of Surgical Oncology, University of Newcastle, Newcastle Mater Hospital, New South Wales, Australia
| | - Jack Cuzick
- Francesco Spagnolo, Ivana Sestak, and Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Anthony Howell, Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom; and John F. Forbes, Department of Surgical Oncology, University of Newcastle, Newcastle Mater Hospital, New South Wales, Australia
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25
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Lombard JM, Zdenkowski N, Wells K, Beckmore C, Reaby L, Forbes JF, Chirgwin J. Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options. Support Care Cancer 2015; 24:2139-2146. [PMID: 26556210 DOI: 10.1007/s00520-015-3001-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management. METHODS A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used. RESULTS Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82 %) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68 % discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20 % of respondents found no intervention effective in any category. CONCLUSION We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.
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Affiliation(s)
- Janine M Lombard
- Calvary Mater Newcastle, Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia. .,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.
| | - Nicholas Zdenkowski
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Kathy Wells
- Breast Cancer Network Australia, Newcastle, Vic, Australia
| | - Corinna Beckmore
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Linda Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - John F Forbes
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Jacquie Chirgwin
- University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.,Monash University, Newcastle, Vic, Australia
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26
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Zdenkowski N, Butow P, Fewster S, Beckmore C, Wells K, Forbes JF, Boyle F. Exploring Decision-Making about Neo-adjuvant Chemotherapy for Breast Cancer. Breast J 2015; 22:133-4. [PMID: 26530428 DOI: 10.1111/tbj.12537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - Phyllis Butow
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - Sheryl Fewster
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - Corinna Beckmore
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - Kathryn Wells
- Breast Cancer Network Australia, Camberwell, Victoria, Australia
| | - John F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - Frances Boyle
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
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27
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Dowsett M, Sestak I, Buus R, Lopez-Knowles E, Mallon E, Howell A, Forbes JF, Buzdar A, Cuzick J. Estrogen Receptor Expression in 21-Gene Recurrence Score Predicts Increased Late Recurrence for Estrogen-Positive/HER2-Negative Breast Cancer. Clin Cancer Res 2015; 21:2763-70. [PMID: 26078431 DOI: 10.1158/1078-0432.ccr-14-2842] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify the individual genes or gene modules that lead to the OncoptypeDx 21-gene recurrence score's reduced performance after 5 years and thereby identify indices of residual risk that may guide selection of patients for extended adjuvant therapy. EXPERIMENTAL DESIGN We conducted a retrospective assessment of the relationship between (i) the individual genes and gene modules of the Recurrence Score and (ii) early (0-5 years) and late (5-10 years) recurrence rates in 1,125 postmenopausal patients with primary estrogen receptor-positive breast cancer treated with anastrozole or tamoxifen in the Arimidex, Tamoxifen, Alone or Combined (ATAC) randomized clinical trial. RESULTS In the HER2-negative population (n = 1,009), estimates of recurrence risk were similar between years 0-5 and 5-10 for proliferation and invasion modules but markedly different for the estrogen module and genes within it (all split at the median): for low estrogen module, annual recurrence rates were similar across the two time windows (2.06% vs. 2.46%, respectively); for high estrogen module, annual rates were 1.14% versus 2.72%, respectively (P interaction = 0.004). Estrogen receptor transcript levels showed inverse prediction across the time windows: HR, 0.88 (0.73-1.07) and 1.19 (0.99-1.43), respectively (P interaction = 0.03). Similar time-, module-, and estrogen-dependent relationships were seen for distant recurrence. CONCLUSIONS Patients with tumors with high estrogen receptor transcript levels benefit most from 5 years' endocrine therapy but show increased recurrence rates after 5 years and may benefit from extended therapy. Improved prognostic profiles may be created by considering period of treatment and follow-up time.
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Affiliation(s)
- Mitch Dowsett
- Royal Marsden Hospital and Breakthrough Breast Cancer Centre, Institute of Cancer Research, London, United Kingdom.
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Richard Buus
- Royal Marsden Hospital and Breakthrough Breast Cancer Centre, Institute of Cancer Research, London, United Kingdom
| | - Elena Lopez-Knowles
- Royal Marsden Hospital and Breakthrough Breast Cancer Centre, Institute of Cancer Research, London, United Kingdom
| | - Elizabeth Mallon
- Department of Pathology, Western Infirmary, Glasgow, United Kingdom
| | - Anthony Howell
- Christie Hospital, Manchester Breast Centre and Breakthrough Breast Cancer Research Unit, Manchester, United Kingdom
| | - John F Forbes
- Department of Surgical Oncology, University of Newcastle, Newcastle Mater Hospital, New South Wales, Australia
| | - Aman Buzdar
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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28
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Walsh TS, Salisbury LG, Merriweather JL, Boyd JA, Griffith DM, Huby G, Kean S, Mackenzie SJ, Krishan A, Lewis SC, Murray GD, Forbes JF, Smith J, Rattray JE, Hull AM, Ramsay P. Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial. JAMA Intern Med 2015; 175:901-10. [PMID: 25867659 DOI: 10.1001/jamainternmed.2015.0822] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. OBJECTIVE To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. DESIGN, SETTING, AND PARTICIPANTS A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. INTERVENTIONS During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. MAIN OUTCOMES AND MEASURES The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). RESULTS Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. CONCLUSIONS AND RELEVANCE Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN09412438.
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Affiliation(s)
- Timothy S Walsh
- Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland2Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edin
| | - Lisa G Salisbury
- Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland4Department of Nursing, School of Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Judith L Merriweather
- Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland3Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland4Department o
| | - Julia A Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland
| | - David M Griffith
- Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland3Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland
| | - Guro Huby
- Interdisciplinary Social Sciences in Health, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland7Faculty of Health and Social Studies, University College Østfold, Østfold, Norway
| | - Susanne Kean
- Department of Nursing, School of Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Simon J Mackenzie
- Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland
| | - Ashma Krishan
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland
| | - Stephanie C Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland8Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Gordon D Murray
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland8Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - John F Forbes
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Joel Smith
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland8Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Janice E Rattray
- School of Nursing and Midwifery, University of Dundee, Dundee, Scotland
| | - Alastair M Hull
- Perth Royal Infirmary, NHS Tayside, Dundee, Scotland12Department of Psychiatry, University of Dundee, Dundee, Scotland
| | - Pamela Ramsay
- Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland3Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland4Department o
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Zdenkowski N, Green M, Boyle FM, Kannourakis G, Gill PG, Bayliss E, Saunders C, Della-Fiorentina S, Kling N, Campbell I, Gebski V, Veillard AS, Davies LC, Thornton R, Fong A, Reaby LL, Forbes JF. Final analysis of a randomized comparison of letrozole (Let) vs observation (Obs) as late reintroduction of adjuvant endocrine therapy (AET) for postmenopausal women with hormone receptor positive (HR+) breast cancer (BC) after completion of prior AET: ANZBCTG 0501 (LATER). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Frances M. Boyle
- University of Sydney and Mater Hospital, North Sydney, Australia
| | | | | | | | | | | | - Neill Kling
- Bunbury and St John of God Medical Centre, Bunbury, Australia
| | | | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia
| | - Anne-Sophie Veillard
- National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia
| | - Lucy Claire Davies
- National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia
| | - Rochelle Thornton
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia
| | - Akiko Fong
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia
| | - Linda Louise Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia
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Pundavela J, Roselli S, Faulkner S, Attia J, Scott RJ, Thorne RF, Forbes JF, Bradshaw RA, Walker MM, Jobling P, Hondermarck H. Nerve fibers infiltrate the tumor microenvironment and are associated with nerve growth factor production and lymph node invasion in breast cancer. Mol Oncol 2015; 9:1626-35. [PMID: 26009480 DOI: 10.1016/j.molonc.2015.05.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [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: 03/18/2015] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 01/15/2023] Open
Abstract
Infiltration of the tumor microenvironment by nerve fibers is an understudied aspect of breast carcinogenesis. In this study, the presence of nerve fibers was investigated in a cohort of 369 primary breast cancers (ductal carcinomas in situ, invasive ductal and lobular carcinomas) by immunohistochemistry for the neuronal marker PGP9.5. Isolated nerve fibers (axons) were detected in 28% of invasive ductal carcinomas as compared to only 12% of invasive lobular carcinomas and 8% of ductal carcinomas in situ (p = 0.0003). In invasive breast cancers, the presence of nerve fibers was observed in 15% of lymph node negative tumors and 28% of lymph node positive tumors (p = 0.0031), indicating a relationship with the metastatic potential. In addition, there was an association between the presence of nerve fibers and the expression of nerve growth factor (NGF) in cancer cells (p = 0.0001). In vitro, breast cancer cells were able to induce neurite outgrowth in PC12 cells, and this neurotrophic activity was partially inhibited by anti-NGF blocking antibodies. In conclusion, infiltration by nerve fibers is a feature of the tumor microenvironment that is associated with aggressiveness and involves NGF production by cancer cells. The potential participation of nerve fibers in breast cancer progression needs to be further considered.
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Affiliation(s)
- Jay Pundavela
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Severine Roselli
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Sam Faulkner
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - John Attia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rodney J Scott
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Rick F Thorne
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - John F Forbes
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ralph A Bradshaw
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA 94158, USA
| | - Marjorie M Walker
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Phillip Jobling
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Hubert Hondermarck
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.
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Cuzick J, Sestak I, Cawthorn S, Hamed H, Holli K, Howell A, Forbes JF. Abstract S3-07: 16 year long-term follow-up of the IBIS-I breast cancer prevention trial. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-s3-07] [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: Several randomised clinical trials have shown the benefit of tamoxifen in healthy women to reduce their risk of breast cancer. Here, we report the blinded median 16 year follow-up of the IBIS-I trial to update the long-term prevention of breast cancer with tamoxifen treatment.
Methods: 7154 pre- and postmenopausal women were randomised to receive daily 20mg tamoxifen (N=3579) or matching placebo (N=3575) for 5 years. The primary endpoint of this analysis was the occurrence of breast cancer (invasive and ductal carcinoma in situ (DCIS)). Secondary endpoints included overall mortality, other cancers, and breast cancer specific mortality. Cox proportional hazard models were used to assess occurrence of breast cancer and survival. All statistical tests were two-sided.
Results: After a median of 16.2 years (IQR 14.4 to 17.7) of follow-up, a total of 589 breast cancers have been reported (tamoxifen: 246 (6.9%) vs. placebo: 343 (9.6%)). Tamoxifen reduced the incidence of all breast cancer overall by 29% (HR=0.71 (0.60-0.83), P<0.0001) (Figure 1). Invasive ER-positive (ER+) breast cancers were reduced by 35% (HR=0.65 (0.53-0.80), P<0.0001) (Figure 1), but no effect was seen for invasive ER-negative (ER-) breast cancers (HR=1.06 (0.71-1.58), P=0.8). A non-significant 30% reduction in DCIS was seen with tamoxifen (36 vs. 51, HR=0.70 (0.46-1.07); P=0.1). The overall risk reduction was similar in years 0-10 (HR=0.71) and years 10-20 (HR=0.70). Similar effects were seen in pre- and postmenopausal women (HR 0.71 vs. 0.71). All-cause mortality was non-significantly increased in women randomised to tamoxifen (173 vs. 158, OR=1.10 (0.88-1.38), P=0.4). The excess in deaths with tamoxifen is smaller than in the 96 month update. No differences in breast cancer mortality was seen (24 tamoxifen vs. 27 placebo; OR=0.89 (0.49-1.60), P=0.7). A non-significant increase in other cancers than breast were reported by women on tamoxifen (350 vs. 315, OR=1.12 (0.95-1.32); P=0.2). Specifically more endometrial cancers (28 vs. 17), non-melanoma skin cancers (108 vs. 85), and lung cancer (32 vs. 20) were found in those randomised to tamoxifen.
Conclusion: This updated analysis of the IBIS-I trial confirms the significant reduction in breast cancer occurrence with tamoxifen in the post-treatment follow-up period. These results indicate tamoxifen has a long-term preventive effect on invasive ER+ breast cancer in both pre- and postmenopausal women.
Citation Format: Jack Cuzick, Ivana Sestak, Simon Cawthorn, Hisham Hamed, Kaija Holli, Anthony Howell, John F Forbes. 16 year long-term follow-up of the IBIS-I breast cancer prevention trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr S3-07.
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Affiliation(s)
- Jack Cuzick
- 1Centre for Cancer Prevention, Queen Mary University
| | - Ivana Sestak
- 1Centre for Cancer Prevention, Queen Mary University
| | | | | | | | | | - John F Forbes
- 6School of Medicine and Public Health, University of Newcastle
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Giobbie-Hurder A, Thürlimann B, Ejlertsen B, Neven P, Coleman RE, Smith I, Wardley AM, Láng I, Colleoni M, Debled M, Forbes JF, Price KN, Regan MM, Rabaglio M, Goldhirsch A, Coates AS, Gelber RD. Abstract P4-18-03: IBCSG BIG 1-98 study: The long-term follow-up experience. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p4-18-03] [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
Industry-sponsored clinical trials often have duration of patient follow-up that is defined according to regulatory requirements. However, in diseases such as endocrine-responsive, early breast cancer, recurrences occur after protocol follow-up, and monitoring of long-term toxicity is important. It is challenging to continue patient follow-up after industry sponsorship ends. Transferring responsibility for additional follow-up to the participating academic centers is required. One such example is the long-term follow-up (LTFU) of patients in the Breast International Group (BIG) 1-98 Trial. We present the procedures and current status of the BIG 1-98 LTFU protocol.
Methods
In 2010, the BIG 1-98 trial embarked on a new LTFU protocol to gather data on patient outcomes for an additional five years after study completion (2011-2015). Industry sponsorship ceased at the end of 2010. The LTFU study is designed as an observational, non-interventional study to continue the collection of simplified and updated data on survival, disease status, and long-term adverse events from centers participating in the 4-arm option. The International Breast Cancer Study Group (IBCSG) is sponsoring BIG 1-98 LTFU, and per case reimbursement is available.
Results
The potential BIG 1-98 LTFU cohort consists of the 148 academic medical centers that participated in the 4-arm option with a maximum of 6843 patients enrolled to the parent study. In May 2014, approximately 3 years after initiation of the LTFU protocol, 96 centers had agreed to participate, of which 67 sites had activated the protocol and submitted LTFU data; 31 additional centers were not participating, and the status of 21 centers was unknown.
Participation StatusNumber of CentersPatients Enrolled in BIG 1-98Closed317Not Participating28643No response/Unknown21850Yes, participating965333 Activated674215Not Activated291118Totals1486843
Because the original BIG 1-98 informed consent indicated life-long follow-up, only three countries required patient re-consent in order to participate. At least one LTFU data submission has occurred for 73% of patients participating in the LTFU (May 2014).
Conclusion
Long-term follow-up for a large-scale clinical trial is feasible, but challenging. The methods used for BIG 1-98 LTFU will be described and the status will be updated at the meeting.
Citation Format: Anita Giobbie-Hurder, Beat Thürlimann, Bent Ejlertsen, Patrick Neven, Robert E Coleman, Ian Smith, Andrew M Wardley, István Láng, Marco Colleoni, Marc Debled, John F Forbes, Karen N Price, Meredith M Regan, Manuela Rabaglio, Aron Goldhirsch, Alan S Coates, Richard D Gelber. IBCSG BIG 1-98 study: The long-term follow-up experience [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-18-03.
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Affiliation(s)
| | - Beat Thürlimann
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Bent Ejlertsen
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Patrick Neven
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Robert E Coleman
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Ian Smith
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Andrew M Wardley
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - István Láng
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Marco Colleoni
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Marc Debled
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - John F Forbes
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Karen N Price
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Meredith M Regan
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Manuela Rabaglio
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Aron Goldhirsch
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Alan S Coates
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
| | - Richard D Gelber
- 1BIG 1-98 Collaborative Group and International Breast Cancer Study Group
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Phillips KA, Feng Y, Ribi K, Bernhard J, Puglisi F, Bellet M, Spazzapan S, Karlsson P, Budman DR, Zaman K, Abdi EA, Domchek SM, Regan MM, Coates AS, Gelber RD, Maruff P, Boyle F, Forbes JF, Fleming GF, Francis PA. Abstract P1-12-06: Co-SOFT: The cognitive function substudy of the suppression of ovarian function trial (SOFT). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-12-06] [Citation(s) in RCA: 2] [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: Cognitive impairment is a potential side-effect of breast cancer (BC) treatment. Estrogen is an important neuromodulator that affects cognition. Estrogen depletion by oophorectomy or GnRH agonists may adversely affect cognition in non-oncological settings, but there are few data regarding the cognitive effects of ovarian function suppression (OFS) in women with breast cancer.
Patients and Methods: Between November 2003 and January 2011, 3066 premenopausal women with hormone receptor-positive BC were randomised on the SOFT trial to 5 years of adjuvant endocrine therapy with tamoxifen alone, tamoxifen+OFS or exemestane+OFS. OFS was achieved by the GnRH agonist triptorelin, oophorectomy or ovarian irradiation. Prior chemotherapy was allowed, provided women had premenopausal estradiol levels at enrolment. Women eligible for Co-SOFT must not have received any prior adjuvant endocrine therapy. At study entry (t1), and approximately 1 year after SOFT randomisation (t2), objective cognitive function was assessed with a brief computerized test battery comprising 7 tasks (CogState Ltd: cogstate.com). Subjective cognitive function, psychological distress, fatigue, insomnia and quality of life were also assessed. Co-SOFT recruited 86 of a planned 321 patients from 27 of 426 SOFT centres between November 2007 and January 2011, when Co-SOFT was closed as the SOFT trial completed accrual. The protocol-specified primary comparison was the change in the composite score of the CogState tasks over 1 year for women randomised to tamoxifen versus tamoxifen+OFS. However, due to low accrual this was modified, prior to any analysis, to compare the tamoxifen versus the pooled tamoxifen+OFS and exemestane+OFS groups. Cognitive test scores were standardized according to age-specific norms, averaged to compute the composite score and then change between t1 and t2 calculated; a negative change in composite score indicates deterioration in cognitive function. Change in composite score was compared using Wilcoxon rank sum test.
Results: Of 86 Co-SOFT enrolled patients, 74 underwent both t1 and t2 CogState testing and were included in the primary analysis (7 withdrew consent/declined assessment, 5 missed testing due to scheduling). Of these 74 women, 20 were randomised to tamoxifen and 54 to OFS+tamoxifen (28) or OFS+exemestane (26). Baseline characteristics were well balanced between the 2 groups. During the first year 49 women utilised GnRH alone for OFS, 4 had GnRH followed by oophorectomy and 1 had oophorectomy alone. There was no significant difference in the changes in the CogState composite scores from t1 and t2 for patients randomised to tamoxifen alone compared with OFS+oral endocrine therapy (median, -0.057 versus -0.146 respectively, p=0.51). There were no significant between-group differences in the changes from t1 and t2 for any of the 7 individual cognitive tasks comprising the composite score.
Conclusions: The results of this 1-year longitudinal substudy suggest that the addition of OFS to oral endocrine therapy does not significantly affect cognitive function in the setting of adjuvant BC treatment. Co-SOFT was limited by small sample size, so further investigation of the impact of OFS on cognitive function in BC patients is warranted.
Citation Format: Kelly-Anne Phillips, Yang Feng, Karin Ribi, Jürg Bernhard, Fabio Puglisi, Meritxell Bellet, Simon Spazzapan, Per Karlsson, Daniel R Budman, Khalil Zaman, Ehtesham A Abdi, Susan M Domchek, Meredith M Regan, Alan S Coates, Richard D Gelber, Paul Maruff, Frances Boyle, John F Forbes, Gini F Fleming, Prudence A Francis. Co-SOFT: The cognitive function substudy of the suppression of ovarian function trial (SOFT) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-12-06.
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Affiliation(s)
| | - Yang Feng
- 2IBCSG Statistical Center, Dana-Farber Cancer Institute
| | | | | | | | | | | | | | | | - Khalil Zaman
- 9Centre Pluridisciplinaire d'Oncologie CHUV & IBCSG
| | - Ehtesham A Abdi
- 10Tweed Heads Hospital, Tweed Heads, Griffith University, ANZBCTG & IBCSG
| | | | | | | | | | | | | | | | - Gini F Fleming
- 16University of Chicago Medical Center & Alliance for Clinical Trials in Oncology
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Sestak I, Howell A, Forbes JF, Neven P, Cuzick J. Abstract PD4-1: Timing, severity and risk factors for arthralgia in the IBIS-II trial: A retrospective and exploratory analysis. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-pd4-1] [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: Arthralgia is a well known side effect of aromatase inhibitors and low oestrogen levels and postmenopausal status are associated with this event. Anastrozole reduced the incidence of oestrogen receptor positive, invasive breast cancer by 58% in the IBIS-II trial. However, timing, severity and risk factors for arthralgia have not been assessed in detail in this trial.
Methods: The IBIS-II trial randomised postmenopausal women at high risk to receive 1mg anastrozole or matching placebo for 5 years. Date of occurrence of arthralgia along with severity (mild, moderate, severe) were recorded at each yearly follow-up visit. Age, body mass index (BMI), and previous hormone replacement therapy (HRT) were investigated as potential risk factors for arthralgia. All analyses were done by the use of logistic regression.
Results: 3864 postmenopausal women (anastrozole: 1920, placebo: 1944) were enrolled in the IBIS-II trial. 58.5% of women randomised to anastrozole reported arthralgia at any time during the trial compared with 52.8% on placebo (OR=1.26 (1.11-1.43), P=0.0004). The majority of arthralgias were reported within the first 18 months of randomisation, with a decline thereafter (Table). 17.5% of women who reported arthralgia withdrew from the trial compared to 13.9% without any of these symptoms (OR=1.31 (1.10-1.57)), and the withdrawal was significantly greater for those with severe symptoms compared to mild (OR=5.97 (4.27-8.33)). Women who used HRT before trial entry had a significant higher risk of developing arthralgia than their counterparts irrespective of allocated treatment (OR=1.45 (1.27-1.64), P<0.001). Increasing BMI (lowest vs. highest BMI group: OR=1.30 (1.11-1.53)) and age (lowest vs. highest age group: OR=1.23 (1.01-1.50)) were also significant risk factors for arthralgia. HRT and BMI remained highly significant in a multivariate model.
Conclusion: Arthalgia was common in the IBIS-II trial irrespective of treatment. However it increased in severity in the active treatment arm mainly in the 18 month period after randomisation. Severe arthralgia led to significantly more withdrawals from the trial than mild symptoms irrespective of treatment. Major risk factors for arthralgia in both arms were previous HRT use and obesity.
Number and percentages (%) of arthralgia of any severity according to treatment allocation and time point.Overall0-18 months18-30 months30-42 months42-54 months>54 monthsAnastrozoleWomen at risk19201150842673543401Number with arthralgia1123770170865344Percentage (%)58.567.020.212.89.811.0PlaceboWomen at risk19441294979782618481Number with arthralgia10266501531096945Percentage (%)52.850.315.613.911.29.4OR (95% CI) (A vs. P)1.26 (1.11-1.43)1.33 (1.17-1.52)1.29 (1.01-1.65)0.92 (0.67-1.25)0.87 (0.59-1.29)1.17 (0.74-1.86)
Citation Format: Ivana Sestak, Anthony Howell, John F Forbes, Patrick Neven, Jack Cuzick. Timing, severity and risk factors for arthralgia in the IBIS-II trial: A retrospective and exploratory analysis [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD4-1.
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Affiliation(s)
- Ivana Sestak
- 1Centre for Cancer Prevention, Queen Mary University
| | | | - John F Forbes
- 3School of Medicine and Public Health, University of Newcastle
| | | | - Jack Cuzick
- 1Centre for Cancer Prevention, Queen Mary University
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Toi M, Winer EP, Benson JR, Inamoto T, Forbes JF, von Minckwitz G, Robertson JFR, Grobmyer SR, Jatoi I, Sasano H, Kunkler I, Ho AY, Yamauchi C, Chow LWC, Huang CS, Han W, Noguchi S, Pegram MD, Yamauchi H, Lee ES, Larionov AA, Bevilacqua JLB, Yoshimura M, Sugie T, Yamauchi A, Krop IE, Noh DY, Klimberg VS. Personalization of loco-regional care for primary breast cancer patients (part 1). Future Oncol 2015; 11:1297-300. [DOI: 10.2217/fon.15.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
ABSTRACT Kyoto Breast Cancer Consensus Conference, Kyoto, Japan, 18–20 February 2014 The loco-regional management of breast cancer is increasingly complex with application of primary systemic therapies, oncoplastic techniques and genetic testing for breast cancer susceptibility. Personalization of loco-regional treatment is integral to optimization of breast cancer care. Clinical and pathological tumor stage, biological features and host factors influence loco-regional treatment strategies and extent of surgical procedures. Key issues including axillary staging, axillary treatment, radiation therapy, primary systemic therapy (PST), preoperative hormonal therapy and genetic predisposition were identified and discussed at the Kyoto Breast Cancer Consensus Conference (KBCCC2014). In the first of a two part conference scene, consensus recommendations for axillary management are presented and focus on the following topics: indications for completion axillary lymph node dissection in primary surgical patients with ≤2 macrometastases or any sentinel nodal deposits after PST; the timing of sentinel lymph node biopsy in the context of PST; use of axillary irradiation as a component of primary treatment plans and the role of intraoperative node assessment in the post-Z0011 era.
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Affiliation(s)
- Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto 606–8507, Japan
| | - Eric P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Brigham & Women's Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - John R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Takashi Inamoto
- Faculty of Health Care, Tenri Health Care University, Nara, Japan
| | - John F Forbes
- Surgical Oncology, University of Newcastle, Newcastle, Australia
| | | | - John FR Robertson
- Breast Surgery, University of Nottingham, Royal Derby Hospital, Nottingham, UK
| | - Stephen R Grobmyer
- Cleveland Clinic & Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
| | - Ismail Jatoi
- The University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Hironobu Sasano
- Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Ian Kunkler
- Edinburgh Cancer Research UK Centre, The University of Edinburgh, UK
| | - Alice Y Ho
- Radiation Oncology, Memorial Sloan–Kettering Cancer Center, NY 10065, USA
| | - Chikako Yamauchi
- Radiation Oncology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Louis WC Chow
- UNIMED Medical Institute/University of Hong Kong, Hong Kong
| | - Chiun-Sheng Huang
- Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wonshik Han
- Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Shinzaburo Noguchi
- Breast & Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mark D Pegram
- Stanford Cancer Institute, School of Medicine, Stanford University, CA 94305, USA
| | | | - Eun-Sook Lee
- Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Alexey A Larionov
- Statistics & Computational Biology Laboratory, University of Cambridge, Cancer Research UK Cambridge Institute, UK
| | - Jose LB Bevilacqua
- Department of Breast Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Michio Yoshimura
- Radiation Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Akira Yamauchi
- Breast Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Ian E Krop
- Breast Oncology Center, Dana-Farber Cancer Institute, Brigham & Women's Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - Dong Young Noh
- Surgery, Seoul National University Hospital, Seoul, South Korea
| | - V Suzanne Klimberg
- Surgery, Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, AR 72205, USA
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Lombard JM, Zdenkowski N, Wells K, Grant N, Reaby L, Forbes JF, Chirgwin J. Abstract P1-12-05: Aromatase inhibitor induced musculoskeletal syndrome (AIMSS) in Australian women with early breast cancer: An Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) survey of members of the Breast Cancer Network Australia (BCNA). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-12-05] [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: AIMSS is experienced by approximately half of women taking an aromatase inhibitor (AI), impairing quality of life and in some leading to AI discontinuation. There is a lack of evidence for effective AIMSS treatments.
Aim: To investigate the importance of AIMSS in Australian women with early breast cancer.
Method: A survey invitation was distributed to 2390 members of the BCNA Review and Survey Group in April 2014. The online questionnaire consisted of 45 questions covering demographics, AI use, clinical manifestations and risk factors for AIMSS, reasons for AI discontinuation and efficacy of interventions used for AIMSS. AIMSS was defined as joint pain or stiffness that developed or worsened after commencing an AI.
Results: Of 594 respondents, 370 (62%) were eligible. Reasons for exclusion were: preinvasive disease, locally advanced/metastatic breast cancer, or other reason.
Eligible respondents had a median age range of 50-59 years. Duration of AI use varied (26%1year, 64% 1-5years, 10% 5years). 57% had received adjuvant chemotherapy. 43% of these commenced AI within 3 months of chemotherapy and 30% within 3-6 months of chemotherapy. A vitamin D test was performed in 64% of women and 68% were currently using vitamin D supplements. Joint pain during menopause was reported by 22% of respondents.
AIMSS occurred in 302/370 women (81%). Of those who developed AIMSS, sites affected were feet (68%), hands or wrists (65%), knees (62%), hips (56%), shoulders or elbows (49%), back (46%), or neck (3%). 34% of women had considered stopping an AI because of AIMSS.
99 (27%) of respondents had discontinued AI for any reason and of these 68% discontinued because of AIMSS. Non-AIMSS symptoms identified as reasons for discontinuation included fatigue, vaginal/urinary symptoms and hot flushes. In respondents who discontinued AI, 20% ceased use in the first 3 months, 30% during months 3-12 and 38%12 months. 42% of respondents who discontinued an AI restarted the same or a different AI after a treatment break.
To manage AIMSS 23% of respondents used doctor prescribed medications (eg anti-inflammatories, codeine, morphine,), 55% over the counter (OTC) or complementary medicines (eg low dose anti-inflammatories, paracetamol, chondroitin, fish or krill oil, glucosamine, and vitamin D) and 29% alternative therapies (eg acupuncture, massage, Tai Chi and yoga). Respondents identified the following in each of the above categories as most successful in relieving AIMSS symptoms: doctor prescribed anti-inflammatories, paracetamol and yoga. Doctor prescribed medications and OTC/complementary medicine either completely or significantly relieved AIMSS in 12% and 25% of cases respectively. 27% of respondents found that one or more of the interventions that they had used to manage AIMSS helped prevent AI discontinuation.
Conclusion: AIMSS is a significant issue for Australian women and is an important reason for AI discontinuation. Women use a number of interventions to manage AIMSS, however their efficacy appears limited. Effective AIMSS interventions are needed, to improve quality of life and reduce AI discontinuation.
Citation Format: Janine M Lombard, Nicholas Zdenkowski, Kathy Wells, Nicca Grant, Linda Reaby, John F Forbes, Jacquie Chirgwin. Aromatase inhibitor induced musculoskeletal syndrome (AIMSS) in Australian women with early breast cancer: An Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) survey of members of the Breast Cancer Network Australia (BCNA) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-12-05.
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Affiliation(s)
- Janine M Lombard
- 1Calvary Mater Newcastle
- 2University of Newcastle
- 3Australia and New Zealand Breast Cancer Trials Group
| | - Nicholas Zdenkowski
- 1Calvary Mater Newcastle
- 2University of Newcastle
- 3Australia and New Zealand Breast Cancer Trials Group
| | | | | | - Linda Reaby
- 3Australia and New Zealand Breast Cancer Trials Group
| | - John F Forbes
- 1Calvary Mater Newcastle
- 2University of Newcastle
- 3Australia and New Zealand Breast Cancer Trials Group
| | - Jacquie Chirgwin
- 2University of Newcastle
- 3Australia and New Zealand Breast Cancer Trials Group
- 5Monash University
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Toi M, Winer EP, Benson JR, Inamoto T, Forbes JF, von Minckwitz G, Robertson JFR, Grobmyer SR, Jatoi I, Sasano H, Kunkler I, Ho AY, Yamauchi C, Chow LWC, Huang CS, Han W, Noguchi S, Pegram MD, Yamauchi H, Lee ES, Larionov AA, Bevilacqua JLB, Yoshimura M, Sugie T, Yamauchi A, Krop IE, Noh DY, Klimberg VS. Personalization of loco-regional care for primary breast cancer patients (part 2). Future Oncol 2015; 11:1301-5. [DOI: 10.2217/fon.15.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Kyoto Breast Cancer Consensus Conference, Kyoto, Japan, 18–20 February 2014 The loco-regional management of breast cancer is increasingly complex with application of primary systemic therapies, oncoplastic techniques and genetic testing for breast cancer susceptibility. Personalization of loco-regional treatment is integral to optimization of breast cancer care. Clinical and pathological tumor stage, biological features and host factors influence loco-regional treatment strategies and extent of surgical procedures. Key issues including axillary staging, axillary treatment, radiation therapy, primary systemic therapy (PST), preoperative hormonal therapy and genetic predisposition were identified and discussed at the Kyoto Breast Cancer Consensus Conference (KBCCC2014). In the second of a two part conference scene, consensus recommendations for radiation treatment, primary systemic therapies and management of genetic predisposition are reported and focus on the following topics: influence of both clinical response to PST and stage at presentation on recommendations for postmastectomy radiotherapy; use of regional nodal irradiation in selected node-positive patients and those with adverse pathological factors; extent of surgical resection following downstaging of tumors with PST; use of preoperative hormonal therapy in premenopausal women with larger, node-negative luminal A-like tumors and managing increasing demands for contralateral prophylactic mastectomy in patients with a unilateral sporadic breast cancer.
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Affiliation(s)
- Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto 606–8507, Japan
| | - Eric P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Brigham & Women's Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - John R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Takashi Inamoto
- Faculty of Health Care, Tenri Health Care University, Nara, Japan
| | - John F Forbes
- Surgical Oncology, University of Newcastle, Newcastle, Australia
| | | | - John FR Robertson
- Breast Surgery, University of Nottingham, Royal Derby Hospital, Nottingham, UK
| | - Stephen R Grobmyer
- Cleveland Clinic & Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
| | - Ismail Jatoi
- The University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Hironobu Sasano
- Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Ian Kunkler
- Edinburgh Cancer Research UK Centre, The University of Edinburgh, UK
| | - Alice Y Ho
- Radiation Oncology, Memorial Sloan-Kettering Cancer Center, NY 10065, USA
| | - Chikako Yamauchi
- Radiation Oncology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Louis WC Chow
- UNIMED Medical Institute/University of Hong Kong, Hong Kong
| | - Chiun-Sheng Huang
- Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wonshik Han
- Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Shinzaburo Noguchi
- Breast & Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mark D Pegram
- Stanford Cancer Institute, School of Medicine, Stanford University, USA
| | | | - Eun-Sook Lee
- Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Alexey A Larionov
- Statistics & Computational Biology Laboratory, University of Cambridge, Cancer Research UK Cambridge Institute, UK
| | - Jose LB Bevilacqua
- Department of Breast Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Michio Yoshimura
- Radiation Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Akira Yamauchi
- Breast Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Ian E Krop
- Breast Oncology Center, Dana-Farber Cancer Institute, Brigham & Women's Cancer Center, Harvard Medical School, Boston, MA 02215, USA
| | - Dong Young Noh
- Surgery, Seoul National University Hospital, Seoul, South Korea
| | - V Suzanne Klimberg
- Surgery, Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, AR 72205, USA
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Healy D, Clarke-Moloney M, Gaughan B, O'Daly S, Hausenloy D, Sharif F, Newell J, O'Donnell M, Grace P, Forbes JF, Cullen W, Kavanagh E, Burke P, Cross S, Dowdall J, McMonagle M, Fulton G, Manning BJ, Kheirelseid EAH, Leahy A, Moneley D, Naughton P, Boyle E, McHugh S, Madhaven P, O'Neill S, Martin Z, Courtney D, Tubassam M, Sultan S, McCartan D, Medani M, Walsh S. Preconditioning Shields Against Vascular Events in Surgery (SAVES), a multicentre feasibility trial of preconditioning against adverse events in major vascular surgery: study protocol for a randomised control trial. Trials 2015; 16:185. [PMID: 25903752 PMCID: PMC4414457 DOI: 10.1186/s13063-015-0678-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Received: 06/09/2014] [Accepted: 03/25/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff. METHODS/DESIGN Four hundred major vascular surgery patients in five Irish vascular centres will be randomised (stratified for centre and procedure) to undergo RIPC or not immediately before surgery. RIPC will be induced using a blood pressure cuff with four cycles of 5 minutes of ischaemia followed by 5 minutes of reperfusion immediately before the start of operations. There is no sham intervention. Participants will undergo serum troponin measurements pre-operatively and 1, 2, and 3 days post-operatively. Participants will undergo 12-lead electrocardiograms pre-operatively and on the second post-operative day. Predefined complications within one year of surgery will be recorded. Patient and staff experiences will be explored using qualitative techniques. The primary outcome measure is the proportion of patients who develop elevated serum troponin levels in the first 3 days post-operatively. Secondary outcome measures include length of hospital and critical care stay, unplanned critical care admissions, death, myocardial infarction, stroke, mesenteric ischaemia and need for renal replacement therapy (within 30 days of surgery). DISCUSSION RIPC is novel intervention with the potential to significantly improve perioperative outcomes. This trial will provide the first evaluation of RIPC's ability to reduce adverse clinical events following major vascular surgery. TRIAL REGISTRATION www.clinicaltrials.gov NCT02097186 Date Registered: 24 March 2014.
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Affiliation(s)
- Donagh Healy
- Department of Vascular Surgery, University Hospital Limerick, Saint Nessan's Road, Dooradoyle, Limerick, Ireland.
| | | | - Brendan Gaughan
- National Cardiovascular and Stroke Research Network, Irish Heart Foundation, 50 Ringsend Road, Dublin, Ireland.
| | - Siobhan O'Daly
- National Cardiovascular and Stroke Research Network, Irish Heart Foundation, 50 Ringsend Road, Dublin, Ireland.
| | - Derek Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
| | | | - John Newell
- Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.
| | - Martin O'Donnell
- Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.
| | - Pierce Grace
- University of Limerick, Castletroy, Limerick, Ireland.
| | - John F Forbes
- University of Limerick, Castletroy, Limerick, Ireland.
| | - Walter Cullen
- University of Limerick, Castletroy, Limerick, Ireland.
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Saint Nessan's Road, Dooradoyle, Limerick, Ireland.
| | - Paul Burke
- Department of Vascular Surgery, University Hospital Limerick, Saint Nessan's Road, Dooradoyle, Limerick, Ireland.
| | - Simon Cross
- Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
| | - Joseph Dowdall
- Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
| | | | - Greg Fulton
- Cork University Hospital, Corcaigh, Wilton, Co. Cork, Ireland.
| | - Brian J Manning
- Cork University Hospital, Corcaigh, Wilton, Co. Cork, Ireland.
| | - Elrasheid A H Kheirelseid
- Department of Vascular Surgery, University Hospital Limerick, Saint Nessan's Road, Dooradoyle, Limerick, Ireland.
| | - Austin Leahy
- Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | | | | | - Emily Boyle
- Department of Vascular Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - Seamus McHugh
- Department of Vascular Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | | | - Sean O'Neill
- St. James's Hospital, James Street, Dublin 8, Ireland.
| | - Zenia Martin
- St. James's Hospital, James Street, Dublin 8, Ireland.
| | - Donal Courtney
- Galway University Hospital, Newcastle Road, Galway, Ireland.
| | | | - Sherif Sultan
- Galway University Hospital, Newcastle Road, Galway, Ireland.
| | - Damian McCartan
- Department of Vascular Surgery, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
| | - Mekki Medani
- Department of Vascular Surgery, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
| | - Stewart Walsh
- Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med 2015; 372:923-32. [PMID: 25738668 PMCID: PMC4405231 DOI: 10.1056/nejmoa1413204] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ovarian failure is a common toxic effect of chemotherapy. Studies of the use of gonadotropin-releasing hormone (GnRH) agonists to protect ovarian function have shown mixed results and lack data on pregnancy outcomes. METHODS We randomly assigned 257 premenopausal women with operable hormone-receptor-negative breast cancer to receive standard chemotherapy with the GnRH agonist goserelin (goserelin group) or standard chemotherapy without goserelin (chemotherapy-alone group). The primary study end point was the rate of ovarian failure at 2 years, with ovarian failure defined as the absence of menses in the preceding 6 months and levels of follicle-stimulating hormone (FSH) in the postmenopausal range. Rates were compared with the use of conditional logistic regression. Secondary end points included pregnancy outcomes and disease-free and overall survival. RESULTS At baseline, 218 patients were eligible and could be evaluated. Among 135 with complete primary end-point data, the ovarian failure rate was 8% in the goserelin group and 22% in the chemotherapy-alone group (odds ratio, 0.30; 95% confidence interval [CI], 0.09 to 0.97; two-sided P=0.04). Owing to missing primary end-point data, sensitivity analyses were performed, and the results were consistent with the main findings. Missing data did not differ according to treatment group or according to the stratification factors of age and planned chemotherapy regimen. Among the 218 patients who could be evaluated, pregnancy occurred in more women in the goserelin group than in the chemotherapy-alone group (21% vs. 11%, P=0.03); women in the goserelin group also had improved disease-free survival (P=0.04) and overall survival (P=0.05). CONCLUSIONS Although missing data weaken interpretation of the findings, administration of goserelin with chemotherapy appeared to protect against ovarian failure, reducing the risk of early menopause and improving prospects for fertility. (Funded by the National Cancer Institute and others; POEMS/S0230 ClinicalTrials.gov number, NCT00068601.).
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Affiliation(s)
- Halle C F Moore
- From the Cleveland Clinic Foundation, Cleveland (H.C.F.M.); SWOG Cancer Research Group Statistical Center, Fred Hutchinson Cancer Research Center (J.M.U., W.E.B.), and Seattle Cancer Care Alliance and University of Washington (J.G.) - all in Seattle; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC (K.-A.P., P.A.F.), Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) (K.-A.P., P.A.F., J.F.F.), Calvary Mater Hospital, Newcastle, NSW (F.B., J.M.L., J.F.F.), and University of Sydney, Sydney (F.B.) - all in Australia; International Breast Cancer Study Group (IBCSG), Bern, Switzerland (K.-A.P., P.A.F.); National Institute of Oncology, Budapest, Hungary (E.H.); Auckland Regional Cancer and Blood Service, Auckland, New Zealand (D.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.); Instituto de Enfermedades Neoplasicas (H.L.G.) and Oncosalud SAC (C.S.V.), Lima, Peru; Dana-Farber Cancer Institute (A.H.P., R.D.G.) and IBCSG Statistical Center (R.D.G.) - both in Boston; Wichita Community Clinical Oncology Program, Wichita (S.R.D.), and University of Kansas, Westwood (C.J.F.) - both in Kansas; University of Southern California Norris Cancer Center, Los Angeles (A.A.G.), the Angeles Clinic and Research Institute, Santa Monica (S.M.), and University of California at Irvine Chao Family Comprehensive Cancer Center, Orange (F.L.M) - all in California; National Cancer Institute, Division of Cancer Prevention, Bethesda, MD (L.M.); M.D. Anderson Cancer Center, Houston (G.N.H.); and Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL (K.S.A.)
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Cuzick J, Sestak I, Cawthorn S, Hamed H, Holli K, Howell A, Forbes JF. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol 2015; 16:67-75. [PMID: 25497694 PMCID: PMC4772450 DOI: 10.1016/s1470-2045(14)71171-4] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. METHODS In the IBIS-I randomised controlled trial, premenopausal and postmenopausal women 35-70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomisation schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomisation and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analysed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with controlledtrials.com, number ISRCTN91879928. FINDINGS Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 3579 to tamoxifen and 3575 to placebo. After a median follow up of 16.0 years (IQR 14.1-17.6), 601 breast cancers have been reported (251 [7.0%] in 3579 patients in the tamoxifen group vs 350 [9.8%] in 3575 women in the placebo group; hazard ratio [HR] 0.71 [95% CI 0.60-0.83], p<0.0001). The risk of developing breast cancer was similar between years 0-10 (226 [6.3%] in 3575 women in the placebo group vs 163 [4.6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0.72 [95% CI 0.59-0.88], p=0.001) and after 10 years (124 [3.8%] in 3295 women vs 88 [2.6%] in 3343, respectively; HR 0.69 [0.53-0.91], p=0.009). The greatest reduction in risk was seen in invasive oestrogen receptor-positive breast cancer (HR 0.66 [95% CI 0.54-0.81], p<0.0001) and ductal carcinoma in situ (0.65 [0.43-1.00], p=0.05), but no effect was noted for invasive oestrogen receptor-negative breast cancer (HR 1.05 [95% CI 0.71-1.57], p=0.8). INTERPRETATION These results show that tamoxifen offers a very long period of protection after treatment cessation, and thus substantially improves the benefit-to-harm ratio of the drug for breast cancer prevention. FUNDING Cancer Research UK (UK) and the National Health and Medical Research Council (Australia).
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Anticarcinogenic Agents/administration & dosage
- Anticarcinogenic Agents/adverse effects
- Australia
- Biomarkers, Tumor/analysis
- Breast Neoplasms/chemistry
- Breast Neoplasms/etiology
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/prevention & control
- Carcinoma, Intraductal, Noninfiltrating/chemistry
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/prevention & control
- Drug Administration Schedule
- Europe
- Female
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Neoplasm Invasiveness
- New Zealand
- Odds Ratio
- Proportional Hazards Models
- Receptors, Estrogen/analysis
- Risk Assessment
- Risk Factors
- Tamoxifen/administration & dosage
- Tamoxifen/adverse effects
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | | | | | - Kaija Holli
- The University of Tampere, Pirkanmaa Cancer Society, Tampere, Finland
| | | | - John F Forbes
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Australia
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Sestak I, Singh S, Cuzick J, Blake GM, Patel R, Gossiel F, Coleman R, Dowsett M, Forbes JF, Howell A, Eastell R. Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: an international, double-blind, randomised, placebo-controlled trial. Lancet Oncol 2014; 15:1460-1468. [PMID: 25456365 DOI: 10.1016/s1470-2045(14)71035-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Aromatase inhibitors prevent breast cancer in postmenopausal women at high risk of the disease but are associated with accelerated bone loss. We assessed effectiveness of oral risedronate for prevention of reduction in bone mineral density (BMD) after 3 years of follow-up in a subset of patients in the IBIS-II trial. METHODS The double-blind IBIS-II trial recruited 3864 healthy, postmenopausal women at increased risk of breast cancer and randomly allocated them oral anastrozole (1 mg/day) or matched placebo. 1410 (36%) postmenopausal women were then enrolled in a bone substudy and stratified at baseline according to their lowest baseline T score at spine or femoral neck (stratum I: T score at least -1·0; stratum II: T score at least -2·5 but less than -1·0; stratum III: T score less than -2·5 but greater than -4·0). Women in stratum I were monitored only; women in stratum III were all given risedronate (35 mg/week). Women in stratum II were randomly assigned (1:1) to risedronate (35 mg/week) or matched placebo by use of a block randomisation schedule via a web-based programme. The primary outcome of this per-protocol analysis (done with all women with a baseline and 3 year DXA assessment) was the effect of risedronate versus placebo for osteopenic women in stratum II randomly allocated to anastrozole (1 mg/day). Secondary outcomes included effect of anastrozole (1 mg/day) on BMD in women not receiving risedronate (strata I and II) and in osteoporotic women who were all treated with risedronate (stratum III). The trial is ongoing, but no longer recruiting. This trial is registered, number ISRCTN31488319. FINDINGS Between Feb 2, 2003, and Sept 30, 2010, 150 (58%) of 260 women in stratum II who had been randomly allocated to anastrozole and either risedronate or placebo had baseline and 3 year assessments. At the lumbar spine, 3 year mean BMD change for the 77 women receiving anastrozole/risedronate was 1·1% (95% CI 0·2 to 2·1) versus -2·6% (-4·0 to -1·3) for the 73 women receiving anastrozole/placebo (p<0·0001). For the total hip, 3 year mean BMD change for women receiving anastrozole/risedronate was -0·7% (-1·6 to 0·2) versus -3·5% (-4·6 to -2·3) for women receiving anastrozole/placebo (p=0·0001). 652 (65%) of 1008 women in strata I and II who were not randomly allocated to risedronate had both baseline and 3 year assessments. Women not receiving risedronate in stratum I and II who received anastrozole (310 women) had a significant BMD decrease after 3 years of follow-up compared with women who received placebo (342 women) at the lumbar spine (-4·0% [-4·5 to -3·4] vs -1·2% [-1·7 to -0·7], p<0·0001) and total hip (-4·0% [-4·4 to -3·6] vs -1·8% [-2·1 to -1·4], p<0·0001). 106 (79%) of 149 women in stratum III had a baseline and a 3 year assessment. The 46 women allocated to anastrozole had a modest BMD increase of 1·2% (-0·1 to 2·6) at the spine compared with a 3·9% (2·6 to 5·2) increase for the 60 women allocated to placebo (p=0·006). For the total hip, a small 0·3% (-0·9 to 1·5) increase was noted for women allocated anastrozole compared with a 1·5% (0·5 to 2·5) increase for women allocated placebo, but the difference was not significant (p=0·12). The most common adverse event reported was arthralgia (stratum I: 94 placebo and 114 anastrozole; stratum II: 39 placebo/placebo, 25 placebo/risedronate, 34 anastrozole/placebo, and 34 anastrozole/risedronate; stratum III: 21 placebo/risedronate, 17 anastrozole/risedronate). Other adverse events included hot flushes, alopecia, abdominal pain, and back pain. INTERPRETATION Risedronate counterbalances the effect of anastrozole-induced bone loss in osteopenic and osteoporotic women and might be offered in combination with anastrozole treatment to provide an improved risk-benefit profile. FUNDING Cancer Research UK (C569/A5032), National Health and Medical Research Council Australia (GNT300755, GNT569213), Sanofi-Aventis, and AstraZeneca.
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.
| | - Shalini Singh
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | - Glen M Blake
- Biomedical Engineering Department, King's College London, London, UK
| | | | - Fatma Gossiel
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - Rob Coleman
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - Mitch Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, London, UK
| | - John F Forbes
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, NSW, Australia
| | | | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
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Juraskova I, Butow P, Bonner C, Bell ML, Smith AB, Seccombe M, Boyle F, Reaby L, Cuzick J, Forbes JF. Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial. Br J Cancer 2014; 111:1-7. [PMID: 24892447 PMCID: PMC4090720 DOI: 10.1038/bjc.2014.144] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/11/2013] [Accepted: 02/24/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Decision aids may improve informed consent in clinical trial recruitment, but have not been evaluated in this context. This study investigated whether decision aids (DAs) can reduce decisional difficulties among women considering participation in the International Breast Cancer Intervention Study-II (IBIS-II) trial. METHODS The IBIS-II trial investigated breast cancer prevention with anastrazole in two cohorts: women with increased risk (Prevention), and women treated for ductal carcinoma in situ (DCIS). Australia, New Zealand and United Kingdom participants were randomised to receive a DA (DA group) or standard trial consent materials (control group). Questionnaires were completed after deciding about participation in IBIS-II (post decision) and 3 months later (follow-up). RESULTS Data from 112 Prevention and 34 DCIS participants were analysed post decision (73 DA; 73 control); 95 Prevention and 24 DCIS participants were analysed at follow-up (58 DA; 61 control). There was no effect on the primary outcome of decisional conflict. The DCIS-DA group had higher knowledge post decision, and the Prevention-DA group had lower decisional regret at follow-up. CONCLUSIONS This was the first study to evaluate a DA in the clinical trial setting. The results suggest DAs can potentially increase knowledge and reduce decisional regret about clinical trial participation.
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Affiliation(s)
- I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - P Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - C Bonner
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - M L Bell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - A B Smith
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - M Seccombe
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
| | - F Boyle
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
- Pam McLean Centre, The University of Sydney, Sydney 2006, Australia
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
| | - J Cuzick
- Cancer Research UK, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary College, University of London, London E1 4NS, UK
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
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43
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Zdenkowski N, Butow PN, Fewster S, Beckmore C, Wells K, Forbes JF, Boyle FM. Exploring decision making about neoadjuvant chemotherapy for early breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20578] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Sheryl Fewster
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia
| | - Corinna Beckmore
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia
| | - Kathryn Wells
- Breast Cancer Network Australia, Camberwell, Australia
| | - John F. Forbes
- Faculty of Health, University of Newcastle, Newcastle, Australia
| | - Frances M. Boyle
- Patricial Rigchie Centre for Cancer Care and Research, North Sydney NSW, Australia
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44
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Forbes JF, Dowsett M, Bradley R, Ingle JN, Aihara T, Bliss JM, Boccardo FM, Coates AS, Coombes RC, Cuzick JM, Dubsky PC, Gnant M, Kaufmann M, Kilburn LS, Perrone F, Rea D, Thurlimann BJK, Van De Velde CJH, Davies C, Gray RG. Patient-level meta-analysis of randomized trials of aromatase inhibitors (AI) versus tamoxifen (Tam). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- John F. Forbes
- University of Newcastle, ANZBCTG, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | | | | | | | | | | | | | | | | | - Jack M. Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London, United Kingdom
| | | | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Lucy S Kilburn
- The Institute of Cancer Research, London, United Kingdom
| | | | - Daniel Rea
- University of Birmingham, Birmingham, United Kingdom
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Avery-Kiejda KA, Braye SG, Forbes JF, Scott RJ. The expression of Dicer and Drosha in matched normal tissues, tumours and lymph node metastases in triple negative breast cancer. BMC Cancer 2014; 14:253. [PMID: 24725360 PMCID: PMC4021460 DOI: 10.1186/1471-2407-14-253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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] [Received: 08/05/2013] [Accepted: 04/09/2014] [Indexed: 12/21/2022] Open
Abstract
Background Breast cancer is the most common malignancy in women world-wide. Triple negative breast cancer (TNBC) is a highly aggressive subtype that lacks expression of hormone receptors for estrogen, progesterone and human epidermal growth factor 2; and is associated with a high propensity for metastatic spread. Several studies have identified critical roles for microRNAs in breast cancer, but the role of two critical enzymes involved in microRNA biogenesis, Dicer and Drosha, is not well understood, particularly with respect to metastatic progression in this subtype. Methods We examined the expression of Dicer and Drosha in a series of invasive 35 TNBCs with matched normal adjacent tissues (n = 18) and lymph node metastases (n = 15) using semi-quantitative real time RT-PCR. The relationship of their expression with clinical features including age at diagnosis, lymph node positivity and tumour size was analysed. Results We report that Dicer was significantly decreased while Drosha was significantly increased in tumours when compared to normal adjacent tissues. While there was no difference in Drosha expression in lymph node metastases when compared to the primary tumour, Dicer was significantly increased. There was no correlation between the expression of either Dicer or Drosha to age at diagnosis, lymph node positivity and tumour size. Conclusions In conclusion, Dicer and Drosha are dysregulated in TNBC and matched lymph node metastases however, the clinical relevance of this is still not known. The altered expression of Dicer and Drosha may serve as markers for disrupted miRNA biogenesis in TNBC.
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Affiliation(s)
- Kelly A Avery-Kiejda
- Centre for Information-Based Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia.
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46
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Cuzick J, Sestak I, Forbes JF, Dowsett M, Knox J, Cawthorn S, Saunders C, Roche N, Mansel RE, von Minckwitz G, Bonanni B, Palva T, Howell A. Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial. Lancet 2014; 383:1041-8. [PMID: 24333009 DOI: 10.1016/s0140-6736(13)62292-8] [Citation(s) in RCA: 382] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease. METHODS Between Feb 2, 2003, and Jan 31, 2012, we recruited postmenopausal women aged 40-70 years from 18 countries into an international, double-blind, randomised placebo-controlled trial. To be eligible, women had to be at increased risk of breast cancer (judged on the basis of specific criteria). Eligible women were randomly assigned (1:1) by central computer allocation to receive 1 mg oral anastrozole or matching placebo every day for 5 years. Randomisation was stratified by country and was done with blocks (size six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation; only the trial statistician was unmasked. The primary endpoint was histologically confirmed breast cancer (invasive cancers or non-invasive ductal carcinoma in situ). Analyses were done by intention to treat. This trial is registered, number ISRCTN31488319. FINDINGS 1920 women were randomly assigned to receive anastrozole and 1944 to placebo. After a median follow-up of 5·0 years (IQR 3·0-7·1), 40 women in the anastrozole group (2%) and 85 in the placebo group (4%) had developed breast cancer (hazard ratio 0·47, 95% CI 0·32-0·68, p<0·0001). The predicted cumulative incidence of all breast cancers after 7 years was 5·6% in the placebo group and 2·8% in the anastrozole group. 18 deaths were reported in the anastrozole group and 17 in the placebo group, and no specific causes were more common in one group than the other (p=0·836). INTERPRETATION Anastrozole effectively reduces incidence of breast cancer in high-risk postmenopausal women. This finding, along with the fact that most of the side-effects associated with oestrogen deprivation were not attributable to treatment, provides support for the use of anastrozole in postmenopausal women at high risk of breast cancer. FUNDING Cancer Research UK, the National Health and Medical Research Council Australia, Sanofi-Aventis, and AstraZeneca.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - John F Forbes
- Australian New Zealand Breast Cancer Trials Group, Calvary Mater Newcastle, University of Newcastle, Waratah, NSW, Australia
| | - Mitch Dowsett
- Academic Department of Biochemistry, The Royal Marsden NHS Trust, London, UK
| | - Jill Knox
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | | | - Nicola Roche
- Breast Unit, The Royal Marsden NHS Trust, London, UK
| | - Robert E Mansel
- Department of Surgery, University of Wales College of Medicine, Cardiff, UK
| | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; University Women's Hospital, Frankfurt, Germany
| | - Bernardo Bonanni
- Division of Chemoprevention and Genetics, European Institute of Oncology, Milan, Italy
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47
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Bhopal RS, Douglas A, Wallia S, Forbes JF, Lean MEJ, Gill JMR, McKnight JA, Sattar N, Sheikh A, Wild SH, Tuomilehto J, Sharma A, Bhopal R, Smith JBE, Butcher I, Murray GD. Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial. Lancet Diabetes Endocrinol 2014; 2:218-27. [PMID: 24622752 DOI: 10.1016/s2213-8587(13)70204-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK. METHODS We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565. FINDINGS Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44). INTERPRETATION Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases. FUNDING National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland.
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Affiliation(s)
- Raj S Bhopal
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
| | - Anne Douglas
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Sunita Wallia
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - John F Forbes
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael E J Lean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John A McKnight
- Metabolic Unit, Anne Ferguson Building, Western General Hospital, Edinburgh, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah H Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anu Sharma
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Ruby Bhopal
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Joel B E Smith
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Isabella Butcher
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon D Murray
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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48
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Ramsay P, Salisbury LG, Merriweather JL, Huby G, Rattray JE, Hull AM, Brett SJ, Mackenzie SJ, Murray GD, Forbes JF, Walsh TS. A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial. Trials 2014; 15:38. [PMID: 24476530 PMCID: PMC4016544 DOI: 10.1186/1745-6215-15-38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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] [Received: 06/24/2013] [Accepted: 01/08/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). METHODS The intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. RESULTS The final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. CONCLUSIONS The MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.
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Affiliation(s)
| | - Lisa G Salisbury
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Chancellors Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK.
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McCarthy N, Boyle F, Zdenkowski N, Bull J, Leong E, Simpson A, Kannourakis G, Francis PA, Chirgwin J, Abdi E, Gebski V, Veillard AS, Zannino D, Wilcken N, Reaby L, Lindsay DF, Badger HD, Forbes JF. Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem). Breast 2014; 23:142-51. [PMID: 24393617 DOI: 10.1016/j.breast.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/04/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy has a sound rationale for use in women with large operable breast cancer, and achievement of pathological complete response (pCR) is prognostic. Epirubicin and cyclophosphamide followed by docetaxel is a standard chemotherapy regimen for early breast cancer. In metastatic breast cancer the combination of gemcitabine and a taxane has shown promising results. This phase II study investigated the efficacy and safety of incorporating gemcitabine into neoadjuvant therapy. METHODS Female patients with operable breast cancer that was clinically T2 (≥3 cm) or T3-4, N0-1, M0 were enrolled to receive 24 weeks of neoadjuvant chemotherapy using epirubicin and cyclophosphamide followed by docetaxel and gemcitabine, plus trastuzumab if HER2-positive. The primary endpoint was the pathological complete response (pCR) rate in the breast in separate HER2-negative and HER2-positive cohorts. Secondary endpoints included pCR in both the breast and axillary lymph nodes, clinical and radiological response rates, disease free survival and safety. RESULTS 81 patients were enrolled: 63 HER2-negative and 18 HER2-positive. 67 (84%) completed all cycles of chemotherapy, and 78 (96%) proceeded to surgery. pCR was achieved by 12 (20%) patients with HER2-negative, and 9 (53%) with HER2-positive disease. At the first interim analysis, addition of prophylactic G-CSF was recommended due to excess neutropenia. The HER2-negative cohort was closed to accrual because it did not meet the pre-specified target for pCR, and the HER2-positive cohort was closed due to slow accrual. At a median follow-up of 24 months, 12 of 81 (15%) patients had experienced a relapse of their breast cancer. CONCLUSION Neoadjuvant gemcitabine, when added to docetaxel, after epirubicin and cyclophosphamide, did not reach the pre-specified expectations for pCR rate in HER2-negative tumours. Excess neutropenia was observed, requiring growth factor support. Addition of gemcitabine to docetaxel in this schedule cannot be recommended. Australia and New Zealand Clinical Trials Registry (www.anzctr.org.au) registration number ACTRN12606000191594.
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Affiliation(s)
- N McCarthy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD 4029, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - F Boyle
- The Mater Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - N Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - J Bull
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - E Leong
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - A Simpson
- Wellington Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - G Kannourakis
- Ballarat Oncology and Haematology Service, Ballarat, VIC, Australia
| | - P A Francis
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Medicine, St. Vincent's Hospital, University of Melbourne, VIC, Australia
| | - J Chirgwin
- University of Newcastle, Newcastle, NSW, Australia; Box Hill Hospital, Box Hill, VIC, Australia; Maroondah Breast Clinic, Maroondah Hospital, Ringwood East, VIC, Australia; Monash University, VIC, Australia
| | - E Abdi
- Tweed Hospital, Tweed Heads, NSW, Australia; Griffith University- Gold Coast, Southport, QLD, Australia
| | - V Gebski
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - A S Veillard
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - D Zannino
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - N Wilcken
- Westmead Cancer Care Centre, Westmead Hospital, University of Sydney, NSW, Australia
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - D F Lindsay
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - H D Badger
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia; Department of Surgical Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
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50
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Huober J, Cole BF, Rabaglio M, Giobbie-Hurder A, Wu J, Ejlertsen B, Bonnefoi H, Forbes JF, Neven P, Láng I, Smith I, Wardley A, Price KN, Goldhirsch A, Coates AS, Colleoni M, Gelber RD, Thürlimann B. Symptoms of endocrine treatment and outcome in the BIG 1-98 study. Breast Cancer Res Treat 2014; 143:159-69. [PMID: 24305979 PMCID: PMC3913479 DOI: 10.1007/s10549-013-2792-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/23/2013] [Indexed: 01/13/2023]
Abstract
There may be a relationship between the incidence of vasomotor and arthralgia/myalgia symptoms and treatment outcomes for postmenopausal breast cancer patients with endocrine-responsive disease who received adjuvant letrozole or tamoxifen. Data on patients randomized into the monotherapy arms of the BIG 1-98 clinical trial who did not have either vasomotor or arthralgia/myalgia/carpal tunnel (AMC) symptoms reported at baseline, started protocol treatment and were alive and disease-free at the 3-month landmark (n = 4,798) and at the 12-month landmark (n = 4,682) were used for this report. Cohorts of patients with vasomotor symptoms, AMC symptoms, neither, or both were defined at both 3 and 12 months from randomization. Landmark analyses were performed for disease-free survival (DFS) and for breast cancer free interval (BCFI), using regression analysis to estimate hazard ratios (HR) and 95 % confidence intervals (CI). Median follow-up was 7.0 years. Reporting of AMC symptoms was associated with better outcome for both the 3- and 12-month landmark analyses [e.g., 12-month landmark, HR (95 % CI) for DFS = 0.65 (0.49-0.87), and for BCFI = 0.70 (0.49-0.99)]. By contrast, reporting of vasomotor symptoms was less clearly associated with DFS [12-month DFS HR (95 % CI) = 0.82 (0.70-0.96)] and BCFI (12-month DFS HR (95 % CI) = 0.97 (0.80-1.18). Interaction tests indicated no effect of treatment group on associations between symptoms and outcomes. While reporting of AMC symptoms was clearly associated with better DFS and BCFI, the association between vasomotor symptoms and outcome was less clear, especially with respect to breast cancer-related events.
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Affiliation(s)
- J Huober
- Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland,
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