bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Oncotype DX recurrence score (RS) be used in luminal A and luminal B breast cancer patients (pts) to predict the likely benefit of chemotherapy? A retrospective study in the Spanish population.
Authors: García-Estevez Laura , Contreras Ana C , Calvo Isabel , Fernandez Abad Maria , de la Cruz Juan J , Perea Sofia , Suárez Ana , López-Ríos Fernando , Hidalgo Manuel
Published: March 2020

e11006

Background: The 2011 St Gallen guidelines recommend the use of Ki67 as a surrogate marker for luminal A and Luminal B breast cancer subtypes. Pts with luminal B subtypes should be considered for adjuvant chemotherapy. The guidelines also recognize the Oncotype DX RS as a predictor of chemotherapy benefit. The aim of this study is to assess the distribution of the RS in luminal A and luminal B breast cancer subtypes as defined by Ki67. Methods: Data from 91 pts with invasive breast cancer for which Oncotype DX results and pathology data were available. Pathological assessment was evaluated by the same pathologist. Estrogen (ER) and progesterone (PR) receptor was assessed by immunostaining (cut-off 10% nuclear staining). Ki67 was assessed by IHC [high (≥14%) and low (< 14%)]. Grading was performed by using Nottingham grading system. Results: Median age: 50 years (range: 35-78); premenopausal status: 49 pts (53.8%). Median tumor size: 1.5 cm (0, 3-6); Median of Ki 67 index: 15. 5 (range: 3-63); Median ER: 93 (35-100) and PR: 85(0-100). Sixty nine pts (75.8%) had negative-lymph nodes. RS was low in 56 (61. 5%) cases, intermediate in 24 (26. 4%), and high in 11 (12. 1%). The median RS was 16 (range 3-55). Forty six (51%) tumors were classified as luminal B (according to high Ki 67) and 38 (41.7%) as Luminal A. In the Luminal B group RS was low in 28 (61%) pts, intermediate in 10 (22%) and high in 8 (17%) while in the Luminal A group 23 (61%) had low RS; 13 (34%) intermediate and 2 (5%) high RS. RS changed the first treatment recommendation in 23 (50%) cases of Luminal B subtype vs. 10 (26%) cases in Luminal A subtype (p=0.013). Conclusions: Although based in a small case series, the results show that a substantial number (61%) pts with Luminal B breast cancer subtype had a low RS, therefore preserving them from adjuvant chemotherapy treatment. In addition, 5% of patients with Luminal A breast cancer had a high RS and thereby likely to benefit from chemotherapy. The wide range of RS in both Luminal B and Luminal A breast cancer subtypes confirm the important role of Oncotype DX in treatment decision- making.
Does obesity change the effect of aromatase inhibitors (AIs) on estradiol, leptin, insulin, and IGF-1 serum levels in breast cancer patients?
Authors: Artac Mehmet , Askin Dudu , Kiyici Aysel , Eren Onder Orhan , Oncel Mufide , Boruban Melih Cem , Bozcuk Hakan Sat
Published: March 2020

e11008

Background: The complexity of the relationship between obesity and breast cancer reflects important contributions of obesity-related factors in the adjuvant therapy. The efficacy of adjuvant AIs compared to tamoxifen is lower in obese postmenopausal women. Therefore, we aimed to identify whether the effect of AIs on estradiol, leptin, insulin, and IGF-1 serum levels with respect to the status of the obesity in breast cancer patients. Methods: A total of 34 postmenopausal breast cancer patients treated with adjuvant AIs were enrolled in the study. Pretreatment and 3 months after treatment body weight, height, waist-to-hip (WHR) ratio and body mass index (BMI) were recorded. Blood samples for serum estradiol, leptin, insulin and IGF-1 were drawn after 12 hour starvation and stored in – 70o before and 3 months after the onset of AI treatment. Results: Median age and BMI were 61 years (range 49-84) and 31 (range 22-43), respectively. 18 (%52.9) patients were treated with letrozole and 16 (%47.1) patients were treated with anastrazole. There was no change in the 3 months period in weight, BMI and WHR. Estradiol levels were decreased significantly between the baseline and the 3rd month (p<0.01). There was a slight increase in the leptin levels between the basal and 3rd month (p>0.05). No significant change was detected in insulin and IGF-1 levels in the follow-up period. In the multivariate regression model, there was no difference between the effect of letrozole and anastrazole on estradiol levels. Pretreatment BMI did not alter the effect of AIs on estradiol levels. The only factor related with the effect of the AIs is the pretreatment estradiol levels. Conclusions: This study shows that the suppression of estrogen in obese breast cancer patients with AIs at the standard doses may not be different from non-obese patients. Further researches may show us other mechanisms for the obesity-related factors to improve outcome with aromatase inhibition in obese breast cancer patients.
Advanced breast cancer (ABC): Clinical-pathologic characteristics of long-term survivors after dissemination of the tumor.
Authors: Nacul Mario Javier , Gil Deza Ernesto , Morgenfeld Eduardo L. , Rivarola Edgardo G. J. , Gercovich Felipe G.
Published: March 2020

e11037

Background: ABC is currently an incurable disease but some patients achieve a longer survival. The following case-control study compared patients suffering from ABC that survived 50 months or more after the onset of metastasis (case) with a group of patients similarly diagnosed treated alongside the case group, whose survival after metastasis was less than 50 months (control). Methods: A search of the IOHM breast cancer tumors registry between September 1997 and April 2010 was carried out. Only those with ABC were included in the paper. The population was divided between cases and controls and both groups were compared. Results: 227 patients meeting the required criteria were found. The population characteristics are detailed in the table below. In 161 pts (70%), a molecular subtype was established: Luminal Type A or B (Cases: 49 pts; Controls: 84 pts), Her2 (Cases: 5 pts; Controls: 9 pts), Triple Negative (Cases: 0 pts; Controls: 14 pts). Systemic and local treatments were similar in both groups, depending on the disease’s stage. Conclusions: 1 – Sixty seven patients (cases) survived 50 or more months after the onset of metastasis. 2 – The Luminal Subtype, long DFS of early stages, compromise of non-visceral organs and the compromise of only one organ were indicative of extended survival of the patients. 3 – No patient with Triple Negative tumors was able to achieve prolonged survival, and so we must continue to research better treatments for these patients. [Table: see text]
Use of platinum-based neoadjuvant chemotherapy (NACT) in patients (pts) with hormone receptor-positive breast cancer.
Authors: Kyriakopoulos Christos , Ambros Tadeu Frantz , Montero Alberto J. , Hurley Judith
Published: March 2020

e11038

Background: NACT is used for the treatment of locally advanced breast cancer. Evaluation of breast cancer subtypes and their responses to specific chemotherapy regimens is important. Methods: Retrospective review of medical records from University of Miami/Sylvester Comprehensive Cancer Center/Jackson Memorial Hospital from 1998-2011. Complete pathologic response (pCR) was classified as absence of malignant tissue both in the breast and the lymph nodes in the surgical specimen. Results: One hundred ninety-one women with ER-positive breast cancer received platinum based NACT. Mean age was 52 years (range 31-83). One hundred eleven (58.1%) women were premenopausal and 80 (41.9%) postmenopausal. The clinical stage at presentation: IIA (6.3%), IIB (26.7%), IIIA (31.9%), IIIB (30.9%), IIIC (4.2%). Sixty one (31.9%) pts had her-2/neu positive tumors. pCR occurred in 17 patients (8.9%), premenopausal vs. postmenopausal (9.9% vs. 7.5%, p=0.56), white race vs. black (9.9% vs. 4.9%, p=0.32), Hispanic vs. non-Hispanic (9.4% vs. 6.8%, p=0.6), tumor size <=4 cm vs. >4 cm (14.7% vs. 7.6%, p=0.19), her-2/neu positive vs. her-2/neu negative (13.1% vs. 6.9%, p=0.16), T4 vs. T1-T3 (4.8% vs. 10.9%, p=0.19). Conclusions: pCR rates with platinum based NACT in pts with hormone receptor-positive tumors were low. The pCR rate did not appear to be influenced by her2/neu, tumor size, race, ethnicity or menopausal status.
Compliance and arthralgias in clinical therapy (COMPACT): Assessment of the incidence of arthralgia, therapy costs, and compliance in the first year of adjuvant anastrozole.
Authors: Hadji Peyman , Blettner Maria , Bolten Wolfgang W. , Harbeck Nadia , Hindenburg Hans-Joachim , Jackisch Christian , Klein Peter , König Klaus , Rief Winfried , Wallwiener Diethelm , Zaun Silke , Kreienberg Rolf
Published: March 2020

e11040^

Background: Aromatase Inhibitors (AI) are well established as adjuvant endocrine treatment for postmenopausal women with HR+ early breast cancer (EBC). However, clinical trial data show higher frequently of arthralgia with AI than tamoxifen. As arthralgia may be greatly influencing compliance to adjuvant therapy, we designed a prospective trial to collect real world data on the effects of AI-associated arthralgia on patient compliance, patient outcomes and treatment costs of arthralgia. Methods: COMPACT is an open, prospective non-interventional study (NCT00857012) assessing the incidence of arthralgia, therapy costs, and compliance within the first year of adjuvant anastrozole (ANA) therapy in postmenopausal patients with HR+ EBC. Patients on adjuvant ANA for 3-6 months were enrolled and stratified by initial adjuvant ANA or switch from tamoxifen. All patients receive regular standardized information about breast cancer from baseline to week 20 to support treatment compliance. Data on demographics, arthralgia, therapy thereof and QoL are collected at baseline, 3, 6 and 9 months. Primary endpoints are scaled data on arthralgia and compliance within the first year of ANA therapy. Secondary endpoints include the incidence of arthralgia, therapy costs, reasons for non-compliance, and influence of arthralgia on clinical outcome. Results: From Apr 2009 to Mar 2011, 2313 patients were enrolled, 2007 on upfront ANA and 306 patients on switch therapy. The mean age was 64.5 years, mean BMI 27.7. Only 16.8% had received HRT prior to their EBC. 41.5% had symptoms relating to skeleton or musculature, and 11.9% stated arthralgia existing prior to ANA. 13.1% reported a worsening of pre-existing arthralgias or new arthralgia after starting ANA. Predictors for non-adherence to AI and scaled data on arthralgia are under analysis. Conclusions: COMPACT aims to provide valid data on AI-associated arthralgia, treatment, treatment costs and compliance to AI. This may help to better inform patients and health care providers about these clinically important issues with the aim to improve adherence to adjuvant ANA, breast cancer outcomes, and therapy costs.
Relationship between obesity and survival in advanced breast cancer.
Authors: Castagneris Nicolas , Cortes Matias Nicolas , Richardet Eduardo , Richardet Martin Eduardo , Laura Perelli , Molina Matias
Published: March 2020

e11044

Background: Breast cancer is the second cause of cancer-related deaths. Obesity is defined as an excessive accumulation of fat. The body mass index (BMI) indicates relationship between weight and height and is used to identify obesity, which is associated with increased risk of cancer. Studies have shown the worst prognosis of obese patients undergoing adjuvant therapy. This paper aims to assess progression-free survival (PFS) and overall survival (OS) in relation to BMI, in patients with advanced breast cancer. Methods: We retrospectively analyzed medical records of 132 patients treated in the IONC from 2005 to 2010. We divided the patients into two groups: group A, BMI <30 (not obese), Group B, BMI ≥ 30 (obese). Analysis of SG and TLP were estimated by the Kaplan-Meier method and compared using the log-rank test. Results: The PFS for group A was 16.44 months, and for group B it was 13.08 (p = 0.40). OS was 31.93 and 27.12, respectively (p = 0.31). Regarding BMI and menopausal status, we observed a marked increase in survival for non-obese premenopausal patients with statistical significance. See table below. Conclusions: Patients with BMI <30 had higher survival rates, without reaching statistical significance. This could be due to small sample size and heterogeneity. Another relevant finding is the statistically significant difference in survival that favors premenopausal patients with lower BMI, which raises an area to be studied. This work demonstrates the importance of guiding patients towards a healthier life habit. [Table: see text] [Table: see text]
Equivocal results of HER2 fluorescent in situ hybridization (FISH) assessment in breast cancer: Diagnostic limitations and therapeutical implications.
Authors: Cruz Marcelo Rocha De Sousa , Ribeiro Adriana Regina G. , Santos Fábio Nasser , Cunha Isabela Werneck , Lima Vladmir C.
Published: March 2020

e11058

Background: HER2/neu status is a well established prognostic and predictive factor for breast cancer (BC) patients. However, HER2 testing remains controversial because of technical issues, lack of consensus on cut point determinations and pathology interpretation. As a result, some patients present tumors with inconclusive or equivocal tests, making the indication of anti-HER2 therapy questionable. Methods: We evaluated the incidence of inconclusive and equivocal HER2 amplification by FISH after an equivocal HER2 immunohistochemical (IHC) result in a cohort of breast cancer patients treated at a cancer center. Equivocal IHC was defined as tumor cells showing 2+ membranous immunoreactivity out of a possible 3+. Inconclusive FISH was considered when probe signs were weak and did not allow proper evaluation. Equivocal FISH was defined according to ASCO/CAP recommendation. Patients’ clinical characteristics, treatments and outcomes were evaluated. Results: From 2006 to 2011 we analyzed BC tissue samples from 404 patients that underwent HER2 FISH assessment after equivocal IHC. Gene amplification was found in 28,7% (n=116) of samples; 65,5% (n=265) showed non-amplification results. Inconclusive (n=12) plus equivocal (n=11) FISH results were found in 5,7% (n=23) of patients. In the inconclusive/equivocal FISH cohort, 78% of evaluated tissue came from breast biopsy and 22% were extracted from metastatic sites. When HER2 amplification by FISH was reclassified according to the FDA criteria (HER2/CEP17 FISH ratio above 2.0), 45% of patients previously classified as equivocal became HER2 positive. None of equivocal HER2 FISH patients received anti-HER2 therapy. Conclusions: The incidence of BC patients with equivocal HER2 FISH at our institution is similar to other large series, reflecting our adequate quality assurance methods. Anti-HER2 therapy is the backbone for HER2-positive BC patients irrespective of hormone receptor status. Further analyses using different techniques for HER2 expression and amplification status assessment are urged in order to better select patients for appropriate therapy.
Pathologic response rate in HER2-positive locally advanced breast cancers treated with neoadjuvant trastuzumab and concurrent paclitaxel/radiotherapy.
Authors: Adams Sylvia , Hochman Tsivia , Huppert Nelly , Dhage Shubhada , Checka Cristina , Singh Baljit , Speyer James L. , Schneider Robert , Goldberg Judith D. , Formenti Silvia
Published: March 2020

e11064

Background: We demonstrated in three prospective trials that taxane-based concurrent chemo-radiation achieves high pathological response rates that correlate with decreased recurrence rates and improved survival in locally advanced breast cancers (LABC, Adams et al, BCRT 2010). We now report the results among HER-2 positive LABC patients treated with trastuzumab and concurrent paclitaxel and radiotherapy, preoperatively. Methods: Patients with HER-2 positive LABC (stages IIB-IIIC) were prospectively treated as part of an IRB-approved neoadjuvant trastuzumab-paclitaxel-radiotherapy protocol. Paclitaxel was administered at a dose of 30 mg/m2 twice a week and trastuzumab was given weekly at a dose of 2 mg/kg (after initial loading with 4 mg/kg) for a total of 10 weeks. Radiotherapy was delivered to the breast and regional lymph nodes during weeks 2-7, daily, at 1.8 Gy per fraction to a total dose of 45 Gy. A 14 Gy boost (2 Gy per fraction) was added to the area of the originally palpable tumor site. Tumor response was assessed at definitive cancer surgery; defined as pathological complete response (pCR) in the absence of invasive cancer in breast and lymph nodes; pathological partial response (pPR) as the persistence of < 10 microscopic foci of invasive carcinoma in breast or lymph nodes. All other patients were classified as having achieved no pathologic response. Results: Twenty-one patients with HER-2 positive LABC were treated. The median age of the patients was 50 years (range 28-76). The most common toxicity was acute dermatitis; no grade IV toxicity was detected. Pathological response (pCR and pPR) after neoadjuvant trastuzumab/paclitaxel/radiation was achieved in 12 patients (57%, 95% CI: 37% - 76%). Responses were observed in 8/12 patients with hormone receptor (HR)-negative (7 pCR, 1 pPR) and in 4/9 patients with HR-positive cancers (3 pCR, 1 pPR). Conclusions: In HER-2 positive LABC, neoadjuvant trastuzumab during paclitaxel and concurrent radiotherapy resulted in a 57% pathological response rate, independently of HR status.
Time of disease control (TDC) with hormone and chemotherapy in metastatic breast cancer (MBC).
Authors: Singh Hitesh , Hodges David , Reynolds Jana , Ashley Pandora , Ruud Christopher O.
Published: March 2020

e11069

Background: Patients with metastatic breast cancer are treated with multiple lines of therapy. Less is known about the relative benefits from subsequent lines of hormone and chemotherapy and the influence of the molecular subtypes; luminal, HER2, and triple negative. Methods: The tumor registry at Scott & White Memorial Hospital (S&W) was queried for consecutive patients diagnosed with MBC between 2000 and 2009. Of the 409 patients identified, 252 patients met inclusion criteria. Exclusions were partial treatment at S&W (112), unknown ER or HER2 status (26), male sex (5), and palliative care only (14). Treatment regimen and start date was recorded for each line of therapy by review of EMRs. TDC for each line was defined as the treatment start date to the date of the next line of therapy, or the end date of treatment for the final line. Lines of therapy were reported sequentially relative to their order in either hormone or chemotherapy, not in regard to their overall line in systemic treatment. Results: For patients followed to death, median overall survival for luminal (104), HER2 (57), and triple negative (62) was 19.0, 24.1, and 9.3 months respectively. For those who underwent chemotherapy as their final line (162), the median time between last chemotherapy administration and death was 1.5 months. The table reports the median TDC for the first five lines of chemotherapy and first three lines of hormone therapy. Conclusions: All subtypes had continued benefit of chemotherapy on subsequent chemotherapy lines. Overall, HER2 exhibited longer TDCs on chemotherapy. Although biased by case selection, TDC on hormone therapy was superior to chemotherapy for the first three lines of hormone treatment. Our findings support the benefit of successive lines of hormone and chemotherapy for palliation in MBC. [Table: see text]
Correlation between triodothyronine levels and cancer cell proliferation in high Ki-67 estrogen receptor-positive breast cancer patients.
Authors: Tzovaras Alexandros , Mourouzis Iordanis , Tsapralis Nikos , Tsoukalas Grecory , Tsoukalas Nikolaos , Stamatopoulou Sofia , Oikonomopoulos Georgios , Misitzis Ioannis , Pantos Christos , Ardavanis Alexandros
Published: March 2020

e11073

Background: Although thyroid hormone is a critical regulator of cell growth, differentiation and survival during development, the relationship between thyroid hormone status and breast cancer has not been adequately explored. Recent findings suggest that T3 administration reduces cancer cell proliferation depending on the type of tumor cell line with aggressive tumors to be more sensitive to thyroid hormone treatment. Thus, the present study investigated the potential relationship between thyroid hormone levels and strong prognostic factors (such as tumor size, nodal status, and Ki67) in estrogen receptor positive (ER+) breast cancer patients. Methods: 86 ER(+) breast cancer patients were studied. Levels of TSH (μΙU/ml), FT3 (pg/ml) and FT4 (ng/ml) were measured in all patients before surgery. After surgical excision of the tumor, samples were taken for histopathological analysis to determine tumor size, an index of cell proliferation Ki67 and HER2 receptor expression. HER2 receptor when amplified, it results in an aggressive subtype of breast cancer. In addition, activation of Akt and ERK signaling was examined in tumor samples by western blotting analysis. Akt signaling activation is linked to cell differentiation, while ERK signaling activation induces cell proliferation and dedifferentiation. Results: See table. HER2(+) breast cancers were found to have 2.0 fold increase in levels of phospho-p44/total p44 ERK and 3.0 fold decrease in levels of phospho-Akt/total Akt as compared to HER2(-) breast cancers. In HER(-) breast cancers no correlation was found between TSH, FT3 or FT4 and tumor size, Ki67 and nodal status. However, in HER(+) breast cancers a strong negative correlation was found only between FT3 levels and Ki67, r = -0.60 and p = 0.004. Conclusions: Levels of FT3 show a negative strong correlation with cell proliferation of HER2(+) aggressive breast cancers. This finding may have important therapeutic implications. [Table: see text]
Observational cross-sectional study to evaluate the prognostic factors influencing the selection of bevacizumab combined with chemotherapy in patients with HER2-negative metastatic breast cancer in routine clinical practice. ONCOSUR-AVALOX study.
Authors: Manso Luis , Perez-Carrion Ramon , Chacon Lopez-Muniz Jose Ignacio , Garcia Palomo Andres , Galve Calvo Elena , Llorente Rosa M. , Cassinello Javier , Catalan Gustavo , Llorca Cristina , Torregrosa Maria Dolores , Alvarez Inaki , Gallegos Sancho Isabel , Blanco Esperanza , Oruezabal Mauro , Mielgo Rubio Xabier , Garcia Lopez Maria Jose , Hernando Blanca , Enrech Santos , Lara Miguel Angel , Cortes-Funes Hernan
Published: March 2020

e11074

Background: Combining bevacizumab (BEV) with chemotherapy (CT) improves survival in HER2-negative metastatic breast cancer (MBC). We investigated the influence of age, ECOG, hormonal status, number of sites and location of metastases and patient decision on the selection of BEV combined with CT in MBC. Methods: Observational cross-sectional multicenter study in pts with HER2-negative MBC who have received first-line CT with BEV. Results: From November 2010 to November 2011, 124 pts were included: median age 51 (45-64) yr; ECOG: 0=50%; 60% pre-menopausic; 23% triple-negative (TN); 77% hormone receptor-positive (HR+). Metastatic disease: ≥3 sites=42% (TN: 32%; HR+: 45%); location: 44% bone, 35% lung, 30% liver. Most frequent BEV-based combinations were paclitaxel/BEV (53%) and docetaxel/BEV (14.5%); median no. of CT cycles: 6 (5-8). A disease-free survival (DFS) ≥12 months was achieved by 73%; TN: 68%; HR+: 76%. Overall response rate (ORR) was 58%: 51% partial response (PR), 7% complete response (CR); 28% stable disease (SD) and 10% disease progression. TN: ORR 44% (40% PR), clinical benefit 80% (36% SD); HR+: ORR 62% (54% PR), clinical benefit 87% (25% SD). 58% presented at least one toxicity, mainly grade 1-2; 26% BEV-related: only 3 (2.4%) grade 3 toxicities; no grade 4. Receiving adjuvant hormonal therapy was associated to DFS ≥12 months (p<0.05). ER+ tumors (OR: 0.215; 95% CI: 0.08-0.56; p=0.002) and one metastatic site, vs. ≥3 sites (OR: 0.309; 95% CI: 0.12-0.83; p=0,020) were independent factors associated with the selection of paclitaxel-BEV therapy in the overall population (TN or HR+). Metastases in the liver were significantly related to paclitaxel-BEV administration (p<0.01). Conclusions: Our findings suggest that first-line CT with BEV is an active and tolerable treatment option for pts with TN and HR+ MBC. ER+ tumors and a single metastatic site were identified as independent factors for the selection of a paclitaxel-BEV therapy. The presence of metastases in the liver was significantly associated to the administration of a paclitaxel-BEV regimen.
Simultaneous peripheral facial palsies (SPFP) and bilateral foot drops after initiation of eribulin in a patient with triple-negative breast cancer.
Authors: Morrison Tara , Swaby Ramona F. , Ryan Paula D. , Ambady Prakash
Published: March 2020

e11085

Background: Simultaneous peripheral facial palsy (SPFP) is extremely rare. Unlike Bell’s palsy it is seldom idiopathic. We describe a case of acute SPFP and bilateral foot drops attributed to the novel chemotherapeutic agent, eribulin mesylate (EM), a synthetic microtubule inhibitor. Methods: Utilizing the medical record as well as physical evaluation and assessment, we diagnosed SPFP and bilateral foot drops temporally related to administration of EM for metastatic triple negative (ER neg/PR neg/HER2 neg) breast cancer. Results: A 71-year-old woman initially diagnosed with Stage I, T1N0M0, ER neg/PR neg/HER2 neg invasive ductal carcinoma of the left breast treated with adjuvant radiotherapy recurred 3 years later with liver metastases. Salvage treatment included first-line capecitabine for 6 months followed by paclitaxel for 13 months with residual grade 1 peripheral neuropathy. Fourteen days following last paclitaxel dosing, EM was started. Within 3 weeks of initiation of therapy, the patient presented with bilateral SPFP, as well as bilateral complete foot drops. She was unable to speak or take liquid or solid oral intake and unable to bear weight. Extensive work-up including initial CT of the brain, followed by MRI and LP revealed no metastatic or infectious (i.e. – Lyme disease, ACE, TSH, ANA, SPEP) etiology. After discontinuation of EM, physical and speech therapy were instituted including in-patient rehab. After follow-up of 16 weeks, she has partial resolution of the facial palsy and improved ambulation with bilateral foot braces and walking cane. Conclusions: Unlike unilateral Bell’s palsy, the differential diagnosis for SPFP includes many conditions that can potentially turn fatal within a short period of time if they are not diagnosed and treated promptly. To the best of our knowledge, CIN presenting with SPFP or foot drop due to EM has not been reported. We highlight the need to screen patients for pre-existing neuropathy and continued close monitoring for development of neuropathy to avoid potentially dose-limiting disabilities before initiating eribulin.
Non-breast solid malignancies among breast cancer survivors.
Authors: Altundag Kadri , Petekkaya Ibrahim , Sahin Ugur , Solak Mustafa , Ozisik Yavuz
Published: March 2020

e11092

Background: Due to advances in treatment modalities and palliative care patients with breast cancer live longer compared to the past and thus encounter an increased risk for secondary cancers. This study aims at finding the frequency of other solid cancers in a retrospective cohort. Methods: A search for the history of a non-breast solid tumor (NBST) among 1914 women admitted to our institute with stage I to IV breast cancer between 2006 – 2012 was conducted. Frequency of NBST according to temporal relation with breast cancer diagnosis was calculated Results: Overall 79 NBST and 75 patients (3.9 %) with another solid tumor were discovered. Of the patients 4 had more than one tumor. For these patients the median age at diagnosis was 55 (28 – 93), median follow-up time for breast cancer was 32 months (1 – 132). Post-menopausality was 60.8 %. The most common breast cancer histology was infiltrative ductal carcinoma (70.9 %). Of the 79 NBST, 34 (43.0 %) were diagnosed after breast cancer; 30 (38.0 %) before; and 15 (19.0 %) synchronously. Median time of diagnosis for NBST after breast cancer was 21 months (7 – 296). The most common malignancies were cancers of the ovary, thyroid and uterus (17.7, 15.2 and 11.4 %, respectively). Conclusions: The frequency of gynecological cancers and thyroid cancer along the course of breast cancer is high. Common environmental and genetic factors and may be involved. These patients should be followed closely
Diagnosis of axillar lymph node status and sentinel node biopy (SNB) by indocyanin green (ICG) fluorescence imaging in early breast cancer patients.
Authors: Hisamatsu Kazufumi
Published: March 2020

e11503

Background: In breast cancer patients, diagnosis of Axillar lymph node (Ax LN) status is practical use in deciding treatment strategy. But, diagnostic methods are different by different institution. The purpose of this study was to review diagnostic methods of Ax LN status. Methods: From December 2006, 483 cases were underwent breast cancer operation and within 356 (74%) clinical node negative primary breast cancer cases underwent Sentinel Node biopsy (SNB) by indocyanine green (ICG) fluorescence imaging. Dye was injected sub dermal in the areola. After one minute massage, subcutaneous lymphatic channel draining from the areola to the axilla was observed by Image processing and measuring system (PDE C9830, Hamamatsu Photonics Co). Skin incision was done at the point which fluorescence imaging disappeared (ASCO2011, Electronic Publication only). From September 2010, Aspiration Biopsy Cytology (ABC) of Ax LN (LN-ABC), Ultrasonography (US) and CT were done as routine workup in breast cancer patients. Node positive cases were received pre-operative chemotherapy or Ax LN dissection and node negative cases were underwent SNB by ICG fluorescence imaging during operation. Results: From December 2006, SNB were done 356 clinical node negative primary breast cancer cases. SN was detected 342 cases, detective rate was 96 %. This rate was as good as SNB done by radioactive colloid (Phytate radiolabelled by Tc98) with dye (detective rate was 95%, ASCO2011). The lymph node metastasis was detected 48 cases (14%). From Sep 2010 to Oct 2011, LN-ABC was done 49 cases of the 142 primary breast cancer patients. Fourteen cases were LN-ABC positive and 35cases were LN-ABC negative. Positive SNB were detected 3 of the 35 cases (2 cases had micro metastasis and one case had macro metastasis). Within three SNB positive cases, pre-operative US and CT had no positive finding. Positive LN-ABC cases (14 cases) were received pre-operative therapy or Ax LN dissection. Conclusions: These results suggest that LN-ABC was useful procedure detecting positive Ax LN and SNB by ICG fluorescence imaging was useful and easy tool in operative breast cancer patients.
Feasibility of dietary intervention in a breast cancer population.
Authors: Champ Colin E. , Anne Pramila R. , Showalter Timothy Norman , Heersink Mila J , Iacono Rosanne , Mishra Mark Vikas , Dicker Adam P. , Rosenberg Anne Louise , Simone Nicole L.
Published: March 2020

e11505

Background: Caloric restriction (CR), or reducing caloric intake by 20-40%, induces molecular changes which are also altered in breast cancer leaving cancer cells more susceptible to cytotoxic treatment. In vivo, CR decreases tumor growth and metastases. Recent research shows that breast cancer patients with metabolic syndrome and high blood glucose had higher mortality and poorer response to treatment. Diet modification may be an attractive potential adjunct to improve standard therapies, but little is known of the feasibility of enrolling patients into such a trial. Methods: After obtaining IRB approval, a survey was administered to a sample of patients in an academic breast cancer clinic to determine their interest in participating in nutrition trials during cancer treatment. Women were questioned regarding demographics, overall health status, comorbidities, and willingness to participate in clinical trials aimed at potentially increasing the efficacy of treatment through diet. Results: 50 breast cancer patients participated. 48% had comorbidities, 56% were self or physician-described as overweight, and 76% exercise at least once per week. 70% of respondents state that nutrition was never discussed with a physician prior to cancer care, 32% searched online for dietary information, and 62% expressed willingness to participate in a clinical trial involving a dietary regimen. Patients willing to participate in such a trial were more likely to be: currently exercising (73%), vitamin users (90%), not obese (64%), and more educated about diet related information (78%). Patients determined the most important tools to help them with dietary trial compliance would be speaking with a dietician weekly and weekly phone calls with the physician. Adherence would be increased if participants were provided meals. Conclusions: A significant proportion of breast cancer patients in this survey are interested in nutritional guidance and there is strong interest in participating in clinical trials with a dietary modification. Promising approaches include weekly meetings with dieticians and phone-based support. Based on these data, clinical trials of nutritional interventions appear warranted and feasible for enrolling breast cancer patients.
Predictive factors of no response during neoadjuvant chemotherapy in breast cancer.
Authors: Jo Jungmin , Yoo Changhoon , Kim Jeong-Eun , Ahn Jin-Hee , Kim Sung-Bae , Kim Hak-Hee , Cha Joo Hee , Shin Hee Jung , Ahn Sei-Hyun , Son Byung Ho , Lee Jong Won , Kim Hee Jeong , Gong Gyungyub , Jung Kyung Hae
Published: March 2020

e11508

Background: Neoadjuvant chemotherapy (NACT) has been the standard for patients with inflammatory (IBC) and locally advanced breast cancer (LABC) and increases breast conservation rates in patients with operable tumor. Pathologic complete response (pCR) after NACT has been accepted as a marker for improved long-term outcome and predictors of pCR have been reported in many trials. However, predictors of progression or stable disease have been limitedly reported. We aimed to identify predictors of no response during NACT to identify patients who might benefit from an alternative approach. Methods: The medical records of patients with breast cancer who received NACT were reviewed retrospectively at a single center. Between March 2000 and January 2010, 316 patients were enrolled with stage I to III breast cancer. Statistical analyses were performed to compare patients with any response (RG) with patients with progression or stable disease (NRG). Results: Out of 316 patients, 263 patients (83.2%) had some response, 36 (11.4%) had SD, and 17 (5.4%) had PD during NACT. Factors predictive of NRG included nodal (N) status (p=.007) and clinical stage (p=.004), IBC cancer type (p=.02), negative estrogen receptor (ER) status, and negative HER2 status (p=0.04). Pre-NACT N stage, ER status, cancer type, and treatment with trastuzumab were independent predictors of NRG in multivariate analysis. NRG was a negative predictor of disease-free survival (p=.002) and overall survival (p=.026) in multivariate analysis. Conclusions: Factors predicting NRG include advanced nodal stage, ER negativity, IBC and NACT without trastuzumab in HER2-positve tumors. Because these variables are associated with poor prognosis, novel targeted therapies and molecular predictors are needed to improve outcome
Mixed metabolic response on PET/CT in patients with metastatic breast cancer as an early predictor of disease progression.
Authors: Sen Urmi , Ling Huichung Tina , Chhabra Akansha , Friedman Kent P , Tiersten Amy
Published: March 2020

e11522

Background: It has been observed that patients undergoing systemic therapy for metastatic breast cancer (MBC) may demonstrate a mixed metabolic treatment response on FDG PET (MMTR) while maintaining stable disease on CT (SDCT). The purpose of this study is to determine (1) the clinical outcome of MBC patients demonstrating MMTR+SDCT who were maintained on the same treatment regimen and (2) the behavior of oncologists when faced with a report of MMTR+SDCT. Methods: All FDG PET/CT scan reports performed at one institution between 2006-2011 were searched and studies describing a MMTR also containing the term “breast cancer” were identified. MBC patients without other active malignancies were extracted from the search and scans were re-analyzed. MMTR was defined as a PET/CT scan demonstrating a minimum of 2 lesions with a SUVmax change of +25% or more combined with at least 2 lesions demonstrating a SUVmax change of -25% or more. The subset of patients with MMTR+SDCT (by anatomical RECIST criteria) who were maintained on their current treatment regimen was further examined to identify time to progression (TTP). Results: Thirty-two cases were identified that demonstrated MMTR+SDCT in metastatic breast cancer patients. No change in therapy occurred within 3 months of the scan in 9/32 patients. Of the 9 patients who were maintained on their current treatment regimen, 5 patients demonstrated subsequent disease progression at 3 (n=2), 5 (n=2), and 11 (n=1) months (mean TTP = 5.4 months, range 3-11 months). One patient remains stable at 16 months and 3 patients have insufficient follow-up. Therapy was changed immediately after the scan in the remaining 22 patients for various reasons including preference of the treating oncologists, treatment toxicities, increase in tumor markers, or clinical progression. Conclusions: MMTR+SDCT in patients with MBC predicted subsequent disease progression within 6 months in the majority of individuals. Oncologists commonly alter treatment regimen when faced with a report of MMTR+SDCT. Based on the observation of outcomes in patients who did not change therapy, this practice seems justified.
Gemcitabine (G) and cisplatin (C) as first-line treatment of metastatic breast cancer (MBC): Results of phase II trial.
Authors: Karthaus Meinolf , Poddubnaya Irina , Churilova L. , Khazanov R. , Veremeychuk T. , Rumyantzeva E , Garin M. , Brichkova O. , Heinrich Bernhard , Heinemann Volker
Published: March 2020

e11528

Background: G has been studied in combination with a variety of agents known to be active in cancer. G has a mild toxicity profile. GC is active in various advanced tumors. Splitting of C dose (d1 + d8) is better tolerated and can be a good alternative to once a cycle in pts with advanced breast cancer. This phase II trial evaluates G (1000 mg/m2) C (35 mg/ m2) d1+d8 repeated every 21 d in the 1st-line treatment of metastatic breast cancer (MBC). The primary objective of the study was to determine the objective tumor response rate (ORR) of 1st-line GC in patients with metastatic breast cancer. The one-stage design tested the null hypothesis that the true response rate for this population should be equal to 50% for efficacy. Overall survival (OS), time to progression (TTP) and toxicity were evaluated. Methods: 70 female MBC pts with the median age of 49.8 yrs (range 29.6-80.0) were enrolled. Tumor assessment was performed every other cycle by standard criteria including CT or MRI. 67 pts received a total of 310 cycles GC, out of these 54 pts were evaluable for efficacy. Results: Complete and partial responses were observed in 7/54 (13.0%) and 19/54 (35.2%) evaluable pts, respectively with an overall response of 48.1%. Disease stabilization was noticed in 19/54 (35.2%) pts. Progression was observed in 5/54 (9.3%) pts. Median TTP was 33.9 weeks (95% CI, 23.9-48.0). Median OS was 84.0 weeks (95% CI, 58.6-119.3). 1-year overall survival rate was 68.4% (95% CI, 53.6-79.3%). Hematological toxicity G4 was neutropenia in 14.9% (10/67), and no G4 thrombocytopenia. Hypotension G4 (1.5%) was the only severe non-hematological toxicity. Conclusions: GC in the first-line treatment of MBC demonstrated a substantial overall response rate and had a good toxicity profile. GC is a suitable option for first-line MBC in selected pts.
Factors affecting survival in upfront metastatic breast carcinoma patients.
Authors: Uyeturk Ummugul , Budakoglu Burcin , Turker Ibrahim , Helvaci Kaan , Uysal Sonmez Ozlem , Yalçintas Arslan Ülkü , Oksuzoglu Omur Berna
Published: March 2020

e11540

Background: Metastatic breast cancer is a heterogenous disease. There are several subgroups according to pathological, biological and molecular behaviours of the tumor. Recurrent metastatic breast carcinoma (RMBC) and upfront metastatic breast carcinoma (UMBC) may differ according to clinical and prognostic characteristics. Intrinsic genetic heterogeneity may be responsible for these differences. To date, little is known about the clinical features and outcome of patients with UMBC. Methods: Patients were considered to have UMBC if patients were admitted to the clinics with stage IV disease. Patients were considered to have RMBC if metastases had developed during followup for localized breast carcinoma. Between September 2007 and May 2011, 102 of 2478 (4.1%) UMBC patients who was admitted to Department of Medical Oncology Clinic, was included in this retrospective trial. Patients’ characteristics, treatment schedules and survival data were evaluated. Results: All patients were female. Median age was 50.0 (range: 26-90). More than half of patients (58.8%) were postmenopausal. Frequent histological type was invasive ductal carcinoma (89.2%). Most of the patients had grade 3 (57.8%) tumor. Hormone receptor (HR) and HER2 positivity were76.5% and 42.2%, respectively. Metastatic sites were visceral, isolated bone-soft tissue and combination in 20%, 42% and 37%, respectively. Most of visceral metastatic patients were HR negative and HER2 positive. Median PFS and OS were 30 and 66 months, respectively. Both PFS and OS were affected from HR status, HER2 status, sites of metastatic disease and chemotherapy (log-rank p=0.006, 0.04, 0.02, 0.004, 0.03 and log-rank p= 0.04, 0.04, 0.01, 0.03, 0.01 respectively). Both PFS and OS were not affected by age, menopausal status, performance status, histology and grade of the tumor. OS were longest in patients group who received chemotherapy (76 months) and shortest in patients group who received chemotherapy and targeted therapy combinations (23 months). Conclusions: Factors affecting survival were comparable to previous studies in UMBC patient population similiar to results RMBC studies. This finding should be confirmed with prospective trials in larger study populations.
Safety and activity of nonpegylated liposomal doxorubicin (nPLD) combined with oral metronomic cyclophosphamide (mC) as preoperative treatment for locally advanced breast cancer (BC) patients (pts).
Authors: Andreis Daniele , Generali Daniele Giulio , Foroni Chiara , Bazzola Letizia , Cappelletti Mariarosa , Zanoni Vanessa , Milani Manuela , Strina Carla , Allevi Giovanni , Aguggini Sergio , Boni Ermenegilda , Giardini Roberto , Bertoni Ramona , Bottini Alberto
Published: March 2020

e11546

Background: nPLD has the same clinical benefits but less toxicity than the traditional doxorubicin. It’s well reported mC produces anti-proliferative and anti-angiogenic effect in tumours. We conducted a retrospective study to evaluate the safety and activity of the association of nPLD and mC in pts with locally advanced BC. Methods: A total of 41 female pts with HER2-negative locally advanced BC unfit for standard chemotherapy received nPLD 25 mg/mq biweekly for eight courses along with mC 50 mg daily as primary systemic treatment. Toxicity and clinical-radiological response with Ki67 and CD31 expression were evaluated in tumour specimens obtained before and after treatment. Results: Pts characteristics included: median age 47.5 years; 31.7% Luminal A (LA), 56.1% Luminal B (LB), and 12.2% Triple Negative BC subtype classified by immunohistochemistry. The rate of breast-conserving surgery was 59.5%. All pts were evaluable for response. Objective response rate (ORR) was 58.5% (95% confidence interval, 42.1% to 73.7%), with 4 (9.7%) clinical complete responses (CR) and 20 (48.8%) partial responses. Sixteen pts (39.0%) achieved a stable disease and 1 pt progressed. One pt experienced a pathological CR. LA subtype was significantly associated with better ORR than others subtypes (p=0.049) and especially than LB (p=0.040). There was a borderline significant reduction of Ki67 expression after treatment (median, 15.5% to 9%; p=0.056), but no significant variation in CD31 expression (p=0.865). The majority of adverse events (AEs) were mild or moderate. Grade ≥3 AEs included neutropenia (12.2%), vomiting (4.9%) and hyperglycemia (2.44%). Temporary treatment suspension due to toxicity occurred in 8 (19.5%) pts; discontinuation was necessary in 1 pt. No symptoms were related to impairment of cardiac function. Mean left ventricular ejection fraction levels did not change substantially before and after treatment: 58.7% and 57.1%, respectively. Conclusions: The combination of nPLD and mC is well tolerated, with a promising activity as preoperative therapy in unfit pts with locally advanced BC.
Neoadjuvant capecitabine chemotherapy in women with newly diagnosed locally advanced breast cancer in a resource-poor setting (Nigeria): Efficacy and safety in a phase II feasibility study.
Authors: Arowolo Olukayode Adeolu , Njiaju Uchenna O , Ogundiran Temidayo O , Lawal Olukayode O , Obajimi Millicent , Adetiloye Adebayo , Im Hae Kyung , Akinkuolie Akinbolaju Andrew , Oluwasola Abideen Olayiwola , Adelusola Kayode , Adesunkanmi Abdulrusheed Kayode , Agbakwuru Augustine , Falusi Adeyinka , Durosinmin Muheez , Olopade Olusola C , Olopade Olufunmilayo I
Published: March 2020

e11554

Background: The majority of clinical trials of neoadjuvant therapy for breast cancer have been conducted in resource-rich countries. We chose Nigeria, a resource-poor country, as the major site for a phase II feasibility open label multicenter clinical trial designed to evaluate the efficacy, safety and tolerability of neoadjuvant capecitabine in locally advanced breast cancer. Methods: Planned treatment consisted of 24 weeks of capecitabine at a dose of 1000mg/m2 twice daily (2000mg/m2 total per day). Each cycle consisted of a 14-day period of therapy followed by a 7-day pause, and patients were evaluated after 3 cycles and taken off study if no response was documented. Responding patients were treated for no more than 8 cycles. The primary endpoints were partial, complete clinical response and pathologic complete response. Results: A total of 16 patients were recruited from August 2007 to April 2010. The study was terminated early as a result of slow accrual. After the first 3 cycles of therapy, partial clinical responses were seen in 5 of 16 patients (31%; 95% CI 11% - 59%). Of the remaining 11 patients, 8 had no response or stable disease, and 3 had progressive disease. Seven pateints proceeded with further therapy, two of them with stable disease but exactly in the border line of 25% increase. By physical examination, only 2 of the 6 patients had a documented complete clinical response, while by ultrasonomammography, partial responses were observed in 5 patients. Thus, overall response rate at the end of 8 cycles were 31.1% both by clinical examination and by ultrasonomammography. Clinical response by physical examination and radiologic response by ultrasonomammography were highly concordant (the spearman correlation between the two ratios was 0.70). The most common adverse effect was Grade 1 Hand and Foot Syndrome in 75% of patients. Conclusions: Despite several limitations, we successfully carried out this phase II feasibility study of neoadjuvant capecitabine for locally advanced breast cancer in Nigeria. Capecitabine monotherapy showed good overall response rates with minimal toxicity and further studies are warranted.