bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between positive sentinel node (SN) and micrometastases (mMTS) or isolated tumor cells (ITC) with breast tumor pathological features.
Authors: Calvo Isabel , Suárez Ana , Perez Francisco Jose , Fernandez Abad Maria , Cardenas Jose M , García Lina , Alonso Paloma , Miro Cristina , Quevedo Paloma , Parras Manuela , Marquez Cristina , Herrero Mercedes , Buelga Paula , Rodriguez Isabel , Skaarup Jesika , Chereguini Maria F , Marcos Manuel , Contreras Ana Cecilia , Hidalgo Manuel , García-Estevez Laura
Published: March 2020

e11517

Background: Aim:To study the relation of positive(pos) SN and mMTS or ITC in negative(neg) SN at surgery with tumor pathological(pathol) features (grade;carcinoma type;Ki67;Her2;hormonal status;tumor size). Methods: Cohort of 271 patients with clinically and ultrasonographically node-neg pT1-2 breast cancer and high grade or extended intraductal who received breast cancer surgery with SN biopsy alone in the last 2 years was studied. No previous chemotherapy was administered. Hormone(ER/RP) and Ki67 status were analyzed by inmunohistochemistry(IHC) while HER2 by FISH. Presence of mMTS and ITC were studied by IHC(AE1-AE3). Statistical analysis was conducted to ascertain significant relation among pos-SN or detection of mMTS/ITC in neg-SN and each of the tumor pathol features (test U-Mann-Whitney). Results: Data from 263 patients were analyzed (28 pos-SN;235 neg-SN;8 technique failures). Carcinoma type: Ductal (158;60%);lobular (46;17.5%);in-situ(53;20.2%);others(6;2.3%). Infiltrative cancer:(56% grade 2;20% grade 3;10% Her2+;9% triple-neg;81% pos-RE/RP). In-situ:(28% grade 2;64% grade 3;39% Her2+;55% pos-RE/RP). Mean pathological size 16.2mm(1-118) for infiltrative tumor and 20.1mm(1-90) for in-situ. Mean of SN found at surgery 1.98(1-5). In neg-SN, 35 cases with mMTS(14;6.2%) or ITC(21;9.2%) were found. No statistically significant relation was established between the finding of mMTS or ITC and any of the pathol features at in-situ or infiltrative tumors. In pos-SN a statistically significant relation between pos-SN and pathol size was found (p=0.003; mean pathol size 20.16mm and 15.69mm for pos and neg-SN). Conclusions: A significant relation was established with pathol size and pos-SN. In patients with neg-SN no significant relationship was found between detection of mMTS or ITC and the pathol features of the tumor.
Breast MRI in elderly patients with breast cancer: Does breast density matter?
Authors: Casher Jennifer , Stempel Michelle , Eaton Anne , Morris Elizabeth Ann , Gemignani Mary
Published: March 2020

e11531

Background: MRI of the breast (BR) is useful in patients (pts) with dense BR in extent of disease evaluation (EOD) and high risk screening. The purpose of this study was to investigate whether MRI breast cancer (BC) detection was associated with BR density in elderly pts. Methods: Retrospective review included pts age >69 diagnosed with BC at our institution between 2/2001 and 12/2005 and their concurrent BR MRIs as well as clinical and pathologic factors. BR density was defined as mild (M) if BR were fatty/mildly dense, and dense (D) if BR were moderately/extremely dense. MRI data was coded for the number of additional sites beyond the known cancer site. Results: MRI occurred in 113 BR in 59 pts; 5 pts had unilateral MRI. 3 pts had bilateral BC. The mean age was 74 (range 69-84). Median tumor size was 1.2 cm (range 0.06-2.6, n=54). 27 pts (46%) had M density and 32 (54%) had D density. In 51/62 (82%) the index lesion was mammographically detected, and in 11 (17%) it was mammographically occult. The majority of BR MRIs 36/62 (58%) identified no additional sites. Biopsy was performed for 18/29 (62%) of the additional sites and 6 cancers were found (PPV of 33%). MRI detected an additional site of BC in 6/62 (9.7%) diseased BR and a new BC in 4/51 (7.8%) screened BR. Pts with D density had more additional MRI sites 18/33 (54.6%) as compared with M density 8/29 (27.6%) p = 0.04. However, D density was not associated with increase in BC detection; 4/33 (12%) D vs 2/29 (7%) M density, p =0.67. BR conserving surgery was performed in 46 pts and mastectomy in 16. We did not find a correlation between additional sites on MRI and final mastectomy, p=0.56. Conclusions: In our study the majority of pts had mammographically evident BC at the time of diagnosis and unifocal BC on MRI. We found that although 54% of our pts had dense BR, the additional detection of BC in the BR by MRI was the same as in pts with mild density. However, we found that increased density was associated with an increased detection of additional lesions on MRI. [Table: see text]
Breast-conserving surgery after neoadjuvant chemotherapy for stage III breast cancer patients.
Authors: Shin Hee-Chul , Han Wonshik , Moon Hyeong-Gon , Moon Woo Kyung , Im Seock-Ah , Kim Tae-You , Park In-Ae , Noh Dong-Young
Published: March 2020

e11532

Background: Neoadjuvant chemotherapy (NCT) is a reasonable option for operable breast cancer in terms of downsizing large tumor and increasing the rate of breast-conserving surgery (BCS). However, BCS in patients with large breast tumors down-staged by NCT remains still controversial because of the possibility of residual tumor and resistance to NCT. Aims of this study were to evaluate the long-term survival results of patients who received NCT and BCS compared to patients who received BCS first and to compare recurrence and survival rates between patients who received preplanned BCS and those who received down-staged BCS among patients who underwent NCT. Methods: Between 2000 and 2007, 70 patients with clinical stage III breast cancer who received BCS after NCT (NCT group) and 72 patients with clinical stage III breast cancer who underwent BCS first (Surgery group) were retrospectively reviewed. Among 70 patients received NCT, 45 patients (64.3%) received preplanned BCS (preplanned BCS group) and 25 patients (35.7%) received down-staged BCS (down-staged BCS group). The long-term results including ipsilateral breast tumor recurrence (IBTR), locoregional recurrence (LRR), disease recurrence and survival rates were compared with groups. Results: There was no significant difference in IBTR-free survival, LRR-free survival rates, disease-free survival and overall survival rates between the NCT and the Surgery group (p=0.971, p=0.294, p=0.863 and p=0.933, respectively). Among patients who received NCT, IBTR-free survival, LRR-free survival, disease-free survival and overall survival rates was not also different between the preplanned BCS group and the down-staged BCS group (p=0.278, p=0.501, p=0.776 and p=0.412, respectively). Conclusions: Our study demonstrated that patients who received BCS after NCT showed similar long-term resutls compared to patients who received BCS first in clinical stage III breast cancer patients. Also, down-staged BCS shows is oncologically as safe as preplanned BCS in clinical stage III breast cancer patients in terms of recurrence and survival.
Targeting triple-negative breast cancer by conversion into HER2-positive cancer: A novel therapeutic approach.
Authors: Bernemann Christof , Huelsewig Carolin , Kiesel Ludwig , Liedtke Cornelia
Published: March 2020

e11534

Background: Triple negative breast cancer (TNBC) is defined by the lack of estrogen-receptor alpha (ERα) and progesterone receptor (PGR) expression as well as absence of human epidermal growth factor receptor2 (HER2/neu) overexpression. This type of breast cancer is characterized by a poor prognosis and significantly reduced survival rate compared to other BC subtypes. This is mostly due to the lack of targeted agents like endocrine or anti HER2 targets. Breast cancers which overexpress HER2 are usually treated by chemicals targeting HER2; either by blocking the extracellular domain through trastuzumab or the intracellular domain through the small molecule lapatinib. Both therapeutics lead to inhibition of downstream pathways like MAPK and PI3K, resulting in increased apoptosis as well as reduced proliferation. Methods: We hypothesize that downstream effects might be induced in TNBC cells when HER2 is artificially overexpressed and cells get treated as HER2 positive cells. Therefore, triple negative breast cancer cell lines were transfected with HER2. These cells were treated with anti-HER2 agents. Molecular analyses will demonstrate whether transfection with HER2 will yield a HER2 positive breast cancer phenotype in that all downstream signaling mechanisms act similarly to a priori HER2 positive cells. Results: Preliminary experiments suggest that proliferation of TNBC cells transfected with HER2 does not change significantly. Treatment with HER2-blocking antibody trastuzumab leads to significant decrease of proliferation in HER2 transfected, initially triple negative MDA-MB-231 breast cancer cells. Only a moderate decrease in proliferation was observed when lapatinib, a molecule directed against both EGFR and HER2, was used in both MDA-MB-231 wildtype and HER2-transfected cell lines. Conclusions: We surmise that firstly, conversion of cancer might become a clinical tool to treat cancer of poor prognosis and secondly that our results might shed light on future therapeutic approaches e.g. small molecule compound screening for endogenous HER2 reactivation / overexpression and subsequent targeted treatment of triple negative breast cancers.
Docetaxel-carboplatin-bevacizumab (TCV): A novel combination that promises a high activity in triple-negative breast cancer: A pilot study.
Authors: Chacon Jose Ignacio , Rubio Salvador(2) Ana Rosa , Cordero Franco(1) Nazaret , Martinez Carrasco (1) Begona , Alonso Soler(1) Sonia , Diaz Paniagua(1) Laura , Fernandez Franco(1) Lourdes , San Juan del Moral(1) Alberto , Esteban Esteban(1) Carmen , Moya Gomez(2) Paloma , Cruz Mora(1) Miguel Angel
Published: March 2020

e11543

Background: Triple negative breast cancer (TNBC) is an anthracycline resistant subtype, for which there is no standard chemotherapy. Taxanes, platinum-derived drugs and bevacizumab all seem to be active drugs in this setting, but definitive data are still lacking. Our purpose is to report our experience with the combination Docetaxel-Carboplatin-Bevacizumab (TCV) in TNBC. Methods: We retrospectively analysed our database using medical claims for patients diagnosed with TNBC and treated with TCV in neoadjuvant (NAJ) or metastasic( MD), between July 1, 2009, and December 31, 2011. Informed consent was obtained from all patients. Results: 13 pts have received 86 TCV cycles, 8 in NAJ and 5 for MD. NAJ: Median age: 48(28-60) y. T3-T4 tumors: 62,5% . N+: 62.5%. All pts received 6 TCV cycles, except 1 pt, still on therapy. 5 (62.5%) pts received quadrantectomy, 2(25%) mastectomy as surgical treatment after TCV. One pt has not received surgery yet. Sentinel lymph node biopsy was done in 5/8 (62.5%) pts, the other 3 received axillary dissection for clinically N+ metastasis. After surgery, pathologic complete response (pCR) in breast in 6/7 pts (85.7%); in axillary nodes, pCR in 5/7 pts (71,4%). One has not been surgically evaluated yet. Median follow-up: 10 months (2-18). Only one pt has relapsed with cerebral metastasis. MD: Median age: 54.4 (40-71) y. 4 pts received TCV as first line, one as third line therapy. 3 pts obtained complete response, 2 partial responses, but both progressed in three months. Median follow-up: 14.4 months. Only one of these pts has died. Toxicity: Was mild, without any grade 3 or 4 toxic effect. Only one pt showed grade 2 hypertension after bevacizumab infusion. Neutropenia was not evaluable for use of G-CSF per protocol. Conclusions: Although this is a short series, it suggests that TCV may be a highly active combination in TNBC with a good tolerability profile. These data warrant continuing testing of this combination in TNBC.
Does progesterone protect from chemotherapy-induced peripheral neuropathy? A retrospective audit of breast cancer patients.
Authors: Prabhu Aruna Laxman , Singh Akshita , Kaushik Rucha Vishal , Nair Nita S. , Hawaldar Rohini W , Vanmali Vaibhav , Parmar Vani , Gupta Sudeep , Badwe Rajendra A.
Published: March 2020

e11552

Background: Paclitaxel is an integral component of chemotherapy for breast cancer but its benefit comes at the risk of peripheral neuropathy. There are experimental models of peripheral nerve injury in which progesterone is protective, possibly through remyelination and other mechanisms. Methods: We evaluated the effect of menopausal status, as a surrogate for circulating progesterone levels, on the risk of developing paclitaxel induced peripheral neuropathy, in a retrospective audit of breast cancer patients. Patients who had received paclitaxel chemotherapy for breast cancer were characterized as having CIPN or not by clinical history/examination. Results: 256 women treated with paclitaxel at our institution were assessed for CIPN. Of these 133(52%) were premenopausal and 123(48%) postmenopausal at diagnosis. 22(8.6%) had preexisting diabetes mellitus. Of the 133 premenopausal women 97(72.9%) developed chemotherapy induced amenorrhea (CIA). The incidence of CIPN was 23.1% in persistently premenopausal patients 47.4% in patients with CIA and 57.7% in postmenopausal patients. In patients with DM 81.8% had CIPN. In a multivariate logistic regression model, increasing age (continuous variable RR=1.04 95%CI 1.02-1.08 p=0.001) DM (RR=4.39 95% CI 1.42-13.38 p=0.01) and postmenopausal/CIA status (RR=2.48 95% CI 1.05-5.88 p=0.03) were risk factors for CIPN. Because patients developed CIA at variable times and circulating progesterone levels at the time of neurotoxin insult maybe variable in them such patients were excluded in the second model, which included only patients with continuing menses (n=36) and postmenopausal at diagnosis (n=123). In the latter model postmenopausal status (RR=3.5 95%CI 1.18-10.39 p=0.02) and DM (RR=6.8 95%CI 1.44-31.82 p=0.01) were associated with CIPN but increasing age (RR=1.03 95% CI 0.98-1.07 p=0.21) was not. Conclusions: These results suggest a neuroprotective effect of premenopausal status, possibly related to higher circulating levels of progesterone. We hypothesize that progesterone administration prior to taxane chemotherapy may protect against CIPN. This will be tested in a RCT.
Oxidative stress induced by early cycles of combination chemotherapy in chemonaive and radionaive breast cancer patients.
Authors: Kok Victor C. , Ko Wan-Seng , Guo C.H. , Chen P.C.
Published: March 2020

e11561

Background: Chemotherapy-induced oxidative stress (CIOS) can be altered multifactorially in time course of treatment. Initial changes of CIOS in the breast cancer patients are not clear. OBJECTIVES: IRB-approved prospective study of the changes of CIOS in chemo-naïve and radiotherapy-naïve breast cancer patients who undergo chemotherapy(CT) or radiotherapy(RT) in either adjuvant or metastatic settings. Methods: Exclusion criteria: Patient who has prior exposure to CT or RT, active infection, connective tissue disorder, been taking antioxidant agent(s), active hepatitis, liver cirrhosis, renal insufficiency and no written informed consent. Blood samplings were done before CT or RT and day 22 since chemotherapy or day 29 since RT. Serum analyzed for glutathione peroxidase(GSH-Px), glutathione reductase(GR), Vit.E, malondialdehyde (MDA), and trace elements including Zn, Cu, Fe, Se. Results: 10 patients and 10 healthy volunteers were entered. Median age: 47.5 (R: 38~80); Tumor type; infiltrating ductal ca: 8 pts; lobular ca: 1; mucinous: 1. Stage: IIA: 4 pts; IIB: 1; IIIA: 3; IIIB: 0; IIIC: 1; Relapsed: 1. ECOG 0/1: 9/1 pts; Regimens: FEC: 5 pts, CAF: 1, EC: 2, CMF: 1; RT: 1. After 1 cycle of CT or 28 days of RT: GSH-Px was significantly increased (P=0.0003); GR increased (P=0.0002); Vit. E increased (1-sided P=0.028); MDA decreased (P=0.0073) and Zn decreased (P=0.0162). Contrary to some oncologists initial expectations, the early changes after chemotherapy or radiotherapy are elevation of body's antioxidative capacity. Conclusions: Spontaneous counterbalance of CIOS after initial cycles of chemotherapy is suggested from this study.
Patterns of in vitro chemotherapy (CT)-induced apoptosis (APOP) in recurrent/metastatic breast carcinoma (CA): Comparisons of generic multisource drugs (generics) with proprietary single-source drugs (proprietaries).
Authors: Bosserman Linda D. , Rogers Karl , Davidson Dirk C. , Willis Carl Rogaston , Rutledge James , Hallquist Allan , Young Tracy , Rajurkar Swapnil Padmakar , Karimi Misagh , Presant Cary A.
Published: March 2020

e11562

Background: Therapy of metastatic breast CA involves choices between Generics and Proprietaries, and between combination CTs (Combos) and single-agent CTs. This study determined the relative in vitro CT induced APOP of Generics versus Proprietaries, and Combos versus single agents. Methods: Purified breast CA cells from 67 patient (Pt) biopsies were placed in short-term culture with CT using the microculture kinetic (MiCK) assay. APOP was analyzed every five min over 48 hrs. APOP was defined in kinetic units (KU) of apoptosis. Significant APOP was > 1.0 KU. Significant difference between individual assays was > 0.57 KU based on replicate analyses. Results: 43 Pts were evaluable for comparison of Generics versus Proprietaries. Generics produced APOP > Proprietaries in 36/43 Pts (84%) and = to Proprietaries in 6 Pts (14%). Proprietaries produced APOP > Generics in 1 Pt (2%). In-class comparisons indicated epirubicin had mean APOP > doxorubicin (P=0.01), cisplatin had APOP > carboplatin (P<0.01); vinorelbine had APOP > vincristine (P=0.02); docetaxel had APOP > nab-paclitaxel (P=0.01); whereas docetaxel and paclitaxel APOP were not different (P=0.85). However, in individual Pts, docetaxel had APOP > paclitaxel in 37% of Pts, whereas paclitaxel was better than docetaxel in 31%. For Combos, cyclophosphamide + doxorubicin produced APOP > single agents in 25%, while single agents had APOP = or > cyclophosphamide plus doxorubicin in 67%. Cyclophosphamide plus docetaxel had APOP > single agents in 33%, but single agents had APOP = or > cyclophosphamide plus docetaxel in 66%. Other comparisons will be presented. Conclusions: Generics APOP is often equal to or better than Proprietaries APOP. In individual Pts single agents frequently produced higher APOP than Combos. The MiCK APOP assay can identify individual Pts with metastatic breast CA for whom Generics or single agents produce higher APOP than Proprietaries or Combos. Prospective clinical trials confirming these predictive differences are warranted. These differences could result in significant savings in health care costs.
Albumin component of nab-paclitaxel and skin toxicities in Chinese breast cancer patients.
Authors: Hu Xi-Chun , Tang Lichen , Wang Biyun , Sun Si , Zhang Jian , Jia Zhen , Lu Yunhua , Di Genhong , Zhimin Shao
Published: March 2020

e11567

Background: This phase II study was to explore the efficacy and safety of weekly nab-paclitaxel and cisplatin combinationin Chinese advanced breast cancer (ABC) patients. While all other safety profiles were similar and expected based on published clinical trial results conducted in Western patients, the incidence of skin rash was unexpectedly higher. Methods: Nab-paclitaxel(125 mg/m2) was administered on days 1, 8, 15, followed by cisplatin (75 mg/m2) on day 1 every 28 day cycle until disease progression, intolerable toxicities or the maximum of 6 cycles. Patients who received at least one injection of the study drug were included in this analysis of the incidence of skin rash among Chinese patients. Toxicity was graded using the CTCAE4.0. The incidences of skin toxicity with conventional- and nab-paclitaxel were obtained from published trial results in both Chinese and Western patients. Results: 73 patients enrolled were qualified to be analyzed, and a total of 384 cycles were administered before the datalock on Oct 1st, 2011. Rash was presented in 27 patients (37.0%). The most common sites involved were face (14/27), neck (14/27), limbs (18/27) and frictional parts of the trunk (10/27). Macular and papular rash with pruritus commonly occurred 2 (1-7) days after the first day of chemotherapy. Only one patient developed Grade 3 skin toxicity with generalized erythroderma and disfigurement of the face requiring dose reduction. The rash gradually regressed 2 (1-10) days after antihistamines using and pigmentation remained in 13/27 cases. The incidence rate of skin toxicity was significantly higher in Chinese patients than Western counterparts (P<0.0001), while no difference was found with conventional paclitaxel. Conclusions: A higher rate of skin toxicity occurred in Chinese breast cancer patients treated with weekly nab-paclitaxel comparing to Western patients. The albumin component of nab-paclitaxel maybe the cause of the skin disorder. [Table: see text]
A phase II study of weekly nanoparticle albumin-bound paclitaxel combined with cisplatin in patients with metastatic breast cancer.
Authors: Wang Biyun , Hu Xi-Chun , Sun Si , Zhang Jian , Tang Lichen , Wang Zhong Hua , Wang Lei Ping , Lv Fangfang , Zhang Qunling , Zheng Chunlei , Jia Zhen , Lu Yunhua
Published: March 2020

e11568

Background: This prospective phase II study was to investigate the efficacy and toxicity of weekly albumin-bound paclitaxel (nab-paclitaxel) and cisplatin combination in patients with metastatic breast cancer. Methods: Females with unresectable, recurrent or metastatic breast cancer were eligible for participation. Nab-paclitaxel was administered weekly at a dose of 125 mg/m2 on d1, 8, 15, followed by cisplatin 75 mg/m2 on d1, repeated every 28 days with a maximum of 6 cycles. The primary objective was overall response rate (ORR) and the second objectives were progression free survival (PFS), safety, and overall survival (OS). Results: Seventy-three women were enrolled into this study. A total of 384 chemotherapy cycles were administered with a median of 6 cycles. A high overall response rate (67.1%) was achieved in the whole population. The highest response rate was observed in the first line patients (80.6%) and in patients who had not received taxane previously (80%). After a median follow-up of 12.8 months, the median PFS was 10.5 months. For the patients receiving first-, second- and third-line or more,median PFS was 12.3, 9.0 and 7.7 months, respectively (P=0.006). Subgroup analysis showed that the highest response rate was obtained in Her-2 positive patients, followed by patients with triple negative and luminal subtypes, yielding a response rate of 77.8%, 68.8% and 63.9%, respectively (P=0.584). The corresponding median PFS was 13.6, 12.7 and 10.0 months, respectively (P=0.83). While grade 4 neutropenia occurred in 46 patients (63.0%), febrile neutropenia occurred only in 9 patients (12.3%). Grade 3 peripheral neuropathy was an accumulated dose-limiting toxicity occurring in 19 patients (26.0%), 13 of whom had to stop chemotherapy due to no recovery to grade 2 or less within 2 weeks. Other common toxicities included alopecia, nausea, vomiting and rash. Conclusions: The results of this trial add to the clinical evidence that doublet of nab-paclitaxel and cisplatin has high efficacy and a good safety profile in treatment of patients with metastatic breast cancer. Further evaluation of this regimen in metastatic breast cancer, especially triple negative subtype, is justified.
Thrombocytopenia in hematologic malignancy and solid tumors in the United States.
Authors: Bennett Dimitri , Suppapanya Nittaya , Grotzinger Kelly
Published: March 2020

e12001

Background: Thrombocytopenia (TCP) frequently occurs in patients with hematologic or solid malignancies resulting from the underlying disease processes or a complication of cancer treatments. Severe TCP may both increase the risk of bleeding, interrupt or reduce optimal dosing with therapies. Epidemiological data on these patients are limited. Therefore, to increase our knowledge, we identified patients with hematologic & solid malignancies & assessed the frequency of primary, secondary & TCP not otherwise classified, following diagnosis & through treatment using a large US claims database. Methods: Hematologic & solid malignancy adult cases were identified during the calendar year 2008 in the Integrated Healthcare Information Service, a medical & prescription claims database comprised of ~101.7 million members from 46 health plans in the US. Malignancies were defined using ICD-9 diagnosis codes; 2 codes were required to confirm cancer. TCP was defined as the presence of at least 2 claims with ICD-9 codes 287.3 or 287.4 or 287.5 within 365 days of the first malignancy diagnosis in 2008. All grades of TCP thus might be reflected as platelet counts were not used to verify diagnostic coding. Adults on active cancer therapy as well as those for whom cancer therapy was not yet initiated & those who have completed their therapeutic regimen are included in the analyses. Results: The frequency of TCP was higher among patients with hematologic malignancies compared to those with solid tumors. Among hematologic cancers, TCP was more common among patients diagnosed with acute myeloid leukemia 33.4% & acute lymphoblastic leukemia 19.1%, followed by aplastic anemia 13.6%, MDS 12.6%, multiple myeloma 9.4%, chronic lymphocytic leukemia 6.9%, chronic myelogenous leukemia 5.9% & non-Hodgkin’s lymphoma 5.1%. Of all patients with solid tumors, the greatest proportion with TCP were observed among those with small cell lung cancer 9.4%; TCP was relatively rare among patients with cancers of the ovary 3.1%, non-small cell lung cancer 2.9%, cervical cancer 2.3%, bladder 1.6%, uterus 1.1%, & breast cancer 0.7%. Conclusions: Overall, TCP occurrence varies widely by cancer type but is commonly higher among patients with hematological malignancies than solid tumors.
Lung cancer and benign lung diseases in patients with serious vitamin D deficiency in eastern China.
Authors: Li Rong , Wu Jing , Xiong Liwen , Han Baohui
Published: March 2020

e12010

Background: Vitamin D deficiency is a global problem. Methods: We estimated the 25-hydroxyvitamin D (25(OH)D) concentrations to confirm whether patients with lung diseases in eastern China showed vitamin D deficiency and whether this deficiency was related to the risk of lung cancer.We used chemiluminescence to estimate the 25(OH)D concentrations in 250 patients from eastern China, of whom 197 had untreated stage III/IV lung cancer and 53 had benign lung diseases. Results: The mean serum 25(OH)D concentration of patients with lung cancer was 10.63 ± 7.04 ng/mL and that of patients with benign lung disease was 9.62 ± 6.37 ng/mL. Although there was no significant difference between the values, the mean serum concentrations of 25(OH)D obtained in patients with lung cancer and benign lung diseases were lower than the normal value (>20 ng/mL); p values in both cases were less than 0.0001. Among the 250 patients, 90 showed low serum 25(OH)D levels of ≤ 4 ng/mL. Conclusions: Patients with lung diseases in eastern China show low serum levels of 25(OH)D, and the average serum 25(OH)D level is much below the normal vitamin D level. Presently it cannot be concluded whether the low levels of 25(OH)D is a risk factor for lung cancer, because the average serum 25(OH)D levels in patients with lung cancer or benign lung diseases are very low.
Characteristic and management of lung cancer as a secondary malignancy.
Authors: Pluzanski Adam , Badurak Pawel , Kowalski Dariusz M , Glogowski Maciej , Zajda Katarzyna , Krzakowski Maciej Jerzy
Published: March 2020

e12011

Background: New diagnostic and therapeutic strategies increase survival in cancer patients. Etiology and management of primary lung cancer (LC) are well established, but little is known about incidence of LC as a secondary neoplasm. The study analyzes the clinical characteristic, pathology and management of LC as a secondary neoplasm. Methods: We reviewed medical records of patients (pts) treated in our institution from Feb.1998 to Aug.2011 with diagnosis of LC as a second malignancy. The analysis included median age at the time of diagnosis of primary cancer, histology, type of treatment and time until diagnosis of LC. Results: 84 pts were analyzed – median age at the time of diagnosis of primary cancer was 62 years (range 35-79) (65 years in men and 58 years in women p<0,05). The most frequent primary was: breast -21 pts (25%), larynx -19 pts (23%), colon - 9 pts (11%). According to etiology, tobacco-related primary cancers occurred in 37 (44%) pts. Radiotherapy/chemoradiotherapy was the treatment for primary cancer in 42 (50%) pts, surgery alone in 31 (37%) and chemotherapy in 11 (13%) pts. Adenocarcinoma as a secondary LC was diagnosed in 43 pts (51%), squamos-cell carcinoma in 30 pts (36%), small-cell lung cancer or carcinoid in 6 pts (7%), other types of non-small cell lung cancer in 5 pts (6%). Median time between diagnosis of primary cancer and LC was 50 months (range 0-354). Stage I or II LC was found in 56 pts (67%) and stage of III or IV in 26 (31%) pts (contrary to staging observed in pts diagnosed with LC as a primary malignancy in our institution concurrently). After diagnosis of LC radical and palliative treatment was offered in 65 (77%) pts and 19 (23%) pts respectively. After median follow-up of 84 months, progression of LC was noted in 27 pts (32%) and median time to progression was 16 months (range 2-89). Conclusions: Patients after treatment of tobacco-related cancers are at risk of developing LC as a second malignancy. LC as a secondary cancer is observed also after treatment of breast cancer and radiotherapy use. Close surveillance after treatment of primary malignancy allows detection of LC at early stage with a chance of radical treatment.
Malignancy following lung transplantation.
Authors: Khanshour Ammar , Abu Awwad Raed , Chapman Robert , Betensley Alan
Published: March 2020

e12019

Background: Malignancy has been shown to be a frequent complication of solid organ transplantation. It has been reported more commonly in lung transplant patients compared to other solid organ transplant recipients presumably due to the greater degree of immunosuppression required for these patients; the International Society for Heart and Lung Transplantation (ISHLT) reported that malignancies account for 15% of all deaths of lung transplant patients between 5 and 10 years after transplant. The aim of this study is to describe malignancies observed in patients who underwent lung transplantation in a single, large tertiary center. Methods: A retrospective analysis of the medical records of all adult recipients of lung allografts transplanted at Henry Ford Hospital between 1994 and 2010 was performed. Main variables included age at transplant, type of transplant, smoking status and type of malignancy. Study end point was development of malignancy. Patients surviving less than 3 months were excluded from the final analysis. T-test and Chi-square tests were used in the statistical analysis. Results: 145 patients received lung transplants with 136 patients surviving at least 3 months. Of the 136 cases included; 31 (23%) patients developed post-transplant malignancy as follows: skin cancer in 17, lung cancer (in the native lung) in 10, colon cancer in 3, cervical cancer in 3, renal cell carcinoma in 2, post transplant lymphoproliferative disorder (PTLD) in 2, head and neck cancer in 2, bladder cancer in 1 and vulvar cancer in 1. Eight patients developed more than one malignancy. 83% of those who developed malignancy were smokers while 67% of those who did not develop malignancy were smokers (Chi-square is 3.41, P>0.05). Patients who developed malignancy were older at time of transplantation (mean ± SD, 58.0±7.5 vs. 55.6±9.0 years; P= 0.04). Conclusions: Malignancy is a common complication after lung transplantation, with skin cancer being the most common. Age at transplantation seems to be a risk factor for development of malignancy. Smoking as a risk factor did not reach statistical significance in the studied population.
Impact of diabetes and hyperglycemia on outcomes in advanced breast cancer patients.
Authors: Villarreal-Garza Cynthia Mayte , Shaw Robin J. , Lara-Medina Fernando , Bacon Ludwing , Rivera Daniel , Urzua Lorena , Aguila Christian , Ramirez-Morales Rebeca , Bargallo Rocha Enrique , Alvarado Miranda Alberto , Santamaria-Galicia Julieta , Sifuentes Erika , Mohar Alejandro , Herrera Luis A
Published: March 2020

e12027

Background: Clinical experience and previous studies suggest that women with diabetes and breast cancer (BrCa) have worse outcomes than their non-diabetic counterparts. However, analysis of the contribution of diabetes to BrCa specific mortality is difficult because of the substantial mortality attributed to diabetes alone and because diabetes is commonly associated with adverse prognostic factors specific to BrCa. The purpose of this study was to examine the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent BrCa. Methods: We performed a retrospective analysis of patients with advanced BrCa receiving palliative chemotherapy from 2006 to 2011 at the National Cancer Institute in Mexico, and compared breast cancer-specific mortality in diabetic and non-diabetic patients, as well as in patients that presented hyperglycemia during palliative treatment. Results: A total of 265 patients receiving palliative therapy were eligible for inclusion. Previous diagnosis or detection of diabetes at recurrence was recorded in 40 patients (15%). No difference was observed between diabetic and non-diabetic patients in terms of overall survival (OS). A statistically significant difference in OS was observed between patients without diabetes and diabetics who had hyperglycemia (p=0.003). OS in diabetic patients with proper metabolic control was shown to be superior compared to diabetics with hyperglycemia (p=0.01). Hyperglycemia was identified in 14% of non-diabetics at some point while receiving palliative treatment. For patients that experienced hyperglycemia during treatment or who had a mean glucose level > 130, either in the diabetic or non-diabetic subgroups, a worse outcome was noted compared to normoglycemic patients, with a HR of 1.5 (p=0.029) and HR of 2.04 (p=0.006) for death, respectively. Conclusions: Elevated glucose levels confer a poor outcome in diabetic and non-diabetic patients in contrast with patients with normoglycemic levels, conferring an elevated risk of death. According to these results, clinicians must monitor glucose levels during treatment for advanced BrCa disease, and should take action in order to maintain normal glucose levels.
Prognostic significance of NANOG and KLF4 for breast cancer.
Authors: Nagata Takuya
Published: March 2020

e12028

Background: iPS cell inducing factors (Oct3/4, Sox2, Klf4, c-Myc, and Nanog ) are reported that they appears not only in ES cells(Embryonic stem cell), but also in normal cell or carcinoma cell, including breast carcinoma. We evaluated the expression of iPS inducing factors in the human breast cancer specimen with immunohistochemistry, and analyze the relativity of the relapse and the prognosis after the operation. Methods: 200 cases of breast cancer that were performed the surgical operation in this department were examined. Expression of c-MYC, KLF4, NANOG, OCT4 and SOX2 were determined by immunohistochemistry using a tissue microarray. Results: The average of the patient's age was 55.2 years old (29 - 87), and the advanced breast cancers in stage II or more were 122 cases (61%). About the hormone receptor and the HER2 appearance, Hormone receptor positively (HR+) types were 162 cases (81%), 10 cases (5%) were HER2 positively (HER2+) type, and 28 cases (14%) were triple negative (TN) type. During the following period from operation, the relapse was found in 48 cases (24%), and 18 cases (9%) were died. The average of survival time after the operation was 80.7 months (4 - 162). Patients with strong expression of NANOG had significantly lower disease-free survival and overall survival rates than those with weak expression of NANOG (p=0.004 and P=0.033, respectively). In contrast, patients with strong expression of KLF4 had better disease-free survival (p=0.014). Conclusions: Strong expression of NANOG was an indicator of a poor prognosis for breast cancer patients, while KLF4 was a favorable prognostic indicator. Our results suggest that NANOG stimulates the growth and metastasis of breast cancer cells, whereas KLF4 inhibits these processes.
Cancer sites and/or histologies with increasing incidence in elderly.
Authors: Thakkar Jigisha P. , McCarthy Bridget J. , Villano John L.
Published: March 2020

e12036

Background: In the US, from 2004-2008, approximately 7.8% of all cancers were diagnosed and 15.2% of cancer deaths occurred in those age 85 and older. Due to the aging of the US population, a focus on the incidence of cancer in the elderly population is needed to advance knowledge on the prevention, diagnosis, and treatment of cancer in this age group. Methods: Data was retrieved from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Cancer Statistics Review and from the SEER website. Data from seventeen SEER registries for the years 2000-2008 were included. Cancer sites/histologies included invasive cases only, unless otherwise noted, and rates were per 100,000. Age-specific incidence rates for meningioma were obtained from Central Brain Tumor Registry of the United States (CBTRUS) Statistical Report: NPCR (National Program of Cancer Registries) and SEER (2004-2007). Results: The overall cancer incidence rate decreases in the elderly age group. The age-specific (crude) SEER incidence rate for all cancer sites combined for those aged 85+ is 2299.65/100,000. Elderly males have a higher incidence rate as compared to elderly females (3220.7 versus 1884.9). Despite the overall decline in the incidence rate in the oldest age group, the cancer sites and/or histologies with continued increasing incidence rates after 85 years of age are: colon, bones and joints, gall bladder, Kaposi’s sarcoma, leukemia, myelodysplastic syndromes, pancreas, soft tissue including heart, vulva, vagina, and meningioma. Conclusions: Among cancer sites with increasing incidence after age 85; colon cancer has the highest incidence rate. Screening and early diagnosis for cancer in the elderly should be critically considered for colorectal cancers.
Distribution and impact of research in hematology and oncology in Latin America (LATAM): A decade of uncertainty (ONCOLGroup).
Authors: Acevedo Andres , Cardona Zorrilla Andres Felipe , Rios Paola , Becerra Henry A. , Gomez Alexandra , Hernan Carranza , Vargas Carlos A. , Otero Jorge M. , Castro Carlos , Reveiz Ludovic
Published: March 2020

e12039

Background: Brazil provides 1% of the worldwide scientific output registered in ASCO. However, contribution made by other LATAM countries remains unknown. The main objective is to evaluate LATAM countries’ scientific output regarding hematology and oncology and their global impact. Methods: Astructured search was made in ASCO, ASH, ESMO and ASTRO databases to identify abstracts recorded between 2000 and 2010 referring to any author, institution or population from LATAM. The search was expanded using Internet to find indexed or non-indexed publications referring to each selected reference. Simple random sampling was used to check 10% of the references and verify the quality of the data. Results: 1,858 of the 2,625 references that were identified fulfilled the inclusion criteria. Sixteen of 19 countries evaluated had at least one record during the 10 year target period; five countries represented 93.6% of scientific output (Brazil 51.1%/Argentina 19.9%/ México 14.1%/Peru 6.2%/Chile 2.4%) whilst Colombia only contributed 1.3%. Two-thirds of the work had been presented as abstracts, a third as posters and less than 2% orally; 17% of the abstracts had been published in a scientific journal (90% in international journals, with a mean impact factor and average citations rate of 3.5 and 14.2 respectively), 1.6 years after the meeting. Conclusions: Latin America’s contribution to scientific knowledge regarding hematology, oncology and radiotherapy is growing. The geographical distribution of such production depends on 5 countries; nevertheless, abstracts’ publication rate in journals is low.
Direct burden of oncologic disease in a socialized health care system: Using acute myeloid leukemia as an example.
Authors: De Correia Pereira Marta Isabel , Cortesao Emilia , Espadana Ana , Marques Gilberto P , Geraldes Catarina , Teixeira Adriana
Published: March 2020

e12040

Background: Portugal has a socialized national healthcare system (NHS), rated 12th overall by WHO (2000), that exempts oncologic patients from paying the direct costs of treatment. It has a per capita Gross Domestic Product of $22 699 (International Monetary Fund, 2011), less than 50% of the US, and was severely affected by the international Financial Crisis, requiring a bail-out; in this scenario, the state budget for health for 2012 is approximately $9900 million. Adult acute myeloid leukemia (AML) is a relatively rare cancer, with standardized non-surgical inpatient treatment protocols (outside clinical trials) that are subject to little variation between centers and over time, characteristics that make it an ideal example to evaluate the impact of oncologic disease on a socialized healthcare system. Methods: We reviewed all new diagnoses of AML over a five-year period (2006 to 2010) in one of the 7 national centers that treat adult AML, to estimate the yearly expenditure with direct costs. Results: Over the period considered, 192 new adult cases were diagnosed (38.4 cases per year, 47% male), with a median age of 63 years; 43.8% were 65 or over. The 2009 National Directive assumes the daily cost of one hospitalization for uncomplicated adult “acute leukemia” [sic] to be $1250, with an average hospital stay of 12.2 days, amounting to $15 250; minor complications increase this to $2400 and 19.5 days, and major complications to $6 480 times 25 days, or $162 000. An allogeneic HSC transplant (allo-HSC) costs $9 605 daily, over 35.5 days, or $340 800. Assuming induction and one cycle of consolidation in under-65 cases, this Hospital would spend between $700 000 (no complications in either cycle) and $7 million (all cases with major complications in both cycles) on new cases per year. Additional cycles and allo-HSC push the estimate towards $1-10 million. Conclusions: While chronic metabolic, cardiovascular and respiratory diseases consume the bulk of resources, the burden of oncologic disease on a socialized NHS is marked. AML ideally exemplifies how a small number of patients can consume vast resources: as this estimate shows, Portugal could expect to spend $7-70 million of the 2012 health budget on new cases of AML alone.
Prevalence of angiomyolipoma among patients with tuberous sclerosis complex: A U.S. Healthcare Claims Database study.
Authors: Liu Zhimei , Sun Peter , Kohrman Michael , Bissler John
Published: March 2020

e12042

Background: Angiomyolipoma (AML) are common benign neoplasm in the kidney, and are associated with tuberous sclerosis complex (TSC). The objectives of this study were to examine AML prevalence among TSC patients in a real world setting, and to explore the relationship between AML prevalence and ages, genders, or residential regions. Methods: A retrospective cohort study was conducted based on a large US commercial healthcare claims database. Patients with a TSC claim between 2000 and 2009 and with continuous 12-month enrollment after their first TSC claim were selected for the study. AML patients were identified based on ICD-9CM code (223.0X). Patients’ genders, residential regions, and age on their first TSC/or AML claim (if they had AML) were derived respectively from enrollment files and healthcare claims. Two-sample t tests and Chi-square tests were used to explore the relationships between AML prevalence, genders, residential regions and the age groups. Results: The study included 2,767 TSC patients with a mean age of 28.5 years on their first TSC claims, and 55.3% were female. AML prevalence among TSC patients was 7.8% in their first observed post-TSC year, and could be 78% at the end of the 10th observed post-TSC year if AML incidence rate (701.1 per 10,000 TSC patient years) remains constant. Associations between AML prevalence and age groups, genders, or residential regions were statistically significant (all p<0.05); and variations of AML prevalence by genders (Male: 5.6 vs. Female: 9.7%), residential regions (6.2-9.4%) and age groups at the first TSC claim (3.9% for age<1 year, 5.2% for age 1-5 years, 10.6% for 6-10 years, 8.4% for age 11-18 years, 13.6% for age 19-25 years, and 6.9% for age 26 years or more) were observed. Conclusions: In a real world setting AML occurred in 7.8% TSC patients in the first post-TSC year, and could increase to 78% within 10 years if the incidence rate remained at 701.1 per 10,000 TSC patient years. AML prevalence was associated with age, gender and residential regions, and varied significantly by ages, genders and residential regions. Further research is needed to explore the factors that resulted into these associations.
Acute toxicity profile of patients with low-grade gliomas and meningiomas receiving proton therapy.
Authors: Maquilan Genevieve , Grover Surbhi , Alonso-Basanta Michelle , Lustig Robert A.
Published: March 2020

e12508

Background: Quality of life is not often studied but is an important outcome to measure when evaluating types of radiation treatment. This study attempts to provide data on the treatment effects of proton beam therapy on patients with low grade gliomas and meningiomas, using the National Cancer Institute Common Terminology Criteria (CTCAE) version 4.0 to analyze the severity and frequency of symptoms experienced acutely during and after radiotherapy. Methods: 23 patients diagnosed with low grade gliomas or meningiomas were enrolled in a prospective proton beam radiation treatment protocol (NCT01024907) and were treated and followed between April 2010 and August 2011 in the University of Pennsylvania Radiation Oncology Department. Patients received 54 Gy [relative biologic effectiveness (RBE)] in 1.8 Gy (RBE) per fraction and were assessed at the time of consult, weekly during treatment, and followed up at 1, 3, 6, and 9 months after treatment. Symptoms were graded based on the CTCAE version 4.0. Results: At week 1 of treatment, 4/23 patients experienced Grade 1 anorexia. At week 3, 5/23 patients had Grade 1 nausea, 10/23 patients had Grade 1 headaches, and 1/23 patients had a Grade 3 headache. At the end of treatment at week 6, 13/23 patients had Grade 1 fatigue, 6/23 patients had Grade 2 fatigue, 3/23 patients had Grade 1 nausea, 4/23 patients had Grade 1 headaches, 7/23 patients had Grade 1 insomnia, and 1/23 patients had Grade 2 insomnia. At the 1-month follow-up, 3/23 patients had Grade 1 fatigue, 1/23 patients had Grade 2 fatigue, 2/23 patients had Grade 1 anorexia, 1/23 patients had a Grade 1 headache, and 2/23 patients had Grade 1 insomnia. No patients were reported to have experienced vomiting at any of the 4 time points. Conclusions: Proton therapy has a favorable side effect profile--most patients experienced mild fatigue, headaches, and insomnia that largely resolved by one month after treatment. This study provides a useful starting point for larger-scale studies which could directly compare the acute side effects of proton and conventional radiotherapy.