bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment patterns and survival in elderly women with HER2-negative, hormone receptor positive metastatic breast cancer: Analysis of the SEER-Medicare database.
Authors: Karve Sudeep , Pawaskar Manjiri , Davis Keith L. , Dalvi Tapashi , Deeter Robert 
Published: March 2020

e11570 Background: Although metastatic breast cancer (MBC) is a leading cause of death in elderly women, there is limited population-based data available on treatment patterns and survival in post-menopausal women with HER2 negative, hormone receptor (HR) positive MBC. This study therefore examined real-world treatment patterns and survival in this population Methods: A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, which comprised 13,170 women aged ≥65 years diagnosed with HER–, HR+ MBC between 1/1/2000 and 12/31/2009. The index date was defined as MBC diagnosis date or date of progression to MBC. Patients were followed from index date to death or end of database. Absence of trastuzumab and lapatinib treatment, and use of immunohistochemistry and fluorescence in-situ hybridization tests, was utilized as a proxy measure for HER2– status. Descriptive statistics were used to assess treatment patterns. Kaplan-Meier curves were used to examine survival in this patient population. Results: Over 78% of women (mean age 76.7 years, 88% white) were both ER+ and PR+ and 61% had ductal histology. The majority of patients had surgery (54%), followed by radiation (50%), hormone therapy (49%) and chemotherapy (40%). Among patients receiving hormonal therapy, megestrol (20%), anastrazole (16%) and fulvestrant (11%) were the most commonly used agents. Among patients receiving chemotherapy, cyclophosphamide (21%), doxorubicin (17%) and paclitaxel (14%) were most common agents. Median overall survival in these patients was 50 months and the 5-year survival rate was 45%. Median survival was lowest for patients aged >85 years (25 months), ER– PR+ (24 months), and distant stage at diagnosis (21 months). Conclusions: In spite of advances in treatment of MBC, survival remains lower in older and ER– PR+ women with MBC. This could be due to the limited access to effective treatments in elderly with HER2– and HR+ MBC patients.
Study of lapatinib (T) in combination with trastuzumab (T) in women heavily pretreated with HER2-positive metastatic breast cancer (MBC).
Authors: Salvador Javier , Ruiz Borrego Manuel , Valero Maria , Bayo Juan L. , De La Cruz-Merino Luis , Carabantes FRancisco , Rodriguez de la Borbolla Maria 
Published: March 2020

e11577 Background: The anti-HER2 monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib have complementary mechanisms of action and synergistic antitumour activity in models of HER2-overexpressing breast cancer.In heavily pre-treated pts, L+T is associated with improved outcomes compared to L alone and significantly improved progression-free survival (PFS), offering a chemotherapy-free option for patients with heavily pretreated human epidermal growth factor. (Kimberly L et al, 2012 JCO). Methods: We evaluated the safety and efficacy of L+T in patients with 1-4 prior (Median 3) lines of chemotherapy (CT) for HER2+ MBC.: 20 Pts with measurable, HER2+ MBC were eligible. Pts received every 3 weeks T (8 mg/kg loading then 6 mg/Kg) and daily L 1000 mg. Results: The characteristic of the all of pts included (20) are: median age 51.4 (32-68) Total number of cycles administered was 141. The median cycles administered per pts was 6 (range 1-18). Median follow-up was 6 months. Of the 18 pts with response assessment, the clinical benefit obtained was: 76,1% (5,9% PR + and 70,6% disease stabilization) with 95% CI 71.3%-80.9%. Disease progression was 17,6%. Of the 20 pts with a median follow up of 13,32 m (3-32), median PFS for these pts was 6 m. The one year OS % was 64,70% (56,7-72,7). All pts had received al least one line lapatinib prior (1-3). Toxicity was generally manageable. No major cardiac dysfunctions ocurred. Grade 3/4 treatment-related toxicities were uncommon (grade 3 diarrhea, 18%; grade 3 hepatic 7%. All others < 3 %). Conclusions: L+T is an active regimen in HER2+ MBC. L+T showed high clinical benefit with manageable safety profile. Dual inhibition of HER2 might be a valid approach to treatment of Her-2 positive metastatic breast cancer.
Adherence rates to endocrine therapy among African American women with stage I-III, hormone receptor-positive breast cancer treated at Grady Memorial Hospital in Atlanta, Georgia.
Authors: McKee Megan Jean , Nguyen Danny , Al Haddad Seham , Paplomata Elsa , Curry Marjorie Adams , Liu Yuan , O'Regan Ruth , Zelnak Amelia Bruce 
Published: March 2020

e11582 Background: Breast cancer mortality has historically been higher in African American (AA) women compared to Caucasian women. Controlling for tumor characteristics, biological markers and comorbidities does not account for the disparity. Previous studies have shown that AA women are more likely to have a high 21-gene recurrence score compared to Caucasian women. Another potential variable affecting treatment outcomes is adherence to adjuvant endocrine therapy (ET). We conducted a retrospective review of pharmacy records at Grady Memorial Hospital (GMH) to examine the non-adherence rate among predominantly AA patients (pts). Methods: Pharmacy database records were examined for pts filling prescriptions for tamoxifen, anastrozole, or letrozole at GMH in Atlanta, Georgia from 2004-2009. Baseline characteristics were obtained by chart review. Pts were excluded if they had metastatic disease, DCIS, less than 60 days of eligible prescription, were male, deceased during the study period, benign disease, or no documentation of breast cancer in the electronic medical record (EMR). Non-adherence was defined as those filling less than 80% of eligible days covered by her prescription. Results: 679 pts were identified who filled prescriptions for tamoxifen, anastrozole, or letrozole at Grady pharmacy from 2004-2009. Pts who were excluded had metastatic disease (152), DCIS (101), had less than 60 days of eligible prescription (65), had no documentation of breast cancer in the EMR (25), were male (6), deceased before 2009 (5), or had benign disease (9). Of the 316 pts eligible for the study, median age was 60 (26 to 94) at time of diagnosis, 86% were AA, and 39% were node positive. 167 pts filled prescriptions for tamoxifen, 95 for anastrozole, and 54 for letrozole. The non-adherence rate for tamoxifen was 50%, anastrozole 38%, and letrozole 48%. Overall non-adherence rate was 46%. Conclusions: The overall non-adherence rate to adjuvant ET among a predominately AA population seen in a county hospital was similar to previously reported rates. Non-adherence to ET in this underserved AA pt population does not fully account for disparate outcomes.
Evaluation of anthracycline incuced cardiotoxicity by speckle tracking echocardiography.
Authors: Dogru Atalay , Cabuk Devrim , Sahin Tayfun , Dolasik Ilhan , Uygun Kazim 
Published: March 2020

e11585 Background: Anthracyclines have been widely used in the treatment of solid and hematologic malignancies. Cardiotoxicity is the most serious adverse effect that limits anthracycline treatment. Cardiotoxicity is classified by time of onset as acute, subacute and chronic. Conventional echocardiography is not sensitive enough for early detection of cardiotoxicity. In this study we aimed to evaluate anthracycline induced cardiac toxicity by speckle tracking echocardiography (STE) before left ventricular dysfunction occurs. Methods: The study included newly diagnosed breast cancer (BC) and lymphoma patients (pts) who were treated with an anthracycline containing chemotherapy (CT) regimen. They had examination with conventional echocardiyography, STE before and after anthracycline treatment. Longitudinal strain values were assessed by automated function image (AFI). Results: Thirty five pts with BC and 15 pts with lymphoma were included in the study. Ejection fraction (EF) and fractional shortening values were decreased in lymphoma pts receiving high dose anthracycline treatment (346 mg/m2) compared to BC pts receiving low dose (168 mg/m2) anthracycline. There was statistically significant increase in myocardial performance index in both groups after anthracycline CT (p=0.001 and p=0.004 for BC and lymphoma group respectively). In STE measurements, apical long axis, apikal 4 chamber and global peak systolic strain showed significant reduction in lymphoma group who had a post-therapy EF <55% (p=0.002, p=0.041, and p=0.004, respectively). Apical long axis and global peak systolic strain were also significantly decreased among the lymphoma pts with normal systolic function after CT (p=0.01 and p=0.05, respectively). Conclusions: STE can display the effect of anthracycline induced cardiotoxicity early before left ventricular dysfunction occurs. Larger prospective studies are needed to verify these data and direct the treatment of pts receiving anthracycline.
Factors that predict pathologic complete response in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer.
Authors: Hulikal Narendra , Thomas Joseph , Fernandes Donald J. , Ray Satadru 
Published: March 2020

e11588 Background: Locally advanced breast cancer (LABC) accounts for 30-60% of all breast cancer patients presenting to the public hospitals in India. The neoadjuvant chemotherapy is reported to achieve a pathological complete response (pCR) rate of 35-60% depending on the receptor subsets and the chemotherapeutic drugs employed. The patients who achieve a pCR are expected to do better in terms of progression free survival. Hence we reviewed our data base to know pCR rates, to compare pCR rates among various receptor subgroups, and to determine the factors which predict pCR. Methods: All patients with LABC (defined as Stage III, AJCC, 7th edition, 2010) and agreed by the hospital tumor board to receive preoperative chemotherapy were included. At each visit, clinical response was assessed according to RECIST criteria. Re-staging work up and mammography were done prior to surgery. Results: Total 84 patients received preoperative chemotherapy. Most common regimen used was 4 courses of AC followed by 4 courses of 3 weekly paclitaxel. Two patients developed systemic metastasis during chemotherapy and were not considered for surgery. Median age was 46 years (ranged from 28 to 66), 46 patients were premenopausal, and 43 % of the tumors were hormone receptor negative. Her 2nu amplification defined as immunohistochemistry 3 + or FISH positive was seen in 27% of patients. Thirty nine patients were stage IIIB, 38 were III A and 5 were IIIC. Total 72 patients completed full course of chemotherapy before surgery. Clinical response was complete in 26, partial in 52, 3 had local progression, one stable and two patient developed distant metastasis (not considered for surgery). Forty eight patients underwent modified radical mastectomy and breast could be conserved in 34 patients. The pCR rate was 36%. Of all the factors (cT status, hormone receptor status, menopausal status, age) cT status was found to be statistically significant factor to predict pCR (p<0.005). Conclusions: Overall pCR rate in the study was 36%, maximum response was noted in ER/PR negative, Her 2nu positive subset. Only factor which was found to be associated with pCR on univariate analysis was cT size.
Demographic and clinicopathologic characteristics in patients with invasive breast cancer receiving metformin.
Authors: Aksoy Sercan , Sendur Mehmet Ali Nahit , Altundag Kadri 
Published: March 2020

e11593 Background: There was contradictory data with metformin use on breast cancer risk, but there is growing evidence that the use of metformin in diabetic patients was associated with lower risks of breast cancer mortality and incidence. The effect of metformin on clinical and pathological properties of breast cancer was not known exactly, we aimed to investigate the demographic and clinico-pathological characteristics of patients with metformin users at the time of breast cancer diagnosis. Methods: Patients with breast cancer diagnosed from 2000 to 2012 in our clinic were retrospectively analyzed. Patient’s demographics, including survival data and tumor characteristics were obtained from medical charts. Breast cancer patients who were taking metformin at the time of breast cancer diagnosis were enrolled as metformin users (n=148), where the patients matched with the same age who were not taking metformin were included as a control group (n=636). Results: A total of 784 patients were included in this study. Median age of both metformin users and nonusers was 57 (23-87). There were no significant differences in baseline tumor size (P=0.60), tumor stage (P=0.76) node positivity (P=0.13) between the two groups. Metformin user patients compared to nonusers had significantly lower incidence of histological grade III tumor (P=0.03). A similar significant trend for lower incidence of triple-negative (P=0.01) and higher incidence ER positivity (P=0.008), PR positivity (P=0.01) was also seen in metformin users. In survival analysis the estimated median disease free survival (DFS) was 118 months in metformin users whereas 69 months in nonusers (P=0.09). Median overall survival (OS) could not be obtained due to low events. In patients with metformin users OS rate was 98.4%, 97.1%, and 93.8% and in nonusers was 99.6%, 94.4% and 90.5% the first, third, and fifth years, respectively. Conclusions: The use of metformin at the time of breast cancer diagnosis was associated with better clinico-pathological properties and non-significantly improved disease free survival in patients with breast cancer.
Association of expression of aquaporin 5 (AQP5) with prognosis in hormone-responsive early breast cancer patients.
Authors: Lee Soo Jung , Chae Yee Soo , Lee Yoo Jin , Kim Jong Gwang , Park Ho Yong , Kang Byung Woog , Jeong Ji Yun , Park Ji-young , Kwon Tae-Hwan , Jung Hyun Jun 
Published: March 2020

e11594 Background: Our previous study showed the association of AQP5 up-regulation with cancer proliferation and migration in hormone-responsive breast cancer cell lines (MCF-7) and with unfavorable prognosis in a small number of patients with breast cancer. Accordingly, we analyzed the prognostic impact of AQP5 expression in a number of patients with early breast cancer (EBC). Methods: We enrolled 447 patients who underwent operation for EBC between June 2003 and August 2008 and performed immunohistochemical (IHC) stain for AQP5 expression in tissue microarray (TMA) collected from tumor tissue. Two pathologists independently scored staining intensity (IS, 0 through3) and percentage of positive tumor cells (PC, 0 through 4) and categorized as negative (0 through 2), weak (3 through 5), and strong (6 or more) according to the sum. Results: The median age of patients was 49 years (range 23-82). 80 (17.9%) patients underwent breast conserving surgery and adjuvant chemotherapy was given to 406 (90.8%) patients. Among enrolled subjects, 298 (66.7%) were hormone-responsive, 64 (14.3%) for HER2 overexpressed, and 79 (17.7%) for triple negative EBC by ER, PgR, and HER2 expression. AQP5 expression (staining score >2) was observed in 267 (59.7%) patients including 123 (27.5%) overexpression (stating score >5). In univariate analysis, AQP5 overexpression was associated with survival in patients with hormone-responsive and HER2 overexpressed EBC. Moreover, multivariate survival analysis revealed that AQP5 overexpression was an independent prognostic marker for survival in patients EBC, which was prominent in patients with ER/PgR-positive tumor type. However, no difference in AQP5 expression was observed based on patient and tumor characteristics. Conclusions: Consistent with our previous study with breast cancer cell lines, AQP5 expression in tumor tissue can be considered as a prognostic marker in patients with EBC after curative operation.
Trial of concurrent versus sequential tamoxifen with radiotherapy in breast cancer patients with study of the combination of pentoxifylline and tocopherol for prevention of radiation-induced lung fibrosis.
Authors: Ismail Soheir Sayed , Abdel-Hafeez Zeinab Mohamed , El Khodary Dalia Abd-Elghany , Kelany Mohamed rada 
Published: March 2020

e11599 Background: Although the efficacy of both radiation and tamoxifen (TAM) in early-stage breast cancer is well established, data are lacking about the impact of this sequence on outcomes, including local recurrence and complications of therapy. These are questions of practical importance in the treatment of breast cancer patients, many of whom require both radiation (RT) and adjuvant TAM. Methods: 160 eligible patients were prospectively randomized 1:1 into two groups: The control group (80 patients) , containing one arm (C) received sequential TAM and RT and the intervention group which was further subdivided into arm (A) (40 patients), received concurrent TAM 20 mg/day with RT, arm( B) (40 patients), received concurrent TAM + Pentoxifylline (PTX) ( 800 mg/day )+ Alpha-Tocopherol (AT) (1000 U/day) and RT. The primary endpoint was to compare the radiation induced pulmonary fibrosis using serial high resolution computed tomography (HRCT) and the role of the PTX and AT combination in reduction of pulmonary fibrosis, the secondary endpoint was to evaluate loco-regional control in the three arms usingChi-Square test, Fisher’s exact test, Log rank test andAnova test. Results: Analysis of the incidence of clinical pneumonitis was 25% in arm A ( TAM) , 12.5% in arm B (TAM+PTX+AT) and 18.8% in arm C (control) with p=.110. The incidence of lung fibrosis was 26.5% in arm A( TAM) , 12.9% in arm B (TAM+VIT.E) and 23.4% in arm C (Control) with p=.608. As regard loco-regional relapse, the preliminary result, revealed no significant difference in the 3 arms (1.3% in control arm, 5 % in TAM, 2.5% in TAM+VIT) (p=.827). Conclusions: It seems that the interaction between tamoxifen and radiotherapy could affect the tissue remodeling rather than the damage induction step of the radiation pathogenesis. In this case, temporal separation of the two modalities (Concurrent Versus Sequential) may not make much difference in the incidence of radiation induced lung fibrosis.
Periodontal disease prevalence in patients treated with tamoxifen.
Authors: Brusca Marisa Isabel , Blanco Villalba Marcelo , Grandinetti Jose , Re Juan Pablo , PINI Alejandra , Streich Guillermo Juan , Molinas Emiliano , Gonzalez Palacios Carlos , Bramajo Marina Paula 
Published: March 2020

e11600 Background: Periodontal diseases arise from inflammatory diseases involving the periodontal connective tissue as a common factor. Estrogen produces inflammatory changes that worseness the periodontal preexistent status; and alters the microbiologic environment acting as a nutrient. The objective of this study is to determinate the relation between the treatment with tamoxifen and the prevalence of periodontal disease in women with breast cancer. Methods: Observational study. Sample: 70 postmenopausal patients, distributed in the following groups: Group 1 (N: 17) patients with breast cancer diagnosis and treated with tamoxifen less than one year; Group 2 (N: 18) patients with breast cancer and treated with tamoxifen for 1 to 2 years; Group 3 (N: 18) patients with breast cancer and treated with tamoxifen for 2 to 5 years; Group 4 (N:17) patients with breast cancer that have finalized their treatment with tamoxifen. A poll was performed between these patients, a periodontal scale and a mouth hispid was performed. Microbiologic standard tests were performed for Candida and also molecular biologic tests. Results: Group 1: health: 0%, severe periodontal diseases: 22% Group 2: health: 0% severe periodontal disease: 25% Group 3: health: 25% severe periodontal disease: 10% Group 4: health: 35% severe periodontal disease: 5%. Microbiologic cultives: presence of Candida albicans, tropicalis, parapsilosis, dubliniensis and glabrata. The maoyor variety of species were isolated from Group 1. Conclusions: The time frame with Tamoxifen treatment shows differences in the Periodontal status and reveals differences in the growth of Candida species because a decrease in number and species of yeast, this means an additional benefit in the studied population. We believe it is important to run this study with larger populations in order to determine the benefits of the treatment with Tamoxifen.
Hormone receptor alterations and treatment responses after neoadjuvant therapy in patients with ER+/HER2- breast cancer.
Authors: Maeda Shigeto , Tohyama Hiroaki , Tokai Yukiko , Nakashima Kazuaki , Kamohara Yukio , Nagata Yasuhiro , Ito Masahiro , Fujioka Hikaru 
Published: March 2020

e11605 Background: Hormone therapy is recommended for treating patients with luminal A type early breast cancer by the International Conference in St. Gallen, 2011. However, precisely which neoadjuvant therapeutic strategies are optimal for such patients still remains controversial. We retrospectively evaluated the treatment responses to neoadjuvant chemotherapy (NAC) or neoadjuvant endocrine therapy (NAE) in patients with ER (+)/HER2 (-) breast cancer. Methods: Four hundred and sixty-one patients with primary breast cancer underwent surgery between November 2007 and October 2012. Of 243 patients with hormone receptor (+)/HER2 (-) breast cancer, 63 with ER (+)/HER2 (-) breast cancer were preoperatively treated with either NAC (n=47, median age: 49 years) or NAE (n=16, median age: 63 years). Four cycles (c) of FEC 100 (epirubicin 100 mg/m2 + 5-fluorouracil and cyclophosphamide 500 mg/m2) followed by 4 cycles of Docetaxel (75 mg/m2) every 3 weeks were administered for the NAC treatment regimen, while Letrozole was administered for 6 months for the menopausal patients in the NAE treatment protocol. Results: NAC did not alter the ER status, while the ER status was decreased by NAE (from 83% to 62%). NAE altered the ER status (positive rate; from 83 % to 62 %), but NAC did not. The PR status was decreased by both NAC and NAE (from 51% to 30% and from 63% to 9%, respectively). ER (P=0.0327) and PR (P=0.0019) were statistically decreased after NAE compared to that observed after NAC. The response rates determined by RECIST {PD/SD/PR/CR (%)} in the NAC- and NAE-treated patients were 2/34/58/6 and 0/50/50/0, respectively. The rate of tumor shrinkage was 41% (3.9 to 2.3 cm) after NAC and 39% (2.3 to 1.4 cm) after NAE. The pathological complete response rate was 9% after NAC and 6% after NAE. The recurrence rate in the stage I/II patients was 5% (2/38) after NAC and 0% (0/16) after NAE for short-term outcomes. Conclusions: The hormone status significantly changed after NAE compared to that observed after NAC. Both of the NAC and NAE treatment protocols caused a decrease in the tumor size. As a result, both of these therapeutic modalities were found to improve the rate of breast-conserving surgery.