bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast cancer biomolecular profile in 909 patients of a lower-incomes province in Argentina.
Authors: Holgado Silvia , Elias Adriana del Carmen , Zarba Juan Jose , Audi Raul , Vinuales Ana , Audi Viviana , Gonzalez Diego , Arcuri Jorge , Pedruzzi Hector , Gonzalez Adriana , Arrieta Fernanda 
Published: March 2020

e11538 Background: Recent reports of the increasing incidence of BC in low and middle-income countries highlights the need to have a better understanding of prognostic biomarkers with clinical utility. The aims of this study were to analyze the biomolecular profile in a population with BC of Tucumán, Argentine. Methods: The study population consisted of 909 patients with primary or metastatic BC. The immunostainning results for hormones receptors (ER-PR) and Her2/neu protein expression in patients with histological breast diagnosis were assessed. The study design was cross sectional and the statistical study was exploratory. We compared the frequencies of patients with ER+/PR+/Her2-, ER+/PR-/Her2-, ER+/PR+/Her2+, ER+/PR-/Her2+, ER-/PR-/Her2+ and ER-/PR-/Her2- with those published in 2011 by St Gallen and relative variations were calculated to meet the relative percentages of the differences. Results: 893 were studied for all three. Molecular Expression (Population: 909): ER 58% (486/841); PR 48% (405/841); Her2 10% (85/893) Population Age: 21-89 years old (mean 58 yrs). Conclusions: The molecular profile in BC in our province seems to be different of the previously reported in western countries (St Gallen 2011), showing a more aggressive biomolecular profile with higher incidence of triple negative patients and lower incidence of Her2neu positive. With these results it is possible to assume that we are dealing with a population with particular characteristics. [Table: see text]
Clinical and pathologic characteristics of patients with breast cancer and a second non-breast primary tumor.
Authors: Atalay Basaran Gul , Yazar Aziz , Uras Cihan , Tezcanli Evrim , Cabuk Devrim , Atalar Banu , Ozyar Enis 
Published: March 2020

e11539 Background: We aimed to investigate the clinical and pathologic characteristics of patients with breast cancer (BC) who had a non-breast primary tumor and treated in our hospital. Methods: We identified BC patients with a second non-breast primary tumor retrospectively in our database. The tumors arising in a sequence by less than 2 months are accepted as synchronous malignancies. We noted clinical and pathological characteristics of breast tumors and analyzed the relapse patterns, the frequency and type of second non-breast primary tumors. Results: A total of 48 patients were identified. Median age was 59 years old. Thirty-four patients were postmenopausal, 41 tumors were IDC, 2 were DCIS only, eight were multiffocal. Two patients had metastatic BC at the time of diagnosis. Ninety-three (n: 26) % patients had breast conserving surgery, 2 had bilateral BC. Twenty-eight patients had node negative disease, 12 had node positive disease and 2 had micrometatatic nodal involvement. Fifty-four % were T1, 31% were T2 tumors. Histological grade was 3 for 14, 2 for 15 and 1 for 7 breast tumors. Forty patients had ER positive disease, 4 had ER/ PR negative disease, 2 tumors were triple negative and 6 tumors were Her-2 positive. Among non-breast second primary tumors; 29 arose after, 11 arose before the diagnosis of BC and 8 arose synchronously with BC. The most common non-breast second primary tumors were as follows: 15% lung cancer, 20% colorectal cancers, 13% ovarian cancer, 10% thyroid cancer, and 8% lymphoma/leukemia. With a median follow up of 76 months, there were 6 relapses; 4 of them were BC relapses. Among these 4 BC relapses, 3 patients had brain metastases and one patient had bone metastasis. There were 4 deaths; 2 were due to BC metastases, one was due to rectal cancer metastasis and the other was due to relapse of sarcoma. Conclusions: Most breast tumors were at early stage and were hormone sensitive. The most common second non-breast primary tumors arising after diagnosis of BC were colorectal, thyroid and lung cancers. The most common second non-breast tumor arising synchronously with BC was lung cancer and the most common second non-breast tumor arising before diagnosis of BC was lymphoma/leukemia.
Re-biopsy in breast cancer recurrence: Is there really a clinical impact?
Authors: Collignon Joelle , Schroeder Helene , Rorive Andree , Colin Paul Emile , Hanocq Florence , Joskin Julien , Delvenne Philippe , Jerusalem Guy Heinrich Maria 
Published: March 2020

e11549 Background: Several retrospective studies and 3 prospective studies have shown discordance in receptor status between primary tumor and metastasis leading to a treatment modification in about one out of 7 patients. However, some clinicians report unpublished data suggesting that these findings are not observed in all centers. We did prospectively a biopsy at suspicion of first relapse in our center and evaluated the impact of this biopsy on the management of our patients. Methods: Thirty four patients underwent a biopsy between October 2011 and January 2013. Hormonal receptor status was determined by the same IHC methodology for primary and metastatic tissue. Primary tumors were reanalyzed if necessary with our current IHC technique. A change in ER or PgR status was considered clinically significant if quantitative staining changed from <5 % to at least 10% of tumor cells expressing the hormonal receptor or if the opposite is observed. We tested HER2 status by IHC and/or FISH: HER2 3+ or 2+ and FISH positive cases were considered as HER2 positive. Results: Three of 34 patients were considered as screening failure. 1/31 (3.2 %) biopsies showed a benign disease, 2/31 (6.4 %) were non contributive and 5/31 (16 %) showed a metastasis of a second primary tumor. Two of these findings were totally unexpected according to clinical data. Changes in hormone receptor status were observed in 25 % but no change in HER2 status was observed. Time to recurrence was not significantly different between groups with or without modified hormonal status. No clinically significant complication was observed following the biopsies. Only patients presenting a second primary tumor had their management changed based on the new biopsy. Conclusions: We found discordance in hormone receptor status (25 %) but it did not change the treatment. Our study confirms the importance of re-biopsy in order to exclude benign disease or to find metastasis from an unknown and sometimes unexpected second primary tumor. Although our study does neither confirm changes in hormonal receptors resulting in the modification of the treatment strategy nor a change in HER2 status, our data suggest that a new biopsy at first relapse should be performed because unexpected second primaries can be discovered.
Adjuvant endocrine treatment in premenopausal patients with breast cancer: Clinical practice in an Italian cancer center.
Authors: Collovà Elena , Barni Sandro , Frassoldati Antonio , Amoroso Domenico 
Published: March 2020

e11550 Background: Overall results from past and recent trials favor ovarian ablation, with luteinizing hormone-releasing hormone (LHRHa) analogues alone or in combination with the anti-estrogen tamoxifen (TAM), rather than with chemotherapy. The aim of this survey was to obtain more informations about the clinical practice of adjuvant endocrine therapy. Methods: 11 items electronic questionnaire was submitted to italian oncologists and 611 filled questionnaires were collected. The results were examined globally and according to sex, age, working institution and geographical origin of the oncologists. Results: 97.7% of patients less than 40 years needing only hormonal therapy would receive both TAM and LHRHa; 2.3% TAM or LHRHa alone. 93.6% of patients over 40 years would receive the combination with TAM or LHRHa When LHRHa would be added to TAM the treatment length would be: 5 years in 60% and 44%, 3 years in 20.8% and 26.4%, 2 years in 19.2% and 29.6%, in patients aged under and over 40 respectively. At least one risk factors like positive nodes, high ki-67, G3, vascular invasion, HER2 3+, influence neither the therapeutic options nor the length of LHRHa use. In patients under 40 with chemotherapy induced amenorrhea, the oncologists would prescribe: TAM in 22.4%, TAM and LHRHa in 68,1% (LHRHa for 5 years in 55.3%, for 3 years in 22.1%, for 2 years in 22.6%), aromatase inhibitor (AI) +/- LHRHa in 6.6%, LHRHa alone in 2.9%. A greater number of patients would be treated with AI among women aged over 40 (11%). The reasons to add LHRHa toTAM and the length of treatment would be: in higher efficacy of the combination: 45.5%; patient’s age: 30.1%; risk of recurrence: 20.8%; and, side effect: 3.6%. Conclusions: A high concordance between the Italian Oncologist attitude and the European Guidelines is confirmed by this large survey. However, a wide preference for a TAM/LHRHa combination is reported, as well as a significant preference for LHRHa and AI combination in women under 40 years with chemotherapy induced amenorrhoea.
Cardiotoxicity and cardiac monitoring during adjuvant trastuzumab in daily Dutch practice.
Authors: Tjan-Heijnen Vivianne C. , Seferina Shanly C. , De Boer Maaike , van den Berkmortel Franchette W.P.J. , Van Kampen Roel JW , Van de Wouw Agnes W , Joore Manuela A , Borm George F , Voogd Adri C 
Published: March 2020

e11558 Background: In this study we assessed the cardiotoxic effects of adjuvant trastuzumab in daily practice after its introduction in the Netherlands in 2005. Methods: We included all patients with stage I-III breast cancer diagnosed in the years 2005 to 2007 in 5 hospitals in the South of the Netherlands. We studied guidelines adherence on left ventricular ejection fraction (LVEF) monitoring and the incidence of cardiotoxicity in patients with HER2 positive disease treated with adjuvant trastuzumab, using similar cardiac-endpoints as in prior randomized trials. In addition, we determined predictors of onset of cardiotoxicity. Results: Of 2685 patients included, 494 (18.4%) had a HER2 positive tumor. From these 494, 266 (53.8%) were treated with adjuvant chemotherapy and 228 (85.7%) received trastuzumab. Anthracycline based chemotherapy was given to 218 (96%) patients prior to trastuzumab treatment. LVEF measurements were done in 222 patients (97.4%). Fifty eight patients (25.4%) had ‘symptomatic cardiotoxicity’ during trastuzumab treatment, of whom 43 (18.9%) patients had a drop in LVEF of ≥ 10 percentage points. In 36 (15.8%) patients, cardiotoxicity led to permanent discontinuation of trastuzumab although in 50% LVEF recovered to levels permitting continuation, and in 22 (9.6%) patients treatment was temporary discontinued. No cardiac deaths were seen. The largest drops in LVEF occurred between baseline and the first 3-month assessment. Only 3.1% permanently discontinued treatment ≥ 6 months measurement. Patients with trastuzumab related cardiotoxicity did not show more cardiac comorbidities at baseline (14% vs. 24% p=0.12) and did not receive a higher cumulative dose of anthracyclines (mean 549mg vs. 546mg, p=0.48) than those without trastuzumab related cardiotoxicity. Conclusions: Regarding cardiotoxicity,trastuzumab was cautiously implemented in the Netherlands. In the first years, physicians based their decision to discontinue treatment frequently on patient ‘symptoms’ apart from LVEF outcome. Treatment discontinuation occurred mainly in the first three months after start of trastuzumab. Funding:Netherlands Organization for Health Research and Development and Roche Netherlands.
Relevance of rise in CA15.3 during fulvestrant therapy in advanced breast cancer patients.
Authors: Agrawal Amit , Balakrishnan B , Cheung Kwok-Leung , Robertson John Forsyth Russell 
Published: March 2020

e11567 Background: Serum CA15.3 (assay for MUC1 mucin, a membrane glycoprotein of breast ductal epithelium) is elevated in 50-70% of patients with metastatic disease. Transient initial rise (i.e., spike) of CA15.3 due to partial agonistic or cytotoxic effects of tamoxifen and chemotherapy is known. We report differential expression of spike in ER+ breast cancer showing clinical benefit (CB) or progressive disease (PD) on fulvestrant therapy (250mg). Methods: Serial serum CA15.3 measured at therapy initiation (Rx), 1, 3, 6, 9, 12 months and at progression were correlated with clinical outcome (CB/PD). Results: 112 patients (median age=71.4 years) with DOR=10.7+ (median duration of response in months, range) showed 63%CB (DOR=19.2+, 7-120.8+; MBC=48, LAPC=23) and 37%PD (DOR=3, 1-6; MBC=38, LAPC=3). Conclusions: CA15.3 spike was a common feature during therapy regardless of baseline level or clinical outcome (2nd row). However, in those with abnormal baseline (3rd row), %rise was higher in CB than PD patients reflecting greater tumour lyses (and perhaps therapy effectiveness) suggesting continuing therapy beyond early months (1-2 months) even with rising CA15.3. However, on analysis of only patients with spike, the majority of either CB or PD (4th row) were patients with MBC (perhaps reflecting higher tumour load) but with much larger %change in PD. Therefore, though therapy may not be stopped at early rise of CA15.3 but additional interim imaging may be required in MBC patients. [Table: see text]
Treatment effectiveness in advanced breast cancer patients in Italy: Ten years experience.
Authors: Barni Sandro , Vallini Ilaria , Bonotto Marta , Brunello Antonella , Indelli Monica , Gori Stefania , Saggia Chiara , Petrella Maria Cristina , Generali Daniele Giulio , Di Pietro Paolo Marzia , Moretti Anna , Massari Francesco , Fausti Valentina , Pinotti Graziella , Puglisi Fabio , Borgonovo Karen , Zagonel Vittorina , Porcu Luca , Collovà Elena 
Published: March 2020

e11573 Background: Several studies suggest that newer therapies can improve survival in MBC, but a different impact on overall survival (OS) is observed according to histology, extension of disease and prognostic factors. This survey was performed for evaluate Italian experience in cancer treatment in the last ten years. Methods: We collected data from 13 Italian Medical Oncology Unit; we registered all consecutive patients (pts) with breast cancer who have developed metastasis between 2000 and 2008. Demographic data, pathological characteristics and treatment were reported. OS was calculated from time of recurrence and stratified according to biological characteristics and to recurrence date. Results: 1542 pts was suitable for analysis; median age 61,7 (range 22-94); MBC at diagnosis 21,8%. Site of disease recurrence: bone 26,2%, visceral 25,4%, bone and visceral 20,7%, soft tissue 11,5%, soft tissue and visceral 8,4%, bone and soft tissue 7,8%. Molecolar classification: luminal A 66,3%, luminal B 14,5%, triple negative 11,5%, HER2+ like 7,7%. Pts received a median of 2 lines of chemotherapy (range 0-10) and 1 line of hormonal therapy (range 0-7); 22,5% received biological drugs. 15,5% of metastatic pts were enrolled in clinical trials. After a median follow up of 7.1 years 84,1% pts died (1297/1542 pts) and median OS was 2,7 years (range 2,6-2,9). We did not observe difference in OS for pts divided into 3 groups according to recurrence date (2000-2002, 2003-2005, 2006-2008). A longer median OS was observed in luminal B (3,8 years) versus luminal A and HER2+ like (2,8 years) and triple negative disease (1,2 years). Conclusions: Our survey describe a large number of MBC pts treated in 13 Italian Oncology Unit. OS analysis did not show significant differences according to recurrence date, but for different prognostic factors. OS data are superimposable to literature ones, showing a good transfer from clinical trials to clinical practice.
Breast cancer biomarker discordance between primary and sites of metastasis: A systematic review.
Authors: Yeung Isis Ching , Clemons Mark , Addison Christina L. , Hutton Brian , Zhu Xiaofu , Mazzerello Sasha , Arnaout Angel 
Published: March 2020

e11574 Background: Systemic treatment choices for breast cancer patients with recurrent disease are usually based on the ER/PR/Her2 biomarker status of the primary cancer. Biomarker discordance between the primary and metastatic sites is well recognised and could have important therapeutic implications. A systematic review was conducted to assess the extent of biomarker discordance between the primary cancer and metastasis, and whether is influenced by the site of metastasis. Methods: An electronic search of multiple literature databases implemented by an information scientist was conducted to identify studies reporting outcomes of ER/PR/Her2 receptor stability between primary site and recurrent disease. Seven reviewers independently screened the 5034 abstracts and full text articles, which were identified according to pre-defined selection criteria. The same reviewers performed data collection from all included studies. Studies that were identified reported on receptor conversion between primary sites of breast cancer and various sites of metastasis including lymph node, liver, brain, lung, skin, GI sites and bone marrow. Results: Preliminary results from 385 eligible studies consistently demonstrated discordance between the primary and metastatic sites. When discordance occurred, the general trend was for loss of hormone receptor. ER hormone status was more stable (discordance 10.2-32.5%) than PR (discordance 25.5-40.7%). HER2 was found to have lower rates of discordance (2.6-14.5%). In general, higher ER/PR discordance was found in bone (40-68%) and liver (0-54%) when compared to other sites brain (36%), lung (9-18%), skin (6-22%), GI (15-40%). In the prospective studies, biomarker discordance led to change in patient management in up to 20% of the patient population. Conclusions: Our results demonstrate that biomarker discordance between primary and distant metastases does occur in breast cancer, occurs more frequently with PR, and the extent of discordance is influenced by the site of metastasis. Further research is required to have a better explanation about the pathophysiology of the biomarker status change and its clinical implications.
The potential benefit of trastuzumab-based therapy upon lapatinib progression in heavily preatreated patients with advanced HER2 positive breast cancer.
Authors: Boutis Anastasios L. , Chatzileontiadou Sofia , Diamantopoulos Nikolaos , Pouptsis Athanasios , Fotiou Chariklia 
Published: March 2020

e11576 Background: Overexpression of human epidermal growth factor receptor 2 (HER2) occurring in about 20% of breast cancers is associated with increased risk of disease recurrence and worse prognosis. Despite the advent of therapies that target HER2, particularly, trastuzumab and lapatinib, that have altered the natural course of HER2-positive advanced breast cancer, tumor progression remains inevitable. New agents are in clinical development, but up to date there are limited data to direct the treatment of patients after lapatinib progression. Methods: We retrospectively searched for HER2-positive advanced breast cancer patients treated at our clinic, who received both trastuzumab-based therapy and lapatinib upon trastuzumab-progression in the metastatic setting. Thirty patients, all female, suffering from HER2-positive advanced breast cancer were identified. HER-2 positivity was assessed by immunohistochemistry (IHC 3+) or chromogenic in situ hybridization (CISH+). Results: Of the 30 patients, 83.3% had invasive ductal carcinoma; 60% had positive hormone receptor status, and 80% grade 3 tumours. Half of the patients received adjuvant trastuzumab. Median age was 57 years, range 37-79 years. 36.6% were switched to lapatinib after a median of three (range 2-6 lines) trastuzumab-based treatment lines. In 8 pts (37.5%) trastuzumab was re-started after lapatinib progression. In 7 of these patients, trastuzumab was combined with chemotherapy. Median progression free survival and overall survival in these patients was 4.75 and 8.87 months respectively. 3 patients received bevacizumab-based therapy upon lapatinib failure. Conclusions: Trastuzumab rechallenge after lapatinib progression may be active in a subgroup of heavily pre-treated patients. Clinical benefit of this strategy has to be balanced especially in limited resource settings with unavailability of novel agents or early phase clinical trials. As of now, there is no uniform accepted standard to define the optimal treatment approach of patients upon lapatinib progression showing the real need for new therapies in this population.
The impact of estrogen receptor (ER), progesterone receptor (PR), and HER-2 receptor status on treatment of patients with advanced breast cancer.
Authors: Bains Paramjot , Powell Erin Diana 
Published: March 2020

e11580 Background: There are many variables that affect treatment options and outcomes in advanced breast cancer. The expression of ER, PR and HER2 are key in determining prognosis and management. The traditional management of breast cancer did not involve biopsy of metastatic sites. Recent studies indicate that, in a significant number of patients, there is a change in receptor status in the metastasis, and this may alter treatment. There have been many retrospective studies looking at the change in the ER/PR status of the metastatic site. Change in treatment as a result has been less of a focus. Our objective is to document the likelihood of a change in receptor status and the impact of this on treatment. Methods: This is a single center retrospective chart review. Ethics approval has been obtained through Memorial Univeristy of Newfoundland. The Dr. H. Bliss Murphy Cancer Centre database was used to identify 250 patients in Newfoundland who were diagnosed with metastatic breast cancer between January 2006 and November 2011. The review includes patients diagnosed with de novo metastases and those who developed metastases following adjuvant treatment. The information we are collecting includes ER, PR, and HER2 status of original tumour, whether metastases were biopsied and the results of the biopsy. We are also documenting all treatments administered. Results: The percentage of patients who underwent biopsy of metastases, the likelihood of change in receptor status and the likelihood of change in treatment will be calculated. Approximately half of the charts that met our criteria have been reviewed. Of those 125 patients, 35 had a biopsy specimen analyzed for ER/PR and HER2 status. 6 of these 35 patients had a change in their hormone receptor status, and 3 had a change in their HER2 status. The likelihood of change in treatment recommendations will be determined once all the data have been reviewed. These results will be available for the 2013 ASCO meeting. Conclusions: ER, PR and HER2 status may change from initial diagnosis of breast cancer to metastatic disease. This has important implications for treatment and prognosis, suggesting that biopsy of metastatic sites should be routine.