bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathological complete response (pCR) in stage II and III breast cancer patients treated with neoadjuvant chemotherapy (CT): Dose dense ACx4 followed by AT/Tx4 (weekly paclitaxel)
Authors: Alarcon-Rozas A. E. , Melendez R. , Ramirez J. , Salas F. , Ramirez J. , Guevara J. , Galarreta A. , Hernandez E. , Viayrada F. , Torres J. 
Published: March 2020

10746 Background: This is a prospective study of a single Institution to determine the pCR in stage II and II breast cancer patients after dose dense and sequential CT using the most active drugs. Patients and Methods: Between June/2004 and July/2005 we collected 28 patients, they have echocardiogram and needle biopsy for IHC before starting the treatment. All of them received Adriamicin 60mg/m2 in 3hrs infusion and Cyclophosphamide 600mg/m2 x4 in dose dense schedule (every 2 weeks) with G-CSF support and then Adriamicin 60mg/m2 and Taxol 80mg/m2 days 1,8 every 3 weeks. Once the treatment was finished they went to surgery. Results: Six (21%) patients were stage II and 22 (79%) were stage III; 8 (35%) patients achieve pCR, 50% of them had Her2/neu positive and 7/8 (90%) were ER/PR negative; 60% (5) had T more than 5cm and 75% were post menopausal. 12 patients had clinical complete remission. Eight patients had progressive disease with 50% ER/PR negative, 37% Her2/neu positive and all of them with T more than 5cm. 50% were premenopausal. Conclusion: This is one of the highest pCR of the literature (35%) achieved and it is interesting to note that 90% of them were ER/PR negative, so this is a potential target group for CT intensification. There is a group of patients (with progressive disease) that will never respond to CT, and it would be worst in the adjuvant setting (blindly treatment) because the great toxicity. We need more studies to confirm this hypothesis. No significant financial relationships to disclose.
Docetaxel versus paclitaxel and “paclitaxel” versus paclitaxel: The optional therapy in breast cancer
Authors: Sulemanjee G. , Ristzert S. , Cao T. L. 
Published: March 2020

10758 Background: For the past fifteen years many clinical trials have demonstrated that paclitaxel therapy could generate 30% to 60% response rate in patients with breast cancer. Recent clinical trials indicated that when used as control, paclitaxel therapy only produced 20% response rate in patients with breast cancer. Methods and Results: Using Medline study, data from early clinical trials indicated that paclitaxel, as first-line or second-line therapy, could generate 30% to 60% response rate in patients with breast cancer and the response rate was dose-dependent and toxicity-limited (Seidman, 1994; Perez, 1998). Therefore, paclitaxel is considered superior to older chemotherapeutic agents in treating breast cancer. When used as control to compare with two newer agents, docetaxel and nanoparticle albumin-bound paclitaxel (“paclitaxel”), data from recent clinical trials indicated that paclitaxel therapy only produced 19% to 25% response rate in patients with breast cancer. Many questions remain because the response rate from any chemotherapeutic agent is dose-dependent and toxicity-limited. Nishimura et al (2005) recently reported that weekly placlitaxel as second-line therapy in breast cancer resulted in 41.2% response rate which is much higher than the rates from either docetaxel or “paclitaxe” therapy (33% and 32%, respectively). The cost of paclitaxel dropped from $5000 per three-week therapy when it could produce 30% to 60% response rate years ago to $300 in recent years while the other agents such as docetaxel and “paclitaxel” cost about $3000 to $5000 per therapy. Conclusion: The role of inferior control in clinical trials is no longer a puzzle. Whether the quality of the low-cost paclitaxel or other factors could alter the response rate in clinical trials requires future research. No significant financial relationships to disclose.
Combined modality treatment for breast cancer: Justification for integration of transplants at diagnosis
Authors: Hupperets P. , Van Hoef M. E. 
Published: March 2020

10760   >Introduction: In acute leukemia best therapy consist of fast remission-induction, consolidation of complete response and allogeneic transplantation to eradicate residual malignant cells. This therapeutic plan at diagnosis consists of three treatment combinations that have been proven to be most efficacious when administered consecutively according to protocol. Methods: The three treatment combinations were defined as independent entities and literature search was pursued to identify equivalent components for high risk and metastatic breast cancer. Results were tabulated. Results: First line combination treatment induces complete response rates that can be enhanced by dose density. This type of intensification does not change the risk of relapse although time to relapse may vary by a few months; survival in high risk breast cancer is about 50% and in early metastatic 10%. Failure to treat more aggressively induces respectively 50% and 90% relapse mortality. It is hidden treatment-failure related mortality. High-dose autologous transplants (HD-auto-tx) add a survival advantage of about 10% but this is statistically not considered significant. In large series treatment related mortality (TRM) of HD-auto-tx is 0–3%. Treatment integrating autologous transplantation reduce relapse mortality to respectively 60% and 80%. Allogeneic transplants induce an immune response in breast cancer that is comparable to the response observed in leukemia; micrometastatic bone marrow disease can be eradicated. After an autologous transplant risk of relapse is 80% and after an allogeneic transplant in first consolidated remission 20%. Allogeneic transplants make the combination attractive, despite the risk of TRM, mainly attributable to graft versus host disease. Selection of right treatment schedules and adequate prophylaxis for and treatment of graft versus host disease is emerging and may minimize the risk of TRM as result of this side effect to <5%. Discussion: Optimization of treatment by integration of transplants in treatment at diagnosis is warranted to offer breast cancer patients the choice of cure at certain risks versus the standard chemotherapy resulting in remarkably higher disease driven mortality. Details will be presented. No significant financial relationships to disclose.
Axillary lymph node metastases from papilloma of the breast
Authors: Singh T. , Tso E. , Kumar A. , Ahrens P. 
Published: March 2020

10764 Background: To report a unique case of papilloma of the breast with metastases to the axillary lymph node. Methods: Case report and review of literature. Results: 80 year old Caucasian male presented with right gynacomastia of 3 months duration. The lesion was resected. Pathology was consistent with intraductal papilloma with hyperplasia and no evidence of malignancy. Subsequently, after 2–3 weeks a mass was noted in the right axilla. This mass was resected and was found to be consistent with papilloma of the axillary lymph node and had the pathological characteristics of the original breast papilloma. Conclusion: Solitary papillomas are generally lesions of the large ducts usually located in the subareolar region of the breast. They are among the commonest cause of spontaneous nipple discharge. After resection of the primary lesion, local recurrence is fairly common. Recurrence is especially common if hyperplasia is associated with the papilloma. There is also an increased incidence of carcinoma in the affected breast. Due to the benign nature of papillomas, they do not metastasize. We did an extensive review of literature and did not find any cases of metastatic lesions from a papilloma of the breast. The underlying reason and pathogenesis for the metastases is not known. No significant financial relationships to disclose.
Cost-effective treatment with half year of trastuzumab and chemotherapy as adjuvant treatment for overexpression of Her2/neu breast cancer patients: Two institutional experiences in Taiwan
Authors: Tai C. J. , Pan C. K. , Wu C. H. , Chen C. S. 
Published: March 2020

10765 Background: In this study, we are evaluating the utilizing trastuzumab as an adjuvant combination with chemotherapy in an half year interval for breast cancer (1–3). Methods: Patients after October 2000 with HER2-positive (3+ by immunohistochemistry; if 2+, should fit over expression by FISH) stage II/III breast cancer who received adjuvant trastuzumab (4mg/kg ×1, then 2mg/kg/wk ×22, equals 6 bottles of trastuzumab) in combination with chemotherapy. The chemotherapy utilized for stage II breast cancer patients received CEF only and for those patients with LN(+) but ER/PR(−/−) also added paclitaxel for another 4 cycles besides CEF with interval of 3 weeks, and for those with stage III breast cancer patient with ER or PR(+), the docetaxel was given with CEF for 6 cycles). Clinical response rates were followed by using imaging studies with chest films, CT scanning, bone scan and sonography. Results: Overall, there were 37 patients enrolled in this study. The median age was 43 years old (22–74 y/o). Two patients (including the youngest one) were found to have bilateral breast cancer on diagnosis but both were still alive without disease so far. There were 3 patients developed disease progression after adjuvant chemotherapy with trastuzumab and 2 of them died thereafter and all these 3 patients were stage III disease. The oldest patient was one of the exception without receiving adjuvant chemotherapy and received monotherapy of trastuzumab only and so far, she was still alive without disease. The side effect including chills (24.32%), dizziness (8.10%), cough (2.10%), cold sweating (2.10%). Conclusions: For her2/neu overexpression patients, trastuzumabwith chemotherapy may have positive role in adjuvant therapy. In this study, our main goal is to achieve patient’s treatment outcome in disease free status. Nonetheless, the cost was high if we applied trastuzumab as adjuvant therapy with 1- or 2-year interval (4–6). Even if this required further time to demonstrate this study’s final outcome, I suppose that utilization of trastuzumab as adjuvant treatment plus chemotherapy in a half interval will be a good alternative treatment option. No significant financial relationships to disclose.
Rapid and prolonged palliation of symptoms with improved quality of life (QOL) with endocrine therapy (anastrazole) in metastatic breast cancer (MBC)
Authors: Samuel J. , Osafo D. 
Published: March 2020

10767 Background: Efficacy of anastrazole in receptor positive post-menopausal MBC; rapid palliation of symptoms with improved QOL. Methods: Case Report: A 62 year old woman diagnosed with right breast cancer in 1995, stage IIB, underwent surgery, adjuvant chemotherapy, and tamoxifen for 5 years. In February 2004, a left supraclavicular lymph node (1 cm) was felt. Chest x-ray (CXR) showed blunting of right cardiophrenic angle. CT scan of the neck showed multiple left cervical lymph nodes. In April 2004, her condition deteriorated rapidly needing hospitalization. She developed 15 pound weight loss, anemia, anorexia, shortness of breath, dyspnea on exertion, dry cough, and chest pain. CXR showed large right pleural effusion needing multiple thoracentesis. Hemorrhagic exudative effusion was seen with negative cytology and cultures. She also developed multiple palpable left cervical and left axillary lymphadenopathy. Breast exam was normal. Mammogram was not diagnostic but ultrasound of breast showed a 2.5cm left breast mass, axillary lymphadenopathy and additional lesions in the breast. Left cervical lymph node biopsy showed metastatic adenocarcinoma favoring primary breast cancer. A diagnosis of 2nd primary breast cancer with metastasis was made. Within 1 week of palliative capecitabine, she was readmitted with significant mucositis, diarrhea, dehydration, dysphagia, electrolyte imbalance, and reaccumulation of right pleural effusion. She lost 35 lbs. in 4 months. She was aggressively resuscitated and also needed thoracocentesis. Markers from prior biopsy showed Estrogen receptor 20%, Progesterone receptor <5%, and HER 2 (Herceptest) 3+. Palliative hormonal therapy with anastrazole was started in July 2004. Results: Within 4 weeks, she improved significantly with disappearance of lymphadenopathy and resolution of effusion. Performance status improved to ECOG 0. She is continuing anastrazole, 17 months since the diagnosis of debilitating metastatic breast cancer. Conclusions: Anastrazole is approved for the treatment of hormone receptor positive post-menopausal MBC. We describe the efficacy of endocrine therapy (anastrazole) leading to rapid and meaningful palliation of symptoms with improved QOL. No significant financial relationships to disclose.
Five years update of sequential high dose doxorubicin, cyclophosphamide and docetaxel in inflammatory breast cancer; PEGAGE05 trial on behalf of FNLCC
Authors: Palangie T. , Pouillart P. , Roche H. , Viens P. , Linassier C. 
Published: March 2020

10773 Background: Inflammatory breast carcinoma is a distinct clinicopathologic entity with poor survival outcome. Early response to initial chemotherapy was reported as predictive for survival and complete pathological response is considered as a major prognostic factor. This study was conducted to determine the safety and to estimate the efficacy of sequential high dose chemotherapy with doxorubicine (D) + cyclophosphamide (CPM) and docetaxel (Doc), in terms of pathological response, disease-free and overall survival Methods: Fifty-four patients entered into the trial from July 1997 to March 1999; treatment consisted in four 3 weekly cycles of D75 mg/m2 + CPM 6 g/m2 in C1 and C2; Doc 100 mg/m2 q 2w in C3, C4 and C6; D75 mg/m2 + CPM3 g/m2 in C6 and C7. Mastectomy with axillary dissection was performed for responding patients, followed by radiotherapy. Results: An interim analysis showed the same efficacy reported in previous high dose chemotherapy trial Pegase 02, without Docetaxel, and unexpected toxicity with 2 toxic deaths that warranted an early closure of the trial The overall 35% [22.5%–47.9%] grade 1 or 2 pathological response according to Chevallier as compared to the 32% reported in the Pagase 02 trial, suggest no greater efficacy for additionel Docetaxel to high dose D + CPM Five-year disease-free survival and overall survival showed a better tendency in Pegase 05 trial, with respectively 42% and 62% as compared to Pegase 02 trial with 33% and 50% Conclusions: these results suggest some benefit from dose intensified CT in terms of complete pathological response rate with improvment of the disease- free and survival outcome. The positive impact of additional docetaxel will be assessed in the last randomized multicenter Pegase 07 trial. No significant financial relationships to disclose.
Multiple primary neoplasms involving the breast
Authors: Maddali L. S. , Maddali S. 
Published: March 2020

10786 Background: Multiple Primary Neoplasms (MPN) are being identified with increasing frequency in Breast cancer patients. We studied MPN involving Breast cancer as at least one primary for (1) incidence and (2) identifying. subsets with special features. Methods: 83 patients with MPN were identified among 3378 patients seen between January 1st 1999 and 31st December 2005. (2.15%). 40 of these had Breast primary (48.19%). which form the basis of the present report. One or both primaries were identified during this period. But in some cases with primaries in remote past, available documentation was accepted. Results: Breast cancer was the Index cancer 31/40 (77.50%)and second primary in 9/40 (22.50%). Among the index cancers, 4/31 cases (12.90%) were synchronous and 27/31 (87.10%) were metachronous. 100% of the second primary in breast group were metachronous. Breast-Breast MPN 15/40 (37.50%) and Breast-Non breast MPN 25/40 (62.50%). Mean ages for Breast-Breast MPN 47.33 years, Synchronous tumors 38.66 yrs, metachronous tumors 58.20 yrs, Breast-Non Breast MPN 55.44 yrs. Mortality for Breast-Breast MPN as a group was 73.33%, synchronous tumors (2/3) 66.67%, metachronous tumors (10/12) 83.33%, Breast-Non Breast MPN, metachronous tumors (13/24) 54.17%. When the interval between index and second primary was studied, the Breast-Breast MPN mortality was (7/9) 77.78% for 2 yrs or less duration, (3/3) 100% for more than 2yrs. For Breast-NonBreast MPN, mortality was (6/9) 66.67% for duration of 2 yrs or less and (7/15) 46.67% for more than 2 yrs. The common malignancies associated in the index Breast cancer group were from Ovary (6),Thyroid (2),pancreas (2), Hematologic neoplasms (3) Upper Aero Digestive Tract (2). The second primary Breast cancer group had primaries in ovary (2), colon (2), hematologic (3) neoplasms. Conclusions: Breast-Breast MPN are seen in younger patients with higher mortality than Breast-Non Breast MPN. In the Breast-Non Breast MPN group, longer interval between the primaries is associated with lower mortality. There were no major differences between the Index Breast cancer group and Breast Second Primary group. Mortality appeared to be determined by the nature of the Non Breast Primary. No significant financial relationships to disclose.
Trastuzumab-containing therapies: Activity beyond disease progression in M.B.C.—A pivotal experience
Authors: Del Bianco S. , Rondinelli R. 
Published: March 2020

10788 Background: To evaluate Trastuzumab containing successive therapies activity in patients with overexpressing metastatic breast cancer (MBC). To determine the response rate (RR), time to progression (TTP) and overall survival (OS). Methods: Pivotal study of Trastuzumab (TZB) activity in HER-2 overexpressing MBC patients enrolled in our institution from 2000 to 2005. Results: 12 pts have been evaluated. Median age: 56; 8/12 postmenopausal,. 10/12 received adjuvant chemotherapy. Hormonal receptors: 8/12 positive, 4/12 negative. 8/12 pts had visceral disease. 11/12 had metastases in ≥ 2 locations. 5/12 pts received TZB as front line for MBC. Median previous lines: 2 (0–5). TZB was first time combined as follows: paclitaxel 7/12, docetaxel 4/12, (1/12 TZB alone). Asintomatic cardiac disfunction (LVEF reduction >10%) or CHF occurred in 1/12 pts (=CHF) after 46 months of TZB-treatment, with cardiac function progressively improving after standard medical care. RR for the 1st line (TZB containing): 11/12 (CR 3/12, PR 8/12), stable disease (S): 1/12, Clinical benefit (CB) 12/12, Median TTP 9.5 m (3–61+). 9/12 pts received a 2nd TZB containing therapy. RR for 2nd TZB-containing line: 4/8 (CR 0/8), SD 4/8, CB: 8/8; Median TTP: 8 months (3–14). All the 8/8 pts received a 3rd TZB- containing therapy. RR for 3rd TZB-containing line: 5/8 (CR 1/8), SD: 3/8, CB:8/8; Median TTP: 9 months (1–11). 4/8 pts have received a 4th or more TZB containing therapy with some long-lasting RR still presents at this time. Median overall survival is 33.5 months (9–61+). Conclusions: TZB-containing therapies beyond disease progression in MBC shows an interesting activity even in heavily pre-treated women. Small number of patients perhaps, do not allow to draw any final conclusion. No significant financial relationships to disclose.
A phase II study of gemcitabine (G), peghilated liposomal doxorubicin (PLD) and docetaxel (D) in locally advanced breast cancer (LABC): An interim analysis
Authors: Artioli G. , Bozza F. , Cartei G. , Zovato S. , Mencarelli R. , Zavagno G. , Michelotto M. 
Published: March 2020

10789 Background: On the basis of general and our own experience neoadjuvant therapy is justified in patients with locally advanced breast cancer to reduce cancer and to perform a conservative surgery. In this study we evaluated the efficacy of G plus D and PLD as first-line therapy in LABC. Methods: To date sixteen consecutive patients with LABC have been enrolled into the study. All patients before neoadjuvant treatment, underwent biopsy for hormonal receptors and c-erb-B2 assessment. Patients received G 1250 mg/m2 on day 1 and G 1000 mg/m2, T 75 mg/m2 and D 25–30 mg/m2 on day 8 (escalation dose was 25 mg/m2 at first cycle, 27.5 mg/m2 at second cycle and 30 mg/m2 at third cycle), every 21 days with G-CSF support on day 3, 10, 12 and 14. Tumor response was evaluated on the basis of surgeon consultation and breast MRI after 4 cycles. If tumor response was higher than 50% patients underwent 2 more cycles; if it was 50% ore less or because of unacceptable toxicity they underwent surgery after 4 cycles. Microscopic assessment of the extent and type of residual tumour was made. Results: 16 patients were enrolled comprehensive of 2 with no symptomatic bone metastases. Median age was 50 years-old, and 100% had a WHO performance status (PS) of 0 and EORTC QoL was submitted. Four patients were submitted to surgery after 4 cycles, one after 5 cycles of CT with 5 pPR more than 50%. Three patients had a pathological complete response, 2 partial response more than 50% and 1 stable disease after 6 cycles. (a total of 70% of pPR, 30% of pRC, 10% of pSD). Five patients are still on treatment. One patient died because of acute respiratory distress syndrome. Major toxicity was mucositis G3–4 in one patient. PPE was G3–4 in 3 patients, one discontinued chemotherapy with PLD and continued with Epirubicin. 2 patients received Epirubicin after the first cycle of PLG because of acute allergic reaction. Conclusions: This regimen of chemotherapy seems feasible and active in LABC. At the interim analysis results it has been noted that the best response to chemotherapy was among patients having worse prognostic factors (histology and staging). No significant financial relationships to disclose.
Multivariate analysis identifies factors that affect survival after stereotactic radiosurgery for brain metastases
Authors: Diluna M. L. , King J. T. , Knisely J. P. , Bond J. E. , De Lotbiniere A. C. , Chiang V. L. 
Published: March 2020

11500 Background: Stereotactic radiosurgery (SRS) has become a standard for the treatment of brain metastases. We attempted to determine if specific tumor- or patient-related factors in our population independently predicted better survival. Methods: Survival data for all 334 patients with brain metastases treated with SRS between Jan 1998 and Dec 2004 were analyzed. Clinical data were abstracted retrospectively from treatment records; survival data were obtained from the Connecticut Tumor Registry. Kaplan-Meier plots and Cox proportional hazard multivariate regression models were used to identify the factors that independently affected survival. Variables analyzed included age, sex, race, histology, number, location and total volume of metastatic lesions, surgical resection, WBXRT, chemotherapy, and systemic disease control. Results: Median age of our patient population was 57.3 years. The median number of lesions treated in a single session was 2 (range 1 to 36). Tumor histologies included non-small cell lung carcinoma (36%), breast (17%), melanoma (16%), small cell lung carcinoma (8%), renal cell (8%), esophageal (2%), and other (16%). Three hundred patients (90%) had confirmed deaths, with a median survival after SRS of 8.1 months. Increased survival was independently associated with systemic control (HR = 0.51, P<0.001), breast cancer (HR = 0.60, P=0.003), and total tumor volume <5cc (HR = 0.68, P=0.003). Decreased survival was independently associated with the presence of four or more cerebral metastases (HR = 1.50, P=0.005) and a trend toward decreased survival was associated with esophageal cancer (HR = 2.24, P=0.055). There was no difference in survival associated with age, race, sex, location of metastases, surgical resection, WBXRT before or after SRS, or chemotherapy. Conclusions: Breast cancer, systemic control, and fewer metastases were all significant independent predictors of improved survival. Of note, histological diagnosis, other than breast or esophageal cancer, did not affect patient survival, and a total tumor burden of 5cc or more was associated with worse survival independent of the number of metastases. These results should assist in survival prognostication in patients with cerebral metastases considering SRS. No significant financial relationships to disclose.