bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of treatment patterns and outcomes in metastatic breast cancer (MBC) patients initiated on trastuzumab versus lapatinib: A retrospective analysis.
Authors: Gauthier Genevieve , Guerin Annie , Styles Amy , Wu Eric Q. , Brammer Melissa G. , Lalla Deepa 
Published: March 2020

e11076 Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend trastuzumab- or lapatinib-based therapies as the preferred agents for metastatic HER2-positive breast cancer. Few studies have compared treatment patterns and outcomes in MBC patients (pts) treated with trastuzumab vs. lapatinib. The objective of this study is to compare rates of new metastatic sites, discontinuation, healthcare resource utilization, and costs in MBC pts initiated on lapatinib vs trastuzumab. Methods: Adult women with MBC initiated on trastuzumab or lapatinib on or after 03/13/2007 (lapatinib FDA-approval date) were selected in the PharMetrics® Integrated Database (2000-2011). Pts were followed from trastuzumab or lapatinib initiation date up to the end of continuous healthcare plan enrollment/data availability, whichever occurred first. New metastatic sites and discontinuation rates (gap ≥45 consecutive days) were compared among trastuzumab and lapatinib pts using multivariate Cox proportional-hazards models. Incremental healthcare resource utilization and monthly costs (2010 USD; measured from a payer perspective) were estimated using multivariate generalized linear models. Results: Among the643 pts selected, 381 and 262 pts were initiated on trastuzumab and lapatinib, respectively. After multivariate adjustment, compared to trastuzumab pts, lapatinib pts had a higher rate of new metastases (hazard ratio [HR]=1.65; p<.001) and treatment discontinuation (HR=1.57; p<.001). There was no statistically significant difference in total healthcare cost between lapatinib and trastuzumab pts (p=.397). The incidence of medical visits associated with treatment administration was lower in lapatinib pts (Incidence rate ratio [IRR]=0.34; p<.001), however, the incidence of other outpatient visits was significantly higher in lapatinib pts (IRR=1.19; p<.001). Conclusions: Whileboth cohorts presented similar healthcare costs, pts initiated on lapatinib showed higher rates of new metastatic sites, discontinuation, more outpatient visits (non treatment-related), but fewer medical visits associated with treatment administration.
Limitations in assessment of ER, PR, and HER2 status of breast cancer patients: Yangon experience.
Authors: Mon Yin Yin 
Published: March 2020

e11078 Background: Management of breast cancer become individualized nowadays especially in developed countries. Molecular profile of breast cancer is essential to have this management. However, there are still limitations to examine such molecular profile in developing countries like Myanmar. Our aim in this study is to know the number of patients who underwent ER, PR and HER 2 status assessment among breast cancer patients in Myanmar and to analyze types of limitations for the molecular assessment in management of breast cancer. Methods: Total number of 823 breast cancer patients who registered from January 2009 to December 2011 at Medical Oncology Unit of Yangon General Hospital and two private oncology clinics were studied. Results: The age range from 19-80 years and mean age of 44.36 years. Among 823 breast cancer patients, ER, PR and HER 2 status were done in 134 patients (16.28% ) whereas 689 patients( 83.71% ) were not. 604 (87.66%) out of 689 patients who did not undergo profiling were due to financial problem. 60 patients (8.70 %) were found to have lack of information about molecular profiling although they were affordable . 25 patients (3.62 %) lost their tissue due to technological limitation Conclusions: Financial problem is the major limitation to get molecular profile for breast cancer patients in Myanmar. Patients need self expense to do advanced technology examinations in different health care system of our country. In this study we also found out that there was lack of information which leads not to undergo further investigations to some well to do patients. Overall, we believe that molecular technology support with reduced expense will help more patients in future to get better management in breast cancer in Myanmar. Besides, we need to provide update information about molecular testing in breast cancer to not only patients but also health professionals in our country.
Association of higher proliferation of Ki67 with unfavorable prognostic factors and shorter survival in breast cancer.
Authors: Kilickap Saadettin , Kaya Yalcin , Yucel Birsen , Tuncer Ersin , Elagoz Sahande 
Published: March 2020

e11083 Background: The prognostic value of Ki67 expression level is yet unclear in breast cancer (BC). The aim of this study was to investigate the association between Ki67 expression levels and other prognostic factors in BC. Methods: Demographic, clinical and pathological features of the pts were retreived from the hospital records. Results: In this study, 163 pts with BC were analyzed. The mean age of the pts was 53.4±12.2 years. Median Ki67 level was 20% in this study. Ki67-high tumors were significantly associated with high grade (p<0.001), lymphovascular invasion (p=0.001), estrogen receptor negativity (ER-) (p=0.035), Her2 (+) (p=0.001), advanced stage (p<0.001) and lymph node involvement (LNI) (p<0.003) of the tumor. There was no relationship between the age, perineural invasion, progesterone receptor and Ki67 positivity. Lower Ki67 levels were significantly associated with longer median relaps-free survival (RFS) compared to those of higher Ki67 levels (p=0.008). The overall survival (OS) was longer in pts with lower Ki67 levels than those with higher levels (p=0.017). Conclusions: High Ki67 expression was associated with ER-, Her2 (+), higher grade and LNI in BC. The level of Ki67 expression was a prognostic factor predicting the RFS and OS in BC pts. [Table: see text]
Expression of PTEN, Akt, MAPK, p53, p95 for predicting trastuzumab resistance in breast cancer.
Authors: Duman Berna Bozkurt , Sahin Berksoy , Ergin Melek , Zorludemir Suzan , Acikalin Arbil 
Published: March 2020

e11088 Background: The activation of the oncogene PIK3CA and the loss of the tumor suppressor gene PTEN are mutations commonly found in breast tumors. AKT is a key activator of cell survival mechanisms. Mutant p53 proteins can actively contribute to tumorigenesis. Trastuzumab in particular are the primary treatment in the adjuvant and recurrent settings for breast cancer. Many studies reported that selected patients may present with resistance to trastuzumab due to the presence of p95 HER2 fragments. To address this challenge,we analyzied PTEN, Akt, MAPK, p53, p95expressions in breast cancer treated with trastuzumab therapy. . Methods: Ninety patients were assessed for this study and in the guidance of inclusion and exclusion criteria 25 patients were enrolled to the study. HER2 positivite, metastatic or locally advanced patients were enrolled to the study.. All of the patients that included to the study were treated with trastuzumab. Trastusumab resistance was assessed. Antracylin and taxane containing regimens were given to all patients. Gemcitabine, cisplatine capectabine, navelbine containing regimens were given on second and third line treatment choices. Tissue samples were obtained from parafine blocks and evaluated for PTEN, Akt, mapk, p53, p95 expression with immunohistochemical method. Results: The median age was 54±12. PTEN, Akt, MAPK, p53, p95 expressions were found in different levels on tumor tissue samples. Trastuzumab resistance were detected in 5 (20%) patients. Akt expression was positive in 2(8%) patients, MAPK expression was positive in 1 (4%) patient, p95 expression was positive in 1 (4%) patient, p53 expression was positive in 1 (4%) patient, PTEN expression was negative 3 (12%). Statistically significant difference was not found between trastuzumab resistance and PTEN, Akt, MAPK, p53, p95 expressions (respectively p:0,11, 0,79, 0,95, 0,88, 0,74). Conclusions: PTEN, Akt, MAPK, p53, p95expressions were assessed on HER2 positive breast cancers for predicting trastuzumab resistance. There was no statistically significant correlations between trastuzumab resistance and the expressions of these biomarkers. This study is ongoing, this is the preliminary results of this study.
Breast cancer in young women in India.
Authors: Deshmukh Sanjay P , Mane Anupama Dutt 
Published: March 2020

e11506 Background: The incidence of breast cancer is rising in India. It presents at a younger age in Indian population as compared to the western countries. Methods: This is a retrospective review of all breast cancer patients less than 40 years of age treated in single tertiary care center from June 2006 to June 2011. The aim was to assess the factors that may influence clinical outcome and prognosis including demographics, clinical characteristics, surgical and pathological findings and the treatment given. Clinical data was collected from medical records and histopathology reports. Independent variables like age, stage at presentation, surgery type, chemotherapy, radiation, tumour size, grade, nodal status, no. of positive nodes, perinodal extension, lymphovascular extension, ER, PR and Her2 neu were analysed. Results: Out of a total of 613 patients, 91 were under 40 years of age, corresponding to a prevalence of 14.8%. Median age was 35 years with the youngest being 23 years old. Maximum patients were in the age group of 36-40 years. Lymphovascular emboli was positive in 42 patients (48.8%) and perinodal extension was positive in 36 patients (41.8%). 30 patients(34.8%) had ER positivity, while 39 patients (45.3%) had PR positivity. Her 2 neu receptors were positive in 20 patients (23.2%). 39 patients were triple negative (45.3%). The median follow up period for all the patients was 28 months with the DFS being 76.1% and OS being 88.3%. In univariate analysis, factors significantly associated with survival were stage at presentation (p value- 0.026), presence of lymhovascular emboli (p value- 0.019) and presence of perinodal extension (p value- 0.007 ).Grade of the tumour also correlated with survival , however it was not statistically significant (p value- 0.086). Statistical analysis was done with SPSS 17. Conclusions: The incidence of breast cancer in younger women in India is high with increased number of triple negative patients. Overall survival is quite similar to that of the western population. Longer follow up and more studies are required to confirm this finding.
Adherence to yoga practice improves symptom control and quality of life in breast cancer patients undergoing conventional treatment.
Authors: Raghavendra Rao M. , Gopinath Kodaganur Srinivasachar , Srinath B S , Patil Shekhar , Shashidhara P , Diwakar Ravi B , S Ramesh Bilimagga , Rao Nalini K , Ajaikumar Basavalinga S. , Prashanth Jayanna , Chidambaramurthy K N 
Published: March 2020

e11511 Background: Adherence plays an important role in success of mind body interventions such as yoga. In this study we evaluated the effects of adherence to yoga intervention on psychological and quality of life outcomes. Methods: Adherence to yoga program was assessed in a randomized controlled trial comparing yoga (n=45) vs. supportive therapy in breast cancer patients with stage II and III disease undergoing primary surgery followed by adjuvant radiotherapy and chemotherapy. Subjects were assessed for self reported symptoms and affective states using symptom checklist, Spielberger’s State Trait Anxiety, Becks Depression Inventory and Functional Living Index in cancer for Quality of life following surgery and during radiotherapy and chemotherapy. Adherence was categorized based on number of sessions of yoga practiced at home per week [regular (>5 sessions), not so regular (3-5 sessions), occasionally (upto 2 sessions)].Multiple hierarchical regression analysis was used to examine the variance in the above outcomes explained by independent prognostic variables (age group, clinical stage of cancer, type of surgery, respective baseline psychological outcomes and regularity of practice) in yoga group alone. Model B includes these four variables plus regularity of practice. Results: Regularity of practice emerged as a secondary predictor for symptom severity following surgery (β= 0.38, p=0.007) and primary predictor for depression (β= 0.37, p=0.05) and severity of symptoms (β= 0.42, p=0.04) during radiotherapy and depression(β= 0.35, p=0.05), severity of symptoms (β= 0.45, p=0.03), anxiety trait(β= 0.40, p=0.03) and quality of life (β= -0.61, p=0.001) during chemotherapy. Conclusions: Adherence to mind body interventions such as yoga improves psychological and quality of life outcomes in breast cancer patients undergoing conventional cancer treatment.
Metronomic chemotherapy (MC): Results of two feasibility trials in patients (pts) with HER2 positive (HER2+) and negative (HER2-) locally advanced breast cancer (LABC).
Authors: Petry Vanessa , Leal Alessandro , Arai Roberto J. , Piato Jose R. , Andrade Felipe , Paiva Marcelo , Ferraz Marcio R. , Marinho Simone , Hoff Paulo Marcelo , Mano Max S. 
Published: March 2020

e11513 Background: In SWOG0012, MC improved pathologic complete response (pCR) compared to standard neoadjuvant chemotherapy (NC). We evaluated the feasibility of MC with a taxane→anthracycline schedule, which has also been shown potentially superior to the inverse sequence. We also evaluated the feasibility of MC in combination with trastuzumab. Methods: The primary objective was feasibility (defined as a febrile neutropenia (FN) rate ≤10%). Secondary objectives were cardiac safety, tolerability and efficacy as measured by objective response and pCR. The original accrual goal was 25 Her2+ pts and 40 Her2- pts. Her2- pts received paclitaxel (100mg/m2) x8 weeks followed by doxorubicin (24mg/m2) x9 weeks combined with oral cyclophosphamide (100mg/day), without G-CSF. Her2+ pts also received weekly trastuzumab (4 mg/kg followed by 2mg/kg) concurrently with the entire CT. Results: Most pts were stage III (Her+: 8/9; Her-: 4/11). The Her2+ cohort was prematurely closed after 2(22%) pts developed G3 pneumonitis (both during the MC phase). Both recovered completely. There was 1 case of asymptomatic LVEF drop to below 50% (during the taxane phase); 1 pt had G2 hand-foot skin reaction (HFS) and another had G2 mucositis. The Her2- cohort was also prematurely closed with only 11 pts due to high rates of mucocutaneous toxicity (G3 HFS in 36%, G3 rash in 9%) and also because of SWOG0221 negative results. There were 2(18%) cases of FN, but no cases of pneumonitis. 1/11(9%) Her2- and 5/9(55%) Her2 + pts had a pCR. VEGF-related biomarkers were collected and will be presented at a later date. Conclusions: The proposed MC schedules proved too toxic to be considered for further clinical development. In addition, MC resulted in unexpectedly high rates of severe pulmonary toxicity when given in combination with trastuzumab. Her2+ but not Her2- pts had an impressively high pCR rate.
Meningism as a poor risk factor in breast cancer patients with relapse in central nervous system (CNS).
Authors: Schwarz Luis Jesus , Vallejos Carlos S. , Neciosup Silvia P. , Pinto Joseph , Vidaurre Tatiana , Ferreyros Greenlandia , Gomez Henry Leonidas 
Published: March 2020

e11518 Background: CNS relapse in breast cancer patients is invariably defined as a poor prognosis feature with varied and bizarre clinical presentation. We describe the commonest signs and symptoms in CNS relapse and their relation with prognosis Methods: We evaluate retrospectively 2597 women with breast cancer treated at the Instituto Nacional de Enfermedades Neoplásicas (Lima-Perú) between 2000-2005. Phenotypes were determined by IHC and categorized in [HR+, HER2-], triple-negative (TN) [HR-, HER2-] and Her-2 [HR+/-, HER2 +]. Post-CNS recurrence survival was calculated by Kaplan Meier method. We use Chi-square, or exact Fisher test when appropriate, to evaluate correlations between categorical variables. Results: 157 pts (6.04%) had CNS relapse from which 19 had only leptomeningeal carcinomatosis (LMC), 124 only brain metastases and 14 both. In regard to phenotype, 43pts were [HR+, HER2-] (5 LMC), 68 were TN (13 LMC) and 51 were [HR+/-, HER2 +] (15 LMC). 152 pts had stages I-III (96.8% of all SNC relapses). There was no association between phenotypes and age at CNS relapse, ECOG PS, extracraneal metastases, control of primary tumor, number or volume of brain metastases. Significant association was found between phenotype and time from diagnosis to CNS relapse (≤8 months: 16.3% in TN, 7.3% in Her-2 and 0% for [HR+, HER2-], [P=0.017] ) and histological grade (grade III: 74.4% in TN, 55.% in Her-2 and 30% for [HR+, HER2-], [P=0.006]). Symptoms/signs frequently described in LMC patients were cephalea (72%), meningism (24%), nausea (24%), vomiting (20%), ataxia (20%), facial palsy (16%), somnolence (16%), paraparesia (12%), hiporeflexia (12%), apraxia (12%), arreflexia (12%), poor sphincter control (12%), hemiparesia (8%), seizures (8%), bradipsiquia (8%), neuropathic pain (4%). Fifty percent of TN pts with LMC had meningism. Post recurrence survival was shorter in TN patients (3.61mo vs 4.89mo to [HR+, HER2-] vs 5.95mo to [HR+/-, HER2 +; P=0.044] and in patients with meningism (1.38mo vs 5.26mo; P=0.02). Cox regression identify meningism as a risk factor for survival in patients relapsed with LMC (HR: 4.33; P=0.066). Conclusions: Meningism seems to be the only sign related to poor prognosis in patients relapsed with LMC.
Retrospective analysis of the use of GCSF and its impact on dose-response effect for anthracycline plus taxane-based schedules in early breast cancer.
Authors: Bermejo Begona , Perez-Fidalgo Jose Alejandro , Chirivella Isabel , Catoira Isabel , Martinez Patricia , Contel Estela , Lluch Ana 
Published: March 2020

e11523 Background: Previous studies have confirmed that prophylactic GCSF significantly reduced the incidence of febrile neutropenia. Less is known about its impact on the dose-density administered in taxane-based schedules. The objective of this observational, retrospective database analysis was to evaluate the relative dose-intensity (RDI) achieved in a non-selected population in whom GCSF was administered under clinician criteria according to guidelines. Methods: Early breast cancer (stage I-IIIA) patients diagnosed from January 1999 through December 2006 and considered candidates for adjuvant anthracyclines and taxanes were included. RDI administered was measured by the number of delayed cycles as well as by the number of delayed days. GCSF was considered to have been administered even if it was given in only 1 cycle, as primary or secondary prophylaxis, or to treat neutropenia. Results: 231 breast cancer patients were included. Patients had a median age of 59 years (26-80) of whom 52% had stage III cancer. Most patients had tumors positive for hormonal receptors (83%) and 7% of tumors were considered triple negative. Adjuvant schedules administered included docetaxel (68%) or paclitaxel (32%) plus anthracyclines. GCSF was given to 40% of patients, as primary (60%) or secondary prophylaxis (31%), as well as to treat neutropenia (9%). Prophylactic GCSF was mostly given in schedules with docetaxel and anthracyclines such as TAC (85% of patients). Overall, 5 patients (2%) received <85% of the RDI, 23 (10%) delayed 1 cycle and 15 (7%) delayed ≥2 cycles, and 5 (2%) showed a delay of ≥15 days. 5 and 10-year DFS rates were 0.88 (95% CI: 0.84-0.92) and 0.80 (95% CI: 0.72-0.87), respectively. No differences in terms of DFS between patients with <85% vs. ≥85% of RDI were found (p=0.695). Conclusions: With adequate use of GCSF in patients treated with taxane-based schedules, 98% of patients achieved a RDI ≥85%. Schedules with docetaxel or given concurrently with anthracyclines were more likely to receive GCSF. This study was partially funded by Amgen SA.
Local treatment of breast in de novo stage IV breast cancer patients.
Authors: Chen Peng-Yu , Cheng Skye H Hong-Chun 
Published: March 2020

e11526 Background: Stage IV breast cancer is an incurable disease. Systemic therapy is usually the main treatment for these patients. Locoregional therapy, such as surgery or radiotherapy, is controversial. Recent studies suggested locoregional treatments of the primary breast cancer can provide some benefit for these patients. Methods: We conducted a chart review of de novo stage IV breast cancer patients at a cancer center hospital in TAIWAN from 1990 to 2008. A total of 276 patients were reviewed and 268 patients met the inclusion criteria. Tumor characteristics, anti-tumor treatments and survival were analyzed. Results: The median survival of 268 patients was 21.5 months. We divided these patients into two groups. There were 140 patients with less than 21.5 months of survival and 128 patients with more than 21.5 months of survival. In univariate analysis, infiltrating ductal carcinoma (p=0.002), ER-positive (p<0.0001), PR-positive (p<0.0001), and no overexpression of HER2 (p=0.0125) were associated with longer survival. The clinical primary tumor size (p=0.11) and positive axillary lymph node involvement (p=0.61) were not different significantly between two groups. About metastatic site, patients with liver mets (p<0.0001) and lung mets (p=0.025) were associated with shorter survival. Bone mets (p=0.63) was not associated with survival. Patients receiving local treatment of primary tumor, including surgery (p<0.0001) or locoregional radiation (p=0.0034), had longer survival. In multivariate analysis, patients who received surgery of primary breast cancer (HR=0.52, p=0.0006) or received systemic chemotherapy (HR=0.47, p=0.002) had better survival. In subgroup analysis, patients without liver metastasis who received surgery of primary breast cancer had longer overall survival significantly (p<0.0001). In contrast, surgery to the primary breast cancer had no benefit in survival (p=0.91) in patients with liver metastasis. Conclusions: Our institutional experience suggests locoregional treatment for primary breast cancer appear to be beneficial for de novo breast cancer patients, especially those without liver mets.