bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community use of anthracyclines for adjuvant HER2-positive breast cancer (BC).
Authors: Kumar Akhil , Fishman Marc L. , Shimp William S. , Bobolts Laura Rose , Krook James Edward , Fishman Val , Davis Sharon , Huff Dinah , Anthony Carol , Walton Robert , Hrushesky William J. 
Published: March 2020

e11609 Background: Anthracyclines remain among the most active agents for the treatment of BC. NSABP B-31, NCCTG N9831 and HERA, each employing anthracyclines followed by trastuzumab in adjuvant HER2+ BC, demonstrated significant reduction in the risk of recurrence and improvement in survival. A fourth study, BCIRG-006, compared a non-anthracycline containing regimen, TCH, to an anthracycline based regimen, AC-TH. Both arms had similar overall survival, but there was a higher incidence of cardiac events in patients who received anthracycline. HER2-analyses in randomized adjuvant trials, in the pre-trastuzumab era, comparing anthracycline with non-anthracycline chemotherapy regimens, show that HER2+ BC derives greater benefit from anthracycline use. TOP2A coamplification, which occurs in 35% of HER2-positive patients, has shown a direct association with anthracycline benefit in several studies. We investigate and report, herein, the ways in which community oncologists are currently treating these patients. Methods: All treatment requests for adjuvant trastuzumab were examined, from 2009 through 2012. Chi-square analysis at 0.05α was used to test for interaction of age group to type of treatment. Results: During this span, oncologists requested adjuvant trastuzumab for 121 patients. In 10% (12/121) of patients, adjuvant trastuzumab alone, without chemotherapy and with or without hormonal therapy, was requested. Among patients who also received adjuvant chemotherapy (109), 35% (38/109), received anthracyclines. There was no relationship of anthracycline-usage with BC stage (data not shown) or patient age (Chi Sq p = 0.73). Adjuvant trastuzumab, without chemotherapy, was requested more often for the elderly (20% versus 4%; Chi Sq p = 0.003). Conclusions: Anthracyclines are utilized in adjuvant HER2+ BC in only about a third of patients, regardless of BC stage or patient age. The availability of a reliable, inexpensive, and convenient test to predict which patients are most likely to benefit from anthracyclines, over other options, would be useful. [Table: see text]
Evaluation of tobacco use and HER2 receptor expression in breast cancer in an ethnically diverse inner-city population.
Authors: Ambros Tadeu Frantz , Hansra Damien Mikael , Patel Ravi , Koru-Sengul Tulay , Zhao Wei , Miao Feng , Tannenbaum Stacey , Monedero Alicia P , Lee David J , Byrne Margaret M , Hurley Judith 
Published: March 2020

e11611 Background: Tobacco is the leading cause of preventable death in the United States and is linked to many cancers. Despite overwhelming biological plausibility and over four decades of epidemiological studies, no definite association has been established between tobacco and breast cancer. Ovarian, stomach, and uterine cancer are associated with tobacco consumption and these cancers express HER-2. Although estrogen receptor status has been looked at as a variable there has been no evaluation of the role of HER-2 and smoking in breast cancer. Methods: A retrospective review of medical records from patients treated at the University of Miami/Jackson Memorial Hospital from 1998-2012 was undertaken after IRB approval. The incidence of smoking and HER-2 expression in a population of 1255 women was evaluated. Data was analyzed by age, race, ethnic group, menopausal status, tumor stage, and ER/PR/HER-2 receptor status. Results: 1255 charts were analyzed with 1094 having full information. Median age was 56 (range 22 to 94). Smoking rates were significantly higher in Caucasian versus African American women (47.4% vs. 17.1%, P<0.01) and in Latin versus African American women (24.7% vs. 17.1%, P<0.01). Overall rate of HER-2 expression 18.1%. The rate of HER-2 expression was 21.4% in smokers and 17.0% in non-smokers (p=0.10). The rate of HER-2 expression was 10.8% in Caucasian smokers and 9.8% in Caucasian non-smokers (p=0.88); 24.5% in smokers of African descent and 17.3% in non-smokers of African descent (p=0.24); 22.9% in Latino smokers and 17.4% in Latino non-smokers (p=0.10). The rate of HER-2 /ER expression was 9.4% in smokers and 7.9% in non-smokers (p=0.42); 5.4% in Caucasian smokers and 4.9% in Caucasian non-smokers (p=0.916); 12.2% in smokers of African descent and 5.9% in non-smokers of African descent (p=0.11); 9.5% in Latin smokers and 8.8% in Latin non-smokers (p=0.77). Conclusions: We found non-statistically significant positive associations in all analyses between HER-2 expression with or without ER expression and tobacco exposure when analyzed by ethnicity. A larger number of patients needs to be investigated in order to clarify this relationship.
Pathologic complete response (pCR) to predict patients’ survival in luminal breast cancer.
Authors: Wang-Lopez Qian , Kwiatkowski Fabrice , Abrial Catherine , Mouret-Reynier Marie-Ange , Dubray-Longeras Pascale , Van Praagh-Doreau Isabelle , Radosevic-Robin Nina , Durando Xavier , Penault-Llorca Frederique , Chollet Philippe J. M. 
Published: March 2020

e11615 Background: Gene expression studies have demonstrated that breast cancer can be divided into three major subgroups : Luminal, Human Epidermal Growth Factor Receptor-2 (HER2) over-expression and Oestrogen negative (ER-). Luminal breast cancer is well known for its better prognosis compared with the other types. Conversely, response is less effective by pCR criteria after chemotherapy. This work aimed to evaluate if pCR could still be considered as a surrogate marker in luminal subgroup according to immunohistochemical classification : Hormonal receptor positive and HER2 negative (HR+HER2-). Methods: All 132 luminal early breast cancer patients treated by neo-adjuvant chemotherapy (NAC), in our institution from 2001 to 2007 were included in this study. NAC treatment comprised anthracycline alone, taxotere alone or sequential use of these two drugs. Survival curves have been established according to the Kaplan-Meier’s method. Comparison of curves were performed in using Log-rank test. The median of follow-up was 102 months (range 59 – 142 months) in October 2012. Results: Median age was 53.5 (range 34–78) years and median initial tumor size was 4cm (range 1-10). Objective response rate was 65% (86 patients), of which 8% (10 patients) had a complete response after 6 courses. One hundred and six (80%) underwent breast conservation surgery. Seven patients (5%) and ten patients achieved pCR (8%) according to Chevallier and Satatloff’s classification, respectively. Twenty patients did relapse and 18 patients died. At 10 years, Disease-free survival (DFS) and overall survival (OS) rate was 81% and 84%, respectively. All pCR patients, regardless of classification, did not relapse. However, the patients who achieved a pCR had not a significant difference in DFS and OS compared to the patients who did not. Conclusions: pCR was not a surrogate marker after a relatively short survey of 100 months for luminal breast cancers, who have generally late relapses. However, sixty five percent of patients had >50% reduction in primary tumor and 80% of patients had a breast conservation. Further studies are needed to identify new markers able to predict patients’ survival.
ABCG2 as a potential cancer stem cell marker in breast cancer.
Authors: Tiezzi Daniel Guimaraes , Sicchieri Renata D. , Mouro Larissa R. , Oliveira Tatiane M. G. , Silveira Willian A. , Antonio Heriton M. R. , Muglia Valdair Francisco , de Andrade Jurandyr Moreira 
Published: March 2020

e12007 Background: The identification of cancer stem cell (CSC) markers gives opportunity to develop new target therapies. ABCG2 protein is reported as a predictive marker for breast cancer resistance to chemotherapy and as a potential marker for CSC in solid tumors. Methods: We included prospectively 41 patients with locally advanced or metastatic (LAMBC) invasive ductal carcinomas treated with NACT. The expression of CD44/CD24 and ABCG2 was analyzed by flow cytometry after fresh tumor sample digestion. The mammosphere assay (Mammocult) was carried out in 23 samples. We analyzed the correlation between the percentage of ESA+/ABCG2+ and ESA+/CD44+/CD24- cells within the primary tumor with the number of spheres in culture and their relationship with clinical and pathological parameters. ABCG2+ and ABCG2- cells from four primary tumors and from MDA-MB231 cell line were sorted and cultured in triplicate in Mammocult medium for 7 days. The ability to form sphere was analyzed. Patients’ mean age was 52.8 ± 10.3 yo. The ER, PgR and HER2 positive expression rates were 65%, 58% and 45%, respectively. Patients were treated with docetaxel/anthracycline combination (n = 33) of FEC75 combination (n = 8). Results: Complete pathological response was observed in 10 patients (24%). ER negative patients and patients with lower percentage of ABCG2+ cells within the tumor were more likely to achieve near pCR (44% versus 11%, p = 0.04; and 50% versus 14%, p = 0.04, respectively). We did not observe a significant association between pCR and PgR and HER2 expression or the percentage of CD44+/CD24- cells within the tumor. There was a strong correlation between the percentage of ESA+/ABCG2+ cells and the number of mammospheres in culture (r = 0.63; p= 0.0007). This correlation was not significant comparing to CD44+/CD24- cells. Additionally, ABCG2+ cells from primary tumors and MB-231 cell line form a higher number of spheres in culture than ABCG2- (mean difference = 1.15±0.45 /1000 cells, p = 0.04; mean difference = 0.48±0.04 /1000cells, p = 0.008, respectively). Conclusions: ABCG2 is a potential marker for CSC in breast cancer, and the percentage of ABCG2+ cancer cells within the tumor is a predictive factor for pCR in LAMBC patients subjected to NACT.
Prognostic factors influencing the selection of bevacizumab combined with chemotherapy in patients with HER2-negative metastatic breast cancer in routine clinical practice: Oncosur-Avalox—Observational cross-sectional study.
Authors: Manso Luis , Garcia-Palomo Andres , Perez-Carrion Ramon , Chacon Jose Ignacio , Mielgo Rubio Xabier , Gallegos Sancho Isabel , Cassinello Javier , Llorente Rosa , Calvo Elena Galve , Llorca Cristina , Alvarez Inaki , Fernandez Antonio , Catalan Gustavo , Garcia Lopez Maria Jose , Torregrosa Maria Dolores , Blanco Esperanza , Bueno Coralia , Perello Antonia , Méndez Miguel , Cortes-Funes Hernan ,   on behalf of ONCOSUR Study Group
Published: March 2020

e12020 Background: Combining bevacizumab (BEV) with chemotherapy (CT) improves survival in HER2-negative metastatic breast cancer (MBC). We investigated the influence of age, ECOG, hormonal status, number of sites, location of metastases and patient decision on the selection of BEV combined with CT in MBC. Methods: Observational cross-sectional multicenter study in patients with HER2- negative MBC who have received first-line CT with BEV. Results: 219 patients were included: median age 51(44-63) yr; ECOG: 0=53%; 60.4% pre-menopausic; 23.9% triple-negative (TN);76.2 % hormone receptor positive (HR+).Metastatic disease: ≥3 sites=39.2% (TN: 22%; HR+: 43.9%); location: 45.2% bone, 37.4% liver, 30.1% lung. Most frequent BEV combinations were paclitaxel/BEV(60.7%) and docetaxel/BEV(12.8%); median no. of CT cycles: 6 (5- 8). A disease-free survival (DFS) ≥12 months was achieved by 82.8%; TN: 78.9%; HR+: 83.3%. Overall response rate (ORR) was 62.7%: 53.6% partial response (PR), 9.1% complete response (CR); 25.4% stable disease (SD) and 7.2% disease progression (4.8% non evaluated). TN:ORR 54.2% (47.9% PR), clinical benefit 80% (27.1% SD); HR+:ORR 65.8% (55.7% PR), clinical benefit 89.9% (24.1% SD). 66.2% presented at least one toxicity, mainly grade 1-2; 32% BEV-related: only 3 grade 3 toxicities; no grade 4. Receiving adjuvant hormonal therapy was associated to DFS ≥12 months (p<0.05). ER+ tumors (OR:0.326;95%CI:0.16-0.65;p=0.002) and patient decision after consider doctor opinion (OR:0.026;95%CI:0.01-0.74; p=0.085) were independent factors associated with the selection of paclitaxel-BEV in the overall population (TN or HR+). Liver metastases were significantly related to paclitaxel-BEV administration (p<0.01). Conclusions: First-line CT with BEV is an effective and safe scheme for patients with TN and HR+ MBC. ER+ tumors and patient decision after consider doctor opinion were identified as independent factors for the selection of paclitaxel-BEV therapy. The presence of liver metastases was significantly associated to the administration of a paclitaxel-BEV regimen.
Long-term outcomes of post-mastectomy radiation therapy in the setting of neoadjuvant chemotherapy for locally advanced breast cancer.
Authors: Wong Winnifred M. , Korde Larissa A. , Roberts Toni K. , Arnett Andrea L. , Mart Dylan A. , Barnes Brie S. , Neradilek Moni B. , Polissar Nayak L. , Amlag Joanne O. , Kim Janice N. 
Published: March 2020

e12030 Background: The role of post-mastectomy radiation therapy (PMRT) after neo-adjuvant chemotherapy (NCT) in those with T3N0 disease, younger age, and different tumor subtypes is unclear. Methods: We conducted a single institution, retrospective analysis of patients treated with NCT and mastectomy from 1985-2010. The primary objectives were to (1) assess the association between PMRT and long-term outcomes, and (2) describe outcomes and practice patterns based on tumor subtype, pathologic response, and age at diagnosis. Secondary objectives were to analyze the benefit of PMRT in those with favorable tumor subtypes, cT3N0 disease, and patients younger than 40. Log-rank test and Cox regression was used to test the association of predictors with outcomes. IRB approval was obtained. Results: Of 131 evaluable patients, 115 (88%) received PMRT. Mean±SD age was 48±10 years (range 29-79). Of patients <40 years of age (n=33) 88% received PMRT. At diagnosis, 69.5% were cT3; 53.5% were cN1; 12.3% were cT3N0. Seventy-eight percent of patients received anthracycline-based NCT and 52% received both anthracycline and taxane NCT. Twenty-eight percent of all patients achieved pCR. With a median f/u of 39 months (range 8-177), 30.5% of patients had a recurrence event (6.9% local, 5.3% nodal, 16.8% distant). Ten year OS and DFS for all patients were 56.7% (95% CI, 43.5-73.8) and 66.1% (95% CI, 52.3-83.5), respectively. Those with pCR had a non-significant trend toward better outcome, with 10 year OS=68.0% vs. 54.0% (p=0.7); DFS=70.2% vs. 65.2% (p=1.0). In the Cox regression analysis, pathologic T-stage, triple negative disease, and tumor grade were significantly associated with OS; triple negative disease was also predictive of DFS. Benefit of PMRT was not analyzable in cT3N0 due to small numbers. Conclusions: Most patients had PMRT, with outcomes on par with historical data. Most patients <40 years received PMRT, with no events for the non-PMRT cohort most likely due to selection bias. Unfavorable subgroups were not more likely to receive PMRT, but of those who did, only triple negative was predictive of outcome. A future non-PMRT matched cohort study is necessary to further elucidate the role of PMRT.
Microdochectomy for pathologic nipple discharge.
Authors: Baldota Sanjay Zumberlal , Lai Lee Min , Raymond S P , Thomson Simon David 
Published: March 2020

e12032 Background: Nipple discharge has a known association with breast cancer, determing which cases to identify as being at high risk is a complex task for the clinician. The current policy at West Herfordshire hospital NHS Trust is to offer microdochectomy to all women who present with unilateral single duct nipple discharge, dominant duct discharge, or peristent duct discharge. The aim of this study was to determine if on basis of the pattern ofnipple discharge, patients could be subselected for microdochectomies, and to create a base line to allow future subselection of patients for survillience only. Methods: All patient with single duct unilateral spontaenous nipple discharge, who underwent microdochectomy, were assessed. Demongraphics, clincial presentation, radilogical assessment, cytology, core biopsy. This group of patients was anlysed and correlated with their final histological assessment. Results: 122 patients were analysed in this study. 7 ( 5.74%) were diagnosed with carcinomas. 4patients had ductal carcinoma in situ, three patients had dutcal carcinoma in situ and invasive ductal carcinoma, of these two patients had blood stained nipple discharge. two other patients had papillary carcinomas, one patient of these two had blood stained nipple discharge. 47 out of 122 patient presened with history of blood statined discharge,30 were negative for cytology, two patients had (ductal carcinoma in situ with Invasive ductal carcinoma and papillary ca) at final histololgy. 17 of the 47 showed cellular cytology.and one patient had intermediate grade DCIS confirmed on final histology, whereas in the remaining sixteen patients histological feaatures of papillomas, duct ectasia, and benign breast disease was noted. Of the 122 patient 42 patients had mammary duct ectasia (34%), 52 patients had papillomas (42%) at final hisotology. Conclusions: The negative predictive value (2/30), appears in this series appreas to be more valuable than, the positive predictive value (1/17) in cellular smears to predict ductal carcinoma or invasive ductal carcinoma. Cytological assessment of nipple discharge is equivocal at its best. Microdochectomy perford for nipple discharge results in a low rate of malignacy on excision and is comparable with other series.
Off-label capecitabine, eribulin, or ixabepilone use in metastatic breast cancer (MBC).
Authors: Bobolts Laura Rose , Kumar Akhil , Fishman Marc L. , Shimp William S. , Krook James Edward , Fishman Val , Davis Sharon , Anthony Carol , Walton Robert , Huff Dinah , Hrushesky William John Michael 
Published: March 2020

e12034 Background: Anthracyclines and taxanes have proven to be the most effective treatments for MBC. The FDA indications for capecitabine, eribulin, and ixabepilone recommend prior anthracycline and taxane therapy, unless contraindicated. The proportion of patients who receive these drugs after having received an anthracycline and/or taxane is unknown. We retrospectively reviewed capecitabine, eribulin, and ixabepilone treatment requests to examine the utilization patterns, specifically in relation to prior anthracycline and/or taxane therapy. Methods: All capecitabine, eribulin, or ixabepilone requests for MBC from 2009 through January 2013 were reviewed. The proportion of requests for these agents with and without FDA stipulated prior therapies were contrasted, using Chi squared analyses. Results: 36 MBC requests were identified for capecitabine, eribulin, or ixabepilone. The majority (67%) of these occurred among patients who had no documentation of prior anthracycline therapy. 36% of all requests were not preceded by any documented taxane therapy. Anthracyclines were avoided more frequently than taxanes (p=0.011). All requests without documentation of prior taxane use (36%; 13/36) were also made without prior anthracycline use. Oncologists were more likely to initiate capecitabine without prior anthracycline and taxane, as compared to eribulin or ixabepilone (64% v 18% v 18%, respectively; p=0.042). Conclusions: In our sample, more than two thirds of MBC treatment requests for eribulin, capecitabine, or ixabepilone occurred prior to a request for an anthracycline, and more than a third prior to receiving a taxane. Since, in general, it is considered standard of care to use the most active drugs early in the course of disease, this trend could have negative effects upon the optimal control of MBC. [Table: see text]
Disease and treatment characteristics of breast cancer in an urban, low-income hospital following a major hurricane: A temporal and racial analysis.
Authors: Gadinsky Naomi , Keeport Melissa Lina , Shin Adeline Jae Hyun , Srivastav Sudesh , Kruse-Jarres Rebecca 
Published: March 2020

e12503 Background: The Medical Center of Louisiana, New Orleans (MCLNO) serves a metropolitan area and is the only hospital delivering care to the indigent population in the area. Hurricane Katrina devastated New Orleans on 8/29/05. No oncology services were available for two years. We examined characteristics/care for patients with breast cancer 2 years after re-opening clinics compared with the subsequent 2.5 years. Differences between Whites (W) and African Americans (AA) were examined and compared to state and national averages. Methods: After IRB approval, we reviewed charts of patients establishing care for breast cancer at MCLNO between 09/07-05/12: Group 1 (09/07-08/09) vs. Group 2 (09/09 – 05/12). Racial analysis was done between W and AA independent of temporal factors. Results: Our cohort included 153 patients (25 W, 105 AA , and 23 other race): Group 1- 68 patients, Group 2- 85. There were no significant temporal or racial differences in age, race, insurance, menopausal status, family history, cancer type, stage, or treatment regimen. More AA were triple negative (25.5% AA, 0% W; p= 0.002). Compared to state and national averages, our patients underwent more mastectomies: 58% mastectomy (M) and 42% lumpectomy (L) - compared to Louisiana (M - 50.7%, L - 48.7%) and the National (M - 42.0%, L - 57.8%) data. Our cohort presented with more advanced disease: 10.5% presented with stage IV breast cancer, which is higher than the state average (6.0%) and the national average (5.5%). Conclusions: Despite the suspicion that tumor presentation would be worse after a delay in access to care due to Katrina and that AA might have even worse characteristics, our data showed this not to be the case. Interesting was the finding that triple negative cancers seemed to be an AA phenomenon. It is important to continue following these patients to see how these presenting and prognostic factors will affect long term patient outcomes. [Table: see text]