bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of adjuvant aromatase inhibitors on bone mineral density in breast cancer patients
Authors: Lai C. N. , Correa P. D. , Alhasso A. 
Published: August 2020

e11616 Aims: It is well known that aromatase inhibitors (AI) are associated with significant reduction in bone mineral density (BMD) through suppression of estrogen production. This effect has been confirmed in several studies. It is considered important that we evaluate our patients and assess their baseline BMD in the adjuvant setting in relation to the use of AIs. Methods: 122 patients on adjuvant AI were evaluated retrospectively. AIs were used either as upfront, early switch or extended adjuvant therapy. BMD (T score for hip and lumbar spine) was evaluated using DEXA scanning at baseline and annually thereafter. Risk factors for osteoporosis were assessed prior to each scan. Results: Mean baseline T scores for lumbar spine and hip were - 0.95 and - 0.79 respectively. The corresponding T scores after 1 year of treatment were -1.06 and -0.92 respectively. This represents 10.6% and 17.4% reduction in T scores for the spine and hip. 24 patients (19.7%) required anti osteoporosis therapy on the basis of their baseline T Score and they were predominantly osteoporotic. 77 patients had chemotherapy as well and had a more significant reduction in their T scores (29% reduction at the hips) in comparison to non chemotherapy patients. Patients on upfront AIs had lower baseline mean T scores (- 0.932 at hip and - 1.119 at L- Spine) and at follow up (- 1.066 at hip and -1.165 at L spine) in comparison to those on the switch approach (baseline: - 0.666 hip, - 0.816 spine; follow up: - 0.809 hip, - 0.974 spine) Conclusions: AIs are associated with decreased BMD particularly for patients who had chemotherapy. Normal T scores at baseline are reassuring and in the absence of other risk factors probably do not require further scanning. Those with low T scores (<-1.5) will require continued follow up, however, the optimal scanning interval is not yet fully established and longer follow up is required. No significant financial relationships to disclose.
Single-center experiences of neoadjuvant systemic therapy in breast cancer: Individualization of the treatment
Authors: Gumus M. , Ustaalioglu B. O. , Seker M. , Bilici A. , Salman T. , Sönmez B. , Aliustaoglu M. , Eser M. , Salepci T. , Yaylaci M. 
Published: August 2020

e11628 Background: Neoadjuvant chemotherapy is one of the standard treatment options for patients with locally advanced breast cancer for twenty five years. In this study, we evaluate results of neoadjuvant chemotherapy in breast cancer patients. Methods: We retrospectively analyzed 68 patients with locally advanced breast cancer. Anthracycline/taxane-based chemotherapy regimens were prescribed mostly for neoadjuvant chemotherapy. Before chemotherapy was given, patients were examined for distant metastasis by radiologic methods thereafter if patient had distant metastasis, they were excluded. Patients with breast cancer received neoadjuvant chemotherapy were analyzed according to age, menopausal status, type of surgery, response to the treatment, histopathological properties and survival. After 3 to 6 cycle of chemotherapy patients were reevaluated by clinically and radiologically for response. Surgery was performed for appropriate patient thereafter adjuvant locoregional and systemic chemotherapy were continued. Results: Median age was 47 (29–43) years. 17,6 % of them were younger than 35 years and 42,6 % were premenopausal. Median follow-up time was 19 month. After 3 to 6 cycle of neoadjuvant chemotherapy 64 of patients responded to therapy (94,1 %). Breast conserving surgery was performed for 15,6 % patients. In histopathologic analysis most of patients were invasive ductal carcinoma and there was lymph node invasion for 84,9 %. Estrogen and progesterone receptor status were negative for 18,6 % of patients and cerbB2 was positive for 14,8 % of patients. Median disease free survival time was 44 month (SE: 9; 95% CI: 25–62) but median overall survival time could not be reached. Three years disease free survival rate and overall survival rate were 55,3% and 90,1% respectively. According to Cox regression analyses; we did not find any demographic and pathologic characteristic of breast cancer that is related to prognosis. Conclusions: In recent years neoadjuvant chemotherapy in breast cancer is increasingly being used for early stage disease. Further study will be facilitated establishment of guidelines for preselecting patients for neoadjuvant chemotherapy and will provide beneficial effect on treatment option and survival. No significant financial relationships to disclose.
Early-stage male breast cancer: A 10-year experience
Authors: Gercovich N. , Gil Deza E. , Russo M. , Garcia Gerardi C. , Diaz C. , Morgenfeld E. , Rolnik B. , Emina J. , Rivarola E. , Gercovich F. G. 
Published: August 2020

e11630 Introduction: Male breast cancer is very rare, representing only between 0.7% and 1% of all breast cancers, and only half of them are early stage cases. Objective: The present study has been designed with the aim of studying retrospectively the clinical onset and evolution of male invasive breast cancer patients (stages I and II) treated at IOHM between 1997 and 2008. Methods: The records of 3,000 breast cancer cases followed between 1997 and 2008 were searched, looking for male stage I and II breast cancer patients. A database was designed following the recommendations of the Directors of Surgical Pathology of the USA. The information registered encompassed: adjuvant treatments, recurrence date and date of final consultation or death. Results: Twelve pts were identified. Mean age (range)= 66 yo (50–89 yo). Tumoral type= Invasive Ductal Carcinoma 12 pt. Tumoral subtype= NOS 9 pt (75%) Apocrine 2 pt (17%) Micropapillar 1 pt (8%). Nottingham´s grade= Grade 2: 8 pt, Grade 3: 3 pt, N/A=1 pt. Stage= I= 6 pt, II=6 pt. ER (Positve= 9 pt, Negative=1 pt, N/A= 2 pt). PR (Positve= 8 pt, Negative= 2 pt, N/A=2 pt). Her2neu (0+= 3 pt, 1+= 3 pt, 2+= 2 pt, N/A= 4 pt). Surgery= Mastectomy= 11 pt, Lumpectomy 1= pt. Radiotherapy=5 pt. Adjuvance= No=2 pt, Hormonotherapy (HT)= 3 pt, Chemotherapy (CHT) = 3 pt, CHT+HT= 4 pt. Recurrence= Yes= 2 pt, No= 10 pt. Survival: Dead= 1 pt, Alive =11 pt. Mean Time To Progression= Stage I =66 months, Stage II =42 months. Global survival: Stage I =66 months, Stage II =52 months. Conclusions: 1. Twelve stage I and II male breast cancer patients were identified out of 3000 (0.4%) breast cancer cases diagnosed and followed in the past 10 years at the IOHM. 2. Mastectomy was the surgical procedure in 11 of the 12 cases 3. Ten pt underwent adjuvant treatment. 4. With a mean follow up time of 60 months, all stage I patients are alive and there were no recurrences. Two of the 6 stage II pts progressed and one died. No significant financial relationships to disclose.
Case series: Paclitaxel (P) and pegfigrastim (PF)-induced hypersensitivity pneumonitis (HSP) in breast cancer patients (pts)
Authors: Cream L. , Barochia A. C. , Sivik J. , Kass R. 
Published: August 2020

e11631 Background: P, a chemotherapeutic agent, extensively used in management of solid tumors. Although hypersensitivity reactions from P are common; HSP is rarely reported. We report 3 pts with early stage, high risk breast cancer, who developed HSP while receiving dose dense (DD) P with PF support. Methods: C#1 51 yr old woman (W) was diagnosed (Di) with triple negative (TN), infiltrating duct carcinoma (ca) with nodal metastasis. Neoadjuvant chemo (NC) with DD adriamycin 60 mg/m2 (A) and Cyclophosphamide 600 mg/m2 (C) was started. She completed 4 cycles of AC with PF 6 mg SQ given day 2 of each cycle without complications. Several days after her first dose of P with PF, she experienced dyspnea on exertion (DOE) and a non productive cough (NPC). CT of chest (CC) revealed ground glass opacity more in upper lungs, suggestive of HSP, and echocardiogram (echo) was within normal limits (WNL). She rapidly improved with steroid (S). C#2 46 yr w was Di with hormone positive, her 2 negative, infiltrating duct ca with nodal involvement. NC with DD AC followed by P was started. She completed 4 cycles of AC with minimal toxicity followed by DDP. After the third P infusion, she developed NPC with DOE. CC revealed diffuse interstitial prominence and echo was WNL. She rapidly improved with S. C#3 63 yr W was Di with 2.3 cm, TN, invasive duct carcinoma of left breast. NC with DD AC followed by P was started. After 2nd infusion of P, she developed hypoxia and cough; CC revealed diffuse groundglass opacities throughout lungs bilaterally, suggestive of HSP. She rapidly improved with S. Results: All 3 cases occurred in non-smoking pts without known lung/cardiac disease, treated with PF on day 2 of each cycle. Pts had abnormal CCs, were afebrile and responded quickly to steroids. Published DD experience (Citron et al) uses daily filgrastim (F), not the pegylated form which our pts received. We believe that HSP in these pts may be related to long acting growth factor stimulation of white cells and causing reversible HSP. Conclusions: Future prospective studies on taxanes using DD regimens should include a randomized design where pts given PF are compared to pts who receive F. No significant financial relationships to disclose.
Case report of a 27-year-old male with DCIS
Authors: Hamm C. , Coroneos C. 
Published: August 2020

e11635 DCIS in a young male is rarely reported. Our patient is a 25 year old male who presented with symptomatic unilateral gynecomastia. He presented with a strong family history of cancer on both maternal and paternal sides of his family including breast, lung (maternal) and melanoma, colon and pancreatic (paternal). His mother tested negative for BRCA1 and BRCA2. There is no information on the paternal genetic testing. He was treated with left subcutaneous mastectomy. Upon histologic review of the sample, concurrent gyecomastia and ductal carcinoma in situ was discovered. To date, only four cases of gynecomastia and DCIS have been described in younger male patients. Since only 30 - 50% of patients with DCIS eventually develop invasive cancer in the subsequent 10 - 20 years, this figure in the general population may be higher. This case underscores the importance of family history in any patient presenting with a breast mass. Patients must be made aware of the risk, however small it may be and physicians must remain cautious of malignancy in young males with gynecomastia. No significant financial relationships to disclose.
Triple negative breast cancer: Adjuvant treatment and outcome of 62 patients
Authors: Koussis H. , Scola A. , Maruzzo M. , Ghiotto C. , Orvieto E. , Bozza F. , Zavagno G. , Jirillo A. 
Published: August 2020

e11636 Background: Triple negative breast cancer (TNBC) represents around 12–20%. They are high risk in view of poorly differentiated tumor shortened survival, younger age, increased mortality rate in the first 5 years, increased risk of brain metastasis, rapid progression from distant recurrence to death of patients. To provide further insight we have undertaken a comprehensive multi year review of demographics tumor features adjuvant treatment and outcomes in this patients group. Methods: A retrospective analysis of all patients with TNBC treated by adjuvant chemotherapy between January 2000 and June 2008 was done though chart review. Results: Sixty-two patients were seen in our institution. The median age at diagnosis was 57 years (range 27–86 yrs). Forty-three patients underwent conservative breast cancer surgery, mastectomy 19 patients. All patients underwent axillary lymph nodes dissection or sentinel lymph node biopsy. The stage of the disease at diagnosis was: I in 22, IIA in 22, IIB in 8, IIIA in 4, IIIB in 2 and stage 0 in 4 patients. After multidisciplinary evaluation 58 patients received adjuvant treatment with: anthracycline based regimen in 30, anthracycline plus taxane in 4 and 24 patients were treated with Cyclophosphamide, methotrexate and 5-Fluorouracil (CMF) regimen. After median 13 months (4–71), 8 (13.7%) relapses were observed: 6 out 8 were anthracycline based regimen treated. The pattern of disease spread was: local recurrence 5, lymph node 1, liver 2 patients. The median follow-up was 25 months (range 95–1). Conclusions: Treatment options for TNBC are limited because of lack of targeted treatment. Current, old and new drugs alone or in combination (anthracycline, taxanes, platinum salts, bevacizumab, erlotinib, dasatinib, cetuximab) are used in an experimental setting. No significant financial relationships to disclose.
Pilot study with pegylated liposomal doxorubicin (PLD) and docetaxel as first-line treatment in patients with metastatic breast cancer (MBC)
Authors: Mel J. R. , Ramos M. , Cueva J. , Castellanos J. , Almanza C. 
Published: August 2020

e12002 Background: Anthracyclines (AC) and taxanes are the most active cytotoxic agents for the treatment of MBC. The use of AC is limited by their acute toxicities and by their potential to cause cumulative cardiac damage. The development of alternative formulations of AC, such as pegylated liposomal doxorubicin (PLD) with lower toxicity may improve tolerability and efficacy of AC based regimens. This study has been conducted to determine the efficacy and toxicity profiles of docetaxel and PLD as first line treatment in patients (pts) with MBC. Methods: Pts ≥ 18 years with histologically confirmed breast cancer, advanced disease, PS ≥ 60%, LVEF> 50%, adequate bone marrow, renal and hepatic function were included. No prior systemic therapy for MBC was allowed. Pts with brain metastases were excluded. Docetaxel 60 mg/m2 iv followed by PLD 30 mg/m2 iv day 1 every 3 weeks up to 6 cycles were given. Results: Thirty women with a median age of 64 years (40–81) were included. (76.7%) of pts were postmenopausal, Karnofsky PS 100 and 90 were 48% and 21% respectively, 86% of pts had ductal carcinoma. Most common sites of metastasis were lung (57%), liver (47%), and bone (43%). 20/30 (67%) of pts were pretreated, 15 (50%) pts with AC-containing regiment and 17 (57%) with radiotherapy. A total of 157 cycles (median 6, range 2–6) were administered. Median relative dose intensity was 90% for docetaxel and 88% for PLD. Over 28 pts assessable for response, overall response rate was 35.7% (95% CI: 18.0%-53.4%), all of them PR. With a median follow-up of 20.5 months, median time to progression was 8.1 months. Main grade 3 nonhaematological toxicities were PPE (27%), mucositis (27%), and asthenia (17%). No grade 4 nonhaematological toxicities were observed. Main grade 3/4 haematological toxicities were neutropenia (17%), leucopenia (10%), and thrombopenia (6.7%). 4 pts (13%) had febrile neutropenia. Conclusions: Docetaxel and PLD administered every 21 days as first-line treatment in MBC is an active schedule with an acceptable toxicity profile. No significant financial relationships to disclose.
Predictors of progression of bone metastases in breast cancer patients
Authors: El Ayass W. , Sereika S. , Van Londen G. , Brufsky A. 
Published: August 2020

e12011 Background: Breast cancer is mostly diagnosed in elderly women aged >= 65 years and they constitute about 41% of all newly diagnosed cases. Bone metastases is a very common event in these patients especially those with estrogen receptor positive subtypes.Our aim is to identify factors that may be associated with progression of bone metastases in breast bancer (BC) patients with bone metastases only. Methods: Retrospective review of medical records of 50 females with breast cancer with only bone metastases evaluated at Magee Womens Hospital in Pittsburgh, Pennsyvlania, between June 1998 and September 2007. Patients’ progression of their bone disease was followed based on serial bone scans. Candidate predictors considered included: age at breast cancer diagnosis (as a continuous variable and dichotomized at 60 years), age at metastatic BC diagnosis (as a continuous variable and dichotomized at 60 years), time elapsed between breast cancer diagnosis, and metastatic BC diagnosis, ER status, PR status, ER/PR status, HER-2 status, use of radiation, type of bisphosphonate used (since all but two patients had this: aredia use, zometa use), type of disease (IDC, ILC), and stage of disease (I, II, III, IV). Marginal modeling using generalized estimating equations assuming a binomial error distribution was used considering potential candidate predictor variables univariately and then multivariately to identify predictors of progression of bone metastases at a significance level of 0.05. Results: Based on the univariate analysis, age at BC diagnosis (p = 0.03), age at metastatic BC diagnosis (p = 0.03), and being ER+ or PR+ (p = 0.04) were positively predictive of progression, with the latter two being also jointly significant in multivariate analysis. As anticipated, treatment with bisphosphonates and radiation therapy were found to have a protective role against progression. Conclusion: We found that age as a continuous variable and ER/PR + were positive predictors of progression of bone metastases in BC patients. These findings suggest an increased need of individualized treatment especially in elderly to prevent morbidity and lower cost. No significant financial relationships to disclose.
Update of a phase II trial of bevacizumab in combination with hormonal therapy to reverse acquired estrogen independence in metastatic breast cancer patients
Authors: Falkson C. , Rossman J. , Nabell L. , Carpenter J. , Forero A. , Kim Y. , Saleh M. 
Published: August 2020

e12027 Background: Metastatic breast cancer (MBC) remains the second most common cause of cancer death in women in the US. More than 80% of breast cancers are potentially hormone responsive, but resistance eventually precludes cure. Various mechanisms of acquired hormone resistance have been postulated. Our Breast Cancer SPORE showed that increased expression of VEGF caused acquired tamoxifen resistance in MCF-7 xenografts. VEGF over-expressing MCF-7 cells displayed increased tumor growth rates and estrogen independence in vivo, and reversal of VEGF over-expression in vivo returned tumors to estrogen dependent growth. Methods: We hypothesized that adding the anti-VEGF monoclonal antibody, bevacizumab, to hormonal therapy would result in reversal of acquired hormone resistance. This multi-center, open-label, single arm phase II study was designed to evaluate safety and efficacy of this combination. Primary end point was time to progression (TTP), and the secondary endpoints were response rate and toxicity. Eligible patients had MBC and had progressed on hormonal therapy after previously responding for at least 6 months.Results: We previously reported a planned interim analysis. Results of further analysis after completion of accrual will be reported here. All 27 patients were female with median age of 63 years, and all had ER and/or PR positive MBC. Patients were continued on the same hormonal therapy to which they had become refractory, and bevacizumab (15mg/kg IV every 3 weeks) was added. Treatment was stopped early in 3 patients due to a grade 3 leg ulcer, grade 3 hypertension, and grade 3 fatigue, respectively. Overall, the therapy was tolerated well, and no treatment related deaths or thromboembolic events were seen. Stable disease was documented in 18 (66%) patients. There were no complete or partial responses. Updated median TTP will be reported. Conclusions: The combination of bevacizumab plus hormonal therapy is well tolerated in patients with metastatic breast cancer. This combination may prolong the TTP with acceptable toxicity. Further investigation utilizing this combination in metastatic breast cancer are ongoing. [Table: see text]
Patterns of care and outcomes in patients with intracranial hemangiopericytomas: The Memorial Sloan-Kettering Cancer Center (MSKCC) experience
Authors: Dankwah-Quansah M. A. , Gutin P. , Bilsky M. , Huse J. , Rosenblum M. , Abrey L. E. , DeAngelis L. , Omuro A. 
Published: August 2020

e13011 Background: Intracranial hemangiopericytomas are rare primary brain tumors with a tendency to metastasize. Available literature is restricted to small series of patients, and little is known regarding optimal clinical management and disease course, particularly in the targeted therapy era. Methods: Retrospective review of all patients with intracranial hemangiopericytoma seen at MSKCC from January 1, 1990 to December 31, 2008. Patients were included if histology was reviewed at MSKCC, and if clinical information was deemed sufficient for the analysis. Results: A total of 32 patients met inclusion criteria. The median age was 43 (range 24–68), median KPS was 80 (range 70–100), 17 were women. Disease was metastatic at presentation in only one patient. Initial treatment consisted of surgical resection in all patients (gross total resection: 14 patients, partial resection: 7, equivocal/unknown extent of surgery: 11). Adjuvant radiotherapy following surgery was given to 21 patients. The median progression-free survival was 65 months; median overall survival was 153 months and the 15-year survival was 48%. Treatment for recurrence included re-resection in 19 patients, additional radiotherapy in 17, and chemotherapy in 10. Regimens used included cytotoxic chemotherapy (6 patients) and targeted therapy (sorafenib: 3 patients; sunitinib: 3; imatinib: 2; erlotinib: 1; sirolimus: 1; bevacizumab: 1). Stable disease was the best observed response to these agents. Metastatic sites throughout disease course included lungs in 7 patients, bone in 10, liver in 3 and chest wall in 2. Immunohistochemistry and molecular analyses are ongoing and updated results will be presented. Conclusions: Hemangiopericytomas can be associated with late recurrences, even in patients completely resected and irradiated. Salvage treatment with surgery and radiotherapy seems effective, although the efficacy of chemotherapy remains to be determined. Given the slow growth rates, the meaning of stable disease while on chemotherapy is uncertain. Several patients in this series received agents targeting PDGFR or VGFR pathways, but such strategies need to be investigated further. No significant financial relationships to disclose.
Extended exposure to alkylator chemotherapy: Delayed appearance of myelodysplasia
Authors: Chamberlain M. C. , Raizer J. 
Published: August 2020

e13030 Background: Alkylator-based chemotherapy is recognized to be leukemogenic, however, it is infrequently described as a delayed consequence of anti-glioma treatment. Objective: A case series of gliomas treated with alkylator-based chemotherapy who subsequently developed myelodysplastic syndrome (tMDS) or acute myelocytic leukemia (AML). Methods: Seven patients (4 men; 3 women) ages 34–69 years (median 44), with gliomas (3 Grade 2; 4 Grade 3) were treated with surgery, all but one with involved-field radiotherapy and all with alkylator-based chemotherapy (temozolomide; 6 patients, nitrosoureas; 5 patients, both agents; 5 patients). Results: Exposure to alkylator-based chemotherapy ranged from 8 months to 30 months (median 24). The diagnosis of tMDS was determined by bone marrow biopsy in seven patients. Seven patients showed chromosomal abnormalities consistent with chemotherapy induced MDS. Three patients were diagnosed with AML as well (in two determined by bone marrow and one at autopsy). Interval from last chemotherapy exposure to diagnosis of tMDS/AML ranged from 3 months to 31 months (median 24 months). Two patients were treated with bone marrow transplantation and five received supportive care only. Five patients have died, two as a consequence of recurrent brain tumor, one as a complication of transplantation, and due due to AML. Conclusions: Although rare, induction of tMDS/AML following extended use of alkylator-based chemotherapy may become more relevant with the evolving practice to treat gliomas for protracted periods. Future work to determine at-risk patients would be important. No significant financial relationships to disclose.