bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling the consequences of recurrences after trastuzumab treatment of HER2+ early-stage breast cancer.
Authors: Doan Quan V. , Martin Miguel , Lalla Deepa , Halperin Marc , Bryce Richard , Danese Mark D. , Moy Beverly 
Published: May 2019

e12032 Background: The study objective was to estimate the long-term consequences of recurrences following treatment with trastuzumab (TRA) among women with HER2+ early stage breast cancer (BC) in the United States (US). Methods: A simulation model was constructed to estimate the following outcomes for each combination of hormone receptor (+/-) and nodal (+/-) status: number of recurrences, direct medical cost and indirect cost attributed to recurrences. The number of women aged ≥18 years with newly diagnosed HER2+ BC between 2018 and 2037 was estimated using SEER incidence rates (assumed constant over time) and from US Census data and accounted for the proportion of women utilizing adjuvant TRA by nodal status and age (assumed constant over time). The recurrence rate to any regional, distant or contralateral site was based on the long-term follow-up of the HERceptin Adjuvant (HERA) trial (expected 20-year recurrence proportions of 27.6% for TRA and 36.7% without TRA). Medical and pharmacy costs due to a recurrence were based on a 3-year study of metastatic BC patients treated with HER2 targeted agents. Beyond year 3, cost increased by 4.5% per year. The indirect costs of recurrences included loss of income from early retirement valued at the mean hourly wage, work absenteeism ($6,960/year), and reduced productivity while at work ($3,456/year). Non-cancer related mortality was estimated using SEER data. Results: We estimated that there would be 411,373 incident cases of early stage BC who would receive adjuvant TRA treatment from 2018 to 2037. Following each annual cohort for 20 years, we estimated that there would be 112,700 recurrences after TRA treatment and 149,674 recurrences without TRA treatment. The 20-year direct medical costs of recurrences were estimated to be $28.2 and $37.5 billion with and without TRA, respectively and the indirect costs were estimated to be $4.1 and $5.6 billion with and without TRA, respectively. Conclusions: Although TRA reduced recurrences by 25% in our 20-year model, there was a substantial number of recurrences. Future research will assess the clinical and economic impact of newer HER2 directed therapies in the adjuvant (pertuzumab, T-DM1) and extended adjuvant (neratinib) setting.
Impact of delaying initiation of adjuvant chemotherapy and trastuzumab in patients with early-stage HER2-positive breast cancer.
Authors: Fried Georgeta , Strulov Shachar Shlomit , Anani Sapir 
Published: May 2019

e12033 Background: About 20% of breast cancers harbor an amplification and/ or overexpression of human epidermal growth factor receptor 2 (HER2).The treatment of HER2-positive BC combined of chemotherapy and Trastuzumab, results in reduction of disease recurrence in half. However, the optimal timing for adjuvant chemotherapy initiation is unclear. Methods: Retrospective chart review of 226 HER2-positive early-stage BC patients diagnosed between November 2002-May 2014 treated with adjuvant chemotherapy and Trastuzumab was obtained. Patients' average age was 54 years. Bivariate and multivariate analyses were performed to assess optimal timing for treatment initiation from primary diagnosis (obtained by tissue biopsy) and surgery. Primary endpoint was disease recurrence (locoregional/distant metastases). Other analysis included disease free survival (DFS), breast cancer specific survival (BCSS) and overall survival (OS). Results: Among 226 patients, 28 patients (12% of all patients) started Trastuzumab more than 36 weeks from primary diagnosis. The influence of a delay in treatment initiation was more profound as risk factors' number (e.g. stage, histopathological grade, positive lymph node status) increased, particulary with positive lymph nodes or a higher stage. 5-year disease free survival rates (DFS) in patients who had started Trastuzumab within than 36 weeks from diagnosis were: 93% in patient with 0-1 risk factors; 75% in patients with 2 risk factors; 77% in patients with 3-4 risk factors, and DFS rate dropped to 50% when Herceptin was initiated more than 36 weeks from diagnosis in patients with 3-4 risk factors. A higher disease recurrence rate (HR = 3.2 , p= 0.005,) was found in this subgroup, with highest negative impact in patients with stage III BC. A delay of more than 12 weeks from primary diagnosis to chemotherapy initiation in specific subgroups was attributed to a worse prognosis. The influence of treatment delay was more profound in patients with higher number of risk factors (e.g. stage, grade, positive lymph node (LN) status), particularly with positive LN or a higher stage. Conclusions: Delay in Trastuzumab initiation has a crucial negative influence upon DFS and OS rates, especially in specific subgroups with more risk factors. Delay of more than 12 weeks from primary diagnosis obtained by tissue biopsy to chemotherapy initiation may be associated with a worse prognosis.
Impact of chemotherapy sequence on the efficacy of scalp cooling devices for alopecia prevention.
Authors: Peña-Curiel Omar , Garza-Ledezma María Alejandra , Díaz-Pérez Héctor , Martinez-Cannon Bertha Alejandra , Canavati-Marcos Mauricio , Cardona-Huerta Servando , Villarreal-Garza Cynthia 
Published: May 2019

e12034 Background: The use of scalp cooling devices (SCD) has been widely adopted for prevention against chemotherapy-induced alopecia (CIA). However, efficacy of SCD varies between different chemotherapy (CT) regimens. The aim of this study was to evaluate the effectiveness of SCD in breast cancer patients with different CT regimens treated in a tertiary cancer center in Monterrey, Mexico. Methods: All consecutive patients who used SCD were included. Data regarding treatment regimens and efficacy outcomes were prospectively collected. A descriptive analysis was performed to compare the effectiveness among the different CT regimens and sequences used. Results: We included a total of 49 patients with SCD usage from July 2016-January 2019. Table summarizes SCD efficacy, toxicities and CT regimens. In our study, 76% of patients had grade ≤1 CIA using SCD. 35% withdrew SCD use, with hair loss being the most common reason. 58% of patients who received upfront anthracycline-cyclophosphamide (AC) experienced grade 2 CIA. In contrast, no patients receiving taxane-only treatment had grade 2 CIA. Notably, only 3 of 16 patients (19%) who received upfront paclitaxel followed by anthracyclines developed grade 2 CIA. Conclusions: SCD proved to be highly effective in preventing grade 2 CIA with different CT regimens, including patients that received anthracycline-based regimens who started treatment with taxanes upfront. Accordingly, our results suggest that CT sequence, rather than type of CT agent may have a significant impact on the efficacy of SCD in CIA prevention. The results of larger studies are required to confirm our findings.[Table: see text]
Treatment and prognosis analysis of elderly patients with nonmetastatic triple-negative breast cancer.
Authors: Xiu Meng , Zhang Pin 
Published: May 2019

e12038 Background: Treatment of TNBC in elderly women is limited by declining functional status and life expectancy. The impact of providing less aggressive treatment remains controversial. Methods: Data from patients aged ≥65 years with non-metastatic TNBC treated at Cancer Hospital of CAMS from 2010 to 2016 were included. The clinicopathological characteristics, treatment details and long-term survival were analyzed. Results: A total of 183 patients were enrolled. The median age was 69 years, and those ≥75 years old accounted for 23.0%. Of all the patients, 75.0% had chronic comorbidities, and 88.0% were invasive ductal carcinoma pathologically. Patients in stage I, II, III were 37.7%, 41.9%, 20.8%. Stage and age influenced chemotherapy or not independently. 42.0%, 34.7%, and 10.5% of patients with stage I, II and III had no chemotherapy and the proportion of chemotherapy decreased with age. 45.3% of patients had dose reductions during the treatment. At a median follow-up of 45 months, 28 patients (15.3%) had relapsed. The median RFS of patients relapsed was 23.5 months, 71.4% occurred within 3 years after diagnosis. Kaplan-Meier survival analysis estimated that the 3-year RFS and OS were 88.8% and 96.6%, and the 5-year were 84.0% and 92.8%. Multivariate Cox regression analysis (Table) showed that ≥6 cycles of chemotherapy, clinical stage, and lymphovascular invasion influenced prognosis significantly. Most patients received chemotherapy as AC-T/AT, AC/TC/T, or PCb, and RFS of subgroups had no difference obviously, as 3-year RFS were 87.5%, 76.5%, 93.2%. Compared to patients received no or <6 cycles of chemotherapy, the 3-year RFS of patients with stage I, II, and III who received ≥6 cycles of chemotherapy increased 4.4% (95.6% vs 100%), 1.3% (93.7% vs 95.0%) and 35.7% (34.3% vs 70.0%). Conclusions: There is insufficient treatment of non-metastatic TNBC in the elderly. The proportion of patients with stage I and II without chemotherapy is up to 40%, and the overall prognosis is not inferior obviously. We need more individualized treatment strategies for elderly TNBC.[Table: see text]
Chemotherapy-associated lipid changes in breast cancer patients: A retrospective analysis from a high-volume institution in China.
Authors: He Tao , Lv Qing , Wu Yunhao , Fan Yuan , Chen Jie 
Published: May 2019

e12039 Background: Cytotoxic treatment may cause alterations in serum lipid of breast cancer patients but it remains controversial yet. The aim of this study is to investigate status of serum lipid pre- and post-chemotherapy as well as to compare lipid level alterations between different chemotherapy modalities. Methods: We retrospectively identified 1934 consecutive female patients who were surgically treated and pathologically diagnosed as breast cancer from February 2009 to December 2016 in a single institution. Results: There were 483(24.97%), 484(25.03%), 467(24.15%) and 500(25.85%) patients received AC-T, EC-T, TC and FEC chemotherapy regiment respectively. For the entire cohort, the levels of TG, TC and LDL were significant elevated in patients who received chemotherapy ( p＜ 0.01) while no significant difference was observed for HDL between pre- and post-chemotherapy. With chemotherapy regimens stratification, there were statistical significances with respect to TG, TC, HDL and LDL in AC-T, TC and FEC group between pre- and post-chemotherapy respectively ( p ＜0.05). Breast cancer patients with AC-T chemotherapy regimen increased TG value was higher than that of EC-T, TC, FEC regimens ( p ＜0.001) in premenopausal group. Moreover, utilizing of FEC regimen was associated with a significantly increased lipid level of HDL compared with the remaining regimens for both premenopausal and postmenopausal patients. Conclusions: Breast cancer patients receiving chemotherapy may carry a high risk of dyslipidemia. Therefore, regular lipid monitoring is very necessary for those breast cancer patients who receiving chemotherapy postoperatively.
Four versus six cycles of docetaxel and cyclophosphamide in early breast cancer.
Authors: Basu Aparna , Dabak Vrushali S. , Loutfi Randa , Ali Haythem Y. , Mohammed Hadi , Mahmood Sharmeen 
Published: May 2019

e12047 Background: ABC trials established the use of non-anthracycline containing regimen, docetaxel and cyclophosphamide (TC) as adjuvant therapy in early breast cancer. In clinical practice, TC is commonly used in Stage I Triple Negative (TN) and Stage I,II Hormone positive breast cancer. However, no specific recommendations exist in literature, regarding the number of cycles that can be used. i.e. TC4 vs TC6. Our aim, was to determine if TC4 is non-inferior to TC6 when used as adjuvant therapy in early breast cancer. Methods: We retrospectively reviewed 143 patients who were diagnosed with early breast cancer, between 2007 to 2017, at our institution who had received either TC4 or TC6 as adjuvant therapy. The number of cycles the patients received were based on provider preference. The two groups (TC4, TC6) were compared in regard to stage of cancer at diagnosis based on AJCC 7th edition-stratified by TNM staging for hormone positive and T staging only for TN, grade of adverse events, recurrence and death from breast cancer. Median follow up was 5 years. Results: Out of the 143, 102(71.3%) received TC4 and 41(28.7%) received TC6. Among the hormone positive, 42 were stage I and out of which 32(76.2%) received TC4 and 10(23.8%) received TC6 and there were 24 stage II patients, out of which 17(70.8%) received TC4 and 7(29.2%) received TC6. Among the TN group, there were 64 who were T1, out of which 45(70.3%) received TC4 and 19(29.7%) received TC6, while there were 12 T2 patients, out of which 7(58.3%) received TC4 and 5(41.7%) received TC6. Recurrence of breast cancer was seen in 5(4.9%) in TC4 and 3(7.3%) in TC6, p=0.569. Death due to breast cancer was seen in 2(1.9%) in TC4 and 1(2.4%) in TC6, p=0.856. Adverse events were seen in 86(84.3%) in TC4 and 39(95.1%) in TC6,p=0.078. Adverse events of Grade 3 or higher were seen in 10(9.8%) in TC4 and 11(26.8%) in TC6, p=0.09. Conclusions: In this limited series, TC4 appears to be equally effective to TC6, with fewer adverse events of any grade and lower incidence of Grade 3 or higher side effects which was statistically significant. Although the proportion of patients who received TC 4 were higher in our series, the percentage of patients who received TC6 was higher in stage II for hormone positive and T2 for TN when compared to Stage 1 and T1 respectively. We also found a higher percentage of recurrence and death due to breast cancer in TC6 which was not statistically significant and this likely a reflection of the fact that as mentioned above patient with a higher stage at diagnosis tended to receive 6 cycles as compared to 4 cycles and therefore had a higher chance of recurrence in the future.
Variations in compliance with different endocrine therapies in ER-positive breast cancer in elderly females in a rural population.
Authors: Agbisit Christian , Johnson Alexander , Robinson Kathy , Delfino Kristin , Desai Meghna R. 
Published: May 2019

e12052 Background: Compliance is a serious issue for breast cancer patients on endocrine therapy. There are various factors that may alter compliance across different age groups e.g. side effects, cognitive impairment, socioeconomic status etc. Noncompliance to therapy leads to early discontinuation and poor longterm outcome. The purpose of this study was to examine compliance rates with endocrine therapy i.e. aromatase inhibitors & tamoxifen in different age groups of geriatric breast cancer patients and determine its tolerability and impact on survival. Methods: An institutional database of a total of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 years or older at the time of diagnosis was reviewed in an IRB approved fashion. Adjuvant endocrine therapy included tamoxifen, letrozole, anstrozole and fulvestrant. Patients were further subdivided into age groups. Compliance was measured as an early termination of therapy. Fisher’s exact test was used to calculate statistical difference. Results: Out of 266 eligible patients, 221 (83.1%) were offered endocrine therapy. 216 (81.2%) accepted endocrine therapy and 5 (1.9%) declined treatment. Distribution of each therapy was as follows:Anastrozole n = 90, (33.5%), Letrozole n = 88, (32.7%), Fulvestrant n = 6,( 2.3%), Tamoxifen n = 64, (23.8%). Early termination n = 44, (21.4%). Between the ages 65-70, n = 17,(18.had an early termination or noncompliance to therapy, in the age group from 71-80 age group,n = 24,(26.4%) had an early termination, and ages 81 and above,n = 3 (12.5%) had an early termination. There were no statistical differences between Anastrozole, Letrozole, Tamoxifen & Fulvestrant (P = 0.8275, P = 0.4589, P = 0.6136). There was also no statistical difference between age groups (P = 0.2742). Overall survival was worse with early termination,n = 20 vs not n = 6 but did not reach statistical significance ( P = 0.7). Conclusions: In breast cancer patients 65 and older, age can be a factor in noncompliance. However, in our study there were no correlation between age groups and compliance or with which drug used. Tolerability was similar between each endocrine therapy, across different age groups in this geriatric breast cancer population, in a rural setting.
Correlation analysis of radiotherapy and prognosis of elderly patients with hormone receptor-positive breast cancer in different immunohistochemical subtyping.
Authors: Zhang Jin 
Published: May 2019

e12061 Background: Our study aimed to assess the effect of radiotherapy on the recurrence and survival in elderly patients with hormone-receptor-positive early breast cancer. Methods: We performed a retrospective analysis of 327 breast cancer patients who were 65 years or older with stage I-II, hormone-receptor-positive, after breast-conserving surgery and who received endocrine therapy(ET) or radiotherapy plus endocrine therapy(ET+RT). ET group was subgroup analyzed according to luminal A type and luminal B type, the same as ET+RT group. Evaluation Criterias were five-year local relapse rate(LRR),distant metastasis rate(DMR), disease-free survival rate (DFS) and overall survival rate (OS). Results: There were significant differences in five-year LRR (HR 3.33, 95% CI 1.51-7.34, P=0.0028) and DFS (HR 1.59, 95% CI 1.15-2.19, P=0.0045), but there were no significant differences in DMR and OS between the two groups. In luminal A type, there was no significant difference in five-year LRR, DMR,DFS, and OS between the ET group and the ET + RT group. In luminal B type, the difference was statistically significant in five-years LRR(HR 5.447, 95% CI 1.65-17.98, P=0.0054), DFS (HR 2.188, 95% CI 1.37-3.49, P=0.0010) and OS (HR 1.752, 95% CI 1.01-3.054, P=0.0478). In ET group, there were significant differences between luminal A type and luminal B type in five-years DFS (HR 1.841, 95% CI 1.23-2.75, P=0.0028) and OS (HR 1.763, 95% CI 1.07-2.91, P=0.0264). Conclusions: After breast-conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly early patients, but luminal A type elderly early patients can not benefit from radiotherapy. Without radiotherapy, luminal A type patients have a better OS and DFS than luminal B.
“Good Risk”: low-risk patients with ductal carcinoma in situ (DCIS) benefit from whole breast radiotherapy after breast conservation surgery (BCS)–long-term follow-up.
Authors: Niwinska Anna , Galecki Jacek , Jagiello-Gruszfeld Agnieszka Irena , Michalski Wojciech 
Published: May 2019

e12062 Background: Identification of patients group with low risk DCIS that do not require radiation therapy after BCS is still a challenge. We assessed recurrence rates in patients with „good risk” DCIS with and without radiotherapy after BCS, and subsequently compared our results with the long-term data from RTOG 9804 trial [1]. Methods: Out of 737 patients with DCIS managed between 1996-2011 at the Cancer Center Warsaw, Poland, 400 were treated conservatively. Out of those 133 were classified as „good risk” patients in accordance with RTOG 9804 trial criteria (DCIS < 2.5 cm, mammographically detected, NG1/G2 with margin = > 3 mm). 79 patients received only BCS and another 54 patients were treated with BCS and radiotherapy. Competing risk of recurrence, DFS and OS were calculated for both groups. The results were compared with the long-term observation results of RTOG 9804 trial. Results: The competing risk of recurrence after 10 years in the group treated with BCS and in patients receiving BCS with radiotherapy was 26% and 6% respectively (p = 0.013). 10-year DFS was 58% and 88% (p = 0.02) and OS was 94% and 97% (p = 0.3) respectively. Based on the ASTRO Conference 2018, 10-year recurrence risk without and with radiotherapy in RTOG 9804 trial were 9.1% and 1.7% [1]. In our study in comparison to RTOG 9804 trial results, more patients had DCIS sized 1.1-2.5 cm, excision margins of 3-9 mm and no patient received adjuvant tamoxifen. Conclusions: Similarly to the results of RTOG 9804 trial [1], radiotherapy reduced recurrence rate in “good risk” DCIS, however, in our study the recurrence rate was higher - probably due to difference in risk factors and no tamoxifen use. 1.McCormick B et al. Randomized trial evaluating radiation following surgical excision for “Good Risk” DCIS: 12year report from NRG/RTOG 9804. ASTRO October 21, 2018.
Time to surgery and overall survival after breast cancer diagnosis in a universal health system.
Authors: Eaglehouse Yvonne L , Georg Matthew W. , Shriver Craig D. , Zhu Kangmin 
Published: May 2019

e12063 Background: It is unclear whether time between breast cancer diagnosis and surgical treatment is associated with survival. In the general U.S. population, timing of treatment and clinical outcomes may be related to access to care. We aimed to evaluate the relationship between time-to-surgery (TTS) and overall survival among women with a breast cancer diagnosis in the universal-access U.S. Military Health System (MHS). Methods: Women aged 18-64 who had a pathologic diagnosis of stages I-III breast cancer between 1998 and 2007 and who received breast cancer surgery during the primary course of treatment were identified in the Department of Defense’s Central Cancer Registry and MHS Data Repository linked databases containing records through December 31, 2008. The time in days between diagnosis and breast cancer surgery was calculated as TTS. Cox regression models were used to estimate hazards ratios (HR) and 95% confidence intervals (CIs) of all-cause death associated with TTS intervals of 0 days (diagnosis and surgery on the same day), 1-21 days (≤3 weeks), 22-35 days ( > 3-5 weeks), and 36 days or more ( > 5 weeks), controlling for potential confounders. Results: Women (n = 6,033) had a mean age of 50.1 (SD 9.3) years at diagnosis and an average follow-up of 3.8 (SD 2.1) years. The multivariable HRs (95% CIs) of all-cause death associated with TTS intervals were 1.26 (0.97, 1.63) for 0 days, 1.22 (0.94, 1.57) for 22-35 days, and 1.55 (1.18, 2.03) for ≥36 days compared to 1-21 days as the reference. The higher risk of mortality for TTS ≥36 days was observed among patient subgroups stratified by surgery type, age at diagnosis, and tumor stage. It was also shown that women with same-day surgery (TTS 0 days) had a significantly higher risk of all-cause mortality compared to the reference group among those age 18-49 at diagnosis (HR 1.52, 95% CI 1.03, 2.26). Conclusions: In the MHS, we found that longer TTS is associated with poorer overall survival after breast cancer while same-day surgery may also have a higher risk of mortality in some patient groups. Our findings suggest the importance of timeliness in receiving surgical treatment and the need for future research on factors related to TTS and its potential effects on clinical outcomes.