bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and clinical profile of breast cancer in central Nepal: A single institutional experience.
Authors: Shakya Sachin 
Published: September 2018

e12008 Background: In this study, our objective was to determine the epidemiological and clinical profile of Breast Cancers. Different Literatures have highlighted the correlation between stage and age at diagnosis, size and age at diagnosis, correlations of different hormone receptor status with different age group etc. But precise documentation is lacking in Nepal. Methods: The study was conducted at department of Medical Oncology, Nepal Cancer Hospital and Research Centre from Dec 2014 to June 2016 and 183 patients diagnosed with breast cancer were enrolled. A retrospective cross-sectional study was conducted. Results: Prevalence of Breast Cancer was 5.59 %. Newar was the most affected ethnic group. The most frequent age group was 40 to 49. The most common symptom was mass in 80 % of patients. Stage II (49.1 %) was the most common stage at diagnosis. 83% patients had a tumour size of 2-5 cm with average size of 3.25 cm at presentation. Younger women with cancer had a strong correlation with ER-ve/PR-ve and Her-2/Neu +ve receptor status with P<.005. Triple Negative receptor status was 32.87%. Her2/neu +ve receptor status cancer was 39.72%. Conclusions: Majority of patients presented with Stage IIa and IIIa disease breast cancer. Disease is more aggressive and diagnosed at a more advanced stage in younger women. Younger women had a strong correlation with ER-ve/PR-ve and her-2/neu +ve receptor. Recommendation for the Her-2/Neu receptor test should be done in every case of breast cancer. Triple negative status was lower in comparison to the previous studies which is favourable for hormonal antibody treatment implementation.
A retrospective study of 21-gene recurrence score assay compared with clinicopathological markers in node-negative, hormone receptor-positive, HER2-negative breast cancer.
Authors: Chen Junqing , Wang Xiaojia , Chen Zhanhong 
Published: September 2018

e12023 Background: The 21-gene recurrence score assay is a validated genomic predictor of cancer recurrence and the benefits of adjuvant chemotherapy in hormone receptor-positive, HER2-negative early breast cancer patients. However, the assay is rather expensive and complex, and many patients in our country can not afford it. We performed a retrospective study to evaluate the association between traditional clinicopathological features and 21-gene recurrence score in patients with node-negative, hormone receptor-positive, HER2-negative breast cancer. Methods: A total of 76 consecutive patients with node-negative, hormone receptor-positive, HER2-negative breast cancer who underwent 21-gene recurrence score testing in our hospital from 2015 to 2016 were enrolled. Data including age, tumor size, histological type, tumor grade were collected. Estrogen receptor (ER) expression, progesterone receptor (PR) expression, Ki-67 index, p53 and androgen receptor (AR) expression were detected by immunohistochemical assay. 21-gene recurrence score assay was performed by RT-PCR. The correlation between clinicopathological characteristics and 21-gene recurrence score assay was analyzed by using nonparametric tests. Results: Among the 76 patients, 43 (56.6%) had a low recurrence score of < 18, 13 (17.1%) had an intermediate recurrence score of 18-31, and 20 (26.3%) had a high recurrence score of ≥31. There was a significant difference in recurrence score in patients divided by PR expression ( P=0.027). Patients with low PR expression (<20%) had a higher recurrence score as compared to those with high PR expression. Tumor grade was observed to be significantly correlated with recurrence score ( P=0.004). No significant associations were found between recurrence score and age, tumor size, histological type, ER expression, Ki-67 index, p53 or AR expression in this study. Conclusions: Our study shows that low PR expression is associated with higher 21-gene recurrence score, and PR expression may be a promising predictor of 21-gene recurrence score assay in node-negative, hormone receptor-positive, HER2-negative breast cancer patients.
Rates of trastuzumab-associated cardiotoxicity in patients with HER2-positive breast cancer at a tertiary cancer centre.
Authors: Kumar Tyagi Nidhi , Arora Roochi , Partridge Arun , Tharmabala Mithula , Mukherjee Som , Leong Darryl , Dhesy-Thind Sukhbinder K. 
Published: September 2018

e12030 Background: Human epidermal growth factor receptor 2 ( HER2) is overexpressed in 15-25% of breast cancers and associated with decreased rates of survival. Trastuzumab (TZ) is a humanized monoclonal antibody that binds against HER-2 and improves both disease free and overall survival in the adjuvant setting. A side effect of TZ is reversible cardiotoxicity(CT), which can lead to early termination of TZ. The rates of TZ associated CT seen in trials range between 1-16%. These rates may not be representative of clinical practice. Our aim is to identify the rate of TZ-associated CT and the rate of early discontinuation of TZ associated CT at the Juravinski Cancer Centre (JCC), in Hamilton, Ontario. Methods: Patients treated with adjuvant TZ between 2006-2013 at JCC were identified using JCC pharmacy data and included in this audit. We examined patient charts for relevant clinical-pathologic variables, cardiac Results: Results are shown in the table below. Conclusions: In conclusion, we found that rates of CT were higher at JCC than in clinical trials. This is not unexpected as patients with known cardiac risk factors and history of cardiac disease were excluded from most clinical trials. Strategies to optimize cardiac risk factors and management of CT are needed. We have opened a cardio-oncology clinic at JCC and initiated a clinical trial examining the feasibility of ongoing TZ therapy in the setting of mild DLVEF. [Table: see text]
Long-term safety and survival outcomes from the Scandinavian Breast Group 2004–1 (SBG 2004-1) randomized trial of tailored dose adjuvant chemotherapy for early breast cancer.
Authors: Matikas Alexios , Margolin Sara , Hellstrom Mats , Johansson Hemming , Bengtsson Nils-Olof , Carlsson Lena , Edlund Per , Karlsson Per , Lidbrink Elisabet , Linderholm Barbro Kristina , Lindman Henrik , Malmstrom Per , Villman Kenneth Karl , Foukakis Theodoros , Bergh Jonas C. S. 
Published: September 2018

e12036 Background: Although adjuvant polychemotherapy (ACT) improves outcomes for early breast cancer (BC), the significant interpatient variability in pharmacokinetics result in differences in efficacy and both short and long term toxicities. Dose tailored ACT has been shown to improve outcomes, while tailored and dose dense therapy improved 5-year event free survival in the phase 3 PANTHER trial. Methods: The SBG 2004-1 trial was a randomized feasibility/phase II study which assessed dose tailored epirubicin and cyclophosphamide (EC) followed by docetaxel (T), compared to the same fixed dose schedule and to the TAC regimen (table 1). Women aged 18-65 years old, ECOG PS 0-1 with at least one positive lymph node were randomized 1:1:1. The primary endpoint of the study was the safety and feasibility of the administered treatment. The secondary endpoint of the study was to evaluate the dose-intensity of the treatment. Toxicity was graded according to CTC-AE version 3.0. The design and short-term safety results of the trial have been previously published. Here, we report safety and efficacy data after 10 years follow-up. Results: A total of 124 patients were included and >95% of patients without relapse were followed for 10 years.Five secondary malignancies but no myelodysplastic syndrome / acute myeloid leukemias were reported. Long term disease-free and overall survival results will be presented at the meeting. Conclusions: Long term safety results from this study in combination with efficacy results from the PANTHER trial imply the feasibility of a tailor-based approach for ACT in early BC. [Table: see text]
Use of a web-based app to improve breast cancer symptom management and aromatase inhibitor adherence: A pilot randomized controlled trial.
Authors: Graetz Ilana , McKillop Caitlin N , Stepanski Edward J. , Vidal Gregory A. , Schwartzberg Lee Steven 
Published: September 2018

e12044 Background: For postmenopausal women with hormone receptor-positive breast cancer, use of aromatase inhibitors (AI) significantly reduces the risk of cancer recurrence and improves survival, but many patients are nonadherent due to adverse side effects. We conducted a pilot randomized controlled trial of a web-enabled application (app) to provide real-time symptom monitoring between visits and facilitate management of treatment-related adverse symptoms among patients with hormone receptor-positive breast cancer and a new AI prescription. Methods: Patients were randomized into two groups: (1) App+Reminder: had access to the app and received weekly reminders via text or email to use it, or (2) App: had access to the app but did not receive reminders. The app asked patients about their AI use in the last 7 days and about new symptoms related to the treatment. New symptoms with severity in a clinically-relevant range or AI nonadherence triggered email alerts to the patient’s providers. The main analyses compared AI adherence and changes in quality of life. Results: We enrolled 44 patients, 21 in the App+Reminder and 23 in the App group; 83% of patients approached agreed to participate, 23% were African-American, and 32% were over the age of 65. Overall, 74% of participants in the App+Reminder group used the app at least once per week compared with 38% in the App group (p<0.01). Reported AI adherence 8 weeks after initiation was significantly higher among those in the App+Reminder group compared with the App group (100% vs. 72%, p=0.01). Using a differences-in-differences analysis, we found that the decrease in quality of life 8 weeks after AI initiation was substantially larger, but not statistically significant, in the App group compared with App+Reminder (difference=7.6, p=0.191). Conclusions: Use ofa web-enabled app to provide real-time monitoring of AI adherence and treatment-related symptoms with weekly reminders significantly improves short-term AI adherence and may limit reductions in quality of life.If short-term gains in adherence persist, this low-cost intervention could improve survival outcomes for women with hormone receptor-positive breast cancer. Clinical trial information: NCT02957526.
Treatments/clinical outcomes in ER+ HER2-negative breast cancer (BC) where treatment decisions were recurrence score (RS)-guided: Analysis by histologic subtype.
Authors: Stemmer Salomon M. , Steiner Mariana , Rizel Shulamith , Ben Baruch Noa , Geffen David B , Soussan-Gutman Lior , Bareket-Samish Avital , Nisenbaum Bella , Isaacs Kevin , Fried Georgeta , Rosengarten Ora , Uziely Beatrice , Svedman Christer , McCullough Debbie , Klang Shmuel , Evron Ella , Karminsky Natalya , Goldberg Hadassah , Shak Steven , Liebermann Nicky 
Published: September 2018

e12053 Background: The RS assay is widely used to guide treatment decisions in ER+ HER2-negative early BC regardless of tumor histology. However, the RS validation studies did not include an analysis by histologic subtype. We investigated treatments/clinical outcomes in RS-tested Clalit Health Services (CHS) patients (pts) by histologic subtype, focusing on invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC). Methods: This exploratory analysis of the CHS cohort included BC pts with N0/N1mi/N1 disease who were RS-tested from 1/2006 through 12/2010 (N0) or 12/2011 (N1mi/N1). Data from medical records were analyzed to assess risks of distant recurrence and BC death by histologic subtype. Results: The cohort included 2510 pts: 2060 (82%) IDC, 298 (12%) ILC, and 152 (6%) unknown/others. Median follow up for IDC/ILC pts was 6.0/6.1 yrs. Median age in IDC/ILC pts was 60/62 yrs; median tumor size was 1.5/1.8 cm; 71%/71% were N0, and 29%/29% were N1mi/N1. RS distribution (<18, 18-30, ≥31) was 50%, 39%, and 11%, respectively for IDC pts and 48%, 48%, and 4%, respectively, for ILC pts. Chemotherapy (CT) use for each RS group was similar between IDC and ILC pts; 5-yr Kaplan-Meier estimates for the risk of distant recurrence and BC death differed significantly across RS groups in both IDC and ILC; clinical outcomes for IDC and ILC pts were similar within risk groups see Table. Conclusions: For both IDC and ILC pts, treatment was aligned with the RS results. Within each RS group, there was no difference in clinical outcomes between these histologic subtypes, however the number of pts with ILC and RS≥31 was limited. [Table: see text]
Early-stage breast cancer patients reporting difficulty sleeping, mood issues, or pain are more likely to refuse adjuvant hormone therapy.
Authors: Thomas Christian A. 
Published: September 2018

e12065 Background: Adjuvant hormone therapy is a crucial part of the treatment for patients with early stage breast cancer and an important quality measure for programs such as QOPI and the oncology care model (OCM). However, it is not known which factors influence some patients with early stage breast cancer to decline adjuvant hormone therapy. We hypothesized that specific self-reported symptoms might impact a patient’s decision to accept or decline adjuvant hormone therapy. Methods: Patients with stage 0 or I breast cancer were identified by chart review from 2011-2016 and de-identified. On the day patients received a recommendation for adjuvant treatment the following patient reported outcome measures (PROs) were analyzed: difficulty sleeping (DS), fatigue (F), mood (M such as anxiety and depression), and pain (P) on a 0-4 symptom scale based on CTCAE v. 4. PROs were then linked with a patient’s decision to accept or decline adjuvant therapy. Results: A total of 287 patients with stage 0 (n = 80) or stage I (n = 207) breast cancer were identified. 38 stage O and 103 stage I patients had evaluable PROs on the same day a recommendation for adjuvant hormone therapy was made. Overall 18/38 (47.4%) of stage 0 patients and 90 of 103 (87.4%) of stage I patients accepted adjuvant treatment. Stage 0 patients declining adjuvant therapy reported any grade of PROs: DS (40%, n = 8), F (35%, n = 7), M (35%, n = 7), P (20%, n = 4). Stage 0 patients accepting treatment reported: DS (22%, n = 4), F (44%, n = 8), M (6%, n = 1), P (20%, n = 4). Stage I patients who declined treatment reported: DS (54%, n = 7), F (46%, n = 6), M (38%, n = 5), P (62%, n = 8). Stage I patients accepting treatment reported: DS (41%, n = 37), F (49%, n = 44), M (31%, n = 28), P (36%, n = 32). Conclusions: Early stage breast cancer patients declining adjuvant hormone therapy are more likely to self report symptoms such as difficulty sleeping, mood disturbances (anxiety, depression), and pain than those accepting treatment.
Association of PD-L1/CD8+TIL and expression of PD-L1, PTEN as predictive biomarkers for long-term follow-up in early breast cancer.
Authors: Toh Uhi , Okabe Mina , Iwakuma Nobutaka , Saku Shuko , Akashi Momoko , Ogo Etsuyo , Itoh Kyogo , Akagi Yoshito 
Published: September 2018

e12072 Background: The aim of this study was to investigate the correlation of immunologic factors including the expression of PD-1/PD-L1, PTEN, and the density of TILs, macrophages in the tumor area of breast cancer, using immunohistological staining and to evaluate the association between the immunologic factors and the clinical outcome for early breast cancer (EBC). Methods: A total of 97 EBC patients (pts) who underwent surgery from February 1995 to November 2005 were investigated.The postoperative adjuvant chemotherapies were routinely performed, adjuvant Tmab were not available in Japan within this period.The immunohistological staining was performed with the monoclonal antibodies for PD-1/PD-L1, PTEN, CD3, CD8, and CD163. Pathological analysis was performed to measure the expression area of each antibody, using images scanned by a CCD digital camera (Nikon), and the digitized data of the expression area (μm2) were analyzed by ‘Win ROOF’ (version 5.7) software. The association between the immunologic factors and clinical outcome was statistically analyzed for over 10-years follow-up. Results: The density of CD3+TILs, CD8+TILs, CD163+ macrophages and non-expression of PTEN was significantly higher in triple negative breast cancer (TNBC). CD8+TIL density and PD-L1+/CD8+ expression were predictive factors for DFS and OS. Her2+ pts with PTEN expression and luminal/Her2- patients without PD-L1 expression had longer OS, compared to patients without PTEN expression (p=0.049) and with PD-L1 expression (p=0.036), respectively. Furthermore, the pts with PD-L1+/CD8+ expression had worse median PFS (p = 0.022) and median OS (p = 0.037), compared with pts without PD-L1+/CD8+ expression. Conclusions: Our results demonstrated that CD3+ TILs, CD8+ TILs, and CD163+ macrophages were shown to infiltrate the tumor area of EBC. In particular, TNBC had a higher rate of TIL infiltration within the tumor environment. PTEN expression and lack of PD-L1 expression were associated with favorable survival in Her2-positive and luminal/Her2-negative EBC patients, respectively. The PD-L1 expression combined with CD8+ density was significantly associated with an aggressive clinical outcome.
Incidence of febrile neutropenia with use of docetaxel plus cyclophosphamide (TC) for breast cancer.
Authors: Patel Kiran , Diergaarde Brenda , Brufsky Adam , Jankowitz Rachel Catherine , Lembersky Barry C. , Rastogi Priya , Huggins-Puhalla Shannon Leigh 
Published: September 2018

e12073 Background: Incidence of febrile neutropenia (FN) is reported as 5% in breast cancer patients receiving TC (Jones et al., JCO 2006), which would not justify the usage of prophylactic granulocyte colony stimulating factors (G-CSF). We previously showed that the incidence of FN may be as high as 23% in a small study. (N = 130, Soni et al., ASCO 2011). In the current study, we determined the incidence of FN in a larger cohort (N = 415), and evaluated the usage of G-CSF and its relation to FN, age, stage, and hormonal status. Methods: We retrospectively reviewed the electronic medical records from patients diagnosed with breast cancer who received at least one standard dose cycle of adjuvant TC between 2010-2016 at a university-based breast oncology practice. Chi-square or Fisher’s exact tests were used to assess differences between groups. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression models. Results: We identified in total 415 patients who received adjuvant TC. Median age at diagnosis was 58 (range: 25-86), the majority had stage I or II (N = 382; 92.1%) disease, and 315 (75.9%) were ER+, 277 (66.8%) PR+, 42 (10.1%) HER2+, 22 (5.3%) triple-positive, and 81 (19.5%) triple-negative. Prophylactic G-CSF was utilized in 247 patients (59.5%), and unknown for 43 (10.4%). Overall 39 (9.4%) patients experienced febrile neutropenia. Incidence of FN among those receiving G-CSF was 4.5% versus 17.6% among those who did not (p < 0.001). Use of G-CSF significantly lowered risk of FN, OR (95%CI): 0.20 (0.10-0.43) adjusted for age at diagnosis and stage. Use of G-CSF on incidence of FN did not differ significantly by age, stage, or hormonal status. Conclusions: Our data confirms a high rate of FN in patients receiving TC without G-CSF prophylaxis. Our institutional high rate of G-CSF use ( > 50%) reduced the incidence of FN to 4.5% and the observed significant difference in FN incidence between the non G-CSF group and G-CSF group suggests that prophylaxis may be considered when administering TC. Age, stage, and hormonal status do not seem to affect the usage of G-CSF or incidence of FN in our population.
Correlation of Breast Cancer Index (BCI) prognostic and predictive results to Ki67 and tumor grade in early stage HR+ breast cancer.
Authors: Falkson Carla Isadora , Kepes Jeffrey , Poage Graham M. , Liu Junmei , Schnabel Catherine A. 
Published: September 2018

e12075 Background: Markers of tumor proliferative status, e.g., Ki67 and grade (G), are prognostic for early distant recurrence (DR) in HR+ breast cancer and integrated in adjuvant chemotherapy decisions; however, their impact on late DR and extended endocrine therapy (EET) decisions is less clear. BCI is a genomic assay that provides 2 results: BCI Predictive, based on HoxB13/IL17BR (H/I ratio), reports a prediction of likelihood of benefit from EET; BCI Prognostic, based on the algorithmic combination of H/I and proliferation genes, reports risk of late DR. In this study, BCI results were examined within clinicopathologic risk categories based on Ki67 and G. Methods: The BCI Clinical Database for Correlative Studies is an IRB-approved de-identified database that contains > 50 clinicopathologic and molecular variables from cases submitted for BCI testing in clinical practice (N = 14,463). Clinicopathologic variables were abstracted from pathology reports, and were available for a subset of cases. High Ki67 was defined as ≥14%. Chi-squared tests were used to compare BCI results between Ki67 and G subgroups. Results: Analyses included 3395 LN- pts (median age 59.1y; 73% ≥ 50y). BCI Prognostic showed a wide distribution of individual risk assessments in pts with high or low Ki67. A greater proportion of pts with high Ki67 was classified by BCI as high risk of late DR compared to low Ki67 (68.2% vs 26.5%; P < 0.0001); however, substantial proportions of high Ki67 pts were classified as BCI low risk (31.8%) and pts with low Ki67 classified as BCI high risk (26.5%). Overall, there was a moderate correlation between individual BCI Scores and individual Ki67 scores (Correlation = 0.519). 45.5% of pts with high Ki67 were classified as High BCI Predictive (H/I) compared to 35.5% of pts with low Ki67 (p < 0.001). Both BCI Prognostic and BCI Predictive (H/I) classified increasing proportions of pts as high risk or high benefit with increasing G (P < 0.0001). Conclusions: These findings help characterize differential stratification based on tumor biology vs Ki67/G for pts considering EET. While moderately correlated, both BCI Prognostic and BCI Predictive (H/I) identified distinct populations compared to Ki67 and G.