bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P5-10-18: Echocardiography on Neonates Exposed to Anthracycline Therapy In Utero for Maternal Breast Cancer
Authors: Cardonick EH , Usmani A , Ghaffar S , Wood D , Levine M. 
Published: April 2011

Abstract
Background: Anthracycline therapy carries a risk for cardiac toxicity in pediatric and adult populations. It is unknown if this risk also applies to fetuses exposed in utero. The objective of this study is to evaluate the cardiac function of neonates exposed to anthracyclines in utero. Materials and Methods: This was an observational study. Pregnant women diagnosed with breast cancer who underwent anthracycline based chemotherapy and delivered a liveborn infant after 24 weeks, were offered enrollment. Patients provided written consent to obtain doses and dates of chemotherapy treatment. Echocardiograms were offered to all newborns exposed as fetuses to anthracyclines. Women chose to perform this echocardiogram locally or at the institution of the primary investigator. Baseline fetal cardiac evaluation was reportedly normal on ultrasound prior to starting chemotherapy.
Chemotherapy Regimens:
Adriamycin/Cytoxan (n=20).
5-Fluorouracil/Adriamycin/Cytoxan (n=3)
There were no cases of exposure to epirubicin or idarubicin.
Mean dosage of Adriamycin was 57/m2 +/−8.0.
Results: Twenty three neonates participated.
Neonatal echocardiograms done at a mean age of 15 +/−26 months, (range 3 days of life to 9.75 years). RV wall, IVS and LV posterior wall diastolic and systolic thickness measurements were within normal limits for age and BSA. Mean shortening fraction was 41+/−10%. (normal 33 +/− 3%). In all 23, AV and semilunar valves were normal. Great arteries were normal in 22/23, with one case of a small pulmonary artery fistula. At 2 years of age, this was not hemodynamically significant. Patent foramen ovale was noted in 4 cases, all in children less than 2.0 months of age. Two children ages 3 days to 1.4 months had a PDA. One child at 1 year of age had an ASD. No structural or functional heart defects were diagnosed in any of these children.
Discussion:
Cardiac function appears to be preserved in neonates exposed to adriamycin chemotherapy in utero.
Any toxic effects on fetal myocytes was not evident in postnatal echocardiograms.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-18.
Abstract P5-10-20: Breast Cancer Multi Disciplinary Team (MDT)Adjuvant Chemotherapy Decision: Impact of Adjuvant! Online Estimates of 10-Year Risk of Death and Chemotherapy Benefit on the Decision Making Process
Authors: Balakrishnan A , Haysom S , Rivett L , Austin A , Ravichandran D. 
Published: April 2011

Abstract
Introduction: Breast cancer patients in the UK National Health Service (NHS) are cared for by breast cancer multidisciplinary teams (MDT). The wide range of knowledge and experience available in MDT produce a collective expert opinion on the management strategy for individual patients. Adjuvant! Online is an online computer programme that makes quantitative estimates of the effect of adjuvant chemotherapy (CT) on the 10-year risk of death and relapse. We studied whether the Adjuvant! Online produced numerical estimates would influence the adjuvant CT decision making of a breast cancer MDT.
Methods and Materials: We prospectively monitored a breast cancer MDT for a period of 12 months. Once the MDT had finished discussing a patient and adjuvant therapy decisions were made, Adjuvant! Online produced 10-year risk of breast cancer related death and the reduction of this risk that may be achieved by adjuvant CT were presented to the MDT. Any change to the original MDT recommendations as a result of this information was recorded.
Results: 109 post-operative early breast cancer patients that were suitable for input into Adjuvant! Online discussed in 41 MDT's were included in the study. Adjuvant therapy decisions included chemotherapy (n=56), radiotherapy (n=96) and endocrine therapy (n=89). The numerical estimates from Adjuvant! Online only changed the management of one patient, by showing a marginal (3.8%) survival benefit with CT that made the MDT offer chemotherapy to this patient where the original decision was not to.
Conclusions: Most adjuvant therapy decisions are easy to make without the need for numerical estimates of benefit when the MDT's are staffed by experienced breast cancer clinicians. Regular use of Adjuvant! Online or similar aids may not be necessary during the MDT discussion. These could be used on a selective basis where there is difficulty reaching a consensus.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-20.
Abstract P5-10-21: Maternal and Neonatal Outcomes of Dose Dense Chemotherapy for Breast Cancer in Pregnancy
Authors: Cardonick EH , Gilmandyr D 
Published: April 2011

Abstract
Background: Fear of neutropenia requiring the use of pegfilgrastim has prevented the use of dose dense chemotherapy (dd) during pregnancy. Some physicians/patients may be concerned as well about the ability of the pregnant patient and her neonate to tolerate dose dense chemotherapy during pregnancy. The objective of this study is to compare the outcome of women and their neonates when dose dense chemotherapy is used in pregnancy compared to treatment at least 3 weeks apart. Materials and Methods: A retrospective cohort study of pregnant women receiving chemotherapy for breast cancer were identified from the Cancer and Pregnancy Registry. The timing of chemotherapy in pregnancy was decided by the patient's oncologist in consultation with their patient. Fisher's Exact test comparing patient and neonatal outcome was performed.
Results: 109 pregnant women diagnosed with breast cancer participated. Ten women received dose dense (dd) and 99 conventional chemotherapy (cc). The mean gestational age at delivery for dd group was 35.8 (SD 3.1) weeks and 36.3 (SD 2.7) weeks in the cc group, p=.60. Mean birth weight was 2560 (SD 579)grams in the dd group, 2634 (SD 599) grams in the cc group, p=.642]There were no fetuses with growth restriction in the dd group, compared to 7.0% in the cc group, p=1.0. Of the 10 neonates in the dd group, 10% (1/10) experienced transient neutropenia, none did so in the cc group, p=0.09.
Neonatal Outcomes
GA=gestational age at delivery;IUGR=fetal growth restriction. No significant differences in GA at delivery, Birthweight or neutropenia was found.
There was an 10% (1/10) incidence of maternal neutropenia in the dd group, 5.1% in the cc group, p=.45. Maternal mean follow up was 3.5 (2.6) years. The mean time to recurrence was 17.6 months for dd versus 19.7 months in the conventional group, p=0.84. Overall survival in the dd group was 90%, in the cc group, 86%, p=1.0.
Maternal Outcomes
No significant difference in neutropenia, time to recurrence or survival was found.
Discussion: The small number of women receiving dose dense treatment is a limitation of this study. We found that maternal neutropenia, time to recurrence as well as overall survival was comparable between groups. Neonatal birth weight, gestational age at delivery and incidence of neonatal neutropenia was comparable between groups. Dose dense chemotherapy should be considered in pregnant women if the benefits are demonstrated in the nonpregnant population.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-21.
Abstract P5-10-22: Dose Dense Adjuvant Chemotherapy in Breast Cancer Patients with Five or More Nodes Involved: Results of a French Cohort with Long Term Follow-Up
Authors: Cuvier CC , Hocine FF , Hamy AS , Giacchetti SS , de Roquancourt AA , Charveriat PP , Marty MM , Lehmann-Che JJ , Porcher RR , Espie MM. 
Published: April 2011

Abstract
Introduction: Axillary node involvement remains the most important prognosis factor in breast cancer patients. In those with ≥ positive nodes, 5-year overall survival rates range from 47% to 22% and 5-year recurrence rate from 54% to 82%. Several trials have studied the impact of dose dense chemotherapy in node-positive breast cancer. Some have shown a significant improvement in relapse-free survival and even overall survival. However the power of these studies is often insufficient to conclude and the follow up is often short.
Objective: To provide safety and long term efficacy data of a dose dense chemotherapy regimen used in Saint Louis Hospital for patients with ≥5 positive nodes.
Materials and methods: Beetween 1990 and 2003, all patients with ≥5 positive nodes were treated with adjuvant dose dense chemotherapy: 6 cycles of epirubicin 75mg/m2, cyclophosphamide 1200mg/m2 q2w followed by 3 cycles of conventional chemotherapy. No prophylactic G-CSF was given.All patients received adjuvant radiation therapy. Of 95 patients with HR positive tumors,44 received adjuvant tamoxifene therapy after completion of chemotherapy. Patients were followed by clinical and laboratory examinations every 4 months for 3 years then every 6 months for 2 years and every year thereafter. A mammogram was performed each year.
Results: Patients characteristics:
Patients characteristics at inclusion. Figures are median (range) or no. (%).
(Her2 expression will be presented at the meeting.) Median time between surgery and chemotherapy was 30 days (9-91).Grade 3 or 4 toxicities were mainly: neutropenia (89%) gastro-intestinal toxicity(30%) febrile neutropenia 24% cardiac toxicity 2.6% toxic death:1 pt. Median follow-up since the initiation of chemotherapy:10.9 years. Median survival:11.3 years (95% CI 9.4-∞) and median disease-free survival 6.1 years (95% CI 4.6- 8).5, 10 and 15 overall survival rates were 76%, 56% and 41%respectively and disease-free survival were 54%, 37% and 34% respectively. Conclusion: In this very high risk selected population, our dose-dense chemotherapy regimen exhibits an exceptionnaly high 10-year survival rate. A sequential association with taxanes should be studied.
Figure available in online version.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-22.
Abstract P5-10-24: A Pragmatic Review of Adjuvant Chemotherapy Regimens in Early-Stage Breast Cancer — Hematologic Toxicities Experienced in a Single Institution
Authors: Tran M , Simmons CE , Haq R , Brezden CB. 
Published: April 2011

Abstract
Background: Chemotherapy-related toxicities are associated with substantial morbidity, mortality, and health care expenditures. Three newer common adjuvant chemotherapy regimens - 5-fluorouracil, epirubicin, cyclophosphamide plus docetaxel (FEC-D), docetaxel plus cyclophosphamide (TC), and docetaxel, carboplatin plus trastuzumab (TCH) - have emerged as promising therapies. The toxicities experienced with these chemotherapeutic regimens were reviewed in a clinical practice setting outside of clinical trial.
Patients and Methods: Patients (pts) with early-stage breast cancer treated with adjuvant chemotherapy (FEC-D; TC; TCH) at St. Michael's Hospital in Toronto, Canada, between August 2006 and May 2010 were identified. Charts were audited for the presence of neutropenia (defined asabsolute neutrophil count (ANC) &lt; 1.0x109/L), use of granulocyte-colony stimulating factor (G-CSF), incidence of febrile neutropenia (FN; defined as a single oral temperature ≥38.3 0Celsius, or oral temperature ≥38.0 0C lasting over 1 hour, with an ANC &lt; 1.0x109/L).
Results: Overall, 175 pts were reviewed in this study. The rate of neutropenia, FN, and use of primary prophylaxis with G-CSF are summarized in the table below for each regimen. Thirty pts on FEC-D (25.2%) experienced significant complications resulting in dose delay, dose reduction, and discontinuation of chemotherapy, as did 9.1% of pts on TC, and 27.3% of pts on TCH. There was one death associated with FEC-D while on G-CSF.
Conclusion: Our institution reports FN rates higher than originally reported in all three chemotherapy regimens with a greater hematologic toxicity profile with FEC-D. Further investigation with larger patient cohorts is warranted, to determine if there is a need for primary prophylaxis with G-CSF in patients receiving FEC-D, TC, and TCH.
Table 1: Outcomes associated with FEC-D, TC, and TCH chemotherapy regimens

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-24.
Abstract P5-11-08: Effects of Exemestane or Tamoxifen on Bone Health within the Tamoxifen Exemestane Adjuvant Multinational (TEAM) Trial: A Meta-Analysis
Authors: Hadji P , Asmar L , van Nes J , Menschik T , Hasenburg A , Kuck J , Nortier H , Jones S , van der Velde C , Ziller M. 
Published: April 2011

Abstract
Background: TEAM is the largest AI phase III trial comparing exemestane with tamoxifen followed by exemestane as adjuvant breast cancer therapy in postmenopausal women. We performed a meta-analysis of three randomized sub-studies of the TEAM trial conducted in Germany, the Netherlands/Belgium and the United States to determine the effects on bone health.
Methods: Patients were randomised to exemestane or tamoxifen as adjuvant therapy for hormone receptor-positive breast cancer. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry at baseline and after 6, 12 and 24 months’ treatment. Bone turnover markers were also measured.
Results: 412 patients were evaluable. Patients in the tamoxifen group showed a mean increase in lumbar spine BMD of 1.2% from baseline to month 12 and 0.2% to month 24. Patients in the exemestane group showed a mean decrease from baseline of 2.6% after 12 months and 3.5% after 24 months. There were significant differences in the changes in BMD at the lumbar spine between treatment groups (P&lt;0.0001 at both timepoints). In the tamoxifen group, a mean increase in total hip BMD of 0.8% from baseline to month 12 and a mean decrease from baseline of 0.4% after 24 months was observed, compared with a mean decrease of 1.3% after 12 months and 3.3% after 24 months in the exemestane group. Changes in BMD from baseline at the total hip were also significantly different between exemestane and tamoxifen (P&lt;0.05 at both timepoints). Bone turnover markers decreased from baseline with tamoxifen and increased with exemestane.
Conclusions: After 24 months, exemestane treatment resulted in decreases in BMD and increases in bone turnover markers. In contrast, BMD was increased and bone turnover markers were decreased with tamoxifen. BMD and bone turnover changes appeared to stabilise after initial treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-08.
Abstract P5-11-11: Completion of 5-Years Adjuvant Endocrine Therapy in the Community
Authors: Makubate B , McCowan C , Dewar JA , Thompson AM. 
Published: April 2011

Abstract
Background: Adjuvant endocrine therapy is recommended by guidelines for all eligible patients with breast cancer for a minimum 5-year period. Shorter periods of treatment and low adherence to medication are associated with worse outcomes for patients. This study examined whether women in the community completed the full course of adjuvant endocrine therapy and whether they were adherent to their medication. Materials and Methods: A cohort of all women diagnosed and treated for breast cancer in the Tayside region of Scotland during the period January 1993 — December 2008 was identified. Information on dispensed prescribing was linked to hospital discharge records, breast cancer clinical audit, cancer registry and death certification for each individual patient. Patients were identified as starting either aromatase inhibitor or tamoxifen therapy with adherence and duration of use subsequently calculated from dispensed prescribing records. Results: 5,729 women were identified with an incident cancer within the study period. 71% were initially prescribed tamoxifen, 8% started aromatase inhibitors and 21% received no adjuvant endocrine therapy. 25% of women who started on aromatase inhibitors switched treatments, with 19% of those on tamoxifen switching. The majority of women had high adherence, the median figure was 91%, but 1,589 (35%) of women had adherence below 80% which was shown in previous work to increase the risk of mortality. For patients followed for at least 1 year, 51 (11%) started on AIs had stopped medication compared to 373 (9%) started on tamoxifen. At year 2, an additional 40 (12%) stopped AIs and 384 (11%) patients stopped tamoxifen. For 3 years follow up, an additional 39 (19%) stopped AIs, while 351 (11%) stopped tamoxifen. For patients followed for at least 4 and 5 years respectively, an additional 22 (26%) then 5 (20%) stopped AIs compared to 297 (11%) and 316 (16%) patients who stopped tamoxifen. Of the 3,613 patients with adequate follow up 1,876 (52%) stopped medication before completing a 5 year period. Conclusions: Half of all patients prescribed adjuvant endocrine therapy stop medication before completing the recommended 5-year period with approximately 20% stopping in the first two years. Over one in three patients have low adherence at a level known to increase the risk of mortality. All patients need to be encouraged to continue their treatment for the recommended 5-year period and to take it daily to ensure they receive maximum benefit from their medication.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-11.
Abstract P5-12-03: Concurrent vs. Sequential Administration of Adjuvant Trastuzumab in Early Stage Breast Cancer: A Systematic Review and Meta-Analysis
Authors: Lavasani SM , Mahinbakht A , Verma S. 
Published: April 2011

Abstract
Background: Overexpression/Amplification of the HER2 occurs in 15-18% of breast cancers. Adjuvant trastuzumab is now integrated in the care of most HER2-positive early stage breast cancers. However, an important question persists regarding the concurrent vs. sequential use of trastuzumab as adjuvant treatment in early stage breast cancer. A meta-analysis of randomized controlled trials (RCT) was undertaken to compare concurrent vs. sequential trastuzumab. The outcomes of interest were risk of recurrence, death and grade III and IV cardiac toxicity. Method: Systematic review of English literature retrieved from EMBASE (1980 to April 26, 2010), MEDLINE (1996 to April 26, 2010) and Cochrane database for the relevant studies. In addition, conference proceedings of ASCO and SABCS from 2004 to 2009 were searched for relevant abstracts. A manual search of the reference lists of the selected articles was performed in order to further identify relevant studies. The search strategy was conducted according to our well-defined inclusion and exclusion criteria. Our search strategy revealed 1262 citations. Only RCTs were included. The review was performed by 2 reviewers independently. The data analysis was conducted by Review Manager Version 5, which could not compare the number of recurrences and deaths head to head for concurrent vs. sequential trastuzumab. A Fixed effect model was used. When I square showed heterogeneity of &gt;50%, sensitivity analysis was performed. Results: Six eligible trials were identified. Three RCTs used trastuzumab concurrently and 2 RCTs used trastuzumab sequentially. One RCT (NCCTG N9831) had 3 arms, chemo only control arm, sequential trastuzumab arm and concurrent trastuzumab arm. Pooled and sensitivity analysis of 4 RCTS comparing concurrent trastuzumab with chemotherapy showed total HR of 0.73 (P&lt;0.00001) for reduction of recurrence and 0.78 (P=0.0006) for reducing the mortality. The pooled analysis of 3 RCTs comparing sequential trastuzumab with chemotherapy revealed total HR of 0.82 for reduction of recurrence (P&lt;0.0001) and 0.93 for mortality (p=0.27). The cardiac toxicity in concurrent trastuzumab was in favour of control with risk ratio of 4.66 (P&lt;0.00001) and in sequential treatment was also in favour of control with risk ratio of 9.90 (P&lt;0.0001).
Conclusion: Concurrent trastuzumab with chemotherapy shows a greater improvement in DFS (HR: 0.73 vs. 0.82). HR for OS also favours concurrent trastuzumab (0.78 vs. 0.93). Cardiac toxicity in both concurrent and sequential trastuzumab favours control arms.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-12-03.
Abstract P5-14-08: The Impact of Immediate Breast Reconstruction on Surgical Complications and the Delivery of Adjuvant Chemotherapy
Authors: Chang R , Kirkpatrick K , De Boer RH , Mann GB. 
Published: April 2011

Abstract
Introduction: For women undergoing mastectomy immediate breast reconstruction (IBR) offers potential psychological benefits and increased quality of life. This study aimed to answer the question whether IBR might lead to higher complication rates and subsequently delay adjuvant chemotherapy (AdCT). Secondary aims included predictors for complications, and whether patients (pts) with worse tumour prognosis were less likely to undergo IBR.
Materials and Methods: Retrospective analysis was performed on 220 pts who underwent mastectomy ± IBR and received AdCT.
Results: Comparisons were made between the 107 pts who received IBR and 113 who had mastectomy alone (table 1). Women who were younger with less co-morbidity, lower BMI, and had better prognosis tumours were more likely to receive IBR. No statistically significant difference was found in the overall surgical wound complication rate between the groups. There was more return to surgery in the IBR group, resulting in a 9.8% (12/123) prosthesis loss rate. There was no significant difference in the average time to chemotherapy between the two groups. Conclusion: We found no evidence to suggest that IBR compromised the delivery of adjuvant chemotherapy, although there are significant risks of complications associated with reconstruction.
Table 1: Comparison between women who underwent mastectomy alone (no IBR) and women who

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-08.
Abstract P5-14-20: Clinical Features of Surgical Resection for Solitary Pulmonary Metastasis and the Discrepancy in Immunopathological Features between Primary and Metastatic Breast Cancer Lesions
Authors: Shien T , Nogami T , Doihara H , Nishimura R , Takabatake D , Masuda H , Ikeda H , Taira N , Ohsumi S. 
Published: April 2011

Abstract
Background: The treatment for metastatic breast cancer (MBC) is usually systemic therapy decided by the hormone and HER2 status of primary breast cancer lesion. There are some reports about the discrepancy in hormone and HER2 status between primary and metastatic lesion in these days. We have reported previously that the expression of ALDH-1 which considered the pathological markers of breast cancer stem cell in axillary lymph node matastases is a significant predictor of poor outcome in primary breast cancer patients (Figure 1). We evaluated the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in breast cancer patients and demonstrated the significance of analyzing the immunopathological features in metastatic breast cancer lesion.
Methods: Between 1990 and 2006, 17 patients (PM) with SPN which were diagnosed breast cancer metastases underwent complete pulmonary resection and 36 MBC patients (AP) underwent autopsy after breast cancer related death in our hospitals. We retrospectively analyzed clinicopathological features and the expression of ER, HER2, Ki-67 and ALDH-1 in both primary and metastatic breast cancer lesions.
Results: The median age of PM patients was 53 (range 30-80). All PM patients had not other metastases and had undergone curative breast cancer operation. The pulmonary operation were partial pulmonary resection in 15(88%) and lobectomy in 2 (12%) patients. The median disease free survival (DFS) was 63 months (range 9-175). Median overall survival (OS) was 181 months and the median OS after pulmonary operation was 48 months. The median DFS and OS of AP patients were 21 and 43 months. All AP patients had multiple visceral metastases. We compared the immunohistlogical status between primary and metastatic lesion and evaluated the colletation with these status in metastatic lesion and prognosis in all patients. Conclusion: Pulmonary resection was effective to diagnose and the OS after resection was relatively long in PM patients. We report the value of the expression of ER, HER2, Ki67 and ALDH-1 in distant metastatic lesions.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-20.