bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated with Aromatase Inhibitor Use in a Large Cohort of Women Cared for in an Integrated Health Plan.
Authors: Haque R. , Schottinger J. , Fisher A. , Avila C. , Guo A. , Zelt S. , Shi J. , Fong E. , Quinn V. 
Published: December 2010

Abstract
Background: Third generation aromatase inhibitors (AI) have been well tolerated in clinical trials and may have fewer side effects than tamoxifen. While national treatment guidelines recommend AI for postmenopausal women with ER+ tumors, the extent to which women are prescribed AIs in community settings in the U.S., and as front-line or extended therapy, remains unknown. Using data from a large non-profit health plan that serves over 3 million residents in Southern California, we report results examining the characteristics of breast cancer (BCa) survivors who were ever prescribed AIs.Methods: This cross-sectional analysis examined a cohort of 25,577 BCa (in situ and invasive cases) diagnosed from 1996-2006. We collected demographic, tumor, and cancer treatment information from automated health plan databases and SEER-affiliated cancer registry files. We identified patient and clinical factors associated with AI use. P-values (2-sided) were based on the chi-square distribution. Adjusted odds ratios (for age and year at diagnosis) and 95% confidence intervals were estimated using logistic regression.Results: In this cohort, nearly 37% ever used AIs (P&lt;0.0001). Use of AIs increased by year (P&lt;0.0001). Compared to non-Hispanic whites, minority women were less likely prescribed AIs (AOR=0.75 for blacks, 95% CI: 0.69-0.81). Although most women who used AI were first diagnosed with early stage disease (2 cm vs. &lt;1cm). Women with positive lymph nodes had twice the odds of AI use (OR=2.27, 95% CI: 2.13-2.42) than those with negative nodes. Women with ER+ or PR+ lesions were more likely to have ever used AI (P&lt;0.0001) as were those with HER- tumors (AOR=1.67, 95% CI: 1.48-1.89). Women who underwent breast conserving surgery without radiation were 36% less likely to use AI (AOR=0.64 95% CI: 0.59-0.69) than those with radiation. Of the total cohort, nearly 64% received adjuvant treatment. Among the 6716 women who received tamoxifen, about 43% (2918/6716) also used AI. Of note, during the 2005-2006 diagnosis years, the percentage treated with tamoxifen dropped among women ever prescribed AI. Of the 6627 women treated with chemotherapy only, 36% also received AI (2354/6627).Conclusions: Odds of AI use were greater among older women (age 60+), white race, higher stage at diagnosis, worse histology, positive lymph nodes, and those with ER+, PR+, or HER- tumors. However, grade and tumor size did not influence AI use. More work is needed to determine how patterns of AI use alone or following tamoxifen, medication changes, and tumor characteristics at initial diagnosis impact long-term breast cancer recurrence in this diverse group of patients in southern California.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2079.
Population-Based Comparison of CEF and AC/T, Two Adjuvant Chemotherapy 'Standards' for Early Stage Breast Cancer.
Authors: Al-Tourah A. , Woods R. , Norris B. , Speers C. , Kennecke H. 
Published: December 2010

Abstract
Introduction: Anthracyclines and taxanes in adjuvant therapy have improved the outcomes of women with early stage breast cancer. The first analysis of the phase III NCIC-MA21 trial comparing the three 6 month adjuvant regimens CEF, AC followed by q3weekly paclitaxel(AC/T) and dose dense EC followed by paclitaxel (EC/T) revealed inferior Relapse Free Survival for AC/Tversus CEF (HR 1.49[1.12,1.99]) and EC/T (HR1.68 [1.25-2.27]). The purpose of this population based analysis is to evaluate the characteristics and outcome of women with high-risk breast cancer treated with CEF vs q3weekly AC/T.Methods: The British Columbia Breast Cancer Outcomes Unit (BCOU) and Pharmacy databases were used to identify patients with node positive or high-risk node negative breast cancer between years 2000-2004 treated with adjuvant chemotherapy with either CEF or AC/T. Both regimens were available and recommended for high risk breast cancer during the time of the study. Patients with cTx, pTx tumours, previous or synchronous breast cancer and those with with locally advanced/inflammatory breast cancer were excluded. Patient and tumour characteristics were compared across study cohorts.Univariate comparisons of overall survival (OS) and breast cancer specific survival (BCSS) were performed using the Kaplan-Meier method. Propensity score models were used to compare outcomes in the two cohorts, adjusting for differences in prognostic and other treatment variables.Results: Between 2000-2004, 774 (CEF=557, AC/T=217)women with breast cancer met the inclusion criteria. Median follow-up for CEF was 4.7 years and for AC-T was 3.0 years. CEF-treated patients had more LVI (p=0.0001) and node +ve disease (p&lt;0.0001), were younger (p&lt;0.0001), more likely ER+ (p&lt;0.0001), less likely to have grade 3 tumours (p&lt;0.0001) and received higher rates of both hormones (p&lt;0.0001) and radiation therapy to regional nodes (p&lt;0.0001). Univariate analyses showed better outcomes for the CEF-treated cohort for both OS (p=0.0056) and BCSS (p=0.0012). Propensity score models also favoured the CEF cohort with adjusted HR's of 0.47 (95% CI: 0.27, 0.83; p=0.0086) and 0.40 (95% CI: 0.22, 0.71; p=0.0020) for OS and BCSS respectively.Conclusion: Between 2000 and 2004, women in British Columbia treated with adjuvant CEF had higher risk breast cancer than patients who received AC/T. However, CEF-treated patients have better outcomes than those receiving AC/T. Both univariate and adjusted analyses favour the CEF cohort. These population-based outcomes are consistent with the finding of the NCIC-MA21 randomized trial.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2084.
Prospective Evaluation of Ovarian Function in Women with Breast Cancer Treated with Anthracyclin-Based Chemotherapy with or without Docetaxel.
Authors: Berliere M. , Malingret N. , Coudyzer P. , Baurain J. , Mazzeo F. , Galant C. , Fellah L. , Piette P. , Machiels J. 
Published: December 2010

Abstract
Background: to determine prospectively the incidence of chemotherapy-related amenorrhea and the recovery of ovarian function in premenopausal women with breast cancer undergoing adjuvant or neoadjuvant anthracyclin-based chemotherapy with or without docetaxel.Material and methods: we studied the incidence and the reversibility of clinical amenorrhea induced by different chemotherapy regimens: i) 6 cycles of 5-fluorouracil 500mg/m2, epirubicin 100mg/m2 and cyclophosphamide 500mg/m2 on day 1 every 3 weeks (6FEC) and ii) 3 cycles of FEC 100 followed by 3 cycles of docetaxel 100 mg/m2 on day 1 every 3 weeks (3FEC/3D) and iii) 4 cycles of FEC 100 followed by 4 cycles of docetaxel on day 1 every 3 weeks (4FEC100/4D) .Recovery of ovarian function was defined as recovery of premenopausal hormonal values :luteinizing hormone (LH &lt;17mIU/ml),follicle-stimulating hormone (FSH &lt;45.7mIU/Ml) and oestradiol (E2&gt;50pg/ml).This recovery of ovarian function did not need to be associated with regular menses.Hormonal dosages were performed every 3 months starting at the beginning of chemotherapy and during the year following the end of chemotherapy.After, dosages were performed every 6 months.Results: 170 premenopausal patients were included between january 2005 and january 2008: 62 patients received 6FEC, 66 patients 3FEC/3D and 42 patients 4FEC/4D. The median age was 41 years (range: 25-51) in 6FEC, 42.8 years (range: 27-52.8) in 3FEC/3D and 40.2 years (range: 24-49.5)in 4FEC/4D. The incidence of chemotherapy-related amenorrhea at the end of chemotherapy was similar in the 3 groups: 90.3% in the 6FEC arm, 89.4% in the 3FEC/3D arm and 92.8% in the 4FEC/4D arm. However in the year following the end of chemotherapy, more patients recovered ovarian function in the 3FEC/3D arm (51.5%)(p=0.017) and in the 4FEC/4D arm (50%)(p=0.046)compared with the 6FEC group (30.6%). The difference was statisticaly significant for patients &gt; or=40 years but not for patients &lt; 40 years.Importantly, among the 23 patients with premenopausal hormonal values and treated with tamoxifen, 12/23 did not mention any menses recovery during the first year of follow-up.Conclusion: our prospective study confirms our previous retrospective data showing that 3FEC/3D and 4FEC/4D induce less definitive amenorrhea than 6FEC. Age is the most important predictor of ovarian function recovery, independently of chemotherapy regimen.Anamnestic data, especially in patients treated with tamoxifen are insufficient to determine pre-or postmenopausal status. Therefore, hormonal values must be followed regularly during and after chemotherapy. Since the menopausal status has an impact on the endocrine therapy choice.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2086.
Incidence of Febrile Neutropenia with Taxane-Based Systemic Therapy in Women with Early Stage Breast Cancer.
Authors: Alkhayyat S. , Dent S. , Verreault J. , Robinson A. , Germond C. , Vandenberg T. 
Published: December 2010

Abstract
Background: Febrile neutropenia (FN) is one of the most significant toxicities experienced by patients treated with systemic therapy. Taxanes now play an integral role in the systemic therapy for women with early stage breast cancer. The most common taxane-containing regimen utilized in Ontario, Canada is 5-Fluorouracil/Epirubicin/Cyclophosphamide x 3 followed by Docetaxel x 3 (FEC-D). PACS 01 reported a febrile neutropenia (FN) rate of 11.2% in the FEC-D arm. In our clinical practice, clinicians have noted a much higher rate of FN. We report the FN rate with the use of FEC-D in women with early stage breast cancer treated at tertiary care centers in Ontario.Methods: All women with early stage breast cancer who were treated with FEC-D from three tertiary care cancer centers in Ontario, Canada (London, Sudbury, Ottawa) between June 2006 and December 2008 were included in this retrospective analysis. Data included: demographics, staging, hormone receptor status, primary prophylaxis use with growth factors, FN rate, admission to hospital and duration of hospital admission.Results: Median age of 630 women is 52 years (r: 24-77). Staging was: I (88), IIA (243), IIB (159), IIIA (94), IIIB (23), IIIC (14) and 9 unknown. A total of 474 (75.2%) were ER positive. Primary prophylaxis with growth factor support was given to 222 patients (35%) and 408 patients (65%) did not have upfront prophylaxis. Of the 222 patients who were given primary prophylaxis, 14 patients (6.3%) were diagnosed with FN. Of the 408 patients who did not receive primary prophylaxis, 120 patients (29.4%) were diagnosed with FN. All patients (n=120) diagnosed with FN received secondary prophylaxis with growth factor support. A total of 126 patients (20%) were admitted to hospital for FN. The median duration of hospital admission was 3.9 days (r: 1-65 days). The impact of risk factors, the use of filgastrim versus pegylated filgastrim on FN rates and the clinical ramifications of febrile neutropenia (ICU admissions/deaths) will be reported.Conclusions: The results of this retrospective analysis demonstrate a much higher risk of FN (29.4%) with FEC-D than has been previously reported. More complete reporting of primary prophylaxis is required. This rate of FN would warrant use of primary prophylaxis for patients prescribed FEC-D, particularly in high risk subgroups.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2087.
Relationship of Anthracycline-Free Interval to Outcomes in a Phase 3 Trial of Pegylated Liposomal Doxorubicin Plus Docetaxel Compared with Docetaxel Monotherapy in Patients with Advanced Breast Cancer Treated with Adjuvant Anthracycline.
Authors: Sparano J. , Zhuang S. , Londhe A. , Lantz K. , Lowery C. 
Published: December 2010

Abstract
Background: An earlier report showed that pegylated liposomal doxorubicin (PLD) + docetaxel (D) improved time to progression (TTP) vs D alone in patients (pts) with advanced breast cancer (ABC) who had relapsed at least 1 year after adjuvant or neoadjuvant anthracycline therapy. (Sparano et al., SABC 2008, #80) This analysis evaluated whether the time between completion of adjuvant anthracycline therapy until relapse impacts overall outcome. We retrospectively examined outcomes in pts with an anthracycline-free (A-F) interval of 1 to 2 years and pts with an A-F of &gt;2 years.Methods: 751 pts were randomly assigned to receive either D 75 mg/m2 (N=373) or PLD 30 mg/m2 followed by D 60 mg/m2 (N=378) every 21 days. Treatment was continued until disease progression or the occurrence of unacceptable toxicity. The primary endpoint was TTP and secondary endpoints included overall survival (OS), progression free survival (PFS), objective response rate (ORR), and safety. Pts were categorized into groups by anthracycline-free interval of 1-2 years or &gt;2 years. Relationship between the interval and outcomes was examined by proportional hazards model for TTP, OS (updated as of 1-Dec-2008), and PFS.Results: Approximately 60% of pts in both treatment groups had A-F intervals of &gt;2 years. Median TTP, OS, and PFS (months) by A-F interval groups are listed in the Table. A-F interval 1-2 years A-F interval &gt;2 years D, n=151PLD+D, n=155HR (CI)*; P**D, n=221PLD+D, n=221HR (CI)*; P**TTP5.77.80.67 (0.52, 0.87); .0027.710.60.63 (0.50, 0.79); &lt;.001OS15.817.90.90 (0.69, 1.16); .40424.722.91.10 (0.86, 1.40); .448PFS5.57.70.67 (0.52, 0.87); .0027.710.00.65 (0.51, 0.81); &lt;.001ORR25%34%P=.086†27%36%P=.042† A-F interval 1-2 years, N=306 A-F interval &gt;2 years, N=442 HR (CI)***; P**TTP6.6 8.9 0.74 (0.63, 0.88); .001OS17.2 23.4 0.63 (0.52, 0.75); &lt;.001PFS6.5 8.7 0.74 (0.62, 0.87); &lt;.001ORR30% 31% P=.826†*Proportional hazard model for PLD+D vs D; **Log-rank test; ***Proportional hazard model for &gt;2 years vs ≤2 years A-F; †Cochran-Mantel-Haenszel test.Overall, HFS and stomatitis occurred more often in pts treated with PLD+D. The overall incidence of CHF was 1%.Conclusions: An A-F interval of &gt;2 years reduced the risk for TTP, OS, and PFS, regardless of treatment. However, similar to results of the overall study, treatment with the combination PLD+D resulted in statistically significant improvement of TTP and PFS, but not OS, compared with D among pts with ABC, regardless of A-F interval. The addition of PLD to a D-based regimen is an active option for pts with ABC previously treated with adjuvant anthracycline regimens.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2095.
Oral Bisphosphonate and Breast Cancer: Prospective Results from the Women's Health Initiative (WHI).
Authors: Chlebowski R. , Chen Z. , Cauley J. , Rodabough R. , McTiernan A. , Lane D. , Manson J. , Snetselaar L. , Yasmeen S. , O'Sullivan M. , Stafford M. , Hendrix S. , Wallace R. 
Published: December 2010

Abstract
Background: Emerging clinical evidence suggest intravenous bisphosphonates may directly inhibit breast cancer (Gnant SABCS 2008) while oral bisphosphonates in US clinical practice have received limited evaluation regarding breast cancer influence.Methods: To investigate associations between oral bisphosphonates and invasive breast cancer we examined data for 151,592 postmenopausal women enrolled in the WHI. Information was collected on breast cancer risk factors and oral bisphosphonate use. To control for bone mineral density (BMD) we employed a published hip fracture prediction model which did not incorporate BMD (Robbins 2007) against the 10,296 WHI participants who had baseline total hip BMD determination. Breast cancers were centrally adjudicated by pathology report review. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).Results: Of the 151,592 participants, 2,216 were oral bisphosphonate users at entry (90% alendronate, 10% etidronate). An analysis comparing hip fracture risk score to BMD in those with both found a significant correlation (regression line = .79-.0478 log predicted hip fracture, r=0.43). As a result, the hip fracture risk score was used to control for potential BMD group differences. HRs for invasive breast cancer by bisphosphonate use are outlined below after 7.8 (1.7) mean years (SD). Bisphosphonate Use NoYesBreast Cancer Incidence ** Invasive Breast CancerNRate*NRateHR95% CIP-valueTotal50924.38643.290.68(0.52-0.89)&lt; .01ER positive38293.28502.560.70(0.52-0.95)0.02ER negative7170.6180.410.66(0.31-1.39)0.27 * Rate/1000 women years of follow-up**Cox proportional hazards analyses adjusted for age, ethnicity, smoking, alcohol use, physical activity, BMI, mammograms, prior hormone use, calcium, vitamin D, hip fracture risk score, Gail risk score and stratified on WHI trial randomization arm.Conclusion: There was a statistically significant association between oral bisphosphonate use and lower invasive breast cancer incidence with fewer ER positive breast cancers and a non-significant trend for ER negative breast cancers in bisphosphonate users. This result suggests oral bisphosphonates may have direct inhibiting effects on breast cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 21.
Paclitaxel-Related Peripheral Neuropathy Associated with Improved Outcome of Patients with Early Stage HER2+ Breast Cancer Who Did Not Receive Trastuzumab in the N9831 Clinical Trial.
Authors: Moreno-Aspitia A. , Dueck A. , Patel T. , Hillman D. , Tenner K. , Dakhil S. , Rowland K. , McLaughlin S. , Perez E. ,   TBCI Breast Cancer Intergroup of North America
Published: December 2010

Abstract
Background: Microtubules are crucial for spindle formation during mitosis and for cellular proliferation. The antineoplastic effect of paclitaxel is mainly related to its ability to bind the beta subunit of tubulin, thus preventing tubulin chain depolarization and inducing apoptosis. Tubulins are expressed in human peripheral nerves and the binding of paclitaxel to tubulin may lead to neuropathy. Peripheral neuropathy is a common dose limiting toxicity of paclitaxel. We hypothesized that the occurrence of peripheral neuropathy may correlate with outcome (disease-free survival; DFS).Methods: This analysis sought to describe incidence of peripheral neuropathy following paclitaxel and its association to outcome (DFS) in patients who received paclitaxel (weekly x 12) in the adjuvant HER2+ intergroup trial N9831. Only eligible pts who initiated paclitaxel and did not have peripheral neuropathy at initiation of paclitaxel that were randomized to arms A (955 pts; chemotherapy alone) and C (889 pts; chemotherapy plus concurrent trastuzumab) of N9831 were included. Cox regression analysis stratified by ER/PR status and nodal status was used to compare DFS within arm between patients with and without peripheral neuropathy.Results: Out of 1844 eligible pts, 379 developed neuropathy (20.5%). For pts in arm A, those who developed neuropathy had better DFS than pts who did not (3 yr DFS: 86.2% vs 81.8%; HR 0.65; p=0.01), despite lower doses of paclitaxel in the pts with neuropathy. Grade of neuropathy did not appear to impact DFS. No statistical difference was noted for pts treated in the trastuzumab-containing arm (3 yr DFS: 92.8% vs 91.1% for pts with neuropathy vs not; HR 0.79; p=0.34). There were no differences in paclitaxel dose intensity between arms A and C.Conclusion: Patients with early stage HER2+ breast cancer who received adjuvant paclitaxel-containing chemotherapy in arm A and developed peripheral neuropathy had a better DFS than pts who did not develop neuropathy. This effect was possibly abrogated by the use of trastuzumab in Arm C. This side effect may represent effective bindings of paclitaxel to the target tubulin, lack of point mutations in tubulin at the paclitaxel binding site and/or lack of selective overexpression of β-III tubulin. This is a hypothesis generating study and additional analysis needs to be conducted from other large taxane-based trials.Partial support from Genentech and the Breast Cancer Research Foundation
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2100.
Influence of Treatment Conforming to Guidelines on Recurrence Free Survival (RFS) and Overall Survival (OS) in Triple Negative Breast Cancer.
Authors: Atassi Z. , Wischnewsky M. , Wöckel A. , Kurzeder C. , Wolters R. , Novopashenny I. , Kreienberg R. 
Published: December 2010

Abstract
Introduction: The triple negative(TN) breast cancer subtype (ER neg, PR neg, HER 2 neg) represents about 10 to 15% 0f all breast cancer types. It characterizes an aggressive phenotype with significantly worsened RFS, OS as well as specific clinical and pathological properties. The aim of this study was: 1.To assess the efficacy of guideline conforming conventional chemotherapy, local recurrence rate, distant recurrence rate, as well as overall survival. 2.To ask for subgroups that show the greatest benefit from conventional chemotherapy and 3. to ask for impact of guidelines violation on RFS and OA.Patients and methods: 3658 breast cancer Patients that were first diagnosed between the years 2000 and 2005 were analyzed in a multicentric retrospective study. A total of 371 (10,1%) were triple negative. Results: Median age was 62 years(26-101) TN: 60years.(28-97). 13,8% of all included patients are triple negative. 90,3% of all TN patients are at intermediate/high risk according to Nottingham risk classification. 76,5 have G3 tumors. The 5 year DFS is 74,8% (95%CI 68,8% - 80,8%) and for none TN 86,5%(95%CI 84,6% - 88,4%) (logrankp&lt;0,0001). The 5 year OS is 75,8%(95%CI:69,9%- 81,8%) and for none TN 86%(95%CI:84,1%-87,9%). (logrank p &lt; 0,0001). The essential parameters for RFS and OS were guidelines conforming surgery and radiation therapy, when chemotherapy conforming to guidelines was provided. The 5 year RFS for TN patients undergoing a 100% guideline according adjuvant therapy is 86.1%(95%CI:78.9%-93.4%), with 1-2 violations 76.0% (95%CI:69.0%-83.1%) and with ≥3 violations 50.6%(95%CI:20.1%-81.1%) (logrank p&lt;0.0001). In total a 66,8% of all TN patients were not treated according to guidelines (ranking of violations: Chemotherapy, radiation therapy, surgery). 18% had 2 or more violations. Summary: The Results show a significant improvement of outcomes in TN breast cancer patients when treatment is conducted in accordance to guidelines. There are subgroups of TN breast cancer patients that profit from therapy according to guidelines. The leading guideline violation was noted for radiation therapy.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2101.