We present a retrospective analysis on a cohort of low-grade, node-negative patients showing that human epidermal growth factor receptor 2 (HER2) status significantly affects the survival in this otherwise very good prognostic group. Our results provide support for the use of adjuvant trastuzumab in patients who are typically classified as having very good prognosis, not routinely offered standard chemotherapy, and who as such do not fit current UK prescribing guidelines for trastuzumab. Human epidermal growth factor receptor 2 (HER2) amplification has become the prototype biomarker for translation of a laboratory discovery through to development of a highly successful individualised biological therapy agent. Slamon et al (1987) established HER2 as a poor prognostic marker for survival in breast cancer and developed a monoclonal antibody, trastuzumab, targeted to HER2, as a novel therapy for breast cancer patients. More recently, randomised trials in early breast cancer have shown the clinical benefit of trastuzumab after chemotherapy with significant overall survival benefit over chemotherapy alone (Romond et al, 2005;Slamon et al, 2006;Smith et al, 2007). As a result, trastuzumab has been introduced into routine clinical practice in the UK for HER2-positive patients who have completed their standard adjuvant treatment. Current Scottish and National Institute for Health and Clinical Excellence (NICE) guidelines parallel the herceptin adjuvant (HERA) trial entry criteria, according to which trastuzumab is offered only to those patients who have already received standard chemotherapy regimes as part of their treatment regime.However, there remains a small subset of HER2-positive patients who are low grade and node negative and who are currently ineligible for trastuzumab treatment as clinically they have been deemed to have no requirement for standard adjuvant chemotherapy. In our region, approximately 25% of HER2 patients are not offered herceptin as they are deemed to be at 'low risk' (personal communication). Our study analyses a retrospective cohort of lowgrade and node-negative tumours, traditionally classified by Nottingham Prognostic Index (NPI) and Adjuvant! Online as 'low risk' to assess whether HER2 positivity affects survival in this otherwise very good prognostic group. METHODS PatientsWe have a large cohort (n ¼ 1351) of breast cancers diagnosed between 1980 -2002 with full clinical follow-up (median 6.5 years) and pathological details taken from pathology reports. Tissue specimens from these cancers had been used to create tissue microarray technology (TMA) for research purposes (ethical approval was obtained). The grades of tumours from the cohorts diagnosed in the 1980 -90s were reviewed for accuracy by a consultant pathologist (EAM). From this database, we wished to identify a group of patients who would classically be identified as 'low risk'. We selected all node-negative, grade 1 or 2 cancers (n ¼ 362) for further analysis. Human epidermal growth factor receptor 2 status assessmentHuman epider...
A regimen that combines 5-FU and FA has been identified for regional chemotherapy in patients with hepatic metastases from colorectal cancer. The systemic levels of 5-FU achieved are similar to the conventional IV de Gramont regimen using an identical schedule of 5-FU and FA, which implies that this chemotherapy has the best of both worlds, ie, a regional advantage in delivering high drug concentrations to the target organ with adequate systemic cover for extrahepatic micrometastases.
Background Systemic inflammation may influence survival in women with breast cancer. Both the platelet lymphocyte ratio (PLR) and the neutrophil lymphocyte ratio (NLR) have been shown to be associated with survival in a number of solid tumours. The aim of this study was to assess the role of PLR and NLR in survival of women with early breast cancer. Methods: Women diagnosed with early breast cancer at two centres between 2003 and 2006 were included. All women had measured white cells, neutrophils, lymphocytes and platelets. NLR and PLR were calculated. Cox regression survival analysis was performed with breast cancer specific survival used as the primary end point. Significant associations of NLR and PLR with pathological variables was assessed using the Chi squared test. Results: 707 women were included with a median follow up of 3.7yrs. On univariate analysis neither NLR (HR 1.08, 95% CI 0.66−1.79) or PLR (HR 0.96, 95% CI 0.58−1.59) were significantly associated with breast cancer specific survival. An increased PLR was found to be associated with significantly fewer grade 1 tumours (P<0.05) but no other significant associations with pathology was demonstrated for either PLR or NLR. Conclusions: This study would suggest that the NLR and PLR are not prognostic of survival in women with early breast cancer. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-30.
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