Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer

Tolaney, Sara M.; Barry, William T.; Dang, Chau T.; Yardley, Denise A.; Moy, Beverly; Marcom, P. Kelly; Albain, Kathy S.; Rugo, Hope S.; Ellis, Matthew J.; Shapira, Iuliana; Wolff, Antonio C.; Carey, Lisa A.; Overmoyer, Beth; Partridge, Ann H.; Guo, Hao; Hudis, Clifford A.; Krop, Ian E.; Burstein, Harold J.; Winer, Eric P.

doi:10.1056/nejmoa1406281

Cited by 641 publications

(459 citation statements)

References 21 publications

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“…For HER2-positive breast cancer, trastuzumab, a HER2-specific monoclonal antibody, improves the survival of patients with early-stage breast cancer and should be given in addition to chemotherapy (40). Because of the increased risk of heart failure with anthracycline-and trastuzumab-containing regimens, nonanthracycline, taxane-containing regimens can be used (41,42). No trials have compared the various HER2 regimens; therefore, for patients with the highest risk, a standard regimen contains an anthracycline followed by a taxane with trastuzumab.…”

Section: Medical Oncologymentioning

confidence: 99%

Clinical Diagnosis and Management of Breast Cancer

et al. 2016

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The diagnosis and management of breast cancer are undergoing a paradigm shift from a one-size-fits-all approach to an era of personalized medicine. Sophisticated diagnostics, including molecular imaging and genomic expression profiles, enable improved tumor characterization. These diagnostics, combined with newer surgical techniques and radiation therapies, result in a collaborative multidisciplinary approach to minimizing recurrence and reducing treatment-associated morbidity. This article reviews the diagnosis and treatment of breast cancer, including screening, staging, and multidisciplinary management. In this article, we address current approaches to breast cancer diagnosis and management. These approaches include screening recommendations; diagnostic imaging and pathologic assessment to determine the extent of disease; surgery and radiation treatment; and an array of systemic options, such as chemotherapy, endocrine therapy, and targeted agents (Fig. 1). We also consider the potential contribution of functional imaging to a new era of personalized, tumor-specific treatment. BREAST CANCER DIAGNOSIS ScreeningBreast cancer is generally diagnosed through either screening or a symptom (e.g., pain or a palpable mass) that prompts a diagnostic exam. Screening of healthy women is associated with the detection of tumors that are smaller, have lower odds of metastasis, are more amenable to breast-conserving and limited axillary surgery, and are less likely to require chemotherapy (1). This scenario translates to reduced treatment-related morbidity and improved survival.The only screening modality proven to reduce breast cancerspecific mortality is mammography (2). Screening mammography leads to a 19% overall reduction in breast cancer mortality (3), with less benefit for women in their 40s (15%) and more benefit for women in their 60s (32%). As a result, screening mammography is recommended by the American Cancer Society beginning at age 45, or sooner depending on individual preference. The potential negative aspects of screening mammography are falsepositive examinations, radiation exposure, pain, anxiety, and other negative psychologic effects. Mammography has a 61% chance of a false-positive result over a 10-y period for women commencing screening between the ages of 40 y and 50 y. The risk of a falsepositive examination decreases with older age (3). The US Preventative Task Force cited a 15% breast cancer-related mortality reduction for women who were 39-49 y old and a mortality-related benefit from screening between ages 39 and 69. However, the task force released a controversial report recommending only biennial screening mammography for women who were 50-74 y old, excluding younger women to a large extent because of the high rate of false-positive results (4). Mammography for women in the 39-to 49-y-old age group was recommended if indicated after the use of a risk-based model of breast cancer screening, such as the models developed by the Population-Based Research Optimizing Screening Through Personalized Re...

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Section: Medical Oncologymentioning

confidence: 99%

Clinical Diagnosis and Management of Breast Cancer

et al. 2016

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“…But the trials focused mostly on women with more advanced cancer. Tolaney et al (2015) tested a gentler chemotherapy regimen (a single drug, paclitaxel, given weekly for 12 weeks) in over 400 patients with Stage 1 HER? breast cancers.…”

Section: Early Breast Cancer: a Personal Narrativementioning

confidence: 99%

Adjuvant chemotherapy: an autoethnography

Greenhalgh

2017

Subjectivity

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Adjuvant chemotherapy is given after surgery for early stage cancer. It aims to cure. Though potentially toxic, it has dramatically improved survival for some cancers. This paper offers an autoethnographic exploration of three kinds of strangeness that I encountered during a 12-week course of adjuvant chemotherapy for early breast cancer: the material strangeness of what was done to me; the livedbody strangeness of receiving chemotherapy (which makes people sick to make them well) and the existential strangeness of reconstructing my broken narrative. In a discussion, I consider four aspects of autoethnography of deep illness against which this account and its telling might be judged: ethnographic legitimacy (does it meet the standards of analytic social science?), autobiographical legitimacy (is it compelling as literature?), existential ethics (am I, the wounded storyteller, protected from harm?) and relational ethics (have I discharged my duties towards those implicated in the text and its interpretation?).

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“…Dispite the fact that improving outcomes may be associated with a risk of treatment-induced cardiotoxicity (TIC) (Barroso-Sousa et al, 2013;Zhu et al, 2013;Shinde et al, 2015;. And in predominantly stage I HER2-positive breast cancer, treatment with adjuvant paclitaxel plus trastuzumab was associated with a risk of early recurrence of about 2% (Tolaney et al, 2015). Also, the good outcomes are limited regarding its impact on locoregional recurrence (LRR) in patients undergoing mastectomy, particularly those receiving (post-mastectomy radiation) PMRT (Lanning et al, 2015).…”

Section: Trastuzumabmentioning

confidence: 99%