Evaluating the Efficacy of Current Clinical Practice of Adjuvant Chemotherapy in Postmenopausal Women with Early-Stage, Estrogen or Progesterone Receptor–Positive, One-To-Three Positive Axillary Lymph Node, Breast Cancer

Hannouf, Malek B.; Brackstone, Muriel; Xie, Bin; Zaric, Gregory S.

doi:10.3747/co.19.1038

Cited by 6 publications

(4 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although RCTs remain the gold standard for comparing treatments, patient selection criteria and the lack of flexibility in protocol-specified dose modifications and toxicity management limit the generalizability of the findings to the individual patient (Hahn and Schilsky 2012). The major questions are whether results of RCTs can be applied to ‘real world’ patients (sometimes with medical co-morbidities or borderline organ function), whether they are also reliably for subsets of patients with different clinical characteristics and whether patients nonenrolled in RCTs have a worst outcome than randomized patients (Korn and Freidlin 2012; Braunholtz et al 2001; Peppercorn et al 2004; Hannouf et al 2012; Engstrom et al 2012; Tanai et al 2011). From this point of view, observational retrospective studies are considered alternative good sources of information on the effectiveness of treatments used according to patient and tumor characteristics (Korn and Freidlin 2012; Lyman and Levine 2012).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer

Natoli

Vici²,

Sperduti³

et al. 2013

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

PurposeTrastuzumab and chemotherapy is the current standard of care in HER2+ early or locally advanced breast cancer, but there are scanty literature data of its real world effectiveness.MethodsWe retrospectively reviewed 205 patients with HER2+ breast cancer diagnosed in 10 Italian Medical Oncology Units between July 2003 and October 2011. All patients received neoadjuvant systemic therapy (NST) with trastuzumab in association with chemotherapy. Many different chemotherapy regimens were used, even if 90 % of patients received schemes including anthracyclines and 99 % received taxanes. NST was administered for more than 21 weeks (median: 24) in 130/205 (63.4 %) patients, while trastuzumab was given for more than 12 weeks (median: 12 weeks) in 101/205 (49.3 %) patients. pCR/0 was defined as ypT0+ypN0, and pCR/is as ypT0/is+ypN0.ResultspCR/0 was obtained in 24.8 % and pCR/is in 46.8 % of the patients. At multivariate logistic regression, nonluminal/HER2+ tumors (P < 0.0001) and more than 12 weeks of neoadjuvant trastuzumab treatment (P = 0.03) were independent predictors of pCR/0. Median disease-free survival (DFS) and cancer-specific survival (CSS) have not been reached at the time of analysis. At multivariate analysis, nonluminal/HER2+ subclass (DFS: P = 0.01 and CSS: P = 0.01) and pathological stage II–III at surgery (DFS: P < 0.0001 and CSS: P = 0.001) were the only variables significantly associated with a worse long-term outcome.ConclusionsOur data set the relevance of molecular subclasses and residual tumor burden after neoadjuvant as the most relevant prognostic factors for survival in this cohort of patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer

Natoli

Vici²,

Sperduti³

et al. 2013

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

show abstract

“…A recent survey among researchers in the breast cancer field [21] found that the identification of hormone receptor-positive breast cancer patients who might on charged glass slides. After paraffin removal, sections were dehydrated and incubated in 2mM NaCN for 20 minutes and later held in pepsin for an average 30 min followed by denaturation in formamide solution.…”

Section: Tumor Biological Techniquesmentioning

confidence: 99%

Efficacy of combined therapy of goserelin and letrozole on very young women with advanced breast cancer as first-line endocrine therapy

Liu

Cao

et al. 2013

Endocr J

View full text Add to dashboard Cite

Although breAst cAncer is the most common cancer in women in the developing and developed countries, only 1% of the patients are younger than 35 years old [1]. Breast cancer in young women is considered aggressive and associated with a poor prognosis [2,3]. Earlier data from the Finnish Cancer Registry in the 1990's showed that very young women had a more advanced breast cancer at diagnosis and poorer 5-year survival than older premenopausal patients [4]. Recent data indicated the 5-year overall survival (OS) for young women had been better but is still lower than for all breast cancer patients, and disease free interval (DFI) was shorter in patients with hormone receptor positive disease [1].Endocrine therapy is the preferred treatment modality in hormone-receptor-positive (HR) early stage and Abstract. Breast cancer in young women younger than 35 years old is rare, aggressive and associated with a poor prognosis. Endocrine therapy is a preferred treatment modality in hormone receptor-positive early stage and advanced breast cancer, combined therapy of goserelin and letrozole presents an option for premenopausal women. We reported the efficacy and safety of therapy of goserelin plus letrozole on very young women with advanced breast cancer as first-line endocrine therapy. Thirty-five patients with first diagnosed as advanced breast cancer, age younger than 35 years, were enrolled in the study. All patients received goserelin 3.6mg by subcutaneous injection every 4 weeks along with letrozole 2.5mg daily by mouth as first-line endocrine therapy. The study endpoints were objective response rate (ORR), clinical benefit (CB), progression-free survival (PFS), overall survival (OS) and toxicity. The median duration of response to the therapy was 21 (range, 10-56) months, and median duration of follow-up was 44 (range, 5-79) months. The ORR was 25.7%, with one complete response (CR, 2.9%) and eight partial response (PR, 22.9%). Twenty-two patients had stable disease at 24 weeks, for a clinical benefit rate of 65.7%. The median PFS was 9.6 (range 5-58) months and median OS was 33 (range 6-72) months. During the therapy and follow-up, no serious toxicities were reported. Combined therapy of goserelin and letrozole appears to be an efficacious and well-tolerated therapy for very young women with advanced breast cancer. Further investigations involving more patients, combination of other therapies and longer follow-up are requisite.

show abstract

“…Although the clinicopathologic presentation of CUP patients may differ from that of patients with CKP, there does not seem to be a major disparity in the response rates and the outcomes between these two patient groups after the primary tumour is defined and tumour-specific therapies are administered [ 29 ]. However, the impact of primary tumour identification via gene expression profiling on clinical outcomes for patients with CUP remains uncertain and difficult to prove in randomized trials because of a combination of ethical, clinical and logistical considerations [ 29 – 31 ]. Additional clinical evidence is necessary to optimize a precision medicine strategy as a standard of care for patients with CUP.…”

Section: Introductionmentioning

confidence: 99%

The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study

Hannouf

Winquist

Mahmud

et al. 2017

PharmacoEconomics Open

View full text Add to dashboard Cite

PurposeSeveral genomic tests have recently been developed to identify the primary tumour in cancer of unknown primary tumour (CUP). However, the value of identifying the primary tumour in clinical practice for CUP patients remains questionable and difficult to prove in randomized trials.ObjectiveWe aimed to assess the clinical and economic value of primary tumour identification in CUP using a retrospective matched cohort study.MethodsWe used the Manitoba Cancer Registry to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients as having CUP if their primary tumour was found 6 months or more after initial diagnosis or never found during the course of disease. Otherwise, we considered patients to have metastatic cancer from a known primary tumour (CKP). We linked all patients with Manitoba Health databases to estimate their direct healthcare costs using a phase-of-care approach. We used the propensity score matching technique to match each CUP patient with a CKP patient on clinicopathologic characteristics. We compared treatment patterns, overall survival (OS) and phase-specific healthcare costs between the two patient groups and assessed association with OS using Cox regression adjustment.ResultsOf 5839 patients diagnosed with metastatic cancer, 395 had CUP (6.8%); 1:1 matching created a matched group of 395 CKP patients. CUP patients were less likely to receive surgery, radiation, hormonal and targeted therapy and more likely to receive cytotoxic empiric chemotherapeutic agents. Having CUP was associated with reduced OS (hazard ratio [HR] 1.31; 95% confidence interval 1.1–1.58), but this lost statistical significance with adjustment for treatment differences. CUP patients had a significant increase in the mean net cost of initial diagnostic workup before diagnosis and a significant reduction in the mean net cost of continuing cancer care.ConclusionIdentifying the primary tumour in CUP patients might enable the use of more effective therapies, improve OS and allow more efficient allocation of healthcare resources.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0051-2) contains supplementary material, which is available to authorized users.

show abstract

Evaluating the Efficacy of Current Clinical Practice of Adjuvant Chemotherapy in Postmenopausal Women with Early-Stage, Estrogen or Progesterone Receptor–Positive, One-To-Three Positive Axillary Lymph Node, Breast Cancer

Cited by 6 publications

References 40 publications

Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer

Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer

Efficacy of combined therapy of goserelin and letrozole on very young women with advanced breast cancer as first-line endocrine therapy

The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study

Contact Info

Product

Resources

About