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Shelby RA, Dorfman CS, Bosworth HB, Keefe F, Sutton L, Owen L, Corsino L, Erkanli A, Reed SD, Arthur SS, Somers T, Barrett N, Huettel S, Gonzalez JM, Kimmick G. Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET). Contemp Clin Trials 2019; 76:120-131. [PMID: 30472215 PMCID: PMC6346744 DOI: 10.1016/j.cct.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N = 400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes. Trials registration: ClinicalTrials.gov, NCT02707471, registered 3/3/2016.
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Affiliation(s)
- Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Hayden B Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Linda Sutton
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Lynda Owen
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Leonor Corsino
- Division of Endocrinology, Duke University, Durham, NC, United States.
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States.
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Sarah S Arthur
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Nadine Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University, Durham, NC, United States.
| | - Scott Huettel
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, United States.
| | - Gretchen Kimmick
- Division of Medical Oncology, Duke University, Durham, NC, United States.
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Chen PH, Huang SM, Lai JCY, Tai CJ, Chien LY, Lee YH. Factors associated with seeking western or Chinese medical treatment for fertility among women with breast cancer in Taiwan. J TRADIT CHIN MED 2018. [DOI: 10.1016/s0254-6272(18)30990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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53
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Xiao H, Jiang X, Chen C, Montero AJ, Diaby V. Longitudinal Effects of Adjuvant Endocrine Therapy on the Quality of Life of Post-menopausal Women with Non-metastatic ER+ Breast Cancer: A Systematic Review. PHARMACOECONOMICS - OPEN 2018; 2:359-369. [PMID: 29470807 PMCID: PMC6249194 DOI: 10.1007/s41669-018-0070-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Anti-estrogen (ER) endocrine therapy is an effective treatment strategy in reducing breast cancer mortality. This therapy has a better therapeutic index than chemotherapy but can still affect patients' quality of life (QOL) over time. OBJECTIVE The objectives of this systematic review were to (1) describe QOL instruments used in ER-positive (ER+) non-metastatic breast cancer trials and (2) document the longitudinal effects of adjuvant endocrine therapy on the QOL of post-menopausal women with ER+ non-metastatic breast cancer. METHODS We searched three electronic bibliographic databases for articles published from inception to October 2017 that described (1) a randomized controlled trial (RCT) of non-metastatic breast cancer containing an adjuvant endocrine regimen in at least one arm; (2) the use of a patient self-report measure assessing general or breast cancer-specific QOL; and (3) QOL outcomes at multiple time points during follow-up of at least 5 years. All included trials were independently evaluated by two reviewers, and data were extracted using standardized forms. RESULTS In total, 13 studies met our inclusion criteria and were assessed in this review. The quality of the trials was reasonably good. The top three most commonly used QOL instruments in the trials were the Functional Assessment of Cancer Therapy/Functional Assessment of Chronic Illness Therapy, the Short Form-36 and the Menopause-Specific Quality of Life. Most studies found no differences between tamoxifen and aromatase inhibitor groups in terms of global QOL. QOL data affected treatment regimen recommendations in a few cases. A meta-analysis was not feasible because the RCTs included in our review varied in terms of sample size, comparators, QOL instrument used, and timing of QOL measurement. Additionally, as no search strategy has perfect sensitivity, specificity and accuracy, there is always a chance that potentially relevant articles were missed. CONCLUSION This systematic review suggests that the QOL of post-menopausal women is unlikely to be adversely affected by long-term use of adjuvant endocrine therapy. Efforts are needed to improve the quality of QOL reporting in clinical trials.
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Affiliation(s)
- Hong Xiao
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP Building Room 3338, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP 2309, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Cheng Chen
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP 2309, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Alberto J Montero
- Cleveland Clinic Foundation, Taussig Cancer Institute, 9500 Euclid Ave, R35, Cleveland, OH, 44195, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP 3317, 1225 Center Drive, Gainesville, FL, 32610, USA
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Pineda-Moncusí M, Servitja S, Casamayor G, Cos ML, Rial A, Rodriguez-Morera J, Tusquets I, Diez-Perez A, Garcia-Giralt N, Nogués X. Bone health evaluation one year after aromatase inhibitors completion. Bone 2018; 117:54-59. [PMID: 30223134 DOI: 10.1016/j.bone.2018.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Breast cancer patients treated with aromatase inhibitors (AIs) experience increased bone loss during their treatment. However, there is little information about bone mineral density (BMD) after completing AI-treatment. The present study aimed to assess BMD changes one year after AI-therapy completion. METHODS Data were collected from 864 postmenopausal women treated with AI during 5 years (5y-AI group), or during 2-3 years after taking tamoxifen therapy (pTAM-AI group). Participants with osteoporosis were treated with oral bisphosphonates (BP). BMD changes in lumbar spine (LS), femoral neck (FN) and total hip (TH) between baseline, end of treatment, and at one year post-treatment were assessed using repeated-measures ANOVA. RESULTS At the end of AI-treatment, 382 patients had available BMD values and 316 also had post-treatment BMD values. As expected, BMD levels were decreased at AI-completion in non-BP treated patients. After one year, LS BMD increased in both groups (5y-AI: +2.11% [95%CI: 1.55 to 2.68], p < 0.001; pTAM-AI: +1.00% [95%CI: 0.49 to 1.51], p < 0.001) compared with the end of AI-therapy, while values at FN and TH remained stable. On the other hand, BMD values of BP-treated patients were increased or maintained at the end of AI-treatment and also at post-treatment. CONCLUSIONS At one year after AI-completion, FN and TH BMD remained reduced in non-BP treated women, while LS BMD was recovered in the 5y-AI group and partially recovered in the pTAM-AI group. BP treatment increased or maintained BMD values at the end of therapy and at one year post-treatment.
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Affiliation(s)
- Marta Pineda-Moncusí
- IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain
| | - Sonia Servitja
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Guillem Casamayor
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Lourdes Cos
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Abora Rial
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaime Rodriguez-Morera
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Tusquets
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Adolfo Diez-Perez
- IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natalia Garcia-Giralt
- IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain.
| | - Xavier Nogués
- IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Wöckel A, Festl J, Stüber T, Brust K, Stangl S, Heuschmann PU, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching PA, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Krockenberger M. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 1 with Recommendations for the Screening, Diagnosis and Therapy of Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:927-948. [PMID: 30369626 PMCID: PMC6202580 DOI: 10.1055/a-0646-4522] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Methods The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure. Recommendations Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.
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Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter A. Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
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Sim S, Lövrot J, Lindh JD, Bergh J, Xie H. Effect of CYP2C19 and CYP2D6 genotype on tamoxifen treatment outcome indicates endogenous and exogenous interplay. Pharmacogenomics 2018; 19:1027-1037. [DOI: 10.2217/pgs-2018-0089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: We investigated the interaction of CYP2C19 and CYP2D6 genotype on clinical outcome in tamoxifen-treated breast cancer patients. Materials & methods: A cohort of 306 patients on tamoxifen treatment for a minimum of 1 year were employed to analyze the effect of genotype-predicted phenotype on relapse-free survival. Results & conclusion: We show that the group with worst outcome and highest risk of relapse is that of 2C19↑–2D6↓ (hazard ratio: 2.94), when adjusting for age, Nottingham prognostic index and adjuvant chemotherapy. Furthermore, the effect of 2C19↑–2D6↓genotype-predicted phenotype is greatly enhanced in premenopausal patients (hazard ratio: 21.08). We hypothesize that poor bioactivation of tamoxifen in patients with low CYP2D6 activity and high CYP2C19 metabolism represents a tamoxifen-treated patient group that has the worst clinical outcome.
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Affiliation(s)
- Sarah Sim
- Department of Physiology & Pharmacology, Karolinska Institutet, SE171-76 Stockholm, Sweden
| | - John Lövrot
- Department of Oncology & Pathology, Karolinska Institutet, SE171-76 Stockholm, Sweden
| | - Jonatan D Lindh
- Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology & Pathology, Karolinska Institutet, SE171-76 Stockholm, Sweden
- Department of Clinical Oncology, Karolinska University Hospital, SE171-76 Stockholm, Sweden
| | - Hanjing Xie
- Department of Oncology & Pathology, Karolinska Institutet, SE171-76 Stockholm, Sweden
- Department of Clinical Oncology, Karolinska University Hospital, SE171-76 Stockholm, Sweden
- Department of Oncology, Capio S:t Görans Hospital, SE112-81 Stockholm, Sweden
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Nakatsukasa K, Koyama H, Ouchi Y, Sakaguchi K, Fujita Y, Matsuda T, Kato M, Konishi E, Taguchi T. Effect of denosumab on bone mineral density in Japanese women with osteopenia treated with aromatase inhibitors for breast cancer: subgroup analyses of a Phase II study. Ther Clin Risk Manag 2018; 14:1213-1218. [PMID: 30022834 PMCID: PMC6044343 DOI: 10.2147/tcrm.s167579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the study was to conduct subgroup analyses of therapeutic effects of 12-month denosumab therapy on the percentage change in bone mineral density (BMD) from baseline in the lumber spine and femoral neck. Materials and methods We prospectively evaluated the BMD of the lumbar spine and femoral neck of 100 hormone receptor-positive, clinical stage I–IIIA postoperative postmenopausal breast cancer patients, for whom treatment with aromatase inhibitors (AIs) as adjuvant endocrine therapy was scheduled. The primary endpoint was the percent change in lumbar spine BMD from baseline to 12 months. Patient subgroups were analyzed according to baseline variables that are known risk factors for bone loss, including previous AI therapy, age, time since menopause, baseline body mass index (BMI), and baseline BMD T-score. Results At 12 months, lumbar spine BMD increased by 4.7%; the patients who were administered AI therapy prior to denosumab (n=70) demonstrated a 4.7% increase in BMD, and the patients who received denosumab at the start of AI therapy (n=30) demonstrated a 4.5% increase in BMD (p=0.8385). Additionally, 2.4% and 1.4% increases in BMD of the right and left femoral neck, respectively, were observed. Initiation of AI (with denosumab, before denosumab), type of AI (non-steroidal, steroidal), age (<65, ≥65 years), time since menopause (≤5, >5 years), BMI (<25, ≥25 kg/m2), and T-score (≤−1.0, >−1.0) of the right femoral neck were as follows: (2.2%, 2.5%, p=0.7773), (2.6%, 0.9%, p=0.1726), (2.5%, 2.3%, p=0.7594), (2.1%, 2.4%, p=0.2034), (2.1%, 2.9%, p=0.2034), and (2.3%, 2.7%, p=0.6823), respectively. Initiation of AI (with denosumab, before denosumab), type of AI (non-steroidal, steroidal), age (<65, ≥65 years), time since menopause (≤5, >5 years), BMI (<25, ≥25 kg/m2), and T-score (≤−1.0, >−1.0) of the left femoral neck were as follows: (1.0%, 1.5%, p=0.1972), (1.2%, 2.7%, p=0.2931), (1.4%, 1.3%, p=0.8817), (−0.1%, 1.6%, p=0.1766), (1.3%, 1.9%, p=0.6465), and (1.5%, 1.1%, p=0.6573), respectively. Conclusion Twice-yearly treatment with denosumab was associated with increased BMD among Japanese women receiving adjuvant AI therapy, regardless of the baseline characteristics or skeletal site.
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Affiliation(s)
- Katsuhiko Nakatsukasa
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Hiroshi Koyama
- Department of Breast Surgery, Nara City Hospital, Nara, Japan
| | - Yoshimi Ouchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Kouichi Sakaguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Yoshifumi Fujita
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Takayuki Matsuda
- Department of Breast Surgery, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Makoto Kato
- Department of Breast Surgery, Kato Breast Surgery Clinic, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan,
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Baker MK, Peddle-McIntyre CJ, Galvão DA, Hunt C, Spry N, Newton RU. Whole Body Vibration Exposure on Markers of Bone Turnover, Body Composition, and Physical Functioning in Breast Cancer Patients Receiving Aromatase Inhibitor Therapy: A Randomized Controlled Trial. Integr Cancer Ther 2018; 17:968-978. [PMID: 29952241 PMCID: PMC6142085 DOI: 10.1177/1534735418781489] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Women with breast cancer are often prescribed
aromatase inhibitors, which can cause rapid loss of bone mass leading to
significant potential for morbidity. Vibration training has been shown to be
helpful in reducing bone turnover in postmenopausal women without cancer.
Aim: To examine the effect of vibration stimulus on markers of
bone turnover in breast cancer patients receiving aromatase inhibitors.
Methods: Thirty-one breast cancer survivors undergoing
treatment with aromatase inhibitors were randomized to vibration stimulus (n =
14) or usual care control (n = 17). Low-frequency and low-magnitude vibration
stimulus (27-32 Hz, 0.3g) was delivered in supervised sessions
via standing on a vibration platform for 20 minutes, 3 times per week for 12
weeks. The primary outcome was blood markers of bone resorption (serum
N-telopeptide X/creatine) and formation (serum type 1 procollagen N-terminal
propeptide; P1NP). Other study outcomes body composition as well as measures of
physical functioning. Outcomes were compared between groups using analysis of
covariance adjusted for baseline values as well as time on aromatase inhibitors.
Outcomes: On average, participants were 61.5 years old and
overweight (ie, body mass index = 28.5 kg/m2). Following vibration
training, there was no significant difference between groups for bone resorption
(adjusted group difference 0.5, P = .929) or formation
(adjusted group difference 5.3, P = .286). There were also no
changes in any measure of physical functioning body composition.
Conclusions: Short-term low-magnitude vibration stimulus does
not appear to be useful for reducing markers of bone turnover secondary to
aromatase inhibitors in breast cancer patients; nor is it useful in improving
physical function or symptoms. However, further investigations with larger
samples and higher doses of vibration are warranted. Trial
Registration: Australian and New Zealand Clinical Trials Registry
(ACTRN12611001094965).
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Affiliation(s)
- Michael K Baker
- 1 Australian Catholic University, Strathfield, New South Wales, Australia
| | | | - Daniel A Galvão
- 2 Edith Cowan University, Joondalup, Western Australia, Australia
| | - Catherine Hunt
- 3 Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Nigel Spry
- 2 Edith Cowan University, Joondalup, Western Australia, Australia.,3 Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Robert U Newton
- 2 Edith Cowan University, Joondalup, Western Australia, Australia
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Yang Y, Pan W, Tang X, Wu S, Sun X. A meta-analysis of randomized controlled trials comparing the efficacy and safety of anastrozole versus tamoxifen for breast cancer. Oncotarget 2018; 8:48362-48374. [PMID: 28415634 PMCID: PMC5564654 DOI: 10.18632/oncotarget.16466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/04/2017] [Indexed: 11/25/2022] Open
Abstract
Whether anastrozole has superior effects to tamoxifen for breast cancer remains controversial. Therefore, we conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of anastrozole versus tamoxifen as adjuvant therapy in breast cancer. A systematic literature search of PubMed, Web of Science, Embase, and Cochrane library were performed to evaluate the survival benefits and toxicity profiles of patients with breast cancer who were treated with anastrozole or tamoxifen. The main outcome measures included disease-free survival (DFS), recurrence-free survival (RFS), overall survival (OS), overall response rate (ORR), and adverse events. Hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a fixed-effects model or random-effects model. Nine RCTs with a total of 15,300 patients met the inclusion criteria and were included in this meta-analysis. Pooled estimates suggested that, anastrozole was associated with a significantly improvement in DFS (HR=0.72, 95%CI: 0.55-0.94; P=0.016), and ORR (RR=1.21, 95% CI: 1.05-1.39; P=0.009) than tamoxifen. But it did not prolong OS (HR=0.96, 95%CI: 0.77-1.21; P=0.751). Compared with tamoxifen, anastrozole induced a higher incidence of arthralgia (RR=1.55, 95%CI: 1.20-1.99; P=0.001) and bone pain (RR=1.31, 95%CI: 1.05-1.62; P=0.015), as well as a lower incidence of vaginal bleeding (RR=0.51, 95%CI: 0.28-0.93; P=0.029), vaginal discharge (RR=0.31, 95%CI: 0.12-0.82; P=0.017), and thromboembolic events (RR=0.39, 95%CI: 0.28-0.55; P<0.001). Based on the current evidence, patients with breast cancer would benefit from the anastrozole treatment.
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Affiliation(s)
- Yan Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Pan
- Department of Radiation Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyu Tang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuqing Wu
- Department of Radiation Oncology, The Affiliated Danyang Hospital of Nantong University, Nantong, China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system. Breast Cancer Res Treat 2018; 170:623-631. [PMID: 29671113 DOI: 10.1007/s10549-018-4774-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/29/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE We evaluated associations between personal and clinical social support and non-adherence to adjuvant endocrine therapy (AET) in a large, Northern California breast cancer (BC) cohort from an integrated healthcare network. METHODS This study included 3382 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-III hormone receptor-positive BC and who responded to the Medical Outcomes Study Social Support and Interpersonal Processes of Care surveys, approximately 2 months post-diagnosis. We used logistic regression to evaluate associations between tertiles of social support and non-initiation (< 2 consecutive prescription fills within a year after diagnosis). Among those who initiated treatment, we used proportional hazards regression to evaluate associations with discontinuation (≥ 90 day gap) and non-adherence (< 80% medical possession ratio). RESULTS Of those who initiated AET (79%), approximately one-fourth either discontinued AET or were non-adherent. AET non-initiation was more likely in women with moderate (adjusted OR 1.18, 95% CI 0.96-1.46) or low (OR 1.30, 95% CI 1.05-1.62) versus high personal social support (P trend = 0.02). Women with moderate (HR 1.20, 95% CI 0.99-1.45) or low (HR 1.32, 95% CI 1.09-1.60) personal social support were also more likely to discontinue treatment (P trend = 0.01). Furthermore, women with moderate (HR 1.25, 95% CI 1.02-1.53) or low (HR 1.38, 95% CI 1.12-1.70) personal social support had higher non-adherence (P trend = 0.007). Associations with clinical social support and outcomes were similar. Notably, high clinical social support mitigated the risk of discontinuation when patients' personal support was moderate or low (P value = 0.04). CONCLUSIONS Women with low personal or clinical social support had higher AET non-adherence. Clinician teams may need to fill support gaps that compromise treatment adherence.
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Boukhechba M, Baee S, Nobles AL, Gong J, Wells K, Barnes LE. A Social Cognitive Theory-based Framework for Monitoring Medication Adherence Applied to Endocrine Therapy in Breast Cancer Survivors. ... IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS. IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS 2018; 2018:275-278. [PMID: 29862383 PMCID: PMC5983047 DOI: 10.1109/bhi.2018.8333422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Poor adherence to long-term therapies for chronic diseases, such as cancer, compromises effectiveness of treatment and increases the likelihood of disease progression, making medication adherence a critical issue in population health. While the field has documented many eers to adherence to medication, it has also come up with few efficacious solutions to medication adherence, indicating that new and innovative approaches are needed. In this paper, we evaluate medication-taking behaviors based on social cognitive theory (SCT), presenting patterns of adherence stratified across SCT constructs in 33 breast cancer survivors over an 8-month period. Findings indicate that medication adherence is a very personal experience influenced by many simultaneously interacting factors, and a deeper contextual understanding is needed to understand and develop interventions targeting non-adherence.
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Affiliation(s)
- Mehdi Boukhechba
- Systems and Information Engineering, University of Virginia. mob3f/sb5ce/aln2dh/
| | - Sonia Baee
- Systems and Information Engineering, University of Virginia. mob3f/sb5ce/aln2dh/
| | - Alicia L Nobles
- Systems and Information Engineering, University of Virginia. mob3f/sb5ce/aln2dh/
| | - Jiaqi Gong
- Department of Information Systems, University of Maryland Baltimore County.
| | | | - Laura E Barnes
- Systems and Information Engineering, University of Virginia. mob3f/sb5ce/aln2dh/
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Guo C, Fu M, Dilimina Y, Liu S, Guo L. microRNA-10b expression and its correlation with molecular subtypes of early invasive ductal carcinoma. Exp Ther Med 2018; 15:2851-2859. [PMID: 29599829 PMCID: PMC5867397 DOI: 10.3892/etm.2018.5797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/18/2017] [Indexed: 01/31/2023] Open
Abstract
The present study aimed to determine whether the expression of microRNA (miR)-10b was correlated with the molecular subtypes of early invasive ductal carcinoma of the breast. In situ hybridization was used to detect the expression of miR-10b in 193 patients diagnosed with early invasive ductal carcinoma. Immunohistochemistry was performed to evaluate the expression of estrogen receptor (ER)-α, progesterone receptor (PR) and human epidermal growth factor receptor-2 (Her-2). The positive expression rate of miR-10b in patients with early invasive ductal carcinoma with ER-α (+) or PR (+) was decreased compared with ER-α (-) or PR (-) patients (P<0.05). Furthermore, the positive expression rate of miR-10b in patients with Her-2 (-) was significantly increased compared with patients that were Her-2 (+) (P=0.031). The positive expression rate of miR-10b in the luminal B subtype was significantly decreased compared with that in the luminal A, Her-2 and basal-like subtypes (P=0.037). In patients that were identified as miR-10b (+), the median disease-free survival time was significantly increased in patients that were ER-α (+)/PR (+)/Her-2 (-) compared with patients that were ER-α (-)/PR (-)/Her-2 (+) (P<0.05). In addition, the median disease-free survival time was significantly decreased in Her-2 overexpression and basal-like subtypes when compared with luminal A and B subtypes (P<0.05). The molecular subtype was an independent prognostic factor for early invasive ductal carcinoma (odds ratios for luminal B, Basal-like, and Her-2 overexpression were 2.900, 5.232 and 4.214, respectively; all P<0.05). Positive expression of miR-10b may also be a prognostic risk factor (odds ratio >1), though this was not statistically significant (P>0.05). The present findings indicated that miR-10b-positive expression was correlated with the expression of ER-α, Her-2 and the molecular subtypes of early invasive ductal carcinoma of the breast.
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Affiliation(s)
- Chenming Guo
- Department of Breast Cancer, Digestive and Vascular Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Minggang Fu
- Department of Breast Cancer, Digestive and Vascular Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Yilamu Dilimina
- Department of Breast Cancer, Digestive and Vascular Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Sha Liu
- Department of Breast Cancer, Digestive and Vascular Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Liying Guo
- Department of Breast Cancer, Digestive and Vascular Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
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Adjuvant hormonal therapy for early breast cancer: an epidemiologic study of medication adherence. Breast Cancer Res Treat 2018; 169:153-162. [PMID: 29362956 DOI: 10.1007/s10549-018-4676-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to determine the prevalence of adherence to adjuvant hormonal therapy (AHT) and to identify risk factors for medication non-adherence in clinical practice in patients with early-stage hormone receptor (HR)-positive breast cancer (BC) previously treated with chemotherapy. METHODS We carried out a cross-sectional, observational, prospective, and multicenter survey based on a structured self-report postal questionnaire (35 items investigating six areas). A sample of 474 patients was drawn from 676 patients potentially eligible. The structured and validated Morisky Medication Adherence Scale-4 items was used for measuring medication adherence. An analysis of risk factors for non-adherence to AHT was performed using a two-step approach: univariate, then multivariate analysis. RESULTS A total of 280 patients out of the 428 analyzed patients participated in the survey, yielding a response rate of 65.4% [60.9-69.9]. The prevalence of adherence to AHT was estimated at 68.6% [63.1-74.0], corresponding to a high level of adherence. Three risk factors for non-adherence to AHT were identified: > 2 medications to treat comorbidities (p-value = 0.003), age less than 65 years (p-value = 0.008), and patient management in a university hospital setting (p-value = 0.014). CONCLUSIONS Non-adherence is a common, complex, and multidimensional healthcare problem. This better understanding and knowledge of risk factors will allow healthcare providers (such as oncologists, general practitioners, pharmacists) to more easily identify patients at risk for non-adherence and help them provide appropriate information about AHT and its management, thus improving medication adherence in their patients.
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Zaidi S, Hussain S, Verma S, Veqar Z, Khan A, Nazir SU, Singh N, Moiz JA, Tanwar P, Srivastava A, Rath GK, Mehrotra R. Efficacy of Complementary Therapies in the Quality of Life of Breast Cancer Survivors. Front Oncol 2018; 7:326. [PMID: 29376027 PMCID: PMC5768617 DOI: 10.3389/fonc.2017.00326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most common cancer diagnosed in women and the second most common cancer overall, ranking as the fifth cause of death from cancer. The chronicity of the disease produces long-term physiological and psychological manifestations, which adversely affect the quality of life of the individual. The primary treatment while managing cancer presents with various debilitating side effects. With the recent advances in treatment techniques that have improved the survival rate, patients suffer from continuing posttreatment complications. Patients seem to cope well with the stress of treatment of BC and sustain a normal life; however, the deterioration in physical well-being makes the patient functionally inefficient. Exercise has been proven to be an effective, safe, and feasible tool in combating the adverse effects of treatment, prevents complications and decreases the risk of BC-specific mortality. This review briefly presents an overview of the burden of the disease and its management strategies. Owing to the heterogeneity of the population and the multitude of therapies they receive, the response of each patient to treatment is different and so is the magnitude of adverse effects. The review discusses the late sequelae following treatment and evidence supporting the role of physical activity in their management. In conclusion, there is a need for personalized physical activity plans to be developed to suit the individual and their circumstances.
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Affiliation(s)
- Sahar Zaidi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Showket Hussain
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
| | - Shalini Verma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Asiya Khan
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sheeraz Un Nazir
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
| | - Neha Singh
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenberg University, Gothenberg, Sweden
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Pranay Tanwar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - G K Rath
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
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Zhang B, Wu J, Zheng R, Zhang Q, Wang MZ, Qi J, Liu H, Wang Y, Guo Y, Chen F, Wang J, Lyu W, Gao J, Fang Y, Chen W, Wang X. Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea. Chin J Cancer Res 2018; 30:468-476. [PMID: 30210227 PMCID: PMC6129567 DOI: 10.21147/j.issn.1000-9604.2018.04.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective In patients with chemotherapy-induced amenorrhea (CIA), the menopausal status is ambiguous and difficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausal status of breast cancer patients with CIA. Methods This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution and accumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potential confounding factors including age, serum concentration of estradiol (E2) and follicle-stimulating hormone (FSH), feeding, pregnancy, parity, abortions, and body mass index (BMI). The odds ratio (OR) and 95% confidence interval (95% CI) of different risk factors were estimated. Results A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 (65.42%) were premenopausal patients and 621 (34.58%) were post-menopause patients. Five hundred and fifty patients were included in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age (OR: 1.856, 95% CI: 1.732-1.990), serum concentration of E2 (OR: 0.976, 95% CI: 0.972-0.980) and FSH (OR: 1.060, 95% CI: 1.053-1.066), and menarche age (OR: 1.074, 95% CI: 1.009-1.144) were found to be associated with the patients' menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status is Logit (P)=-28.396+0.536Age-0.014E2+0.031FSH. The sensitivities for this model were higher than 85%, and its specificities were higher than 89%. Conclusions The discriminative model obtained from this study for predicting menstrual state is important for premenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.
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Affiliation(s)
- Bailin Zhang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jinqi Wu
- Department of Breast Surgery, Cancer Hospital of Huanxing Chaoyang District Beijing, Beijing 100122, China
| | - Rongshou Zheng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qian Zhang
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | | | - Jun Qi
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Haijing Liu
- Pharmacy Department, Kailuan General Hospital, Tangshan 063000, China
| | - Yipeng Wang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Guo
- Surgery Department, Maternal and Child Health Care Hospital of Yanqing District Beijing, Beijing 102100, China
| | - Feng Chen
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jing Wang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenyue Lyu
- Surgery Department, Maternal and Child Health Care Hospital of Yanqing District Beijing, Beijing 102100, China
| | - Jidong Gao
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yi Fang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiang Wang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Dreyer MS, Nattinger AB, McGinley EL, Pezzin LE. Socioeconomic status and breast cancer treatment. Breast Cancer Res Treat 2018; 167:1-8. [PMID: 28884392 PMCID: PMC5790605 DOI: 10.1007/s10549-017-4490-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Evidence suggests substantial disparities in breast cancer survival by socioeconomic status (SES). We examine the extent to which receipt of newer, less invasive, or more effective treatments-a plausible source of disparities in survival-varies by SES among elderly women with early-stage breast cancer. METHODS Multivariate regression analyses applied to 11,368 women (age 66-90 years) identified from SEER-Medicare as having invasive breast cancer diagnosed in 2006-2009. Socioeconomic status was defined based on Medicaid enrollment and level of poverty of the census tract of residence. All analyses controlled for demographic, clinical health status, spatial, and healthcare system characteristics. RESULTS Poor and near-poor women were less likely than high SES women to receive sentinel lymph node biopsy and radiation after breast-conserving surgery (BCS). Poor women were also less likely than near-poor or high SES women to receive any axillary surgery and adjuvant chemotherapy. There were no significant differences in use of aromatase inhibitors (AI) between poor and high SES women. However, near-poor women who initiated hormonal therapy were more likely to rely exclusively on tamoxifen, and less likely to use the more expensive but more effective AI when compared to both poor and high SES women. CONCLUSIONS Our results indicate that SES disparities in the receipt of treatments for incident breast cancer are both pervasive and substantial. These disparities remained despite women's geographic area of residence and extent of disease, suggesting important gaps in access to effective breast cancer care.
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Affiliation(s)
- Marie S Dreyer
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA
| | - Ann B Nattinger
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA
| | - Emily L McGinley
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA
| | - Liliana E Pezzin
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA.
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Yi M, Hwang E. Pain and Menopause Symptoms of Breast Cancer Patients with Adjuvant Hormonal Therapy in Korea: Secondary Analysis. Asia Pac J Oncol Nurs 2018; 5:262-269. [PMID: 29963588 PMCID: PMC5996590 DOI: 10.4103/apjon.apjon_45_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this study was to describe the prevalence and levels of pain and menopause symptoms of breast cancer patients with adjuvant hormonal therapy (HT). Methods: A cross-sectional survey design was used. Secondary analysis was used from the primary data collected in 2013 from a total of 110 breast cancer patients receiving HT for more than 3 months, using questionnaires of the Korean version of brief pain inventory and the menopause rating scale. Results: Mean age of the participants was 53.56. Most (88.2%) of the participants reported to have pain and almost (95.5%) of them reported to have menopause symptoms. More pain was reported in participants with aromatase inhibitor (AI) than those with tamoxifen. Adherence to HT showed a significant difference according to the rate of feeling increased pain (P = 0.001). Among the menopause symptoms, fatigue was the most common symptom (97.3%). Sweating/flush was significantly higher in tamoxifen group (P < 0.005), and joint and muscle complaints were higher in AI group (P < 005). Conclusions: The results of the study show that the prevalence and levels of pain and menopause symptoms among breast cancer patients receiving HT were high. Thus, oncology professionals need to provide appropriate interventions to relieve pain and menopause symptom to improve adherence to HT.
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Affiliation(s)
- Myungsun Yi
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Eunkyung Hwang
- Breast Care Center, Seoul National University Hospital, Seoul, South Korea
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Dackus GMHE, Jóźwiak K, Sonke GS, van der Wall E, van Diest PJ, Hauptmann M, Siesling S, Linn SC. Optimal adjuvant endocrine treatment of ER+/HER2+ breast cancer patients by age at diagnosis: A population-based cohort study. Eur J Cancer 2017; 90:92-101. [PMID: 29274928 DOI: 10.1016/j.ejca.2017.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior randomised controlled trials on adjuvant hormonal therapy included HER2any patients; however, a differential effect of aromatase inhibitors (AIs) versus tamoxifen (TAM) may have been missed in ER+/HER2+ patients that comprise 7-15% of all breast cancer patients. In addition, a woman's hormonal microenvironment may influence sensitivity to TAM and AIs in the adjuvant setting, which changes during menopausal transition, a process that takes years. We studied the efficacy of AIs versus TAM in ER+/HER2+ breast cancer patients grouped by age at diagnosis as a proxy for menopausal status using treatment and outcome data from the nationwide population-based Netherlands Cancer Registry (NCR). PATIENTS AND METHODS All women diagnosed between 2005 and 2007 with endocrine-treated, TanyNanyM0, ER+/HER2+ breast cancer were identified through the NCR (n = 1155). Patients were divided by age at diagnosis: premenopausal (≤45 years; n = 326), perimenopausal (45<years≤55; n = 304) and postmenopausal (>55 years; n = 525). A time-dependent variable, indicating whether AI or TAM was received for >50% of endocrine treatment duration, was applied to subdivide groups by predominant treatment received. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier survival estimation and Cox regression. Hazard ratios (HRs) were adjusted for chemotherapy, trastuzumab, age at diagnosis, N-status, grade, pT-stage and ovarian ablation. RESULTS During follow-up, 237 recurrences and 182 deaths occurred. Perimenopausal women derived significant RFS and OS benefit from AI compared with TAM, HR 0.47 (95% CI 0.25-0.91; P = 0.03) and HR 0.37 (95% CI 0.18-0.79; P = 0.01), respectively, whereas premenopausal women derived no benefit from AI compared with TAM. Treatment effects differed significantly between these age groups (interaction P = 0.03 and P = 0.02, respectively). Among postmenopausal women a small but non-significant AI benefit was observed. CONCLUSION AI treatment, preferably without any TAM treatment, was associated with the best RFS and OS outcome in ER+/HER2+ perimenopausal breast cancer patients.
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Affiliation(s)
- G M H E Dackus
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - K Jóźwiak
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - E van der Wall
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Hpn Q05.4300, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - M Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands; Department of Health Technology & Services Research (HTSR), University of Twente, PO Box 217, Enschede 7500 AE, Enschede, The Netherlands
| | - S C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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Temi YB, Sedef AM. Angioneurotic edema of metastatic breast cancer patient associated with letrozole. JOURNAL OF ONCOLOGICAL SCIENCES 2017. [DOI: 10.1016/j.jons.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ferreira AR, Palha A, Correia L, Filipe P, Rodrigues V, Miranda A, André R, Fernandes J, Gouveia J, Passos-Coelho JL, Moreira A, Brito M, Ribeiro J, Metzger-Filho O, Lin NU, Costa L, Vaz-Luis I. Treatment adoption and relative effectiveness of aromatase inhibitors compared to tamoxifen in early breast cancer: A multi-institutional observational study. Breast 2017; 37:107-113. [PMID: 29131988 DOI: 10.1016/j.breast.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/18/2017] [Accepted: 11/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM). PATIENTS AND METHODS This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions. RESULTS Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37-0.81). CONCLUSION AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.
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Affiliation(s)
- Arlindo R Ferreira
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Ana Palha
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Lurdes Correia
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Pedro Filipe
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Vasco Rodrigues
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Ana Miranda
- Registo Oncológico Regional do Sul, Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Rosário André
- Registo Oncológico Regional do Sul, Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - João Fernandes
- Hospitais CUF Lisboa, R. Mário Botas, 1998-018 Lisbon, Portugal
| | - Joaquim Gouveia
- Hospitais CUF Lisboa, R. Mário Botas, 1998-018 Lisbon, Portugal
| | | | - António Moreira
- Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Margarida Brito
- Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Joana Ribeiro
- Fundação Champalimaud, Av. Brasília, 1400-038 Lisbon, Portugal
| | | | - Nancy U Lin
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA
| | - Luís Costa
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Inês Vaz-Luis
- Institut Gustave Roussy, Unit INSERM 981, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
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Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res 2017; 50:33. [PMID: 28969709 PMCID: PMC5625777 DOI: 10.1186/s40659-017-0140-9] [Citation(s) in RCA: 609] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/22/2017] [Indexed: 02/01/2023] Open
Abstract
Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading cause of mortality among women population. For the previous two decades, studies related to the breast cancer has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell therapy etc for breast cancer.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine and Surgery, Directorate of Medical Sciences, GC University Faisalabad, Old Campus, Allam Iqbal Road, Faisalabad, 38000 Pakistan
| | - Mehwish Iqbal
- Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan
| | - Muhammad Daniyal
- Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan
| | - Asmat Ullah Khan
- Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, RibeirãoPreto Medical School of the University of São Paulo, AV. Bandeirantes, 3900, RibeirãoPreto, 14049-900 São Paulo, Brazil
- Department of Eastern Medicine and Surgery, School of Medical and Health Sciences, University of Poonch Rawalakot, Hajira Road, Shamsabad, Rawalakot, 12350 Azad Jammu and Kashmir Pakistan
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Goenka L, George M, Sen M. A peek into the drug development scenario of endometriosis – A systematic review. Biomed Pharmacother 2017; 90:575-585. [DOI: 10.1016/j.biopha.2017.03.092] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/18/2017] [Accepted: 03/27/2017] [Indexed: 12/28/2022] Open
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Hadji P, Aapro MS, Body JJ, Gnant M, Brandi ML, Reginster JY, Zillikens MC, Glüer CC, de Villiers T, Baber R, Roodman GD, Cooper C, Langdahl B, Palacios S, Kanis J, Al-Daghri N, Nogues X, Eriksen EF, Kurth A, Rizzoli R, Coleman RE. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol 2017; 7:1-12. [PMID: 28413771 PMCID: PMC5384888 DOI: 10.1016/j.jbo.2017.03.001] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). PATIENTS AND METHODS A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. RESULTS Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60 mg s.c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality that needs to be taken into account when advising on management of AIBL. CONCLUSIONS In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score<-2.0 or with a T-score of <-1.5 SD with one additional RF, or with ≥2 risk factors (without BMD) for the duration of AI treatment. Patients with T-score>-1.5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Compliance should be regularly assessed as well as BMD on treatment after 12 - 24 months. Furthermore, because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - John Kanis
- Catholic University of Australia, Melbourne, Australia and University of Sheffield, UK
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Gupta I, Burney I, Al-Moundhri MS, Tamimi Y. Molecular genetics complexity impeding research progress in breast and ovarian cancers. Mol Clin Oncol 2017; 7:3-14. [PMID: 28685067 PMCID: PMC5492732 DOI: 10.3892/mco.2017.1275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
Breast and ovarian cancer are heterogeneous diseases. While breast cancer accounts for 25% of cancers worldwide, ovarian cancer accounts for 3.5% of all cancers and it is considered to be the most lethal type of cancer among women. In Oman, breast cancer accounts for 25% and ovarian cancer for 4.5% of all cancer cases. Various risk factors, including variable biological and clinical traits, are involved in the onset of breast and ovarian cancer. Although highly developed diagnostic and therapeutic methods have paved the way for better management, targeted therapy against specific biomarkers has not yet shown any significant improvement, particularly in triple-negative breast cancer and epithelial ovarian cancer, which are associated with high mortality rates. Thus, elucidating the mechanisms underlying the pathology of these diseases is expected to improve their prevention, prognosis and management. The aim of the present study was to provide a comprehensive review and updated information on genomics and proteomics alterations associated with cancer pathogenesis, as reported by several research groups worldwide. Furthermore, molecular research in our laboratory, aimed at identifying new pathways involved in the pathogenesis of breast and ovarian cancer using microarray and chromatin immunoprecipitation (ChIP), is discussed. Relevant candidate genes were found to be either up- or downregulated in a cohort of breast cancer cases. Similarly, ChIP analysis revealed that relevant candidate genes were regulated by the E2F5 transcription factor in ovarian cancer tissue. An ongoing study aims to validate these genes with a putative role as biological markers that may contribute to the development of targeted therapies for breast and ovarian cancer.
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Affiliation(s)
- Ishita Gupta
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Ikram Burney
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mansour S Al-Moundhri
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Yahya Tamimi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
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Hsieh PL, Huang SM, Chien LY, Lee CF, Hsiung Y, Tai CJ. Risk-benefit perception of pregnancy among breast cancer survivors. Eur J Cancer Care (Engl) 2017; 27:e12696. [DOI: 10.1111/ecc.12696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 01/10/2023]
Affiliation(s)
- P.-L. Hsieh
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - S.-M. Huang
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - L.-Y. Chien
- Institute of Community Health care; National Yang-Ming University; Taipei Taiwan
| | - C.-F. Lee
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - Y. Hsiung
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - C.-J. Tai
- Department of Traditional Chinese Medicine; Taipei Medical University Hospital; Taipei Taiwan
- Department of OB/GYN; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
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Overcoming aromatase inhibitor resistance in breast cancer: possible mechanisms and clinical applications. Breast Cancer 2017; 25:379-391. [PMID: 28389808 DOI: 10.1007/s12282-017-0772-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Estrogen plays crucial roles in the progression of hormone-dependent breast cancers through activation of nuclear estrogen receptor α (ER). Estrogen is produced locally from circulating inactive steroids and adrenal androgens in postmenopausal women. However, conversion by aromatase is a rate-limiting step in intratumoral estrogen production in breast cancer. Aromatase inhibitors (AIs) inhibit the growth of hormone-dependent breast cancers by blocking the conversion of adrenal androgens to estrogen and by unmasking the inhibitory effect of androgens, acting via the androgen receptor (AR). AIs are thus a standard treatment option for postmenopausal hormone-dependent breast cancer. However, although initial use of AIs provides substantial clinical benefit, some breast cancer patients relapse because of the acquisition of AI resistance. A better understanding of the mechanisms of AI resistance may contribute to the development of new therapeutic strategies and aid in the search for new therapeutic targets and agents. We have investigated AI-resistance mechanisms and established six AI-resistant cell lines. Some of them exhibit estrogen depletion-resistance properties via constitutive ER-activation or ER-independent growth signaling. We examined how breast cancer cells can adapt to estrogen depletion and androgen superabundance. Estrogen and estrogenic androgen produced independently from aromatase contributed to cell proliferation in some of these cell lines, while another showed AR-dependent cell proliferation. Based on these findings, currently proposed AI-resistance mechanisms include an aromatase-independent estrogen-producing pathway, estrogen-independent ER function, and ER-independent growth signaling. This review summarizes several hypotheses of AI-resistance mechanisms and discusses how existing or novel therapeutic agents may be applied to treat AI-resistant breast cancers.
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Kalam A, Talegaonkar S, Vohora D. Effects of raloxifene against letrozole-induced bone loss in chemically-induced model of menopause in mice. Mol Cell Endocrinol 2017; 440:34-43. [PMID: 27832985 DOI: 10.1016/j.mce.2016.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/10/2016] [Accepted: 11/05/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The deleterious effects of letrozole, an aromatase inhibitor, used in the adjuvant treatment of breast cancer in postmenopausal women, on bone are well-documented and represent a major drawback to its clinical use. Raloxifene, a selective estrogen receptor modulator and a clinically approved anti-osteoporotic drug, has been recently demonstrated to be efficacious in women with breast cancer. The present study evaluated the effects of preventive and curative treatment with raloxifene on letrozole-induced alterations of bone microarchitecture and turnover markers in a chemically-induced menopause model in mice. METHOD Swiss strain albino female mice were made menopausal by inducing ovotoxicity using vinyl cyclohexene di epoxide (VCD, 160 mg/kg for 15 days followed by 30 days drug-free period) confirmed by ovarian histology and serum estradiol levels. Effects on femoral and lumbar bones were evaluated by micro CT determination of bone volume, trabecular number, separation, thickness, connective density and trabecular pattern factor and bone turnover markers including ALP, TRAP5b, hydroxyproline and RANKL. In addition to these, markers of Wnt signaling (sclerostin and dickkopf-1) were also evaluated. To rule out the involvement of pharmacokinetic interaction, plasma levels of letrozole and raloxifene were measured following drugs alone and in combination. RESULTS Though bone loss was observed in VCD treated mice (as indicated by micro CT measurements), it was further enhanced with letrozole administration (1 mg/kg) for one month particularly in epiphysis of femoral bones. Raloxifene (15 mg/kg), whether administered concurrently or post-letrozole was able to revert the structural alterations and changes in turnover markers caused by letrozole to varying degrees (p < 0.01 or p < 0.001). Further, estrogen deficiency following letrozole treatment in ovotoxic mice was associated with significant increase in sclerostin and dickkopf-1 in both lumbar and femur bones (p < 0.001) which was attenuated with preventive and curative treatment with raloxifene (p < 0.05). The plasma levels of letrozole remained unaffected by raloxifene administration and vice versa. CONCLUSIONS Our study indicates the potential of raloxifene in preventing and attenuating letrozole-induced bone loss. Further, these effects were found to be independent of a pharmacokinetic interaction between the two drugs.
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Affiliation(s)
- Abul Kalam
- Department of Pharmacology, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi 110062, India
| | - Sushama Talegaonkar
- Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi 110062, India
| | - Divya Vohora
- Department of Pharmacology, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi 110062, India.
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Dellapasqua S. Systemic Treatment for Specific Medical Situations. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Therapeutic Use of Estrogen Receptor β Agonists in Prevention and Treatment of Endocrine Therapy Resistant Breast Cancers: Observations From Preclinical Models. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 151:177-194. [DOI: 10.1016/bs.pmbts.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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de Vries Schultink AHM, Alexi X, van Werkhoven E, Madlensky L, Natarajan L, Flatt SW, Zwart W, Linn SC, Parker BA, Wu AHB, Pierce JP, Huitema ADR, Beijnen JH. An Antiestrogenic Activity Score for tamoxifen and its metabolites is associated with breast cancer outcome. Breast Cancer Res Treat 2016; 161:567-574. [PMID: 28005246 DOI: 10.1007/s10549-016-4083-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Endoxifen concentrations have been associated with breast cancer recurrence in tamoxifen-treated patients. However, tamoxifen itself and other metabolites also show antiestrogenic anti-tumor activity. Therefore, the aim of this study was to develop a comprehensive Antiestrogenic Activity Score (AAS), which accounts for concentration and antiestrogenic activity of tamoxifen and three metabolites. An association between the AAS and recurrence-free survival was investigated and compared to a previously published threshold for endoxifen concentrations of 5.97 ng/mL. PATIENTS AND METHODS The antiestrogenic activities of tamoxifen, (Z)-endoxifen, (Z)-4-hydroxytamoxifen, and N-desmethyltamoxifen were determined in a cell proliferation assay. The AAS was determined by calculating the sum of each metabolite concentration multiplied by an IC50 ratio, relative to tamoxifen. The AAS was calculated for 1370 patients with estrogen receptor alpha (ERα)-positive breast cancer. An association between AAS and recurrence was investigated using Cox regression and compared with the 5.97 ng/mL endoxifen threshold using concordance indices. RESULTS An AAS threshold of 1798 was associated with recurrence-free survival, hazard ratio (HR) 0.67 (95% confidence interval (CI) 0.47-0.96), bias corrected after bootstrap HR 0.69 (95% CI 0.48-0.99). The concordance indices for AAS and endoxifen did not significantly differ; however, using the AAS threshold instead of endoxifen led to different dose recommendations for 5.2% of the patients. CONCLUSIONS Endoxifen concentrations can serve as a proxy for the antiestrogenic effect of tamoxifen and metabolites. However, for the aggregate effect of tamoxifen and three metabolites, defined by an integrative algorithm, a trend towards improving treatment is seen and moreover, is significantly associated with breast cancer recurrence.
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Affiliation(s)
- A H M de Vries Schultink
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
| | - X Alexi
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E van Werkhoven
- Department of Biometrics, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Madlensky
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - L Natarajan
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - S W Flatt
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - W Zwart
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S C Linn
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - B A Parker
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - A H B Wu
- Laboratory Medicine, University of California, San Francisco, CA, USA
| | - J P Pierce
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - A D R Huitema
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J H Beijnen
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute and MC Slotervaart, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.,Science Faculty, Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Meguerditchian A, Tamblyn R, Meterissian S, Law S, Prchal J, Winslade N, Stern D. Adjuvant Endocrine Therapy in Breast Cancer: A Novel e-Health Approach in Optimizing Treatment for Seniors (OPTIMUM): A Two-Group Controlled Comparison Pilot Study. JMIR Res Protoc 2016; 5:e199. [PMID: 27821385 PMCID: PMC5118585 DOI: 10.2196/resprot.6519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In women with hormone receptor positive breast cancer, adjuvant endocrine therapy (AET) is associated with a significant survival advantage. Nonadherence is a particular challenge in older women, even though they stand to benefit the most from AET. Therefore, a novel eHealth tool (OPTIMUM) that integrates real-time analysis of health administrative claims data was developed to provide point-of-care decision support for clinicians. OBJECTIVES The objectives of the study are to determine the effectiveness of a patient-specific, real-time eHealth alert delivered at point-of-care in reducing rates of AET discontinuation and to understand patient-level factors related to AET discontinuation as well as to assess integration of eHealth alerts regarding deviations from best practices in administration of AET by cancer care teams. METHODS A prospective, 2-group controlled comparison pilot study will be conducted at 2 urban, McGill University-affiliated hospitals, the Royal Victoria Hospital and St. Mary's Hospital. A minimum of 43 patients per study arm will be enrolled through site-level allocation. Follow-up is 1.5 years. Health care professionals at the intervention site will have access to the eHealth tool, which will report to them in real-time medical events with known associations to AET discontinuation, an AET adherence monitor, and a discontinuation alert. Cox proportional hazard ratios with 95% confidence intervals will estimate risks of AET discontinuation. Tests for significance will be 2-sided with a significance level of P<.05. RESULTS This protocol has been approved and funded by the Canadian Institutes of Health Research. The study will evaluate site-level differences between AET discontinuation and AET adherence and assess care team actions at the intervention site. Participant enrollment into this project is expected to start September 2016 with primary data ready to present by June 2018. CONCLUSION This study will offer an opportunity to verify the feasibility of integrating an eHealth tool that aims to improve the long-term management of breast cancer in a high-risk population by allowing more timely intervention to prevent or rapidly address AET discontinuation.
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Affiliation(s)
- Ari Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- Breast Clinic, McGill University Health Centre, Montreal, QC, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- Breast Clinic, McGill University Health Centre, Montreal, QC, Canada
| | - Susan Law
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Research Centre, St. Mary's Hospital, Montreal, QC, Canada
| | - Jaroslav Prchal
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Oncology, St. Mary's Hospital Center, Montreal, QC, Canada
| | - Nancy Winslade
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Donna Stern
- Department of Oncology, St. Mary's Hospital Center, Montreal, QC, Canada
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82
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Torrisi R, Rota S, Losurdo A, Zuradelli M, Masci G, Santoro A. Aromatase inhibitors in premenopause: Great expectations fulfilled? Crit Rev Oncol Hematol 2016; 107:82-89. [DOI: 10.1016/j.critrevonc.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/14/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022] Open
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83
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María RS, Marta PM, Sonia S, Natalia GG, Tamara M, Ignasi T, Maria MG, Jaime RM, Adolfo DP, Joan A, Xavier N. TBS and BMD at the end of AI-therapy: A prospective study of the B-ABLE cohort. Bone 2016; 92:1-8. [PMID: 27519968 DOI: 10.1016/j.bone.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Patients with breast cancer under aromatase inhibitor (AI) treatment often develop osteoporosis and their average bone loss rate is twice that of natural reduction during menopause, increasing fracture risk. As the current diagnostic technique based on bone mineral density (BMD) provides no information on bone quality, the Trabecular Bone Score (TBS) has been proposed to reflect bone microarchitecture status. The present study was designed to assess prospective changes in TBS and lumbar spine (LS) BMD in postmenopausal women with breast cancer at completion of AI treatment. METHODS B-ABLE is a prospective cohort of 735 women with breast cancer treated with AIs according to American Society of Clinical Oncology recommendations: 5years of AI starting within 6weeks post-surgery or 1month after the last cycle of chemotherapy (5y-AI group), or switching to an AI to complete 5-year therapy after 2-3years of tamoxifen (pTMX-AI group). Patients with osteoporosis were treated with oral bisphosphonates (BP). TBS and LS-BMD changes at completion of AI therapy were evaluated by Student t-test for paired samples. Pearson correlation coefficients were computed for correlations between LS-BMD and TBS. RESULTS AI treatment was completed by 277 women. Of these, 70 (25.3%) were allocated to BP therapy. The non-BP-treated patients (74.7%) showed significant decreases in TBS (-2.94% in pTMX-AI and -2.93% in 5y-AI groups) and in LS-BMD (-4.14% in pTMX-AI and -2.28% in 5y-AI groups) at the end of AI treatment. In BP-treated patients, TBS remained stable at the end of AI treatment, whereas LS-BMD showed significant increases (+2.30% in pTMX-AI and +5.33% in 5y-AI groups). Moderate associations between TBS and LS-BMD values at baseline and at the end of AI treatment (r=0.4; P<0.001) were observed. At the end of treatment, changes in spine BMD and TBS were weakly correlated (r=0.1, P<0.01). CONCLUSIONS AI therapy induces significant decreases in TBS, comparable to BMD loss. BP-treated patients maintained TBS values, whereas BMD increased. AI treatment leads to deterioration of bone microarchitecture, which seems to be attenuated by BP therapy.
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Affiliation(s)
- Rodríguez-Sanz María
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Pineda-Moncusí Marta
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Servitja Sonia
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Garcia-Giralt Natalia
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain.
| | - Martos Tamara
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tusquets Ignasi
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martínez-García Maria
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rodriguez-Morera Jaime
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diez-Perez Adolfo
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albanell Joan
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nogués Xavier
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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84
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Tryfonidis K, Zardavas D, Katzenellenbogen BS, Piccart M. Endocrine treatment in breast cancer: Cure, resistance and beyond. Cancer Treat Rev 2016; 50:68-81. [DOI: 10.1016/j.ctrv.2016.08.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
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85
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Irwin KE, Freudenreich O, Peppercorn J, Taghian AG, Freer PE, Gudewicz TM. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 30-2016. A 63-Year-Old Woman with Bipolar Disorder, Cancer, and Worsening Depression. N Engl J Med 2016; 375:1270-81. [PMID: 27682037 DOI: 10.1056/nejmcpc1609309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kelly E Irwin
- From the Departments of Psychiatry (K.E.I., O.F.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.) and the Division of Medical Oncology (J.P.), Massachusetts General Hospital, and the Departments of Psychiatry (K.E.I., O.F.), Medicine (J.P.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.), Harvard Medical School - both in Boston
| | - Oliver Freudenreich
- From the Departments of Psychiatry (K.E.I., O.F.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.) and the Division of Medical Oncology (J.P.), Massachusetts General Hospital, and the Departments of Psychiatry (K.E.I., O.F.), Medicine (J.P.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.), Harvard Medical School - both in Boston
| | - Jeffrey Peppercorn
- From the Departments of Psychiatry (K.E.I., O.F.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.) and the Division of Medical Oncology (J.P.), Massachusetts General Hospital, and the Departments of Psychiatry (K.E.I., O.F.), Medicine (J.P.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.), Harvard Medical School - both in Boston
| | - Alphonse G Taghian
- From the Departments of Psychiatry (K.E.I., O.F.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.) and the Division of Medical Oncology (J.P.), Massachusetts General Hospital, and the Departments of Psychiatry (K.E.I., O.F.), Medicine (J.P.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.), Harvard Medical School - both in Boston
| | - Phoebe E Freer
- From the Departments of Psychiatry (K.E.I., O.F.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.) and the Division of Medical Oncology (J.P.), Massachusetts General Hospital, and the Departments of Psychiatry (K.E.I., O.F.), Medicine (J.P.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.), Harvard Medical School - both in Boston
| | - Thomas M Gudewicz
- From the Departments of Psychiatry (K.E.I., O.F.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.) and the Division of Medical Oncology (J.P.), Massachusetts General Hospital, and the Departments of Psychiatry (K.E.I., O.F.), Medicine (J.P.), Radiation Oncology (A.G.T.), Radiology (P.E.F.), and Pathology (T.M.G.), Harvard Medical School - both in Boston
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86
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The lncRNA landscape of breast cancer reveals a role for DSCAM-AS1 in breast cancer progression. Nat Commun 2016; 7:12791. [PMID: 27666543 PMCID: PMC5052669 DOI: 10.1038/ncomms12791] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/01/2016] [Indexed: 12/18/2022] Open
Abstract
Molecular classification of cancers into subtypes has resulted in an advance in our understanding of tumour biology and treatment response across multiple tumour types. However, to date, cancer profiling has largely focused on protein-coding genes, which comprise <1% of the genome. Here we leverage a compendium of 58,648 long noncoding RNAs (lncRNAs) to subtype 947 breast cancer samples. We show that lncRNA-based profiling categorizes breast tumours by their known molecular subtypes in breast cancer. We identify a cohort of breast cancer-associated and oestrogen-regulated lncRNAs, and investigate the role of the top prioritized oestrogen receptor (ER)-regulated lncRNA, DSCAM-AS1. We demonstrate that DSCAM-AS1 mediates tumour progression and tamoxifen resistance and identify hnRNPL as an interacting protein involved in the mechanism of DSCAM-AS1 action. By highlighting the role of DSCAM-AS1 in breast cancer biology and treatment resistance, this study provides insight into the potential clinical implications of lncRNAs in breast cancer. LncRNAs have been associated with cancer. Here, the authors carry out a systematic review of lncRNAs in breast cancer and show that DSCAM-AS1 is highly expressed in oestrogen receptor positive tumours and enhances cancer through an interaction with hnRNPL; and is also associated with tamoxifen resistance.
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Morimoto M, Takahashi M, Honda J, Yoshida T, Yoshida M, Toba H, Imoto I, Tangoku A, Sasa M. Assay of serum E2 concentration in postmenopausal breast cancer patients using a high-sensitivity RIA method is generally useful. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:236-40. [PMID: 27644565 DOI: 10.2152/jmi.63.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Serum E2 must be monitored for aromatase inhibitor (AI) therapy, but conventional assays lack sensitivity. SUBJECTS/METHODS Forty amenorrheic breast cancer patients scheduled for AI treatment but requiring hormonological confirmation of their menopausal status were studied. Serum E2 data generated by high-sensitivity RIA and by LC-MS/MS were analyzed for correlation. RESULTS RIA gave a higher E2 value than LC-MS/MS in 62% of cases, but there was a significant positive correlation. Patients whose E2 levels by RIA were ≥ 2.5 pg/mL higher than those by LC-MS/MS (RIA-H group) and all other patients (RIA-N group) were compared. Both groups showed strong correlations between the two assay methods. With both methods patients with a high BMI had significantly elevated E2. Multiple regression analysis used age, age at menarche, number of births and BMI as explanatory variables. Significant variables were the BMI with LC-MS/MS, and both BMI and age with RIA. The RIA-H and RIA-N groups showed no difference in regard to the BMI, whereas the age was significantly lower in the RIA-H group. SUMMARY Serum E2 levels determined for postmenopausal women by RIA and LC-MS/MS generally correlated well. High-sensitivity RIA is a potentially useful clinical assay, but it overestimated serum E2 in some women. J. Med. Invest. 63: 236-240, August, 2016.
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Affiliation(s)
- Masami Morimoto
- Department of Oncological and Regenerative Surgery, Institute of Health Biosciences, the University of Tokushima
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88
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Harvie M, Howell T. Need for Weight Management among Postmenopausal Early Breast Cancer Patients Receiving Adjuvant Endocrine Therapy. WOMENS HEALTH 2016; 1:205-22. [DOI: 10.2217/17455057.1.2.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Increasingly effective adjuvant therapies mean that the prognosis for postmenopausal women with breast cancer has never been better. Weight problems are common among breast cancer patients and worsen due to the impact of diagnosis and treatment. Recent studies have linked excess weight with the risk of recurrence of breast cancer among premenopausal women. While general obesity (body mass index) does not appear to influence the already much improved prognosis for postmenopausal women, there is some evidence that limiting central obesity and improving insulin resistance may improve survival. The focus of attention for postmenopausal breast cancer survivors is also shifting to consider the mortality and morbidity from other weight-related cancers and noncancer causes, such as cardiovascular disease, making weight control a potentially important adjunct to endocrine therapy. This paper outlines the rationale and optimal design for effective weight management strategies among postmenopausal breast cancer patients receiving endocrine therapy.
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Affiliation(s)
- Michelle Harvie
- CRUK University Department of Medical Oncology Christie Hospital, Christie Hospital Wilmslow road Manchester M20 4BX, Tel.: +44 161 446 8037; Fax: +44 161 446 8000
| | - Tony Howell
- CRUK University Department of Medical Oncology Christie Hospital, Christie Hospital Wilmslow road Manchester M20 4BX, Tel.: +44 161 446 8037; Fax: +44 161 446 8000
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Briest S, Stearns V. Advances in the Adjuvant and Neoadjuvant Treatment of Breast Cancer. WOMENS HEALTH 2016; 3:325-39. [DOI: 10.2217/17455057.3.3.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Several advances in the adjuvant systemic therapy of primary breast cancer have occurred in the last decade and contributed to a decline in disease-related mortality. These include the introduction of aromatase inhibitors, new chemotherapy agents, and the novel antibody trastuzumab. New supportive treatments, such as growth factors, have contributed to the optimization of chemotherapy dose and schedule, and have improved the efficacy and safety of the treatment. In this review we will outline some of the recent advances in the adjuvant and neoadjuvant treatment of breast cancer. We will also discuss ongoing and proposed clinical trials.
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Affiliation(s)
- Susanne Briest
- University of Leipzig, Department of Gynecology and Obstetrics, Leipzig Germany
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB I, Room 186, Baltimore, MD 21231-1000, USA, Tel.: +1 410 502 3472; Fax: +1 410 614 9421
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB I, Room 1M-53 Baltimore, MD 21231-1000, USA, Tel.: +1 443 287 6489; Fax: +1 410 955 0125
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90
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Lipton A, Gnant M, Aapro M. Managing Aromatase Inhibitor-Associated Bone Loss in Breast Cancer. WOMENS HEALTH 2016; 3:441-8. [DOI: 10.2217/17455057.3.4.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although the incidence of breast cancer has increased, there is a concurrent decrease in the death rate, and the outlook for women with early-stage breast cancer remains positive. The current 5-year survival rate of women diagnosed with breast cancer is nearly 90%, due, in part, to the use of effective adjuvant therapies that often include aromatase inhibitors. However, long-term treatment with these therapies is known to have adverse effects on bone metabolism, leading to bone loss. Bone loss during adjuvant endocrine therapy may be higher than that observed during menopause and may require more potent therapy. Although there are approved treatments for osteolytic bone lesions from bone metastases, there is no approved therapy for bone loss associated with adjuvant cancer therapy. Bisphosphonates have demonstrated promising results in this setting, and zoledronic acid is currently under consideration by the US FDA and Europe (EMEA) for the treatment of aromatase inhibitor-associated bone loss.
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Affiliation(s)
- Allan Lipton
- Pennsylvania State University, Milton S Hershey Medical Center, 500 University Drive, Hershey Pennsylvania, PA 17033, USA, Tel.: +1 717 531 5960; Fax: +1 717 531 5076
| | - Michael Gnant
- Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria, Tel.: +43 01 40400 5646; Fax: +43 01 40400 6807
| | - Matti Aapro
- Doyen IMO Clinique de Genolier, 1 route du Muids, CH 1272, Genolier, Switzerland, Tel.: +41 22 366 9106; Fax: +41 22 366 9131
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91
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Abdel-Rahman O. Denosumab versus zoledronic acid to prevent aromatase inhibitors-associated fractures in postmenopausal early breast cancer; a mixed treatment meta-analysis. Expert Rev Anticancer Ther 2016; 16:885-91. [DOI: 10.1080/14737140.2016.1192466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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92
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Barriers and facilitators to endocrine therapy adherence among underserved hormone-receptor-positive breast cancer survivors: a qualitative study. Support Care Cancer 2016; 24:4123-30. [PMID: 27146492 DOI: 10.1007/s00520-016-3229-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the barriers and facilitators to taking anti-hormonal medications among medically and historically underserved breast cancer survivors within the first 5 years post chemotherapy, radiation, and/or surgery. METHODS The current study was framed within the National Institutes of Health Centers for Population Health and Health Disparities Model (NIHCPHHD Model). Twenty-five historically or medically underserved breast cancer survivors participated in an in-depth interview, in either English or Spanish. Interviews were audio recorded and transcribed verbatim. Interview data were analyzed using content analysis. RESULTS Anti-hormonal medication adherence was facilitated in several ways, including establishing a routine of medication taking, leaving the medicine in a visible or easily accessible place, taking the medication with other medications, reducing the cost of medicine, using a pillbox, understanding the negative consequences of lack of adherence, and having positive interactions with physicians. Side effects were the most commonly mentioned barrier to medication adherence. CONCLUSIONS Similar to other research, this qualitative study of medically and historically underserved breast cancer survivors in the USA found that side effects are the most frequently endorsed barrier to anti-hormonal medication adherence. Conversely, there were a number of facilitators of correct and consistent anti-hormonal medication use. The management of side effects is critically important to increase adherence to anti-hormonal medications. Health care providers, support providers, and caregivers can encourage breast cancer survivors to better adhere to anti-hormonal medications using a number of approaches that have been successful for other women.
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93
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Popp AW, Zysset PK, Lippuner K. Rebound-associated vertebral fractures after discontinuation of denosumab-from clinic and biomechanics. Osteoporos Int 2016; 27:1917-21. [PMID: 26694598 DOI: 10.1007/s00198-015-3458-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Rebound-associated vertebral fractures may follow treatment discontinuation of highly potent reversible bone antiresorptives, resulting from the synergy of rapid bone resorption and accelerated microdamage accumulation in trabecular bone. INTRODUCTION The purposes of this study are to characterize rebound-associated vertebral fractures following the discontinuation of a highly potent reversible antiresorptive therapy based on clinical observation and propose a pathophysiological rationale. METHODS This study is a case report of multiple vertebral fractures early after discontinuation of denosumab therapy in a patient with hormone receptor-positive non-metastatic breast cancer treated with an aromatase inhibitor. RESULTS Discontinuation of highly potent reversible bone antiresorptives such as denosumab may expose patients to an increased fracture risk due to the joined effects of absent microdamage repair during therapy followed by synchronous excess activation of multiple bone remodelling units at the time of loss-of-effect. We suggest the term rebound-associated vertebral fractures (RVF) for this phenomenon characterized by the presence of multiple new clinical vertebral fractures, associated with either no or low trauma, in a context consistent with the presence of high bone turnover and rapid loss of lumbar spine bone mineral density (BMD) occurring within 3 to 12 months after discontinuation (loss-of-effect) of a reversible antiresorptive therapy in the absence of secondary causes of bone loss or fractures. Unlike atypical femoral fractures that emerge from failure of microdamage repair in cortical bone with long-term antiresorptive treatment, RVF originate from the synergy of rapid bone resorption and accelerated microdamage accumulation in trabecular bone triggered by the discontinuation of highly potent reversible antiresorptives. CONCLUSIONS Studies are urgently needed to i) prove the underlying pathophysiological processes suggested above, ii) establish the predictive criteria exposing patients to an increased risk of RVF, and iii) determine appropriate treatment regimens to be applied in such patients.
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Affiliation(s)
- A W Popp
- Department of Osteoporosis, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
| | - P K Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - K Lippuner
- Department of Osteoporosis, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
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94
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Felder TM, Do DP, Lu ZK, Lal LS, Heiney SP, Bennett CL. Racial differences in receipt of adjuvant hormonal therapy among Medicaid enrollees in South Carolina diagnosed with breast cancer. Breast Cancer Res Treat 2016; 157:193-200. [PMID: 27120468 DOI: 10.1007/s10549-016-3803-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/19/2016] [Indexed: 12/29/2022]
Abstract
Several factors contribute to the pervasive Black-White disparity in breast cancer mortality in the U.S., such as tumor biology, access to care, and treatments received including adjuvant hormonal therapy (AHT), which significantly improves survival for hormone receptor-positive breast cancers (HR+). We analyzed South Carolina Central Cancer Registry-Medicaid linked data to determine if, in an equal access health care system, racial differences in the receipt of AHT exist. We evaluated 494 study-eligible, Black (n = 255) and White women (n = 269) who were under 65 years old and diagnosed with stages I-III, HR+ breast cancers between 2004 and 2007. Bivariate and multivariate analyses were conducted to assess receipt of ≥1 AHT prescriptions at any point in time following (ever-use) or within 12 months of (early-use) breast cancer diagnosis. Seventy-two percent of the participants were ever-users (70 % Black, 74 % White) and 68 % were early-users (65 % Black, 71 % White) of AHT. Neither ever-use (adjusted OR (AOR) = 0.75, 95 % CI 0.48-1.17) nor early-use (AOR = 0.70, 95 % CI 0.46-1.06) of AHT differed by race. However, receipt of other breast cancer-specific treatments was independently associated with ever-use and early-use of AHT [ever-use: receipt of surgery (AOR = 2.15, 95 % CI 1.35-3.44); chemotherapy (AOR = 1.97, 95 % CI 1.22-3.20); radiation (AOR = 2.33, 95 % CI 1.50-3.63); early-use: receipt of surgery (AOR = 2.03, 95 % CI 1.30-3.17); chemotherapy (AOR = 1.90, 95 % CI 1.20-3.03); radiation (AOR = 1.73, 95 % CI 1.14-2.63)]. No racial variations in use of AHT among women with HR+ breast cancers insured by Medicaid in South Carolina were identified, but overall rates of AHT use by these women is low. Strategies to improve overall use of AHT should include targeting breast cancer patients who do not receive adjuvant chemotherapy and/or radiation.
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Affiliation(s)
- Tisha M Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC, 29208, USA.
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC, 29208, USA.
| | - D Phuong Do
- Public Health Policy and Administration, Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, WI, 53201, USA
| | - Z Kevin Lu
- Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
| | - Lincy S Lal
- Management, Policy & Community Health, University of Texas School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Drive, Houston, TX, 77030, USA
| | - Sue P Heiney
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 617, Columbia, SC, 29208, USA
| | - Charles L Bennett
- Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
- SmartState Center for Medication Safety and Efficacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
- Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29201, USA
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95
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de Vries Schultink AHM, Zwart W, Linn SC, Beijnen JH, Huitema ADR. Effects of Pharmacogenetics on the Pharmacokinetics and Pharmacodynamics of Tamoxifen. Clin Pharmacokinet 2016; 54:797-810. [PMID: 25940823 PMCID: PMC4513218 DOI: 10.1007/s40262-015-0273-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The antiestrogenic drug tamoxifen is widely used in the treatment of estrogen receptor-α-positive breast cancer and substantially decreases recurrence and mortality rates. However, high interindividual variability in response is observed, calling for a personalized approach to tamoxifen treatment. Tamoxifen is bioactivated by cytochrome P450 (CYP) enzymes such as CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4/5, resulting in the formation of active metabolites, including 4-hydroxy-tamoxifen and endoxifen. Therefore, polymorphisms in the genes encoding these enzymes are proposed to influence tamoxifen and active tamoxifen metabolites in the serum and consequently affect patient response rates. To tailor tamoxifen treatment, multiple studies have been performed to clarify the influence of polymorphisms on its pharmacokinetics and pharmacodynamics. Nevertheless, personalized treatment of tamoxifen based on genotyping has not yet met consensus. This article critically reviews the published data on the effect of various genetic polymorphisms on the pharmacokinetics and pharmacodynamics of tamoxifen, and reviews the clinical implications of its findings. For each CYP enzyme, the influence of polymorphisms on pharmacokinetic and pharmacodynamic outcome measures is described throughout this review. No clear effects on pharmacokinetics and pharmacodynamics were seen for various polymorphisms in the CYP encoding genes CYP2B6, CYP2C9, CYP2C19 and CYP3A4/5. For CYP2D6, there was a clear gene-exposure effect that was able to partially explain the interindividual variability in plasma concentrations of the pharmacologically most active metabolite endoxifen; however, a clear exposure-response effect remained controversial. These controversial findings and the partial contribution of genotype in explaining interindividual variability in plasma concentrations of, in particular, endoxifen, imply that tailored tamoxifen treatment may not be fully realized through pharmacogenetics of metabolizing enzymes alone.
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Affiliation(s)
- Aurelia H M de Vries Schultink
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands
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96
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Rodríguez-Sanz M, Prieto-Alhambra D, Servitja S, Garcia-Giralt N, Garrigos L, Rodriguez-Morera J, Albanell J, Martínez-García M, González I, Diez-Perez A, Tusquets I, Nogués X. AI-related BMD variation in actual practice conditions: A prospective cohort study. Endocr Relat Cancer 2016; 23:303-12. [PMID: 26911377 DOI: 10.1530/erc-16-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/24/2016] [Indexed: 01/23/2023]
Abstract
The aim of the study was to evaluate the progression of bone mineral density (BMD) during 3 years of aromatase inhibitors (AI) therapy in actual practice conditions. This prospective, clinical cohort study of Barcelona-Aromatase induced Bone Loss in Early breast cancer (B-ABLE) assessed BMD changes during 3 years of AI treatment in women with breast cancer. Patients with osteoporosis (T score < -2.5 or T score ≤ -2.0) and a major risk factor and/or prevalent fragility fractures were treated with oral bisphosphonates (BPs). Of 685 women recruited, 179 (26.1%) received BP treatment. By the third year of AI therapy, this group exhibited increased BMD in the lumbar spine (LS; 2.59%) and femoral neck (FN; 2.50%), although the increase was significant only within the first year (LS: 1.99% and FN: 2.04%). Despite BP therapy, however, approximately 15% of these patients lost more than 3% of their baseline bone mass. At 3 years, patients without BP experienced BMD decreases in the LS (-3.10%) and FN (-2.79%). In this group, BMD changes occurred during the first (LS: -1.33% and FN: -1.25%), second (LS: -1.19% and FN: -0.82%), and third (LS: -0.57% and FN: -0.65%) years of AI treatment. Increased BMD (>3%) was observed in just 7.6% and 10.8% of these patients at the LS and FN, respectively. Our data confirm a clinically relevant bone loss associated with AI therapy amongst nonusers of preventative BPs. We further report on the importance of BMD monitoring as well as calcium and 25-hydroxy vitamin D supplementation in these patients.
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Affiliation(s)
- María Rodríguez-Sanz
- IMIM (Hospital del Mar Research Institute)Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Daniel Prieto-Alhambra
- IMIM (Hospital del Mar Research Institute)Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain IDIAP Jordi Gol Primary Care Research InstituteUniversitat Autònoma de Barcelona, Barcelona, Spain Nuffield Department of OrthopaedicsRheumatology and Musculoskeletal Sciences, Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK MRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton, UK
| | - Sonia Servitja
- Cancer Research ProgramIMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Natalia Garcia-Giralt
- IMIM (Hospital del Mar Research Institute)Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Laia Garrigos
- Cancer Research ProgramIMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Rodriguez-Morera
- Internal Medicine DepartmentHospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Albanell
- Cancer Research ProgramIMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria Martínez-García
- Cancer Research ProgramIMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Iria González
- Cancer Research ProgramIMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Adolfo Diez-Perez
- IMIM (Hospital del Mar Research Institute)Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain Internal Medicine DepartmentHospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Tusquets
- Cancer Research ProgramIMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Nogués
- IMIM (Hospital del Mar Research Institute)Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain Internal Medicine DepartmentHospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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97
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The Metabolism, Analysis, and Targeting of Steroid Hormones in Breast and Prostate Cancer. Discov Oncol 2016; 7:149-64. [PMID: 26969590 DOI: 10.1007/s12672-016-0259-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/24/2016] [Indexed: 12/14/2022] Open
Abstract
Breast and prostate cancers are malignancies in which steroid hormones drive cellular proliferation. Over the past century, this understanding has led to successful treatment strategies aimed to inhibit hormone-mediated tumor growth. Nonetheless, disease relapse and progression still pose significant clinical problems, with recurrent and metastatic tumors often exhibiting resistance to current drug therapies. The central role of androgens and estrogens in prostate and breast cancer etiology explains not only why endocrine therapies are often initially successful but also why many tumors ultimately become resistant. It is hypothesized that reducing the concentration of active hormones in the systemic circulation may be insufficient to block cancer progression, as this action selects for tumor cells that can generate active steroids from circulating precursors. This review aims to highlight the currently known differences of steroid biosynthesis in normal physiology versus hormone-dependent cancers, modern approaches to the assessment and targeting of these pathways, and priorities for future research.
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98
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Shaby BA, Skibinski G, Ando M, LaDow ES, Finkbeiner S. A three-groups model for high-throughput survival screens. Biometrics 2016; 72:936-44. [PMID: 26821783 DOI: 10.1111/biom.12479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/01/2015] [Accepted: 11/01/2015] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition characterized by the progressive deterioration of motor neurons in the cortex and spinal cord. Using an automated robotic microscope platform that enables the longitudinal tracking of thousands of single neurons, we examine the effects a large library of compounds on modulating the survival of primary neurons expressing a mutation known to cause ALS. The goal of our analysis is to identify the few potentially beneficial compounds among the many assayed, the vast majority of which do not extend neuronal survival. This resembles the large-scale simultaneous inference scenario familiar from microarray analysis, but transferred to the survival analysis setting due to the novel experimental setup. We apply a three-component mixture model to censored survival times of thousands of individual neurons subjected to hundreds of different compounds. The shrinkage induced by our model significantly improves performance in simulations relative to performing treatment-wise survival analysis and subsequent multiple testing adjustment. Our analysis identified compounds that provide insight into potential novel therapeutic strategies for ALS.
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Affiliation(s)
- Benjamin A Shaby
- Department of Statistics, Pennsylvania State University, University Park, Pennsylvania 16802, U.S.A..
| | - Gaia Skibinski
- Gladstone Institute of Neurological Disease, J. David Gladstone Institutes, San Francisco, California 94158, U.S.A
| | - Michael Ando
- Gladstone Institute of Neurological Disease, J. David Gladstone Institutes, San Francisco, California 94158, U.S.A
| | - Eva S LaDow
- Department of Neuroscience, University of Texas at Dallas, Richardson, Texas 75080, U.S.A
| | - Steven Finkbeiner
- Gladstone Institute of Neurological Disease, J. David Gladstone Institutes, San Francisco, California 94158, U.S.A
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99
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Aromatase inhibitor treatment for breast cancer: short-term effect on bone health. Contemp Oncol (Pozn) 2016; 19:374-7. [PMID: 26793021 PMCID: PMC4709393 DOI: 10.5114/wo.2014.45305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/25/2014] [Indexed: 11/17/2022] Open
Abstract
Aim of this study Aim of this study was to examine the effects of aromatase inhibitors (AIs), which are used in every phase of breast cancer treatment, on the bone mineral density (BMD) of patients with early-stage breast cancer. Material and methods Menopausal female patients who were diagnosed with stages 1–3 breast cancer and who were planned for anastrazole or letrozole as adjuvant therapy were examined. After the patients’ BMD was measured, 45 patients without osteoporosis were included in the study. Six months after AI therapy started, the patients’ BMD was measured again. Results In this study, we tried to show that there was a statistical difference in the BMD of 45 patients before and 6 months after treatment. Among all measurements (femur and lumbar T-scores), the femur Z-score (p = 0.52) was the only score that was not statistically significant. Statistical significance (p < 0.01) was detected in comparative analysis of the other measurements. According to this analysis, a significant loss of BMD was seen even in the first six months after AI treatment was introduced. Conclusions Female patients with breast cancer are at higher risk for bone loss and fractures than healthy women. In this study, we showed the negative effects on BMD of aromatase inhibitor therapy, one of the main contributions to osteoporosis in women with breast cancer. This study is the first to quantify the short-term effect of AI treatment on BMD in postmenopausal women with breast cancer.
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100
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Bacci M, Giannoni E, Fearns A, Ribas R, Gao Q, Taddei ML, Pintus G, Dowsett M, Isacke CM, Martin LA, Chiarugi P, Morandi A. miR-155 Drives Metabolic Reprogramming of ER+ Breast Cancer Cells Following Long-Term Estrogen Deprivation and Predicts Clinical Response to Aromatase Inhibitors. Cancer Res 2016; 76:1615-26. [DOI: 10.1158/0008-5472.can-15-2038] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/28/2015] [Indexed: 11/16/2022]
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