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Li Y, Chen X, Zhu Q, Chen R, Xu L, Li S, Shi X, Xu H, Xu Y, Zhang W, Huang X, Zha X, Wang J. Retrospective comparisons of nanoparticle albumin-bound paclitaxel and docetaxel neoadjuvant regimens for breast cancer. Nanomedicine (Lond) 2021; 16:391-400. [PMID: 33502252 DOI: 10.2217/nnm-2020-0458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: To compare the efficacy and safety of 2-weekly nanoparticle albumin-bound paclitaxel (nP) and 3-weekly docetaxel regimens as neoadjuvant systemic therapy (NST) for breast cancer. Materials & methods: Patients (n = 201) received NST comprising either dose-dense epirubicin and cyclophosphamide followed by 2-weekly nP (n = 104) or 3-weekly courses of epirubicin and cyclophosphamide followed by docetaxel (n = 97). Results: Higher pathological complete response rates were achieved by the nP group. Subgroup analysis showed that the nP-based regimen achieved higher pathological complete response rates in patients with triple-negative tumor cells and high Ki67 levels. However, grades 3-4 peripheral sensory neuropathies were more frequent in the nP group. Conclusion: The 2-weekly nP-based regimen might be a better choice of NST for patients with breast cancer.
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Affiliation(s)
- Yan Li
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Xiang Chen
- Department of Thyroid and Mammary Gland Surgery, Yixing People's Hospital, Wuxi 214200, PR China
| | - Qiannan Zhu
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Rui Chen
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Lu Xu
- Department of Clinical Nutrition, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Shuo Li
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Xiaoqing Shi
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Haiping Xu
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Yinggang Xu
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Weiwei Zhang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Xiaofeng Huang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Xiaoming Zha
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 210000, PR China
| | - Jue Wang
- Department of Breast Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, PR China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 210000, PR China
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Intermittent versus continuous first-line treatment for HER2-negative metastatic breast cancer: the Stop & Go study of the Dutch Breast Cancer Research Group (BOOG). Breast Cancer Res Treat 2018; 172:413-423. [DOI: 10.1007/s10549-018-4906-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
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3
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Fietz T, Tesch H, Rauh J, Boller E, Kruggel L, Jänicke M, Marschner N. Palliative systemic therapy and overall survival of 1,395 patients with advanced breast cancer - Results from the prospective German TMK cohort study. Breast 2017; 34:122-130. [PMID: 28586735 DOI: 10.1016/j.breast.2017.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 11/18/2022] Open
Abstract
Data on treatment and outcome of advanced breast cancer in routine practice are rare, especially concerning recurrent disease, but important to complement the results from clinical trials and to improve the standard of care. We present data on choice of systemic first-line treatment, number of treatment lines, and survival of patients treated by medical oncologists in Germany. 1395 patients recruited by 124 sites at start of first-line therapy into the ongoing, prospective German clinical cohort study TMK (Tumour Registry Breast Cancer) between February 2007 and October 2015 were analysed. The median OS was 33.8 months (95% CI 30.2-40.2) for HR-positive/HER2-negative, 38.2 months (95% CI 31.3-43.0) for HER2-positive and 16.8 months (95% CI 11.5-22.0) for triple negative breast cancer. Patients with triple negative tumours more often died before start of a third-line therapy than patients with HR-positive or HER2-positive tumours (44% vs. 25%). Use of taxane-based chemotherapies has increased since 2007, with 65% of all first-line chemotherapy-treatments containing taxanes in 2013-15 (60% HR-positive/HER2-negative, 75% HER2-positive, 56% triple negative). 52% of the patients with HR-positive/HER2-negative tumours received first-line endocrine therapy in 2013-15; when restricted to patients with only non-visceral metastases this percentage increased to 63%. To our knowledge, this is the first cohort study showing systemic first-line therapy for all subtypes of advanced breast cancer. Overall survival in the TMK is comparable to that reported by clinical trials despite the inclusion of older and comorbid patients.
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Affiliation(s)
- Thomas Fietz
- Outpatient-Centre for Internal Medicine, Haematology and Oncology, Singen, Germany
| | - Hans Tesch
- Outpatient-Centre for Haematology and Medical Oncology at Bethanien, Frankfurt/Main, Germany
| | - Jacqueline Rauh
- Joint Outpatient-Centre for Internal Medicine, Witten, Germany
| | | | - Lisa Kruggel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Norbert Marschner
- Outpatient-Centre for Interdisciplinary Oncology and Haematology, Freiburg, Germany.
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A qualitative study of women's experiences of healthcare, treatment and support for metastatic breast cancer. Breast 2015; 24:242-7. [PMID: 25753212 DOI: 10.1016/j.breast.2015.02.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/13/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this qualitative research was to identify the healthcare, information and support needs of women living with metastatic breast cancer. MATERIALS AND METHODS Semi-structured qualitative interviews were conducted with 18 women. Women were asked about their experiences of living with metastatic breast cancer and their information and support needs. RESULTS Women valued relationships with their healthcare professionals, particularly their oncologists. They wanted more attention paid to side-effects of ongoing treatments, which had a negative impact on their health. While oncologists were a primary source of information, women also drew on other sources. There were mixed findings about the value of support groups, with women preferring to seek alternative sources of social support. CONCLUSION A diagnosis of metastatic breast cancer brings heightened reliance on healthcare professionals to respond to women's needs in a way that is different to that required with a diagnosis of early breast cancer.
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Bonotto M, Gerratana L, Poletto E, Driol P, Giangreco M, Russo S, Minisini AM, Andreetta C, Mansutti M, Pisa FE, Fasola G, Puglisi F. Measures of outcome in metastatic breast cancer: insights from a real-world scenario. Oncologist 2014; 19:608-15. [PMID: 24794159 PMCID: PMC4041678 DOI: 10.1634/theoncologist.2014-0002] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/03/2014] [Indexed: 11/17/2022] Open
Abstract
No gold standard treatment exists for metastatic breast cancer (MBC). Clinical decision making is based on knowledge of prognostic and predictive factors that are extrapolated from clinical trials and, sometimes, are not reliably transferable to a real-world scenario. Moreover, misalignment between endpoints used in drug development and measures of outcome in clinical practice has been noted. The roles of overall survival (OS) and progression-free survival (PFS) as primary endpoints in the context of clinical trials are the subjects of lively debate. Information about these parameters in routine clinical practice is potentially useful to design new studies and/or to interpret the results of clinical research. This study analyzed the impact of patient and tumor characteristics on the major measures of outcome across different lines of treatment in a cohort of 472 patients treated for MBC. OS, PFS, and postprogression survival (PPS) were analyzed. The study showed how biological and clinical characteristics may have different prognostic value across different lines of therapy for MBC. After first-line treatment, the median PPS of luminal A, luminal B, and human epidermal growth factor receptor 2 (HER2)-positive groups was longer than 12 months. The choice of OS as a primary endpoint for clinical trials could not be appropriate with these subtypes. In contrast, OS could be an appropriate endpoint when PPS is expected to be low (e.g., triple-negative subtype after the first line; other subtypes after the third line). The potential implications of these findings are clinical and methodological.
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Affiliation(s)
- Marta Bonotto
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Lorenzo Gerratana
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Elena Poletto
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Pamela Driol
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Manuela Giangreco
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Stefania Russo
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Alessandro M Minisini
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Claudia Andreetta
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Mauro Mansutti
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Federica E Pisa
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Gianpiero Fasola
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
| | - Fabio Puglisi
- Department of Oncology and Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy; General Hospital, Gorizia, Italy
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Aarts MJ, Grutters JP, Peters FP, Mandigers CM, Dercksen MW, Stouthard JM, Nortier HJ, van Laarhoven HW, van Warmerdam LJ, van de Wouw AJ, Jacobs EM, Mattijssen V, van der Rijt CC, Smilde TJ, van der Velden AW, Temizkan M, Batman E, Muller EW, van Gastel SM, Joore MA, Borm GF, Tjan-Heijnen VC. Cost effectiveness of primary pegfilgrastim prophylaxis in patients with breast cancer at risk of febrile neutropenia. J Clin Oncol 2013; 31:4283-9. [PMID: 24166522 DOI: 10.1200/jco.2012.48.3644] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Guidelines advise primary granulocyte colony-stimulating factor (G-CSF) prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary pegfilgrastim prophylaxis. METHODS Our economic evaluation used a health care perspective and was based on a randomized study in patients with breast cancer with increased risk of FN, comparing primary G-CSF prophylaxis throughout all chemotherapy cycles (G-CSF 1-6 cycles) with prophylaxis during the first two cycles only (G-CSF 1-2 cycles). Primary outcome was cost effectiveness expressed as costs per patient with episodes of FN prevented. RESULTS The incidence of FN increased from 10% in the G-CSF 1 to 6 cycles study arm (eight of 84 patients) to 36% in the G-CSF 1 to 2 cycles study arm (30 of 83 patients), whereas the mean total costs decreased from € 20,658 (95% CI, € 20,049 to € 21,247) to € 17,168 (95% CI € 16,239 to € 18,029) per patient, respectively. Chemotherapy and G-CSF determined 80% of the total costs. As expected, FN-related costs were higher in the G-CSF 1 to 2 cycles arm. The incremental cost effectiveness ratio for the G-CSF 1 to 6 cycles arm compared with the G-CSF 1 to 2 cycles arm was € 13,112 per patient with episodes of FN prevented. CONCLUSION We conclude that G-CSF prophylaxis throughout all chemotherapy cycles is more effective, but more costly, compared with prophylaxis limited to the first two cycles. Whether G-CSF prophylaxis throughout all chemotherapy cycles is considered cost effective depends on the willingness to pay per patient with episodes of FN prevented.
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Affiliation(s)
- Maureen J Aarts
- Maureen J. Aarts, Vivianne C. Tjan-Heijnen, Janneke P. Grutters, Manuela A. Joore, Maastricht University Medical Center, Maastricht; Frank P. Peters, Orbis Medical Centre, Sittard; Caroline M. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; M. Wouter Dercksen, Maxima Medical Center, Veldhoven; Jacqueline M. Stouthard, Maasstad Medical Center, Rotterdam; Hans J. Nortier, Leiden University Medical Center, Leiden; Hanneke W. van Laarhoven, George F. Borm, Radboud University Nijmegen Medical Centre, Nijmegen; Laurence J. van Warmerdam, Catharina Hospital, Eindhoven; Agnes J. van de Wouw, VieCuri Medical Center, Venlo; Esther M. Jacobs, Elkerliek Hospital, Helmond; Vera Mattijssen, Rijnstate Hospital, Arnhem; Carin C. van der Rijt, Erasmus Medical Center Daniel den Hoed Cancer Center, Rotterdam; Tineke J. Smilde, Jeroen Bosch Hospital, 's-Hertogenbosch; Annette W. van der Velden, Martini Hospital, Groningen; Mehmet Temizkan, Hospital St Jansdal, Harderwijk; Erdogan Batman, Diaconessenhuis Leiden, Leiden; Erik W. Muller, Slingeland Hospital, Doetinchem; Saskia M. van Gastel, Comprehensive Cancer Center East, Nijmegen the Netherlands
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Doxorubicin/cyclophosphamide with concurrent versus sequential docetaxel as neoadjuvant treatment in patients with breast cancer. Eur J Cancer 2013; 49:3102-10. [DOI: 10.1016/j.ejca.2013.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/23/2022]
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