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Martin H, Saunders C, Redfern A, Hickey M. A Dedicated Menopausal After Cancer Clinic May Improve Adherence to Endocrine Therapy For Breast Cancer: A Population Based Study. Clin Breast Cancer 2024:S1526-8209(24)00230-1. [PMID: 39395849 DOI: 10.1016/j.clbc.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/10/2024] [Accepted: 08/20/2024] [Indexed: 10/14/2024]
Abstract
PURPOSE To examine utilization of a dedicated menopause symptoms after cancer clinic (MSAC) and to determine whether women referred to the MSAC for management of severe hot flush symptoms are more likely to adhere to endocrine therapy compare to those with severe symptoms not referred to MSAC. PATIENTS AND METHODS Breast cancer patients prescribed endocrine therapy with a diagnosis of estrogen-receptor positive breast cancer between January 2003 and December 2011 were identified from the Royal Perth Hospital Breast Unit database. Details of breast cancer pathology, endocrine therapy, endocrine therapy related side effects, referral to MSAC and patient reported adherence to endocrine therapy for up to 4 years were ascertained from the database and medical records systems. For those with severe vasomotor symptoms, total duration of endocrine therapy was compared between women referred to MSAC and those who were not referred to MSAC. RESULTS About 1275 women were identified from the database, with the cohort followed up until Dec 2016. Of these women, 120 (9.4%) were referred to MSAC and 1155 (90.1%) received usual care. In total, 147 reported severe vasomotor symptoms of whom almost half (71) were referred to MSAC. Women with severe vasomotor symptoms managed by MSAC were less likely to discontinue endocrine therapy (15.5%) compared with those managed with usual care (26.3%). However, this difference was not statistically significant (chi-square test statistic = 2.584, 1df, P = .1). CONCLUSION Management of severe vasomotor symptoms at a dedicated menopause clinic may increase adherence to endocrine therapy for breast cancer.
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Affiliation(s)
- Hilary Martin
- Medical Oncology Department, Fiona Stanley Hospital, Western Australia, Australia; School of Medicine, University of Western Australia, Western Australia, Australia.
| | - Christobel Saunders
- Department of Surgery, Melbourne Medical School University of Melbourne, Victoria, Australia; Royal Melbourne Hospital and Peter MacCallum Cancer Institute, Victoria, Australia
| | - Andrew Redfern
- Medical Oncology Department, Fiona Stanley Hospital, Western Australia, Australia; School of Medicine, University of Western Australia, Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
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Martin H, Redfern A. Bone mineral density fall during aromatase inhibitor treatment may predict lower breast cancer recurrence. Cancer Med 2024; 13:e6846. [PMID: 38186326 PMCID: PMC10807598 DOI: 10.1002/cam4.6846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE Aromatase inhibitors (AIs) are associated with reduction in bone mineral density (BMD). The use of bone strengthening agents zoledronic acid and denosumab are associated with improved breast cancer outcomes for post-menopausal patients treated with AIs. This study investigates whether change in BMD with AI therapy is associated with breast cancer recurrence. METHODS A cohort of patients treated at a single institution diagnosed with hormone receptor-positive breast cancer with baseline BMD and subsequent BMD test while receiving adjuvant aromatase inhibitor therapy were studied. Demographic, treatment and outcome data was obtained. Simple and multiple linear regression analysis was performed to investigate predictors of annual percent BMD change at the LS and hip. Univariate and multivariate Cox proportional hazards modelling were undertaken to investigate predictors of breast cancer recurrence. RESULTS 353 patients eligible patients were identified. In multivariate analysis of lumbar spine BMD change, the difference between those in quartile 1, which showed the greatest reduction in BMD, and quartile 3, with substantially less reduction, was significant (HR = 3.02, 95% CI 1.15-7.90 p = 0.025). Hip BMD reduction was also not significantly associated with breast cancer recurrence. The two quartiles with the least reduction in hip BMD showing a non-significant reduced risk of recurrence relative to the quartile with the greatest (p = 0.10). CONCLUSIONS The findings suggest an association may exist between lumbar spine BMD change and breast cancer recurrence for patients treated with adjuvant AI. Further research is required to determine whether BMD change can be utilised as a biomarker.
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Affiliation(s)
- Hilary Martin
- Medical OncologyFiona Stanley HospitalMurdochWestern AustraliaAustralia
- School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Andrew Redfern
- Medical OncologyFiona Stanley HospitalMurdochWestern AustraliaAustralia
- School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
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Wang MX, Peng ZG. 17β-hydroxysteroid dehydrogenases in the progression of nonalcoholic fatty liver disease. Pharmacol Ther 2023; 246:108428. [PMID: 37116587 DOI: 10.1016/j.pharmthera.2023.108428] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has become a worldwide epidemic and a major public health problem, with a prevalence of approximately 25%. The pathogenesis of NAFLD is complex and may be affected by the environment and susceptible genetic factors, resulting in a highly variable disease course and no approved drugs in the clinic. Notably, 17β-hydroxysteroid dehydrogenase type 13 (HSD17B13), which belongs to the 17β-hydroxysteroid dehydrogenase superfamily (HSD17Bs), is closely related to the clinical outcome of liver disease. HSD17Bs consists of fifteen members, most related to steroid and lipid metabolism, and may have the same biological function as HSD17B13. In this review, we highlight recent advances in basic research on the functional activities, major substrates, and key roles of HSD17Bs in the progression of NAFLD to develop innovative anti-NAFLD drugs targeting HSD17Bs.
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Affiliation(s)
- Mei-Xi Wang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China; Public Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, China
| | - Zong-Gen Peng
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China; Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China; Key Laboratory of Biotechnology of Antibiotics, The National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China.
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Short-term changes in ultrasound tomography measures of breast density and treatment-associated endocrine symptoms after tamoxifen therapy. NPJ Breast Cancer 2023; 9:12. [PMID: 36922547 PMCID: PMC10017770 DOI: 10.1038/s41523-023-00511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/13/2023] [Indexed: 03/17/2023] Open
Abstract
Although breast density decline with tamoxifen therapy is associated with greater therapeutic benefit, limited data suggest that endocrine symptoms may also be associated with improved breast cancer outcomes. However, it is unknown whether endocrine symptoms are associated with reductions in breast density after tamoxifen initiation. We evaluated treatment-associated endocrine symptoms and breast density change among 74 women prescribed tamoxifen in a 12-month longitudinal study. Treatment-associated endocrine symptoms and sound speed measures of breast density, assessed via novel whole breast ultrasound tomography (m/s), were ascertained before tamoxifen (T0) and at 1-3 (T1), 4-6 (T2), and 12 months (T3) after initiation. CYP2D6 status was genotyped, and tamoxifen metabolites were measured at T3. Using multivariable linear regression, we estimated mean change in breast density by treatment-associated endocrine symptoms adjusting for age, race, menopausal status, body mass index, and baseline density. Significant breast density declines were observed in women with treatment-associated endocrine symptoms (mean change (95% confidence interval) at T1:-0.26 m/s (-2.17,1.65); T2:-2.12 m/s (-4.02,-0.22); T3:-3.73 m/s (-5.82,-1.63); p-trend = 0.004), but not among women without symptoms (p-trend = 0.18) (p-interaction = 0.02). Similar declines were observed with increasing symptom frequency (p-trends for no symptoms = 0.91; low/moderate symptoms = 0.03; high symptoms = 0.004). Density declines remained among women with detectable tamoxifen metabolites or intermediate/efficient CYP2D6 metabolizer status. Emergent/worsening endocrine symptoms are associated with significant, early declines in breast density after tamoxifen initiation. Further studies are needed to assess whether these observations predict clinical outcomes. If confirmed, endocrine symptoms may be a proxy for tamoxifen response and useful for patients and providers to encourage adherence.
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5
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Bluethmann SM, Flores E, Grotte M, Heitzenrater J, Truica CI, Olsen NJ, Sciamanna C, Schmitz KH. Adapting an Evidence-Based Exercise and Education Program for Older Breast Cancer Survivors for the REJOIN Trial. J Aging Phys Act 2023; 31:59-67. [PMID: 35700977 PMCID: PMC10903157 DOI: 10.1123/japa.2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
Abstract
Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
| | - Eileen Flores
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
| | - Meghan Grotte
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Jared Heitzenrater
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Cristina I Truica
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Nancy J Olsen
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, Hershey, PA,USA
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Pasqualoni M, Orlandi A, Palazzo A, Garufi G, Cannizzaro MC, Pontolillo L, Pannunzio S, Cutigni C, Sollena P, Federico F, Bria E, Tortora G. Case report: Vitiligo-like toxicity due to ribociclib during first-line treatment of metastatic breast cancer: two cases of premature interruption of therapy and exceptional response. Front Oncol 2023; 13:1067264. [PMID: 36969030 PMCID: PMC10034067 DOI: 10.3389/fonc.2023.1067264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Cancer treatment-related adverse events (AEs) are sometimes associated with outcomes for cancer patients, especially with the newest therapies such as target therapy and immunotherapy. A few years ago, the first-line therapy for hormone-receptor-positive metastatic breast cancer (mBC) patients has been deeply changed by the introduction of cyclin-dependent kinase (CDK) 4/6 inhibitors, and now, we are improving our knowledge about their AEs and significance in clinical practice. Here, we report our experience with two cases of vitiligo-like lesions that occur early during treatment with ribociclib. We tried to change the CDK4/6 inhibitor for one patient, but the skin reaction persisted. Both patients retained only the endocrine therapy alone and had an unexpected durable progression-free survival (PFS). Some data on skin toxicities, including vitiligo-like lesions by CDK4/6 inhibitors, have recently been reported in the literature, but for the first time, we highlight a possible correlation with improved survival outcomes of patients. Uncovering the etiology of this toxicity, verifying the involvement of the immune system, and demonstrating a possible positive impact in survival represent an intriguing research objective for the near future.
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Affiliation(s)
- Mariangela Pasqualoni
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Armando Orlandi
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- *Correspondence: Armando Orlandi,
| | - Antonella Palazzo
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
| | - Giovanna Garufi
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Maria Chiara Cannizzaro
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Letizia Pontolillo
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Sergio Pannunzio
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Claudia Cutigni
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Sollena
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Federico
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario ‘A. Gemelli’ – IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
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Cho B, Pérez M, Jeffe DB, Kreuter MW, Margenthaler JA, Colditz GA, Liu Y. Factors associated with initiation and continuation of endocrine therapy in women with hormone receptor-positive breast cancer. BMC Cancer 2022; 22:837. [PMID: 35915419 PMCID: PMC9341086 DOI: 10.1186/s12885-022-09946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite benefits of endocrine therapy (ET) for patients with hormone-receptor (HR)-positive breast cancer, many patients do not initiate or discontinue ET against recommendations.
Methods
We identified variables associated with ET initiation and continuation, analyzing pooled data from two longitudinal studies at a National Cancer Institute comprehensive cancer center in St. Louis, Missouri. The sample included 533 women with newly diagnosed, non-metastatic, HR-positive breast cancer who completed interviews at enrollment and 6, 12, and 24 months after definitive surgical treatment. Logistic regression models estimated the adjusted odds ratio and 95% confidence interval (aOR [95% CI]) for each of self-reported ET initiation by the 12-month interview and continuation for ≥12 months by the 24-month interview in association with self-reported diabetes, elevated depressed mood, menopausal-symptom severity and obesity, adjusting for race, age, insurance status, chemotherapy, and radiation therapy.
Results
Overall, 81.4% (434/533) of patients initiated ET, and 86.5% (371/429) continued ET ≥12 months. Patients with diabetes had lower odds of initiating ET (0.50 [0.27-0.91]). Patients reporting greater menopausal-symptom severity had lower odds of continuing ET (0.72 [0.53-0.99]).
Conclusion
Efforts to increase ET initiation among patients with diabetes and better manage severe menopausal symptoms among ET users might promote ET continuation.
Clinical trial information
ClinicalTrials.gov: #NCT00929084.
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TKIs beyond immunotherapy predict improved survival in advanced HCC. J Cancer Res Clin Oncol 2022; 149:2559-2574. [PMID: 35773429 DOI: 10.1007/s00432-022-04115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE For patients with advanced HCC, predictors of immunotherapy response are scarce, and the benefits of tyrosine kinase inhibitor (TKI) treatment after immunotherapy are unclear. We explored whether clinical features, such as target lesion response, immune-mediated toxicity, or subsequent TKI therapy predict immunotherapy response. METHODS We retrospectively studied 77 patients with advanced HCC receiving immunotherapy. Patient characteristics and outcomes were assessed using various statistical methods, including the log-rank test and Kaplan-Meier methods. Cox proportional hazard modeling was used for multivariable survival analysis. RESULTS For all patients, median overall survival (mOS) was 13 months (95% CI 8-19), and median progression-free survival (mPFS) was 6 months (95% CI 4-10). Patients with partial response (PR) and stable disease (SD) compared to progressive disease (PD) had prolonged mPFS (27 vs. 5 vs. 1 month(s), p < 0.0001) and mOS (not met vs. 11 vs. 3 months, p < 0.0001). Patients with vs. without immune-mediated toxicities trended towards longer mPFS (9 vs. 4 months p = 0.133) and mOS (17 vs. 9 months; p = 0.095). Patients who did vs. did not receive a tyrosine kinase inhibitor (TKI) after immunotherapy had a significantly improved mOS (19 vs. 5 months, p = 0.0024)). Based on multivariate modeling, the hazard ratio (HR) of overall survival (OS) of patients receiving TKI vs. no TKI was 0.412 (p = 0.0043). CONCLUSION We show that disease control predicts prolonged mOS and mPFS. Furthermore, TKI therapy administered after immunotherapy predicts prolonged mOS in patients with advanced HCC.
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Zeng E, He W, Smedby KE, Czene K. Adjuvant Hormone Therapy-Related Hot Flashes Predict Treatment Discontinuation and Worse Breast Cancer Prognosis. J Natl Compr Canc Netw 2022; 20:683-689.e2. [PMID: 35385829 DOI: 10.6004/jnccn.2021.7116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Clinical trials have shown that adjuvant hormone therapy (AHT)-related hot flashes can predict better breast cancer outcomes. This population-based cohort study investigated whether this result can be generalized to a real-world setting. PATIENTS AND METHODS By linking the National Quality Registry for Breast Cancer, Prescribed Drug Register, and Cause-of-Death Register, we identified 7,152 chemotherapy-free patients with breast cancer who initiated AHT in Stockholm from 2006 through 2019, and followed them until 2020. Hot flashes were defined as new use of drugs for hot flashes within 6 months after initiating AHT. We used Cox models to compare disease-free survival and treatment discontinuation among patients with and without hot flashes. RESULTS Patients who newly used drugs for hot flashes shortly after AHT initiation had worse disease-free survival (adjusted hazard ratio [HR], 1.67; 95% CI, 1.11-2.52) and a higher treatment discontinuation rate (adjusted HR, 1.47; 95% CI, 1.21-1.78). The association between drugs for hot flashes and discontinuation of AHT differed by patient characteristics, with stronger associations among low-income patients (HR, 1.91; 95% CI, 1.41-2.59) and those without first-degree relatives who had cancer (HR, 1.81; 95% CI, 1.39-2.35) or died from cancer (HR, 1.71; 95% CI, 1.37-2.12). CONCLUSIONS AHT-related hot flashes predict worse, rather than better, breast cancer outcomes among patients in clinical routine practice. The identification of adverse effects by the initiation of hot flash medications may identify a subset of patients with more severe hot flashes who are more likely to discontinue AHT and need more support for treatment adherence.
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Affiliation(s)
- Erwei Zeng
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Wei He
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,2Chronic Disease Research Institute, the Children's Hospital, and.,3Department of Nutrition and Food Hygiene, and National Clinical Research Center for Child Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; and
| | - Karin E Smedby
- 4Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Gold EB, Crawford SL, Leung K, Greendale G, Reeves KW, Joffe H, Avis NE. Vasomotor symptoms in midlife women with incident breast cancer: pink SWAN. Breast Cancer Res Treat 2022; 191:125-135. [PMID: 34694536 PMCID: PMC8758653 DOI: 10.1007/s10549-021-06425-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/14/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE We compared trajectories of vasomotor symptoms (VMS) and their risk factors in women with breast cancer (BrCa) to those of cancer-free controls. METHODS Data were from 15 nearly annual follow-up visits (1996-2017) of the multi-racial/ethnic cohort of midlife women enrolled in the Study of Women's Health Across the Nation (SWAN). We compared women with incident BrCa to controls for patterns of VMS, controlling for risk factors identified in bivariate analyses using multivariable longitudinal analyses. RESULTS Characteristics at study entry largely did not differ between cases (n = 151) and controls (n = 2161). Adjusted prevalence of any VMS increased significantly among cases from diagnosis to 2.75 years post diagnosis [per-year adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) 1.39-2.24], peaking at 2.75 years post diagnosis, whereas prevalence was stable among controls in this interval [aOR = 1.04, 95% CI 0.99-1.11]. Beyond 2.75 years post diagnosis, prevalence declined significantly in cases [aOR = 0.72, 95% CI 0.61-0.84] and less in controls [aOR = 0.96, 95% CI 0.92-1.00]. Patterns were similar for frequent VMS. Adjustment for tamoxifen use slightly reduced the per-year OR for any prevalent VMS post diagnosis, partially explaining excess VMS in cases. Other treatments were unassociated with VMS. CONCLUSIONS Patterns of prevalent VMS reporting differed significantly between cases and controls, particularly post diagnosis, the latter only partially explained by tamoxifen use among cases. Risk factors for VMS largely did not differ between cases and controls.
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Affiliation(s)
- Ellen B Gold
- University of California Davis School of Medicine, Davis, USA.
- Department of Public Health Sciences, University of California Davis, One Shields Ave., Med Sci 1C, Davis, CA, 95616, USA.
| | | | | | - Gail Greendale
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Katherine W Reeves
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, USA
| | - Hadine Joffe
- Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, USA
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Toivonen KI, Oberoi D, King-Shier K, Piedalue KAL, Rash JA, Carlson LE, Campbell TS. Both "Vitamin L for Life" and "One Milligram of Satan": A Multi-Perspective Qualitative Exploration of Adjuvant Endocrine Therapy Use after Breast Cancer. Curr Oncol 2021; 28:2496-2515. [PMID: 34287250 PMCID: PMC8293219 DOI: 10.3390/curroncol28040227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
Adjuvant endocrine therapy (AET) is recommended after hormone receptor-positive breast cancer to reduce risk of recurrence, but adherence is sub-optimal in many women. Behavioral interventions have been ineffective in improving adherence rates to AET. This qualitative descriptive study investigates factors that support women in AET use and suggestions for interventions to improve AET use and management. Interviews with women who persisted with AET (n = 23), women who discontinued AET (n = 15), and healthcare providers (HCPs; oncologists, oncology residents, and pharmacists; n = 9) were conducted, transcribed, and described using thematic analysis. Data collection stopped once saturation occurred (i.e., no new codes or themes emerged during interviews). Two researchers created codes and developed themes in an iterative process; a third researcher verified the representativeness of final themes. This study was approved by the Health Research Ethics Board of Alberta (ID: HREBA.CC-17-0513). Women who persisted described being prepared for side effects and having self-management strategies, strong rationale for AET use, supportive HCPs, and available resources as relevant factors. Women who discontinued described feeling overwhelmed by side effects, information needs, drawbacks of AET, helpful/unhelpful experiences with HCPs, and contextual factors as relevant to their discontinuation. HCPs described health system-related and patient-related barriers, side effect management, and patient-provider interactions as relevant to supporting AET use. The considerable overlap in themes among the three groups suggests broad recognition of salient factors relevant to AET use and that associated strategies to improve use may be acceptable to patients and providers alike. Factors supporting AET use could include the following: education (which may be necessary but insufficient), developing a strong personal rationale for use, being prepared for side effects, having side effect management strategies, reciprocal communication between patients and HCPs, and accessible resources.
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Affiliation(s)
- Kirsti I. Toivonen
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Devesh Oberoi
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (D.O.); (K.-A.L.P.)
| | | | - Katherine-Ann L. Piedalue
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (D.O.); (K.-A.L.P.)
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada;
| | - Linda E. Carlson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (D.O.); (K.-A.L.P.)
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
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Neupane R, Boddu SHS, Abou-Dahech MS, Bachu RD, Terrero D, Babu RJ, Tiwari AK. Transdermal Delivery of Chemotherapeutics: Strategies, Requirements, and Opportunities. Pharmaceutics 2021; 13:960. [PMID: 34206728 PMCID: PMC8308987 DOI: 10.3390/pharmaceutics13070960] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
Chemotherapeutic drugs are primarily administered to cancer patients via oral or parenteral routes. The use of transdermal drug delivery could potentially be a better alternative to decrease the dose frequency and severity of adverse or toxic effects associated with oral or parenteral administration of chemotherapeutic drugs. The transdermal delivery of drugs has shown to be advantageous for the treatment of highly localized tumors in certain types of breast and skin cancers. In addition, the transdermal route can be used to deliver low-dose chemotherapeutics in a sustained manner. The transdermal route can also be utilized for vaccine design in cancer management, for example, vaccines against cervical cancer. However, the design of transdermal formulations may be challenging in terms of the conjugation chemistry of the molecules and the sustained and reproducible delivery of therapeutically efficacious doses. In this review, we discuss the nano-carrier systems, such as nanoparticles, liposomes, etc., used in recent literature to deliver chemotherapeutic agents. The advantages of transdermal route over oral and parenteral routes for popular chemotherapeutic drugs are summarized. Furthermore, we also discuss a possible in silico approach, Formulating for Efficacy™, to design transdermal formulations that would probably be economical, robust, and more efficacious.
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Affiliation(s)
- Rabin Neupane
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA; (R.N.); (M.S.A.-D.); (R.D.B.); (D.T.)
| | - Sai H. S. Boddu
- College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates;
| | - Mariam Sami Abou-Dahech
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA; (R.N.); (M.S.A.-D.); (R.D.B.); (D.T.)
| | - Rinda Devi Bachu
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA; (R.N.); (M.S.A.-D.); (R.D.B.); (D.T.)
| | - David Terrero
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA; (R.N.); (M.S.A.-D.); (R.D.B.); (D.T.)
| | - R. Jayachandra Babu
- Department of Drug Discovery & Development, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA;
| | - Amit K. Tiwari
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43614, USA; (R.N.); (M.S.A.-D.); (R.D.B.); (D.T.)
- Department of Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43606, USA
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Bluethmann SM, Truica C, Klepin HD, Olsen N, Sciamanna C, Chinchilli VM, Schmitz KH. Study design and methods for the using exercise to relieve joint pain and improve AI adherence in older breast cancer survivors (REJOIN) trial. J Geriatr Oncol 2021; 12:1146-1153. [PMID: 34049837 DOI: 10.1016/j.jgo.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Aromatase Inhibitors (AIs) are recommended for survival in post-menopausal breast cancer survivors (BCS) with hormone-sensitive disease. AI Adherence is suboptimal, especially in older BCS. Joint pain is a common AI-related symptom that is associated with low AI adherence. The Using Exercise to Relieve Joint Pain in Older Breast Cancer Survivors (REJOIN) Trial will evaluate the efficacy of a self-management intervention (exercise + education) to increase knowledge/self-efficacy for symptom management, reduce joint pain and potentially increase AI adherence in older BCS planning to take AIs. METHODS This randomized controlled pilot trial will include sedentary BCS, 65 years and older, diagnosed with stage I-III hormone-sensitive breast cancer, who have completed primary cancer treatment and are planning to initiate AIs. We will adapt an evidence-based physical activity program for older adults that includes bi-weekly, supervised exercise sessions plus 30 min of education. The 16-week intervention program includes: 8-weeks of supervised sessions plus 8-weeks of self-guided home sessions with periodic phone coaching. We will conduct geriatric assessments plus measurements of exercise, joint pain, and AI adherence (baseline, 4, 6 and 12 months). DISCUSSION REJOIN is one of the first trials to exclusively target older BCS using a self-management intervention, informed by geriatric assessment and exercise physiology, to improve health outcomes in survivorship. The REJOIN trial could lay the foundation for transdisciplinary research that bridges the gap between clinical and public health perspectives in healthy aging, with the opportunity to translate clinical interventions into non-pharmacological tools for a growing, yet underserved population of older survivors. TRIAL REGISTRATION NCT03955627.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America; Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America.
| | - Cristina Truica
- Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America; Department of Medicine, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Heidi D Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Nancy Olsen
- Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America; Department of Medicine, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America; Department of Medicine, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Vernon M Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America; Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America; Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, PA, United States of America
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14
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Toivonen KI, Carlson LE, Rash JA, Campbell TS. A Survey of Potentially Modifiable Patient-Level Factors Associated with Self-Report and Objectively Measured Adherence to Adjuvant Endocrine Therapies After Breast Cancer. Patient Prefer Adherence 2021; 15:2039-2050. [PMID: 34552322 PMCID: PMC8450192 DOI: 10.2147/ppa.s319087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/21/2021] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Despite the efficacy of adjuvant endocrine therapy (AET) in reducing breast cancer recurrence and mortality, suboptimal AET adherence is common and hence an important clinical issue among breast cancer survivors. Delineating potentially modifiable patient-level factors associated with AET adherence may support the development of successful adherence-enhancing interventions. PATIENTS AND METHODS The present study included 133 breast cancer survivors prescribed AET recruited from a cancer pharmacy. Women completed a baseline questionnaire examining psychosocial factors and self-reported adherence and consented to their prescription records being monitored for the proceeding 12 months to ascertain proportion of days covered (PDC), an objective measure of adherence. Regression analyses were used to identify the factors most strongly associated with both self-reported and objective adherence. Exploratory moderation analyses examined whether factors were differentially associated with adherence based on AET type (aromatase inhibitors or tamoxifen). RESULTS Adherence was high in this sample (PDC over 12 months was 95%). Side effect severity was most strongly associated with self-reported adherence, followed by self-efficacy, and medication/healthcare system-related barriers. Medication/healthcare system-related barriers was the only factor that uniquely predicted objective adherence. Within medication/healthcare system-related barriers, fear of side effects was most strongly associated with both measures of adherence. There were no significant interactions between AET type and potentially modifiable factors in predicting self-reported or objective adherence. CONCLUSION Side effects, reactions to side effects, and self-efficacy may represent modifiable targets through which AET adherence can be improved. Associations between potentially modifiable factors and adherence did not vary by AET type, despite distinct side-effect profiles.
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Affiliation(s)
- Kirsti I Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Linda E Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Joshua A Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Correspondence: Tavis S Campbell Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, T2N 1N4, AB, CanadaTel +1 403-210-8606 Email
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15
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Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management. Front Endocrinol (Lausanne) 2021; 12:713700. [PMID: 34385978 PMCID: PMC8353230 DOI: 10.3389/fendo.2021.713700] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/31/2022] Open
Abstract
Aromatase inhibitors (AIs) are a key component in the chemoprevention and treatment of hormone receptor-positive (HR+) breast cancer. While the addition of AI therapy has improved cancer-related outcomes in the management of HR+ breast cancer, AIs are associated with musculoskeletal adverse effects known as the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) that limit its tolerability and use. AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence. The pathophysiology of AIMSS is not fully understood though has been proposed to be related to estrogen deprivation within the musculoskeletal and nervous systems. This review aims to characterize the prevalence, risk factors, and clinical features of AIMSS, and explore the syndrome's underlying mechanisms and management strategies.
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Affiliation(s)
- Tara Hyder
- University of Pittsburgh Physicians, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Marino
- Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Sasha Ahmad
- Department of Sciences, Sewickley Academy, Pittsburgh, PA, United States
| | - Azadeh Nasrazadani
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
| | - Adam M Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
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16
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Hale MJ, Howell A, Dowsett M, Cuzick J, Sestak I. Tamoxifen related side effects and their impact on breast cancer incidence: A retrospective analysis of the randomised IBIS-I trial. Breast 2020; 54:216-221. [PMID: 33160147 PMCID: PMC7649356 DOI: 10.1016/j.breast.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studies in the adjuvant setting have shown that endocrine therapy related side effects predict breast cancer recurrence risk. Here, we assess the relationship between early reported side effects and incidence of breast cancer in women randomised to tamoxifen for cancer prevention in the International Breast Intervention Study (IBIS)-I trial. METHODS Women randomised to tamoxifen in the IBIS-I trial and for whom side effect status was known at the 6-month follow-up visit were included in this analysis. Side effects included in this analysis were hot flushes, vaginal discharge, and vaginal dryness. The primary endpoint was all breast cancer and secondary endpoint was oestrogen receptor (ER) positive breast cancer. Cox proportional hazard models were used to investigate breast cancer incidence in the tamoxifen group with and without side effects reported within 6 months of randomisation. RESULTS Women randomised to tamoxifen and reporting hot flushes at the 6-month follow-up visit had a non-statistically significant increase in breast cancer compared to those without hot flushes (HR = 1.26 (0.98-1.62), P = 0.08). A significant higher breast cancer risk was observed for postmenopausal women who reported hot flushes at the 6-month follow-up visit compared to those without hot flushes (HR = 1.59 (1.12-2.26), P = 0.01). A higher risk was observed for ER-positive breast cancer in postmenopausal women (HR = 1.81 (1.19-2.74), P = 0.01). No significant associations between gynaecological side effects and breast cancer occurrence was observed. CONCLUSIONS Overall, no association between side effects reported at 6 months and subsequent breast cancer occurrence was observed. Some side effects might be useful markers for breast cancer occurrence in postmenopausal women.
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Affiliation(s)
- Michael J Hale
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Queen Mary University London, London, EC1M 6BQ, UK
| | - Anthony Howell
- Division of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, London, SW3 6JJ, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Queen Mary University London, London, EC1M 6BQ, UK
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Queen Mary University London, London, EC1M 6BQ, UK.
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Ho KG, Uhlmann EN, Wong ET, Uhlmann EJ. Leukopenia is a biomarker for effective temozolomide dosing and predicts overall survival of patients with glioblastoma. Mol Clin Oncol 2020; 13:80. [PMID: 33062270 PMCID: PMC7549395 DOI: 10.3892/mco.2020.2150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
The median survival time of patients with glioblastoma is 14-16 months with a 5-year overall survival rate of 9.8%. Standard of care treatment includes radiation with concomitant temozolomide followed by cyclic temozolomide. If the patient develops myelosuppression (thrombocytopenia, leukopenia or anemia), the dose of temozolomide is reduced or stopped to avoid bleeding or infections. Recent studies have demonstrated that mild leukopenia is associated with increased overall survival in patients with glioblastoma. To confirm prior results showing that leukopenia is associated with increased overall survival as a primary outcome in patients with glioblastoma, the present study retrospectively collected complete blood counts from 141 patients with glioblastoma treated at the Beth Israel Deaconess Medical Center (Boston, USA) between January 2012 and December 2017. According to Kaplan-Meier analysis with a log-rank test, the presence of leukopenia was associated with increased overall survival (P=0.008). Furthermore, patients with grade 2 leukopenia (Common Terminology Criteria for Adverse Events version 5.0) survived longer than those without myelosuppression (P=0.024). There was no difference in overall survival between patients with grade 1, 3 or 4 leukopenia and those without myelosuppression. Leukopenia was associated with longer survival independent of age or extent of surgery in Cox proportional hazards regression modeling (P=0.00205). A possible interpretation is that grade 2 leukopenia is a biomarker of adequate temozolomide dosing in a population with diverse DNA repair function, which may be the consequence of variable O6-methylguanine-DNA methyltransferase activity. A prospective dose escalation trial is necessary to determine if treatment-induced leukopenia is beneficial for all patients receiving temozolomide.
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Affiliation(s)
- K Grace Ho
- Department of Neurology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Erik N Uhlmann
- Khoury College of Computer Sciences, Northeastern University, Boston, MA 02115, USA
| | - Eric T Wong
- Department of Neurology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Erik J Uhlmann
- Department of Neurology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA 02215, USA
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18
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Wang C, Zhou Y, Huang W, Chen Z, Zhu H, Mao F, Lin Y, Zhang X, Shen S, Zhong Y, Huang X, Chen C, Sun Q. The impact of pre-existed and SERM-induced non-alcoholic fatty liver disease on breast cancer survival: a meta-analysis. J Cancer 2020; 11:4597-4604. [PMID: 32489477 PMCID: PMC7255364 DOI: 10.7150/jca.44872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is a common disorder and a frequent side effect of endocrine therapy (ET) for breast cancer treatment. This was the first meta-analysis to investigate the impact of NAFLD on breast cancer survival. Material and Methods: We searched Pubmed, Embase and Cochrane Central Register of Controlled Trials database for relevant studies that investigated the correlation between NAFLD and breast cancer survival. Fixed- and random-effect meta-analyses were conducted according to the heterogeneity of enrolled studies. Subgroup analyses were performed based on whether NAFLD was induced by ET administration Results: Eight cohorts from six studies including 3684 breast cancer patients were enrolled. NAFLD was significantly associated with advanced age (p < 0.001), obesity (p < 0.001), lymph node metastases (p = 0.003) and hormone receptor positivity (p < 0.001). NAFLD had no significant impact on disease free survival (DFS) [hazard ratio (HR) 1.07, 95% confidence interval (CI) = 0.64-1.77, p = 0.81] and overall survival (OS) (HR 1.29, 95% CI = 0.68-2.44, p = 0.44). In subgroup analyses, ET-associated NAFLD showed no significant impact on DFS and OS. Nonetheless, non-ET-associated NAFLD had a strong prognostic correlation with poor OS (HR 1.92, 95% CI = 1.09-3.41, p = 0.02). Conclusion: NAFLD had no significant impact on breast cancer survival. However, non-ET-associated NAFLD implied increasing death risk. Future large-scale studies are warranted to further elucidate the correlation between NAFLD and breast cancer prognosis.
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Affiliation(s)
- Changjun Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Wei Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ziyuan Chen
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Hanjiang Zhu
- Department of Dermatology, 90 Medical Center Way, Surge 110, University of California, San Francisco, CA 94143-0989, United States
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ying Zhong
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xin Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Chang Chen
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
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Abstract
OBJECTIVE Vasomotor symptoms (VMS) including hot flashes and night sweats are common during the menopausal transition and may persist. Although VMS pathophysiology is complex, estrogen's efficiency as VMS therapy suggests hormonal environment change may influence this process. As studies of VMS and breast cancer are inconsistent, we examined associations between persistent VMS and breast cancer incidence and mortality. METHODS The analytic sample included 25,499 postmenopausal women aged 50 to 79 in the Women's Health Initiative (WHI) without current/former menopausal hormone therapy use with information on VMS status (never vs persistent). Breast cancers were verified by medical record review. Cause of death attribution was enhanced by serial National Death Index queries. Associations between VMS status and breast cancer incidence and mortality was determined using time dependent Cox regression analyses adjusted for breast cancer risk factors. RESULTS Through 17.9 years (median) follow-up, 1,399 incident breast cancers were seen. Women with persistent VMS (VMS median duration 10+ years) (n = 9,715), compared to women with never VMS (n = 15,784), had a higher breast cancer incidence (hazard ratio [HR] 1.13 95% confidence interval [CI] 1.02-1.27). While breast cancer-specific mortality was higher in women with persistent VMS (HR 1.33 95% CI 0.88-2.02), the difference was not statistically significant. Persistent VMS status had no influence on breast cancer overall survival (HR 1.02 95% CI 0.81-1.29). CONCLUSION Women with persistent VMS are more likely to be diagnosed with breast cancer than women who never experienced VMS, but not more likely to die from breast cancer.
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20
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Lee SW, Lee TY, Yang SS, Tong CF, Yeh HZ, Chang CS. Sorafenib-Related Adverse Events in Predicting the Early Radiologic Responses of Hepatocellular Carcinoma. Gastroenterology Res 2019; 12:16-20. [PMID: 30834030 PMCID: PMC6396795 DOI: 10.14740/gr1109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) has a poor prognosis with low chemotherapeutic efficiency to medications except to sorafenib. Previous studies showed that adverse events (AEs) of sorafenib can predict therapy efficacy to HCC. The aim of the study is to evaluate the early efficacy and AEs of sorafenib therapy. Methods The database of HCC patients receiving sorafenib at Taichung Veterans General Hospital during the period from June 2012 to October 2016 was analyzed. All HCC cases were Barcelona Clinic Liver Cancer (BCLC) classification stage C. The early efficacy of sorafenib was classified according to the mRECIST criteria as either partial response (PR), stable disease (SD) or progressive disease (PD). Responses were recorded within 6 weeks after the start of sorafenib treatment. AEs were defined as the appearance of hand-foot skin reaction (HFSR), hypertension (HTN) and diarrhea. Exclusion criteria were poor performance status, poor drug compliance, discontinued follow-up or mortality occurring within 1 day after medication. Results From a total of 222 subjects, eight cases (3.6%) were classified as PR, 82 cases (36.9%) SD, and 132 cases (59.5%) PD. The PR group had the highest ratio of HFSR (62.4%) and hypertension (37.5%). Pooling cases of PR and SD together, the presence of HFSR adjusted odd ratio (aOR) 2.80, 95% confidence interval (CI) 1.52 - 5.16) and diarrhea (aOR 3.42, 95% CI 1.67 - 7.01) were good predictors of favorable responses to sorafenib therapy. Conclusions HFSR and diarrhea are good predictors of early therapy efficacy to the sorafenib treatment.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan
| | - Chun-Fang Tong
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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21
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Ishiguro H, Ohno S, Yamamoto Y, Takao S, Sato N, Fujisawa T, Kadoya T, Kuroi K, Bando H, Teramura Y, Iwata H, Tanaka S, Toi M. Pharmacogenomic-pharmacokinetic study of selective estrogen-receptor modulators with intra-patient dose escalation in breast cancer. Breast Cancer 2019; 26:535-543. [PMID: 30734152 PMCID: PMC6694038 DOI: 10.1007/s12282-019-00952-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/03/2019] [Indexed: 10/30/2022]
Abstract
BACKGROUND An association between CYP2D6 polymorphisms and tamoxifen (TAM) efficacy has not been confirmed, partly due to unreliable prediction of active metabolite exposure solely by CYP2D6 activity. The efficacy of TAM dose escalation appears limited in poor TAM metabolizers. Since the chlorine atom on the side chain of toremifene (TOR) prevents 4-hydroxylation by CYP2D6, its contribution to active conversion of TOR is minor. We examined the role of TOR and its dose escalation among poor TAM metabolizers. METHODS The pharmacokinetics (PK) and pharmacogenomics (PGx) of TAM and TOR were studied. Correlation between PK and CYP2D6 inhibitor use, smoking status, and PGx were examined by regression analysis. For patients showing low endoxifen levels, an intra-patient dose escalation of TOR was conducted, and TOR was increased from 40 to 120 mg for ≥ 24 weeks with PK sampling. Total activity was calculated as the sum of the concentration of each active metabolite adjusted by their respective in vitro activities. RESULTS Fifty and 11 of the 273 participating patients had endoxifen levels < 15 and < 7.5 ng/mL, respectively. The CYP2D6 genotype was the major determinant for TAM activity (p < 0.01). Smoking status (p = 0.07) and the CYP2C19 phenotype (p = 0.07), but not the CYP2D6 genotype (p = 0.61), showed marginally significant effects on TOR activity. TOR activity increased significantly with dose escalation, even among poor TAM metabolizers, and was maintained for ≥ 24 weeks. CONCLUSION TOR might be a valid alternative to TAM in patients predicted to be poor TAM metabolizers.
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Affiliation(s)
- Hiroshi Ishiguro
- Department of Medical Oncology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan. .,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan.
| | - Shinji Ohno
- Center of Breast Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Yutaka Yamamoto
- Department of Molecular-Targeting Therapy for Breast Cancer, Kumamoto University Hospital, Kumamoto, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Shintaro Takao
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Nobuaki Sato
- Department of Breast Surgery, Niigata Cancer Center Hospital, Niigata, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Tomomi Fujisawa
- Department of Breast Oncology, Gunma Prefectural Cancer Center, Ohta, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Katsumasa Kuroi
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Hiroko Bando
- Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Yasufumi Teramura
- Department of Surgery, Hikone Municipal Hospital, Hikone, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan.,Japan Breast Cancer Research Group (JBCRG), Tokyo, Japan
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22
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Hamadeh IS, Patel JN, Rusin S, Tan AR. Personalizing aromatase inhibitor therapy in patients with breast cancer. Cancer Treat Rev 2018; 70:47-55. [PMID: 30086432 DOI: 10.1016/j.ctrv.2018.07.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Aromatase inhibitors are the mainstay of therapy for patients with hormone receptor-positive breast cancer in both adjuvant and metastatic settings. Their use in clinical practice has been challenged by significant inter-individual variability in response and tolerability. Hence, the purpose of this paper is to provide a succinct review of the literature on the genetic factors contributing to this variability. DESIGN A systematic search in PUBMED was conducted to identify studies that investigated the association between germline polymorphisms and disposition, clinical response and toxicities of aromatase inhibitors, as well as those evaluating the implications of mutations in ESR1 on clinical response. RESULTS Polymorphisms in genes coding for phase I and phase II enzymes (pharmacokinetic genes) significantly modulated exposure to aromatase inhibitors; however, there is a paucity of data linking interindividual variability in drug exposure to clinical response. Furthermore, pharmacogenetic studies interrogating relationship between polymorphisms in CYP19A1 (the target site of aromatase inhibitors, i.e. a pharmacodynamic gene) and response yielded conflicting results. Acquired mutations in ESR1 receptors have been identified as the underlying mechanism of resistance to aromatase inhibitors, and likely predict drug response. Although some pharmacogenetic studies have implicated polymorphisms in CYP19A1 and ESR1 with drug-related side effects, the putative role of these genes in predicting toxicity warrants further validation. CONCLUSION Genetic polymorphisms in pharmacokinetic and pharmacodynamic genes appear to influence aromatase inhibitor disposition, response and/or toxicity; however, prospective interventional studies are needed to understand the application of genomics to personalize aromatase inhibitor therapy in breast cancer patients.
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Affiliation(s)
- Issam S Hamadeh
- Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States.
| | - Jai N Patel
- Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Stephanie Rusin
- Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Antoinette R Tan
- Department of Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
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23
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Bluethmann SM, Murphy CC, Tiro JA, Mollica MA, Vernon SW, Bartholomew LK. Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study. Oncol Nurs Forum 2018. [PMID: 28635973 DOI: 10.1188/17.onf.e101-e110] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE/OBJECTIVES Adjuvant endocrine therapy (AET) has been shown to improve survival in hormone receptor-positive breast cancer survivors, but as many as half do not complete recommended treatment. Management of medication-related side effects and engagement with providers are two potentially modifiable factors, but their associations with adherence are not well understood. The aims were to build on survey results to qualitatively explore survivors' experiences with prescribed AET to (a) describe appraisal and management of AET side effects and (b) deconstruct decisions to initiate, discontinue, or maintain AET.
. RESEARCH APPROACH The authors used a mixed-methods explanatory sequence research design with a qualitative emphasis.
. SETTING Survivors were recruited from a clinical cancer registry maintained at the University of Texas Southwestern Medical Center, which includes the Harold C. Simmons Comprehensive Cancer Center (National Cancer Institute-designated), in Dallas.
. PARTICIPANTS 452 survivors completed a survey, and 30 took part in telephone interviews.
. METHODOLOGIC APPROACH Qualitative methods were used in which the authors recorded and transcribed interviews for analysis and used open coding to reduce data into themes.
. FINDINGS Among adherent survivors, the themes of tolerance of side effects and perseverance were strong. Nonadherent survivors expressed more difficulty managing side effects and perceived fewer benefits when side effects were bothersome. The most common side effects mentioned by all survivors were menopausal symptoms and joint pain; less common side effects were cognitive decline and cardiac distress. Some sought advice from their oncology team. Nonadherent survivors appeared initially motivated to maintain AET but identified a tolerance limit for side effects after which a provider's recommendation was less influential in their decision to maintain or discontinue AET.
. INTERPRETATION This study elucidated adherence as a complex continuum of behaviors, appraisals, and decision points. These insights may be particularly useful in counseling survivors taking AET and promoting timely delivery of clinical interventions to enhance adherence.
. IMPLICATIONS FOR NURSING Nurses should be involved in the planning and implementation of clinical interventions to manage side effects and other barriers to AET adherence.
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24
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Nabieva N, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Popovic M, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Hack CC, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of side-effects on early therapy persistence with letrozole in post-menopausal patients with early breast cancer: Results of the prospective EvAluate-TM study. Eur J Cancer 2018; 96:82-90. [PMID: 29679775 DOI: 10.1016/j.ejca.2018.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endocrine treatment (ET) with an aromatase inhibitor (AI) is the treatment of choice in post-menopausal patients with hormone receptor-positive early breast cancer (EBC). However, adverse events (AEs) often lead to treatment discontinuation. This analysis aimed to identify side-effects that lead to patients failing to persist with letrozole treatment. PATIENTS AND METHODS Post-menopausal hormone receptor-positive EBC patients starting ET with letrozole were enroled in EvAluate-TM, a non-interventional study. Information regarding treatment compliance and persistence was gathered in months 6 and 12. Persistence was defined as the time from 30 d after the start to the end of treatment. The influence on persistence of musculoskeletal syndrome, menopausal disorder, sleep disorder and other AEs within the first 30 d was analysed using Cox regression analyses. RESULTS Among 3887 patients analysed, the persistence rate after 12 months was >85%. In all, 568 patients (14.6%) discontinued the treatment, 358 of whom (63.0%) did so only because of side-effects. The main AEs influencing persistence were musculoskeletal symptoms (hazard ratio [HR] 2.55; 95% confidence interval [CI], 1.90-3.42), sleep disorders (HR 1.95; 95% CI, 1.41-2.70) and other AEs (HR 2.03; 95% CI, 1.51-2.73). Menopausal disorder was not associated with non-persistence (HR 1.17; 95% CI, 0.74-1.84). CONCLUSIONS These results suggest that side-effects of AIs such as musculoskeletal syndrome and sleep disorder lead to ET discontinuation within the first treatment year in significant numbers of EBC patients. Compliance programmes adapted for subgroups that are at risk for early non-persistence might help to ensure the recommended therapy duration. CLINICAL TRIALS NUMBER CFEM345DDE19.
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Affiliation(s)
- N Nabieva
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; Breast Center, Clinics of Cologne GmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - M Popovic
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- Johanniter Hospital Genthin Stendal gGmbH, Hansestadt Stendal, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Passau, Passau, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital Kiel GmbH, Kiel, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C C Hack
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
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25
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Yoo TK, Jang MJ, Lee E, Moon HG, Noh DY, Han W. Endocrine Treatment-Related Symptoms and Patient Outcomes in Breast Cancer: A Meta-Analysis. J Breast Cancer 2018; 21:37-44. [PMID: 29628982 PMCID: PMC5880964 DOI: 10.4048/jbc.2018.21.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose An association between endocrine treatment-related symptoms and breast cancer recurrence has been suggested previously; however, conflicting results have been reported. We performed a meta-analysis of published studies to clarify this relationship. Methods We systematically searched PubMed, Embase, Scopus, and the Cochrane database for studies investigating the association between endocrine treatment-related symptoms and patient survival. Random-effects meta-analysis was conducted with recurrence rate as the primary outcome. Results Out of 7,713 retrieved articles, six studies were included. In patients who received endocrine treatment, the presence of any endocrine treatment-related symptom was found to be associated with a lower recurrence rate in comparison to an absence of any symptoms (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.66-0.87). This relationship persisted in patients presenting with only vasomotor or only musculoskeletal symptoms (HR, 0.74, 95% CI, 0.63-0.87; HR, 0.69, 95% CI, 0.55-0.86, respectively). At both time-points of symptom evaluation (3 months and 12 months), patients with endocrine treatment-related symptoms had a lower recurrence rate (HR, 0.74, 95% CI, 0.66-0.84; HR, 0.79, 95% CI, 0.69-0.90, respectively). This association was also significant in pooled studies including patients with and without baseline symptoms (HR, 0.73, 95% CI, 0.54-0.99; HR, 0.76, 95% CI, 0.69-0.85, respectively). Conclusion Endocrine treatment-related symptoms are significantly predictive of lower recurrence rate in breast cancer patients, regardless of the type of symptoms, time-point of evaluation, or inclusion of baseline symptoms. These symptoms could be biomarkers for the prediction of long-term responses to endocrine treatment in patients with breast cancer.
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Affiliation(s)
- Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Eunshin Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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26
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Kus T, Aktas G, Ekici H, Elboga G. Comparison of distress in breast cancer survivors treated with different adjuvant endocrine therapies: a single-centre cross-sectional study. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1342316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Tulay Kus
- Department of Internal Medicine, Division of Medical Oncology, University of Adıyaman, Training and Research Hospital, Adıyaman, Turkey
| | - Gokmen Aktas
- Department of Internal Medicine, Division of Medical Oncology, School of Medicine, Gaziantep Oncology Hospital, University of Gaziantep, Gaziantep, Turkey
| | - Hatice Ekici
- Department of Psychological Counseling and Guidance, Near East University, Lefkosa, Cyprus
| | - Gulcin Elboga
- Department of Psychiatry, Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
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27
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Stapled BIG3 helical peptide ERAP potentiates anti-tumour activity for breast cancer therapeutics. Sci Rep 2017; 7:1821. [PMID: 28500289 PMCID: PMC5431889 DOI: 10.1038/s41598-017-01951-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/05/2017] [Indexed: 12/02/2022] Open
Abstract
Estradiol (E2) and the oestrogen receptor-alpha (ERα) signalling pathway play pivotal roles in the proliferative activity of breast cancer cells. Recent findings show that the brefeldin A-inhibited guanine nucleotide-exchange protein 3-prohibitin 2 (BIG3-PHB2) complex plays a crucial role in E2/ERα signalling modulation in breast cancer cells. Moreover, specific inhibition of the BIG3-PHB2 interaction using the ERα activity-regulator synthetic peptide (ERAP: 165–177 amino acids), derived from α-helical BIG3 sequence, resulted in a significant anti-tumour effect. However, the duration of this effect was very short for viable clinical application. We developed the chemically modified ERAP using stapling methods (stapledERAP) to improve the duration of its antitumour effects. The stapledERAP specifically inhibited the BIG3-PHB2 interaction and exhibited long-lasting suppressive activity. Its intracellular localization without the membrane-permeable polyarginine sequence was possible via the formation of a stable α-helix structure by stapling. Tumour bearing-mice treated daily or weekly with stapledERAP effectively prevented the BIG3-PHB2 interaction, leading to complete regression of E2-dependent tumours in vivo. Most importantly, combination of stapledERAP with tamoxifen, fulvestrant, and everolimus caused synergistic inhibitory effects on growth of breast cancer cells. Our findings suggested that the stapled ERAP may be a promising anti-tumour drug to suppress luminal-type breast cancer growth.
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28
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Hertz DL, Henry NL, Rae JM. Germline genetic predictors of aromatase inhibitor concentrations, estrogen suppression and drug efficacy and toxicity in breast cancer patients. Pharmacogenomics 2017; 18:481-499. [PMID: 28346074 PMCID: PMC6219438 DOI: 10.2217/pgs-2016-0205] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 02/07/2023] Open
Abstract
The third-generation aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, are highly effective for the treatment of estrogen receptor-positive breast cancer in postmenopausal women. AIs inhibit the aromatase (CYP19A1)-mediated production of estrogens. Most patients taking AIs achieve undetectable blood estrogen concentrations resulting in drug efficacy with tolerable side effects. However, some patients have suboptimal outcomes, which may be due, in part, to inherited germline genetic variants. This review summarizes published germline genetic associations with AI treatment outcomes including systemic AI concentrations, estrogenic response to AIs, AI treatment efficacy and AI treatment toxicities. Significant associations are highlighted with commentary about prioritization for future validation to identify pharmacogenetic predictors of AI treatment outcomes that can be used to inform personalized treatment decisions in patients with estrogen receptor-positive breast cancer.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, USA
| | - N Lynn Henry
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84103, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-1065, USA
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29
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Fontein DBY, Charehbili A, Nortier JWR, Putter H, Kranenbarg EMK, Kroep JR, Linn SC, van de Velde CJH. Specific adverse events are associated with response to exemestane therapy in postmenopausal breast cancer patients: Results from the TEAMIIA study (BOOG2006-04). Eur J Surg Oncol 2016; 43:619-624. [PMID: 28017458 DOI: 10.1016/j.ejso.2016.07.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/26/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE In the adjuvant setting, specific adverse events (AEs) such as vasomotor symptoms (VMS) and musculoskeletal AEs are associated with relapse-free survival in aromatase inhibitor (AI)-treated patients. In the neoadjuvant setting, specific AEs may be associated with tumor response to AIs as well. METHODS Between 2007 and 2012, 107 patients participated in the prospective TEAMIIA trial, a prospective, phase II trial investigating 6 months of neoadjuvant exemestane in patients with strongly ER-positive breast cancer. Radiological response (≥30% decrease in tumor size) was studied in relation to VMSs and MSAEs. Pearson's Chi-Square tests and multivariate logistic regression analyses were used to evaluate of statistical significance (p < 0.05). RESULTS Out of 102 patients 26 patients (25.4%) experienced at least one episode of VMS and 27 patients (26.4%) experienced MSAE. Out of 240 reported adverse events, 71 were specific AEs (40 MSAEs, 31 VMSs). Radiological response was greater in patients who reported VMSs compared to patients who did not (70.8% vs. 49.3%, multivariate OR 2.91, 95% C.I. 1.03-8.26, P = 0.045). No significant advantage towards better response was observed in patients who experienced MSAEs (60.0% vs. 53.3%, univariate OR 1.33, 95% C.I. 0.53-3.38, P = 0.545). CONCLUSION VMSs are associated with tumor response to neoadjuvant exemestane and may be useful for predicting treatment outcomes of AI treatment at an early stage in patients treated with neoadjuvant AIs.
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MESH Headings
- Aged
- Aged, 80 and over
- Androstadienes/adverse effects
- Aromatase Inhibitors/adverse effects
- Arthralgia/chemically induced
- Arthritis/chemically induced
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/metabolism
- Disease-Free Survival
- Female
- Hot Flashes/chemically induced
- Humans
- Joint Diseases/chemically induced
- Logistic Models
- Magnetic Resonance Imaging
- Mammography
- Mastectomy
- Middle Aged
- Multivariate Analysis
- Musculoskeletal Diseases/chemically induced
- Myalgia/chemically induced
- Neoadjuvant Therapy
- Odds Ratio
- Osteoporosis/chemically induced
- Postmenopause
- Prognosis
- Receptors, Estrogen/metabolism
- Treatment Outcome
- Ultrasonography, Mammary
- Vasomotor System
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Affiliation(s)
- D B Y Fontein
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A Charehbili
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
| | - J W R Nortier
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - S C Linn
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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30
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Johansson H, Gray KP, Pagani O, Regan MM, Viale G, Aristarco V, Macis D, Puccio A, Roux S, Maibach R, Colleoni M, Rabaglio M, Price KN, Coates AS, Gelber RD, Goldhirsch A, Kammler R, Bonanni B, Walley BA. Impact of CYP19A1 and ESR1 variants on early-onset side effects during combined endocrine therapy in the TEXT trial. Breast Cancer Res 2016; 18:110. [PMID: 27825388 PMCID: PMC5101790 DOI: 10.1186/s13058-016-0771-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/17/2016] [Indexed: 01/21/2023] Open
Abstract
Background Single nucleotide polymorphisms (SNPs) in the estrogen receptor 1 (ESR1) and cytochrome P450 19A1 (CYP19A1) genes have been associated with breast cancer risk, endocrine therapy response and side effects, mainly in postmenopausal women with early breast cancer. This analysis aimed to assess the association of selected germline CYP19A1 and ESR1 SNPs with early-onset hot flashes, sweating and musculoskeletal symptoms in premenopausal patients enrolled in the Tamoxifen and Exemestane Trial (TEXT). Methods Blood was collected from consenting premenopausal women with hormone-responsive early breast cancer, randomly assigned to 5-years of tamoxifen plus ovarian suppression (OFS) or exemestane plus OFS. DNA was extracted with QIAamp kits and genotyped for two CYP19A1 (rs4646 and rs10046) and three ESR1 (rs2077647, rs2234693 and rs9340799) SNPs by a real-time pyrosequencing technique. Adverse events (AEs) were recorded at baseline and 3-monthly during the first year. Associations of the genotype variants with grade ≥2 early-onset targeted AEs of hot flashes/sweating or musculoskeletal events were assessed using logistic regression models. Results There were 2660 premenopausal patients with breast cancer in the intention-to-treat population of TEXT, and 1967 (74 %) are included in this translational study. The CYP19A1 rs10046 variant T/T, represented in 23 % of women, was associated with a reduced incidence of grade ≥2 hot flashes/sweating (univariate odds ratio (OR) = 0.78; 95 % CI 0.63–0.97; P = 0.03), more strongly in patients assigned exemestane + OFS (TT vs CT/CC: OR = 0.65, 95 % CI = 0.48–0.89) than assigned tamoxifen + OFS (OR = 0.94, 95 % CI = 0.69–1.27, interaction P = 0.03). No association with any of the CYP19A1/ESR1 genotypes and musculoskeletal AEs was found. Conclusion The CYP19A1 rs10046 variant T/T favors lower incidence of hot flashes/sweating under exemestane + OFS treatment, suggesting endocrine-mediated effects. Based on findings from others, this SNP may potentially enhance treatment adherence and treatment efficacy. We plan to evaluate the clinical impact of this polymorphism during time, pending sufficient median follow up. Trial registration ClinicalTrials.gov NCT00066703, registered August 6, 2003.
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Affiliation(s)
- Harriet Johansson
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy.
| | - Kathryn P Gray
- International Breast Cancer Study Group (IBCSG) Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard T. H. Chan School of Public Health, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Olivia Pagani
- Institute of Oncology of Southern Switzerland (IOSI), Bellinzona, Switzerland.,International Breast Cancer Study Group, Bern, Switzerland.,Swiss Group for Clinical Cancer Research SAKK, Lugano Viganello, Switzerland
| | - Meredith M Regan
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Giuseppe Viale
- Department of Pathology and Laboratory Medicine, IBCSG Central Pathology Laboratory, European Institute of Oncology, and University of Milan, Via Ripamonti 435, Milan, 20141, Italy
| | - Valentina Aristarco
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy
| | - Debora Macis
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy
| | - Antonella Puccio
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy
| | - Susanne Roux
- International Breast Cancer Study Group (IBCSG) Coordinating Center, Effingerstrasse 40, Bern, CH-3008, Switzerland
| | - Rudolf Maibach
- International Breast Cancer Study Group (IBCSG) Coordinating Center, Effingerstrasse 40, Bern, CH-3008, Switzerland
| | - Marco Colleoni
- Division of Medical Senology, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy
| | - Manuela Rabaglio
- IBCSG Statistical Center, Frontier Science and Technology Research Foundation, Boston, MA, USA
| | - Karen N Price
- IBCSG Statistical Center, Frontier Science and Technology Research Foundation, Boston, MA, USA.,Dana-Farber Cancer Institute, Department of Biostatistics and Computatonal Biology, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Alan S Coates
- International Breast Cancer Study Group and University of Sydney School of Public Health, Sydney, Australia
| | - Richard D Gelber
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Harvard Medical School, Frontier Science and Technology Research Foundation, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Aron Goldhirsch
- Program for Breast Health, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy
| | - Roswitha Kammler
- Translational Research Coordination and Central Pathology Office, IBCSG Coordinating Center, Effingerstrasse 40, Bern, CH-3008, Switzerland
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy
| | - Barbara A Walley
- Breast Unit of Southern Switzerland, Bellinzona, Switzerland.,National Cancer Institute of Canada, Kingston, ON, Canada
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Aromatase inhibitor-induced carpal tunnel syndrome: prevalence in daily practice. Cancer Chemother Pharmacol 2016; 78:1311-1315. [DOI: 10.1007/s00280-016-3190-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
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Nestoriuc Y, von Blanckenburg P, Schuricht F, Barsky A, Hadji P, Albert US, Rief W. Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a 2-year prospective clinical cohort study. Ann Oncol 2016; 27:1909-15. [DOI: 10.1093/annonc/mdw266] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/25/2016] [Indexed: 12/11/2022] Open
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Zeidan B, Anderson K, Peiris L, Rainsbury D, Laws S. The impact of tamoxifen brand switch on side effects and patient compliance in hormone receptor positive breast cancer patients. Breast 2016; 29:62-7. [DOI: 10.1016/j.breast.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 11/16/2022] Open
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Zheng Q, Xia W, Lu Q, Hong R, Qin G, Xu F, Qin T, Shi Y, Yuan Z, Wang S. Prognostic value of endocrine treatment-related symptoms in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat 2016; 160:197-209. [DOI: 10.1007/s10549-016-3995-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/20/2016] [Indexed: 01/23/2023]
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Putter H, van Houwelingen HC. Understanding Landmarking and Its Relation with Time-Dependent Cox Regression. STATISTICS IN BIOSCIENCES 2016; 9:489-503. [PMID: 29225713 PMCID: PMC5711994 DOI: 10.1007/s12561-016-9157-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/11/2016] [Accepted: 06/26/2016] [Indexed: 11/24/2022]
Abstract
Time-dependent Cox regression and landmarking are the two most commonly used approaches for the analysis of time-dependent covariates in time-to-event data. The estimated effect of the time-dependent covariate in a landmarking analysis is based on the value of the time-dependent covariate at the landmark time point, after which the time-dependent covariate may change value. In this note we derive expressions for the (time-varying) regression coefficient of the time-dependent covariate in the landmark analysis, in terms of the regression coefficient and baseline hazard of the time-dependent Cox regression. These relations are illustrated using simulation studies and using the Stanford heart transplant data.
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Affiliation(s)
- Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, PO Box 9600, 2300 Leiden, RC The Netherlands
| | - Hans C van Houwelingen
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, PO Box 9600, 2300 Leiden, RC The Netherlands
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36
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Liedke PER, Tu D, Shepherd L, Chavarri-Guerra Y, Pritchard KI, Stearns V, Goss PE. New onset vasomotor symptoms but not musculoskeletal symptoms associate with clinical outcomes on extended adjuvant letrozole - Analyses from NCIC CTG MA.17. Breast 2016; 27:99-104. [PMID: 27058233 DOI: 10.1016/j.breast.2016.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/14/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE New onset symptoms on adjuvant aromatase inhibitors for hormone receptor positive early breast cancer may associate with clinical outcomes. We performed this exploratory analysis of the association of new onset musculoskeletal (MSK) and vasomotor (VM) symptoms with clinical outcomes in the NCIC CTG MA.17 trial 5 years of extended adjuvant endocrine therapy with letrozole after tamoxifen. METHODS Symptoms were collected at baseline, 1, 6, and every 12 months on study. Multivariate Cox Models adjusting for age, nodal status, duration of tamoxifen and prior chemotherapy were used to compare disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) based on data collected before, and after, the unblinding between women with VM or MSK symptoms and those without. RESULTS Data post-unblinding showed new VM symptoms on extended letrozole significantly improved DFS and DDFS when occurring 1 month (DFS HR 0.52, 95% CI, 0.28-0.96; p = 0.04; DDFS HR 0.49, 95% CI, 0.24-0.99; p = 0.046) and 6 months (DFS HR 0.43, 95% CI, 0.24-0.78; p = 0.006; DDFS HR 0.44, 95% CI, 0.22-0.85; p = 0.02) after treatment initiation. Those with new VM symptoms at 12 months also had a significantly better DFS (HR 0.47, 95% CI 0.26, 0.84; P = 0.01) and a trend in improved DDFS. Only a trend to improved OS was found for those with VM symptoms 6 month after treatment. No significant improvement was found for those with new MSK symptoms at any time point or for any endpoint. CONCLUSIONS New onset VM symptoms with extended letrozole may be useful in predicting treatment benefit.
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Affiliation(s)
- P E R Liedke
- Department of Clinical Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Mãe de Deus Cancer Institute, Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Brazilian Breast Cancer Study Group, Porto Alegre, RS, Brazil; Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program, Boston, MA, USA
| | - D Tu
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada
| | - L Shepherd
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada
| | - Y Chavarri-Guerra
- Department of Hematology-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico; Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program, Boston, MA, USA
| | - K I Pritchard
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada; Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - V Stearns
- Kimmel Cancer Center at Johns Hopkins, Breast Cancer Program, Baltimore, MD, USA
| | - P E Goss
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada; Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program, Boston, MA, USA
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Granito A, Marinelli S, Negrini G, Menetti S, Benevento F, Bolondi L. Prognostic significance of adverse events in patients with hepatocellular carcinoma treated with sorafenib. Therap Adv Gastroenterol 2016; 9:240-9. [PMID: 26929785 PMCID: PMC4749854 DOI: 10.1177/1756283x15618129] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Sorafenib is the standard treatment for patients with hepatocellular carcinoma (HCC) with advanced stage disease. Although its effectiveness has been demonstrated by randomized clinical trials and confirmed by field practice studies, reliable markers predicting therapeutic response have not yet been identified. Like other tyrosine kinase inhibitors, treatment with sorafenib is burdened by the development of adverse effects, the most frequent being cutaneous toxicity, diarrhoea, arterial hypertension and fatigue. In recent years, several studies have analysed the correlation between off-target effects and sorafenib efficacy in patients with HCC. In this review, an overview of the studies assessing the prognostic significance of sorafenib-related adverse events is provided.
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Affiliation(s)
| | - Sara Marinelli
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giulia Negrini
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Saverio Menetti
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Benevento
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Bolondi
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Lombard JM, Zdenkowski N, Wells K, Beckmore C, Reaby L, Forbes JF, Chirgwin J. Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options. Support Care Cancer 2015; 24:2139-2146. [PMID: 26556210 DOI: 10.1007/s00520-015-3001-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management. METHODS A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used. RESULTS Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82 %) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68 % discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20 % of respondents found no intervention effective in any category. CONCLUSION We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.
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Affiliation(s)
- Janine M Lombard
- Calvary Mater Newcastle, Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia. .,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.
| | - Nicholas Zdenkowski
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Kathy Wells
- Breast Cancer Network Australia, Newcastle, Vic, Australia
| | - Corinna Beckmore
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Linda Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - John F Forbes
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Jacquie Chirgwin
- University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.,Monash University, Newcastle, Vic, Australia
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Zheng Q, Xu F, Nie M, Xia W, Qin T, Qin G, An X, Xue C, Peng R, Yuan Z, Shi Y, Wang S. Selective Estrogen Receptor Modulator-Associated Nonalcoholic Fatty Liver Disease Improved Survival in Patients With Breast Cancer: A Retrospective Cohort Analysis. Medicine (Baltimore) 2015; 94:e1718. [PMID: 26448028 PMCID: PMC4616748 DOI: 10.1097/md.0000000000001718] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Selective estrogen receptor modulator (SERM)-associated nonalcoholic fatty liver disease (NAFLD) might be related to treatment efficacy in patients with breast cancer because of circulating estrogen antagonism. The aim of the study was to investigate the relationship between NAFLD and survival outcomes in patients with breast cancer who were treated with tamoxifen or toremifene. This single-center, retrospective, cohort study included 785 eligible patients who received tamoxifen or toremifene, after curative resection for breast cancer, at the Sun Yat-sen University Cancer Center between January 2005 and December 2009. Data were extracted from patient medical records. All patients underwent abdominal ultrasonography, at least once, at baseline and at the annual follow-up. Patients who were diagnosed with NAFLD on ultrasonography were classified into the NAFLD or the non-NAFLD arm at the 3-year follow-up visit. Univariate and multivariate Cox regression analyses were conducted to evaluate any associations between NAFLD and disease-free survival (DFS) or overall survival (OS). One hundred fifty-eight patients were diagnosed with NAFLD. Patients who developed NAFLD had better DFS and OS compared with those who did not. Univariate analyses revealed that the 5-year DFS rates were 91.56% and 85.01% for the NAFLD and non-NAFLD arms, respectively (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.37-0.96; log-rank P = 0.032). The 5-year OS rates were 96.64% and 93.31% for the NAFLD and non-NAFLD arms, respectively (HR, 0.39; 95% CI, 0.16-0.99; log-rank P = 0.039). Multivariate analysis revealed that NAFLD was an independent prognostic factor for DFS, improving the DFS rate by 41% compared with that in the non-NAFLD arm (HR, 0.59; 95% CI, 0.36-0.96; P = 0.033). SERM-associated NAFLD was independently associated with improved DFS and might be useful for predicting treatment responses in breast cancer patients treated with SERMs.
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Affiliation(s)
- Qiufan Zheng
- From the Department of Medical Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, PR China
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van Londen GJ, Donovan HS, Beckjord EB, Cardy AL, Bovbjerg DH, Davidson NE, Morse JQ, Switzer GE, Verdonck-de Leeuw IM, Dew MA. Perspectives of postmenopausal breast cancer survivors on adjuvant endocrine therapy-related symptoms. Oncol Nurs Forum 2015; 41:660-8. [PMID: 25355021 DOI: 10.1188/14.onf.660-668] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE/OBJECTIVES To conduct an investigation of women's experiences related to adjuvant endocrine therapy (AET) and managing AET-related symptoms. RESEARCH APPROACH Qualitative, focus group design. SETTING Main campus of the University of Pittsburgh in Pennsylvania. PARTICIPANTS 14 breast cancer survivors, aged 50 years or older, with AET-related symptoms. METHODOLOGIC APPROACH Semistructured discussion guides were used to elicit recollections of conversations with healthcare providers about starting AET, symptom experiences, symptom management, and suggestions for improving management. Audiotaped discussions were transcribed and analyzed to identify themes. FINDINGS Women reported that, initially, AET was not viewed as a choice, but rather as the necessary next step to save their lives. After starting AET, women experienced difficulties making sense of, communicating about, and managing unanticipated AET-related symptoms. Women who experienced persistently bothersome symptoms began weighing the pros and cons of AET to decide whether to continue treatment. CONCLUSIONS Focus group findings suggest multiple opportunities to better prepare patients for AET and to improve assessment and management of AET-related symptoms. INTERPRETATION By exploring AET-related symptom experiences, nurses may be able to promote AET adherence in breast cancer survivors.
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Affiliation(s)
- G J van Londen
- Division of Hematology-Oncology and Geriatric Medicine in the Department of Medicine, University of Pittsburgh
| | - Heidi S Donovan
- Department of Acute and Tertiary Care, Office of Community Partnerships, University of Pittsburgh
| | | | - Alexandra L Cardy
- Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute
| | - Dana H Bovbjerg
- Department of Psychiatry, Psychology, Clinical and Translational Science Institute, Behavioral and Community Health Services, University of Pittsburgh
| | | | | | - Galen E Switzer
- Department of Medicine, Psychiatry, and Clinical and Translational Science, University of Pittsburgh
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, Vrije Universiteit (VU) Medical Center, Amsterdam, Netherlands
| | - Mary Amanda Dew
- Department of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh
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Abstract
INTRODUCTION Aromatase inhibitor (AI) therapy is the current preferred choice of endocrine therapy in postmenopausal estrogen receptor-positive breast cancer patients thanks to their improved effectiveness compared to tamoxifen. Despite the absence of increased endometrial pathology and deep venous thrombosis seen in tamoxifen-users, the safety profile of AIs consists of a variety of bothersome side effects negatively influencing daily functioning. AREAS COVERED Besides the well-known adverse effects on joints and bone and the vasomotor system, more neglected and latent toxicity like cognitive problems and vulvovaginal atrophy will be discussed. Concern has been raised in terms of increased risk of fractures and cardiovascular events with chronic AI use. EXPERT OPINION Placebo-controlled long-term studies carefully monitoring these adverse events, together with more extensive research in the etiologies, are warranted.
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Aphinives P, Vachirodom D, Thanapaisal C, Rangsrikajee D, Somintara O. A comparison of letrozole and anastrozole followed by letrozole in breast cancer patients. BREAST CANCER-TARGETS AND THERAPY 2015; 7:37-41. [PMID: 25653555 PMCID: PMC4309671 DOI: 10.2147/bctt.s73997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background We previously studied the noninferiority of anastrozole (ANZ) versus ANZ followed by letrozole (A-LTZ) due to reimbursement policy. We found that patients with A-LTZ had better overall survival (OS) than did patients with ANZ alone. This study aimed to prove that patients with A-LTZ also had better OS than patients with letrozole (LTZ) alone. Methods All medical records of the breast cancer patients taking LTZ with or without ANZ between 2004 and 2013 were reviewed. All patients were divided into two groups: the LTZ group included patients treated with LTZ alone, and the A-LTZ group included patients treated with ANZ who were automatically changed to LTZ due to change of the reimbursement policy. Results From 359 cases, there were 179 cases in the LTZ group and 180 cases in the A-LTZ group. The mean age of patients in the LTZ group was 53.7 years and in the A-LTZ group was 54.2 years. The distribution of clinical stages among the LTZ group versus the A-LTZ group was 21 versus 4 (stage 1), 86 versus 116 (stage 2), 55 versus 46 (stage 3), and 17 versus 14 (stage 4), respectively. Among the LTZ patients, 63.7% took aromatase inhibitor monotherapy and 36.3% had a switching strategy, while in the A-LTZ group, 53.9% took AI monotherapy and 46.1% had a switching strategy. OS of the A-LTZ group was longer than that of the LTZ group. Conclusion The patients in A-LTZ, taking ANZ followed by LTZ had better OS than those in LTZ, taking LTZ alone.
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Affiliation(s)
- Potchavit Aphinives
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Damnern Vachirodom
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chaiyut Thanapaisal
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dhanes Rangsrikajee
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Abstract
Adjuvant endocrine therapy reduces the risk of recurrence and death from breast cancer in women with hormone receptor-positive early breast cancer. Tamoxifen has been the standard therapy for decades, and this is still the case for pre-menopausal women. Ovarian suppression is of similar efficacy but currently there is no strong evidence for adding this to tamoxifen and the additional morbidity can be considerable. Results from two important trials addressing this issue are imminent. In post-menopausal women, aromatase inhibitors (AIs) (letrozole, anastrozole, or exemestane) are superior to tamoxifen in preventing recurrence but only letrozole has been shown to improve survival. The main gain is against high-risk cancers, and tamoxifen gives very similar benefit for low-risk disease. Traditionally, treatment has been given for around 5 years, but many women remain at risk of relapse for 10 years or more. The AIs, and more recently tamoxifen, have been shown to reduce further the risk of late recurrence in women still in remission after 5 years of tamoxifen if given for a further 5 years. The comparative benefits of these two options and the selection of patients most likely to benefit from long-term adjuvant endocrine therapy are important topics for further research, as is the optimum duration of AI therapy started upfront.
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Le Saux O, Ripamonti B, Bruyas A, Bonin O, Freyer G, Bonnefoy M, Falandry C. Optimal management of breast cancer in the elderly patient: current perspectives. Clin Interv Aging 2015; 10:157-74. [PMID: 25609933 PMCID: PMC4293298 DOI: 10.2147/cia.s50670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Bertrand Ripamonti
- Gynaecology-Obstetrics Department, University Hospital, Saint-Etienne, France
| | - Amandine Bruyas
- Croix Rousse University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | | | - Gilles Freyer
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | - Marc Bonnefoy
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Falandry
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
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46
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Stearns V, Chapman JAW, Ma CX, Ellis MJ, Ingle JN, Pritchard KI, Budd GT, Rabaglio M, Sledge GW, Le Maitre A, Kundapur J, Liedke PER, Shepherd LE, Goss PE. Treatment-associated musculoskeletal and vasomotor symptoms and relapse-free survival in the NCIC CTG MA.27 adjuvant breast cancer aromatase inhibitor trial. J Clin Oncol 2014; 33:265-71. [PMID: 25512454 DOI: 10.1200/jco.2014.57.6926] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment-emergent symptoms with adjuvant tamoxifen and aromatase inhibitors (AIs) have been associated with superior recurrence-free survival (RFS). We hypothesized that MA.27 anastrozole- or exemestane-treated patients with new or worsening vasomotor and/or joint symptoms would have improved RFS. PATIENTS AND METHODS MA.27 randomly assigned 7,576 postmenopausal women with breast cancer to 5 years of anastrozole or exemestane. Patient-reported symptoms were collected using the Common Terminology Criteria for Adverse Events version 3.0 at protocol-specified baseline and 6- and 12-month clinical visits. Symptoms were considered present with either vasomotor and/or joint complaints. Associations between symptoms and baseline patient characteristics were examined with χ(2) and Fisher's exact tests. Subsequent effects of new or worsening symptoms on RFS were examined with landmark analyses and stratified univariable and multivariable Cox models. We examined the effects of 3-month symptoms arising from unplanned clinic visits as a result of severe toxicity. RESULTS Patients were assessable if eligible for the MA.27 trial, received some trial therapy, and had no disease recurrence at the end of a symptom assessment period; 96% of patients (n = 7,306 patients) were included at 6 months, and 96% (n = 7,246) were included at 12 months. Thirty-four percent of patients had baseline symptoms. For patients without baseline symptoms, 25% and 52% had new symptoms by 6 and 12 months, respectively. Neither treatment-emergent nor baseline symptoms significantly impacted RFS (P > .10) in patients with or without baseline symptoms. CONCLUSION In MA.27, anastrozole or exemestane treatment-emergent symptoms were not associated with improved RFS. Women should be supported through treatment and encouraged to remain on their AI regardless of their symptoms.
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Affiliation(s)
- Vered Stearns
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Judith-Anne W Chapman
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cynthia X Ma
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Matthew J Ellis
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - James N Ingle
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Kathleen I Pritchard
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - G Thomas Budd
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Manuela Rabaglio
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - George W Sledge
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Aurélie Le Maitre
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jessica Kundapur
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lois E Shepherd
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paul E Goss
- Vered Stearns, Kimmel Cancer Center, Johns Hopkins, Baltimore, MD; Judith-Anne W. Chapman, Aurélie Le Maitre, Jessica Kundapur, and Lois E. Shepherd, NCIC Clinical Trials Group, Queen's University, Kingston; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; Cynthia X. Ma, Siteman Cancer Center, Washington University, St Louis, MO; Matthew J. Ellis, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX; James N. Ingle, Mayo Clinic, Rochester, MN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; George W. Sledge, Stanford University, San Francisco, CA; Pedro E.R. Liedke and Paul E. Goss, Harvard University; Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Manuela Rabaglio, Inselspital University Hospital and International Breast Cancer Study Group Coordinating Center, Berne, Switzerland; and Pedro E.R. Liedke, Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Oncologia, Porto Alegre, Rio Grande do Sul, Brazil.
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Soveri L, Hermunen K, de Gramont A, Poussa T, Quinaux E, Bono P, André T, Österlund P. Association of adverse events and survival in colorectal cancer patients treated with adjuvant 5-fluorouracil and leucovorin: Is efficacy an impact of toxicity? Eur J Cancer 2014; 50:2966-74. [DOI: 10.1016/j.ejca.2014.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/22/2014] [Accepted: 08/06/2014] [Indexed: 12/27/2022]
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Aphinives P, Vachirodom D, Thanapaisal C, Rangsrikajee D, Somintara O. Effects of switching from anastrozole to letrozole, due to reimbursement policy, on the outcome of breast cancer therapy. BREAST CANCER-TARGETS AND THERAPY 2014; 6:145-50. [PMID: 25249759 PMCID: PMC4154879 DOI: 10.2147/bctt.s67553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Endocrine therapy is one of the standard treatments for estrogen-receptor-positive breast cancer patients. Letrozole is the only aromatase inhibitor (AI) included in Thailand’s essential drug list since the change of reimbursement policy in 2008, when patients had to change their AIs (other than letrozole) to letrozole. This study aimed to prove that the efficacy of anastrozole plus letrozole is not less than anastrozole alone. Methods All medical records of breast cancer patients taking anastrozole between 2004 and 2013 were reviewed. Some patients were initially treated with anastrozole and then changed to letrozole (A-LTZ group), whereas the other patients were continuously treated with anastrozole until completion of therapy (ANZ group). Results In a total of 180 (55.9%) out of the 322 cases, anastrozole was replaced with letrozole. The mean age of patients in the ANZ group was 54.9 years and that of those in the A-LTZ group was 54.2 years. Clinical stages (1–4) of the ANZ versus A-LTZ patients were four versus four, 76 versus 116, 46 versus 46, and 16 versus 14, respectively. ANZ patients took AI monotherapy (46.5%) and switching strategy (53.5%), while A-LTZ patients took AI monotherapy (53.9%) and switching strategy (46.1%). The overall survival (OS) of A-LTZ patients was longer than that of ANZ patients. Stage 2 and 4 patients in the A-LTZ group also had better OS than those in the ANZ group, but stage 3 patients had similar OS in both groups. Conclusion Anastrozole can be replaced by letrozole any time during endocrine therapy. The patients taking anastrozole plus letrozole surprisingly seemed to have better OS than patients taking anastrozole alone.
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Affiliation(s)
| | - Damnern Vachirodom
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand
| | | | | | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand
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Abola MV, Prasad V, Jena AB. Association between treatment toxicity and outcomes in oncology clinical trials. Ann Oncol 2014; 25:2284-2289. [PMID: 25193993 DOI: 10.1093/annonc/mdu444] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whether or not toxicity predicts clinical outcomes has long been a question regarding cancer treatments. While prior studies have focused on specific cancers, therapies, and toxicities, no comprehensive evidence exists on whether treatment toxicity predicts favorable outcomes. METHODS We abstracted treatment toxicity and clinical outcome data from a sample of phase III oncology randomized clinical trials (n = 99 trials). We investigated whether treatments with relatively greater toxicity compared with their controls had relatively higher, lower, or equivocal rates of clinical efficacy, measured by progression-free survival (PFS) and overall survival (OS). Several toxicities were assessed (all grades, grades III/IV, cutaneous rash, gastrointestinal toxicity, and myelosuppression). RESULTS Toxicity and efficacy were greater among treatments than controls (e.g. 3.5 instances of all-grade toxicity per patient in treatment arms versus 2.8 instances in controls, P < 0.001; mean PFS of 9.1 months across treatment arms versus 7.1 months across controls, P < 0.001; mean OS of 18.6 months across treatment arms versus 16.9 months across controls, P < 0.001). Across trials, greater relative treatment toxicity was strongly associated with greater PFS in treatments versus controls (P < 0.001), but not OS (P = 0.44). Although higher relative rates of myelosuppression and cutaneous rash among treatments were not associated with greater treatment efficacy, greater relative gastrointestinal toxicity among treatments was associated with greater relative PFS compared with controls (P = 0.007). CONCLUSION Across trials, treatments with relatively greater all-grade toxicity compared with controls are associated with relatively greater PFS but not OS.
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Affiliation(s)
- M V Abola
- Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland
| | - V Prasad
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda
| | - A B Jena
- Department of Health Care Policy, Harvard Medical School, Boston; Department of Medicine, Massachusetts General Hospital, Boston, USA.
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Stone A, Schmitt N. Can a treatment be licenced on the basis of post-treatment predictive biomarkers? Pharm Stat 2014; 13:214-21. [DOI: 10.1002/pst.1620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 03/25/2014] [Accepted: 03/30/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew Stone
- AstraZeneca, Parklands; Alderley Park, Macclesfield Cheshire SK10 4TG UK
| | - Nicola Schmitt
- AstraZeneca, Parklands; Alderley Park, Macclesfield Cheshire SK10 4TG UK
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