National Cancer Institute®
Last Modified: November 21, 2001
UI - 20322812
AU - Aebi S; Gelber S; Castiglione-Gertsch M; Gelber RD; Collins J;
TI - Thurlimann B; Rudenstam CM; Lindtner J; Crivellari D; Cortes-Funes H; Simoncini E; Werner ID; Coates AS; Goldhirsch A Is chemotherapy alone adequate for young women with oestrogen-receptor-positive breast cancer?
SO - Lancet 2000 May 27;355(9218):1869-74
AD - University Hospital Inselspital, Bern, Switzerland. email@example.com
BACKGROUND: The prognosis of breast cancer in very young women is generally considered to be unfavourable. Therefore, the outcome of adjuvant therapy was analysed in a population of young (<35 years) premenopausal patients treated in four randomised controlled trials. METHODS: Between 1978 and 1993 the International Breast Cancer Study Group (IBCSG) treated 3700 premenopausal and perimenopausal patients with various timing and duration of adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF with or without low-dose prednisone and oophorectomy). 314 of these women were less than 35 years old at randomisation. FINDINGS: Relapse and death occurred earlier and more often in younger (<35 years) than in older (> or = 35) patients with a 10 year disease-free survival of 35% (SE 3) versus 47% (1) (hazard ratio 1.41 [95% CI 1.22-1.62], p<0.001) and overall survival of 49% (3) versus 62% (1) (1.50 [1.28-1.77], p<0.001). Younger patients with oestrogen-receptor positive tumours had a significantly worse disease-free survival than younger patients with oestrogen-receptor negative tumours. By contrast, among older patients the disease-free survival was similar irrespective of oestrogen-receptor status. INTERPRETATION: Young premenopausal breast cancer patients treated with adjuvant CMF chemotherapy had higher risk of relapse and death than older premenopausal patients, especially if their tumours expressed oestrogen receptors. The endocrine effects of chemotherapy alone are insufficient for the younger age group and these patients should strongly consider additional endocrine therapies (tamoxifen or ovarian ablation) if their tumours express oestrogen receptors.
UI - 21340687
AU - Dvorak J; Zoul Z; Melichar B; Jandik P; Mergancova J; Hrncirova I;
TI - Urminska H; Petera J Pegylated liposomal doxorubicin in combination with hyperthermia for treatment of skin metastases of breast carcinoma: a case report.
SO - Onkologie 2001 Apr;24(2):166-8
AD - Department of Oncology and Radiotherapy, Charles University Medical School & Teaching Hospital, Hradec Kralove, Czech Republic. firstname.lastname@example.org
BACKGROUND: Incorporation of doxorubicin hydrochloride into pegylated liposomes (PLD) may decrease chemotherapy side effects and increase the activity. Hyperthermia could further potentiate its effectiveness. CASE REPORT: A patient with skin metastases of breast carcinoma was treated with intravenous infusion of PLD (Caelyx) in combination with ultrasound hyperthermia. Each cycle consisted of infusion of 40 mg PLD absolute dose, followed by 2 fractions of hyperthermia 41-43 degrees C for 45 min 1 and 48 h after infusion. A complete remission was observed after the combination treatment with no significant toxicity. CONCLUSION: Present observations suggest that the combination of PLD with hyperthermia of skin metastases of breast carcinoma may be an active and well tolerated treatment. Copyright 2001 S. Karger GmbH, Freiburg
UI - 21340692
AU - Kaufmann M; von Minckwitz G
TI - [Report on the NIH Consensus Development Conference on Adjuvant Therapy of Breast Carcinoma]
SO - Onkologie 2001 Apr;24(2):190-2
AD - Universitats-Frauenklinik Frankfurt/Main.
UI - 21383082
AU - Meyer-Wittkopf M; Barth H; Emons G; Schmidt S
TI - Fetal cardiac effects of doxorubicin therapy for carcinoma of the breast during pregnancy: case report and review of the literature.
SO - Ultrasound Obstet Gynecol 2001 Jul;18(1):62-6
AD - Department of Obstetrics and Perinatal Medicine, Philipps-University of Marburg, Marburg, Germany. email@example.com
Cardiotoxicity is a recognized complication of anthracycline drugs given as part of chemotherapy; however, the pre- and postnatal cardiac effects of in utero exposure are not well documented. In this report we present a case of gestational breast cancer with initiation of four cycles of doxorubicin/cyclophosphamide chemotherapy after modified radical mastectomy and axilla dissection during the early second trimester. Serial echocardiographic measurements of the ventricular shortening fraction and biometry of the ventricular cavities were performed. Allowing for the individual variability of these values in the fetus no myocardial dysfunction was observed. The literature was reviewed in an attempt to delineate the possible role of prenatal echocardiography in the diagnosis of doxorubicin-induced cardiotoxicity in the fetus.
UI - 21377749
AU - Burkart C; Wight E; Pok J; Kernen B; Traber M; Haller U; Bajka M
TI - [Ultrasound endometrium follow-up during tamoxifen treatment: Really not reliable or useful after all?]
SO - Ultraschall Med 2001 Jun;22(3):136-42
AD - Klinik fur Gynakologie, Dept. Frauenheilkunde, Universitatsspital Zurich, Schweiz.
AIM: To investigate whether an examination of the endometrium of women treated with tamoxifen (TAM) is useful or not. METHOD: 40 breast cancer patients who displayed a thickened endometrium of > 8 mm and/or vaginal bleeding were included in the study. They received daily TAM adjuvantly. Histologic clarification by hysteroscopy and D&C was recommended for patients with an endometrium of > 8 mm or vaginal bleeding. RESULTS: In our collective, the mean endometrial thickness was 13.7 +/- 5.6 mm (SD). 32 patients underwent a histological examination. Most had a benign lesion; in 2 cases we merely found a cystic atrophy (11 mm, 18 mm), 2 displayed atypical tissue (13 mm, 25 mm) and 2 an endometrial cancer (19 mm, 33 mm). All patients with atypical tissue or cancer had an endometrial thickness markedly above the norm, but 3 of them were not bleeding. No linear correlation between thickness of the endometrium and duration of TAM intake was found. CONCLUSION: To detect early premalignant or malignant changes of the endometrium, we recommend histological examination by hysteroscopy and dilatation and curettage when the endometrium is > 8 mm thick, even in the absence of symptoms. Therefore, these patients should have regular examinations by transvaginal ultrasound once or twice a year. Moreover, continuing regular screening of the endometrium for years after termination of tamoxifen-therapy is also to be recommended.
UI - 21367957
AU - Matsumoto Y; Takano H; Kunishio K; Nagao S; Fojo T
TI - Expression of drug resistance genes in VP-16 and mAMSA-selected human carcinoma cells.
SO - Jpn J Cancer Res 2001 Jul;92(7):778-84
AD - Department of Neurological Surgery, Kagawa Medical University, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. firstname.lastname@example.org
The cell lines described in the present study were isolated as part of an effort to understand resistance to topoisomerase (topo) II inhibitors. To that end, 50 sublines were isolated from four human breast cancer cell lines, i.e., MCF-7, T47D, MDA-MB-231, and ZR-75B. As an initial step, a concentration that would be lethal to the majority of cells (IC99) was selected for both VP-16 and mAMSA, for each cell line. The identification of an increasing number of putative drug resistance-related proteins provided the opportunity to examine expression of the corresponding genes in the selected cell lines. Northern blot analysis revealed different responses to the selecting agents in the different cell lines. Previous studies examining expression of multidrug resistance (MDR)-1 in resistant cell lines had found undetectable levels in all cells. In the ZR-75B sublines, increased expression of MDR-associated protein (MRP) and canalicular multispecific organic anion transporter (cMOAT) was observed, and when the relative levels of overexpression were compared, a high correlation was found. In contrast, increased expression of MRP was observed in some of the MDA-MB-231 sublines, without a concomitant increase in cMOAT expression. Finally, in both T47D and MCF-7 sublines, increased expression of cMOAT or MRP was observed infrequently, and where it occurred, was of a much smaller magnitude. In the analysis of expression of MRP, the highest levels were found in the ZR-75B and MDA-MB-231 sublines, with lower levels in the MCF-7 and T47D clones. Similarly, differences in the expression of topo IIalpha were observed among the sublines. Although the differences in expression appear to depend on the parental cell line from which the resistant sublines were derived, a strong correlation was observed between the expression of MRP and the levels of topo IIalpha. Cell lines with low levels of MRP had lower levels of topo IIalpha, while those with high levels of MRP maintained higher levels of topo IIalpha. While a reduced topo IIalpha level was common, there did not appear to be a compensating increase in the expression of topo IIbeta or topo I or casein kinase (CK) IIalpha in any of the cell lines. While the possibility that such compensation could occur has been discussed and even reported in some cell lines, such an adaptation was not observed in the present study, suggesting that it is not common.
UI - 21411912
AU - Nishimura N; Hachisuga T; Saito T; Kawarabayashi T
TI - Subsequent endometrial carcinoma with adjuvant tamoxifen treatment in Japanese breast cancer patients.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):272-6
AD - Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Japan.
This study aimed to detail the clinicopathologic features of endometrial carcinomas that developed in Japanese patients receiving adjuvant tamoxifen treatment for breast cancer patients. Ten endometrial carcinomas in tamoxifen-treated breast cancer patients were collected from two medical centers. The endometrial carcinomas included two stage Ia, four stage Ib, two stage Ic and two stage IIIc. Three tumors were Grade 1, six were Grade 2, and one was Grade 3. The tumor was limited to the endometrium in two cases. Myometrial invasion was limited to the inner half of the myometrium in five cases and involved the outer half in three. A mild degree of lymphovascular space invasion was identified in five cases. Deep cervical invasion was recognized in one case. The cell types comprised nine endometrioid adenocarcinomas and one serous carcinoma. Five of eight postmenopausal endometrial carcinomas were associated with polypoid endometrial lesions composed of cystically dilated atrophic and proliferative glands widely separated by fibrotic stroma. Two patients with retroperitoneal lymph node metastases died of endometrial cancer. One patient developed a contralateral breast cancer during tamoxifen treatment. No patient died of breast cancer. We did not demonstrate a higher frequency of either high-grade tumors or unfavorable histologic subtypes in tamoxifen-treated Japanese breast cancer patients.
UI - 21436350
AU - Valero V; Perez E; Dieras V
TI - Doxorubicin and taxane combination regimens for metastatic breast cancer: focus on cardiac effects.
SO - Semin Oncol 2001 Aug;28(4 Suppl 12):15-23
AD - Department of Breast Medical Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Investigation of the combination of the taxanes with doxorubicin in the treatment of breast cancer has logically progressed, with the ultimate goal of identifying a safe and effective regimen for use in the adjuvant setting. Initial phase II findings of the concurrent doxorubicin/paclitaxel combination resulted in substantial response rates, but at a high cost. A much higher percentage of patients than expected developed anthracycline-induced cardiomyopathy. Subsequent phase II and phase III trials have determined administration schedules of doxorubicin/paclitaxel that reduce the risk for cardiotoxicity. However, the overall response rate is only modestly improved over sequential single-agent therapy or standard doxorubicin-containing combination therapy. The lack of cardiotoxicity with docetaxel, its high antitumor activity, and its linear pharmacokinetics have made it an attractive taxane for combination with doxorubicin. In addition, it is easily administered in the outpatient setting. Phase I/II trials of the combination of doxorubicin/docetaxel resulted in high response rates with a lack of adverse modification of anthracycline-induced cardiomyopathy. These findings have been confirmed in a large phase III randomized trial where overall response rates and time to disease progression were significantly improved, but the incidence of cardiomyopathy was not different for the doxorubicin/docetaxel versus doxorubicin/cyclophosphamide (AC) regimen. Ongoing studies are underway to assess the role of the doxorubicin/docetaxel combination in the adjuvant setting as primary chemotherapy in the neoadjuvant setting. It is here that the most benefit on survival of breast cancer patients is likely to be shown. At the same time, it is in the adjuvant setting where the absence of potentially late cardiac and other toxicities must be assured. Copyright 2001 by W.B. Saunders Company.
UI - 21436351
AU - Mamounas EP; Sledge GW Jr
TI - Combined anthracycline-taxane regimens in the adjuvant setting.
SO - Semin Oncol 2001 Aug;28(4 Suppl 12):24-31
AD - Aultman Cancer Center, Canton, OH 44202, USA.
Within the past decade there has been enormous interest in integrating the taxanes into the adjuvant breast cancer setting. Adjuvant trial designs in the early 1990s were absent of taxanes. By the mid 1990s, the taxanes were included in adjuvant trials, but were mainly limited to trials conducted in node-positive patients. Currently, taxanes are a chemotherapeutic modality in the majority of ongoing adjuvant trials in both node-negative and node-positive patients. These trials are being conducted in thousands of patients worldwide by several of the cooperative research organizations. Most of the adjuvant trials have focused on defining the clinical efficacy and toxicity of the concurrent or sequential use of taxanes with anthracyclines. The collective experience with taxanes over the next 3 to 5 years will make them one of the most intensely studied treatments in the history of patients with breast cancer. The outcome of these trials is greatly anticipated because they have the potential of changing the current standards of care in the adjuvant treatment of patients with breast cancer. Copyright 2001 by W.B. Saunders Company.
UI - 21436353
AU - Trudeau M; Pagani O
TI - Epirubicin in combination with the taxanes.
SO - Semin Oncol 2001 Aug;28(4 Suppl 12):41-50
AD - Toronto Sunnybrook Regional Cancer Centre, Ontario, Canada.
The anthracyclines, and doxorubicin in particular, have been the most widely used drugs for advanced and metastatic breast cancer. Epirubicin shares the same spectrum of antitumor activity as doxorubicin, however, a therapeutic advantage of epirubicin is the higher cumulative dose at which the anthracycline-induced cardiotoxicity becomes clinically evident. The taxanes have quickly been established as important chemotherapeutic agents in the armamentarium of drugs to treat breast cancer. Evaluation of the combination of anthracyclines with the taxanes was a logical research step with the aim to improve overall outcome and, potentially, survival of breast cancer patients. The findings of a high rate of cardiotoxicity from the initial phase II trials of combination doxorubicin/paclitaxel led investigators to alter the anthracycline and the taxane component of the combination by substitution with epirubicin and/or docetaxel, respectively. Results of phase I and II clinical trials with epirubicin plus a taxane shows a high level of antitumor activity, with the absence of significant cardiac toxicity and limited severity of other nonhematologic toxicities, thus making the epirubicin and taxane combinations highly attractive. Additional studies in metastatic breast cancer patients, for whom prolonged administration with an anthracycline is of potential clinical benefit, are underway. Evaluation of epirubicin and taxane combinations in the adjuvant setting are warranted and ongoing where prevention of cardiotoxicity is as important as efficacy. Copyright 2001 by W.B. Saunders Company.
UI - 21439109
AU - Buzdar A; Howell A
TI - Advances in aromatase inhibition: clinical efficacy and tolerability in the treatment of breast cancer.
SO - Clin Cancer Res 2001 Sep;7(9):2620-35
AD - Department of Breast Medical Oncology, M. D., Anderson Cancer Center, University of Texas, Houston, 77030, USA.
UI - 21445734
AU - Ito T; Katagiri C; Murata Y; Hamazoe R; Morita K
TI - Indication for histological examination of endometrium in breast carcinoma patients receiving tamoxifen therapy.
SO - J Obstet Gynaecol Res 2001 Jun;27(3):141-5
AD - Department of Obstetrics and Gynecology, Hakuai Hospital, Yonago, Japan.
OBJECTIVE: To investigate the effects of tamoxifen on the uterine endometrium and define the indications for histological examination of endometrium on the thickness of uterine endometrium and on the duration of tamoxifen therapy. METHODS: The endometrial thickness was measured on the transvaginal ultrasonogram in 40 postmenopausal breast carcinoma patients receiving tamoxifen (tamoxifen group), and control group. Endometrial histological examination was carried out. Receiver operating characteristic (ROC) curve analysis was carried out. RESULTS: Endometrial thickness in the tamoxifen group was 11.2 +/- 5.1 mm, and that of the control group was 3.8 +/- 2.1 mm. The incidence of endometrial abnormalities in the tamoxifen group was greater than that in control group. The cut off values derived from the ROC curve analysis were 9 mm for endometrial thickness, and 24 months for duration of tamoxifen therapy. CONCLUSION: The histological examination of endometrium should be carried out if the endometrial thickness is more than 9 mm, or the duration of tamoxifen therapy is more than 24 months even if the patients do not have any symptoms.
UI - 21443822
AU - Ellis MJ; Coop A; Singh B; Mauriac L; Llombert-Cussac A; Janicke F;
TI - Miller WR; Evans DB; Dugan M; Brady C; Quebe-Fehling E; Borgs M Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial.
SO - J Clin Oncol 2001 Sep 15;19(18):3808-16
AD - Duke University Breast Cancer Program, Duke University Comprehensive Cancer Center, Durham, NC 27710, USA. email@example.com
PURPOSE: Expression of ErbB-1 and ErbB-2 (epidermal growth factor receptor and HER2/neu) in breast cancer may cause tamoxifen resistance, but not all studies concur. Additionally, the relationship between ErbB-1 and ErbB-2 expression and response to selective aromatase inhibitors is unknown. A neoadjuvant study for primary breast cancer that randomized treatment between letrozole and tamoxifen provided a context within which these issues could be addressed prospectively. PATIENTS AND METHODS: Postmenopausal patients with estrogen- and/or progesterone receptor-positive (ER+ and/or PgR+) primary breast cancer ineligible for breast-conserving surgery were randomly assigned to 4 months of neoadjuvant letrozole 2.5 mg daily or tamoxifen 20 mg daily in a double-blinded study. Immunohistochemistry (IHC) for ER and PgR was conducted on pretreatment biopsies and assessed by the Allred score. ErbB-1 and ErbB-2 IHC were assessed by intensity and completeness of membranous staining according to published criteria. RESULTS: For study biopsy-confirmed ER+ and/or PgR+ cases that received letrozole, 60% responded and 48% underwent successful breast-conserving surgery. The response to tamoxifen was inferior (41%, P =.004), and fewer patients underwent breast conservation (36%, P =.036). Differences in response rates between letrozole and tamoxifen were most marked for tumors that were positive for ErbB-1 and/or ErbB-2 and ER (88% v 21%, P =.0004). CONCLUSION: ER+, ErbB-1+, and/or ErbB-2+ primary breast cancer responded well to letrozole, but responses to tamoxifen were infrequent. This suggests that ErbB-1 and ErbB-2 signaling through ER is ligand-dependent and that the growth-promoting effects of these receptor tyrosine kinases on ER+ breast cancer can be inhibited by potent estrogen deprivation therapy.
UI - 21443824
AU - Rouzier R; Extra JM; Carton M; Falcou MC; Vincent-Salomon A; Fourquet A;
TI - Pouillart P; Bourstyn E Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery.
SO - J Clin Oncol 2001 Sep 15;19(18):3828-35
AD - Department of Surgery, Institut Curie, Paris, France.
PURPOSE: To determine the incidence and the prognostic value of ipsilateral breast tumor recurrence (IBTR) in patients treated with primary chemotherapy and breast-conserving surgery. PATIENTS AND invasive T1 to T3 breast carcinoma were treated with primary chemotherapy, lumpectomy, and radiation therapy. The median follow-up time was 93 months. To evaluate the role of IBTR in metastase-free survival, a Cox regression multivariate analysis was performed using IBTR as a time-dependent covariate. RESULTS: The IBTR rates were 16% (+/- 2.4%) at 5 years and 21.5% (+/- 3.2%) at 10 years. Multivariate analysis showed that the probability of local control was decreased by the following independent factors: age < or = 40 years, excision margin < or = 2 mm, S-phase fraction more than 4%, and clinical tumor size more than 2 cm at the time of surgery. In patients with excision margins of more than 2 mm, the IBTR rates were 12.7% at 5 years and 17% at 10 years. Nodal status, age < or = 40 years, and negative estrogen receptor status were predictors of distant disease in the Cox multivariate model with fixed covariates. The contribution of IBTR was highly significant (relative risk = 5.34) when added to the model, whereas age < or = 40 years was no longer significant. After IBTR, 31.4% (+/- 7.0%) of patients developed metastases at 2 years and 59.7% (+/- 8.1%) at 5 years. Skin involvement, size at initial surgery, and estrogen receptor status were predictors of metastases after IBTR. CONCLUSION: IBTR is a strong predictor for distant metastases. There are implications for conservative surgery after downstaging of the tumor and therapy at the time of IBTR.
UI - 21443832
AU - Gralow JR; Livingston RB
TI - University of Washington high-dose cyclophosphamide, mitoxantrone, and etoposide experience in metastatic breast cancer: unexpected cardiac toxicity.
SO - J Clin Oncol 2001 Sep 15;19(18):3903-4
UI - 21455241
AU - Cohen I; Azaria R; Bernheim J; Shapira J; Beyth Y
TI - Risk factors of endometrial polyps resected from postmenopausal patients with breast carcinoma treated with tamoxifen.
SO - Cancer 2001 Sep 1;92(5):1151-5
AD - Department of Obstetrics and Gynecology, Sapir Medical Center, Kfar-Saba, Tel Aviv University, Israel. firstname.lastname@example.org
BACKGROUND: Endometrial polyps are the most common endometrial pathology described in association with postmenopausal tamoxifen exposure. Up to 3% of these polyps may show malignant changes. However, to the authors' knowledge no one has described any risk factor for the development of this pathology in postmenopausal patients with breast carcinoma treated with tamoxifen. OBJECTIVE. The objective of this study was to evaluate whether risk factors can be identified for the development of endometrial polyps in postmenopausal patients with breast carcinoma treated with tamoxifen. METHODS: The authors reviewed the medical records of 54 postmenopausal patients with breast carcinoma in whom endometrial polyps were resected by hysteroscopy after at least 6 months of tamoxifen treatment (Group I). Demographic characteristics, health habits, risk factors for endometrial carcinoma, and clinical factors related to the primary breast disease were examined. The results were compared with those obtained from 210 similar patients in whom hysteroscopy did not reveal any endometrial pathology (Group II). RESULTS: Age at menopause was significantly older, duration of breast disease was significantly longer, and body weight was significantly heavier among Group I patients compared with Group II patients (P = 0.0162, P = 0.0026, and P = 0.0364, respectively). Endometrial thickness, measured by transvaginal ultrasonography, was significantly thicker in Group I patients (16.3 +/- 7.2 mm) compared with that detected in Group II patients (11.8 +/- 6.3; P = 0.0001). CONCLUSIONS: Various factors, such as older age at menopause, longer duration of breast disease, heavier weight, and thicker endometrium may contribute to the prediction of increased risk of development of endometrial polyps in postmenopausal patients with breast carcinoma treated with tamoxifen. Copyright 2001 American Cancer Society.
UI - 21455258
AU - Arora NK; Gustafson DH; Hawkins RP; McTavish F; Cella DF; Pingree S;
TI - Mendenhall JH; Mahvi DM Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: a prospective study.
SO - Cancer 2001 Sep 1;92(5):1288-98
AD - Center for Health Systems Research and Analysis, University of Wisconsin, Madison, USA. email@example.com
BACKGROUND: Studies that prospectively and simultaneously evaluate, within the first year of diagnosis, the impact of surgery and chemotherapy on quality of life (QOL) of younger women (60 years or younger) with early stage breast carcinoma are limited. METHODS: Quality of life of 103 women who had surgery (lumpectomy, 49; mastectomy, 54) approximately 1 month before the start of the study was evaluated at baseline and again after 5 months. Thirty-two women received chemotherapy during the study. RESULTS: Over time, subjects reported improvement in body image and physical, emotional, and functional well-being (P < 0.001). They were less bothered by swollen/tender arms and worried less about risk of cancer to family members (P < 0.001). However, satisfaction with sex life, social support, and social/family well-being declined (P < 0.001). In the period closer to surgery, women with mastectomy reported poorer body image (P = 0.001) and worse functional (P = 0.08) and physical well-being (P = 0.10). Women with lumpectomy worried more about the effects of stress on their illness (P < 0.01) and had lower emotional well-being (P = 0.06). By 6 months after surgery, the two groups reported similar QOL scores. Chemotherapy had a negative impact on women's sexual functioning (P = 0.01) and their physical well-being (P = 0.09). Women who received chemotherapy also reported more shortness of breath (P = 0.07). Post hoc analysis showed that women with breast reconstruction had higher emotional well-being at baseline than those with lumpectomy (P = 0.001) and mastectomy alone (P < 0.01). CONCLUSIONS: Younger women with breast carcinoma could experience a range of adjustment problems at various points in the treatment cycle. Interventions that would help reduce the negative impact of treatment on QOL need to be designed and integrated into routine clinical practice. Copyright 2001 American Cancer Society.
UI - 21468600
AU - Robain M; Pierga JY; Jouve M; Asselain B; Dieras V; Beuzeboc P; Palangie
TI - T; Dorval T; Extra JM; Scholl S; Pouillart P Predictive factors of response to first-line chemotherapy in 1426 women with metastatic breast cancer.
SO - Eur J Cancer 2000 Dec;36(18):2301-12
AD - Department of Biostatistics, Institut Curie, Paris, France.
Since response to chemotherapy is a major determinant of survival in metastatic breast cancer, the purpose of our study was to analyse the predictive factors of response. 1426 patients enrolled into eight consecutive randomised trials of anthracycline-based first-line chemotherapy in metastatic breast cancer, between 1977 and 1992, were analysed. A forward stepwise logistic regression analysis was used. The objective response rate (ORR) to chemotherapy in the total population was 63.6% (95% confidence interval (CI): 61.5-67.7). The complete response rate was 17.5%. Multivariate analysis defined adjuvant chemotherapy, lactate dehydrogenase (LDH), Karnofsky index (KI), and pleural and lung metastases to be the five main variables correlated with ORR. A predictive score was calculated using the coefficient of these five variables, The score was established as follows: -1.32+0.54 (if prior adjuvant chemotherapy) +0.80 (low KI) +0.75 (raised LDH) +0.49 (lung metastases) +0.51 (pleural metastases). A low score (less than -0.78) was associated with an ORR greater than 70.0%, representing 41.2% of our population. An intermediate score (between -0.78 and 0) was associated with an ORR of 50 to 70%, representing 37.5% of our population and a positive score was associated with an ORR of less than 50%, representing 21.3% of our population. This score can be used to predict objective response rates to first-line anthracycline-based chemotherapy. This method now needs to be evaluated prospectively in phase II trials. Identification of various risk groups may also be useful for interpretation and design of clinical trials.
UI - 20575037
AU - Cutuli B; Quentin P; Rodier JF; Barakat P; Grob JC
TI - Severe hypothyroidism after chemotherapy and locoregional irradiation for breast cancer.
SO - Radiother Oncol 2000 Oct;57(1):103-5
UI - 21435103
AU - Sliwinska M; Wojtacki J; Sliwinski W
TI - Endometrial cancer in patients with breast carcinoma treated with tamoxifen: report of two cases and the literature overview.
SO - Med Sci Monit 2000 Mar-Apr;6(2):399-406
AD - Department of Radiotherapy, Polish Red Cross Marine Hospital, Gdynia-Redlowo, Poland.
Tamoxifen (TAM) is the endocrine treatment of choice in the first-line therapy for all stages of breast cancer, in both pre- and postmenopausal women. Some clinical studies indicated a small but significant increase in the risk of subsequent endometrial carcinoma in breast cancer women who take TAM as an adjuvant therapy. In this study, we present two cases of breast cancer patients in whom endometrial cancer was diagnosed during TAM treatment; the current status of knowledge on the relationship between TAM use and the risk of endometrial cancer is reviewed.
UI - 21279727
AU - Schagen SB; Hamburger HL; Muller MJ; Boogerd W; van Dam FS
TI - Neurophysiological evaluation of late effects of adjuvant high-dose chemotherapy on cognitive function.
SO - J Neurooncol 2001 Jan;51(2):159-65
AD - Department of Psychosocial research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam.
OBJECTIVES: To evaluate late neurotoxicity of adjuvant high-dose (HD) chemotherapy versus standard-dose (SD) chemotherapy by event-related potentials (ERP) and quantitative electroencephalography (qEEG). PATIENTS AND METHODS: From a randomized study in high-risk breast cancer patients on the efficacy of high-dose versus standard-dose adjuvant chemotherapy, late effects on cognitive functioning were analyzed by neuropsychological tests. Cognitive impairment was found in 32% of the HD group, 17% of the SD group and in 9% of a control group of stage I breast cancer patients not treated with chemotherapy. In 17 consecutive patients in the HD group and 16 consecutive patients in the SD group neurophysiological tests were performed, consisting of P300 and qEEG. Results of patients treated with chemotherapy were compared with results of 14 control patients not treated with chemotherapy. All patients were tested two years after treatment. RESULTS: Asymmetry of the alpha rhythm of > or =0.5 Hz was found in 7 HD patients, 2 SD patients and in none of the control patients (p = 0.01). No differences were found between the groups with regard to frequency of alpha rhythm, alpha blocking and latency of P300. No correlation was found between neurophysiological parameters and neuropsychological performance, except for an overall relation between the P300 latencies and the total number of deviant test scores. CONCLUSION: Although the neurophysiological differences are subtle and the relation with the cognitive functioning in individual patients as measured by the neuropsychological examination is equivocal, the results suggest that there is neurophysiological support for cognitive dysfunction as a late complication of high-dose systemic chemotherapy in breast cancer.
UI - 21291645
AU - Curran M; Wiseman L
TI - Fulvestrant.
SO - Drugs 2001;61(6):807-13; discussion 814
AD - Adis International Limited, Mairangi Bay, Auckland, New Zealand. firstname.lastname@example.org
Fulvestrant is a 7alpha-alkylsulphinyl analogue of estradiol that competes with endogenous estrogen for binding to the estrogen receptor. Once bound to the receptor, fulvestrant attenuates receptor dimerisation, effecting a rapid degradation of the estrogen receptor protein and inhibition of transcription. Fulvestrant is a potent inhibitor of the growth of human breast cancer cells in vitro and in vivo. It has demonstrated pure anti-estrogenic activity in animal systems. Intramuscular fulvestrant 250 mg once a month was as effective as the oral aromatase inhibitor anastrozole 1 mg/day in 2 phase III trials in postmenopausal women with advanced breast cancer who had received prior endocrine therapy. Median time to disease progression (the primary end-point) with fulvestrant and anastrozole was 5.4 and 3.4 months (North American trial) and 5.5 and 5.1 months (European trial). The median duration of response was 19.3 and 10.5 months (North American trial) and 14.3 and 14.0 months (European trial). The most common adverse events with fulvestrant are gastrointestinal disturbances and hot flushes. Fulvestrant showed similar tolerability to anastrozole in 2 phase III trials.
UI - 21421283
AU - Hakamies-Blomqvist L; Luoma ML; Sjostrom J; Pluzanska A; Sjodin M;
TI - Mouridsen H; Ostenstad B; Mjaaland I; Ottosson S; Bergh J; Malmstrom PO; Blomqvist C Timing of quality of life (QoL) assessments as a source of error in oncological trials.
SO - J Adv Nurs 2001 Sep;35(5):709-16
AD - Swedish School of Social Science, University of Helsinki, Helsinki, Finland. email@example.com
AIM OF THE STUDY: To produce an empirical estimate of the nature and magnitude of the error produced by incorrect timing quality of life (QoL) measurements in patients receiving chemotherapy. DESIGN: In a multicentre trial, 283 patients were randomized to receive either docetaxel (T) or sequential methotrexate and 5-fluorouracil (MF). The QoL was assessed at baseline and before each treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The study design was retrospective. Data were analysed using t-tests. RESULTS: Erroneous timing affected the QoL findings in both treatment arms. At baseline, there were statistically significant differences in the MF group on the nausea/vomiting scale, with ill-timed assessment showing more symptoms, and in the T group on the physical functioning scale with ill-timed assessments indicating better QoL. The mean scores of correct vs. incorrect timings over the first 14 cycles showed statistically significant differences on several scales. In the MF group, ill-timed assessments indicated significantly worse physical functioning and global QoL, and significantly more of the following symptoms: fatigue, nausea/vomiting, insomnia, appetite loss, and constipation. In the T group, ill-timed assessment showed better physical functioning, less dyspnoea and more insomnia than correctly timed assessments. The reasons for erroneous timing were not always detectable retrospectively. However, in some cases the MF group, being in standard treatment, seemed to have followed a clinical routine not involving the active participation of the study nurse responsible, whereas patients in the experimental T group were more consistently taken care of by the study nurses. CONCLUSIONS: Incorrect timing of QoL assessments in oncological trials jeopardises both the reliability of the QoL findings within treatment and the validity of QoL outcome comparisons between treatments. This issue should be emphasized in the planning of both the study design and clinical routines.
UI - 21445116
AU - Swain SM
TI - Tamoxifen for patients with estrogen receptor-negative breast cancer.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):93S-97S
AD - National Cancer Institute, Bethesda, MD 20889-5105, USA. firstname.lastname@example.org
UI - 21464097
AU - Momiyama N; Kameda K; Mochizuki Y; Natori S; Takekawa Y; Kubo A
TI - [A case of breast cancer with bone marrow and liver metastases responding completely to low-dose weekly paclitaxel combined with toremifene]
SO - Gan To Kagaku Ryoho 2001 Sep;28(9):1287-9
AD - Dept. of Surgery, Yokosuka City Municipal Hospital.
A 36-year-old woman was admitted to our hospital because of general with bone marrow and liver metastases. Low-dose weekly paclitaxel (60 mg/body/week) combined with toremifene (120 mg/day) was started in (CT), and the primary tumors and cervical/axillary lymphadenopathy disappeared after 4 weeks of CT. Bone marrow and liver metastases was no longer detected after 16 weeks of CT, and the case was evaluated as a complete response (CR). The same therapy has been performed for eight months and no evidence of recurrence has been observed.
UI - 21461558
AU - Hutchins LF; Arick CL
TI - Adjuvant treatment in node-negative, postmenopausal breast cancer.
SO - Cancer Invest 2001;19(7):706-22
AD - Department of Medicine, Division of Hematology/Oncology, The University of Arkansas for Medical Sciences, Little Rock 72205, USA. HutchinsLauraF@uams.edu
UI - 21461559
AU - Sadler IJ; Jacobsen PB
TI - Progress in understanding fatigue associated with breast cancer treatment.
SO - Cancer Invest 2001;19(7):723-31
AD - Department of Psychology, University of South Florida, Tampa, USA.
Fatigue is one of the most common and distressing symptoms reported by cancer patients. This article reviews research that has examined the extent to which breast cancer patients experience fatigue during and following completion of chemotherapy and radiotherapy. The article also addresses methodological issues in the study of fatigue as well as the current status of efforts to prevent or relieve fatigue associated with breast cancer treatment.
UI - 21458877
AU - Shigeoka Y; Itoh K; Igarashi T; Ishizawa K; Saeki T; Fujii H; Minami H;
TI - Imoto S; Sasaki Y Clinical effect of irinotecan in advanced and metastatic breast cancer patients previously treated with doxorubicin- and docetaxel-containing regimens.
SO - Jpn J Clin Oncol 2001 Aug;31(8):370-4
AD - Division of Oncology/Hematology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
BACKGROUND: Previous phase II trials in Japan suggested that irinotecan was a promising agent for advanced or metastatic breast cancer pretreated with anthracycline. However, irinotecan has not yet been evaluated in the salvage setting for breast cancer pretreated with both anthracycline and taxane, which are two active agents for breast cancer. METHODS: The efficacy and safety of irinotecan were retrospectively evaluated in patients with breast cancer who had previously been treated with both doxorubicin and docetaxel. From 1996 to 1999, irinotecan was administered to 20 patients, all with a performance status of <2. Irinotecan treatment was repeated in approximately 6 week cycles consisting of the administration of irinotecan once weekly for 4 weeks followed by a 2 week rest. The median dose of irinotecan administered was 100 mg/m(2) weekly. The median number of irinotecan cycles given was 1 (range: 1-8 cycles). The median total dose was 388 mg/m(2) (range: 50-2400 mg/m(2)). RESULTS: Performance status declined to >3 after treatment with irinotecan in four patients. Two patients had grade 3 leukopenia; three had grade 3 anemia and one had a creatinine elevation of grade 4. The objective response rate for all patients was 5.0% (95% CI: 0-15.5%). The median time to progression