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Abramson Cancer CenterNCI CANCERLIT® Search: Chemotherapy for Breast Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
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. stefan.aebi@insel.ch
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.
2
UI - 20462693
AU - Menard S; Casalini P; Cascinelli N; Balsari A
TI -
Breast carcinoma in young patients.
SO - Lancet 2000 Sep 23;356(9235):1113
3
UI - 20462694
AU - Guinee VF; Moller T
TI -
Breast carcinoma in young patients.
SO - Lancet 2000 Sep 23;356(9235):1113
4
UI - 21245393
AU - Anonymous
TI -
Are older lymphoma and breast cancer patients undertreated?
SO - Oncology (Huntingt) 2001 Apr;15(4):406, 436
5
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.
dvorakj@fnhk.cz
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
6
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.
7
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. bs-mmw@gmx.de
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.
8
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.
9
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. mizaya@kms.ac.jp
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.
10
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.
11
UI - 21442332
AU - Behr TM; Behe M; Wormann B
TI -
Trastuzumab and breast cancer.
SO - N Engl J Med 2001 Sep 27;345(13):995-6
12
UI - 21442333
AU - Strasser F; Betticher DC; Suter TM
TI -
Trastuzumab and breast cancer.
SO - N Engl J Med 2001 Sep 27;345(13):996
13
UI - 21442334
AU - Palmieri C; Powles T; Vigushin D
TI -
Trastuzumab and breast cancer.
SO - N Engl J Med 2001 Sep 27;345(13):996-7
14
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.
15
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.
16
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.
17
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.
18
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.
19
UI - 21443819
AU - Pritchard KI
TI -
Use of ErbB-1 and ErbB-2 to select endocrine therapy for breast cancer:
will it play in Peoria?
SO - J Clin Oncol 2001 Sep 15;19(18):3795-7
20
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. ellis053@mc.duke.edu
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.
21
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.
22
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
23
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. ruth@clalit.org.il
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.
24
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. aroran@mail.nih.gov
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.
25
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.
26
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
27
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.
28
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.
29
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.
demail@adis.co.nz
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.
30
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. liisa.hakamies-blomqvist@helsinki.fi
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.
31
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.
swains@mail.nih.gov
32
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.
33
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
34
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.
35
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
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