Trade-offs Between Efficacy and Cardiac Toxicity of Adjuvant Chemotherapy in Early-Stage Breast Cancer Patients: Do Competing Risks Matter?

2017 ◽  
Vol 23 (4) ◽  
pp. 401-409 ◽  
Author(s):  
Fernando Alarid-Escudero ◽  
Anne H. Blaes ◽  
Karen M. Kuntz
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Competing Risks ◽  
Cardiac Toxicity ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Trade Offs

Cardiovascular risk profile of breast cancer patients treated with anthracycline-taxane containing adjuvant chemotherapy and/or trastuzumab

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 666-666 ◽  
Author(s):  
L. W. Jones ◽  
M. Haykowsky ◽  
C. J. Peddle ◽  
A. A. Joy ◽  
E. N. Pituskin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Sinus Tachycardia ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Cvd Risk Factors ◽  
Cvd Risk

666 Background: With improving longevity, post-treatment cardiovascular disorders will become an increasingly important indicator of competing mortality in early-stage breast cancer. As such, we conducted a pilot study to comprehensively evaluate the CVD profile of a subset of early-stage breast cancer patients treated with adjuvant taxane-anthracycline containing chemotherapy and/or trastuzumab. Methods: Twenty-six breast cancer patients (mean 20 months post chemotherapy) who participated in Breast Cancer International Research Group 006 clinical trial and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established CVD risk factors, BMI, VO2peak and left ventricular systolic function. All assessments were performed within a 14-day period. Results: Cardiac abnormalities were suggested by LVEF <50% in 10% of patients, LVEF remained >10% below pre-treatment values in 38% while 50% presented with resting sinus tachycardia. BNP was significantly elevated in 40% and was correlated with LVEF (r = -0.72, p=<.001). For the majority of CVD risk factors, similar proportions of patients and controls (35% to 60%) were classified as ‘undesirable.’ A significantly higher proportion of patients were classified with low VO2peak (46% vs. 0%, p<0.01), being overweight/obese (72% vs. 50%, p<0.05), and having resting sinus tachycardia (50% vs. 0%, p<0.01) compared with controls. VO2peak and BMI were correlated with CV risk factors (r = -0.64 to 0.63, p<0.05; r = -0.63 to 0.67, p<0.05, respectively). Exploratory analyses revealed several differences between CVD risk factors based on chemotherapy regimen. Conclusions: Breast cancer survivors treated with adjuvant chemotherapy are at a higher risk of developing late-occurring CVD than age matched controls due to direct and indirect treatment-related toxicity. No significant financial relationships to disclose.

scholarly journals Evaluation of the prognostic value of CD3, CD8, and FOXP3 mRNA expression in early-stage breast cancer patients treated with anthracycline-based adjuvant chemotherapy

2018 ◽  
Vol 7 (10) ◽  
pp. 5066-5082 ◽  
Author(s):  
Marinos Tsiatas ◽  
Konstantine T. Kalogeras ◽  
Kyriaki Manousou ◽  
Ralph M. Wirtz ◽  
Helen Gogas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Mrna Expression ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Foxp3 Mrna

Influences on Oncologists’ Adoption of New Agents in Adjuvant Chemotherapy of Breast Cancer

2001 ◽  
Vol 19 (4) ◽  
pp. 954-959 ◽  
Author(s):  
Gina M. Buban ◽  
Brian K. Link ◽  
William R. Doucette
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Social Systems ◽  
Communication Channels ◽  
Early Stage Breast Cancer ◽  
Phase Iii ◽  
Breast Cancer Patients ◽  
New Treatments

PURPOSE: Little is known about how oncologists’ adopt new treatments for breast cancer. This study investigated influences on oncologists’ adoption of paclitaxel as adjuvant chemotherapy for early-stage breast cancer, 9 months after presentation of phase III data suggesting improved disease-free and overall survival when paclitaxel was added to doxorubicin and cyclophosphamide for such patients. METHODS: Self-reported data were collected with a mail survey of a random sample of 1,200 oncologists practicing in the United States. Using Rogers’ model, we measured four types of influences on adoption of innovation: (1) communication channels, (2) innovation characteristics, (3) a practitioner’s social system, and (4) physician characteristics. Multiple regression analysis assessed the associations between oncologist adoption of paclitaxel for early-stage breast cancer patients and variables representing the modeled influences on adoption. RESULTS: On average, respondents (n = 181) reported having adopted paclitaxel for 37% of their early-stage breast cancer patients. The overall model was significant, with seven variables associated (P ≤ .05) with adoption of paclitaxel. Significant influences on adoption included use of symposia as a therapy information source, physician experience with paclitaxel to treat late-stage breast cancer, and perceived advantage in efficacy of paclitaxel. CONCLUSION: As new modalities become available to treat cancer, it is vital to understand what factors influence oncologists and patients when choosing to use them. Those parties interested in fostering the adoption of new breast cancer treatments should address features of communication channels (eg, use of symposia), characteristics of new treatments (eg, perceived advantage in efficacy), physicians’ social systems (eg, patient requests), and characteristics of potential adopters (eg, previous experience with the treatment).

Breast Cancer Patients Undergoing Adjuvant Chemotherapy Do Not Acquire Activated Protein C Resistance (APC-R).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5058-5058
Author(s):  
Madhu N Belur Shivananda ◽  
Theodore Bell ◽  
Edith Sielsch ◽  
Diane Gaspari ◽  
Amir Tabatabai
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Venous Thrombosis ◽  
Cancer Patients ◽  
Early Stage ◽  
Factor V Leiden ◽  
Early Stage Breast Cancer ◽  
Factor V ◽  
Breast Cancer Patients ◽  
History Of

Abstract Abstract 5058 Background Malignancy has been known to be associated with a hypercoagulable state since Trosseau first described it a hundred years ago. This is a multifactorial process that includes (1) direct activation of the coagulation system by production of procoagulants, (2) indirect activation through release of cytokines, (3) the complex interaction between tumor cells, blood cells, and endothelium, and (4) problems associated with malignancy including surgery, immobility, and intravenous catheters. One of the most recent postulated mechanisms is acquired resistance to APC. APC is a serum protein that normally inhibits the coagulation cascade. APC-R increases the risk of venous thrombosis and can be either hereditary or acquired. The hereditary form is caused by the well-known mutation, factor V Leiden. More recently, acquired forms of APC-R have been described, and the list of possible etiologies is growing. In cancer patients, APC-R has been detected in the absence of factor V Leiden mutation, suggesting a possible cause-effect relationship between malignancy and acquired APC-R. A possible mechanism is thought to be an increase in serum levels of another coagulation protein, factor VIII. However, the exact incidence, mechanism, and possible role of exposure to chemotherapeutic agents remain unclear. This pilot study was designed to study whether chemotherapy can induce APC-R in early stage breast cancer patients who were rendered cancer-free surgically, and then received adjuvant chemotherapy. Patients and Methods We enrolled women with stage I - III breast cancer between July 2007 and December 2008. Personal histories were obtained for all patients to document the absence of any prior history of venous thrombosis. Patients with a known history of any hypercoagulable state such as factor V Leiden and prothrombin G20210A mutations were excluded. Also, patients were excluded if they had any other cancers or taking anticoagulants. Typical chemotherapies included cyclophosphamide, doxorubicin, docetaxel and paclitaxel. Venous blood samples were drawn in citrated vacuum tubes on the first and last day of chemotherapy and centrifuged within 4 hours. These samples were coded and stored at – 70° C. The APC-R was measured in thawed plasma by a functional clotting test system (Dade Behring assay, Behring Diagnostics Inc, Cupertino, CA). Results A total of 31 women were enrolled in the study. These patients were treated with either lumpectomy or mastectomy and opted to undergo adjuvant chemotherapy. The study was approved by the health system Institutional Review Board. Most study subjects, 28 (90%), were in the 42-68 age group. Only 2 women (6%) were ages 30-39, and 1 woman (3%) was age 20-29. Seventeen (54.8%) of our study participants were menopausal. Twenty (56%) of the study subjects had undergone lumpectomy, and 11 (38%) had a total mastectomy. The average postoperative duration before receiving chemotherapy was 47.3 (SD 26.5) days. None of the 31 samples tested before chemotherapy had APC-R. When the test was repeated on the last day of chemotherapy, none of the samples showed evidence of acquired APC-R (p = 1). The patients were monitored clinically during their routine chemotherapy visits and no evidence of either arterial or venous thrombosis was noted. Discussion Although acquired APC-R after chemotherapy has been increasingly reported in the literature in the last few years, our study clearly indicates that in early stage breast cancer patients who were rendered cancer-free surgically, there was no development of APC-R after chemotherapy. Our study has several limitations. First, the sample size was small. Even with a larger sample size, it is very unlikely that acquired APC-R would be detected, as not a single sample out of 31 converted to APC-R after chemotherapy. Secondly, the duration of follow up was limited; patients were not tested or monitored clinically for several months after receiving chemotherapy and this could have affected our results. Thirdly, the study subjects were mainly caucasian women and the results cannot be extrapolated to men or other ethnicities. Our study indicates that there is no relationship between undergoing adjuvant chemotherapy and subsequently acquiring resistance to APC in patients with early stage breast cancer. Further studies should look at the possible connection between chemotherapy and acquired APC-R in other malignancies. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document