scholarly journals Endocrine Therapy Initiation among Older Women with Ductal Carcinoma In Situ

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Chelsea Anderson ◽  
Aaron N. Winn ◽  
Stacie B. Dusetzina ◽  
Hazel B. Nichols
Keyword(s):  
Older Women ◽  
Endocrine Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Cancers ◽  
National Guidelines ◽  
Therapy Initiation ◽  
Er Positive

Background. Although treatment of ductal carcinoma in situ (DCIS) is controversial, national guidelines recommend considering endocrine therapy for women with estrogen receptor- (ER-) positive DCIS or those undergoing breast conserving surgery (BCS) without radiation. We evaluated uptake and predictors of endocrine therapy use among older women with DCIS. Methods. In the SEER-Medicare database, we identified women aged 65+ years diagnosed with DCIS during 2007–2011. We evaluated demographic, tumor, and treatment characteristics associated with endocrine therapy initiation. Results. Among 2,945 women with DCIS, 41% initiated endocrine therapy (66% tamoxifen, 34% aromatase inhibitors). Initiation was more common among women with ER-positive than ER-negative DCIS (48% versus 16%; HR = 3.75, 95% CI: 2.91–4.83); 28% of women with unknown ER status initiated endocrine therapy. Initiation was less common after BCS alone compared to BCS with radiation (32% versus 50%; HR = 0.69, 95% CI: 0.59–0.80). Conclusions. Less than half of older women with DCIS initiate endocrine therapy to prevent second breast cancers. Our findings suggest use was more common, but not exclusive, among women with ER-positive DCIS, but not among women who underwent BCS alone. Endocrine therapy should be targeted toward patients most likely to benefit from its use.

scholarly journals Endocrine Therapy Initiation and Medical Oncologist Utilization Among Women Diagnosed with Ductal Carcinoma in Situ

2017 ◽  
Vol 22 (5) ◽  
pp. 535-541 ◽  
Author(s):  
Chelsea Anderson ◽  
Anne Marie Meyer ◽  
Stephanie B. Wheeler ◽  
Lei Zhou ◽  
Katherine E. Reeder‐Hayes ◽  
...  
Keyword(s):  
Endocrine Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Medical Oncologist ◽  
Therapy Initiation

scholarly journals Pathologic and biologic response to preoperative endocrine therapy in patients with ER-positive ductal carcinoma in situ

BMC Cancer ◽  
2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Yunn-Yi Chen ◽  
Sandy DeVries ◽  
Joseph Anderson ◽  
Juan Lessing ◽  
Rebecca Swain ◽  
...  
Keyword(s):  
Endocrine Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Er Positive ◽  
Biologic Response

scholarly journals Phase II Single-Arm Study of Preoperative Letrozole for Estrogen Receptor–Positive Postmenopausal Ductal Carcinoma In Situ: CALGB 40903 (Alliance)

2020 ◽  
Vol 38 (12) ◽  
pp. 1284-1292 ◽  
Author(s):  
E. Shelley Hwang ◽  
Terry Hyslop ◽  
Laura H. Hendrix ◽  
Stephanie Duong ◽  
Isabelle Bedrosian ◽  
...  
Keyword(s):  
Estrogen Receptor ◽  
Endocrine Therapy ◽  
Phase Ii ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Invasive Cancer ◽  
Median Reduction ◽  
Er Positive

PURPOSE Primary endocrine therapy for ductal carcinoma in situ (DCIS) as a potential alternative to surgery has been understudied. This trial explored the feasibility of a short-term course of letrozole and sought to determine whether treatment results in measurable radiographic and biologic changes in estrogen receptor (ER)–positive DCIS. PATIENTS AND METHODS A phase II single-arm multicenter cooperative-group trial was conducted in postmenopausal patients diagnosed with ER-positive DCIS without invasion. Patients were treated with letrozole 2.5 mg per day for 6 months before surgery. Breast magnetic resonance imaging (MRI) was obtained at baseline, 3 months, and 6 months. The primary end point was change in 6-month MRI enhancement volume compared with baseline. RESULTS Overall, 79 patients were enrolled and 70 completed 6 months of letrozole. Of these, 67 patients had MRI data available for each timepoint. Baseline MRI volumes ranged from 0.004 to 26.3 cm3. Median reductions from baseline MRI volume (1.4 cm3) were 0.6 cm3 (61.0%) at 3 months ( P < .001) and 0.8 cm3 (71.7%) at 6 months ( P < .001). Consistent reductions were seen in median baseline ER H-score (228; median reduction, 15.0; P = .005), progesterone receptor H-score (15; median reduction, 85.0; P < .001), and Ki67 score (12%; median reduction, 6.3%; P = .007). Of the 59 patients who underwent surgery per study protocol, persistent DCIS remained in 50 patients (85%), invasive cancer was detected in six patients (10%), and no residual DCIS or invasive cancer was seen in nine patients (15%). CONCLUSIONS In a cohort of postmenopausal women with ER-positive DCIS, preoperative letrozole resulted in significant imaging and biomarker changes. These findings support future trials of extended endocrine therapy as primary nonoperative treatment of some DCIS.

scholarly journals Prescribing practices of endocrine therapy for ductal carcinoma in situ in British Columbia

2018 ◽  
Vol 25 (2) ◽  
pp. 133 ◽  
Author(s):  
A.T. Chaudhry ◽  
T.A. Koulis ◽  
C. Speers ◽  
R.A. Olson
Keyword(s):  
British Columbia ◽  
Endocrine Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Population Based ◽  
Cox Regression Analysis ◽  
Treatment Centre ◽  
Er Status

Purpose The mainstay of treatment for ductal carcinoma in situ (dcis) involves surgery in the form of mastectomy or lumpectomy. Inconsistency in the use of endocrine therapy (et) for dcis is evident worldwide. We sought to assess the variation in et prescribing for patients with dcis across a population-based radiotherapy (rt) program and to identify variables that predict its use.Methods Data from a breast cancer database were obtained for women diagnosed with dcis in British Columbia from 2009 to 2014. Associations between et use and patient characteristics were assessed by chi-square test and multilevel multivariate logistic regression. The Kaplan–Meier method, with propensity score matching and Cox regression analysis, was used to assess the effects of et on overall survival (os) and relapse-free survival (rfs).Results For the 2336 dcis patients included in the study, et use was 13% in dcis patients overall, and 17% in patients with estrogen receptor–positive (er+) tumours treated with breast-conserving surgery and rt. Significant variation in et use by treatment centre was observed (range: 8%–23%; p < 0.001), and prescription of et by individual oncologists varied in the range 0%–40%. After controlling for confounding factors, age less than 50 years [odds ratio (or): 1.72; p = 0.01], treatment centre, er+ status (or: 5.33; p < 0.001), and rt use (or: 1.77; p < 0.001) were significant predictors of et use. No difference in os or rfs with the use of et was observed.Conclusions In this population-based analysis, 13% of patients with dcis in British Columbia received et, with variation by treatment centre (8%–23%) and individual oncologist (0%–40%). Age less than 50 years, er+ status, and rt use were most associated with et use.

scholarly journals Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24

2012 ◽  
Vol 30 (12) ◽  
pp. 1268-1273 ◽  
Author(s):  
D. Craig Allred ◽  
Stewart J. Anderson ◽  
Soonmyung Paik ◽  
D. Lawrence Wickerham ◽  
Iris D. Nagtegaal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Significant Benefit ◽  
Adjuvant Tamoxifen ◽  
Receptor Status ◽  
Er Positive

Purpose The NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen. Patients and Methods Estrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n = 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n = 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years). Results ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P < .001) and overall follow-up (HR, 0.60; P = .003), which remained significant in multivariable analysis (overall HR, 0.64; P = .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone. Conclusion Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.

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