Description of Major Osteoporotic Fractures in Women with Invasive Breast Cancer Who Received Endocrine Therapy

Background Completion of surgical resection and adjuvant/neoadjuvant treatments (chemotherapy, radiation, and endocrine therapy) is necessary to achieve optimal outcomes in invasive breast cancer. The objective of this study was to determine the characteristics of patients refusing treatment and to analyze the impact of refusal on survival. Study Design A retrospective cohort study of invasive breast cancer cases diagnosed 2004-2016 was performed utilizing the National Cancer Database. Results Of 2 058 568 cases comprising the study cohort, .6% refused recommended surgery, 14.1% refused chemotherapy, 5.5% refused radiation, and 6.3% refused endocrine therapy. Patients refusing therapy were older and more likely uninsured; they did not live farther from the treating hospital. Racial disparities were also associated with refusal. Surgery refusal had the highest hazard ratio for mortality (2.7; 95% CI: 2.5-3.0, P < .001) compared to chemotherapy (1.3; 95% CI: 1.3-1.4, P < .001), radiation (1.8; 95% CI: 1.7-1.9, P < .001), and endocrine therapy (1.5; 95% CI: 1.4-1.6, P < .001) independent of race, insurance, receptor status, and stage. Conclusion This study demonstrates significant associations with refusal of breast cancer treatment and quantifies the impact on mortality, which may help to identify at-risk groups for whom interventions could prevent increases in mortality associated with declining treatment.

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Prognostic value of Bcl-2 in invasive breast cancer receiving chemotherapy and endocrine therapy

Oncology Reports ◽

10.3892/or.10.1.121 ◽

2003 ◽

Author(s):

Qifeng Yang ◽

Takeo Sakurai ◽

Goro Yoshimura ◽

Takaomi Suzuma ◽

Teiji Umemura ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Prognostic Value

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Impact of delays in initiation of adjuvant endocrine therapy and survival among patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.537 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 537-537

Author(s):

Kimberley Lee ◽

Lisa K. Jacobs ◽

Jodi Segal

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Population Level ◽

Initial Diagnosis ◽

Adjuvant Endocrine Therapy ◽

Delayed Surgery ◽

Delayed Initiation

537 Background: Time to adjuvant endocrine therapy concerns patients and clinicians, but its impact on overall survival is not clear. There are no population level studies that address this question. Our primary objective is to describe the relationship between time from diagnosis of breast cancer to start of adjuvant endocrine therapy and overall survival. Methods: This is a population-based cohort study using prospectively collected population level data from the National Cancer Database (NCDB). The NCDB prospectively collects data on incident cancer cases from over 1500 Commission on Cancer-accredited facilities nationally. NCDB captures approximately 70% of incident cases of cancer in the United States. The participants are women with Stage II and III estrogen or progesterone receptor positive, human epidermal receptor 2 negative, invasive breast cancer who underwent definitive surgical treatment. Results: Of the 391,594 women in this study, 12,162 (3.1%) began treatment with adjuvant endocrine therapy more than 12 months after initial diagnosis of hormone receptor positive, invasive breast cancer. Mean age at diagnosis was 59.7 years (SD 13.4). Predictors of delayed initiation of adjuvant endocrine therapy include Black race or Hispanic ethnicity (adjusted odds ratio [aOR] of Black vs White, 1.57; 95% CI, 1.48-1.66; P < .001, Hispanic vs White, aOR 1.22, 95% CI 1.13-1.32; P < .001), Insurance other than private insurance (Medicare vs Private, aOR 1.09, 95% CI 1.01-1.17; P = .007, Medicaid vs Private, aOR 1.36, 95% CI 1.28-1.45; P < .001), higher stage of disease at diagnosis (Stage III vs II, aOR 1.24, 95% CI 1.19-1.30; P < .001), and delayed surgery or chemotherapy (Delayed surgery vs On-time lumpectomy, aOR 2.76, 95% CI 2.60-2.93; P < .001 and Delayed chemotherapy vs no chemotherapy, aOR 11.5, 95%CI 10.6-12.5). With median follow-up of 63.2 months, 67,335 (17.2%) patients died by the end of follow-up. Delayed initiation of AET resulted in no change in the hazard of death (HR, 1.00; 95% CI, 0.95-1.05; P = .97) compared to initiation within 12 months of diagnosis after adjusting for age, race and ethnicity, insurance type, urban vs rural residence, neighborhood income and education, comorbidity, cancer grade, stage, and receipt of timely or delayed surgery, chemotherapy, and/or radiation therapy. Conclusions: These results suggest that there may be no detriment to survival if initiation of adjuvant endocrine therapy occurs 12 to 24 months after initial diagnosis compared to within 12 months of diagnosis, as currently recommended.

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Perfusion in the contralateral breast on preoperative MRI may complement ER-pathway activity from the index tumor to stratify outcome of endocrine therapy for early-stage invasive breast cancer

European Journal of Cancer ◽

10.1016/s0959-8049(18)30374-5 ◽

2018 ◽

Vol 92 ◽

pp. S49-S50

Author(s):

B. Van der Velden ◽

T. Bismeijer ◽

S. Canisius ◽

C. Loo ◽

E. Lips ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Early Stage ◽

Contralateral Breast ◽

Pathway Activity ◽

Index Tumor

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Preventing invasive breast cancer using endocrine therapy

The Breast ◽

10.1016/j.breast.2017.06.027 ◽

2017 ◽

Vol 34 ◽

pp. S47-S54 ◽

Cited By ~ 6

Author(s):

Mangesh A. Thorat ◽

Jack Cuzick

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Invasive Breast Cancer

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P1-07-15: The Reliability of Ki-67 Expression Assessment Using Core Needle Biopsy and Surgical Specimens of Invasive Breast Cancer: Can Ki-67 Change Predict Benefits of Preoperative Endocrine Therapy?

10.1158/0008-5472.sabcs11-p1-07-15 ◽

2011 ◽

Author(s):

Y Mizuno ◽

H Takayanagi ◽

K Sato

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Ki 67 ◽

Core Needle

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Relationship of the breast ductal carcinoma in situ (DCIS) immune microenvironment with clinicopathological features: An institutional experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e12565 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e12565-e12565

Author(s):

Lauren Eisenbud ◽

Tsering G. Lama Tamang ◽

Caleb Cheng ◽

Ibe Ifegwu ◽

Tianyi Tang ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Clinical Outcomes ◽

Invasive Ductal Carcinoma ◽

Invasive Breast Cancer ◽

Ductal Carcinoma ◽

Recurrent Disease ◽

Response To Therapy ◽

Data Set ◽

Risk Of Recurrence

e12565 Background: DCIS is usually treated with resection followed by 5 years of adjuvant endocrine therapy for hormone receptor (HR) + DCIS. Endocrine therapy is not used in HR- DCIS. Although DCIS is considered a precursor lesion to invasive breast cancer, the different molecular subtypes confer variable clinical outcomes. The host immune response plays a key role in breast cancer progression and response to therapy. However, relative to invasive breast cancer, the immune milieu of DCIS is less understood. This retrospective study compares the clinical outcomes and tumor microenvironment of HR+ and HR- DCIS in order to identify clinical and immunological features in HR- DCIS that may predict an increased risk of recurrence or progression to invasive breast cancer. Methods: A single institution retrospective chart review was performed to identify patients diagnosed with DCIS between 2012 and 2017. A clinico-pathologic data set, as well as the PD-L1 expression of the DCIS and TILs were collected and correlated with various outcomes. Results: Our cohort consisted of 20 cases of HR- DCIS and 50 cases of HR+ DCIS. Overall, 56% were Caucasian, 20% Asian, 18% Hispanic, and 6% African American. Of the HR- patients, 70% were Caucasian, 15% Hispanic, and 15% Asian. Of the 17 HR- patients with available HER2 data, 76% had HER2+, and 24% triple negative (TN) DCIS. 18% of the HR+ patients and 38% of the HR- patients were PD-L1+. 25% of the HR-/HER2+ patients, and 75% of the TN patients were PD-L1+. 6% of the HR+ patients developed recurrent disease, 2 with DCIS and 1 with invasive ductal carcinoma. 20% of the HR- patients had recurrent disease, all of whom were HER2+. Of the HR- patients that recurred, 2 recurred with metastatic disease, 1 with ipsilateral invasive ductal carcinoma, and 1 with DCIS. All 7 patients that recurred had original DCIS pathology showing a high nuclear grade. Our future results at the time of the meeting will expand on this cohort. Conclusions: This retrospective analysis showed that HR- DCIS conferred higher rates of local and distant recurrence. Therefore, there is a need for treatments to reduce the recurrence rates of HR- DCIS. There are ongoing clinical trials for the high risk, HR-/HER2+ DCIS subtype. TN DCIS is also an aggressive phenotype. Given the high rate of PD-L1 positivity we detected in TN DCIS, immune-based therapy may be useful in the adjuvant setting to reduce the risk of recurrence in this cohort of patients.

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The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS)

BMJ Open ◽

10.1136/bmjopen-2018-026797 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026797 ◽

Cited By ~ 48

Author(s):

E Shelley Hwang ◽

Terry Hyslop ◽

Thomas Lynch ◽

Elizabeth Frank ◽

Donna Pinto ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Ductal Carcinoma ◽

Low Risk ◽

Phase Iii ◽

Controlled Clinical Trial ◽

Institutional Review ◽

Randomised Controlled

IntroductionDuctal carcinoma in situ (DCIS) is a non-invasive non-obligate precursor of invasive breast cancer. With guideline concordant care (GCC), DCIS outcomes are at least as favourable as some other early stage cancer types such as prostate cancer, for which active surveillance (AS) is a standard of care option. However, AS has not yet been tested in relation to DCIS. The goal of the COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial for low-risk DCIS is to gather evidence to help future patients consider the range of treatment choices for low-risk DCIS, from standard therapies to AS. The trial will determine whether there may be some women who do not substantially benefit from current GCC and who could thus be safely managed with AS. This protocol is version 5 (11 July 2018). Any future protocol amendments will be submitted to Quorum Centralised Institutional Review Board/local institutional review boards for approval via the sponsor of the study (Alliance Foundation Trials).Methods and analysisCOMET is a phase III, randomised controlled clinical trial for patients with low-risk DCIS. The primary outcome is ipsilateral invasive breast cancer rate in women undergoing GCC compared with AS. Secondary objectives will be to compare surgical, oncological and patient-reported outcomes. Patients randomised to the GCC group will undergo surgery as well as radiotherapy when appropriate; those in the AS group will be monitored closely with surgery only on identification of invasive breast cancer. Patients in both the GCC and AS groups will have the option of endocrine therapy. The total planned accrual goal is 1200 patients.Ethics and disseminationThe COMET trial will be subject to biannual formal review at the Alliance Foundation Data Safety Monitoring Board meetings. Interim analyses for futility/safety will be completed annually, with reporting following Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-inferiority trials.Trial registration numberNCT02926911; Pre-results.

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