Which benefit from subsequent chemotherapy lines beyond the second for women with metastatic breast cancer? Evidence from a single-center retrospective analysis of survivorship.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 255-255
Author(s):  
G. Bernardo ◽  
R. Palumbo ◽  
A. Bernardo ◽  
C. Teragni ◽  
F. Sottotetti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Retrospective Analysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model

255 Background: Although the true impact of chemotherapy (CT) in metastatic breast cancer (MBC) is still debated, in the routine clinical practice an increasing number of women asking for further treatment after progression receive subsequent CT lines. This study aimed to assess which benefit could be brought by the succession of CT lines in patients treated for MBC and to identify women who benefit from these treatments. Methods: This retrospective analysis included 980 women treated with CT for MBC at our Institution over a 7-year period (May 1999-July 2006). With overall survival (OS) data updated at December 1, 2008, the median follow-up was 125 months (range 48-192), OS and time to treatment failure (TTF) were calculated according to the Kaplan-Meyer method for each CT line. Cox proportional hazards model was used to identify factors that could influence TTF and OS. Results: Median OS evaluated from day 1 of each CT line decreased with the line number from 34.8 months (980 patients, 1st line, range 4-208) to 22.6 months (838 patients, 2nd line), 14.6 months (684 patients, 3rd line), 12.4 months (302 patients, 4th line), 9.4 months (88 patients, 5th line), 8.2 months (45 patients, seven or more lines). Median TTF ranged from 9.2 months to 7.8 and 6.4 months for the first, second and third line, respectively, with no significant decrease observed beyond the 3rd line (median 5.2 months, range 4.8-6.2). In univariate analysis factors positively linked to a longer duration of TTF for each CT line were positive hormonal receptor status, absence of liver metastasis, adjuvant CT exposure, response to CT for the metastatic disease; in the multivariate analysis the duration of TTF for each CT line was the only one factor with significant impact on survival benefit for subsequent treatments (p<0.001). Conclusions: CT beyond the 2nd line may be beneficial in a significant subset of women treated for MBC, with improved TTF and OS. These findings could help physician in planning an appropriate strategy of subsequent schedules for women with symptomatic MBC who responded to their 1st line CT, while non responder patients should be considered for clinical trials.

A randomized trial of two dose levels of cyclophosphamide, methotrexate, and fluorouracil chemotherapy for patients with metastatic breast cancer.

1988 ◽  
Vol 6 (9) ◽  
pp. 1377-1387 ◽  
Author(s):  
I F Tannock ◽  
N F Boyd ◽  
G DeBoer ◽  
C Erlichman ◽  
S Fine ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Metastatic Breast ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Primary Surgery ◽  
Dose Levels

This study was designed to assess the role of dosage of chemotherapy for treatment of metastatic breast cancer. One hundred thirty-three patients without prior chemotherapy for metastatic disease were randomly allocated to receive two different dose levels of cyclophosphamide (C), methotrexate (M), and fluorouracil (F), administered intravenously (IV) every 3 weeks. Patients were stratified by sites of disease (visceral, bone, or soft-tissue dominant) and by interval from primary surgery to first recurrence. Doses on the higher-dose arm were 600 mg/m2 (C,F) and 40 mg/m2 (M) with escalation if possible; doses on the lower-dose arm were 300 mg/m2 (C,F) and 20 mg/m2 (M) without escalation. Patients who failed to respond to lower-dose CMF were crossed over to the higher-dose arm. Patients randomized to the higher-dose arm had longer survival measured from initiation of chemotherapy (median survival, 15.6 months v 12.8 months, P = .026 by log-rank test), but the effect of dose was of borderline significance (P approximately 0.12) when adjusted for a chance imbalance between the two arms in the time from first relapse to randomization, using the Cox proportional hazards model. Response rates (International Union Against Cancer [UICC] criteria) for patients with measurable disease were higher-dose arm: 16/53 (30%) and lower-dose arm: 6/53 (11%), (P = .03). Only one of 37 patients responded on crossover from the lower- to the higher-dose arm. Patients experienced more vomiting, myelosuppression, conjunctivitis, and alopecia when receiving higher doses of chemotherapy. A series of 34 linear analogue self-assessment scales were used to make detailed quality of life assessments on a subset of 49 patients. These scales confirmed greater toxicity in the immediate posttreatment period, but also a trend to improvement in general health and some disease-related indices, in patients receiving higher-dose chemotherapy. This trial suggests that better palliation is achieved by using full-dose chemotherapy.

Patient weight and event-free survival for children under 2 years of age at diagnosis with favorable histology Wilms tumor

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20002-20002
Author(s):  
C. V. Fernandez ◽  
J. Anderson ◽  
N. Breslow ◽  
J. Dome ◽  
P. Grundy ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Wilms Tumor ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Favorable Histology ◽  
Hazards Model ◽  
Risk Treatment ◽  
Weight For Age

20002 Background: Over- and underweight have been associated with excess mortality in certain childhood cancers. The impact of the child’s weight at diagnosis on event-free survival (EFS) in favorable histology Wilms tumor (FH WT) is unknown. Methods: Patients with FH WT under 2 years of age at enrolment on NWTS-5 were included. This age group was analyzed by body weight in kilograms because body mass index (BMI) norms do not exist for individuals less than 2 years old. Outcomes by BMI for children older than 2 years of age with FH WT will be analyzed separately. CDC 2000 growth charts were used. Patients were stratified for risk based on stage and chemotherapy protocol [EE4A = vincristine/dactinomycin] [DD4A = vincristine/doxorubicin/ actinomycin]. A univariate analysis of the relationship of weight-for-age and EFS was calculated. A Cox proportional hazards model was fitted for EFS examining four subsets of weight-for-age by percentiles: a) less than 5%, b) 5–9.9%, c) 90–94.9% and d) more than 95% and adjusting for risk/treatment groups via stratification. Results: 594 patients met the study criteria. 567 had weights recorded. Median follow-up was 4.7 years. 10% of patients had a weight for age percentile of 5.6 or below and 10% had a weight percentile of 94.1 or above. A univariate analysis of the relationship of weight-for-age and EFS showed no relationship (p=0.40, log-rank test). A Cox proportional hazards model, stratified by risk/treatment groups, showed that low or high weight-for-age was not predictive of outcome (p=0.24). Conclusions: There was no evidence that low or high weight-for-age was predictive for EFS among patients less than 2 years old with FH WT. There were more patients with lower or higher weight than would be expected. [Table: see text] No significant financial relationships to disclose.

Multiple chemotherapy (CT) lines in metastatic breast cancer (MBC): Which survival benefit for women with hormone receptor (HR)-positive disease?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 589-589 ◽  
Author(s):  
Raffaella Palumbo ◽  
Antonio Bernardo ◽  
Alberto Riccardi ◽  
Federico Sottotetti ◽  
Cristina Teragni ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Factors Affecting ◽  
Significant Difference ◽  
Third Line

589 Background: Although the development of modern systemic therapies has clearly improved outcome of patients with MBC, the true impact of further CT on overall survival (OS) and QoL of these women is still debated. The aim of this study was to determine which benefit could be brought by successive CT lines in patients with HR-positive disease, aiming to identify factors affecting outcome and survival. Methods: This retrospective analysis included 980 women treated with CT for MBC at our Institution over a eight year period (July 2000-July 2008). With OS data updated in March 2010, the median follow-up was 146 months (range 48-198), OS and time to treatment failure (TTF) were calculated according to the Kaplan-Meyer method for each CT line. Cox proportional hazards model was used to identify factors that could influence TTF and OS. Results: Median OS evaluated from day 1 of each CT line decreased with the line number from 34.8 months for first line to 8.2 months for 7 or more lines). Median TTF ranged from 9.2 months to 7.8 and 6.4 months for the first, second and third line, respectively, with no significant decrease observed beyond the third line (median 5.2 months, range 4.8-6.2). No statistically significant difference was found between HR-positive and HR-negative patients in terms of OS and TTF by each CT line. In univariate analysis factors positively linked to a longer duration of TTF for each CT line were positive hormonal receptor status, more than 3 hormonotherapy lines, absence of liver metastasis, adjuvant CT exposure, response to CT for the metastatic disease; in the multivariate analysis the duration of TTF for each CT line was the only one factor with significant impact on survival benefit for subsequent treatments, in both HR-positive and negative populations (p<0.001). Conclusions: Our results support the benefit of multiple lines of CT in a significant subset of women treated for MBC, since each CT line may contribute to a longer OS. Of interest, such a benefit was also observed for patients with HR-positive disease, although the number of hormonotherpy lines received did not significantly influence the outcome.

scholarly journals Antibiotics modulate neoadjuvant therapy efficiency in patients with breast cancer: a pilot analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xi Zhang ◽  
Long Yu ◽  
Jiajie Shi ◽  
Sainan Li ◽  
Shiwei Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Antibiotic Administration ◽  
Hazards Model ◽  
Kaplan Meier ◽  
The Impact

AbstractMounting evidence suggests that microbiota dysbiosis caused by antibiotic administration is a risk factor for cancer, but few research reports focus on the relationships between antibiotics and chemotherapy efficiency. We evaluated the influence of antibiotic administration on neoadjuvant therapy efficacy in patients with breast cancer (BC) in the present study. BC patients were stratified into two groups: antibiotic-treated and control based on antibiotic administration within 30 days after neoadjuvant therapy initiation. Disease-free survival (DFS) and overall survival (OS) were assessed using the Kaplan–Meier method, and the Cox proportional hazards model was used for multivariate analyses. The pathologic complete response rate of the control group was significantly higher than that of the antibiotic-treated group (29.09% vs. 10.20%, p = 0.017). Further univariate analysis with Kaplan–Meier calculations demonstrated that antibiotic administration was strongly linked with both reduced DFS (p = 0.04) at significant statistical levels and OS (p = 0.088) at borderline statistical levels. Antibiotic administration was identified as a significant independent prognostic factor for DFS [hazard ratio (HR) 3.026, 95%, confidence interval (CI) 1.314–6.969, p = 0.009] and OS (HR 2.836, 95% CI 1.016–7.858, p = 0.047) by Cox proportional hazards model analysis. Antibiotics that initiated reduced efficiency of chemotherapy were more noticeable in the HER2-positive subgroup for both DFS (HR 5.51, 95% CI 1.77–17.2, p = 0.003) and OS (HR 7.0395% CI 1.94–25.53, p = 0.003), as well as in the T3-4 subgroup for both DFS (HR 20.36, 95% CI 2.41–172.07, p = 0.006) and OS (HR 13.45, 95% CI 1.39–130.08, p = 0.025) by stratified analysis. Antibiotic administration might be associated with reduced efficacy of neoadjuvant therapy and poor prognosis in BC patients. As a preliminary study, our research made preparations for further understanding and large-scale analyses of the impact of antibiotics on the efficacy of neoadjuvant therapy.

Prognostic Factors and Survival Outcomes among Patients with Breast Cancer and Brain Metastases at Diagnosis: A National Cancer Database Analysis

Oncology ◽  
2021 ◽  
Vol 99 (5) ◽  
pp. 280-291
Author(s):  
Brittney S. Zimmerman ◽  
Danielle Seidman ◽  
Krystal P. Cascetta ◽  
Meng Ru ◽  
Erin Moshier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Breast Cancer Diagnosis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
National Cancer Database ◽  
Hazards Model ◽  
Sites Of Metastases

Introduction: The aim of this study was to assess for clinicopathologic and socioeconomic features that predict improved survival for patients with advanced breast cancer with synchronous brain metastases at diagnosis. Methods: We utilized the National Cancer Database (NCDB) to identify all patients with brain metastases present at diagnosis, with adequate information on receptor status (ER, PR, Her2), clinical T stage of cT1-4, clinical M1, with 3,943 patients available for analysis. The association between brain metastases patterns and patient/disease variables was examined by robust Poisson regression model. Cox proportional hazards model was used to quantify the associations between overall survival (OS) and these variables. Results: In univariable analysis, OS was significantly associated with the number of sites of metastases (p < 0.0001). Patients with 2 or more additional extracranial sites of metastases had significantly worse OS (median 8.8 months, 95% confidence interval [CI] 7.8, 9.9) than patients with brain metastases only (median OS 10.6 months, 95% CI 9.4, 12.9) or brain metastases plus one other extracranial site of metastases (median OS 13.1 months, 95% CI 11.8, 14.4). Risk factors which predicted poor prognosis included triple-negative disease, high comorbidity score, poorly differentiated tumors, invasive lobular histology, multi-organ involvement of metastases, and government or lack of insurance. Factors which improve survival include younger age and Hispanic race. Discussion/Conclusion: Using a large NCDB, we identified various factors associated with prognosis for patients with brain metastases at the time of breast cancer diagnosis. Insurance status and related socioeconomic challenges provide potential areas for improvement in care for these patients. This information may help stratify patients into prognostic categories at the time of diagnosis to improve treatment plans.

Tamoxifen, hot flashes, and breast cancer recurrence: Support for pharmacogenetics

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 500-500 ◽  
Author(s):  
J. Mortimer ◽  
S. Flatt ◽  
B. Parker ◽  
E. Gold ◽  
J. P. Pierce
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Hot Flashes ◽  
Tumor Stage ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Adjuvant Tamoxifen ◽  
Hazards Model ◽  
Night Sweats

500 Background: Knowledge of the pharmacogenetics of the CYP2D6 enzyme has been shown to correlate with the efficacy of adjuvant tamoxifen. Women who are ‘extensive metabolizers” of CYP2D6 have an improved relapse free survival and experience more hot flashes than women who have impaired metabolism (Goetz, JCO 2005;23:9312–18). We hypothesized that the development of hot flashes on adjuvant tamoxifen was an indicator of drug metabolism and would correlate with a more favorable outcome than women who did not experience hot flashes. Methods: The WHEL trial enrolled 3,088 breast cancer survivors with stages I (T1c)-IIIA breast cancer, within 2–48 months of initial diagnosis, and age < 75 years to either a dietary intervention (n=1,537) or a control group (n=1,551). Data on the primary tumor, cancer treatment, disease status, and quality of life measures were collected at baseline and annually. Bivariate associations of vasomotor symptoms with age, race/ethnicity, menopausal status, cancer stage, ER and PR status, and time since diagnosis were tested using chi-square tests for categorical and t-tests for continuous variables. A left-truncated Cox proportional hazards model tested the association between recurrence-free survival and hot flashes, adjusting for tumor stage and grade and patient age. Women who died without a new breast cancer event were censored at their date of death; those without a new breast cancer event were censored at December 1, 2006 or the date of their most recent self-report of their breast cancer status. Results: The study sample includes 864 women treated with adjuvant tamoxifen 78% who reported hot flashes, and 69% of those reporting hot flashes also reported night sweats; 4% reported night sweats without hot flashes, and 18% reported neither hot flashes nor night sweats. A delayed entry Cox proportional hazards model adjusting for tumor stage and grade showed that those reporting hot flashes had a hazard ratio of 0.51 of recurrence during the follow-up period (95% CI 0.32–0.79) and that hot flashes were more predictive of outcome for tamoxifen treated patients than were age, grade, hormone receptor status, or stage II cancer. Conclusions: Our results contribute to the data that suggest tamoxifen side effects and efficacy may relate to an individual’s pharmacogenetics. No significant financial relationships to disclose.

The effect of delay of adjuvant chemotherapy on survival in patients with resected stage II and III gastric cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15144-e15144
Author(s):  
Minkyu Jung ◽  
Hyoung Soon Park ◽  
Han Na Park ◽  
Seungtaek Lim ◽  
Ji Soo Park ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Stage Ii ◽  
Hazards Model ◽  
Resected Stage

e15144 Background: Adjuvant chemotherapy improved survival in patients with gastric cancer. However, the association between the timing of adjuvant chemotherapy and survival has not been investigated. Methods: Patients with stage II and III gastric cancer who received adjuvant chemotherapy at Yonsei University Health System were included in this study. Time to adjuvant chemotherapy, relapse free survival (RFS), and overall survival (OS) were calculated from the day of surgery. RFS and OS were compared using log-rank test and multivariate analysis by the Cox proportional hazards model. Results: Among 675 patients, 226 patients (33.5%) began adjuvant chemotherapy within 1 month, 421 patients (60.1%) began adjuvant chemotherapy in 1 to 2 months, and 28 patients (4.1%) began adjuvant chemotherapy > 2 months after surgery. Intervals > 2 months between chemotherapy and surgery was associated with worse RFS and OS in both univariate analysis (RFS, p=0.039; OS, p=0.022, respectively) and a Cox proportional hazards model (RFS, hazard ratio [HR] =1.81, 95% confidential interval [CI] =1.05-3.12; OS, HR=1.96, 95% CI=1.11-3.47, respectively). Conclusions: Only 4.1% of patients initiated adjuvant chemotherapy >2 months after the date of curative surgery. Adjuvant chemotherapy delay > 2 months after surgical resection is associated with worse survival among patients with resected stage II and III gastric cancer.

scholarly journals Clinical and Epidemiological Factors Associated with Mortality in Parkinson’s Disease in a Brazilian Cohort

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Gustavo Costa Fernandes ◽  
Mariana Peixoto Socal ◽  
Artur Francisco Schumacher Schuh ◽  
Carlos R. M. Rieder
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Disease Onset ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Epidemiologic Factors ◽  
Hazards Model ◽  
Race Ethnicity

Background. Prognosis of PD is variable. Most studies show higher mortality rates in PD patients compared to the general population. Clinical and epidemiologic factors predicting mortality are poorly understood.Methods. Clinical and epidemiologic features including patient history and physical, functional, and cognitive scores were collected from a hospital-based cohort of PD patients using standardized protocols and clinical scales. Data on comorbidities and mortality were collected on follow-up.Results. During a mean follow-up of 4.71 years (range 1–10), 43 (20.9%) of the 206 patients died. Those who died had higher mean age at disease onset than those still alive at the last follow-up (67.7 years versus 56.3 years;p<0.01). In the univariate analysis, age at baseline was associated with decreased survival. In the adjusted Cox proportional hazards model, age at disease onset and race/ethnicity were predictors of mortality.Conclusions. Late age at disease onset and advanced chronological age are associated with decreased survival. Comorbidities and PD characteristics were not associated with decreased survival in our sample. Race/ethnicity was found in our study to be associated with increased hazard of mortality. Our findings indicate the importance of studying survival among different populations of PD patients.

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