scholarly journals Comparative Toxicity and Effectiveness of Trastuzumab-Based Chemotherapy Regimens in Older Women With Early-Stage Breast Cancer

2017 ◽  
Vol 35 (29) ◽  
pp. 3298-3305 ◽  
Author(s):  
Katherine E. Reeder-Hayes ◽  
Anne Marie Meyer ◽  
Sharon Peacock Hinton ◽  
Ke Meng ◽  
Lisa A. Carey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Adverse Events ◽  
Older Patients ◽  
Early Stage ◽  
The United States ◽  
Health Care Use ◽  
Significant Shift ◽  
Serious Adverse Events ◽  
Adjuvant Trastuzumab

Purpose The combination of chemotherapy and trastuzumab is the standard of care for adjuvant treatment of human epidermal growth factor receptor 2–positive breast cancer. Two regimens have been widely adopted in the United States: doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab (ACTH) and docetaxel, carboplatin, and trastuzumab (TCH). No head-to-head comparison of these regimens has been conducted in a clinical trial, and existing trial data have limited generalizability to older patients. Methods We used SEER-Medicare data from 2005 to 2013 to compare outcomes of ACTH versus TCH among patients age older than 65 years. Propensity score matching was used to balance cohort characteristics between treatment arms. Outcomes included toxicity-related hospitalization, survival, and trastuzumab completion. Data from 1,077 patients receiving ACTH or TCH were analyzed, and the propensity-matched subsample included 416 women. Results There was a significant shift toward TCH over time, with 88% of patients receiving ACTH in 2005 compared with 15% by 2011. Among propensity score–matched patients, we found no difference between regimens in health care use overall or for chemotherapy-related adverse events (ACTH, 34% v TCH, 36.5%; P = .46). Patients receiving TCH were significantly more likely to complete trastuzumab (89% v 77%; P = .001). There was no difference in 5-year breast cancer–specific survival (ACTH, 92% v TCH, 96%; hazard ratio, 2.08; 95% CI, 0.90 to 4.82) or overall survival. Conclusion Among a matched sample of older patients, ACTH compared with TCH was not associated with a higher rate of serious adverse events or hospitalizations, but it was associated with less completion of adjuvant trastuzumab. We did not detect a difference in 5-year survival outcomes for ACTH compared with TCH. In the context of limited evidence in older patients, selection between these two regimens on the basis of concerns about differential toxicity or efficacy may not be appropriate.

scholarly journals Duration and Toxicity of Adjuvant Trastuzumab in Older Patients With Early-Stage Breast Cancer: A Population-Based Study

2014 ◽  
Vol 32 (9) ◽  
pp. 927-934 ◽  
Author(s):  
Ines Vaz-Luis ◽  
Nancy L. Keating ◽  
Nancy U. Lin ◽  
Huichuan Lii ◽  
Eric P. Winer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Older Patients ◽  
Early Stage ◽  
Treatment Completion ◽  
Early Stage Breast Cancer ◽  
Cardiac Events ◽  
Adjuvant Trastuzumab ◽  
Comorbidity Score ◽  
Days Of Therapy

Purpose Few data are available regarding adjuvant trastuzumab use in older women with early-stage breast cancer. We examined rates and predictors of adjuvant trastuzumab completion and cardiac events in this population. Patients and Methods We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify patients age ≥ 66 years with stage I to III breast cancer diagnosed between 2005 and 2009 who received trastuzumab. Completion of trastuzumab was defined as receipt of more than 270 days of therapy. We used multivariable logistic regression to examine patient, clinical, and geographic characteristics associated with trastuzumab completion. We also examined rates of hospital admissions for cardiac events. Results Among 2,028 women, most (71.2%) were younger than age 76 years and had a comorbidity score of 0 (66.8%); 85.2% received trastuzumab with chemotherapy. Overall, 1,656 women (81.7%) completed trastuzumab. Older patients and those with more comorbidity had lower odds of treatment completion (odds ratio [OR], 0.40 [95% CI, 0.30 to 0.55] for age ≥ 80 years v age 66 to 70 years; OR, 0.65 [95% CI, 0.49 to 0.88] for comorbidity score of 2 v 0). During treatment, 73 patients (3.6%) were hospitalized for cardiac events (2.6% of those who completed trastuzumab v 8.1% of those who did not; P < .001). Conclusion Most older patients who initiated adjuvant trastuzumab completed therapy. Age and comorbidity were among factors that were associated with treatment completion, and rates of significant cardiac events were higher in those who did not complete therapy. Further exploration of toxicities and optimal treatments for older women with human epidermal growth factor receptor 2–positive breast cancer are warranted.

Evaluating the association between adjuvant chemotherapy and function-related adverse events among older patients with early stage breast cancer

2017 ◽  
Vol 8 (4) ◽  
pp. 242-248 ◽  
Author(s):  
Caroline Mariano ◽  
Jennifer L. Lund ◽  
Sharon Peacock Hinton ◽  
Phyo Htoo ◽  
Hyman Muss ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Adverse Events ◽  
Older Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
And Function

scholarly journals ReCAP: Treatment Patterns and Cost of Care Associated With Initial Therapy Among Patients Diagnosed With Operable Early-Stage Human Epidermal Growth Factor Receptor 2-Overexpressed Breast Cancer in the United States: A Real-World Retrospective Study

2016 ◽  
Vol 12 (2) ◽  
pp. 159-160 ◽  
Author(s):  
Stacey DaCosta Byfield ◽  
Philip O. Buck ◽  
Cori Blauer-Peterson ◽  
Sara A. Poston ◽  
Stacey DaCosta Byfield ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Health Care ◽  
Targeted Therapy ◽  
Early Stage ◽  
Growth Factor Receptor ◽  
The United States ◽  
Treatment Patterns ◽  
Health Care Use ◽  
Her2 Breast Cancer

QUESTION ASKED: This study assessed real-world treatment patterns, health care use, and costs associated with initial treatment of resected nonmetastatic human epidermal growth factor receptor 2–overexpressing (HER2+) breast cancer in the United States. SUMMARY ANSWER: Although trastuzumab-based therapy is considered standard of care among patients with HER2+ early-stage breast cancer, approximately 28% of these patients did not receive HER2-targeted therapy; in addition, receipt of HER2-targeted therapy differed by hormone receptor status. METHODS: Oncology registry data linked to a large US commercial administrative claims database were used to identify and examine treatment patterns, health care use, and costs of commercially insured patients with operable HER2+ breast cancer during the initial phase of care. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Claims data are appropriate for evaluating treatment patterns and health care costs; however, they typically lack important clinical information (eg, history of cardiac disease) that may influence treatment decisions and, ultimately, study outcomes. The follow-up period for many patients was censored, which limited the ability to determine when the initial phase of care should be considered completed. Also, newer therapies may not have been adequately captured. For example, pertuzumab was approved for neoadjuvant use after the end of the study period. Finally, the results of this study are limited to the patient sample examined and may not be generalizable to other populations such as patients older than 65 years, those with no or different types of insurance coverage, or patients outside the United States. REAL-LIFE IMPLICATIONS: Although HER2-targeted therapy is the standard of care for patients with HER2+ breast cancer, HER2-based therapy may be underused among patients with nonmetastatic HER2+ breast cancer in the United States. [Table: see text]

scholarly journals Adjuvant trastuzumab regimen for HER2-positive early-stage breast cancer: a systematic review and meta-analysis

2019 ◽  
Vol 12 (8) ◽  
pp. 815-824 ◽  
Author(s):  
Anne Julienne Genuino ◽  
Usa Chaikledkaew ◽  
Due Ong The ◽  
Thanyanan Reungwetwattana ◽  
Ammarin Thakkinstian
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Early Stage ◽  
Meta Analysis ◽  
Early Stage Breast Cancer ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab

scholarly journals Ampicillin-Ceftriaxone vs Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score–Matched, Retrospective Cohort Analysis

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Niyati H Shah ◽  
Kathleen A Shutt ◽  
Yohei Doi
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Adverse Events ◽  
Cohort Analysis ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Aminoglycoside Resistance ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen for enterococcal infective endocarditis (EIE) with reduced toxicity compared with ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated death in the United States is limited. Methods We conducted a retrospective, propensity score–matched cohort analysis of EIE patients treated with AC or AG between 2010 and 2017 at 3 hospitals in Pittsburgh, Pennsylvania. We assessed all-cause 90-day mortality as the primary outcome and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher with AC than AG (21% vs 8%; P = .02). After propensity score matching, 56 patients in each group remained for the outcomes analysis. Documented aminoglycoside resistance, presence of annular or aortic abscess, and complete pacemaker removal were the significantly different variables between the 2 matched cohorts. We observed no statistically significant difference in 90-day mortality between the 2 treatment groups (11% vs 7%; P = .55). Adverse events were more common in patients treated with AG (25 vs 39; P = .0091), and more patients in the propensity score–matched AG cohort switched antibiotic regimens than in the AC group (10% vs 49%; P &lt; .0001). Conclusions Patients treated with AC demonstrate no significant differences in mortality, treatment failure, or bacteremia relapse compared with AG in a propensity score–matched EIE cohort.

Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer

JAMA Oncology ◽  
2021 ◽  
Author(s):  
Rachel A. Freedman ◽  
Christina A. Minami ◽  
Eric P. Winer ◽  
Monica Morrow ◽  
Alexander K. Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Surveillance Mammography

scholarly journals Descriptive analysis of 192 cases of breast cancer occurring before age 40 in Yaounde, Cameroon

2017 ◽  
Vol 6 (7) ◽  
pp. 2704 ◽  
Author(s):  
Félix Essiben ◽  
Pascal Foumane ◽  
Esther JNU Meka ◽  
Michèle Tchakounté ◽  
Julius Sama Dohbit ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Descriptive Analysis ◽  
Survival Rates ◽  
The United States ◽  
Therapeutic Modalities ◽  
History Of ◽  
Case Files ◽  
Common Histological Type

Background: Breast cancer is today a global health problem. With 1,671,149 new cases diagnosed in 2012, it is the most common female cancer in the world and accounts for 11.9% of all cancers and it affects more people than prostate cancer. In 2008, The United States statistics showed that, for all cancer that affect women before 40 years, more than 40% of them concerned the breast. The aim of this study was to describe the clinical, histopathological and therapeutic aspects of breast cancer in women under 40 years of age in Yaoundé.Methods: This was a retrospective study with data collected from 192 medical case files of women treated over a period of 12 years, from January 2004 to December 2015 at the Yaounde General Hospital and the Yaounde Gyneco-Obstetric and Pediatric Hospital. Microsoft Epi Info version 3.4.5 and SPSS version 20.0 softwares were used for data analysis.Results: From 2004 to 2015, 1489 cases of breast cancer were treated in both hospitals. Of these, 462 women were less than 40 years old, representing a proportion of 31.0%. The mean age at diagnosis was 33.5±5.0 years and 17.7% of women had a family history of breast cancer. The average time before an initial consultation was 6.7±6.6 months.  Most cases were classified as T4 (46.1%). The most common histological type was ductal carcinoma (87.4%). Grades SBR II and SBR III were predominant (76.4%). Axillary dissection (64.4%) and neoadjuvant chemotherapy (43.9%) were the main therapeutic modalities. The overall survival rate at 5 years was 51.2%. Five-year survival rates with no local recurrence and no metastatic occurrence were 35.8% and 43.2% respectively.Conclusions: Breast cancer largely affects women under the age of 40 and is often discovered late, at an advanced stage. The prognosis appears poor. Only screening could facilitate diagnosis at an early stage of the disease for better outcomes.

Serious Adverse Events Reported with Dietary Supplement Use in the United States: A 2.5 Year Experience

2018 ◽  
Vol 17 (2) ◽  
pp. 227-248 ◽  
Author(s):  
Stephen M. Schmitz ◽  
Hector L. Lopez ◽  
Douglas Mackay ◽  
Haiuyen Nguyen ◽  
Paula E. Miller
Keyword(s):  
United States ◽  
Adverse Events ◽  
Dietary Supplement ◽  
The United States ◽  
Serious Adverse Events ◽  
Supplement Use ◽  
Dietary Supplement Use

Breast-Conserving Therapy is Associated with Better Survival than Mastectomy in Early-Stage Breast Cancer: A Propensity Score Analysis

2021 ◽  
Author(s):  
Jiali Ji ◽  
Shushu Yuan ◽  
Jiawei He ◽  
Hong Liu ◽  
Lei Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Cancer Patients ◽  
Propensity Score Analysis ◽  
Early Stage ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Kaplan Meier ◽  
Score Analysis

Abstract Background: Recent retrospective studies have reported that breast-conserving therapy (BCT) led to improved overall survival (OS) than mastectomy in some populations. We aimed to compare the efficacy of BCT and mastectomy using the SEER database. Methods: Between 2010 and 2015, 99,790 eligible patients were identified. We included early-stage breast cancer patients with 5cm or smaller tumors and three or fewer positive lymph nodes in our study. We compared the OS results among patients with BCT and mastectomy. Kaplan-Meier plots, Cox proportional hazard regressions were used to evaluate the outcomes. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. Results: In our study, 77,452 (77.6%) patients underwent BCT and 22,338 (22.4%) underwent mastectomy. The 5-year OS rate was 94.7% in the BCT group and 87.6% in the mastectomy group (P <0.001). After matching, multivariate analysis in the matched cohort showed that women underwent mastectomy was associated with worse OS results compared with those with BCT (Hazard ratio (HR) = 1.628; 95% confidence intervals (CIs) = 1.445- 1.834, P<0.001). Patients with different subtypes and age group (>50 years old; ≤50 years old) received BCT all showed significantly better OS than those received mastectomy. The effect of surgery choice on survival was the same in matched and all cohorts. Conclusions: Our study showed that BCT was associated with improved survival compared with mastectomy in early-stage breast cancer patients. It seems advisable to encourage patients to receive BCT rather than mastectomy in early-stage patients when feasible and appropriate.

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