scholarly journals Q and A: A New Standard of Care for Germline BRCA1 and/or BRCA2 Mutation Carriers With Early-Stage Breast Cancer

2022 ◽  
Author(s):  
Neelam V. Desai ◽  
Dana Zakalik ◽  
Mark R. Somerfield ◽  
Nadine M. Tung
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Brca2 Mutation ◽  
Standard Of Care ◽  
Early Stage Breast Cancer ◽  
Mutation Carriers

scholarly journals Prophylactic irradiation to the contralateral breast for BRCA mutation carriers with early-stage breast cancer

2019 ◽  
Vol 30 (3) ◽  
pp. 412-417 ◽  
Author(s):  
E. Evron ◽  
A.M. Ben-David ◽  
H. Goldberg ◽  
G. Fried ◽  
B. Kaufman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Brca Mutation ◽  
Contralateral Breast ◽  
Early Stage Breast Cancer ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
Prophylactic Irradiation

Vascular toxicities of endocrine therapy in early-stage breast cancer: Encouraging observations in a nontrial setting.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 68-68
Author(s):  
Susan Faye Dent ◽  
Freya L. Crawley ◽  
Nadine A. Graham ◽  
Michelle M. Campbell
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Life Experience ◽  
Early Stage ◽  
Real Life ◽  
Standard Of Care ◽  
T Test ◽  
Early Stage Breast Cancer ◽  
Cancer Center ◽  
Increased Risk

68 Background: Endocrine therapy (ET) is the standard of care for postmenopausal (PM) women with early stage breast cancer (EBC). Studies suggest higher risk of vascular toxicities (VT) on aromatase inhibitor (AI) therapy. We report incidence/discontinuation rates of VTs in a cardiac clinic. Methods: PM women with hormone receptor positive EBC treated with ET (tamoxifen (T) ± AI) at Ottawa Hospital Cancer Center 01/99-2/06. Data included: demographics, vascular co-morbidities (VCM), ET, duration, VTs. Results: 626 pts, median age 59 years (r: 30-92), median follow-up 98 months (m), stage: I (196 pts), II (341 pts) III (89 pts) EBC. Majority (52.5%) pts had VCM at ET initiation; hypertension (HTN) (36%), hyperlipidemia (HYLP) (17%), coronary disease (12%), thrombosis (9%), angina (6%) TIA (6%). Treatment discontinued due to VT 3x more with T vs. AI. Most common VTs: edema, arrhythmias (ARR), cardiovascular (CVS) event, and HYLP. With Letrozole and T, previous VCM significantly increased risk of developing VT (chi-square: P=0.022 and 0.009). Time to develop VT shortest for T and exemestane. Previous VCM did not affect this interval. Longer exposure to T correlated with higher VT rate (t-test: p=0.046) not seen with AIs. Exposure to multiple AIs associated with higher VT rate (t-test: p=0.009). Conclusions: This cohort study reports similar VT rates with AI therapy as reported in the literature. T was associated with higher discontinuation rates (10.5%) due to VTs compared to AIs (2.8-3.3%). Longer duration of AI therapy was not associated with increased risk of VTs. These encouraging results reflect the real-life experience of women exposed to ET. [Table: see text]

The relationship between treatment intensity and characteristics of patients with early-stage breast cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 125-125
Author(s):  
Jeffrey Franks ◽  
Nicole Caston ◽  
Courtney Williams ◽  
Andres Azuero ◽  
Monica S. Aswani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
High Intensity ◽  
Early Stage ◽  
Standard Of Care ◽  
Early Stage Breast Cancer ◽  
Treatment Intensity ◽  
Low Intensity ◽  
Her2 Breast Cancer ◽  
To Receive

125 Background: Clinical trials are used to generate standard-of-care, yet often do not reflect patient populations treated in real-world settings. Elderly patients or patients of color who are often underrepresented in trials, which may impact what types of treatments are prescribed. This study examines how patient characteristics are associated with treatment intensity in early stage breast cancer. Methods: This retrospective cross-sectional study included women with a stage I-III breast cancer from American Society of Clinical Oncology’s CancerLinQ database treated by chemotherapy from 2005-2019. Seven standard-of-care regimens were characterized by intensity. For patients with ER+/- HER2- breast cancer, low-intensity regimens were Taxol and Cyclophosphamide or Adriamycin and Cyclophosphamide; while Taxol, Adriamycin, and Cyclophosphamide was considered high intensity. For patients with HER2+ breast cancer, the low intensity regimen was Taxol and Herceptin; while Adriamycin and Cyclophosphamide followed by Taxol and Herceptin; Taxol, Carboplatin, and Herceptin; or Taxol, Carboplatin, Herceptin, and Pertuzumab were considered high intensity. A model estimating the likelihood of intensity was calculated using log-binomial regression, in order to produce relative risks. The models were adjusted for patient demographics and cancer stage. Results: Of 24,383 patients, 51% had ER+HER2-, 20% ER-HER2-, and 29% HER2+ breast cancer. Most patients were White (60%), age 40-69 (80%), had stage II breast cancer (39%), and received higher intensity treatment (65%). Adjusted for the other covariates, patient who were Black were more likely to receive high-intensity treatment than patients who were White (61% vs 58%; RR 1.05, 95%CI 1.02-1.06. Additionally, older adults were more likely to receive low-intensity treatment, with 42% of patients over 70 receiving low intensity treatment, and 29% of patients between the ages 40 and 69 received low intensity treatment (RR 1.5, 95% CI 1.44 -1.54). Conclusions: Differences in treatment intensity were observed for patients with differing demographic characteristics. Further research is needed to determine lack of representation in clinical trials impacts on prescribing patterns, regimen intensity, and survival.

Oncotype Dx analysis in early stage breast cancer (BC) in BRCA mutation carriers versus non-carriers.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e12065-e12065
Author(s):  
Maryam Nemati Shafaee ◽  
Heather Y. Lin ◽  
Angelica Gutierrez Barrera ◽  
Banu Arun
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Brca Mutation ◽  
Oncotype Dx ◽  
Early Stage Breast Cancer ◽  
Mutation Carriers ◽  
Brca Mutation Carriers

scholarly journals Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice

2021 ◽  
Author(s):  
Chirag Shah ◽  
Zahraa Al-Hilli ◽  
Frank Vicini
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Standard Of Care ◽  
Early Stage Breast Cancer ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Duration Of Treatment ◽  
Regional Lymph Nodes ◽  
Cancer Radiotherapy ◽  
Breast Cancer Radiotherapy

Radiation therapy (RT) is an essential component in the management of breast cancer. Following breast-conserving surgery (BCS), adjuvant RT is the standard of care for most patients. Traditionally, RT was delivered with standard whole breast irradiation (WBI) over 5-7 weeks following BCS. However, WBI regimens have evolved; hypofractionated WBI now represents the standard approach, reducing the duration of treatment to 3-4 weeks. Over the past year, five-fraction WBI regimens have also emerged as standard of care for some patients based on data from the FAST and FAST-Forward trials. An alternative to WBI that is also available for patients with early-stage breast cancer following BCS is partial breast irradiation, which can reduce the duration of treatment and the volume of breast tissue irradiated. Outcomes from multiple randomized trials with over a 10-year follow-up have demonstrated the safety and efficacy of partial breast irradiation approaches. Single-fraction intraoperative RT has also been evaluated in two prospective trials although the outcomes available, as well as current guidelines, do not support its utilization outside of prospective studies. For patients requiring RT to the regional lymph nodes, data have demonstrated the safety of hypofractionated approaches for those undergoing BCS or mastectomy without reconstruction. Future directions for early-stage breast cancer radiotherapy include the study of even shorter regimens and studies evaluating the omission of RT versus omission of endocrine therapy for favorable-risk patients. Furthermore, studies are also underway evaluating shorter courses of radiation in patients undergoing breast reconstruction and the use of tumor genomics to identify appropriate patients for omission of radiation with limited nodal involvement.

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