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  • 1
    Electronic Resource
    Electronic Resource
    A Roundtable Discussion of Aromatase Inhibitors as Therapy for Breast Cancer (2003)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 9 (2003), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  This article summarizes the conclusions of a meeting of diverse breast cancer experts who discussed issues, controversies, and new clinical trial results relevant to the use of aromatase inhibitors for treating postmenopausal women with breast cancer. The new generation of aromatase inhibitors (anastrozole, letrozole, exemestane) have largely replaced megestrol acetate as a second-line therapy in postmenopausal women with hormone-responsive advanced breast cancer. In addition, anastrozole and letrozole have been shown to be superior to tamoxifen for first-line therapy. Finally, recent results suggest that anastrozole may be superior to tamoxifen as adjuvant therapy for early stage disease in postmenopausal women with hormone-responsive disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2003.09305.x
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  • 2
    Electronic Resource
    Electronic Resource
    Response to Induction Chemotherapy in Black and White Patients with Locally Advanced Breast Cancer (2000)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 6 (2000), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Black women with breast cancer have significantly poorer survival rates, a more advanced stage distribution, and are diagnosed at younger ages compared to white patients in the United States. We evaluated tumor response and survival with respect to race and age after induction chemotherapy. The study population consisted of 303 patients (229 white, 74 black) registered in two prospective trials of induction chemotherapy for locally advanced breast cancer [stage II (T 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ99071:ges" location="ges.gif"/〉 4 cm), stage III (noninflammatory), and stage IV (supraclavicular lymph node involvement only)] between 1989 and 1996. Chemotherapy regimens utilized 5-fluorouracil, cyclophosphamide, and doxorubicin (FAC). Response was defined as complete (CR, no clinical/radiographic detectable disease), partial (PR, 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ99071:ges" location="ges.gif"/〉50% reduction in disease), minor (MR, 〈50% reduction), no change (NC), or progressive disease (PD). Median follow-up was 58 months; survival was calculated using the Kaplan–Meier method. There was no significant difference in age at presentation (54% of black patients compared to 58% of white patients 〈50 years of age). The black patients had significantly more advanced stages of disease at diagnosis (50% of black patients compared to 30% of white patients with stage IIIB disease; p = 0.03). For both age groups together, tumor response, 5-year overall survival (OS), and 5-year disease-free survival (DFS) rates were similar between the black and white patients. A trend was noted that the younger black patients were more likely to have a clinical CR or PR; this did not translate into a survival advantage. Despite the more advanced stage distribution for black women with breast cancer, induction chemotherapy yields high response rates (especially for younger black patients) and survival rates equivalent to white patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2000.99071.x
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  • 3
    Electronic Resource
    Electronic Resource
    Inflammatory Breast Cancer: Clinical Features and the Role of Multimodality Therapy (1996)
    Oxford, UK : Blackwell Publishing Ltd
    The @breast journal 2 (1996), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1524-4741.1996.tb00119.x
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  • 4
    Electronic Resource
    Electronic Resource
    Hormonal Therapy in Early and Advanced Breast Cancer (2004)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 10 (2004), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  While some of the most intriguing data on the development of hormonal therapy for breast cancer have come from studies on aromatase inhibitors (AIs), few trials have compared these agents directly, with the exception of the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial. Based on the latest results from this trial and on previous investigations of other AIs, a proposed sequence of hormonal therapies (including anastrozole, tamoxifen, letrozole, fulvestrant, and megestrol acetate) for the treatment of breast cancer is beginning to emerge for various patient populations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1524-4741.2004.101S7.x
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  • 5
    Electronic Resource
    Electronic Resource
    Fluorouracil, Doxorubicin, and Cyclophosphamide Followed by Tamoxifen as Adjuvant Treatment for Patients with Stage IV Breast Cancer with No Evidence of Disease (2002)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 8 (2002), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We conducted a single-institution study to determine whether local therapy plus six cycles of chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) followed by 5 years of tamoxifen is superior to local treatment alone in terms of disease-free survival (DFS) and overall survival (OS) in patients with stage IV breast cancer with no evidence of disease (stage IV-NED breast cancer). Patients with breast cancer were eligible if they had histologic proof of a locoregional or distant recurrence that had been curatively resected, irradiated, or both and had no other evidence of disease. Patients who had received prior anthracycline therapy were not eligible. All patients received six cycles of intravenous FAC, with cycles repeated every 3 weeks. After completion of chemotherapy, patients whose tumors had not previously demonstrated resistance to tamoxifen and had positive or unknown estrogen receptor status received tamoxifen 20 mg by mouth daily for 5 years. Patients in this study were compared with a historical control population (patients with stage IV-NED breast cancer who never received systemic therapy) as well as with the patients in two previously reported trials of chemotherapy for stage IV-NED disease. Forty-seven patients were registered, but only 45 were evaluable. There was a highly statistically significant difference ( p 〈 0.001) in OS and DFS among the four groups, with patients in our most recent study having the best OS and DFS at 3 years compared with the control group (84% vs. 55% and 66% vs. 11%, respectively). When patients in all four groups were analyzed together in search of prognostic factors, we found that patients whose primary tumors had negative axillary lymph nodes had a statistically significant improvement in OS and DFS (p 〈 0.01) compared with patients with positive axillary lymph nodes. No survival differences were found between patients with positive and those with negative hormone receptor status. This study demonstrates a benefit in terms of OS and DFS for patients with stage IV-NED breast cancer who receive doxorubicin-based adjuvant chemotherapy. The benefit was greater on patients with node-negative primary tumors. In patients with stage IV-NED disease, doxorubicin-based chemotherapy should be considered standard treatment after adequate local control is achieved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2002.08002.x
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  • 6
    Electronic Resource
    Electronic Resource
    The Impact of Hormone Receptor Status on the Clinical Efficacy of the New-Generation Aromatase Inhibitors: A Review of Data from First-Line Metastatic Disease Trials in Postmenopausal Women (2004)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 10 (2004), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  Hormone receptor status has long been considered important in predicting the efficacy of endocrine agents for the treatment of breast cancer. We aim to address whether hormone receptor status influences treatment outcome in postmenopausal women receiving aromatase inhibitors for advanced breast cancer. We include data from three phase III clinical trials, comparing the activity of the new-generation aromatase inhibitors, anastrozole or letrozole, with tamoxifen as a first-line treatment. For both agents, a significant relationship was observed between hormone receptor status and time to disease progression (TTP), with increased TTP seen in patients with a higher confirmed percentage of estrogen receptor (ER)- and/or progesterone receptor (PR)-positive tumors. A relationship between objective response rate (complete or partial response) or clinical benefit (complete or partial response or stabilization for ≥24 weeks) and hormone receptor status was apparent for anastrozole but not letrozole treatment. Overall these data confirm that hormone receptor status should be a strong consideration in the selection of endocrine treatment for postmenopausal women with advanced breast cancer. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1075-122X.2004.21320.x
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  • 7
    Electronic Resource
    Electronic Resource
    Efficacy of Anastrozole in a Consecutive Series of Advanced Breast Cancer Patients Treated with Multiple Prior Chemotherapies and Endocrine Agents: M. D. Anderson Cancer Center Experience (1999)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 5 (1999), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: ▪ Abstract: Anastrozole is a highly selective, nonsteroidal aromatase inhibitor approved by the U.S. Food and Drug Administration (FDA) in January 1996 for the treatment of advanced breast cancer in postmenopausal women with disease progression following tamoxifen therapy. To date, information on anastrozole’s use has been limited to breast cancer patients with minimal prior therapy. The purpose of this review was to determine, in clinical practice, the benefits of anastrozole in advanced breast cancer patients treated with multiple prior cytotoxic and endocrine therapies. This was a retrospective review of a consecutive series of 117 patients who received anastrozole after marketing in January 1996. As this was not a prospective study, rigorous response criteria could not be applied. Responses were categorized as improvement in disease (ID), stable disease (SD), or progressive disease (PD). One hundred eight patients were evaluable for response with a median age of 61 years and the number of prior therapies ranging from one to nine. Response, defined as improvement of disease or stable disease 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ98055:ges" location="ges.gif"/〉8 weeks, was seen in 59% of patients. Patients with three or more prior endocrine therapies demonstrated a 61% response (ID + SD) and patients with ER-negative tumors demonstrated 50% response. Patients with prior aminoglutethamide therapy exhibited similar response rates to the overall group. One male patient received anastrozole without benefit. This data determines the activity of anastrozole even in heavily pretreated patients and suggests that patients who have tumors that are ER-negative may also benefit from anastrozole therapy. ▪
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.1999.98055.x
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  • 8
    Electronic Resource
    Electronic Resource
    Aggressive therapy for locoregional recurrence after mastectomy in stage II and III breast cancer patients (1996)
    Springer
    Annals of surgical oncology 3 (1996), S. 162-168 
    Details
    ISSN: 1534-4681
    Keywords: Locoregional recurrence ; Mastectomy ; Breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: To determine if aggressive treatment of locoregional recurrence affects survival, we retrospectively analyzed the clinical outcome of 69 breast cancer patients who developed locoregional disease as their first episode of recurrence following mastectomy and adjuvant chemotherapy. Methods: Patients were identified from among 1,707 stage II and III breast cancer patients who enrolled in five different doxorubicin-based adjuvant chemotherapy protocols at The University of Texas M. D. Anderson Cancer Center from 1975 to 1986. Sixty-nine evaluable patients who had a locoregional recurrence as the first site of relapse after mastectomy formed the study group. Multifactorial analysis of clinical and histopathological characteristics of both the primary tumor and the subsequent recurrence was performed using a logistic regression method. Survival analysis was performed using an actuarial life-table method calculated from the date of registration into the adjuvant therapy protocols. Results: Median follow-up was 6.6 years. Two factors significantly affected survival: recurrence of disease during or after adjuvant treatment of the primary and whether the patient was rendered disease free after recurrence. Conclusions: Stage II and III breast cancer patients who have locoregional recurrence after adjuvant chemotherapy and can be rendered disease free may have a better survival rate. Aggressive treatment of locoregional recurrence including complete surgical excision should be considered in this subgroup of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02305796
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  • 9
    Electronic Resource
    Electronic Resource
    Prognostic Implications of Pathological Lymph Node Status After Preoperative Chemotherapy for Operable T3N0M0 Breast Cancer (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 435-440 
    Details
    ISSN: 1534-4681
    Keywords: Prognostic factor ; Axillary lymph node dissection ; Preoperative chemotherapy ; Locally advanced breast cancer.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Although preoperative chemotherapy has become the standard of care for inoperable locally advanced breast cancer, its role for downstaging resectable primary tumors is still evolving. The purpose of this study was to determine whether the prognostic information from an axillary node dissection in patients with clinical T3N0 breast cancer was altered by preoperative chemotherapy compared with surgery de novo. Methods: Between 1976 and 1994, 91 patients with clinically node-negative operable T3 breast cancer received doxorubicin-based combination chemotherapy on protocol at one institution. Fifty-three patients received both preoperative and postoperative chemotherapy (PreopCT), and 38 received postoperative chemotherapy only (PostopCT). All patients underwent axillary lymph node dissection as part of their definitive surgical treatment. There were no differences between the PreopCT and PostopCT groups in median age (51 vs. 49 years), median tumor size at presentation (6 cm vs. 6 cm), tumor grade, or estrogen receptor status (estrogen receptor negative 38% vs. 32%). The median follow-up time was 7 years. Results: Patients in the PreopCT group had fewer histologically positive lymph nodes (median, 0 vs. 3, P 〈 .01), and a lower incidence of extranodal extension (19% vs. 42%, P 5 .02). By univariate analysis, the number of pathologically positive lymph nodes (P 〈 .01) and extranodal extension (P 〈 .01) were predictors of disease-specific survival in PreopCT patients. Multivariate analysis showed that extranodal extension was the only independent prognostic factor in PreopCT patients (P 〈 .01). Overall, PreopCT and PostopCT patients had similar 5-year disease-free survival rates (66% vs. 57%); however, PreopCT patients had worse disease-free (P 5 .01) and diseasespecific survival (P 5 .04) when survival was compared after adjustment for the number of positive lymph nodes. Furthermore, PreopCT patients with 4–9 positive lymph nodes had a lower 5-year disease-free survival rate than PostopCT patients with 4–9 positive nodes (17 vs. 48%, P 5 .04). Conclusions: Axillary lymph node status remains prognostic after chemotherapy. Pathologically positive lymph nodes after preoperative chemotherapy are associated with a worse prognosis than the same nodal status before chemotherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0435-9
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  • 10
    Electronic Resource
    Electronic Resource
    Effectiveness of mastectomy by response to induction chemotherapy for control in inflammatory breast carcinoma (1997)
    Springer
    Annals of surgical oncology 4 (1997), S. 452-461 
    Details
    ISSN: 1534-4681
    Keywords: Inflammatory breast carcinoma ; Local recurrence ; Chemotherapy ; Mastectomy ; Radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Controversy exists as to the treatment regimen necessary to best provide optimal local control for inflammatory breast carcinoma (IBC). This study was conducted to determine if mastectomy combined with radiotherapy offered any advantages over radiotherapy alone in patients with IBC who had been treated with doxorubicin-based combination chemotherapy. Methods: A retrospective review of 178 women treated for IBC on doxorubicin-based multimodality therapy protocols between January 1974 and September 1993 was performed. Clinical and histologic response to treatment, time to local recurrence, survival, and ultimate control of local disease were analyzed. Kaplan-Meier analysis was used to examine survival and relapse times, and Fisher's exact test was used to test differences in treatment outcomes. Significance was determined at p≤0.05. Results: Median follow-up was 89 months (range 22 to 223 months). Locoregional disease persisted in seven patients and recurred in 44 patients who had been rendered disease free at a median time of 10 months. The mortality rate after a local recurrence (LR) was 98%, and all patients but one with LR developed systemic metastases. Response to induction chemotherapy influenced the incidence of LR, and the amount of residual disease found on histologic examination of mastectomy specimens was highly prognostic for local failure. Patients who underwent mastectomy in addition to radiotherapy had a lower incidence of LR than did patients who received radiotherapy alone (16.3% vs. 35.7%, p=0.015). Conclusions: The addition of mastectomy to combination chemotherapy plus radiotherapy improved local control in patients with IBC. The addition of mastectomy to chemotherapy plus radiotherapy improved distant disease-free and overall survival in patients with a clinical complete or partial response to induction chemotherapy. Patients who had no significant response to induction chemotherapy received no survival or local disease-control benefit from the addition of mastectomy to their treatment regimen. These patients should be considered for entry into clinical trials of new treatment regimens.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303668
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