Intermuscular fat density as a novel prognostic factor in breast cancer patients treated with adjuvant chemotherapy

Purpose

In the KATHERINE study (NCT01772472), patients with HER2-positive early breast cancer (EBC) and residual invasive disease after neoadjuvant chemotherapy plus HER2-targeted therapy who were treated with adjuvant trastuzumab emtansine (T-DM1) had a 50% reduction in the risk of an invasive disease-free survival (IDFS) event compared to patients treated with adjuvant trastuzumab. In metastatic disease, T-DM1 has resulted in higher rates of thrombocytopenia in Asian versus non-Asian patients. Here, we report safety and efficacy in Chinese patients from KATHERINE.

Methods

Patients with HER2-positive EBC and residual invasive disease after taxane- and trastuzumab-containing neoadjuvant chemotherapy followed by surgery were randomized 1:1 to 14 cycles of adjuvant T-DM1 or trastuzumab. The primary endpoint was time to an IDFS event.

Results

Among Chinese patients (T-DM1 n?=?51, trastuzumab n?=?50), T-DM1 treatment resulted in a 43% reduction in risk of an IDFS event compared to trastuzumab (HR?=?0.57; 95% CI 0.25–1.31), with similar results for secondary endpoints. As in the global population, Chinese patients receiving T-DM1 versus trastuzumab had more grade?≥?3 adverse events (AEs; 39.2% versus 4.1%) and AEs leading to treatment discontinuation (27.5% versus 0%). The most common grade?≥?3 AE with T-DM1 was thrombocytopenia (21.6%), a frequency higher than the frequency in the global population (5.7%). Grade?≥?3 hemorrhage was reported in 1 patient (T-DM1 arm).

Conclusions

In the KATHERINE study, T-DM1 demonstrated increased efficacy compared to trastuzumab in Chinese patients. Consistent with previous data in Asian patients, T-DM1 was associated with more grade?≥?3 AEs, and AEs leading to discontinuation, which was driven by an increase in thrombocytopenia.

     

Brief relaxation training is associated with long-term endocrine therapy adherence among women with breast cancer: post hoc analysis of a randomized controlled trial

Purpose

Despite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their breast cancer (BCa). Prior research has demonstrated that emotional distress is a barrier to AET adherence. We followed women from a trial to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT), and relaxation training versus an attention-matched health education control, on AET adherence.

Methods

We conducted a long-term follow-up (median?=?8 years) of women randomized to CBT, relaxation training, or health education after surgery for stage 0–3 BCa. We measured adherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ). First, we established factors on the ETMUQ via confirmatory factor analysis. We then used Bayesian structural equation modeling to regress these factors on study arm, controlling for age and treatments received.

Results

Of those who completed long-term follow-up (n?=?59, 44.7%), over half (n?=?33; 55.9%) reported problems with adherence generally. Women receiving relaxation training (n?=?15) had better adherence than those receiving health education (n?=?24) on the Forgetfulness/Inconsistency [B(SE)?=?0.25(0.14), p?=?0.049] and Intentional Nonadherence [B(SE)?=?0.31(0.14), p?=?0.018] factors of the ETMUQ. Similar results were observed for those receiving relaxation training compared to CBT (n?=?20): Forgetfulness/Inconsistency [B(SE)?=???0.47(0.25), p?=?0.031]; Intentional Nonadherence [B(SE)?=???0.31(0.15), p?=?0.027].

Conclusion

Women receiving relaxation training were less likely to (1) forget to take their AET and (2) intentionally miss doses of AET in the long term compared to women receiving health education or CBT. This is evidence for the need of randomized trials that aim to improve adherence by incorporating theoretically based behavioral change techniques.

Trial registration and dates

Trial 2R01-CA-064710 was registered March 26, 2006.

     

Comparison of survival outcomes for axillary surgery extent based on intraoperative sentinel lymph node biopsy result after neoadjuvant chemotherapy for breast cancer

Purpose

To investigate the survival difference between limited axillary surgery and full axillary lymph node dissection (ALND) in patients with 1–3 positive sentinel lymph node biopsies (SLNBs) after neoadjuvant chemotherapy (NAC).

Method

We retrospectively analyzed data from 676 patients who underwent surgery between 2007 and 2017 with cT1–4, cN0–3, cM0 breast cancer at the time of diagnosis and 1–3 positive SLNBs after NAC. The patients received either SLNB only or completed level I or II ALND based on SLNB results. After propensity score matching, 483 patients who had undergone SLNB only (n?=?188) and ALND (n?=?295) were included. We examined overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival and compared them between the subgroups.

Result

At a median follow-up of 59.4 months, no significant statistical difference was observed in overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival between SLNB only and ALND. No significant differences were observed in the 5-year axillary recurrence-free survival (93.1% vs. 94.0%, hazard ratio [HR]?=?0.94, 95% confidence interval [CI]?=?0.43–2.05, p?=?0.876) and 5-year overall survival (97.7% vs. 97.3%, HR?=?1.65, 95% CI?=?0.58–4.65, p?=?0.347) between the two groups.

Conclusion

Our analysis suggests that SLNB alone may be a possible option for patients with 1–3 sentinel node-positive breast cancer following NAC without significant compromise of recurrence or overall survival.

     

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings

Abstract

Background: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings.

Aim: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests.

Methods: We prospectively included patients complaining sore throat (N?=?282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture.

Results: In GABHS cases (n?=?32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (n?=?19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC.

Conclusion: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.     

Family caregivers’ perspectives on communication with cancer care providers

Abstract

Purpose/Objectives: Family caregivers of individuals living with cancer are often highly involved in communication with healthcare teams, yet little is known about their experiences, needs, and preferences in this role. To address this gap in the knowledge base, researchers sought to explore family caregivers’ perspectives on communication with oncology care providers.

Design and Methods: Researchers conducted a secondary inductive thematic analysis of qualitative interviews originally collected as part of a randomized clinical trial of a supportive intervention for family caregivers of patients with cancer (N?=?63).

Participants: Participants were family caregivers of adult patients with cancer. Most were patients’ spouses/long-term partners (52.3%) or adult children/grandchildren (29.2%). Caregivers of patients with all cancer types and stages of disease progression were eligible for study enrollment.

Findings: Caregivers valued communication with healthcare providers who were attentive, genuine, broadly focused on patients and caregivers’ experiences, sensitive to unmet information needs, and responsive to the potentially different communication preferences of patients and caregivers.

Interpretation: Family caregivers expressed a strong preference for person-centered communication, conceptualized as communication that helps healthcare providers meet the needs of patients and caregivers both as individuals and as an interdependent unit of care, and that acknowledges individuals’ experiences beyond their prescribed roles of “cancer patient” and “caregiver.”

Implications for Psychosocial Oncology Practice: Psychosocial oncology providers’ strong orientation to the biopsychosocial and spiritual aspects of cancer care delivery make them uniquely positioned to support family caregivers. Findings suggest that providers should explicitly communicate their commitment to both patient and family care, involve family caregivers in psychosocial assessment activities and subsequent intervention, and strive to honor patients and caregivers’ potentially different communication preferences.     

Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience

Objectives: This study investigated the correlation between the peritoneal carcinomatosis index (PCI) and patient outcome depending on the tumour type.

Background: Peritoneal surface malignancy (PSM) treatment depends on tumour type. Mucinous PSM (m-PSM) is associated with a better prognosis than non-mucinous PSM (nm-PSM). The PCI’s predictive ability has not yet been evaluated.

Methods: We analysed 123 patients with PSM treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between 2008 and 2015. The m-PSM group (n?=?75) included patients with appendiceal cancer (n?=?15), colorectal cancer (n?=?21), or low-grade appendiceal mucinous neoplasm (n?=?39); the nm-PSM group (n?=?48) included patients with gastric (n?=?18) or colorectal (n?=?30) cancer. The PCI’s predictive ability was evaluated by multiple Cox-proportional hazard regression analysis and Kaplan–Meier curves.

Results: The 5-year survival and PCI were higher in m-PSM patients (67.0%; 20.5?±?12.1) than in nm-PSM patients (32.6%; p?=?0.013; 8.9?±?6.0; p?vs. 68.1%; p?=?0.935). Underlying disease (HR 5.666–16.240), BMI (HR 1.109), and PCI (HR 1.068) significantly influenced overall survival in all patients.

Conclusions: PCI is prognostic in nm-PSM, but not in m-PSM. CRS and HIPEC may benefit not only patients with low PCI, but also those with high PCI and m-PSM.     

An inventory of psychosocial oncological interventions in The Netherlands: identifying availability,gaps, and overlap in care provision

Abstract

Purpose: While a wide range of psychosocial oncological (PO) interventions has been developed, a systematic overview of interventions to inform patients, care providers, as well as researchers, policy makers and health insurers, is lacking. The aims of this paper were (1) to describe the attainment of this overview, which may be used in other jurisdictions and for other health conditions and (2) to reflect on what determines developments in this field.

Methods: Dutch researchers and care providers were invited to describe PO-interventions they apply in research or clinical practice. Selection criteria for what constituted a PO-intervention were determined. The input was organized in 12 predefined categories (e.g. physical functioning, genetics).

Findings: Sixty-six PO-interventions were included in the overview. Two major categories were psychosocial functioning (24%) and physical functioning and recovery (24%). Interventions are mostly directed at adults (65%) and not aimed at a specific type of cancer (61%). Nearly 25% of the interventions lacked scientific underpinning.

Conclusions: This paper provides an overview of Dutch PO-interventions and input on what drives their development. The categorizing method can be used in other jurisdictions and for other health care conditions. A next step would be to investigate the effectiveness and evidence of PO-interventions.

Implications for Psychosocial Providers and Policy: The open access overview of interventions provides referral information for care providers. By identifying possible gaps and overlap, the overview looks at possible drivers behind developments in this field which will be of interest to policy makers.     

Prediction of pathological complete response after neoadjuvant chemotherapy in breast cancer: comparison of diagnostic performances of dedicated breast PET,whole-body PET,and dynamic contrast-enhanced MRI

Purpose

To compare the diagnostic performance of ring-type dedicated breast PET (dbPET), whole-body PET (WBPET), and DCE-MRI for predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NAC).

Methods

This prospective study included 29 women with histologically proven breast cancer on needle biopsy between July 2016 and July 2019 (age: mean 55 years; range 35–78). Patients underwent WBPET followed by ring-type dbPET and DCE-MRI pre- and post-NAC for preoperative evaluation. pCR was defined as an invasive tumor that disappeared in the breast. Standardized uptake values corrected for lean body mass (SULpeak) were calculated for dbPET and WBPET scans. Maximum tumor length was measured in DCE-MRI images.

Reduction rates were calculated for quantitative evaluation. Two radiologists independently evaluated the qualitative findings. Reduction rates and qualitative findings were compared between the pCR (n?=?7) and non-pCR (n?=?22) groups for each modality. Differences in quantitative and qualitative data between the two groups were analyzed statistically.

Results

Significant differences were observed in the reduction rates of dbPET and DCE-MRI (P?=?0.01 and 0.03, respectively) between the two groups. Univariate and multiple logistic regression analyses revealed that SULpeak reduction rates in WBPET and dbPET (P?=?0.02 and P?=?0.01, respectively) and in dbPET (odds ratio, 16.00; 95% CI 1.57–162.10; P?=?0.01) were significant indicators associated with pCR, respectively. No between-group differences were observed in qualitative findings in the three modalities.

Conclusion

SULpeak reduction rate of dbPET?>?82% was an independent indicator associated with pCR after NAC in breast cancer.

     

Computed tomography-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: safety and efficacy of high-power microwave platforms

Objective: To evaluate the clinical efficacy/safety of CT-guided percutaneous microwave ablation for HCC in challenging locations using high-power microwave platforms.

Materials and methods: A retrospective review was conducted in 26 patients with 36 HCC tumours in challenging locations (hepatic dome, subcapsular, close to the heart/diaphragm/hepatic hilum, exophytic) undergoing CT-guided percutaneous microwave ablation in a single centre since January 2011. Two different microwave platforms were used both operating at 2.45?GHz: AMICA and Acculis MWA System. Patient demographics including age, sex, tumour size and location, as well as technical details were recorded. Technical success, treatment response, patients survival and complication rate were evaluated.

Results: Treated tumours were located in the hepatic dome (n?=?14), subcapsularly (n?=?16), in proximity to the heart (n?=?2) or liver hilum (n?=?2), while two were exophytic tumours at segment VI (n?=?2). Mean tumour diameter was 3.30?cm (range 1.4–5?cm). In 3/26 patients (diameter?>4?cm), an additional session of DEB-TACE was performed due to tumour size. Technical success rate was 100%; complete response rate was recorded in 33/36 tumours (91.6%). According to Kaplan–Meier analysis, survival rate was 92.3% and 72.11% at 24- and 60-month follow-up, respectively. There were no major complications; two cases of minor pneumothorax and two cases of small subcapsular haematoma were resolved only with observation requiring no further treatment.

Conclusion: CT-guided percutaneous microwave ablation for hepatocellular carcinoma tumours in challenging locations and up to 5?cm in diameter can be performed with high efficacy and safety rates.     

Isolated limb perfusion as a treatment option for rare types of tumours

Background: Isolated limb perfusion (ILP) is an established and effective treatment for advanced melanoma and soft tissue sarcomas of the extremities with a high overall response rate. The aim of this study was to describe our experience of ILP for more rare types of tumours.

Methods: Patients with Merkel cell carcinoma (MCC) (n?=?4), squamous cell carcinoma (SCC) (n?=?2), B-cell lymphoma (n?=?1), desmoid tumours (n?=?3), pigmented villonodular synovitis (PVNS) (n?=?1) and giant cell tumour (n?=?1) were treated with ILP and analysed retrospectively.

Results: The four patients with in-transit MCC had three complete responses (CR) and one partial response (PR); the two patients with SCC had one CR and one stable disease (SD); the patients with desmoid tumours had two PR and one SD. A CR was also observed for the patient with a giant cell tumour, but the patient with PVNS had a SD. The patient with cutaneous metastases of B-cell lymphoma showed a CR, however with rapid systemic progression. Local toxicity according to Wieberdink was grade II in 10 patients (83%) and grade III in two patients (17%).

Conclusions: These results show that ILP can be used as a treatment option also for more rare disease entities when other treatments have failed.     

Treatment challenges and support needs of underserved Hispanic patients diagnosed with lung cancer and head-and-neck cancer

Abstract

Purpose: We explored the treatment challenges and support needs that Hispanic underserved lung cancer and head-and-neck cancer patients face while undergoing cancer treatment.

Design: Qualitative design - ethnography.

Sample: Using a sample of 29 participants, we conducted semi-structured interviews with nine lung cancer and head-and-neck cancer survivors and seven health care providers and focus group interviews with six caregivers and seven patient navigators.

Method: Relevant themes were extracted with Ethnographic content analysis.

Findings: Participants reported treatment challenges and support needs in four areas: medical, financial, socio-cultural, and mental health. Health care providers and navigators primarily identified medical and financial challenges that impact treatment adherence, while patients and caregivers expressed the need for support for mental health problems (i.e., depression, anxiety).

Implications for psychosocial providers: Understanding the experiences of underserved Hispanic cancer survivors can aid in creating psychosocial interventions that successfully target treatment-related challenges and provide them with the support they need.     

Prognosis of breast cancer diagnosed during pregnancy and early postpartum according to immunohistochemical subtype: A matched case–control study

Purpose

Pregnancy-associated breast cancer (PABC) poses a clinical challenge and its prognosis remains controversial. During the pregnancy and postpartum periods, the breast undergoes biological events that may uniquely influence disease behavior and treatment response. This study aimed to assess if a PABC diagnosis influences survival compared to non-PABC.

Methods

A single-center record review was performed to identify PABC patients diagnosed from January 2007 through June 2018. Two controls were matched to each PABC case by stage, immunohistochemical (IHC) subtype, age (±?3) and year of diagnosis (±?2). Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan–Meier method and compared with the log-rank test. Multivariate analysis was used to assess the impact of PABC on outcomes.

Results

125 PABC patients (pregnant: 62; postpartum: 63) and 250 controls were included. Median follow-up was 67.7 and 73.4 months, respectively. 4-year DFS was 62% in pregnant vs 78% in controls (p?=?0.010), and 63% in postpartum vs 83% in controls (p?=?0.034). Subanalysis by IHC subtype revealed a significantly inferior DFS in PABC with hormone receptor-positive/HER2-negative (p?=?0.032) and HER2-positive disease (p?=?0.005) compared to corresponding non-PABC patients. 4-year OS was similar between case groups and controls. Multivariate analysis supported the independent impact of pregnant and postpartum status on DFS (p?<?0.05).

Conclusion

Patients diagnosed during pregnancy and early postpartum are at high risk of recurrence. Further research is warranted to better characterize PABC tumor biology and enable the identification of novel therapeutic interventions to improve treatment outcomes.

     

Pre-diagnosis major life stressors and breast cancer outcomes

Purpose

While the association between diagnosis of breast cancer and post-diagnosis psychological distress has been well documented, data regarding pre-diagnosis psychological distress in the breast cancer population are limited. Here, we assessed pre-diagnosis major life stressors and breast cancer outcomes, namely stage of disease and choice of surgery, in a single-center population.

Methods

Patients with newly diagnosed clinical stage 0–3 breast cancer seen at Mayo Clinic Florida between June 11, 2018, and October 7, 2019, were administered voluntary telephone surveys to assess major life stressors during the 24 months preceding their cancer diagnosis. Subsequent clinical outcomes of cancer stage at diagnosis and surgical treatment were obtained through retrospective chart review. Study subjects who had experienced major life stressors and those who had not were compared using Chi-square tests.

Results

Of 222 patients who were included, 51.3% reported experiencing a major life event before breast cancer diagnosis. 43.9% of these patients endorsed family-related stress. 21.1% had experienced multiple stressors. 1.8% described financial stress. Although more patients in the group with pre-diagnosis stress had carcinoma in situ (21.1% versus 13.0%, p?=?0.11) and fewer had stage T1/T2 disease (64% versus 73.1%, p?=?0.14) than in the group without stress, these differences were not statistically significant. More patients with pre-diagnosis stress chose mastectomy (34.2% versus 22.2%, p?=?0.048).

Conclusions

Psychological distress is prevalent prior to breast cancer diagnosis and may merit early intervention. While additional study in diverse populations is needed, current data suggest possible associations between pre-diagnosis psychological distress and surgical decision making, specifically mastectomy.

     

Racial disparities in routine health checkup and adherence to cancer screening guidelines among women in the United States of America

Purpose

Routine health checkup and cancer screening rates among women are suboptimal, partially due to the health care disparities by race/ethnicity in the USA. This study examined the previously understudied associations between routine health checkup, cervical cancer screening, and breast cancer screening by race/ethnicity using the national representative sample of women.

Methods

Data were obtained from three cycles (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS) (n?=?12,227). Survey-weighted logistic regressions were evaluated to assess associations between routine health checkup and cervical and breast cancer screening compliance with the established guidelines with the age criteria and frequency of screening by race/ethnicity (Black, White, Hispanic, and Other).

Results

This study included 6,941 women in the cervical cancer screening and 8,005 women for breast cancer screening, considering the age criteria. Women who had received routine health checkups were more likely to meet the cervical cancer screening guideline (Odds ratio?3.24, p?<?0.05) and breast cancer screening guideline (OR?5.86, p?<?0.05) compared to women who did not receive routine health checkups. While routine health checkups were associated with both types of cancer screenings in most racial/ethnic groups, analyses stratified by race/ethnicity suggest that Hispanic women and Other women did not benefit from routine health checkup in relation to cervical and breast cancer screening, respectively.

Conclusion

Promotion of routine health checkups could promote cancer screening among women across racial/ethnic groups, although specific racial/ethnic groups may require additional support.

     

Exploring the trend in referrals for consideration of CRS and HIPEC to understand the attitudes of clinicians in the development of a national cancer centre programme in peritoneal disease

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival in selected patients with peritoneal metastases. However, only some patients who are potentially eligible for the procedure are considered and referred to the appropriate surgical department. By studying the trends of patients being considered for CRS and HIPEC in our centre, we hope to better understand the demographics of our patient cohort and the attitudes of physicians involved towards CRS and HIPEC.

Methods: Patients who were presented and discussed at our institution’s multidisciplinary tumour board (MDTB) for consideration of CRS and HIPEC, between 5 January 2011 and 16 December 2015, were identified from the institutional database and included in the study. Patient demographics and clinico-pathological data were retrospectively collected from electronic records and clinical charts.

Results: A total of 407 patients were presented at the MDTB for consideration of CRS and HIPEC. Referrals were most commonly from oncology-related departments (65.8%, n?=?268). This was followed by referrals from other hospitals (15.0%, n?=?61), overseas self-referrals (12.0%, n?=?49) and non-oncologic departments within the same institution (7.1%, n?=?29). Referrals made by oncology-related departments and overseas self-referrals showed an increasing trend over the years. Of the patients discussed, 197 patients (48.4%) were recommended for CRS and HIPEC, and 134 (68.0%) successfully underwent the procedure.

Conclusions: There is growing acceptance of CRS and HIPEC in patients and oncologic-related departments. However, consideration of this procedure as a treatment option remains low in non-oncologic departments. Dissemination of information and well-defined clinical recommendations may help physicians identify and select potentially eligible patients for consideration of CRS and HIPEC.     

Circulating tumor cells,circulating tumor DNA,and disease characteristics in young women with metastatic breast cancer

Background

Clinical and genomic data from patients with early-stage breast cancer suggest more aggressive disease in premenopausal women. However, the association between age, disease course, and molecular profile from liquid biopsy in metastatic breast cancer (MBC) is not well characterized.

Methods

Patients were classified as premenopausal (< 45 years), perimenopausal (45–55 years), or postmenopausal (>?55 years). Cohort 1 consisted of patients with MBC who consented for prospective serial evaluation of circulating tumor cells (CTCs) using CellSearch?. Cohort 2 included patients who, as part of routine care, had circulating tumor DNA (ctDNA) sequenced by the Guardant360? assay. Clinicopathologic data were collected from retrospective review to compare disease features between premenopausal and postmenopausal women.

Results

Premenopausal women represented 26% of 138 patients in Cohort 1 and 21% of 253 patients in Cohort 2. In Cohort 1, younger patients had a shorter time to metastases and a higher prevalence of lung and brain metastases. Overall, there were similar rates of?≥?5 CTCs/7.5 mL, HER2?+?CTC expression, and CTC clusters between pre- and postmenopausal women. However, for those with triple negative breast cancer, premenopausal women had a higher proportion of?≥?5 CTCs/7.5 mL. In Cohort 2, premenopausal women had a higher incidence of FGFR1 (OR 2.75, p?=?0.022) and CCND2 (OR 6.91, p?=?0.024) alterations. There was no difference in the ctDNA mutant allele frequency or the number of detected alterations between these age groups.

Conclusions

Our data reveal that premenopausal women diagnosed with MBC have unique clinical, pathologic, and molecular features when compared to their postmenopausal counterparts. Our results highlight FGFR1 inhibitors as potential therapeutics of particular interest among premenopausal women.

     

Phase II trial of veliparib and temozolomide in metastatic breast cancer patients with and without BRCA1/2 mutations

Background

Operative complications affect recurrence in non-breast malignancies. Rising rates of mastectomy with immediate reconstruction and their increased post-operative complications fuel concerns for poorer outcome in breast cancer (BC). We sought to determine the effect of complications on recurrence in BC patients.

Methods

A single-institution retrospective review was conducted of incident BC treated with mastectomy and immediate reconstruction. Overall survival and recurrence were compared between patients with complications to those without.

Results

Of 201 patients (350 mastectomies, 86 nipple-sparing), 62 (30.8%) had a surgical complication. Patients with complications were older, but groups were similar for type of reconstruction, tobacco use, hormone receptor status, HER2, lymphovascular invasion, and pathologic stage (all p?>?0.05). Twenty-two complications (10.9%) were infection, 5 (2.5%) dehiscence, 14 flap necrosis (7%), 21 hematomas (10.4%), and 8 nipple necroses (9%). Recurrence occurred in 18 (8.9%) patients: 4 local, 2 regional, and 12 distant. After 8.9 years of median follow-up, patients with complications trended towards higher recurrence (hazard ratio (HR) 2.23, log-rank p?=?0.08, Cox regression p?=?0.05), particularly with nipple necrosis (HR 3.28, log-rank p?=?0.09, regression p?=?0.06). Patients with other complications had similar recurrence-free survival to those without (all p?>?0.05). Higher stage (HR 13.66, log-rank p?=?0.03) and adjuvant radiation (HR 2.78, log-rank p?=?0.04) cases were more likely to recur. Patients with complications had similar overall survival to those without (log-rank p?>?0.05).

Conclusion

BC patients with surgical complications do not have lower overall survival. This finding may be due to the improved prognosis compared to non-breast malignancies.

     

High-dose versus standard-dose daunorubicin in induction therapy for young patients with de novo acute myeloid leukaemia: a meta-analysis of randomised trials

Purpose: To compare the efficacy and safety of high-dose versus standard-dose daunorubicin for young patients with de novo acute myeloid leukaemia (AML) using meta-analysis.

Methods: Two trials were taken from 2,481 full-text articles. Heterogeneity was assessed using the I² index. Quality assessment was performed with the Cochrane Collaboration’s risk-of-bias tool.

Results: The analysis showed that high-dose daunorubicin induction therapy was associated with higher complete remission (CR) rate (n?=?965; RR?=?1.80; 95% CI?=?1.36–2.38; p?I^2?=?0%) and improved overall survival (n?=?1040; HR?=?0.74; 95% CI?=?0.63–0.87; p?=?0.0003; I^2?=?0%) compared with standard-dose daunorubicin. However, there was no significant interaction between treatment efficacy and prognostic category based on cytogenetics (favourable, intermediate and unfavourable) (p?=?0.44, I^2?=?0%).

Conclusion: High-dose daunorubicin therapy could increase CR rate and improve long-term outcome for young patients with de novo AML. However, further study is needed to identify those who can benefit from high-dose daunorubicin.     

Evaluation of microwave ablation of liver malignancy with enabled constant spatial energy control to achieve a predictable spherical ablation zone

Objectives: To evaluate the clinical performance of a new microwave ablation (MWA) system with enabled constant spatial energy control (ECSEC) to achieve spherical ablation zones in the treatment of liver malignancies.

Materials and methods: In this retrospective study, 56 hepatic tumours in 48 patients (23 men, 25 women; mean age: 59.6 years) were treated using a new high-frequency MWA-system with ECSEC. Parameters evaluated were technical success, technical efficacy, tumour diameter, tumour and ablation volume, complication rate, 90-day mortality, local tumour progression (LTP) at the 12-month follow-up, ablative margin and ablation zone sphericity. These parameters were compared using the Kruskal–Wallis test with the same parameters collected retrospectively from cohorts of patients treated with conventional high-frequency (HF) MWA (n?=?20) or low-frequency (LF) MWA (n?=?20).

Results: Technical success was achieved in all interventions. The technical efficacy was 100% (ECSEC) vs. 100% (LF-MWA) vs. 95% (HF-MWA). There were no intra-procedural deaths or major complications. Minor complications occurred in 3.57% (2/56), 0% (0/20) and 0% (0/20) of the patients, respectively. The one-year mortality rate was 16.1% (9/56), 15% (3/20) and 10% (2/20), respectively. The LTP was 3.57% (2/56), 5% (1/20) and 5% (1/20), respectively. The median deviation from ideal sphericity (1.0) was 0.135 (ECSEC) vs. 0.344 (LF-MWA) vs. 0.314 (HF-MWA) (p?p?Conclusions: Microwave ablation of liver malignancies is a safe and efficient treatment independent of the system used. Hepatic MWA with ECSEC achieves significantly more spherical ablation zones and higher minimal ablative margins.     

Facilitators and barriers to medication adherence with adjuvant endocrine therapy in women with breast cancer: a structural equation modelling approach

Purpose

To identify a structure to explain the relationship between socio-clinico factors, necessity-concerns beliefs, and perceived barriers to adherence with adjuvant endocrine therapy (AET) amongst women with breast cancer.

Methods

Participants were 244 patients with early-stage breast cancer recruited from two tertiary hospitals from May 2015 to December 2018 who completed questionnaires on medication adherence (Simplified Medication Adherence Questionnaire), necessity-concerns beliefs (Beliefs about Medicine Questionnaire), and barriers to adherence (Adherence Starts with Knowledge Questionnaire). Socio-clinico variables were collected via interview and medical records review. Structural equation modelling was applied to examine the relationships between these variables and possible mediating effects of necessity-concerns beliefs on adherence to AET.

Results

The median age of the study participants was 61 (range 32–80) years and the median duration on AET was 1.6 (IQR 1.2–2.6) years. Adherence was positively associated with age (β?=?0.145, 95% CI: 0.011 to 0.279, p?=?0.034) and negatively associated with barriers (β?=?? 0.381, 95% CI: ? 0.511 to ? 0.251, p?<?0.001). There was no effect of Necessity (β?=?0.006, 95% CI: ? 0.145 to 0.158, p?=?0.933) or Concerns (β?=?0.041, 95% CI: ? 0.117 to 0.199, p?=?0.614) on adherence. Necessity-concerns beliefs were also not significant mediators in the relationship between socio-clinico factors and medication adherence.

Conclusions

Older age and lower barriers to adherence were associated with higher adherence scores. Necessity-concerns beliefs did not have a significant effect on adherence as majority of the patients identified forgetfulness as a reason for non-adherence.