329 research outputs found
Clinical experience with venlafaxine in the treatment of hot flushes in women with a history of breast cancer
OBJECTIVE: To obtain practical experience with venlafaxine for hot flushes
in breast cancer patients and incorporate this in a treatment protocol.
METHOD: Twenty-two women with a history of breast cancer (mean age 49.2
years, range 35-65) were referred for consideration of treatment with
venlafaxine for hot flushes. Patients received extensive information on
treatment with venlafaxine and were advised to self-monitor the frequency
of their hot flushes. RESULTS: Eight women did not start venlafaxine
because they had no postmenopausal complaints, were lost to follow-up, had
too low a frequency of hot flushes, or refused treatment. Eventually 14
women started venlafaxine. Two of them did not tolerate venlafaxine, four
reported some effect but stopped because of side effects, two women had no
effect whatsoever. Six women observed a clear ( > 50%) reduction in their
hot flush frequency that was maintained at a median follow-up of 13
months. CONCLUSION: The group of patients referred for treatment was more
heterogeneous and more patients dropped out because of side effects than
expected. Extensive patient education, patient selection and evaluation of
the treatment effect (by self-monitoring of hot flush frequency) are
mandatory to avoid useless (continuation of) treatment and to prepare
patients for side effects. Under these conditions, a substantial minority
of patients benefit from venlafaxine
Severe akathisia as a side effect of metoclopramide
Case description A case of severe metoclopramide-induced akathisia in a breast cancer patient being treated with chemotherapy is presented, eventually culminating in hospital admission. In retrospect, this adverse effect was not recognized for several weeks because the prescription had not been properly recorded in the chart, the patient initially denied using the drug, and extensive psychological adjustment difficulties were also present. Conclusion Movement disorders as an adverse effect of metoclopramide have been described on a regular basis over the past decades. Case reports such as this confirm there is under-recognition of adverse effects and emphasize the need to take a comprehensive medication history and recognize well known side effects of medications such as metoclopramide
Prognostic Impact of HER2 and ER Status of Circulating Tumor Cells in Metastatic Breast Cancer Patients with a HER2-Negative Primary Tumor
AbstractBACKGROUND: Preclinical and clinical studies have reported that human epidermal growth factor receptor 2 (HER2) overexpression yields resistance to endocrine therapies. Here the prevalence and prognostic impact of HER2-positive circulating tumor cells (CTCs) were investigated retrospectively in metastatic breast cancer (MBC) patients with a HER2-negative primary tumor receiving endocrine therapy. Additionally, the prevalence and prognostic significance of HER2-positive CTCs were explored in a chemotherapy cohort, as well as the prognostic impact of the estrogen receptor (ER) CTC status in both cohorts. METHODS: Included were MBC patients with a HER2-negative primary tumor, with ā„1 detectable CTC, starting a new line of treatment. CTCs were enumerated using the CellSearch system, characterized for HER2 with the CellSearch anti-HER2 phenotyping reagent, and characterized for ER mRNA expression. Primary end point was progression-free rate after 6 months (PFR6months) of endocrine treatment in HER2-positive versus HER2-negative CTC patients. RESULTS: HER2-positive CTCs were present in 29% of all patients. In the endocrine cohort (n=72), the PFR6months was 53% for HER2-positive versus 68% for HER2-negative CTC patients (P=.23). In the chemotherapy cohort (n=82), no prognostic value of HER2-positive CTCs on PFR6months was observed either. Discordances in ER status between the primary tumor and CTCs occurred in 25% of all patients but had no prognostic value in exploratory survival analyses. CONCLUSION: Discordances regarding HER2 status and ER status between CTCs and the primary tumor occurred frequently but had no prognostic impact in our MBC patient cohorts
The skeletons of free distributive lattices
AbstractThe skeletons of free distributive lattices are studied by methods of formal concept analysis; in particular, a specific closure system of sublattices is elaborated to clarify the structure of the skeletons. Up to five generators, the skeletons are completely described
Heart failure after treatment for breast cancer
Background: We aimed to develop doseāresponse relationships for heart failure (HF) following radiation and anthracyclines in breast cancer treatment, and to assess HF associations with trastuzumab and endocrine therapies. Methods and results: A caseācontrol study was performed within a cohort of breast cancer survivors treated during 1980ā2009. Cases (nĀ = 102) had HF as first cardiovascular diagnosis and were matched 1:3 on age and date of diagnosis. Individual cardiac radiation doses were estimated, and anthracycline doses and use of trastuzumab and endocrine therapy were abstracted from oncology notes. For HF cases who received radiotherapy, the estimated median mean heart dose (MHD) was 6.8Ā Gy [interquartile range (IQR) 0.9ā13.7]. MHD was not associated with HF risk overall [excess rate ratio (ERR)Ā =Ā 1%/Gy, 95% confidence interval (CI) ā2 to 10]. In patients treated with anthracyclines, exposure of ā„20% of the heart to ā„20 Gy was associated with a rate ratio of 5.7 (95% CI 1.7ā21.7) compared to <10% exposed to ā„20 Gy. For cases who received radiotherapy, median cumulative anthracycline dose was 247 mg/m2 (IQR 240ā319). A dose-dependent increase was observed after anthracycline without trastuzumab (ERRĀ =Ā 1.5% per mg/m2, 95% CI 0.5ā4.1). After anthracycline and trastuzumab, the rate ratio was 34.9 (95% CI 11.1ā110.1) compared to no chemotherapy. Conclusions: In absence of anthracyclines, breast cancer radiotherapy was not associated with increased HF risk. Strongly elevated HF risks were observed after treatment with anthracyclines and also after treatment with trastuzumab. The benefits of these systemic treatments usually exceed the risks of HF, but our results emphasize the need to support ongoing efforts to evaluate preventative strategies
Relevant factors for the optimal duration of extended endocrine therapy in early breast cancer
Purpose: For postmenopausal patients with hormone receptor-positive early breast cancer, the optimal subgroup and duration of extended endocrine therapy is not clear yet. The aim of this study using the IDEAL patient cohort was to identify a subgroup for which longer (5 years) extended therapy is beneficial over shorter (2.5 years) extended endocrine therapy. Methods: In the IDEAL trial, 1824 patients who completed 5 years of adjuvant endocrine therapy (either 5 years of tamoxifen (12%), 5 years of an AI (29%), or a sequential strategy of both (59%)) were randomized between either 2.5 or 5 years of extended letrozole. For each prior therapy subgroup, the value of longer therapy was assessed for both node-negative and node-positive patients using Kaplan Meier and Cox regression survival analyses. Results: In node-positive patients, there was a significant benefit of 5 years (over 2.5 years) of extended therapy (disease-free survival (DFS) HR 0.67, p = 0.03, 95% CI 0.47ā0.96). This effect was only observed in patients who were treated initially with a sequential scheme (DFS HR 0.60, p = 0.03, 95% CI 0.38ā0.95). In all other subgroups, there was no significant benefit of longer extended therapy. Similar results were found in patients who were randomized for their initial adjuvant therapy in the TEAM trial (DFS HR 0.37, p = 0.07, 95% CI 0.13ā1.06), although this additional analysis was underpowered for definite conclusions. Conclusions: This study suggests that node-positive patients could benefit from longer extended endocrine therapy, although this effect appears isol
- ā¦