Predictors of pathological complete response to neoadjuvant chemotherapy in stage II and III breast cancer: The impact of chemotherapeutic regimen

In this study, we sought to determine the predictors of pathological complete response (pCR) and compare the chemotherapeutic regimens administered to breast cancer patients with and those without pCR. We retrospectively reviewed the data of 879 patients treated at the Alvin J. Siteman Cancer Center between 2006 and 2010, to identify patients who were diagnosed with primary stage II or III breast cancer and received neoadjuvant chemotherapy. Patients who received only neoadjuvant endocrine therapy were considered to be ineligible. Patient, tumor, and treatment characteristics, including type of chemotherapy, were compared between patients who did and those who did not achieve pCR using Chi-square or Fishers exact tests and multivariate logistic regression analysis. Two-sided P-values of <0.05 were considered significant. Of the 333 patients who met the inclusion criteria, 61 (18.3%) had documented pCR. Compared with patients not achieving pCR, a greater proportion of patients with pCR had stage II disease (80.3 vs. 68%, P=0.057), had poorly differentiated (grade 3) tumors (82 vs. 59.2%, P<0.001), had negative lymph node involvement (41 vs. 34%, P=0.0004) and had tumors that were HER2-amplified (41 vs. 23.5%, P=0.0054). A greater proportion of patients with pCR received taxane-based chemotherapy (23 vs. 12.5%, P=0.016) or trastuzumab in conjunction with chemotherapy (41.0 vs. 16.9%, P<0.001). No patients receiving solely anthracycline-based therapy achieved pCR in our study. Our study demonstrated that, for stage II and III breast cancer, lower stage, negative lymph node involvement and HER2 receptor amplification were each associated with pCR. Taxane therapy and the concurrent use of trastuzumab were also associated with a higher likelihood of pCR

Pathological complete response in breast cancer patients following neoadjuvant chemotherapy at a Comprehensive Cancer Center: The natural history of an elusive prognosticator

Given the prognostic significance of pathological complete response (pCR) to neoadjuvant chemotherapy, we sought to chronicle the clinical course of breast cancer patients whose tumors exhibited pCR at our institution. We retrospectively reviewed 5,533 cancer center patients treated for a first primary breast cancer between March, 1999 and September, 2010 to identify those who received neoadjuvant chemotherapy that resulted in pCR (i.e., no residual invasive malignancy in the breast or axilla). The descriptive statistics of treatments received, recurrence, morbidity and mortality as of October, 2013 were reported. Of the 5,533 patients reviewed, 86 met the inclusion criteria. The mean age at diagnosis was 48 years [standard deviation (SD), 9.4 years] and the mean length of follow-up was 68 months (SD, 27 months). The majority of the patients underwent axillary lymph node dissection (ALND; n=60, 69.8%), received adjuvant radiation therapy (XRT; n=72, 83.7%), had poorly differentiated (grade 3) tumors (n=74, 86.1%) and had pure ductal histology (n=74, 86.1%). A total of 5 patients (5.8%) developed disease recurrence. All the patients who recurred had grade 3 tumors with ductal histology and underwent ALND for known pre-neoadjuvant-treatment lymph node metastases; none received adjuvant chemotherapy. A total of 4 patients (4.7%) succumbed to the disease, 3 due to breast cancer recurrence <18 months following the initial diagnosis. Recurrence following pCR was rare, but when it did occur, time- to-recurrence was short at <18 months. All the patients who recurred and eventually succumbed to breast cancer had axillary metastases at diagnosis, indicating that axillary disease is a major negative prognostic factor in patients who achieve pCR following neoadjuvant chemotherapy

A method for achieving reciprocity of funding in community-based participatory research

BACKGROUND: The St. Louis Komen Project was conceived to address disparities in breast cancer treatment and outcomes between African-American and White women in St. Louis, Missouri. Our goal was to apportion tasks and funding through a process to which all researcher partners had input and to which all could agree, thus eliminating institutionalized inequalities. METHODS: This paper describes the collaborative process and resulting division of responsibilities, determination of costs, and ultimate allocation of funds and resources, as well as the documentation employed to achieve funding reciprocity and equal accountability. RESULTS: Both communication and documentation are critical. Although the Memoranda of Understanding employed are not a panacea, they codify roles and expectations and promote trust. The process of developing financial transparency set the tone for subsequent steps in the research process. CONCLUSIONS: The exhaustive planning process and project-specific procedures developed by its partners have helped the project foster reciprocity, facilitate participation, and equitably distribute resources

Patient-Reported Outcomes in the Translational Breast Cancer Research Consortium

Members of the Translational Breast Cancer Research Consortium conducted an expert-driven literature review to identify a list of domains and to evaluate potential measures of these domains for inclusion in a list of preferred measures. Measures were included if they were easily available, free of charge, and had acceptable psychometrics based on published peer-reviewed analyses. A total of 22 domains and 52 measures were identified during the selection process. Taken together, these measures form a reliable and validated list of measurement tools that are easily available and used in multiple cancer trials to assess patient-reported outcomes in relevant patients

Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management—American Society of Breast Surgeons Opioid/Pain Control Workgroup

Introduction: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. Methods: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. Results: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. Conclusions: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended

Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Abstract Individual environmental contaminants have been associated with breast cancer; however, evaluations of multiple exposures simultaneously are limited. Herein, we evaluated associations between breast cancer summary stages and the Environmental Quality Index (EQI), which includes a range of environmental factors across five domains. The EQI (2000–2005) was linked to county-level age-standardized incidence rates (SIRs) obtained from the North Carolina Central Cancer Registry (2010–2014). Incidence rates and SIRs of total, in situ, localized, regional, and distant breast cancers were evaluated stratified by rural–urban status. In counties with poor environmental quality compared to those with good environmental quality, total breast cancer incidence was higher by 10.82 cases per 100,000 persons (95% CI 2.04, 19.60, p = 0.02). This association was most pronounced for localized breast cancer (β = 5.59, 95% CI 0.59, 10.58, p = 0.03). Higher incidence of early-stage disease (carcinoma in situ β = 5.25, 95% CI 2.34, 8.16, p = 0.00 and localized breast cancer β = 6.98, 95% CI 2.24, 11.73, p = 0.00) and total breast cancer (β = 11.44, 95% CI 3.01, 19.87, p = 0.01) occurred in counties with poor land quality, especially urban counties. Our analyses indicate significant associations between environmental quality and breast cancer incidence, which differ by breast cancer stage and urbanicity, identifying a critical need to assess cumulative environmental exposures in the context of cancer stage