4 research outputs found
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Neoadjuvant chemotherapy versus neoadjuvant hormonal therapy in postmenopausal women with ER-positive, HER2/neu negative locally advanced breast cancer
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Background: Postmenopausal women with large ER+/HER-2 negative tumors frequently receive neoadjuvant chemotherapy (NC), but pathological complete response (pCR) rates are low. Neoadjuvant hormonal therapy (NH) may offer benefit in this setting. Methods: Retrospective review of medical records from University of Miami/Jackson Memorial Hospital from 1998-2011. Primary outcomes: pCR (absence of invasive tumor in breast and lymph nodes at surgery), recurrence free survival (RFS) and tumor size reduction evaluated through comparison of palpable breast mass size at presentation with pathological tumor size in surgical specimen, and categorized as good response (GR) ≥ 30% reduction or no response (NR) < 30%. The Kaplan-Meier method and the log-rank test were used in the analysis of RFS. Results: Data from 151 post-menopausal women with ER+/HER-2 negative BC who received NC (57%) or NH (43%) was analyzed. Median follow-up among alive patients with no evidence of disease was 5.4 years in NC and 2.9 years in NH. Mean age was higher in the NH group (63.3 vs 56.1, p<0.0001). There were no racial or ethnic differences between the groups. Clinical stage was comparable in NC and NH (IIA 5.8% vs 9.2%, IIB 25.6% vs 20%, IIIA 37.2% vs 29.2%, IIIB/IIIC 31.4% vs 41.5%, p=0.775). Tumor histology was predominantly ductal in both groups (NC 85.7% and NH 78.5%, p=0.247). pCR was similar in NC and NH (4.7% vs 0%, p=0.078) along with RFS (median 8.5 yrs vs 6.0 yrs, p=0.946). In the NC group, GR was significantly more frequent (77.9% vs 60%, p=0.017). Among patients in the NH group, having GR was predictive of longer RFS (5-year rate 83.7% vs 50.5%, p=0.014). Breast only pCR occurred at equivalent rates between NC and NH (9.3% vs 3.1%, p=0.189) as did the absence of lymph node metastasis (29.1% vs 26.2%, p=0.606). In the NH cohort 38.5% received no adjuvant chemotherapy. Conclusions: NH provides an effective alternative to NC and, if there is a GR, may preclude the need for chemotherapy in over one third of postmenopausal women with large ER positive/HER-2 negative breast cancer
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Evaluation of tobacco use and HER2 receptor expression in breast cancer in an ethnically diverse inner-city population
e11611 Background: Tobacco is the leading cause of preventable death in the United States and is linked to many cancers. Despite overwhelming biological plausibility and over four decades of epidemiological studies, no definite association has been established between tobacco and breast cancer. Ovarian, stomach, and uterine cancer are associated with tobacco consumption and these cancers express HER-2. Although estrogen receptor status has been looked at as a variable there has been no evaluation of the role of HER-2 and smoking in breast cancer. Methods: A retrospective review of medical records from patients treated at the University of Miami/Jackson Memorial Hospital from 1998-2012 was undertaken after IRB approval. The incidence of smoking and HER-2 expression in a population of 1255 women was evaluated. Data was analyzed by age, race, ethnic group, menopausal status, tumor stage, and ER/PR/HER-2 receptor status. Results: 1255 charts were analyzed with 1094 having full information. Median age was 56 (range 22 to 94). Smoking rates were significantly higher in Caucasian versus African American women (47.4% vs. 17.1%, P<0.01) and in Latin versus African American women (24.7% vs. 17.1%, P<0.01). Overall rate of HER-2 expression 18.1%. The rate of HER-2 expression was 21.4% in smokers and 17.0% in non-smokers (p=0.10). The rate of HER-2 expression was 10.8% in Caucasian smokers and 9.8% in Caucasian non-smokers (p=0.88); 24.5% in smokers of African descent and 17.3% in non-smokers of African descent (p=0.24); 22.9% in Latino smokers and 17.4% in Latino non-smokers (p=0.10). The rate of HER-2 /ER expression was 9.4% in smokers and 7.9% in non-smokers (p=0.42); 5.4% in Caucasian smokers and 4.9% in Caucasian non-smokers (p=0.916); 12.2% in smokers of African descent and 5.9% in non-smokers of African descent (p=0.11); 9.5% in Latin smokers and 8.8% in Latin non-smokers (p=0.77). Conclusions: We found non-statistically significant positive associations in all analyses between HER-2 expression with or without ER expression and tobacco exposure when analyzed by ethnicity. A larger number of patients needs to be investigated in order to clarify this relationship