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important clinical challenges. The landscape of metastatic breast cancer treatment has changed considerably with the incorporation of novel agents, including cyclin-dependent kinase (CDK) 4/6, and mammalian target of rapamycin (mTOR) inhibitors. This article

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William J. Gradishar, Benjamin O. Anderson, Ron Balassanian, Sarah L. Blair, Harold J. Burstein, Amy Cyr, Anthony D. Elias, William B. Farrar, Andres Forero, Sharon Hermes Giordano, Matthew Goetz, Lori J. Goldstein, Clifford A. Hudis, Steven J. Isakoff, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Meena Moran, Sameer A. Patel, Lori J. Pierce, Elizabeth C. Reed, Kilian E. Salerno, Lee S. Schwartzberg, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, George Somlo, Melinda Telli, John H. Ward, Dottie A. Shead and Rashmi Kumar

(T-DM1) for patients with HER2-positive metastatic breast cancer. Principles of Preoperative Systemic Therapy The NCCN Breast Cancer Panel has outlined the rationale, appropriate patient selection, and response assessment for preoperative

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Alyssa G. Rieber and Richard L. Theriault

results of a randomized phase II multicenter study of exemestane versus tamoxifen as first-line hormone therapy for postmenopausal women with metastatic breast cancer . Ann Oncol 2003 ; 14 : 1391 – 1398 . 11 Paridaens R Therasse P Dirix L

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Noa Efrat Ben-Baruch, Ron Bose, Shyam M. Kavuri, Cynthia X. Ma and Matthew J. Ellis

metastatic breast cancer for HER2 mutations, and treating patients with HER2-positive breast cancer with the second-generation HER2/EGFR tyrosine kinase inhibitor neratinib (HKI-272) ( ClinicalTrials.gov identifiers: NCT01670877 and NCT01953926). This

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Kathleen Harnden and Kimberly Blackwell

disease course, localize to the skeleton, and reside in a dormant state for many years before developing into incurable metastatic breast cancer. 11 It is estimated that up to half of patients with ESBC have DTCs, 12 and chemotherapy does not clear DTCs

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Rachana Yendala, Kyaw Thein, Sriman Swarup, Anita Sultan, Somedeb Ball, Miguel Quirch, Myo H. Zaw, Yin M. Myat and Catherine Jones

Background: Pain, fatigue, hot flushes, and rash significantly contribute to quality of life in breast cancer patients undergoing chemotherapy. Hormone receptor-positive breast cancer is a common entity among women worldwide. In cancer cells, CDK4/6 activity is over expressed, which can lead to amplification or overexpression of the genes encoding for CDK 4/6 or the cyclin D, ultimately leading to endocrine therapy resistance. We undertook a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of health-related quality of life (HRQOL) events associated with CDK 4/6 inhibitors. Methods: We conducted a comprehensive literature search using MEDLINE, EMBASE databases, and meeting abstracts from inception through September 2018. RTCs that mention HRQOL events as adverse effects were incorporated in the analysis. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95%CI. Random effects model was applied. Results: 8 RCTs (7 phase III and 1 phase II) with a total of 4,557 patients were eligible. The study arms used palbociclib/ribociclib/abemaciclib with letrozole or anastrozole or fulvestrant or other hormonal agent while the control arms utilized placebo in combination with letrozole or anastrozole or fulvestrant or other hormonal agent. The RR of all-grade side effects were as follows: fatigue, 1.226 (95% CI: 1.079–1.393; P=.002); back pain, 0.971 (95% CI: 0.844–1.117; P=.681); arthralgia, 0.978 (95% CI: 0.830–1.152; P=.790); headache, 1.046 (95% CI: 0.928–1.179; P=.459); alopecia, 2.635 (95% CI: 1.966–3.533; P<.001); hot flushes, 0.901 (95% CI: 0.766–1.060; P=.210); and rash, 2.068 (95% CI: 1.604–2.666; P<.001). The RR of high-grade side effects were as follows: fatigue, 3.487 (95% CI: 1.765–6.889; P<.001); back pain, 1.364 (95% CI: 0.695–2.679; P=.367); arthralgia, 1.148 (95% CI: 0.509–2.593; P=.740); headache, 0.807 (95% CI: 0.303–2.147; P=.667); and rash, 3.018(95% CI: 0.954–9.554; P=.060). Conclusions: Our study showed that the risk of developing all grades of fatigue and any-grade alopecia and rash was significantly with CDK 4/6 inhibitors. Prompt intervention with good supportive care is required.

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Rodger J. Winn

: 505 - 514 . 3 Leyland-Jones B Semiglazov V Pawlicki M . Maintaining normal hemoglobin levels with epoetin alfa in mainly nonanemic patients with metastatic breast cancer receiving first-line chemotherapy: A survival study . J Clin Oncol

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Jennifer A. Ligibel and Eric P. Winer

metastatic breast cancer: Analysis of randomized studies comparing oral aromatase inhibitors versus megestrol . Anti-cancer Drugs 2000 ; 11 : 701 – 706 . 29 Dirix L Piccart M Lohrish C . Efficacy of and tolerance to exemestane versus tamoxifen

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Jennifer Shih, Babar Bashir, Karen S. Gustafson, Mark Andrake, Roland L. Dunbrack, Lori J. Goldstein and Yanis Boumber

chemotherapy was changed to docetaxel/trastuzumab/pertuzumab to treat ER/PR-negative and HER2-positive metastatic breast cancer, and was subsequently switched to carboplatin/trastuzumab/pertuzumab because of a hypersensitivity reaction to docetaxel. To date