Breast Cancer Adjuvant Chemotherapy Regimens Research Articles

Effects of breast cancer adjuvant chemotherapy regimens on expression of the aging biomarker, p16ink4a

Effects of breast cancer adjuvant chemotherapy regimens on expression of the aging biomarker, p16ink4a

Effects of Breast Cancer Adjuvant Chemotherapy Regimens on Expression of the Aging Biomarker, p16INK4a.

BackgroundAlthough chemotherapy saves lives, increasing evidence shows that chemotherapy accelerates aging. We previously demonstrated that mRNA expression of p16INK4a, a biomarker of senescence and molecular aging, increased early and dramatically after beginning adjuvant anthracycline-based regimens in early stage breast cancer patients. Here, we determined if changes in p16INK4a expression vary by chemotherapy regimen among early stage breast cancer patients.MethodsWe conducted a study of stage I-III breast cancer patients receiving adjuvant or neoadjuvant chemotherapy. p16INK4a expression was analyzed prechemotherapy and postchemotherapy (median 6.2 months after the last chemotherapy) in peripheral blood T lymphocytes. Chemotherapy-induced change in p16INK4a expression was compared among regimens. All statistical tests were 2-sided.ResultsIn 146 women, chemotherapy was associated with a statistically significant increase in p16INK4a expression (accelerated aging of 17 years; P < .001). Anthracycline-based regimens were associated with the largest increases (accelerated aging of 23 to 26 years; P ≤ .008). Nonanthracycline-based regimens demonstrated a much smaller increase (accelerated aging of 9 to 11 years; P ≤ .15). In addition to the type of chemotherapy regimen, baseline p16INK4a levels, but not chronologic age or race, were also associated with the magnitude of increases in p16INK4a. Patients with lower p16INK4a levels at baseline were more likely to experience larger increases.ConclusionsOur findings suggest that the aging effects of chemotherapy may be influenced by both chemotherapy type and the patient’s baseline p16INK4a level. Measurement of p16INK4a expression is not currently available in the clinic, but nonanthracycline regimens offering similar efficacy as anthracycline regimens might be favored.

Significantly different costs of adjuvant chemotherapy regimens in the United States.

1131 Background: We examined the relative and absolute costs in the United States for several widely used breast cancer adjuvant chemotherapy regimens. Although clinical trials commonly report the endpoints of efficacy (in terms of relapse free survival and overall survival) and toxicity, clinical trials rarely comment on the costs of the therapy. There are several reasons for this. One is that the costs are time and site and/or country specific. It is noteworthy that the total cost ideally includes the cost for care and may not be easily captured from the clinic (additional laboratory tests, radiology, hospitalization, etc.). Nonetheless simple cost estimate based on costs in the clinic can be so strikingly different, that they would seem to worth taking into consideration and examining further. Methods: To make the estimates we used the Regimen Profiler available at https://www.onmarkservices.com. We used Medicare reimbursement cost estimates effective in January 2011. The cost estimates were based treatment of a 70 kg woman with a BSA of 1.6 m2. Results: An example of these analyses are cost estimates for the chemotherapy alone which for dose dense CA (Q2w)*4 followed by P (q2w)*4, CA (q3w)*4 followed by P (qw)*12, DAC (q3w)*6, and 4*DC (q3w)*4 were: $924, $1,024, $14,827, and $9,890 respectively. For the dose dense regimen and the DAC regimen growth factor support is recommended. If the cost of support with a long acting form of CSF is included the costs become $21,274, $4,140, $31,222, and $10,651. Conclusions: We found that estimates of the cost of adjuvant chemotherapy regimens varied widely. The inclusion of a non-generic agent, or the necessity of routine growth factor support greatly increase the cost. By far the least costly of the third generation adjuvant breast cancer regimens was CA*4 then P*12, the efficacy and safety of which was established in E1199. The DC regimen cost comparatively little but, estimates of its efficacy and safety are based on only one trial against a relatively simple regimen. We conclude the cost differentials between widely used breast cancer regimens for adjuvant therapy are so large that particularly when efficacy and safety are approximately equal, that cost should be estimated and taken into consideration.

Utilization and relative value of breast cancer adjuvant chemotherapy regimens in the community.

e16595 Background: Selection of adjuvant breast cancer (BC) therapy varies based on patient risk factors. Utilization and choice of chemotherapy (CT), schedule, duration, and supportive care affects costs. We aimed to characterize neoadjuvant/adjuvant (N/Ad) CT utilization by tumor type and regimen (R) type, and estimate associated costs. Methods: Using the US Oncology iKnowMed EHR database, we retrospectively identified female BC patients (pts) diagnosed with stage I-III BC, between 7/2006 and 11/2010. Secondary diagnoses were excluded. Pts were characterized by age, ER and HER2 status, tumor size, grade, and nodes. CT utilization was determined by the number of pts assigned an N/Ad line of therapy (LOT) during the study period. Rs were categorized by CT title and drugs. Clinical trial pts were included. Incomplete, changed, and non-standard Rs were categorized as ‘other’. Medicare allowable was used for CT costs (using 70 kg or 1.7m2). Office visit (OV) and lab costs were added to each CT administration excluding trastuzumab maintenance. Results: During the time period, 40,881 BC pts were identified. An N/Ad LOT was documented in 37% of pts. CT utilization was 65% in HER2+ pts, 60% in ER-/HER2- pts, and 29% in ER+/HER2- pts. Other subsets were also characterized. TC (docetaxel/cyclophosphamide) then AC-paclitaxel like regimens were the most used HER2- regimens. TCH (docetaxel/carboplatin/trastuzumab) then AC-TH (paclitaxel/trastuzumab) were the most used HER2+ regimens. The table shows utilization and estimated costs. Conclusions: CT is a driver of cost. Nonanthracycline regimens are highly utilized in the community for N/Ad BC treatment. Use of docetaxel, trastuzumab, and pegfilgrastim increased treatment costs. Utilization and costs of select regimens. Utilization (%) Regimens ER+/HER2- ER-/HER2- Estimated total cost* ($) HER2- AC x 4 6 7 1,153 AC x 4 - docetaxel x 4 2 2 14,328 AC x 4 - paclitaxel weekly x 12 19 27 3,520 CMF x 6 1 1 1,518 FEC x 6 <1 <1 2,219 TC x 4 37 26 10,411 TAC x 6 16 13 31,009 Other 11 16 Clinical trial 8 8 HER2+ Any HER2+ AC x 4 - paclitaxel weekly x 12 + H x 1 yr 14 55,201 TCH x 6 - H x 1 yr 37 67,076 Other 39 Clinical trial 10 * CT Medicare allowable 1Q2011 + level 5 established OV and CBC and CMP per dose. Includes pegfilgrastim.

Abstract P1-10-11: Outcome of Patients with Early Breast Cancer Is Not Related to Their State of Social or Health Insurance

Abstract Background: Recent studies in the US showed a relationship between the state of social or health insurance of cancer patients and their overall survival. [1-3] In Germany 91% of all women are estimated to have a compulsory health insurance whereas 9% have private health coverage. There are no patients without any health insurance in Germany. Patients and Methods: In a retrospective analysis of 1846 german patients with early breast cancer the correlation between state of social and health insurance and overall survival was investigated. 59.6% of the patients had a social insurance whereas 40.4% had none. 69.1% of the patients carried compulsory health insurance while 30.9% had private coverage. Among the patients with compulsory health insurance 56.6% had had a professional education and 41.5% were employed whereas among the patients with private coverage 66.2% were professionally experienced and 43.9% were working. Age, tumor size, lymph node metastases, grading and both hormone and her2-status were well balanced between the two groups. 25.4% of all patients had undergone mastectomy and 72.6% had had a breast conserving therapy. In 2.0% of the patients no surgery was performed. 33.6% of all patients received adjuvant chemotherapy while endocrine therapy or radiotherapy was administered to 40.1% and 61.1% respectively. Results: Overall survival as expected was strongly correlated to established prognostic factors such as age, tumor size, lymph node status, and grading (p&amp;lt; 0.001) respectively. However, overall survival of the patients did not correlate to either social (p= 0.110) or health (p= 0.659) insurance state. Neither did the professional education of the patients play a role concerning overall survival (p= 0. 217.. Conclusions: Unlike the American results there was no correlation seen between state of social or health insurance for german early breast cancer patients. Thus, although patients with private coverage are supposed to receive more intensive medical care, outcome for these patients concerning overall survival is not better than for patients with compulsory insurance. Literature: 1. Banerjee M, George J, Yee C, Hryniuk W, Schwartz K.: Disentangling the effects of race on breast cancer treatment. Cancer. 2007 Nov 15;110(10):2169-77. 2. Griggs JJ, Culakova E, Sorbero ME, Poniewierski MS, Wolff DA, Crawford J, Dale DC, Lyman GH. Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol. 2007 Jun 20;25(18):2522-7. 3. Brookfield KF, Cheung MC, Lucci J, Fleming LE, Koniaris LG. Disparities in survival among women with invasive cervical cancer : a problem of access to care. Cancer. 2008 Dec 18. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-11.

Variability of Patterns of Fatigue and Quality of Life Over Time Based on Different Breast Cancer Adjuvant Chemotherapy Regimens

To examine the relationships among fatigue and physical and mental quality of life (QOL) and different adjuvant chemotherapy regimens in patients with stage I-IIIA breast cancer prior to, during, and after treatment. Longitudinal, descriptive design embedded in a randomized, clinical trial. Outpatient oncology clinics in the midwestern United States. 196 postoperative women, mean age of 52 years, receiving anthracycline-based chemotherapy regimens: dose-dense taxane, dose-standard taxane, or dose-standard without taxane. The Piper Fatigue Scale and Medical Outcomes Study SF-36(R) (v.2) Survey were completed 48 hours prior to treatment 1, at treatments 4 and 8, and 30 days after the final treatment. Fatigue, adjuvant chemotherapy regimen, and QOL. Fatigue and mental QOL changed significantly over time for all regimens, but the patterns of change did not differ based on regimen. Physical QOL changed significantly over time for all regimens, and the pattern of change differed based on whether taxanes were received. Higher fatigue was correlated with lower physical and mental QOL prior to and 30 days after the final treatment, regardless of regimen. Women who receive taxanes are at higher risk for lower physical QOL over time. Higher fatigue was associated with lower QOL regardless of the chemotherapy regimens. Clinicians should screen patients for fatigue and assess for contributing factors at clinic visits. Methods to integrate evidence-based fatigue interventions into practice should be tested and outcomes evaluated.

Social and Racial Differences in Selection of Breast Cancer Adjuvant Chemotherapy Regimens

Social and Racial Differences in Selection of Breast Cancer Adjuvant Chemotherapy Regimens

Social and Racial Differences in Selection of Breast Cancer Adjuvant Chemotherapy Regimens

Breast cancer outcomes are worse among black women and women of lower socioeconomic status. The purpose of this study was to investigate racial and social differences in selection of breast cancer adjuvant chemotherapy regimens. Detailed information on patient, disease, and treatment factors was collected prospectively on 957 patients who were receiving breast cancer adjuvant chemotherapy in 101 oncology practices throughout the United States. Adjuvant chemotherapy regimens included in any of several published guidelines were considered standard. Receipt of nonstandard regimens was examined according to clinical and nonclinical factors. Differences between groups were assessed using chi2 tests. Multivariate logistic regression was used to identify factors associated with use of nonstandard regimens. Black race (P = .008), lower educational attainment (P = .003), age 70 years (P = .001), higher stage (P < .0001), insurance type (P = .048), employment status (P = .045), employment type (P = .025), and geographic location (P = .021) were associated with the use of nonstandard regimens in univariate analyses. In multivariate analysis, black race (P = .020), lower educational attainment (P = .024), age > or = 70 years (P = .032), and higher stage (P < .0001) were associated with receipt of nonstandard regimens. The more frequent use of non-guideline-concordant adjuvant chemotherapy regimens in black women and women with lower educational attainment may contribute to less favorable outcomes in these populations. Addressing such differences in care may improve cancer outcomes in vulnerable populations.

Social and racial disparities in the use of non-standard breast cancer adjuvant chemotherapy regimens

6036 Background: Economically disadvantaged and black women have worse stage-specific breast cancer outcomes than other women, even after controlling for tumor histologic features. Disparities quality of chemotherapy may contribute to differences in outcome. The purpose of this study was to investigate the use of non-standard breast cancer adjuvant chemotherapy regimens in black women and those of lower socioeconomic status (SES). Methods: Detailed information on patient, disease, and treatment factors was collected prospectively on 1,006 patients receiving adjuvant chemotherapy for early-stage breast cancer in 115 oncology practices throughout the US. All patients signed informed consent. Regimens included in the guidelines of the National Comprehensive Cancer Network were considered standard regimens; all others were considered non-standard. Receipt of non-standard regimens was examined according to clinical and non-clinical factors. Differences between groups were assessed using a chi-square test. Multivariate logistic regression was used to identify factors associated with use of non-standard regimens. Results: Non-standard regimens were used in the treatment of 136 (14%) of the participants. Black patients were twice as likely to receive a non-standard regimen as whites (23% vs. 12%, p = .0014). Patients with less than a high school education were twice as likely to receive a non-standard regimen compared with those with a college education (21% vs. 8%, p = 0.0011). Other factors associated with non-standard chemotherapy regimens were past chemotherapy exposure (p &lt; .0001), higher stage disease (p &lt; .0001) and geographic location (p = 0.0059). Age, comorbidity, body mass index, type of insurance, and employment status were not associated with receipt of non-standard chemotherapy. In multivariate analysis, all variables that were significant in the bivariate analysis remained independently associated with receipt of non-standard chemotherapy. Conclusions: The more frequent use of non-guideline concordant adjuvant chemotherapy regimens in black women and women with lower SES may contribute to their less favorable outcomes. These findings offer an opportunity to improve patient care and perhaps cancer outcomes. [Table: see text]