Cycles Of Anthracycline Chemotherapy Research Articles

Home-Based Buddhist Walking Meditation Mitigates Cardiotoxicity of Anthracycline Chemotherapy in Breast Cancer Patients: A Randomized Controlled Trial.

Purpose: To investigate the effect of walking meditation on vascular function, aerobic fitness, and quality of life in breast cancer patients receiving anthracycline chemotherapy and compare with the nonexercising control group. Methods: Patients aged 40-60 years with newly diagnosed, histologically confirmed resected stage I-II breast cancer were studied in a parallel randomized controlled trial. The participants were randomly assigned to either the nonexercising control group (n = 15) or the Buddhist walking meditation group (n = 15). All participants received four cycles of anthracycline chemotherapy every 3 weeks starting at 2 weeks before the start of the exercise intervention. The walking meditation group performed home-based mindfulness walking exercises at a moderate exercise intensity for 30 min/session, 3 times/week for 12 weeks. The primary outcome measures were vascular reactivity (flow-mediated dilation [FMD]) and arterial stiffness (brachial-ankle pulse wave velocity [baPWV]). Results: Eleven participants from each group completed the entire study. Analysis of variance with repeated measures indicated that FMD and peak oxygen consumption (VO2peak) decreased in both groups after the initiation of anthracycline chemotherapy (all p < 0.05). After the exercise intervention, FMD, VO2peak, peak stroke volume, and peak cardiac output remained lower in the controls, but improved in the walking meditation group (all p < 0.05). baPWV increased in the control group, while no such change was observed in the walking meditation group. There were no significant changes in blood cortisol, malondialdehyde, and interleukin-6 concentrations in both groups. Overall quality of life decreased after 2 weeks of anthracycline chemotherapy in both groups (all p < 0.05). However, the walking meditation group improved many of these symptoms significantly (all p < 0.05), while no such changes were observed in the control group. Conclusions: Buddhist walking meditation exercise was effective in mitigating cardiotoxicity of anthracycline chemotherapy on vascular function, aerobic fitness, and quality of life in breast cancer patients. Clinical trial registration number: NCT02676531.

Evaluation of Serum Lipid Profile after Different Chemotherapeutic Regimens in Iraqi Patients with Breast Cancer

Objective: To investigate the effect of doxorubicin, cyclophosphamide and taxane chemotherapy on thelipid profile in Iraqi patients with breast cancer.Method: This cohort prospective study was carried out at the Biochemistry Department, Baghdad Collegeof Medical Sciences, and at the Oncology Clinic, Oncology Teaching Hospital, Baghdad, Iraq, during theperiod from May 2019 to October 2019. It included 56 women with regular menstrual cycle (25-45 years)classified into 3 groups: GI: 29 women with primary breast cancer (before starting chemotherapy), GII:the same 29 women of GI who were finished 4 cycles of anthracycline chemotherapy (course 1) and GIII:which involved another 27 women who had finished both courses of chemotherapy, (course 1) and 4 cyclesof taxanes (course 2). Serum cholesterol, LDL, HDL and TG were measured using colorimetric method.Results: The results of the present study showed that the (mean±SEM) of the serum cholesterol wasdecreased significantly (p&lt;0.05) in GIII compared to GI and highly significantly (p&lt;0.01) compared to GII.While, the serum HDL level was significantly (p&lt;0.05) lower in GIII compared to GI. Concerning the serumLDL level, it was increased significantly (p&lt;0.05) in GII compared to both GI and GIII. While; the serumTG level shows no significant difference between all groups.Conclusion: Iraqi women with breast cancer had an abnormal state of dyslipidemia that become worsenedafter chemotherapy.

Abstract 1409: Characterization of the LAR subtype triple negative breast cancer population

Abstract Background: The LAR subtype of triple negative breast cancer (TNBC) was defined using the Vanderbilt genomic signature in cell lines. The characteristics of this population remain unclear. Methods: We collected the clinicopathological, molecular and imaging characteristics of the LAR population who were enrolled in the ARTEMIS trial, a prospective trial to treat women with TNBC to receive neoadjuvant anthracycline therapy followed by experimental arms based on biomarker versus taxane. The ultrasonography-based response assessment was performed at baseline, after 2 and 4 cycles of anthracycline chemotherapy. The Vanderbilt genomic signature was used to classify the TNBC into the basal-like 1, basal-like 2, immunomodulatory, mesenchymal, mesenchymal stem-like and luminal androgen receptor (LAR) subtypes. The clinical data for this analysis included age, race, menopausal status, TNM stage and BRCA mutation status. Pathological and molecular characteristics included histologic subtype, nuclear grade, Ki67, vimentin expression, androgen receptor (AR) immunohistochemical (IHC) nuclear staining, stromal tumor infiltrating lymphocytes (TIL) percentage and residual cancer burden (RCB) at surgery. Results: Total 28 patients with the LAR signature were analyzed. The characteristics are showed in the table: AgeRaceno. (%)Clinical Stageno. (%)AR IHC StainingBRCA Mutationno. (%)Median (yr)55White19 (68)IA1 (4)Median (%)52No mutation16 (57)Distribution(%)no. (%)Asian3 (11)IIA6 (21)Distribution (%)no(%)Mutation present018-402 (7)Black2 (7)IIB10 (36)&amp;lt;259 (32)VUS1 (4)41-6012 (43)Hispanic3 (11)IIIA6 (21)25-505 (18)Test not indicated6 (21)&amp;gt;6014 (50)American Indian1 (3)IIIB051-751 (3,5)Unknown5 (18)IIIC5 (18)76-10012 (43)Not available1 (3,5)Menopauseno. (%)Histologic subtypeno. (%)Ki67Stromal TILno. (%)Vimentin expressionno. (%)Postmenopausal23 (82)IDC24 (87)Median (%)40&amp;lt;5%10 (36)&amp;lt; 1%24 (85)Perimenopausal2 (7)ILC2 (7)Distribution (%)no. (%)5% - &amp;lt;50 %16 (57)≥1%3 (11)Premenopausal3 (11)Apocrine Carcinoma1 (3)&amp;lt;205 (18)≥50%1 (3,5)N/A1 (4)Metaplastic carcinoma1 (3)≥2013 (46)N/A1 (3,5)N/A10 (36)T stageno. (%)Lymph node involvementno. (%)Nuclear gradeno. (%)Tumor reduction (%)no. (%)RCBno(%)T1c3 (11)Yes22 (79)11 (4)≥ 7012 (43)pCR-111 (39)T213 (46)No6 (21)26 (21)&amp;lt; 7014 (50)2-315 (54)T311 (39)321 (75)N/A2 (7)N/A2 (7)T41 (4)Experimental armno. (%)Enzalutamide8 (29)Atezolizumab4 (14)None16 (57) Relevant characteristics are: median age of 55 years, 82% postmenopausal, 89% breast tumor size &amp;gt; 2cm, 79% with lymph node involvement, no BRCA mutation detected, 75% nuclear grade III, 46% with Ki67 ≥ 20%, median AR IHC staining of 52%, 85% vimentin expression of &amp;lt;1%, 93% had stromal TIL &amp;lt;50%, 39% RCB 0-1 and 54% RCB 2-3. We found that 43% had ≥ 70% reduction in size after 4 cycles of AC. Univariate and multivariate analysis using characteristics did not reveal contributing factor to the RCB. Conclusion: The LAR subgroup harbors unique characteristics that require further confirmation in larger cohorts. Citation Format: James Crespo, Seth Sahil, Elizabeth Ravenberg, Lei Huo, Kenneth Hess, Lumarie Santiago, Beatriz Adrada, Gaiane Rauch, Damodaran Senthil, Rashmi Murthy, Jennifer Litton, Debu Tripathy, Naoto Ueno, Stacy Moulder, Bora Lim. Characterization of the LAR subtype triple negative breast cancer population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1409.

Chemotherapy and Dyslipidemia (Doxorubicin and Cyclophosphamide Regimen versus Taxane) in Iraqi Women with Breast Cancer: A Compara-tive Study

Lipids are a major component of the cell membrane, essential for the growth and division of both the normal and malignant cell. This study aimed to study the effect of different chemotherapy regimens in the induction of dyslipidemia in Iraqi women with breast cancer. This cross-sectional study was conducted at the Department of Biochemistry, Medical College, University of Baghdad and at the Oncology Hospital, Medical City Hospital, Baghdad, Iraq, during the period from May 2018 to October 2018. It involved 56 regularly menstruated women (25-45 years) categorized into: group 1 [G1] included 29 women with primary breast carcinoma, group 2 [G2] consisted of the same 29 women of G1 but after finishing the first course of treatment [4 cycles of anthracycline chemotherapy], and group 3 [G3] which involved 27 women who completed full regimen of chemotherapy treatment [course 1 and 4 cycles of taxanes; the course 2]. Serum cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and TG were measured using colorimetric methods. The mean (± SEM) of serum cholesterol was significantly increased in G1 (p&lt; 0.05) and G2 (p&lt;0.01) compared to G3. Also, the mean values of serum LDL-C were significantly elevated in G2 than G1 and G3 (p&lt;0.05). Serum TG level showed no significant differences among the three groups. While that of serum HDL-C levels was significantly decreased in G3 compared to G1 (p&lt;0.05), this study showed that breast cancer chemotherapy-associated dyslipidemia is transient, and anthracycline course has a significant effect than Taxane one.

Serum anti-müllerian hormone levels in evaluation of chemotherapy effect on ovarian reserve in women with breast cancer. A follow-up study.

Objectives:To investigate the role of serum anti müllerian hormone (AMH) pre-chemotherapy treatment levels in prediction of post-chemotherapy effect on the ovarian reserve of women with breast cancer.Methods:This cohort prospective study was carried out at the Biochemistry Department, College of Medicine, University of Baghdad and at the Oncology Clinic, Oncology Teaching Hospital, Baghdad, Iraq. It included 58 women with regular menstrual cycle (25-45 years) who were newly diagnosed with breast cancer. The women were classified into 3 groups: GI: 30 women with breast cancer before starting chemotherapy, GII: the same 30 women of GI who finished 4 cycles of anthracycline chemotherapy (course 1) and GIII: which involved another 28 women who had finished both courses of chemotherapy, (course 1) and (course 2).Results:The mean (±SEM) value of AMH levels was significantly decreased in GII and GIII when compared with GI (for both, p<0.0005). However, there was no significant difference in serum AMH levels between GII and GIII.Conclusion:The measurement of serum AMH may be a useful biochemical marker of the chemotherapy extent induced ovarian reserve damage and the incidence of amenorrhea.

Effect of doxorubicin and cyclophosphamide regimen versus taxane on liver enzymes in Iraqi women with breast cancer.

Objective: To investigate the effect of doxorubicin, cyclophosphamide and taxane chemotherapy on the liver enzymes in Iraqi women with breast cancer. Methods: This cohort prospective study was carried out at the Biochemistry Department, College of Medicine, University of Baghdad and at the Oncology Clinic, Oncology Teaching Hospital, Baghdad, Iraq. It included 56 women with regular menstrual cycle (25-45 y) who were newly diagnosed with breast cancer. The women were classified into 3 groups: GI (pre-treatment): 29 women with breast cancer before starting chemotherapy and the post treatment group: the same 29 women of GI (pre-treatment) who finished 4 cycles of anthracycline chemotherapy (course 1), and GII: which involved another 27 women who had finished both courses of chemotherapy, (course 1) and 4 cycles of taxanes (course 2), serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALK) and serum total proteins were measured using colorimetric methods. Results: Concerning the liver biochemical parameters (ALT and AST); there was no significant difference between GII and both GI (pre-treatment and post treatment) groups. While the serum levels of these enzymes increased significantly in GI (post treatment) compared to the (pre-treatment) group. According to the serum ALP; there was no significant difference between all groups. While the serum TP shows a significant increase in GI (post treatment) compared to the (pre-treatment) group. And a highly significant increase in GII compared to both GI (pre-treatment and post treatment) groups. Conclusion: Breast cancer chemotherapeutic agents’ combinations cause hepatic toxicity indicated by changes in liver enzymes levels and activity.

Abstract P5-16-19: Evaluation of weekly paclitaxel plus carboplatin followed by anthracycline chemotherapy on the neoadjuvant treatment of patients with triple-negative breast cancer

Abstract Background Triple negative breast cancer (TNBC) accounts for 15 to 20 % of the invasive breast cancers. Pathological complete response (pCR) in this subgroup of breast cancer is associated with improved long term event free survival. Results from previous studies indicate that the addition of carboplatinum (Cb) to standard neoadjuvant anthracycline-taxane chemotherapy results in an increase in pCR. One of the investigational arms of the CALGB 40603 tested paclitaxel 80 mg/m2 once a week (wP) for 12 weeks with concurrent Cb (area under curve 6) once every 3 weeks for four cycles, followed by doxorubicin plus cyclophosphamide once every 2 weeks (ddAC) for four cycles. Although effective this regimen has been difficult to reproduce in the daily practice. The purpose of this study was to evaluate the effectiveness and tolerability of wP in combination with weekly Cb (wP+wCb) area under curve 2 (AUC=2) followed by anthracycline chemotherapy. Methodology The electronic medical record system was used to identify female patients 18 years of age or older with clinical stage I-III (TNBC) who received neoadjuvant chemotherapy of wP+wCb (AUC=2) before or after anthracycline chemotherapy between January 1, 2014 and March 1, 2016. The primary outcome was to evaluate the tolerability of fractionating carboplatin to weekly infusions in combination with weekly paclitaxel. The secondary outcomes included the pCR (no evidence of invasive tumor in the breast and axilla), Residual Cancer Burden (RCB), the number of cycles received in each chemotherapy regimen and frequency of chemotherapy related toxicities. Results: For the 32 eligible patients, median age: 51 years, Stage I: 6%, Stage II: 68%, Stage: III 26%, germline BRCA mutation: 10%, KI 67 &amp;gt; 75% : 72%. 93% of the patients received 11-12 cycles of wP+wCb and 83% received all 4 planned cycles of anthracycline chemotherapy. 83% of patients completed all planned therapy. pCR and RCB 0/1 rates were 60% (19/32) and 75% (24/32) respectively. RCB 2: 22% (7/32), RCB 3: 3% (1/32). 93% of the patients experienced grade 3 neutropenia during wP+wCb requiring GCSF, Grade 3 anemia was seen in 15 % (5/32) and Grade 3 thrombocytopenia was seen in 18 % (6/32). Conclusion: The combination of neoadjuvant chemotherapy with wP+wCb before or after anthracycline chemotherapy was well tolerated among patients with TNBC as demonstrated by the fact that most participants were able to receive all planned 12 cycles of wP+ wCb and all 4 cycles of anthracycline chemotherapy. Complete pathologic response rates were comparable to historically seen. The findings support the continued use of this treatment modality in the general practice. Citation Format: Castrellon AB, Velez M, Blaya M, Barnick S, Dumais K, LeCroy N. Evaluation of weekly paclitaxel plus carboplatin followed by anthracycline chemotherapy on the neoadjuvant treatment of patients with triple-negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-19.

Adjuvant chemotherapy in older women (ACTION) study – what did we learn from the pilot phase?

Background:The ACTION trial was initiated to provide evidence from a randomised trial on the effects of chemotherapy in women aged over 70 years where evidence for risk and benefit are lacking.Methods:This was a randomised, phase III clinical trial for high risk, oestrogen receptor (ER) negative/ER weakly positive early breast cancer. The trial planned to recruit 1000 women aged 70 years and older, randomised to receive 4 cycles of anthracycline chemotherapy or observation. The primary endpoint was relapse-free interval. The trial included a pilot phase to assess the acceptability and feasibility of recruitment.Results:The trial opened at 43 UK centres. Information on number of patients approached was available from 38 centres. Of the 43 eligible patients that were approached, 39 were not randomised due to patients declining entry. After 10 months only 4 patients had been randomised and after discussion with the research funder, the trial was closed and funding terminated.Conclusion:Despite widespread support at several public meetings, input from patient groups including representation on the Trial Management Group, the trial failed to recruit due to the inability to convince patients to accept randomisation. It would therefore seem that randomising the patients to receive chemotherapy vs observation is not a viable design in the current era for this patient population.

Manageability of Acute Severe Heart Failure Complicated With Left Ventricular Thrombosis During Therapy for Breast Cancer

Trastuzumab-related cardiac dysfunction may be manageable and completely reversible with suitable cardiac medication, allowing optimal breast cancer treatment to continue. We present the case of a 42-year-old woman who developed severe systolic left ventricular failure with impaired contractility of the right ventricle, pulmonary hypertension, and clots in the left ventricular cavity during adjuvant treatment for breast cancer. The patient was initially diagnosed with early breast cancer and underwent surgery on her left breast. She received 6 cycles of anthracycline chemotherapy followed by radiation therapy in the left breast area, then 5 cycles of trastuzumab. After the fifth cycle of trastuzumab, she experienced dyspnoea and leg edema. Fluid was detected in the pleural cavities but no lung metastases were identified. Echocardiography was performed, revealing a severely reduced left ventricular ejection fraction (10%) with impaired contractility of the right ventricle and pulmonary hypertension. Standard medication for heart failure resulted in complete recovery of normal systolic and diastolic function of the left and right ventricles. The combination of low molecular weight heparin and acetylsalicylic acid completely resolved the thrombotic complications. The patient regained her full range of social, occupational, and family activities. This case study is the first to demonstrate the manageability and reversibility of trastuzumab-related cardiac complications in a patient who had developed severe heart failure complicated with left ventricular thrombosis during sequential anthracycline and trastuzumab therapy for breast cancer. The findings contradict other opinions that trastuzumab-related acute heart failure is analogous to stunning or hibernation and recovers without specific cardiac treatment.

Prediction of response of locally advanced breast cancer (LABC) to neoadjuvant anthracycline chemotherapy using 99mTc-sestamibi

2100 Background: P-glycoprotein (Pgp) is an ATP-dependent efflux membrane transporter that confers multidrug resistance in cancer cells. It has been shown that the efflux rate of technetium 99mTc-sestamibi, a transport substrate of Pgp, is directly correlated with Pgp levels in untreated breast carcinoma. We performed an exploratory study to investigate whether efflux rates of 99mTc-sestamibi correlates with response to neoadjuvant anthracycline chemotherapy in LABC. Methods: Following IV 25 mCi of 99mTc-sestamibi, pixel counts of both tumor (T) and corresponding normal contralateral breast (B) were acquired at 10 (B10,T10) and 120 (B120, T120) mins. The retention index (RI) was calculated as the ratio of (B120/T120) and (B10/T10). Neoadjuvant doxorubicin/epirubicin and cyclophosphamide given 3 weekly was administered following a baseline 99mTc-sestamibi scan. Response was evaluated after at least 3 cycles of anthracycline chemotherapy. Results: 23 patients with LABC were accrued. The median age was 50 ye...