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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EThis article discusses the effect of trastuzumab on cardiac function, the final results from the\nphase 3 Intergroup Trial E1199, novel regimens for the treatment of triple-negative breast cancer\ntumors, and a comparison of magnetic resonance imaging versus mammography in detecting ductal\ncarcinoma \u003Cem\u003Ein situ\u003C\/em\u003E.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe incidence of congestive heart failure (CHF) associated with trastuzumab, for early breast\ncancer treatment, does not increase over time, according to a 5-year update of cardiac dysfunction\nin patients in the adjuvant NSABP B31 trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EWhile CHF occurred more often in patients who received trastuzumab, versus those who did not, the\ncumulative incidence at 5 years was no greater than the incidence observed at 3 years, reported\nPriya Rastogi, MD, University of Pittsburgh Cancer Institute.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ENSABP B31 compared adjuvant doxorubicin\/cyclophosphamide followed by paclitaxel, to the same\nregimen plus trastuzumab for 1 year. The initiation of trastuzumab required normal post-AC left\nventricular ejection fraction (LVEF) on MUGA scan. Nearly 8% of women did not receive\ntrastuzumab on the basis of positive cardiac findings.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe 1,850 women who were randomized to standard treatment or treatment plus 1 year of trastuzumab\nwere carefully followed for cardiac toxicity with periodic MUGA scans. If symptoms suggestive of CHF\ndeveloped, the records were blindly reviewed by a panel of cardiologists to determine whether\ncriteria were met for a cardiac event, defined as NYHA class III or IV CHF or possible\/probable\ncardiac death.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAfter 5 years, the cumulative incidence of cardiac events was 0.9% with standard treatment\nand 3.8% when trastuzumab was added for 1 year (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The incidence was similar to that reported at 3\nyears, and most patients on trastuzumab recovered full cardiac function, Dr. Rastogi reported.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11064\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11064\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11064\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003E5 Year Cumulative Incidence of Cardiac Events in the Evaluable Cohorts.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EArm 1: AC\u2192PTX, n=898, 6 CHFs, 1 Cardiac Death\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EArm 2: AC\u2192PTX + Trastuzumab, n=947, 35 CHFs, No Cardiac Deaths\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003E\u201cWe are encouraged by these new data showing no additional late cardiotoxicity associated\nwith trastuzumab,\u201d she said.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EOf 33 trastuzumab patients in whom a cardiac event was confirmed, 5 were symptomatic in the 6\nmonths prior to the ASCO presentation, and 20 were still on medication (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). While ejection fractions tended to normalize by 18\nmonths, they remained above baseline levels in some patients, she added.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EAs part of the study, investigators examined potential risk factors for cardiac toxicity and\nidentified advanced age (\u0026gt;65), use of hypertension medications at baseline, and low baseline\nejection fraction as important. Radiation site was not a significant predictor.\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11066\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11066\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11066\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n\u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ERecovery of Patients Reporting Symptoms of Possible CHF.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EBy individual risk factor, the incidence of heart failure was 5.4% for patients \u0026gt;65\ncompared to 2.3% for those \u0026lt;50 years of age; 6.8% for patients on\nantihypertensives vs 3% for others; and 12.9% for patients with baseline ejection\nfraction \u0026lt;54%, compared to 2.1% when ejection fraction was \u0026gt;65 (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E), Dr. Rastogi reported.\u003C\/p\u003E\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11070\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11070\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11070\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n\u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003ERisk Factors for Cardiac Toxicity.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EA prediction model incorporating these risk factors was able to show, for example, that cardiac\nrisk was only 1.3% for a 48-year-old female with a baseline ejection fraction of 69%\nwho was not on antihypertensive medication, but rose to 15% in a 57-year-old patient with an\nejection fraction of 54% who was on a blood-pressure-lowering agent.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EDr. Rastogi advised clinicians to consider individual risk for cardiac events when deciding\nwhether to administer trastuzumab.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003ETaxanes Comparable in Adjuvant Regimen\u003C\/h2\u003E\n\u003Cp id=\u0022p-19\u0022\u003EIn adjuvant regimens for early breast cancer, the choice of taxane\u2014docetaxel or\npaclitaxel\u2014may be unimportant, in terms of disease-free survival, according to the final\nresults from the phase 3 Intergroup Trial E1199, reported by Joseph Sparano, MD, Albert Einstein\nCollege of Medicine, New York.\u003C\/p\u003E\n\u003Cp id=\u0022p-20\u0022\u003EEvidence has suggested that docetaxel is more effective than paclitaxel, and paclitaxel is more\neffective when given weekly versus every 3 weeks in metastatic breast cancer. This study evaluated\nthese agents and schedules in the adjuvant setting.\u003C\/p\u003E\n\u003Cp id=\u0022p-21\u0022\u003EE1199 randomized 4,590 patients with node-positive or high-risk node-negative breast cancer to\ndoxorubin 60 mg\/m\u003Csup\u003E2\u003C\/sup\u003E plus cyclophosphamide 600 mg\/m\u003Csup\u003E2\u003C\/sup\u003E (AC) every 3 weeks for 4\ncycles, followed by either (1) paclitaxel 175 mg\/m\u003Csup\u003E2\u003C\/sup\u003E every 3 weeks for 4 cycles, (2)\npaclitaxel 80 mg\/m\u003Csup\u003E2\u003C\/sup\u003E weekly for 12 cycles, (3) docetaxel 100 mg\/m\u003Csup\u003E2\u003C\/sup\u003E every 3\nweeks for 4 cycles, or (4) docetaxel 35 mg\/m\u003Csup\u003E2\u003C\/sup\u003E weekly for 12 cycles. The primary\ncomparisons included taxane (docetaxel vs paclitaxel) and schedule (weekly vs every 3 weeks).\u003C\/p\u003E\n\u003Cp id=\u0022p-22\u0022\u003EAt a median follow-up time of 64 months, no differences in disease-free survival (DFS) were\nshown. There was, however, a 5% absolute improvement in DFS with paclitaxel given weekly and\nwith docetaxel given every 3 weeks, and a 3% absolute improvement in overall survival with\npaclitaxel given weekly, Dr. Sparano reported.\u003C\/p\u003E\n\u003Cp id=\u0022p-23\u0022\u003E\u201cCompared with paclitaxel, docetaxel did not improve disease-free survival. And compared\nwith a regimen given every 3 weeks, weekly treatment did not improve disease-free survival,\u201d\nhe said, referring to the primary endpoints (\u003Ca id=\u0022xref-table-wrap-4-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T4\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022T4\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11074\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11074\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11074\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-24\u0022 class=\u0022first-child\u0022\u003EOutcomes by Taxane and Regimen.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-25\u0022\u003EWith weekly paclitaxel and q-3-week docetaxel, the risk of disease progression was reduced by\n25%. Similar trends observed in hormone-receptor-negative and hormone-receptor-positive\npatients. Weekly paclitaxel improved overall survival, reducing the risk of death by 30% over\nother arms.\u003C\/p\u003E\n\u003Cp id=\u0022p-26\u0022\u003EToxicity was generally mild, with some differences between the regimens. The q-3-week docetaxel\narm was associated with more severe neutropenia, febrile neutropenia, and infection, while weekly\npaclitaxel was associated with more neuropathy. The neuropathy with paclitaxel was reversible in\nmost patients, he added.\u003C\/p\u003E\n\u003Cp id=\u0022p-27\u0022\u003EAs the discussant for this presentation, Robert Carlson, MD, Stanford University Palo Alto,\nCalifornia, concluded, \u201cWeekly paclitaxel is substantially more effective than paclitaxel\ngiven every 3 weeks, and weekly paclitaxel is more effective than either docetaxel regimen. The\ntoxicity profile also favors weekly paclitaxel.\u201d\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003ETriple-Negative Breast Cancer Tumors Have Good Response to Novel Regimen\u003C\/h2\u003E\n\u003Cp id=\u0022p-28\u0022\u003EIn the adjuvant treatment of breast cancer, a regimen of anthracycline plus paclitaxel (without\ncyclophosphamide) followed by weekly paclitaxel (AP\u2192wP) may be as effective as the standard\nregimen of anthracycline\/cyclophosphamide (AC) followed by paclitaxel given every 3 weeks\n(AC\u2192P). The study was reported by David Loesch, MD, of US Oncology, Houston, Texas.\u003C\/p\u003E\n\u003Cp id=\u0022p-29\u0022\u003E\u201cAnthracycline\/paclitaxel followed by weekly paclitaxel can be considered a standard\ntreatment in the community,\u201d Dr. Loesch said, \u201calthough it is more neurotoxic and must\nbe used with caution.\u201d\u003C\/p\u003E\n\u003Cp id=\u0022p-30\u0022\u003EIn particular, this regimen was of the greatest benefit in the patients with\n\u201ctriple-negative\u201d breast cancer: HER2-negative, estrogen receptor (ER)-negative, and\nprogesterone receptor (PR)-negative, he reported. Especially in these patients, AP\u2192wP was\nsuperior to AC\u2192P, he reported.\u003C\/p\u003E\n\u003Cp id=\u0022p-31\u0022\u003EThe study randomized 1,830 early breast cancer patients to one of these arms. About two thirds of\neach arm were ER+ and\/or PR+, while one third were negative for hormone receptors.\nAbout two thirds were also HER2-negative. Most patients had 1\u20133 positive lymph nodes.\u003C\/p\u003E\n\u003Cp id=\u0022p-32\u0022\u003EIn a previous interim analysis, disease-free survival at 3 years was significantly better with\nAP\u2192wP: 88% vs 85% with AC\u2192P, for a 26% reduction in relapse\n(p=0.05). However, the current 5-year analysis found no difference between the arms:\n81% vs 80% (p=0.38), Dr. Loesch reported.\u003C\/p\u003E\n\u003Cp id=\u0022p-33\u0022\u003EHowever, the differences in overall survival that were previously reported were maintained in the\nASCO report. At 5 years, overall survival was 90% with AP\u2192wP compared with 87%\nwith AC\u2192P, for a 24% reduction in risk with AP\u2192wP (p=0.04; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Overall Survival (ITT).\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-876054892\u0022 data-figure-caption=\u0022Overall Survival (ITT).\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11053\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-34\u0022 class=\u0022first-child\u0022\u003EOverall Survival (ITT).\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-35\u0022\u003EThis 3% absolute survival difference was based on the considerable number of deaths in the\nAC\u2192P arm: 106 vs 80 for AP\u2192wP. Breast cancer deaths numbered 83 and 63,\nrespectively.\u003C\/p\u003E\n\u003Cp id=\u0022p-36\u0022\u003E\u201cOmitting cyclophosphamide in the AP\u2192wP regimen did not compromise disease-free\nsurvival or overall survival,\u201d he pointed out.\u003C\/p\u003E\n\u003Cp id=\u0022p-37\u0022\u003EThere were no differences in disease-free or overall survival between the arm based on hormone\nreceptor status or HER2 status. But in the unplanned analysis of triple-negative tumors,\nAP\u2192wP was clearly superior. In fact, the superiority in this arm probably accounted for the\ndifference in overall survival that was seen, according to the investigators.\u003C\/p\u003E\n\u003Cp id=\u0022p-38\u0022\u003EAmong the 378 triple-negative patients, disease-free survival at 5 years was 79% for the\nAP\u2192wP arm and 74% for the AC\u2192P arm, for a 41% reduction in risk. Overall\nsurvival was 87% and 79%, respectively. Again, this represented a 61% reduction\nin risk in this subgroup (p=0.037; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure\n2\u003C\/a\u003E), Dr. Loesch reported.\u003C\/p\u003E\n\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Overall Survival for Triple Negative ER-\/PR-\/HER2neu.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-876054892\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Overall Survival for Triple Negative ER-\/PR-\/HER2\u0026amp;lt;em\u0026amp;gt;neu\u0026amp;lt;\/em\u0026amp;gt;.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11057\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n\u003Cp id=\u0022p-39\u0022 class=\u0022first-child\u0022\u003EOverall Survival for Triple Negative ER-\/PR-\/HER2\u003Cem\u003Eneu\u003C\/em\u003E.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-40\u0022\u003EThere was no difference in cardiotoxicity between the arms. Nonhematologic toxicity was primarily\nneuropathy, which was 32% with the AP\u2192wP regimen and 17% with AC\u2192P\n(p\u0026lt;0.01).\u003C\/p\u003E\n\u003Cp id=\u0022p-41\u0022\u003EThe study\u0027s discussant, Robert Carlson, MD, Stanford University, Palo Alto, California,\nnoted the better outcomes with AP\u2192wP in the triple-negative patients. But he said that, in\nhis opinion, the study \u201cdoes not change practice in early disease or in the triple-negative\nsubset.\u201d\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EMRI More Accurate than Mammography in Diagnosing Aggressive DCIS\u003C\/h2\u003E\n\u003Cp id=\u0022p-42\u0022\u003EIn a breast cancer screening population, magnetic resonance imaging (MRI) was more effective than\nmammography in detecting ductal carcinoma in situ (DCIS), especially high-grade lesions that are\nmost likely to progress, a recent German study found.\u003C\/p\u003E\n\u003Cp id=\u0022p-43\u0022\u003ECristiane K. Kuhl, MD, University of Bonn, Germany, noted that mammography is the standard means\nof diagnosing DCIS but often results in the over diagnosis of low-grade lesions that are not\nclinically meaningful. MRI has recently become established as superior in the diagnosis of invasive\nbreast cancer in high-risk women, but is still controversial in the case of DCIS, she said. The\nstudy investigators aimed, therefore, to clarify the value of MRI in diagnosing DCIS that is\nclinically important.\u003C\/p\u003E\n\u003Cp id=\u0022p-44\u0022\u003EThe prospective study included 5,960 women referred to a dedicated breast unit for screening or\nfor diagnostic assessment (ie, an unselected cohort). Women underwent bilateral mammography with at\nleast two views, plus spot compression views where appropriate, and high-resolution bilateral\nMRI.\u003C\/p\u003E\n\u003Cp id=\u0022p-45\u0022\u003EA total of 167 women received the final pathologic diagnosis of DCIS. This included 44 low-grade\nlesions, 34 intermediate-grade lesions, and 89 high-grade lesions. Of these women, 89% had\nbeen referred for regular screening, 10% for high-risk screening, 7% for follow-up\nafter breast cancer, and 4% for clinical symptoms. Women were assessed for mode of detection\nand the biologic profile of the DCIS (size, nuclear grading, hormone receptor status and HER2\/neu\nstatus).\u003C\/p\u003E\n\u003Cp id=\u0022p-46\u0022\u003EOf the 167 DCIS cases, the diagnosis was made only on MRI in 153\/197 (92%), and only by\nmammography in 93\/167 (56%), Dr. Kuhl reported.\u003C\/p\u003E\n\u003Cp id=\u0022p-47\u0022\u003EMRI was significantly more sensitive for all lesion grades, and was substantially more sensitive\nin diagnosing high-grade lesions. Among cases diagnosed by MRI, 69% were high-grade lesion;\namong the mammography-diagnosed cases, 17% were high-grade. MRI-detected lesions were also\nmore likely to estrogen-receptor-negative and HER2-positive, compared to mammography-diagnosed\nlesions, she said.\u003C\/p\u003E\n\u003Cp id=\u0022p-48\u0022\u003E\u003Cstrong\u003EDigital Mammogram of a patient with High Grade DCIS (Read as Normal) (left).\u003C\/strong\u003E\u003C\/p\u003E\n\u003Cp id=\u0022p-49\u0022\u003E\u003Cstrong\u003EMRI Study of a Patient with DCIS in the Upper Inner Quadrant of Right Breast\n(right).\u003C\/strong\u003E\u003C\/p\u003E\n\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-876054892\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure3\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure3\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/16\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11060\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EImages courtesy of Cristiane K. Kuhl, MD, University of Bonn\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-50\u0022\u003EThere were no differences between the lesions detected by MRI versus mammography in terms of\npatient age, history of breast cancer, familial risk, breast density, or menopausal status.\u003C\/p\u003E\n\u003Cp id=\u0022p-51\u0022\u003E\u201cMRI was more sensitive than mammography for diagnosing DCIS, and particularly high-grade\nlesions. Over half of all high-grade lesions were diagnosed only by MRI,\u201d Dr. Kuhl concluded.\n\u201cMRI detects DCIS with an aggressive biological profile.\u201d\u003C\/p\u003E\n\u003Cp id=\u0022p-52\u0022\u003E\u201cIt is important to diagnose high-grade DCIS for breast cancer prevention. This is another\npiece of evidence that MRI is the new gold standard, adding to information that it is better for\ndetecting invasive cancer in high-risk patients,\u201d she said. While MRI was more sensitive in\nthis study, the impact of MRI on long-term outcomes, however, remains unknown.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/3\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzma8e\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzma8e\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzma8e\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}