Publications by authors named "Ivana Bozovic-Spasojevic"

17 Publications

  • Page 1 of 1

Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer.

JCO Glob Oncol 2022 Jan;8:e2100153

Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Purpose: Fertility and pregnancy-related issues are highly relevant for young (≤ 40 years) patients with breast cancer. Limited evidence exists on knowledge, practice, and attitudes of physicians from low- and middle-income countries (LMICs) regarding these issues.

Methods: A 19-item questionnaire adapted from an international survey exploring issues about fertility preservation and pregnancy after breast cancer was sent by e-mail between November 2019 and January 2020 to physicians from LMICs involved in breast cancer care. Descriptive analyses were performed.

Results: A total of 288 physicians from Asia, Africa, America, and Europe completed the survey. Median age was 38 years. Responders were mainly medical oncologists (44.4%) working in an academic setting (46.9%). Among responders, 40.2% and 53.8% reported having never consulted the available international guidelines on fertility preservation and pregnancy after breast cancer, respectively. 25.0%, 19.1%, and 24.3% of responders answered to be not at all knowledgeable about embryo, oocyte, or ovarian tissue cryopreservation, respectively; 29.2%, 23.6%, and 31.3% declared that embryo, oocyte, and ovarian tissue cryopreservation were not available in their countries, respectively. 57.6% of responders disagreed or were neutral on the statement that controlled ovarian stimulation can be considered safe in patients with breast cancer. 49.7% and 58.6% of responders agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence overall or only in those with hormone receptor-positive disease, respectively.

Conclusion: This survey showed suboptimal knowledge, practice, and attitudes of physicians from LMICs on fertility preservation and pregnancy after treatment completion in young women with breast cancer. Increasing awareness and education on these aspects are needed to improve adherence to available guidelines and to promote patients' oncofertility counseling.
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http://dx.doi.org/10.1200/GO.21.00153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769103PMC
January 2022

Mutational profile of hereditary breast and ovarian cancer - Establishing genetic testing guidelines in a developing country.

Curr Probl Cancer 2021 Jul 10:100767. Epub 2021 Jul 10.

Department for genetic counseling for hereditary cancers, Institute for Oncology and radiology of Serbia, Belgrade.

Purpose: Because many countries lack the capacity to follow the international guidelines for genetic testing, we suggest the specific approach for establishing local genetic testing guidelines that could be applied in developing countries. We focus on hereditary breast (BC) and ovarian cancer (OC) in Serbia.

Methods: From the cohort of 550 persons who were referred for genetic counseling at the Institute for Oncology and Radiology of Serbia, 392 were selected. Personal and family histories were collected and germline DNA was sequenced with NGS in a panel of 20 genes.

Results: Pathogenic (PV) and likely-pathogenic variants (LPV) were detected in 8 genes with the frequency of 23.7%. The most frequent were in BRCA1(7.6%), BRCA2(4.8%), PALB2(4.1%) and CHEK2(3.8%). They were also detected in ATM(1.8%), NBN(0.8%), TP53(0.5%) and RAD51C(0.3%). Whereas high carrier probability (CP), bilateral BC, BC and OC in the same patient and family history (FH) of BC/OC, were the strongest predictors for BRCA1/2 PV/LPV, lower CP values and early age of BC onset without FH were associated with higher frequency of PALB2 and CHEK2 PV/LPV.

Conclusions: Population specific studies to identify specific mutational patterns and predictors of PV/LPV should be conducted in order to make scientifically sound and cost-effective guidelines for genetic testing in developing countries.
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http://dx.doi.org/10.1016/j.currproblcancer.2021.100767DOI Listing
July 2021

A European Network for Teenagers and Young Adults with Cancer.

J Adolesc Young Adult Oncol 2021 04 12;10(2):117-119. Epub 2021 Apr 12.

Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, United Kingdom.

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http://dx.doi.org/10.1089/jayao.2021.0028DOI Listing
April 2021

Cancer Treatment and Research During the COVID-19 Pandemic: Experience of the First 6 Months.

Oncol Ther 2020 Dec 4;8(2):171-182. Epub 2020 Aug 4.

Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.

The coronavirus disease-2019 (COVID-19) pandemic has had a significant impact on patients with underlying malignancy. In this article, we summarize emerging data related to patients with cancer and COVID-19. Among patients with COVID-19, a higher proportion have an underlying diagnosis of cancer than seen in the general population. Also, patients with malignancy are likely to be more vulnerable than the general population to contracting COVID-19. Mortality is significantly higher in patients with both cancer and COVID-19 compared with the overall COVID-19-positive population. The early months of the pandemic saw a decrease in cancer screening and diagnosis, as well as postponement of standard treatments, which could lead to excess deaths from cancer in the future.
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http://dx.doi.org/10.1007/s40487-020-00124-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402077PMC
December 2020

From presentation to paper: Gender disparities in oncological research.

Int J Cancer 2020 06 11;146(11):3011-3021. Epub 2019 Oct 11.

Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Gender disparities in scientific publications have been identified in oncological research. Oral research presentations at major conferences enhance visibility of presenters. The share of women presenting at such podia is unknown. We aim to identify gender-based differences in contributions to presentations at two major oncological conferences. Abstracts presented at plenary sessions of the American Society of Clinical Oncology (ASCO) Annual Meetings and European Society for Medical Oncology (ESMO) Congresses were collected. Trend analyses were used to analyze female contribution over time. The association between presenter's sex, study outcome (positive/negative) and journals' impact factors (IFs) of subsequently published papers was assessed using Chi-square and Mann-Whitney U tests. Of 166 consecutive abstracts presented at ASCO in 2011-2018 (n = 34) and ESMO in 2008-2018 (n = 132), 21% had female presenters, all originating from Northern America (n = 17) or Europe (n = 18). The distribution of presenter's sex was similar over time (p = 0.70). Of 2,425 contributing authors to these presented abstracts, 28% were women. The proportion of female abstract authors increased over time (p < 0.05) and was higher in abstracts with female (34%) compared to male presenters (26%; p < 0.01). Presenter's sex was not associated with study outcome (p = 0.82). Median journals' IFs were lower in papers with a female first author (p < 0.05). In conclusion, there is a clear gender disparity in research presentations at two major oncological conferences, with 28% of authors and 21% of presenters of these studies being female. Lack of visibility of female presenters could impair acknowledgement for their research, opportunities in their academic career and even hamper heterogeneity in research.
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http://dx.doi.org/10.1002/ijc.32660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187424PMC
June 2020

How to become a breast cancer specialist in 2018: The point of view of the second cohort of the Certificate of Competence in Breast Cancer (CCB2).

Breast 2019 Feb 22;43:18-21. Epub 2018 Oct 22.

Department of Clinical Medicine and Surgery, University of Naples "FedericoII", Naples, Italy.

Breast cancer (BC) is the most frequent cancer in women and the leading cause of cancer death in females worldwide. Rapid research advancements add to the complexity of treatment options for this disease. It is known that the quality of patients' care is deeply affected by healthcare professionals following these advancements. There is a growing need for academic education to increase clinical knowledge and skills of physicians treating BC patients. The certificate of Competence in Breast Cancer Program (CCB) is a Certificate in Advanced Studies (CAS) organized by the European School of Oncology in cooperation with Ulm University (Germany), which focuses on both the clinical and scientific competence required for improving quality in the management of BC patients. This paper describes the experience of the second CCB cohort (CCB2), which brought together 24 physicians from four continents who shared the common will to improve their competence and skills in BC treatment.
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http://dx.doi.org/10.1016/j.breast.2018.10.006DOI Listing
February 2019

Treatment outcome in patients with breast conserving surgery after neoadjuvant therapy for breast carcinoma - a single institution experience.

J BUON 2018 Jul-Aug;23(4):883-890

Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.

Purpose: The aim of this study was to analyze outcomes of breast conserving surgery (BCS) after neoadjuvant treatment (NAT) in comparison to radical mastectomy (RM) after NAT in terms of disease-free survival (DFS), overall survival (OS) and patients' satisfaction with the esthetic outcomes of surgery.

Methods: This prospective study was conducted at the National Cancer Research Center of Serbia, Belgrade, from January 1st 2011 to December 31st 2015, on breast carcinoma patients receiving NAT. Treatment outcome was assessed by MDAPI (MD Anderson Prognostic Index). Female patients (n=52) with satisfactory clinical response to NAT and MDAPI scores 0 or 1 were included into the treatment group (NAT-BCS group). The control group (NAT-RM group) consisted of patients (n=52) with poorer clinical response and MDAPI scores 2 to 4. On check-ups, local or distant relapses were noted and both groups were asked to value their satisfaction with the esthetic outcomes of surgery using the Likert scale.

Results: OS was 100% in both groups. DFS was 96.1% in NAT-BCS group and 100% in NAT-RM group. Local recurrences were observed in two patients from the age group ≥60 years, with initial disease stage IIIA and "clear" resection margins on frozen section study. Patients in the NAT-BCS group were more satisfied with the esthetic outcome of surgery than the control group.

Conclusions: BCS after NAT provides good esthetic outcome and is oncologically safe if adequate clinical response is achieved after NAT and if established criteria for patient selection are followed.
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November 2019

Cardiac biomarkers for early detection and prediction of trastuzumab and/or lapatinib-induced cardiotoxicity in patients with HER2-positive early-stage breast cancer: a NeoALTTO sub-study (BIG 1-06).

Breast Cancer Res Treat 2018 Apr 27;168(3):631-638. Epub 2017 Dec 27.

Breast Cancer Research Laboratory, Department of Medicine, Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Blvd de Waterloo 121, Brussels, Belgium.

Background: Biomarkers of cardiac damages, such as troponin T (TnT) and the amino-terminal fragment of brain natriuretic peptide (NT-proBNP), may be useful as early predictors of cardiac dysfunction. The role of these biomarkers in patients receiving lapatinib and/or trastuzumab before anthracyclines is unknown. This study explores TnT and NT-proBNP as predictors of early cardiac toxicity in neoadjuvant breast cancer patients.

Methods: This sub-study of the NEOALTTO trial tested if changes in the levels of TnT and NT-proBNP occurred after 2 weeks of anti-HER2 therapy (lapatinib, trastuzumab or their combination) alone and/or after 18 weeks of anti-HER2 therapy plus weekly paclitaxel.

Results: 173 and 172 were tested at all three timepoints for NT-proBNP and TnT, respectively. The incidence of biomarker elevation was overall low at all timepoints for all the three treatment arms. A total of 13 CEs in 11 patients occurred. Biomarker elevations in patients with CEs were very rare; only one patient with subsequent CE had a NT-proBNP elevation at baseline and at week 2.

Conclusion: These results suggest that TnT and proBNP may not be useful as early predictors of cardiac toxicity in anthracycline-naïve patients receiving trastuzumab and/or lapatinib.
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http://dx.doi.org/10.1007/s10549-017-4628-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843537PMC
April 2018

The Prognostic Role of Androgen Receptor in Patients with Early-Stage Breast Cancer: A Meta-analysis of Clinical and Gene Expression Data.

Clin Cancer Res 2017 Jun 9;23(11):2702-2712. Epub 2016 Nov 9.

Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brusells, Belgium.

Androgen receptor (AR) expression has been observed in about 70% of patients with breast cancer, but its prognostic role remains uncertain. To assess the prognostic role of AR expression in early-stage breast cancer, we performed a meta-analysis of studies that evaluated the impact of AR at the protein and gene expression level on disease-free survival (DFS) and/or overall survival (OS). Eligible studies were identified by systematic review of electronic databases using the MeSH-terms "breast neoplasm" and "androgen receptor" and were selected after a qualitative assessment based on the REMARK criteria. A pooled gene expression analysis of 35 publicly available microarray data sets was also performed from patients with early-stage breast cancer with available gene expression and clinical outcome data. Twenty-two of 33 eligible studies for the clinical meta-analysis, including 10,004 patients, were considered as evaluable for the current study after the qualitative assessment. AR positivity defined by IHC was associated with improved DFS in all patients with breast cancer [multivariate (M) analysis, HR 0.46; 95% confidence interval (CI) 0.37-0.58, < 0.001] and better OS [M-HR 0.53; 95% CI, 0.38-0.73, < 0.001]. Thirty-five datasets including 7,220 patients were eligible for the pooled gene expression analysis. High mRNA levels were found to confer positive prognosis overall in terms of DFS (HR 0.82; 95% CI 0.72-0.92; = 0.0007) and OS (HR 0.84; 95% CI, 0.75-0.94; = 0.02) only in univariate analysis. Our analysis, conducted among more than 17,000 women with early-stage breast cancer included in clinical and gene expression analysis, demonstrates that AR positivity is associated with favorable clinical outcome. .
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http://dx.doi.org/10.1158/1078-0432.CCR-16-0979DOI Listing
June 2017

Oral administration of antineoplastic agents: the challenges for healthcare professionals.

J BUON 2015 May-Jun;20(3):690-8

Higher Health School of Professional Studies in Belgrade, Belgrade, Serbia.

Recent progress in cancer treatment has increased the use of oral antineoplastic agents. It is now estimated that at least 25% of the existing antineoplastic agents are planned to be used as oral agents and this mode of administration is likely to increase in the coming years. The use of oral anti- neoplastic agents affects many aspects of cancer treatment, and despite advantages, it also poses challenges to health care professionals and patients, many of which refer to the adherence and safety. Low patient adherence demonstrates the need for better management and monitoring of patients on oral antineoplastic agents. Patient education is essential to maintain adherence to oral antineoplastic therapy, promoting a better understanding of the patient treatment regimen, treatment goals and potential side-effects, patient safety and implementation of self-care measurement. This article discusses the above-mentioned challenges, as well as the possibilities of patient and family education to improve adherence, outcomes of treatment and quality of life, and offers recommendations for practice and further research.
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August 2015

A rare case of isolated adrenal metastasis of invasive ductal breast carcinoma.

Srp Arh Celok Lek 2014 Sep-Oct;142(9-10):597-601

Introduction: Isolated adrenal metastases of invasive ductal breast carcinoma are extremely rare. We report a case with isolated left adrenal metastases, verified three years after diagnosed breast carcinoma.

Case Outline: A 58-year-old female patient with a right breast tumor, clinically staged as IIIA (T2N2M0) started neoadjuvant anthracycline chemotherapy after biopsy which revealed invasive ductal breast carcinoma. Immunohistochemical findings of tumor biopsy showed hormonal steroid receptors for estrogen and progesterone negative, and human epidermal growth factor receptor 2 (HER2) positive. After 4 cycles of chemotherapy and partial tumor regression the patient underwent radical mastectomy. Definite histopathological analysis confirmed the diagnosis of invasive ductal carcinoma. The patient continued treatment with adjuvant chemotherapy to cumulative dose of anthracyclines, postoperative radiotherapy and adjuvant trastuzumab for one year. Three years later abdominal computerized tomography showed tumor in the left adrenal gland as the only metastatic site. Left adrenalectomy was performed and histopathological finding confirmed breast cancer metastases. Postoperatively, the patient received 6 cycles of docetaxel with trastuzumab and continued trastuzumab until disease progression. One year after left adrenalectomy control abdominal computerized tomography showed a right adrenal tumor with retroperitoneal lymphadenopathy. Treatment with capecitabine was continued for one year, but eventually she developed brain metastasis causing lethal outcome.

Conclusion: In order to better understand metastatic pathways of invasive ductal breast carcinoma, publications of individual patient cases diagnosed with rare metastatic sites should be encouraged. This might improve our understanding of metastatic behavior of breast cancer and stimulate further clinical research.
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http://dx.doi.org/10.2298/sarh1410597aDOI Listing
June 2017

Luminal B breast cancer: molecular characterization, clinical management, and future perspectives.

J Clin Oncol 2014 Sep 21;32(25):2794-803. Epub 2014 Jul 21.

Felipe Ades, Lina Pugliano, Debora Fumagalli, Evandro de Azambuja, Christos Sotiriou, and Martine Piccart, Institut Jules Bordet, Université Libre de Bruxelles; Dimitrios Zardavas, Breast International Group, Brussels, Belgium; Ivana Bozovic-Spasojevic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; and Giuseppe Viale, European Institute of Oncology, University of Milan, Milan, Italy.

Gene expression profiling has reshaped our understanding of breast cancer by defining and characterizing four main intrinsic molecular subtypes: human epidermal growth factor receptor 2-enriched, basal-like, luminal A, and luminal B subtypes. Luminal B breast cancer has been reported to have lower expression of hormone receptors, higher expression of proliferation markers, and higher histologic grade than luminal A. It also exhibits worse prognosis and has a distinct profile of response to hormone therapy and chemotherapy. Although luminal cancers share similarities, the studies conducted in recent years using next-generation sequencing technology show that luminal A and B breast cancers should be perceived as distinct entities, with specific oncogenic drivers, rather than more proliferative varieties of luminal tumors. This review discusses the definition and molecular characterization of luminal B breast cancer and presents the available clinical evidence for chemotherapy and endocrine therapy patterns of response. It also provides an overview of ongoing research on molecularly targeted agents for this disease.
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http://dx.doi.org/10.1200/JCO.2013.54.1870DOI Listing
September 2014

Prognostic, predictive abilities and concordance of BCL2 and TP53 protein expression in primary breast cancers and axillary lymph-nodes: a retrospective analysis of the Belgian three arm study evaluating anthracycline vs CMF adjuvant chemotherapy.

Breast 2014 Aug 24;23(4):473-81. Epub 2014 Apr 24.

Breast Cancer Translational Research Laboratory JC Heuson, Institut Jules Bordet, Boulevard de Waterloo 125, Brussels, Belgium; Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Electronic address:

Given recent data on genetic heterogeneity within and individual's tumor, we investigated if there were differences in the prognostic and predictive abilities of BCL2 and TP53 protein expression in primary breast cancer (TU) and corresponding axillary lymph-nodes (LN). We used patient samples from the adjuvant Belgian three-arm study which randomized between anthracycline containing regimens and traditional CMF. The endpoints analyzed were overall survival (OS), event-free survival (EFS) and interactions between chemotherapy regimens. At a median follow-up of 15.6 years, BCL2 and TP53 (in both TU and LN) were significantly associated with OS but only in the first 5 years. Likewise, BCL2 and TP53 (in both TU and LN) were associated with EFS in the first 2 years after randomization, with no association after 2 years. BCL2 and TP53 remained statistically significant after adjustment for the standard clinical-pathological characteristics in regard to OS and EFS in the respective first years after randomization, (p value < 0.001 for both markers). Furthermore, an interaction was found between high BCL2 expression in the TU (but not in LN) and benefit to CMF over anthracycline-based chemotherapy (interaction p value EFS: 0.042; OS = 0.01). No interaction was found for TP53 expression neither in TU nor in LN. We conclude that BCL2 and TP53 were predictive biomarkers for better and worse survival respectively, but only in the first two to five years after diagnosis. BCL2 expression in the TU but not in the LN was predictive of increased benefit to CMF vs anthracycline-based chemotherapy.
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http://dx.doi.org/10.1016/j.breast.2014.03.012DOI Listing
August 2014

Dual human epidermal growth factor receptor 2 blockade: another step forward in treating patients with human epidermal growth factor receptor 2-positive breast cancer.

Curr Opin Oncol 2012 Nov;24(6):612-22

Institut Jules Bordet, l'Université Libre de Bruxelles, Brussels, Belgium.

Purpose Of Review: Many antihuman epidermal growth factor receptor (anti-HER2)-targeted agents, covering a broad spectrum of mechanisms of action, have been recently developed. The concept of dual anti-HER2 blockade has been preclinically and clinically assessed with positive results. In this article, the authors review the biologic rationale for dual HER2 blockade, along with the clinical findings.

Recent Findings: Dual anti-HER2 blockade has been assessed in the metastatic setting, including with chemotherapy-free regimens, leading to impressive responses, even in heavily pretreated patients. In the neoadjuvant setting, dual anti-HER2 blockade combinations and chemotherapy have almost doubled the rates of pathologic complete response compared to single anti-HER2 therapy. Similar strategies are now actively being pursued in the adjuvant setting and, it is hoped, will improve the outcome of many patients with HER2-positive breast cancer.

Summary: Combining different anti-HER2-targeted agents represents a promising therapeutic strategy, now reaching clinical practice. There are major clinical challenges yet to be resolved, rising from the increasing number of potential combinations and their mechanisms of resistance. Smartly designed clinical trials are required to address these challenges and perhaps to define a subset of patients that can be spared chemotherapy.
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http://dx.doi.org/10.1097/CCO.0b013e328358a29aDOI Listing
November 2012

New therapies in HER2-positive breast cancer: a major step towards a cure of the disease?

Cancer Treat Rev 2012 Aug 3;38(5):494-504. Epub 2012 Feb 3.

Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.

Overexpression of the human epidermal growth factor receptor 2 (HER2) predicts a poor prognosis in metastatic breast cancer. While the introduction of HER2-targeted therapies, such as the monoclonal antibody trastuzumab and the small-molecule tyrosine kinase inhibitor lapatinib, has significantly improved outcomes in HER2+ breast cancer compared with previously available therapies, use of these targeted therapies is often limited by the development of drug resistance and tolerability issues. These limitations create the need for further development and investigation of new targeted therapies that show potent and selective inhibition of these targets or closely connected molecular pathways. Recently, several agents have demonstrated promising activity in HER2+ metastatic breast cancer, either as monotherapy or in combination therapy, including the tyrosine-kinase inhibitors neratinib (HKI-272) and afatinib (BIBW-2992) and the anti-HER2 monoclonal antibodies pertuzumab and trastuzumab-DM1 (T-DM1). Agents that target other molecular pathways, such as the vascular endothelial growth factor receptor, mammalian target of rapamycin, PI3-kinases, insulin-like growth factor (IGFR), HSP-90, and other kinases also have potential, in combination with anti-HER2 and/or other systemic therapies, to be active in this subtype of breast cancer. Innovative clinical studies are required in well-characterized patient populations to define the true clinical value of these emerging new approaches.
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http://dx.doi.org/10.1016/j.ctrv.2012.01.001DOI Listing
August 2012

Neoadjuvant anthracycline and trastuzumab for breast cancer: is concurrent treatment safe?

Lancet Oncol 2011 Mar 25;12(3):209-11. Epub 2011 Feb 25.

Department of Medical Oncology, Institut Jules Bordet, Universite Libre de Bruxelles, 1000 Brussels, Belgium.

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http://dx.doi.org/10.1016/S1470-2045(11)70013-4DOI Listing
March 2011

[Slow release tramadol in the initial treatment of moderate to severe cancer pain: open, multicentric clinical trial].

Srp Arh Celok Lek 2007 Jul-Aug;135(7-8):453-60

Introduction: The analgesic efficacy of slow release tramadol in the titration phase of treatment of moderate to severe cancer pain has been demonstrated in clinical trials.

Objective: The aim of the study was to evaluate this treatment strategy in routine daily practice.

Method: This was a prospective, non-randomized, open, multicentric, phase IV two-week study. Each patient received 100 mg slow release tramadol orally, twice a day. Patients were allowed to take 20 drops (50 mg) of tramadol as needed for breakthrough pain. The pain intensity and tramadol tolerability were recorded every day for the previous 24 hours, in the first week and at the end of the study. Pain relief and the impact of pain on sleep were evaluated on the 8th and 15th day.

Results: The study included 46 patients with metastatic malignant disease. The total of 46 patients completed the first week of treatment, and 33 patients completed the whole study. At the end of study, the intensity of pain was significantly reduced from 6.75 to 3.03 on numerical scale (NS 0-100) (p < 0.001). At the end of study, 60.6% of patients graded the severity of pain as maximally mild on a verbal scale. The pain relief significantly improved from 25.75 to 71.81 on a numerical scale (NS 0-100) (p < 0.001). The impact of pain on sleep was significantly reduced from 51.51% to 10.61% on a numerical scale (NS 0-100) (p < 0.001). There were no differences in the drowsiness/confusion, nausea, vomiting, dizziness, loss of appetite and constipation, from the beginning to the end of treatment.

Conclusion: Tramadol slow release was effective in the titration phase of treatment of moderate to severe cancer pain with good tolerability.
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http://dx.doi.org/10.2298/sarh0708453bDOI Listing
November 2007
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