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1.
J Natl Compr Canc Netw ; 13(8): 1005-11, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26285246

ABSTRACT

CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.


Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Education, Medical, Continuing , Health Personnel , Quality Improvement , Adaptation, Psychological , Breast Neoplasms/metabolism , Female , Guideline Adherence , Health Personnel/education , Health Personnel/standards , Humans , Medication Adherence , Receptor, ErbB-2/metabolism
2.
J Neurooncol ; 83(1): 81-3, 2007 May.
Article in English | MEDLINE | ID: mdl-17205388

ABSTRACT

We report a case in which the only presenting symptoms of the underlying ovarian malignancy were that of paraneoplastic cerebellar degeneration and nonbacterial thrombotic endocarditis. If suspecting paraneoplastic cerebellar degeneration and nonbacterial thrombotic endocarditis, complete physical examination, including pelvic exams in female patients is warranted. Investigations should include CT chest/abdominal/pelvis, MRI brain, and Transesophageal Echocardiogram. Early recognition will lead to early diagnosis of occult malignancy and initiation of appropriate therapy. Awareness of these complications as initial presentation for internists, gynecologists and neurologists may avoid diagnostic delay.


Subject(s)
Endocarditis/etiology , Ovarian Neoplasms/complications , Paraneoplastic Cerebellar Degeneration/etiology , Pulmonary Embolism/etiology , Thrombosis/etiology , Adenocarcinoma/complications , Adenocarcinoma/diagnostic imaging , Echocardiography, Transesophageal , Endocarditis/diagnostic imaging , Fatal Outcome , Female , Humans , Middle Aged , Mitral Valve/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed
4.
J Clin Oncol ; 21(15): 2889-95, 2003 Aug 01.
Article in English | MEDLINE | ID: mdl-12885806

ABSTRACT

PURPOSE: Trastuzumab-based therapy improves survival for women with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer. We conducted a multicenter phase II study to evaluate the efficacy and safety of trastuzumab combined with vinorelbine, and to assess cardiac surveillance algorithms and tumor markers as prognostic tools. PATIENTS AND METHODS: Patients with HER2-positive (immunohistochemistry [IHC] 3+-positive or fluorescence in situ hybridization [FISH]-positive) metastatic breast cancer received first-line chemotherapy with trastuzumab and vinorelbine to determine response rate. Eligibility criteria were measurable disease and baseline ejection fraction >or= 50%. Serial testing for HER2 extracellular domain (ECD) was performed. RESULTS: Fifty-four women from 17 participating centers were entered onto the study. The overall response rate was 68% (95% confidence interval, 54% to 80%). Response rates were not affected by method of HER2 status determination (FISH v IHC) or by prior adjuvant chemotherapy. Median time to treatment failure was 5.6 months; 38% of patients were progression free after 1 year. Concurrent therapy was quite feasible with maintained dose-intensity. Patients received both chemotherapy and trastuzumab on 90% of scheduled treatment dates. Two patients experienced cardiotoxicity in excess of grade 1; one patient experienced symptomatic heart failure. A surveillance algorithm of screening left ventricular ejection fraction (LVEF) at 16 weeks successfully identified women at risk for experiencing cardiotoxicity. Other acute and chronic side effects were tolerable. Lack of decline in HER2 ECD during cycle 1 predicted tumor progression. CONCLUSION: Trastuzumab and vinorelbine constitute effective and well-tolerated first-line treatment for HER2-positive metastatic breast cancer. Patients with normal LVEF can be observed with surveillance of LVEF at 16 weeks to identify those at risk for cardiotoxicity.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Receptor, ErbB-2/metabolism , Vinblastine/analogs & derivatives , Adult , Aged , Aged, 80 and over , Algorithms , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Biomarkers, Tumor/blood , Breast Neoplasms/pathology , Disease Progression , Female , Heart Diseases/chemically induced , Humans , Infusions, Intravenous , Middle Aged , Predictive Value of Tests , ROC Curve , Survival Analysis , Trastuzumab , Treatment Outcome , Vinblastine/administration & dosage , Vinblastine/adverse effects , Vinorelbine
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