Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Cornell University, January, 2009. / Vita. Includes bibliographical references.

<p>Glavni problem u lečenju karcinoma dojke je kako na osnovu kliničke klasifikacije i morfolo&scaron;kih osobina tumora predvideti njegovo dalje pona&scaron;anje. Vrlo često ni kombinacija standardnih prognostičkih faktora ne daje odgovor o potrebi davanja adjuvantne hemioterapije. U cilju sprovođenja adekvatne dalje terapije karcinoma dojke i otkrivanja agresivnih tipova tumora, a nakon hirur&scaron;kog lečenja, postoji stalna potreba za pronalaženjem novih pokazatelja pomoću kojih bi se identifikovale bolesnice koje imaju povećan rizik od razvoja relapsa bolesti. Ciljevi ove studije su bili da se odredi učestalost ekspresije androgenih receptora (AR) u infiltrativnom duktalnom karcinomu dojke. Da se utvrdi povezanost ekspresije AR i kliničko-patolo&scaron;kih prognostičkih faktora u infiltrativnom duktalnom karcinomu dojke. Odnos ekspresije AR i ekspresije estrogen receptora (ER), progesteron receptora (PR) i humanog epidermalnog faktora rasta (HER-2). Da se proceni povezanosti pozitivne ekspresije AR, kao i odnosa AR/ER, sa odgovorom na primenjenu hormonsku terapiju kod ER pozitivnih bolesnica. Da se proceni povezanost ekspresije AR, kao i odnosa AR/ER, sa kliničkim tokom bolesti: pojavom recidiva, metastaza, kao i smrtnim ishodom u toku petogodi&scaron;njeg perioda praćenja pacijentkinja. Istraživanjem je obuhvaćeno oko 200 pacijentkinja obolelih od infiltrativnog duktalnog karcinoma dojke, koje su operisane na Institutu za onkologiju Vojvodine u periodu 2010-2012. godine. Pacijentkinje su odabrane metodom slučajnog izbora. Ne postoji statistički značajna razlika između kliničko patololo&scaron;kih faktora i ekspresije androgenih receptora. Kod pacijentkinja sa infiltrativnim duktalnih karcinomom dojke koje su ER-/AR+ nije pokazana statistički značajna razlika u HER2 proteinskoj ekspresiji. Učestalost receptora za progesteron, estrogen, HER2, Ki-67, tripl negativne ćelija ne karakteri&scaron;u prisustvo androgenskih receptora Nije dokazana statistička značajnost za prvi i drugi stadijum bolesti duktalnog invazivnog karcinoma dojke kada se uzme u obzir kraće vreme preživljavanja kod pacijentkinja koje su primale hormonoterapiju. Statistički značajno kraće vreme preživljavanja pokazano je za treći stadijum bolesti kod pacijentkinja koje su AR i ER (&ge; 2) u odnosu na pacijentkinje kod kojih je odnos AR/ER &lt; 2, čime je za treći stadijum bolesti dokazana inicijalna hipoteza . Analize u prikazanom istraživanju nisu pokazale statističku značajnost kada se porede učestalost relapsa i smrtnog ishoda kada se posmatraju pacijentkinje sa AR pozitivnim i AR negativnim infiltrativnim duktalnim karcinomom dojke. Pokazana je statistički značajna razlika u učestalosti smrtnog ishoda između pacijenatkinja koje su lečene i inhibitorima aromataze i tamoksifenom. Zaključci ove studije bi mogli biti osnova za preporuku da se utvrđivanje ekspresije AR kod karcinoma dojke uvrsti u rutinsku praksu i sadržaj patohistolo&scaron;kog nalaza. Određivanje odnosa ekspresije AR i ER u grupi ER pozitivnih bolesnica moglo bi poslužiti kao vodič za primenu konvencionalne hormonske terapije ili, s druge strane, preporuka za terapiju antiandrogenima, sa ciljem da se izborom novih terapijskih modaliteta pobolj&scaron;a efikasnost lečenja bolesnica sa karcinomom dojke.</p> / <p>The main problem in the treatment of breast cancer is how to predict its future behavior based on the clinical classification and morphological characteristics of the tumor. Very often even a combination of standard prognostic factors does not answer the need for adjuvant chemotherapy. In order to conduct adequate further breast cancer therapy and to detect aggressive tumor types, and following surgical treatment, there is a continuing need to find new indicators to identify patients at increased risk of relapse. The objectives of this study were to determine the frequency of androgen receptor (AR) expression in infiltrative ductal breast cancer. To determine the association between AR expression and clinical-pathological prognostic factors in infiltrative ductal breast cancer. Relationship between AR expression and expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor (HER-2). To evaluate the association of positive AR expression, as well as the AR / ER ratio, with response to hormone therapy in ER positive patients. To evaluate the association of AR expression, as well as the relationship of AR / ER, with the clinical course of the disease: onset of relapse, metastasis, as well as fatal outcome during the 5-year follow-up period. The study included about 200 patients suffering from infiltrative ductal breast cancer, operated on at the Institute of Oncology of Vojvodina in the period 2010-2012. years. Patients were selected by random selection. The results there is no statistically significant difference between clinically pathologic factors and androgen receptor expression. No statistically significant difference in HER2 protein expression was shown in patients with infiltrative ductal breast cancer who are ER- / AR +. The frequency of progesterone receptors, estrogen, HER2, Ki-67, tripl negative cells do not characterize the presence of androgen receptors. No statistical significance was demonstrated for the first and second stages of ductal invasive breast cancer when considering shorter survival times in patients receiving hormone therapy. A statistically significant shorter survival time was shown for the third stage of disease in patients with AR and ER (&ge; 2) compared to patients with an AR / ER ratio of &lt;2, thus proving an initial hypothesis for the third stage of disease. The analyzes in the study presented showed no statistical significance when comparing the incidence of relapse and death when looking at patients with AR positive and AR negative infiltrative ductal breast cancer. There was a statistically significant difference in the incidence of death between patients treated with both aromatase inhibitors and tamoxifen. Conclusions of this study could be the basis for recommending that the determination of AR expression in breast cancer be incorporated into the routine practice and content of pathohistological findings. Determining the ratio of AR and ER expression in a group of ER-positive patients could serve as a guide for the administration of conventional hormone therapy or, on the other hand, a recommendation for anti-androgen therapy, with the aim of improving the effectiveness of breast cancer treatment in the choice of new therapeutic modalities.</p>

Objetivo: Estimar a utilização de recursos e custos diretos relacionados à terapia endócrina (TE) versus quimioterapia (QT) no tratamento de câncer de mama avançado (CMA) receptores hormonais positivos (RH+) em pacientes pós menopáusicas,depois de pelo menos uma TE anterior. Métodos: Estudo longitudinal retrospectivo analisou pacientes pós menopáusicas com CMA em tratamento com fulvestranto ou QT entre 2006 e 2008, em um serviço público de oncologia ambulatorial. Apenas pacientes sem crise visceral e com pelo menos uma terapia anterior hormonal foram considerados elegíveis. Os prontuários foram revisados e as informações sobre diagnóstico, tratamento, e utilização de recursos foram obtidas. Resultados: As pacientes eram do sexo feminino e a idade média foi de 64,6 ± 12,6 anos. As pacientes estavam bem balanceados entre os grupos, considerando as características basais. Vinte e cinco pacientes foram incluídas no estudo, 13 pacientes receberam QT e 12 pacientes receberam fulvestranto. O esquema de QT mais usado foi o regime com paclitaxel (n = 5, 38%). O número médio de ciclos foi de 7,6 e 5,8 para fulvestranto e QT, respectivamente. O custo médio de tratamento por paciente foi de R$ 16.679 (USD11,914, 2005 índice de paridade de poder de compra 1USD = 1,4BRL) para fulvestranto e BRL 32946 (USD 23, 533) para QT. O custo médio por ciclo foi de R$ 2,199 (US$ 1,571) e BRL 5,710 (USD 4,079) para fulvestranto e QT, respectivamente, resultando em BRL 3,511(USD 2,508) de custo incremental por ciclo. Conclusões: Nossos resultados indicam que TE com fulvestranto pode ser economicamente adequada em pacientes com CMA RH + que falharam a pelo menos uma linha anterior de TE. Futuras pesquisas são necessárias para validar estes resultados em outros contextos, mas consideramos que as nossas estimativas refletem o mundo real da prática clínica no Brasil / OBJECTIVES: To estimate the resource utilization and costs related to endocrine therapy (ET) versus chemotherapy (CT) in the treatment of hormonal receptor positive (HR+), advanced breast cancer (ABC) patients, after at least one previous ET. METHODS: This retrospective longitudinal study analyzed ABC patients treatment with fulvestrant or CT between 2006 and 2008 in a public oncology outpatient service. Only patients without visceral crisis and with at least one previous hormonal therapy were considered eligible. Medical charts were reviewed by two investigators and information about diagnosis, course of treatment, and resource utilization was obtained. RESULTS: Patients were all female and the mean age was 64,6 ± 12,6 years. Patients were well matched between groups considering baseline characteristics. Twenty-five patients were enrolled in the study, 13 patients received CT and 12 patients received fulvestrant. The most common CT regimen was paclitaxel (n = 5, 38%). The mean number of cycles was 7,6 and 5,8 for fulvestrant and CT, respectively. The mean treatment cost per patient was BRL 16,679 (USD 11,914; 2005 purchasing power parity index 1USD = 1.4BRL) for fulvestrant and BRL 32,946 (USD 23,533) for CT. The mean cost per cycle was BRL 2,199 (USD 1,571) and BRL 5,710 (USD 4,079) for fulvestrant and CT, respectively, resulting in BRL 3,511 (USD 2,508) incremental cost per cycle. CONCLUSIONS: Our study results indicate that subsequent ET with fulvestrant can be economically appropriate among HR+ ABC patients. Further researches could validate these findings in other contexts, but we consider that our estimations reflect the real world clinical practice in Brazil

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 4 uppsatser.

Objetivo: Estimar a utilização de recursos e custos diretos relacionados à terapia endócrina (TE) versus quimioterapia (QT) no tratamento de câncer de mama avançado (CMA) receptores hormonais positivos (RH+) em pacientes pós menopáusicas,depois de pelo menos uma TE anterior. Métodos: Estudo longitudinal retrospectivo analisou pacientes pós menopáusicas com CMA em tratamento com fulvestranto ou QT entre 2006 e 2008, em um serviço público de oncologia ambulatorial. Apenas pacientes sem crise visceral e com pelo menos uma terapia anterior hormonal foram considerados elegíveis. Os prontuários foram revisados e as informações sobre diagnóstico, tratamento, e utilização de recursos foram obtidas. Resultados: As pacientes eram do sexo feminino e a idade média foi de 64,6 ± 12,6 anos. As pacientes estavam bem balanceados entre os grupos, considerando as características basais. Vinte e cinco pacientes foram incluídas no estudo, 13 pacientes receberam QT e 12 pacientes receberam fulvestranto. O esquema de QT mais usado foi o regime com paclitaxel (n = 5, 38%). O número médio de ciclos foi de 7,6 e 5,8 para fulvestranto e QT, respectivamente. O custo médio de tratamento por paciente foi de R$ 16.679 (USD11,914, 2005 índice de paridade de poder de compra 1USD = 1,4BRL) para fulvestranto e BRL 32946 (USD 23, 533) para QT. O custo médio por ciclo foi de R$ 2,199 (US$ 1,571) e BRL 5,710 (USD 4,079) para fulvestranto e QT, respectivamente, resultando em BRL 3,511(USD 2,508) de custo incremental por ciclo. Conclusões: Nossos resultados indicam que TE com fulvestranto pode ser economicamente adequada em pacientes com CMA RH + que falharam a pelo menos uma linha anterior de TE. Futuras pesquisas são necessárias para validar estes resultados em outros contextos, mas consideramos que as nossas estimativas refletem o mundo real da prática clínica no Brasil / OBJECTIVES: To estimate the resource utilization and costs related to endocrine therapy (ET) versus chemotherapy (CT) in the treatment of hormonal receptor positive (HR+), advanced breast cancer (ABC) patients, after at least one previous ET. METHODS: This retrospective longitudinal study analyzed ABC patients treatment with fulvestrant or CT between 2006 and 2008 in a public oncology outpatient service. Only patients without visceral crisis and with at least one previous hormonal therapy were considered eligible. Medical charts were reviewed by two investigators and information about diagnosis, course of treatment, and resource utilization was obtained. RESULTS: Patients were all female and the mean age was 64,6 ± 12,6 years. Patients were well matched between groups considering baseline characteristics. Twenty-five patients were enrolled in the study, 13 patients received CT and 12 patients received fulvestrant. The most common CT regimen was paclitaxel (n = 5, 38%). The mean number of cycles was 7,6 and 5,8 for fulvestrant and CT, respectively. The mean treatment cost per patient was BRL 16,679 (USD 11,914; 2005 purchasing power parity index 1USD = 1.4BRL) for fulvestrant and BRL 32,946 (USD 23,533) for CT. The mean cost per cycle was BRL 2,199 (USD 1,571) and BRL 5,710 (USD 4,079) for fulvestrant and CT, respectively, resulting in BRL 3,511 (USD 2,508) incremental cost per cycle. CONCLUSIONS: Our study results indicate that subsequent ET with fulvestrant can be economically appropriate among HR+ ABC patients. Further researches could validate these findings in other contexts, but we consider that our estimations reflect the real world clinical practice in Brazil

Thesis (Ph. D.)--University of Virginia, 2008. / Includes bibliographical references. Also available online through Digital Dissertations.