Ta

ble of Contents

Volume 14, Number 1 � February 2014

Illustration by Erin Moore

Review1 Toremifene for Breast Cancer: A Review of 20 Years of Data

Charles L. Vogel, Mary Ann Johnston, Christi Capers, Deborah Braccia

Commentary10 The Potential Role of Radiation Therapy to the Primary Site of Disease in Stage IV Breast Cancer Presenting

With Synchronous MetastasisJyoti Mayadev, Megan Daly, Allen Chen, Richard Bold, Helen Chew

Original Studies13 Phase II Trial of Fulvestrant With Metronomic Capecitabine for Postmenopausal Women With Hormone

Receptor-Positive, HER2-Negative Metastatic Breast CancerLee S. Schwartzberg, Grace Wang, Bradley G. Somer, L. Johnetta Blakely, Benton M. Wheeler,Mark S. Walker, Edward J. Stepanski, Arthur C. Houts

We present results of a phase II study of 41 patients with hormone-positive, HER2-negative metastatic breastcancer (MBC), who received fulvestrant and low-dose metronomic capecitabine. Primary end points wereprogression-free survival (PFS) and time to progression (TTP). Patients completed a median of 11 monthlytreatment cycles, with median PFS of 14.98 months, and median TTP of 26.94 months, with treatmentwell-tolerated overall.

20 Assessing the Impact of Neoadjuvant Chemotherapy on the Management of the Breast and Axilla inBreast CancerTerri Patricia McVeigh, Dhafir Al-Azawi, David E. Kearney, Carmel Malone, Karl J. Sweeney, Kevin Barry,Ray McLaughlin, Maccon Keane, Michael J. Kerin

The surgical management of the axillae in patients with breast cancer in whom disease burden is modifiedby neoadjuvant chemotherapy is controversial. This observational study examines patients undergoingneoadjuvant chemotherapy and surgery for breast cancer over a ten-year period. Her2-overexpressingsubtypes were less likely to have residual axillary disease and more likely to have complete pathologicalresponse in the tumour.

26 Eniluracil Plus 5-Fluorouracil and Leucovorin: Treatment for Metastatic Breast Cancer Patientsin Whom Capecitabine Treatment Rapidly FailedEdgardo Rivera, Jenny C. Chang, Vladimir Semiglazov, Olga Burdaeva, M. Gray Kirby, Thomas Spector

As part of a comparative phase II study of eniluracil plus 5-fluorouracil (5-FU) and leucovorin (Lv) vs.capecitabine, an oral 5-FU prodrug for metastatic breast cancer (MBC), 10 evaluable patients with rapiddisease progression (PD) during capecitabine treatment crossed over to take eniluracil/5-FU/Lv. Of thesepatients, 3 had partial tumor response (PR), 6 had stable disease (SD), and 4 had > 7 months progression-free survival (PFS) with eniluracil/5-FU/Lv treatment.

31 Contemporary Systemic Therapy for Male Breast CancerKatherine L. Bradley, Scott Tyldesley, Caroline H. Speers, Ryan Woods, Diego Villa

The management of male breast cancer remains complex and undefined because it occurs infrequently. Malebreast cancers almost always express hormone receptors, and although endocrine therapy is an importanttreatment cornerstone, men often encounter challenges with toxicity and adherence. The outcomes of menwith breast cancer appear to be similar to those of women matched by prognostic and treatment factors.

40 Ultrasonography-Guided Breast-Conserving Surgery Is Superior to Palpation-Guided Surgery forPalpable Breast CancerHolm Eggemann, Tanja Ignatov, Alexander Beni, Serban Dan Costa, Atanas Ignatov

We investigated the efficacy of ultrasonography-guided breast-conserving surgery in 335 women withpalpable breast cancer. We found that ultrasonography-guided breast-conserving surgery is superior topalpation-guided excision in predicting the closest margins, obtaining clear surgical margins, and reducingre-operations.

46 Use of an Intraoperative Ultrasonography-Guided Localization and Tissue Fixation Device DemonstratesLess Margin Positivity During Breast-Conserving Surgery for Invasive Breast Cancer Than StandardPreoperative Needle-Wire Localization: A Retrospective Comparative Analysis in a Consecutively TreatedCase SeriesStephen P. Povoski, Rafael E. Jimenez, Wenle P. Wang

We compare 2 methods of pre-resection, image-guided tumor localization—preoperative needle-wirelocalization (PNWL) and intraoperative ultrasonography-guided localization and tissue fixation (IUGLTF)—for 118 patients with invasive breast cancer who underwent breast-conserving surgery. A positive marginwas identified in 6 of 54 (11.1%) PNWL vs. 1 of 64 (1.6%) IUGLTF procedures (P ¼ .046). A positive orclose margin was identified in 9 of 54 (16.7%) PNWL vs. 3 of 64 (4.7%) IUGLTF procedures (P ¼ .032).Use of an IUGLTF device during breast-conserving surgery could be advantageous in the surgicalmanagement of invasive breast cancers.

53 Outcomes of Patients With Breast Cancer Who Present With Ipsilateral Supraclavicular or InternalMammary Lymph Node MetastasesSilvia Dellapasqua, Vincenzo Bagnardi, Alessandra Balduzzi, Monica Iorfida, Nicole Rotmensz,Barbara Santillo, Giuseppe Viale, Raffaella Ghisini, Paolo Veronesi, Alberto Luini, Anna Morra,Aron Goldhirsch, Marco Colleoni

To evaluate outcome of breast cancer IM and SC node involvement, we evaluated 107 patients with IMor SC node involvement and a matched cohort of patients as controls. Patients with SC node involvementhad a significantly poorer DFS and higher loco-regional recurrence rates compared with controls withoutSC node involvement.

61 Optimization of the Parameters for Diffusion Tensor Magnetic Resonance Imaging Data Acquisitionfor Breast Fiber Tractography at 1.5 TYuan Wang, Xiao-Peng Zhang, Yan-Ling Li, Xiao-Ting Li, Yan Hu, Yong Cui, Ying-Shi Sun, Xiao-Yan Zhang

Optimizing image acquisition parameters is essential for producing high-quality diffusion tensor (DT) imaging(DTI) data. This study aimed to optimize the parameters for DTI data acquisition for breast fiber tractograhy.Twenty-one healthy volunteers received breast DTI scanning using an array spatial sensitivity encodingtechnique (ASSET)-based echo-planar imaging (EPI) technique. The optimization of data acquisitionparameters could improve the quality of breast DT magnetic resonance imaging (MRI) images and assistfiber tractography at 1.5 T.

68 Risk Stratification of Patients With Early Breast CancerPankaj Gupta Roy, Suet M. Chan, Vivien Ng, Brendan M. Smith, Hilary Umeh, Stephen P. Courtney

A retrospective study of the patients with early breast cancer who underwent axillary node clearance to assessthe role of pre-operative axillary ultrasound þ/� biopsy and to assess the need for ANC for node positivepatients. This study proves that pre-op axillary US helps to identify high risk patients and ANC is notwarranted in micro metastasis.

Available Exclusively Online atwww.clinical-breast-cancer.come1 Clinicopathologic Implications of EpCAM and Sox2 Expression in Breast Cancer

Nehad M.R. Abd El-Maqsoud, Dalia M. Abd El-Rehim

Epithelial cell adhesion molecule (EpCAM) and sex-determining region Y-box protein 2 (Sox2) are aberrantlyexpressed in breast cancer and other cancers. This is a retrospective study aimed at evaluating EpCAM andSox2 expression in 19 cases of ductal carcinoma in situ (DCIS), 126 cases of invasive breast cancer (IBC),and 86 samples of matched lymph node (LN) metastasis using immunohistochemistry. Our findings highlightthe role of EpCAM and Sox2 in breast cancer development and progression.

e10 Conservative Surgery Plus Axillary Radiotherapy vs. Modified Radical Mastectomy in Patients WithStage I Breast CancerDian Chen, Lin Lai, Chunyan Duan, Miya Yan, Maohui Xing, Jiaquan Chen, Fang Zhang

Breast-conserving therapy has become the first choice for treatment of early breast cancer patients. Our studyaimed to explore the difference between postoperative axillary radiotherapy without axillary lymph nodedissection and modified radical mastectomy of 186 patients with stage I breast cancer undergoingconservative therapy. Our results showed that the efficacy of conservative surgery plus axillary radiotherapyis superior to that of axillary node dissection.

e14 Antitumor Response of an ERBB2 Amplified Inflammatory Breast Carcinoma With EGFR Mutation to theEGFR-TKI ErlotinibSiraj M. Ali, R. Kathy Alpaugh, Jamie K. Buell, Philip J. Stephens, Jian Qin (Michael) Yu, Hong Wu,Christine N. Hiemstra, Vincent A. Miller, Doron Lipson, Gary A. Palmer, Jeffrey S. Ross, Massimo Cristofanilli

e17 Overcoming Resistance Against HER2-Targeting Agents in Fifth-Line Therapy: Is There Still a Place forBevacizumab in HER2þ Breast Cancer?Florian Huemer, Simon Peter Gampenrieder, Alexander Schlattau, Richard Greil