Publications by authors named "Philip D Poorvu"
Purpose: With limited lifestyle interventions available for women with metastatic breast cancer, we aimed to evaluate feasibility of a combined prolonged overnight fasting and exercise intervention in women with hormone receptor-positive metastatic breast cancer initiating treatment.
Methods: Women with metastatic breast cancer initiating endocrine therapy plus targeted therapy were included in a single-arm pilot trial testing a combined 12-week prolonged nightly fasting and exercise intervention. Fasting goals included abstaining from calorie intake after 8 pm and fasting for 13 + hours 6 days per week; weekly exercise goals were 120 min of home-based aerobic exercise and 2 sessions of resistance exercise.
Article Synopsis
- Young women with a type of breast cancer called HR-positive can benefit from a treatment that suppresses ovarian function, but they might still have some hormones called estrogen (E2) that sneak through.
- In a study of women under 40, many still had higher levels of estrogen 1 and 4 years after starting treatment, especially if they hadn't had chemotherapy before.
- The study found that the estrogen levels didn't really change the chances of surviving early cancer, but for more advanced cases, those with higher estrogen levels seemed to have a higher death rate, suggesting we need more research to find the best treatment.
Article Synopsis
- - The study examined the cardiovascular disease (CVD) risk linked to cancer treatments in young women (≤40 years) with breast cancer, focusing on data from 372 survivors over five years.
- - Findings revealed that radiation treatment, especially left-sided radiation, was associated with a significant increase in excess heart age, while systemic cancer treatments showed no correlation with heart age changes.
- - The authors suggest that CVD risk assessment tools should integrate cancer treatment history to better identify young breast cancer survivors at high risk for cardiovascular issues.
Purpose: Compared with older women diagnosed with breast cancer, younger women are more likely to die of breast cancer and more likely to suffer psychosocially in both the short-term and long term. The Young Women's Breast Cancer Study (YWS) is a multisite prospective cohort study established to address gaps in our knowledge about this vulnerable and understudied population.
Participants: The YWS enrolled 1302 women newly diagnosed with stages 0-IV breast cancer at age 40 years or younger at 13 academic and community sites in North America between 2006 and 2016.
Article Synopsis
- Palbociclib is a common treatment for advanced breast cancer in older adults, but its safety and tolerability for those aged 70 and older is not well established based on current studies.
- A phase 2 study was conducted with 90 participants (median age 74) to assess safety, finding that 75.6% experienced grade 3 or higher adverse events within six months, with the most common being neutropenia.
- The study revealed that older participants (≥75 years) tended to have higher rates of early treatment discontinuations due to adverse events compared to younger older adults (70-74 years), indicating the need for further research on treatment delivery in this age group.
In the OlympiA study, 1 year of adjuvant olaparib significantly extended invasive disease-free survival and overall survival. The benefit was consistent across subgroups, and this regimen is now recommended after chemotherapy for germline BRCA1/2 mutation (gBRCA1/2m) carriers with high-risk, HER2-negative early breast cancer. However, the integration of olaparib in the landscape of agents currently available in the post(neo)adjuvant setting-ie, pembrolizumab, abemaciclib, and capecitabine-is challenging, as there are no data suggesting how to select, sequence, and/or combine these therapeutic approaches.
View Article and Find Full Text PDFBackground: The impact of abbreviated neoadjuvant regimens for HER2+ breast cancer on rates of breast conservation therapy (BCT) is unclear. We aimed to determine BCT rates in a single-arm prospective trial of neoadjuvant paclitaxel/trastuzumab/pertuzumab (THP) in patients with stage II or III HER2+ breast cancer.
Study Design: BCT eligibility was prospectively recorded before and after THP.
Purpose: We sought to describe coping strategies reported by young breast cancer survivors and evaluate the relationship between utilization of specific coping strategies and anxiety in survivorship.
Methods: Participants enrolled in The Young Women's Breast Cancer Study, a multi-center, cohort of women diagnosed with breast cancer at age ≤ 40 years, completed surveys that assessed demographics, coping strategies (reported at 6-month post-enrollment and 18-month post-diagnosis), and anxiety (2 years post-diagnosis). We used univariable and multivariable logistic regression to examine the relationship between coping strategies and anxiety.
Purpose: To support shared decision-making, patient-facing resources are needed to complement recently published guidelines on approaches for surveillance mammography in breast cancer survivors aged ≥ 75 or with < 10-year life expectancy. We created a patient guide to facilitate discussions about surveillance mammography in older breast cancer survivors.
Methods: The "Are Mammograms Still Right for Me?" guide estimates future ipsilateral and contralateral breast (in-breast) cancer risks, general health, and the potential benefits/harms of mammography, with prompts for discussion.
Background: Weight gain after a breast cancer diagnosis is common and is associated with inferior outcomes. Young survivors may be especially susceptible to weight changes given the impact of treatment on menopausal status.
Methods: The authors identified women who were diagnosed with stage 0 to III breast cancer at age 40 years or younger between 2006 and 2016 from a multicenter prospective cohort.
De-escalating adjuvant therapy following pathologic complete response (pCR) to an abbreviated neoadjuvant regimen in human epidermal growth factor receptor 2-positive (HER2+) breast cancer is the focus of international research efforts. However, the feasibility of this approach and its appeal to patients and providers had not been formally investigated. We aimed to assess adherence to de-escalated adjuvant antibody doublet therapy (trastuzumab and pertuzumab [HP], without chemotherapy) among patients with pCR following neoadjuvant paclitaxel/HP (THP).
View Article and Find Full Text PDFSomatic and Germline Genomic Alterations in Very Young Women with Breast Cancer.
Clin Cancer Res
June 2022
Purpose: Young age at breast cancer diagnosis correlates with unfavorable clinicopathologic features and worse outcomes compared with older women. Understanding biological differences between breast tumors in young versus older women may lead to better therapeutic approaches for younger patients.
Experimental Design: We identified 100 patients ≤35 years old at nonmetastatic breast cancer diagnosis who participated in the prospective Young Women's Breast Cancer Study cohort.
Background: Breast cancer in young women is more likely to have higher risk features and be associated with germline BRCA1/BRCA2 mutations. We present the clinicopathologic features of breast cancers in a prospective cohort of young women, and associations between surrogate molecular subtype and BRCA1/BRCA2 mutation status.
Methods: Histopathological features, biomarker status, tumour stage and BRCA status were collected.
Purpose: Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic.
Methods: Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome-based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs).
Treatment-related amenorrhea in a modern, prospective cohort study of young women with breast cancer.
NPJ Breast Cancer
July 2021
Young women with breast cancer experience unique treatment and survivorship issues centering on treatment-related amenorrhea (TRA), including fertility preservation and management of ovarian function as endocrine therapy. The Young Women's Breast Cancer Study (YWS) is a multi-center, prospective cohort study of women diagnosed at age ≤40, enrolled from 2006 to 2016. Menstrual outcomes were self-reported on serial surveys.
View Article and Find Full Text PDFPregnancy After Breast Cancer: A Systematic Review and Meta-Analysis.
J Clin Oncol
October 2021
Purpose: Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics.
Methods: A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324).
Background: Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes.
Methods: The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017.
Background: The diagnosis and treatment of breast cancer can have profound effects on a young woman's family planning and fertility, particularly among women with hormone receptor-positive breast cancer.
Methods: The Young Women's Breast Cancer Study was a multicenter cohort of women aged 40 years or younger and newly diagnosed with breast cancer from 2006 to 2016. Surveys included assessments of fertility concerns, endocrine therapy (ET) preferences, and use.
Clinical behavior and outcomes of breast cancer in young women with germline BRCA pathogenic variants.
NPJ Breast Cancer
February 2021
Article Synopsis
- Young breast cancer patients with BRCA pathogenic variants show similar outcomes as non-carriers, but the effects of gene type (BRCA1 vs. BRCA2) and hormone receptor status (positive vs. negative) on their clinical outcomes are not well understood.
- An international study of 1,236 young mBRCA patients revealed that BRCA1 carriers had higher rates of second primary cancers but less frequent distant recurrences compared to BRCA2 carriers.
- The findings highlight the significant influence of gene type and hormone receptor status on breast cancer behavior, offering essential insights for better patient counseling regarding treatment and prevention.
Objective: We aimed to investigate eligibility for breast conserving surgery (BCS) pre- and post-neoadjuvant systemic therapy (NST), and trends in the surgical treatment of young breast cancer patients.
Background: Young women with breast cancer are more likely to present with larger tumors and aggressive phenotypes, and may benefit from NST. Little is known about how response to NST influences surgical decisions in young women.
Background: Many young women with newly diagnosed breast cancer are interested in future pregnancies. Prospective data regarding fertility interest and reproductive patterns after diagnosis are needed to counsel patients.
Methods: The Young Women's Breast Cancer Study is a multicenter, prospective cohort of women who were diagnosed with breast cancer at age ≤40 years between 2006 and 2016.
Purpose: The 21-gene Breast Recurrence Score test predicts benefit from adjuvant chemotherapy in estrogen receptor-positive, HER2-negative (ER+/HER2-) breast cancer (BC). We examined whether the 21-gene assay predicts response to neoadjuvant chemotherapy (NCT).
Methods: We identified patients with stage I-III ER+/HER2- BC treated with NCT from the Young Women's Breast Cancer Study, a prospective cohort of women diagnosed with BC at age ≤40 years.
Importance: Young women with breast cancer are increasingly choosing bilateral mastectomy (BM), yet little is known about short-term and long-term physical and psychosocial well-being following surgery in this population.
Objective: To evaluate the differential associations of surgery with quality of life (QOL) and psychosocial outcomes from 1 to 5 years following diagnosis.
Design, Setting, And Participants: Cohort study.
Article Synopsis
- The study examines the effects of pregnancy on breast cancer outcomes in young women with germline mutations, finding that pregnancy does not increase the risk of cancer recurrence.
- Out of 1,252 patients studied, 195 had at least one pregnancy post-cancer treatment, with a 10-year pregnancy rate of 19%; complications were relatively low among those who gave birth.
- Results indicated no significant difference in disease-free survival (DFS) or overall survival (OS) between those who became pregnant and those who did not, suggesting that pregnancy is safe for these patients.
Purpose: The 21-gene recurrence score (RS) assay is prognostic among women with early-stage estrogen receptor-positive (ER+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer and is used to inform recommendations for chemotherapy. Women ≤ 40 years of age represent a minority of patients studied using gene expression profiles.
Methods: The Young Women's Breast Cancer Study is a prospective cohort of women diagnosed with breast cancer at age ≤ 40 years and enrolled patients between 2006 and 2016 (N = 1,302).