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PURPOSE: Many studies have sought to optimize the dosing schedule of adjuvant chemotherapy in early stage breast cancer. Here we assessed the use of continuous metronomic weekly doxorubicin plus daily oral cyclophosphamide (AC) with continuous G-CSF growth factor support for 12 weeks followed by weekly nab-paclitaxel (nP) for 12 weeks. METHOD: A non-randomized phase II clinical trial was designed to assess (1) DFS at 2 years, (2) dose delivered, (3) use of nP in the adjuvant setting, and (4) toxicities. The dosing of A was 24mg/m2 IV weekly and C was 60mg/m2 oral daily (with scheduled filgrastim 5mcg/kg 6days/week); nP, 100mg/m2 IV weekly. For patients with HER2+ disease, trastuzumab was started during the nP portion of therapy and continued for 12 months. RESULTS: Sixty patients enrolled with a median follow-up of 6 years. 58% had node positive disease. Receptor categories included hormone receptor positive/ HER2 negative (n=25; 42%); triple negative (n=19; 32%); or HER2 positive (n=16; 27%). DFS at 2 years was 93%. Mean dose delivered was greater than 90% for metronomic AC and 88% for nP. Treatment was well-tolerated with a 2% incidence of febrile neutropenia. CONCLUSIONS: Continuous metronomic AC followed by nP was well tolerated in our patients with comparable DFS to historical controls.

Background Commonly used adjuvant systemic therapies harbor high rates of severe short-term and long-term side effects but are often justified to patients because of curative intent in early-stage breast cancer. One of the oldest and least toxic adjuvant regimens, CMF (oral cyclophosphamide given with intravenous methotrexate and 5-fluourouracil), has been largely abandoned because of the perception that it underperforms for survival outcomes compared with modern regimens containing anthracycline and/or taxanes. Materials and Methods To address this misperception, we performed a review of all consecutive breast cancer patients at the Seattle Cancer Care Alliance over the past decade who received 6 months of adjuvant CMF as their sole chemotherapy regimen and determined rates for relapse-free survival (RFS), overall survival (OS), and major organ toxicity. From January 2003 to August 2013, 248 patients (median age of 52 years at the start of chemotherapy) met criteria for inclusion in this series and had a median follow-up of 67 months. Results RFS and OS at 5 years was 94.5% (91.3%-97.9%) and 98% (96%-100%), respectively. The only major organ toxicity that occurred in > 5% of patients was Grade 3 neutropenia (18.1%, 24 patients). One patient died during therapy from pneumocystis pneumonia attributed to previously undiagnosed AIDS. Conclusion In a modern cohort of patients thoroughly characterized for Grade and hormone receptor status, CMF was a well-tolerated and effective adjuvant regimen for early-stage breast cancer and should be considered for appropriately selected patients.

Brain metastases (BM) from primary breast cancer can arise despite use of systemic therapies that provide excellent extracranial disease control. Local modalities for treating BM include surgery, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). We sought to determine the benefits of SRS for management of BM arising from different biologic breast cancer subtypes. We reviewed records of 131 patients who received SRS for breast cancer BM between 2001 and 2013. Survival was estimated by the Kaplan-Meier method. Effects of tumor biology, number and location of lesions, and number of SRS sessions on survival were evaluated by Cox proportional hazards regression. Of the 122 patients with subtypes available, 41 patients (31%) were classified as estrogen receptor positive/HER2 negative (ER(+)HER2(-)); 30 patients (23%), ER(+)HER2(+); 23 patients (18%), ER(-)HER2(+); and 28 patients (21%), ER(-)HER2(-) (or triple negative breast cancer, TNBC). Median age at first SRS was 50 years. Median overall survival for ER(+)HER2(-), ER(+)HER2(+), ER(-)HER2(+), and TNBC was 16, 26, 23, and 7 months, respectively (p0.001 for difference between groups). Patients with TNBC had the shortest time to retreatment with WBRT or SRS or death with hazard ratio of 3.12 (p0.001) compared to ER(+)HER2(-). In all subtypes other than TNBC, SRS can provide meaningful control of BM even in the setting of multiple lesions and may be worth repeating for new lesions that develop metachronously. For patients with TNBC, prognosis is guarded following SRS, and there is an urgent need to develop more effective treatment strategies.

SUMMARY This study focusses on the curricula event of the Swedish preschool programme called circle time. The chief question addressed in the study was: “What actually happens during circle time, and what are the implications for the participants?” The present study can be defined as a process-analytic study of the social and educational content of circle time, where an attempt is made to integrate structural, group and individual perspectives. The main empirical data contains observations through video-taping of circle time in five groups in different day-care centres and so-called ‘stimulated-recall’ interviews with staff and children. The results indicate that circle time is both a ritual and meeting. To the staff circle time corresponds to a need for structuring activities and indicating obvious changes during the day. Circle time also makes it manifest that something is being done, involving a legitimation and also an opportunity to appear before others and be acknowledged. To the children, circles c...

e11584 Background: Brain metastases occur late in the course of metastatic breast cancer and the median survival from time of brain metastases has historically been ~4 months. Stereotactic radiosur...