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Sequential therapy in metastatic breast cancer: Survival analysis with time dependent covariates

Vuga, Marike (2006) Sequential therapy in metastatic breast cancer: Survival analysis with time dependent covariates. Master's Thesis, University of Pittsburgh. (Unpublished)

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Metastatic breast cancer, a disease with a high mortality rate among women, is a major public health problem in the United States and other developed countries. This study evaluated the effect of certain treatments within the clinical setting during the patients' individual courses of sequential treatments. A database based on clinical data from one practice of the University of Pittsburgh Cancer Institute Breast Cancer Program was used to analyze from data metastatic breast cancer patients receiving sequential therapies. Data from the clinic cohort were available from January 1999 to July 2005.Taxanes, a specific class of chemotherapeutic agents including Taxol® and Taxotere® have been demonstrated to be very effective in tumor control and symptom relief in metastatic breast cancer patients. However, it is unclear whether there is a benefit in survival compared to non-taxane compounds. Therefore, the survival among patients who received taxane-containing regimes versus those who never received taxane-containing regimes as chemotherapeutic agents needs attention.The purpose of this study is to investigate the survival benefit of taxanes, after initiating chemotherapy or hormonal therapy. Hence, survival analyses with time dependent covariates were employed. The results showed that taxane was beneficial for survival in women with metastatic breast cancer. However, the effect strongly depended on the estrogen receptor type. Patients who had metastatic breast cancer with negative estrogen receptors benefited from taxane therapy. In contrary, taxane showed an adverse effect in patients with positive estrogen receptor cancer. The combination of toxic side effects from the drug, patient characteristics, and timeline of taxane intervention might have possibly contributed to this finding.These results will facilitate the development of guidelines for the management of metastatic breast cancer. In the meantime it will be useful to guide clinicians in their decision-making regarding therapeutic regimes for metastatic breast cancer providing physicians and health care professionals with an important tool to improve public health.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Vuga, Marikeessl@pitt.eduESSL
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee MemberBrufsky, Adambrufskyam@upmc.eduADB5
Committee MemberWilson, Johnjww@pitt.eduJWW
Committee MemberMazumdar, Satimaz1@pitt.eduMAZ1
Date: 1 February 2006
Date Type: Completion
Defense Date: 8 December 2005
Approval Date: 1 February 2006
Submission Date: 9 December 2005
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Biostatistics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Cox proportional hazard model; metastatic breast cancer; sequential therapy; time dependent covariate
Other ID:, etd-12092005-170901
Date Deposited: 10 Nov 2011 20:09
Last Modified: 19 Dec 2016 14:38


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