Skip to main content

Advertisement

SpringerLink
Log in

Identification of risk factors for toxicity in patients with hormone receptor-positive advanced breast cancer treated with bevacizumab plus letrozole: a CALGB 40503 (alliance) correlative study

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

In hormone receptor-positive advanced breast cancer, a progression-free survival benefit was reported with addition of bevacizumab to first-line letrozole. However, increased toxicity was observed. We hypothesized that functional age measures could be used to identify patients at risk for toxicity while receiving letrozole plus bevacizumab for hormone receptor-positive advanced breast cancer.

Methods

CALGB 40503 was a phase III trial that enrolled patients with hormone receptor-positive advanced breast cancer randomized to letrozole with or without bevacizumab. Patients randomized to bevacizumab were approached to complete a validated assessment tool evaluating physical function, comorbidity, cognition, psychological state, social support, and nutritional status. The relationship between pretreatment assessment measures and the incidence of grade ≥ 3 (National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0) adverse events was determined.

Results

One hundred thirteen (58%) of 195 patients treated with letrozole plus bevacizumab completed the pretreatment assessment questionnaire. One patient was excluded due to missing adverse event data. The median age of patients was 56. Frequently reported grade ≥ 3 adverse events were hypertension (26%), pain (20%), and proteinuria (7%). Two hemorrhagic events (one grade 5) and 1 thrombosis event occurred. Age ≥ 65 years (p < 0.01), decreased vision (p = 0.04), and poorer pretreatment physical function measures (p < 0.05) were found on univariate analysis to be significantly associated with increased incidence of grade ≥ 3 adverse events. Upon multivariate analysis, age ≥ 65 years (p = 0.01) and decreased vision (p = 0.04) remained significant. Univariable and multivariable logistic regression models demonstrated associations between age, vision, the ability to walk up flights of stairs, and grade ≥ 3 adverse events.

Conclusions

Age (≥ 65 years), decreased vision, and impairments in physical function correlated with increased incidence of toxicity in patients receiving first-line letrozole plus bevacizumab. When evaluating therapy likely to increase toxicity, functional assessment measures can identify patients at increased risk for side effects who may benefit from closer monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The analyzed datasets are available from the corresponding author upon reasonable request.

References

  1. Rodin MB, Mohile SG (2007) A practical approach to geriatric assessment in oncology. J Clin Oncol 25(14):1936–1944. https://doi.org/10.1200/JCO.2006.10.2954

    Article  PubMed  Google Scholar 

  2. Maione P, Perrone F, Gallo C, Manzione L, Piantedosi F, Barbera S, Cigolari S, Rosetti F, Piazza E, Robbiati SF, Bertetto O, Novello S, Migliorino MR, Favaretto A, Spatafora M, Ferrau F, Frontini L, Bearz A, Repetto L, Gridelli C, Barletta E, Barzelloni ML, Iaffaioli RV, De Maio E, Di Maio M, De Feo G, Sigoriello G, Chiodini P, Cioffi A, Guardasole V, Angelini V, Rossi A, Bilancia D, Germano D, Lamberti A, Pontillo V, Brancaccio L, Renda F, Romano F, Esani G, Gambaro A, Vinante O, Azzarello G, Clerici M, Bollina R, Belloni P, Sannicolo M, Ciuffreda L, Parello G, Cabiddu M, Sacco C, Sibau A, Porcile G, Castiglione F, Ostellino O, Monfardini S, Stefani M, Scagliotti G, Selvaggi G, De Marinis F, Martelli O, Gasparini G, Morabito A, Gattuso D, Colucci G, Galetta D, Giotta F, Gebbia V, Borsellino N, Testa A, Malaponte E, Capuano MA, Angiolillo M, Sollitto F, Tirelli U, Spazzapan S, Adamo V, Altavilla G, Scimone A, Hopps MR, Tartamella F, Ianniello GP, Tinessa V, Failla G, Bordonaro R, Gebbia N, Valerio MR, D’Aprile M, Veltri E, Tonato M, Darwish S, Romito S, Carrozza F, Barni S, Ardizzoia A, Corradini GM, Pavia G, Belli M, Colantuoni G, Galligioni E, Caffo O, Labianca R, Quadri A, Cortesi E, D’Auria G, Fava S, Calcagno A, Luporini G, Locatelli MC, Di Costanzo F, Gasperoni S, Isa L, Candido P, Gaion F, Palazzolo G, Nettis G, Annamaria A, Rinaldi M, Lopez M, Felletti R, Di Negro GB, Rossi N, Calandriello A, Maiorino L, Mattioli R, Celano A, Schiavon S, Illiano A, Raucci CA, Caruso M, Foa P, Tonini G, Curcio C, Cazzaniga M (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23(28):6865–6872. https://doi.org/10.1200/JCO.2005.02.527

    Article  PubMed  Google Scholar 

  3. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291(20):2441–2447. https://doi.org/10.1001/jama.291.20.2441

    Article  PubMed  CAS  Google Scholar 

  4. Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120(2):104–110

    Article  PubMed  CAS  Google Scholar 

  5. Wadley VG, Okonkwo O, Crowe M, Ross-Meadows LA (2008) Mild cognitive impairment and everyday function: evidence of reduced speed in performing instrumental activities of daily living. Am J Geriatr Psychiatr 16(5):416–424. https://doi.org/10.1097/JGP.0b013e31816b7303

    Article  Google Scholar 

  6. Hurria A, Li D, Hansen K, Patil S, Gupta R, Nelson C, Lichtman SM, Tew WP, Hamlin P, Zuckerman E, Gardes J, Limaye S, Lachs M, Kelly E (2009) Distress in older patients with cancer. J Clin Oncol 27(26):4346–4351. https://doi.org/10.1200/JCO.2008.19.9463

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I (2006) Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 24(7):1105–1111. https://doi.org/10.1200/JCO.2005.04.2846

    Article  PubMed  Google Scholar 

  8. Waxler-Morrison N, Hislop TG, Mears B, Kan L (1991) Effects of social relationships on survival for women with breast cancer: a prospective study. Soc Sci Med 33(2):177–183

    Article  PubMed  CAS  Google Scholar 

  9. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69(4):491–497

    Article  PubMed  CAS  Google Scholar 

  10. Borgstrom P, Gold DP, Hillan KJ, Ferrara N (1999) Importance of VEGF for breast cancer angiogenesis in vivo: implications from intravital microscopy of combination treatments with an anti-VEGF neutralizing monoclonal antibody and doxorubicin. Anticancer Res 19(5B):4203–4214

    PubMed  CAS  Google Scholar 

  11. Dickler MN, Barry WT, Cirrincione CT, Ellis MJ, Moynahan ME, Innocenti F, Hurria A, Rugo HS, Lake DE, Hahn O, Schneider BP, Tripathy D, Carey LA, Winer EP, Hudis CA (2016) Phase III trial evaluating letrozole as first-line endocrine therapy with or without bevacizumab for the treatment of postmenopausal women with hormone receptor-positive advanced-stage breast cancer: CALGB 40503 (alliance). J Clin Oncol 34(22):2602–2609. https://doi.org/10.1200/JCO.2015.66.1595

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Martin M, Loibl S, von Minckwitz G, Morales S, Martinez N, Guerrero A, Anton A, Aktas B, Schoenegg W, Munoz M, Garcia-Saenz JA, Gil M, Ramos M, Margeli M, Carrasco E, Liedtke C, Wachsmann G, Mehta K, De la Haba-Rodriguez JR (2015) Phase III trial evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for advanced breast cancer: the letrozole/fulvestrant and avastin (LEA) study. J Clin Oncol 33(9):1045–1052. https://doi.org/10.1200/JCO.2014.57.2388

    Article  PubMed  CAS  Google Scholar 

  13. Scappaticci FA, Skillings JR, Holden SN, Gerber HP, Miller K, Kabbinavar F, Bergsland E, Ngai J, Holmgren E, Wang J, Hurwitz H (2007) Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. J Natl Cancer Inst 99(16):1232–1239

    Article  PubMed  Google Scholar 

  14. Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45(8):2220–2224

    Article  PubMed  CAS  Google Scholar 

  15. Podsiadlo D, Richardson S (1991) The timed “up and go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148

    Article  PubMed  CAS  Google Scholar 

  16. Kawas C, Karagiozis H, Resau L, Corrada M, Brookmeyer R (1995) Reliability of the blessed telephone information-memory-concentration test. J Geriatr Psychiatr Neurol 8(4):238–242. https://doi.org/10.1177/089198879500800408

    Article  CAS  Google Scholar 

  17. Keating NL, Norredam M, Landrum MB, Huskamp HA, Meara E (2005) Physical and mental health status of older long-term cancer survivors. J Am Geriatr Soc 53(12):2145–2152. https://doi.org/10.1111/j.1532-5415.2005.00507.x

    Article  PubMed  Google Scholar 

  18. Stafford RS, Cyr PL (1997) The impact of cancer on the physical function of the elderly and their utilization of health care. Cancer 80(10):1973–1980

    Article  PubMed  CAS  Google Scholar 

  19. Frasci G, Lorusso V, Panza N, Comella P, Nicolella G, Bianco A, De Cataldis G, Iannelli A, Bilancia D, Belli M, Massidda B, Piantedosi F, Comella G, De Lena M (2000) Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 18(13):2529–2536. https://doi.org/10.1200/JCO.2000.18.13.2529

    Article  PubMed  CAS  Google Scholar 

  20. Extermann M, Balducci L, Lyman GH (2000) What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 18(8):1709–1717. https://doi.org/10.1200/JCO.2000.18.8.1709

    Article  PubMed  CAS  Google Scholar 

  21. Firat S, Bousamra M, Gore E, Byhardt RW (2002) Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 52(4):1047–1057

    Article  PubMed  Google Scholar 

  22. Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coebergh JW, Weeks JC, Earle CC (2006) Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 24(26):4277–4284. https://doi.org/10.1200/JCO.2005.05.0658

    Article  PubMed  Google Scholar 

  23. Birim O, Kappetein AP, van Klaveren RJ, Bogers AJ (2006) Prognostic factors in non-small cell lung cancer surgery. Eur J Surg Oncol 32(1):12–23. https://doi.org/10.1016/j.ejso.2005.10.001

    Article  PubMed  CAS  Google Scholar 

  24. Zauderer M, Patil S, Hurria A (2009) Feasibility and toxicity of dose-dense adjuvant chemotherapy in older women with breast cancer. Breast Cancer Res Treat 117(1):205–210. https://doi.org/10.1007/s10549-008-0116-0

    Article  PubMed  CAS  Google Scholar 

  25. Sauvaget C, Yamada M, Fujiwara S, Sasaki H, Mimori Y (2002) Dementia as a predictor of functional disability: a 4-year follow-up study. Gerontology 48(4):226–233. doi:58355

    Article  PubMed  CAS  Google Scholar 

  26. Dodge HH, Kadowaki T, Hayakawa T, Yamakawa M, Sekikawa A, Ueshima H (2005) Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi study. Gerontol 45(2):222–230

    Article  Google Scholar 

  27. Penninx BW, Guralnik JM, Ferrucci L, Simonsick EM, Deeg DJ, Wallace RB (1998) Depressive symptoms and physical decline in community-dwelling older persons. JAMA 279(21):1720–1726

    Article  PubMed  CAS  Google Scholar 

  28. Kornblith AB, Herndon JE, 2nd, Zuckerman E, Viscoli CM, Horwitz RI, Cooper MR, Harris MR, Tkaczuk KH, Perry MC, Budman D, Norton LC, Holland J, Cancer Leukemia Group B (2001) Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer 91(2):443–454

    Article  PubMed  CAS  Google Scholar 

  29. Kornblith AB, Herndon JE, 2nd, Weiss RB, Zhang C, Zuckerman EL, Rosenberg S, Mertz M, Payne D, Massie MJ, Holland JF, Wingate P, Norton L, Holland JC (2003) Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer 98(4):679–689. https://doi.org/10.1002/cncr.11531

    Article  PubMed  Google Scholar 

  30. Landi F, Zuccala G, Gambassi G, Incalzi RA, Manigrasso L, Pagano F, Carbonin P, Bernabei R (1999) Body mass index and mortality among older people living in the community. J Am Geriatr Soc 47(9):1072–1076

    Article  PubMed  CAS  Google Scholar 

  31. Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, Rodin M, Panageas KS, Holland JC, Saltz L, Kris MG, Noy A, Gomez J, Jakubowski A, Hudis C, Kornblith AB (2005) Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 104(9):1998–2005. https://doi.org/10.1002/cncr.21422

    Article  PubMed  Google Scholar 

  32. Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36(4):428–434

    Article  PubMed  CAS  Google Scholar 

  33. Stewart ALWJ (1992) Measuring functioning and well-being: the medical outcomes study approach. Duke University Press, Durham

    Book  Google Scholar 

  34. Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714

    Article  PubMed  CAS  Google Scholar 

  35. Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, Incorporated

    Google Scholar 

  36. Altman DG (1990) Practical statistics for medical research. Taylor and Francis, Routledge

    Google Scholar 

  37. Selle F, Emile G, Pautier P, Asmane I, Soares DG, Khalil A, Alexandre J, Lhomme C, Ray-Coquard I, Lotz JP, Goldwasser F, Tazi Y, Heudel P, Pujade-Lauraine E, Gouy S, Tredan O, Barbaza MO, Ady-Vago N, Dubot C (2016) Safety of bevacizumab in clinical practice for recurrent ovarian cancer: a retrospective cohort study. Oncol Lett 11(3):1859–1865. https://doi.org/10.3892/ol.2016.4146

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, Berlin J, Baron A, Griffing S, Holmgren E, Ferrara N, Fyfe G, Rogers B, Ross R, Kabbinavar F (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350(23):2335–2342. https://doi.org/10.1056/NEJMoa032691

    Article  PubMed  CAS  Google Scholar 

  39. Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, Schwartz MA, Benson AB III, Eastern Cooperative Oncology Group Study E (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 25(12):1539–1544. https://doi.org/10.1200/JCO.2006.09.6305

    Article  PubMed  CAS  Google Scholar 

  40. Sandler A, Gray R, Perry MC, Brahmer J, Schiller JH, Dowlati A, Lilenbaum R, Johnson DH (2006) Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 355(24):2542–2550. https://doi.org/10.1056/NEJMoa061884

    Article  PubMed  CAS  Google Scholar 

  41. Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, Shenkier T, Cella D, Davidson NE (2007) Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 357(26):2666–2676

    Article  PubMed  CAS  Google Scholar 

  42. Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, Parodi S, Dal Lago D, Gioia F, Monfardini S, Aapro MS, Serraino D, Zagonel V (2002) Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 20(2):494–502. https://doi.org/10.1200/JCO.2002.20.2.494

    Article  PubMed  Google Scholar 

  43. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465. https://doi.org/10.1200/JCO.2011.34.7625

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ 3rd, Balducci L (2012) Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer 118(13):3377–3386. https://doi.org/10.1002/cncr.26646

    Article  PubMed  Google Scholar 

  45. Mohile SG, Hardt M, Tew W, Owusu C, Klepin H, Gross C, Gajra A, Lichtman SM, Feng T, Togawa K, Ramani R, Katheria V, Hansen K, Hurria A, Cancer, Aging Research G (2013) Toxicity of bevacizumab in combination with chemotherapy in older patients. Oncol 18(4):408–414. https://doi.org/10.1634/theoncologist.2012-0351

    Article  CAS  Google Scholar 

  46. Goldstein JE, Massof RW, Deremeik JT, Braudway S, Jackson ML, Kehler KB, Primo SA, Sunness JS (2012) Baseline traits of low vision patients served by private outpatient clinical centers in the United States. Arch Ophthalmol 130 (8):1028–1037. https://doi.org/10.1001/archophthalmol.2012.1197

    Article  PubMed  Google Scholar 

  47. Whitson HE, Steinhauser K, Ammarell N, Whitaker D, Cousins SW, Ansah D, Sanders LL, Cohen HJ (2011) Categorizing the effect of comorbidity: a qualitative study of individuals’ experiences in a low-vision rehabilitation program. J Am Geriatr Soc 59(10):1802–1809. https://doi.org/10.1111/j.1532-5415.2011.03602.x

    Article  PubMed  PubMed Central  Google Scholar 

  48. van Nispen RM, de Boer MR, Hoeijmakers JG, Ringens PJ, van Rens GH (2009) Co-morbidity and visual acuity are risk factors for health-related quality of life decline: 5-month follow-up EQ-5D data of visually impaired older patients. Health Qual Life Outcomes 7:18. https://doi.org/10.1186/1477-7525-7-18

    Article  PubMed  PubMed Central  Google Scholar 

  49. Court H, McLean G, Guthrie B, Mercer SW, Smith DJ (2014) Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC Med 12:181. https://doi.org/10.1186/s12916-014-0181-7

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (Alliance for Clinical Trials in Oncology NCORP Grant), U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology), P30CA033572, U10CA180790, U10CA180795, U10CA180820, U10CA180836, U10CA180838, U10CA180857, U10CA180858, U10CA180867, U10CA180888, and CA180858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. CALGB/Alliance 40503 was supported in part by Genentech and by a grant from The Breast Cancer Research Foundation.

Author information

Authors and Affiliations

  1. Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA

    Daneng Li & Arti Hurria

  2. Alliance Statistics and Data Center, Duke University, Durham, NC, USA

    Linda M. McCall

  3. University of Chicago Comprehensive Cancer Center, Chicago, IL, USA

    Olwen M. Hahn

  4. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Clifford A. Hudis & Maura N. Dickler

  5. Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA

    Harvey J. Cohen

  6. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Hyman B. Muss

  7. Mayo Clinic, Rochester, MN, USA

    Aminah Jatoi & Jacqueline M. Lafky

  8. Weill Medical College of Cornell University, New York, NY, USA

    Karla V. Ballman

  9. Dana-Farber/Partners CancerCare, Boston, MA, USA

    Eric P. Winer & William Barry

  10. MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    Debu Tripathy

  11. Indiana University Cancer Center, Indianapolis, IN, USA

    Bryan Schneider

Authors
  1. Daneng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda M. McCall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olwen M. Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clifford A. Hudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harvey J. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyman B. Muss
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aminah Jatoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jacqueline M. Lafky
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Karla V. Ballman
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eric P. Winer
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Debu Tripathy
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bryan Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. William Barry
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Maura N. Dickler
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Arti Hurria
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daneng Li.

Ethics declarations

Conflict of interest

Debu Tripathy has received remuneration from Novartis and serves in a consultant/advisory role for Novartis, Pfizer, and Nektar. Maura N. Dickler serves in a consultant/advisory role for Genentech/Roche, Pfizer, Novartis, Eli Lilly, AstraZeneca, TapImmune, and GI Therapeutics. Arti Hurria serves in a consultant/advisory role for Pierian Biosciences and MJH Healthcare Holdings, LLC and has received funding from Celgene and Novartis.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Each participant signed an IRB-approved, protocol-specific informed consent document in accordance with federal and institutional guidelines.

Additional information

Maura N. Dickler and Arti Hurria are Co-Senior Authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, D., McCall, L.M., Hahn, O.M. et al. Identification of risk factors for toxicity in patients with hormone receptor-positive advanced breast cancer treated with bevacizumab plus letrozole: a CALGB 40503 (alliance) correlative study. Breast Cancer Res Treat 171, 325–334 (2018). https://doi.org/10.1007/s10549-018-4828-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-4828-5

Keywords

Search

Navigation