Eitan Amir

Eitan Amir
The Princess Margaret Hospital · Department of Medical Oncology

MB ChB (Hons), PhD

About

574
Publications
56,796
Reads
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14,720
Citations
Additional affiliations
January 2012 - present
University of Toronto
Position
  • Professor (Associate)
January 2012 - present
The Princess Margaret Hospital
Position
  • Medical Oncologist

Publications

Publications (574)
Article
Full-text available
Background: It is unknown to what extent cancer drugs approved in Switzerland by the Swissmedic fulfil criteria of clinical benefit according to the European Society of Medical Oncology Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS), the American Society of Clinical Oncology Value Framework version 2 (ASCO-VF) and the Swiss OLUtool v2...
Article
Background: Many randomized control trials (RCTs) evaluating programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1) targeting monoclonal antibodies (mAbs) have been completed or are in progress. We examined hypothesized hazard ratios (HHRs) and observed hazard ratios (OHRs) from published RCTs evaluating these mAbs. Methods: Public...
Article
579 Background: The Katherine trial reported a 3-year invasive disease-free survival (DFS) of 77% in patients not achieving pathological complete response (pCR) and continuing on adjuvant trastuzumab. Case series suggest better outcomes and data support that some patients with residual disease have similar outcomes to those with pCR (Steenbruggen e...
Article
1545 Background: Early recognition and management of symptoms can improve outcomes in cancer patients receiving treatment. A number of randomized trials have investigated the effects of adding proactive symptom monitoring to usual care (UC). These include web-based, application-based, or telephone-based assessments. Results have been variable, and...
Article
2544 Background: Quantification of ctDNA levels can be a reliable prognostic tool in several malignancies. More recently, detection of genomic alterations in ctDNA have been validated as a predictive biomarker to guide treatment planning. Dynamic changes in ctDNA levels over time and in response to treatment may also provide prognostic information....
Article
584 Background: HER2-positive early-stage breast cancer (EBC) treated with neoadjuvant chemotherapy and HER2-targeted therapy has favourable outcomes, especially for those attaining pathologic complete response (pCR). Among those with residual invasive disease (RD), outcomes are variable. Replacing adjuvant trastuzumab with ado-trastuzumab emtansin...
Article
Objectives This work aims to determine whether myocardial work (MW) indices can help diagnose or prognosticate cancer treatment–related cardiac dysfunction (CTRCD). Background Echocardiographic global longitudinal strain (GLS) is a useful measure for detection of CTRCD but is influenced by blood pressure changes. This limitation may be overcome by...
Article
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Disease-free survival (DFS) comprises both breast cancer and non-breast cancer events. DFS has not been validated as a surrogate endpoint for overall survival (OS) in most breast cancer subtypes. We assessed changes to the type of events contributing to DFS over time. We identified adjuvant studies in breast cancer (BC) from 2000 to 2020 where the...
Article
Rationale & Objective Patients with chronic kidney disease (CKD) may be at increased risk for cancer. CKD may also be associated with worse cancer outcomes. This study examined cancer incidence and mortality across the spectrum of CKD. Study Design Population-based cohort study. Setting & Participants All adult Ontario residents with data on esti...
Article
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Cognitive impairment (CI) is common among older adults with cancer, but its effect on cancer outcomes is not known. This systematic review sought to identify research investigating clinical endpoints (toxicity risk, treatment completion, and survival) of chemotherapy treatment in those with baseline CI. A systematic search of five databases (incept...
Article
Importance: Diagnosis of cancer therapy-related cardiac dysfunction (CTRCD) remains a challenge. Cardiovascular magnetic resonance (CMR) provides accurate measurement of left ventricular ejection fraction (LVEF), but access to repeated scans is limited. Objective: To develop a diagnostic model for CTRCD using echocardiographic LVEF and strain an...
Article
Full-text available
Cancer-therapeutics-related cardiac dysfunction (CTRCD) is an important concern in women receiving trastuzumab therapy for HER2+ breast cancer. However, the ability to assess CTRCD risk remains limited. In this retrospective cohort study, we apply three published risk prediction models (Ezaz et al., NSABP-31 cardiac risk scores (CRS), and HFA-ICOS...
Article
The programmed cell death-1/programmed cell death ligand-1 (PD-L1) pathway, which plays a crucial role in cancer immune surveillance, is the target of several approved immunotherapeutic agents and is used as a predictive biomarker in some solid tumors. However, its use as a prognostic marker (i.e., regardless of therapy used) is not established cle...
Article
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Background Identification of membrane proteins differentially expressed on tumor cells is a key step in drug development. The carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) is a cell adhesion protein belonging to the immunoglobulin superfamily. Here, we explore the prognostic role CEACAM6 expression on patient outcome in cancer...
Article
Full-text available
Objective To evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer. Design Pragmatic, cluster randomised trial. Setting 20 cancer centres in Ontario, Canada, allocated by covariate constrained randomisation to remote management of toxicities or routine care. Participants All pat...
Article
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Circulating tumor cells (CTC) are prognostic in metastatic breast cancer (MBC). The CTC-endocrine therapy index (CTC-ETI), consisting of CTC-ER (estrogen receptor), BCL2, human epidermal growth factor receptor (HER2), and Ki67 expression, might predict resistance to endocrine therapy (ET) in patients with ER-positive MBC. One hundred twenty-one pat...
Article
Full-text available
Falls are a major issue among older adults with cancer and lead to interruptions in cancer treatment. Resistance and balance training can prevent falls in older adults, but minimal evidence is available regarding the older cancer population, who often have unique risk factors. We used a pre–post design to assess the feasibility of a remotely delive...
Article
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PurposeThere is uncertainty regarding the role of adding immune checkpoint inhibitors (ICIs) to neoadjuvant chemotherapy (NACT) in early-stage triple-negative breast cancer (TNBC).Methods We identified randomized controlled trials (RCTs) comparing ICIs combined with NACT to NACT in early-stage TNBC. Efficacy outcomes included pathological complete...
Article
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Background Cardiorespiratory fitness (CRF) is reduced in cancer survivors and predicts cardiovascular disease (CVD)–related and all-cause mortality. However, routine measurement of CRF is not always feasible. Objectives The purpose of this study was to identify clinical, cardiac biomarker, and imaging measures associated with reduced peak oxygen c...
Article
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Purpose Taxane-associated pain syndrome (TAPS) is common with docetaxel and is characterised by myalgias and arthralgias starting 2–3 days after treatment and can last for up to 7 days. Anecdotal evidence suggests that corticosteroids can reduce TAPS. This multicentre, randomized trial evaluated the effect of additional tapering dexamethasone on TA...
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PurposeCanadian breast cancer screening guidelines state that mammography screening for women 40–49 should be individualized based on risk assessment and preferences. This retrospective cohort study describes the frequency of screening in women aged 40–49 and identifies patient and provider-level associations with screening.Methods Administrative d...
Article
Background Gastroenteropancreatic neoplasms (GEP-NENs) can potentially be cured through surgical resection, but only 42–57% achieve 5-year disease-free survival. There is a lack of consensus regarding the factors associated with relapse following resection of GEP-NENs. Methods A systematic review identified studies reporting factors associated wit...
Article
BACKGROUND Anthracycline and trastuzumab are important systemic therapies for early breast cancer (EBC) but are associated with an increased incidence of heart failure (HF). However, the prognosis of HF associated with anthracyclines and/or trastuzumab for EBC is not well-elucidated. Our objective was to describe the characteristics and prognosis o...
Article
Purpose Current guidelines recommend somatic genomic sequencing for patients with advanced pancreatic cancer to identify targetable alterations amenable to targeted therapy. The benefit of somatic genomic sequencing in pancreatic cancer remains unclear. This studied aims to assess the evidence supporting genomic sequencing to inform treatment selec...
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PURPOSE Resource-stratified guidelines (RSG) for cancer provide a hierarchy of interventions, based on resource availability. We quantify treatment need and cost if National Comprehensive Cancer Network (NCCN) RSGs for breast cancer (BC) are adopted globally. METHODS We developed decision trees for first-course systemic therapy, merged with SEER an...
Article
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Background: Most anticancer drugs are approved by regulatory agencies based on surrogate measures. This article explores the variables associated with overall survival (OS), quality of life (QoL), and substantial clinical benefit among anticancer drugs at the time of approval and in the postmarketing period. Methods: Anticancer drugs approved by...
Article
Background: Censoring due to early drug discontinuation (EDD) or withdrawal of consent or loss to follow-up (WCLFU) can result in postrandomization bias. In oncology, censoring rules vary with no defined standards. In this study, we sought to describe the planned handling and transparency of censoring data in oncology trials supporting FDA approva...
Article
Background: The impact of interval of restaging on the observed magnitude of benefit of progression-free survival (PFS) is undefined. Materials and methods: Phase 3 randomized controlled trials (RCTs) investigating anti-neoplastic drugs for metastatic breast cancer which reported the restaging interval and hazard ratio (HR) for PFS were included...
Article
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A number of organisations are producing resource stratified guidelines (RSGs) for cancer. Despite using similar definitions of resource levels, systemic treatment recommendations often differ between organisations. We systematically searched for RSGs focusing on solid tumours. We qualitatively compared the methods used to generate guidelines using...
Article
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Background Locoregional therapy (LRT) in de novo metastatic disease is controversial with inconsistent results from randomized control trials (RCTs). Methods RCTs comparing LRT and systemic therapy to standard therapy alone in de novo metastatic breast cancer were identified. Hazard ratios (HRs) and their associated 95% confidence intervals (CIs)...
Article
Purpose The addition of platinum agents to anthracycline and taxane-based chemotherapy in early-stage triple negative breast cancer (TNBC) patients improves pathological complete response (pCR). Long-term outcomes, such as disease-free survival (DFS) and overall survival (OS), have not been well-established. Methods A systematic literature review...
Article
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Background It has been suggested that the results from fragile trials are less likely to translate into benefit in routine clinical practice. Methods We searched the Food and Drug Administration (FDA) archives to identify drug approvals for solid organ malignancies between 2010 and 2019. We calculated the Fragility Index (FI) supporting each appro...
Article
Importance Clinical trials have shown that the addition of pertuzumab to trastuzumab-based chemotherapy for first-line treatment of ERBB2-positive metastatic breast cancer is associated with considerable improvement in overall survival (OS). In the second-line setting, trastuzumab emtansine (T-DM1) improves OS compared with capecitabine/lapatinib i...
Article
Background The prognosis of heart failure (HF) after early stage breast cancer (EBC) treatment with anthracyclines or trastuzumab is not well-characterized. Methods Using administrative databases, women diagnosed with HF after receiving anthracyclines or trastuzumab for EBC in Ontario during 2007 to 2017 (the EBC-HF cohort) were categorized by car...
Article
In this issue of JAMA Oncology, Friedl and colleagues¹ report results of the SUCCESS-A trial in which 2987 women were randomized to receive zoledronate either for 5 years (4 mg intravenously every 3 months for 2 years, then every 6 months for 3 years) or for 2 years (4 mg intravenously every 3 months). Eligible women had invasive breast cancer at h...
Article
Purpose: Resource-stratified guidelines (RSG) for cancer provide a hierarchy of interventions, based on resource availability. We quantify treatment need and cost if National Comprehensive Cancer Network (NCCN) RSGs for breast cancer (BC) are adopted globally. Methods: We developed decision trees for first-course systemic therapy, merged with SE...
Article
Full-text available
Data suggest that for newly approved cancer drugs safety and tolerability are worse than in control arms of registration trials. Less is known about the balance between efficacy and toxicity of drugs studied in unselected phase 3 randomized controlled trials (RCTs) including those not resulting in regulatory approval. We searched Clinicaltrials.gov...
Article
12002 Background: Falls are a major issue among older patients with cancer and can lead to interruption in cancer treatment. Ample evidence shows resistance and balance training can prevent falls in older adults; however, there is a paucity of evidence regarding exercise on fall prevention in the older cancer population, who often have unique risk...
Article
6571 Background: The American Society of Clinical Oncology Cancer Research Committee (ASCO-CRC), the ASCO Value Framework Net Health Benefit score version 2 (ASCO-VF), and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS) are validated tools quantifying the clinical benefit for cancer drugs. Here,...
Article
12011 Background: Comprehensive Geriatric Assessment (CGA) is recommended by ASCO for older adults with cancer undergoing chemotherapy to identify issues that can interfere with treatment delivery and optimize functional status and quality of life. However, few randomized controlled trials have been completed so far. Our objective is to evaluate th...
Article
1086 Background: The impact of the interval of radiological assessment on the magnitude of benefit observed in randomized trials (RCTs) in metastatic breast cancer is undefined. Methods: All RCTs investigating anti-neoplastic drugs for metastatic breast cancer published between 2006 and 2019 were identified. Intervals for restaging were categorized...
Article
e18616 Background: PD-1/PD-L1 targeting monoclonal antibodies (mAbs) improve outcomes in multiple cancer types. Multiple mAbs are in clinical development, and many randomized control trials (RCTs) have been completed or are in progress. These RCTs compete for limited clinical trials infrastructure, human resources and patients. Since the hypothesiz...
Article
Full-text available
Background: Multiple anti-PD-1/PD-L1 antibodies have been approved, and in some diseases, there is a choice of more than one. Comparative efficacy, safety and tolerability are unknown. Methods: Randomized trials (RCTs) supporting the registration of single agent anti-PD1 or anti-PDL1 inhibitors between 2015-2019 were identified. We extracted the ha...
Article
Background Many women diagnosed with early-stage hormone-sensitive breast cancer die of causes other than their breast cancer. These competing risks can create challenges in analysing and clearly communicating data on risk of breast cancer recurrence or death. Here, we quantify the impact of competing risks on estimates of disease recurrence and be...
Article
Full-text available
Background: Obesity at breast cancer (BC) diagnosis has been associated with poor outcome, although the magnitude of effect in different BC subtypes is uncertain. We report on the association of obesity/overweight at diagnosis of non-metastatic BC with disease-free (DFS) and overall survival (OS) in the following defined subtypes: hormone receptor...
Conference Paper
Background: For women aged 40-49, Canadian guidelines recommend individualized-decision making (based on risk assessment, values, and preferences) rather than routine screening mammography (SM). In this age group, family physicians are the gatekeepers to access SM; however, studies indicate substantial variability in practice patterns. There are fe...
Conference Paper
BACKGROUND: Despite reduction in the risk of breast cancer occurrence, the use of prophylactic tamoxifen does not improve longer term outcomes such as survival and comes at the cost of toxicity. As such, chemoprophylaxis is utilized poorly in routine practice. Lower dose tamoxifen has been proposed as a more acceptable alternative for breast cancer...
Conference Paper
Background: De novo metastatic breast cancer represents around 6% of breast cancer diagnoses. Retrospective data suggest that locoregional therapy (LRT) for the primary breast cancer in metastatic disease may improve outcomes. Randomized control trials (RCTs) have evaluated the role of LRT in this setting with inconsistent results. Methods: We sear...
Conference Paper
Background: NCCN guidelines include recommendations not approved by the FDA. We aimed to compare the NCCN recommendations for metastatic breast cancer (MBC) with the FDA approved indications and to identify characteristics that are associated with NCCN recommendations for off-label treatment. Methods: All NCCN recommendations for MBC and their supp...
Conference Paper
Background: PARP inhibitors (PARPi), when given as single agents, have modest antitumor activity in patients with advanced breast cancer and mutation in BRCA1 or BRCA2. It is unclear whether some subgroups derive greater benefit from treatment.Methods: Two electronic databases (MEDLINE, CENTRAL) and one registry (Clinicaltrials.gov) were searched f...
Article
BACKGROUND The Fragility Index quantifies the reliability of positive trials by estimating the number of events, which would change statistically significant results to non-significant results. METHODS We identified randomized trials supporting drug approvals by the US FDA between 2009 and 2019 in lung, breast, prostate, and colon cancers and in m...
Article
Background Statins are hypothesized to reduce the risk of cardiotoxicity associated with anthracyclines and trastuzumab. Our aim was to study the association of statin exposure with hospitalization or emergency department visits (hospital presentations) for heart failure (HF) after anthracycline‐ and/or trastuzumab‐containing chemotherapy for early...
Article
Full-text available
We investigated the prognostic utility of pre-chemotherapy neutrophil-to-lymphocyte ratio (NLR) in patients with metastatic germ cell tumors (GCTs) undergoing first-line chemotherapy. We utilized two institutional databases to analyze the pretreatment-derived NLR (dNLR). Predictive accuracy was evaluated using the Cox proportional hazard model adju...
Article
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Abstract Studies have suggested that women with elevated BMI or 25-OH vitamin D levels may derive less benefit from AIs versus tamoxifen. We prospectively investigated whether high BMI or 25-OH vitamin D levels were associated with higher estrogen levels in post-menopausal women receiving standard adjuvant letrozole (2.5 mg/day). Furthermore, we ev...
Article
Background National Comprehensive Cancer Network (NCCN) guidelines can include recommendations for off-label use of anti-cancer drugs. Here, we evaluate NCCN recommendations not supported by US Food and Drug Administration (FDA) approval and explore associations with such recommendations. Methods All NCCN recommendations for MBC and their supporti...
Article
Objectives This study sought to compare the prognostic value of cardiovascular magnetic resonance (CMR) and 2-dimensional echocardiography (2DE) derived left ventricular (LV) strain, volumes, and ejection fraction for cancer therapy–related cardiac dysfunction (CTRCD) in women with early stage breast cancer. Background There are limited comparativ...
Article
Background Anthracycline and trastuzumab therapies improve survival in the cancer population, but are limited by treatment induced cardiotoxicity. Echocardiography derived global longitudinal strain (GLS) permits more sensitive detection of cardiotoxicity than left ventricular ejection fraction (LVEF). However, the clinical implication of a reducti...
Article
283 Background: There is limited real-world evidence of impact of large clinical panel sequencing on treatment-matching for patients with advanced solid tumors. The province of Ontario has a single payer, publicly funded health care system. We linked genomic testing results from a prospective province-wide trial, OCTANE (Ontario-Wide Cancer TArgete...
Article
Full-text available
Background: It remains unclear which patients with metastatic germ cell tumours (mGCTs) need prophylactic anticoagulation to prevent venous thromboembolic events (VTEs). Objective: To assess the risk and onset of VTEs stratified by risk factors. Design, setting, and participants: This multi-institutional retrospective dataset included mGCT pat...
Article
Full-text available
Background Fibroblast growth factor receptor 3 (FGFR3) mutations have been implicated in urothelial tumorigenesis. FGFR3 inhibitors are being explored in clinical trials. Objective We aimed to study the association between FGFR3 mutations and survival in urothelial carcinoma. Design, setting, and participants We performed a systematic literature...
Article
Full-text available
Background: Anti-cancer drugs are approved typically on the basis of efficacy and safety as evaluated in phase III randomized trials (RCTs). Health-related quality of life (HRQoL) is a direct measure of patient benefit, but is under-reported. Here we explore associations with reporting of HRQoL data in phase III RCTs in common solid tumors. Metho...
Article
Background Palbociclib, ribociclib and abemaciclib have all been approved in combination with endocrine therapy in hormone-receptor positive, HER2 negative metastatic breast cancer. While the efficacy of these drugs appears similar, differences in safety and tolerability are apparent. Methods We searched PubMed and ASCO, ESMO and SABCS proceedings...
Article
Full-text available
Background Adjuvant endocrine therapy is a gold standard in early-stage, hormone receptor positive breast cancer. In postmenopausal women, aromatase inhibitors (AIs) are associated with improved outcome compared to tamoxifen monotherapy. Differences in the toxicity profiles of these drugs are described; however, little is known about whether the ri...