2023
Impact of pembrolizumab versus chemotherapy on health-related quality of life in patients with metastatic triple-negative breast cancer: results from the phase 3 randomised KEYNOTE-119 study
Schmid P, Lipatov O, Im S, Goncalves A, Muñoz-Couselo E, Lee K, Tamura K, Testa L, Witzel I, Ohtani S, Turner N, Zambelli S, Harbeck N, Andre F, Dent R, Mejia J, Zhou X, Haiderali A, Nguyen A, Cortes J, Winer E. Impact of pembrolizumab versus chemotherapy on health-related quality of life in patients with metastatic triple-negative breast cancer: results from the phase 3 randomised KEYNOTE-119 study. European Journal Of Cancer 2023, 195: 113393. PMID: 37976633, DOI: 10.1016/j.ejca.2023.113393.Peer-Reviewed Original ResearchConceptsTriple-negative breast cancerCombined positive scoreMetastatic triple-negative breast cancerPD-L1 combined positive scoreHealth-related qualityBreast cancerQLQ-C30 functional scalesTumor PD-L1 expressionGHS/QoLNausea/vomitingPD-L1 expressionStart of treatmentHRQoL resultsEligible patientsHRQoL analysisOverall survivalSystemic therapyClinical outcomesFunctional scalesPhysician's choicePatientsChemotherapyFirst onsetCountry guidelinesMedian TTDImpact of Neoadjuvant Paclitaxel/Trastuzumab/Pertuzumab on Breast Tumor Downsizing for Patients with HER2+ Breast Cancer: Single-Arm Prospective Clinical Trial.
Weiss A, Li T, Desai N, Tung N, Poorvu P, Partridge A, Nakhlis F, Dominici L, Sinclair N, Spring L, Faggen M, Constantine M, Krop I, DeMeo M, Wrabel E, Alberti J, Chikarmane S, Tayob N, King T, Tolaney S, Winer E, Mittendorf E, Waks A. Impact of Neoadjuvant Paclitaxel/Trastuzumab/Pertuzumab on Breast Tumor Downsizing for Patients with HER2+ Breast Cancer: Single-Arm Prospective Clinical Trial. Journal Of The American College Of Surgeons 2023, 237: 247-256. PMID: 37194964, DOI: 10.1097/xcs.0000000000000761.Peer-Reviewed Original ResearchConceptsBreast conservation therapyTrastuzumab/pertuzumabBreast cancerTumor downsizingSystemic therapyBCT ratesSingle-arm prospective clinical trialBreast pathologic complete responseSingle-arm prospective trialBreast cancer warrants further investigationBCT-eligible patientsBreast size ratioCancer warrants further investigationEarly-stage HER2Neoadjuvant systemic therapyPathologic complete responseProspective clinical trialsWarrants further investigationBCT eligibilityMulticentric tumorsNeoadjuvant regimensProspective trialComplete responseLocal therapyConservation therapyAssociation Between Biomarkers and Clinical Outcomes of Pembrolizumab Monotherapy in Patients With Metastatic Triple-Negative Breast Cancer: KEYNOTE-086 Exploratory Analysis
Loi S, Salgado R, Schmid P, Cortes J, Cescon D, Winer E, Toppmeyer D, Rugo H, De Laurentiis M, Nanda R, Iwata H, Awada A, Tan A, Sun Y, Karantza V, Wang A, Huang L, Saadatpour A, Cristescu R, Yearley J, Lunceford J, Jelinic P, Adams S. Association Between Biomarkers and Clinical Outcomes of Pembrolizumab Monotherapy in Patients With Metastatic Triple-Negative Breast Cancer: KEYNOTE-086 Exploratory Analysis. JCO Precision Oncology 2023, 7: e2200317. PMID: 37099733, DOI: 10.1200/po.22.00317.Peer-Reviewed Original ResearchConceptsMetastatic triple-negative breast cancerTriple-negative breast cancerClinical outcomesPembrolizumab monotherapyPD-L1Metastatic diseaseGEP signaturesBreast cancerStromal tumor-infiltrating lymphocytesT-cell-inflamed gene expression profileExploratory biomarker analysisMore systemic therapiesPD-L1 CPSTumor PD-L1PD-L1 statusTumor-infiltrating lymphocytesImproved clinical outcomesTumor mutational burdenSignature 3Mutational signature 3Cohort BDifferentiation 8Systemic therapyCohort ACombined cohortNodal positivity and systemic therapy among patients with clinical T1–T2N0 human epidermal growth factor receptor‐positive breast cancer: Results from two international cohorts
Weiss A, Martínez‐Sáez O, Waks A, Laws A, McGrath M, Tarantino P, Portnow L, Winer E, Rey M, Tapia M, Prat A, Partridge A, Tolaney S, Cejalvo J, Mittendorf E, King T. Nodal positivity and systemic therapy among patients with clinical T1–T2N0 human epidermal growth factor receptor‐positive breast cancer: Results from two international cohorts. Cancer 2023, 129: 1836-1845. PMID: 36951169, DOI: 10.1002/cncr.34750.Peer-Reviewed Original ResearchConceptsHER2-positive breast cancerNeoadjuvant chemotherapyUpfront surgeryNodal positivityBreast cancerTumor sizeALND ratesCT1c tumorsTreatment strategiesSmall human epidermal growth factor receptor 2Lymph node dissection ratesReceptor-positive breast cancerHuman epidermal growth factor receptor 2Epidermal growth factor receptor 2Clinical T1-T2Lymph node positiveHER2-positive patientsGrowth factor receptor 2Optimal treatment strategyFactor receptor 2Nodal statusSystemic therapyNode positiveAxillary imagingPositive tumors
2021
How we treat HER2-positive brain metastases
Stavrou E, Winer EP, Lin NU. How we treat HER2-positive brain metastases. ESMO Open 2021, 6: 100256. PMID: 34482180, PMCID: PMC8424223, DOI: 10.1016/j.esmoop.2021.100256.Peer-Reviewed Original ResearchConceptsHER2-positive brain metastasesHuman epidermal growth factor 2Brain metastasesAdvanced diseaseBreast cancerCentral nervous system metastasesHER2-positive breast cancerEpidermal growth factor 2Nervous system metastasesExperienced multidisciplinary teamSurvival of patientsCentral nervous system activitySite of diseaseNervous system activityUnique clinical challengesAssociated morbiditySystemic therapyGrowth factor 2Clinical challengeReview of agentsClinical scenariosMultidisciplinary teamMetastasisSystem activityDiseaseCustomizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021
Burstein HJ, Curigliano G, Thürlimann B, Weber WP, Poortmans P, Regan MM, Senn HJ, Winer EP, Gnant M, Conference P, Aebi S, André F, Barrios C, Bergh J, Bonnefoi H, Morales D, Brucker S, Burstein H, Cameron D, Cardoso F, Carey L, Chua B, Ciruelos E, Colleoni M, Curigliano G, Delaloge S, Denkert C, Dubsky P, Ejlertsen B, Fitzal F, Francis P, Galimberti V, Mahmoud H, Garber J, Gnant M, Gradishar W, Gulluoglu B, Harbeck N, Huang C, Huober J, Ilbawi A, Jiang Z, Johnston S, Lee E, Loibl S, Morrow M, Partridge A, Piccart M, Poortmans P, Prat A, Regan M, Rubio I, Rugo H, Rutgers E, Sedlmayer F, Semiglazov V, Senn H, Shao Z, Spanic T, Tesarova P, Thürlimann B, Tjulandin S, Toi M, Trudeau M, Turner N, Luis I, Viale G, Watanabe T, Weber W, Winer E, Xu B. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Annals Of Oncology 2021, 32: 1216-1235. PMID: 34242744, PMCID: PMC9906308, DOI: 10.1016/j.annonc.2021.06.023.Peer-Reviewed Original ResearchConceptsEarly-stage breast cancerBreast cancerSystemic therapyEarly breast cancerTime of diagnosisBreast cancer patientsInternational consensus guidelinesBreast cancer riskRadiation oncology providersBreast cancer diagnosisNeoadjuvant therapyMultidisciplinary careOncology providersClinical featuresConsensus guidelinesCancer patientsPatient preferencesTreatment recommendationsTreatment responseCancer riskClinical careClinical informationConsensus conferenceEarly breast cancer diagnosisPatient experience
2019
Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019
Burstein H, Curigliano G, Loibl S, Dubsky P, Gnant M, Poortmans P, Colleoni M, Denkert C, Piccart-Gebhart M, Regan M, Senn H, Winer E, Thurlimann B, 2019 M. Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. Annals Of Oncology 2019, 30: 1541-1557. PMID: 31373601, DOI: 10.1093/annonc/mdz235.Peer-Reviewed Original ResearchConceptsEarly-stage breast cancerBreast cancerBreast cancer histologyClinical benefitCancer histologySt. Gallen Consensus ConferenceEarly breast cancerInternational consensus guidelinesBenefits of therapyBreast cancer recurrenceSubstantial new evidenceMagnitude of benefitAdjuvant therapyLack of evidencePrimary therapyOverall survivalSystemic therapyHealthy womenConsensus guidelinesCancer recurrenceAppropriate treatmentClinical studiesIndividual patientsPatient participationConsensus conferenceLocal–regional recurrence in women with small node-negative, HER2-positive breast cancer: results from a prospective multi-institutional study (the APT trial)
Bellon JR, Guo H, Barry WT, Dang CT, Yardley DA, Moy B, Marcom PK, Albain KS, Rugo HS, Ellis M, Wolff AC, Carey LA, Overmoyer BA, Partridge AH, Hudis CA, Krop I, Burstein HJ, Winer EP, Tolaney SM. Local–regional recurrence in women with small node-negative, HER2-positive breast cancer: results from a prospective multi-institutional study (the APT trial). Breast Cancer Research And Treatment 2019, 176: 303-310. PMID: 31004299, DOI: 10.1007/s10549-019-05238-4.Peer-Reviewed Original ResearchConceptsHER2-positive breast cancerLocal-regional recurrenceDisease-free survivalEffective anti-HER2 therapyLRR-free survivalAnti-HER2 therapyBreast-conserving surgeryBreast cancerRadiation therapySystemic therapyHormone receptor-positive tumorsProspective multi-institutional studyHER2-negative diseaseHER2-positive diseaseNegative axillary nodesEffective systemic therapyProspective multicenter trialEarly-stage patientsKaplan-Meier methodReceptor-positive tumorsHER2-positive tumorsMulti-institutional studyFuture investigational effortsAdjuvant trastuzumabProtocol therapyBreast Cancer Treatment
Waks AG, Winer EP. Breast Cancer Treatment. JAMA 2019, 321: 288-300. PMID: 30667505, DOI: 10.1001/jama.2018.19323.Peer-Reviewed Original ResearchConceptsTriple-negative breast cancerNonmetastatic breast cancerTriple-negative tumorsBreast cancerSystemic therapyTumor subtypesMetastatic triple-negative breast cancerHormone receptor-positive tumorsBreast cancer-specific survivalHuman epidermal growth factor 2Epidermal growth factor 2Small-molecule inhibitor therapyMajor tumor subtypesCancer-specific survivalMedian overall survivalProgesterone receptor expressionMetastatic breast cancerTime of diagnosisReceptor-positive tumorsBreast cancer treatmentErbB2-positive tumorsPreoperative treatment responseERBB2 gene amplificationDistinct risk profilesPalliating symptoms
2018
Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade
Metzger‐Filho O, Ferreira AR, Jeselsohn R, Barry WT, Dillon DA, Brock JE, Vaz‐Luis I, Hughes ME, Winer EP, Lin NU. Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade. The Oncologist 2018, 24: e441-e449. PMID: 30518616, PMCID: PMC6656459, DOI: 10.1634/theoncologist.2018-0363.Peer-Reviewed Original ResearchConceptsInvasive lobular carcinomaDisease-free survivalHistologic gradeLobular carcinomaPostmenopausal womenSystemic therapyBetter prognosisAromatase inhibitorsPrognostic powerDisease-free survival advantageEarly-stage breast cancerFavorable disease-free survivalCox proportional hazards modelAdjuvant aromatase inhibitorsBaseline clinicopathologic characteristicsDetailed clinical databaseHER2-negative diseaseRetrospective cohort studyImportant prognostic factorKaplan-Meier methodProportional hazards modelIntermediate histologic gradeDistinct disease subtypesCohort studyOverall prognosisSystemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: ASCO Clinical Practice Guideline Update
Giordano SH, Temin S, Chandarlapaty S, Crews JR, Esteva FJ, Kirshner JJ, Krop IE, Levinson J, Lin NU, Modi S, Patt DA, Perlmutter J, Ramakrishna N, Winer EP, Davidson NE. Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: ASCO Clinical Practice Guideline Update. Journal Of Clinical Oncology 2018, 36: jco.2018.79.269. PMID: 29939838, DOI: 10.1200/jco.2018.79.2697.Peer-Reviewed Original ResearchConceptsAdvanced breast cancerBreast cancerSystemic therapyTrastuzumab emtansineEstrogen receptor-positive/progesterone receptor-positive breast cancerAdvanced human epidermal growth factor receptorASCO Clinical Practice Guideline UpdateHER2-positive advanced breast cancerProgesterone receptor-positive breast cancerClinical congestive heart failureClinical Practice Guideline UpdateEvidence-based guideline recommendationsStandard first-line therapyPositive advanced breast cancerLeft ventricular ejection fractionReceptor-positive breast cancerHuman epidermal growth factor receptor 2Epidermal growth factor receptor 2Human epidermal growth factor receptorThird-line settingSecond-line treatmentFirst-line therapyFirst-line treatmentProgression-free survivalTime of progressionRecommendations on Disease Management for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases: ASCO Clinical Practice Guideline Update
Ramakrishna N, Temin S, Chandarlapaty S, Crews JR, Davidson NE, Esteva FJ, Giordano SH, Kirshner JJ, Krop IE, Levinson J, Modi S, Patt DA, Perlmutter J, Winer EP, Lin NU. Recommendations on Disease Management for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases: ASCO Clinical Practice Guideline Update. Journal Of Clinical Oncology 2018, 36: jco.2018.79.271. PMID: 29939840, DOI: 10.1200/jco.2018.79.2713.Peer-Reviewed Original ResearchConceptsHuman epidermal growth factor receptorAdvanced breast cancerBrain metastasesBreast cancerEpidermal growth factor receptorGrowth factor receptorSystemic therapyLocal therapyAdvanced human epidermal growth factor receptorASCO Clinical Practice Guideline UpdateHER2-positive advanced breast cancerClinical Practice Guideline UpdateAppropriate local therapyBest supportive careWhole brain radiotherapyProgression-free survivalSize of metastasesFactor receptorExpert panelPresence of symptomsRoutine magnetic resonanceOutcomes of interestStrong quality evidenceMagnetic resonance imagingAdvocacy expertsHomologous recombination deficiency and host anti-tumor immunity in triple-negative breast cancer
Telli ML, Stover DG, Loi S, Aparicio S, Carey LA, Domchek SM, Newman L, Sledge GW, Winer EP. Homologous recombination deficiency and host anti-tumor immunity in triple-negative breast cancer. Breast Cancer Research And Treatment 2018, 171: 21-31. PMID: 29736741, DOI: 10.1007/s10549-018-4807-x.Peer-Reviewed Original ResearchMeSH KeywordsAnimalsAntineoplastic AgentsB7-H1 AntigenBiomarkers, TumorDisease SusceptibilityDNA DamageDNA RepairFemaleGene Expression Regulation, NeoplasticGenes, BRCA1Genes, BRCA2Germ-Line MutationHomologous RecombinationHumansImmunityImmunomodulationMolecular Targeted TherapyProgrammed Cell Death 1 ReceptorTriple Negative Breast NeoplasmsConceptsHost anti-tumor immunityAnti-tumor immunityHomologous recombination deficiencyBreast cancerPurposeTriple-negative breast cancerAnti-tumor immune cellsRecombination deficiencyTriple-negative breast cancerCare systemic therapyImmune-directed therapiesImmune cell subsetsHomologous recombination DNA repair deficiencyBRCA2 mutation carriersBiomarker-driven approachBreast cancer subtypesPARP inhibitor olaparibHR-deficient tumorsDNA repair capacityMetastatic diseaseSystemic therapyImmune infiltratesImproved prognosisCell subsetsImmune cellsWorse outcomesVariation in guideline-concordant care for elderly patients with metastatic breast cancer in the United States
Poorvu PD, Vaz-Luis I, Freedman RA, Lin NU, Barry WT, Winer EP, Hassett MJ. Variation in guideline-concordant care for elderly patients with metastatic breast cancer in the United States. Breast Cancer Research And Treatment 2018, 168: 727-737. PMID: 29332137, DOI: 10.1007/s10549-018-4659-4.Peer-Reviewed Original ResearchConceptsInitial systemic therapyMetastatic breast cancerSystemic therapyBreast cancerDe novo metastatic breast cancerNovo metastatic breast cancerEarly-stage breast cancerHuman epidermal receptor 2HR-positive patientsInitial systemic treatmentGuideline-concordant careHER2-positive patientsFirst-line therapyTriple-negative tumorsPatterns of careQuality of careGuideline concordanceInitial therapyMBC cohortUntreated patientsElderly patientsMost patientsSystemic treatmentInitial treatmentHospice utilization69 Chemotherapy and HER2-Directed Therapy for Metastatic Breast Cancer
Waks A, Winer E. 69 Chemotherapy and HER2-Directed Therapy for Metastatic Breast Cancer. 2018, 885-906.e8. DOI: 10.1016/b978-0-323-35955-9.00069-6.Peer-Reviewed Original ResearchMetastatic breast cancerBreast cancerHER2-positive metastatic breast cancerTriple-negative breast cancerTriple-negative diseaseBRCA-deficient breast cancersUnderstanding of treatmentDistinct disease subtypesBrain metastasesOverall survivalSystemic therapyClinical efficacyNovel therapiesDisease subtypesTherapyCancerHER2ChemotherapyImportant advancesImmunotherapyPertuzumabPatientsMetastasisSubtypesDisease
2017
Axillary Management of Stage II/III Breast Cancer in Patients Treated with Neoadjuvant Systemic Therapy: Results of CALGB 40601 (HER2-Positive) and CALGB 40603 (Triple-Negative)
Ollila DW, Cirrincione CT, Berry DA, Carey LA, Sikov WM, Hudis CA, Winer EP, Golshan M. Axillary Management of Stage II/III Breast Cancer in Patients Treated with Neoadjuvant Systemic Therapy: Results of CALGB 40601 (HER2-Positive) and CALGB 40603 (Triple-Negative). Journal Of The American College Of Surgeons 2017, 224: 688-694. PMID: 28089784, PMCID: PMC5616181, DOI: 10.1016/j.jamcollsurg.2016.12.036.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAxillaBiopsyBreast NeoplasmsCarcinoma, Ductal, BreastCarcinoma, LobularFemaleHumansLymph Node ExcisionLymph NodesLymphatic MetastasisMastectomyMiddle AgedNeoadjuvant TherapyNeoplasm StagingPractice Patterns, Physicians'Receptor, ErbB-2Sentinel Lymph Node BiopsyTriple Negative Breast NeoplasmsUnited StatesConceptsAxillary lymph node dissectionNeoadjuvant systemic therapyNode-positive patientsSentinel node biopsyStage II/III breast cancerResidual axillary diseaseNode biopsyAxillary diseaseSystemic therapyBreast cancerAxillary node evaluationAxillary surgical proceduresPathologic nodal statusLymph node dissectionNode-positive diseaseCore needle biopsyFine-needle aspirationAxillary evaluationAxillary managementCALGB 40601N0 diseaseAxillary procedureNode dissectionRadiologic stagingNodal status
2016
Treatment of early-stage human epidermal growth factor 2-positive cancers among medicare enrollees: age and race strongly associated with non-use of trastuzumab
Vaz-Luis I, Lin NU, Keating NL, Barry WT, Lii J, Burstein HJ, Winer EP, Freedman RA. Treatment of early-stage human epidermal growth factor 2-positive cancers among medicare enrollees: age and race strongly associated with non-use of trastuzumab. Breast Cancer Research And Treatment 2016, 159: 151-162. PMID: 27484879, DOI: 10.1007/s10549-016-3927-4.Peer-Reviewed Original ResearchConceptsAdjuvant trastuzumabOlder patientsSystemic treatmentBreast cancerHuman epidermal growth factor receptor 2HER2-positive breast cancerEpidermal growth factor receptor 2HER2-positive diseaseStage III diseaseCongestive heart failureGrowth factor receptor 2Positive breast cancerFactor receptor 2Treatment omissionEndocrine therapyClinical characteristicsSystemic therapyHeart failureBlack patientsTreatment disparitiesTreatment patternsHuman epidermal growth factorEpidermal growth factorMedicare dataPatientsI-SPY 2 — Toward More Rapid Progress in Breast Cancer Treatment
Carey LA, Winer EP. I-SPY 2 — Toward More Rapid Progress in Breast Cancer Treatment. New England Journal Of Medicine 2016, 375: 83-84. PMID: 27406352, DOI: 10.1056/nejme1603691.Peer-Reviewed Original Research
2015
Impact of Neoadjuvant Chemotherapy in Stage II–III Triple Negative Breast Cancer on Eligibility for Breast-conserving Surgery and Breast Conservation Rates
Golshan M, Cirrincione CT, Sikov WM, Berry DA, Jasinski S, Weisberg TF, Somlo G, Hudis C, Winer E, Ollila DW. Impact of Neoadjuvant Chemotherapy in Stage II–III Triple Negative Breast Cancer on Eligibility for Breast-conserving Surgery and Breast Conservation Rates. Annals Of Surgery 2015, 262: 434-439. PMID: 26222764, PMCID: PMC4710511, DOI: 10.1097/sla.0000000000001417.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAntibodies, Monoclonal, HumanizedAntineoplastic Combined Chemotherapy ProtocolsBevacizumabCarboplatinChemotherapy, AdjuvantDisease-Free SurvivalDoxorubicinFemaleHumansMastectomy, SegmentalMaximum Tolerated DoseMiddle AgedNeoadjuvant TherapyNeoplasm InvasivenessNeoplasm StagingPaclitaxelPatient SelectionPrognosisProspective StudiesSurvival AnalysisTreatment OutcomeTriple Negative Breast NeoplasmsYoung AdultConceptsNeoadjuvant systemic therapyBreast-conserving therapyTriple-negative breast cancerNegative breast cancerSuccessful breast-conserving therapyBCT candidatesBreast cancerStage IIAddition of carboplatinBCT-eligible patientsRandomized phase IIBreast conservation ratesTumor-free marginsBCT eligibilityNeoadjuvant paclitaxelNeoadjuvant chemotherapySystemic therapySurgical outcomesSurgical choiceTumor regressionPatient's discretionFactorial trialPatientsAbsolute increaseCancerTailoring adjuvant chemotherapy regimens for patients with triple negative breast cancer
Stover DG, Winer EP. Tailoring adjuvant chemotherapy regimens for patients with triple negative breast cancer. The Breast 2015, 24: s132-s135. PMID: 26255198, DOI: 10.1016/j.breast.2015.07.032.Peer-Reviewed Original ResearchConceptsTriple-negative breast cancerBreast cancerAdjuvant chemotherapyHigh-risk triple negative breast cancerLong-term outcome dataAnthracycline-taxane combinationsBRCA mutation carriersStandard of careNegative breast cancerPoor prognosis subtypeAdjuvant settingStandard regimensToxic regimensMetastatic settingCytotoxic chemotherapySystemic therapyImmune infiltratesTumor characteristicsMutation carriersOutcome dataWarrants further considerationStage ISpecific subgroupsChemotherapyCancer