Randomized Phase 3, Double-blind, Placebo-controlled Study of Prophylactic Gabapentin for the Reduction of Oral Mucositis Pain During the Treatment of Oropharyngeal Squamous Cell Carcinoma

PURPOSE

The purpose of this paper is to determine whether prophylactic gabapentin usage in patients undergoing definitive concurrent chemotherapy and radiation therapy (chemoRT) for oropharyngeal cancer (OPC) improves treatment-related oral mucositis pain, opioid use, and feeding tube (FT) placement.

METHODS AND MATERIALS

This double-blind, randomized phase 3 study for patients with locally advanced OPC undergoing chemoRT randomly allocated patients to prophylactic gabapentin (600 mg thrice daily) or placebo. The primary endpoint was change in Patient-Reported Oral Mucositis Symptom (PROMS) scores over the entire treatment period (baseline to 6 weeks post-radiation therapy [RT] follow-up) with higher scores indicating worse outcomes. Opioid requirements, FT placement, and other patient-reported quality of life (QOL) metrics (Functional Assessment of Cancer Therapy-Head and Neck [FACT-HN] and Patient-Reported Outcomes version of the National Cancer Institute Common Terminology Criteria for Adverse Events [PRO-CTCAE]) were assessed. Lower scores suggested poorer QOL with the FACT-HN questionnaire, and higher scores suggested worse outcomes with the PRO-CTCAE questionnaire. Questionnaires were administered at baseline, weekly during RT, and at 6 weeks post-RT follow-up. Repeated measures analysis of variance was used to detect differences in PROMS scores and change in opioid use from baseline. Wilcoxon rank sum tests were used to compare averages for the other secondary endpoints. A P value less than .05 was considered statistically significant.

RESULTS

Treatment arms were well balanced overall, including T and N staging and dosimetric variables. There were 58 patients analyzed. No significant difference was found in PROMS scores (mean 29.1, standard deviation [SD] 22.5 vs 20.1, SD 16.8 for gabapentin vs placebo, respectively, P = .11). The FACT-HN functional well-being index had a significant decrease in scores from baseline to follow-up in the gabapentin arm (median -6, interquartile range [IQR] -10.0 to -0.5 vs -1, IQR -5.5 to 3.0, P = .03). PRO-CTCAE scores increased significantly at follow-up for gabapentin (median 6.5, IQR 3.5-11.8 vs 1, IQR -2.0 to 6.0, P = .01). There was no significant difference in average or change in opioid use. FT placement was significantly higher in the gabapentin arm (62.1% vs 20.7%, P < .01).

CONCLUSIONS

This study suggests that prophylactic gabapentin is not effective in improving treatment-related oral mucositis symptoms in a select population of patients with OPC undergoing definitive chemoRT.

A Diagnostic Pitfall in the Evaluation of CD138-Positive Plasmacytoid Cells in a Fine Needle Aspiration Biopsy

Introduction/Objective

The identification of plasmacytoid cells on rapid assessment leads to a wide range of differential diagnoses.

Methods/Case Report

We present a 51-year-old female with a parotid mass and cervical lymphadenopathy. The fine needle aspiration biopsy of the lymph node showed clusters of plasmacytoid cells. Flow cytometric studies showed cells positive for CD19, CD45, CD138 and kappa, but negative for CD38 and lambda. The kappa to lambda ratio was greater than 100. Histological sections showed plasmacytoid cells that were positive for AE1/AE3, S100, and SOX10, weakly positive for CK7 and GATA3, but negative for CD79a, CD45, EMA, p40, p63, and pan-melanoma markers. Kappa and lambda had a 1:1 ratio. Due to the discrepancy between the flow cytometric results and the immunohistochemistry, excision was recommended. The subsequent excision specimen showed classic morphology for myoepithelial carcinoma, plasmacytoid variant.

Results (if a Case Study enter NA)

NA

Conclusion

Myoepithelial carcinomas of the salivary glands are rare neoplasms, and they have various morphologies. The plasmacytoid variant can pose as a diagnostic pitfall. In fine needle aspiration biopsies, carcinoma cells with plasmacytoid morphology can be confused with a plasma cell neoplasm. CD138 is nonspecific marker, and it can be expressed in plasma cells as well as carcinomas. To further complicate matters, pancytokeratin and SOX10 can aberrantly expressed in some plasma cell myelomas. Flow cytometry studies is a valuable tool to define various cell types. However, it can be misleading if it is used as a sole source for interpreting plasmacytoid cells. Epithelial and myoepithelial neoplasms should be considered as differential diagnoses when CD138-positive plasmacytoid cells are encountered. Extended immunohistochemistry panel including multiple epithelial and myoepithelial markers play pivotal role in settling the diagnosis.

Honey as a bioindicator of environmental organochlorine insecticides contamination

Honey is a suitable matrix for the evaluation of environmental contaminants including organochlorine insecticides. The present study was conducted to evaluate residues of fifteen organochlorine insecticides in honey samples of unifloral and multifloral origins from Dir, Pakistan. Honey samples (5 g each) were extracted with GC grade organic solvents and then subjected to Rotary Evaporator till dryness. The extracts were then mixed with n-Hexane (5 ml) and purified through Column Chromatography. Purified extracts (1μl each) were processed through Gas Chromatograph coupled with Electron Capture Detector (GC-ECD) for identification and quantification of the insecticides. Of the 15 insecticides tested, 46.7% were detected while 53.3% were not detected in the honey samples. Heptachlor was the most prevalent insecticide with a mean level of 0.0018 mg/kg detected in 80% of the samples followed by β-HCH with a mean level of 0.0016 mg/kg detected in 71.4% of the honey samples. Honey samples from Acacia modesta Wall. were 100% positive for Heptachlor with a mean level of 0.0048 mg/kg followed by β-HCH with a mean level of 0.003 mg/kg and frequency of 83.3%. Minimum levels of the tested insecticides were detected in the unifloral honey from Ziziphus jujuba Mill. Methoxychlor, Endosulfan, Endrin and metabolites of DDT were not detected in the studied honey samples. Some of the tested insecticides are banned in Pakistan but are still detected in honey samples indicating their use in the study area. The detected levels of all insecticides were below the Maximum Residue Levels (MRLs) and safe for consumers. However, the levels detected can cause mortality in insect fauna. The use of banned insecticides is one of the main factors responsible for the declining populations of important insect pollinators including honeybees.

Tuneable exchange-spring stiffness in amorphous magnetic trilayer structures

We investigate the magnetic properties of amorphous Sm₁₀Co₉₀/Co₆₀(Al₇₀Zr₃₀)₄₀/Co₈₅(Al₇₀Zr₃₀)₁₅exchange-spring magnet trilayers. The magnetically soft Co₈₅(Al₇₀Zr₃₀)₁₅layer is coupled to the magnetically hard Sm₁₀Co₉₀layer through the weakly magnetic low-T_cCo₆₀(Al₇₀Zr₃₀)₄₀spacer layer. The strength of the coupling can be controlled with temperature and the coupling persists above the intrinsicT_cof the spacer layer due to a long-range magnetic proximity effect. Polarized neutron reflectivity is used to examine the magnetic profile of the trilayers during magnetization reversal. A two-step switching occurs, with the switching angle of the soft layer strongly dependent on the strength of the coupling. In the strong coupling regime a magnetic state can be achieved where the soft layer magnetization is perpendicular to the hard layer whereas in the weak coupling regime the soft layer reverses fully.

Shoulder Function Assessment After Head And Neck Reconstruction With Pedicled Supraclavicular Flap

The supraclavicular artery flap is used for reconstruction of defects of the head and neck. One of the major implications of this procedure is injury to the nerve roots of C3 and C4 of the superficial cervical plexus, which provides sensation over the clavicle, shoulder and proximal chest, thereby causing problems in overall shoulder function. The objective of this study was to assess shoulder function, range of motion, pain, daily activities and overall satisfaction of the patient after using this flap. This study was conducted at the Department of Plastic & Reconstructive Surgery, Dow University of Health Sciences & Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan, from May 2015 to November 2018. Supraclavicular flap was used in 35 patients who underwent soft tissue reconstruction of defect of the neck after release of post burn contracture. Penn Shoulder Score and Constant Murley Score were used as assessment tools. Assessment by Penn Shoulder Score resulted in 25 (71.4%) patients within the upper quartile and 10 (18.6%) patients within the lower quartile. Constant Murley Score showed 19 (54.2%) of patients had 161°-180° shoulder abduction and lateral elevation. Forward flexion of 161°-180° was seen in 17 (48.5%) patients, 17 (48.5%) had internal rotation till the inter scapular region, 15 (42.8%) had no impairment of external rotation, 19 (54.2%) patients had no impairment of work/recreation, 25 (71.4%) had felt no change in their sleep and 22 (62.8%) were able to position their arm above their head. Overall parameters indicate better function, good range of motion, less pain, resumption of daily activities, and overall satisfaction.

High-Fidelity Controlled-Z Gate with Maximal Intermediate Leakage Operating at the Speed Limit in a Superconducting Quantum Processor

Simple tuneup of fast two-qubit gates is essential for the scaling of quantum processors. We introduce the sudden variant (SNZ) of the net zero scheme realizing controlled-Z (CZ) gates by flux control of transmon frequency. SNZ CZ gates realized in a multitransmon processor operate at the speed limit of transverse coupling between computational and noncomputational states by maximizing intermediate leakage. Beyond speed, the key advantage of SNZ is tuneup simplicity, owing to the regular structure of conditional phase and leakage as a function of two control parameters. SNZ is compatible with scalable schemes for quantum error correction and adaptable to generalized conditional-phase gates useful in intermediate-scale applications.

Abstract PO-189: Precision medicine for African breast cancer: Bringing African researchers together to study African breast cancer

Introduction In sub-Saharan Africa, breast cancer (BC) is the leading cancer in women and the second cause of cancer mortality. In order to reduce the burden of BC in women with African ancestry there is a need for a structured, coordinated effort to address gaps in our understanding of the factors associated with the disease that influence tumor initiation, progression, and outcomes. To address this need ‘Precision Medicine for African Breast Cancer (PMABC)’ a comprehensive partnership housed at the Henry Ford Cancer Institute was created with the aim of bringing together African researchers to study African BC. We are currently composed of nine leading institutions spanning West and East Africa and two institutions in the United States. Objectives The broad aim of PMABC is to bring together researchers and institutions across sub-Saharan Africa to partner with foreign institutions and funding agencies to study and identify new and improved methods of screening, diagnosing, and treating BC in Africans to improve the overall outcome. Among the aims of PMABC are: • Registry: Create a national BC registry building on data from participating institutions which comprise at least 80% of all BC cases seen in the respective country • Standardization of pathology protocol and reporting: harmonize the pathology reporting scheme and ensure its conformity to international standards Standardization of treatment protocols: Study and compare treatment protocols with international standards and make recommendations • Biorepository: Create a national repository of patient samples to be used in genetic and biological studies • Study African tumor biology: Build the capacity to be able to study African tumors locally and participate in clinical trials • Patient follow up and survival studies: study and obtain data on patient outcomes Achievements We currently have ethical approval and have begun work in nine institutions across West and East Africa. • Creation of a national database in Ghana that currently consists of over 7000 patients. The data is being analyzed to determine risk factors and the distribution of BC by subtypes • We are setting up two research labs in Ghana to train local researchers for basic and translational research • We have a biorepository of over 2000 patient samples that is available for collaborative studies • We have developed tumor models from continental African breast tumors • Building partnership with international organizations, pharmaceutical companies, and funding agencies to study African BC Conclusion PMABC serves as an umbrella institution to coordinate the work between these researchers and to provide resources for the institutions to provide a high level of BC research and treatment. We are aiming to partner with countries across Africa to translate the model created by PMABC in order fulfill the need for further BC research and standardization of data collection and treatment.

PMABC is made possible because of the dedication and passion of our collaborating researchers.

Citation Format: Sabrina I. Fossi, Sylvester Antwi, Kwabena Agbedinu, Kafui Akakpo, Samuel Mensah, Nelson Affram, Mohammed Sheriff, Foster Amponsah, Jacqueline Asibey, Osei Collins, Alex Mremi, Livingstone Aduse-Poku, Kurt Fernando, Haythem Ali, Eleanor Walker, Jessica Bensenhaver, Evelyn M. Jiagge. Precision medicine for African breast cancer: Bringing African researchers together to study African breast cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-189.

Abstract PO-152: A systematic review and meta-analysis of the prevalence of breast cancer in Africa: Identifying unanswered questions

Introduction One major limitation to cancer prevention and control in Africa has been lack of accurate and reliable epidemiological data. To date, there is no publicly available systematic review and meta-analysis on the prevalence of breast cancer in Africa. This data is important to understand the burden of the disease in Africa and identify areas lacking reliable studies. Objective The objective of this review was to examine the prevalence of breast cancer in Africa based on region, subtype, and screening. Methods A systematic search of MEDLINE, EMBASE, PUBMED, ISI Web of Science, BIOSIS, African Journal Online, and Global Health was conducted. We included population-based or hospital-based cancer registry studies on breast cancer conducted on African populations and providing estimates of breast cancer cases or prevalence over a period. A random effect meta-analysis was done to determine the pooled prevalence of breast cancer in Africa based on region, subtype and screening, using Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC. Results Our search of databases yielded 2030 references that were imported into Covidence. A total of 44 studies were included in the review. The overall pooled prevalence of breast cancer in Africa was 0.48% (95% CI: 0.05-0.92). With regards to regional prevalence, the estimated prevalence of breast cancer among women in Sub-Saharan Africa (SSA), 0.68% (-0.03 - 0.1.39) was remarkably higher than that of women in North Africa (NA) 0.16% (95% CI: -0.11-0.42). Also, the overall prevalence of triple negative breast cancer (TNBC) among female breast cancer patients was 29.51% (CI: 23.94-35.08). A sub-group analysis revealed, TNBC was more prevalent in women from SSA 29.51 (CI: 23.94- 35.08, 18 studies) than women from NA 20.17(14.63-25.71, 8 studies). Meta-analysis of African women participation in Breast Self-Examination (BSE) produced a prevalence of 29.57 (CI: 7.90-51.25). This was higher than the prevalence of African women participation in Clinical Breast Examination and mammography, 12.22 (7.58-16.86). Conclusions Though the incidence of breast cancer in Africa is relatively low, the same cannot be said of its prevalence. Also, within Africa, there are clear regional and sub-regional differences in both breast cancer prevalence and the prevalence of TNBC among breast cancer patients. This may be attributed to limited infrastructure needed for breast cancer control and prevention especially within SSA regions. Establishment of robust hospital-based cancer registries in Africa will boost the collection of accurate and complete cancer data that can be used in epidemiological research, patient care improvement, and cancer control which will ultimately lead to the reduction of breast cancer burden in Africa.

Citation Format: Livingstone Aduse-Poku, Kurt Fernando, Sabrina I. Fossi, Sylvester Antwi, Haythem Ali, Eleanor Walker, Evelyn M. Jiagge. A systematic review and meta-analysis of the prevalence of breast cancer in Africa: Identifying unanswered questions [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-152.

Is implantable loop recorder the answer to reduce the increased risk of stroke in cancer patients?

Introduction

Recent epidemiologic data suggests increased risk of ischaemic stroke in cancer patients. The etiology of increased ischaemic stroke is unknown. Atrial fibrillation (AF) is among the potential etiologies. The risk of AF has not been studied among cancer patients in the United States.

Purpose

Ascertain the association of AF in cancer patients in the USA by using the largest database i.e. National Inpatient Sample (NIS).

Methods

Patients ≥18 years old were selected in the NIS database for years 2010 to 2014 and stratified based on presence or absence of any of four cancers (lung, colon, breast and prostate; 4CA) using ICD 9 codes. Atrial fibrillation and stroke/TIA were also identified using ICD 9 codes. Components of CHADS2 score (CHF, hypertension, Age&gt;75, diabetes and stroke/TIA) were identified using ICD 9 codes. χ2 tests performed for prevalence of AF in patients with or without these cancers stratified by CHADS2 score. Binary logistic regression was used to analyze individual components of CHADS2 score.

Results

AF and stroke/TIA were significantly higher among 4CA than non-4CA group (18.7% vs 12.0%, P&lt;0.001 and 5.4% vs 4.8%, P&lt;0.001 respectively). AF prevalence increased with CHADS2 and was significantly higher in 4CA group with CHADS2 score 0 to 4 (Table 1 and Figure 1). Logistic regression for the outcome of AF showed “Age &gt;75” OR (3.0), CHF (2.8), CVA (1.2), HTN (1.3) and DM (1.1).

Conclusion

This is the first study using a national database of USA patients to estimate prevalence of AF in cancer patients compared to non-cancer patients and reaffirms the higher burden of AF in cancer patients. Prevalence of both AF and stroke were greater in cancer patients when stratified by CHADS2 score. This may indicate not just an increased risk of AF but an increased risk of stroke/TIA for the same CHADS2 score. Stroke incidence was also higher in the 4CA group (5.4% vs. 4.8% P&lt;0.001). Cancer patients with CHADS2 score &gt;1 may benefit from screening with loop recorder to identify previously undetected AF and initiate anticoagulation therapy. Prospective longitudinal studies are needed to validate this retrospective study.

Funding Acknowledgement

Type of funding source: None

Acceptability and Feasibility of an Isometric Resistance Exercise Program for Abdominal Cancer Surgery: An Embedded Qualitative Study

Although it is recognized in the early stages of cancer recovery that changes in lifestyle including increases in physical activity improves physical function, there are no clear findings whether low versus moderate intensity activity or home or gym exercise offer optimal benefit. Isometric-resistance exercises can be carried out with very little equipment and space and can be performed while patients are bed-bound in hospital or at home. This embedded qualitative study, based in an English hospital trust providing specialist cancer care, was undertaken as a component of a feasibility trial to evaluate the acceptability and feasibility of an isometric-resistance exercise program and explore the suitability of functional assessments by drawing from the experiences of abdominal cancer patients following surgery. Telephone interviews were undertaken with 7 participants in the intervention group, and 8 interviews with the usual care group (n = 15). The gender composition consisted of 11 females and 4 males. Participants’ ages ranged from 27 to 84 (M = 60.07, SD = 15.40). Interviews were conducted between August 2017 and May 2018, with audio files digitally recorded and data coded using thematic framework analysis. Our results show that blinding to intervention or usual care was a challenge, participants felt the intervention was safe and suitable aided by the assistance of a research nurse, yet, found the self-completion questionnaire tools hard to complete. Our study provides an insight of trial processes, participants’ adherence and completion of exercise interventions, and informs the design and conduct of larger RCTs based on the experiences of abdominal cancer surgery patients.

The importance of cancer patients' functional recollections to explore the acceptability of an isometric-resistance exercise intervention: A qualitative study

BACKGROUND AND AIMS

Although it has been widely recognized the potential of physical activity to help cancer patients' preparation for and recovery from surgery, there is little consideration of patient reflections and recovery experiences to help shape adherence to exercise programs. The aim was to explore the acceptability of our newly proposed isometric exercise program in a large general hospital trust in England providing specialist cancer care by using patient recollections of illness and therapy prior to undertaking a randomized controlled trial.

METHODS

Four Focus groups (FGs) were conducted with cancer survivors with an explicit focus on patient identity, functional capacity, physical strength, exercise advice, types of activities as well as the timing of our exercise program and its suitability. Thematic framework analysis was used with NVivo 11.

RESULTS

FG data was collected in January 2016. A total of 13 patients were participated, 10 were male and 3 were female with participants' ages ranging from 39 to 77. Data saturation was achieved when no new information had been generated reaching "information redundancy." Participants reflected upon their post-surgery recovery experiences on the appropriateness and suitability of the proposed intervention, what they thought about its delivery and format, and with hindsight what the psychological enablers and barriers would be to participation.

CONCLUSION

Based upon the subjective recollections and recovery experiences of cancer survivors, isometric-resistance exercise interventions tailored to individuals with abdominal cancer has the potential to be acceptable for perioperative patients to help increase their physical activity and can also help with emotional and psychological recovery.

Abstract 4975: Breast tumor expression of DARC/ACKR1 and impacts on disease progression and immune cell recruitment in the tumor microenvironment

The Duffy Antigen Receptor for Chemokines (DARC/ACKR1) is an atypical chemokine receptor which promiscuously binds chemokines of both CC and CXC chemokine families. DARC/ACKR1 maintains homeostatic levels of chemokines in circulation through its expression on erythrocytes, and in tissues participates in chemokine transport, where chemokines are transported across the cell layer to help establish chemokine gradients. Establishment of these chemokine gradients is essential for proper immune cell trafficking.

In our recent study, we have shown that DARC/ACKR1 is expressed on the tumor epithelium, and through in silico analysis of data from the Cancer Genome Atlas (TCGA), that higher DARC/ACKR1 expression is positively and significantly correlated with tumor-associated leukocyte abundance when using CIBERSORT deconvolution methods. Specifically, higher DARC/ACKR1 expression was linked with increases in B cell, T cell, monocyte and macrophage populations. Higher DARC/ACKR1 expression is also significantly associated with better survival outcomes, across all breast cancer molecular subtypes.

To further evaluate DARC/ACKR1 expression and influences on the breast TME, we have employed multiple approaches to characterize how DARC/ACKR1 impacts immune cell recruitment and subsequent infiltration into the tumor.

In our patient cohort, we have recently completed Hyperion imaging mass cytometry staining of tumors that have been scored by IHC as DARC/ACKR1 high or low expressing. We used a panel of approximately 30 markers, including structural, immune, and other markers of interest. Following imaging, we have used cell segmentation software to quantify marker expression on a cell-by-cell basis. Using this method, we are able to conduct single-cell analyses of our markers of interest, while also retaining the spatial composition of the cells. We have used the tSNE algorithm to identify cell populations that cluster uniquely within DARC/ACKR1 high or low tumor expressing groups, specifically identifying different clusters of immune cell populations, which show different spatial expression patterns in our comparison groups.

In addition to investigations of immune cell recruitment to the TME, we have also developed a novel DARC/ACKR1 breast cancer transgenic mouse model to study how disease progression may differ with differing DARC/ACKR1 phenotypes. Briefly, DARC -/- female mice were crossed with the male C3(1)Tag +/0 breast cancer transgenic mouse to generate DARC +/-, C3(1)Tag +/0 male mice. These males were subsequently backcrossed to DARC -/- females, to generate the target DARC/ACKR1 +/- or -/-, C3(1)Tag+ mice. These mice show evidence of early disease beginning at 3.5 months of age, and progress to advanced disease by 5 months of age. We have collected tumor tissue and blood specimens from mice ranging from 3.5 to 7 months of age, to characterize disease progression over time between our DARC/ACKR1 expressing and non-expressing groups. We have observed differences in tumors characteristics between our DARC/ACKR1 expressing groups, and upon histological and immunofluorescent evaluation, we have begun to observe differences in immune cell recruitment, following similar patterns to what we observed in our in silico and patient cohort analyses.

Citation Format: Rachel Martini, Brittany Jenkins, Dorrah Deeb, Hiranmayi Ravichandran, Paula Ginter, Esther Cheng, Syed Hoda, Dhananjay Chitale, Haythem Ali, Eleanor Walker, Jessica Bensenhaver, Olivier Elemento, Nancy Manley, Lisa Newman, Melissa Davis. Breast tumor expression of DARC/ACKR1 and impacts on disease progression and immune cell recruitment in the tumor microenvironment [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4975.

Abstract 5805: Treatment-associated endocrine symptoms and change in ultrasound tomography measures of breast density after tamoxifen therapy

Background: Tamoxifen therapy has been shown to have greater therapeutic benefit among women whose breast density declines subsequent to treatment than among women whose density does not decline. Although limited data suggests that endocrine symptoms after tamoxifen initiation may be associated with improved breast cancer outcomes, it is unknown whether these symptoms are associated with reductions in breast density. We therefore evaluated endocrine symptoms and change in breast density in a 12-month longitudinal study of women undergoing tamoxifen therapy for clinical indications.

Methods: Cohort members (N=74) were aged 30-74 years in the Ultrasound Study of Tamoxifen at Karmanos Cancer Institute and Henry Ford Health Systems (Detroit, MI). Endocrine symptoms and breast density were both assessed prior to tamoxifen initiation (T0) and at 1-3 months (T1), 4-6 months (T2), and approximately 12 months (T3) post-tamoxifen initiation. Treatment-associated endocrine symptoms included treatment-emergent or increasing vasomotor and/or joint symptoms. Endocrine symptom severity was also assessed with a Likert scale for symptom frequency and categorized as no symptoms (score=0), low/moderate symptoms (score=1-5), and high symptoms (score=6+). Sound speed (m/s), a surrogate of volumetric breast density, was measured with whole breast ultrasound tomography. Change in breast density was calculated as density at T1-T3 minus density at T0. We used multivariable linear regression to estimate mean change in density by endocrine symptoms adjusting for age, race, menopausal status, body mass index, and baseline sound speed. Generalized estimating equations were used to account for within-subject correlations over time.

Results: Women with treatment-associated endocrine symptoms had an overall greater mean reduction in breast density compared with women without symptoms (mean change [95% CI]: -1.97 m/s [-3.80, -0.13]; -0.27 m/s [- 3.50, 2.95], respectively; p=0.22). Longitudinal trends in breast density significantly differed for women with versus without treatment-associated endocrine symptoms (p-interaction=0.02). Significant declines in breast density over time were observed among women with treatment-associated endocrine symptoms (p-trend=0.005), but not among women without symptoms (p-trend=0.16). Similar trends in breast density decline were observed among women with higher symptom severity (p-trends for no symptoms=0.53; low/moderate symptoms=0.04; high symptoms=0.008).

Conclusions: These findings suggest that treatment-associated endocrine symptoms may be associated with a significant decline in breast density after tamoxifen initiation. Further studies are needed to assess whether these observations can predict clinical outcome, and if confirmed, both treatment-associated endocrine symptoms and observed reductions in breast density may be useful for patients and providers to improve adherence.

Citation Format: Cody Ramin, Ruth Pfeiffer, Shaoqi Fan, Maeve Mullooly, Roni T. Falk, Mark A. Sak, Michael S. Simon, David H. Gorski, Haythem Ali, Peter Littrup, Nebojsa Duric, Mark E. Sherman, Gretchen L. Gierach. Treatment-associated endocrine symptoms and change in ultrasound tomography measures of breast density after tamoxifen therapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5805.

Agronomic efficiency and profitability of cotton on integrated use of phosphorus and plant microbes

Cotton crop, plays a significant role in Pakistan's economy by ruling a prominent place in edible oil and local textile industry. Phosphorus (P) inaccessibility and deficiency of soil organic matter are the key restraints for low crop productivity in cotton. Therefore, a two years field study was designed during 2014-15, to explore the influence of phosphate solubilizing bacteria (PSB), farmyard manure (FYM), poultry manure (PM) and inanimate sources of P on various physiological, growth, yield and quality parameters of cotton crop at CCRI Multan. Field responses of seeds inoculated with two distinctive phosphate solubilizing bacteria (PSB) strains viz. S0 = control, S1 =strain-1, S2 = strain-2 and eight organic, inorganic P sources viz., P0= control, P1 = 80 kg ha-1 P from inorganic source, P2 = 80 kg ha-1 P from FYM, P3 = 80 kg ha-1 P from PM, P4 = 40 kg ha-1 P from FYM + 40 kg ha-1 P from inorganic source, P5 = 40 kg ha-1 P from PM + 40 kg ha-1 P from inorganic source, P6 = 80 kg ha-1 P from FYM + 40 kg ha-1 P from inorganic source, P7 = 80 kg ha-1 P from PM + 40 kg ha-1 P from inorganic source and P8 = 40 kg ha-1 P from FYM + 40 kg ha-1 P from PM were evaluated. Results revealed that inoculation of seeds with PSB and collective use of inorganic and organic sources of P had considerably increased the yield contributing attributes in cotton. However, the treatment P7 (80 kg P ha-1 from PM + 40 kg P ha-1 from inorganic source) in coincidence with seeds inoculated with PSB (S1) produced taller plant, maximum boll weight, significantly higher LAI and CGR. Significantly higher seed cotton yield, lint yield, fiber length and maximum BCR of 1.95 and 1.81 was also obtained from the P7 treatment during both crop-growing seasons. In conclusion, combined use of 80 kg P ha-1 from PM + 40 kg P ha-1 from inorganic source and cotton seeds inoculated with strain-1 improved phosphorus uptake ensuing in greater consumption of photo-assimilates for maximum growth and yield.

Atypical Chemokine Receptor 1 (DARC/ACKR1) in Breast Tumors Is Associated with Survival, Circulating Chemokines, Tumor-Infiltrating Immune Cells, and African Ancestry

BACKGROUND

Tumor-specific immune response is an important aspect of disease prognosis and ultimately impacts treatment decisions for innovative immunotherapies. The atypical chemokine receptor 1 (ACKR1 or DARC) gene plays a pivotal role in immune regulation and harbors several single-nucleotide variants (SNV) that are specific to sub-Saharan African ancestry.

METHODS

Using computational The Cancer Genome Atlas (TCGA) analysis, case-control clinical cohort Luminex assays, and CIBERSORT deconvolution, we identified distinct immune cell profile-associated DARC/ACKR1 tumor expression and race with increased macrophage subtypes and regulatory T cells in DARC/ACKR1-high tumors.

RESULTS

In this study, we report the clinical relevance of DARC/ACKR1 tumor expression in breast cancer, in the context of a tumor immune response that may be associated with sub-Saharan African ancestry. Briefly, we found that for infiltrating carcinomas, African Americans have a higher proportion of DARC/ACKR1-negative tumors compared with white Americans, and DARC/ACKR1 tumor expression is correlated with proinflammatory chemokines, CCL2/MCP-1 (P <0.0001) and anticorrelated with CXCL8/IL8 (P <0.0001). Sub-Saharan African-specific DARC/ACKR1 alleles likely drive these correlations. Relapse-free survival (RFS) and overall survival (OS) were significantly longer in individuals with DARC/ACKR1-high tumors (P <1.0 × 10^-16 and P <2.2 × 10^-6, respectively) across all molecular tumor subtypes.

CONCLUSIONS

DARC/AKCR1 regulates immune responses in tumors, and its expression is associated with sub-Saharan African-specific alleles. DARC/ACKR1-positive tumors will have a distinct immune response compared with DARC/AKCR1-negative tumors.

IMPACT

This study has high relevance in cancer management, as we introduce a functional regulator of inflammatory chemokines that can determine an infiltrating tumor immune cell landscape that is distinct among patients of African ancestry.

Abstract IA27: Exploring the impact of African ancestry in tumor immune response, a possible role in disparate clinical outcomes

Disparities in breast cancer survival among ethnic groups have been a persistent finding over the past five decades, exacerbated in part by the lack of improvement to non-white patient outcomes, despite treatment advancements that have improved clinical outcomes in white women. A significant part of this disparity is health equity; however, recent evidence from several groups indicates that histologic and pathologic diversity in tumor phenotypes among ethnic groups is also a key factor affecting the differences in clinical outcome. Specifically, correlated findings among women with significant West African ancestry reveal that there is a genetic link between women across the African Diaspora that is associated with aggressive tumor phenotypes, including triple-negative breast cancer. Aside from the global incidence of TNBC being higher in regions with relatively higher numbers of women with African ancestry, we also find that pathologic progression of tumors in African Americans tends to mimic that of African women. Tumor progression is directly related to the immune response elicited by the onset of tumor growth as well as the underlying tissue microenvironment, particularly the inflammatory status. We have identified several lines of evidence that suggest there is a distinct immune response to breast cancer, which is also tumor phenotype/subtype specific, when comparing patients of significant African ancestry with those of primarily European ancestry. These findings suggest that there could be a unique mechanism of tumor immunology at work, driven by population private genetic alleles derived in Africa and transmitted throughout the African Diaspora, causing a unique tumor phenotype in these breast cancer patients. This unique phenotype is likely the key factor in distinct treatment responses that result in poorer clinical outcomes for African American women.

Citation Format: Melissa B. Davis, Brittany D. Jenkins, Rachel A. Martini, Haythem Ali, Clayton C. Yates, Elizabeth A. Howerth, Petros Nikolinakos, Michele Monteil, Lisa A. Newman. Exploring the impact of African ancestry in tumor immune response, a possible role in disparate clinical outcomes [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA27.

Abstract B056: Tumor-associated ACKR1/DARC is correlated with a unique signature of proinflammatory chemokines and TILs in African-American women with breast cancer

Part of the delicate interplay of interactions between tumor cells, immune cells, and other cell types cells contribute to the complexities of the tumor microenvironment (TME). Specific interactions between chemokines and their receptors can influence the migration of immune cells, thereby directing tumor immune responses. In general immune response, the Atypical Chemokine Receptor 1 (ACKR1/DARC) modulates chemokine levels through the sequestration of proinflammatory chemokines in circulation and transcytosis across endothelial and epithelial tissue. This can affect not only the concentration of immune cells brought to the TME, but also the profile of immune cell types, given that ACKR1 is a promiscuous binder of both chemokine classes (CXCL and CCL). ACKR1 also serves as an ancestral informative marker. The gene harbors a mutation (“Duffy-null”) in its promoter/5′ UTR region that abolishes its normal erythrocytic expression, a status that only exists in populations of sub-Saharan African descent, conferring an evolutionary advantage against malaria. This polymorphism is carried by 60-80% of African-Americans, and based on our findings, it can influence chemokine and immune cell migration in the context of tumorigenesis. Our study reveals the potential effect of this mutation in women with breast cancer (BC) by showing correlations between circulating chemokine concentrations, measured through Luminex multiplexing immunoassays, and relative levels of ACKR1 and tumor-infiltrating lymphocytes (TIL), scored through immunohistochemistry. Our initial investigation of epithelial expression of ACKR1 on breast tumors revealed supporting data of our hypothesis that differential expression of ACKR1 on breast tumor tissue is correlated with a distinct signature of TILs and associated proinflammatory chemokines. Specifically, lower levels of tumor-associated ACKR1 were seen in African-Americans, in addition to a less robust signature of TILs, including macrophages and T-cells. Genotyping for the Duffy-null mutation also showed correlations with proinflammatory chemokines, including CCL2 and CXCL8. Our data suggest that ACKR1 levels in circulation and tissues can indirectly influence the immune cell profile in African-American women with BC, potentially leading to changes in tumor aggressiveness and response to treatment.

Citation Format: Brittany D. Jenkins, Talina Fleifel, Rachel N. Martini, Haythem Ali, Lisa A. Newman, Melissa B. Davis. Tumor-associated ACKR1/DARC is correlated with a unique signature of proinflammatory chemokines and TILs in African-American women with breast cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B056.

AB0139 T FOLLICULAR HELPER CELLS MAY BE INVOLVED IN THE LUPUS DEVELOPMENT IN HIGH FAT DIET-INDUCED OBESITY MICE

Background:

System lupus erythematosus (SLE) is an autoimmune disease that is associated with skin rash and multiple organs lesion. It is known that obesity is a major factor contributing to the onset and progression of autoimmune diseases including SLE. Our previous study showed that circulating T follicular helper (Tfh) cells played an important role in autoantibody production in SLE patients. A recent study showed that Tfh cells promote B cell production of IgA antibodies, which help shape the composition of the gut microbiota and may modulate obesity.

Objectives:

By establishing an obesity-associated lupus mouse model, we investigated the pathophysiologic link of obesity, SLE and Tfh cells using MRL/lpr lupus prone mice.

Methods:

Twenty MRL/lpr mice (10 male and 10 female) were randomized equally fed with a regular diet (RD) or high fat diet (HFD, 60% calories comprised of fat). Their body weights were recorded weekly as an indicator of obesity achievement. SLE progression was monitored weekly by development of skin lesion and urine protein levels assessed by Bradford assay. Blood was collected for IgG, anti-dsDNA and anti-nuclear antibody (ANA) detection. At the endpoint of week 14, spleen was measured and weighted. Spleen, kidney, and dorsum of neck skin were collected and embedded for H&E, PAS, Masson’s staining, and immune complex staining to detect active histopathological lupus lesions and be quantified as histological skin score and kidney index. Tfh cells in spleen was identified by immunohistochemistry (IHC) staining glomerulus of kidney.

Results:

Obesity was achieved with a significant difference of mouse body weight between the RD and HFD groups by week 3 and continued until week 14 (p<0.05 top<0.01). Evidence of SLE development, such as skin rash on the dorsal neck and back in HFD group showed up as earlier as week 6 and occurred in 55.6% of the HFD group vs 11.1% of the RD group (p<0.05), with a higher histological score of skin in HFD group (p<0.05). Proteinuria was increased from 11 to 14 week in male HFD group with an elevated kidney index and immune-complex deposits in their glomerulus of kidney. There was an increase trend of anti-dsDNA and IgG titer in HFD group, but no difference of ANA was observed between these two groups. Splenomegaly was observed in the HFD mice (p<0.05). The Tfh cells in the spleen of HFD group were higher than RD group.

Conclusion:

Our results show accelerated and greater severity of lupus development in MRL/lpr mice with HFD compared to mice on RD, indicating HFD-induced obesity exacerbates lupus development in mice. Tfh cells may be involved in the relation of SLE and obesity. This model could be used to investigate the mechanism underlying the link between obesity and SLE development. Interventions to reduce body weight or target Tfh cells may improve both lupus symptoms and outcomes in genetically predisposed SLE patients.

References:

[1]Tedeschi S, et al. Obesity and the risk of systemic lupus erythematosus among woman in the Nurses’ Health Studies. Semi in Arth and Rheu. 2017, 47:376-383

[2]Cozier YC, et al. A prospective study of obesity and risk of systemic lupus erythematosus (SLE) among Black woman. Semi in Arth and Rheu. 2019, 48:1030-1034

[3]Wang G, et al. Differential oxidative modification of proteins in MRL+/+and MRL/lpr mice: Increased formation of lipid peroxidation-derived aldehyde-protein adducts may contribute to accelerated onset of autoimmune response. Free Radic Res. 2012, 46(12):1472-1481

[4]Seth A, et al. Spatial and functional heterogeneity of follicular helper T cells in autoimmunity. Current Opinion in Immunology. 2019, 61:1-9

5.Petersen C, et al. T cell–mediated regulation of the microbiota protects against obesity. Science. 2019, 365 (6451): eaat9351

Disclosure of Interests:

None declared