Comparison of biochemical markers of bone metabolism between conventional labial and lingual fixed orthodontic appliances

Objectives

The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances.

Patients and Methods

The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels.

Results

Interleukin (IL)-1α, 1β, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P < 0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1β, 2, 6, 8, and TNF-α levels were significantly high (P < 0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1β were increased higher than other cytokines in both the treatment groups.

Conclusion

Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.

Profound approach to check legitimacy of an old technique used to gauge palatal rugae

Aims

The present study aimed at assessing two fixed points of reference from where the mesial and distal point of all rugae can be measured so that the exact movement of particular rugae in any direction can be evaluated and assessing the changes in the palatal rugae after orthodontic treatment.

Methods

A longitudinal study conducted among a sample of 20 (8 male and 12 female) adult patients. Pre- and post-orthodontic treatment casts of patients were obtained from the Department of Orthodontics College of Dentistry Jazan University. Antero-posterior linear distances (Technique I) between medial and lateral points of primary, secondary and tertiary rugae were measured. Also, the transverse linear distance (Technique II) between medial and lateral points of right and left rugae were measured. Technique III involved marking two fixed points and using these two points a third point is located on the medial or lateral end of rugae of right and left side in pre and post-treatment orthodontic casts. The independent sample t-test was employed to compare gender. Difference between the pre- and post-treatment mean values were checked by the paired t-test.

Results

Technique III successfully showed the statistically significant difference (P ≤ 0.05, 95% CI) in the overall pre and post-treatment values on the patients' cast (N = 20) which was not observed with a technique I and technique II.

Conclusion

The triangle created by the three reference points in the technique III was able to identify the changes in the palatine rugae more precisely than the technique I and Technique II.

Optical-vortex diagnostics via Fraunhofer slit diffraction with controllable wavefront curvature

Far-field slit diffraction of circular optical-vortex (OV) beams is efficient for measurement of the topological charge (TC) magnitude but does not reveal its sign. We show that this is because in the common diffraction schemes the diffraction plane coincides with the incident OV waist plane. Based on the examples of Laguerre-Gaussian incident beams containing a spherical wavefront component, we demonstrate that the far-field diffracted beam profile possesses an asymmetry depending on the incident wavefront curvature and the TC sign. This finding enables simple and efficient ways for the simultaneous diagnostics of the TC magnitude and sign, which can be useful in many OV applications, including OV-assisted metrology and information processing.

Mechanistic insights into controlled depolymerization of Chitosan using H-Mordenite

Kinetics of chitosan depolymerization were studied in dilute acetic acid solution, in presence of H-Mordenite (H-MOR). Rate constants for chitosan depolymerization were determined by measurement of molecular weight, using Gel permeation Chromatography (GPC). Depolymerization rate of chitosan was altered in presence of an acidic, porous material like H-MOR. Maximum concentration of H-MOR studied during process led to minimal increase in energy of activation, from 20.54 kJ/moL to 23.25 kJ/moL. Infra-red spectroscopy, adsorption studies and rheological assessment indicated adsorption /grafting of chitosan onto porous H-MOR surface as the possible mechanism for facilitation of the depolymerization process. Under extreme conditions investigated during process optimization, H-MOR resulted in a three-fold reduction in 5-Hydroxy Methyl Furfural (5-HMF) formation and over ten times decrease in glucosamine content, as compared to reactions conducted without H-MOR. Therefore, presence of H-MOR is imperative to cleave chitosan in controlled manner and obtain products of desired molecular weight, with fewer impurities.

Detection of CMB-Cluster Lensing using Polarization Data from SPTpol

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes QU map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500  deg^{2} survey at the locations of roughly 18 000 clusters with richness λ≥10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8σ. The mean stacked mass of the selected sample is found to be (1.43±0.40)×10^{14}M_{⊙} which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements.

Serum and seminal plasma IGF-1 associations with semen variables and effect of IGF-1 supplementation on semen freezing capacity in buffalo bulls

The objective of the study was to establish correlation of seminal and serum IGF-1 with seminal attributes, estimate antioxidant potential of IGF-1 by 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays and to study the effect of IGF-1 supplementation on semen cryopreservation. For this study, buffalo bulls were divided into sub-fertile (n = 2) and normal (n = 5) on the basis of sperm mass motility and individual motility. The serum IGF-1 concentration of normal bulls was greater than in sub-fertile bulls, but there was no difference in the seminal IGF-1 concentration among the groups. The values from correlation analyses indicated that serum IGF-1 concentration is positively correlated with semen mass motility and sperm concentration. In the second experiment, IGF-1 did not have antioxidant activities when assessed with DPPH and FRAP assays. In the third experiment, the ejaculates of normal and sub-fertile bulls were cryopreserved using semen extender in which there was IGF-1 supplementation at 0 (control), 50, 100, 150, 200, 250, 350 and 450 ng/mL of extender. Supplementation of IGF-1 at 250 ng/ml resulted in improved sperm motility, longevity and membrane intactness as compared to control after cryopreservation of semen from normal buffalo bulls, but not sub-fertile bulls. In summary, serum IGF-1 concentration was correlated with sperm mass motility and concentration in buffalo bulls and supplementation of IGF-1 protected sperm during the cryopreservation process but effects were not due to direct antioxidant activity.

Abstract OT2-06-05: A randomized phase II study of peri-operative ipilimumab, nivolumab and cryoablation versus standard peri-operative care in women with residual triple negative early stage/resectable breast cancer after standard-of-care neoadjuvant chemotherapy

Background: Triple negative breast cancer (TNBC) is a biologically distinct subtype with high risk of early relapse, particularly for patients who do not achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC), with an event free survival of &lt; 60% at 3 years. Physical disruption of tumors with cryoablation (cryo) induces inflammation and releases antigens that can activate tumor-specific immune responses. In pre-clinical studies, the combination of cryo with checkpoint inhibition augmented tumor-specific immune responses and prevented cancer recurrence. In clinical studies, the combination of pre-operative ipilimumab (ipi)- +/- nivolumab (nivo)-mediated checkpoint blockade with cryo was safely administered in women with operable, early stage breast cancer and generated intra-tumoral and systemic immune responses (NCT01502592, NCT02833233). In this multi-center, randomized study, we evaluate the disease specific impact of peri-operative ipi, nivo and cryo versus standard care in women with residual TNBC after neoadjuvant taxane-based chemotherapy (NCT03546686).

Methods:Eligible pts are aged ≥18 years, with ER, PR and HER2 negative operable tumors ≥ 1.0 cm after neoadjuvant taxane-based chemotherapy. Approximately 160 patients will be randomized to one of two arms: standard-of-care breast surgery (control arm) or ipi/nivo/cryo followed by standard-of-care breast surgery (intervention arm). Subjects randomized to the intervention arm will undergo percutaneous, ultrasound- (or MRI-) guided cryoablation with concurrent research core biopsy 7-10 days prior to surgery, and will receive a pre-operative infusion with ipilimumab at the dose of 1mg/kg IV, and nivolumab 240mg flat dose IV (1 to 5 days prior to cryoablation). After surgery, patients will receive three additional doses of nivolumab 240mg flat dose IV Q2 weeks. Adjuvant capecitabine is recommended for all participants and will be administered per standard-of-care at the treating physician's discretion. Patients will be stratified by prior platinum administration, prior anthracycline administration, and clinical nodal status (positive versus negative) at enrollment. The primary endpoint is 3-year Event Free Survival (EFS). Secondary end points include Invasive Disease-Free Survival (IDFS), Distant Disease-Free Survival (DDFS), overall survival (OS) and safety. Exploratory correlative studies will be performed on tumor and serum to characterize the immunologic impact of the intervention and to explore predictors of efficacy and toxicity.

Citation Format: McArthur HL, Comen EA, Solomon S, Rodine M, DiLauro Abaya C, Leal JHS, Patil S, Norton L. A randomized phase II study of peri-operative ipilimumab, nivolumab and cryoablation versus standard peri-operative care in women with residual triple negative early stage/resectable breast cancer after standard-of-care neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-06-05.

Abstract OT1-08-01: A pilot randomized usual care controlled study of yoga for persistent chemotherapy-induced peripheral neuropathy (CIPN) in breast and gynecological cancer survivors

Background: CIPN is a common, painful, and debilitating side effect of many standard chemotherapy regimens. Patients with CIPN typically experience paresthesia (tingling, numbness), pain, and muscle weakness, and may exhibit significant functional decline and diminished quality of life. Our prior study showed that more than half of breast cancer survivors experience persistent CIPN up to a mean duration of 5.6 years and that this symptom is associated with a doubled fall risk. There is an urgent need to identify nonpharmacological approaches to reduce CIPN symptoms and improve cancer survivors' functional outcomes. Yoga is a mind-body modality that includes stretching, flexibility, and balance training; however, little is known about its effects on symptoms and functional outcomes among cancer survivors with CIPN.

Trial Design: We are conducting a two-arm pilot randomized usual care controlled trial in breast and gynecological cancer survivors at Memorial Sloan Kettering Cancer Center (MSK), New York, NY. Eligible subjects in the intervention arm receive one-hour Hatha Yoga classes taught twice weekly for eight weeks, and practice home-based yoga for a total of 12 weeks. Subjects in the wait list control (WLC) arm continue usual care for 12 weeks, followed by eight weeks of yoga classes and home-based yoga.

Eligibility Criteria: 1) Patients with a primary diagnosis of stage I-III breast, ovarian, uterine, or endometrial cancer; 2) moderate to severe CIPN, defined by four or greater on a 0–10 Numeric Rating Scale (NRS); 3) completion of neurotoxic chemotherapy at least three months prior; 4) no changes in anti-neuropathy medications within three months of enrollment; and 5) an ECOG performance status of 0–2.

Specific Aims: The primary endpoint is safety, feasibility, and NRS changes at eight weeks (end of treatment). The secondary endpoints include the Neuropathic Pain Scale (NPS) and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) at eight, 12, and 20 weeks.

Statistical Methods: We will accrue 40 patients to get 36 patients evaluable for the primary endpoint at eight weeks. Using an ANCOVA analysis with a sample size of 36, we will be able to detect an effect size of 00.58 standard deviations (SD) of NRS (moderate effect size) between yoga and WLC assuming a NRS correlation between pre- and post-yoga of 0.5 SD. If we assume a 10% dropout rate based on our recently completed trial, we will need to recruit 20 subjects per arm (total of 40) to fall within the precision noted in the sample size calculation. We recognize that the sample size calculation was based on detecting a moderate effect between yoga and WLC and may miss small but clinically meaningful effects that can be used to design a future trial that is sufficiently powered.

Present accrual and target accrual: 40 participants. We have accrued 25 participants as of June 2018 and anticipate accrual completion by October 2018.

Citation Format: Zhi WI, Leeolou MC, Piulson L, Chen P, Patterson C, Paul T, Patil S, Mao JJ, Bao T. A pilot randomized usual care controlled study of yoga for persistent chemotherapy-induced peripheral neuropathy (CIPN) in breast and gynecological cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-08-01.

Abstract P6-20-03: Tumor epichaperome expression using 124I PU-H71 PET (PU-PET) as a biomarker of response for PU-H71 plus nab-paclitaxel in HER2 negative (HER2-) metastatic breast cancer (MBC)

Background: The epichaperome is a new cancer target required for tumor survival (Joshi et al. Nature Reviews Cancer 2018). PU-H71 is a synthetic, purine scaffold epichaperome inhibitor that binds to the ATP-binding site of HSP90 specifically when HSP90 is integrated into the epichaperome (Rodina et al. Nature 2016). It has demonstrated antitumor activity in multiple xenograft models. Furthermore, sequential administration of nab-paclitaxel and PU-H71 in TNBC xenograft models augmented epichaperome levels, and in turn resulted in super-synergistic drug action with ablation of xenografted tumors and cures in mice.

Methods: This is an open label phase1b study of PU-H71 + nab-paclitaxel in pts with HER2- MBC. Pts received nab-paclitaxel at a standard dose of 260mg/m2 IV Q 3weeks. PU-H71 was administered IV 6 hrs (+/-1 hr) post nab-paclitaxel Q3weeks in 2 escalating dose levels (225mg/m2 and 300 mg/m2). All pts underwent FDG PET/CT every 6 weeks. Additionally, patients had the option to enroll on a separate diagnostic PU-PET protocol to measure epichaperome expression prior to initiating treatment on the phase 1b study, wherein they received a single dose of up to 11mci of 124I-PU-H71 IV and underwent imaging at 3-4hrs and 20-24 hrs. Primary objective was to establish the MTD/RP2D of this regimen. Secondary objectives were to assess PK of PU-H71 + nab-paclitaxel and clinical efficacy. Exploratory analysis included correlation of epichaperome expression at baseline using PU-PET with tumor response.

Results: 12 patients (5 ER+/HER2- ; 7 TNBC) were enrolled (6 at 225mg/m2 of PU-H71 and 6 at 300mg/m2). Median Age: 54 yrs (range: 37-71). Median ECOG: 0. Median lines of therapy in the metastatic setting: 6 (range 1-11) including prior taxanes in 75% of pts. Most common toxicities included diarrhea G1 58%; G2 7%, G3 7%) that was easily managed with anti-diarrheal agents, G1 fatigue (25%), G1/2 peripheral neuropathy (17%), G1 hyperglycemia (67%), G1 increases in alk phos (58%), AST (50%) and ALT (42%). Hematological toxicities included G3 leukopenia (42%), G3/4 neutropenia (67%), G3 anemia (50%) and G2 thrombocytopenia (17%). There were no DLTs. 33% (4/12) had PR, 58% (7/12) achieved SD with only 1 PD at the time of first scan; 5 pts are currently ongoing including 2 TNBC pts with PR who have been on therapy &gt; 7 months. PK data will be presented. 8/12 patients also underwent PU-PET at baseline. A higher tumor to muscle SUV ratio at 24 hrs on PU-PET predicted response and increased PU-H71 retention on PU-PET at 24 hrs correlated with a longer duration of response.

Conclusion: The RP2D of PU-H71 was 300mg/m2 with 260mg/m2 of nab-paclitaxel administered IV every 3 weeks. The regimen is well tolerated with promising clinical activity in this heavily pre-treated cohort. Tumor epichaperome expression at baseline using PU-PET has the potential to serve as a predictive biomarker of response. A Phase 2 trial of this combination along with baseline PU-PET is currently planned.

Citation Format: Jhaveri K, Dunphy M, Wang R, Comen E, Fornier M, Moynahan ME, Bromberg J, Ma W, Patil S, Taldone T, Rodina A, Sterlin V, Khoshi S, Lewis J, Norton L, Chiosis G, Modi S. Tumor epichaperome expression using 124I PU-H71 PET (PU-PET) as a biomarker of response for PU-H71 plus nab-paclitaxel in HER2 negative (HER2-) metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-20-03.

Abstract P1-11-15: Chemotherapy-induced peripheral neuropathy in breast cancer survivors: Comparison of objective and subjective measures

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, potentially debilitating, and dose-limiting side effect experienced by breast cancer survivors. CIPN encompasses symptoms such as pain, numbness, and tingling, which can be measured subjectively by patient-reported outcomes (PRO), or objectively by quantitative sensory testing (QST); however, little is known how QST correlates with symptom profiles measured by PRO.

Methods: We conducted a cross-sectional analysis using baseline data of two ongoing clinical trials of breast cancer survivors who experienced moderate to severe CIPN defined by pain, numbness, or tingling ratings of four or greater on a numeric rating scale (NRS) after chemotherapy completion for at least three months. PRO measures of CIPN symptoms included Neuropathic Pain Scale (NPS) and Functional Assessment of Cancer Therapy-Gynecologic Oncology Group/Neurotoxicity subscale (FACT/GOG-Ntx). QST included tactile threshold (TT) measured by Von Frey's filaments, and vibration threshold (VT) measured by biothesiometer. We ran a Spearman correlation to assess the relationship between the subjective measures (NPS and FACT/GOG-Ntx) and objective measures (TT and VT QST).

Results: We included 52 sets of baseline data on 50 unique patients; two patients were enrolled in both trials at different times. Mean age was 61 years (SD 10) and 66% were white. The mean NRS pain score was 3.9 (SD 2.8), numbness 5.7 (SD 2.2), and tingling 4.3 (SD 2.8) on a 0-10 scale. The mean NPS total score was 39.2 (SD 23.1) on a 0-100 scale, and FACT/GOG-Ntx was 26.2 (SD 6.8) on a 0-44 scale. High scores on NRS and NPS and low scores on FACT/GOG-Ntx signify more severe CIPN symptoms. See Table 1 for a summary of the correlation between two questions on FACT/GOG-Ntx on tingling/numbness in hands and feet, and NPS total score with QST. A moderate correlation was observed between FACT/GOG-Ntx and QST results, suggesting patient-reported hand and foot numbness or tingling is associated with decreased hand and foot tactile and vibration perception. NPS was positively correlated with tactile perception for the hand and foot, but not with vibration perception.

Table 1.Correlation between objective and subjective measures of CIPN Tactile QSTVibration QST HandFeetHandFeetFACT/GOG-Ntx-0.33 (P=0.018)-0.28 (P=0.045)-0.37 (P=0.008)-0.40 (P=0.0034)NPS0.34 (P=0.015)0.32 (P=0.022)0.22 (P=0.12)0.03 (P=0.81)

Conclusions: A mild to moderate correlation was observed between subjective and objective measurements of CIPN. As CIPN presents a diverse range of symptoms, better quantifying the subjective and objective measures of CIPN can help incorporate these tools in observational and intervention trials. Understanding the correlation between PRO and QST can help establish QST as a reliable objective measurement of CIPN symptoms, and enable targeted interventions to alleviate CIPN symptoms.

Citation Format: Bao T, Kwon A, Piulson L, Chen P, Li Q, Patil S, Seidman A, Blinder V, Vahdat L, Zhi WI, Mao JJ. Chemotherapy-induced peripheral neuropathy in breast cancer survivors: Comparison of objective and subjective measures [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-15.

Abstract P4-16-07: The CHANCE study: Mechanical skin changes among women with non-metastatic breast cancer receiving chemotherapy and endocrine therapy

Background: The persistent effects on skin hydration and elasticity resulting from cytotoxic and endocrine agents used in early stages of breast cancer are poorly understood. The objective of this preliminary analysis of the CHANCE study is to describe the pattern of persistent biomechanical skin changes in non-metastatic breast cancer patients treated with cytotoxic chemotherapies and/or endocrine therapies.

Methods: This is an ongoing single-center, prospective, longitudinal cohort study of non-metastatic breast cancer patients treated with cytotoxic chemotherapies and/or endocrine therapies. Objective skin hydration and elasticity measurements of the forearm were measured using Tewameter® (TM 300; Courage & Khazaka) and Cutometer® (MPA 580; Courage & Khazaka) devices under a controlled ambient environment at baseline and 6 months after chemotherapy completion, or one year after initiation of endocrine therapy.

Results: A total of 107 patients were assessed at baseline and follow-up for transepidermal water loss (TEWL) (median age 53, range 26-82) and 106 patients for skin elasticity (median age 53.5, range 26-82). Fifty-three healthy controls were evaluated at baseline with median age 47 (range, 22-73). The mean TEWL at baseline and follow-up among patients were 6.922 g/h/m2 and 8.521 g/h/m2, respectively (p&lt;.0001). Skin firmness (0.420 versus 0.421 mm, p=0.949) and elasticity (77.2% versus 77.4%, p=0.836) did not significantly change during follow-up. When comparing chemotherapy recipients with endocrine therapy recipients, chemotherapy patients had a mildly lower TEWL at follow-up (8.369 versus 8.928 g/h/m2, p=.247) but a greater net increase in TEWL (1.687 versus 1.359 g/h/m2, p=.5) compared to endocrine patients over the study period.

Conclusions: An increase in TEWL was observed in patients receiving cytotoxic and endocrine therapies, suggesting a deterioration of the protective skin barrier possibly attributed to these therapies. No significant changes in skin firmness or elasticity were found in this preliminary analysis. Further studies are needed to elucidate the pathophysiologic mechanisms involved in persistent skin changes after systemic breast cancer therapies.

Objective skin hydration and elasticity in patients receiving breast cancer therapy Control (n=53)Baseline (n=107)Follow-Up (n=107)p-value*TEWL (g/h/m2)9.4626.9228.521&lt;.0001Cutometer Baseline (n=106)Follow-Up (n=106) Immediate recovery, R0 (mm)0.4150.4200.4210.949Gross elasticity, R2 (%)79.3%77.2%77.4%0.836*p-value calculated from baseline and follow-up only

Citation Format: Lacouture ME, Phillips GS, Freites-Martinez A, Patil S, Samuels A, Shapiro J, Kukoyi O, Goldfarb S. The CHANCE study: Mechanical skin changes among women with non-metastatic breast cancer receiving chemotherapy and endocrine therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-07.

Methodology of Niyantrita Madhumeha Bharata Abhiyaan-2017, a Nationwide Multicentric Trial on the Effect of a Validated Culturally Acceptable Lifestyle Intervention for Primary Prevention of Diabetes: Part 2

Background

The rapidly increasing diabetes burden, reaching epidemic proportions despite decades of efforts, reflects our failure to translate the proven evidence for prevention of diabetes. Yoga, with its holistic approach, alters the habituated patterns of lifestyles and behaviour. Motivated by the accumulating evidence, the Government of India funded a large randomized controlled trial.

Aims and Objectives

The twin objectives were: (a) estimate the prevalence of prediabetes and diabetes through a parallel multisite stratified cluster sampling method and (b) implement NMB 2017 (niyantrita madhumeha bharata abhiyaan), a randomized control trial using yoga based lifestyle program.

Materials and Methods

Screening for Indian Diabetes Risk score(IDRS) was conducted in randomly selected clusters in all 7 zones (65 districts from 29 states/union territories) of India. This was followed by detailed assessments in those with known diabetes and high risk (≥60) on IDRS. Those who satisfied the selection criteria and consented were recruited for the two armed waitlisted randomized control trial. A validated remedial diabetesspecific integrated yoga lifestyle module was taught to the experimental arm by certified volunteers of Indian Yoga Association. Followup assessments were done after 3 months in both groups. In this article, we report the methodology of the trial.

Results

Response to door to door visits (n-240,968 adults >20yrs) in randomly selected urban and rural households for screening was 162,330; detailed assessments (A1c, lipid profile, BMI, stress, tobacco etc) were performed on 50,199 individuals. Of these 12466 (6531 yoga 5935 control) consented and for the RCT; 52% females, 48% males; 38% rural, 62% urban; BMI 21.1 ± 3.8; waist circumference 91.7 ± 11.9. A1c in diabetes subjects in yoga group was 7.63 ± 2.17 and 7.86 ± 2.13 in control group.

Conclusion

This unique methodology provides the evidence to implement a validated yoga life style module using yoga volunteers in all parts of the country which is an urgent need to prevent India from becoming the global capital for diabetes.

Epidermal growth factor receptor T790M mutation: A major culprit in the progression of epidermal growth factor receptor-driven non-small cell lung cancer and the role of repeat biopsy

Non-small cell lung cancer (NSCLC) accounts for the majority of primary lung cancer cases worldwide. The activating mutations of epidermal growth factor receptor (EGFR) have been demonstrated to associate with the development of NSCLC, with T790M mutation being the most common. Over the years, EGFR tyrosine kinase inhibitors (TKIs) were developed to target EGFR-related mutations. However, patients with activating EGFR mutations who are initially responsive to EGFR-TKIs eventually develop acquired resistance after a median progression-free survival of 10-16 months, followed by disease progression. Recently, the third-generation EGFR inhibitors have emerged as potential therapeutics to block the growth of EGFR T790M-positive tumors. This article reviews the emerging data regarding EGFR mutations and clinical evidence on third-generation agents against EGFR T790M mutation in the treatment of patients with advanced NSCLC. It also reviews the role of repeat biopsy in improving the success rates of treatment of EGFR T790M-derived drug-resistant NSCLC.

Abstract P6-13-07: Chemotherapy with and without trastuzumab or no treatment in elderly patients with HER2 amplified breast cancer at a single center

Introduction

Trastuzumab with systemic chemotherapy has shown an improvement in outcomes for patients (pts) with HER2 amplified/overexpressed (HER2+) breast cancer. Pts enrolled onto trials were young with a minority of pts at ≥65 years (yrs) of age. Herein, we report the administration of systemic treatment (ST) (chemotherapy and/or trastuzumab) verus no treatment in elderly pts at a single center.

Methods

Patients ≥65 yrs with stage I-III HER2+ (defined as IHC 3+ or FISH &gt;2.0) breast cancer, treated at Memorial Sloan Kettering Cancer Center between 2000-2012, were retrospectively identified from our database.

Clinicopathologic features were retrieved and co-morbidity indexes (CI) were calculated. Pts were divided by hormone receptor (HR) (defined as ER &gt;10% and/or PR &gt;10%) status into HER2+HR- and HER2+HR+. Each group was further divided by use of ST into: chemotherapy and trastuzumab (CT+T), chemotherapy alone (CT) or no systemic treatment (No Rx). Patients receiving neoadjuvant ST or trastuzumab only as ST were excluded from the KM analysis. Primary objective was to identify patterns of treatment recommendation in the elderly population. We explored disease-free survival (DFS) as estimated using the Kaplan-Meier (KM) method.

Results

We identified 300 pts ≥65 yrs with HER2+ tumors. 128 (42.7%) were HER2+HR- and 172 (57.3%) were HER2+HR+. The median follow-up for all patients was 6.1 years (range, 0.07-16.7).

In the HER2+HR- group, 63 (49.2%) patients received CT+T, 25 (19.5%) CT alone, and 40 (31.3%) had no Rx. Anthracycline based chemotherapy was administered to 57/88 (65%) of patients on CT. Women receiving chemotherapy with or without trastuzumab were younger (65-70 vs &gt;70 years of age) (p=.002) and had more advanced tumor stages (p=.003). Their respective 5-yr DFS KM estimates were 0.84, 0.80, and 0.61 (logrank p=0.06).

In the HER2+HR+ group, 77 (44.8%) patients received CT+T, 22 (12.8%) CT alone, and 73 (42.2%) had no Rx. Anthracycline based chemotherapy was administered to 51/99 (51%) of patients on CT. Endocrine therapy was given to 153/172 (89%) of the total cohort. Women receiving chemotherapy with or without trastuzumab were younger (p&lt;.001), and had higher nuclear grade (NG) (p=.04), more lymphovascular invasion (&lt;.001) and more advanced tumor stages (p=.002). Their respective 5-yr DFS KM estimates were 0.84, 1.00, and 0.83 (log rank p=0.02).

Conclusions

At a single center, in the elderly populations at ≥65 years of age with HER2+ HR- and HER2+HR+ breast cancer, pts who received systemic treatment were younger and had higher stage of disease than those who received no treatment. In an exploratory analysis, there appeared to be a benefit of systemic treatment in pts in the HER+HR- group.

Citation Format: Muhsen S, Dang C, Plitas G, Seier K, Stempel M, Patil S, Morrow M, El-Tamer M. Chemotherapy with and without trastuzumab or no treatment in elderly patients with HER2 amplified breast cancer at a single center [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-13-07.

Abstract P4-10-12: Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families

Introduction: In spite of rapid urbanization and modernization the family remains central in the socio-cultural structure of India. The individuals are enmeshed into this unit and tend to be interlinked financially, emotionally and socially. The head of this family unit tends to be a male more often than not. As is well known, despite recent attempts by the governments at the state and centre at providing health coverage for cancer through regional cancer centres, a majority have to raise the money for cancer care by themselves. We have examined the role of the family in treatment decision making and in the strategies employed to raise the money and cope with the financial stress imposed by a diagnosis of breast cancer.

Method: 378 women with breast cancer were enrolled into a longitudinal study at first diagnosis between the years 2008-2012, at two tertiary care hospitals in Bangalore, India. The median follow up as of May 31st 2017 is 78 months with only 2% loss to follow-up over the past 8 years. Follow-up was maintained by frequent meetings between a counselling psychologist (AA) and the patient and/or a family member. The frequency of meetings was monthly during the initial treatment and then quarterly over the next 5 years. Information on demographics was collected during the treatment phase and information on the psychosocial aspects was collected in non-structured interactions subsequently. This information included details of support structure, decision making, and financial arrangements.

Results: This is a predominantly urban cohort with 80% being urban. The median age of patients at first diagnosis was 55 years. Almost all of our patients (99%) had the support of one or more family members. We analysed the pattern of decision making for treatment and in half of all cases either the husband or the son were the decision makers. In an additional 15% daughters and other relatives were the primary decision makers. Approximately a third of women made the decision concerning treatment themselves, and these women tended to be college educated (51% vs 16%) and employed (53% vs 12%).

30% of the patients met the costs incurred through medical insurance plans purchased by the family. Another quarter of patients were able to meet the costs from their savings. 45% had difficulty in finding the money for treatment and 15% took personal loans while 30% had to sell land/gold ornaments or take loans against assets of these sorts. Only (3%) discontinued the treatment due to financial difficulties. As in the case of decision making those who had the financial resources tended to be more educated (41% vs 11%), and were employed (31% vs 21%).

Conclusion: The data from a predominantly urban cohort of breast cancer enrolled between 2008-2012, supports the general belief that in India the family remains the fulcrum of an individual during crises, and not surprisingly education and employment lead to both psychological and economic emancipation of women.

Citation Format: Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-12.

Abstract P6-13-05: Frequency of delivery of systemic chemotherapy in elderly versus younger patients with triple negative breast cancer

Introduction

Chemotherapy (CT) is the standard of care for most triple negative breast cancer (TNBC). Chemotherapy is less commonly recommended in older than younger patients. We aim to explore the frequency of CT delivered in elderly patients when compared to young patients.

Methods

Patients ≤50yrs and ≥70 yrs with stage I-III TNBC defined as ER &lt;10% PR &lt; 10% HER2 IHC &lt; 3+ or FISH &lt; 2.0 and treated at our institution from 2000-2011 were identified from our institutional breast cancer database. Clinicopathologic features were retrieved and co-morbidity indexes (CI) were calculated. Patients were grouped by age and CT use, and features were compared between groups using chi-square tests. Cause of death was reported as dead of disease (DOD) or dead of other causes (DOC) when available; otherwise, it was recorded as dead of unknown causes (DUC). OS survival was estimated using the Kaplan-Meier (KM) methods. Cumulative incidence functions for competing risks were calculated and compared between groups using Gray's test. Competing risks regression was performed for multivariate analysis.

Results

We identified 901 pts with TNBC; 664 (73.7%) were ≤50yrs and 237 (26.3%) were ≥70 yrs. Median followup is 7 yrs (range, 0-16.8yrs).

Younger women diagnosed with TNBC were more likely to have stronger family history of breast cancer (p&lt;.001), to present with palpable masses (p&lt;.001), higher nuclear grade (NG) (p&lt;.001), larger tumors (p=.04), more involved nodes (p=.01), advanced tumor stage (p=.02) and to receive systemic chemotherapy (&lt;.001). Anthracycline-based chemotherapy was administered to 486 (80.3%) in women ≤50yrs and only to 42 (36.5%) in the ≥70 yrs cohort (p&lt;0.001). Chemotherapy data was missing on 2 pts in ≤50 yrs and 4 pts ≥70 for a total cohort of 662 patients ≤50 yrs and 233 pts ≥70 yrs.

The 5 year rates of DOD were similar between both groups at 10.6% (range, 8.3-13.2) for pts ≤50yrs and 10.8% (range, 7.0-15.4) (p=0.52) for the older group; meanwhile, the 5 year OS rates were significantly different between both groups at 87.5% (range, 84.7-90.0) for pts ≤50yrs and 74.3% (range, 68.2-80.0) (p&lt;.001) for the older group since older women die at higher rates from causes other than disease.

CT was given to 115 (49%) patients of the ≥70 yrs cohort with a selection biased by larger tumors (p&lt;.001) and more advanced stages (p&lt;.001). There was no significant difference however, between tumor size (p=0.47) and stage (p=0.98) when comparing the 609 (92%) pts ≤50 yrs and the 115 (49%) of ≥70 yrs patients who received CT.

When categorized based on age and receipt of CT, in the 662 pts ≤ 50 yrs, 609 (92%) and 53 (8%) received CT vs no CT respectively; in the 233 pts ≥70 yrs, 115 (49%) and 118 (50%) received CT vs no CT; the cumulative incidence curves for DOD were not statistically different for the four groups (p=0.85) at 5 years.

Conclusions

In our series, CT was given to 92% of patients ≤ 50 yrs of age. In the elderly pts ≥ 70 yrs of age, CT was limited to 50% of patients, namely those with worse clinicopathologic features.

Citation Format: Muhsen S, Dang C, Plitas G, Knezevic A, Stempel M, Patil S, Morrow M, El-Tamer M. Frequency of delivery of systemic chemotherapy in elderly versus younger patients with triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-13-05.