Abstract 4221: Association between SOX9 expression in Mexican patients with early colon cancer stage

Introduction. Colon cancer is the fourth leading cause of mortality worldwide. Between 30-40% of patients are diagnosed at early stage (I or II), sadly 20% will relapse. It is necessary to have a biomarker that identifies patients at high risk. SOX 9 is a transcription factor required for differentiation of different cells and is important for cell proliferation, senescence and lineage commitment. The exact role of SOX9 in carcinogenesis and cancer progression is controversial because could have oncogenic and tumor-suppressing functions. Reports show that strong levels of SOX 9 in colon cancer stage II are linked to low risk of relapse. Objective. The aim of this study was to investigate if the protein expression of SOX9 was associated with the stage, clinical characteristics and relapse of Mexican colon cancer patients. Methods. We obtained 97 samples embedded in paraffin. A pathologist blinded to the clinical information determined the immunoreactivity of SOX9 into 2 groups: low and high expression (by evaluating the percentage of positive nucleus and the tissue staining intensity). All statistical analyses were conducted with SPSS v.22 Statistics. Results. We include stage I (N= 34) and stage II (N=63) patients. The median follow-up period was 42 months. We found statistical difference between SOX9 expression and age (p=0.003), tumor localization (p=0.048) and stage (p&lt0.001) for whole patients group. Twelve patients (12.3%) relapsed, 7 (at locally level) and 5 with distant metastasis: liver (N=3) and retroperitoneal nodes (N=2), all had low SOX9 expression; one patient with local relapse had died (because of surgical complications). In the relapse group, we found a significant correlation between SOX9 expression and stage (p=0.038) but not with relapse free survival (RFS). Conclusion. We found interesting data even though this is a retrospective study with limitations. This study could not associated SOX9 and RFS, because there are few events. Nevertheless, we observe that 41% patients had a systemic relapse. In the other hand, the youngest patients (&lt40 y) and the right colon had the highest SOX9 expression. With this result, we have decided to increase the sample size before any assumption, and perform NGS to the five systemic relapses.

Citation Format: Erika Ruiz-Garcia, Tatiana Galicia, Edith Fernandez Figueroa, Saul Lino-Silva, Cesar Lopez-Camarillo, Laurence Marchat, German Calderillo, Juan Zinser, Abelardo Meneses-Garcia, Horacio Astudillo-de la Vega. Association between SOX9 expression in Mexican patients with early colon cancer stage [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4221.

Cancer pain management: recommendations from a Latin-American experts panel

Generating a consensus in the Latin-American region on cancer pain management is a current need. Thus a panel of Latin-American experts met in Madrid in March 2017 in order to review the published literature, discuss the best approach for cancer pain classification and evaluation and also make recommendations of pharmacological and nonpharmacological therapies for cancer pain management improvement in Latin-American countries. The result of that meeting is presented in this document. The experts participating were from Costa Rica, Mexico, Chile, Colombia, Peru, Brazil and Ecuador, and the project coordinator was from Spain.

Abstract 2728: Frequency and prognostic value of PI3KCA mutations in early stage of colorectal cancer in Mexican patients

Background: There are molecular associations between mutated profiles and microsatelital instability, both related with tumor growth and oncogenic development by activating tyrosine receptors families in colorectal cancer (CRC). It is known that exon 9 and exon 20 (H1047R) mutations in PIK3CA increased PI3K activity. Moreover, PIK3CA mutations are significantly associated with tumor recurrence and poor overall survival. The frequency of PIK3CA mutations in CCR occurs in 15-20%, being the catalytic subunit more frequently affected. The aim of our study was to investigate the frequencies and clinical implications of these genetic alterations in advanced CRC.

Methods: Retrospectively, we analyzed the initial paraffin embedded tissue block of 71 Mexican patients with CCR stage II. We evaluated mutations frequency of PIK3CA exon 9 (E542K, E545K) and exon 20 (H1047R) using qBiomarker Somatic Mutation PCR for real-time PCR-based. These methodology increases specificity, multiplex PCR and allelic discrimination. The data analysis was done using Ct values and Analysis Webportal.

Results: We found in our population a frequency of PIK3CA mutations of 26%. Of those, double mutants were present in 7% with a higher frequency for E545K/H1047R. Clinical implication that we found is that any active mutation of PIK3CA is associated to an increase of recurrence risk (HR 1.86;CI 95% =0.46-7.5), but most important is for E545K mutation (HR 4.17; CI 95% 0.85-20.39), meanwhile comparing no mutated with H1074R mutated samples there were no differences in HR (0.53 vs. 0.60, respectively).

Conclusions: We found a higher number of PI3KCA mutations that literature reports and that E545K mutation have a worst prognostic implication but we need to increase our sample looking for statistical significance results. Data from H1047R mutation raise de hypothesis that it could exist a compensatory mechanism related to structural interactions between both helicoidal and catalitic domains.

Citation Format: Erika Ruiz-Garcia, Alette Ortega, Antonio Bahena, Edith Fernandez, German Calderillo, Cesar Lopez Camarillo, Laurence Marchat, Jorge Guadarrama, Abelardo Meneses-Garcia, Horacio Astudillo-de la Vega. Frequency and prognostic value of PI3KCA mutations in early stage of colorectal cancer in Mexican patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2728. doi:10.1158/1538-7445.AM2017-2728

Significance of Prognostic Nutritional Index in post-surgical outcomes after surgical management in gastric cancer patients

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Background: Preoperative nutritional status in gastric cancer patients is not only correlated with postoperative complications, also, prognostic nutritional index or Onodera´s nutritional index (PNI) may relate with overall survival (OS) after gastrectomy. There is no available data of preoperative nutritional status in Mexican population. We decide to explore these variables and analyze its impact in outcomes reported in our population. Methods: This is a retrospective included a total of 91 patients patients with locally advanced gastric cancer confirmed by laparoscopy treated in the National Cancer Institute in México between January 2010 and June 2016. The PNI level was determined according the following formula: 10 x serum albumin (g/dl) + 0.005 x total lymphocyte count (per mm3). The optimal cutoff value of PNI in our population was set at 38.7 according the median, we stratified patients in high (PNI > 38.7) or low (PNI < 38.7) nutritional status, clinicopathologic features were compared. Results: We analyzed 91 patients, the mean patients age was 58, 61.5% were man, the 51.6% went to total gastrectomy with D2 dissection, 56% were pathologic stage III and 61.5% of the patients received adjuvant chemotherapy. The patients with high nutritional status had a OS of 46 months vs patients with low nutritional status with 25 months (p = 0.009). Patients with body mass index (BMI) > 23 had a OS of 41 months vs patients with BMI < 23 with 19 months of OS (p = 0.001), finally the patients with albumin > 3.75 had a 39 months of OS vs 23 months with albumin < 3.75 (p = 0.011) Conclusions: The low PNI group had worse OS than the high PNI group (46 months vs 25 months, p = 0.009). Preoperative is a simple and useful marker to predict overall survival in patients with locally advanced gastric cancer

Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in patients with metastatic colorectal cancer: A sensitivity marker to 5-FU-based therapy

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Background: 5-Fluorouracil (5FU) and Folinic Acid (FA) with either oxaliplatin or irinotecan have become the standard chemotherapy used for metastatic colorectal cancer. However, more than 50% of our patients cannot afford it. Moreover, we lack of predictive markers to 5FU/AF therapy. The methylenetetrahydrofolate reductase (MTHFR) is a key enzyme regulating the folate pool and its substrate 5,10-methylenetetrahydrofolate is needed for modulation of 5FU. The C677T MTHFR gene polymorphism is highly prevalent in Mexican population and is linked to altered enzyme activity and increases substrate levels. Many studies have suggested a better response rate to fluoropyrimidine based therapy related with C677T polymorphism. The aim of this study was to evaluate the presence of this polymorphism and its relation with progression free and overall survival in metastatic colon cancer treated with 5FU/FA Methods: Sections of paraffin- embedded healthy colonic mucosa of 29 patients with metastatic unresectable colorectal cancer treated with 5FU/FA as first line chemotherapy between 1998 and 2004 were collected to obtain DNA and determine the polymorphism by PCR and allele specific digestion. Results: We found a highly proportion of at least one mutated allele in our patients (8 homozygous wild type CC, 15 heterozygous CT, 6 mutated homozygous TT). C677T MTHFR gene polymorphism showed statistically significant differences in median progression free survival non polymorphic CC 3.23±0.68 month versus 4.8±0.18 month in polymorphic group CT and TT (p= 0.011 log rank test) and median overall survival in non polymorphic groups 6.7±2.63month versus 13 ±2.51 month in polymorphic group (p= 0.03 Breslow test).No other variable affected progression free or overall survival on univariate analysis. Conclusions: Our findings suggest that C677T polymorphism could play a role on survival in metastatic colorectal cancer treated with 5FU/FA. Futher studies evaluating standard chemotherapy and the analyzed polymorphism are recommended.

No significant financial relationships to disclose.

A phase II study of gemcitabine plus cisplatin in previously untreated advanced ovarian cancer

BACKGROUND

The primary objective was the evaluation of the effects of gemcitabine plus cisplatin on the overall response rate (ORR) of patients with advanced ovarian cancer; the secondary assessments included toxicity, time to progressive disease (TtPD) and the duration of response.

MATERIALS AND METHODS

Chemonaive patients with stage III/IV ovarian cancer received gemcitabine 1250 mg/m2 (d 1,8) and cisplatin 75 mg/m2 (d 1), every 21 days for a maximum of six cycles.

RESULTS

Between March 1999 and June 2003, 28 patients (median age 52 years, range 23-72) had received chemotherapy. Of 26 assessable patients, the ORR was 57.7% (95% CI, 42.7%-83.6%) based on four complete responses and eleven partial responses, six patients experienced stable disease, while five had progressive disease. The median survival was 28.1 months (95% CI, 11.4-33.4 months), the median TtPD was 10.5 months (95% CI, 1.4-44.2 months) and the median duration of response was 24.3 months (95% CI, 12.3-33.4 months). The most common grade 3/4 toxicities were nausea/vomiting (15.2%) and neutropenia (10.7%). There was no grade 3 or 4 thrombocytopenia.

CONCLUSION

Gemcitabine plus cisplatin exhibited activity in advanced ovarian cancer with an acceptable toxicity profile.

Survival of patients with testicular germ-cell tumors with poor prognosis secondary to liver metastases

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Background: Most patients with disseminated germ-cell tumor have an excellent prognosis with cisplatin-based combination chemotherapy, although there have been described certain subgroups with a worse prognosis. The presence of liver metastases (LM) represents an independent cause of poor prognosis. This study reviews the clinical course and treatment results of patients treated at Instituto Nacional de Cancerología de México (INCan-Mex). Methods: The records of all patients with germ-cell cancer and LM between 1992 and 2002 were reviewed. Age, primary site, metastases site, number of metastasis sites, histopathology type, serum tumor markers (STM) levels, liver functional assay, number of LM and used chemotherapy were examinated. The overall survival (OS) and disease free survival (DFS) were analized with Kaplan-Meier method and Log Rank test. Results: Of 32 reviewed patients, median age was 24 (range 18–42 y). The primary site was testis in 27 patients and retroperitoneal in 5 patients. The number of metastasis sites was > 3 en all cases. All patients had nonseminomatous component, predominating choriocarcinoma (82%) and seminoma (78%). The 60% of patients had STM of poor prognosis. 50% of the patients had abnormal liver functional assay. 25 cases (78%) had multiple LM. First line chemotherapy had complete response (CR) in 2 patients, partial response with STM negative (PRM-) in 12 cases, partial response with STM positive (PRM+) 8, and progression in 9 patients. All patients were treated with cisplatin-based chemotherapy. No prognostic factors of chemotherapy response were determined. Only 11 cases underwent to resection surgery of retroperitoneal or pulmonary residual. No patients underwent to liver surgery. Five year OS of 32 cases were 50%, 34% with DFS, between the patients with superior response to chemotherapy (RC + PRM-) the OS and DFS was better in relation with minor response or progression (p < 0.05). The cases with RC in liver (11) were 5-year OS 100% and DFS 66% (p < 0.05). Conclusions: The clinical course and results of treatment in the 32 cases of the INCan-Mex were similar to the literature. This study represents the greatest individual serie reported. These patients with poor prognosis are candidates to innovative treatment modalities.

No significant financial relationships to disclose.

Chemoradiotherapy in anal carcinoma using cisplatin and 5FU

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Background: Chemoradiation (CRT) is now established as the primary treatment for anal carcinoma. The original combination was 5Fu and mitomycin C, but the cisplatin may offer better local control than the standar of MMC with toxicity more tolerable. Methods: Between March 2000 and January 2005, 25 patients with anal carcinoma advanced with non pre-treated were enrolled. Eligible patients had an ECOG PS 0–2. They received cisplatin 80–100 mg/m2 day 1 and 5FU 800–1000 mg/m2 day 1–4 every 4 weeks and radiotherapy >45 Gys. Results: 25 patients, 12 male and 13 female, median age 63 (range 36–83 y). 22 with squamous cell carcinoma and 3 adenocarcinoma. (A) 11 patients recieved QT concurrente with RT, median cycles 2 and median of RT 50 Gys and (B) 14 patients recieved QT follow QT-RT concurrent, median cycles 3.5 and median of RT 48 Gys. The toxicity 3–4 were: neutropenia 23%, anaemia 4%, trombocytopenia 8%, diarrhea 15%, vomiting and nausea 19%. The evaluation: (RC) (64%), (RP) (28%) and PD (8%). The median survival 15.5 m (9–42 m), 12 m group A vs 16 m group B. Conclusions: The combination RT-QT with cisplatin and 5FU is feasible and tolerable, and may offer more the secuencie QT follow CRT.

No significant financial relationships to disclose.

Phase II study of gemcitabine plus cisplatin in metastatic breast cancer

Our objectives were to assess the efficacy and toxicity of gemcitabine plus cisplatin as first-line therapy in metastatic breast cancer (MBC). Patients with stage IV MBC and no prior chemotherapy for metastatic disease were treated with gemcitabine 1200 mg/m on days 1 and 8, and cisplatin 75 mg/m on day 1 every 21 days. Up to 6 cycles were given. A total of 46 patients with a median age of 49 years (range 24-77) and Karnofsky performance status of 80 or above were enrolled. In total, 238 cycles were administered. Of the 42 patients evaluable for response, seven (17%) achieved a complete response and 27 (64%) a partial response, for an overall response rate of 81% [95% confidence interval (CI) 69-93%]. Median time to progression was 14.9 months (95% CI 0-30.2 months). Median duration of response was 24.2 months (95% CI 11.2-37.3 months). The median survival was 27.9 months (95% CI 23.1-32.7 months), and the 1- and 2-year survival probabilities were 71.4 and 61.4%, respectively. All patients were evaluable for toxicity, and grade 3/4 WHO toxicities included neutropenia (41.3%), anemia (8.7%), thrombocytopenia (8.7%), alopecia (26.1%) and nausea/vomiting (32.6%). We conclude that gemcitabine plus cisplatin is a highly effective and safe first-line treatment for patients with MBC. The time to progression of 14.9 months compares favorably with other standard treatments (anthracyclines, taxanes). A randomized study is required to further investigate the role of this combination as first-line treatment for MBC.

Cisplatin, radiation, and amifostine in carcinoma of the uterine cervix

A pilot, open, comparative study was performed on patients with locally advanced cervical cancer to investigate the efficacy and safety of amifostine. Twenty patients with a histologic diagnosis of squamous cervical cancer were treated with radiotherapy and randomized in two groups. Group A received cisplatin at 20 mg/m2 for five days in two cycles during intracavitary radiotherapy and 100 mg/m2 x 2 cycles during external radiotherapy, and amifostine 825 mg/m2 15 min before the cisplatin infusion. Patients in group B received cisplatin in the same doses without amifostine. All patients had complete responses during a median follow-up of 20 months. Grade three neutropenia was present in two patients in group A and in four of the control group, P = 0.31; grade 2 neurologic toxicity was seen in four patients in group B and in one of the patients in group A, P = 0.15. One patient needed temporary interruption of amifostine due to hypotension. Eight of 10 patients in group A developed hypocalcemia during the treatment with amifostine. Our findings indicate that amifostine was well tolerated. In this series a mild neurologic and hematologic protection was found in patients that received amifostine, although this was not statistically significant. No differences in disease-free survival response and overall survival was seen between the two groups.