Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer

Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.

The first BGICC consensus and recommendations for breast cancer awareness, early detection and risk reduction in low- and middle-income countries and the MENA region

In low-middle income countries (LMICs) and the Middle East and North Africa (MENA) region, there is an unmet need to establish and improve breast cancer (BC) awareness, early diagnosis and risk reduction programs. During the 12th Breast, Gynecological & Immuno-oncology International Cancer Conference - Egypt 2020, 26 experts from 7 countries worldwide voted to establish the first consensus for BC awareness, early detection and risk reduction in LMICs/MENA region. The panel advised that there is an extreme necessity for a well-developed BC data registries and prospective clinical studies that address alternative modalities/modified BC screening programs in areas of limited resources. The most important recommendations of the panel were: (a) BC awareness campaigns should be promoted to public and all adult age groups; (b) early detection programs should combine geographically distributed mammographic facilities with clinical breast examination (CBE); (c) breast awareness should be encouraged; and (d) intensive surveillance and chemoprevention strategies should be fostered for high-risk women. The panel defined some areas for future clinical research, which included the role of CBE and breast self-examination as an alternative to radiological screening in areas of limited resources, the interval and methodology of BC surveillance in women with increased risk of BC and the use of low dose tamoxifen in BC risk reduction. In LMICs/MENA region, BC awareness and early detection campaigns should take into consideration the specific disease criteria and the socioeconomic status of the target population. The statements with no consensus reached should serve as potential catalyst for future clinical research.

Novel therapeutic strategies in the treatment of triple-negative breast cancer

Triple-negative breast cancer (TNBC) is a heterogeneous subtype of breast cancer that is defined by negative estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status. Treating patients with TNBC remains clinically challenging, as patients are not candidates for endocrine or HER2-directed therapy. As a result, chemotherapy with traditional agents such as anthracyclines and taxanes remains the only available option with moderate success. Recent discoveries have revealed that TNBC is a heterogeneous disease at the clinical, histological and molecular levels. The use of biomarkers to identify distinct subsets of TNBC that derive the greatest benefit from presently approved as well as novel therapeutics has become the main focus of current research. The aim of this review is to explore the clinical and biological complexity of TNBC as well as identify novel therapeutic options that target the various molecular subsets of TNBC.

Abstract P1-04-10: Assessment of circulating tumor cells (CTC) by RT/PCR as a surrogate marker for PFS in metastatic breast cancer (MBC)

Background: Despite significant improvements in the treatment of metastatic breast cancer (MBC), it remains an incurable disease. The presence of circulating tumor cells (CTC) predicts for progression free survival (PFS) in (MBC) patients. We hypothesized that the change in level of CTCs can be a good surrogate marker for PFS.

Methods: CTC level was determined by flow cytometry (FCM) in the blood of MBC female patients with measurable or non-measurable evaluable disease excluding CNS metastasis 1) before starting taxanes (Docetaxel or Paclitaxel) regimen, 2) after the first cycle, and 3) at assessment of the disease after 3-4 cycles. The breast origin was further confirmed through assessment of CK19, mammaglobin, prolactin inducible peptide (PIP), aldehyde dehydrogenase 1 (ALDH1) and human chorionic gonadotropin (hCG) in the separated CTCs by quantitative real time PCR (QRT-PCR). CTC level and level of these markers were correlated with the clinical features of the patients, response to treatment and PFS.

Results: Sixty-six female patients were enrolled between May 2010 and Jan. 2011. The median age was 48.9 years and duct carcinoma was the main pathologic subtype. After a median follow up period of 20 months, median PFS was 6 months. There was a very strong relation between the selection marker CK-19 and the breast cancer markers (p value = 0.0001). Patients with baseline CTC < 4 had significantly higher median, 6 months and 1 year PFS when compared with those with CTC ≥ 4 (p value = 0.03) while CTC levels did not correlate with PFS in the 2nd & 3rd samples respectively (p value = 0.28). Also patients whose CTC level decreased after treatment had significantly prolonged median PFS compared to patients whose CTC level increased (10 versus 4 months, p = 0.007).

Conclusions: CTCs; measured by RT-PCR were strongly predictive of PFS in MBC. CTC also could be of a great potential value in early assessment of response to chemotherapy after the 1st cycle especially in non-measurable lesions.

Key Words: Circulating tumor cells, metastatic breast cancer, progression free survival and RT-PCR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-04-10.

Cost and outcome of treatment of adults with acute myeloid leukemia at the National Cancer Institute-Egypt

BACKGROUND

Despite important advances in the therapy of acute myeloid leukemia (AML), the majority of patients die of their disease, unless bone marrow transplantation (BMT) is done. Infection and hemorrhage are still the major causes of mortality in AML patients. Progress in therapy and supportive care has led to gradual improvement in the overall results, but further improvements are still needed.

PATIENTS AND METHODS

The aim of this study is to identify the outcome and costs of adult AML patients treated with conventional chemotherapy (CCT) at the National Cancer Institute (NCI), Cairo University during the time period from April 1999 to January 2002. Clinical, laboratory characteristics were all recorded. Data regarding different types of therapies given for these patients including response, outcome and costs were also collected.

RESULTS

The median age of 82 identified AML patients was 34 years. The complete remission (CR) rate after induction with CCT was 52% (42/82 patients) with a median CR duration of 9 months. Twenty-eight percent of patients who achieved CR subsequently relapsed. By January 2003, fifty-eight patients were dead (70.7%). Infections were the major mortality cause, followed by disease progression then bleeding (65% , 28% and 7% respectively). The median treatment cost per patient was 33158 Egyptian Pounds (LE). It was higher for patients who achieved CR compared to those who relapsed and/or died. Drugs contributed by 78 % to the total treatment cost, while hospitalization, investigations and blood-component therapy contributed by 6%, 7% and 8% respectively.

CONCLUSIONS

Outcome of patients with AML treated at NCI- Cairo University can be enhanced by improvement of supportive therapy; mainly infection control and expanding BMT programs to accommodate all eligible patients.