Abstract GS1-07: Results from a phase III randomized, placebo-controlled clinical trial evaluating adjuvant endocrine therapy +/- 1 year of everolimus in patients with high-risk hormone receptor-positive, HER2-negative breast cancer: SWOG S1207

BACKGROUND: Abnormalities of the PI3kinase/AKT/mTOR signaling network are common in breast cancer (BC) and are associated with endocrine resistance. Everolimus, an mTOR-inhibitor increased PFS when combined with endocrine therapy (ET) in the metastatic setting and is thought to revert endocrine resistance. S1207 is a phase III randomized, placebo-controlled trial evaluating the role of everolimus in combination with ET in the adjuvant setting among patients with high-risk hormone receptor-positive, HER2-negative BC (NCT01674140). METHODS: Eligible patients were >18 years of age with histologically confirmed invasive hormone receptor-positive and HER2-negative high-risk BC. Four risk groups were defined as: 1) > 2cm node-negative disease (or pN1mi), and either an Oncotype DX® Recurrence Score (RS) > 25 or MammaPrint® high-risk category (MP high); 2) 1-3 positive nodes and either RS >25, MP high or a pathological grade 3 tumor; 3) >4 positive lymph nodes. Patients treated with neoadjuvant chemotherapy were eligible if: 4) after surgery had >1 lymph node involvement. Patients were randomized 1:1 to physician’s choice adjuvant ET in combination with one year of everolimus (10 mg PO daily) or ET plus placebo stratified by risk group. The primary endpoint was invasive disease-free survival (IDFS) evaluated by a stratified log-rank test. Secondary endpoints included overall survival (OS) and safety. The hazard ratio (HR) for treatment efficacy was estimated using Cox regression with stratification by risk groups. Subset analyses included preplanned evaluation within risk group and exploratory analyses of menopausal status and age. RESULTS: 1,939 patients were randomized between September 2013 and May 2019, of them 1,792 were eligible and included in the analysis (896 per arm). Primary reason for ineligibility was timing after chemotherapy/radiation or not high risk. Median age was 54 years (22-85) and 32% were premenopausal. With a median follow-up of 50.5 months, there were 389 IDFS events as of May 2022 (data cutoff). 5-year IDFS was 74.8% among patients treated with everolimus and 73.9% among patients treated with placebo, HR=0.93 (95% CI 0.76-1.14). However, the proportional hazards assumption was violated (p=0.02) suggesting differential treatment effect over time. The HR during the one year of treatment was 0.72 (95% CI 0.47-1.10) while after one year it was 1.00 (95% CI 0.80-1.26). The 5-year OS was 87.6% in the everolimus arm and 85.5% in the placebo arm, HR=0.98 (95% CI 0.75-1.28). Analysis by risk group did not show higher everolimus benefit as risk increased. No difference in IDFS or OS was seen among postmenopausal patients (IDFS HR=1.08 [95% CI 0.85-1.36], OS HR=1.19 [95% CI 0.87-1.61]). Among premenopausal patients, everolimus was associated with improved IDFS (HR=0.63 [95% CI 0.43-0.93]) and OS (HR=0.48 [95% CI 0.26-0.88]). Treatment completion of randomized therapy was lower in the everolimus arm compared to placebo (47.9% v 72.7%). Grade 3 and 4 toxicities were noted in 6.5% and 0.5% of patients in the placebo arm and in 31.2% and 3.7% in the everolimus arm respectively. CONCLUSIONS: Addition of one year of adjuvant everolimus to standard adjuvant ET did not improve IDFS or OS and was associated with low completion rate and increased AEs. Among premenopausal patients there was a benefit in IDFS and OS that is hypothesis generating. Future translational studies will evaluate potential predictors of everolimus benefit and drug toxicity.

Citation Format: Marianna Chavez, Jieling Miao, Lajos Pusztai, Matthew P. Goetz, Priya Rastogi, Patricia A. Ganz, Eleftherios (Terry) Mamounas, Soonmyung Paik, Hanna Bandos, Wajeeha Razaq, Anne O’Dea, Virginia Kaklamani, Andrea L.M. Silber, Lisa E. Flaum, Eleni Andreopolu, Joseph Baar, Albert G. Wendt, Jennifer F. Carney, Priyanka Sharma, Julie R. Gralow, Danika L. Lew, William E. Barlow, Gabriel N. Hortobagyi. Results from a phase III randomized, placebo-controlled clinical trial evaluating adjuvant endocrine therapy +/- 1 year of everolimus in patients with high-risk hormone receptor-positive, HER2-negative breast cancer: SWOG S1207 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS1-07.

Keratitis, ichthyosis, and deafness (KID) syndrome: management with chronic oral ketoconazole therapy

Extensive cutaneous mycoses have been described in patients with the keratitis, ichthyosis, and deafness (KID) syndrome. We present a case occurring in a 48-year-old woman where improvement in the ichthyosiform dermatosis, stabilization of her ocular disease, and apparent partial prevention of further cutaneous malignancies occurred in association with ketoconazole therapy.

Angiolymphoid hyperplasia with eosinophilia: removal with carbon dioxide laser in a patient on chronic oral anticoagulants

A patient with angiolymphoid hyperplasia with eosinophilia of the arm is described. In spite of anticoagulant therapy, successful surgical removal of the lesion was carried out with carbon dioxide laser excision and vaporization.

Disseminated superficial actinic porokeratosis: appearance associated with photochemotherapy for psoriasis

A patient with chronic psoriasis treated with psoralens plus ultraviolet A (PUVA) developed characteristic lesions of disseminated superficial actinic porokeratosis (DSAP). Since other processes associated with ultraviolet irradiation, including epidermal dysplasia, actinic keratoses, squamous cell carcinomas, and keratoacanthomas, have been reported to result from PUVA, it is possible that her DSAP lesions were induced by this therapy.

Acute febrile neutrophilic dermatosis in children. Report of two cases in male infants

Two male infants manifested a complex of symptoms and signs that we believed represented a distinctive hypersensitivity disease, with features of acute febrile neutrophilic dermatosis and allergic vasculitis. Both were less than 1 year of age, and both acquired their disease during or after an upper respiratory illness. Each infant was initially seen with waxy and erythematous to slightly violaceous papules that enlarged to form plaques. The lesions developed at sites of trauma and were distributed on the trunk, face, and extremities. Both infants were febrile and had leukocytosis. On histopathologic examination, biopsy specimens taken from the lesions demonstrated a pronounced dermal infiltration of polymorphonuclear leukocytes. These lesions responded to treatment with prednisone and topical fluorinated corticosteroids, healed with scarring, and recurred after initial improvement.

The induction of immunologic tolerance in guinea pigs infused with dimethylbenz(a)anthracene

The infusion of 7,12 dimethylbenz(a)anthracene (DMBA) dissolved in DMSO:glycofurol into adult guinea pigs rendered most recipients unresponsive to the induction of contact sensitization with DMBA, either by injection in adjuvant or topical application. The results were similar when guinea pigs infused with DMBA dissolved in Upjohn fat emulsion, were challenged with DMBA in adjuvant, but studies attempting topical sensitization to demonstrate unresponsiveness were inconclusive. Mammary tumors appeared after a latent period of 8 to 11 mo in 4 guinea pigs infused with DMBA in fat emulsion in which topical sensitization with DMBA was attempted.

Acanthosis nigricans presenting as hyperkeratosis of the palms and soles

A patient with an unusual form of palmoplantar hyperkeratosis is described. On thorough physical examination, widespread acanthosis nigricans was discovered. We believe this patient's distinctive keratoderma represents acanthosis nigricans.

Heterotrophic utilization of glucose and glutamate in an estuary: effect of season and nutrient load

Uptake of 14C-labeled glucose and glutamate was studied at several sites in Baltimore Harbor, Eastern Bay, and the Rhode River. Levels of uptake of 14C-labeled glutamate, measured over a period of 1 year during September, December, April, May, and June to estimate seasonal effects on heterotrophic utilization of selected nutrients, were highest in May and lowest in December. In a comparison of visibly polluted and unpolluted sites, the greatest amount of incorporation of glucose or glutamate and the highest Vmax values were observed at those sites where the microorganisms were exposed to varied and higher levels of pollutants, suggesting that Vmax may function as an indicator of relative pollution. Mineralization values ranged from 30 to 43%. A range of 0.44 to 2.32 mumol of C/liter per day was calculated for glutamate uptake.

Seasonal occurrence and distribution of microbial indicators and pathogens in the Rhode River of Chesapeake Bay

The seasonal incidence and occurrence of indicator organisms and pathogens were studied at four sites in the Rhode River, a subestuary of Chesapeake Bay. The highest frequency of occurrence of total and fecal coliforms and fecal streptococci was in Muddy Creek, a marsh area receiving pasture land runoff. Second highest frequency of occurrence of these bacteria was in Cadle Creek, a populated area. Lowest measurements of these parameters were obtained at stations in the central portion of the Rhode River. No Salmonella spp. were detected by the methods employed in this study. However, it is concluded that if these organisms are present, the concentrations are less than or equal to 1 organism per liter. The presence of Clostridium botulinum was detected in 12% of the samples tested.

Effect of sera from patients with sarcoidosis on in vitro lymphocyte response

Sera from 10 of 14 patients with sarcoidosis reduced the <i>in vitro </i>transformation of normal lymphocytes to <i>Candida </i>and mumps antigens. The response of lymphocytes to phytohemagglutinin was also diminished by 7 of 14 sera. The inhibitory activity of sarcoidosis patients sera on normal lymphocytes did not correlate well with the results of <i>in vivo </i>studies of cellular immunity in the serum donors. The impaired cell-mediated immunity in patients with sarcoidosis may be, in part, related to lymphocyte inhibitors in their sera, however, these studies suggest that sarcoidosis patients may have an additional unidentified immune defect.