1
|
Young JR, Ressler JA, Mortimer JE, Schmolze D, Fitzgibbons M, Chen BT. Association Between 18F-FDG PET Activity and HER2 Status in Breast Cancer Brain Metastases. Nucl Med Mol Imaging 2024; 58:113-119. [PMID: 38633284 PMCID: PMC11018722 DOI: 10.1007/s13139-024-00843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose The objective of this study was to evaluate whether uptake on 18F-fluorodeoxyglucose (18F-FDG) PET could help differentiate HER2-positive from HER2-negative breast cancer brain metastases. Methods In this retrospective, cross-sectional study of a cohort of 14 histologically proven breast cancer brain metastases, we analyzed both preoperative 18F-FDG PET/CT and HER2 status of the resected/biopsied brain specimens. The maximum standardized uptake values (SUVmax) of the lesions were normalized to contralateral normal white matter and compared using Mann-Whitney U tests. Results The study cohort was comprised of 12 women with breast cancer with a mean age of 59 years (range: 43-76 years) with a total of 14 distinct brain metastatic lesions. The SUVmax ratio of HER2-positive breast cancer brain metastases was significantly greater than that of HER2-negative lesions (3.98 vs 1.79, U = 38.00, p = 0.008). Conclusion The SUVmax ratio may help to identify the HER2 status of breast cancer brain metastases, if validated prospectively.
Collapse
Affiliation(s)
- Jonathan R. Young
- Department of Radiology, Division of Neuroradiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, 91010 CA USA
| | - Julie A. Ressler
- Department of Radiology, Division of Neuroradiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, 91010 CA USA
| | - Joanne E. Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, 91010 CA USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, 91010 CA USA
| | - Mariko Fitzgibbons
- Department of Radiology, Division of Neuroradiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, 91010 CA USA
| | - Bihong T. Chen
- Department of Radiology, Division of Neuroradiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, 91010 CA USA
| |
Collapse
|
2
|
Chlebowski RT, Aragaki AK, Pan K, Mortimer JE, Johnson KC, Wactawski-Wende J, LeBoff MS, Lavasani S, Lane D, Nelson RA, Manson JE. Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis. Breast Cancer Res Treat 2024:10.1007/s10549-024-07307-9. [PMID: 38653905 DOI: 10.1007/s10549-024-07307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE In the Women's Health initiative (WHI) randomized clinical trial, conjugated equine estrogen (CEE)-alone significantly reduced breast cancer incidence (P = 0.005). As cohort studies had opposite findings, other randomized clinical trials were identified to conduct a meta-analysis of estrogen-alone influence on breast cancer incidence. METHODS We conducted literature searches on randomized trials and: estrogen, hormone therapy, and breast cancer, and searches from a prior meta-analysis and reviews. In the meta-analysis, for trials with published relative risks (RR) and 95% confidence intervals (CI), each log-RR was multiplied by weight = 1/V, where V = variance of the log-RR, and V was derived from the corresponding 95% CI. For smaller trials with only breast cancer numbers, the corresponding log-RR = (O - E)/weight, where O is the observed case number in the oestrogen-alone group and E the corresponding expected case number, E = nP. RESULTS Findings from 10 randomized trials included 14,282 participants and 591 incident breast cancers. In 9 smaller trials, with 1.2% (24 of 2029) vs 2.2% (33 of 1514) randomized to estrogen-alone vs placebo (open label, one trial) (RR 0.65 95% CI 0.38-1.11, P = 0.12). For 5 trials evaluating estradiol formulations, RR = 0.63 95% CI 0.34-1.16, P = 0.15. Combining the 10 trials, 3.6% (262 of 7339) vs 4.7% (329 of 6943) randomized to estrogen-alone vs placebo (overall RR 0.77 95% CI 0.65-0.91, P = 0.002). CONCLUSION The totality of randomized clinical trial evidence supports a conclusion that estrogen-alone use significantly reduces breast cancer incidence.
Collapse
Affiliation(s)
| | | | - Kathy Pan
- Kaiser Permanente Southern California, Downey, CA, USA
| | | | - Karen C Johnson
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Meryl S LeBoff
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Dorothy Lane
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Hernandez MC, Yazaki P, Mortimer JE, Yamauchi D, Poku E, Park J, Frankel P, Kim J, Colcher DM, Wong J, Fong Y, Shively J, Woo Y. Pilot study of HER2 targeted 64 Cu-DOTA-tagged PET imaging in gastric cancer patients. Nucl Med Commun 2023; 44:1151-1155. [PMID: 37901917 PMCID: PMC10872802 DOI: 10.1097/mnm.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Human epidermal growth factor receptor 2 (HER2) is an important biomarker for targeted gastric cancer (GC) immunotherapy. However, heterogeneous HER2 overexpression in GC, loss of HER2 expression during therapy, and inability to non-invasively identify HER2 overexpressing tumors impede effective targeting therapies. Improved HER2-specific functional imaging can address these challenges. Trastuzumab is a HER2-directed mAb to treat HER2 overexpressing cancers. The 64 Cu-DOTA-trastuzumab radiotracer is used to detect HER2+ metastatic breast cancer. We aimed to develop 64 Cu-DOTA-trastuzumab PET-CT to detect and characterize tumor uptake in HER2+ or - GC patients. METHODS We conducted a single-arm phase II pilot study exploring the feasibility of 64 Cu-DOTA-trastuzumab for PET imaging of HER2 overexpressing GC compared to HER2 non-expressing tumors. Eight patients with biopsy-confirmed gastric adenocarcinoma were included. Immunohistochemistry was used to evaluate primary tumor biopsies for HER2 overexpression. Patients were injected with 45 mg of cold trastuzumab followed by 5 mg of 64 Cu-DOTA-trastuzumab. PET-CT scans were performed 24-48 h post radiotracer injection and compared to standard staging CT scans. RESULTS We observed limited toxicity following 64 Cu-DOTA-trastuzumab injections. While there was uptake of the radiotracer in portions of HER2+ lesions, there was no statistically significant distinction between tumor and background by standardized uptake value analysis. CONCLUSION Despite the potential of 64 Cu-DOTA-trastuzumab PET imaging of HER2+ metastatic breast cancer, a 5 mg dose of this radiotracer injected 24-48 h before imaging was insufficient to identify HER2+ GC. These results inform future GC imaging studies to optimize biomarker-targeted therapies based on dosage and timing for more clinically relevant imaging.
Collapse
Affiliation(s)
- Matthew C. Hernandez
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paul Yazaki
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope Medical Center, Duarte, CA
| | - Joanne E. Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | | | - Erasmus Poku
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jinha Park
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Paul Frankel
- Department of Biostatistics, Beckman Research Institute, Duarte, CA
| | - Joseph Kim
- Division of Surgical Oncology, Department of Surgery, UK Healthcare, University of Kentucky, Lexington, KY
| | - David M. Colcher
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - Jeffrey Wong
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - John Shively
- Department of Immunology, Beckman Research Institute, City of Hope, Duarte, CA
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
| |
Collapse
|
4
|
Rainone M, Kasparian S, Nguyen T, Talwar N, Yuan Y, Mei M, Mortimer JE, Waisman JR, Patel N, Pullarkat V. Thrombopoietin Receptor Agonists for Thrombocytopenia Secondary to HER2-Targeted Antibody Drug Conjugates. Oncologist 2023; 28:e843-e846. [PMID: 37335880 PMCID: PMC10485295 DOI: 10.1093/oncolo/oyad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023] Open
Abstract
Trastuzumab emtansine and trastuzumab deruxtecan are widely used in breast cancer and other solid tumor malignancies. Thrombocytopenia is a common adverse event associated with the use of these agents that can lead to a treatment delay, reduction in dose intensity, and discontinuation. The role of thrombopoietin receptor agonists (TPO-RA) remains unknown in this setting. We report a case series of 6 individuals with breast cancer that experienced dose-reductions and therapy delays due to thrombocytopenia secondary to trastuzumab emtansine or trastuzumab deruxtecan therapy and received intervention with TPO-RA. All 6 were able to resume therapy with TPO-RA support.
Collapse
Affiliation(s)
- Michael Rainone
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Saro Kasparian
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Tina Nguyen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Neel Talwar
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Yuan Yuan
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Joanne E Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James R Waisman
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Niki Patel
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| |
Collapse
|
5
|
Rainone M, Behrendt CE, Kasparian S, Nguyen T, Sedrak MS, Lavasani S, Stewart DB, Yuan Y, Mortimer JE, Waisman JR, Patel N, Pullarkat V. HER2-targeted antibody-drug conjugates for breast cancer: ancestry and dose adjustment for thrombocytopenia. Breast Cancer 2023; 30:796-801. [PMID: 37326930 PMCID: PMC10404202 DOI: 10.1007/s12282-023-01473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Thrombocytopenia is a common adverse event on HER2-targeted therapies, fam-trastuzumab deruxtecan (T-DXd) and ado-trastuzumab emtansine (T-DM1). A reported association of Asian ancestry with this event merits investigation to rule out potential confounding. METHODS Subjects in this retrospective cohort were female patients with HER2 positive breast cancer, of Asian or non-Hispanic White ancestry, who initiated T-DM1 or T-DXd from January 2017 through October 2021. Follow-up closed in January 2022. Primary endpoint was dose adjustment for thrombocytopenia. Competing endpoints were discontinuation of drug for other toxicity, disease progression, or for completion of prescribed cycles. The association between Asian ancestry and thrombocytopenia-related dose adjustment was tested at p < 0.01 in a proportional hazards model for the sub-distributions of 4 (primary and competing) endpoints. Covariates examined as potential confounders were age, metastatic disease, specific HER2-targeted drug, and prior drug switching for toxicity. RESULTS Among 181 subjects, 48 reported Asian ancestry. Incidence of dose adjustment for thrombocytopenia was higher in patients with Asian ancestry and among patients switched to T-DXd after experiencing thrombocytopenia on T-DM1. Independent of specific drug and prior drug switching, Asian ancestry was associated with dose adjustment for thrombocytopenia (hazards ratio 2.95, 95% confidence interval 1.41-6.18) but not with competing endpoints. Among participants of Asian ancestry, the ancestral origin was usually China or the Philippines (where Chinese ancestry is common). CONCLUSIONS The association between Asian ancestry and thrombocytopenia on HER2-targeted therapy is independent of age, metastatic disease, drug, and history of similar toxicity. This association may have a genetic basis linked to Chinese ancestry.
Collapse
Affiliation(s)
- Michael Rainone
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
- Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Carolyn E Behrendt
- Biostatistics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Saro Kasparian
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
- Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Tina Nguyen
- Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Mina S Sedrak
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Sayeh Lavasani
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Daphne B Stewart
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Yuan Yuan
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
- Medical Oncology, Cedars-Sinai Medical Center, 127 South San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Joanne E Mortimer
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - James R Waisman
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
| | - Niki Patel
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA
- Medical Oncology, Cedars-Sinai Medical Center, 127 South San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Vinod Pullarkat
- Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91101, USA.
| |
Collapse
|
6
|
Young JR, Ressler JA, Shiroishi MS, Mortimer JE, Schmolze D, Fitzgibbons M, Chen BT. Association of Relative Cerebral Blood Volume from Dynamic Susceptibility Contrast-Enhanced Perfusion MR with HER2 Status in Breast Cancer Brain Metastases. Acad Radiol 2023; 30:1816-1822. [PMID: 36549990 DOI: 10.1016/j.acra.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES With the development of HER2-directed therapies, identifying non-invasive imaging biomarkers of HER2 expression in breast cancer brain metastases has become increasingly important. The purpose of this study was to investigate whether relative cerebral blood volume (rCBV) from dynamic susceptibility contrast-enhanced (DSC) perfusion MR could help identify the HER2 status of breast cancer brain metastases. MATERIALS AND METHODS With IRB approval for this HIPAA-compliant cross-sectional study and a waiver of informed consent, we queried our institution's electronic medical record to derive a cohort of 14 histologically proven breast cancer brain metastases with preoperative DSC perfusion MR and HER2 analyses of the resected/biopsied brain specimens from 2011-2021. The rCBV of the lesions was measured and compared using Mann-Whitney tests. Receiver operating characteristic analyses were performed to evaluate the performance of rCBV in identifying HER2 status. RESULTS The study cohort was comprised of 14 women with a mean age of 56 years (range: 32-81 years) with a total of 14 distinct lesions. The rCBV of HER2-positive breast cancer brain metastases was significantly greater than the rCBV of HER2-negative lesions (8.02 vs 3.97, U=48.00, p=0.001). rCBV differentiated HER2-positive lesions from HER2-negative lesions with an area under the curve of 0.98 (standard error=0.032, p<0.001). The accuracy-maximizing rCBV threshold (4.8) was associated with an accuracy of 93% (13/14), a sensitivity of 100% (7/7), and a specificity of 86% (6/7). CONCLUSION rCBV may assist in identifying the HER2 status of breast cancer brain metastases, if validated in a large prospective trial.
Collapse
Affiliation(s)
- Jonathan R Young
- Division of Neuroradiology, Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, California, 91010.
| | - Julie A Ressler
- Division of Neuroradiology, Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, California, 91010
| | - Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joanne E Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mariko Fitzgibbons
- Division of Neuroradiology, Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, California, 91010
| | - Bihong T Chen
- Division of Neuroradiology, Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, California, 91010
| |
Collapse
|
7
|
Young JR, Ressler JA, Mortimer JE, Schmolze D, Fitzgibbons M, Chen BT. Association of lesion contour and lesion composition on MR with HER2 status in breast cancer brain metastases. Magn Reson Imaging 2023; 96:60-66. [PMID: 36423795 DOI: 10.1016/j.mri.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE With the development of HER2-directed therapies, identifying non-invasive imaging biomarkers of HER2 status in breast cancer brain metastases has become increasingly important, particularly given the risks of tissue sampling within the brain and the possibility of a change in receptor expression from the primary tumor to the brain metastasis. The purpose of this study was to evaluate whether lesion contour and composition on MR could help identify the HER2 status of breast cancer brain metastases. MATERIALS AND METHODS We derived a cohort of 34 women with a mean age of 55 years (range: 31-81 years) with a total of 47 distinct histologically proven breast cancer brain metastases with preoperative contrast-enhanced brain MR and HER2 immunohistochemistry and/or fluorescent in-situ hybridization (FISH) of the resected/biopsied brain specimens from 2018 to 2021. Two fellowship-trained neuroradiologists evaluated the lesion contour and lesion composition of each lesion. Logistic regression analyses were performed. RESULTS In a logistic regression model, an irregular contour had an odds ratio of 170 (p = 0.007) in differentiating HER2-positive from HER2-negative lesions. In a logistic regression model, when compared to a predominantly cystic lesion composition, a solid lesion composition had an odds ratio of 17 (p = 0.016) in differentiating HER2-positive from HER2-negative lesions. CONCLUSION Lesion contour and lesion composition on MR were significantly associated with the HER2 status of breast cancer brain metastases. Current assessment of HER2 status requires tissue sampling and immunochemical and/or FISH analyses. A non-invasive imaging biomarker that may help predict HER2 status may be of great clinical value.
Collapse
Affiliation(s)
- Jonathan R Young
- Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA 91010, USA.
| | - Julie A Ressler
- Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Joanne E Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Mariko Fitzgibbons
- Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Bihong T Chen
- Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| |
Collapse
|
8
|
Mortimer JE, Bading JR, Frankel PH, Carroll MI, Yuan Y, Park JM, Tumyan L, Gidwaney N, Poku EK, Shively JE, Colcher DM. Use of 64Cu-DOTA-Trastuzumab PET to Predict Response and Outcome of Patients Receiving Trastuzumab Emtansine for Metastatic Breast Cancer: A Pilot Study. J Nucl Med 2022; 63:1145-1148. [PMID: 34857660 PMCID: PMC9364339 DOI: 10.2967/jnumed.121.262940] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
We hypothesized that functional imaging with 64Cu-DOTA-trastuzumab PET/CT would predict the response to the antibody-drug conjugate trastuzumab-emtansine (T-DM1). Methods: Ten women with metastatic human epidermal growth factor receptor 2-positive breast cancer underwent 18F-FDG PET/CT and 64Cu-DOTA-trastuzumab PET/CT on days 1 and 2 before treatment with T-DM1. Results: T-DM1-responsive patients had higher uptake than nonresponsive patients. Day 1 minimum SUVmax (5.6 vs. 2.8, P < 0.02), day 2 minimum SUVmax (8.1 vs. 3.2, P < 0.01), and day 2 average SUVmax (8.5 vs. 5.4, P < 0.05) for 64Cu-DOTA-trastuzumab all favored responding patients. Tumor-level response suggested threshold dependence on SUVmax Patients with a day 2 minimum SUVmax above versus below the threshold had a median time to treatment failure of 28 mo versus 2 mo (P < 0.02). Conclusion: Measurement of trastuzumab uptake in tumors via PET/CT is promising for identifying patients with metastatic breast cancer who will benefit from T-DM1.
Collapse
Affiliation(s)
- Joanne E. Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - James R. Bading
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Paul H. Frankel
- Department of Information Sciences, City of Hope, Duarte, California
| | - Mary I. Carroll
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Yuan Yuan
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Jinha M. Park
- Department of Radiology, City of Hope, Duarte, California; and
| | - Lusine Tumyan
- Department of Radiology, City of Hope, Duarte, California; and
| | - Nikita Gidwaney
- Department of Radiology, City of Hope, Duarte, California; and
| | - Erasmus K. Poku
- Department of Cancer Molecular Imaging and Therapy, Beckman Research Institute of the City of Hope, Duarte, California
| | - John E. Shively
- Department of Cancer Molecular Imaging and Therapy, Beckman Research Institute of the City of Hope, Duarte, California
| | - David M. Colcher
- Department of Cancer Molecular Imaging and Therapy, Beckman Research Institute of the City of Hope, Duarte, California
| |
Collapse
|
9
|
Ge X, Yost SE, Lee JS, Frankel PH, Ruel C, Cui Y, Murga M, Tang A, Martinez N, Chung S, Yeon CH, Stewart DB, Li D, Rajurkar SP, Somlo G, Mortimer JE, Waisman JR, Yuan Y. Phase I study combining pembrolizumab and aromatase inhibitor in patients with metastatic hormone receptor–positive breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1053 Background: Aromatase inhibitor (AI) is standard of care for patients with hormone receptor positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). The current phase I trial was designed to test the safety and efficacy of AI and the immune checkpoint inhibitor pembrolizumab (NCT 02648477). Methods: Key eligibility criteria were HR+ HER2- MBC per ASCO/CAP; RECIST 1.1 measurable disease; adequate organ function; and ECOG 0-1. Eligible patients received 200 mg pembrolizumab IV every 3 weeks plus AI until progression or unacceptable toxicity. Primary objectives were to evaluate the safety and efficacy of this combination. This study employed a 3-at-risk design with a lead-in at the standard dosing of both AI and pembrolizumab with a targeted accrual of 20 patients. Results: A total of 20 patients were accrued between March 2016 and April 2017. Median age was 62 (range 34-79), with 75% white, 15% Asian and 10% unknown. Median lines of therapy were 3 (0, 9). All but one patient received aromatase inhibitor and/or fulvestrant prior to enrollment. The combination was well tolerated, and the most common adverse events were grade 2 fatigue (35%), rash (15%), and hot flashes (10%). Grade 3 adverse events were elevated AST/ALT (5%), rash (5%), and lymphopenia (5%). Responses were 10% partial response and 15% stable disease, resulting in a clinical benefit rate (CBR) of 20% at 6 months. Median follow-up time was 40.1 months (range 31.3 – 46.8 months). Median progression free survival was 1.8 months (95% CI 1.6, 2.6) and median overall survival was 17.2 months (95% CI 9.4, NA). 14 tumor specimens had programmed death ligand 1–positive (PD-L1) by 22C3 testing, including 3 PD-L1-positive and 11 PD-L1 negative. No association between PD-L1 and response was found. Conclusions: The combination of pembrolizumab and AI is well tolerated in patients with HR+ HER2- MBC who were not pre-selected for PD-L1. There was minimal overall clinical activity observed beyond what was to be expected with AI alone in this group of patients. Clinical trial information: NCT 02648477.
Collapse
Affiliation(s)
| | | | - Jin Sun Lee
- Beverly Hills Cancer Center, Los Angeles, CA
| | | | | | - Yujie Cui
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - Aileen Tang
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - Daneng Li
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | | | - George Somlo
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
10
|
Yuan Y, Zhang J, Kessler J, Rand J, Modi B, Chaurasiya S, Murga M, Tang A, Martinez N, Meisen H, Yamauchi D, Yost SE, Chong LMO, Seiz A, Nixon B, Ede N, Waisman JR, Stewart DB, Mortimer JE, Fong Y. Phase I study of intratumoral administration of CF33-HNIS-antiPDL1 in patients with metastatic triple negative breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13070 Background: Despite recent FDA approval of immune checkpoint inhibitor pembrolizumab and drug-antibody conjugate in the treatment of metastatic triple negative breast cancer (mTNBC), the overall survival benefit of these therapies remains modest. Oncolytic virotherapy (OV) utilizes genetically modified viruses to infect and kill cancer cells while sparing healthy cells. CF33-hNIS-anti-PD-L1 (CHECKvacc) is a novel chimeric orthopoxvirus with robust anti-cancer activity in TNBC xenografts. Cells infected with CHECKvacc were shown to express functional human sodium-iodide symporter (hNIS) and anti-PD-L1 proteins. hNIS gene transfer allows tracking of virus by 99mTc single-photon emission computed tomography (SPECT). Our preliminary animal studies demonstrated that tumor cells infected with CHECKvacc successfully secrete functional hNIS and anti-PD-L1. CHECKvacc is safe and well-tolerated, and detects and effectively kills TNBC at doses several magnitudes lower than other OVs in xenograft models. Methods: This study is a first-in-human (FIH) phase I, single center, single arm clinical trial evaluating the safety and tolerability of CHECKvacc intratumoral injection in patients with mTNBC. Key eligibility criteria include patients with unresectable or metastatic TNBC; progressed on at least 2 prior chemotherapies including immune checkpoint inhibitor-containing regimen; ECOG 0-1; RECIST 1.1 measurable disease; and at least one tumor amenable to repeated intratumoral injections. Eligible patients receive CHECKvacc intratumorally at one of 8 assigned dose levels (1 × 105 PFU, 3 × 105 PFU, 1 × 106 PFU, 3× 106 PFU, 1 × 107 PFU, 3 × 107 PFU, 1 × 108 PFU, 3 x 108 PFU) on Days 1 and 15 of each 28-day cycle for a total of 3 cycles of treatment. Primary objectives are to evaluate the safety and tolerability of CHECKvacc (DLTs and other toxicities by CTCAE v5.0). Secondary objectives are to determine optimal biological dose (OBD), recommended phase II dose (RP2D), and response rate by RECIST1.1. Results: The first 3 subjects of dose level 1 will be enrolled sequentially for safety monitoring. Once the initial 3 subjects are treated sequentially, the study will follow the Phase I Queue 3+3 (IQ 3+3) design which expands a dose level up to 8 subjects after a single DLT has been observed. Enrollment to the final RP2D may be expanded to include up to 12 patients for efficacy assessment. The estimated targeted accrual is 33 patients (minimum) to 78 patients (maximum). Correlative aims include assessing viral kinetics, viral plaque assay, 99mTc SPECT imaging for virus tracking, peripheral blood and tumor tissue for antiviral immune activation, and tumor microenvironment changes in association with response to therapy. Conclusions: This FIH trial of CF33-hNIS-antiPD-L1 intratumoral injection in patients with mTNBC is currently underway. Clinical trial information: NCT05081492.
Collapse
Affiliation(s)
- Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Jamie Rand
- City of Hope National Medical Center, Duarte, CA
| | - Badri Modi
- City of Hope National Medical Center, Duarte, CA
| | | | - Mireya Murga
- City of Hope National Medical Center, Duarte, CA
| | - Aileen Tang
- City of Hope National Medical Center, Duarte, CA
| | | | - Hans Meisen
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | | | | | | | | | - Yuman Fong
- City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
11
|
Rainone M, Behrendt CE, Kasparian S, Nguyen T, Mortimer JE, Yuan Y, Waisman JR, Stewart DB, Lavasani SM, Sedrak MS, Patel N, Pullarkat VA. HER2-targeted immunoconjugates for breast cancer: Ancestry and dose adjustment for thrombocytopenia. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1048 Background: Thrombocytopenia (TCP) is a common toxicity of HER2-targeted agents, trastuzumab emtansine (TDM1) and trastuzumab deruxtecan (TDXd). A high incidence of this toxicity was observed in pivotal trials that led to approval of these agents. We investigated whether Asian ancestry increases risk of dose adjustment for TCP on TDM1/TDXd and its impact on dosing in the real-world setting. Methods: Females with HER2+ breast cancer who initiated TDM1/TDXd between 1/16/17-10/26/21 were identified by retrospective review. Primary endpoint was number of chemotherapy cycles until adjustment of TDM1/TDXd dose for TCP; competing endpoints included discontinuation for other toxicity, disease progression, and completion of treatment. Individuals who were switched from TDM1 to TDXd contributed an additional observation post-switch. Recurrent events analysis evaluated Asian ancestry (p<0.05) using a proportional means model, with robust sandwich estimate recognizing correlation between repeated observations per individual. Covariates (age, metastatic disease, drug, prior adjustment) were retained if they improved the model. Results: The study excluded individuals who declined to self-identify (n=23), self-identified as other than Asian or White (n=28), and/or dissented to research (n=24). The study included n=181 individuals (mean age 55.1+12.8 years), of whom n=48 (26.5%) identified as Asian and n=124 (68.5%) had metastatic disease. Overall, 33 individuals received TDXd exclusively, leaving 148 (81.8%) individuals who received TDM1, including 45 individuals who later switched to TDXd after development of TCP while on TDM1 (n=9) or other toxicity (n=36) on TDM1. For n=226 observations (total 2551 cycles), the endpoint was dose adjustment for TCP (n=32), discontinuation for other toxicity or disease progression (n=112), completion of treatment (n=27), or censoring (n=55). Taking into account history of switching drug for TCP, Asian ancestry was associated with increased risk of dose adjustment for TCP (Table). Neither age, metastatic disease, nor specific drug improved the model (data not shown). Conclusions: Among individuals taking TDM1 and/or TDXd for HER2+ breast cancer, we observed that those with Asian ancestry are at greater risk of dose reduction for TCP than their non-Asian counterparts. Upon confirmation in additional individuals with HER2+ cancers of the breast and other sites, this heightened susceptibility to TCP among Asian individuals should be further investigated to elucidate the underlying mechanism and optimize clinical guidelines for prevention and management. [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | - Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - Niki Patel
- City of Hope National Medical Center, Duarte, CA
| | | |
Collapse
|
12
|
Yuan Y, Ge X, Yost SE, Lee JS, Frankel PH, Ruel C, Cui Y, Murga M, Tang A, Martinez N, Karimi M, Somlo G, Mortimer JE, Waisman JR. Phase I trial combining pembrolizumab and doxorubicin in patients with metastatic triple negative breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13071 Background: Pembrolizumab (pembro) in combination with chemotherapy (chemo) has recently become standard of care in patients with programmed death-ligand 1 (PD-L1) positive metastatic triple negative breast cancer (mTNBC). Optimal chemo partner with pembro remains debatable. The current phase I study evaluated the safety and efficacy of doxorubicin (dox) + pembro in anthracycline-naïve mTNBC patients (NCT02648477). Methods: Patients with mTNBC, no prior anthracycline, and ≤2 lines of prior chemo for metastatic disease were enrolled. Patients received pembro 200mg IV and 50-60 mg/m2 dox IV every 3 weeks x6, followed by pembro maintenance until progression or unacceptable toxicity. The primary objectives were safety and objective response rate (ORR per RECIST 1.1). For the safety lead-in, we employed a 3-at-risk rolling design. Results: Ten patients were accrued between March 2016 and November 2019. The trial stopped early due to poor accrual. The first 3 patients received dox at 50mg/m2 without dose limiting toxicities and dose was escalated to 60mg/m2 for the remaining patients. Median age was 62 years (range 41-87). Grade ≥ 3 AEs were: 4 neutropenia, 2 dyspnea, 2 fatigue, 1 oral mucositis, 1 hyponatremia, 1 acidosis, 1 alkalosis, 1 hypotension and 1 respiratory failure. One patient (age 87) received 1 dose of therapy, developed neutropenia and respiratory failure which led to death, and was not eligible for response assessment. 1 patient did not have RECIST measurable disease. Two patients had dose delay (1 G3 neutropenia and 1 G2 upper airway infection). 1 patient had dose reduction due to G3 fatigue. Immune toxicity was consistent with known pembro toxicity. Of 9 evaluable patients, responses were : 1 CR, 3 PR, 2 UPR, 2 SD and 1 PD, which translated to a best ORR of 67% (95% CI, 13.7%, 78.8%). CBR at 6 mo was 56% (95% CI 21.2%, 86.3%). Median follow-up time was 34.6 mo (range 14.5 - 45.4 mo). Median PFS was 5.2 mo (95% CI 4.7, NA); and median OS was 15.6 mo (95% CI 13.3, NA). Eight patients had PD-L1 (22C3) testing: 4 positive and 4 negative. No association between the PD-L1 status and response was observed. Conclusions: The combination of pembro+dox was well tolerated and had modest activity in anthracycline-naïve patients with mTNBC. The finding needs to be further confirmed with future study. Clinical trial information: NCT02648477.
Collapse
Affiliation(s)
- Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Jin Sun Lee
- Beverly Hills Cancer Center, Los Angeles, CA
| | | | | | - Yujie Cui
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - Aileen Tang
- City of Hope National Medical Center, Duarte, CA
| | | | | | - George Somlo
- City of Hope National Medical Center, Duarte, CA
| | | | | |
Collapse
|
13
|
Ge X, Behrendt CE, Yost SE, Patel N, Samoa R, Stewart DB, Sedrak MS, Lavasani SM, Waisman JR, Yuan Y, Mortimer JE. Predicting hyperglycemia among patients receiving alpelisib plus fulvestrant for metastatic breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1060 Background: Although hyperglycemia is recognized as a common adverse event (AE) on alpelisib (ALP), this AE has been little studied outside clinical trials. We report the frequency of ALP-associated hyperglycemia in a real-world setting and evaluate proposed risk factors. Methods: We retrospectively identified patients with PIK3CA-mutated, hormone receptor-positive, metastatic breast cancer who initiated treatment with ALP+fulvestrant (FUL) between August 2019 and December 2021. Five primary characteristics (diabetes, prediabetes, body mass index (BMI), age, Asian ancestry) were evaluated as independent risk factors for ALP-associated hyperglycemia using ordinal logistic regression that considered 3 glycemic levels: normoglycemia, grade 2, and grade 3-4 hyperglycemia. Overall risk of error from multiple hypothesis testing was kept below 5% using the False Discovery Rate method. Results: The study included n = 92 subjects, all but 1 female, mean age 59.9 (+11.9) years, 13.0% with Asian ancestry. One third (33.7%) of patients had pre-existing diabetes, another 9.8% had pre-diabetes only. One third (32.6%) were obese, another third (31.5%) were overweight. Hypertension and hyperlipidemia were present in 53.3% and 41.3%, respectively. On ALP+FUL, 59 (64.1%) current subjects developed hyperglycemia of grade 1-4, a rate no different than the 181/284 (63.7%) reported in the ALP+FUL arm of the SOLAR-1 trial. Among our subjects, risk of grade 2-4 hyperglycemia was independently increased by 4 of 5 hypothesized risk factors, specifically pre-existing diabetes (Odds Ratio 3.75, 95% Confidence Interval: 1.40-10.01), pre-diabetes (6.22, 1.12-34.47), Asian ancestry (7.10, 1.75-28.84), each unit of BMI above 20 (1.17, 1.07-1.28), but not by additional year of age (1.01, 0.97-1.05). Exploratory analysis detected no association with pre-existing hypertension or hyperlipidemia. Conclusions: These findings suggest that Asian ancestry merits further study as a predisposing factor for ALP-associated hyperglycemia. Our study of this AE also demonstrates that pre-existing hyperglycemia and greater BMI are independent risk factors; diabetes and pre-diabetes confer similar degrees of risk; risk from BMI begins after BMI 20 and rises incrementally; and age is not a contributing factor.
Collapse
Affiliation(s)
| | | | | | - Niki Patel
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | - Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| | | |
Collapse
|
14
|
Affiliation(s)
- Joanne E Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | | |
Collapse
|
15
|
Dieli-Conwright CM, Wong L, Waliany S, Mortimer JE. Metabolic syndrome and breast cancer survivors: a follow-up analysis after completion of chemotherapy. Diabetol Metab Syndr 2022; 14:36. [PMID: 35241143 PMCID: PMC8895575 DOI: 10.1186/s13098-022-00807-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/16/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We previously reported that (neo)adjuvant chemotherapy adversely altered metabolic syndrome (MetS) components, body composition, and related biomarkers after a 12 to 18-week chemotherapy treatment course in women. Here, we sought to determine whether these measures worsened within 4-5 years post-chemotherapy among the same sample of early stage breast cancer survivors. METHODS Twenty-eight breast cancer survivors were reassessed within 4-5 years post-chemotherapy. Participants were tested for MetS, lipid profile (total cholesterol; TC, low-density lipoprotein cholesterol; LDL-C), glucose metabolism (insulin, homeostatic model- insulin resistance; HOMA-IR, glycosylated hemoglobin; HbA1c), inflammation (C-reactive protein; CRP) and body composition (body weight; BW, percent body fat; BF, fat mass; FM) during follow-up physical exams. A comparison of measurements between post-chemotherapy and follow-up periods was performed using repeated measures analysis of covariance. RESULTS Most study patients were Caucasian (44%) or Hispanic (30%) with a mean age of 48.2 years. Average time from completion of chemotherapy was 4.75 years. At follow-up, MetS components significantly increased (p < 0.01) compared with the post chemotherapy assessment. Additionally, BF, FM, lipids (TC, LDL), glucose metabolism (HOMA-IR, insulin, HbA1c), and inflammation (CRP) significantly increased (p < 0.01). Notably BW significantly increased; mean weight gain after chemotherapy was 6.1 kg and increased an additional 8.2% at follow-up (p < 0.01). CONCLUSION MetS components, body composition, and biomarkers continued to worsen within 4-5 years post-chemotherapy in breast cancer survivors. Energy balance interventions should target breast cancer patients to reduce the exacerbation of MetS.
Collapse
Affiliation(s)
- Christina M Dieli-Conwright
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Avenue, Boston, MA, 02215, USA.
| | - Louise Wong
- Division of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| |
Collapse
|
16
|
Wei CH, Yang L, Stewart D, Bedell V, Schmolze D, Apple S, Murata-Collins JL, Pillai R, Mortimer JE. Abstract P3-09-05: Genomic and clinical characterization of breast tumors with unusual HER2 FISH pattern (ratio < 2, HER2 copy number ≥ 6): Are they mostly HER2 “positive?”. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-09-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast tumors with HER2/CEP17 fluorescent in situ hybridization (FISH) ratio < 2 and HER2 copy number ≥ 6, defined as Group 3 FISH pattern by the 2018 ASCO/CAP HER2 testing guidelines, are clinically rare. Their biologic and molecular characteristics are under-characterized. They require only a concomitant HER2 immunohistochemistry score of at least 2+ to merit HER2 “positive” status by the ASCO/CAP guidelines. We seek to characterize the genomic and tumor microenvironment landscape of breast tumors with this unique HER2 FISH pattern. Our second aim is to assess the clinicopathologic features with emphasis on HER2-targeted therapy response.Method: Breast cancers with Group 3 FISH pattern were evaluated by the following methods: 1) High-resolution genome-wide copy number alterations by molecular inversion probe (MIP) array; 2) molecular profiling of tumor immune microenvironment, tumor signaling pathways, and PAM50-based intrinsic subtypes by Nanostring nCounter Breast Cancer 360 Panel; 3) tumor infiltrating lymphocytes (TIL) histologic quantitation, and 4) clinical chart review. Classically amplified HER2 breast tumors (Group 1 FISH pattern; ratio ≥ 2 and HER2 copy number ≥ 2) were used as comparison. Results: Thirty-five (1.3%) cases were identified from 2731 consecutive clinical cases that underwent HER2 FISH testing from 2014 to 2019. Of those, thirteen consecutive cases (spanning 2014 - 2017) with sufficient genomic material were analyzed using MIP array. Group 3 tumors had a more complex karyotype and greater chromosomal instability, compared to classically amplified HER2 breast tumors. None of the Group 3 tumors showed HER2 locus amplification at 17q12. Instead, most showed gain of the 17q arm. Six of the Group 3 tumors were profiled by Nanostring nCounter. Compared to HER2 classically amplified tumors, Group 3 tumors were more immune cold, enriched in ER signaling and TGF-beta signaling pathways. In contrast, HER2 classically amplified tumors were enriched in immune infiltration, cytokine and chemokine signaling, PI3K and MAPK signaling, epithelial-mesenchymal transition signaling, and proliferation (P < 0.5 for all). PAM50 analysis showed that classically amplified tumors were more enriched for HER2-subtype (2/4; 50%), while the majority of the Group 3 tumors were enriched for Luminal B-subtype (5/6; 83%). TIL percentage was statistically higher in HER2 classically amplified tumors compare to Group 3 tumors (avg 53% vs 3%; P = 0.02). Clinicopathologic correlation revealed a high rate of ER positivity and high tumor grade in Group 3 tumors. Group 3 FISH pattern can occur as de novo or in the context of FISH status change following therapy. In the 17 evaluable patients for HER2-targeted treatment efficacy, none of the eight patients who received HER2-targeted neoadjuvant therapy achieved complete pathologic response. Nine of ten patients who received TDM-1 in the metastatic setting progressed with minimal treatment response. Significantly, most of these patients (16/17; 94%) were considered overall HER2 positive by the latest ASCO/CAP guideline. Conclusion: Breast tumors with Group 3 HER2 FISH pattern are molecularly and clinically dissimilar from classically amplified HER2 positive breast tumors. HER2-targeted therapy did not appear efficacious in either the neoadjuvant or metastatic/recurrent settings. The lack of apparent efficacy of HER2-targeted therapy, in the context of their HER2 positive status by the current HER2 guideline assessment, warrants further investigation of this HER2 FISH subtype.
Citation Format: Christina H Wei, Lixin Yang, Daphne Stewart, Victoria Bedell, Daniel Schmolze, Sophia Apple, Joyce L. Murata-Collins, Raju Pillai, Joanne E. Mortimer. Genomic and clinical characterization of breast tumors with unusual HER2 FISH pattern (ratio < 2, HER2 copy number ≥ 6): Are they mostly HER2 “positive?” [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-09-05.
Collapse
Affiliation(s)
| | - Lixin Yang
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | - Sophia Apple
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - Raju Pillai
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | |
Collapse
|
17
|
Egelston CA, Guo W, Tan J, Avalos C, Simons DL, Lim MH, Huang YJ, Nelson MS, Chowdhury A, Schmolze DB, Yim JH, Kruper L, Melstrom L, Margolin K, Mortimer JE, Yuan Y, Waisman JR, Lee PP. Tumor-infiltrating exhausted CD8+ T cells dictate reduced survival in premenopausal estrogen receptor-positive breast cancer. JCI Insight 2022; 7:153963. [PMID: 35132960 PMCID: PMC8855819 DOI: 10.1172/jci.insight.153963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022] Open
Abstract
CD8+ tumor-infiltrating lymphocytes (TILs) are associated with improved survival in triple-negative breast cancer (TNBC) yet have no association with survival in estrogen receptor–positive (ER+) BC. The basis for these contrasting findings remains elusive. We identified subsets of BC tumors infiltrated by CD8+ T cells with characteristic features of exhausted T cells (TEX). Tumors with abundant CD8+ TEX exhibited a distinct tumor microenvironment marked by amplified interferon-γ signaling–related pathways and higher programmed death ligand 1 expression. Paradoxically, higher levels of tumor-infiltrating CD8+ TEX associated with decreased overall survival of patients with ER+ BC but not patients with TNBC. Moreover, high tumor expression of a CD8+ TEX signature identified dramatically reduced survival in premenopausal, but not postmenopausal, patients with ER+ BC. Finally, we demonstrated the value of a tumor TEX signature score in identifying high-risk premenopausal ER+ BC patients among those with intermediate Oncotype DX Breast Recurrence Scores. Our data highlight the complex relationship between CD8+ TILs, interferon-γ signaling, and ER status in BC patient survival. This work identifies tumor-infiltrating CD8+ TEX as a key feature of reduced survival outcomes in premenopausal patients with early-stage ER+ BC.
Collapse
Affiliation(s)
| | - Weihua Guo
- Department of Immuno-Oncology, Beckman Research Institute
| | - Jiayi Tan
- Department of Immuno-Oncology, Beckman Research Institute
| | | | - Diana L Simons
- Department of Immuno-Oncology, Beckman Research Institute
| | - Min Hui Lim
- Department of Immuno-Oncology, Beckman Research Institute
| | | | - Michael S Nelson
- Light Microscopy Digital Imaging Core, Beckman Research Institute
| | - Arnab Chowdhury
- Division of Biostatistics, Department of Computational and Quantitative Medicine, Beckman Research Institute; and
| | | | | | | | | | - Kim Margolin
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Joanne E Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - James R Waisman
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Peter P Lee
- Department of Immuno-Oncology, Beckman Research Institute
| |
Collapse
|
18
|
Pan K, Aragaki AK, Neuhouser ML, Simon MS, Luo J, Caan B, Snetselaar L, Mortimer JE, Manson JE, Kroenke C, Lane D, Reding K, Rohan TE, Chlebowski RT. Low-fat dietary pattern and breast cancer mortality by metabolic syndrome components: a secondary analysis of the Women's Health Initiative (WHI) randomised trial. Br J Cancer 2021; 125:372-379. [PMID: 34006923 PMCID: PMC8329224 DOI: 10.1038/s41416-021-01379-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In the Women's Health Initiative (WHI) dietary modification (DM) randomised trial, the low-fat dietary intervention reduced deaths from breast cancer (P = 0.02). Extending these findings, secondary analysis examined dietary intervention influence on breast cancer mortality by metabolic syndrome (MS) components. METHODS In total, 48,835 postmenopausal women with no prior breast cancer were randomised to a low-fat dietary intervention or comparison groups. Four MS components were determined at entry in 45,833 participants: (1) high waist circumference, (2) high blood pressure, (3) high cholesterol and (4) diabetes history. Forest plots of hazard ratios (HRs) were generated with P-values for interaction between randomisation groups and MS component score. Primary outcome was death from breast cancer by metabolic syndrome score. RESULTS HRs and 95% confidence intervals (CI) for dietary intervention influence on death from breast cancer were with no MS components (n = 10,639), HR 1.09, 95% CI 0.63-1.87; with 1-2 MS components (n = 30,948), HR 0.80, 95% CI 0.62-1.02; with 3-4 MS components (n = 4,246), HR 0.31, 95% CI 0.14-0.69 (interaction P = 0.01). CONCLUSIONS While postmenopausal women with 3-4 MS components were at higher risk of death from breast cancer, those randomised to a low-fat dietary intervention more likely had reduction in this risk. REGISTRY ClinicalTrials.gov (NCT00000611).
Collapse
Affiliation(s)
- Kathy Pan
- grid.239844.00000 0001 0157 6501Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Aaron K. Aragaki
- grid.270240.30000 0001 2180 1622Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Marian L. Neuhouser
- grid.270240.30000 0001 2180 1622Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Michael S. Simon
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, Seattle, WA USA ,grid.254444.70000 0001 1456 7807Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI USA
| | - Juhua Luo
- grid.257410.50000 0004 0413 3089University of Indiana, Bloomington, IN USA
| | - Bette Caan
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Northern California Division of Research, Oakland, CA USA
| | - Linda Snetselaar
- grid.214572.70000 0004 1936 8294University of Iowa, Bloomington, IN USA
| | - Joanne E. Mortimer
- grid.410425.60000 0004 0421 8357City of Hope National Medical Center, Duarte, CA USA
| | - JoAnn E. Manson
- grid.38142.3c000000041936754XBrigham and Women’s Hospital/Harvard Medical School, Boston, MA USA
| | - Candyce Kroenke
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Northern California Division of Research, Oakland, CA USA
| | - Dorothy Lane
- grid.36425.360000 0001 2216 9681State University of New York at Stony Brook, Stony Brook, NY USA
| | - Kerryn Reding
- grid.34477.330000000122986657Fred Hutchinson Cancer Research Center & University of Washington, School of Nursing, Seattle, WA USA
| | - Thomas E. Rohan
- grid.251993.50000000121791997Albert Einstein College of Medicine, Bronx, NY USA
| | - Rowan T. Chlebowski
- grid.239844.00000 0001 0157 6501Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA USA
| |
Collapse
|
19
|
Lavasani SM, Yost SE, Frankel PH, Ruel C, Murga M, Tang A, Martinez N, Kruper L, Tumyan L, Schmolze D, Menghi F, Liu ET, Yeon CH, Yuan Y, Waisman JR, Somlo G, Mortimer JE. Phase II prospective open label study of neoadjuvant pertuzumab, trastuzumab, and nab-paclitaxel in patients with HER-2 positive advanced breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
583 Background: HER2 overexpression occurs in 20-25% of breast cancers (BC) and is associated with poor prognosis. The addition of trastuzumab (trast) to chemotherapy significantly improves disease-free (DFS) and overall survival (OS) in the adjuvant setting. Pertuzumab (pert) inhibits ligand-activated signaling and in combination with trast has synergistic inhibition of BC cells overexpressing HER2. In the neoadjuvant therapy (NT) setting, the combination of trast, pert, and docetaxel can improve the pCR rate. PCR may predict for improved DFS and OS. De-escalation with weekly paclitaxel combined with trast and pert appeared to be safe and efficacious but requires steroid premedication, whereas nab-paclitaxel (nab) does not require steroid premedication. To decrease treatment-associated toxicity in patients with HER2+ BC, we utilized a non-anthracycline regimen with pert, trast, and nab as NT. The objectives of this study were to evaluate the safety and efficacy of pert added to trast and nab in HER2+ locally advanced BC (LABC) to determine the pCR, as well as DFS and OS. Methods: A total of 45 patients with biopsy-confirmed HER2+ LABC or inflammatory BC were enrolled from 2013-2017, and were treated with 6 cycles of neoadjuvant pert (840 mg loading dose, then 420 mg IV day 1 every 21 days), weekly trast (4 mg/kg loading dose, then 2 mg/kg), and weekly nab (100 mg/m2 IV). Patient characteristics, including age, race, menopausal status, grade, stage, and prior surgery and radiation were recorded. Median treatment cycles determined, and events (AE) were identified for each arm. PCR rate, DFS and OS were calculated. Results: Median age was 56 (31-78) years. 1/45 (2%) was stage I, 30/45 (67%) were stage II, 14/45 (31%) were stage III. pCR rate was 29/45 (64.4%). The initial primary tumor size was similar in pCR and non-pCR patients (mean 4.1 cm vs. 3.2 cm, respectively). Median follow-up was 36.1 months (95% CI [27.1, 41.8]). Median treatment cycles completed was 6 (1-6). A total of 4/45 (9%) patients had >1 cycle delayed, and 32/45 (71%) patients had >1 cycle modified. For the patients achieving pCR, the DFS (95% CI) at 3 years was 85.9% (66.7%, 94.4%) and for those without pCR, it was 87.5% (58.6%, 96.7%). OS was not reached (95% CI [NR, NR]). Grade 3 AEs (> 2 patients) included 7/45 (16%) of patients with hypertension; 4/45 (9%) with anemia; and 2/45 (4%) with diarrhea, ALT, fatigue, or rash. Conclusions: This anthracycline-free regimen which included nab achieved great pCR rate of 64.4% in HER2+ BC patients with fewer treatment-related toxicities. The pCR rate is comparable with docetaxel, carboplatin, trast, and pert (TCHP) therapy in NT setting, but without the treatment-associated toxicities. This suggests we may be able to safely avoid anthracyclines and carboplatin for NT in HER2+ BC patients. The improved pCR did not translate into DFS benefit. Clinical trial information: NCT01730833.
Collapse
Affiliation(s)
| | | | | | | | - Mireya Murga
- City of Hope National Medical Center, Duarte, CA
| | - Aileen Tang
- City of Hope National Medical Center, Duarte, CA
| | | | - Laura Kruper
- City of Hope National Medical Center, Duarte, CA
| | | | - Dan Schmolze
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| | | | - George Somlo
- City of Hope National Medical Center, Duarte, CA
| | | |
Collapse
|
20
|
Yuan Y, Yost SE, Frankel PH, Ruel C, Murga M, Tang A, Martinez N, Waisman JR, Stewart DB, Patel NH, Mortimer JE. A phase I/IB study of ipatasertib in combination with carboplatin or carboplatin/paclitaxel or capecitabine and atezolizumab in patients with metastatic triple-negative breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1078 Background: Ipatasertib (ipat) is an AKT inhibitor which has shown efficacy in combination with paclitaxel and atezolizumab in patients with triple negative breast cancer (TNBC). In previous trials, ipat was given 21 days on 7 days off due to gastrointestinal toxicities. The current trial was designed to test the safety and efficacy of ipat continuous dosing in combination with carboplatin (carbo) or carboplatin/paclitaxel (carbo/taxol). The trial was later amended to include an additional arm using ipat 21 days on 7 days off with capecitabine/atezolizumab (cape/atezo) to explore the safety of the combination. Methods: Patients with metastatic TNBC and up to 2 lines of prior chemotherapy were enrolled to receive the following: Arm A, ipat 400 mg daily, carbo AUC 2 and taxol 80 mg/m2 IV days 1, 8, 15, every 28 days; Arm B, ipat 400 mg daily, carbo AUC 2 IV days 1, 8, 15, every 28 days; Arm C, ipat 300 mg daily 21 days on 7 days off, cape 750 mg/m2 7 days on 7 days off, atezo 840 mg IV every 28 days. Ipat continuous dosing was used for Arms A and B. Ipat 21 days on 7 days off dosing was used for Arm C. The primary endpoint is safety and recommended phase II dose (RP2D). Secondary endpoints are response rate (RR) and overall survival (OS). Results: Twenty-three patients with median age 49 (29-75) were enrolled from 04/2019 to 12/2020, with 9 in Arm A, 10 in Arm B, and 4 in Arm C. A total of 15/23 (65%) had dose delay and 10/23 (43%) had dose modification. 3/4 (75%) of patients in Arm A had dose limiting toxicities (DLT) including diarrhea and gastric pain, which led to de-escalation to dose -1 with ipat (300 mg daily). 5 more patients were treated at dose -1 of Arm A with only 1 DLT (maculo-papular rash). No DLTs were observed in Arm B. Of the 4 patients treated in Arm C, 1 had DLT (maculo-papular rash). The RP2D for Arms A and B are: ipat 300 mg/carbo AUC2/taxol 80 mg/m2; ipat 400 mg/carbo AUC2. RP2D for Arm C has not been determined and accrual is ongoing. There were no clinically significant G4 toxicities in Arm A; G3 toxicities included 4/9 (44%) diarrhea, 1/9 (11%) hypertension, 1/9 (11%) stomach pain, and 1/9 (11%) neutropenia. For Arm B, G3 toxicities included 2/10 (20%) diarrhea, 1/10 (10%) anemia, 1/10 (10%) maculo-papular rash, and 1/10 (10%) hyperglycemia. For Arm C, there was 1/4 (25%) G3 maculo-papular rash. Best overall responses for Arm A were: 2/9 (22%) PR, 4/9 (44%) SD, and 3/9 (33%) PD. Best responses for Arm B were 2/10 (20%) PR, 6/10 (60%) SD, and 2/10 (20%) PD. For Arm C, best responses were 3/4 (75%) SD, and 1 not evaluable (repeat biopsy showed HER2+ disease). With a median follow up of 8.1 months, the median PFS was 4.0 months (95% CI [2.6, 5.3]). Conclusions: Continuous dosing of ipatasertib in combination with carbo or carbo/taxol is well-tolerated with modest efficacy. Clinical trial information: NCT03853707 .
Collapse
Affiliation(s)
- Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - Mireya Murga
- City of Hope National Medical Center, Duarte, CA
| | - Aileen Tang
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | |
Collapse
|
21
|
Nelson RA, Lai LL, Mortimer JE, Soto Perez De Celis E, Chlebowski RT, Kruper L. Prior DCIS and overall mortality in women with stage I breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12593 Background: Whether a prior diagnosis of ductal carcinoma in situ (DCIS) impacts women later diagnosed with invasive breast cancer is unclear. If localized breast cancer following DCIS is more aggressive than localized breast cancer alone, this could inform therapy decisions. To our knowledge, no study has examined the impact of prior DCIS on overall mortality in women with stage I invasive breast cancer. The study objective was to determine if overall mortality for women with stage I breast cancer with prior DCIS is different from those with stage I disease without prior DCIS. Our hypothesis was that women with prior DCIS would have higher mortality compared to those without prior DCIS. Methods: 302,484 patients with stage I cancer diagnosed from 1998 to 2016 were ascertained from SEER. Of these, 5,011 (1.7%) had prior DCIS. Patients with DCIS were matched 1:2 to women with no prior DCIS based on age, year of diagnosis, race/ethnicity, marital status, and invasive breast cancer characteristics including histology, tumor grade, tumor size, T stage, N stage, ER/PR status, surgery type, radiation, and chemotherapy status. The primary study outcome was overall mortality. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI). Results: Cases and controls had similar demographics. Compared to women with stage I breast cancer without prior DCIS, overall mortality was statistically significantly lower in women with stage I breast cancer with prior DCIS (hazard ratio [HR] 0.89 95% confidence interval [CI]0.80-0.98). Other factors associated with overall mortality were bilateral mastectomy (adjusted HR: 0.62; 95% CI: 0.49-0.78), radiation therapy (adjusted HR: 0.64; 95% CI: 0.56-0.75) and chemotherapy (adjusted HR: 0.85; 95% CI: 0.72-0.99). Factors associated with higher overall mortality included age (trend p < 0.001), tumor grade (trend p = 0.003), and negative PR receptor status (adjusted HR: 1.29; 95% CI: 1.13-1.45). Breast cancer specific mortality, however, was statistically significantly higher in women with prior DCIS to their breast cancer diagnosis compared to women without prior DCIS to their breast cancer diagnosis (HR 1.24 95% CI 1.01-1.52). Conclusions: Contrary to our hypothesis, women with prior DCIS and subsequent stage I breast cancer have lower overall mortality compared to matched controls with stage I breast cancer without prior DCIS. In contrast, those with prior DCIS have higher breast cancer specific mortality than those without prior DCIS. Reasons for this discrepancy are unknown, but since DCIS is most commonly diagnosed on mammogram, differences may be related to sociodemographic characteristics that are associated with both higher screening adherence and higher overall survival, such as higher income, higher education achievement , and higher access to health care.
Collapse
Affiliation(s)
| | | | | | | | | | - Laura Kruper
- City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
22
|
Pan K, Larson JC, Prentice RL, Mortimer JE, Neuhouser ML, Manson JE, Van Horn L, Rohan TE, Lane D, Chlebowski RT. Protein Intake by Source and Breast Cancer Incidence and Mortality: The Women's Health Initiative. JNCI Cancer Spectr 2021; 4:pkaa101. [PMID: 33392445 PMCID: PMC7768926 DOI: 10.1093/jncics/pkaa101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background Prior studies of dietary protein intake and breast cancer have been mixed and were limited by dietary self-report measurement error. Methods Biomarker-calibrated total protein intake and estimated vegetable protein and animal protein intake were determined from baseline food frequency questionnaires in 100 024 Women’s Health Initiative participants. Associations between total, animal, and vegetable protein intake and breast cancer incidence, deaths from breast cancer, and deaths after breast cancer were estimated using Cox proportional hazards regression. Breast cancers were verified by medical record review and survival outcomes enhanced by National Death Index queries. All statistical tests were 2-sided. Results After 14 years of follow-up, there were 6340 incident breast cancers, 764 deaths from breast cancer, and 2059 deaths after breast cancer. In multivariable analyses, higher calibrated total protein intake was not associated with breast cancer incidence or deaths from or after breast cancer. Vegetable protein intake was associated with statistically significantly lower breast cancer incidence (hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.96 to 0.99, Ptrend = .006) and statistically significantly lower risk of death after breast cancer (HR = 0.93, 95% CI = 0.91 to 0.97, Ptrend < .001) but not with deaths from breast cancer. In contrast, higher animal protein intake was associated with statistically significantly higher breast cancer incidence (HR = 1.03, 95% CI = 1.01 to 1.06, Ptrend = .02) but not with deaths from or after breast cancer. Conclusions Calibrated total protein intake was not associated with breast cancer incidence or mortality. Higher vegetable protein intake was associated with lower breast cancer incidence and lower risk of death after breast cancer. Higher animal protein intake was associated with higher breast cancer incidence.
Collapse
Affiliation(s)
- Kathy Pan
- Lundquist Institute for Biomedical Innovation at Harbor, UCLA Medical Center, Torrance, CA, USA
| | | | | | | | | | - JoAnn E Manson
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | | | | | - Dorothy Lane
- State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor, UCLA Medical Center, Torrance, CA, USA
| |
Collapse
|
23
|
Pan K, Chlebowski RT, Mortimer JE, Gunter MJ, Rohan T, Vitolins MZ, Adams-Campbell LL, Ho GYF, Cheng TYD, Nelson RA. Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women's Health Initiative. Cancer 2020; 126:3638-3647. [PMID: 32530506 DOI: 10.1002/cncr.33002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/22/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insulin resistance is associated with higher all-cause and cancer-specific mortality in postmenopausal women. However, to the authors' knowledge, information regarding insulin resistance and breast cancer mortality risk is limited. Therefore, the authors examined associations between insulin resistance and breast cancer incidence and mortality in a subsample of Women's Health Initiative participants. METHODS A total of 22,837 postmenopausal women with fasting baseline glucose and insulin levels were followed for incident breast cancer and breast cancer mortality. Breast cancers were verified by medical record review and serial National Death Index linkage-enhanced mortality findings. Insulin resistance was estimated using the homeostatic model assessment of insulin resistance (HOMA-IR). Multivariable Cox proportional hazards models were used to compute hazard ratios (HRs) with 95% confidence intervals (95% CIs) for quartile comparisons. Outcomes included breast cancer incidence, deaths from breast cancer, and deaths after breast cancer (breast cancer followed by death from any cause). RESULTS During a median of 19.8 years of follow-up of 1328 breast cancer cases, there were 512 deaths reported, 151 of which were from breast cancer. Breast cancer incidence was higher in women in the highest HOMA-IR quartile (HR, 1.34; 95% CI, 1.12-1.61 [P for trend = .003]). Although HOMA-IR was not found to be associated with risk of death from breast cancer (HR, 1.04; 95% CI, 0.60-1.79), women in the highest versus those in the lowest HOMA-IR quartile were at a higher risk of death after breast cancer (HR, 1.78; 95% CI, 1.32-2.39 [P for trend <.001]). CONCLUSIONS Higher levels of insulin resistance in postmenopausal women are associated with higher breast cancer incidence and higher all-cause mortality after breast cancer.
Collapse
Affiliation(s)
- Kathy Pan
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | - Rowan T Chlebowski
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | | | - Marc J Gunter
- The International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Gloria Y F Ho
- Division of Epidemiology, Northwell Health, Great Neck, New York
| | - Ting-Yuan David Cheng
- Department of Epidemiology, University of Florida at Gainesville, Gainesville, Florida
| | | |
Collapse
|
24
|
Pan K, Nelson RA, Wactawski-Wende J, Lee DJ, Manson JE, Aragaki AK, Mortimer JE, Phillips LS, Rohan T, Ho GYF, Saquib N, Shadyab AH, Nassir R, Rhee JJ, Hurria A, Chlebowski RT. Insulin Resistance and Cancer-Specific and All-Cause Mortality in Postmenopausal Women: The Women's Health Initiative. J Natl Cancer Inst 2020; 112:170-178. [PMID: 31184362 DOI: 10.1093/jnci/djz069] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/09/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Insulin resistance has been proposed as a mediator of the increased cancer incidence and mortality associated with obesity. However, prior studies included limited cancer deaths and had inconsistent findings. Therefore, we evaluated insulin resistance and cancer-specific and all-cause mortality in postmenopausal women participating in the Women's Health Initiative (WHI). METHODS Eligible were a subsample of 22 837 WHI participants aged 50-79 years enrolled at 40 US clinical centers from 1993 to 1998 who had baseline fasting glucose and insulin levels. Baseline insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Cancers were verified by central medical record review and deaths verified by medical record and death certificate review enhanced by National Death Index queries. Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality. All statistical tests were two-sided. RESULTS During a median of 18.9 years of follow-up, 1820 cancer deaths and 7415 total deaths occurred. Higher HOMA-IR quartile was associated with higher cancer-specific mortality (Q4 vs Q1, HR = 1.26, 95% CI = 1.09 to 1.47; Ptrend = .003) and all-cause mortality (Q4 vs Q1, HR = 1.63, 95% CI = 1.51 to 1.76; Ptrend < .001). A sensitivity analysis for diabetes status did not change findings. Among women with body mass index less than 25 kg/m2, higher HOMA-IR quartile was associated with higher cancer mortality (Fine and Gray, P = .004). CONCLUSIONS High insulin resistance, as measured by HOMA-IR, identifies postmenopausal women at higher risk for cancer-specific and all-cause mortality who could potentially benefit from early intervention.
Collapse
Affiliation(s)
- Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | | | - JoAnn E Manson
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | - Lawrence S Phillips
- Atlanta VA Medical Center, Decatur, GA.,Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, GA
| | - Thomas Rohan
- Albert Einstein College of Medicine, New York, NY
| | - Gloria Y F Ho
- Feinstein Institute for Medical Research, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi Colleges, Saudi Arabia
| | | | - Rami Nassir
- Department of Pathology, School of Medicine, Umm Al-Qura'a University, Saudi Arabia
| | - Jinnie J Rhee
- Stanford University School of Medicine, Palo Alto, CA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | | |
Collapse
|
25
|
Sweeney FC, Demark-Wahnefried W, Courneya KS, Tripathy D, Sami N, Lee K, Buchanan TA, Spicer D, Bernstein L, Mortimer JE, Dieli-Conwright CM. Abstract C123: Ethnocentric differences in sarcopenic obesity and body composition in response to an aerobic and resistance exercise intervention for breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background and Purpose: Hispanic breast cancer survivors (HBCS) have a 1.1-1.5 greater risk of breast cancer mortality when compared to non-Hispanic breast cancer survivors (NHBCS). This disparity may result from modifiable lifestyle factors, as Hispanic women are more apt to be obese and sedentary than matched non-Hispanic counterparts, placing them at risk for obesity-related comorbidities. Also, gains in fat mass with declines in lean mass, known as sarcopenic obesity (SOb), often occur as a side effect of cancer treatment. Thus, participation in physical activity is paramount, as exercise is strongly associated with lowering the risk of cancer recurrence and premature mortality. The purpose of this analysis was to examine ethnicity as a moderator of the effects of a 16-week supervised aerobic and resistance exercise intervention on SOb and body composition (BCM) in overweight/obese breast cancer survivors.
Experimental Design: Sedentary, overweight or obese (BMI>25.0 kg/m2) breast cancer survivors (Stage I-III; n=100) were randomized to exercise (n=50) or usual care (n=50). The exercise intervention promoted supervised, progressive moderate-vigorous (65-85% maximum heart rate [MHR]) aerobic and resistance exercise thrice weekly for 16 weeks. Markers of SOB and BCM, including appendicular skeletal muscle index (ASMI), BMI, % body fat and truncal fat were measured at baseline and post-intervention (4 months). Differences in mean changes for outcomes by ethnicity were evaluated using linear mixed-models to assess effect modification.
Summary of Results: The study enrolled 57 HBCS and 43 NHBCS with an average age of 53.5±10.4 years and BMI of 33.5±5.5 kg/m2. HBCS were diagnosed with more advanced cancers, were significantly more obese and less physically active compared to NHBCS (p<0.001); 96% of the HBCS and 92% of the NHBCS presented with SOb. Post-intervention, SOb and BCM indices were significantly improved in the exercise arm (both HBCS and NHBCS) as compared to baseline (p 0.01) and usual care (p<0.001). However, HBCS exhibited more favorable improvements compared to NHBCS, including an increase in ASMI (mean difference, -2.1; 95% confidence interval (95% CI), 0.4 to 5.1; p<0.001) and truncal fat (-4.4; 95% CI, -9.1 to -0.8; p<0.001). Ethnicity was found to moderate the effect of the exercise intervention on fat mass (P for interaction=0.09) and % body fat (P for interaction=0.09).
Conclusions: HBCS may achieve better outcomes with exercise in attenuating disparities related to SOb and BCM. To our knowledge, this is the first study to investigate ethnocentric differences between HBCS and NHBCS as they pertain to participation in physical activity and high-risk comorbidities related to poorer cancer prognosis and mortality. Exercise presents as a useful lifestyle modifiable intervention to attenuate ethnic health disparities in breast cancer survivors; future studies should aim to enroll diverse populations.
Citation Format: Frank C. Sweeney, Wendy Demark-Wahnefried, Kerry S. Courneya, Debu Tripathy, Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, Darcy Spicer, Leslie Bernstein, Joanne E. Mortimer, Christina M. Dieli-Conwright. Ethnocentric differences in sarcopenic obesity and body composition in response to an aerobic and resistance exercise intervention for breast cancer survivors [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 C123.
Collapse
Affiliation(s)
| | | | | | - Debu Tripathy
- 4University of Texas MD Anderson Cancer Center, Houston, TX,
| | - Nathalie Sami
- 1University of Southern California, Los Angeles, CA,
| | - Kyuwan Lee
- 1University of Southern California, Los Angeles, CA,
| | | | - Darcy Spicer
- 1University of Southern California, Los Angeles, CA,
| | | | | | | |
Collapse
|
26
|
Chung CP, Behrendt C, Wong L, Flores S, Mortimer JE. Serial Assessment of Urinary Incontinence in Breast Cancer Survivors Undergoing (Neo)Adjuvant Therapy. J Natl Compr Canc Netw 2020; 18:712-716. [PMID: 32502980 PMCID: PMC9126173 DOI: 10.6004/jnccn.2020.7535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Among breast cancer survivors, urinary incontinence (UI) is often attributed to cancer therapy. We prospectively assessed urinary symptoms before and after (neo)adjuvant treatment of early-stage breast cancer. METHODS With consent, women with stage I-III breast cancer completed the Urogenital Distress Inventory and the Incontinence Impact Questionnaire before and 3 months after initiating (neo)adjuvant therapy. Patients with UI were at least slightly bothered by urinary symptoms. If UI was present pretreatment, it was considered prevalent; if UI was new or worse at 3 months posttreatment, it was considered incident; if prevalent UI was no worse at 3 months posttreatment, it was considered stable. Ordinal logistic regression models identified characteristics associated with the level of prevalent UI and with the degree of UI impact on quality of life (QoL). RESULTS On pretreatment surveys, participants (N=203; age 54.5 ± 11.4 years) reported 79.8% prevalence of UI, including overactive bladder (29.1%), stress incontinence (10.8%), or both (39.9%). The level of prevalent UI increased with body mass index (BMI; P<.05). Of 163 participants assessed at both time points, incident UI developed in 12 of 32 patients without prevalent UI and 27 of 131 patients with prevalent UI. Regardless of whether UI was prevalent (n=162), incident (n=39), or stable (n=94) at QoL assessment, the impact of UI increased (P<.01) with the number and severity of UI symptoms, subjective urinary retention, and BMI. Adjusted for those characteristics, incident UI had less impact on QoL (P<.05) than did prevalent or stable UI. CONCLUSIONS We found that UI is highly prevalent at breast cancer diagnosis and that new or worsened UI is common after (neo)adjuvant therapy. Because UI often impairs QoL, appropriate treatment strategies are needed.
Collapse
Affiliation(s)
- Christopher P. Chung
- Urogynecology, Division of Gynecologic Oncology, City of Hope National Medical Center, Duarte, California
| | - Carolyn Behrendt
- Division of Biostatistics, Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Louise Wong
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| | - Sarah Flores
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| | - Joanne E. Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| |
Collapse
|
27
|
Dieli-Conwright CM, Sweeney FC, Courneya KS, Tripathy D, Sami N, Lee K, Buchanan TA, Spicer D, Bernstein L, Mortimer JE, Demark-Wahnefried W. Abstract C122: Ethnicity as a moderator of the effects of aerobic and resistance exercise on metabolic syndrome in breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background and Purpose: Metabolic syndrome (MSY) is associated with increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic compared to non-Hispanic women. Hispanic women in the United States are more likely to be obese and physically inactive than matched non-Hispanic counterparts, raising risk for developing MSY. Exercise mitigates MSY in BCS; however, few studies have focused on minorities. The purpose of this secondary analysis was to examine ethnicity as a moderator of the effects of a 16-week combined aerobic and resistance clinical exercise intervention on MSY and related biomarkers in BCS.
Experimental Design: Sedentary, overweight or obese (BMI>25.0 kg/m2) BCS (Stage I-III; n=100) were randomized to exercise (n=50) or usual care (n=50). The exercise intervention promoted supervised, progressive moderate-vigorous (65-85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Aerobic exercise included cycling, walking, or jogging at 65-85% maximum heart rate. Resistance exercise was performed in circuit-fashion with 3 sets of 10-15 repetitions including upper and lower body exercises at 65-70% 1-repetition maximum. MSY variables (blood pressure, waist circumference, triglycerides, glucose, and high-density lipoprotein-cholesterol) and related biomarkers (insulin, insulin resistance HOMA-IR, C-reactive protein [CRP]) were measured at baseline and post-intervention (4 months). Differences in mean changes for outcomes by ethnicity were evaluated using linear mixed-models to assess effect modification.
Summary of Results: Fifty-seven Hispanic BCS and 43 non-Hispanic BCS with an average age of 53.5±10.4 years and BMI of 33.5±5.5 kg/m2 were included. Hispanic BCS were younger, of greater adiposity, had higher-stage cancers, and had worse metabolic profiles at baseline compared to non-Hispanic BCS (p<0.001). Ethnicity was found to moderate the effects of exercise training on triglycerides (mean difference, -36.4; 95% confidence interval (95% CI), -62.1-18.3; p=0.04) and glucose (mean difference, -8.6; 95% CI, -18.7-3.1; p=0.05) with Hispanic BCS exhibiting larger improvements than non-Hispanic BCS. Ethnicity moderated the effect of exercise on insulin (P for interaction=0.09), HOMA-IR (P for interaction=0.06), and CRP (P for interaction=0.05).
Conclusions: Hispanic, as compared to non-Hispanic, BCS have poorer metabolic profiles, but may achieve better outcomes from exercise. To our knowledge, this is the first study to explore racial/ethnic disparities in MSY between Hispanic and non-Hispanic BCS and document differential response to exercise. Clinical exercise interventions may attenuate ethnic health disparities in BCS. Future trials should aim for diversity.
Citation Format: Christina M. Dieli-Conwright, Frank C. Sweeney, Kerry S. Courneya, Debu Tripathy, Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, Darcy Spicer, Leslie Bernstein, Joanne E. Mortimer, Wendy Demark-Wahnefried. Ethnicity as a moderator of the effects of aerobic and resistance exercise on metabolic syndrome in breast cancer survivors [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 C122.
Collapse
Affiliation(s)
| | | | | | - Debu Tripathy
- 3University of Texas MD Anderson Cancer Center, Houston, TX,
| | | | - Kyuwan Lee
- 1University of Southern California, Los Angeles,
| | | | - Darcy Spicer
- 1University of Southern California, Los Angeles,
| | | | | | | |
Collapse
|
28
|
Pan K, Larson JC, Chlebowski RT, Mortimer JE, Manson JE, Van Horn L, Rohan TE, Lane D. Protein intake and breast cancer incidence and mortality. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1569 Background: Associations between dietary protein intake and breast cancer are unclear, in part due to limitations of dietary self-report. Women’s Health Initiative (WHI) investigators compared the accuracy of food frequency questionnaire (FFQ) data on energy and protein intake with objective measures of dietary intake using biomarkers (doubly labeled water for energy and urinary nitrogen for protein [n=544]). Subsequently, regression equations incorporating participant characteristics were developed acknowledging differential reporting dietary data errors based on participant characteristics (Neuhouser Am J Epidemiol). FFQ findings were then used to determine biomarker- adjusted animal vs vegetable protein ratios. Methods: We examined associations of energy and protein intake with breast cancer incidence and mortality in Women’s Health Initiative (WHI) participants 50-79 years of age at entry between1993-1998, with breast cancers verified by medical record review and survival enhanced by serial National Death Index (NDI) searches through 2016. Associations between sources of protein intake (animal versus vegetable) quintiles and breast cancer incidence and mortality were estimated using multivariable Cox proportional hazards regression. Results: With 100,024 eligible participants, after 14 years follow-up, women with higher total protein intake had greater body mass index, were more likely White, menopausal hormone therapy users with higher total energy intake and fat intake. With 6,340 incident breast cancers, 764 deaths from breast cancer and 2,059 deaths after breast cancer, higher vegetable protein intake was associated with significantly lower breast cancer incidence (P for linear trend = 0.01) while higher animal protein intake was associated with significantly higher breast cancer incidence (P for linear trend = 0.03). Higher vegetable protein intake was also associated with significantly lower risk of death after breast cancer (P <0.001) but not with lower risk of deaths from breast cancer (breast cancer followed by death attributed to breast cancer). Animal protein intake was not associated with deaths from breast cancer or deaths after breast cancer. Conclusions: Based on findings from biomarker-calibrated determination of protein intake by source, higher vegetable protein intake was associated with significantly lower risk of breast cancer incidence and of death after breast cancer while higher animal protein intake was associated with significantly higher risk of breast cancer incidence, but not mortality.
Collapse
Affiliation(s)
- Kathy Pan
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Rowan T. Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | | | - JoAnn E Manson
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | | | - Dorothy Lane
- State University of New York at Stony Brook, Stony Brook, NY
| |
Collapse
|
29
|
Lee JS, Yost SE, Stiller T, Blanchard S, Padam S, Katheria V, Tang A, Martinez N, Patel NH, Sedrak MS, Waisman JR, Li D, Sanani S, Presant CA, Mortimer JE, Yuan Y. Tolerability of neratinib in older adults with HER2 positive or HER2 mutated metastatic breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13018 Background: The tolerability and efficacy of targeted therapy in older adults with cancer have not been adequately studied. Neratinib is an oral pan-HER1, HER2, and HER4 tyrosine kinase inhibitor that has been FDA approved for early stage HER 2+ breast cancer. This phase II trial is designed to evaluate the safety of neratinib in older adults (≥60 years) who have HER2 amplified or HER2 mutated metastatic breast cancer (MBC). Methods: Older adults with HER2+ or HER2 mutated MBC with any number of previous lines of therapy received neratinib at 240 mg daily in 28-day cycles. Loperamide was used for diarrhea prophylaxis: 4mg tid x 14 days followed by 4mg bid for days 15-28, and as needed after first cycle. Participants completed a pre-treatment geriatric assessment (GA) including measures of function, comorbidity, cognition, nutrition, and psychosocial status at cycle 1, cycle 4, and end of the study. Relationships between tolerability (dose reductions and number of completed courses) and log2 risk score were assessed using t-test and linear regression. Response rate (RR), progression free survival (PFS) and overall survival (OS) were evaluated. Results: Twenty-five patients (mean age 68 [60-79]) were enrolled from 12/2016 to 03/2019, and 36% of patients (pts) were >70 years old. Median number of cycles completed was 3 (0-13): 1/25 (4%) pts had a partial response, 11/25 (44%) had stable disease, 12/25 (48%) had progression of disease, and 1/25 (4%) was not evaluable for response. PFS was 2.6 months (95% CI [2.56-5.26]). The median OS was 17.4 months (95% CI [10.3, NA]). A total of 9/25 pts (36%) had dose modification. Of these, 3/9 had at least one dose hold, and all 9 had at least one dose reduction (diarrhea, n = 6). 20/25 participants (80%, 95% CI [59%, 93%]) had grade ≥2 toxicities, and 9/25 pts (36%, 95% CI [18%, 57%]) had grade 3 toxicities that were attributable to treatment: diarrhea (n = 5), abdominal pain (n = 2), and vomiting (n = 2). There were no grade 4 or 5 toxicities. Two pts (8%) were hospitalized due to neratinib toxicity, and two pts went off treatment due to toxicity attributed to neratinib (diarrhea and nausea). There was a trend in the difference in toxicity risk scores by whether a participant had a dose reduction (t-test: p-value = 0.054) with participants with higher risk scores being more likely to require a dose reduction; however, toxicity risk score did not predict number of cycles completed based on linear regression (slope = -1.29, se = 1.44, p = .39). Conclusions: Neratinib is safe in older adults with HER2 positive or HER2 mutated MBC. Clinical trial information: NCT02673398 .
Collapse
Affiliation(s)
- Jin Sun Lee
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | | | - Aileen Tang
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Shamel Sanani
- City of Hope National Medical Center, Mission Hills, CA
| | | | | | - Yuan Yuan
- City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
30
|
Mahinbakht D, Lavasani SM, Yu W(K, Samoa R, Ruel N, Mortimer JE. Incidence of diabetes and prediabetes unmasked by dexamethasone in women undergoing (neo) adjuvant taxane therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12526 Background: Women with early stage breast cancer receive premedication with dexamethasone prior to administration of paclitaxel and docetaxel. We undertook a retrospective chart review to determine the frequency of steroid-induced hyperglycemia in women receiving steroid premedication with paclitaxel and docetaxel. Methods: Women who were receiving paclitaxel or taxotere chemotherapy as (neo)adjuvant therapy were identified from pharmacy records. Patients were excluded if they were currently receiving insulin or hypoglycemic agents for diabetes. A Comprehensive Metabolic Panel (CMP) was performed prior to chemotherapy and the random glucose level was recorded. The highest random glucose level recorded during all cycles of treatment was used in the analysis. The threshold for diabetes is a random glucose of 200 mg/dL and levels > 150 mg/dL, but less than 200 mg/dL is considered prediabetes. Between August 2017 to December 2019, 131 patients were identified and 100 met the criteria for inclusion. The study was approved by the Institutional Review Board. A single individual abstracted the data which included demographic data, BMI, comorbidities, random glucose levels prior to therapy and whether they received treatment for the elevations in blood glucose. Results: A total of 131 charts were reviewed, but 31 were excluded because 2 were male, 13 had type 2 diabetes at diagnosis, and 16 had metastatic disease. The median age of the 100 patients was 53 years (range 31 to 82 years); 45% were White/Non-Hispanic, 28% Hispanic, 18% Asian, 5% African American, 1% were Native Hawaiian or other Pacific Islander, 2% were unknown, and 1% were of mixed race. Prediabetic random glucose levels were recorded in 30% of patients and 23% had levels consistent with a diagnosis of diabetes. Out of the patients who exhibited a blood glucose above 200, 16 out of the 23 patients were White, 6 of them were Hispanic and 1 was Asian. The average BMI was 27.7. The average BMI of patients who exhibited a blood glucose of over 200 mg/dL was 28.85 and the average of those who had a blood glucose of over 150 mg/dL was 27.56. Conclusions: Diabetes and prediabetes were unmasked by taking the premedication with dexamethasone in 53% of women undergoing (neo)adjuvant docetaxel or paclitaxel. Current guidelines do not recommend additional blood work after completion of active treatment. Given our results, it is important that medical oncologist ensure that patients with elevations in random glucose be referred for appropriate endocrine workup and therapy, including lifestyle modifications.
Collapse
|
31
|
Lee K, Tripathy D, Demark-Wahnefried W, Courneya KS, Sami N, Bernstein L, Spicer D, Buchanan TA, Mortimer JE, Dieli-Conwright CM. Effect of Aerobic and Resistance Exercise Intervention on Cardiovascular Disease Risk in Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. JAMA Oncol 2020; 5:710-714. [PMID: 30920602 PMCID: PMC6512455 DOI: 10.1001/jamaoncol.2019.0038] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance The Framingham Risk Score (FRS) is a valid method for predicting the 10-year risk of developing cardiovascular disease. Higher FRS is reported in patients with early-stage breast cancer who are overweight than in healthy, age-matched women, but whether exercise reduces FRS in this patient population is unclear. Objective To examine the effects of a 16-week aerobic and resistance exercise intervention on the FRS in women with early-stage breast cancer and with overweight condition or obesity. Design, Setting, and Participants This single-center, prospective randomized clinical trial included 100 women with stage I to III breast cancer who were sedentary, with overweight condition or obesity (body mass index of ≥25.0 or body fat of ≥30%), and completed cancer treatment within 6 months prior to enrollment. Participants were randomized to either the usual care or exercise group. Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analyses. Data were collected from August 1, 2012, through July 1, 2017. Data analysis, which followed the intention-to-treat approach, was performed from May 24 to October 2, 2018. Interventions The exercise group underwent supervised aerobic and resistance exercise sessions thrice weekly for 16 weeks. Main Outcomes and Measures The FRS was calculated for each participant using preset points for each of the 6 FRS categories: age, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, diabetes presence, and smoking status. Results In total, 100 women were randomized to either the exercise group (n = 50) or usual care group (n = 50). Of these women, 55 (55%) were of Hispanic white race/ethnicity and the mean (SD) age was 53.5 (10.4) years. The mean (SD) total FRS scores postintervention were 2.0 (1.5) in the exercise group and 13.0 (3.0) in the usual care group. The postintervention FRS was significantly reduced in the exercise group compared with the usual care group (mean, -9.5; 95% CI, -13.0 to -6.0), which corresponds to an 11% (95% CI, -15.0 to -5.0) decrease on the FRS-predicted 10-year risk of developing cardiovascular disease. Conclusions and Relevance A 16-week supervised aerobic and resistance exercise intervention appeared to reduce the FRS-predicted 10-year risk of cardiovascular disease in women with early-stage breast cancer with overweight condition or obesity. Clinical Trial Registration ClinicalTrials.gov identifier: NCT01140282.
Collapse
Affiliation(s)
- Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope National Medical Center, Duarte, California
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center, Duarte, California
| | - Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles.,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| |
Collapse
|
32
|
Mortimer JE, Nelson RA, Kruper L, Pan K, Conwright CMD, Shadyab AH, Kuller L, Howard B, Chlebowski RT. Abstract P5-12-04: Association of adjuvant endocrine therapy with diabetes among women with postmenopausal breast cancer in the Women’s Health Initiative (WHI). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-12-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In postmenopausal women, use of hormone therapy is associated with a lower incidence of diabetes (DM). The association of adjuvant endocrine therapy (AET) with DM has not been well studied among women treated for early stage breast cancer. The objective of this study was to examine the association of AET with risk of developing DM among postmenopausal women who developed breast cancer. Methods: 5,013 postmenopausal women from the Women’s Health Initiative diagnosed with non-metastatic breast cancer who were diabetes-free at cancer diagnosis and who had information on use of AET were included. AET use was gathered using 2 methods: 1) review of medication inventories for use of tamoxifen or aromatase inhibitors (AI) and 2) review of the Life and Longevity after Cancer (LILAC), a supplemental questionnaire used from 2009-2010 to gather treatment information from women who developed cancer. Results from these 2 collection methods were analyzed separately due to the timing of the surveys as well as data granularity (i.e. LILAC queried use of AET, not type). The primary outcome of interest for this study was diabetes-free survival, which was calculated from the date of breast cancer diagnosis to first diagnosis of DM. Participants who did not develop DM after breast cancer were censored at their last follow-up visit or date of death. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI). Results: After 10.4 median year’s follow-up post breast cancer diagnosis, 13% (632/5,013) of participants developed DM. Of the 2,646 who had medication inventory data, 1,352 (51%) reported AI use and 1,449 (55%) reported tamoxifen use. Participants who reported use of AIs were 13% more likely to develop DM than participants who did not use AIs (HR=1.13, CI=0.91-1.39). Participants who reported use of tamoxifen were 11% less likely to develop DM than those who did not use tamoxifen (HR=0.89, CI=0.72-1.11). Of the 3,769 participants with LILAC data from the supplemental questionnaire, 2,543 (67%) reported use of AET; these participants were 25% more likely to develop DM than those who did not use AET (HR=1.25, CI=1.02-1.53). When plotted over time, the risk of diabetes in AET users versus non-users was identical at 5 years (5% v 5%, respectively), was 35% higher at 10 years (12% v 9%, respectively), and 30% higher at 15 years (18% v 14%, respectively) (log-rank p=0.029). Conclusion: DM has not been reported as an adverse event in women on AET. Our data suggest an association of AET with DM among postmenopausal women with early stage breast cancer. When looking at specific types of AETs, the risk was marginally increased for AIs but marginally decreased for tamoxifen, with risk more apparent in subsequent years. These data have significance for survivorship care.
Citation Format: Joanne E Mortimer, Rebecca A Nelson, Laura Kruper, Kathy Pan, Christina M Dieli Conwright, Aladdin H Shadyab, Lewis Kuller, Barbara Howard, Rowan T Chlebowski. Association of adjuvant endocrine therapy with diabetes among women with postmenopausal breast cancer in the Women’s Health Initiative (WHI) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-04.
Collapse
|
33
|
Yee LD, Mortimer JE, Natarajan R, Dietze EC, Seewaldt VL. Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin. Front Endocrinol (Lausanne) 2020; 11:58. [PMID: 32153503 PMCID: PMC7045050 DOI: 10.3389/fendo.2020.00058] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 01/29/2020] [Indexed: 12/13/2022] Open
Abstract
Studies investigating the potential link between adult pre-menopausal obesity [as measured by body mass index (BMI)] and triple-negative breast cancer have been inconsistent. Recent studies show that BMI is not an exact measure of metabolic health; individuals can be obese (BMI > 30 kg/m2) and metabolically healthy or lean (BMI < 25 kg/m2) and metabolically unhealthy. Consequently, there is a need to better understand the molecular signaling pathways that might be activated in individuals that are metabolically unhealthy and how these signaling pathways may drive biologically aggressive breast cancer. One key driver of both type-2 diabetes and cancer is insulin. Insulin is a potent hormone that activates many pathways that drive aggressive breast cancer biology. Here, we review (1) the controversial relationship between obesity and breast cancer, (2) the impact of insulin on organs, subcellular components, and cancer processes, (3) the potential link between insulin-signaling and cancer, and (4) consider time points during breast cancer prevention and treatment where insulin-signaling could be better controlled, with the ultimate goal of improving overall health, optimizing breast cancer prevention, and improving breast cancer survival.
Collapse
|
34
|
Sweeney FC, Demark-Wahnefried W, Courneya KS, Sami N, Lee K, Tripathy D, Yamada K, Buchanan TA, Spicer DV, Bernstein L, Mortimer JE, Dieli-Conwright CM. Aerobic and Resistance Exercise Improves Shoulder Function in Women Who Are Overweight or Obese and Have Breast Cancer: A Randomized Controlled Trial. Phys Ther 2019; 99:1334-1345. [PMID: 31309977 PMCID: PMC6821226 DOI: 10.1093/ptj/pzz096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/09/2019] [Accepted: 02/27/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. OBJECTIVE The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. DESIGN This study was a randomized controlled trial. SETTING The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. PARTICIPANTS One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. INTERVENTION The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. MEASUREMENTS Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. RESULTS Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2-20.7°], external rotation at 0° = 23.4° [95% CI = 31.1-12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9-26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. LIMITATIONS Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). CONCLUSIONS A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.
Collapse
Affiliation(s)
- Frank C Sweeney
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | | | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimiko Yamada
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California
| | - Darcy V Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope, Duarte, California
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope
| | - Christina M Dieli-Conwright
- Department of Supportive Care Medicine, City of Hope, 1500 East Duarte Road, Duarte, CA 91010 (USA),Address all correspondence to Dr Dieli-Conwright at:
| |
Collapse
|
35
|
Pan K, Aragaki AK, Neuhouser ML, Simon MS, Luo J, Caan B, Linda S, Mortimer JE, Manson JE, Kroenke C, Lane D, Reding K, Rohan TE, Chlebowski RT. Low-fat dietary pattern and breast cancer mortality by metabolic syndrome degree: Secondary analyses of the Women’s Health Initiative (WHI) Dietary Modification randomized trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1539 Background: The WHI Diet Modification (DM) trial randomized 48,835 postmenopausal women with no prior breast cancer to a low-fat dietary intervention or comparison group. After 16.1 years follow-up, the intervention was associated with an 18% reduction in risk of death after breast cancer (P =0.01), with greater reduction (29%) in those with waist circumference≥88 cm (J Clin Oncol 2017). To extend these findings, we examined the influence of the dietary intervention on breast cancer mortality in subgroups defined by number of metabolic syndrome (MS) components with 19.6 years median cumulative follow-up. Methods: WHI DM has been previously described. Four MS components were determined at entry: 1) waist circumference≥ 88 cm, 2) high blood pressure or anti-hypertensive use, 3) high cholesterol history and 4) diabetes history, with women categorized as having 0 (n=10,639), 1-2 (n=30,948), or 3-4 (n=4,246) MS components. Forest plots of hazard ratios (HRs) were generated with P-values for interaction between randomized group assignment and number of MS components. Results: Women with 3-4 MS components were more likely to be Black, be obese (BMI ≥30), and have diabetes (all P < 0.001). Breast cancers in women with 3-4 MS components were less likely to be local stage (P = 0.005) or well differentiated (P = 0.03). The magnitude of reduction in deaths from breast cancer in the dietary intervention vs comparison group increased as the number of MS components increased (interaction P = 0.01). Hazard ratios (HR) and 95% confidence intervals (CI) for death from breast cancer for intervention vs comparison groups for women with 0 MS components was 1.09 95% CI, 0.63-1.87, with risk low in both randomization groups (0.028% and 0.026%, respectively); for women with 1-2 MS components, HR 0.80 95% CI 0.62-1.02; and for women with 3-4 MS components, HR 0.31 95% CI, 0.14-0.69, with risk in the intervention group reduced to 0.026%. Conclusions: Adoption of a low-fat dietary pattern had a greater effect on reducing deaths from breast cancer in women with more MS components, suggesting that this is a high risk group more likely to benefit from the dietary intervention. Clinical trial information: NCT00000611.
Collapse
Affiliation(s)
- Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Michael S. Simon
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Juhua Luo
- University of Indiana, Bloomington, IN
| | | | | | | | - JoAnn E Manson
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | - Dorothy Lane
- State University of New York at Stony Brook, Stony Brook, NY
| | - Kerryn Reding
- Fred Hutchinson Cancer Research Center & University of Washington, School of Nursing, Seattle, WA
| | | | | |
Collapse
|
36
|
Sedrak MS, Hurria A, Li D, George K, Padam S, Liu J, Wong AR, Vargas N, Eskandar J, Katheria V, Mortimer JE, Mohile SG, Dale W. Barriers to clinical trial enrollment of older adults with cancer: A systematic review. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18130 Background: Despite the disproportionate impact of cancer on older adults, older patients are vastly underrepresented in clinical trials that set the standards for cancer treatment. To better understand the reasons for this disparity, we conducted a systematic review of studies that have specifically examined barriers and interventions to improve clinical trial enrollment of older adults with cancer. Methods: We conducted a comprehensive two-step search strategy. First, we consulted an information specialist to develop an electronic search for the following databases from inception to January 15, 2019: PubMed, Ovid/Medline, Embase, Scopus, PsycINFO, and Cochrane library. Second, references of retrieved key articles were screened for relevant studies. Two authors then independently reviewed all titles and abstracts (N = 10,985) and examined studies for full text eligibility (N = 221). Inclusion criteria were: 1) original research; 2) study assessed barriers and/or interventions to enrollment in oncology clinical trials; 3) included patients ≥ 60 years with cancer. Narrative reviews and abstracts without full text were excluded. Data was extracted by independent raters and summarized using a qualitative analysis software, NVivo v12. Results: 12 observational studies examining barriers and 1 randomized intervention were included. Barriers were assessed at the patient level (N = 5 studies), healthcare professional (HCP) level (N = 5), and both patient and HCP levels (N = 2). Stringent eligibility criteria (N = 7) and oncologists’ concerns for toxicity (N = 7) were the most common barriers cited. Patient barriers included transportation (N = 6), time/burden (N = 6), and awareness (N = 6). Although caregiver barriers (N = 4) were identified, none of the studies examined caregiver perceptions. One study evaluated a physician-directed educational intervention and found no significant impact on accrual of older adults. Conclusions: Although several studies have examined the barriers to accrual of older adults with cancer, only one intervention study has attempted to address these barriers. Given the aging of the cancer population, new strategies for including older adults in cancer clinical trials are critically needed.
Collapse
Affiliation(s)
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA
| | | | - Noel Vargas
- City of Hope National Medical Center, Duarte, CA
| | - Joy Eskandar
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
37
|
Lee-Bitar JS, Frankel PH, Yost SE, Synold TW, Martinez N, Tang A, Schmolze D, Apple S, Hurria A, Waisman JR, Somlo G, Patel NT, Sedrak MS, Mortimer JE, Yuan Y. A phase II clinical trial of pembrolizumab and selective androgen receptor modulator GTx-024 in patients with advanced androgen receptor-positive triple-negative breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1069 Background: Androgen receptor (AR) targeting therapy has shown single agent activity in triple negative breast cancer (TNBC). GTx-024, a nonsteroidal selective androgen receptor modulator (SARM), demonstrated preclinical and clinical activity in AR+ breast cancer. The current study is designed to test the safety and efficacy of GTx-024 and pembrolizumab in patients with AR+ metastatic TNBC (mTNBC). Methods: This is an open-label phase 2 study for AR+ mTNBC. Eligible participants receive pembrolizumab 200mg IV every 3 weeks in combination with GTx-024 18mg po daily. Key eligibility criteria include patients with AR+ ( > 10%, 1+ by IHC); mTNBC; ECOG 0-1; measurable disease per RECIST 1.1. Patients are excluded if they had prior checkpoint inhibitors or AR targeted agents. The primary objective is to evaluate the tolerability of GTx-024 and pembrolizumab, and determine the response rate. Results: Seventeen patients were enrolled in the study. One patient was ineligible due to previously undiagnosed brain metastases. Ten of 16 patients had visceral metastasis (lung or liver), and 15% of patients had received ≥ 3 previous lines of therapy for mTNBC. Among 16 patients evaluable for response, 2 patients achieved a best response of partial response (PR), 2 patient had stable disease (SD, 18 and 19 weeks ), 11 patients had progressive disease (PD), and 1 patient is too early for restaging imaging. Durable response was found in 1 patient. Grade 3 toxicities include 1 diarrhea and 1 dry skin. Grade 2 adverse events include 3 elevated liver function, 1 adrenal insufficiency, 1 hyperthyroidism, 1 palpitation, 1 diarrhea, 1 hyperhydrosis, 1 hot flashes and 1 headache. Three patients had dose delay and two patients had dose reduction. Conclusions: AR targeted therapy GTx-024 combined with pembrolizumab is well tolerated with clinical activity. Clinical trial information: NCT02971761.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Dan Schmolze
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sophia Apple
- City of Hope National Medical Center, Duarte, CA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | - Yuan Yuan
- City of Hope Cancer Center, Duarte, CA
| |
Collapse
|
38
|
Wong AR, Hurria A, Sun V, Li D, George K, Liu J, Padam S, Katheria V, Waisman JR, Mortimer JE, Mohile SG, Dale W, Sedrak MS. Barriers and facilitators to oncology clinical trial accrual: Comparing perceptions of community and academic oncologists. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18131 Background: Multiple studies have described the barriers and facilitators to oncology clinical trial accrual in academic practices. However, few studies have been done in community settings, even though the majority of patients with cancer receive their care in the community. We examined and compared community and academic oncologists’ perceptions of the barriers and facilitators to cancer clinical trial accrual. Methods: Semi-structured interviews were conducted from March to June 2018 with 44 medical oncologists at City of Hope (24 in academia; 20 in community sites). Purposive sampling was used to ensure participant diversity. Primary measures were oncologists’ self-reported perceptions of the barriers and facilitators to clinical trial accrual. Responses were recorded digitally, transcribed, and de-identified. Data was managed using NVivo v12. Two analysts coded the interview data using thematic content analysis (kappa = 0.74). A third analyst adjudicated discrepancies. Results: Of the 44 participants, 36% were women, and 68% had > 10 years of experience. Compared to academic oncologists, community oncologists more often cited barriers due to the lack of protocols suitable for community patients’ histology and stage (13% vs. 6%) and insufficient trial personnel support (13% vs. 9%). Compared to community oncologists, academic oncologists more often cited barriers due to limited time (14% vs. 8%) and overly stringent eligibility criteria (14% vs. 9%). Community oncologists more commonly reported extrinsic facilitators (e.g. reminders of available protocols from trial support staff) (91% vs. 76%) while academic oncologists more commonly reported intrinsic facilitators for offering clinical trials (e.g. self-motivation to prioritize clinical trials) (24% vs. 9%). Conclusions: Community oncologists more often reported facing barriers to accrual due to limited suitable trials and insufficient personnel support compared to academic oncologists. Additionally, community oncologists cite the need for more infrastructure to support accrual. Interventions to increase trial accrual must be tailored to address the unique needs of both community and academic practices.
Collapse
Affiliation(s)
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - Virginia Sun
- City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
| | | |
Collapse
|
39
|
Cristea MC, Frankel PH, Synold TW, Mortimer JE, Stewart DB, Wang EW, Jung A, Wilczynski SP, Konecny GE, Parungao D, Eng M, Kilpatrick L, Chen YJ, Glaser S, Han ES, Dellinger TH, Hakim A, Lee S, Morgan R, Wakabayashi MT. A phase I study of mirvetuximab soravtansine (IMGN853) and gemcitabine (G) in patients with FOLR1-positive recurrent epithelial ovarian (EOC), endometrial cancer (EC), or triple-negative breast cancer (TNBC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3009 Background: IMGN853 is an antibody-drug conjugate targeting the folate receptor alpha (FOLR1), linked to maytansinoid, DM4. IMGN853 has promising single agent activity in FOLR1+ EOC. The recommended phase 2 dose (RP2D) is 6 mg/kg, based on adjusted ideal body weight (AIBW) IV every 3 wks. This study evaluates IMGN853 and G. Methods: Patients (pts) with FOLR1+ tumors including: platinum resistant EOC with ≤4 prior chemotherapy (CT) regimens, EC with ≤2 CT and TNBC ≤4 CT are eligible. FOLR1 + is defined as ≥25% of tumor staining (all tumors) ≥2+ intensity (EOC, EC) and ≥1+ (TNBC). A standard 3+3 design combines IMGN853 and G. EOC pts undergo one research biopsy to assess intratumoral vs. circulating DM4 level and biopsy vs. archival tissue FOLR1 expression. Dose-limiting toxicity (DLT) is assessed during cycle 1. Responses as per RECIST 1.1 are assessed at 12 wks. and adverse events (AEs) are evaluated by CTCAE v4.0. Results: From 10/2017 to 1/2019 a total of 15 pts. were treated (3 additional pts have consented on dose level [DL] 4):10 EOC, 3 EC and 2 TNBC. One pt. on DL1 had grade (G) 4 thrombocytopenia (PLT) DLT. Three pts were inevaluable for DLT and were replaced: 1 pt. at DL1 with G4 neutropenia without fever of unknown duration due to delayed follow up blood work, 1 pt. at DL2 and 1 pt. at DL3 due to incomplete cycle 1. No DLTs were observed on DL2-3. Day 8 cycle 1 dose modifications were required in 3 of 4 patients on DL3 (for mucositis [1 pt.], and PLT [2 pts]). We are now enrolling at the RP2D for both agents, and MTD will be determined prior to May 2019. Conclusions: IMGN853 in combination with G is achievable at clinically relevant doses and the recommended Phase 2 dose and MTD will be reported. Support: NCCN grant; with support from ImmunoGen Corp and Cancer Center Support Grant P30CA033572. Clinical trial information: NCT02996825. [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dia Parungao
- City of Hope National Medical Center, Duarte, CA
| | - Melissa Eng
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | | | | | - Stephen Lee
- City of Hope National Medical Center, Duarte, CA
| | | | | |
Collapse
|
40
|
Sedrak MS, Hurria A, Sun V, Li D, Liu J, George K, Wong AR, Padam S, Katheria V, Mohile SG, Waisman JR, Dale W, Mortimer JE, Dizon DS. Social media for oncology clinical trial recruitment: Oncologists’ attitudes and perceptions. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18066 Background: Social media may be an effective strategy to improve public awareness of oncology clinical trials and increase accrual. How oncologists perceive the role of social media in clinical trials now and in the future remains unknown. We explored oncologists’ attitudes and perceptions related to social media and clinical trial recruitment. Methods: Semi-structured interviews were conducted with 44 medical oncologists at City of Hope from March to June 2018. Primary measures were oncologists’ self-reported benefits, concerns, and future interventions to leverage social media for trial recruitment. Secondary measures were facilitators and barriers to social media use for professional purposes. Responses were recorded digitally, transcribed, and de-identified. Data was managed using NVivo v12. Two analysts coded interview data using thematic content analysis (kappa = 0.7). Results: Of the 44 participants, 55% were academic and 45% were community oncologists, 36% were women, and 68% had > 10 years of experience. The most commonly cited benefit was increased awareness and visibility (63%). The most commonly cited concerns were: lack of time or support (31%), misinformation or oversimplification (31%), and lack of guidance (regulatory/ethical oversight) (28%). Oncologists reported a desire for an institutional-level intervention (e.g., personnel support with social media expertise) to facilitate trial recruitment using social media (50%). Oncologists’ perceptions of the facilitators to social media use for professional purposes were centered on networking (40%) and staying up to date in the field (33%). Perceived barriers were clustered around lack of comfort, training, time (38%), and lack of evidence of benefit (25%). No differences were identified between academic and community oncologists. Conclusions: Oncologists are hopeful that social media can increase awareness and visibility of cancer clinical trials. However, they have numerous concerns about the application of social media in clinical trials due to lack of time, support, and risk of misinformation. Further research is needed to examine whether social media can facilitate recruitment to oncology clinical trials.
Collapse
Affiliation(s)
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - Virginia Sun
- City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA
| | | | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
| | | | | |
Collapse
|
41
|
Abstract
Purpose of Review Obesity is a recognized risk factor for the development of breast cancer and recurrence even when patients are treated appropriately. We reviewed the literature that addresses the impact of obesity on diagnosis and the individual therapeutic interventions, and present a summary of the findings. Recent Findings Compared to non-obese women with breast cancer, obese women with breast cancer have a worse disease-free and overall survival despite appropriate local and systemic therapies. In brief, obese breast cancer patients experience more complications related to surgery, radiation, and chemotherapy. Further, obese patients are at increased risk for local recurrence compared to normal-weight women. Similarly, systemic chemotherapy is less effective, even when dosed appropriately on the basis of actual weight. Overall, endocrine therapy is less effective in obese women, and there is a suggestion that aromatase inhibitors may be selectively less effective than tamoxifen. Obese women are less likely to undergo breast reconstruction than normal-weight women, and those who do have surgery experience more surgical complications. Summary The efficacy of cancer treatments is significantly lower in obese breast cancer survivors, posing greater challenges in patient care and disease management in this patient population. Further investigations are warranted to assess the effects on treatment outcomes and optimize therapeutic mechanisms in order to successfully target breast cancer associated with obesity.
Collapse
Affiliation(s)
- Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC), 1540 E. Alcazar Street, CHP 155, Los Angeles, CA, 90033, USA
| | - Laura Kruper
- Department of Surgical Oncology, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC), 1540 E. Alcazar Street, CHP 155, Los Angeles, CA, 90033, USA
| | - Joanne E Mortimer
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer, 1500 E Duarte Rd, Duarte, CA, 91010, USA. .,Department of Medical Oncology & Experimental Therapeutics, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
| |
Collapse
|
42
|
Mortimer JE, Bading JR, Frankel P, Tumyan L, Tran TT, Rockne RC, Shively JE, Gidwaney N, Park J, Colcher DM. Abstract PD4-12: Use of 64Cu-DOTA-trastuzumab positron emission tomography (PET) to predict response to ado-trastuzumab emtansine (TDM1). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd4-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We have demonstrated that 64Cu-DOTA trastuzumab is an effective PET imaging agent for HER2 positive breast cancer and are now seeking to evaluate the methodology for prediction of response and benefit to ado-trastuzumab emtansine (TDM1) in women with metastatic disease.
Methods: Patients with metastatic breast cancer were eligible if they had biopsy confirmed HER2 + disease, at least 1 site of metastasis 2.0 cm or larger outside the biopsy site, and were to receive TDM1 as therapy. Pretreatment staging included 18F-FDG/PET. Prior to injection of 64Cu-DOTA-trastuzumab, patients received 45 mg of cold trastuzumab to reduce liver uptake. PET-CT scans were obtained at 21-25 h and 47-48 h over fields of view chosen in reference to 18F-FDG scans. TDM1 was administered at a dose of 3.6 mg/kg every 3 weeks. Restaging 18F-FDG/PET was performed every 2 cycles, and response to therapy was determined by PERCIST criteria. The radiolabel uptake was measured in terms of maximum voxel standardized uptake value (SUVmax).
Results: Ten women enrolled on study and are evaluable for response; three continue on TDM1 for 22-40 months and four patients remained on treatment for at least 1 year. The median age was 54.5 years (48-83 years); seven received prior trastuzumab-containing chemotherapy 3 wks to 55 months prior to study entry. HER2 was positive by IHC in 5 and by FISH in 5 (3 were 2+ by IHC; 1 was 1+ and 1 indeterminate). Complete or partial metabolic response was observed in 5 patients. Patients had their average SUVmax on 64Cu-DOTA trastuzumab PET (aSUVmax) assessed in addition to individual assessments on up to 8 lesions on both Day1 and Day2. The mean aSUVmax was (6.3, 8.8) for responding patients and (4.4, 5.2) for non-responder (day1, day2). The difference between responders and non-responders on Day1 aSUVmax was marginally significant (p=0.06), but significant on Day2 (p=0.04). The three highest aSUVmax on both day1 and day2 were three of the four patients with PFS>1 year. Data on the relationship of 64Cu-DOTA trastuzumab PET to IHC and FISH, and individual lesion SUVmax including evidence suggesting a potential threshold effect will be presented.
Conclusions: In women with biopsy confirmed HER2 positive metastatic disease, 64Cu-DOTA-trastuzumab PET imaging is predictive for response to TDM1.
Citation Format: Mortimer JE, Bading JR, Frankel P, Tumyan L, Tran TT, Rockne RC, Shively JE, Gidwaney N, Park J, Colcher DM. Use of 64Cu-DOTA-trastuzumab positron emission tomography (PET) to predict response to ado-trastuzumab emtansine (TDM1) [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 PD4-12.
Collapse
|
43
|
Soto-Perez-de-Celis E, Vazquez J, Kim H, Sun CL, Somlo G, Yuan Y, Waisman JR, Mortimer JE, Kruper L, Taylor L, Patel NH, Moreno J, Charles K, Roberts E, Uranga C, Levi A, Katheria V, Paredero-Perez I, Mitani D, Hurria A. Abstract P6-16-04: A self-administered geriatric assessment tool for Spanish-speaking older women with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-16-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Almost a quarter of older adults in the United States will identify themselves as Hispanic/Latino by 2060. Our group has previously developed and validated a self-administered geriatric assessment tool which can be used to identify functional, psychological, social and cognitive impairments among older patients with various types of cancer. Among English-speaking older adults, completing this tool using paper/pencil or a tablet takes a median of 15-21 minutes (min), with < 10% needing assistance to answer it (Hurria, JOP 2016). However, the utilization of this tool among Spanish-speaking older adults has not been tested. We assessed the feasibility of administering a translated and validated Spanish version of our geriatric assessment tool for older Hispanic women with breast cancer, and identified their preferred format (tablet or paper/pencil).
Methods: Spanish-speaking women aged ≥ 65 years with a diagnosis of breast cancer completed the geriatric assessment twice on the same day. Patients were randomized into 3 groups: paper/pencil twice; tablet and paper/pencil in random order; and tablet twice. We assessed the proportion of patients requiring assistance to complete the geriatric assessment, the time needed to complete it, and the proportion of patients who thought the geriatric assessment was difficult/very difficult.
Results: 140 older women with breast cancer completed the geriatric assessment twice and were evaluable. Mean age was 71.6 years (SD 5.8), 53% had ≤ 8th grade education, 43% were married, 45% were retired, 32% were homemakers, and 6% were employed. The participants came from 13 different Spanish-speaking countries, although 70% were born in Mexico. For 90%, Spanish was their primary language, and 75% spoke only in Spanish at home. Regarding computer skills, 64% of the patients said they had none. 39% (n = 54) were unable to complete the geriatric assessment on their own; mean time to complete the geriatric assessment was 29 min (range 8-90); and 28% (n = 39) thought the geriatric assessment was difficult/very difficult. The most common reasons for needing assistance were difficulty understanding questions (39%) and visual problems (31%). Patients with ≤ 8th grade education took longer to complete the geriatric assessment (mean 37.2 vs 29.4 min, p < 0.01), and more often needed help completing the assessment (51% vs 19%, p < 0.01) than those with ≥9th grade education. 53% of the participants preferred using a tablet to answer the geriatric assessment, while 47% preferred paper/pencil.
Conclusions: A substantial proportion of Spanish-speaking older women with breast cancer required assistance to complete our self-administered geriatric assessment tool. This may be a consequence of the low educational level we found among this patient population. Tailoring assessments for diverse populations with particular attention to educational level is needed in multicultural settings.
Citation Format: Soto-Perez-de-Celis E, Vazquez J, Kim H, Sun C-L, Somlo G, Yuan Y, Waisman JR, Mortimer JE, Kruper L, Taylor L, Patel NH, Moreno J, Charles K, Roberts E, Uranga C, Levi A, Katheria V, Paredero-Perez I, Mitani D, Hurria A. A self-administered geriatric assessment tool for Spanish-speaking older women with breast cancer [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 P6-16-04.
Collapse
Affiliation(s)
- E Soto-Perez-de-Celis
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - J Vazquez
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - H Kim
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - C-L Sun
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - G Somlo
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - Y Yuan
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - JR Waisman
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - JE Mortimer
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - L Kruper
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - L Taylor
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - NH Patel
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - J Moreno
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - K Charles
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - E Roberts
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - C Uranga
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Levi
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - V Katheria
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - I Paredero-Perez
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - D Mitani
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Hurria
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| |
Collapse
|
44
|
Mortimer JE, Shively JE. Functional Imaging of Human Epidermal Growth Factor Receptor 2-Positive Breast Cancers and a Note about NOTA. J Nucl Med 2018; 60:23-25. [PMID: 30573641 DOI: 10.2967/jnumed.118.220905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Joanne E Mortimer
- City of Hope Comprehensive Cancer Center/Beckman Research Institute, Duarte, California
| | - John E Shively
- City of Hope Comprehensive Cancer Center/Beckman Research Institute, Duarte, California
| |
Collapse
|
45
|
Dieli-Conwright CM, Sweeney FC, Courneya KS, Tripathy D, Sami N, Lee K, Buchanan TA, Spicer D, Bernstein L, Mortimer JE, Demark-Wahnefried W. Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise in survivors of breast cancer. Cancer 2018; 125:910-920. [PMID: 30500981 PMCID: PMC7164690 DOI: 10.1002/cncr.31879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/21/2018] [Accepted: 10/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. METHODS A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28-week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). CONCLUSIONS HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS.
Collapse
Affiliation(s)
- Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California.,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Frank C Sweeney
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope, Duarte, California
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | | |
Collapse
|
46
|
Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, Stewart C, Buchanan TA, Spicer D, Tripathy D, Bernstein L, Mortimer JE. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res 2018; 20:124. [PMID: 30340503 PMCID: PMC6194749 DOI: 10.1186/s13058-018-1051-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/13/2018] [Indexed: 01/12/2023] Open
Abstract
Background Exercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors. Methods One hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65–85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis. Results At post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7; p < 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO2max (p < 0.001), muscular strength (p < 0.001), osteocalcin (p = 0.01), and BSAP (p = 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group (p < 0.01). Conclusions A 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care. Trial registration This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010.
Collapse
Affiliation(s)
- Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA. .,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Frank C Sweeney
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Christina Stewart
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, USC, Los Angeles, CA, 90033, USA
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope (COH), Duarte, CA, 91010, USA
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, COH, Duarte, CA, 91010, USA
| |
Collapse
|
47
|
Blenman KRM, He TF, Frankel PH, Ruel NH, Schwartz EJ, Krag DN, Tan LK, Yim JH, Mortimer JE, Yuan Y, Lee PP. Sentinel lymph node B cells can predict disease-free survival in breast cancer patients. NPJ Breast Cancer 2018; 4:28. [PMID: 30155518 PMCID: PMC6107630 DOI: 10.1038/s41523-018-0081-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022] Open
Abstract
Tumor invasion into draining lymph nodes, especially sentinel lymph nodes (SLNs), is a key determinant of prognosis and treatment in breast cancer as part of the TNM staging system. Using multicolor histology and quantitative image analysis, we quantified immune cells within SLNs from a discovery cohort of 76 breast cancer patients. We found statistically more in situ CD3+ T cells in tumor negative vs. tumor positive nodes (mean of 8878 vs. 6704, respectively, p = 0.006), but no statistical difference in CD20+ B cells or CD1a+ dendritic cells. In univariate analysis, a reduced hazard was seen with a unit increase in log CD3 with HR 0.49 (95% CI 0.30–0.80) and log CD20 with HR 0.37 (95% CI 0.22–0.62). In multivariate analysis, log CD20 remained significant with HR 0.42 (95% CI 0.25–0.69). When restricted to SLN tumor negative patients, increased log CD20 was still associated with improved DFS (HR = 0.26, 95% CI 0.08–0.90). The CD20 results were validated in a separate cohort of 21 patients (n = 11 good outcome, n = 10 poor outcome) with SLN negative triple-negative breast cancer (TNBC) (“good” mean of 7011 vs. “poor” mean of 4656, p = 0.002). Our study demonstrates that analysis of immune cells within SLNs, regardless of tumor invasion status, may provide additional prognostic information, and highlights B cells within SLNs as important in preventing future recurrence. B cells within the tumor-draining lymph nodes may have an important biological role in preventing relapse of breast cancer. A team led by Peter Lee from City of Hope in Duarte, California, USA, quantified the levels of three populations of immune cells—T cells, B cells and dendritic cells—within sentinel lymph nodes biopsied from a cohort of 76 patients. They found that larger numbers of T cells and B cells were both linked to longer progression-free survival in the women. However, after statistically accounting for correlations between the two immune cell types, the researchers concluded that B cells had the dominant beneficial effect on survival times. They validated the finding that high B-cell counts are a prognostic indicator of better outcomes in a separate cohort of 21 women with triple-negative breast cancer.
Collapse
Affiliation(s)
- Kim R M Blenman
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA.,8Present Address: Department of Dermatology, Yale University, New Haven, CT USA
| | - Ting-Fang He
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Paul H Frankel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Nora H Ruel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Erich J Schwartz
- 3Department of Pathology, Stanford University, Stanford, CA USA.,9Present Address: Department of Pathology, Beaumont Health, Farmington Hills, MI USA
| | - David N Krag
- 4Department of Surgery, University of Vermont College of Medicine, Burlington, VT USA
| | - Lee K Tan
- 5Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - John H Yim
- 6Department of Surgery, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Joanne E Mortimer
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Yuan Yuan
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Peter P Lee
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
| |
Collapse
|
48
|
Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Buchanan TA, Spicer D, Tripathy D, Bernstein L, Mortimer JE. Reply to E. Parkin et al. J Clin Oncol 2018; 36:2129-2130. [PMID: 29847294 DOI: 10.1200/jco.2018.78.7754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christina M Dieli-Conwright
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Kerry S Courneya
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Wendy Demark-Wahnefried
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Nathalie Sami
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Kyuwan Lee
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Thomas A Buchanan
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Darcy Spicer
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Debu Tripathy
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Leslie Bernstein
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| | - Joanne E Mortimer
- Christina M. Dieli-Conwright, University of Southern California Los Angeles, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy Spicer, University of Southern California Los Angeles, CA; Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX; and Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA
| |
Collapse
|
49
|
Pan K, Nelson R, Wactawski-Wende J, Lee DJ, Manson JE, Mortimer JE, Phillips LS, Rohan T, Ho GY, Saquib N, Shadyab AH, Nassir R, Rhee JJ, Hurria A, Chlebowski RT. Abstract 4944: Insulin resistance and long-term cancer-specific and all-cause mortality: The Women's Health Initiative (WHI). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Elevated insulin resistance has been associated with multiple morbid conditions. To our review, only one cohort study has evaluated insulin resistance and all-cause mortality in a general population (Pyorala 2000).
Objective: To examine associations of insulin resistance with long-term cancer-specific and all-cause mortality in postmenopausal women.
Methods: Included were 22,837 postmenopausal women aged 50-79 from the WHI cohort without prior cancer and with available fasting glucose and insulin levels. Using multivariate Cox proportional hazard models, we compared cancer-specific and all-cause mortality across quartiles of insulin resistance estimated by the homeostasis model assessment-insulin resistance (HOMA-IR) index.
Results: Women in the highest HOMA-IR quartile were less educated, had higher BMI and waist circumference, were more likely to be Black, and were more likely to have hypertension than those in lower HOMA-IR quartiles. Women in the highest quartile were also significantly more likely to have a history of treated diabetes than those in lower quartiles (23.5% in Q4 versus 0.6% in Q1). After a median follow-up of 18.1 years, cancer-specific and all-cause mortality were significantly higher in the highest HOMA-IR quartile compared to the lowest (HR 1.25, 95% CI 1.07-1.46 and HR 1.62, 95% CI 1.50-1.75, respectively) (Table 1). In a sensitivity analysis excluding women with treated diabetes (remaining n=21,104), all-cause mortality findings were similar (HR 1.36, 95% CI 1.25-1.48, p<0.0001). Specific causes of the 7,194 total deaths were cancer (1,786, 25%), cardiovascular disease (2,458, 34%), Alzheimer's/dementia (549, 8%), other (2,041, 28%), and unknown (360, 5%).
Conclusion: Insulin resistance by HOMA-IR index identifies a substantial, previously under-recognized population of postmenopausal women at increased risk for cancer-specific and all-cause mortality who could potentially benefit from early intervention.
Table 1. Adjusted* HRs for cancer-specific and all-cause mortality by HOMA-IR quartilesHOMA-IR QuartilesNCancer Specific Mortality HR (95% CI) P valueAll Cause Mortality HR (95% CI) P valueQ1: 0.04-1.0857071.0 (reference)0.04311.0 (reference)<0.0001Q2: 1.09-1.7657131.11 (0.97-1.28)1.13 (1.05-1.21)Q3: 1.77-3.0257161.17 (1.01-1.36)1.20 (1.11-1.29)Q4: 3.03-40357011.25 (1.07-1.46)1.62 (1.50-1.75)*Adjusted for education level, BMI, age at menopause, parity, alcohol consumption, and Gail score
Citation Format: Kathy Pan, Rebecca Nelson, Jean Wactawski-Wende, Delphine J. Lee, JoAnn E. Manson, Joanne E. Mortimer, Lawrence S. Phillips, Thomas Rohan, Gloria Y. Ho, Nazmus Saquib, Aladdin H. Shadyab, Rami Nassir, Jinnie J. Rhee, Arti Hurria, Rowan T. Chlebowski. Insulin resistance and long-term cancer-specific and all-cause mortality: The Women's Health Initiative (WHI) [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 4944.
Collapse
Affiliation(s)
- Kathy Pan
- 1Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | - Delphine J. Lee
- 1Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | | | - Thomas Rohan
- 6Albert Einstein College of Medicine, New York, NY
| | - Gloria Y. Ho
- 7Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY
| | - Nazmus Saquib
- 8College of Medicine, Sulaiman AlRajhi Colleges, Al-Qassim, Saudi Arabia
| | | | - Rami Nassir
- 10Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - Arti Hurria
- 2City of Hope National Medical Center, Duarte, CA
| | | |
Collapse
|
50
|
Lee K, Kang I, Mortimer JE, Sattler F, Mack WJ, Fitzsimons LA, Salem G, Dieli-Conwright CM. Effects of high-intensity interval training on vascular function in breast cancer survivors undergoing anthracycline chemotherapy: design of a pilot study. BMJ Open 2018; 8:e022622. [PMID: 29961039 PMCID: PMC6042553 DOI: 10.1136/bmjopen-2018-022622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) mortality is higher among breast cancer survivors (BCS) who receive chemotherapy compared with those not receiving chemotherapy. Anthracycline chemotherapy is of particular concern due to anthracycline-related impairment of vascular endothelial cells and dysregulation of the extracellular matrix. One strategy proven to offset these impairments is a form of exercise known as high-intensity interval training (HIIT). HIIT improves endothelial function in non-cancer populations by decreasing oxidative stress, the main contributor to anthracycline-induced vascular dysfunction. The purpose of this pilot study is to assess the feasibility of an 8-week HIIT, as well as the HIIT effects on endothelial function and extracellular matrix remodelling, in BCS undergoing anthracycline chemotherapy. METHODS AND ANALYSIS Thirty BCS are randomised to either HIIT, an 8-week HIIT intervention occurring three times per week (seven alternating bouts of 90% of peak power output followed by 10% peak power output), or delayed group (DEL). Feasibility of HIIT is assessed by (1) the percentage of completed exercise sessions and (2) the number of minutes of exercise completed over the course of the study. Vascular function is assessed using brachial artery flow-mediated dilation and carotid intima media thickness. Extracellular matrix remodelling is assessed by the level of matrix metalloproteinases in the plasma. A repeated-measures analysis of covariance model will be performed with group (HIIT and DEL group) and time (pre/post assessment) as independent factors. We hypothesise that HIIT will be feasible in BCS undergoing anthracycline chemotherapy, and that HIIT will improve endothelial function and extracellular matrix remodelling, compared with the DEL group. Success of this study will provide evidence of feasibility and efficacy to support a larger definitive trial which will impact cancer survivorship by decreasing anthracycline-induced vascular dysfunction, thereby benefiting cardiovascular markers that are related to CVD risk. ETHICS AND DISSEMINATION This trial was approved by the University of Southern California Institutional Review Board (HS-15-00227). TRIAL REGISTRATION NUMBER NCT02454777; Pre-results.
Collapse
Affiliation(s)
- Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, California, USA
| | - Irene Kang
- Department of Medicine, University of Southern California (USC), Los Angeles, California, USA
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Fred Sattler
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, California, USA
- Department of Medicine, University of Southern California (USC), Los Angeles, California, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California (USC), Los Angeles, California, USA
| | | | - George Salem
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, California, USA
| | - Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, California, USA
- Department of Medicine, University of Southern California (USC), Los Angeles, California, USA
| |
Collapse
|