Abstract P6-10-04: “Disparities in breast cancer: A multi-institutional comparative analysis focusing on American Hispanics”

Background: Breast cancer (BC) is the leading cause of cancer death in Hispanic/Latina women nationwide. Hispanic women are more likely to be presented with advanced disease and might have adverse prognosis. Further, the Hispanics of Mexican-American origin might reflect different clinico-pathological characteristics as opposed to other Hispanics and ethnic groups. No previous largest studies comprised with Hispanics of Mexican-American origin explored tumor characteristics and compared to other ethnic groups. Thus, the aim of this study was to describe the clinico- pathological characteristics and disparities in breast cancer in this minority group at two tertiary care University- based medical centers in 2 states with a large Hispanic presence.

Methods: After IRB approval, cancer registry was used to analyze the variables of 3,441 patients with breast cancer diagnosed and treated consecutively at two large tertiary University based medical centers in El Paso, TX and Loma Linda, CA between 2005-2015. Unadjusted and adjusted associations of race/ethnicity with cancer stage, hormone receptor status and treatment option were investigated, as well as comparison to other ethnic groups.

Results: Overall 45.5% of the patients were Hispanic (n= 1566). Hispanics were more likely to be diagnosed at a younger age (57 years) compared to in non-Hispanic (NH) whites, more likely to have invasive ductal carcinoma type (82.7%) & triple negative disease (17.1%, 95%CI: 15% to 19%). 58.8% of Hispanics (95%CI: 56% to 61%) have HR+ & HER2- as opposed to 71% in NH whites. In addition, Hispanic individuals presented with advanced stages (III and IV) of BC (25.3%, 95% CI: 23% to 28%) similar to African Americans (25.4%), and had a lower proportion of lumpectomy versus mastectomy compared to NH whites (50%) but similar to African Americans (50%). Hispanic patients had the highest prevalence of triple negative BC (17.1% in Hispanics Versus 13.9 % in African Americans, versus 8.5% in NH whites). Hispanics also had significantly higher relative risk of HER2+/HR - disease (RRR=1.77, p<0.0001) compared to NH whites with no difference in African Americans (RRR= 1.21, p=0.56).

Conclusions: This large multi-institutional study shows that Hispanics are diagnosed with breast cancer at a younger age, have a higher prevalence of triple negative and HER2 positive/HR- breast cancer, are diagnosed at more advanced stages of disease and undergo less lumpectomies compared to NH whites. Increased efforts geared toward early detection, improving awareness and access to health care is desperately needed in this rapidly increasing minority in the U.S.

Citation Format: Otoukesh S, Nahleh Z, Mirshahidi HR, Nguyen AL, Botrus G, Badri N, Diab N, Alvarado A, Sanchez LA, Dwivedi A. “Disparities in breast cancer: A multi-institutional comparative analysis focusing on American Hispanics” [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-04.

Clinico-pathologic disparities of breast cancer in Hispanic/Latina women

BACKGROUND

Breast cancer is the leading cause of cancer death in Hispanic/Latina women nationwide. Limited cancer research has been conducted in this population. El Paso, Texas is a large border city with a population of around 900,000, of which 85% are Latinos and would provide a suitable setting for this study. The aim of this study is to evaluate ethnic differences and cancer characteristics in Hispanic/latina women with breast cancer.

METHODS

After IRB approval, we retrospectively analyzed the variables of patients with breast cancer treated consecutively at a large tertiary medical center in El Paso, TX between 2005-2015. Descriptive statistics, bivariate, and multivariable analyses were conducted.

RESULTS

1,252 patients were identified. Mean age at diagnosis was 57 years. 1074 were Hispanics/Latinas (86%). When comparing Hispanics versus non-Hispanics, 31% of Hispanics compared to 24% Non-Hispanics were diagnosed at age <50 (P = 0.043). More Hispanics are uninsured (34%) compared to Non-Hispanics (25%) (p = 0.008). Hispanics presenting with advanced stages were more likely to be uninsured (P = 0.02).

CONCLUSIONS

This analysis confirms that Hispanics/Latinas are diagnosed with breast cancer at a younger age and are more commonly uninsured than Non-Hispanics. We did not observe significant differences in the prevalence of ER+, triple negative or Her2 -neu positive disease or stages at presentation between the 2 groups in this cohort, however the non-Hispanic group was constituted only 14% of the studied population. A larger multi-institutional comparative study is being conducted to confirm these findings.

Two open-label, randomized, crossover studies assessing the bioequivalence of ofloxacin administered as immediateand extended-release formulations in healthy subjects

BACKGROUND

Ofloxacin is a fluoroquinolone agent available as an immediate-release (IR) tablet formulation administered twice daily. An extended-release (ER) formulation of ofloxacin has been developed for oncedaily administration.

OBJECTIVES

The present studies compared the pharmacokinetic (PK) and safety profiles of the ER and IR formulations of ofloxacin.

METHODS

Based on specific inclusion and exclusion criteria, healthy adult male and female volunteers were selected to receive single and multiple oral doses of ofloxacin ER 400 mg QD and ofloxacin IR 200 mg BID in 2 separate open-label, randomized, crossover studies. Multiple blood samples were collected, and plasma concentrations of ofloxacin were analyzed using a high-throughput liquid chromatography system. PK parameters were calculated using noncompartmental methods. Safety was assessed in the clinical pharmacology unit based on vital signs, electrocardiograms (ECGs), and reported adverse events. The relationship of an adverse event to study drugs (definitely, probably, possibly, remotely, or unrelated) was assessed by the principal investigator.

RESULTS

Forty healthy subjects were included in each study. Thirty-seven subjects (28 men, 9 women; mean age, 37 years; mean weight, 71.2 kg) completed the single-dose study, and 38 subjects (33 men, 5 women; mean age, 36 years; mean weight, 72.2 kg) completed the multiple-dose study. With the exception of 3 black subjects in each study of African-American origin, all subjects in both studies were white. The mean AUC(0-24) values for the ER formulation in the single-and multiple-dose studies (18.6 and 21.4 mg . h/L, respectively) were similar to those for the IR formulation (17.7 and 22.8 mg x h/L), with the 90% CIs falling between 80.0 and 125.0. Mean C(max) values for the ER formulation in the single- and multiple-dose studies (2.02 and 2.12 mg/L) were also similar to those for the IR formulation (1.74 and 1.85 mg/L). Under steady-state conditions, median T(max) values for the ER formulation were significantly longer than those for the IR formulation (5.00 vs 2.00 hours, respectively; P < 0.05). All vital signs and ECGs were within normal ranges during the single- and multipledose studies. Adverse events probably related to study drugs (eg, nausea, loose stools, emesis) were similar in nature and frequency between the 2 formulations. No serious adverse events were reported during either study.

CONCLUSION

In these 2 trials in a selected group of healthy adult male and female volunteers, the ER and IR formulations of ofloxacin displayed a similar rate and extent of bioavailability and comparable safety profiles.

Mobilisation of healthy donors with lenograstim and transplantation of HLA-genoidentical blood progenitors in 54 patients with hematological malignancies: a pilot study

Blood cell transplantation (BCT) is now common practice in the autologous setting. We performed a pilot study of allogeneic BCT, collected after the priming of an HLA-identical sibling with a glycosylated rhu-G-CSF (lenograstim) (10 microg/kg). Fifty-four patients were included (38 +/- 11; M/F = 33/21; CML (n = 17), AML (n = 14), ALL (n = 15); MDS (n = 8)). Transplant procedures were standard (TBI regimen = 47 (87%); MTX-CsA: n = 37; CsA-PDN: n = 17). No serious adverse events were reported in donors. A median of 11 (3.5-29.1) x 10(6)/kg CD34+ cells, 332 (33-820) x 10(6)/kg CD3+ cells were collected. Four patients did not engraft (early death: n = 2; graft failure: n = 2). Fifty-one patients initially recovered 0.5 x 10(9)/l ANC and 25 x 10(9)/l platelets at 15 (10-30) and 13 (9-188) days. 29/51 and 29/38 experienced grade > or =2 acute and chronic GVHD. With a median follow-up of 25 months (18-36), relapse rate is 16% +/- 8, survival and DFS probabilities are similar (50% +/- 13). A better outcome is documented for patients under 45 years and in the early phase of the disease (n = 28), with an identical survival and DFS of 71% +/- 13. In conclusion, lenograstim is a potent rhu-G-CSF for mobilisation of allogeneic hematopoietic progenitors. Two-year follow-up indicates good haematological recovery but some concerns about graft failure and chronic GVHD have arisen deserving prospective evaluation.

Mobilization of Philadelphia-negative peripheral blood progenitor cells with chemotherapy and rhuG-CSF in chronic myelogenous leukaemia patients with a poor response to interferon-alpha

The purpose of this cooperative study was to evaluate the quantity and quality of Ph1-negative progenitor cells mobilized in the peripheral blood of patients with chronic myelogenous leukaemia soon after aplasia induced by chemotherapy. 32 patients ineligible for allografting who were cytogenetically refractory to interferon-alpha (IFN-alpha) were entered into this study. The chronic phase varied widely, with a median duration of 17 months (range 3-90 months). All patients were treated with intensive conventional chemotherapy regimens and recombinant human granulocyte colony-stimulating factor (rhuG-CSF, lenograstim). Peripheral blood progenitor cells (PBPC) were harvested by leukaphereses during early recovery from chemotherapy-induced aplasia. A total of 119 leukaphereses were performed. Median numbers of CD34+ cells and CFU-GM collected were 2.04 x 10(6)/kg and 2 9 x 10(4)/kg, respectively. There was a significant correlation between white cell count and number of CD34+ cells in the leukaphereses (P = 0.0001, r2 = 0.41, n = 104). A strict correlation between the number of CD34+ cells and CFU-GM in the leukapheretic product (P = 0.0001, r2 = 0.39, n = 110) was observed. 21% of evaluable patients (6/29) achieved a complete cytogenetic remission in the leukapheretic product and the other four patients achieved a major cytogenetic response for an overall response of 35% (10/22 patients). To date, 16 patients have been autografted and are alive. Five of them are Ph1-negative (three patients) or partially Ph1-negative (two patients). In conclusion, despite the high-risk characteristics of this study population, Ph1-negative PBPC were successfully mobilized in more than one-quarter of patients using a chemotherapy plus rhuG-CSF regimen. The importance of this achievement is increased by the current lack of other practical methods of rescuing Ph-negative cells in such patients.

[Factors of severity in placental choriocarcinoma]

A retrospective study has been carried out on the poor prognostic features of a group of 57 patients. These are: the existence of extra-pelvic and extra-pulmonary metastases and a level of serum HCG above 200000. The most favourable prognostic signs are absence of these two factors in pregnancy that is not normal and a delay between the onset of the first diagnostic elements and treatment of less than 6 months.