Incidence and outcome of brain and/or leptomeningeal metastases in HER2-low metastatic breast cancer in the French ESME cohort

BACKGROUND

Breast cancer (BC) is the second most common cancer that metastasizes to the brain. Particularly up to half of patients with human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (mBC) may develop brain metastases over the course of the disease. Nevertheless, little is known about the prevalence and the outcome of brain and leptomeningeal metastases (BLMM) in HER2-low BC. We compared the cumulative incidence of BLMM and associated outcomes among patients with HER2-low, HER2-negative (HER2-) and HER2+ mBC.

PATIENTS AND METHODS

This cohort study was conducted from the Epidemiological Strategy and Medical Economics (ESME) mBC database and included patients treated for mBC between 2012 and 2020 across 18 French comprehensive cancer centers and with known HER2 and hormone receptor (HR) status. The cumulative incidence of BLMM after metastatic diagnosis was estimated using a competing risk methodology with death defined as a competing event.

RESULTS

19 585 patients were included with 6118 (31.2%), 9943 (50.8%) and 3524 (18.0%) being HER2-low, HER2- and HER2+ mBC, respectively. After a median follow-up of 48.6 months [95% confidence interval (CI) 47.7-49.3 months], BLMM were reported in 4727 patients: 1192 (25.2%) were diagnosed with BLMM at first metastatic diagnosis and 3535 (74.8%) after metastatic diagnosis. Multivariable analysis adjusted for age, histological grade, metastases-free interval and HR status showed that the risk of BLMM at metastatic diagnosis was similar in patients with HER2- compared to HER2-low mBC [odds ratio (OR) (95% CI) 1.00 (0.86-1.17)] and higher in those with HER2+ compared to HER2-low [OR (95% CI) 2.23 (1.87-2.66)]. Similar results were found after metastatic diagnosis; the risk of BLMM was similar in HER2- compared to HER2-low [subdistribution hazard ratio (sHR) (95% CI) 1.07 (0.98-1.16)] and higher in the HER2+ group [sHR (95% CI) 1.56 (1.41-1.73)].

CONCLUSIONS

The prevalence and evolution of BLMM in HER2-low mBC are similar to those in patients with HER2- tumors. In contrast to patients with HER2+ mBC, the prognosis of BLMM remains dismal in this population.

Tuning the Microenvironment of Water Confined in Ti3C2Tx MXene by Cation Intercalation

The local microenvironment has recently been found to play a major role in the electrocatalytic activity of nanomaterials. Modulating the microenvironment by adding alkali metal cations into the electrolyte can be used to either suppress hydrogen or oxygen evolution, thereby extending the electrochemical window of energy storage systems, or to tune the selectivity of electrocatalysts. MXenes are a large family of two-dimensional transition metal carbides, nitrides, and carbonitrides that have shown potential for use in electrochemical energy storage applications. Due to their negatively charged surfaces, MXenes can accommodate cations and water molecules between the layers. Nevertheless, the nature of the aqueous microenvironment in the MXene interlayer space is poorly understood. Here, we apply Fourier transform infrared spectroscopy (FTIR) to probe the hydrogen bonding of intercalated water in Ti3C2Tx as a function of intercalated cation and relative humidity. Substantial changes in the FTIR spectra after cation exchange demonstrate that the hydrogen bonding of water molecules confined between the MXene layers is strongly cation-dependent. Furthermore, the IR absorbance of the confined water correlates with resistivity estimated by 4-point probe measurements and interlayer distance calculated from XRD patterns. This work demonstrates that cation intercalation strongly modulates the confined microenvironment, which can be used to tune the activity or selectivity of electrochemical reactions in the interlayer space of MXenes in the future.

Surface-Mediated Charge Transfer of Photogenerated Carriers in Diamond

Solvated electrons are highly reductive chemical species whose chemical properties remain largely unknown. Diamond materials are proposed as a promising emitter of solvated electrons and visible light excitation would enable solar-driven CO2 or N2 reductions reactions in aqueous medium. But sub-bandgap excitation remains challenging. In this work, the role of surface states on diamond materials for charge separation and emission in both gaseous and aqueous environments from deep UV to visible light excitation is elucidated. Four different X-ray and UV-vis spectroscopy methods are applied to diamond materials with different surface termination, doping and crystallinity. Surface states are found to dominate sub-bandgap charge transfer. However, the surface charge separation is drastically reduced for boron-doped diamond due to a very high density of bulk defects. In a gaseous atmosphere, the oxidized diamond surface maintains a negative electron affinity, allowing charge emission, due to remaining hydrogenated and hydroxylated groups. In an aqueous electrolyte, a photocurrent for illumination down to 3.5 eV is observed for boron-doped nanostructured diamond, independent of the surface termination. This study opens new perspectives on photo-induced interfacial charge transfer processes from metal-free semiconductors such as diamonds.

Coordinative Stabilization of Single Bismuth Sites in a Carbon-Nitrogen Matrix to Generate Atom-Efficient Catalysts for Electrochemical Nitrate Reduction to Ammonia

Electrochemical nitrate reduction to ammonia powered by renewable electricity is not only a promising alternative to the established energy-intense and non-ecofriendly Haber-Bosch reaction for ammonia generation but also a future contributor to the ever-more important denitrification schemes. Nevertheless, this reaction is still impeded by the lack of understanding for the underlying reaction mechanism on the molecular scale which is necessary for the rational design of active, selective, and stable electrocatalysts. Herein, a novel single-site bismuth catalyst (Bi-N-C) for nitrate electroreduction is reported to produce ammonia with maximum Faradaic efficiency of 88.7% and at a high rate of 1.38 mg h-1 mgcat -1 at -0.35 V versus reversible hydrogen electrode (RHE). The active center (described as BiN2 C2 ) is uncovered by detailed structural analysis. Coupled density functional theory calculations are applied to analyze the reaction mechanism and potential rate-limiting steps for nitrate reduction based on the BiN2 C2 model. The findings highlight the importance of model catalysts to utilize the potential of nitrate reduction as a new-generation nitrogen-management technology based on the construction of efficient active sites.

Low-Volume Reaction Monitoring of Carbon Dot Light Absorbers in Optofluidic Microreactors

Optical monitoring and screening of photocatalytic batch reactions using cuvettes ex situ is time-consuming, requires substantial amounts of samples, and does not allow the analysis of species with low extinction coefficients. Hollow-core photonic crystal fibers (HC-PCFs) provide an innovative approach for in situ reaction detection using ultraviolet-visible absorption spectroscopy, with the potential for high-throughput automation using extremely low sample volumes with high sensitivity for monitoring of the analyte. HC-PCFs use interference effects to guide light at the center of a microfluidic channel and use this to enhance detection sensitivity. They open the possibility of comprehensively studying photocatalysts to extract structure-activity relationships, which is unfeasible with similar reaction volume, time, and sensitivity in cuvettes. Here, we demonstrate the use of HC-PCF microreactors for the screening of the electron transfer properties of carbon dots (CDs), a nanometer-sized material that is emerging as a homogeneous light absorber in photocatalysis. The CD-driven photoreduction reaction of viologens (XV²⁺) to the corresponding radical monocation XV^•+ is monitored in situ as a model reaction, using a sample volume of 1 μL per measurement and with a detectability of <1 μM. A range of different reaction conditions have been systematically studied, including different types of CDs (i.e., amorphous, graphitic, and graphitic nitrogen-doped CDs), surface chemistry, viologens, and electron donors. Furthermore, the excitation irradiance was varied to study its effect on the photoreduction rate. The findings are correlated with the electron transfer properties of CDs based on their electronic structure characterized by soft X-ray absorption spectroscopy. Optofluidic microreactors with real-time optical detection provide unique insight into the reaction dynamics of photocatalytic systems and could form the basis of future automated catalyst screening platforms, where samples are only available on small scales or at a high cost.

Capecitabine efficacy after cycline-dependent-kinase 4/6 inhibitor plus endocrine therapy in metastatic hormone receptor-positive breast cancer

BACKGROUND

The combination of endocrine treatment with cycline-dependent-kinase 4/6 inhibitor is the new standard of treatment in hormone receptor-positive HER2 negative metastatic breast cancer. The optimal subsequent treatment after CDK4/6 inhibitor remain unclear. As recommended by standard guidelines, capecitabine, an oral chemotherapy is a therapeutic option in endocrine resistant metastatic breast cancer. The objective of this study was to evaluate capecitabine efficacy after disease progression under combination of ET and CDK4/6 inhibitor in a hormone receptor positive metastatic breast cancer population.

PATIENTS AND METHODS

Patients progressing under CDK 4/6 inhibitor plus ET and treated with capecitabine, between January 2016 and December 2020, were retrospectively included. Primary endpoint was time to treatment failure (TTF) on capecitabine. Logistic regression were used to identify predictive factors: exclusive bone versus visceral metastases, first-line versus ≥ 2 lines of combination therapy, aromatase inhibitor (AI) versus fulvestrant.

RESULTS

Fifty-six patients with a 62-year median age (IC95% 42-81) were analyzed. The CDK 4/6 inhibitor and ET combination was prescribed in first-line setting in 26 patients (46%). Twenty-five patients (44%) had exclusive bone metastasis. Median TTF was 6.1 months. Six patients discontinued capecitabine due to toxicity. Outcomes were not significantly different regardless of metastases localization, ET, and treatment line of the combination of CDK 4/6 inhibitor and ET. Median PFS was 7.1 months. Median OS was 41.3 months.

CONCLUSION

Compared to other data of capecitabine prescribed in patients with hormonal resistant MBC, this retrospective study suggests that capecitabine remains effective after CDK 4/6 inhibitor plus ET progression, regardless of therapeutic-line setting and metastases localization.

MICRO ABSTRACT

Cycline dependant kinase 4/6 inhibitor plus endocrine therapy have become the standard of care in metastatic hormone receptor positive (HR+) breast cancer (BC). Few data reported the optimal subsequent therapy after progression under the combination. Capecitabine is a therapeutic option in endocrine resistant HR+/HER2- metastatic breast cancer. Data evaluating efficacy of capecitabine after disease progression on endocrine therapy plus cycline-dependant kinase 4/6 inhibitor are poor. This study showed a 6.1-month median time to treatment failure on capecitabine. Capecitabine remained effective regardless of therapeutic-line setting and metastases localization.

Efficacy of front-line treatment for hormone receptor-positive HER2-negative metastatic breast cancer with germline BRCA1/2 mutation

BACKGROUND

Efficacy of endocrine therapy in HR+/HER2- metastatic breast cancer could differ depending on the presence of BRCA1/2 germline mutation.

METHODS

The ESME metastatic breast cancer platform (NCT03275311) is a French real world database. Multivariable models including a time-varying approach and landmark analyses assessed the association between time-dependent gBRCA status (categorised as gBRCAm, gBRCAwt (wild type), and untested), overall survival (OS), and first-line progression-free survival (PFS1).

RESULTS

A total of 170 patients were gBRCAm carriers, 676 gBRCAwt, and 12,930 were untested at baseline. In the multivariable analysis, gBRCAm carriers overall had a lower OS compared to gBRCAwt (adjusted HR [95% CI] 1.26 [1.03-1.55]). gBRCAm patients treated with front-line endocrine therapy had lower adjusted OS (adjusted HR [95% CI] = 1.54 [1.03-2.32]) and PFS1 (adjusted HR [95% CI] 1.58 [1.17-2.12]) compared to gBRCAwt patients. However, for patients who received frontline chemotherapy, neither OS nor PFS1 differed between gBRCAm carriers and the other groups (HR versus gBRCAwt for OS: 1.12 [0.88-1.41], p = 0.350; PFS1: 1.09 [0.90-1.31], p = 0.379).

CONCLUSION

In this large cohort of HR+/HER2- MBC patients treated in a pre-CDK4/6 inhibitors era, gBRCAm status was associated with a lower OS and lower PFS following first-line endocrine therapy, but not following first-line chemotherapy.

Nanointerfaces: Concepts and Strategies for Optical and X-ray Spectroscopic Characterization

Interfaces at the nanoscale, also called nanointerfaces, play a fundamental role in physics and chemistry. Probing the chemical and electronic environment at nanointerfaces is essential in order to elucidate chemical processes relevant for applications in a variety of fields. Many spectroscopic techniques have been applied for this purpose, although some approaches are more appropriate than others depending on the type of the nanointerface and the physical properties of the different phases. In this Perspective, we introduce the major concepts to be considered when characterizing nanointerfaces. In particular, the interplay between the characteristic length of the nanointerfaces, and the probing and information depths of different spectroscopy techniques is discussed. Differences between nano- and bulk interfaces are explained and illustrated with chosen examples from optical and X-ray spectroscopies, focusing on solid-liquid nanointerfaces. We hope that this Perspective will help to prepare spectroscopic characterization of nanointerfaces and stimulate interest in the development of new spectroscopic techniques adapted to the nanointerfaces.

Overcoming Diffusion Limitation of Faradaic Processes: Property-Performance Relationships of 2D Conductive Metal-Organic Framework Cu3(HHTP)2 for Reversible Lithium-Ion Storage

Faradaic reactions including charge transfer are often accompanied with diffusion limitation inside the bulk. Conductive two-dimensional frameworks (2D MOFs) with a fast ion transport can combine both - charge transfer and fast diffusion inside their porous structure. To study remaining diffusion limitations caused by particle morphology, different synthesis routes of Cu-2,3,6,7,10,11-hexahydroxytriphenylene (Cu3(HHTP)2), a copper-based 2D MOF, are used to obtain flake- and rod-like MOF particles. Both morphologies are systematically characterized and evaluated for redox-active Li+ ion storage. The redox mechanism is investigated by means of X-ray absorption spectroscopy, FTIR spectroscopy and in situ XRD. Both types are compared regarding kinetic properties for Li+ ion storage via cyclic voltammetry and impedance spectroscopy. A significant influence of particle morphology for 2D MOFs on kinetic aspects of electrochemical Li+ ion storage can be observed. This study opens the path for optimization of redox active porous structures to overcome diffusion limitations of Faradaic processes.

Vibrational signature of hydrated protons confined in MXene interlayers

The hydration structure of protons has been studied for decades in bulk water and protonated clusters due to its importance but has remained elusive in planar confined environments. Two-dimensional (2D) transition metal carbides known as MXenes show extreme capacitance in protic electrolytes, which has attracted attention in the energy storage field. We report here that discrete vibrational modes related to protons intercalated in the 2D slits between Ti₃C₂T_x MXene layers can be detected using operando infrared spectroscopy. The origin of these modes, not observed for protons in bulk water, is attributed to protons with reduced coordination number in confinement based on Density Functional Theory calculations. This study therefore demonstrates a useful tool for the characterization of chemical species under 2D confinement.

In situ X-ray Absorption Spectroscopy of Metal/Nitrogen-doped Carbons in Oxygen Electrocatalysis

Metal/nitrogen-doped carbons (M-N-C) are promising candidates as oxygen electrocatalysts due to their low cost, tunable catalytic activity and selectivity, and well-dispersed morphologies. To improve the electrocatalytic performance of such systems, it is critical to gain a detailed understanding of their structure and properties through advanced characterization. In situ X-ray absorption spectroscopy (XAS) serves as a powerful tool to probe both the active sites and structural evolution of catalytic materials under reaction conditions. In this review, we firstly provide an overview of the fundamental concepts of XAS and then comprehensively review the setup and application of in situ XAS, introducing electrochemical XAS cells, experimental methods, as well as primary functions on catalytic applications. The active sites and the structural evolution of M-N-C catalysts caused by the interplay with electric fields, electrolytes and reactants/intermediates during the oxygen evolution reaction and the oxygen reduction reaction are subsequently discussed in detail. Finally, major challenges and future opportunities in this exciting field are highlighted.

Hydrogen-Bond Restructuring of Water-in-Salt Electrolyte Confined in Ti3C2Tx MXene Monitored by Operando Infrared Spectroscopy

Highly concentrated water-in-salt aqueous electrolytes exhibit a wider potential window compared to conventional, dilute aqueous electrolytes. Coupled with MXenes, a family of two-dimensional transition metal carbides and nitrides with impressive charge storage capabilities, water-in-salt electrolytes present a potential candidate to replace flammable and toxic organic solvents in electrochemical energy storage devices. A new charge storage mechanism was recently discovered during electrochemical cycling of Ti₃C₂T_x MXene electrodes in lithium-based water-in-salt electrolytes, attributed to intercalation and deintercalation of solvated Li⁺ ions at anodic potentials. Nevertheless, direct evidence of the state of Li⁺ solvation during cycling is still missing. Here, we investigate the hydrogen bonding of water intercalated between MXene layers during electrochemical cycling in a water-in-salt electrolyte with operando infrared spectroscopy. The hydrogen-bonding state of the confined water was found to change significantly as a function of potential and the concentration of Li⁺ ions in the interlayer space. This study provides fundamentally new insights into the electrolyte structural changes while intercalating Li⁺ in the MXene interlayer space.

A propensity score-weighted study comparing a two- versus four-weekly pegylated liposomal doxorubicin regimen in metastatic breast cancer

PURPOSE

A 4-weekly schedule of pegylated liposomal doxorubicin (PLD) has been approved for the treatment of metastatic breast cancer (MBC). Phase II trials have suggested interest in a 2-weekly regimen. This study aimed to compare the efficacy and safety of these two schedules.

METHODS

Data from MBC patients treated with PLD between 2011 and 2021 were retrospectively collected. The objective was to demonstrate the noninferiority of the 2-weekly versus the 4-weekly schedule in terms of 6-month progression-free survival (PFS). The prespecified noninferiority margin was calculated as 1.20. A propensity score to receive either schedule was estimated using a gradient boosting algorithm. Survival analyses using Cox regression models weighted by the propensity score were performed to compare the schedules.

RESULTS

Among the 192 patients included, 96 (50%) underwent each schedule. The median number of previous systemic therapies was 4 (IQR, 3 to 6). Anthracyclines were previously given in early breast cancer in 63.9% of patients. The median follow-up was 10.0 months (IQR, 5.0 to 20.1). A comparable distribution of adverse events was observed. The median PFS was 3.2 months (95% CI, 2.9 to 3.9), and the median overall survival was 12.1 months (95% CI, 10.8 to 14.9). The weighted hazard ratio for PFS was 1.12 (90% CI, 0.82 to 1.54), including the noninferiority boundaries.

CONCLUSION

PLD appeared to be a well-tolerated drug in this heavily pretreated MBC population. The efficacy and safety of the 2-weekly schedule did not provide any advantage, suggesting no interest in changing the registered regimen.

Early dynamics of the emission of solvated electrons from nanodiamonds in water

Solvated electrons are among the most reductive species in an aqueous environment. Diamond materials have been proposed as a promising source of solvated electrons, but the underlying emission process in water remains elusive so far. Here, we show spectroscopic evidence for the emission of solvated electrons from detonation nanodiamonds upon excitation with both deep ultraviolet (225 nm) and visible (400 nm) light using ultrafast transient absorption. The crucial role of surface termination in the emission process is evidenced by comparing hydrogenated, hydroxylated and carboxylated nanodiamonds. In particular, a transient response that we attribute to solvated electrons is observed on hydrogenated nanodiamonds upon visible light excitation, while it shows a sub-ps recombination due to trap states when excited with deep ultraviolet light. The essential role of surface reconstructions on the nanodiamonds in these processes is proposed based on density functional theory calculations. These results open new perspectives for solar-driven emission of solvated electrons in an aqueous phase using nanodiamonds.

Effects of oxidative adsorbates and cluster formation on the electronic structure of nanodiamonds

Nanodiamonds (NDs) are modern high-potential materials relevant for applications in biomedicine, photocatalysis, and various other fields. Their electronic surface properties, especially in the liquid phase, are key to their function in the applications, but we show that they are sensitively modified by their interactions with the environment. Two important interaction modes are those with oxidative aqueous adsorbates as well as ND self-aggregation towards the formation of ND clusters. For planar diamond surfaces it is known that the electron density migrates from the diamond towards oxidative adsorbates, which is known as transfer doping. Here, we quantify this effect for highly curved NDs of varying sizes (35-147 C atoms) and surface terminations (H, OH, F), focusing on their interactions with the most abundant aqueous oxidative adsorbates (H₃ O⁺ , O₂ , O₃ ). We prove that the concept of transfer doping stays valid for the case of the high-curvature NDs and can be tuned via the ND's specific properties. Secondly, we investigate the electronic structures of clusters of NDs which are known to form in particular in aqueous dispersions. Upon cluster formation, we find that the optical gaps of the structures are significantly reduced, which explains why different experimental values were obtained for the optical gap of the same structures, and the cluster's LUMO shapes resemble atom-type orbitals, as in the case of isolated spherical NDs. Our findings have implications for ND applications as photocatalysts or electronic devices, where the specific electronic properties are key to the functionality of the ND material.

De novo metastatic breast cancer in patients with a small locoregional tumour (T1-T2/N0): Characteristics and prognosis

INTRODUCTION

The estimated rate of de novo metastatic breast cancer (dnMBC) at the time of diagnosis is between 5 to 12%. International guidelines recommend metastatic work-up (MWU) only in women with advanced breast cancer. The purpose of this study was to describe the characteristics and prognosis of patients with dnMBC diagnosed without an initial indication for MWU.

METHODS

We conducted a retrospective, comparative study in dnMBC patients selected from the ESME-MBC cohort. Patients were treated in France between 2008 and 2016. We compared two populations: patients in whom dnMBC was diagnosed by staging although not indicated by guidelines (non-guideline staging [NGS]) and those in whom dnMBC was diagnosed by guideline staging (GS).

RESULTS

During the study period, 22,463 patients with MBC were included in the ESME cohort. Among them, 6698 were dnMBC patients. In 247 of these patients (6% of dnMBC and 1% of the overall population), dnMBC was diagnosed by non-guideline staging. Women in this group were significantly younger (57 vs. 59 years, p = 0.02) and had fewer metastatic sites at diagnosis than dnMBC-GS patients. The two groups were not significantly different in terms of the other characteristics. Overall survival (OS) and progression-free survival (PFS) were better in the dnMBC-NGS group than in the dnMBC-GS group. The impact on survival was confirmed by univariate and multivariate analysis (HR 1.83 [1.31-2.57], p < 0.01).

CONCLUSION

This study provides the first description of a very specific population. These patients with dnMBC-NGS were younger and more likely to have oligometastatic disease with a better prognosis.

Subpolar North Atlantic western boundary density anomalies and the Meridional Overturning Circulation

Changes in the Atlantic Meridional Overturning Circulation, which have the potential to drive societally-important climate impacts, have traditionally been linked to the strength of deep water formation in the subpolar North Atlantic. Yet there is neither clear observational evidence nor agreement among models about how changes in deep water formation influence overturning. Here, we use data from a trans-basin mooring array (OSNAP-Overturning in the Subpolar North Atlantic Program) to show that winter convection during 2014-2018 in the interior basin had minimal impact on density changes in the deep western boundary currents in the subpolar basins. Contrary to previous modeling studies, we find no discernable relationship between western boundary changes and subpolar overturning variability over the observational time scales. Our results require a reconsideration of the notion of deep western boundary changes representing overturning characteristics, with implications for constraining the source of overturning variability within and downstream of the subpolar region.

Role of Dopants on the Local Electronic Structure of Polymeric Carbon Nitride Photocatalysts

Polymeric carbon nitride (PCN) is a promising class of materials for solar-to-chemical energy conversion. The increase of the photocatalytic activity of PCN is often achieved by the incorporation of heteroatoms, whose impact on the electronic structure of PCN remains poorly explored. This work reveals that the local electronic structure of PCN is strongly altered by doping with sulfur and iron using X-ray absorption spectroscopy (XAS) and resonant inelastic X-ray scattering (RIXS). From XAS at the carbon and nitrogen K-edges, sulfur atoms are found to mostly affect carbon atoms, in contrast to iron doping mostly altering nitrogen sites. In RIXS at the nitrogen K-edge, a vibrational progression, affected by iron doping, is evidenced, which is attributed to a vibronic coupling between excited electrons in nitrogen atoms and C-N stretching modes in PCN heterocycling rings. This work opens new perspectives for the characterization of vibronic coupling in polymeric photocatalysts.

Differential impact of endocrine therapy and chemotherapy on quality of life of breast cancer survivors: a prospective patient-reported outcomes analysis

BACKGROUND

In early breast cancer (BC), there has been a trend to escalate endocrine therapy (ET) and to de-escalate chemotherapy (CT). However, the impact of ET versus CT on the quality of life (QoL) of early BC patients is unknown. Here, we characterize the independent contribution of ET and CT on patient-reported outcomes (PROs) at 2 years after diagnosis.

PATIENTS AND METHODS

We prospectively collected PROs in 4262 eligible patients using the European Organization for Research and Treatment of Cancer QLQ-C30/BR23 questionnaires inside CANTO trial (NCT01993498). The primary outcome was the C30 summary score (C30-SumSc) at 2 years after diagnosis.

RESULTS

From eligible patients, 37.2% were premenopausal and 62.8% postmenopausal; 81.9% received ET and 52.8% CT. In the overall cohort, QoL worsened by 2 years after diagnosis in multiple functions and symptoms; exceptions included emotional function and future perspective, which improved over time. ET (Pint = 0.004), but not CT (Pint = 0.924), had a persistent negative impact on the C30-SumSc. In addition, ET negatively impacted role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms and further limited emotional function and future perspective recovery. Although CT had no impact on the C30-SumSc at 2-years it was associated with deteriorated physical and cognitive function, dyspnea, financial difficulties, body image and breast symptoms. We found a differential effect of treatment by menopausal status; in premenopausal patients, CT, despite only a non-significant trend for deteriorated C30-SumSc (Pint = 0.100), was more frequently associated with QoL domains deterioration than ET, whereas in postmenopausal patients, ET was more frequently associated with QoL deterioration, namely using the C30-SumSc (Pint = 0.004).

CONCLUSION(S)

QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation.

Impact of Cation Intercalation on the Electronic Structure of Ti3C2Tx MXenes in Sulfuric Acid

Intercalation in Ti₃C₂T_x MXene is essential for a diverse set of applications such as water purification, desalination, electrochemical energy storage, and sensing. The interlayer spacing between the Ti₃C₂T_x nanosheets can be controlled by cation intercalation; however, the impact of intercalation on the Ti₃C₂T_x MXene chemical and electronic structures is not well understood. Herein, we characterized the electronic structure of pristine, Li-, Na-, K-, and Mg-intercalated Ti₃C₂T_x MXenes dispersed initially in water and 10 mM sulfuric acid (H₂SO₄) using X-ray absorption spectroscopy (XAS). The cation intercalation is found to dramatically influence the chemical environment of Ti atoms. The Ti oxidation of the MXene increases progressively upon intercalation of cations of larger sizes after drying in air, while interestingly a low Ti oxidation is observed for all intercalated MXenes after dispersion in diluted H₂SO₄. In situ XAS at the Ti L-edge was conducted during electrochemical oxidation to probe the changes in the Ti oxidation state in the presence of different cations in H₂SO₄ aqueous electrolyte. By applying the sensitivity of the Ti L-edge to probe the oxidation state of Ti atoms, we demonstrate that cation-intercalation and H₂SO₄ environment significantly alter the Ti₃C₂T_x surface chemistry.

CinéBreast-factors influencing the time to first metastatic recurrence in breast cancer: Analysis of real-life data from the French ESME MBC database

Purpose

The Time to First Metastatic Recurrence (TFMR) could be considered as an indirect reflection of the tumour growth kinetics which plays an important role in cancer. Molecular subtypes such as expression of estrogen receptor are known predictive factors of TFMR. The CinéBreast study aimed to identify predictive factors of the time to TFMR.

Methods

The French Epidemiological Strategy and Medical Economics (ESME) Metastatic Breast Cancer (MBC) Database (NCT03275311) was used, which contains data from a cohort of metastatic breast cancer patients from 2008 to 2016 using retrospective data collection. It is a national multi-centre database. The impact of TFMR on overall survival (OS) since first metastasis was also evaluated.

Results

Among 16 702 patients recorded in the ESME MBC database, 10 595 had an initially localised breast cancer with hormone receptor (HR) and HER2 status available, with a metastatic recurrence. Median follow up was 56 months. Median TFMR was 59 months (<24: 20%, 24–60: 31%, 60–120: 25%, >120: 24%). HER2+ and TNBC were respectively 4 times and 12 times (p < 0.0001) more likely to have a recurrence within 2 years when compared to the luminal subgroup. Short TFMR and HR-/HER2-subtype significantly correlated with a poor OS in multivariate analysis.

Some patients with MBC (20% in HER2+, 10% in ER+/HER2-and <5% in the ER-/HER2-) were long-term survivors in all 3 subgroups.

Conclusions

In this large-scale real-life data study, patients with a TNBC metastatic recurrence had a shorter TFMR. Short TFMR significantly correlated with worse overall survival.

•

ESME is a large-scale real-life database of 16 702 metastatic breast cancer patients.

•

A short time to first metastatic recurrence is associated with poor overall survival.

•

Triple-negative tumours were more likely to recur early than HR+ and HER2+ tumours.

Surgery for no palpable testis before the age of one year: a risk for the testis?

INTRODUCTION

Surgery for undescended testis is now commonly recommended before the age of one year. However, the risk of testicular atrophy or miss location after surgery at a young age has not been clearly evaluated.

OBJECTIVE

The objective of this study is to evaluate the rate of testicular atrophy after surgery for non-palpable testis before the age of one year.

MATERIALS

Fifty-five patients operated between 2005 and 2014 for non-palpable testes were reviewed for clinical and ultrasound (US) evaluation. Median follow-up after surgery was of 68.5 months (range 26-130 months). The median age at surgery was of months (5-12 months). Eight patients (14.5%) had bilateral non-palpable testis; thus, 63 testes were evaluated. At surgery, 38 (60%) testes were located in the high inguinal canal; 25 (40%), in the abdominal cavity. Orchiopexy was performed with preservation of the testicular vessels for 58 testes. Fowler-Stephens (FS) procedure was performed for 5 testes. Testicular location was clinically evaluated, and testicular volume was measured using a standard sonogram technique in our pediatric radiology department. Ratio comparing the volume of the descended testis to the spontaneously scrotal located testis was calculated in unilateral forms.

RESULTS

After surgery, testes had scrotal location in 62 cases and inguinal location in one case. Seven cases of atrophy were confirmed after US control (11%), more frequently (odds ratio, OR 11.68 [1.9-72.5]) in abdominal testis (24%) than in inguinal testis (2.6%). Atrophy testicular was more frequent with FS technique (OR 7.1 [1.3-40.1]), but the population was weak (N = 5). Median volume ratio for unilateral form was 0.88 [0-1.8]; 14 patients presented a ratio greater than 1.

DISCUSSION

The influence of the young age at surgery and the risk of post operative testicular atrophy had not been clearly evaluated. The term of 'no palpable testis' supports an heterogeneous group mixing abdominal and extra-abdominal testis sharing a uniform clinical presentation. Our rate of atrophy in the group of abdominal testes (24%) and inguinal testes (2.6%) is similar to the literature, which concerns older patients. The long-term sonogram assessment demonstrated a good development of the testis after surgery, especially in inguinal cases.

CONCLUSION

Surgery for no palpable testis before the age of one year does not lead to a superior risk of testicular atrophy compared with surgery at an older age and allows a good development of the testis.

Uncovering the Charge Transfer between Carbon Dots and Water by In Situ Soft X-ray Absorption Spectroscopy

Carbon dots (CDs) exhibit outstanding physicochemical properties that render them excellent materials for various applications, often occurring in an aqueous environment, such as light harvesting and fluorescence bioimaging. Here we characterize the electronic structures of CDs and water molecules in aqueous dispersions using in situ X-ray absorption spectroscopy. Three types of CDs with different core structures (amorphous vs graphitic) and compositions (undoped vs nitrogen-doped) were investigated. Depending on the CD core structure, different ionic currents generated upon X-ray irradiation of the CD dispersions at the carbon K-edge were detected, which are interpreted in terms of different charge transfer to the surrounding solvent molecules. The hydrogen bonding networks of water molecules upon interaction with the different CDs were also probed at the oxygen K-edge. Both core graphitization and nitrogen doping were found to endow the CDs with enhanced electron transfer and hydrogen bonding capabilities with the surrounding water molecules.

Theoretical X-ray absorption spectroscopy database analysis for oxidised 2D carbon nanomaterials

In this work we provide a proof of principle for a theoretical methodology to identify functionalisation patterns in oxidised carbon 2D nanomaterials. The methodology is based on calculating a large number of X-ray absorption spectra of individually excited carbon atoms in different chemical environments using density functional theory. Since each resulting spectrum gives a fingerprint of the local electronic structure surrounding the excited atom, we may relate each spectrum to the functionalisation pattern of that excited atom up to a desired neighbourhood radius. These functionalisation pattern-specific spectra are collected in a database, that allows fast composition of X-ray absorption spectra for arbitrary structures in density functional theory quality. Finally, we present an exemplary application of the database approach to estimate the relative amount of functional groups in two different experimental samples of carbon nanomaterials.

Abstract P5-17-04: Metastatic inflammatory breast cancer: Clinical features and outcomes in the national, multicentric, real-life ESME cohort

Background:Primary inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Survival of IBC patients has been improved by multimodal therapy. However 5-year overall survival (OS) still remains close to 50-60%, due to high risk of disseminated disease. Given the low incidence, prognosis of metastatic cases stages is poorly described.

Methods:This study aimed to describe OS of IBC (T4d AJCC TNM classification) with upfront or recurrent metastatic disease compared with non-IBC patients in the ESME database (N=16,702 patients). OS was calculated from the diagnosis of metastasis to the date of death (from any cause), or censored to date of latest news. Secondary objectives included progression-free survival (PFS).

Results:From 2008 to 2014, 7,465 patients with diagnosis of MBC and known clinical status of their primary tumor (T) were identified, including 582 IBC (T4d) and 6,883 non-IBC. As expected, metastatic IBC was associated with pejorative features compared to non-IBC, with less hormonal receptors-positive tumors (44% vs 65.6%), more HER2-positive (30% vs 18.6%) or triple-negative (25.9% vs 15.8%) cases (p&lt;0.001), more frequent upfront M1 stage (53.3% vs 27.7%; p&lt;0.001), and shorter median disease-free interval (2.02 years vs. 4.9 years; p&lt;0.001). With a median follow-up of 50.2 months (0-104), median OS was 28.4 [95%CI 24-33.8] versus 37.2 months [95%CI 36.1-38.5] in metastatic IBC and non-IBC cases respectively (p&lt;0.0001, log-rank test). By multivariate Cox model with adjustment for major prognostic factors [including age, disease-free interval, type of relapse, visceral metastases, molecular subtype, grade], OS was significantly shorter in the metastatic IBC group compared with non-IBC group (HR 1.25 [95%CI 1.1-1.4], p=0.0002). Of note, survival of metastatic IBC patients improved over the last years: median OS 24 months [95%CI 20-31.9], 29 months [95%CI 21.7-39.9] and 36 months [95%CI 27.9-NE] if diagnosed before 2011, between 2011 and 2012, or after 2012 respectively (p=0.003). Such improvement was not observed in non-IBC patients. IBC was associated with shorter median PFS under first line systemic treatment compared with non-IBC (7.2 months [95%CI 6.6-8.3] vs 9.5 months [95%CI 9.1-9.8] respectively, p=0.0136). This was maintained in a multivariate Cox model adjusting for same factors as for OS (HR 1.15 [95%CI 1-1.3], p=0.0050).

Compared with non-IBC, synchronous metastatic IBC showed worse median OS and PFS (39.9 months [95%CI 34.2-45.3] vs 48.4 months [95%CI 46.3-50.8], p=0.0035; 10 months [95%CI 8.8-12.7] vs 14.5 months [95%CI 13.6-15.7], p=0.0027, respectively. Similar results were obtained in metachronous metastatic cases (20.01 months [95%CI 17.1-21.2] vs 32.8 months [95%CI 31.5-34.3], p&lt;0.0001; 5.1 months [95%CI 4.1-6] vs 7.9 months [95%CI 7.6-8.3], p&lt;0.0001, respectively).

Conclusion:In this large national and multicentric study, IBC is a major and independent factor associated with adverse outcome in metastatic setting. Of note, the independent adverse impact on PFS identified in this study may suggest a lower sensitivity of metastatic IBC to available therapeutics. However, results seem to improve in the last years. Detailed analysis according to phenotype will be available.

Citation Format: Monneur A, Bertucci F, Lardy-Cleaud A, Augereau P, Debled M, Levy C, Mouret-Reynier MA, Coudert B, Mailliez A, Bachelot T, Ferrero J-M, Guiu S, Uwer L, Campone M, Cottu P, Jouannaud C, De la Motte Rouge T, Leheurteur M, Petit T, Pistilli B, Dalenc F, Simon G, Robain M, Viens P, Lerebours F, Gonçalves A. Metastatic inflammatory breast cancer: Clinical features and outcomes in the national, multicentric, real-life ESME cohort [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 P5-17-04.

Influence of surface chemistry on optical, chemical and electronic properties of blue luminescent carbon dots

Carbon dots have attracted much attention due to their unique optical, chemical and electronic properties enabling a wide range of applications. The properties of carbon dots can be effectively adjusted through modifying their chemical composition. However, a major challenge remains in understanding the core and surface contributions to optical and electronic transitions. Here, three blue luminescent carbon dots with carboxyl, amino and hydroxyl groups were comprehensively characterized by UV-vis absorption and emission spectroscopy, synchrotron-based X-ray spectroscopy, and infrared spectroscopy. The influence of the surface functionality on their fluorescence was probed by pH-dependent photoluminescence measurements. Moreover, the hydrogen bonding interactions between water and the surface groups of carbon dots were characterized by infrared spectroscopy. Our results show that both core and surface electronic states of blue luminescent carbon dots contribute to electronic acceptor levels while the chemical nature of the surface groups determines the hydrogen bonding behavior of the carbon dots. This comprehensive spectroscopic study demonstrates that the surface chemistry has a profound influence on the electronic configuration and surface-water interaction of carbon dots, thus affecting their photoluminescence properties.

[Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]

PURPOSE

The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris.

RESULTS

We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P.

CONCLUSION

Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.

Abstract P6-08-10: Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life "ESME" cohort

Background

Young age is a known poor prognosis factor in early stage breast cancer (BC). Its value is less documented for metastatic BC (MBC). Guidelines state that age should not guide the treatment strategy. We used the ESME database to evaluate the impact of age at MBC diagnosis on overall survival (OS).

Patients and Methods

ESME is a unique national cohort, collecting retrospective data using clinical trial-like methodology. It included all consecutive MBC patients (pts) who initiated at least 1 treatment in one of the 18 participating French cancer centers between 01/01/2008 and 12/31/2014. The database was locked on 12/8/2016. Primary objective were the comparisons of MBC characteristics between age groups (&lt;40, 40 to 60 and &gt;60 years (y)) and the evaluation of the impact of age at MBC diagnosis on OS.

Interaction between age and tumor subtype was tested using a Cox regression model.

ResultsAmong 16 703 included pts, 1539 had no information on tumor receptors (ER/PR/HER2) and 682 had an exclusion criteria (unknown age, men or other cancer in the last 5y), leaving 14 482 for analysis. At the onset of MBC, 902 pts (6.2%), 6269 (43.3%) and 7311 (50.5%) were &lt;40y, 40y to 60y and older than 60y respectively. Median follow-up was 54.8 months.

Pts &lt;40 had significantly more aggressive presentations than other age groups: more HER2+ (26.5%), and triple negative (26.4%) subtypes, more visceral involvement (57.1%), and shorter time to metastasis (26.9% between 6 to 24 months) (all p-value vs other age groups &lt;0.0001).

MBC characteristics according to age groups Age at MBC diagnosis (years)p-value &lt;4040-60&gt;60 Tumor subtype   &lt;0.0001HR+/HER2-425 (47.12)3816 (60.87)5262 (71.97) HR-/HER2-238 (26.39)1126 (17.96)884 (12.09) HER2+239 (26.5)1327 (21.17)1165 (15.93) Type of metastasis, N(%)   &lt;0.0001Bone only219 (24.31)1832 (29.23)2367 (32.41) Non visceral168 (18.65)1046 (16.69)1314 (17.99) Visceral514 (57.05)3389 (54.08)3623 (49.6) Time to first metastasis (months), N(%)   &lt;0.0001&lt; 6304 (33.74)1882 (30.1)2107 (28.9) [6-12[65 (7.21)241 (3.85)209 (2.9) [12-24[177 (19.64)760 (12.15)564 (7.7) ≥24355 (39.4)3370 (53.89)4416 (60.53) Number of metastatic sites, N(%)   0.51 site709(78.6)4948 (78.93)5805 (79.4) 2 sites163(18.07)1130 (18.03)1313(17.96) ≥3 sites30(3.33)191 (3.05)193 (2.64) 

Overall, median OS was identical in the different age groups: 39.1, 41.1 and 39.8 months for pts &lt;40, 40-60 and &gt;60, respectively (p=0.2).

Tumor subtype and age showed a significant interaction on OS (p&lt;0.0001), especially among HER2+ MBC

Overall survival (months) according to tumor subtypes and age groups Age groups (years)p-value (log-rank)Tumor subtype&lt;4040-60&gt;60 HR+/HER2-46,4 (CI 95% 40.5-55.4)47,8 (CI 95% 46-50)44,2 (CI 95% 42.1-46.3)0.0023HER2+60,7 (CI 95% 45.6-76.4)50,4 (CI 95% 46.3-56.3)44 (CI 95% 38.8-48.9)&lt;0.0001Triple negative14 (CI 95% 11.5-16.5)14,7 (CI 95% 13.7-15.9)15,7 (CI 95% 14.6-17.1)0.01

. Anti-HER2 with first-line treatment was given preferentially to young pts: 86.6, 81.9 and 74.9%for pts &lt;40, 40-60 and &gt;60, respectively (p&lt;0.0001).

Conclusion

At onset of MBC, young age was associated with more aggressive presentations, however with no global impact on OS. Pts &lt;40 with HER2+ disease carried a better prognosis, maybe related to therapy.

Citation Format: Frank S, Tchokothe C, Carton M, Mouret-Fourme E, Dubot C, Campone M, Pistilli B, Dalenc F, Mailliez A, Levy C, D'Hondt V, Debled M, Leheurteur M, Coudert B, Perrin C, Gonçalves A, Uwer L, Ferrero J-M, Eymard J-C, Petit T, Mouret-Reynier M-A, Guesmia T, Bachelot T, Robain M, Cottu P. Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life "ESME" cohort [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 P6-08-10.

Abstract P1-07-07: Overtime distribution and predictors of local recurrences (LRs) in patients with hormone receptor positive (HR+) and node positive (N+) breast cancers (BCs): 10 -year follow-up analysis of UNICANCER-PACS 01 and PACS04 trials

Purpose:Incidence of LRs in patients (pts) treated for HR+ HER2- localized BC and distribution overtime have not been described in recent years after introduction of new generation of adjuvant therapies and more extensive use of radiotherapy. We evaluated the incidence and distribution overtime of LRs in pts with HR+ HER2- N+ BCs who entered PACS 01 and PACS04 trials.

Patients and Methods: Data were analyzed from 2909 pts with HR+/HER2- BC out of 5008 included in both trials. Pts underwent mastectomy or lumpectomy plus axillary dissection for a localized N+ BC and, according to study design, were randomized to: 6 cycles of FE100C (standard arm) versus FE100C x 3 cycles followed by docetaxel 100 mg/m2 x 3 cycles (FEC-D) (PACS01) or 6 cycles of Epirubicin 75mg/m2 and Docetaxel 75 mg/m2 (ED75)(PACS04). Loco-regional radiotherapy was mandatory after lumpectomy and recommended in other cases. All pts received 5 years of hormone therapy (HT). A competing risk multivariate analysis was conduct using Fine and Gray model to identify risk factors associated to isolated LRs. Competing events were nodal recurrence, contralateral BC, distant metastasis and death. Cumulative incidence associated to each event was estimated by a Kablfleish-Prentice estimator.

Results: Pts' median age was 50 (22-65); 67.2% underwent lumpectomy, 32.8% mastectomy; 67.6% had 1 to 3 N+, 32.4% more than 3 N+; 45.7% had lymphovascular invasion; 49.5% received FE100C, 35.8% ET75, 14.7% had FEC-D; while radiotherapy was given to 97.3% and HT to 92.2%, of whom 90.5% received tamoxifen. At a median follow-up of 9.1 years, 60 pts (2.1%) experienced LR as first event. The 5-year and 10-year cumulative incidence of LRs were 1.04% and 2.53%, respectively. The cumulative incidence of LRs increased from the 5th year, and the annual risk tended to remain constant over time. Multivariate analysis of competing risk showed that younger age, conservative surgery and omission of HT (not prescribed or non-adherence) were independently associated with risk of developing LRs.

Table 1. Multivariate analysis on competing risk of predictors of LRsVariablesHR 95%CIP valueAge at entry (&lt;35 years, ≥ 35)*0.95 [0.92; 0.99]0.009Mastectomy, lumpectomy0.39 [0.17; 0.86]0.020&gt; 20mm, ≤20 mm0.68 [0.37; 1.24]0.203N+ &gt;3, 1-31.73 [0.99; 3.02]0.055Grade II/III, I1.06 [0.50; 2.24]0.885PR+,PR-1.78 [0.70; 4.53]0.223Type of chemotherapy 3FEC-3D, 6FEC/6ET1.32 [0.65; 2.69]0.446Number of cycles 6, &lt;60.71 [0.17; 0.75]0.630Hormone therapy Yes,No0.36 [0.17; 0.75]0.006*treated as continuous variable

Conclusion: Our analysis showed that incidence of LRs in pts with HR+ N+ BCs treated within PACS trials were considerably lower as compared to earlier studies. These findings may reflect differences in treatment era, as the more extensive use of radiotherapy and new generation of adjuvant chemotherapy. Despite current adjuvant strategies, young age at diagnosis and omission of HT remain independent risk factors of LRs.

Citation Format: Pistilli B, Filleron T, Mazouni C, Zingarello A, Lacroix-Triki M, Rivera S, Coudert B, Serin D, Canon J-L, Campone M, Bachelot T, Goncalves A, Levy C, Cottu P, Petit T, Eymard J-C, Tunon De Lara C, Roché H, Roca L, Lemonnier J, Delaloge S. Overtime distribution and predictors of local recurrences (LRs) in patients with hormone receptor positive (HR+) and node positive (N+) breast cancers (BCs): 10 -year follow-up analysis of UNICANCER-PACS 01 and PACS04 trials [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 P1-07-07.