Frequency of Radiation Therapy-Induced Malignancies in Patients With Li-Fraumeni Syndrome and Early-Stage Breast Cancer and the Influence of Radiation Therapy Technique

PURPOSE

Breast cancer (BC) is the most common malignancy in female patients with Li-Fraumeni syndrome (LFS), a condition associated with an increased risk of various malignancies, including radiation therapy (RT)-induced malignancies (RIM) within previously irradiated areas. Our study aimed to assess the incidence of RIM in patients with LFS and early-stage BC treated with adjuvant RT, including the effect of RT dose and technique.

METHODS AND MATERIALS

We examined patients with a germline pathogenic/likely pathogenic TP53 variant diagnosed with early-stage BC and monitored by a hereditary cancer team at a single cancer center. The study endpoints included RIM frequency, the association of RIM with the dose and type of RT (2-dimensional [2D] RT, 3-dimensional [3D] RT, and intensity modulated RT [IMRT]), and BC recurrence.

RESULTS

We analyzed 48 patients with a median age of 39 years (range, 21-62). The majority (71%) had the TP53 R337H variant, and 87% were unaware of their LFS diagnosis at the time of BC treatment. Treatment modalities included mastectomy (62%), (neo)adjuvant chemotherapy (66%), and RT (62%), with RT being more common after breast-conserving surgery (87% vs 46% with mastectomy, P = .010). Among the 30 patients treated with RT, 10% developed RIM in the irradiated field, consisting of 3 soft tissue malignancies. RT dose (≤40.8 or >40.8 Gy) did not influence RIM occurrence, but the type of RT did. RIM was observed in 100% of cases with 2D RT (2/2), 50% with IMRT (1/2), and 0% with 3D RT (0/16) (P = .004).

CONCLUSIONS

Our study underscores a concerning rate of RIM after adjuvant RT, emphasizing the importance of a thorough risk-benefit evaluation before recommending RT, with preference for its avoidance if possible. Although subgroup sizes were limited, the risk of RIM appeared to be influenced by the RT technique, with higher rates observed with 2D RT and IMRT compared with 3D RT. Early TP53 testing is essential to guide the BC treatment plan.

A matched case-control study of the prognosis of early breast cancer in patients with Li-Fraumeni syndrome (BREAST TP53)

INTRODUCTION

Breast cancer (BC) is the most common type of cancer in premenopausal women with germline TP53 pathogenic variants (mTP53) (Li Fraumeni syndrome - LFS). However, little is known about the BC prognosis in these patients. This study analyzed the BC-related oncologic outcomes of patients with LFS.

METHODS

We evaluated a cohort of LFS patients with BC in comparison with a control cohort of BC patients with no pathogenic variant in a hereditary cancer panel. The primary endpoint was recurrence-free survival (RFS). Due to the risk of second malignancies in LFS, only locoregional and distant recurrences were considered events for RFS. Secondary endpoints included rates of contralateral BC, overall survival (OS), and breast cancer-specific survival (BCSS).

RESULTS

Forty-one patients were evaluated in the mTP53 group and 82 in the control group. Median age at BC diagnosis was 40 and 41 years, respectively. The mTP53 group received less adjuvant radiotherapy than the control group (63.4% vs 93.9%, P < 0.001). Other relevant baseline characteristics and treatment received were similar between groups. 5y-RFS rates were 79.4% in the mTP53 versus 93.6% in the control group (HR 2.43, 95%CI 0.74-8.01, P = 0.143); and were not impacted by the use of adjuvant radiotherapy. 5y-BCSS rates were 92.2% and 98.6%, respectively (HR 1.87, IC95% 0.25-13.48, P = 0.534).

CONCLUSIONS

Our results showed no statistically significant difference in BC-related RFS and BCSS between patients with mTP53 and a control group with no pathogenic variant. Larger multicentric studies are warranted to confirm these results.

Abstract P3-05-12: A matched cohort study of the prognosis of early breast cancer in patients with Li-Fraumeni syndrome

Background: Patients with germline TP53 pathogenic variants (Li-Fraumeni syndrome - LFS) have an increased risk of breast cancer, which is the most common type of cancer in premenopausal women with LFS. These women are also at risk of other second malignancies, including radiotherapy-induced malignancies. On the other hand, little is known about the prognosis of breast cancer in patients with LFS or if the disease behavior differs from non-hereditary BC. The objective of this study was to characterize the phenotype and prognosis of early BC in patients with LFS compared to a matched cohort of patients without germline pathogenic variants (PV) related to BC.

Methods: This retrospective study evaluated patients with early BC treated in an academic cancer center from Dec 1999 to Mar 2022. The LFS cohort included consecutive patients with BC who harbored a PV or likely PV of TP53. The matched control cohort (2:1) included patients with BC with no germline PV in a panel test. Primary endpoint was disease-free survival (DFS). Since LFS is associated with an increased risk of new primary malignancies, only locoregional and distant BC recurrence were considered as events in the DFS analysis. Secondary endpoints included response to systemic therapy, sites of recurrence, and breast cancer-related deaths.

Results: Forty-six patients with LFS were evaluated; the control cohort included 91 matched patients. In the LFS cohort, 14 different PV or likely PV were identified, with TP53 p.R337H being the most common (n=32). Median age was 40 years in both groups. In the LFS cohort, 35% of the pts had HER2-positive BC compared to 21% in the control cohort. Primary tumors greater than 5 cm were observed in 15% of pts in the LFS cohort and 25% of pts in the control cohort. Positive lymph nodes were observed in 11% and 14%, respectively. Among 15 pts with LFS who received neoadjuvant chemotherapy, all (100%) had a response, with 5 (33%) complete responses. Thirty-five patients in the control group received neoadjuvant chemotherapy: 83% responded, with 11 (31%) presenting a complete response. With a median follow-up of 43 months, 5-year DFS rates were 82.6% (95% CI 65.1 – 91.9%) in the LFS cohort and 91.5% (95% CI 79.1 – 96.6%) in the control cohort (P=0.427). Rates and sites of recurrence, new primary BC, and deaths are detailed in the table.

Conclusions: In addition to a higher risk of new primary breast cancer, LFS patients with early breast cancer had numerically higher rates of locoregional and distant recurrence in comparison with a matched cohort. Nevertheless, further studies are required to understand if these differences are due to tumor behavior particularities or to differences in therapeutic management.

Recurrence and death events

Citation Format: Vanessa Petry, Renata Colombo Bonadio, Daniela Jafet, Roberta Campos, Luiz Senna, Allyne Cagnacci, Laura Testa, Maria Candida Villares Fragoso, Maria del Pilar Estevez Diz. A matched cohort study of the prognosis of early breast cancer in patients with Li-Fraumeni syndrome [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-12.

Abstract P1-03-05: Overview of the management and factors associated with outcomes of metastatic breast cancer among elderly patients

Background: Management of metastatic breast cancer (mBC) in elderly patients (pts) faces some challenges since some pts are frail or have functionality impairment, with higher risk of severe adverse events from oncologic therapy. We aimed to assess the treatment patterns for elderly pts with MBC and evaluate factors associated with outcomes in this population. Methods: This retrospective study evaluated pts 70 years and older with mBC treated in a tertiary cancer center from 2009 to 2022. Charlson index (ChI) was used to measure comorbidities. Endpoints were proportion and type of first-line systemic therapy, rates of treatment discontinuation due to toxicities, overall survival (OS) and prognostic factors. The Kaplan-Meier method was used for survival analyses. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated using Cox regression. Results: 460 pts with mBC were evaluated. Median age was 78 years (IQR 70-96). Most pts (n=331; 72%) had hormone receptor-positive HER2-negative (HR+HER2-) BC, while 11% (n=50) had HER2-positive (HER2+) BC and 14% (n=64) triple-negative (TN) BC. Most pts has de novo metastatic disease (n=316; 69%); ECOG-PS 3-4 (n=313, 68%), and ChI ≤ 7 (n=354; 77%). Forty-five pts (10%) did not receive systemic therapy for metastatic BC; this proportion was higher among TNBC (34%) than other subtypes (HR+HER2-: 5%; HER2+: 6%) (P&lt; 0.001). The proportion not receiving systemic therapy was also higher among pts with ECOG-PS 3-4 (13%, P&lt; 0.001), older than 90 years (19%; P=0.069), and with ChI &gt; 7 (15%; P=0.088). Among 165 pts who received first-line endocrine therapy, 2% discontinued due to toxicity. Ninety pts received first-line chemotherapy and 18% discontinued due to toxicity. Breast cancer was the main cause of death (94%) in the cohort. Factors associated with increased risk of death were HER2+BC (HR 1.48, 95% CI 1.04 – 2.09; P=0.027), TNBC (HR 1.52, 95% CI 1.05 – 2.20; P=0.025), age group 80-90 years (HR 1.30, 95% CI 1.02-1.64; P=0.028), ECOG-PS 3-4 (HR 2.34, 95% CI 1.73-3.15, P&lt; 0.001), and not receiving systemic therapy (HR 4.48, 95% CI 2.88-6.98, P&lt; 0.001). Median OS was 29 months for pts treated with systemic therapy, and 2.3 months for those who did not receive it (P&lt; 0.001). Conclusions: Many factors influence the prognosis and the treatment decision for elderly pts with mBC. The rates of pts who do not receive systemic therapy are higher among TNBC, which points to the need for better tolerated therapies for this group.

Citation Format: Sofia Vidaurre Mendes, Bruna Zanin Orsi, Jessica Monteiro Vasconcellos, Augusto Araujo Neto, Erika Andrade Rocha, Ana Paula Messias, Otavio Noschang Moreira, Pedro José Galvão Freire, Leticia Vecchi Leis, Mauricio Baptista Pereira, Vanessa Petry, Renata Colombo Bonadio, Laura Testa. Overview of the management and factors associated with outcomes of metastatic breast cancer among elderly patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-03-05.

Abstract P4-07-32: Prognostic factors among elderly patients with operable non-metastatic breast cancer treated with primary endocrine therapy

Background: The growing population of elderly patients with breast cancer imposes challenges for treatment when frailty and comorbidities may coexist. Age alone should not be a cutoff for cancer treatment decisions: benefit and risk should be taken into account, considering comorbidities burden, functionality, life expectancy and patient preferences. Primary endocrine therapy (PET) represents an alternative when primary surgery or neoadjuvant chemotherapy would not be adequate treatment choices for patients with hormonal receptor positive (HR+) non-metastatic breast cancer. We aimed to evaluate the prognostic factors associated with survival among elderly patients treated with PET with or without surgery. Methods: We retrospectively reviewed electronic medical records of a cohort of patients who were 70 years of age or older and were treated with PET for operable non-metastatic breast cancer in an academic cancer center from 2009 to 2021. Study endpoints were progression-free survival (PFS), overall survival (OS), and factors associated with PFS and OS. For PFS, the events considered were disease progression in patients treated with PET alone, disease recurrence in those who underwent surgery, or death from any cause. Survival was estimated using the Kaplan-Meir method and compared with the log-rank test. Prognostic factors evaluated were age, histological type, grade, Ki67 index, stage, ECOG-performance status (ECOG-PS) and comorbidities burden, according to Charlson index. Univariate and multivariable analysis were performed using Cox regression. Results: PET was the first treatment for 197 pts aged 70 years or older. The median age was 81 years (range 70-101). Most patients had ductal (N=149; 75%) or lobular carcinomas (N=22; 11%), grade 1 (N=48; 24%) or grade 2 (N=114; 58%), and stage II (N=67; 34%) or stage III (N=94; 48%) disease. Half of the patients had an ECOG-PS 3 (n=65) or 4 (n=35); 165 pts (83%) had an Charlson index &lt; 6. Seventy-two pts (36%) underwent surgery. Thirty pts (15%) had a disease recurrence or progression and 60 pts (30.5%) died; most deaths (n=38; 63%) were not related to breast cancer. In a multivariable analysis, pts with grade 3 disease had higher risk of recurrence/progression/death (HR 3.31, 95% CI 1.45-7.58, P=0.005), while those treated with surgery had a decreased risk (HR 0.37, 95% CI 0.21-0.65; P=0.001). Median PFS was 55.2 mo for pts treated with PET alone and 99.7 mo in those treated with ET followed by surgery. Median OS was 63 mo and 111.9 mo, respectively. Conclusion: In this cohort, deaths observed were mostly unrelated to breast cancer, suggesting that PET is an appropriate choice for selected pts. Nevertheless, patients with grade 3 disease and those who were not treated with surgery after PET had a higher risk of disease progression/recurrence or death. Prognostic factors can be useful to select candidates for PET.

Citation Format: Erika Andrade Rocha, Jessica Monteiro Vasconcellos, Sofia Vidaurre Mendes, Pedro José Galvão Freire, Ana Paula Messias, Leticia Vecchi Leis, Otavio Noschang Moreira, Mauricio Baptista Pereira, Bruna Zanin Orsi, Augusto Araujo Neto, Vanessa Petry, Renata Colombo Bonadio, Laura Testa. Prognostic factors among elderly patients with operable non-metastatic breast cancer treated with primary endocrine therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-32.

Trastuzumab deruxtecan versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer: updated results from DESTINY-Breast03, a randomised, open-label, phase 3 trial

BACKGROUND

An improvement in progression-free survival was shown with trastuzumab deruxtecan versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer in the progression-free survival interim analysis of the DESTINY-Breast03 trial. The aim of DESTINY-Breast03 was to compare the efficacy and safety of trastuzumab deruxtecan versus trastuzumab emtansine.

METHODS

This open-label, randomised, multicentre, phase 3 trial was done in 169 study centres in North America, Asia, Europe, Australia, and South America. Eligible patients were aged 18 or older, had HER2-positive unresectable or metastatic breast cancer previously treated with trastuzumab and a taxane, had an Eastern Cooperative Oncology Group performance status 0-1, and at least one measurable lesion per Response Evaluation Criteria in Solid Tumours version 1.1. Patients were randomly assigned (1:1) to receive trastuzumab deruxtecan 5·4 mg/kg or trastuzumab emtansine 3·6 mg/kg, both administered by intravenous infusion every 3 weeks. Randomisation was stratified by hormone receptor status, previous treatment with pertuzumab, and history of visceral disease, and was managed through an interactive web-based system. Within each stratum, balanced block randomisation was used with a block size of four. Patients and investigators were not masked to the treatment received. The primary endpoint was progression-free survival by blinded independent central review. The key secondary endpoint was overall survival and this prespecified second overall survival interim analysis reports updated overall survival, efficacy, and safety results. Efficacy analyses were performed using the full analysis set. Safety analyses included all randomly assigned patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT03529110.

FINDINGS

Between July 20, 2018, and June 23, 2020, 699 patients were screened for eligibility, 524 of whom were enrolled and randomly assigned to receive trastuzumab deruxtecan (n=261) or trastuzumab emtansine (n=263). Median duration of study follow-up was 28·4 months (IQR 22·1-32·9) with trastuzumab deruxtecan and 26·5 months (14·5-31·3) with trastuzumab emtansine. Median progression-free survival by blinded independent central review was 28·8 months (95% CI 22·4-37·9) with trastuzumab deruxtecan and 6·8 months (5·6-8·2) with trastuzumab emtansine (hazard ratio [HR] 0·33 [95% CI 0·26-0·43]; nominal p<0·0001). Median overall survival was not reached (95% CI 40·5 months-not estimable), with 72 (28%) overall survival events, in the trastuzumab deruxtecan group and was not reached (34·0 months-not estimable), with 97 (37%) overall survival events, in the trastuzumab emtansine group (HR 0·64; 95% CI 0·47-0·87]; p=0·0037). The number of grade 3 or worse treatment-emergent adverse events was similar in patients who received trastuzumab deruxtecan versus trastuzumab emtansine (145 [56%] patients versus 135 [52%] patients). Adjudicated drug-related interstitial lung disease or pneumonitis occurred in 39 (15%) patients treated with trastuzumab deruxtecan and eight (3%) patients treated with trastuzumab emtansine, with no grade 4 or 5 events in either group.

INTERPRETATION

Trastuzumab deruxtecan showed a significant improvement in overall survival versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer, as well as the longest reported median progression-free survival, reaffirming trastuzumab deruxtecan as the standard of care in the second-line setting. A manageable safety profile of trastuzumab deruxtecan was confirmed with longer treatment duration.

FUNDING

Daiichi Sankyo and AstraZeneca.

Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer

BACKGROUND

Trastuzumab emtansine is the current standard treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer whose disease progresses after treatment with a combination of anti-HER2 antibodies and a taxane.

METHODS

We conducted a phase 3, multicenter, open-label, randomized trial to compare the efficacy and safety of trastuzumab deruxtecan (a HER2 antibody-drug conjugate) with those of trastuzumab emtansine in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane. The primary end point was progression-free survival (as determined by blinded independent central review); secondary end points included overall survival, objective response, and safety.

RESULTS

Among 524 randomly assigned patients, the percentage of those who were alive without disease progression at 12 months was 75.8% (95% confidence interval [CI], 69.8 to 80.7) with trastuzumab deruxtecan and 34.1% (95% CI, 27.7 to 40.5) with trastuzumab emtansine (hazard ratio for progression or death from any cause, 0.28; 95% CI, 0.22 to 0.37; P<0.001). The percentage of patients who were alive at 12 months was 94.1% (95% CI, 90.3 to 96.4) with trastuzumab deruxtecan and 85.9% (95% CI, 80.9 to 89.7) with trastuzumab emtansine (hazard ratio for death, 0.55; 95% CI, 0.36 to 0.86; prespecified significance boundary not reached). An overall response (a complete or partial response) occurred in 79.7% (95% CI, 74.3 to 84.4) of the patients who received trastuzumab deruxtecan and in 34.2% (95% CI, 28.5 to 40.3) of those who received trastuzumab emtansine. The incidence of drug-related adverse events of any grade was 98.1% with trastuzumab deruxtecan and 86.6% with trastuzumab emtansine, and the incidence of drug-related adverse events of grade 3 or 4 was 45.1% and 39.8%, respectively. Adjudicated drug-related interstitial lung disease or pneumonitis occurred in 10.5% of the patients in the trastuzumab deruxtecan group and in 1.9% of those in the trastuzumab emtansine group; none of these events were of grade 4 or 5.

CONCLUSIONS

Among patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane, the risk of disease progression or death was lower among those who received trastuzumab deruxtecan than among those who received trastuzumab emtansine. Treatment with trastuzumab deruxtecan was associated with interstitial lung disease and pneumonitis. (Funded by Daiichi Sankyo and AstraZeneca; DESTINY-Breast03 ClinicalTrials.gov number, NCT03529110.).

Abstract GS3-01: Trastuzumab deruxtecan (T-DXd; DS-8201a) vs. trastuzumab emtansine (T-DM1) in patients (pts) with HER2+ metastatic breast cancer (mBC): subgroup analyses from the randomized phase 3 study DESTINY-Breast03

Background: T-DXd is a HER2-targeting antibody-drug conjugate approved for the treatment of pts with advanced HER2+ mBC based on the DESTINY-Breast01 study (NCT03248492). DESTINY-Breast03 (NCT03529110) isa randomized, multicenter, open-label, phase 3 study assessing the efficacy and safety of T-DXd vs. T-DM1 in pts with HER2+ mBC previously treated with trastuzumab and taxane. In the primary analysis, T-DXd demonstrated a clinically meaningful and statistically significant improvement in PFS vs. T-DM1 (Corteset al, ESMO 2021). In this exploratory analysis, we provide additional efficacy and safety data in subgroups, including in pts with brain metastases (BMs). Methods: Pts were randomly assigned 1:1 to receive 5.4 mg/kg T-DXd or 3.6 mg/kg T-DM1 Q3W. Pts with clinically stable BMs were eligible. Lesions were measured per modified Response Evaluation Criteria in Solid Tumors version 1.1. The primary endpoint was progression-free survival (PFS) determined by blinded independent central review (BICR). PFS and overall response rate (ORR) were analyzed for subgroups.Sites of progression and post-end-of-study therapies were also investigated. Results: At data cutoff (May 21, 2021), 524 pts were randomly assigned to T-DXd (n=261) orT-DM1 (n=263). T-DXd demonstrated superior PFS by BICR vs. T-DM1 (HR, 0.28 [95%CI, 0.22-0.37]; P=7.8 x 10-22); median (m) PFS by BICR was not reached (95% CI, 18.5-NE) for T-DXd compared with 6.8 mo (95% CI, 5.6-8.2) forT-DM1. For pts with stable BMs at baseline (n=82), mPFS was 15.0 mo (95% CI,12.5-22.2) for T-DXd vs. 3.0 mo (95% CI, 2.8-5.8) for T-DM1 (HR, 0.25 [95% CI,0.31-0.45)]. Overall, confirmed ORR for T-DXd was 79.7% vs. 34.2% for T-DM1.For patients with stable BMs at baseline, ORR was 67.4% for T-DXd vs. 20.5% forT-DM1. Consistent PFS and ORR benefit was also observed across other subgroups(Table 1). At data cutoff, 84 (32.2%) pts treated with T-DXd had progressive disease (PD) versus 155 (58.9%) with T-DM1. In pts with stable BMs in the T-DXd arm, 48.8% of pts (21/43) had PD. In pts with stable BMs in the T-DM1 arm, 69.2%of pts (27/39) had PD. Data on sites of progression will be presented. Further analyses are underway and will be presented. Overall, the safety profile of T-DXd was manageable and comparable with its known safety profile. Adjudicated drug-related interstitial lung disease/pneumonitis was reported in 27 (10.5%) pts treated with T-DXd and 5 (1.9%) pts treated with T-DM1 overall, with no grade 4 or 5 events. Additional new safety data will be presented. Conclusion: DESTINY-Breast03,the first-reported randomized phase 3 trial comparing T-DXd to standard of care, met the primary endpoint with T-DXd demonstrating superior PFS vs. T-DM1and T-DXd had a manageable safety profile. In this exploratory analysis, consistent PFS and ORR benefit with T-DXd vs. T-DM1 was observed across subgroups in pts with HER2+ mBC previously treated with trastuzumab and taxane, including in pts with BMs.

Table 1.Subgroup Analyses forPFS and ORR of T-DXd versus T-DM1PFS by BICR HR (95% CI)Absolute ORR Difference (T-DXd-T-DM1) (95% CI)All patients (N=524)0.28 (0.22-0.37)45.5 (37.6-53.4)Hormone receptorPositive (n=272)0.32 (0.22-0.46)47.3 (36.1-58.4)Negative (n=248)0.30 (0.20-0.44)43.2 (31.5-55.0)Prior pertuzumabYes (n=320)0.31 (0.22-0.43)46.7 (36.5-56.9)No (n=204)0.30 (0.19-0.47)43.6 (30.5-56.7)Prior lines of therapya0-1 (n=258)0.33 (0.23-0.48)39.3 (27.3-51.2)≥2 (n=266)0.28 (0.19-0.41)51.6 (40.9-62.4)Visceral disease Yes (n=384)0.28 (0.21-0.38)48.3 (39.1-57.6)No (n=140)0.32 (0.17-0.58)39.1 (23.6-54.6)Brain metastases at baseline Yes (n=82)0.25 (0.13-0.45)46.9 (25.6-68.3)No (n=442)0.30 (0.22-0.40)45.5 (36.9-54.1)

Citation Format: Sara Hurvitz, Sung-Bae Kim, Wei-Pang Chung, Seock-Ah Im, Yeon Hee Park, Roberto Hegg, Min-Hwan Kim, Ling-Ming Tseng, Vanessa Petry, Chi-Feng Chung, Hiroji Iwata, Erika Hamilton, Giuseppe Curigliano, Binghe Xu, Caleb Lee, Yali Liu, Jillian Cathcart, Emarjola Bako, Sunil Verma, Javier Cortés. Trastuzumab deruxtecan (T-DXd; DS-8201a) vs. trastuzumab emtansine (T-DM1) in patients (pts) with HER2+ metastatic breast cancer (mBC): subgroup analyses from the randomized phase 3 study DESTINY-Breast03 [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 GS3-01.

Abstract PS16-34: Phenotype and prognosis of patients with breast cancer and pathogenic TP53 variants

Background: The lifetime risk of cancer in individuals with Li Fraumeni syndrome (LFS) is more than 70% for men and more than 90% for women. Breast cancer (BC) is the most common type of cancer in premenopause women with pathogenic allelic TP53 variants (PVs). However, little is known about the BC response to systemic therapy and the prognosis in these patients. We aim to analyze the phenotype and the outcomes of patients with LFS and BC. Methods: We evaluated a cohort of patients with PVs or likely PVs of TP53 with BC diagnosis treated from December 1999 to June 2020 from a single tertiary cancer center. Our primary objective is to evaluate the outcomes of these patients. Secondary objective is to describe the BC phenotype, characterizing the clinical and the pathological features.Results: Among 56 patients with PVs or likely PVs of TP53, 25 were diagnosed with BC. Median age at BC diagnosis was 39.2 years (range 23.4-57.4 years). The majority (N= 18, 72%) harbored a germline PV TP53 p.R337H in heterozygosity status. The most common histology type was an invasive carcinoma of no special subtype, 73% were hormone receptor-positive, and 32% were HER2-positive. Three (12%) patients were metastatic at diagnosis. Seven (28%) of the patients with localized disease at diagnosis received neoadjuvant chemotherapy, and other 7 (28%) received adjuvant chemotherapy. Among patients treated with neoadjuvant chemotherapy, 5 (71%) had a tumor response, while 2 (29%) presented with disease progression. No pathologic complete response was achieved. After a median follow-up of 52.6 months, no deaths secondary to breast cancer occurred. Only 1 patient died due to another neoplasm (jaw osteosarcoma), and 3 (12%) patients developed radiotherapy-induced malignancies in the irradiated field. Conclusions: BC in patients with LFS is mainly the invasive carcinoma of no special subtype, enriched in hormone receptor and HER2 positivity. Although response to neoadjuvant chemotherapy is high, no pathologic complete response occurred in this cohort. Favorable outcomes were observed, with a high BC specific survival. Secondary malignancies remain a major concern. Larger cohorts should test whether new genes act as modifiers of p53 function and breast cancer susceptibility.

Citation Format: Vanessa Petry. Phenotype and prognosis of patients with breast cancer and pathogenic TP53 variants [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS16-34.

Radiotherapy-induced malignancies in breast cancer patients with TP53 pathogenic germline variants (Li-Fraumeni syndrome)

The risk of radiotherapy-induced malignancies (RIMs) is a concern when treating Li-Fraumeni syndrome (LFS) or Li-Fraumeni Like (LFL) patients. However, the type of TP53 pathogenic germline variant may possibly influence this risk. TP53 p.R337H mutation is particularly prevalent in Brazil. We aimed to evaluate the outcomes of patients with pathogenic TP53 variants treated for localized breast cancer in a Brazilian cohort. We evaluated retrospectively a cohort of patients with germline TP53 pathogenic variants treated for localized breast cancer between December 1999 and October 2017. All patients were followed by the Hereditary Cancer Group of an academic cancer center. Our primary objective was to evaluate the occurrence of RIMs after adjuvant radiotherapy. Sixteen patients were evaluated; 10 (62.5%) had a germline TP53 p.R337H pathogenic variant. Median age was 39.8 years. Thirteen patients had invasive ductal carcinoma: 8 (61.5%) were hormone receptor-positive; 6 (46.1%), human epithelial growth factor receptor 2 (HER2)-amplified. Three patients had ductal carcinoma in situ. Most patients (N = 12/16, 75%) received adjuvant radiotherapy. After a median follow-up of 52.5 months, 2 patients (2/12, 16.6%) had RIMs. One had a fibrosarcoma and the other, a low-grade leiomyosarcoma. In the group treated with radiotherapy, one distant recurrence was diagnosed (1/12), and no loco-regional recurrence occurred. Among 4 patients who did not receive radiotherapy, 2 presented with loco-regional recurrence. In this cohort of patients with LFS enriched in TP53 p.R337H pathogenic variant, the incidence of RIMs after treatment of localized breast cancer was lower than previous literature. Nevertheless, rates of RIMs were still alarming. Early molecular diagnosis and careful evaluation of treatment risks and benefits are essential for these patients.

Return to work after breast cancer diagnosis: An observational prospective study in Brazil

BACKGROUND

In North America and Europe, return-to-work (RTW) rates vary among breast cancer (BC) survivors, from 24% to 66% and from 53% to 82% at 6 and 36 months after diagnosis, respectively. To date, there is a lack of data on RTW rates after BC diagnosis in Latin America. Therefore, the primary objectives of this study were to define RTW rates at 12 and 24 months after BC diagnosis and to identify the factors associated with RTW in this population.

METHODS

In total, 125 employed women from a single institution with newly diagnosed BC were interviewed by telephone at 6, 12, and 24 months after diagnosis. Those who had inoperable or metastatic disease were excluded.

RESULTS

Overall, RTW rates were 30.3% and 60.4% at 12 and 24 months after BC diagnosis, respectively. Most women reported that they received support from their employer, but only 29.1% reported having been offered work adjustments. In multivariate analysis, the factors associated with positive RTW outcomes included higher household income (odds ratio [OR], 17.76; 95% confidence interval [CI], 3.33-94.75; P = .001), breast-conserving surgery (OR, 9.77; 95% CI, 2.03-47.05; P = .004), and work adjustments (OR, 37.62; 95% CI, 2.03-47.05; P = .004). The factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR, 0.11; 95% CI, 0.02-0.74; P = .023), and depression diagnosed after BC (OR, 0.07; 95% CI, 0.01-0.63; P = .017).

CONCLUSIONS

RTW rates in the current study were lower than those observed in developed countries but similar to the rates among low-income Americans. Workplace adjustments, higher income, breast-conserving surgery, endocrine therapy, and depression after BC played an important role in the RTW decision.

Serum levels of VEGF and MCSF in HER2+ / HER2- breast cancer patients with metronomic neoadjuvant chemotherapy

Metronomic therapy has been gaining importance in the neoadjuvant setting of breast cancer treatment. Its clinical benefits may involve antiangiogenic machinery. Cancer cells induce angiogenesis to support tumor growth by secreting factors, such as vascular endothelial growth factor (VEGF). In breast cancer, Trastuzumab (TZM) based treatment is of key importance and is believed to reduce diameter and volume of blood vessels as well as vascular permeability. Here in we investigated serum levels of angiogenic factors VEGF and MCSF in patients receiving metronomic neoadjuvant therapy with or without TZM. We observed in HER2+ cohort stable levels of MCSF through treatment, whereas VEGF trend was of decreasing levels. In HER2- cohort we observed increasing levels of MCSF and VEGF trend. Overall, HER2+ patients had better pathological response to treatment. These findings suggest that angiogenic pathway may be involved in TZM anti-tumoral effect in the neoadjuvant setting.

Bone Metastases in Patients with Neuroendocrine Neoplasm: Frequency and Clinical, Therapeutic, and Prognostic Relevance

BACKGROUND

The incidence and prevalence of neuroendocrine neoplasms (NEN) are rising. In view of continuously improving imaging techniques, more than half of the patients present with distant metastases at initial diagnosis. An advanced disease stage negatively correlates with the 5-year survival rate. In stage IV disease, bone metastases (BM) are frequent, yet knowledge concerning their clinical or prognostic relevance is rare. This study presents a single-center experience on the frequency and management of BM in patients with gastroenteropancreatic NEN and lung carcinoids.

METHODS

Between 2000 and June 2015, 327 of 677 patients treated in the European Neuroendocrine Tumor Society (ENETS) center in Marburg (Germany) presented with distant metastases (48.3%), including 85 patients (12.6%) with BM. Data of both groups were analyzed using descriptive statistics. Overall survival was assessed by Kaplan-Meier curves and compared by log-rank test.

RESULTS

Median age in the BM group was 54.9 years, the small intestine and the pancreas being the most common primaries. 83.5% of the tumors were well and moderately differentiated (G1/G2). Nearly half of the patients with BM were symptomatic and suffered either from pain (42.4%) or had fractures (11.7%). Bisphosphonates were employed in almost two-thirds of the patients, radiation therapy in 25.9%. Overall survival was significantly inferior in patients with BM than in those with other distant metastases (p = 0.01; 49.0 vs. 100.8 months).

CONCLUSION

BM appear to have a significant clinical and prognostic impact. Further studies are needed to evaluate therapeutic approaches directed to the treatment of BM in particular for asymptomatic patients.

Abstract P4-19-06: Return to work after breast cancer diagnosis: An observational prospective study of 125 patients in South America

Background:Breast cancer is the most common cancer in women. While its incidence has been increasing, recurrence and mortality rates have been decreasing. Because of that, cancer can now be regarded as a transient shock that does not prevent the survivors to live normal lives, including returning to their workplace. From a social perspective, long periods of sick leave have a strong economic impact. From the patient perspective, prolonged sick leave can cause financial difficulties and emotional distress. In United States and Europe, RTW rates vary among breast cancer patients from 24-66% after 6 months and 53-82% after 36 months of diagnosis. Factors associated with the decision to return to work are: age, chemotherapy, sequelae related to cancer therapy and support from the employer and coworkers. However, these findings vary among the different populations studied, suggesting that other factors may also interfere with the decision to return to work. Data on RTW after breast cancer diagnosis is not avaliable in South America nor in developing countries – where the workforce tends to be relatively younger than average. The primary objective of this study was to evaluate RTW rates on months 12 and 24 after breast cancer diagnosis, and to evaluate factors associated with the decision to return to work.

Methods: Prospective, observational study evaluating RTW rates in patients diagnosed with breast cancer, &gt; 18 and &lt;57 years old (in Brazil women can retire at age 60) and under remunerated work for at least 03 months at the time of diagnosis. Patients with metastatic disease were excluded. Based on previously data, we estimated that 125 patients would be required to achieve the primary endpoint. Each patient was followed for 02 years. On months 6, 12 and 24 they answered a telephone interview and the FACT-B questionnaire. Disease characteristics and treatment were collected from electronic medical records. After completion of all third row of interviews (by september, 2016) we will perform univariate and multivariate analysis by logistic regression method to determine the independent predictors of return to work.

Results: Between july, 2012 and september, 2014, 125 patients were enrolled. The median age was 45.1 (range 25-57). Half of the patients (52.9%) were married at the time of diagnosis, and 96.9% received support from their life partner. Most of them reported that they liked their job (93.8%) and received support from their employer (61.5%), but only 29.1% reported adjustment offering, so that they could keep working during treatment. Almost half of patients (47.6%) had stage II disease, 75.4% and 19.7% were HR and Her 2 positive, respectively, and 92.6% received chemotherapy as part of their treatment. Overall, 22.1% and 28.8% of patients returned to work, at 6 and 12 months after breast cancer diagnosis, respectively.

Conclusion: Twelve months after breast cancer diagnosis, less than 30% of the patients had returned to work. By september, 2016, we will have completed the “24 month” interviews and will present RTW rates at that time and also correlative analyses of factors that affected the RTW in this population.

Citation Format: Landeiro LG, Fraile NMP, Fede AB, Fonseca LG, Testa L, Petry V, Gonçalves MS, Costa RDP, Cohn DB, Ferrari MM, Sunahara RS, de Gouveia ACC, Mano MS. Return to work after breast cancer diagnosis: An observational prospective study of 125 patients in South America [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-06.

Metronomic chemotherapy in the neoadjuvant setting: results of two parallel feasibility trials (TraQme and TAME) in patients with HER2+ and HER2- locally advanced breast cancer

Neoadjuvant chemotherapy has practical and theoretical advantages over adjuvant chemotherapy strategy in breast cancer (BC) management. Moreover, metronomic delivery has a more favorable toxicity profile. The present study examined the feasibility of neoadjuvant metronomic chemotherapy in two cohorts [HER2+ (TraQme) and HER2− (TAME)] of locally advanced BC. Twenty patients were prospectively enrolled (TraQme, n=9; TAME, n=11). Both cohorts received weekly paclitaxel at 100 mg/m² during 8 weeks followed by weekly doxorubicin at 24 mg/m² for 9 weeks in combination with oral cyclophosphamide at 100 mg/day (fixed dose). The HER2+ cohort received weekly trastuzumab. The study was interrupted because of safety issues. Thirty-six percent of patients in the TAME cohort and all patients from the TraQme cohort had stage III BC. Of note, 33% from the TraQme cohort and 66% from the TAME cohort displayed hormone receptor positivity in tumor tissue. The pathological complete response rates were 55% and 18% among patients enrolled in the TraQme and TAME cohorts, respectively. Patients in the TraQme cohort had more advanced BC stages at diagnosis, higher-grade pathological classification, and more tumors lacking hormone receptor expression, compared to the TAME cohort. The toxicity profile was also different. Two patients in the TraQme cohort developed pneumonitis, and in the TAME cohort we observed more hematological toxicity and hand-foot syndrome. The neoadjuvant metronomic chemotherapy regimen evaluated in this trial was highly effective in achieving a tumor response, especially in the HER2+ cohort. Pneumonitis was a serious, unexpected adverse event observed in this group. Further larger and randomized trials are warranted to evaluate the association between metronomic chemotherapy and trastuzumab treatment.

Prevalence of community-acquired methicillin-resistant Staphylococcus aureus and antibiotic resistance in patients with atopic dermatitis in Porto Alegre, Brazil

BACKGROUND

Atopic dermatitis (AD) is a skin manifestation of atopy caused by hyperreactivity to various antigens. Studies have shown that 60-100% of patients with this condition present with colonization by Staphylococcus aureus. Given increasing rates of antimicrobial resistance, the sensitivity to antimicrobials of S. aureus colonizing atopic patients has been investigated. Cross-sectional studies worldwide suggest that the prevalence of methicillin-resistant S. aureus infection (MRSA) in the AD population varies from 0% to 30.8%.

OBJECTIVES

The objectives of this study were to determinate the prevalence of S. aureus and MRSA in patients with AD in two dermatologic centers in Porto Alegre, Brazil.

METHODS

A total of 91 patients with AD attending two dermatologic centers in Porto Alegre were enrolled in this study from December 2009 to July 2011. Two skin swabs were taken from each patient, one from the nares and the other from a non-infected eczematous skin lesion. The swabs were sent to the laboratory, where standard procedures to isolate bacteria and identify S. aureus, antimicrobial resistance, and sensitivity patterns were carried out. The severity of AD was defined using the Eczema Area and Severity Index (EASI).

RESULTS

Of the 91 patients sampled, 67 (73.6%) patients were found to be positive for S. aureus colonization. Nasal swabs were positive in 55 (60.4%) patients, lesional swabs in 44 (48.4%) patients, and both lesional and nasal swabs were positive in 32 (35.2%) patients. Patients with positive swabs had a higher mean ± standard deviation EASI score [mean (9.1 ± 8.8)] compared with patients with negative swabs (3.9 ± 3.6) (P = 0.002). None of the 91 patients showed any evidence of MRSA infection. Overall, nearly 32% of the S. aureus isolated from nasal swabs and 36.40% of the S. aureus isolated from lesional swabs was resistant to erythromycin.

CONCLUSIONS

The results of this study confirm a high rate of S. aureus colonization in pediatric patients with AD and indicate a relevant association between colonization and high EASI score. No MRSA was found in cultures from this sample of patients in southern Brazil. Nearly one-third of isolates were identified as resistant to erythromycin, an antibiotic that is commonly used in pediatric patients.

Bacterial skin colonization and infections in patients with atopic dermatitis

Atopic Dermatitis is a chronic inflammatory skin disease that affects a large number of children and adults. The disease results from an interaction between genetic predisposition, host environment, skin barrier defects, and immunological factors. A major aggravating factor associated with Atopic Dermatitis is the presence of microorganisms on the patient's skin surface. Staphylococcus aureus and Streptococcus pyogenes, for instance, can exacerbate chronic skin inflammation. As a result, antimicrobials have often been prescribed to control the acute phase of the disease. However, increased bacterial resistance to antimicrobial agents has made it difficult for dermatologists to prescribe appropriate medication. In the presence of disseminated dermatitis with secondary infection, systemic antibiotics need to be prescribed; however, treatment should be individualized, in an attempt to find the most effective antibiotic with fewer side effects. Also, the medication should be used for as short as possible in order to minimize bacterial resistance.

Metronomic chemotherapy (MC) in the neoadjuvant setting: Results of two parallel feasibility trials in patients (pts) with HER2 positive (HER2+) and negative (HER2-) locally advanced breast cancer (LABC) (Traq-Me and TAME)

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Background: In a previous randomized trial (SWOG 0012), MC seemed to improve pCR rates compared to standard anthracycline/taxane neoadjuvant chemotherapy (NC). We aimed to evaluate the feasibility of MC with a taxane→anthracycline schedule, which has also been shown potentially superior to the reverse sequence [J Clin Oncol 28:15s, 2010 (suppl; abstr 548)]. We also aimed to establish the feasibility of MC in combination with trastuzumab. Methods: The original accrual goal was 25 HER2+ pts and 40 HER2- pts. HER2- pts received MC consisting of paclitaxel (100mg/m2) x8 weeks followed by doxorubicin (24mg/m2) x9 weeks combined with oral cyclophosphamide (100mg/day), without G-CSF. HER2+ pts also received trastuzumab (4 mg/kg followed by 2mg/kg) concurrently with the entire CT. Objectives: Primary: To evaluate the feasibility of these schedules (defined as a febrile neutropenia [FN] rate no higher than 10%). Secondary: cardiac safety and general tolerability; efficacy as measured by objective clinical, radiological and pathologic complete response (pCR). Results: Almost all pts were staged as III (TraQme 8/9 88% and MeTo 4/11 36%). The HER2+ cohort was prematurely closed after 2 (22%) pts developed G3 pneumonitis (during the metromonic phase). Both responded to medical treatment and recovered. One pt had G2 hand-foot skin reaction (HFS) and another had G2 mucositis. The HER2- cohort was also prematurely closed with only 11 pts because of high rates of mucocutaneous toxicity (G3 HFS in 36%, G3 rash in 9%) and also due to the recent SWOG0221 negative results. There were 2 (18%) cases of FN and 3 (27%) of G4 neutropenia in this cohort, but no cases of pneumonitis. 1/11(9%) HER2- and 5/9HER2+(55%) pts had a pCR. VEGF pathway-related biomarkers were collected and will be presented at a later date. Conclusions: The proposed MC schedules proved too toxic to be considered for further clinical development. In addition, MC resulted in unexpectedly high rates of severe pulmonary toxicity when given in combination with trastuzumab. HER2+ but not HER2- pts had an impressively high pCR rate.

Feasibility of two schedules of weekly paclitaxel as (neo)adjuvant treatment for patients (PTS) with HER2-negative breast cancer (BC) in the Brazilian community setting

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Background: Paclitaxel is one of the most active drugs in BC and the weekly administration has been shown more effective and better. GEICAM9906 was a phase III trial that demonstrated the effectiveness and safety of a pragmatic dose-dense schedule of 100mg/m2 of paclitaxel given over 8 consecutive weeks (w), without G-CSF support. This schedule has been adopted at our institution in 2009 for HER2 negative disease and herein we present the first off-trial experience and also compare its safety profile with that of a historical cohort of pts treated with the conventional 80mg/m2 x12w schedule. Methods: The study consists of a retrospective review of medical files from pts with locally advanced BC treated with (neo)adjuvant paclitaxel-based therapy with one of two schedules: (1) 80 mg/m² x 12w or (2) 100 mg/m² x 8w. Adverse events (AE) were graded according to Common Terminology Criteria for Adverse Events 4.0 (CTCAE). Results: We reviewed files from 326 women with a median age of 52 (±10.9). Seventy and 256 pts received schedule (1) and (2), respectively. No significant difference was observed in the incidence of G3/4 toxicity: pneumonitis (2.8% vs 0.3% p=0.097), neuropathy (2.8% vs 0.7% p=0.303); hand-foot syndrome (1.4% vs 0.3% p=0.538); anaemia (0 vs 0.6% p=0.624); neutropenia (5.7% vs 6.2% p=0.408) with only one case of febrile neutropenia in schedule (2) arm; without cases of grade 3/4 thrombocytopenia, nausea, mucositis or anaphylaxis in both groups. Also, no significant difference was seen when comparing all grades toxicty. The dose intensity of paclitaxel was higher in schedule (2) with 97.72 mg/m² per week vs 77.07 mg/m² per week (p<0.0001). Conclusions: Weekly paclitaxel given according to GEICAM9906 is a pragmatic and well tolerated schedule when used in the Brazilian community setting, with a safety profile comparable to the conventional 80mg/m2 x12w schedule. In addition to being convenient to pts, it may also be cost-effective because of a lower number of clinic visits and infusions.

Metronomic chemotherapy (MC): Results of two feasibility trials in patients (pts) with HER2 positive (HER2+) and negative (HER2-) locally advanced breast cancer (LABC)

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Background: In SWOG0012, MC improved pathologic complete response (pCR) compared to standard neoadjuvant chemotherapy (NC). We evaluated the feasibility of MC with a taxane→anthracycline schedule, which has also been shown potentially superior to the inverse sequence. We also evaluated the feasibility of MC in combination with trastuzumab. Methods: The primary objective was feasibility (defined as a febrile neutropenia (FN) rate ≤10%). Secondary objectives were cardiac safety, tolerability and efficacy as measured by objective response and pCR. The original accrual goal was 25 Her2+ pts and 40 Her2- pts. Her2- pts received paclitaxel (100mg/m2) x8 weeks followed by doxorubicin (24mg/m2) x9 weeks combined with oral cyclophosphamide (100mg/day), without G-CSF. Her2+ pts also received weekly trastuzumab (4 mg/kg followed by 2mg/kg) concurrently with the entire CT. Results: Most pts were stage III (Her+: 8/9; Her-: 4/11). The Her2+ cohort was prematurely closed after 2(22%) pts developed G3 pneumonitis (both during the MC phase). Both recovered completely. There was 1 case of asymptomatic LVEF drop to below 50% (during the taxane phase); 1 pt had G2 hand-foot skin reaction (HFS) and another had G2 mucositis. The Her2- cohort was also prematurely closed with only 11 pts due to high rates of mucocutaneous toxicity (G3 HFS in 36%, G3 rash in 9%) and also because of SWOG0221 negative results. There were 2(18%) cases of FN, but no cases of pneumonitis. 1/11(9%) Her2- and 5/9(55%) Her2 + pts had a pCR. VEGF-related biomarkers were collected and will be presented at a later date. Conclusions: The proposed MC schedules proved too toxic to be considered for further clinical development. In addition, MC resulted in unexpectedly high rates of severe pulmonary toxicity when given in combination with trastuzumab. Her2+ but not Her2- pts had an impressively high pCR rate.

Relação entre de prurido e qualidade de vida de pacientes em hemodiálise

FUNDAMENTOS: O prurido é um sintoma freqüente nos pacientes em hemodiálise. Tem etiologia não totalmente esclarecida e difícil manejo, o que piora de modo considerável a qualidade de vida dos doentes. OBJETIVOS: Avaliar o grau de prurido e sua influência na qualidade de vida dos pacientes renais crônicos em hemodiálise. MÉTODOS: Estudo transversal com pacientes renais crônicos em hemodiálise no Complexo Hospitalar Santa Casa de Porto Alegre, que apresentassem prurido sem outras dermatoses. Utilizou-se a escala análoga visual para mensuração do grau de prurido e o questionário do Índice de Qualidade de Vida para Dermatologia. RESULTADOS: Dos 200 pacientes avaliados, 69 (34,5%) apresentaram prurido, dos quais 16 (23%) de grau leve, 39 (56,5%) moderado e 14 (20,2%) grave. Quando analisada a qualidade de vida, verificou-se que em 14 (20,3%) não houve influência do prurido na qualidade de vida. Entretanto, para 26 pacientes (37,4%), o prurido teve um pequeno efeito, em nove (13%) houve efeito moderado, 13 (18,8%) foram afetados de maneira grave e em sete (10,1%) houve influência extremamente grave. CONCLUSÕES: Neste estudo, 57% dos indivíduos não demonstraram alterações importantes na qualidade de vida relacionadas ao prurido, mas um número significativo estava na faixa de muito e extremamente alterado, o que denota a necessidade de atenção ao tratamento deste sintoma neste grupo de pacientes.

Avaliação da relação do prurido e níveis sangüíneos de IgE com a gravidade do quadro clínico em pacientes com dermatite atópica

FUNDAMENTOS: Pacientes portadores de dermatite atópica apresentam freqüentemente níveis séricos elevados de IgE, e o prurido é uma das manifestações cardinais da doença. OBJETIVOS: Descrever as características do prurido nos pacientes com dermatite atópica (DA) e correlacionar a gravidade do eczema com os níveis plasmáticos de imunoglobulina E (IgE). MÉTODOS: Os pacientes com dermatite atópica atendidos no Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre e nos Serviços de Pediatria e Dermatologia da Universidade Luterana do Brasil responderam a um questionário sobre sintomas da dermatite atópica e deles foi coletado sangue para dosagem da IgE sérica. A gravidade da dermatose foi calculada conforme critérios sugeridos por Rajka et al. Os dados foram analisados no programa SPSS. RESULTADOS: Oitenta e nove pacientes completaram o estudo. A média de idade foi de 9,6 ± 9 anos, e 51% dos pacientes eram do sexo feminino. Quando analisada a freqüência de prurido de acordo com a gravidade do quadro clínico, foi encontrada uma relação significativa (p = 0,003). Os pacientes com quadro leve de dermatite atópica tinham coceira diária em 45% dos casos; aqueles com quadro grave tinham 90,9% de sintomas diários; e apenas 4,5% tinham mais de sete dias de intervalo entre os episódios de coceira. A mediana dos níveis de IgE sérica foi de 347UI\ml. As medianas da IgE sérica nos pacientes com eczema leve, moderado e grave foram 279UI\ml, 347UI/ml e 952UI/ml, respectivamente (p = 0,699). Pacientes do sexo feminino apresentaram níveis de IgE menores do que os do sexo masculino (212UI/ml and 2067UI/ml, p= 0,004). CONCLUSÃO: Pacientes com quadros graves de dermatite atópica apresentam prurido mais freqüente do que aqueles com manifestações mais leves. Na avaliação dos níveis séricos de IgE em relação à gravidade da DA, apesar de os valores serem mais altos nos pacientes mais graves, não se encontrou relação estatística significativa. Pacientes do sexo masculino têm níveis séricos de IgE significativamente mais altos do que os do sexo feminino. A freqüência do prurido está relacionada com a gravidade da dermatite atópica.