Increased intraocular pressure secondary to retinal detachment

Four clinical cases of patients with rhegmatogenous retinal detachment (RRD) associated with elevated intraocular pressure (IOP) are described. All the patients were men who came to the emergency service with floaters, all presented mild to moderate inflammation in the anterior chamber and increased intraocular pressure greater than 30 mmHg. All were diagnosed of RRD. This demonstrates that a RRD does not always present low IOP. In these cases of clinical retinal pathology and high IOP, we must carefully examine the anterior chamber and the fundus of the eye so that an associated retinal detachment does not remain unnoticed, and can be treated immediately. This association of elevated IOP and RRD is called as Schwartz-Matsuo Syndrome.¹.

Burden of disease assessment for Germany and its regions – results from the BURDEN 2020 study

Background

Epidemiological measures such as incidence, prevalence, or deaths are essential for monitoring population health. However, evaluating them in isolation cannot adequately compare and assess the relative importance of different diseases. Assessments of the burden of disease (BoD) are therefore of growing importance in supporting health policy decisions. Using disability-adjusted life years (DALY) as a summary measure of population health, BoD integrates morbidity and mortality in a transparent approach.

Methods

Within BoD methodology, deviations in the health of the population from an ‘ideal’ health status is quantified in the unit of life years. DALY are the sum of years of life lost due to death (YLL) and years lived with disability (YLD). While YLL describe the gap between age at death and statistical life expectancy, the indicator YLD quantifies years lived with a disability or disease. Calculations were based on different primary and secondary data sources for Germany, especially cause-of-death statistics, epidemiological survey data, and statutory health insurance data.

Results

In Germany, there were about 12 million DALY in 2017, the equivalent of 14,584 DALY per 100,000 population. Coronary heart disease contributes the most to the overall burden of disease, followed by lower back pain and lung cancer. In women, headache disorders and dementias account for more DALY as compared to men. Men have a higher burden of disease from lung cancer or alcohol use disorders. Pain disorders and alcohol use disorders lead the DALY rankings for both sexes in younger adulthood. The burden due to cardiovascular disease, COPD, and diabetes mellitus increases with age and also varies by region.

Conclusions

The results suggest age- and gender-specific prevention as well as regional health care needs. BoD studies therefore provide comprehensive data for population health surveillance and can support health policy decisions.

Key messages

• The importance of specific diseases as measured by DALY differs greatly by age and gender, highlighting the need for targeted prevention measures.

• Regional patterns emerge for cardiovascular disease, COPD, and depressive disorders, among others, which may indicate health care needs.

Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple negative, early high-risk and locally advanced breast cancer. NeoTRIP Michelangelo randomized study

BACKGROUND

High-risk triple negative breast cancers (TNBC) are characterized by poor prognosis, rapid progression to metastatic stage and onset of resistance to chemotherapy, thus representing an area in need of new therapeutic approaches. PD-L1 expression is an adaptive mechanism of tumour resistance to tumour infiltrating lymphocytes, which in turn are needed for response to chemotherapy. Overall, available data support the concept that blockade of PD-L1/PD-1 check-point may improve efficacy of classical chemotherapy.

PATIENTS AND METHODS

Two-hundred-eighty patients with TNBC were enrolled in this multicentre study (NCT002620280) and randomized to neoadjuvant carboplatin AUC 2 and nab-paclitaxel 125 mg/m² iv on days 1 and 8, without (N = 142) or with (N = 138) atezolizumab 1200 mg iv on day 1. Both regimens were given q3 weeks for 8 cycles before surgery and 4 cycles of an adjuvant anthracycline regimen. The primary aim of the study is to compare event-free survival, an important secondary aim was the rate of pathological complete remission (pCR defined as absence of invasive cells in breast and lymph nodes). The primary population for all efficacy endpoints is the intention-to-treat population.

RESULTS

The intention-to-treat analysis revealed that pCR rate after treatment with atezolizumab (48.6%) did not reach statistical significance compared to no atezolizumab [44.4%: odds ratio (OR) 1.18; 95% CI 0.74-1.89; P = 0.48]. Treatment-related adverse events were similar with either regimen except for a significantly higher overall incidence of serious adverse events and liver transaminases abnormalities with atezolizumab.

CONCLUSIONS

The addition of atezolizumab to nab-paclitaxel and carboplatin did not significantly increase the rate of pCR in women with TNBC. In multivariate analysis the presence of PD-L1 expression was the most significant factor influencing rate of pCR (OR 2.08). Continuing follow up for the event-free survival is ongoing, and molecular studies are under way.

Burden 2020: The German Burden of Disease Study Informative, comprehensive, appealing and digital: Providing health data to users. Accessibility of scientific results in the burden context

The aim of the BURDEN 2020 project is to calculate the Burden of Disease for Germany at the national and regional level. Based on the methods of the Global Burden of Disease study, the results will assess the impact of diseases on population health thus providing a freely accessible information basis for policy making and health care planning. How can the transfer from science to society take place on a low-threshold basis? We will talk about our strategy reaching out to decision-makers within health care planning in Germany and Europe. In addition, it will be examined how we wanted our results to be accessible, which possibilities of publication we choose beyond scientific articles and what options we had when talking about research marketing. We will also have a closer look on our demands for data visualization and transparency. In an ongoing process, two things were at stake: how do we define our target groups and how we address them. It has been proven to be a good strategy to continuously build up (international) networks, to share our knowledge and implement feedback. When publishing scientific results, it has turned out to be helpful for the project to approach a well-known bi-lingual journal with a wide range of coverage. We aimed to present the pilot project online with an appealing data visualization and graphic formats. This type of presentation made it easier to approach members of the press. Also, the inclusion of current topics such as COVID-19 helped to increase the media response. There are plans to include the use of the data in media formats such as webinars. Burden of Disease assessments can be challenging in implementation and communication. Before the start, the use of the metrics for Germany had to be thoroughly explained to national stakeholders. Within the project, we had to discuss how our data should be communicated to the public, to explain strength and weaknesses, and to produce publication formats that suit different target groups.

Long-term follow-up of intraocular pressure and pressure-lowering medication in patients following Excimer laser trabeculotomy

BACKGROUND

Excimer laser trabeculotomy (ELT) is a minimally invasive procedure to lower the intraocular pressure (IOP) via a photo-ablative laser that is applied to the trabecular meshwork. With this procedure, it is possible to improve the outflow of the aqueous humor. Until now, a limited number of studies examining mostly relatively small sample sizes with midterm follow-up exist. We therefore present the analysis of a large ELT cohort in a long-term follow-up.

METHODS

We recorded data from 580 patients who underwent ELT or combined ELT with cataract surgery at our institution from November 2000 until March 2011. A total of 512 patients with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and ocular hypertension (OHT) were included in the analysis. At every follow-up examination, the usage of IOP-lowering medication and the IOP were recorded. Failure criteria were defined as the need for another surgical glaucoma procedure, when the IOP was not 21 mmHg or less and a reduction of 20% from the baseline was not achieved with (qualified success) or without (absolute success) additional medication. Statistical analysis was done using Kaplan-Meier analysis and Cox regression.

RESULTS

Four hundred twenty-eight patients underwent combined cataract and ELT surgery, and 84 underwent solitary ELT surgery. After a median follow-up time of 656 days, 87% (combined surgery) and 66% (ELT) of the patients did not have to undergo another IOP-lowering intervention; 47/31% were classified as a qualified success and 31/11% as a complete success. The IOP-lowering medication, however, could not be significantly reduced within that time period.

CONCLUSION

Especially when combined with cataract surgery, ELT is a feasible minimally invasive procedure to lower the IOP on a mid- to long-term basis. Over the long term, however, IOP-lowering medication could not be reduced.

[Acute angle closure : An ophthalmological emergency in the emergency room]

Hintergrund

Die Symptome des akuten Winkelblocks, ein Notfallereignis, das ohne rechtzeitige Therapie zur irreversiblen Erblindung führen kann, sind vielfältig. Diese können initial als internistische oder neurologische Erkrankungen gedeutet werden, wenn Kopfschmerzen, Pupillenstarre oder Übelkeit im Vordergrund stehen. Ziel unserer Studie war es, die Rate belastender und invasiver Diagnostik durch primäre Vorstellung bei Nichtophthalmologen bei akutem primären Winkelblock zu erfassen.

Methode

Retrospektive Single-Center-Studie von Patienten mit akutem primärem Winkelblock. Zur Identifizierung dieser wurden alle Patienten erfasst, bei denen im Universitätsklinikum Freiburg, Klinik für Augenheilkunde im Zeitraum 2014–2018 eine chirurgische Iridektomie (5-133.0) oder Iridotomie durch Laser (5-136.1) durchgeführt wurde. Anschließend erfolgte durch Akteneinsicht die Datenanalyse zur Prüfung der Ein- und Ausschlusskriterien sowie des Krankheitsverlaufs.

Ergebnisse

Eingeschlossen wurden 91 Patienten mit akutem primären Winkelblock. Davon stellten sich 28 % (n = 25) initial bei nichtophthalmologischen Fachdisziplinen vor. In dieser Patientengruppe erhielten 56 % (n = 11) eine nichtzielführende Diagnostik, wobei bei 32 % (n = 8) eine kraniale Bildgebung und bei 8 % (n = 2) eine Lumbalpunktion durchgeführt wurde.

Schlussfolgerung

Bei akutem primären Winkelblock zeigt sich eine hohe Rate an nicht wegweisender Diagnostik durch Nichtophthalmologen, weshalb dieses Krankheitsbild fächerübergreifend präsent sein sollte. Bei unspezifischen Symptomen, wie Kopfschmerzen, Übelkeit und Erbrechen sowie Pupillenstarre, muss an die Möglichkeit eines akuten Augeninnendruckanstiegs durch einen akuten Winkelblock gedacht und das frühzeitige Hinzuziehen eines Ophthalmologen erwogen werden.

Palbociclib in combination with endocrine therapy versus capecitabine in hormonal receptor-positive, human epidermal growth factor 2-negative, aromatase inhibitor-resistant metastatic breast cancer: a phase III randomised controlled trial-PEARL

BACKGROUND

Palbociclib plus endocrine therapy (ET) is the standard treatment of hormone receptor-positive and human epidermal growth factor receptor 2-negative, metastatic breast cancer (MBC). However, its efficacy has not been compared with that of chemotherapy in a phase III trial.

PATIENTS AND METHODS

PEARL is a multicentre, phase III randomised study in which patients with aromatase inhibitor (AI)-resistant MBC were included in two consecutive cohorts. In cohort 1, patients were randomised 1 : 1 to palbociclib plus exemestane or capecitabine. On discovering new evidence about estrogen receptor-1 (ESR1) mutations inducing resistance to AIs, the trial was amended to include cohort 2, in which patients were randomised 1 : 1 between palbociclib plus fulvestrant and capecitabine. The stratification criteria were disease site, prior sensitivity to ET, prior chemotherapy for MBC, and country of origin. Co-primary endpoints were progression-free survival (PFS) in cohort 2 and in wild-type ESR1 patients (cohort 1 + cohort 2). ESR1 hotspot mutations were analysed in baseline circulating tumour DNA.

RESULTS

From March 2014 to July 2018, 296 and 305 patients were included in cohort 1 and cohort 2, respectively. Palbociclib plus ET was not superior to capecitabine in both cohort 2 [median PFS: 7.5 versus 10.0 months; adjusted hazard ratio (aHR): 1.13; 95% confidence interval (CI): 0.85-1.50] and wild-type ESR1 patients (median PFS: 8.0 versus 10.6 months; aHR: 1.11; 95% CI: 0.87-1.41). The most frequent grade 3-4 toxicities with palbociclib plus exemestane, palbociclib plus fulvestrant and capecitabine, respectively, were neutropenia (57.4%, 55.7% and 5.5%), hand/foot syndrome (0%, 0% and 23.5%), and diarrhoea (1.3%, 1.3% and 7.6%). Palbociclib plus ET offered better quality of life (aHR for time to deterioration of global health status: 0.67; 95% CI: 0.53-0.85).

CONCLUSIONS

There was no statistical superiority of palbociclib plus ET over capecitabine with respect to PFS in MBC patients resistant to AIs. Palbociclib plus ET showed a better safety profile and improved quality of life.

P934 Left atrial strain association with left ventricular diastolic function

Objectives

to evaluate the relationship between left atrial (LA) peak strain and left ventricular (LV) diastolic function and determine whether LA strain could be used to detect elevated filling pressures in a population of patients with preserved LV ejection fraction (LVpEF).

Background

the assessment of diastolic function is complex and multiparameter. 2016 ASE and EACVI algorithm has simplified this approach, but there are still patients with discrepant values leading to an indeterminate diagnosis, specially in patients with preserved ejection fraction.

Methods

we prospectively included 129 patients in our cohort. Inclusion criteria were LVEF > 50% and sinus rhythm. Patients with atrial fibrillation, significant mitral valvulopathy or poor quality imaging were excluded. Two-dimensional speckle tracking was used to measure peak LA strain in all LA segments (using apical 4 chamber, 2 chamber and 3 chamber views). We evaluated the association of LA global peak strain and LA 4 chamber peak strain with the different categories of diastolic function according to the 2016 ASE and EACVI algorithm.

Results

Both LA global peak strain and 4 chamber LA peak strain showed a progressive decrease with worsening diastolic dysfunction (DD) severity (Table 1). A global LA peak strain cutoff value of 28,35% was very accurate to differentiate normal from elevated filling pressures (normal function or grade 1 DD from grades 2 and 3 DD). Diagnostic accuracy: 80.20%; area under the curve: 0,80 (0,72-0,88); A significant group of patients (21,1%) could not be categorized using 2016 algorithm.

Conclusions

Both LA global peak strain and 4 chamber LA peak strain demonstrated a progressive decrease with worsening DD severity. Global LA peak strain value of 28,35% was an accurate cutoff to differenciate patients with normal vs elevated filling pressures.

LA strain values and diastolic function Total LA global peak STRAIN LA 4C STRAIN N (%) p-value p-value Total 129 30.90 %(11.77) 30.43 (12.36) Diastole <0.0001 <0.0001 Normal function 36 (28.13) 39.72% (9.59) 39.98 (10.59) Indeterminate Diastolic Function 23 (17.97) 31.07% (7.97) 30.19 (7.50) Indeterminate DD 4 (3.13) 30.68 % (6.72) 29.75 (7.31) grade 1 DD 22 (17.19) 32.69 % (12.54) 32.98 (14.46) grade 2 DD 36 (28.13) 23.90 % (9.32) 23.53 (9.49) grade 3 DD 7 (5.47) 15.43 % (5.72) 15.85 (7.32)

[Scleral melting after cyclophotocoagulation]

We report on a case of a scleral melting as a rare but severe complication of transscleral cyclophotocoagulation. The tissue defect was successfully repaired by tectonic keratoplasty.

Pregnancy outcomes after maternal Zika virus infection in a non-endemic region: prospective cohort study

OBJECTIVES

The aim was to describe pregnancy outcomes after Zika virus (ZIKV) infection in a non-endemic region.

METHODS

According to the Spanish protocol issued after the ZIKV outbreak in Brazil in 2015, all pregnant women who had travelled to high-burden countries were screened for ZIKV. Serological and molecular tests were used to identify ZIKV-infected pregnant women. They were classified as confirmed ZIKV infection when reverse transcription (RT) PCR tested positive, or probable ZIKV infection when ZIKV immunoglobulin M and/or immunoglobulin G and ZIKV plaque reduction neutralization tests were positive. Women found positive using molecular or serological tests were prospectively followed-up with ultrasound scans and neurosonograms on a monthly basis until delivery; magnetic resonance imaging and amniotic fluid testing were performed after signed informed consent. Samples of placenta, and fetal and neonatal tissues were obtained.

RESULTS

Seventy-two pregnant women tested positive for ZIKV infection: ten were confirmed by RT-PCR, and 62 were probable cases based on serological tests. The prevalence of adverse perinatal outcomes was 33.3% (three out of nine, 95% CI 12.1-64.6%): two cases of congenital ZIKV syndrome (CZS) and one miscarriage, all born to women infected in the first trimester of gestation. All ZIKV-confirmed women had persistent viraemias beyond 2 weeks (median 61.50 days; IQR 35.50-80.75). Amniotic fluid testing was only positive in the two fetuses with anomalies.

CONCLUSION

The prevalence of perinatal adverse outcomes for women with ZIKV-confirmed infection was 33.3%. Amniocentesis for ZIKV RT-PCR is recommended when fetal abnormalities are found. Intensive prenatal and postnatal follow-up of ZIKV-infected pregnancies is advised in confirmed cases.

Bleb-related infections and long-term follow-up after trabeculectomy

PURPOSE

Bleb-related infections are serious complications after trabeculectomy. They can be limited to the bleb or disseminate and lead to endophthalmitis. We herein report on all bleb-related infections that have been diagnosed at the Eye Center of the University of Freiburg, Germany, since 1999.

METHODS

We reviewed a total of 1816 consecutive trabeculectomies that were performed at our hospital between the years 1999 and 2014 (353 without and 1463 with intraoperative application of mitomycin C). All bleb-related infections that were diagnosed at our clinic during the same period were included in the analysis. We fitted a Cox proportional hazards model to characterize risk factors for bleb-related infections.

RESULTS

We diagnosed a total of 19 bleb-related infections in this period. Three patients with bleb-related infections that came to our clinic had their trabeculectomy performed elsewhere. The overall percentage of bleb-related infections was 0.1% after 2 years (Kaplan-Meier estimate at median follow-up). Nine eyes suffered from only localized infection of the bleb. Seven eyes developed endophthalmitis. Four infections occurred during the first postoperative month. The median age on the day of diagnosis was 71 years; the median age at surgery was 69 years. In the Cox model, intraoperative application of mitomycin C and a fornix-based conjunctival flap were identified as significant risk factors (hazard ratio: 79.02, 4.69; p < 0.01, p < 0.01). The whole group showed a reduction of visual acuity in the median from logMAR 0.12 to 0.2. Eyes that suffered from endophthalmitis showed a loss from 0.3 to 0.96, while the localized infections had a reduction from 0.04 to 0.07.

CONCLUSION

Bleb-related infections are a rare complication following trabeculectomy and can be localized on the bleb or can lead to endophthalmitis, thereby threatening visual acuity. The risks and benefits of mitomycin C-augmented trabeculectomies should be taken into consideration.

Increasing temperature decreases the predatory effect of the intertidal shanny Lipophrys pholis on an amphipod prey

Interactions between Lipophrys pholis and its amphipod prey Echinogammarus marinus were used to investigate the effect of changing water temperatures, comparing current and predicted mean summer temperatures. Contrary to expectations, predator attack rates significantly decreased with increasing temperature. Handling times were significantly longer at 19° C than at 17 and 15° C and the maximum feeding estimate was significantly lower at 19° C than at 17° C. Functional-response type changed from a destabilizing type II to the more stabilizing type III with a temperature increase to 19° C. This suggests that a temperature increase can mediate refuge for prey at low densities. Predatory pressure by teleosts may be dampened by a large increase in temperature (here from 15 to 19° C), but a short-term and smaller temperature increase (to 17° C) may increase destabilizing resource consumption due to high maximum feeding rates; this has implications for the stability of important intertidal ecosystems during warming events.

Quality of life in glaucoma patients and normal subjects related to the severity of damage in each eye

OBJECTIVE

To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye.

METHODS

A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP>21mmHg and abnormal VF with mean defect (MD) over -6dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IOP>21mmHg and abnormal VF with MD between -6 and -12dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP>21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI).

RESULTS

VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and group 4 (the group in which one eye has only mild glaucoma or no glaucoma). This finding confirms that the eye with less glaucoma damage determines the quality of life.

CONCLUSIONS

Our results demonstrate that quality of life is impaired in patients with glaucoma, and this alteration is greater the more advanced is glaucoma damage in the best or both eyes.

Post-Thaw Viability and Functionality of Cryopreserved Rat Fetal Brain Cells Cocultured with Sertoli Cells

Testis-derived Sertoli cells have been used to create an immune “privileged” site outside of the testis to facilitate cell transplantation protocols for diabetes and neurodegenerative diseases. In addition to secreting immunoprotective factors, Sertoli cells also secrete growth and trophic factors that appear to enhance the posttransplantation viability of isolated cells and, likewise, the postthaw viability of isolated, cryopreserved cells (26). It would be beneficial if Sertoli cells could be cryopreserved with the transplantable cell type without deleterious effects on the cells. This report describes a protocol for the cocryopreservation of rat Sertoli cells with rat ventral mesencephalic neurons, neurons from the lateral and medial ganglionic eminences and the hNT neuron cell line, and reports on the effects of Sertoli cells on the the postthaw viability of these neurons. Results of trypan blue exclusion analysis indicated that the presence of Sertoli cells did not deleteriously effect cryopreserved neurons and may improve their postthaw recoverability and viability in general. Specifically, results of the tyrosine hydroxylase immunostaining showed that Sertoli cells significantly enhance the postthaw viability of ventral mesencephalic dopaminergic cells in vitro.

Trophic Effect of Porcine Sertoli Cells on Rat and Human Ventral Mesencephalic Cells and Hnt Neurons in Vitro

The poor survival of embryonic dopaminergic (DA) neurons transplanted into patients with Parkinson's disease (PD) has encouraged researchers to search for new methods to affect the short- as well as long-term survival of these neurons after transplantation. In several previous rodent studies Sertoli cells increased survival of islet cells and chromaffin cells when cotransplanted in vivo. The aims of this study were to investigate whether porcine Sertoli cells had a positive effect on the survival and maturation of rat and human DA neurons, and whether the Sertoli cells had an effect on differentiation of neurons derived from a human teratocarcinoma cell line (hNT neurons). A significant increase of tyrosine hydroxylase (TH)-positive neurons of both rat and human ventral mesencephalic tissue was found when cocultured with Sertoli cells. Furthermore, there was a significantly increased soma size and neurite outgrowth of neurons in the coculture treated group. The Sertoli cell and hNT coculture also revealed an increased number of TH-positive cells. These results demonstrate that the wide variety of proteins and factors secreted by porcine Sertoli cells benefit the survival and maturation of embryonic DA neurons and suggest that cotransplantation of Sertoli cells and embryonic DA neurons may be useful for a cell transplantation therapy in PD.

Abstract P1-12-10: Safety and efficacy of trastuzumab emtansine (T-DM1) in 399 patients with central nervous system metastases: Exploratory subgroup analysis from the KAMILLA study

Introduction T-DM1 treatment significantly improved overall survival and had a lower incidence of grade ≥3 adverse events (AEs) vs capecitabine plus lapatinib in patients (pts) with HER2-positive advanced breast cancer (BC) in the EMILIA study, including pts with treated, asymptomatic CNS metastases (mets). KAMILLA is an ongoing, single-arm, open-label, phase 3b global safety study of T-DM1 in pts with HER2-positive locally-advanced or metastatic BC (target n=2220). In this interim analysis we describe clinical characteristics, safety, and efficacy in pts with stable CNS mets at baseline (BL).

Methods Eligible pts received prior HER2-directed therapy and chemotherapy and progressed on or after most recent treatment for advanced BC, or within 6 months of completing adjuvant therapy. Pts with asymptomatic CNS mets were eligible, including pts with stable CNS disease with prior radiation therapy. Pts received T-DM1 3.6 mg/kg every 3 weeks until unacceptable toxicity, withdrawal of consent, or disease progression. This exploratory analysis describes pts with BL CNS mets. Median progression-free survival (PFS) was estimated using the Kaplan-Meier method.

Results As of April 4, 2016, data were available for 2017 treated pts, of whom 399 (20%) had BL CNS mets, with a median follow-up of 33 months. Table 1 presents demographic and BL characteristics.

The incidence of AEs was similar between pts with and without BL CNS mets. Serious AEs (SAEs) occurred in 112 pts with BL CNS mets (28%) vs 311 of 1618 pts without BL CNS mets (19%), and the frequency of SAEs was comparable to that observed in EMILIA. However, nervous system disorder SAEs, such as seizure, epilepsy, and brain edema, occurred more frequently in pts with BL CNS mets (30 pts [8%]) vs 18 pts [1%] with no BL CNS mets.

Mean T-DM1 treatment duration was 8.0 months (median 8 cycles; range 1–55) in pts with BL CNS mets and 9.4 months (median 9 cycles; range 1–57) in pts with no BL CNS mets. Median PFS was 5.5 months in pts with BL CNS mets vs 7.9 months in pts with no BL CNS mets. A decrease in the size of brain target lesions was observed during T-DM1 treatment in 84 of 126 pts with measurable CNS lesions.

Table 1. BL characteristics CNS mets at BL (n=399)No BL CNS mets (n=1618)Median age, yrs (range)52 (28–83)55 (26–88)ECOG performance status, n (%)  0193 (48)929 (57)1174 (44)605 (37)232 (8)83 (5)Hormone receptor status, n (%)  ER and/or PR positive246 (62)992 (61)ER and PR negative149 (37)593 (37)Median time since initial BC diagnosis, yrs (range)4.8 (0–28)5.0 (0–53)Median time since first metastasis, yrs (range)2.4 (0–25)2.6 (0–35)Median number of prior therapies for metastatic BC (range)3 (0–&gt;10)2 (0–&gt;10)

Conclusions This subgroup analysis of KAMILLA is the largest reported cohort of pts with CNS mets treated with T-DM1. The overall safety profile of T-DM1 in pts with BL CNS mets was comparable to that of pts without CNS mets. As might be expected in pts with CNS disease, serious neurological AEs occurred more frequently in pts with BL CNS mets vs those without. Response to T-DM1 was seen in the CNS in pts with BL CNS mets, however, median PFS was lower in pts with BL CNS mets vs those without BL CNS mets.

Citation Format: Montemurro F, Ellis P, Delaloge S, Wuerstlein R, Anton A, Button P, Lindegger N, Barrios C. Safety and efficacy of trastuzumab emtansine (T-DM1) in 399 patients with central nervous system metastases: Exploratory subgroup analysis from the KAMILLA study [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 P1-12-10.

[Bruch's Membrane Opening in OCT in Correlation with Corneal Correction - a Pilot Study]

Background: The measurement by optical coherence tomography (OCT) of the Bruch membrane opening (BMO) and the thinnest retinal fiber nerve layer in relation to it (BMO-MRW) has been performed in clinical routine since 2014. To compensate for astigmatism, or increased or decreased corneal power, a correction is performed through the mean K-value of the measured eye. The aim of this study was to measure the value of this correction and its influence on the measurement results. Methods: The sectors of BMO-MRW and BMO values of the five right eyes of five healthy patients were measured five times each with Heidelberg Spectralis OCT. Corneal compensation was systematically raised with each single measurement (7.1, 7.4, 7.7, 8.0, 8.3 mm).

RESULTS

The data showed almost linear dependence on the given corneal compensation values, with intraindividual variability. For the BMO-MRW, only small effects of compensation were found (0.85 up to 1.97 % per K-value difference of 0.3 mm). For BMO, the effect was greater, with a mean change of 7.71 % for every 0.3 mm change in compensation. Conclusion: For BMO-MRW, corneal compensation is of low clinical relevance. BMO is more dependent on this correction. In follow-up measurements, the compensation might not account for significant changes, although we recommend using correct corneal compensation values when obtaining single or first-time measurements.

Analgesia with interfascial continuous wound infiltration after laparoscopic colon surgery: A randomized clinical trial

OBJECTIVES

For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects.

METHODS

We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion.

RESULTS

92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63±5.02mg among wound catheter patients and 21. 86±17.88mg among control patients (P=.0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P=.02).

CONCLUSIONS

In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays.

Anxiety and depression in patients with hepatic versus cardiac disease

Background

In both hepatic and cardiac disease, a bidirectional relationship exists between somatic and psychiatric symptoms: is anxiety/depression caused by the somatic burden of the symptoms or the psychiatric symptoms and stress are an important pathophysiologic factor for the somatic disease?

Objective

The objectives of our observational study were to see if any differences exist regarding the anxiety level in patients with hepatic versus cardiac disease and if the depressive symptomatology differs between the two groups of patients.

Materials and methods

: We conceived a 2X2 study model by including two independent variables (the somatic pathology, hepatic and cardiac) and two dependent variables (anxiety and depression) which included 66 patients (35 with hepatic and 31 with cardiac pathology) who completed both STAI X1 scale for anxiety and BECK scale for depression with good reliability for both scales (Cronbach's alpha value of 0.74 for STAI X1 and 0.76 for BECK), data analyzed with SPSS 17.

Results

We obtained a low level for anxiety (mean = 17.76) and a medium level for depression (mean = 49), both anxiety and depression level being higher in the patients with hepatic disease versus cardiac patients (P > 0.05). The patients with hepatic failure had a higher medium anxiety score (54.66) vs cardiac failure patients (42.61). The depression score was 19.71 in patients with hepatic failure and 15.55 in patients with cardiac failure.

Conclusion

Both anxiety and depression severity scores were increased in patients with hepatic disease vs patients with cardiac disease in the studied groups.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Unilateral periocular angioedema after application of contrast agent]

This article presents a case report of unilateral, periocular angioedema after intravenous application of a contrast agent with a temporary increase of intraocular pressure in an eye in which trabeculectomy had been carried out 5 weeks previously.

Refractive and visual outcomes after combined cataract and trabectome surgery: a report on the possible influences of combining cataract and trabectome surgery on refractive and visual outcomes

PURPOSE

To compare combined trabectome-cataract surgery with cataract-alone surgery regarding their refractive and visual outcomes and complications.

METHODS

In 137 eyes that underwent combined trabectome-cataract surgery, the postoperative refraction error and best visual acuity after at least 2 months postoperatively were compared to those of an in-house control group of 1,704 eyes that underwent outpatient cataract surgery.

RESULTS

Combined trabectome-cataract surgery showed no significant differences regarding the biometry prediction error (BPE, mean 0.53 D vs. 0.48 D, p = 0.24) or visual outcome (BCVA, 0.81 vs. 0.78, p = 0.06). The rate of postoperative cystoid macular edema was slightly higher in the combined surgery group (2.2 % vs. 1.9 %).

CONCLUSIONS

Refractive and visual outcomes were similar in both groups. Despite the slightly higher rate of postoperative macula edema, we were able to observe that the combination of these two procedures is a feasible method in glaucoma and cataract surgeries.

[Body mass index as an influencing factor for outcome of trabectome surgery?]

BACKGROUND

The aim of this study was to investigate a possible influence of body mass index (BMI) to the outcome of trabectome surgery.

METHODS

131 eyes with primary open angle glaucoma, myopia-associated glaucoma and pseudoexfoliation glaucoma were included into this retrospective study. The data were extracted from the Freiburg trabectome database from June 2009 to April 2013. We fitted a Cox proportional hazards model in order to assess the influence of the BMI on trabectome outcome.

RESULTS

The absolute success after trabectome surgery (20 % pressure reduction without anti-glaucomatous medication) was statistically significantly better in the group with BMI > 25 kg/m(2) (p = 0.047). No statistically significant effect was observed for relative success or the rate of re-operation respectively.

CONCLUSION

In our patient cohort of 131 eyes, a high BMI was associated with a reduced success, as long as an absolute success is required. No difference is seen if additional anti-glaucomatous medication is acceptable (relative success).

[Trauma-related secondary glaucoma in childhood: a therapeutic challenge]

CASE REPORT

We performed a minimally invasive trabeculotomy using a trabectome on a 9-year-old boy with a trauma-related secondary glaucoma where the intraocular pressure (IOP) could not be controlled by conservative approaches. After a 1-year follow-up the patient showed well controlled IOP values without using drugs to reduce pressure.

CONCLUSION

Trabectome surgery seems to be a suitable first step intervention for trauma-related glaucoma in selected cases, even in children.

Abstract P3-14-15: Nabrax: Neoadjuvant therapy of breast cancer with weekly nab-paclitaxel: Final safety of GEICAM 2011-02

Aims: nab-paclitaxel is an innovative chemotherapy that consists of nano-particles of human serum albumin bound paclitaxel. It exploits the role of albumin as the natural carrier of hydrophobic molecules in human to increase paclitaxel delivery to tumor cells. Weekly nab-paclitaxel showed a superior efficacy compared to every 3-weeks docetaxel in a randomized phase II study in metastatic breast cancer (Gradishar JCO 2009, Clin. Breast Cancer 2012). This single arm phase II trial has been designed to evaluate the activity and safety of weekly nab-paclitaxel as neoadjuvant treatment of early stage breast cancer patients with positive estrogen receptors and negative HER2.

Methods: Stage II-III patients were included and treated with nab-paclitaxel weekly at a dose of 150 mg/m2 on days 1, 8 and 15 every 4 weeks for 4 cycles. Following chemotherapy, patients undergo surgery and adjuvant therapy (with radiation, chemo and endocrine therapy) under the investigator criteria. The primary objective is to determine the residual cancer burden class III as measured by the Symmans criteria (JCO 25:4422,2007). Secondary objectives include pathological complete response, overall response, invasive disease free survival, safety and potential correlative biomarkers.

Results: Eighty-three patients have been recruited in the study in 13 Spanish institutions. Here we report safety data from 77 patients. Median age was 48 years, 62% were postmenopausal and 94% had ECOG PS 0; most patients were stage II (23% IIa and 36% IIb). A total of 259 cycles have been administered to date; 47 patients completed 4 cycles as planned, 5 patients discontinued treatment early (due to grade 2-3 sensory neuropathy in 4 patients), the remaining patients are still under treatment. The treatment was delayed in 8.1% of patients; nab-paclitaxel doses were omitted and reduced in 3.9% and 9.7% of cycles respectively, for a relative dose intensity of nab-paclitaxel of 97.3%. The most frequent reasons for dose modifications were neutropenia (5.4%) and neuropathy (2.7%). The main grade 2/3 adverse events are described in table 1.

Table 1Related adverse events.Per patient (N = 74)Per Cycle (N = 259)NCI-CTCAE vs 4.0. (&gt;5% grade 2-4)Grade 2, N (%)Grade 3, N (%)Grade 2, N (%)Grade 3, N (%)Leukopenia6 (8.1)1 (1.4)11 (4.2)1 (0.4)Neutropenia17(23)7 (9.5)30 (11.6)9 (3.5)Alopecia47(63.5)—121 (46.7)—Fatigue11 (14.9)2 (2.7)17 (6.6)2 (0.8)Neuropathy: Sensory17 (23)2 (2.7)25(9.6)5 (1.9)Musculoskeletal Pain11 (14.9)0 (0)13 (5.0)0 (0)

Conclusions: Neoadjuvant therapy with weekly nab-paclitaxel at dose of 150 mg/m2 on days 1, 8 and 15 every 4 weeks was well tolerated. Final safety data for the entire treated patients will be mature and presented at the meeting.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-15.

Stapled esophagojejunal anastomoses: particular aspects of minimally invasive surgery and comparison with manual anastomoses--a single team experience

BACKGROUND/AIMS

Surgery remains a mainstay of current approaches for the treatment of gastric cancer. Since the introduction of the first mechanical stapling devices, a debate started about whether mechanical staplers or manual suture produce better results.

METHODS

88 patients operated by a single team between January 2004 and November 2011 were included in this study: 14 patients underwent minimally invasive total gastrectomy and 74 patients had an open total gastrectomy. Manual suture anastomoses were performed on 59 patients and stapled anastomoses were done on 29 patients.

RESULTS

There were no cases of anastomotic leakage or stenosis for the stapled group. There were 4 cases of anastomotic leakage in the manually suture group. There were no cases of anastomosis related mortality.

CONCLUSION

the data support the use of stapled esophagojejunal anastomosis as a safe way to create a esophagojejunal anastomosis, with superior results in term of anastomotic leakage or stenosis to those with hand suturing.

P2-09-02: Predicting Response to Bevacizumab in Primary Breast Cancer Using 18F-Fluorothymidina (FLT) and 18F-Misonidazole (MISO) Positron Emission/Computed Tomography (PET/CT) as Imaging Biomarkers

Background: To investigate the hypothesis that early changes in tumor proliferation and hypoxic status induced by bevacizumab and assessed by imaging biomarkers might predict response to bevacizumab therapy.

Methods: 73 chemotherapy naïve, stage II-III breast cancer (BC) patients (pts) were enrolled in the training set of this phase II, single-arm, multicenter and prospective clinical trial from October 2009 until November 2010. Pts received single infusion of bevacizumab (15 mg/kg) (C1) 3 weeks prior to the beginning of neoadjuvant chemotherapy (NAC) consisting in 4 cycles of docetaxel (60 mg/mq), doxorubicin (50 mg/mq) and bevacizumab (15 mg/kg) every 21 days (C2-C5) following by surgery. Tumor proliferation and hypoxic status were evaluated using FLT and MISO PET/CT at baseline and 14–21 days after bevacizumab (C1). Standardized uptake values (SUV) for FLT and MISO and ratios to reference tissues, mediastinum (T/Me) or muscle (T/Mu), for MISO were calculated. Pathological response on surgical specimens was assessed according to Miller/Payne grading system. Pts with reduction in tumor cells &gt;30% (G3-G4-G5) or &lt;30% (G1-G2) were respectively considered as responders and no-responders. Association between pathological response, baseline and changes induced by bevacizumab (C1) in imaging biomarkers was analyzed using Mann-Whitney test. Receiver operating characteristic (ROC) curve was performed to test sensitivity and specificity of the biomarker found associated to response. Its value as independent predictor was tested in multivariate analysis using logistic regression. Results: Median baseline MISO and FLT SUV values in tumors were 1.2 (range 0.69−2.39) and 2.89 (range 0.97−7.18). Significant change after C1 was observed in FLT (2.7 vs 1.8, p&lt;0.001) but no in MISO uptake. Fifty-two (74%) pts achieved response (G3-G4-G5) whether 18 (24%) were considered as no responder (G1-G2); for 3 (4%) patients Miller/Payne tumor evaluation was not available. Response showed a trend toward an association with negative estrogen receptors (ER) expression (p=0.08) and triple negative tumors (11/73) (p=0.05). FLT SUV baseline and changes after C1 in MISO SUV, T/Mu and T/Me were all significantly associated with pathological response (p=0.057, 0.03, 0.016, 0.010). ER expression and T/Mu change remained significantly associated with response in multivariate analysis (OR=24.8, IC95% 1.8-334, p=0.01 and OR=0.95, IC 95% 0.92−0.99, p value=0.02). Decrease in MISO T/Mu uptake &gt;20% yielded a ROC curve area of 0.7 (95% CI: 0.56 - 0.85) with 94% sensitivity and 87% specificity. Conclusion: Bevacizumab determined a marked decrease in tumor proliferation. Interestingly, a decrease greater than 20% in tumor hypoxic status after C1 and assessed by MISO was found significantly associated with pathological response suggesting a potential value of early decrease in hypoxic tumor status as predictive biomarker of response. Bevacizumab, causing normalization of the tumor microvasculature, seems to potentiate the effect of cytotoxic agents on primary BC. A validation set is warranted to confirm these findings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-02.

P2-08-05: Use of Dynamic Contrast-Enhanced MR Imaging To Predict Pathological Response in Primary Breast Cancer

Purpose: To investigate the effect of bevacizumab infusion on vascular parameters assessed by dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging and to test their association with pathological response in primary breast cancer.

Materials and Methods: 73 patients (median age, 47 ys; age range, 29–70 ys) with biopsy-proven, previously untreated, primary breast cancer were recruited from October 2009 to November 2010 in this phase II, multicenter and non-randomized clinical trial. Patients (pts) received single infusion of bevacizumab (15 mg/kg) (C1) 3 weeks prior to the beginning of neoadjuvant chemotherapy consisting in 4 cycles of docetaxel (60 mg/mq), doxorubicin (50 mg/mq) and bevacizumab (15 mg/kg) every 21 days (C2-C5) following by surgery. All pts underwent DCE-MR imaging before and 14–21 days after C1. Quantitative and semiquantitative kinetic parameters were calculated at baseline and after C1, including the volume transfer constant (K(trans)), which primarily reflects the wash-in of the contrast agent, the backflow rate contrant (K(ep)), extracellular volume fraction (V(e)) and the initial area under the gadolinium concentration-time curve over 60 seconds (IAUGC(60)). Changes in the DCE-MRI kinetic parameters K(trans), K(ep), V(e) and IAUGC(60) were calculated and Wilcoxon test was used to assess significant effects induced by bevacizumab on kinetic parameters. Pathological response on surgical specimens after C5 was assessed according to Miller and Payne classification. Pts with tumor reduction &gt;30% were considered as responders (G3-G4-G5) whether tumor reduction &lt;30% were considered as no responders (G1-G2). DCE-MR imaging parameters and clinical-pathological characteristics were correlated with pathological response using Mann-Whitney test in univariate and logistic regression in multivariate analyses. Receiver operating curves (ROC) was used to define the best cut-off of the parameter found associated with pathological response.

Results: DCE-MRI was performed before (n=72) and after (n=71) C1. K(trans), K(ep), V(e) and IAUCG(60) values were significantly different at the baseline and after C1 (p&lt;0.01). Median changes were, respectively, −51, −101, −52.5 and −4.8. Fifty-two (74%) pts achieved response (G3-G4-G5) after C5 whether 18 (24%) were considered as no responder (G1-G2); for 3 (4%) patients Miller/Payne tumor evaluation was not available. At univariate analysis, negative estrogen receptor (ER) status and higher post-C1 K(ep) (p=.057) showed a trend toward an association with response. At multivariate analysis, only ER status remains a significant predictor of response (p= .04). Area under ROC curve for K(ep) was 0.65 (IC95% 0.05−0.8, p=.057)

Conclusion: Bevacizumab affects tumor vasculature, perfusion and permeability as showed by the significantly reduction in all kinetic vasculature parameters obtained in DCE-MR imaging after C1. However, in our population these changes were not associated with pathological response. On the other hand, backflow rate constant, K(ep), a perfusion-related parameter derived from DCE-MRI yielded after C1 major than 80, may be associated with higher pathological response with a specificity of 88% and sensitivity of 90%. Future studies are warranted to confirm these findings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-05.

P5-13-04: Changes in Phosphorylation Status at VEGFR2 and Basal Tumor Hypoxic Volume Assessed by Misonidazol (MISO) Positron Emission Tomography (PET/CT) as Potential Biomarkers for Predicting Response to Bevacizumab in Breast Cancer

Background: To evaluate the expression of novel putative biomarkers as predictors of benefit from bevacizumab in stage II-III, previously untreated breast cancers (BC) patients (pts) in the context of a phase II, single-arm, multicenter and prospective clinical trial. To address this aim, we examined baseline and induced changes after a single bevacizumab administration as potential early predictors of response. Methods: Pts received a single infusion of bevacizumab (15 mg/kg) (C1) 3 weeks prior to the beginning of neoadjuvant chemotherapy consisting in 4 cycles of docetaxel (60 mg/mq), doxorubicin (50 mg/mq) and bevacizumab (15 mg/kg) every 21 days (C2-C5) following by surgery. Early assessment of tumor changes was performed by paired tumor-biopsies and MISO PET/CT before and 14–21 days after bevacizumab administration (C1). Biomarker expression was assessed by immunohistochemistry (IHC) (Ki67, CD31, CD31/Ki67, VEGFR2, pVEGFR2 [Y951]) on formalin-fixed, paraffin-embedded tissue before and after bevacizumab infusion (C1). MISO SUV and tumor volume depicted by PET were calculated. Pathological response on surgical specimens was assessed according to Miller/Payne classification. Pts with tumor reduction &gt;90% were considered as best responders (G4-G5) whether tumor reduction &lt;90% were considered as no responders. Association between pathological response, IHC and MISO biomarkers was analyzed using Mann-Whitney test. ROC curve was performed to test sensibility and specificity of the biomarker found significantly associated with response and its value as independent predictor was tested in the multivariate analysis using logistic regression.

Results: This analysis was performed on the training set including 73 patients (49 yr, range 29–70). Twenty (27%) patients obtained best response (G4-G5) whether 50 (68%) were considered as no responder (G1-G2-G3). Response was associated with negative estrogen receptors expression (p=0.02) and high Ki67 basal and after C1 expression (p=0.009 and p=0.01). Six (54%) of triple negative tumors were responders (p=0.05). Interestingly, change in pVEGFR2 [Y951] staining induced by bevacizumab administration and basaline MISO tumor volume was found significantly associated with response (p=0.03 and 0.057). Decrease in the phosphorilation status of VEGFR2 (Y951) &gt;70% yielded a receiver operating characteristic (ROC) curve area of 0.681 (95% CI: 0.536 — 0.825) with 84% sensitivity and 95% specificity. The positive and negative predictive values for this marker were 60% and 64%, respectively. The change in phosphorilation status of VEGFR2p remains a significant predictor biomarker of response in multivariate analysis (OR=0.9, IC%95 0.96−0.99, p=0.04) after adjusting for clinical-pathological characteristics.

Conclusion: These findings underline the potential value of early decrease in phosphorilation status of VEGFR2 after bevacizumab infusion as predictive biomarker of response to anti-angiogenic therapy in breast cancer. Moreover, tumor hypoxic volume obtained by MISO might be associated with response. A validation set is warranted to confirm these findings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-04.