Abstract P5-20-03: Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcome in 2863 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program

Background: The management of HER2+ BC has changed dramatically with the introduction and widespread use of HER2-targeted therapies, especially in the adjuvant setting. However, there is relatively limited real-world information on the impact of adjuvant Trastuzumab (aT) on patterns of recurrence and outcome of HER2+ MBC.

Methods: In 2014, the 18 French Cancer Centers launched the Epidemiological Strategy and Medical Economics (ESME) program to provide real-world data on MBC patients (pts). All pts who started a 1st-line treatment for MBC between 01-Jan-2008 and 31-Dec-2014 were included. We examined clinical characteristics and outcomes (overall survival [OS] and time to next treatment [TNT]) in patients with HER2+ MBC pretreated with trastuzumab in the adjuvant setting (aT) compared with trastuzumab-naïve patients (nT) and patients with de novo HER2+ MBC (dn). Multivariate analyses adjusted for baseline demographic, prognostic factors and year of diagnosis (prior or after 2005, when aT was approved and widely administered in France for early HER2+ breast cancer).

Results: Among the 15170 pts of the ESME database, 2863 (19%) were HER2+: 1093 pts (38%) had de novo and 1765 pts (62%) recurrent MBC; 63% were Hormone Receptor (HR) +; 54%, 25% and 21% had respectively 1, 2, or > 2 metastatic sites (68% visceral and 12% brain). Median time to 1st metastasis was 43.4 months (m) (95% CI: 24.6-84.4): 54 m in HR+ and 30 m in HR-. Among pts with recurrent MBC, 55% (995) had received aT. As 1st-line therapy for MBC, 90 % of pts received HER2-targeted agents (73% T-based). With a median follow-up of 46 m, median OS is 45 m (95% CI: 42.5-48). OS is significantly higher in de novo compared to recurrent MBC: 54 m (95% CI: 50.2-60.4) vs. 38.4 m (95% CI: 36.7-41.9), (p < 0.0001). Among pts with recurrent cancers, median OS is inferior in pts who had received aT, as compared to those who had not: 33.4 m (95% CI: 29.6-36.7) vs. 49.5 m (95% CI: 44.3-56.8), (p < 0.0001). Statistically significant differences persist after adjustment for age at MBC, disease-free interval, metastatic sites and RH status in the multivariate model (HR=1.45, 95% CI: 1.26-1.67) but not after adjustment for year of diagnosis (prior or after 2005) (HR=0.90, 95% CI: 0.70-1.15).

Conclusions: These large-scale real-world data in patients with HER2+ MBC provide evidence that the survival outcome remain similar in patients with failure of adjuvant trastuzumab compared with trastuzumab-naïve patients after adjustment for year of diagnosis. De novo HER2+ MBC pts have the best outcomes. Data on clinical characteristics of metastasis and time to next treatment for the three subgroups will be presented at the meeting.

Citation Format: Saghatchian M, Carton M, Piot I, Pérol D, Pistilli B, Brain E, Ghouadni A, Ricci F, Vanlemmens L, Loeb A, Levy C, Goncalves A, Dalenc F, Lefeuvre-Plesse C, Campone M, Jaffre A, Gourgou S, Cailliot C, Robain M, Dieras V. Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcome in 2863 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-03.

Large-Scale Distribution of Total Mass versus Luminous Matter from Baryon Acoustic Oscillations: First Search in the Sloan Digital Sky Survey III Baryon Oscillation Spectroscopic Survey Data Release 10

Baryon acoustic oscillations in the early Universe are predicted to leave an as yet undetected signature on the relative clustering of total mass versus luminous matter. A detection of this effect would provide an important confirmation of the standard cosmological paradigm and constrain alternatives to dark matter as well as nonstandard fluctuations such as compensated isocurvature perturbations (CIPs). We conduct the first observational search for this effect, by comparing the number-weighted and luminosity-weighted correlation functions, using the SDSS-III BOSS Data Release 10 CMASS sample. When including CIPs in our model, we formally obtain evidence at 3.2σ of the relative clustering signature and a limit that matches the existing upper limits on the amplitude of CIPs. However, various tests suggest that these results are not yet robust, perhaps due to systematic biases in the data. The method developed in this Letter used with more accurate future data such as that from DESI, is likely to confirm or disprove our preliminary evidence.

[Routine use of serial plasmatic CA 15-3 determinations during the follow-up of patients treated for breast cancer. Evaluation as factor of early diagnosis of recurrence]

PURPOSE

at our institution, CA 15-3 assays are routinely used for the early diagnosis of recurrence during the follow-up of patients treated for breast cancer, although published guidelines do not recommend this procedure. So, we decided to totally re-assess the usefulness of this policy.

PATIENTS AND METHODS

all records of patients presenting a first recurrence, local (50 cases) or metastatic (88 cases), of breast cancer during 2003 were re-examined. An increase in CA 15-3 concentration of more than 25% was considered significant.

RESULTS

an increase was observed in 18% of non metastatic recurrences. These increases had a prognostic value. CA 15-3 levels remained stable in 23% of metastasis cases and increased in 77%. In 14% of cases, the increase in CA 15-3 levels confirmed a clinically or radiologically suspected metastasis. Moreover, increased CA 15-3 levels in the absence of suggestive clinical or radiological signs led to the diagnosis in 18% of metastasis, 50% of which involved the bone.

CONCLUSION

our study demonstrates that CA 15-3 is useful for the early diagnosis of recurrence. Eighteen per cent of metastases were diagnosed by a marker increase alone. CA 15-3 assays could be useful in the early management of these metastases in patients treated for breast cancer.

A comparison of Hispanic and African-American sexually abused girls and their families

OBJECTIVE

To study the differential effects of sexual abuse on Hispanic (HN) and African-American (AA) girls.

METHOD

Sexually abused girls and their caretakers (N = 159), of which 52% (n = 82) were AA (mean age 9.8 years, SD = 3.4, R = 6-17) and 48% (n = 77) were HN (mean age 10.1 years, SD = 3.8, R = 6-18), were included in the study. The mother/caretaker was administered a demographic form, the Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child completed the FAM-C and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS).

RESULTS

HN girls were found to have a greater number of sexually abusive episodes and waited longer to disclose their abuse while AA girls were more likely to have experienced vaginal penetration. The perpetrators of HN girls were older and more likely to be fathers or stepfathers. The mothers/ caretakers of HN girls perceived their children as having significantly more aggressive behavior, anxiety/depression, somatic complaints, internalizing and externalizing behaviors, and had a higher total score on the CBCL than did AA girls. The HN girls were more likely to see their family as dysfunctional with confusion regarding family values and rules. HN mothers/caretakers perceived their families as more conflicted regarding adaptability and family controls.

CONCLUSIONS

HN girls experienced more emotional and behavioral problems, and both HN girls and their mothers/caretakers perceived their families as more disturbed and dysfunctional.

TeV neutrinos and GeV photons from shock breakout in supernovae

We show that as a Type II supernova shock breaks out of its progenitor star, it becomes collisionless and may accelerate protons to energies >10 TeV. Inelastic nuclear collisions of these protons produce an approximately 1 h long flash of TeV neutrinos and 10 GeV photons, about 10 h after the thermal (10 MeV) neutrino burst from the cooling neutron star. A Galactic supernova in a red supergiant star would produce a photon and neutrino flux of approximately 10(-4) erg cm(-2) s(-1). A km(2) neutrino detector will detect approximately 100 muons, thus allowing to constrain both supernova models and neutrino properties.

Child on child sexual abuse: psychological perspectives

OBJECTIVE

This study describes the emotional and behavioral responses of children who have been sexually victimized by juveniles (CC) 17 years of age and younger compared to child victims of adults (CA) 18 years of age and older.

METHOD

A total sample of N = 194 children and adolescents participated in the study, with 26% (n = 51) comprising CC and 74% (n = 143) encompassing CA. The mother/caretaker was administered a demographic form, Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child was given the Family Assessment Measure (FAM-C) and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS).

RESULTS

No differences were found between the two groups for the type of sexual abuse, penetration, or the use of force. CC were younger and more likely to be males who were abused in a school setting, home, or a relative's home by a sibling or a non-related male. CC endorsed clinically significant sexual preoccupations and manifested borderline clinically significant symptomatology.

CONCLUSIONS

Children victimized by other children manifested elevated levels of emotional and behavioral problems and were not significantly different from those who had been sexually abused by adults.

Regional vascular effects of rHb1.1, a hemoglobin-based oxygen carrier

The goals of this study were to determine the effects of recombinant human hemoglobin (rHb1.1, 1 g/kg i.v.) on systemic hemodynamics, regional blood flows, and regional vascular resistances in rats. Cardiac output (CO) and regional blood flow in 13 tissues were determined by using the radiolabeled-microsphere method during halothane anesthesia. Microspheres were injected at three time points: before (control, t = 0), t = 30 [10 min after a 20-min infusion of vehicle (diluent) or rHb1.1], and at t = 120 min. Infusion of diluent did not alter CO, heart rate (HR), mean arterial pressure (MAP), or systemic vascular resistance (SVR) and had minimal effects on regional blood flows. Infusion of rHb1.1 did not alter CO or HR but did increase MAP and SVR compared with diluent. Infusion of rHb1.1 increased blood flow to the heart and decreased blood flow to the gastrointestinal tract (GIT) and liver. Compared with the corresponding values in the diluent-treated rats, resistance was increased after rHb1.1 in spleen, kidney, and hepatic artery. In conclusion, rHb1.1 administration increased MAP and SVR. The vasoconstriction was heterogeneous and was associated with increased coronary blood flow and with increased regional resistance in kidney, spleen, and hepatic artery, compared with diluent-infused controls.

Cerebral blood flow regulation in neonatal rabbits is altered by chronic cocaine administration

Maternal cocaine abuse has several deleterious effects in the newborn, including perinatal asphyxia, hypoxia, and hypercapnia. We hypothesized that chronic cocaine exposure during development may alter cerebral blood flow (CBF) regulation. We studied 16 neonatal rabbits that had received cocaine (20 mg/kg, i.p. b.i.d.) or saline since birth. Changes in CBF were measured by laser doppler flowmetry before (baseline), and during hypercapnia (FiCO2 = 7.5%), hypoxia (FiO2 = 12%), and asphyxia (apnea for 1 min). During hypercapnia, CBF increased less in cocaine than in control animals (28 +/- 3% vs. 69 +/- 10%, P < 0.05). During hypoxia, CBF increased similarly in both groups. During reventilation after asphyxia, CBF increased more in cocaine than in control animals (391 +/- 52% vs. 225 +/- 43%, P < 0.05). Chronic cocaine exposure during brain development appears to alter CBF regulation to hypercapnia and asphyxia, which may put the drug exposed newborn at risk for neurologic injury around birth.

Use of Synthetic Serum Substitute and alpha-minimum essential medium for the extended culture of human embryos to the blastocyst stage

This study was designed to provide further information on mouse and human embryo development in alpha-modified minimum essential medium (alphaMEM). First, we compared the development and implantation potential of murine in-vitro fertilized (IVF) embryos cultured in alphaMEM, in the presence and absence of co-culture cells. No significant difference was observed in blastocyst rate between alphaMEM alone (76.2%) and alphaMEM plus co-culture (79.9%). The percentage of hatched blastocysts was, however, higher with co-culture (47.5 versus 40%, P < 0.01). Transfer of blastocysts to pseudopregnant foster mothers resulted in similar live birth rates (14.9% alphaMEM alone versus 19.8% alphaMEM/co-culture). alphaMEM was also introduced into our clinical IVF programme for culture of human embryos beyond day 3. Spare human embryos were cultured under oil in microdrops of alphaMEM supplemented with 10% synthetic serum substitute. Blastocysts were evaluated for maturity and the presence and organization of the inner cell mass. A total of 206 embryos from 53 IVF patients underwent extended culture. The overall blastocyst rate was 45.1%. An inner cell mass was observed in 76 blastocysts (81.7%). With regard to developmental maturity, approximately 73% of blastocysts that had been frozen were expanding (cavity > 50% embryo volume) or fully expanded. These data suggest that alphaMEM in conjunction with a commercial protein preparation such as Synthetic Serum Substitute may be a good basal medium for culture of human embryos to the blastocyst stage.

A Simple Model for Neutrino Cooling of the Large Magellanic Cloud Supernova

A simplified analytic model of a cooling hot neutron star, motivated by detailed computer calculations, describes well the neutrinos detected from the recent supernova in the Large Magellanic Cloud. The observations do not require explanations that invoke exotic physics or complicated astrophysics. The parameters in this simple model are not severely constrained: 6.1(-3.6)(+3.5) x 10(52) ergs emitted in electron antineutrinos, a peak temperature of 4.2(-0.8)(+1.2) megaelectron volts, a radius of 27(-15)(+17) kilometers, and a cooling time of 4.5(-2.0)(+1.7) seconds.

Expression of smooth muscle-specific alpha-isoactin in cultured vascular smooth muscle cells: relationship between growth and cytodifferentiation

The relationship between growth and cytodifferentiation was studied in cultured rat aortic smooth muscle cells (SMCs) using expression of the smooth muscle (SM)-specific isoactins (Vanderkerckhove, J., and K. Weber, 1979, Differentiation, 14:123-133) as a marker for differentiation in these cells. Isoactin expression was evaluated by: (a) measurements of fractional isoactin content and synthesis ([35S]methionine incorporation) by densitometric evaluation of two-dimensional isoelectric focusing sodium dodecyl sulfate gels, and (b) immunocytological examination using SM-specific isoactin antibodies. Results showed the following: (a) Loss of alpha-SM isoactin was not a prerequisite for initiation of cellular proliferation in primary cultures of rat aortic SMCs. (b) alpha-SM isoactin synthesis and content were low in subconfluent log phase growth cells but increased nearly threefold in density-arrested postconfluent cells. Conversely, beta-nonmuscle actin synthesis and content were higher in rapidly dividing subconfluent cultures than in quiescent postconfluent cultures. These changes were observed in primary and subpassaged cultures. (c) alpha-SM actin synthesis was increased by growth arrest of sparse cultures in serum-free medium (SFM; Libby, P., and K. V. O'Brien, 1983, J. Cell. Physiol., 115:217-223) but reached levels equivalent to density-arrested cells only after extended periods in SFM (i.e., greater than 5 d). (d) SFM did not further augment alpha-SM actin synthesis in postconfluent SMC cultures. (e) Serum stimulation of cells that had been growth-arrested in SFM resulted in a dramatic decrease in alpha-SM actin synthesis that preceded the onset of cellular proliferation. These findings demonstrate that cultured vascular SMCs undergo differential expression of isoactins in relation to their growth state and indicate that growth arrest promotes cytodifferentiation in these cells.

Cell division during nutritional upshifts of Escherichia coli

Nutritional shifts of Escherichia coli B/r to richer media have been analyzed is synchronously growing and exponential-hase populations. Early perturbations in the timing of cell division were observed. At the slow growth, division progressed at a rate equal to or less than the preshift rate for about 1 h. At intermediate growth, both delays and acceleration in division were observed. The extent of the perturbation depended upon the age of the cells at the time of the shift and the composition of the preshift and postshift media. The perturbation was different in the two substrains of E. coli B/r used in this study.