Real world study of sacituzumab govitecan in metastatic triple-negative breast cancer in the United Kingdom

BACKGROUND

Treatment options for pre-treated patients with metastatic triple-negative breast cancer (mTNBC) remain limited. This is the first study to assess the real-world safety and efficacy of sacituzumab govitecan (SG) in the UK.

METHODS

Data was retrospectively collected from 16 tertiary UK cancer centres. Pts had a diagnosis of mTNBC, received at least two prior lines of treatment (with at least one being in the metastatic setting) and received at least one dose of SG.

RESULTS

132 pts were included. Median age was 56 years (28-91). All patients were ECOG performance status (PS) 0-3 (PS0; 39, PS1; 76, PS2; 16, PS3;1). 75% (99/132) of pts had visceral metastases including 18% (24/132) of pts with CNS disease. Median PFS (mPFS) was 5.2 months (95% CI 4.5-6.6) with a median OS (mOS) of 8.7 months (95% CI 6.8-NA). The most common adverse events (AEs) were fatigue (all grade; 82%, G3/4; 14%), neutropenia (all grade; 55%, G3/4; 29%), diarrhoea (all grade; 58%, G3/4, 15%), and nausea (all grade; 38%, G3/4; 3%). SG dose reduction was required in 54% of pts.

CONCLUSION

This study supports significant anti-tumour activity in heavily pre-treated pts with mTNBC. Toxicity data aligns with clinical trial experience.

Abstract P1-17-08: Abemaciclib and endocrine therapy for hormone receptor-positive, HER2-negative advanced breast cancer: A real-world UK multicentre experience

Background Abemaciclib is approved in 1st and 2nd line for hormone receptor (HR)-positive HER2-negative advanced breast cancer (ABC). However, outcomes on this agent are unclear in the real world.We determined the safety and efficacy profile of abemaciclib across 15 institutions in the United Kingdom. Methods We retrospectively identified HR-positive, HER2-negative ABC patients who received abemaciclib between July 2018 and June 2020. Demographics, disease characteristics, prior treatments, blood tests, toxicities, treatment delays and responses were recorded. Simple statistics, Fisher’s exact test, chi-squared method and Cox regression were used as appropriate. Results 228 patients identified had median age of 64 (31-93). 172 (75.4%) were postmenopausal and 209 (91.7%) had ECOG Performance Status 0-1. 145 (63.6%) had visceral involvement and 44 (19.3%) only bone disease. Patients received a median 1 (range 0-7) prior lines of treatment and 0 (range 0-5) prior chemotherapy lines.148 patients (64.9%) experienced diarrhoea (grade ≥3 in 16 [7.0%]). 146 patients (64.0%) developed neutropenia (grade ≥3 in 40 [17.5%]). 5 experienced febrile neutropenia (2.2%). 32 patients (14.0%) required hospitalisation due to toxicity (diarrhoea in 9 [3.95%]).Dose reductions were required in 107 patients (46.9%), mainly due to diarrhoea (55 [24.1%]) and to 50mg BD in 30 patients (13.2%). Dose delays were in median 14 (range 2-118). Abemaciclib was discontinued in 121 patients (53.1%) due to disease progression in 61 (26.7%) and toxicity in 48 (21.0%) (diarrhoea in 16 [7.0%]).Abemaciclib produced clinical benefit rate of 82.8% and overall response rate of 47.2% in 163 patients assessed. Overall, median progression-free survival (PFS) was 6.4 months (95% confidence interval [CI] 4.4-7.8) and median overall survival (OS) was 8.8 months (95% CI 7.6-10.6). Conclusions This a large real-world analysis of the safety and efficacy of abemaciclib in combination with endocrine therapy for advanced HR-positive breast cancer. In this analysis, the rates of diarrhoea were lower compared with the pivotal trial data, while neutropenia was more frequent. Although the PFS outcomes were similar to those previously reported, median OS was worse in this cohort which may reflect the different population of patients included, who were older and had more frequent visceral involvement. The selection of patients suitable for abemaciclib is crucial to ensure adequate efficacy and safety outcomes in this setting.

Citation Format: Nicolò Matteo Luca Battisti, Laura Morrison, Tamsin Nash, Nishanti Senthivel, Samantha Kestenbaum, Parvin Begum, Mariam Obeid, William Hayhurst, Dorothy Yang, Shafiah Gafoor, Caroline Brown, Farah Rehman, Laura Kenny, Olivia Hatcher, Susan Susan, Jennet Williams, Anna Brown, Hamoun Rozati, Alexandros Alexandros, Elinor Sawyer, Charalampos Gousis, Eleni Karapanagiotou, Anna Rigg, Kleopatra Rapti, Rebecca Roylance, Mark Beresford, Abigail L Gee, Apostolos Konstantis, Judy King, Mark Nathan, Emma Spurrell, Mark Pearce, Dane Bradwell, Arshi Denton, Kate Swain, Sophie McGrath, Mark Allen, Alistair Ring, Stephen Johnston, Fharat Raja. Abemaciclib and endocrine therapy for hormone receptor-positive, HER2-negative advanced breast cancer: A real-world UK multicentre experience [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 P1-17-08.

V6 PRIMROSE: A national trainee collaborative-led, multicentre prospective audit on the care of breast cancer patients with central nervous system disease in the UK

PRIMROSE

A national trainee collaborative-led, multicentre prospective audit on the care of breast cancer patients with central nervous system disease in the UK

Mark P Lythgoe1, Vinton WT Cheng2, Hayley S McKenzie3, Amy Kwan4, Apostolos Konstantis5, Ruichong Ma6, Pei J Teo7, Amanda Fitzpatrick8, Laura Woodhouse9 & Carlo Palmieri10 on behalf of the BNTRC† and PRIMROSE study group

1Imperial College Healthcare NHS Trust, London, 2Leeds Cancer Centre, Leeds, 3University of Southampton, Southampton, 4University of Sheffield, Sheffield, 5The Princess Alexandra NHS Trust, Harlow 6Oxford University Hospitals NHS Trust, Oxford, 7Worcestershire Acute Hospitals NHS Trust, Worcester, 8Institute of Cancer Research, London, 9The Christie NHS Foundation Trust, Manchester, 10University of Liverpool, Liverpool, †British Neurosurgical Trainee Research Collaborative

Introduction

Breast cancer is the commonest cancer in the UK and the 4th leading cause of cancer-related death. Breast cancer brain metastases (BCBM) are a poor prognostic indicator and associated with very poor survival and only a minority of patients survive >1 year despite oncological treatment. The rising prevalence of patients with BCBM represent an increasing unmet healthcare need. However, in the UK there is a paucity of data about prevalence, survival and management. Guidance on managing brain metastases is improving, however it is unclear how this has been applied in the context of BCBM and whether recommended standards are uniformly applied across the UK

Methods

PRIMROSE is a trainee collaborative-led initiative to estimate BCBM prevalence, assess current practice (comparing national/international standards) and determine long term outcomes/sequalae. Anonymised data is being pooled via secure REDCap database collating demographics, clinico-pathological information, prior treatment, BCBM treatment and other key variables. All UK hospitals can register, with recruitment driven by trainees via the UK Breast Cancer Trainees Research Collaborative Group and British Neurosurgical Trainee Research Collaborative. Senior oversight will be provided by a local consultant oncologist or neurosurgeon.

Results

Opened in Jan 2020, 180 datasets have been entered, despite significant disrupted due to COVID-19 from Feburary to May). Over 25 sites are open/in the process of joining. Trainee networks have been established in all regions of the UK with the exception of Yorkshire and The Humber, East of England and North East England. Promotion of the network has occurred at significant oncology conferences (e.g. San Antonio Breast Meeting, and National Cancer Research Institute). We plan to expand to all major UK neurosurgical and oncology centres by December 2020, with data collection completed by December 2021.

Conclusions

PRIMROSE demonstrates the utility of trainee collaborative networks in rapidly organising large-scale multicentre data collection to understand care of patients at a national level. Such information will be important for identifying current pactice and act as a benchmark for improving local service delivery for patients with BCBM.

Abstract OT3-10-02: A breast cancer trainees research collaborative group prospective study of treatment and outcomes related to central nervous system disease secondary to breast cancer in the United Kingdom

Introduction: Breast cancer brain metastasis (BCBM) is a particular feature of HER2-positive and triple negative breast cancer (BC) and is becoming more common. This reflects the improved survival of patients living with metastatic breast cancer as well as increased cross-sectional imaging of the central nervous system with magnetic resonance imaging (1). The development of BCBM on the background of adequately controlled extracranial disease is an increasingly prevalent clinical scenario. BCBM causes significant morbidity and mortality; unfortunately the efficacy of systemic treatment is extremely limited and, at present, no systemic therapies are specifically approved for the treatment of BCBM (2). Basic and translational research to understand the pathophysiology of BCBM remains limited by a lack of access to annotated clinical material. Such research is needed if preventative and novel treatment strategies are to be developed. Moreover, there is currently a lack of basic contemporaneous information regarding the incidence and management of BCBM in the UK, how it may vary across the country and its impact on patient outcomes. Finally, clinical studies have been hampered by a lack of a central resource to aid feasibility work and to identify potentially eligible patients. Study design: PRIMROSE will use the trainee collaborative model to establish an observational prospective UK cohort of newly diagnosed BCBM. Data collected will include routine clinico-pathological information, prior adjuvant and metastatic treatment as well as BCBM-related information including presentation, management and outcome. Anonymised data will be collated in a secure central REDCap database. All hospitals in the UK will be eligible to register patients driven by trainees from all specialties via the UK Breast Cancer Trainees Research Collaborative Group (BCTRCG) network. Eligibility criteria: Inclusion criteria: male or female patients aged >16 years of age, with histologically and/or cytologically confirmed BC with involvement of the brain parenchyma. There are no formal exclusion criteria. Patients with leptomeningeal disease will be registered, with data being collected in a separate project (PRIMROSE-LMD). Aims: The overarching objectives include defining the prevalence, management and outcome of BCBM in the UK. Endpoints: *Primary Endpoint: Overall survival from initial diagnosis of CNS involvement. Secondary Endpoints will include: 1. Time to initial CNS involvement from initial diagnosis of MBC; 2. Therapeutic interventions for management of CNS disease; 3. Time to intracranial tumour progression (for each line of therapy given for CNS disease); 4. Overall survival from MBC diagnosis; 5. Cause of death: progressive CNS disease versus progressive disease at other sites. *Information will be presented for the whole cohort as well as by breast cancer subtype Patient accrual: Patient accrual is due to commence in July 2019 and continue will for 2 years in the first instance. There is no predefined target accrual. Contact information: Study lead: Prof Carlo Palmieri; c.palmieri@liverpool.ac.uk References: (1) Witzel I, Oliveira-Ferrer L, Pantel K, Müller V, Wikman H. Breast cancer brain metastases: biology and new clinical perspectives. Breast Cancer Res. 2016 (2) Kotecki N, Lefranc F, Devriendt D, Awada A. Therapy of breast cancer brain metastases: challenges, emerging treatments and perspectives. Ther Adv Med Oncol. 2018

Citation Format: Vinton WT Cheng, Hayley S McKenzie, Amy Kwan, Apostolos Konstantis, Ruichong Ma, Pei J Teo, Amanda Fitzpatrick, Shaveta Mehta, Arunima Mukhopadhyay, Carlo Palmieri, on Behalf of the PRIMROSE Study Group and the BCTRCG. A breast cancer trainees research collaborative group prospective study of treatment and outcomes related to central nervous system disease secondary to breast cancer in the United Kingdom [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-10-02.

Fulvestrant in hormone receptor-positive advanced breast cancer: A UK retrospective multicenter study

e12525

Background: Fulvestrant is a selective oestrogen receptor (ER) down regulator used to treat hormone receptor-positive advanced breast cancer in postmenopausal women. It is used at various time points in treatment. However, variations in funding across the UK limit universal patient access to fulvestrant. We sought to investigate its use and efficacy in UK clinical practice. Methods: Medical records of 458 patients with ER positive advanced breast cancer treated with fulvestrant between August 2011 and November 2018 at ten UK centres were reviewed. Demographics and treatment responses were recorded. Efficacy was analysed by progression free survival (PFS), clinical benefit rate (CBR) and overall survival (OS) with alive patients censored to December 2018. Results: Of the 445 patients with analysable data, median age was 70 (range 21-95). ECOG performance status was 0-1 in 70% (n = 285). Bone was most commonly involved (73%, n = 323), 307 (69%) had visceral involvement and 228 (51%) had nodal metastases. Both locally advanced and metastatic patients had received a median 2 (range 0 – 5 for all patients) prior endocrine therapy lines and 0 (range 0 – 6) prior chemotherapy lines. Fulvestrant was the first line treatment in 49 (11%). Median duration of fulvestrant use was 5 months (range 1-88). Overall, median PFS was 6 months. This increased to 7 months in absence of visceral disease, in whom 22% of patients achieved a prolonged PFS extending to 30 months. Fulvestrant produced a CBR of 41% in 355 patients assessed, of which 16% partially responded. First radiological assessment occurred at median 3 months (range 1-37). Progressive disease accounted for 82% of discontinuation compared to 4% owing solely to adverse events in 341 assessed patients. Median OS for the whole cohort was 23 months. Conclusions: This is one of the largest studied patient cohorts treated with fulvestrant. This heavily pre-treated population reflects real life fulvestrant use. Reassuringly the results confirm its clinical benefit in maintaining disease response. Given its potential synergistic action with other systemic agents, fair access to this highly active drug for all patients is as important now as ever before.

Family caregiver beliefs and barriers to effective pain management of cancer patients in home care settings

PURPOSE

Pain is one of the most common symptoms in cancer patients, and its management is a significant goal in supportive care. Many barriers interfere with its effective control. Nowadays, with a shift in care from the hospital to the home, there is an increasing tendency to involve family caregivers in pain management. Their beliefs may act as barriers to effective pain management in these homecare settings. This study aimed to validate and explore these beliefs using Barriers Questionnaire II (BQ II).

METHODS

A cross-sectional survey of 202 individuals from a cohort of family caregivers in Greece.

RESULTS

The reliability index Cronbach, a value for the translated version of the BQ II, calculated >0.9. Most participants reported worries about the side effects of analgesics. They often assumed these effects were irreversible, and equally, there were concerns about addiction to these drugs. They agreed on the effectiveness of analgesics in treating cancer pain but disagreed that reporting pain is a distracting factor in active cancer treatment.

CONCLUSIONS

This is the first time BQ II has been used in this population. The results are consistent with the international academic studies in this area, but more research is needed. BQ II was found to be a valid and reliable scale for defining caregiver attitudes and barriers to effective pain management in homecare settings. Health professional training, interventions targeted to caregivers and trained home care teams may improve the quality of cancer care in these settings.

Breaking bad news in cancer patients

Objective:

In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital.

Materials and Methods:

59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic.

Results:

Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient's knowledge about the disease.

Conclusions:

There were low rates of specific training in breaking bad news. However, the selected location, the physician's speech and their plan were according to current guidelines.

The impact of oxaliplatin-based chemotherapy for colorectal cancer on the autonomous nervous system

BACKGROUND

The oxaliplatin (ΟΧΑ)-based regimens FOLFOX and XELOX can cause peripheral neuropathy. It is unknown if ΟΧΑ, alone or in combination regimens, affects the Autonomous Nervous System (ANS). Accordingly, we evaluated the impact of ΟΧΑ-based chemotherapy on the ANS.

METHODS

We enrolled 36 patients with colorectal cancer, treated with adjuvant mFOLFOX6 or XELOX chemotherapy, and 22 healthy volunteers. For the assessment of ANS function, participants completed a questionnaire and underwent neurophysiological examination at three time points (baseline, 3-4 months and 6-8 months after the first chemotherapy cycle). ANS testing included assessment of the adrenergic cardiovascular function (orthostatic hypotension-OH), parasympathetic heart innervation (ratio 30/15) and Sympathetic Skin Response (SSR).

RESULTS

The values of the 30/15 ratio were significantly reduced at the two time point assessments compared to baseline (Wilcoxon signed ranks test, both P < 0.001), while patients had more often diastolic OH at the 6-8 month evaluation compared to baseline (P = 0.039). In contrast, SSR was not affected. The incidence of positive responses in the questionnaire assessing the subjective impact of symptoms attributable to ANS dysfunction was higher at the two time points compared to baseline (P = 0.036 and P = 0.020).

CONCLUSIONS

Oxaliplatin-based chemotherapy is associated with significant effects on the adrenergic cardiovascular reaction and the parasympathetic heart innervation, whereas SSR remains untouched.