Prognostic Value of En-Block Radical Bowel Resection in Advanced Ovarian Cancer Surgery With HIPEC

PURPOSE

To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC.

METHODS

In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC.

RESULTS

Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence.

CONCLUSION

CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.

Short-term risk prediction after major lower limb amputation: PERCEIVE study

BACKGROUND

The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery.

METHODS

The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance.

RESULTS

Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679).

CONCLUSION

Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.

Long-Term (≥25 Years) Kidney Allograft Survivors: Retrospective Analysis at a Single Center

INTRODUCTION

Despite great improvements in the short-term patient and kidney graft survival, the long-term morbidity and mortality in kidney transplant recipients still remains a significant problem. The aim of the study was to evaluate the impact of both donor and transplant recipient factors, as well as renal function indices on the very long-term (>25 years) kidney allograft survival.

MATERIAL AND METHODS

Retrospective analysis was performed on the data of 41 kidney transplant recipients (KTR), group A: follow-up = 25 years, 20 KTR, 10 male, mean age (mean [M] ± standard deviation [SD]): 34.6 ± 12.6 years, 14 living donors (LD), 6 cadaveric donors (CD); group B: follow-up > 25 years, 21 KTR, 16 male, mean age (M ± SD): 30.86 ± 12.37 years, 14 LD, 7 CD). Kidney graft origin, post-kidney transplantation diabetes mellitus, HLA compatibility, delayed graft function, and acute rejection episodes were also analyzed retrospectively. Statistical analysis with Mann-Whitney test and Kaplan-Meier survival analysis was performed (SPSS 20.0 for Windows).

RESULTS

The mean age of CDs was lower than that of LDs: CD mean age (M ± SD): 23.84 ± 16.26 years vs LD mean age: 52.75 ± 12.42 years (P < .001). Cadaveric kidney graft was associated with better renal allograft function 10, 15, and 25 years post kidney transplant. None of the other factors analyzed reached statistical significance between the 2 groups.

CONCLUSION

The age of the donor and the kidney graft origin are important co-factors of the very long-term kidney allograft survival.

ABREAST: a prospective, real-world study on the effect of nab-paclitaxel treatment on clinical outcomes and quality of life of patients with metastatic breast cancer

PURPOSE

The efficacy of nab-paclitaxel in patients with metastatic breast cancer (MBC) has been demonstrated in randomized clinical trials. However, real-world evidence on effectiveness remains limited.

PATIENTS AND METHODS

The primary objective of this multicenter prospective study was to assess the overall response rate (ORR) of patients with MBC treated with nab-paclitaxel. Secondary objectives included progression-free survival (PFS), overall survival (OS) and quality of life, assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument.

RESULTS

Eligible patients (N = 150; 36% with de novo MBC presentation) with a median age of 64.5 years were enrolled (86% were ER+, 33.3% (50/150) were ≥ 70 years of age and 53% were treated in the third or later line of treatment). A median of 6 cycles were administered but 26% of patients required dose reduction due to toxicity. The ORR was 26.7% [95% confidence interval (CI) 19.6-33.7], the median PFS was 6.2 months (95% CI 5.2-7.3), and the median OS 21.1 months (95% CI 17.2-not estimable). There was no statistical significant difference in the median PFS of patients < and ≥ 70 years of age. The patients' baseline FACT-B total score remained unchanged. The serious and non-serious adverse event incidence rates were 13% and 48%, respectively.

CONCLUSIONS

This prospective study provides further evidence on quality of life, efficacy, and safety of nab-paclitaxel in patients with MBC and sheds more light in special subpopulations such as the elderly and those treated beyond the second line.

Ionospheric response to solar and interplanetary disturbances: a Swarm perspective

The ionospheric response to solar and interplanetary disturbances has been the subject of intense study for several decades. For 5 years now, the European Space Agency's Swarm fleet of satellites surveys the Earth's topside ionosphere, measuring magnetic and electric fields at low-Earth orbit with unprecedented detail. Herein, we study in situ the ionospheric response in terms of the occurrence of plasma instabilities based on 2 years of Swarm observations. Plasma instabilities are an important element of space weather because they include irregularities like the equatorial spread F events, which are responsible for the disruption of radio communications. Moreover, we focus on three out of the four most intense geospace magnetic storms of solar cycle 24 that occurred in 2015, including the St Patrick's Day event, which is the strongest magnetic storm of the present solar cycle. We examine the associated ionospheric response at Swarm altitudes through the estimation of a Swarm Dst-like index. The newly proposed Swarm derived Dst index may be suitable for space weather applications. This article is part of the theme issue 'Solar eruptions and their space weather impact'.

Haplotype analysis reveals that the recurrent BRCA1 deletion of exons 23 and 24 is a Greek founder mutation

A recurrent large genomic rearrangement (LGR) encompassing exons 23 and 24 of the BRCA1 gene has been identified in breast-ovarian cancer families of Greek origin. Its breakpoints have been determined as c.5406 + 664_*8273del11052 (RefSeq: NM_007294.3) and a diagnostic polymerase chain reaction (PCR) has been set up for rapid screening. In a series of 2,092 high-risk families completely screened for BRCA1 and BRCA2 germline mutations, we have found the deletion in 35 families (1.68%), representing 7.83% of the mutations identified in both genes and 10.3% of the total BRCA1 mutations. In order to characterize this deletion as a founder mutation, haplotype analysis was conducted in 60 carriers from 35 families, using three BRCA1 intragenic microsatellite markers and four markers surrounding the BRCA1 locus. Our results demonstrate a common shared core disease-associated haplotype of 2.89Mb. Our calculations estimate that the deletion has originated from a common ancestor 1450 years ago, which most probably inhabited the Asia Minor area. The particular (LGR) is the third mutation of such type that is proven to have a Greek founder effect in the Greek population, illustrating the necessity for LGRs testing in individuals of Greek descent.

A hierarchical Bayesian framework for force field selection in molecular dynamics simulations

We present a hierarchical Bayesian framework for the selection of force fields in molecular dynamics (MD) simulations. The framework associates the variability of the optimal parameters of the MD potentials under different environmental conditions with the corresponding variability in experimental data. The high computational cost associated with the hierarchical Bayesian framework is reduced by orders of magnitude through a parallelized Transitional Markov Chain Monte Carlo method combined with the Laplace Asymptotic Approximation. The suitability of the hierarchical approach is demonstrated by performing MD simulations with prescribed parameters to obtain data for transport coefficients under different conditions, which are then used to infer and evaluate the parameters of the MD model. We demonstrate the selection of MD models based on experimental data and verify that the hierarchical model can accurately quantify the uncertainty across experiments; improve the posterior probability density function estimation of the parameters, thus, improve predictions on future experiments; identify the most plausible force field to describe the underlying structure of a given dataset. The framework and associated software are applicable to a wide range of nanoscale simulations associated with experimental data with a hierarchical structure.

Der protektive Effekt von D2O bei Bakterien (E. coli) / he Protective Effect of Heavy Water (D2O) on Bacteria (E. coli)

E. coli suspended in D2O showed a better survival than in H2O when the bacteria were treated with various damaging agents like UV , heat and freezing. On the contrary E. coli grown in D2O - containing media - therefore being fully deuterated - were more sensitive than normally grown bacteria.

Reculturing of Cells from Primary CFU-C Colonies

This study was aimed at investigating whether cells of CFU-C derived colonies could form secondary colonies. Bone marrow cultures of volumes of agar medium between 25 μl and 75 μl contained in glass capillaries were stimulated with mouse lung-conditioned medium (MLCM) containing granulocyte/macrophage colony-stimulating factor (GM-CSF). Agar gels with colonies of up to ≥ 20 were blown out into identical culture medium, completely dispersed on a whirl-mix to single cell suspensions, and used for establishing secondary agar cultures. In these secondary cultures considerable numbers of secondary granulocytic, mixed granulocytic/macrophage and macrophage colonies as well as numerous clusters arose. In contrast, when single colonies were recultured, only few secondary cell aggregates were formed. When primary cultures containing up to ≥ 20 cell aggregates were used for serial reculture at intermittent intervals of 3 and 4 days, a 2 -7-fold increase of colony-forming cells was found in tertiary cultures as was monitored by 7 day colony counts. And by use of different kinds of CSF-containing media, an over 4-fold increase of secondary over primary colonies was obtained with bovine lung-conditioned medium (BLCM) in primary and L-cell-conditioned medium (LCCM) in secondary 7 day cultures. Primary capillary cultures were found to be devoid of CFU-S. Also, setting up bone marrow cultures in petri dishes and stimulating with MLCM, growth of primary as well as secondary colonies was obtained. The results indicate some self-renewal potential of CFU-C in vitro.

Abstract P6-05-27: p53, c-Myc and EGFR protein interactions confer worse prognosis in patients with triple negative breast cancer (TNBC)

Background - aim: TNBC is a heterogeneous disease comprising different molecular subtypes that are mostly defined by gene expression profiling and are related to patient outcome. Herein, we investigated the prognostic significance of molecular subtype-related, surrogate protein markers.

Methods: Immunohistochemistry was applied on tissue microarrays containing a series of 330 centrally assessed TNBC from early high-risk breast cancer patients treated with anthracyclines and/or taxanes. The following markers were examined (in parentheses: cut-offs for low/high and negative/positive): Ki67 (14%); p53 (10%); c-Myc (10%); P-cadherin (10%); E-cadherin (10%); Claudin-7 (H-score median: 105); CK5 (1%); EGFR (1%); androgen receptor (AR [1%]).

Results: The majority of tumors (269/327, 81.5%) were grade-III ductal carcinomas of no special type. Tumors were frequently positive for Ki67 (239/314, 76.1%), E-cadherin (193/271, 71.2%), P-cadherin (249/302, 82.5%) and expressed markers of the basal phenotype (CK5+ and/or EGFR+, 268/316, 84.8%). Grade-III, Ki67-high carcinomas and tumours positive for E- and P-cadherin were more prevalent among those of basal phenotype (Fisher's exact p&lt;0.001). Tumors expressing low levels of Claudin-7 were infrequently positive for AR and EGFR proteins (p = 0.015 and p = 0.003, respectively). AR positivity was more frequent among CK5 negative, grade I-II, and Ki67-low tumors (p = 0.021, p = 0.05 and p = 0.011 respectively). When examined individually, none of these markers was related to patient outcome. An interaction was noticed between p53 and c-Myc immunopositivity (Wald's p = 0.028 for disease-free [DFS] and p = 0.005 for overall survival [OS]). Among patients with c-Myc negative tumors, patients with p53 positive tumors (n = 63) had shorter median DFS (46.8 months) and OS (56 months) (HR 1.9; 95%CI 1.0-3.9; p = 0.049 and HR 2.28; 95%CI 1.0-4.8; p = 0.031, respectively) as compared to those with p53 negative tumors (n = 56; median DFS 69 months, OS 70 months). Similarly, in the absence of p53, c-Myc expression correlated with shorter median OS (44.5 months) (HR 2.1; 95%CI 1.0-4.5; p = 0.038) but showed only a trend for shorter DFS as compared to c-Myc negative tumors. p53 protein status was a discriminating factor for EGFR negative tumors (Wald's p = 0.052), whereby p53 positive tumors (n = 54) were associated with reduced DFS as compared to p53 negative tumors (n = 68; median DFS: 47 vs. 68.8 months; HR 2.1; 95%CI 1.1-4.0; p = 0.025). Accordingly, EGFR immunopositivity conferred a trend for shorter DFS within p53 negative cases.

Conclusions: In the current study, it was not possible to assign prognostic significance to individual proteins that have been introduced as surrogate markers for gene expression-based molecular subtypes in TNBC. By contrast, significant interactions involving the status of p53 and c-Myc or EGFR were observed. It seems that aberrant p53 adversely influences tumor behaviour in the absence of c-Myc and EGFR, while the opposite is also effective but to a lesser extent. These findings are hypothesis generating and need to be pursued in sufficiently powered studies for validating the apparently mutually exclusive adverse effects of p53, c-Myc and EGFR on tumor behaviour.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-27.

Protozoans as indicators of sequential batch processes for phenol treatment; an autoecological approach

The objective of this study was the investigation of the potential use of protistan species as quality indicators of the activated sludge performance in sequential batch processes receiving toxic compounds. Two laboratory scale sequential batch reactors (SBR) were used, a conventional one and a system with plastic biofilm carriers (SBBR), treating wastewater containing phenol at concentrations ranging from 1 up to 40 mg/L. Physicochemical analyses of the samples included the determination of MLSS, effluent suspended solids, BOD5, nitrogen-ammonia, nitrogen-nitrate and phenol. The activated sludge protistan community was identified and enumerated in each reactor. Statistical analyses included Canonical Correspondence Analysis and Indicator Species Analysis of the collected experimental data. Canonical Correspondence Analysis showed inversely proportional relationships between the protozoa and the physicochemical parameters of the effluent as well as protozoan species competition. Indicator species analysis revealed the presence and the prevalence of different species under various phenol influent concentrations. No indicator species were observed for the period of operation under 5 mg/L influent phenol in both reactors, while no indicator species were observed for 20 mg/L influent phenol in the SBR reactor. Carchesium and Epistylis sp. showed the higher values for 1 mg/L phenol in the SBR, while Holophrya sp. showed lower indicator values for the same period in the SBBR. Although several species showed a good correlation to the treatment efficiency of the reactors, Blepharisma sp., could be used as the primary indicator species in both reactors for the operation period under 40 mg/L phenol, as deduced by statistical analysis.

Vascular endothelial growth factor polymorphisms and clinical outcome in patients with metastatic breast cancer treated with weekly docetaxel

The aim of the study was to evaluate the association of vascular endothelial growth factor (VEGF) genotypes with treatment efficacy in a phase II trial. This study evaluated weekly docetaxel, as first-line treatment for metastatic breast cancer. Existing data from in vitro and animal model experiments suggest that docetaxel at low doses has anti-angiogenic activity. DNA was extracted from blood samples of 86 patients participating in the trial. Genotyping was performed for selected single-nucleotide polymorphisms (SNPs; VEGF-2578, -1498, -1154, and +936). Moreover, due to the highly polymorphic nature of the studied areas, we were able to analyze additional registered SNPs. All candidate genotypes were evaluated for associations with overall survival (OS), progression-free survival (PFS) and response rate. The VEGF-1154 GG genotype was more frequent in patients not responding to treatment compared with responders (42.9% vs 0.0%, P=0.048). Moreover, the VEGF-2578 AA genotype was associated with longer PFS compared with CC (hazard ratio (HR)=0.40; 95% confidence interval (CI) 0.17-0.98; pairwise P=0.0457). Patients with the VEGF-1190 GG genotype demonstrated shorter PFS compared with those with the alternative genotypes (GA and AA) combined (HR=3.85; 95% CI: 1.20-12.50; P=0.0224). In addition, the VEGF-2551/-2534 homozygous del18bp and VEGF-2430/-2425 homozygous ins1bp genotypes were associated with worse PFS compared with no deletion and no insertion, respectively (HR=2.49; 95% CI: 1.02-6.07; pairwise P=0.0442 and HR=2.57; 95% CI: 1.05-6.27; pairwise P=0.0385, respectively). Furthermore, patients with the VEGF-1498 CC genotype exhibited longer median OS compared with those with the alternatives genotypes (CT and TT) combined (HR=0.27; 95% CI: 0.08-0.89; P=0.0311). In multivariate analysis, the VEGF-2578 AA genotype retained its significance (P=0.0220) for PFS. Our results support the association of specific VEGF genotypes with clinical outcome in patients with metastatic breast cancer treated with a potentially anti-angiogenic regimen, such as weekly docetaxel. However, current results should be validated prospectively in larger cohorts.

VTD consolidation, without bisphosphonates, reduces bone resorption and is associated with a very low incidence of skeletal-related events in myeloma patients post ASCT

We prospectively evaluated the effect of bortezomib, thalidomide and dexamethasone (VTD) consolidation on bone metabolism of 42 myeloma patients who underwent an autologous stem cell transplantation (ASCT). VTD started on day 100 post ASCT; patients received four cycles of VTD (first block), were followed without treatment for 100 days and then received another four VTD cycles (second block). During this 12-month period, bisphosphonates were not administered. Best response included stringent complete remission (sCR) in 15 (35.7%) patients, complete response (CR) in 13 (30.9%), vgPR in 7 (16.6%), PR in 4 (9.5%), while 3 (7.1%) patients developed a progressive disease (PD). Importantly, 33.3% and 47.6% of patients improved their status of response after the first and second VTD block, respectively. VTD consolidation resulted in a significant reduction of circulating C-terminal cross-linking telopeptide of collagen type I (CTX), soluble receptor activator of the nuclear factor-kappa B ligand (sRANKL) and osteocalcin (OC), whereas bone-specific alkaline phosphatase (bALP) remained stable compared with pre-VTD values. During the study period, only one patient with a PD developed a skeletal-related event (that is, radiation to bone). The median time to progression (TTP) after ASCT was 34 months and the median time of next treatment was 40 months. We conclude that VTD consolidation post ASCT reduces bone resorption and is associated with a very low incidence of skeletal-related events (SREs) despite the absence of bisphosphonates; the later do not appear to be necessary in this context.

Carboplatin Hypersensitivity Reactions: A Single Institution Experience

Carboplatin-related hypersensitivity reactions, frequently encountered in the heavily pretreated subpopulation of patients with gynecologic malignancies, can be severe and even potentially lethal-precluding these patients from an effective salvage treatment. We describe our experience in the management of such reactions and the application of a pretreatment protocol with corticosteroids, antihistamines and a slow infusion rate in order to safely re-administer carboplatin to the above patients. From 1998 to 2004, twenty patients developed an allergic reaction to carboplatin. Sixteen of them (80%) suffered from ovarian cancer. Upon resolution of the acute reaction, thirteen patients were pretreated according to our protocol and were re-exposed to carboplatin. Fifteen patients experienced the reaction during second-line carboplatin-based treatment and 5 patients after 3 or more regimens. Fifteen of the reactions (75%) were severe. Thirteen patients were re-treated with carboplatin after the application of our protocol, all of them successfully, even though 10 patients (77%) experienced minor symptoms during subsequent courses. On the contrary, only one of the 6 patients who were re-treated without the application of the protocol was able to receive further platinum-based treatment. In conclusion, pretreatment with corticosteroids, antihistamines and a slower infusion rate may make re-treatment possible in patients having experienced hypersensitivity to carboplatin.

A test for adequate wastewater treatment based on glutathione S transferase isoenzyme profile

Discharge to the environment of treated or non-treated municipal wastewater imposes several threats to coastal and estuarine ecosystems which are difficult to assess. In our study we evaluate the use of the isoenzyme profile of glutathione S transferase (GST) in combination with the kinetic characteristics of the whole enzyme and of heme peroxidase, as a test of adequate treatment of municipal wastewater. For this reason, Artemia nauplii were incubated in artificial seawater prepared by wastewater samples, such as secondary municipal effluents produced by a conventional activated sludge unit and advanced treated effluents produced by the employment of coagulation, activated carbon adsorption and chlorination as single processes or as combined ones. Characteristic changes of the isoenzyme pattern and the enzymes' kinetic properties were caused by chlorinated secondary municipal effluent or by secondary non-chlorinated effluent. Advanced treatment by combination of coagulation and/or carbon adsorption resulted to less prominent changes, suggesting more adequate treatment. Our results suggest that GST isoenzyme profile in combination with the kinetic properties of the total enzyme family is a sensitive test for the evaluation of the adequateness of the treatment of reclaimed wastewater and the reduction of potentially harmful compounds. Potentially, it may offer a 'fingerprint' characteristic of a particular effluent and probably of the treatment level it has been subjected.

Structure and function of the oncologic boards in Greece. Description of the institutional and scientific frame; objective problems and difficulties

PURPOSE

Oncology boards should constitute a routine in all hospitals that are dealing with the care of cancer patients. Unfortunately the procedure which should be followed to deal with this health problem has some deficiencies.

METHODS

A literature review has recently been attempted, searching Internet databases by using key words such as oncologic board, medical legislation and medical ethics.

RESULTS

Current mentality suggests that hiding the truth from the patient is wrong and unethical. However, in the Greek society, this is not the case as it seems not right to adopt foreign practices, i.e. to disclose directly to the patient all information relevant to his health status, the intended therapy and possible outcome. Instead, ambiguous information pass onto relatives who in turn bear the burden of informing the patient.

CONCLUSIONS

The best solution would be the integration of the positive elements of the patient's awareness and the beneficial effects of the involvement of the Greek family in the general care of the cancer patient.

Abstract P5-18-21: A Phase II randomized trial of lapatinib with either vinorelbine or capecitabine as first- and second-line therapy for ErbB2-overexpressing metastatic breast cancer (MBC)

Background: Lapatinib (L), a dual kinase inhibitor of epidermal growth factor receptor and ErbB2, is effective in the treatment of ErbB2+ MBC in combination with capecitabine (C) following progression after trastuzumab, anthracyclines, and taxanes. Vinorelbine (V) is an important chemotherapy option in MBC, and multiple Phase II trials have been conducted in combination with trastuzumab. This randomized, open-label, multicenter, Phase II study (LAP112620, VITAL) evaluated the efficacy and safety of L with either V or C in women with ErbB2+ MBC.

Methods: Patients with MBC who had received ≤1 chemotherapy regimen in the metastatic setting were randomized 2:1 to either L 1250 mg orally once daily (QD) continuously plus V 20 mg/m2 intravenously on Days 1 and 8, every third week, or L 1250 mg orally QD continuously plus C 2000 mg/m2/day orally in 2 doses 12 hours apart on Days 1–14 every third week. Patients were stratified by prior receipt of therapy for MBC (Y/N) and site of metastatic disease (visceral/soft tissue or bone-only). The primary endpoint of progression-free survival (PFS) was assessed once all subjects had been followed for a minimum of 6 months or had otherwise progressed, died or withdrawn, if sooner. The primary focus was to evaluate PFS in the L plus V arm with a descriptive intent only. Other endpoints included overall response rate, overall survival, and safety. Patients progressing on one treatment arm were given the option of crossing over to the other arm.

Results: 112 patients were randomized. The results and conclusions sections will be updated once the primary analysis has been completed in September 2012.

ClinicalTrials.gov - NCT01013740

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-18-21.

OT1-02-09: A Phase II Randomized Trial of Lapatinib with Either Vinorelbine or Capecitabine as First- and Second-Line Therapy for HER2−Overexpressing Metastatic Breast Cancer

Background: Lapatinib, a dual kinase inhibitor of epidermal growth factor receptor (EGFR) and the human epidermal growth factor receptor-2 (HER2/ErbB2), is approved for the treatment of HER2−overexpressing (HER2+) metastatic breast cancer (MBC) in combination with capecitabine following progression after trastuzumab, anthracyclines, and taxanes. Vinorelbine is an important chemotherapy option in MBC, and multiple phase II trials in combination with trastuzumab have been conducted.

Methods: This randomized, open-label, multicenter, phase II study (VITAL, LAP112620, NCT01013740) is evaluating the efficacy and safety of lapatinib with either vinorelbine or capecitabine in women with HER2+ MBC. A total of 105 stage IV breast cancer patients with disease progression who have received ≤1 chemotherapy regimen in the metastatic setting with an ECOG performance status of ≤1 are randomized 2:1 to either: lapatinib 1250 mg orally once daily (QD) continuously plus vinorelbine 20 mg/m2 intravenously on days 1 and 8 every third week; or lapatinib 1250 mg orally QD continuously plus capecitabine 2000 mg/m2/d orally in 2 doses 12 hours apart on days 1 to 14 every third week. Following progression in the randomized phase, patients will be given the option to cross over to the other arm. The primary endpoint is progression-free survival and will be analyzed with a descriptive intent since the study is not powered to detect differences between treatment arms. Secondary endpoints include overall response rate, overall survival, duration of response, time to response, and clinical benefit rate.

The study is currently recruiting in 8 countries in Europe (Bulgaria, France, Germany, Greece, Italy, Poland, Serbia, Spain) and 2 in Latin America (Chile, Mexico).

Funding Source: GlaxoSmithKline

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-02-09.

PD05-02: Effect of HER2/Topoisomerase II alpha (TOP2A) Gene Status or Protein Expression and Chromosome 17 (CEP17) Polysomy on the Outcome of Breast Cancer Patients Treated with Anthracycline-Containing Dose-Dense Sequential Adjuvant Chemotherapy with or without Paclitaxel – A Pooled Analysis of Two Hellenic Cooperative Oncology Group (HeCOG) Phase III Trials

Background: The HER2 gene has been established as a valid biomarker in the treatment of breast cancer patients with trastuzumab and probably with other agents, such as paclitaxel or anthracyclines. The TOP2A gene has been associated with response to anthracyclines. The relationship of HER2/TOP2A gene status in the presence of CEP17 polysomy with patients’ outcome following adjuvant treatment with anthracyclines with or without paclitaxel is not established.

Patients and methods: Formalin-fixed paraffin-embedded (FFPE) tumor tissue blocks from 1,033 patients (61.5% of 1,681 randomized patients) with high-risk operable breast cancer enrolled in two sequential phase III trials1,2 were assessed in a central laboratory for HER2/TOP2A gene amplification and CEP17 polysomy by fluorescence in situ hybridization (FISH) and tumors were categorized according to the 2007 American Society of Clinical Oncology/College of American Pathologists guidelines. HER2 and TOP2A amplification was defined as a gene/CEP17 ratio of &gt;=2.2 and &gt;=2.0, respectively or a gene copy number of &gt;6. Additionally HER2, TOP2A, ER/PgR, Ki67, CK5 and EGFR protein expression were assessed by immunohistochemistry (IHC) and all patients were classified according to their IHC phenotype. Treatment consisted of epirubicin-based dose-dense sequential adjuvant chemotherapy followed by hormonal therapy and radiation, as indicated.

Results: Disease-free survival (DFS) and overall survival (OS) did not differ significantly between treatment groups. Median follow-up was 92 months, while 5-year DFS (OS) rates were 74% (88%), 69% (81%) and 75% (86%) for the E-T-CMF, E-CMF and ET-CMF groups, respectively. HER2 amplification was found in 24.1% of the patients and TOP2A amplification in 10.3%. In total, 46.7% of HER2 amplified tumors demonstrated TOP2A co-amplification. The median (range) of HER2, TOP2A and CEP17 copy numbers was 2.55 (0.70−45.15), 2.2 (0.50−26.15) and 2.05 (0.45−26.55), respectively. 21% of the tumors were considered to be polysomic (32.5% of those with HER2 amplification). Adjusting for treatment groups in the Cox model, TOP2A amplification, CEP17 polysomy and HER2/TOP2A co-amplification were not associated with either relapse or death. Treatment with paclitaxel was associated with improved survival in the HER2−amplified subgroup (HR=0.493, interaction p=0.036; adjusting for clinicopathological prognostic factors: HR=0.553, interaction p=0.054), an association that was not apparent for DFS. Conclusions: HER2 amplification was predictive for OS benefit from adjuvant treatment with paclitaxel in patients treated with epirubicin-based dose-dense sequential adjuvant chemotherapy, but not for DFS. TOP2A amplification, CEP17 polysomy and HER2/TOP2A co-amplification were not associated with outcome.

1. Ann Oncol 16:1762–71, 2005; 2. Ann Oncol 19:853–60, 2008.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD05-02.

P4-11-15: Increased Propability of Triple Negative Breast Cancer (TNBC) in Premenopausal Patients after Exogenous Hormonal Intake (EHI)

Purpose: HRT is a known risk factor for breast cancer (BC) among post-menopausal women. Our knowledge in relation to EHI (estrogens and/or progestin) and BC among pre-menopausal women is scarce. We have studied whether previous EHI influences BC phenotype, clinical and pathologic characteristics and correlation with other known BC risk factors.

Patients and methods: A prospective analysis (data recorded upon patients first presentation) of an electronic database at a tertiary cancer centre was performed. Patients’ demographics, risk factors for BC (smoking, alcohol use, obesity, family history), clinical profile, EHI parameters (duration, cause) and the tumors’ histopathology (type, grade,ER/PgR and HER2 by IHC and FISH) were analyzed. Premenopausal patients without an EHI history consisted control group.

Results: Out of 938 patients treated for BC between 2006 and 2010, 333(35,5%) were premenopausal and 131(39%) of them reported any use of hormones. Median age was identical (43 years,range:20–57) among premenopausal patients with and without EHI history. Mean duration of use was 28 months (range:1–180). Causes of EHI were contraception (35%), pregnancy(17%), menstrual abnormalities(17%) and medically assisted fertilization(17%). Smoking, alcohol use and obesity didn't differ among two groups. Family history for BC was more common (31, 3% vs. 22,8%, p=0,08)among women with EHI. No correlation was found among duration of use and the time of cancer diagnosis, while the mean time from the cessation of hormones to cancer diagnosis was 13 years(range:1–32). Only 18% of breast cancers were diagnosed within the first 5 years after exogenous hormones cessation.

TNBC was found to be significantly increased among premenopausal women with a history for EHI (23,6% vs. 13,4%, p=0,016). This increase was independent of the existence of positive family history for BC (p=0,61). EHI conferred a twofold increase in the risk for a TNBC (OR=1,99 p=0,019). No other clinical or histopathologic parameter showed any difference among the two groups.

Conclusion: Prior use of exogenous hormones, for any cause and irrespective of the coexistence of other risk factors and family history, increases the probability of a triple negative breast cancer diagnosis by twofold. Whether this represents a trend of a changing epidemiology in the types of BC in prior hormone users vs. nonusers, poses an extremely challenging hypothesis to be verified in large epidemiologic studies — given the young age and the treating difficulties of this patient population.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-15.

Mechanisms of resistance to epidermal growth factor receptor tyrosine kinase inhibitors in patients with advanced non-small-cell lung cancer: clinical and molecular considerations

Non-Small-Cell Lung Cancer (NSCLC) with somatic mutations of the epidermal growth factor receptor (EGFR) is anticipated to respond to small-molecule tyrosine kinase inhibitors (TKIs) of the EGFR tyrosine kinase. There are, however, patients with EGFR mutated tumors who do not demonstrate tumor response. The most widely accepted mechanism of 'de novo' (inherent) resistance to these TKIs involves mutations of the KRAS gene. KRAS is a downstream mediator of EGFR-induced cell signaling, such mutations appear to be mutually exclusive from EGFR mutations in lung cancer. The first molecular modifier of resistance identified in patients who developed resistance (termed 'acquired resistance') to TK inhibition was a new acquired somatic EGFR mutation (T790M). Today there is an ever-growing series of molecular events that have recently come to the forefront to explain other instances of TKI resistance not attributable to T790M or KRAS. These include a number of molecules that interact with EGFR or form part of its downstream signaling pathway such as HER-2, IGFR-1, MET and B-RAF. Considering that the majority of studies carried out to date with respect to the identification of resistant clones have not used highly sensitive techniques (e.g. allelic discrimination to identify somatic mutations), coupled with the relatively low number of studies examining multiple molecular markers and the accepted molecular heterogeneity of NSCLC raise question as to the existence of 'acquired' versus 'de-novo' resistance. By examining the current knowledge base with respect to mechanisms of resistance to EGFR TKIs in NSCLC, we explore whether 'acquired' resistance is 'de-novo' resistance in disguise, and discuss the promises and limitations of molecular stratification with respect to strategies incorporating TKIs in the treatment of NSCLC.

The prognostic and predictive value of ERCC-1, p53, bcl-2 and bax in epithelial ovarian cancer

AIM

To evaluate the expression of ERCC-1 in patients with epithelial ovarian cancer (EOC) and to correlate it with the expression of p53, bcl-2 and bax.

MATERIALS AND METHODS

Tumor samples from 60 patients with EOC were immunohistochemically investigated for the expression of ERCC1, p53, bcl-2 and bax.

RESULTS

ERCC-1 expression was significantly decreased in serous and endometrioid compared to clear cell carcinomas. P53 expression was significantly increased in serous compared to clear cell carcinomas. Bax expression was significantly increased in serous carcinomas as compared to MMTs. High disease stage was correlated with low ERCC-1 and high bcl-2 expression. ERCC-1 expression was associated with increased disease-free interval.

CONCLUSION

ERCC-1 status seems to be correlated with disease-free interval, stage and tumor histologic subtype in patients with EOC. Nevertheless, our results indicate that single-gene expressions may be unreliable and thus caution is needed when used as potential prognostic or predictive markers.