Predicting response to neoadjuvant chemotherapy with liquid biopsies and multiparametric MRI in patients with breast cancer

Accurate prediction of response to neoadjuvant chemotherapy (NAC) can help tailor treatment to individual patients' needs. Little is known about the combination of liquid biopsies and computer extracted features from multiparametric magnetic resonance imaging (MRI) for the prediction of NAC response in breast cancer. Here, we report on a prospective study with the aim to explore the predictive potential of this combination in adjunct to standard clinical and pathological information before, during and after NAC. The study was performed in four Dutch hospitals. Patients without metastases treated with NAC underwent 3 T multiparametric MRI scans before, during and after NAC. Liquid biopsies were obtained before every chemotherapy cycle and before surgery. Prediction models were developed using penalized linear regression to forecast residual cancer burden after NAC and evaluated for pathologic complete response (pCR) using leave-one-out-cross-validation (LOOCV). Sixty-one patients were included. Twenty-three patients (38%) achieved pCR. Most prediction models yielded the highest estimated LOOCV area under the curve (AUC) at the post-treatment timepoint. A clinical-only model including tumor grade, nodal status and receptor subtype yielded an estimated LOOCV AUC for pCR of 0.76, which increased to 0.82 by incorporating post-treatment radiological MRI assessment (i.e., the "clinical-radiological" model). The estimated LOOCV AUC was 0.84 after incorporation of computer-extracted MRI features, and 0.85 when liquid biopsy information was added instead of the radiological MRI assessment. Adding liquid biopsy information to the clinical-radiological resulted in an estimated LOOCV AUC of 0.86. In conclusion, inclusion of liquid biopsy-derived markers in clinical-radiological prediction models may have potential to improve prediction of pCR after NAC in breast cancer.

Abdominal pain in patients with inflammatory bowel disease in remission: A prospective study on contributing factors

BACKGROUND

Abdominal pain is highly prevalent in patients with inflammatory bowel disease (IBD) in remission, but the aetiology is incompletely understood.

AIM

To investigate the association of clinical, lifestyle and psychosocial factors with abdominal pain in patients with IBD in remission.

METHODS

We performed a prospective multicentre study enrolling consecutive patients with IBD. Data were collected between 1 January 2020 and 1 July 2021, using myIBDcoach, an established remote monitoring platform for IBD. Chronic abdominal pain in IBD in remission (IBDremissionPain+) was defined as abdominal pain score ≥3 (0-10 NRS) on ≥1/3 of all assessments, combined with faecal calprotectin <150 μg/g in 90 days around periodic assessments. Disease activity, lifestyle and psychosocial factors were assessed every 1-3 months during 18 months. Using linear mixed models, the association of these factors with abdominal pain over time was analysed.

RESULTS

We included 559 patients, of whom 429 (76.7%) remained in biochemical remission. Of these, 198 (46.2%) fulfilled the criteria for chronic abdominal pain. IBDremissionPain+ patients were characterised by female sex, younger age, higher BMI, and shorter disease duration. They reported more often or higher levels of stress, fatigue, depressive and anxiety symptoms, and life events (all p < 0.001). In the multivariable analysis, sex, disease entity, fatigue, depressive symptoms and life events were associated with abdominal pain over time (all p < 0.05).

CONCLUSION

In this cohort of patients with IBD in remission, abdominal pain was common and associated with psychosocial factors. A more holistic treatment approach for patients with IBD suffering from abdominal pain may improve quality of care and subjective wellbeing.

MRI to assess response after neoadjuvant chemotherapy in breast cancer subtypes: a systematic review and meta-analysis

This meta-analysis aimed to estimate and compare sensitivity, specificity, positive- (PPV) and negative predictive value (NPV) of magnetic resonance imaging (MRI) for predicting pathological complete remission (pCR) after neoadjuvant chemotherapy (NAC) in patients with early-stage breast cancer. We stratified for molecular subtype by immunohistochemistry (IHC) and explored the impact of other factors. Two researchers systematically searched PUBMED and EMBASE to select relevant studies and extract data. For meta-analysis of sensitivity and specificity, we used bivariate random-effects models. Twenty-six included studies contained 4497 patients. There was a significant impact of IHC subtype on post-NAC MRI accuracy (p = 0.0082) for pCR. The pooled sensitivity was 0.67 [95% CI 0.58-0.74] for the HR-/HER2-, 0.65 [95% CI 0.56-0.73] for the HR-/HER2+, 0.55 [95% CI 0.45-0.64] for the HR+/HER2- and 0.60 [95% CI 0.50-0.70] for the HR+/HER2+ subtype. The pooled specificity was 0.85 [95% CI 0.81-0.88] for the HR-/HER2-, 0.81 [95% CI 0.74-0.86] for the HR-/HER2+, 0.88[95% CI 0.84-0.91] for the HR+/HER2- and 0.74 [95% CI 0.63-0.83] for the HR+/HER2+ subtype. The PPV was highest in the HR-/HER2- subtype and lowest in the HR+/HER2- subtype. MRI field strength of 3.0 T was associated with a higher sensitivity compared to 1.5 T (p = 0.00063). The accuracy of MRI for predicting pCR depends on molecular subtype, which should be taken into account in clinical practice. Higher MRI field strength positively impacts accuracy. When intervention trials based on MRI response evaluation are designed, the impact of IHC subtype and field strength on MR accuracy should be considered.

Abstract P2-07-04: Prognostic value of residual cancer burden (RCB), neo-bioscore and neoadjuvant response index (NRI) to evaluate response to neoadjuvant trastuzumab-based therapy in HER2-positive breast cancer (BC)

Intro Pathological complete response (pCR) to neoadjuvant systemic therapy is associated with favorable long-term outcome. As pCR is not an optimal surrogate marker for outcome, other tools were developed to predict long-term outcome more accurately, including the RCB4, NRI3, and Neo-Bioscore5. We evaluated the prognostic value of these tools in a cohort of patients with HER2+ BC with the aim of selecting a group of patients with residual disease but a similar long-term outcome as patients achieving pCR.

Methods We included all patients with stage II-III HER2+ BC who were treated with trastuzumab-based neoadjuvant therapy and surgery in the Netherlands Cancer Institute between November 2004 and December 2016. Patients were identified from the institutes' tumor registry and data was collected from the patients' records. To assess RCB scores surgical specimens (breast and axilla tissue) of patients without pCR were retrospectively reviewed. NRI and Neo-Bioscore were calculated based on original pathology reports.

Primary endpoint was recurrence-free interval (RFI), defined as time since diagnosis of BC till locoregional or distant recurrence or death from BC, whatever came first. Cox proportional models were used with transformations of RCB, NRI, and Neo-Bioscore. In addition, we evaluated at which cut-off point the NRI could select patients with a similar good prognosis as patients who achieved a pCR, defined by the same lower bound of the 95%CI of the 5-year RFI estimate for the pCR-group.

Results 283 women were included, 149 (53%) with HER2+/ER+ BC. 28% received dual HER2-blockade. Median follow-up was 66 months (range 11-148). 157 patients (55%) achieved a pCR in breast and axilla; predicted 5-year RFI for this group was 91% (95%CI 86-96), HR no-pCR vs pCR 2.19, 95%CI 1.07-4.47. Table 1 shows the predicted 5-year RFI and HR for RCB classes. The HR of an RFI event increases gradually for lower NRI values compared to NRI of 1 and gets more steep near NRI values of 0. Patients with a NRI of ≥0.80-0.99 have a 5-year RFI estimate of 90% (95%CI 86-96), HR 1.1 (95%CI 0.6-1.9) compared to patients with NRI of 1 (which is pCR). Table 2 shows the predicted 5-year RFI and HR for the Neo-Bioscore.

Table 1RCB classes, estimated 5-year RFI and HRRCBn% 5-year RFI95% CIHR95% CI016392.688.397.111113990.385.295.61.330.672.6526278.469.488.53.181.427.1131135.316.476.113.605.3034.81

Table 2Neo-Bioscore classes, predicted 5-year RFI and HRNeo-Bioscoren% 5-year RFI95% CIHR95% CI01998.795.510011115392.486.099.36.100.9240.5229384.977.493.012.670.76210.4037289.983.896.58.200.62108.2041974.962.989.222.331.76283.445329.410.384.095.206.271446.64610.601.00406.2619.558442.21

Conclusions We show that in a HER2+ BC cohort the RCB and NRI are able to identify a subgroup of patients with limited residual disease after neoadjuvant therapy with similar good prognosis as patients with pCR and therefore may not benefit from additional adjuvant therapy.

References

1 Cortazar Lancet 2014

2 FDA Regist 2014

3 Rodenhuis Ann Oncol 2010

4 Symmans JCO 2007

5 Jeruss JCO 2008

6 Mittendorf JAMA Oncol 2016

Citation Format: Steenbruggen TG, van Seijen M, Janssen LM, van Ramshorst MS, van Werkhoven E, Lips EH, Vrancken-Peeters M-JT, Horlings HM, Wesseling J, Sonke GS. Prognostic value of residual cancer burden (RCB), neo-bioscore and neoadjuvant response index (NRI) to evaluate response to neoadjuvant trastuzumab-based therapy in HER2-positive breast cancer (BC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-04.

[Cutting through tumour in head and neck cancer: still a taboo?]

When resecting head and neck tumours, the aim is mostly to strive for en bloc resection with sufficiently large tumour-free margins. If this is not possible, as is frequently the case with transoral laser microsurgery and endonasal endoscopic surgery, multiblock resection can be carried out by cutting through the tumour. With this approach, it is also essential that the final resection margins are tumour-negative. In such cases, surgeon and pathologist together should pay extra attention to tissue orientation and outer resection margins.

Systematic review of the diagnostic value of laryngeal stroboscopy in excluding early glottic carcinoma

OBJECTIVE

Laryngeal stroboscopy is an important diagnostic tool in the work-up of patients with phoniatric complaints. The aim of this article was to evaluate the diagnostic value of laryngeal stroboscopy in excluding glottic carcinoma in patients with suspected glottic carcinoma.

DATA SOURCES

PubMed, Embase and the Cochrane Library.

REVIEW METHODS

A systematic literature search was performed in PubMed, Embase and the Cochrane Library. Studies reporting original study data were included. Studies were selected based on predefined inclusion and exclusion criteria and were consequently systematically assessed for their relevance and risk of bias. Studies with low relevance, high risk of bias or both were excluded from analysis. The prevalences, sensitivities, specificities and post-test probabilities of laryngeal stroboscopy for detecting glottic carcinoma were extracted or calculated with data supplied in the articles.

RESULTS

Seven studies, with high relevance and moderate risk of bias, were selected for data extraction. The baseline risk of glottic carcinoma was 25-49% in the included studies. Sensitivity ranged between 80% and 100% and specificity between 25% and 100%. Post-test probabilities of malignancy in case of an abnormal stroboscopy ranged between 35% and 100%. Post-test probabilities of malignancy in case of a normal stroboscopy ranged between 0% and 29%.

CONCLUSION

A normal laryngeal stroboscopic result predicts the absence of invasive carcinoma. Laryngeal stroboscopy can therefore be suggested as a useful supplemental examination in the standard diagnostic work-up for all patients with suspected glottic carcinoma.

[Obstruction of the nose in newborns]

Five newborns, 4 girls and 1 boy, presented with breathing and feeding difficulties caused by obstruction of the nose. The causes were choanal atresia, apertura pyriformis stenosis, teratoma, glioma and haemangioma. Following surgical treatment the children were symptom-free. Rapid diagnosis and treatment of these conditions are essential. An alternative airway should be created if a newborn suffers from breathing problems. Diagnostic work-up includes flexible laryngo-endoscopy followed by MRI- or CT-scan. Treatment is usually surgical.

The lateral sellar nerve plexus and its connections in humans

OBJECT

The aim of the present study was to elucidate the systematic topography of the lateral sellar (cavernous sinus [CS]) nerve plexus and its connections in humans.

METHODS

Seven specimens of human CS and adjacent regions were dissected in steps and stained as whole-mount preparations by using a sensitive acetylcholinesterase method. Another specimen was frozen, cut on a frontal plane, and stained for acetylcholinesterase. The human CS contains an extensive nerve plexus with small ganglia. The plexus is composed of a main part, the lateral sellar plexus proper, which is located around the abducent nerve and medial to the ophthalmic nerve, and a lateral extension just underneath the outermost layer of the lateral CS wall, which is located lateral to the trochlear and ophthalmic nerves. The lateral sellar plexus is connected to the internal carotid nerve, the pterygopalatine ganglion, and the trigeminal ganglion. From the lateral sellar plexus, nerve branches run along the oculomotor, trochlear, ophthalmic, and abducent nerves into the orbit. In addition, the lateral sellar plexus has multiple connections with nerves located around the internal carotid artery. The presence of connections between the lateral sellar plexus and functionally defined neural structures suggests that the plexus receives sympathetic, parasympathetic, and sensory contributions.

CONCLUSIONS

The plexus may distribute nerve subpopulations to several targets, including cerebral arteries and orbital structures. The presence of a mixed nerve plexus that projects to a variety of targets indicates that injury or disease in the CS may result in a variety of symptoms.