Relationship between tumor-associated immune infiltrate and p16 staining over clinicopathological features in acral lentiginous melanoma

PURPOSE

This study aims to evaluate the association between composition of tumor-infiltrating lymphocytes (TIL) and expression of p16 in acral lentiginous melanoma (ALM), and their impact on prognosis.

MATERIALS AND METHODS

A cohort of 148 surgical pathology specimens of ALM was studied. TIL were evaluated by immunohistochemical detection of CD3 and CD8, along with CD20, CD4, CD68, and CD163 in a subset of 43 cases. p16 protein expression was also investigated in all the cases.

RESULTS

The median age was 66 years, median Breslow thickness was 6.0 mm, grade III TIL was found in 28.4% and lymph nodes were involved in 54.2%. Breslow thickness (p < 0.001), stage I-II (p < 0.001), negative lymph nodes (p < 0.001) and < 10% p16 (p = 0.01) were associated with longer survival. Grade III of TIL was associated with thinner Breslow thickness (p = 0.008) and lower mitosis (p = 0.047). A higher density of CD3 TIL was associated with male gender (p = 0.008), thinner Breslow thickness (p = 0.047), negative lymph node (p = 0.031), early stage (p = 0.046), and p16 nuclear expression of > 10% (p = 0.045). Higher CD8 TIL was associated with > p16 (p = 0.03). Survival analysis found that longer survival had a trend to be associated with high TIL (p = 0.090). Levels of CD3+ and CD8+ cells were correlated with those of CD4+, CD20+, CD68+ and CD163+ immune cells.

CONCLUSIONS

Higher levels of TIL tend to be associated with better overall survival in ALM. Loss of expression of p16 is associated with lower levels of CD3+ and CD8+ TIL, indicating a probable relationship between p16 and TIL immune response in ALM .

Abstract P2-14-12: Impact of the time interval between neoadjuvant chemotherapy and surgery in Latin-Americans breast cancer patients

Background: Few studies have evaluated the impact of the time interval between neoadjuvant chemotherapy (NAC) and surgery in breast cancer. In Latin America, where the vast majority of hospitals are oversaturated, it is important to define which patients to give priority and to be clear about ideal time or maximum to schedule surgery after NAC without altering the prognosis. The objective of this work is to establish the ideal time interval for post-neoadjuvant surgery and evaluate the impact on patient survival.

Methods: We reviewed the clinical histories of breast cancer with clinical stage II and III who received NAC between 2005 and 2014. Patients were divided into 3 groups according to the time interval to surgery: &lt;4, 4-8 and &gt;8 weeks. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and comparisons of survival curves using the logrank or Breslow test, both globally and by molecular subtypes. The optimal time to surgery has been determined by the Cox model.

Results: During the study period, 583 patients who had post NA surgery before six months were registered. The median age was 49 years (range: 24-85), 82% had clinical stage III, 53% histological grade III, 32.7% were luminal A, 15.6% luminal B, 24.4% Her2 and 27.3% TN. According to the time interval to surgery, 67 (11.5%) patients had surgery before 4 weeks, 204 (35.0%) between 4 to 8 weeks, and 312 (53.5%) after 8 weeks. The groups do not present differences in relation to the clinical characteristics (p&gt; 0.05). The median follow-up time was 4.8 years. The 5-year OS rate according to the time interval was 57.9, 61.5, and 62.7% (p = 0.581) and the RFS rate was 40.6, 52.3, and 51.1% (p = 0.411). No differences were found in the survival curves by molecular subtypes , except for luminal b like . In the multivariate analysis, the effect of the time interval to surgery was not significant in OS and RFS; however, the HR curve suggests that the appropriate cut-off point for surgical time would be 8 weeks.

Table 1:Time Interval :OS - RFS  RFS  OS  MEDIAN5 - yearsPMEDIAN5 - yearsPWeeks for NAC to Surgery      &lt;4 weeks3.240.6 6.157.9 4-8 weeks6.352.3 9.161.5 &gt;8 weeks5.151.10.416.762.70.581       Weeks for NAC to Surgery      &lt;8 weeks549.5 9.160.7 &gt;8 weeks5.151.10.5856.762.70.414

Table 2 :Time Interval - Molecular Subtype  RFS  OS  MEDIAN5 - yearsPMEDIAN5 - yearsPLUMINAL A LIKE      &lt; 8 weeks----74.1 ----84 &gt;8 weeks7.163.80.719.973.90.236       *LUMINAL B LIKE      &lt; 8 weeks2.336.8 5.460.5 &gt;8 weeks5.857.60.46----820.08       HER2      &lt;8 weeks2.228.7 3.938.4 &gt;8weeks3.645.90.57.26.261.30.616       TRIPLE NEGATIVE      &lt;8 weeks3.144.2 3.448.4 &gt;8 weeks2.041.80.9143.743.90.516* ER + PR &gt;20% KI67&gt;14% , HER2 NEGATIVE

Conclusion: The time interval between the end of neoadjuvant period and surgery has no impact on recurrence-free survival or on overall survival, despite this we suggest that the period of time between neoadjuvant and surgery not be greater than 8 weeks. More studies will be required to determine the ideal time interval and which cases should be prioritized according to the characteristics of our patients.

Citation Format: Rebaza LP, Galarreta JA, Castañeda C, Cotrina JM, Vilchez S, de la Cruz M, Ponce J, Aguilar A, Flores C, Castillo M, Galvez M, Vigil C. Impact of the time interval between neoadjuvant chemotherapy and surgery in Latin-Americans breast cancer patients [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 P2-14-12.

Prevalence of BRCA1 and BRCA2 mutations in unselected breast cancer patients from Peru

The prevalence of BRCA1 and BRCA2 mutations among breast cancer patients in Peru has not yet been explored. We enrolled 266 women with breast cancer from a National cancer hospital in Lima, Peru, unselected for age or family history. DNA was screened with a panel of 114 recurrent Hispanic BRCA mutations (HISPANEL). Among the 266 cases, 13 deleterious mutations were identified (11 in BRCA1 and 2 in BRCA2), representing 5% of the total. The average age of breast cancer in the mutation-positive cases was 44 years. BRCA1 185delAG represented 7 of 11 mutations in BRCA1. Other mutations detected in BRCA1 included: two 2080delA, one 943ins10, and one 3878delTA. The BRCA2 3036del4 mutation was seen in two patients. Given the relatively low cost of the HISPANEL test, one should consider offering this test to all Peruvian women with breast or ovarian cancer.

Utilization of antineoplastic therapy (ANT) in advanced cancer patients admitted to an acute palliative care unit (APCU) at a comprehensive cancer center

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Background: Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of ANT (chemotherapy and targeted agents) in these patients is unclear. We examined the frequency, trends, factors and survival associated with ANT use in hospitalized patients who required an APCU stay. Methods: All patients admitted to APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis and ANTs utilization from day of hospitalization to discharge, and survival information were retrieved retrospectively. Results: 2604 cancer patients had the following characteristics: median age 59 (range 18–101), male 51%, hematologic malignancy 11%, median hospital stay 11 (Q1-Q3 8–17) days, median APCU stay 7 (Q1-Q3 4–10) days and median survival 22 days. During hospitalization, 393 patients (15%) received ANTs, including chemotherapy (N=297, 11%) and targeted therapy (N=155, 6%). No significant change in frequency of ANTs was detected over the 5 year period. Multivariate logistic regression analysis ( Table ) revealed that younger age, cancer primaries and longer admissions were associated with ANT use. Patients with hematologic malignancies received more chemotherapy (38% vs. 8%, p<0.001) and targeted agents (18% vs. 4%, p<0.001) compared to patients with solid tumors. ANT use was associated with longer overall survival in univariate analysis (median 25 days vs. 21 days, p=0.001); however, this was no longer significant in multivariate Cox regression analysis. Conclusions: The use of ANT during hospitalization that included an APCU stay was limited to a highly selected group of patients, and did not increase overtime. ANT use was associated with younger age, specific cancer primaries, longer admissions, and no significant improvement in survival. The APCU at our cancer center facilitates simultaneous care where patients access palliative care while on ANT. [Table: see text]

No significant financial relationships to disclose.

Placebo and nocebo effects in randomized double-blind clinical trials for fatigue in advanced cancer patients

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Background: We have previously reported significant placebo response in randomized controlled treatment trials for cancer related fatigue (CRF). We conducted a retrospective study to determine the frequency and predictors of response to placebo and nocebo effect in patients with CRF. Methods: We reviewed patients that received placebo in two previous randomized clinical trials conducted by our group and determined the proportion of patients who demonstrated clinical response to fatigue using an increase (ΔFACIT-F score) > 7 from baseline to day 8, and those with nocebo response as those who reported side effects. Baseline patient characteristics and symptoms recorded from the Edmonton Symptom Assessment Scale (ESAS) were analyzed to determine their association with placebo and nocebo effects. Results: A total of 105 advanced cancer patients received placebo. 59 (56%) patients responded to placebo (median Δ FACIT-F score of 22). Worse baseline anxiety and well-being subscale score (univariate) and well-being (multivariate, MR) were significantly associated with placebo response. Common side effects reported were insomnia (79%), anorexia (53%), nausea (38%) and restlessness (34%). MR analysis showed that worse baseline (ESAS) sleep, appetite, nausea, and restless are associated with increased reporting of these side effects ( Table ). Conclusions: Nearly half of advanced cancer patients enrolled in the fatigue trials responded to placebo. Worse physical well-being score was associated with placebo response. Patients experiencing specific symptoms at baseline were more likely to report these as side effects of the medication. These findings should be considered in fatigue clinical trial design. [Table: see text]

No significant financial relationships to disclose.

The discovery of moriniafungin, a novel sordarin derivative produced by Morinia pestalozzioides

A novel sordarin derivative, moriniafungin (1), containing a 2-hydroxysebacic acid residue linked to C-3' of the sordarose residue of sordarin through a 1,3-dioxolan-4-one ring was isolated from the fungus Morinia pestalozzioides. Isolation of moriniafungin employed a highly specific bioassay consisting of a panel of Saccharomyces cerevisiae strains containing chimeric eEF2 for Candida glabrata, Candida krusei, Candida lusitaniae, Crytpococcus neoformans, and Aspergillus fumigatus as well as wild type and human eEF2. Moriniafungin exhibited an MIC of 6 microg/mL versus Candida albicans and IC(50)'s ranging from 0.9 to 70 microg/mL against a panel of clinically relevant Candida strains. Moriniafungin was shown to inhibit in vitro translation in the chimeric S. cerevisae strains at levels consistent with the observed IC(50). Moriniafungin has the broadest antifungal spectrum and most potent activity of any natural sordarin analog identified to date.

Carbamazepine-induced sensorineural hearing loss

Carbamazepine is a commonly prescribed anticonvulsant medication that affects various levels of the nervous system. We report a case of temporary sensorineural hearing loss in a patient after overdosing with 36 g of carbamazepine. Six days after the overdose, the patient complained of bilateral hearing loss and tinnitus. Audiograms revealed a 30- to 40-dB sensorineural hearing loss bilaterally. Another audiogram 2 weeks later showed a complete recovery in both ears accompanied by a clinical resolution in audiovestibular symptoms. Carbamazepine is used to treat partial and generalized seizures, trigeminal neuralgia, and bipolar illness. Adverse effects are not common but most frequently include dizziness, drowziness, nausea, and skin rashes; rare complications are agranulocytosis, bradycardia, and heart block. Documented hearing loss as a side effect of carbamazepine has not been reported, to our knowledge.

Bilateral sudden sensorineural hearing loss following non-otologic surgery

Hearing loss as a complication of non-otological surgery is rare. The majority of described cases have followed cardiac bypass surgery. To date there have been only 25 reported cases of non-otological surgery associated hearing loss (NOSAHL) which have not involved cardiopulmonary bypass. Only two cases of bilateral NOSAHL have been previously described, and neither resulted in permanent severe bilateral hearing deficit. We describe a case of permanent bilateral severe hearing loss following metatarsal pinning in a patient with pre-existing non-operated otosclerosis.

Intramedullary dermoid of the cervical spinal cord in a child

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