Prevalence and prognosis of PIK3CA mutations in Bulgarian patients with metastatic breast cancer receiving endocrine therapy in first-line setting

BACKGROUND AND AIMS

In approximately 40% of patients with HER2-negative/HR-positive breast cancer tumors, the PIK3CA gene is mutated. Despite this, clinical outcomes vary between studies in this cohort. We aimed to ascertain the prevalence of PIK3CA mutations in patients with metastatic HR+/HER2- breast in Bulgaria, as well the evaluation and comparison of progression free survival (PFS) between wild-type (WT) and mutation-positive groups in the real-world setting.

METHODS

Three oncology centers in Bulgaria collected 250 tissue samples between 2016 and 2022 for this multicentric retrospective study. PIK3CA mutations were identified using Real-Time qPCR. The median follow-up period was 35 months.

RESULTS

The mean age of the mutant cohort was 57.6 ± 11.6 years, compared to 56.5 ± 12.2 years for the WT cohort (p = .52). The percentage of patients with visceral metastasis was 58.8% (n = 147). Approximately 84.3% (n = 210) of the patients had reached postmenopause. 29.2% (n = 73) of the patients had PIK3CA mutations. The predominant mutation was present in exon 20, H1047R (46.5%). We found a significant correlation only between the presence of a mutation and the metastatic diseases at diagnosis (p = .002). As first-line therapy, 67.1% of patients received endocrine therapy (ET) plus cyclin dependent kinase (CDK4/6) inhibitor, while the remainder received ET alone. The median PFS of patients in the group with the mutation was 32 months (95%, CI: 22-40) compared to 24 months in the WT cohort ((95%, CI: 21-36) (p = .45)); HR = 0.86 (95%, CI: 0.5-1.3) (p = .46). We corroborated our conclusion using propensity matching score analysis, (36 months [95% CI: 20-40] vs. 26 months [95% CI: 21-38], [p = .69]).

CONCLUSIONS

We found that the prevalence of PIK3CA mutations in our patients was comparable to what has been reported in other nations. Our results suggest that PIK3CA mutational status has no bearing to ET efficacy in first-line setting.

AB0636 ASYMPTOMATIC HYPERURICEMIA IN INFLAMMATORY RHEUMATIC DISEASES

Background:

Uric acid (UA) is well-known biomarker of cardiovascular risk and inflammation. However, the data about interrelations between asymptomatic hyperuricemia (AHU) and rheumatic diseases (RD) are limited and contradictory [1].

Objectives:

to identify the occurrence of AHU in pts with different RD and to evaluate the interrelations between the AHU and clinical features of the RD.

Methods:

The study included data from 822 pts with AHU and RD involved in the Saint-Petersburg Register of Pts with AHU in period from the 01jan2000 to the 01apr2020. The AHU was defined as the serum level of uric acid (UA) that exceeded 360 μmol/l without signs of gouty arthritis. Pts with the secondary reasons of AHU (an oncologic diseases, late stages of chronic kidney disease, ets), and inflammatory diseases another than RD were excluded from the study.

Patient’s demographical characteristics, duration of AHU, level of UA, activity of RD, ESR, CRP, urate-lowering therapy (ULT) were analyzed. The study was approved by local ethic committee. Statistics was performed with SPSS17.

Results:

Characteristics of the Patients with the RD and AHU are present in Table 1. The duration of AHU in pts with the RD was 3.4±3.4 [0.08-18] years, mean duration of follow-up 2.7±4.0 years, mean number of visits during the period of follow-up was 3,2 [min 1; max 7], ESR 26.0±14.1 mm / h, CRP 19.6±21.0 mg/l.

Table 1.

Characteristics of the Patients with the Rheumatic diseases and asymptomatic hyperuricemia.

Age, years(Mean±SD)Male, %**Serum UA, μmol/l(Mean±SD)Normalization of UA during the follow-up, n (%)RD, n=82256.7±14.540.27493.3±98.5242 (29.44) ##RA, n=32964.2±12.13.74504.8±107.5#99 (30.09) ##PsA, n= 14956.6±12.953.69531.5±94.9#32 (21.48) ##SpA, n= 10745.6±15.1*33.43520.8±86.5#18 (16.82)##SLE, n=13750.3±14.1*20.44451.6±91.457 (41.61)SSc, n= 5761.0±12.422.81456.2±99.520 (35.09)SD, n= 4362.0±10.716.28442.4±107.516 (37.21)

RD – rheumatic disease; RA –– rheumatoid arthritis; PsA –– psoriatic arthritis; SpA –– spondyloarthritis; SLE –– systemic lupus erythematosus; SSc –– systemic sclerosis; SD –– Sjogren’s disease; * –– p<0.001 for the differences with RD, RA, PsA, SSc, SD; ** –– p < 0.01 for all intergroup differences; # –– p < 0.01 for the differences with RD, RA, SSc, SD; ##–– p < 0.01 for the differences with RA, SSc, SD.

Were revealed the interrelations between the level of UA and ESR (Spearmen’s R=0.1, p=0.01), and UA and CRP (Spearmen’s R =0.12, p=0.001).

The level of UA in male pts was 507.0 [361-940], in female pts 450.0 [361-1010] μmol /l (p<0.0001), in SLE pts with elevated anti-nuclear factor (ANF) UA was 429 [361-940] and with normal 494 [361-973] (p<0.0001). In pts with high and low RD activity UA was 490 [361-940] and 454 [363-1010]) μmol /l respectively, (p<0.0001). The higher UA level was found in any RD as compared with UA in low activity of the same RD (p<0.0001 for all the differences).

Normalization of UA was found in 243 (29.6 %) pts, lack of normalization of UA in 434 (52.8 %) of cases, n = 677, Table 1. ULT received 219 (26.6 %) pts. Normalization of UA without ULT was registered in 16 (1.9 %) of the pts.

Conclusion:

UA level is higher and normalize less often in patients with SpA and PsA as compered with RA, SLA, SSc and SD pts. In any of analyzed rheumatic diseases the level of UA is higher in male pts and in pts with high disease activity.

References:

[1]K.Bosmansky, M. Ondrasik. Ter Arkh.1987;59(4):22-5.

Disclosure of Interests:

None declared.

Drug usage analysis in pregnant women

BACKGROUND

Drug usage in pregnant women is associated with a problem of possible negative influence on prenatal development. It is always necessary to judge the need for drug administration during pregnancy.

OBJECTIVE

The aim of presented study was to analyse data about pregnant women hospitalized in the postpartum period.

METHODS

The study was designed as a retrospective observational study including 300 women hospitalized at the 2nd Department of Gynaecology and Obstetrics, University Hospital, Bratislava. Data were obtained through questionnaires in form of an interview.

RESULTS

The average age of women was 30.79 ± 4.40 years. Risk pregnancy occured in 20.59 % of women. Chronic disorders before pregnancy required regular pharmacotherapy in 29.24 %. Drug usage analysis: I. trimester, 31 % used at least one drug, 52 % nutritional supplements, 63.3 % drug and/or nutritional supplement; II. trimester, 23 % used at least one drug, 45 % nutritional supplements, 58.3 % drug and/or nutritional supplement; III. trimester, 32 % used at least one drug, 67 % nutritional supplements, 75.3 % drug and/or nutritional supplement.

CONCLUSION

Drug usage during pregnancy requires great precaution at choosing pharmacotherapy. The benefit of pharmacotherapy should always outweight the potential risk of administered drug (Tab. 3, Fig. 3, Ref. 37).

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Correction to 'Intramolecular hydrogen bonds in 1,4-dihydropyridine derivatives'

[This corrects the article DOI: 10.1098/rsos.180088.].

Intramolecular hydrogen bonds in 1,4-dihydropyridine derivatives

1,4-Dihydropyridine (1,4-DHP) derivatives have been synthesized and characterized by 1H, 13C, 15N nuclear magnetic resonance (NMR) spectroscopy, secondary proton/deuterium 13C isotope shifts, variable temperature 1H NMR experiments and quantum-chemical calculation. The intramolecular hydrogen bonds NH⋯O=C and CH⋯O=C in these compounds were established by NMR and quantum-chemical studies The downfield shift of the NH proton, accompanied by the upfield shift of the 15N nuclear magnetic resonance signals, the shift to the higher wavenumbers of the NH stretching vibration in the infrared spectra and the increase of the 1J(15N,1H) values may indicate the shortening of the N-H bond length upon intramolecular NH⋯O=C hydrogen bond formation.

Professional burnout in European young oncologists: results of the European Society for Medical Oncology (ESMO) Young Oncologists Committee Burnout Survey

Background

Burnout in health care professionals could have serious negative consequences on quality of patient care, professional satisfaction and personal life. Our aim was to investigate the burnout prevalence, work and lifestyle factors potentially affecting burnout amongst European oncologists ≤40 (YOs).

Methods

A survey was conducted using the validated Maslach Burnout Inventory (MBI) and additional questions exploring work/lifestyle factors. Statistical analyses were carried out to identify factors associated with burnout.

Results

Total of 737 surveys (all ages) were collected from 41 European countries. Countries were divided into six regions. Results from 595 (81%) YOs were included (81% medical oncologists; 52% trainees, 62% women). Seventy-one percent of YOs showed evidence of burnout (burnout subdomains: depersonalization 50%; emotional exhaustion 45; low accomplishment 35%). Twenty-two percent requested support for burnout during training and 74% reported no hospital access to support services. Burnout rates were significantly different across Europe (P < 0.0001). Burnout was highest in central European (84%) and lowest in Northern Europe (52%). Depersonalization scores were higher in men compared with women (60% versus 45% P = 0.0001) and low accomplishment was highest in the 26-30 age group (P < 0.01). In multivariable linear regression analyses, European region, work/life balance, access to support services, living alone and inadequate vacation time remained independent burnout factors (P < 0.05).

Conclusions

This is the largest burnout survey in European Young Oncologists. Burnout is common amongst YOs and rates vary across Europe. Achieving a good work/life balance, access to support services and adequate vacation time may reduce burnout levels. Raising awareness, support and interventional research are needed.

Study of interactions of mononucleotides with 1,4-dihydropyridine vesicles using NMR and ITC techniques

The possible binding site of mononucleotides is the phosphate group with important hydrophobic interactions between the mononucleotides and the alkyl chains of DHP derivatives.

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

PURPOSE

Clinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.

METHODS

In our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT-CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data-driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.

RESULTS

Successful angiographic reperfusion (OR 26.50; 95%-CI 9.33-83.61) and good collaterals (OR 9.69; 95%-CI 2.28-59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%-CI 0.14-0.85), younger age (OR 0.88; 95%-CI 0.83-0.92) and higher NCCT ASPECTS (OR 2.54; 95%-CI 1.01-6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.

CONCLUSIONS

CTA-collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA-collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA-collaterals.

Tunable nanoporous silicon oxide templates by swift heavy ion tracks technology

Nanoporous silicon oxide templates formed by swift heavy ion tracks technology have been investigated. The influence of the heavy ion characteristics, such as type of ion, energy, stopping power and irradiation fluence on the pore properties of the silicon oxide templates, has been studied. Furthermore, the process of pore formation by chemical etching with hydrofluoric acid has been thoroughly investigated by assessing the effect of etchant concentration and etching time. The outcome of this investigation enables us to have precise control over the resulting geometry of nanopores arrays. As a result, guidelines for the creation of a-SiO2/Si templates with tunable parameters and general recommendations for their further application are presented.

Abstract W P18: Evaluating Clot Burden and the Vascular Basis of Pial Collaterals with a Bimodal Angiographic Score

Treatment decision for endovascular recanalization in acute ischemic stroke is based on validated outcome predictors such as age, initial infarct size, collaterals and clot burden. The CTA-based Clot Burden Score (CBS) only considers occlusions of the A1-segment of the anterior cerebral artery (ACA), but patency of the ipsilateral A2-segment is mandatory for collateral formation in a typical middle cerebral artery (MCA) occlusion. Secondly, CTA often cannot differentiate between an extra- or intra-cranial internal carotid artery (ICA) occlusion due to non-contrasting of the whole ICA in both. Thirdly, a 4-vessel angiogram, necessary to grasp the vascular basis of all pial collaterals, is often not done during acute recanalization therapy for reasons of time. To bypass these inadequacies, we propose a combined CTA/DSA score (ALITA) to assess pre-therapeutic thrombus load. We hypothesized a good outcome prediction of this score. We evaluated the ALITA score in a retrospective study including consecutive patients of the years 2010-12, who received endovascular therapy for acute stroke in the ICA-territory. Final outcome was measured with the modified Rankin Scale score (mRS) at 90 days. Reperfusion (mTICI), collaterals (CT-CS), clot burden (CBS), and the ALITA score were independently assessed. ALITA evaluates patency of the ACA and MCA in CTA and of the ICA in DSA. Data-driven ordinal regression analysis modeled outcome prediction of all scores. Of 99 patients 60% had a good reperfusion (mTICI 2b/3) and 29% had a good outcome (mRS 0-2), mortality was 23%. Age and reperfusion were independent predictors of good outcome (p<.001). CT-CS (p<.01), CBS (p<.01) and ALITA (p<.05) were significant predictors, but showed interaction regarding outcome. In the considered model CBS was a stronger predictor than ALITA. Although ALITA assesses all vessels of the anterior circulation contributing to collaterals the score was statistically different from CT-CS. This is consistent with results that describe pial collaterals as genetically determined. In conclusion, the combined CTA/DSA clot burden score better depicts the vascular basis of pial collaterals and predicts outcome in acute stroke patients.

A national facilitation project to improve primary palliative care: impact of the Gold Standards Framework on process and self-ratings of quality

BACKGROUND

Improving quality of end-of-life care is a key driver of UK policy. The Gold Standards Framework (GSF) for Palliative Care aims to strengthen primary palliative care through facilitating implementation of systematic clinical and organisational processes.

OBJECTIVES

To describe the general practices that participated in the GSF programme in 2003-5 and the changes in process and perception of quality that occurred in the year following entry into the programme, and to identify factors associated with the extent of change.

METHODS

Participating practices completed a questionnaire at baseline and another approximately 12 months later. Data were derived from categorical questions about the implementation of 35 organisational and clinical processes, and self-rated assessments of quality, associated with palliative care provision.

PARTICIPANTS

1305 practices (total registered population almost 10 million). Follow-up questionnaire completed by 955 (73.2%) practices (after mean (SD) 12.8 (2.8) months; median 13 months).

FINDINGS

Mean increase in total number of processes implemented (maximum = 35) was 9.6 (95% CI 9.0 to 10.2; p<0.001; baseline: 15.7 (SD 6.4), follow-up: 25.2 (SD 5.2)). Extent of change was largest for practices with low baseline scores. Aspects of process related to coordination and communication showed the greatest change. All dimensions of quality improved following GSF implementation; change was highest for the "quality of palliative care for cancer patients" and "confidence in assessing, recording and addressing the physical and psychosocial areas of patient care".

CONCLUSION

Implementation of the GSF seems to have resulted in substantial improvements in process and quality of palliative care. Further research is required of the extent to which this has enhanced care (physical, practical and psychological outcomes) for patients and carers.