Unveiling the Cation Exchange Reaction between the NASICON Li1.5Al0.5Ge1.5(PO4)3 Solid Electrolyte and the pyr13TFSI Ionic Liquid

Recently, the formation of the ceramic-ionic liquid composite has attracted huge interest in the scientific community. In this work, we investigated the chemical reactions occurring between NASICON LAGP ceramic electrolyte and ionic liquid pyr13TFSI. This study allowed us to identify the cation exchange reaction pyr13-Li occurring on the LAGP surface, forming a LiTFSI salt that was detected by the nuclear magnetic resonance analysis. In addition, using ⁶Li foils, we succeeded in demonstrating that both LAGP and LiTFSI:pyr13TFSI participate in the diffusion of Li ions by the formation of an ionic bridge between two species.

Improved tolerability of neratinib in patients with HER2-positive early-stage breast cancer: the CONTROL trial

BACKGROUND

Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for extended adjuvant treatment in early-stage HER2-positive breast cancer based on the phase III ExteNET study. In that trial, in which no antidiarrheal prophylaxis was mandated, grade 3 diarrhea was observed in 40% of patients and 17% discontinued due to diarrhea. The international, open-label, sequential-cohort, phase II CONTROL study is investigating several strategies to improve tolerability.

PATIENTS AND METHODS

Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year plus loperamide prophylaxis (days 1-28 or 1-56). Sequential cohorts evaluated additional budesonide or colestipol prophylaxis (days 1-28) and neratinib dose escalation (DE; ongoing). The primary end point was the incidence of grade ≥3 diarrhea.

RESULTS

Final data for loperamide (L; n = 137), budesonide + loperamide (BL; n = 64), colestipol + loperamide (CL; n = 136), and colestipol + as-needed loperamide (CL-PRN; n = 104) cohorts, and interim data for DE (n = 60; completed ≥six cycles or discontinued; median duration 11 months) are available. No grade 4 diarrhea was observed. Grade 3 diarrhea rates were lower than ExteNET in all cohorts and lowest in DE (L 31%, BL 28%, CL 21%, CL-PRN 32%, DE 15%). Median number of grade 3 diarrhea episodes was one; median duration per grade 3 episode was 1.0-2.0 days across cohorts. Most grade 3 diarrhea and diarrhea-related discontinuations occurred in month 1. Diarrhea-related discontinuations were lowest in DE (L 20%, BL 8%, CL 4%, CL-PRN 8%, DE 3%). Decreases in health-related quality of life did not cross the clinically important threshold.

CONCLUSIONS

Neratinib tolerability was improved with preemptive prophylaxis or DE, which reduced the rate, severity, and duration of neratinib-associated grade ≥3 diarrhea compared with ExteNET. Lower diarrhea-related treatment discontinuations in multiple cohorts indicate that proactive management can allow patients to stay on neratinib for the recommended time period. CLINICALTRIALS.GOV: NCT02400476.

Perceptual Training and Figure-Ground Performance in Low Vision

This study examined the utility of perceptual training with specific emphasis on figure-ground discrimination. Study participants had low vision which was caused by age-related macular degeneration. The authors studied the relative effectiveness of in-clinic and at-home training in comparison with a no-training condition. The results supported the hypothesis that perceptual skills, such as figure-ground discrimination, can be improved by practice and instruction. The need for task-specific training is also discussed.

Boosting Ultra-Fast Charge Battery Performance: Filling Porous nanoLi4Ti5O12 Particles with 3D Network of N-doped Carbons

Lithium titanium oxide (Li₄Ti₅O₁₂)-based cells are a promising technology for ultra-fast charge-discharge and long life-cycle batteries. However, the surface reactivity of Li₄Ti₅O₁₂ and lack of electronic conductivity still remains problematic. One of the approaches toward mitigating these problems is the use of carbon-coated particles. In this study, we report the development of an economical, eco-friendly, and scalable method of making a homogenous 3D network coating of N-doped carbons. Our method makes it possible, for the first time, to fill the pores of secondary particles with carbons; we reveal that it is possible to cover each primary nanoparticle. This unique approach permits the creation of lithium-ion batteries with outstanding performances during ultra-fast charging (4C and 10C), and demonstrates an excellent ability to inhibit the degradation of cells over time at 1C and 45 °C. Furthermore, using this method, we can eliminate the addition of conductive carbons during electrode preparation, and significantly increase the energy density (by weight) of the anode.

Cost-utility analysis of 21-gene assay for node-positive early breast cancer

Background

For women with lymph node (ln)-positive, estrogen receptor-positive, and her2 (human epidermal growth factor receptor 2)-negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1-3 positive lns and a lower risk of recurrence. In the present study, we performed a cost-utility analysis comparing use of the 21-gene rs assay with current practice from the perspective of a Canadian health care payer.

Methods

A Markov model was developed to determine costs and quality-adjusted life-years (qalys) over a patient's lifetime. Patient outcomes in both study groups were examined based on published clinical trials. Costs were derived primarily from published Canadian sources. Costs and outcomes were discounted at 1.5% annually, and costs are reported in 2016 Canadian dollars. A probabilistic analysis was used, and the model parameters were varied in a sensitivity analysis.

Results

The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice. The probabilistic analysis revealed that 70% of the 10,000 simulated incremental cost-effectiveness ratios were in the southeast quadrant. The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice.

Conclusions

Use of the 21-gene rs assay could be a cost-effective strategy for Ontario patients with estrogen receptor-positive, her2-negative early bca and 1-3 positive lns.

Abstract P2-13-03: The impact of neratinib with or without anti-diarrheal prophylaxis on health-related quality of life in HER2+ early-stage breast cancer: Analyses from the ExteNET and CONTROL trials

Background: Neratinib is an irreversible pan-HER tyrosine kinase inhibitor. ExteNET, a randomized placebo-controlled phase III study, showed that neratinib given for 12 months after trastuzumab-based adjuvant therapy significantly improved 2-year (HR 0.67; 95% CI 0.50–0.91; p=0.0091) and 5-year (HR 0.73; 95% CI 0.57-0.92; p=0.008) iDFS in pts with early-stage HER2+ breast cancer. Anti-diarrheal prophylaxis was not mandated by protocol; grade 3/4 diarrhea occurred in 40% of pts with a median cumulative duration of 5 days. The phase II CONTROL study was initiated to investigate the effectiveness of various prophylactic regimens in the prevention of neratinib-associated diarrhea. Loperamide (L) alone or in combination with add-on agents targeting underlying inflammation [i.e. budesonide (BUD)] or bile acid malabsorption [i.e. colestipol (COL)] were tested. We report longitudinal HRQoL findings from both ExteNET and CONTROL.

Methods: Pts with early-stage HER2+ breast cancer who had received trastuzumab-based adjuvant therapy were eligible for both studies. In ExteNET, pts received neratinib or placebo for 12 months. In CONTROL, pts received neratinib for 13 x 28-day cycles combined with L, L + BUD or L + COL for 1 or 2 cycles (see table for schedules). HRQoL was assessed using Functional Assessment of Cancer Therapy–Breast (FACT-B), v4.0, at baseline, months 1, 3, 6, 9, 12 (ExteNET) or baseline, cycles 2, 4, 7, 10, 13 (CONTROL). Changes in scores from baseline were considered to be clinically meaningful if greater than the lowest estimate for an 'important difference' (ID) reported in the literature. Evaluable pts were required to have HRQoL assessments at baseline and at least 1 post-baseline. ClinicalTrials.gov: NCT00878709 (ExteNET); NCT02400476 (CONTROL).

Results: HRQoL findings are summarized in the table. Hospitalization rates due to diarrhea: 1.5% (neratinib + L), 0% (other cohorts) in CONTROL; and 1.4% (neratinib), 0.1% (placebo) in ExteNET.

  Mean change from baselineStudyCohort/GroupM1M3M6M9M12 FACT-B TOTAL (ID range: 7–8 points)CONTROLN + La,b (N=40)–3.8–4.5–1.5–2.5–3.3 N + L + BUDa,b,c (N=62)–6.0–4.9–1.6–3.6–4.5 N + L + COLa,b,d (N=125)–3.8–2.0–4.0–4.6–3.6 N + L prn + COLa,d (N=85)–1.8–1.54.0e––ExteNETN + L prna (N=1124)–4.6–3.4–3.5–3.3–3.7 P (N=1188)–1.7–3.5–2.9–2.9–2.8 FACT-B PWB (ID range: 2–3 points)CONTROLN + La,b (N=40)–4.0–2.3–1.9–2.4–2.3 N + L + BUDa,b,c (N=62)–3.2–2.1–1.4–1.7–1.7 N + L + COLa,b,d (N=125)–2.8–2.0–2.4–2.5–2.4 N + L prn + COLa,d (N=85)–2.8–1.80.0e––ExteNETN + L prna (N=1124)–2.9–1.9–1.7–1.6–1.5 P (N=1188)–0.6–0.8–0.7–0.6–0.4C, cycle; L, loperamide; M, month; N, neratinib; prn, as needed; PWB, physical well-being. CONTROL cut-off: 1 May 2018. aN 240 mg qd for 13 x 28d cycles or 12 months; bL 4 mg, then 4 mg tid d1-14, then 4 mg bid d15-28 or d15-56, then prn; cBUD 9 mg qd d1-28; dCOL 2 g qd d1-28; en=1.

Conclusions: Adjuvant neratinib with or without anti-diarrheal prophylaxis was associated with small decreases in HRQoL. With the exception of the FACT-B PWB subscale, HRQoL changes did not reach clinically meaningful thresholds. Follow-up in CONTROL is ongoing.

Citation Format: Delaloge S, Hurvitz S, Chan N, Bose R, Jankowitz RC, Thirlwell M, Láng I, ten Tije A, Trudeau M, Osborne CR, Shen Z-Z, Lalla D, Xu F, Hunt D, Olek E, Tripathy D, Rugo HS, Chien J, Chan A, Barcenas CH. The impact of neratinib with or without anti-diarrheal prophylaxis on health-related quality of life in HER2+ early-stage breast cancer: Analyses from the ExteNET and CONTROL trials [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 P2-13-03.

New Avenue for Limiting Degradation in NanoLi4Ti5O12 for Ultrafast-Charge Lithium-Ion Batteries: Hybrid Polymer-Inorganic Particles

Lithium titanium oxide (Li₄Ti₅O₁₂)-based cells are a very promising battery technology for ultrafast-charge-discharge and long-cycle-life batteries. However, the surface reactivity of lithium titanium oxide in the presence of organic electrolytes continues to be a problem that may cause expansion of pouch cells. In this study, we report on the development of a simple and economical grafting method for forming hybrid polymer-Li₄Ti₁₅O₁₂ nanoparticles, which can be successfully applied in lithium-ion batteries. This method utilizes a low-cost and scalable hydrophobic polymer that is applicable in industrial processes. The hybrid materials demonstrated exceptional capability for preventing the degradation of cells in accelerated aging and operating over 150 cycles at 1C and 45 °C.

Clinical utility of multigene profiling assays in early-stage breast cancer

BACKGROUND

This clinical practice guideline was developed to determine the level of evidence supporting the clinical utility of commercially available multigene profiling assays and to provide guidance about whether certain breast cancer patient populations in Ontario would benefit from alternative tests in addition to Oncotype dx (Genomic Health, Redwood City, CA, U.S.A.).

METHODS

A systematic electronic Ovid search of the medline and embase databases sought out systematic reviews and primary literature. A systematic review and practice guideline was written by a working group and was then reviewed and approved by Cancer Care Ontario's Molecular Oncology Advisory Committee.

RESULTS

Twenty-four studies assessing the clinical utility of Oncotype dx, Prosigna (NanoString Technologies, Seattle, WA, U.S.A.), EndoPredict (Myriad Genetics, Salt Lake City, U.S.A.), and MammaPrint (Agendia, Irvine, CA, U.S.A.) were included in the evidence base.

CONCLUSIONS

The clinical utility of multigene profiling assays is currently established for an appropriate subset of patients with estrogen receptor-positive, her2-negative, node-negative breast cancer for whom a decision to give chemotherapy is difficult to make. For patients with estrogen receptor-positive tumours who receive tamoxifen alone, Oncotype dx, Prosigna, and EndoPredict validly identify a low-risk population with favourable outcomes, indicating that a low-risk assay result is actionable and the decision to withhold chemotherapy is supported. Clinical evidence indicates that a high Oncotype dx recurrence score can predict for chemotherapy benefit, but a high Prosigna or EndoPredict score, although prognostic, is not, based on clinical trial evidence, directly actionable. Prosigna and EndoPredict are statistically more likely to identify a population at risk for recurrence beyond 5 years, but that information is currently not actionable because of a lack of interventional studies.

Trends in the use of laboratory tests for the diagnosis of Clostridium difficile infection and association with incidence rates in Quebec, Canada, 2010-2014

BACKGROUND

Several Clostridium difficile infection (CDI) surveillance programs do not specify laboratory strategies to use. We investigated the evolution in testing strategies used across Quebec, Canada, and its association with incidence rates.

METHODS

Cross-sectional study of 95 hospitals by surveys conducted in 2010 and in 2013-2014. The association between testing strategies and institutional CDI incidence rates was analyzed via multivariate Poisson regressions.

RESULTS

The most common assays in 2014 were toxin A/B enzyme immunoassays (EIAs) (61 institutions, 64%), glutamate dehydrogenase (GDH) EIAs (51 institutions, 53.7%), and nucleic acid amplification tests (NAATs) (34 institutions, 35.8%). The most frequent algorithm was a single-step NAAT (20 institutions, 21%). Between 2010 and 2014, 35 institutions (37%) modified their algorithm. Institutions detecting toxigenic C difficile instead of C difficile toxin increased from 14 to 37 (P < .001). Institutions detecting toxigenic C difficile had higher CDI rates (7.9 vs 6.6 per 10,000 patient days; P = .01). Institutions using single-step NAATs, GDH plus toxigenic cultures, and GDH plus cytotoxicity assays had higher CDI rates than those using an EIA-based algorithm (P < .05).

CONCLUSIONS

Laboratory detection of CDI has changed since 2010. There is an association between diagnostic algorithms and CDI incidence. Mitigation strategies are warranted.

Clinician participation in CADTH's pan-Canadian Oncology Drug Review: contribution and impact on cancer drug funding recommendations

In any given week, media headlines publicize the benefits of a new “breakthrough” cancer drug, with patients and clinicians subsequently advocating for its use. [...]

Meeting the Needs of the Aging Population: The Canadian Network on Aging and Cancer—Report on the First Network Meeting, 27 April 2016

The aging of the Canadian population represents the major risk factor for a projected increase in cancer incidence in the coming decades. However, the evidence base to guide management of older adults with cancer remains extremely limited. It is thus imperative that we develop a national research agenda and establish a national collaborative network to devise joint studies that will help to accelerate the development of high-quality research, education, and clinical care and thus better address the needs of older Canadians with cancer. To begin this process, the inaugural meeting of the Canadian Network on Aging and Cancer was held in Toronto, 27 April 2016. The meeting was attended by 51 invited researchers and clinicians from across Canada, as well as by international leaders in geriatric oncology from the United States and France. The objectives of the meeting were to (1) review the present landscape of education, clinical care, and research in the area of cancer and aging in Canada; (2) identify issues of high research priority in Canada within the field of cancer and aging; (3) identify current barriers to geriatric oncology research in Canada and develop potential solutions; (4) develop a Canadian collaborative multidisciplinary research network between investigators to improve health outcomes for older adults with cancer; (5) learn from successful international efforts to stimulate the geriatric oncology research agenda in Canada. In the present report, we describe the education, clinical care, and research priorities that were identified at the meeting.

Abstract P6-09-39: The role of quantitative estrogen receptor status in predicting breast tumor response to neoadjuvant chemotherapy

Introduction:

Patients with Estrogen Receptor negative breast cancer (BC) are known to have higher tumor response rates than ER positive patients when treated with neoadjuvant chemotherapy (NCT). Few studies have assessed ER status as a quantitative continuous measure in predicting tumor response in this setting.

We aimed to study the association between quantitative ER status and tumor response at surgery in BC patients treated with NCT at our institution, and identify potential predictors of better survival outcomes.

Methods:

A retrospective review using a neoadjuvant BC database (The "Sunnybrook Biomatrix") identified 304 eligible patients that were included in the analyses. A univariate followed by a multivariable logistic regression analyses were conducted to assess the association between quantitative ER (expressed in percentage) and tumor response (good vs. poor response defined as &lt; vs. ≥ 50% reduction in tumor size) while controlling for potential confounders.

For the secondary outcome, the Kaplan Meier method was used to estimate the recurrence free survival (RFS) in this cohort. Predictors of RFS were identified using a cox proportional hazards model (CPH) to adjust for clinically relevant variables. A log-rank test was used to compare RFS between groups for any significant binary predictor.

Results:

The median follow up of all patients was 43.3 months (Q1-Q3: 28.7-61.1). Quantitative ER was inversely associated with tumor response in a multivariable logistic regression model (Odds Ratio 0.99 95%CI: 0.99-1.00, p=0.027). A cut-off of 60% seemed to best predict the association based on the c-statistic (c=0.67) and the receiver operating characteristic curve.

However, quantitative ER was not associated with RFS; pathologic complete response (pCR) was shown to be an independent predictor of RFS in a CPH model (Hazard Ratio: 0.17, 95% CI: 0.07, 0.43, p=0.0002) in all patients, after controlling for potential confounders. At 5 years, 93% of patients with pCR and 72% of patients with residual tumor (no pCR) were recurrent-free respectively (log-rank test p=0.0012).

Conclusion:

This study suggests that BC patients with ER status &lt; 60% are more likely to respond to NCT. Although ER status itself did not predict for relapse-free survival, patients with a pCR had better RFS, and this association was seen amongst all tumor phenotypes.

The role of quantitative ER in predicting and maximizing tumour response to NCT (including optimizing pCR rate) needs to be better defined in prospective studies.

Key words: Estrogen receptors, breast cancer, quantitative, tumor response, pathologic complete response.

Citation Format: Raphael J, Trudeau M, Paramsothy T, Lee N, Gandhi S. The role of quantitative estrogen receptor status in predicting breast tumor response to neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-39.

Abstract P2-08-01: Results from a randomized placebo-controlled phase 2 trial evaluating exemestane ± enzalutamide in patients with hormone receptor–positive breast cancer

This abstract was withdrawn by the authors.

Abstract P4-22-08: A single-arm phase 2 study to assess clinical activity, efficacy and safety of enzalutamide with trastuzumab in HER2+ AR+ metastatic or locally advanced breast cancer

Background:Androgen receptor (AR) expression has been observed in up to 77% of human epidermal growth factor receptor 2–positive (HER2+) breast cancer (BC).References:1 Enzalutamide (ENZA) is a potent AR inhibitor approved for patients (pts) with metastatic castration-resistant prostate cancer. In vitro, ENZA enhances antitumor activity of trastuzumab in HER2+ AR+ cell lines and inhibits proliferation in trastuzumab-resistant HER2+ cell lines.2

Methods:Pts with metastatic or locally advanced BC that was HER2+ AR+ by local or central laboratory assessment were enrolled in a single-arm, Simon 2-stage phase 2 study (NCT02091960). Key eligibility criteria included availability of a tissue sample, presence of measurable or evaluable disease per RECIST v1.1, progression on prior trastuzumab and ≥1 prior line of anti-HER2 therapy as the most recent regimen. Brain metastases and history of seizure were exclusionary. Evaluable pts were those with centrally confirmed nuclear AR expression≥10% by immunohistochemistry who received ≥1 dose of ENZA and had ≥1 postbaseline tumor assessment. Pts received ENZA 160 mg daily and trastuzumab 6 mg/kg every 21 days until disease progression. The primary objective was clinical benefit rate at 24 weeks (CBR24), defined as complete or partial response (CR or PR) or stable disease (SD) for ≥24 weeks in evaluable pts. Additional endpoints included safety and progression-free survival (PFS). CBR24 in ≥3 of 21 evaluable pts was required to continue to stage 2 and enrollment of up to 66 evaluable pts total. This design yields a 1-sided type 1 error of 5% and 90% power when the true response is 25%.

Results:Here we present results from stage 1 (data cutoff: Mar 23, 2016), with 22 evaluable pts enrolled (pts 21 and 22 enrolled simultaneously); 18 had received ≥4 prior lines of therapy. Median duration of ENZA exposure was 144 days (range, 22-495), mean number of complete trastuzumab infusions was 6.5. CBR24 was 27.3% (95% confidence interval [CI], 10.7-50.2); 2 confirmed PR and 4 SD ≥24 weeks. Median PFS was 108 days (95% CI, 56-144). All pts experienced ≥1 adverse event (AE) any grade; 5 pts experienced AEs grade ≥3. ENZA-related AEs were reported in 16 pts (72.7%), the most common (in ≥10% of pts) were fatigue (22.7%), nausea (18.2%), diarrhea (13.6%) and arthralgia (13.6%). Serious AEs were reported in 6 pts (27.3%; 2 each of infection and back pain, 1 each of abdominal pain, nausea, vomiting, pyrexia, urinary retention and pulmonary edema). Two pts discontinued due to drug-related AEs: 1 related to both drugs, 1 related to trastuzumab. One on-study death from pulmonary edema was reported, which was not considered related to either drug.

Conclusion:Stage 1 met its primary objective. No new safety signals were identified, and the safety profile in this study was similar to that in men with prostate cancer and women with other BC subtypes treated with ENZA. These results are encouraging for a heavily pretreated population with advanced HER2+ AR+ BC. Enrollment in stage 2 continues with the combination of ENZA and trastuzumab.

1. Micello D et al. Virchows Arch. 2010;457:467-476.

2. Richer J. Presented at AACR Advances in Breast Cancer, San Diego, CA, 2013.

Citation Format: Krop I, Cortes J, Miller K, Huizing MT, Provencher L, Gianni L, Chan S, Trudeau M, Steinberg J, Sugg J, Liosatos M, Paton VE, Peterson A, Wardley A. A single-arm phase 2 study to assess clinical activity, efficacy and safety of enzalutamide with trastuzumab in HER2+ AR+ metastatic or locally advanced breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-08.

Health system costs for stage-specific breast cancer: a population-based approach

OBJECTIVE

The objective of the present analysis was to determine the publicly funded health care costs associated with the care of breast cancer (bca) patients by disease stage.

METHODS

Incident cases of female invasive bca (2005-2009) were extracted from the Ontario Cancer Registry and linked to administrative datasets from the publicly funded system. The type and use of health care services were stratified by disease stage over the first 2 years after diagnosis. Mean costs and costs by type of clinical resource used in the care of bca patients were compared with costs for a matched control group. The attributable cost for the 2-year time horizon was determined in 2008 Canadian dollars.

RESULTS

This cohort study involved 39,655 patients with bca and 190,520 control subjects. The average age in those groups was 61.1 and 60.9 years respectively. Most bca patients were classified as either stage i (34.4%) or stage ii (31.8%). Of the bca cohort, 8% died within the first 2 years after diagnosis. The overall mean cost per bca case from a public payer perspective in the first 2 years after diagnosis was $41,686. Over the 2-year time horizon, the mean cost increased by stage: i, $29,938; ii, $46,893; iii, $65,369; and iv, $66,627. The attributable cost of bca was $31,732. Cost drivers were cancer clinic visits, physician billings, and hospitalizations.

CONCLUSIONS

Costs of care increased by stage of bca. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. These data will assist planning and decision-making for the use of limited health care resources.

Population-based utilization of radiation therapy by a Canadian breast cancer cohort

We examined trends in radiation therapy (rt) utilization by a population-based breast cancer cohort in Ontario. The provincial cancer registry provided a breast cancer cohort based on diagnosis dates from April 1, 2005, to March 31, 2010. Staging information was also available. The cohort was then linked, by encrypted health card number, to linkable administrative datasets, including rt utilization. The average age in the identified female breast cancer cohort (n = 39,656) was 61.6 ± 14.0 years. Almost two thirds of the patients (n = 25,225) received rt, and staging information was available for 22,988 patients (9541 stage i, 8516 stage ii, 4050 stage iii, and 881 stage iv). The average number of rt courses received by the patients was 1.4 ± 0.7 for stage i, 1.8 ± 1.1 for stage ii, 2.5 ± 1.3 for stage iii, and 2.8 ± 2.4 for stage iv. The ratio of conventional rt to intensity-modulated rt was 70.9%:16.6% for stage i, 71.6%:11.3% for stage ii, 74.6%:4.6% for stage iii, and 89.6%:2.2% for stage iv. From 2005 to 2010, almost two thirds of a Canadian female breast cancer cohort received rt, and the average number of courses increased with disease severity. A similar trend was observed with the type of rt (use of conventional rt increased with disease severity). The next step is to apply unit costs to the number of fractions and to obtain rt planning and radiation therapist times.

Access to personalized medicine: factors influencing the use and value of gene expression profiling in breast cancer treatment

Genomic information is increasingly being used to personalize health care. One example is gene expression profiling (gep) tests, which estimate recurrence risk to inform chemotherapy decisions in breast cancer. Recently, gep tests were publicly funded in Ontario. We explored the perceived utility of gep tests, focusing on the factors influencing their use and value in treatment decision-making by patients and oncologists.

METHODS

We conducted interviews with oncologists (n = 14) and interviews and a focus group with early-stage breast cancer patients (n = 28) who underwent gep testing. Both groups were recruited through oncology clinics in Ontario. Data were analyzed using the content analysis and constant comparison techniques.

RESULTS

Narratives from patients and oncologists provided insights into various factors facilitating and restricting access to gep. First, oncologists are positioned as gatekeepers of gep, providing access in medically appropriate cases. However, varying perceptions of appropriateness led to perceived inequities in access and negative impacts on the doctor-patient relationship. Second, media attention facilitated patient awareness of gep, but also complicated gatekeeping. Third, the dedicated administration attached to gep was burdensome and led to long waits for results and also to increased patient anxiety and delayed treatment. Collectively, because of barriers to access, those factors inadvertently heightened the perceived value of gep for patients relative to other prognostic indicators.

CONCLUSIONS

Our study delineates the factors facilitating and restricting access to gep, and highlights the roles of media and organization of services in the perceived value and utilization of gep. The results identify a need for administrative changes and practice guidelines to support streamlined and standardized use of gep tests.

Abstract P3-14-11: Microarray data analysis and long term outcomes of NCIC-CTG MA.22: Neoadjuvant epirubicin and docetaxel with pegfilgrastim support for locally advanced breast cancer

Background: 93 patients were enrolled in sequential phase 1 and 2 trials of epirubicin (E) and docetaxel (D) given at 3 (cohort A) or 2 weekly (cohort B) intervals. We previously reported clinical (93%) and pathologic response rates (pCR 7%) as well as the association of fall in tumour RNA integrity (RIN) with response (ASCO 2010). Here we report the results of microarray analysis of tumor specimens pre-and mid-treatment to determine genes which are differentially expressed in different groups. Methods: 6 core biopsies were collected for all patients pre-, mid- and post-treatment with ED. 3 cores were used for standard pathologic assessment while 3 were used for gene expression assessment using Agilent full genome microarrays. Pre- and mid-treatment cores were used with Agilent Feature Extraction Software to assess microarrays; and baseline continuous (% positive) immunohistochemical ER, PR, HER2, and Topo2 were investigated by schedule and dose. RNAs with RIN &gt; = 5.0 were subjected to microarray analysis. NIH BRB array tools were used for investigations of differential gene expressions. K-M curves were generated for the phase 2 cohorts for disease free (DFS) and event free survival (EFS), and for ER− PR− and ER or PR+ subgroups. Results: Of the 93 patients, 47 were in cohort A and 46 in cohort B. Median overall survival was 6.34 years on study. DFS at 50 months was 55% for A (phase 2) and 67% for B (phase 2), while EFS was 55% for A and 63% for B. For ER or PR+ DFS and EFS were 60% and for ER− PR− DFS and EFS were 63%. 134 arrays were available in total: 57 from A, 68 from B with 11 reference breast tumour RNAs for standardization. Patients with and without microarrays were not significantly different. Pre-treatment, we found 3 differentially expressed genes in A and 6 in B between patients who did and did not have RIN &gt; = 5.0 at mid-treatment. Comparing CR to non-CR (PR, SD, PD), 40 genes were found for A and 2 genes for B. Many genes were also differentially expressed in A and B when analyzed by pathologic factors ER, PR, HER2, Topo2, schedule and dose. Mid-treatment, 4,365 genes in A and 18,770 genes in B were significantly different from pre-treatment. Conclusion: At 50 months, DFS was 55% for 3 weekly and 67% for 2 weekly schedules of ED. The genes identified in each cohort pretreatment will be investigated further for relevance to predicting sensitivity or resistance to E or D.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-11.

Acquisition parameters optimization of a transmission electron forward scatter diffraction system in a cold-field emission scanning electron microscope for nanomaterials characterization

Transmission electron forward scatter diffraction (t-EFSD) is a new technique providing crystallographic information with high resolution on thin specimens by using a conventional electron backscatter diffraction (EBSD) system in a scanning electron microscope. In this study, the impact of tilt angle, working distance, and detector distance on the Kikuchi pattern quality were investigated in a cold-field emission scanning electron microscope (CFE-SEM). We demonstrated that t-EFSD is applicable for tilt angles ranging from -20° to -40°. Working distance (WD) should be optimized for each material by choosing the WD for which the EBSD camera screen illumination is the highest, as the number of detected electrons on the screen is directly dependent on the scattering angle. To take advantage of the best performances of the CFE-SEM, the EBSD camera should be close to the sample and oriented towards the bottom to increase forward scattered electron collection efficiency. However, specimen chamber cluttering and beam/mechanical drift are important limitations in the CFE-SEM used in this work. Finally, the importance of t-EFSD in materials science characterization was illustrated through three examples of phase identification and orientation mapping.

Abstract P5-18-14: Cardiac monitoring during adjuvant trastuzumab therapy for breast cancer

Background: Adjuvant trastuzumab improves survival in HER2+ breast cancer. Cardiac toxicity is an important potential side effect. We report real world practice patterns in cardiac monitoring and outcomes during adjuvant trastuzumab therapy in Ontario.

Methods: A cohort of female patients diagnosed with early breast cancer from Jan 1, 2006 to Dec 31, 2007 and who received trastuzumab was identified retrospectively through linkage of provincial administrative and registry databases. Demographic, pathology, treatment, hospital admissions, claims for cardiac tests (MUGA or echo), and outcomes were extracted for individuals. Pre-existing cardiac disease (CHF, MI, angina, valve disorder, arrhythmia, cardiomyopathy) and risk factors (diabetes, lipid disorder, hypertension) were classified using ICD-10 codes. Appropriate cardiac monitoring definitions were based on published trials and expert opinion. Symptomatic cardiac toxicity was defined as a physician claim or hospital admission with a cardiac diagnosis occurring within 2 years of the first trastuzumab dose. Asymptomatic cardiac toxicity was defined as temporary or permanent cessation of trastuzumab with additional cardiac tests. Patients were categorized into treatment groups: G1 received at least 17 doses (standard 3-weekly administration for 51 weeks) with no complications; G2 stopped early for non-cardiac reasons (no additional cardiac tests); G3 had symptomatic or asymptomatic cardiac toxicity. Analyses of patient, treatment and system factors possibly affecting cardiac monitoring and toxicity were performed.

Results: 1,357 patients diagnosed with early breast cancer between 2006–7 received trastuzumab (median = 18 doses). 77% received anthracyclines; 4.1% had at least 1 cardiac risk factor. The majority (91%) had a baseline cardiac test, including 96% of those with cardiac risks. Geographic region was associated with baseline testing, but multivariable analysis of other factors including urbanicity, left lateral radiation, age, income, and anthracycline use, did not explain the variation in baseline testing patterns. The majority, 81%, had ≥3 cardiac tests, 62.2% had ≥4. Cardiac monitoring was deemed appropriate in 80.7% of patients without cardiac events, and 73.4% in those with symptomatic or asymptomatic cardiac events. Multivariable analysis revealed duration of trastuzumab to be the most significant factor associated with appropriateness of cardiac monitoring (G1 - OR 0.62, p = 0.018, 95% CI 0.45–0.92; G3 - OR 4.56, p &lt; 0.001, 95% CI 2.47–8.42). 297 patients (22%) experienced symptomatic (7%) or asymptomatic (15%) cardiac toxicity. Duration of trastuzumab (&lt;17 doses; OR 6.47, p &lt; 0.001, 95% CI 4.79–8.75) was associated with cardiac toxicity.

Conclusions: The majority of early breast cancer patients that received adjuvant trastuzumab in Ontario between 2006–7 had cardiac monitoring consistent with clinical trials. Cardiac toxicity in this real world population, as defined by our database analysis, was unexpectedly higher than reported in trials. Shorter duration of trastuzumab was associated with cardiac toxicity, likely reflecting the practice of stopping trastuzumab in the presence of cardiac events.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-18-14.

Abstract P2-12-03: A pilot study evaluating the benefits and feasibility of an exercise program for breast cancer patients receiving adjuvant chemotherapy

BACKGROUND: Breast cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, muscle strength and quality of life (QOL). Evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining QOL, cardiorespiratory fitness and strength, however the results of studies conducted to date have not been consistent.

OBJECTIVES: This study aimed to determine the effect of a structured, tailored exercise program involving both aerobic and resistance training, on QOL, physical function, and body composition in breast cancer patients undergoing adjuvant chemotherapy.

METHODS: Women who were within 4–12 weeks of surgery for stage I-III breast cancer and undergoing adjuvant chemotherapy, were randomized to either a structured exercise program (6 months) or to usual oncology care. Functional assessment of cancer therapy-breast cancer (FACT-B), and Short Form Survey (SF-36), weight, waist circumference, waist hip ratio, percent body fat, peak oxygen, strength and arm volume were performed at baseline, and 3-month intervals through 12 months. One-way analysis of variance (ANOVA) was performed at baseline, 3, 6 and 12 months for all endpoints. The Wilcoxon Rank-sum Nonparametric test was applied for all Primary and Secondary endpoints with changing scores at each follow-up visit, p-value &lt; 0.05 was considered as statistical significance.

RESULTS: Of the recruited 62 women, 51 completed all 12 months. One patient developed metastatic disease and 10 others withdrew (4 in the exercise arm and 6 in the standard arm). Median age was 48 (24–75) years. There was a general trend of improvement from baseline for most components of the FACT-B and SF-36 for the exercise group but only the FACT-B social wellbeing was statistically significant at 3 months with a p = 0.0164. Changes in other FACT-B and SF-36 scores were not significantly different between exercise and usual care groups. There were significant improvements at 6 months in weight (p = 0.0192), % body fat (p = 0.0337), max strength (p = 0.0029), and waist circumference (0.0359) and at 12 months in weight (p = 0.0293), % body fat (p = 0.0481), max strength (p = 0.0097) and endurance (p = 0.0037) in the exercise group compared to usual care.

CONCLUSIONS: This randomized prospective study suggests benefit of exercise during chemotherapy. This benefit continued 6 months beyond the completion of the exercise program with significant improvement in physical function, body composition, strength and endurance with no decline in quality of life. Regular moderate exercise may play an important role in improving function during adjuvant chemotherapy and should be further studied in a large randomized trial.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-03.

Contribution of a new generation field-emission scanning electron microscope in the understanding of a 2099 Al-Li alloy

Aluminum-lithium alloys are widespread in the aerospace industry. The new 2099 and 2199 alloys provide improved properties, but their microstructure and texture are not well known. This article describes how state-of-the-art field-emission scanning electron microscopy (FE-SEM) can contribute to the characterization of the 2099 aluminum-lithium alloy and metallic alloys in general. Investigations were carried out on bulk and thinned samples. Backscattered electron imaging at 3 kV and scanning transmission electron microscope imaging at 30 kV along with highly efficient microanalysis permitted correlation of experimental and expected structures. Although our results confirm previous studies, this work points out possible substitutions of Mg and Zn with Li, Al, and Cu in the T1 precipitates. Zinc and magnesium are also present in "rice grain"-shaped precipitates at the grain boundaries. The versatility of the FE-SEM is highlighted as it provides information in the macro- and microscales with relevant details. Its ability to probe the distribution of precipitates from nano- to microsizes throughout the matrix makes FE-SEM an essential technique for the characterization of metallic alloys.

P5-18-02: A Population Level Assessment of Emergency Room Visits and Hospitalizations for Women Undergoing Adjuvant Chemotherapy for Early Breast Cancer

Background: Adjuvant chemotherapy is considered the standard of care for women with lymph node positive and high risk lymph node negative breast cancer. While the acute toxicities of chemotherapy are well documented in clinical trials, the frequency of serious treatment related toxicities of adjuvant chemotherapy in the general population is not well described. We undertook a population based assessment of the frequency of serious treatment related toxicity in women undergoing adjuvant chemotherapy for early breast cancer (EBC). Methods: All incident EBC patients diagnosed between January 2007 and December 2008 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to multiple provincial administrative health care databases to provide comprehensive medical follow-up. Exclusion criteria were set to exclude patients on chemotherapy for advanced breast cancer. Any patient with who received at least 1 cycle of adjuvant chemotherapy was included in the analysis. Serious toxicities resulting in emergency room (ER) visits or hospitalizations occurring between the start date of chemotherapy and 30 days after the last dose of chemotherapy were identified. Logistic regression models were used to identify the impact of chemotherapy regimen, age, comorbidity and duration on therapy on the likelihood of experiencing serious toxicity.

Results: Of the 3090 women identified in our cohort, 1440 (46.6%) experienced at least 1 serious toxicity resulting in an ER visit during their adjuvant treatment. Of the ER visits, the majority (1107, 87%) were attributable to treatment related toxicities. Febrile neutropenia (FN) was the most common treatment related toxicity occurring in 27.1% of patients in the cohort. Docetaxel containing regimens were associated with a significantly higher rate of ER visits and FN (54.6%, 34.6%) compared with paclitaxel (38.0%, 17.9%), or anthracycline alone (epirubicin 45.8%, 23.8%; doxorubicin 32.8%, 15.4%). Table 1 displays the impact of clinical and patient factors on multivariable analysis.

P4-01-04: Effects of CYP2D6 Phenotype and Drug Adherence on Tamoxifen Metabolite Levels

Background

Although the activity of cytochrome P450 2D6 (CYP2D6), the enzyme responsible for conversion of tamoxifen (TAM) to its most important active metabolite endoxifen, varies significantly with genotype. Routine genotype testing in patients on TAM has recently been discouraged. Conflicting results in publications regarding the prognostic utility of this test remain unexplained. Confounding factors could be lack of predicted correlation between CYP2D6 genotype and TAM active metabolites, or variability of patient compliance

Methods: Consecutive breast cancer patients on TAM were asked to enroll in a study to examine the relationship between CYP 2D6 phenotype, patient-reported treatment adherence, and TAM metabolites levels. Patients were genotyped for CYP2D6 polymorphisms using long-range PCR allele-specific amplification and single-nucleotide primer extension assay. From the genotypes, four phenotype groups were defined: Ultra rapid Metabolizer (UM), Extensive Metabolizer (EM), Intermediate Metabolizer (IM) and Poor Metabolizer (PM). Plasma was collected after at least 6 weeks of TAM (20 mg daily). The parent drug TAM, as well as 4-hydroxy N-desmethyl tamoxifen (endoxifen), 4 hydroxy tamoxifen (4OHtam) and N-desmethyl-tamoxifen (NDtam), were determined by Liquid Chromatography tandem mass-spectrometry (LC-MS/MS). Patients also completed a questionnaire about ethinicity, side effects, concurrent medications and tamoxifen adherence. Correlation between metabolite/TAM ratio and phenotype was tested by Spearman correlation test. Relationship between metabolite levels and adherence was tested by Wilcoxon rank sum test. Chi square test was used to compare proportions.

Results: Of the 100 patients enrolled there were 62 Caucasians, 25 Asians, 4 Africans and 6 Unknown. We found a strong correlation between ratio of endoxifen/TAM and phenotype (p &lt;.0001) (Table 1) Over a 2 week period 68 never missed a TAM dose, 25 missed 1–2 times, 2 missed 3–5 times and 2 &gt; 5times (2 missing data). In EM group we found significantly lower levels of TAM (p &lt;.0001), NDtam (p=.008), 4OHtam (p=.003) in less adherent patients. A trend to decreased levels was also shown for endoxifen (p=.081). No associations were found between adherence or phenotype activity and side effects.

Cost effectiveness of TAC versus FAC in adjuvant treatment of node-positive breast cancer

Background

This economic analysis aimed to determine, from the perspective of a Canadian provincial government payer, the cost-effectiveness of docetaxel (Taxotere: Sanofi–Aventis, Laval, QC) in combination with doxorubicin and cyclophosphamide (tac) compared with 5-fluorouracil, doxorubicin, and cyclophosphamide (fac) following primary surgery for breast cancer in women with operable, axillary lymph node–positive breast cancer.

Methods

A Markov model looking at two time phases—5-year treatment and long-term follow-up—was constructed. Clinical events included clinical response (based on disease-free survival and overall survival) and rates of febrile neutropenia, stomatitis, diarrhea, and infections. Health states were “no recurrence,” “locoregional recurrence,” “distant recurrence,” and “death.” Costs were based on published sources and are presented in 2006 Canadian dollars. Model inputs included chemotherapy drug acquisition costs, chemotherapy administration costs, relapse and follow-up costs, costs for management of adverse events, and costs for granulocyte colony-stimulating factor (g-csf) prophylaxis. A 5% discount rate was applied to costs and outcomes alike. Health utilities were obtained from published sources.

Results

For tac as compared with fac, the incremental cost was $6921 per life-year (ly) gained and $6,848 per quality-adjusted life-year (qaly) gained. The model was robust to changes in input variables (for example, febrile neutropenia rate, utility). When g-csf and antibiotics were given prophylactically before every cycle, the incremental ratios increased to $13,183 and $13,044 respectively.

Conclusions

Compared with fac, tac offered improved response at a higher cost. The cost-effectiveness ratios were low, indicating good economic value in the adjuvant setting of node-positive breast cancer patients.

Cancer diagnostic assessment programs: standards for the organization of care in Ontario

Background

Improving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a high-quality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap.

Methods

As a quality initiative of Cancer Care Ontario’s Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback.

Results

The body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are needed (mean: 4.6), that standards should be formally approved (mean: 4.3), and importantly, that standards reflect an effective approach that will lead to quality improvements in the cancer system (mean: 4.5) and in patient care (mean: 4.3).

Interpretation

Based on the best available evidence, standards for the organization of daps are offered. There is clear need to integrate formal and comprehensive evaluation strategies with the implementation of the standards to advance this field.

Coping with uncertainty: T1a,bN0M0 HER2-positive breast cancer, do we have a treatment threshold?

BACKGROUND

Recent retrospective studies have suggested that patients with T1a,bN0M0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a higher risk for recurrence and might benefit from adjuvant trastuzumab. The absolute benefits associated with treating this subgroup are uncertain.

DESIGN

We reviewed recent studies examining the prognostic value of HER2 in patients with node-negative T1a,b HER2-positive breast cancer. We calculated the number needed to treat (NNT) using baseline risk estimates for untreated T1a,bN0M0 breast cancer and the number needed to harm (NNH) using the incidence of cardiac events in each of the adjuvant trastuzumab clinical trials.

RESULTS

Several studies were identified, each with limitations inherent to retrospective database analyses: small cohort sizes, lack of systematic HER2 testing in older specimens, variations in the use of adjuvant therapy and definitions of study end points, and lack of information relating to comorbidities. The 5-year disease-free survival in the pre-trastuzumab era ranged from 77% to 95%. Comparisons between small HER2 -positive and small HER2 -negative cancers showed numerically worse outcome for the HER2-positive cohort in some but not all studies. In many instances, the NNH was larger (26-250) than the NNT (13-35); however, in a subset of patients, the NNH was lower (6) than the NNT (13-35).

CONCLUSIONS

Better prediction tools to estimate more precisely the risk for death due to comorbid illness versus breast cancer are needed. In some patients, the risks of therapy could outweigh the benefits. Treatment selection for T1a,bN0 HER2-positive cancers remains in the transition area between evidence- and subjective judgment-based medicine.

Abstract P1-10-09: Access to HER2 Testing in Early Stage Breast Cancer (ESBC) in a Single Payor, Public Healthcare System — Ontario (ON), Canada

Background: In ON, testing for HER2 overexpression in ESBC was approved, along with trastuzumab (T) treatment with chemotherapy for HER2 positive (IHC = 3 or FISH ≥2.0) tumors in 2005. Guidelines for testing and treatment must be met for provincial T reimbursement. To study adherence to HER2 testing and T utilization guidelines in ESBC, we first describe patient access to HER2 testing by age, tumor, stage, urbanicity and income. Methods: A population-based retrospective cohort of ESBC patients diagnosed in 2006 and 2007 was identified using the Ontario Cancer Registry and for whom ≥1 pathology report was available from Cancer Care Ontario (CCO). All BC-related pathology reports were individually reviewed to identify early stage, resected, primary BC. Information was collected on surgical procedure, TN stage, histologic grade, receptor status (ER/PR) and HER2 test provision. Linkage to other administrative databases provided income quintile, urban vs. rural residence and institution of diagnosis. Odds ratios were calculated to determine association of HER2 testing with any pathologic or socioeconomic factors. Results: The 2-year cohort contains 13,430 ESBC patients, 60% of which had breast conserving surgery. 29,746 (2.2/patient) pathology reports were reviewed. 13% of the cohort had rural residences, and 95% were alive at end of follow-up. Age at diagnosis was distributed as: 5% &lt; 40 years, 18% 40-49 years, 25% 50-59 years, 24% 60- 69 years, 18% 70-79 years and 10% ≥80 years. Stage at diagnosis was: 35% stage I, 32% stage II, 10% stage III and 22% stage unknown after removing all stage IV. No differences in HER2 testing were observed for patients across income quintiles (P&gt;0.3550). Patients ≥80 years (P&lt;0.0001) and &lt;40 years (p=0.0074) had significantly lower odds of receiving ≥1 HER2 test than patients 40-49 years. ESBC of higher histologic grade had significantly greater odds (P&lt;0.0001) of ≥1 HER2 test compared to grade I ESBC. Patients from rural areas had lower odds of HER2 testing compared to urban patients (P&lt;0.0001). Conclusions: For the 2 years 2006-2007: 13,430 ESBC patients were identified from the OCR for which ≥1 pathology report was available from CCO. Age, stage at diagnosis, and surgical procedure were representative of an ESBC population. HER2 testing was universally available per Ontario policy, but not all reports were submitted to CCO. The odds of having a documented HER2 test were not affected by income, but testing was more likely to be documented for high grade tumours and less likely to be documented for the youngest and oldest women and those with rural residence. Pathology reports missing from CCO are being sought. Adherence to guidelines for testing, treatment with T and cardiac monitoring during treatment will be assessed.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-09.

Impact of host tree on forest tent caterpillar performance and offspring overwintering mortality

One of the most damaging insect pests in deciduous forests of North America is the forest tent caterpillar, Malacosoma disstria Hübner. It can feed on a variety of plants, but trembling aspen (Populus tremuloides Michaux) is its preferred host and sugar maple (Acer saccharum Marshall) serves as a secondary one in the northern part of its distribution. Because host plant characteristics influence insect performance and survival, we evaluated the impact of trembling aspen and sugar maple foliage on M. disstria performance. Host effects on insect cold hardiness and overwintering survival of offspring were also studied. Forest tent caterpillar reared on aspen leaves had a shorter development time, higher pupal weights and fecundity, and superior egg parameters (length and weight) compared with those reared on sugar maple leaves. Larvae from the two food treatments had low glucose levels during diapause, whereas glycerol content of insects reared on maple was significantly higher during diapause than larvae fed on aspen. Lower glycerol content may explain the higher overwinter mortality of pharate larvae from aspen-reared parents even though their supercooling points were as low as -36 degrees C. This study shows the influence of host plant on insect life history and the need to consider overwintering success and offspring performance in studies to understand and predict population growth and cycling.

Drug-induced immune thrombocytopenic purpura secondary to sunitinib

Sunitinib (Sutent: Pfizer, New York, NY, U.S.A.) is an oral multi-targeted tyrosine kinase inhibitor approved for use in various solid tumour malignancies. Many side effects secondary to sunitinib have been documented. In particular, sunitinib administration is known to result in thrombocytopenia, with the cause being attributed to myelosuppression. Here, we present the first case report to demonstrate immune-mediated thrombocytopenia secondary to sunitinib administration.