D-CRSE: Diminishing chemotherapy-related side effects through patient education, a mixed-methods pilot study

OBJECTIVES

Patient education materials regarding self-management of chemotherapy-related side effects are limited, which may result in patients using disreputable sources. We created a brochure that educates patients on common side effects, tools to address problems themselves, and guidance on when to contact their oncologist or seek emergency care. This mixed-methods study conducted at Penn State Cancer Institute evaluates the feasibility of using an educational brochure to improve patient outcomes through education.

METHODS

Chemotherapy naïve patients with breast or gastrointestinal (GI) cancer were enrolled in a single-arm clinical trial from December 2021 to 2022. Participants received the educational brochure and were asked to provide their initial impressions. They completed The Emotional Thermometer Scale (ETS) and the Memorial Symptom Assessment Scale (MSAS) to measure changes in patient symptoms and mental health throughout their chemotherapy course at 0, 6, and 12-week intervals. The drop-out rate was recorded as a measure of study feasibility.

RESULTS

The study participants were split between the following cancer types: 77.8% breast and 22.2% GI cancer. A significant decrease in overall mean ETS score was observed between baseline and week 6 (p = 0.001) and 12 (p = 0.0004), respectively. Moreover, the mean MSAS psychological symptoms decreased significantly at week 12 compared to baseline (p = 0.005), while no change was observed in physical symptoms (p = 0.101). Of the 40 participants who completed baseline surveys, 37 had at least one additional visit for a drop-out rate of 7.5%.

CONCLUSION

This mixed-methods pilot study was successful in demonstrating the feasibility of distributing a standardized educational brochure as an intervention for chemotherapy patients. While participants' emotional scores and psychological symptoms decreased over time, physical symptoms did not, which aligns with side effect progression from cumulative chemotherapy burden.

Thoracic splenosis: an important consideration in oncology patients

SummarySplenosis is the implantation of ectopic splenic tissue after splenic injury or splenectomy. Signs and symptoms of splenosis vary based on anatomic location; however, it remains asymptomatic in many cases. On radiographic imaging, splenosis often appears as a soft tissue mass and can be diagnosed using heat-damaged red blood cell scintigraphy, a non-invasive imaging modality. Radiographic findings of splenosis on imaging may be suspicious for metastatic disease in patients with known solid organ tumours. It is important to have a high degree of suspicion for splenosis with known history of splenic trauma or splenectomy in order to avoid invasive procedures and guide appropriate management.

Abstract OT3-06-01: Diminishing Chemotherapy Related Side Effects through Patient Education

Background At the Penn State Cancer Institute (PSCI), there is currently a lack of patient education materials regarding self-management of cytotoxic chemotherapy related side effects, thus leading to use of disreputable sources (online searches) by cancer patients. A standardized brochure developed by our team aims to educate patients about commonly experienced chemotherapy related side effects. It also provides patients with tools to address these problems themselves, information on when to contact their medical oncologist, and brief guidance on when it is appropriate to visit the Emergency Department. We hypothesize that effective patient education through the brochure will improve patient related outcomes and quality of life. Moreover, empowering patients with such a trustworthy resource will decrease anxiety and distress related to their treatments. If this intervention is found to be impactful, it could be expanded to other cancer types within PSCI and eventually to other institutions across the country. Trial design • Recruitment and Screening: Chemotherapy naïve patients with breast cancer are recruited from our institution, screened, and enrolled on a rolling basis • Baseline Visit: Consent, receive the brochure, and complete the following questionnaires: the Patient Education Material Assessment Tool (PEMAT), Emotional Thermometer Scales (ETS), and Memorial Symptom Assessment Scale (MSAS) • PEMAT is utilized to evaluate if a teaching material is understandable and promotes action, which will help determine if the brochure itself is an effective education tool • ETS is utilized to evaluate the mental health, specifically measuring distress, anxiety, depression, and anger • MSAS is a validated patient rated instrument for evaluation of diverse group of symptoms commonly seen with chemotherapy • Follow Up Visits: Fill out the same 3 surveys again at their 6-week and 12-week visits • Patients will fill out the same questionnaires to assess changes over time, a surrogate for effectiveness of the brochure • Surveys take about 12 minutes to complete on average Eligibility Criteria 1. Adult with Breast cancer >18 years of age 2. Chemotherapy naive, will either start cytotoxic chemotherapy in the next 6 weeks or have started cytotoxic chemotherapy in the past 6 weeks prior to enrollment 3. May receive multiple forms of therapy such as immunotherapy, targeted treatment, endocrine therapy or radiation as long as they receive concurrent cytotoxic chemotherapy 4. Ability to understand and read written English or Spanish without any functional difficulty 5. ECOG performance status 0-3 6. May be involved with other cancer trials being offered at the PSCI Specific Aims • Primary Outcome: Determine if effective patient education through a standardized brochure will improve patient related outcomes and quality of life • Secondary Outcome: Drop-out rate after the baseline visit Statistical methods • Outcome variables from survey-based questionnaires will be measured at all three time points • Their distribution at time points will be summarized using numerical and graphical methods • Paired-sample tests will be used to compare the difference between visits’ data • Linear mixed-effect models for repeated measures will be used to examine the overall pattern by using data from all three time points • All tests will be two-sided with a significance level of 0.05 • We do not plan to do adjustments for multiple testing Present accrual and target accrual: • 24 total accrued, 14 completed • 60 target accrual • Plan to approach 70-75 patients and anticipate a 10-15% dropout rate which was considered in determining accrual goals Contact: • Corresponding Author: Shelby Labe SLabe1@pennstatehealth.psu.edu • PI: Monali Vasekar, MD MVasekar@pennstatehealth.psu.edu

Citation Format: Shelby Labe, Monali Vasekar, Daniella Mikhail, Gavin Jones, Joanna Bhasker, Pritika Singh, Rhea Kanwar, Sonia Hafiz, Junjia Zhu, Hannah Dailey. Diminishing Chemotherapy Related Side Effects through Patient Education [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-06-01.

Addressing metastatic individuals everyday: Rationale and design of the nurse AMIE for Amazon Echo Show trial among metastatic breast cancer patients

Background

Metastatic Breast Cancer (MBC) patients often feel their symptom-related needs are unmet, despite visiting their doctors up to once a week. Novel approaches are needed to address symptoms without requiring additional appointments. Technology based symptom management approaches to address symptoms have not been well tested.

Methods

Nurse AMIE (Addressing Metastatic Individuals Everyday) is a technology based supportive care platform that provides guideline-concordant symptom management interventions in response to patient reported symptoms. We have previously successfully implemented a tablet version of Nurse AMIE. However, some eligible patients chose not to participate because they were overwhelmed by the technology. To address this barrier, we translated the Nurse AMIE platform to the Amazon Echo Show, which allowed for voice-based interactions. Forty-two MBC patients were randomized 1:1 to receive the Nurse AMIE for Echo Show immediately for six months, or to receive the same intervention for three months, after a three month delay. The primary outcome was change in physical distress over three months, and secondary outcomes included feasibility, acceptability, patient reported outcomes and usability.

Conclusions

Results from the Nurse AMIE for Echo Show trial will identify the feasibility, acceptability, and preliminary effects of the Nurse AMIE for Echo Show on patient reported outcomes. Untested novel technologies, particularly voice-based artificial intelligence devices may an effective and scalable vehicle through which we can deliver supportive care interventions.

Clinicaltrialsgov identifier

NCT04673019.

Abstract P5-13-10: Elevated plasma IL-8 predicts for reduced outcomes in CCTG MA.38, a phase 2 randomized trial of palbociclib in ER+/HER2- metastatic breast cancer patients

Background: CCTG MA38 (NCT02630693) was a randomized phase II clinical trial that evaluated the efficacy of 2 dose schedules of palbociclib [100mg PO on continuous daily dose (CDD)] compared to 125mg PO daily for 3 weeks on/1 week off (STD) along with physician-choice of endocrine therapy in patients with ER+, HER- metastatic breast cancer (MBC) in the second-line setting. The final analysis indicated that palbociclib had comparable efficacy, safety and QOL for both treatment arms (SABCS 2018, abstr PD1-10). Our lab has reported that IL-8 was highly expressed by primary human breast cancers, and that higher pretreatment plasma IL-8 was significantly correlated with elevated bone resorption in HR+MBC patients (Kamalakar A et al. Bone 61:176-85, 2014). Most recently, our lab has reported that elevated serum IL-8 predicts for significantly reduced OS in 3 large metastatic cohorts of pancreatic (ASCO 2019, abstr 4131), prostate (ASCO 2020, abstr e17565) and breast cancer patients (ASCO 2020, abstr 1067). In this retrospective study, we investigated the prognostic value of pretreatment plasma IL-8 in CCTG MA38. Methods: 123 patients enrolled in MA38 were analyzed in this retrospective biomarker study. Serum IL-8 levels were measured using the ELLA immunoassay platform (ProteinSimple, San Jose, CA). Kaplan-Meier analysis and log-rank test were used to correlate plasma IL-8 levels with OS and progression-free survival (PFS). Results: In the total study cohort, pretreatment plasma IL-8 concentration had a median of 11.10 pg/ml, and 25% and 75% interquartiles of 7.36 and 15.00 pg/ml, respectively. In univariate analysis higher plasma IL-8 was a significant adverse biomarker for reduced PFS as a continuous variable (p = 0.01), at the median cutpoint (HR= 1.55, p=0.042), and in quartile cutpoints (HR=2.28, p=0.03, Q4 vs Q1). For OS, higher plasma IL-8 also trended significant for reduced OS at the median cutpoint (HR= 1.66, p=0.10). In multivariate analysis, higher plasma IL-8 also trended significant for reduced PFS (HR= 1.47, p=0.094). Conclusions: In the CCTG MA.38 trial, higher pre-treatment plasma IL-8 level was associated with reduced PFS, and is therefore an adverse prognostic biomarker for reduced outcome to the CDK 4/6 inhibitor palbociclib. Anti-IL-8 therapy combined with CDK 4/6 inhibitors should be evaluated in future trials to improve outcome in patients with higher circulating IL-8.

Citation Format: Hyma V Polimera, Dhirisha Bhatt, Lois E Shepherd, Karen Gelmon, Anil A Joy, Wendy R Parulekar, Monika Joshi, Suhail M Ali, Kim Leitzel, Cristina Truica, Monali Vasekar, Joseph J Drabick, Harry Menon, Neal Shah, Ashok Maddukuri, Prashanth Moku, E. Scott Halstead, Daniel McKeone, Todd M Umstead, BE Chen, Allan Lipton. Elevated plasma IL-8 predicts for reduced outcomes in CCTG MA.38, a phase 2 randomized trial of palbociclib in ER+/HER2- metastatic breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-10.

Spontaneous Hip Dislocation Complicating the Management of Malignant Peripheral Nerve Sheath Tumor Arising Within a Plexiform Neurofibroma

Neurofibromatosis type 1 (NF1) is one of the most common inherited neurological disorders. It can cause plexiform neurofibromas, leading to diffuse enlargement of a nerve or nerves within the body. There are benign in general, however, can cause significant symptoms due to their size, including bony erosion, pain, and joint instability. Unfortunately, they also have the capacity to become malignant by internal transformation into a malignant peripheral nerve sheath tumor (MPNST). The case presented here is a 27-year-old male with NF1 that was followed for years with a pelvic girdle plexiform neurofibroma whose course was complicated by transformation to MPNST and a spontaneous hip dislocation. He underwent excision, Girdlestone procedure, chemotherapy, and radiation. Unfortunately, he subsequently developed lung metastases and is part of a clinical trial with an MDM2 inhibitor and pembrolizumab.

Group-led creative writing and behavioural health in cancer: a randomised clinical trial

BACKGROUND

Cancer diagnosis can adversely affect mental well-being and overall clinical outcome. We evaluated the efficacy of a group-led creative writing workshop (CWW) on mood in patients with cancer prospectively.

METHODS

We conducted a single-institution phase II study. Sixty adult patients with cancer (any type or stage) were randomised 2:1 to CWW (4×CWW sessions, bimonthly over 8 weeks) versus active control (AC) (independent writing at home with the help of a book, four sessions, bimonthly over 8 weeks). The total study duration was 6 months with a follow-up of up to 3 months.

PRIMARY OBJECTIVE

changes in overall mood, depression and anxiety symptoms before and after intervention in both arms. Emotional Thermometer Scale (ETS) was used to assess changes in patients' mood. Additionally, the Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder Scale (GAD)-7 were used to evaluate depression and anxiety symptoms.

RESULTS

Of 50 evaluable patients (CWW 34, AC 17), 26 patients in the CWW arm attended at least one class and 19 attended at least four classes. Patients in CWW had significant immediate improvement in the overall ETS (post vs preclass scores; p<0.0001, 95% CI -4.31 to -2.47). Four of the five subscale ETS scores were significantly lower for the CWW arm: distress (p=0.0346, 95% CI -2.6 to -0.1), anxiety (p=0.0366, 95% CI -4.1 to -0.2), depression (p=0.0441, 95% CI -3.9 to -0.1) and anger (p=0.0494, 95% CI -3.3 to 0). No significant differences were seen in the AC arm. No significant differences were observed in the PHQ-9 or the GAD-7 scores.

CONCLUSION

CWW had a positive effect on mood based on ETS scores, suggesting a potential therapeutic benefit among patients with cancer.

Compare Breast Cancer Screening, Diagnosis, and Treatment Between Medicare Patients With and Without ADRD

Background: Incidence of both breast cancer and Alzheimer’s disease and related dementias (ADRD) increases with advancing age. Little research has delineated breast cancer screening, diagnosis, and treatment among women with ADRD. Method: Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data were used. Female breast cancer patients diagnosed between 2005-2015 were identified. Chi-square tests were conducted to compare the characteristics of two groups with and without ADRD. Multiple logistic regression models were estimated to explain the diagnosis and treatment differences. Results: A total of 44,112 female Medicare beneficiaries age 65 or older were identified. Patients with ADRD (17.5%) were less likely to receive breast cancer screening (42.8% vs. 46.6% for all data years combined, p<0.0001), more likely to be diagnosed with breast cancer after death by autopsy or death certificate (8.1% vs 2.0%, p<0.0001). Among those who are diagnosed before death, patients with ADRD were more likely to be diagnosed with breast cancer at age 75 and older (84.8% vs. 15.2%, p<0.0001). After adjusting for age, race, poverty level, marital status, cancer stage at diagnosis, cancer screening history, wellness visit history, comorbidity, and rural/urban residence, logistic regressions suggest that patients with ADRD were less likely to receive surgery (AOR=0.48, 95%CI: 0.45-0.52), radiation (AOR=0.41, 95%CI: 0.39-0.44), or chemotherapy (AOR=0.38, 95%CI: 0.35-0.41). Conclusion: Breast cancer screening was less utilized and breast cancer was diagnosed at an older age in patients with ADRD than those without. Treatments (surgery, radiation, and chemotherapy) were given less frequently to patients with ADRD.

Benefits of Surgical Treatment of Stage IV Breast Cancer for Patients With Known Hormone Receptor and HER2 Status

BACKGROUND

For the 6% of breast cancer patients with a diagnosis of stage IV disease, systemic therapy is the cornerstone of treatment, with an unclear role for surgery. Limited evidence exists to delineate treatment methods with regard to hormone receptor and human epidermal growth factor receptor 2 (HER2) status.

METHODS

The National Cancer Database was used to identify 12,838 stage IV breast cancer patients with known hormone receptor and HER2 status from 2010 to 2015. Chi square tests examined subgroup differences between the treatment methods received. Using the Kaplan-Meier method, 5-year overall survival (OS) was assessed. Multivariate Cox proportional hazard models examined factors associated with survival.

RESULTS

A survival advantage was noted for patients who received either systemic therapy and surgery (ST + Surg: hazard ratio [HR] 0.723; 95% confidence interval [CI] 0.671-0.779) or systemic therapy, surgery, and radiation (Trimodality: HR 0.640; 95% CI 0.591-0.694) (both p < 0.0001) compared with systemic therapy alone (ST). The HER2+ patients who received Trimodality or ST + Surg had a better 5-year OS rate than those who received ST (Trimodality [48%], ST + Surg [41%], ST [29%]; p < 0.0001). The sequence of chemotherapy in relation to surgery is significant, with the greatest survival advantage noted for recipients of neoadjuvant chemotherapy (NAC) compared with patients who had adjuvant chemotherapy when they had positive hormone receptor and HER2 status (HER2 + NAC: HR 0.477; estrogen receptor-positive [ER+] NAC: HR 0.453; progesterone receptor-positive [PR+] NAC: HR 0.448; all p < 0.0001).

CONCLUSIONS

Surgery in addition to ST has a survival benefit for stage IV breast cancer patients with known hormone receptor and HER2 status and should be considered after NAC for patients with ER+, PR+, or HER2+ disease.

Prognostic Value of DNA Damage Response Genomic Alterations in Relapsed/Advanced Urothelial Cancer

BACKGROUND

DNA damage response (DDR) genomic alterations may play an important role in clinical outcomes of patients with urothelial cancer (UC). However, data on the prognostic role of DDR gene alterations in patients with advanced UC remain unclear.

MATERIALS AND METHODS

We retrospectively collected data of three independent patient cohorts with relapsed or advanced UC including 81 and 91 patients from four institutions who underwent FoundationOne genomic sequencing as well as 129 patients selected from The Cancer Genome Atlas bladder cohort. Fisher's exact test was used to determine differences of mutation frequency among the three cohorts. Logistic regression analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI). Overall survival (OS) was measured from time of initial diagnosis and Cox proportional hazard regression analysis was performed to calculate the hazard ratio (HR) and 95% CI.

RESULTS

DDR genomic alterations were present in 76.5% (62/81), 40.7% (37/91), and 51.2% (66/129) of the three cohorts. ATM alterations consistently correlated with significantly shorter OS, whereas other DDR alterations (excluding ATM) were associated with better prognosis. In 152 patients treated with platinum pooled from the three cohorts, the prognostic value of alterations in ATM as compared with other predefined DDR genes was substantially different (ATM: adjusted HR [HR], 2.03; 95% CI, 1.03-4; p = .04; other DDR: adjusted HR, 0.49; 95% CI, 0.31-0.8; p = .003).

CONCLUSIONS

Genomic alterations in ATM and other DDR genes may have opposite prognostic value in relapsed and/or advanced UC. ATM may have a complex role in UC progression.

IMPLICATIONS FOR PRACTICE

Somatic mutations of DNA damage response (DDR) genes are frequently found in urothelial cancer and appear to play an important role in tumorigenesis, progression, treatment response, and outcomes. In a set of DDR genes, ATM alterations were associated with worse survival, while other alterations were associated with better survival in advanced urothelial cancer. The results of this study suggest a complex role of ATM in tumor progression and call for further studies to determine the underlying mechanisms and biomarker clinical utility.

Abstract P4-10-25: Pretreatment serum metabolome predicts PFS in first-line trastuzumab-treated metastatic breast cancer

Background: Cancer cells have altered metabolism, which contributes to their ability to proliferate, survive in unusual microenvironments, and invade other tissues. Measuring the complete set of metabolites in an individual (i.e. the metabolome) provides a functional readout for cellular pathways. Further, changes in the metabolome can be correlated with disease status, prognosis and progression. Using a metabolomics platform and machine learning algorithms, biomarker signatures can be identified to predict response to therapy. Metabolite analysis of pretreatment plasma has shown promise for predicting response in a small retrospective study of the CDK 4/6 inhibitors palbociclib and ribociclib in hormone receptor-positive metastatic breast cancer (Zhang B et al, ASCO 2019 Abstr 3043). HER2-positive metastatic breast cancer patients have significant heterogeneity in response and progression-free survival (PFS) to HER2-targeted therapy. Here we retrospectively evaluated the pretreatment serum metabolome for association with PFS in a cohort of trastuzumab-treated metastatic breast cancer patients from a single institution. Methods: Pretreatment serum from 26 HER2-positive trastuzumab-naive metastatic breast cancer patients who were treated with first-line trastuzumab and chemotherapy were included in this exploratory analysis. Metabolites were extracted from previously frozen serum (1 mL) using ice-cold methanol and chloroform. The resulting metabolites were isolated and quantified using an unbiased, non-destructive, nuclear magnetic resonance (NMR)-based profiling platform (Olaris, Inc., Cambridge, MA). The serum was analyzed via 1D 1H NMR and 2D 13C-1H heteronuclear single quantum coherence spectroscopy (HSQC) using customized non-uniform sampling (NUS) techniques and processed with proprietary Olaris software. Supervised and unsupervised machine learning algorithms were used to identify patients with shorter and longer PFS to trastuzumab-based therapy. Results: The median PFS for this cohort was 301 days. Patients were subdivided into early progressors (PFS &lt; 301 days) and late progressors (PFS ≥ 301 days). 23 metabolite resonance levels were statistically different between the two groups (KW test p&lt;0.05, 11 metabolites expected by chance). Using advanced machine learning we constructed a model based on 5 metabolite resonances that showed significant discriminatory ability with an AUC of 0.964 using receiver-operating curve (ROC) analysis. 21 of the 26 patients received trastuzumab and chemotherapy as a first-line therapy, while the remaining 5 patients received first-line trastuzumab with subsequent chemotherapy, after 1 or more lines of previous chemotherapy for metastatic disease. We repeated our analysis using only the first-line therapy subgroup and identified a partially overlapping set of metabolite resonances that could nearly perfectly discriminate early and late progressors with an AUC of 0.973. Further efforts are underway to confirm the identity of these metabolites. Conclusions: Metabolic profiling of pretreatment serum using NMR was successful in identifying a biomarker signature that predicted PFS to trastuzumab in HER2-positive metastatic breast cancer. Expanded metabolome analysis is warranted in larger cohorts and clinical trials to confirm that this serum biomarker signature predicts PFS to trastuzumab therapy, particularly in the first-line setting. Further, by identifying the metabolites and metabolic pathways that differ between early and late progressors, it may be possible to identify novel targets and/or suggest combination treatments in the HER2-positive metastatic breast cancer setting.

Citation Format: Elizabeth O'Day, Kim Leitzel, Suhail M Ali, Bo Zhang, Chen Dong, Haiwei Gu, Xiajian Shi, Joseph J Drabick, Leah Cream, Monali Vasekar, Hyma V Polimera, Vinod Nagabhairu, Prashanth Moku, Ashok Maddukuri, Harry Menon, Neha Pancholy, Walter P Carney, Wolfgang Koestler, Allan Lipton. Pretreatment serum metabolome predicts PFS in first-line trastuzumab-treated metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-10-25.

Abstract P1-03-02: ASCO/CAP human epidermal growth factor receptor-2 (HER2) in situ hybridization (ISH) categories evaluated by quantitative HER2 protein diagnostic methodologies: A comparative analysis

Background: In 2013, the ASCO/CAP consensus panel published updated guidelines for HER2 testing in breast cancer that modified the definition of HER2 amplification by in situ hybridization (ISH), creating five new prognostic categories (group 1: classic amplified, group 2: monosomy, group 3: co-amplified (polysomy), group 4: equivocal, and group 5: classic non-amplified). Patients determined to be ISH amplified, were considered eligible for HER2-directed therapy. Concern over whether patients from non-classic groups 2-4 would benefit from treatment has led to the recent publication of the 2018 HER2 focused update. This update has modified the criteria for interpreting these ISH categories, recommending that the final diagnosis take into consideration a combination of HER2 immunohistochemistry (IHC) and ISH results. With increased emphasis on the HER2 protein assessment, it has prompted us to quantitatively examine HER2 protein expression in the ISH categories, using two different novel technologies. Materials & Methods: A cohort of 170 cases (URMC) and 102 cases (PSHMC) of invasive breast cancers, which had previously undergone HER2 IHC and ISH testing, were selected for this study. Cases were sorted and categorized into the HER2 ISH categories defined by ASCO/CAP. HER2 protein expression was quantitatively measured in the URMC and PSHMC cohorts using a novel immunodetection methodology (streptavidin-coated Phosphor-Integrated Dot (PID) fluorescent nanoparticles), and a novel dual-antibody, proximity-binding immunoassay (HERmark® Breast Cancer Assay, Monogram Biosciences, South San Francisco, California), respectively. HER2 protein expression was compared to the HER2 FISH and IHC results by ASCO/CAP category. Results: Cases in group 1 had a significantly (p &lt; 0.01) higher average PID/cell and HERmark compared to cases in groups 2-5 (Table 1). Cases in groups 2-4 showed lower quantitative levels of HER2 protein expression, similar to the classic non-amplified cases (group 5). Group 1 was further divided into three subgroups (Table 2): Group A - ISH high-level amplified (ratio &gt; 2, HER2 &gt; 6, CEP17 &lt; 2.7), Group B - amplified with elevated CEP17 (ratio &gt; 2, CEP17 &gt; 2.7), and Group C - low-level amplified (ratio &gt; 2, HER2 &gt; 4 and &lt; 6). Group A and B had a significantly (p &lt; 0.01) higher average PID/cell and HERmark compared to Group C. Group C was more comparable to cases in groups 2-5 (Table 1). Conclusion: Our results suggest that quantitative assessment of HER2 protein expression may help to further classify cases for HER2 status for targeted therapy, supporting the 2018 ASCO/CAP recommendation that non-classic ISH results might be resolved by evaluating protein expression. Follow up studies with a larger patient cohort and dual quantitative assessment are warranted.

Average PID/cell and HERmark in ASCO category groupsASCO category groupN (URMC)PID/cell (URMC)*N (PSHMC)HERmark (PSHMC)*18888.07761.521011.20N/A32016.0213.84238.5315.95296.3208.3*averageTable 2:Average PID/cell and HERmark in subgroups of Group 1SubgroupN (URMC)PID/cell (URMC)*N (PSHMC)HERmark (PSHMC)*A24157.66465.7B34101.61044.1C3016.9329.8*average

Citation Format: Buscaglia B, Turner B, Goda H, Huang W, Leitzel K, Natori T, Nakano Y, Okada H, Sperinde J, Ali S, Vasekar M, D'Aguiar M, McMahon L, Henry J, Lipton A, Hicks D. ASCO/CAP human epidermal growth factor receptor-2 (HER2) in situ hybridization (ISH) categories evaluated by quantitative HER2 protein diagnostic methodologies: A comparative analysis [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 P1-03-02.

ATM/RB1 mutations predict shorter overall survival in urothelial cancer

BACKGROUND

Mutations of DNA repair genes, e.g. ATM/RB1, are frequently found in urothelial cancer (UC) and have been associated with better response to cisplatin-based chemotherapy. Further external validation of the prognostic value of ATM/RB1 mutations in UC can inform clinical decision making and trial designs.

RESULTS

In the discovery dataset, ATM/RB1 mutations were present in 24% of patients and were associated with shorter OS (adjusted HR 2.67, 95% CI, 1.45-4.92, p = 0.002). There was a higher mutation load in patients carrying ATM/RB1 mutations (median mutation load: 6.7 versus 5.5 per Mb, p = 0.072). In the validation dataset, ATM/RB1 mutations were present in 22.2% of patients and were non-significantly associated with shorter OS (adjusted HR 1.87, 95% CI, 0.97-3.59, p = 0.06) and higher mutation load (median mutation load: 8.1 versus 7.2 per Mb, p = 0.126).

MATERIALS AND METHODS

Exome sequencing data of 130 bladder UC patients from The Cancer Genome Atlas (TCGA) dataset were analyzed as a discovery cohort to determine the prognostic value of ATM/RB1 mutations. Results were validated in an independent cohort of 81 advanced UC patients. Cox proportional hazard regression analysis was performed to calculate the hazard ratio (HR) and 95% confidence interval (CI) to compare overall survival (OS).

CONCLUSIONS

ATM/RB1 mutations may be a biomarker of poor prognosis in unselected UC patients and may correlate with higher mutational load. Further studies are required to determine factors that can further stratify prognosis and evaluate predictive role of ATM/RB1 mutation status to immunotherapy and platinum-based chemotherapy.

Abstract P1-07-09: Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2

Background: Everolimus (EVE) plus exemestane (EXE) doubled progression-free survival (PFS) while maintaining quality of life versus EXE alone in postmenopausal women with hormone receptor positive (HR+), HER2-negative metastatic breast cancer (mBC) (BOLERO-2 phase 3; NCT00863655). Pretreatment serum activin A was previously reported as a prognostic factor in first-line hormone therapy (letrozole vs tamoxifen) (Novartis P025) and anti-HER2 mBC (lapatinib vs trastzmab) (CCTG MA.31) trials. Here we investigate the prognostic and predictive ability of activin A in BOLERO-2.

Methods: Activin A levels were determined on pretreatment serum samples using ELISA. Cox-proportional hazards model was used to assess the efficacy of EVE in the activin A low and high subgroups (median cut-point), and the prognostic effect of activin A on PFS and overall survival (OS).

Results: Baseline activin A levels were determined in 513 patients (71% of 725 BOLERO-2 patients randomized 2:1 to EVE+EXE or EXE). Predictive and prognostic signals are shown in the table below

Predictive and prognostic signalsPredictive/PrognosticEnd-pointAct-ivin ATreatmentNEventsMedian PFSHR (95% CI); p valuepredictivePFSHEXE93832.5 (1.5-2.8)-predictivePFSHEVE+EXE1631325.4 (4.1-6.8)0.46 (0.34 - 0.60); &lt;0.0001predictivePFSLEXE89774.2 (2.0 -5.4)-predictivePFSLEVE+EXE1681059.9 (8.1-12.5)0.38 (0.28 - 0.51); &lt;0.0001predictiveOSHEXE936820.1 (13.8-22.6)-predictiveOSHEVE+EXE16312917.7 (15.7-22.3)1.04 (0.78 - 1.40); 0.78predictiveOSLEXE8939NA (34.7-NA)-predictiveOSLEVE+EXE1687241.4 (36.4-NA)1.02 (0.69 - 1.50); 0.93prognosticPFSH 2562154.1 (2.9-4.2)-prognosticPFSL 2571826.9 (6.7-8.5)0.54 (0.45 - 0.66); &lt;0.0001prognosticOSH 25619718.0 (16.5-21.1)-prognosticOSL 25711142.3 (38.5-NA)0.34 (0.27 - 0.42); &lt;0.0001

.

In multivariate analysis (including sensitivity to prior hormone therapy and visceral disease), activin A remained a significant independent prognostic factor for PFS and OS [HR 0.57 (0.46-0.69) and 0.34 (0.27-0.43), respectively].

Conclusions: Higher serum activin A was strongly associated with shorter PFS and OS in HR+/HER2- mBC patients. Everolimus was efficacious regardless of serum activin A level. These results are similar to our previous studies in phase 3 trials of letrozole-tamoxifen (Novartis P025), and HER2-targeted therapy, lapatinib vs trastuzmab (CCTG MA.31): pretreatment serum activin A was prognostic for outcome, but was not a predictive factor for treatment arm selection.

Citation Format: Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-09.

Relationship of smoking status to genomic profile, chemotherapy response and clinical outcome in patients with advanced urothelial carcinoma

Smoking has been linked to urothelial carcinoma (UC), but the implications on genomic profile and therapeutic response are poorly understood. To determine how smoking history impacts genomic profile and chemotherapy response, clinicopathologic data was collected for patients with metastatic UC (mUC) across 3 academic medical centers and comprehensive genomic profiling (CGP) was performed through a CLIA-certified lab. Unsupervised hierarchical clustering based on smoking status was used to categorize the frequency of genomic alterations (GAs) amongst current smokers (CS), ex-smokers (ES) and non-smokers (NS), and survival was compared in these subsets. Fisher's exact test identified significant associations between GAs and smoking status. Amongst 83 patients, 23%, 55% and 22% were CS, ES, and NS, respectively, and 95% of patients had stage IV disease. With a median follow up of 14.4 months, the median overall survival (OS) was significantly higher in NS and ES (combined) as compared to CS (51.6 vs 15.6 months; P = 0.04). Of 315 cancer-related genes and 31 genes often related to rearrangement tested, heatmaps show some variations amongst the subsets. GAs in NSD1 were more frequent in CS as compared to other groups (P < 0.001). CS status negatively impacts OS in patients with mUC and is associated with genomic alterations that could have therapeutic implications.

Targeted immunotherapy for non-small cell lung cancer

Targeted therapies that deliver the expected anti-tumor effects while mitigating the adverse effects are taking the cancer world by storm. The need for such therapies in non-small cell lung cancer (NSCLC), where systemic cytotoxic chemotherapies still remain the backbone of management, is felt more than ever before. Runway success of immunotherapies such as Ipilimumab for melanoma has brought excitement among oncologists. Immune-based treatments are in various stages of evaluation for NSCLC as well. Immunotherapies using strategies of antigen based or cell based vaccines, and blocking immune checkpoints are of substantial interest. Meaningful clinical responses are yet to be reaped from these new treatment modalities.