Autologous Mesenchymal Stromal Cells Immobilized in Plasma-Based Hydrogel for the Repair of Articular Cartilage Defects in a Large Animal Model

The treatment of cartilage defects in trauma injuries and degenerative diseases represents a challenge for orthopedists. Advanced mesenchymal stromal cell (MSC)-based therapies are currently of interest for the repair of damaged cartilage. However, an approved system for MSC delivery and maintenance in the defect is still missing. This study aimed to evaluate the effect of autologous porcine bone marrow MSCs anchored in a commercially available polyglycolic acid-hyaluronan scaffold (Chondrotissue®) using autologous blood plasma-based hydrogel in the repair of osteochondral defects in a large animal model. The osteochondral defects were induced in twenty-four minipigs with terminated skeletal growth. Eight animals were left untreated, eight were treated with Chondrotissue® and eight received Chondrotissue® loaded with MSCs. The animals were terminated 90 days after surgery. Macroscopically, the untreated defects were filled with newly formed tissue to a greater extent than in the other groups. The histological evaluations showed that the defects treated with Chondrotissue® and Chondrotissue® loaded with pBMSCs contained a higher amount of hyaline cartilage and a lower amount of connective tissue, while untreated defects contained a higher amount of connective tissue and a lower amount of hyaline cartilage. In addition, undifferentiated connective tissue was observed at the edges of defects receiving Chondrotissue® loaded with MSCs, which may indicate the extracellular matrix production by transplanted MSCs. The immunological analysis of the blood samples revealed no immune response activation by MSCs application. This study demonstrated the successful and safe immobilization of MSCs in commercially available scaffolds and defect sites for cartilage defect repair.

Results of a Phase Ib Study Investigating Durvalumab in Combination with Eribulin in Patients with HER2-Negative Metastatic Breast Cancer and Recurrent Ovarian Cancer

INTRODUCTION

The release of tumor-associated antigens with cytotoxic chemotherapy treatment may enhance the response to immune checkpoint blockade. Eribulin is a microtubule inhibitor with proven overall survival (OS) benefit in metastatic breast cancer (MBC), which may also enhance intratumoral vascular remodeling. Durvalumab, a humanized monoclonal antibody, targets the programmed cell death ligand-1 (PD-L1) receptor. This study sought to determine the maximum tolerated dose and recommended phase II dose (RP2D) of eribulin in combination with durvalumab, as well as the safety and preliminary antitumor activity of the combination in patients with previously treated HER2-negative (HER2-) MBC and recurrent ovarian cancer (ROC).

METHODS

Cohorts of 3-6 patients with HER2- MBC and ROC were treated in a modified 3+3 design. Eligible patients received escalating doses of eribulin (1.1 mg/m2 or 1.4 mg/m2 IV on day 1 and day 8) with durvalumab (1.12 g IV on day 1) in 21-day cycles until dose-limiting toxicity (DLT), intolerable adverse events (AEs), disease progression, or other reasons for withdrawal.

PRIMARY ENDPOINT

the rate of DLTs during cycles 1 and 2 of therapy. Secondary endpoints: AE rate, objective response rate (ORR), progression-free survival (PFS), and OS.

RESULTS

Nine patients with a median of 4 prior therapies for advanced disease were treated: 5 patients with HER2- MBC (1 with triple-negative disease and 4 with hormone-positive disease) and 4 patients with ROC. The RP2D of eribulin was 1.4 mg/m2 in combination with durvalumab. There were no DLTs experienced during the first two cycles of therapy. The most common treatment-related AEs (>50%) were fatigue, neutropenia, decreased white blood cell count, anemia, AST and alkaline phosphatase elevation, hyperglycemia, and nausea; most were grade 1 or 2. There was one immune-related AE of grade 3 (hepatitis) after 5 cycles of treatment, for which patient came off study. Two other patients discontinued study drug related to toxicity (neutropenia [n = 1], hepatic toxicity [n = 1]). ORR was 55%, and 4 additional patients experienced stable disease. All MBC patients exhibited a response to therapy. Median PFS was 6.2 months. Median OS was 15.0 months.

CONCLUSION

The combination of eribulin at a dose of 1.4 mg/m2 with standard dose durvalumab had a favorable AE profile in patients with previously treated HER2- MBC and ROC. The early antitumor activity observed in all MBC patients enrolled in the study suggests that further investigation of this combination is warranted.

An emerging generation of endocrine therapies in breast cancer: a clinical perspective

Anti-estrogen therapy is a key component of the treatment of both early and advanced-stage hormone receptor (HR)-positive breast cancer. This review discusses the recent emergence of several anti-estrogen therapies, some of which were designed to overcome common mechanisms of endocrine resistance. The new generation of drugs includes selective estrogen receptor modulators (SERMs), orally administered selective estrogen receptor degraders (SERDs), as well as more unique agents such as complete estrogen receptor antagonists (CERANs), proteolysis targeting chimeric (PROTACs), and selective estrogen receptor covalent antagonists (SERCAs). These drugs are at various stages of development and are being evaluated in both early and metastatic settings. We discuss the efficacy, toxicity profile, and completed and ongoing clinical trials for each drug and highlight key differences in their activity and study population that have ultimately influenced their advancement.

Abstract P4-07-59: Management of Isolated Contralateral Axillary Lymph Node Metastasis in Breast Cancer: A Single Institution Experience

Background: Contralateral axillary lymph node metastasis (CAM) in breast cancer (BC) is uncommon with an incidence of 1.9-6%. It is considered as stage IV disease based on the TNM classification in the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual. However, in the absence of other distant metastases, patients with CAM have been found to have better outcomes compared to those with stage IV disease. Recent studies suggest that CAM may represent locoregional spread of tumor through lymphatics rather than hematogenous spread and patients should be classified as N3 rather than M1. There are no clear guidelines on the optimal management of these patients and it is unclear if patients with isolated CAM should be treated as curative intent or as metastatic disease with palliative treatment. The goal of this study was to describe the management and outcomes of patients with BC and isolated CAM seen at our institution.

Methods: We performed a retrospective chart review on all patients with BC and isolated CAM but no other distant metastases who were seen at our institution between 2000-2021. We collected information on demographics, tumor characteristics, intent of therapy (curative versus palliative), types of treatment (systemic treatments including chemotherapy (CT), hormone therapy, targeted therapy; radiation therapy; surgery), and response to frontline treatment.

Results: We identified a total of ten eligible patients who were diagnosed between 2011-2020. The median age of diagnosis was 57 years and 70% had de novo cancers while the remainder had recurrent disease. The table below describes each patient’s cancer, treatment, and response. Patients are listed in chronological order, with those at the top diagnosed in 2011 and bottom in 2020. Four patients had hormone receptor (HR)-positive and HER2-negative BC, 3 patients had triple negative BC, 2 had HER2-positive BC and 1 had HR-positive and HER2-positive BC. Regarding treatment, 50% of patients were treated with curative intent, of whom 3 have no evidence of recurrence at a follow up of 23-137 months. Of the other two patients, one had response to systemic treatment but remains surgically unresectable and the other patient developed recurrent disease. In the 5 patients treated with palliative systemic therapy as Stage IV disease, 3 patients had clinical response to first line treatment with control of disease. One patient who passed away had triple negative disease. The last patient developed progression of disease and is on second line systemic treatment.

Conclusions: At our institution, among patients treated with palliative intent systemic therapy, most (60%) had a response to first line treatment. In the 5 patients treated with curative intent, 3 patients remain without evidence of recurrence of whom 2 have had 9 years of follow up. The current study illustrates the heterogeneity in management for patients with CAM. Our findings highlight the need for larger studies focusing on BC patients with CAM to optimize their treatment and outcomes. Limitations of our study include its retrospective nature and small sample size given rarity of CAM.

Table 1. Treatment and Outcomes of Patients with CAM

Citation Format: Rima Patel, Shana Berwick, Cao Jin, Paula Klein. Management of Isolated Contralateral Axillary Lymph Node Metastasis in Breast Cancer: A Single Institution Experience [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 P4-07-59.

Abstract P1-12-02: The tolerance of CREATE-X capecitabine dosing in a United States patient population

Background: Capecitabine was shown to prolong overall survival in patients with triple-negative breast cancer (TNBC) with residual disease after neoadjuvant chemotherapy based on the CREATE-X study. The starting dose of capecitabine in CREATE-X was 1250 mg/m2 twice per day on days 1-14 every 3 weeks whereas the United States (US) standard dosing of capecitabine is 1000 mg/m2. Fluoropyrimidine toxicity is higher in the US compared to East Asia. The goal of this study was to evaluate the tolerance of capecitabine at an urban clinic in the US consisting of predominantly non-Asian patients. . Methods: We performed a retrospective chart review of patients with TNBC with residual disease after neoadjuvant chemotherapy who were prescribed capecitabine from June 1, 2017 through June 1, 2021. Exclusion criteria included patients who received capecitabine concurrently with radiation. All statistical analyses were conducted using R software, version 4.1.0. Results: There were 64 patients who met criteria with an average age of 54 (SD 10) years. Of these patients, 13 (20.3%) were Hispanic/Latino; 26 (40.6%) white, 17 (26.6%) African American, and 4 (6.3%) Asian. There were 28 patients (43.8%) prescribed the CREATE-X capecitabine dosing of 1250 mg/m2, 26 (40.6%) prescribed the US standard dosing of 1000 mg/m2, and 10 (15.6%) prescribed a different dosing regimen. Characteristics of patients prescribed capecitabine 1250 mg/m2 and 1000 mg/m2 are in Table 1. Of the 28 patients prescribed 1250mg/m2 dosing, 8 (28.6%) completed 8 cycles, all requiring dose reductions; 7 (25.0%) discontinued due to intolerance. Of the 283 patients in the CREATE-X study treated with 8 cycles of 1250 mg/m2, 107 (37.8%) completed capecitabine treatment with the planned dose compared to no patients in our cohort. Of the 26 patients prescribed 1000 mg/m2, 9 (34.6%) completed 8 cycles with 3 patients requiring dose reductions; 6 (23.1%) discontinued due to intolerance. The most common adverse events were hand-foot syndrome (HFS) in 48 patients (75.0%), nausea in 24 (37.5%), fatigue in 23 (35.9%), and diarrhea in 22 (34.4%). Adverse events based on starting dose of capecitabine can be found in Table 1. The logistic regression was fitted to test the effect of the starting dose of capecitabine on the incidence of dose change after adjusting for the co-variates. The higher starting dose has higher odds (OR 9.065, 95% CI 2.558, 38.190) to change the capecitabine dose at the significant level of 0.05 (Table 2). Conclusions: No patients in our cohort tolerated 8 cycles of the CREATE-X dosing of 1250 mg/m2 compared to 37.8% of the study population. Of the patients who completed 8 cycles of the US standard dosing of capecitabine 1000 mg/m2, 66.7% of patients completed the planned dose. This dose was not studied in CREATE-X. Trials in metastatic disease comparing these two doses demonstrated similar efficacy with less toxicity. Further studies are warranted in this curative intent population.

Table 1.Characteristics by Starting Dose of CapecitabineCapecitabine DoseCharacteristics1250 mg/m2(N = 28)1000 mg/m2(N = 26)Age – yrsMedian (IQR)53.5 [34.0, 65.0]50.0 [30.0, 68.0]Ethnicity – no (%)Hispanic5 (17.9)6 (23.1)Not Hispanic23 (82.1)20 (76.9)Race – no (%)White15 (53.6)9 (34.6)Black/AA5 (17.9)8 (30.8)Asian1 (3.6)1 (3.8)Other7 (25.0)8 (30.8)Clinical Stage – no (%)16 (21.5)1 (3.8)217 (60.7)9 (34.6)35 (17.8)15 (57.7)Unknown0 (0)1 (3.8)Adverse Event – no (%)HFS22 (78.6)19 (73.1)Diarrhea9 (32.1)10 (38.5)Fatigue8 (28.6)11 (42.3)Mucositis1 (3.6)1 (3.8)

Table 2.Odds Ratio95% CIVariableORLCLUCLp-valueCapecitabine Dose1250 mg/m29.0652.55838.1900.0001000 mg/m2RefAge (yr)> 656.4210.477163.8950.158< 65RefEthnicityHispanic1.4490.15515.4070.744Non-HispanicRefRaceAsian1.2010.02857.1560.992Black/AA1.0450.2095.522Other1.3870.15712.926WhiteRefChemoCarbo1.6800.4396.6790.447No carboRefHFSYes0.9200.1964.1540.913NoRef

Citation Format: Alaina Justine Kessler, Natalie S. Berger, Hsin-Hui Huang, Deborah Blythe Doroshow, Paula Klein. The tolerance of CREATE-X capecitabine dosing in a United States patient population [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 P1-12-02.

Experimental surgery as part of the development of degradable biomaterials for cardiovascular surgery

Introduction: Cardiovascular diseases are responsible for significant morbidity and mortality in the population. Artificial vascular grafts are often essential for surgical procedures in radical or palliative treatment. Many new biodegradable materials are currently under development. Preclinical testing of each new material is imperative, both in vitro and in vivo, and therefore animal experiments are still a necessary part of the testing process before any clinical use. The aim of this paper is to present the options of using various experimental animal models in the field of cardiovascular surgery including their extrapolation to clinical medicine. Methods: The authors present their general experience in the field of experimental surgery. They discuss the selection process of an optimal experimental animal model to test foreign materials for cardiovascular surgery and of an optimal region for implantation. Results: The authors present rat, rabbit and porcine models as optimal experimental animals for material hemocompatibility and degradability testing. Intraperitoneal implantation in the rat is a simple and feasible procedure, as well as aortic banding in the rabbit or pig. The carotid arteries can also be used, as well. Porcine pulmonary artery banding is slightly more difficult with potential complications. The banded vessels, explanted after a defined time period, are suitable for further mechanical testing using biomechanical analyses, for example, the inflation-extension test. Conclusion: An in vivo experiment cannot be avoided in the last phases of preclinical research of new materials. However, we try to strictly observe the 3R concept – Replacement, Reduction and Refinement; in line with this concept, the potential of each animal should be used as much as possible to reduce the number of animals.

Hyperbaric oxygen enhances collagen III formation in wound of ZDF rat

Diabetic foot ulcer (DFU) is a serious complication of diabetes and hyperbaric oxygen therapy (HBOT) is also considered in comprehensive treatment. The evidence supporting the use of HBOT in DFU treatment is controversial. The aim of this work was to introduce a DFU model in ZDF rat by creating a wound on the back of an animal and to investigate the effect of HBOT on the defect by macroscopic evaluation, quantitative histological evaluation of collagen (types I and III), evaluation of angiogenesis and determination of interleukin 6 (IL6) levels in the plasma. The study included 10 rats in the control group (CONT) and 10 in the HBOT group, who underwent HBOT in standard clinical regimen. Histological evaluation was performed on the 18th day after induction of defect. The results show that HBOT did not affect the macroscopic size of the defect nor IL6 plasma levels. A volume fraction of type I collagen was slightly increased by HBOT without reaching statistical significance (1.35+/-0.49 and 1.94+/-0.67 %, CONT and HBOT, respectively). In contrast, the collagen type III volume fraction was ~120 % higher in HBOT wounds (1.41+/-0.81 %) than in CONT ones (0.63+/-0.37 %; p=0.046). In addition, the ratio of the volume fraction of both collagens in the wound ((I+III)w) to the volume fraction of both collagens in the adjacent healthy skin ((I+III)h) was ~65 % higher in rats subjected to HBOT (8.9+/-3.07 vs. 5.38+/-1.86 %, HBOT and CONT, respectively; p=0.028). Vessels density (number per 1 mm2) was found to be higher in CONT vs. HBOT (206.5+/-41.8 and 124+/-28.2, respectively, p<0.001). Our study suggests that HBOT promotes collagen III formation and decreases the number of newly formed vessels at the early phases of healing.

Updated results of hybrid transcatheter and minimally invasive left ventricular reconstruction for the treatment of ischemic cardiomyopathy

Aims

Remodelling of the left ventricle (LV) after anterior myocardial infarction can result in a pathological increase in LV volume and reduction in LV ejection fraction (EF). We describe the updated results of an l hybrid transcatheter and minimally invasive surgical technique to reconstruct the negatively remodelled LV by myocardial scar plication and exclusion to rehape and reduce the excess volume, decrease the wall stress and increase LVEF.

Methods and results

Patients were considered eligible for the procedure when they presented with symptomatic heart failure (NYHA-class ≥II or more) and ischemic cardiomyopathy (EF&lt;40%) after anterior myocardial infarction. All patients had a dilated LV with either a- or dyskinetic scar in the anteroseptal wall and/or apex of ≥50% transmurality. Hybrid transcatheter and minimally technique that relies on micro-anchoring technology is used to reconstruct the LV by plication of the fibrous scar. A series of internal and external micro anchors are brought together over a PEEK (poly-ether-ether-ketone) tether to form a longitudinal line of apposition between the LV free wall and the anterior septum from the mid-ventricle to the apex. Internal anchors are deployed by transcatheter technique on the right side of the ventricular septum through the right internal jugular vein. Paired external anchors are advanced through a left sided mini-thoracotomy and deployed on the LV epicardium (figure 1). A specialized Force Gauge is used to bring these “RV-LV” anchors together under measured compression forces. “LV-LV” anchor pairs through the LV apex beyond the distal tip of the RV complete the reconstruction.

Between October 2016 and March 2021 28 patients (23 males, 5 females; mean age 61±12 years) were operated in a single Dutch centre. Procedural success was 100%. On average 2.3±0.8 anchor-pairs were used to reconstruct the LV. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 33±8% to 44±10% (change +35%, P&lt;0.0001) and LV-volumes decreased: LVESV 116 ml ± 52 ml to 69±39 ml (change −35%, P&lt;0.0001) and LVEDV 170 ml ± 72 ml to 118±55 ml (change −29%, P&lt;0.0001). Hospital mortality was 0%. Also no strokes occurred. Median duration of ICU–stay was 2 days (IQR 1–48 days) and median length of hospital stay was 7 days (IQR 5–61 days). Survival at 48 months was 84%. At latest follow-up, 9670% of surviving patients were in NYHA-class I-II compared to 18% preoperatively.

Conclusions

Hybrid transcatheter and minimally invasive LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischemic cardiomyopathy after anteroseptal myocardial infarction. Updated results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and sustained improvement in heart failure symptoms.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Hybrid transcatheter and minimally invasive left ventricular reconstruction for the treatment of ischemic cardiomyopathy: mid-term results

Background

Remodelling of the left ventricle (LV) after anterior myocardial infarction can result in a pathological increase in LV volume and reduction in LV ejection fraction (EF).

Purpose

We describe the mid-term results of a novel hybrid transcatheter and minimally invasive surgical technique to reconstruct the remodelled LV by plication and exclusion of the scar and reduction of the excess volume, resulting in decreased wall stress and increased EF.

Methods

Patients were considered eligible for the procedure when the presented with symptomatic heart failure (NYHA-class II or more) and ischemic cardiomyopathy (EF&lt;40%) after anterior myocardial infarction. All patients had a dilated LV with either an a- or dyskinetic scar in the anteroseptal wall and/or apex of &gt;50% transmurality. An hybrid transcatheter and minimally technique was used that relies on deploying a series of paired internal and external micro-anchors to plicate fibrous scar of infarcted anterior wall myocardial tissue to reconstruct the LV.

Results

Between October 2016 and January 2020 24 patients (21 males, 3 females; mean age 61±13 years) were operated in a single Dutch centre. Procedural success was 100%. On average 2.3±0.9 anchor-pairs were used to reconstruct the LV. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 34±9% to 44±11% (change +34%, P&lt;0.0001) and LV-volumes decreased: LVESV 113 ml ± 54 ml to 68±41 ml (change −39%, P&lt;0.0001) and LVEDV 166 ml ± 75 ml to 116±57 ml (change −30%, P&lt;0.0001). One patient was converted peroperatively to full sternotomy, ECC and cardioplegic arrest because of partial dislodgement of an apical mural thrombus. After removal of the thrombus, the LV was reconstructed with 2 anchor-pairs. One patient underwent a postoperative revision because of RV restriction. After removal of 1 “RV-LV” anchor-pair, the patient made a full recovery. One patient underwent an uncomplicated minimally invasive tricuspid valve replacement because of a lesion to the tricuspid valve during the procedure. Hospital mortality was 0%. Median duration of ICU–stay was 2 days (IQR 1–46 days) and median length of hospital stay was 7 days (IQR 5–57 days). Survival at 36 months was 88%. At latest follow-up, 86% of surviving patients were in NYHA-class I-II compared to 21% preoperatively.

Conclusions

Hybrid transcatheter and minimally invasive LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischemic cardiomyopathy after anteroseptal myocardial infarction. Mid-term results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and improvement in heart failure symptoms.

Revivent TC technique

Funding Acknowledgement

Type of funding source: None

Abstract CT262: Multicenter, phase I/II trial of anastrozole, palbociclib, trastuzumab, and pertuzumab in HR-positive, HER2-positive metastatic breast cancer

Background: Overexpression or amplification of HER2 occurs in approximately 15-20% of patients and roughly half of these tumors are hormone receptor (HR) positive. The use of aromatase inhibitors in the metastatic setting is well established while significant improvement in overall survival has been established with the use of trastuzumab or pertuzumab in HER2-overexpressing tumors. This study will examine the combination of endocrine therapy, palbociclib, and dual HER2 therapy with pertuzumab and trastuzumab in women with metastatic HR+, HER2+ breast cancer. Trial Design: Multicenter, phase I/II trial of Anastrozole, Palbociclib, Trastuzumab and Pertuzumab in HR+, Her2+ metastatic breast cancer. Eligibility Criteria: Newly diagnosed stage IV HR+, HER2+ breast cancer patients. Specific Aims: Phase I: To determine the maximum dose tolerated of palbociclib. Phase II: To determine the clinical benefit rate (CBR) of treatment with anastrozole, palbociclib, trastuzumab, and pertuzumab in HR+, HER2+ metastatic breast cancer patients. Exploratory: Examine potential biomarkers of response to palbociclib including expression of cyclin D1, cyclin E1 and E2, CDK 2, CDK 4, CDK 6, retinoblastoma, phosphorylated retinoblastoma, and p16. RNA sequencing will be used to assess for other predictors of response in an unbiased manner to assess for correlation with inhibition of Ki-67 and phosphorylated retinoblastoma expression as well as evaluate for potential mechanisms of resistance. Methods: This study will evaluate the maximum tolerated dose (MTD) of the Anastrozole, Palbociclib, Trastuzumab and Pertuzumab. Once the MTD is reached, we will assess the clinical benefit rate using a Simon's II stage design among a maximum 30 patients. Accrual: Maximum of 36 subjects. Current Enrollment: Enrollment to phase I ended in October 2018 with one dose escalation to palbociclib 125mg, at which level one DLT was observed. Thus, the MTD was determined at palbociclib 125 mg and subsequent phase II patients will be treated at this dose level. Enrollment to phase II began in February 2019. 39% of planned patients have been enrolled as of January 2020. Clinical trial registry number: NCT03304080.

Citation Format: Krystal Pauline Cascetta, Poulikos Poulikakos, Charles Shapiro, Julie Fasano, Aarti Bhardwaj, Hanna Irie, Anupama Goel, Paula Klein, Meng Ru, Amy Tiersten. Multicenter, phase I/II trial of anastrozole, palbociclib, trastuzumab, and pertuzumab in HR-positive, HER2-positive metastatic breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT262.

Results of a phase Ib study investigating durvalumab in combination with eribulin in patients with metastatic HER2-negative breast cancer and recurrent ovarian cancer

e15120

Background: The release of tumor-associated antigens with cytotoxic chemotherapy treatment may enhance the response to immune checkpoint blockade. Eribulin is a novel microtubule inhibitor with proven overall survival (OS) benefit in metastatic breast cancer (MBC), which may also enhance intratumoral vascular remodeling. Durvalumab, a humanized monoclonal antibody, targets the programmed cell death ligand-1 (PD-L1) receptor. This study sought to determine the recommended phase II dose (RP2D) of eribulin in combination with durvalumab, as well as the safety and preliminary anti-tumor activity of the combination in patients with previously treated HER2-negative MBC and recurrent ovarian cancer (ROC). Methods: Cohorts of 3-6 patients with HER2-negative MBC and ROC were treated in a modified 3+3 design. Eligible patients received escalating doses of eribulin (1.1mg/m2 or 1.4 mg/m2 IV on day 1 and day 8) with durvalumab (1.12g IV on day 1) in 21-day cycles until dose-limiting toxicity (DLT), intolerable adverse events (AEs), disease progression, or other reasons for withdrawal. Primary endpoint: the rate of dose limiting toxicities (DLTs) during cycle 1 and 2 of therapy. Secondary endpoints: AE rate, Objective Response Rate (ORR), progression-free survival (PFS), and OS. Results: Nine patients [median age 63 (37-77)] with median 4 prior therapies for advanced disease were treated: 5 patients with HER2-negative MBC and 4 patients with ROC. The RP2D of eribulin was 1.4mg/m2 in combination with durvalumab. There were no DLTs experienced during the first two cycles of therapy. The most common treatment-related AEs ( > 50%) were fatigue, neutropenia, decreased white blood cell count, anemia, AST and alkaline phosphatase elevation, hyperglycemia, and nausea; most were grade 1/2. There was one immune-related AE of grade ≥3 (hepatitis). Three patients discontinued study drug related to toxicity [neutropenia (n = 1), hepatic toxicity (n = 2)]. ORR was 55% (all partial response) and 4 additional patients experienced stable disease; all MBC patients experienced a response to therapy. Median PFS was 6.2 months. Median OS has not been reached. Conclusions: The combination of eribulin and durvalumab had a favorable AE profile in patients with previously treated HER2- MBC and ROC. The early anti-tumor activity observed in this study suggests that further investigation of this combination is warranted. Clinical trial information: NCT03430518 .

Abstract P5-01-09: Prospective genomic and PD-L1 profiling of patients with residual triple negative breast cancer after neoadjuvant chemotherapy

Background/Rationale: Sensitivity to chemotherapy consistently remains a strong predictor of long term outcomes and survival for patients diagnosed with triple negative breast cancer (TNBC). Patients who do not achieve a complete pathological response to pre-operative, neoadjuvant chemotherapy are at increased risk for metastatic recurrence. Clinical trials with targeted therapies and immunotherapies aim to reduce this risk of recurrence for this patient population. As part of our ongoing prospective study of patients with TNBC that involves serial blood collections and tissue collections (pre-treatment biopsy and post-neoadjuvant surgical specimen) from the time of initial diagnosis, we are particularly focused on those patients with residual disease following neoadjuvant treatment. Comprehensive tissue and cell-free DNA (cfDNA)/circulating tumor cell (CTC) profiling of these patients could lead to insights into mechanisms of chemotherapy resistance and new treatment strategies to prevent recurrences. In addition to genomic profiling, we have analyzed PD-L1 expression on tissue and CTC’s which may contribute to improve targeted utilization of immunotherapies for patients with early stage, high-risk TNBC. Methods: Patients diagnosed with TNBC (stage 1-3) are consented for this prospective study. Serial collections of blood are obtained at time of initial diagnosis, following neoadjuvant chemotherapy or upfront surgery and at 6 month intervals following completion of all active therapy. cfDNA/CTC are isolated using Cynvenio’s Liquid Biopsy platform and sequenced on a rolling basis with Oncomine V3 panel. Tissue from initial biopsy and surgical resection are also collected and sequenced. PD-L1 staining of breast tumor tissue and CTC is performed using antibody SP-142 and atezolizumab, respectively. Clinical outcomes (response to chemotherapy and recurrence data) are also recorded. Results: 30 patients are currently being followed. Of these 24 patients were treated with neoadjuvant chemotherapy and 10/24 (42%) had a pathological complete response (pCR). For the patients treated with neoadjuvant chemotherapy whose pre-treatment samples have been sequenced, 3/6 (50%) of patients who did not achieve a pCR had pre-treatment detectable mutations in cfDNA/CTC in contrast to 3/9 (33%) patients who achieved a pCR. Furthermore, all 6 patients who had residual disease had at least one blood collection with detectable cfDNA/CTC mutations following completion of all active breast cancer therapy. For the five patients with post-neoadjuvant residual disease whose surgical specimens have been stained for PD-L1 expression, 4/5 (80%) are PD-L1 positive (&gt;1%) either in the tumor or infiltrating leukocyte population. PD-L1 positive circulating CTC’s were also detected in 1 of these patients with PD-L1 positive residual disease thus far. Conclusions: Prospective serial analysis of cfDNA/CTC may identify patients who are at higher risk for incomplete response to neoadjuvant therapy or metastatic recurrence. PD-L1 staining of post-neoadjuvant residual cancer and/or CTC’s may help identify high risk patients most likely to benefit from adjuvant immunotherapy.

Citation Format: Hanna Yoko Irie, Paul Schmidt, Elisa Port, Natalie Berger, Paula Klein, Yayoi Kinoshita, Alan Soto, Kereeti Pisapati, Ronald Couri, Olivia Kolodka, Hanane Arib, Robert Sebra, Michael J Donovan. Prospective genomic and PD-L1 profiling of patients with residual triple negative breast cancer after neoadjuvant chemotherapy [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 P5-01-09.

Abstract P2-12-03: A yoga program for breast cancer patients undergoing chemotherapy: Effects on quality of life and chemotherapy-associated symptoms

Background: Patients undergoing chemotherapy for breast cancer (BC) report side effects such as nausea, fatigue and sleep disturbance, which can be exacerbated by stress and anxiety commonly associated with the diagnosis and treatment of BC. Effective management of these symptoms is limited. With yoga as an increasingly popular mind-body practice among Americans today, we conducted a pilot randomized controlled study to evaluate the feasibility and efficacy of yoga on chemotherapy-related symptoms and quality of life (QOL) in patients receiving neoadjuvant or adjuvant chemotherapy. Methods: Women with stage I-III BC scheduled to undergo neoadjuvant or adjuvant chemotherapy at Mount Sinai Chelsea Cancer Center were randomized to start yoga immediately (yoga group) or in 3 months (waitlist control group). The intervention consisted of 12 weekly 60-minute yoga classes. Demographic, clinical, ad treatment related factors were collected. All patients completed self-reported questionnaires including Functional Assessment of Cancer Therapy-Breast (FACT-Breast), Anxiety and Depression Scale (HADS), and Pittsburgh sleep quality inventory (PSQI) at the start, 6 weeks, and 12 weeks after being randomized. Between group analyses were performed using two-sample t-test for baseline, 6 and 12-week time-points. Results: Among the 50 patients enrolled, median age at diagnosis was 51 (range 34-74). The patient population was diverse, with 36% (18) African Americans, 20% (10) Hispanics, 20% (10) Asians, 20% (10) white, and 2 patients of unknown race. Sixty-six percent of the patients had no prior yoga experience, and the average class participation rate was 55%. There was a significant reduction in reported nausea at 12 weeks in the yoga group compared to the control group (p=0.014). In addition, there were trends towards statistical significance in improvement in sleep efficiency (p=0.075) and overall physical well-being (p=0.090) at 12 weeks in the yoga group compared to the control group. Furthermore, in patients with poorer quality of life at baseline, there was a significant improvement in severity of depression (p = 0.050) at 6 weeks, and a trend towards improvement in overall physical well-being at 12 weeks (0.094) in the yoga group compared to the control group. Conclusions: Our study showed that weekly yoga participation is feasible in BC patients receiving adjuvant or neoadjuvant chemotherapy. Yoga intervention led to a significant reduction in nausea, as well as trends towards improvement in sleep efficiency, severity of depression, and overall physical well-being during chemotherapy. Larger studies are warranted to further assess the efficacy of yoga in reducing chemotherapy-associated symptoms in patients with early stage breast cancer.

Citation Format: Tiffany Chen, Paula Klein, Tiffany Xing, Theresa Shao. A yoga program for breast cancer patients undergoing chemotherapy: Effects on quality of life and chemotherapy-associated symptoms [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 P2-12-03.

Genomic comparison of paired primary breast carcinomas and lymph node macrometastases using the Oncotype DX Breast Recurrence Score® test

PURPOSE

Adjuvant therapy decisions may in part be based on results of Oncotype DX Breast Recurrence Score^® (RS) testing of primary tumors. When necessary, lymph node metastases may be considered as a surrogate. Here we evaluate the concordance in gene expression between primary breast cancers and synchronous lymph node metastases, based on results from quantitative RT-PCR-based RS testing between matched primary tumors and synchronous nodal metastases.

METHODS

This retrospective, exploratory study included patients (≥ 18 years old) treated at our center (2005-2009) who had ER+ , HER2-negative invasive breast cancer and synchronous nodal metastases with available tumor blocks from both sites. Paired tissue blocks underwent RS testing, and RS and single-gene results for ER, PR, and HER2 were explored between paired samples.

RESULTS

A wide distribution of RS results in tumors and in synchronous nodal metastases were modestly correlated between 84 paired samples analyzed (Pearson correlation 0.69 [95% CI 0.55-0.78]). Overall concordance in RS group classification between samples was 63%. ER, PR, and HER2 by RT-PCR between the primary tumor and lymph node were also modestly correlated (Pearson correlation [95% CI] 0.64 [0.50-0.75], 0.64 [0.49-0.75], and 0.51 [0.33-0.65], respectively). Categorical concordance (positive or negative) was 100% for ER, 77% for PR, and 100% for HER2.

CONCLUSIONS

There is modest correlation in continuous gene expression, as measured by the RS and single-gene results for ER, PR, and HER2 between paired primary tumors and synchronous nodal metastases. RS testing for ER+ breast cancer should continue to be based on analysis of primary tumors.

A multicentered randomized phase II comparison of single-agent carboplatin versus the combination of carboplatin and everolimus for the treatment of advanced triple-negative breast cancer

TPS1109

Background: Triple negative breast cancer (TNBC) is an aggressive disease with unmet clinical needs. Women with TNBC tend to be younger and demonstrate early recurrence, higher histological grade, higher rate of visceral metastasis and increased mortality rates when compared to hormone positive breast cancer. Prognosis for metastatic TNBC is especially poor. Due to lack of targeted therapies, there is no standard treatment of choice for triple negative breast cancer and chemotherapy remains the accepted standard. Many chemotherapeutic agents have been reported to have clinical activity either as single agent or in combination. Seventy percent of breast cancers with BRCA-1 germline mutations are triple negative, which suggests a shared carcinogenic pathway between them. In preoperative and metastatic settings, both TNBC and BRCA-1 associated breast cancers are particularly sensitive to DNA cross-linking agents such as platinum compounds due to defective DNA repair by homologous recombination. The recent TNT trial showed in patients with triple negative metastatic or recurrent locally advanced breast cancer with BRCA1/2 mutations, carboplatin resulted in a significantly higher overall response rate versus docetaxel (68% versus 33.3%; p=0.03). Triple negative breast cancers are associated with a high frequency of PTEN loss, which leads to mTOR activation. Moreover, it has been reported that mTOR activation may confer resistance to platinum agents such as cisplatin, a phenomenon that may be reversible by the addition of an mTOR inhibitor such as everolimus. There are reports of synergy between mTOR inhibitors and platinum compounds in pre-clinical and clinical data. Methods: We have opened a multi-centered randomized phase II trial comparing carboplatin AUC 4 q 3 weeks vs carboplatin AUC 4 q 3 weeks combined with daily 5 mg everolimus. 41 of planned 72 patients from the Mount Sinai Health System have been enrolled and are randomized in a 2:1 allocation. The primary objective is to compare progression-free survival in patients treated with carboplatin+everolimus to patients treated with carboplatin alone. Patients may have had up to 3 prior regimens for metastatic disease. Exploratory biomarker assessment is being done to identify markers of response. Clinical trial information: NCT02531932.

Should pregnancy testing during chemotherapy be standardized?

e18314

Background: The incidence of cancer diagnosed during pregnancy is 0.1-0.2%. The incidence of women who become pregnant while on chemotherapy is less clear. As the initiative to improve awareness about the risks of infertility in premenopausal women receiving chemotherapy improves, it is also important to reinforce the risk of pregnancy during chemotherapy. Treating patients with chemotherapy, especially during the first trimester, is an absolute contraindication and a serious adverse event. Pregnancy testing prior to the initiation of chemotherapy is recommended by the NCCN and ASCO. However, recommendations on how to monitor for pregnancy after an initial screen are inconsistent and lack standardization. Methods: We surveyed five breast medical oncologists and six infusion nurses at a busy urban breast center to determine their baseline practices for pregnancy counseling and testing. We then initiated a quality improvement project over a six month period to routinely screen premenopausal patients ( < 55 years) diagnosed with breast cancer for pregnancy prior to each cycle of chemotherapy. Results: Of physicians and nurses surveyed, 40% and 33% respectively have diagnosed a pregnancy during chemotherapy. All physicians surveyed check a pregnancy test prior to the initiation of chemotherapy, 60% check urine and 40% check serum. Counseling patients on the risk of pregnancy varies with 80% of physicians counseling patients prior to initiation of chemotherapy. Half of the infusion nurses ask patients if they are concerned they may be pregnant intermittently during chemotherapy and 50% do not ask again after the initial screen. During routine screening over a 6 month period no pregnancies were detected. One patient missed a baseline screening prior to initiating chemotherapy. Two patients had a borderline result ( < 1%) on urine pregnancy testing but reflex serum testing was negative. Compliance for testing by nurses was 93%. Conclusions: Results of the survey demonstrate that pregnancy counseling and screening practices vary even within the same institution. We must improve and standardize educating patients and healthcare providers on the risks of pregnancy during chemotherapy in order to prevent unwanted pregnancies, and identify pregnancies in a timely manner. Given the very small risk of pregnancy, we would not recommend routine screening prior to each cycle of chemotherapy, but we do recommend asking all premenopausal patients if there is a chance they may be pregnant prior to each treatment and test based on the individual risk.

Abstract P6-16-10: Is pregnancy testing during chemotherapy standardized?

The initiative to improve awareness about the risks of infertility for premenopausal patients receiving chemotherapy has improved significantly over time. While the risks for infertility are high, there is still a small risk of pregnancy during chemotherapy. The incidence of cancer diagnosed during pregnancy is 0.1-0.2%. The incidence of women who become pregnant while on chemotherapy is less clear but does occur. Amenorrhea commonly occurs during chemotherapy but this does not necessarily correlate with lack of ovarian function. Treating a patient with an unidentified pregnancy is an adverse event which must be avoided given the high risk it poses to the fetus, especially during the first trimester. Pregnancy testing prior to the initiation of chemotherapy is recommended by the NCCN and ASCO. However, recommendations on how to monitor for pregnancy after an initial screen are inconsistent and lack standardization. Formal guidelines and policies are needed to prevent and/or identify pregnancies while on chemotherapy.

We surveyed five breast medical oncologists and six infusion nurses at a busy urban breast center to determine their baseline practices in regards to pregnancy counseling and testing. Of physicians and nurses surveyed, 40% (2/5) and 33% (2/6) respectively have diagnosed a pregnancy while on chemotherapy. When surveyed about counseling patients on the risks of pregnancy, 80% of physicians counsel patients prior to initiation of chemotherapy, but one physician and one infusion nurse said they do not counsel patients about the risk of pregnancy at any time but do discuss the risks of infertility. All physicians surveyed check a pregnancy test prior to the initiation of chemotherapy, but 60% check urine and 40% check serum. Thereafter 60% will check a pregnancy test after initial screen if the patient is concerned and 40% will check intermittently during chemotherapy. Of the nurses surveyed, 33% will check a pregnancy test after initial screen if the patient is concerned and 50% check intermittently during treatment. Half of the infusion nurses said they ask patients if they are concerned they may be pregnant intermittently during chemotherapy and 50% answered that they do not ask again after the initial screen. On subsequent screens the choice of urine or serum hCG testing varies and is not standardized.

These survey results demonstrate that both pregnancy counseling and pregnancy screening practices vary widely even within the same institution. A standardized approach is essential to increase awareness of pregnancy risk while on chemotherapy, improve education of this risk to patients, prevent unwanted pregnancies, and identify pregnancies as soon as possible. We have initiated a quality improvement project to check urine pregnancy tests monthly in all premenopausal patients (age &lt;55) receiving chemotherapy for breast cancer. Based on our findings we will institute a protocol at our institution for uniform teaching on the small risk of pregnancy and uniform pregnancy testing while on chemotherapy.

Citation Format: Berger N, Fitzpatrick K, Klein P. Is pregnancy testing during chemotherapy standardized? [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 P6-16-10.

Abstract P1-17-04: Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial

Background

Scalp cooling has demonstrated efficacy in preventing hair loss in women with early stage breast cancer receiving neo/adjuvant chemotherapy. Data from 2 prospective trials (Rugo et al, and Nangia et al, JAMA 2017) led to FDA clearance of 2 automated scalp-cooling devices to prevent chemotherapy induced alopecia (CIA). Although scalp metastases from breast cancer are rare, historical concerns about scalp cooling included a theoretical increase in risk of recurrence in scalp due to reduced delivery of chemotherapy to the scalp.

Methods

We conducted a multicenter prospective trial evaluating the efficacy and safety of the DigniCap in women with stage I-II breast cancer receiving neo/adjuvant chemotherapy excluding sequential or combination anthracycline/taxanes with concurrent matched controls. The primary endpoint was unblinded patient self-assessment of 5 photographs using the Dean scale to estimate hair loss 4 weeks following the last dose of chemotherapy, with success defined as a Dean score of 0-2 (≤ 50% hair loss); additional endpoints included quality of life (QOL) and both short and long-term safety.

Results

106 patients using the scalp cooling device and 16 concurrent controls were enrolled. As previously reported, the use of scalp cooling was associated with less alopecia and improvement in several measures of QOL (Rugo et al, JAMA 2017). 91 patients have follow-up (FU) out to 3 years; 73 with estrogen receptor (ER) positive and 18 with ER negative disease. 5 DigniCap patients have developed recurrent breast cancer in breast (n=1), liver (n=1), bone, liver and breast (n=1), bone, liver, lung, and nodes (1), and bone, breast, GI tract and bladder (n=1). Of 12 control patients with available FU, 1 developed metastases to liver. 2 patients have died of metastatic disease, one in the DigniCap arm and one in the control arm. No new safety signals have been detected.

Conclusion

Scalp cooling using the DigniCap system in patients with early stage breast cancer receiving taxane based neo/adjuvant chemotherapy is safe and effective. No scalp metastases have been reported 3 years following completion of study treatment. 4 year FU data will be presented.

The study was funded by The Lazlo Tauber Family Foundation (UCSF), the Anne Moore Breast Cancer Research Fund (Weil Cornell), and the Friedman Family Foundation (Mount Sinai Beth Israel), as well as partially by Dignitana.

Citation Format: Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, D'Agostino, Jr. RB, Deluca A, Cigler T. Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial [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 P1-17-04.

Analytical solution for bending vibration of a thin-walled cylinder rolling on a time-varying force

This paper presents the analytical solution of radial vibration of a rolling cylinder submitted to a time-varying point force. In the simplest situation of simply supported edges and zero in-plane vibration, the cylinder is equivalent to an orthotropic pre-stressed plate resting on a visco-elastic foundation. We give the closed-form solution of vibration as a series of normal modes whose coefficients are explicitly calculated. Cases of both deterministic and random forces are examined. We analyse the effect of rolling speed on merging of vibrational energy induced by Doppler's effect for the example of rolling tyre.

[Biomechanical screening for injury prevention : The importance of 3D-motion analysis in high performance sports]

Standardized clinical diagnostic procedures cannot assess the functionality of the anatomical structures in sport-specific movement. Biomechanical screening is able to detect deficits but is not sufficiently and objectively precise with the current clinical examination tools including conventional imaging techniques. The fields of use of functional testing methods are versatile and range from injury prevention analysis, screening during rehabilitation phases up to the return-to-play decision. Using simple musculoskeletal function analysis it is difficult to assess the risk of injuries. The main advantage of instrumented 3D-motion analysis is its potential to generate objective, reliable and reproducible data with exact joint angles, muscle activity, as well as loading inside the joints during movement. These marker-based motion analysis procedures are more time-consuming and more cost intensive and necessitate in particular biomechanical and medical knowledge to assess the analytical data in terms of clinical relevance. In the absence of scientific studies on biomechanical analyses in professional sports, this study shows preliminary approaches to this topic.

Randomized Phase II Trial of Fulvestrant Plus Everolimus or Placebo in Postmenopausal Women With Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer Resistant to Aromatase Inhibitor Therapy: Results of PrE0102

Purpose The mammalian target of rapamycin inhibitor everolimus targets aberrant signaling through the PI3K/AKT/mammalian target of rapamycin pathway, a mechanism of resistance to anti-estrogen therapy in estrogen receptor (ER)-positive breast cancer. We hypothesized that everolimus plus the selective ER downregulator fulvestrant would be more efficacious than fulvestrant alone in ER-positive metastatic breast cancer resistant to aromatase inhibitor (AI) therapy. Patients and Methods This randomized, double-blind, placebo-controlled, phase II study included 131 postmenopausal women with ER-positive, human epidermal growth factor receptor 2-negative, AI-resistant metastatic breast cancer randomly assigned to fulvestrant (500 mg days 1 and 15 of cycle 1, then day 1 of cycles 2 and beyond) plus everolimus or placebo. The study was designed to have 90% power to detect a 70% improvement in median progression-free survival from 5.4 months to 9.2 months. Secondary end points included objective response and clinical benefit rate (response or stable disease for at least 24 weeks). Prophylactic corticosteroid mouth rinses were not used. Results The addition of everolimus to fulvestrant improved the median progression-free survival from 5.1 to 10.3 months (hazard ratio, 0.61 [95% CI, 0.40 to 0.92]; stratified log-rank P = .02), indicating that the primary trial end point was met. Objective response rates were similar (18.2% v 12.3%; P = .47), but the clinical benefit rate was significantly higher in the everolimus arm (63.6% v 41.5%; P = .01). Adverse events of all grades occurred more often in the everolimus arm, including oral mucositis (53% v 12%), fatigue (42% v 22%), rash (38% v 5%), anemia (31% v. 6%), diarrhea (23% v 8%), hyperglycemia (19% v 5%), hypertriglyceridemia (17% v 3%), and pneumonitis (17% v 0%), although grade 3 to 4 events were uncommon. Conclusion Everolimus enhances the efficacy of fulvestrant in AI-resistant, ER-positive metastatic breast cancer.

Abstract P3-12-13: Breast atypical hyperplasia and guideline compliance

Background: Atypical hyperplasia of the breast is a high-risk benign lesion that is found in approximately 10% of benign breast biopsies[1]and confers a risk for future breast cancer[2]. The American Society of Clinical Oncology guideline states that pharmacologic risk reduction with the use of a selective estrogen receptor modulator or an aromatase inhibitor should be discussed with women with a 5-year projected absolute risk of breast cancer of 1.7% or higher[3]. The NCCN guideline for risk reduction recommends consideration of risk-reduction interventions, including the use of pharmacologic agents in women with a 5-year risk of 1.7% or higher and a life expectancy of 10 years or longer [4] .The majority of women with atypical hyperplasia meet this risk criterion with their cumulative risk of approximately 1% per year.

Method: We retrospectively reviewed excisional biopsy pathology reports between January 2016 and June 2016 with the diagnosis of atypical ductal or lobular hyperplasia to identify patients with pure atypical hyperplasia. Medical records of these patients were then reviewed to identify the percentage of patients referred to a medical oncologist for chemoprevention discussion and the percentage of patients who received chemoprevention following excisional biopsy.

Results: Two hundred seventy six patients with the diagnosis of atypical ductal or lobular hyperplasia were identified. Two hundred and sixteen patients were excluded from the analysis due to the presence of other histologies such as carcinoma in situ and invasive carcinoma. Medical records of the remaining sixty patients with pure atypical hyperplasia were reviewed. Eighteen patients' charts were unavailable for review. All of the remaining forty two patients had a 5-year breast cancer risk of 1.7% or higher. Five of these patients (8.3%) were referred to a medical oncologist for chemoprevention discussion. Two of these five patients (2.3%) received chemoprevention with tamoxifen. For patients who were not referred to medical oncologist, there was one documented discussion of chemoprevention with patient by her surgical oncologist. One patient underwent prophylactic bilateral mastectomies, and therefore, chemoprevention was not recommended.

Conclusion: Multidisciplinary strategies need to be implemented to bridge the gap between guidelines and clinical practices which may lead to improved patient outcomes.

References:

1. 1. Simpson JF. Update on atypical epithelial hyperplasia and ductal carcinoma in situ. Pathology 2009;41:36-39.

2. 2. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med 2005;353:229-237.

3. Visvanathan K, Hurley P, Bantug E, et al. Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013;31:2942-2962. J Clin Oncol 2013;31:4383.

Citation Format: Lee LM, Klein P, Velazy R. Breast atypical hyperplasia and guideline compliance [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 P3-12-13.

[Asylum seekers and the healthcare situation]

Medical healthcare for refugees is strictly regulated by law in Germany but the great regional variation in the implementation is currently a huge challenge for healthcare providers. Providers are often not familiar with the specific local regulations and especially in emergencies it is often not possible to clarify open questions before treating patients. The high influx of refugees in the summer and fall of 2015 led to a situation that could only be managed with the voluntary and pragmatic help of all healthcare personnel involved. This article explains the most relevant regulations covering medical healthcare for refugees and asylum seekers. In addition, the procedure for the approval of asylum status in itself can have a direct or indirect impact on the health status of these individuals; therefore, some comments are made regarding this aspect.

The last frontier: transcatheter devices for percutaneous or minimally invasive treatment of chronic heart failure

Heart failure has a high prevalence in the general population. Morbidity and mortality of heart failure patients remain high, despite improvements in drug therapy, implantable cardioverter-defibrillators and cardiac resynchronisation therapy. New transcatheter implantable devices have been developed to improve the treatment of heart failure. There has been a rapid development of minimally invasive or transcatheter devices used in the treatment of heart failure associated with aortic and mitral valve disease and these devices are being incorporated into routine clinical practice at a fast rate. Several other new transcatheter structural heart interventions for chronic heart failure aimed at a variety of pathophysiologic approaches are currently being developed. In this review, we focus on devices used in the treatment of chronic heart failure by means of left ventricular remodelling, left atrial pressure reduction, tricuspid regurgitation reduction and neuromodulation. The clinical evaluations of these devices are early-stage evaluations of initial feasibility and safety studies and additional clinical evidence needs to be gathered in appropriately designed clinical trials.

Perioperative management of antiplatelet treatment in patients undergoing isolated coronary artery bypass grafting in Dutch cardiothoracic centres

BACKGROUND

International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG).

METHODS

A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014.

RESULTS

Eleven centres responded to the survey. Acetylsalicylic acid monotherapy was discontinued before surgery in 6 centres. In patients with an acute coronary syndrome receiving dual antiplatelet therapy (DAPT), most centres discontinued the P2Y₁₂ inhibitor preoperatively. DAPT was restarted after surgery in 4 centres. However, 6 centres continued DAPT in patients who had undergone coronary stenting within one month of surgery. In patients with coronary stents, variation in the management of antiplatelet therapy increased in proportion to the interval between stenting and surgery. A total of 70 patients were included in the registry. Acetylsalicylic acid monotherapy was discontinued in 51% of patients and restarted in all patients. P2Y₁₂ inhibitor treatment was discontinued before surgery in 70% of patients and re-initiated after CABG in 29%.

CONCLUSIONS

Major differences were observed in the preoperative and postoperative management of antiplatelet treatment between different Dutch cardiothoracic centres and within a single centre. Part of this variation is probably due to lack of evidence and differences between the current guidelines; however, many of the strategies were not in accordance with any of these guidelines.

PABPN1 gene therapy for oculopharyngeal muscular dystrophy

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant, late-onset muscle disorder characterized by ptosis, swallowing difficulties, proximal limb weakness and nuclear aggregates in skeletal muscles. OPMD is caused by a trinucleotide repeat expansion in the PABPN1 gene that results in an N-terminal expanded polyalanine tract in polyA-binding protein nuclear 1 (PABPN1). Here we show that the treatment of a mouse model of OPMD with an adeno-associated virus-based gene therapy combining complete knockdown of endogenous PABPN1 and its replacement by a wild-type PABPN1 substantially reduces the amount of insoluble aggregates, decreases muscle fibrosis, reverts muscle strength to the level of healthy muscles and normalizes the muscle transcriptome. The efficacy of the combined treatment is further confirmed in cells derived from OPMD patients. These results pave the way towards a gene replacement approach for OPMD treatment.

Oculopharyngeal muscular dystrophy is caused by trinucleotide repeat expansions in the PABPN1 gene. Here the authors use AAV-based gene therapy to knockdown the mutant gene and replace it with a wild-type allele, and show effectiveness in mice and in patient cells.

Abstract P5-11-17: Body image in women with breast cancer using a scalp cooling system to reduce chemotherapy induced alopecia

Background: Most women consider hair to be an important part of body image. Alopecia is an emotionally traumatic side effect for breast cancer patients undergoing adjuvant chemotherapy. The DigniCap™ Scalp Cooling System is the first scalp cooling system cleared by the US Food and Drug Administration to reduce the likelihood of chemotherapy induced alopecia.

Methods: Quality of Life (QOL) data were collected as part of a prospective clinical trial evaluating the clinical performance of scalp cooling in women with early stage BC receiving adjuvant chemotherapy.

The study's primary endpoint was hair loss as evaluated by patient self-assessment. Treatment success was defined as ≤ 50% hair loss. QOL was evaluated by the EORTC-QLQ-BR23 (BR23) administered at baseline, last chemotherapy cycle, and one month later. For BR23, 4 response categories were collapsed to 2 categories (Not at all/A little bit and Quite a bit/Very much) for analysis. QOL was compared between those with success vs. failure of scalp cooling.

Results: 101 patients were evaluable for the primary endpoint: Success was seen in 67 (66.3%) pts. QOL at study entry was comparable between pts with scalp cooling success or failure for each item in the BR23 questionnaire. Results reported as percentages of patients in each group who answered either quite a bit or very much to body image-related questions on the BR23 questionnaire are displayed in Table 1.

BR23 results (% quite a bit/very much) one month after chemotherapyBR23 ItemsTreatment Success % (95% CI)Treatment Failure % (95% CI)Felt physically less attractive18.5% (9.0%, 27.9%)52.2% (31.8%, 72.6%)Felt less feminine15.4% (6.6%, 24.2%)29.1% (19.2%, 59.1%)Found it difficult to see themselves naked13.8% (5.5%, 22.2%)21.7% (4.9%, 38.6%)Felt dissatisfied with their body12.3% (4.3%, 20.3%)26.1% (8.1%, 44.0%)

Conclusions: Women with breast cancer using scalp cooling during chemotherapy who had hair preservation experienced improved quality of life, according to self-assessment of body image, compared to women who had significant hair loss.

Citation Format: Cigler T, Melin SA, Klein P, Hurvitz SA, Melisko M, Moore A, Park GD, Bageman E, Ver Hoeve ES, Rugo HS. Body image in women with breast cancer using a scalp cooling system to reduce chemotherapy induced alopecia [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 P5-11-17.

Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer

IMPORTANCE

Chemotherapy-induced alopecia is a common and distressing adverse effect. In previous studies of scalp cooling to prevent chemotherapy-induced alopecia, conclusions have been limited.

OBJECTIVES

To evaluate whether use of a scalp cooling system is associated with a lower amount of hair loss among women receiving specific chemotherapy regimens for early-stage breast cancer and to assess related changes in quality of life.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study conducted at 5 US medical centers of women with stage I or II breast cancer receiving adjuvant or neoadjuvant chemotherapy regimens excluding sequential or combination anthracycline and taxane (106 patients in the scalp cooling group and 16 in the control group; 14 matched by both age and chemotherapy regimen). The study was conducted between August 2013 and October 2014 with ongoing annual follow-up for 5 years.

EXPOSURES

Use of a scalp cooling system. Scalp cooling was initiated 30 minutes prior to each chemotherapy cycle, with scalp temperature maintained at 3°C (37°F) throughout chemotherapy and for 90 minutes to 120 minutes afterward.

MAIN OUTCOMES AND MEASURES

Self-estimated hair loss using the Dean scale was assessed 4 weeks after the last dose of chemotherapy by unblinded patient review of 5 photographs. A Dean scale score of 0 to 2 (≤50% hair loss) was defined as treatment success. A positive association between scalp cooling and reduced risk of hair loss would be demonstrated if 50% or more of patients in the scalp cooling group achieved treatment success, with the lower bound of the 95% CI greater than 40% of the success proportion. Quality of life was assessed at baseline, at the start of the last chemotherapy cycle, and 1 month later. Median follow-up was 29.5 months.

RESULTS

Among the 122 patients in the study, the mean age was 53 years (range, 28-77 years); 77.0% were white, 9.0% were black, and 10.7% were Asian; and the mean duration of chemotherapy was 2.3 months (median, 2.1 months). No participants in the scalp cooling group received anthracyclines. Hair loss of 50% or less (Dean score of 0-2) was seen in 67 of 101 patients (66.3%; 95% CI, 56.2%-75.4%) evaluable for alopecia in the scalp cooling group vs 0 of 16 patients (0%) in the control group (P < .001). Three of 5 quality-of-life measures were significantly better 1 month after the end of chemotherapy in the scalp cooling group. Of patients who underwent scalp cooling, 27.3% (95% CI, 18.0%-36.6%) reported feeling less physically attractive compared with 56.3% (95% CI, 31.9%-80.6%) of patients in the control group (P = .02). Of the 106 patients in the scalp cooling group, 4 (3.8%) experienced the adverse event of mild headache and 3 (2.8%) discontinued scalp cooling due to feeling cold.

CONCLUSIONS AND RELEVANCE

Among women undergoing non-anthracycline-based adjuvant chemotherapy for early-stage breast cancer, the use of scalp cooling vs no scalp cooling was associated with less hair loss at 4 weeks after the last dose of chemotherapy. Further research is needed to assess outcomes after patients receive anthracycline regimens, longer-term measures of alopecia, and adverse effects.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01831024.

Randomized phase II trial of fulvestrant alone or in combination with bortezomib in hormone receptor-positive metastatic breast cancer resistant to aromatase inhibitors: a New York Cancer Consortium trial

The proteasome inhibitor bortezomib enhances the effect of the selective estrogen receptor (ER) downregulator (SERD) fulvestrant by causing accumulation of cytoplasmic ER aggregates in preclinical models. The purpose of this trial was to determine whether bortezomib enhanced the effectiveness of fulvestrant. One hundred eighteen postmenopausal women with ER-positive metastatic breast cancer resistant to aromatase inhibitors (AIs) were randomized to fulvestrant alone (Arm A-500 mg intramuscular (i.m.) day -14, 1, 15 in cycle 1, and day 1 of additional cycles) or in combination with bortezomib (Arm B-1.6 mg/m² intravenous (i.v.) on days 1, 8, 15 of each cycle). The study was powered to show an improvement in median progression-free survival (PFS) from 5.4 to 9.0 months and compare PFS rates at 6 and 12 months (α=0.10, β=0.10). Patients with progression on fulvestrant could cross over to the combination (arm C). Although there was no difference in median PFS (2.7 months in both arms), the hazard ratio for PFS in Arm B versus Arm A (referent) was 0.73 (95% confidence interval (CI)=0.49, 1.09, P=0.06, 1-sided log-rank test, significant at the prespecified 1-sided 0.10 α level). At 12 months, the PFS proportion in Arm A and Arm B was 13.6% and 28.1% (P=0.03, 1-sided χ²-test; 95% CI for difference (14.5%)=-0.06, 29.1%). Of 27 patients on arm A who crossed over to the combination (arm C), 5 (18%) were progression-free for at least 24 weeks. Bortezomib likely enhances the effectiveness of fulvestrant in AI-resistant, ER-positive metastatic breast cancer by reducing acquired resistance, supporting additional evaluation of proteasome inhibitors in combination with SERDs.

Abstract P3-07-07: The updated ASCO/CAP guidelines for HER2 testing create more uncertainty for clinicians

Background: Accurate assessment of the Human Epidermal Growth Factor Receptor 2 (HER2) status has been an integral part of clinical decision making in treatments of breast cancer. In 2007, American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) published a series of guidelines on how to determine the status of HER2. The guidelines were updated in 2013 with the goal of reducing the numbers of false negative cases. The new guidelines are based on a combination of HER2:CEP17 ratio and average HER2 copy number. We sought to assess the overall effect of the new guidelines.

Methods: We retrospectively identified all cases of invasive breast cancer with HER2 testing done in 2014 from the pathology database of Mount Sinai Beth Israel, Mount Sinai St. Luke's and Roosevelt Hospitals. Our pathology department guideline is to perform initial testing for HER2 with immunohistochemistry (IHC) by the HercepTest (Dako) method. Those with IHC of 2+ would be followed by reflex HER2 dual probe FISH. The HER2:CEP 17 ratio and average HER2 copy number were then reviewed for each IHC 2+ case using the 2013 guidelines. These cases were then rescored using the 2007 guidelines. All equivocal cases as determined by the new 2013 guidelines (HER2:CEP17 ratio &lt;2.0 with an average HER2 copy number ≥4.0 and &lt;6.0 signals/cell) were further evaluated to determine whether repeat HER2 testing was performed as suggested by the new guidelines and whether HER2 directed therapy was recommended for patient.

Results: Among 853 cases identified in the database, 337 were IHC 2+. Using 2007 guidelines, 27/337 cases (8.0%) were amplified (HER2:CEP 17 ratio &gt;2.2), 6 (1.8%) were equivocal (HER2:CEP 17 ratio 1.8-2.2), and 305 cases (90.2%) were non-amplified (HER2:CEP 17 ratio &lt;1.8). Using the 2013 guidelines, 29/337 cases (8.6%) were amplified (HER2:CEP 17 ratio ≥2 or HER2 copy number ≥6), 23 (6.8%) were equivocal (HER2:CEP17 ratio &lt;2.0 with an average HER2 copy number ≥4.0 and &lt;6.0), and 284 (84.3%) were non-amplified (HER2:CEP 17 ratio &lt;2 with an average HER2 copy number &lt;4.0). The new guidelines resulted in change in HER2 status in 24 cases (7.1%): 2 cases changed from equivocal to amplified, 1 case changed from equivocal to non-amplified, but 20 cases changed from non-amplified to equivocal. Of the 23 equivocal cases determined using the 2013 guidelines, only 13 cases had repeat HER2 analysis. On repeat HER2 testing, one case was found to be HER2 amplified, 4 cases were non-amplified, and 8 cases remained equivocal. Only one equivocal case received HER2 directed treatment.

Conclusion: The 2013 ASCO/CAP guidelines for HER2 assessment identified a slightly increased number of patients eligible for HER2 directed therapy, but also resulted in a significant increase in the number of equivocal cases. The new guidelines appear to have generated more uncertainty for the clinician due to the rise in equivocal cases. Further studies are needed to determine whether patients with equivocal HER2 status would benefit from HER2 directed therapy.

Citation Format: Chen J, Klein P, Shao T. The updated ASCO/CAP guidelines for HER2 testing create more uncertainty for clinicians. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-07.

Abstract S6-03: Randomized phase II trial of fulvestrant alone or in combination with bortezomib in hormone receptor-positive metastatic breast cancer resistant to aromatase inhibitors: A New York cancer consortium trial

Purpose: Fulvestrant (F) is a selective estrogen receptor downregulator (SERD) with activity in aromatase-inhibitor (AI) resistant estrogen receptor (ER)-positive metastatic breast cancer (MBC). In preclinical studies, the proteasome inhibitor bortezomib (B) enhances the antineoplastic effects of F, in part by promoting accumulation of large ER-aggregates that lead to cell death (Ishii et al. Clin Cancer Res 2011 17:2292). The objective of this study was to determine if the combination of F+B was more efficacious than F alone in MBC after AI progression.

Patients and Methods: Postmenopausal women with ER-positive MBC who had progressive disease after prior AI therapy were eligible. They were randomized to F alone (500 mg IM days -15, 1, 15 in cycle 1, and day 1 of each subsequent cycle) or in combination with B (1.6 mg/m2 IV on days 1, 8, 15). The primary endpoint was progression free survival (PFS), measured from cycle 1, day 1 of starting F. A sample size of 118 was pre-specified in order to provide sufficient power to detect an improvement in median PFS from 5.4 to 9.0 months, and compare PFS rates after 6 and 12 months (1-sided alpha=0.10, beta=0.10). Patients with progression on F could cross over to the F+B combination.

Results: Of 118 patients enrolled, 59 received F alone (arm A), 57 received F+B (arm B), and 2 assigned to arm B never initiated protocol therapy. There were no significant differences in patient characteristics between arms with regard to median age (57 vs. 59 years), ECOG performance status (0 and 1, 64% and 36%, respectively), prior chemotherapy for metastasis (25%), or liver metastases (37%), although patients in arm A had longer median interval between diagnosis and metastasis (49 vs. 28 months) and were more likely to present with metastasis (32% vs. 26%). Patients in arm B had more adverse events (all grades), including nausea (63% vs. 29%), diarrhea (47% vs. 8%), sensory neuropathy (46% vs. 29%), and limb edema (37% vs. 19%), although grade 3-4 events were uncommon, and only 11% discontinued B due to toxicity. At 12 months, the PFS proportion in Arm A and Arm B was 13.6% vs. 28.1%, respectively (P=0.03, 1-sided chi-square test) (95% CI for difference [14.5%] = -0.06%, 29.1%). Although median PFS was similar in the two arms (2.69 vs. 2.73 months, respectively), the hazard ratio for Arm B vs. Arm A (referent) was 0.73 (95% CI = 0.49, 1.09, P=0.06, 1-sided log rank test). Both results were significant at the pre-specified 1-sided 0.10 alpha level. Of 27 patients on arm A who crossed over to F+B at progression, 4 (15%) were progression-free for at least 24 weeks and had periods of disease control that were longer than when treated with F alone.

Conclusion: Adding bortezomib to fulvestrant in AI-resistant ER-positive MBC enhances its effectiveness by delaying acquired fulvestrant resistance. These results support additional evaluation of proteasome inhibitors in combination with SERDs.

Acknowledgement: Supported by contract N01-CM-62204 to the New York Cancer Consortium (P.I. J. Sparano) and grant P30 CA013330 (P.I. D. Goldman) from the National Institutes of Health, and by a grant from Millennium, Inc.

Citation Format: Kerin B Adelson, Bhuvaneswari Ramaswamy, Joseph A Sparano, Paul J Christos, John J Wright, George Raptis, Miguel C Villalona, Cynthia X Ma, Dawn Hershman, Joseph Baar, Paula Klein, Tessa Cigler, G Thomas Budd, Yelena Novik, Antoinette R Tan, Susan Tannenbaum, Anupama Goel, Ellis Levine, Charles L Shapiro, Eleni Andreopoulou, Michael Naughton, Kevin Kalinsky, Samuel Waxman, Doris Germain. Randomized phase II trial of fulvestrant alone or in combination with bortezomib in hormone receptor-positive metastatic breast cancer resistant to aromatase inhibitors: A New York cancer consortium trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr S6-03.

Abstract P3-12-10: Calcium and magnesium infusion for the prevention of taxane induced neuropathy in early stage breast cancer

Background: Taxane is an active drug in the treatment of breast cancer, but peripheral neuropathy is a major dose limiting side effect. There are currently no effective drugs or treatment modalities for the prevention or treatment of taxane-related neuropathy. We examined whether calcium and magnesium (Ca/Mg) infusions can reduce the incidence of neuropathy in patients with early stage breast cancer who are treated with paclitaxel.

Methods: This was a pilot study evaluating the feasibility of Ca/Mg infusion to prevent taxane induced neuropathy in women with early stage breast cancer receiving adjuvant or neo-adjuvant paclitaxel treatment, either given every 2 weeks for 4 cycles or every week for 12 weeks. All patients received calcium gluconate and magnesium sulfate infusion, 1 g of each agent immediately before and after each dose of paclitaxel. The primary endpoint was paclitaxel-related neuropathy grade 2 or greater as measured by NCI Common Terminology Criteria Version 3 compared with historical controls. Secondary endpoints included other measures of neuropathy and quality of life such as the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) score, taxane-related neuropathic pain as measured by the Brief Pain Inventory-Short Form (BPI-SF). The endpoints were assessed in patients midway through treatment, at the end of treatment and 4 weeks after finishing taxane therapy.

Results: We enrolled 50 patients, 47 patients were evaluable, and 3 patients were taken out of the study due to non-neuropathy related side effects or progression of disease. Median age: 50.8 (range 27-71), White/Hispanic/Black/Asian/Other: 17/16/12/3/2. Two patients received paclitaxel every 2 weeks, while the remainder received weekly therapy. Eight of 47 patients (17%) had grade 2 neuropathy four weeks after treatment completed, while no patients had grade 3 or 4 neuropathy. This rate of neuropathy is significantly lower compared to that seen in historical control where approximately 30% of patients develop grade 2 or greater neuropathy. There were no significant changes in the quality of life measurements. There were no observed toxicities related to the Ca/Mg infusion.

Discussion: Our study showed a decreased incidence of paclitaxel-related neuropathy in patients receiving Ca/Mg infusions when compared to historical controls. The infusions are well tolerated without any side effects. Randomized studies are warranted to further evaluate Ca/Mg infusion for the prevention of paclitaxel-related neuropathy.

Citation Format: Theresa Shao, Joshua Kra, Paula Klein, Anupama Goel, Stephen Malamud, Tiffany Xing, Johnny Chan, Michael L Grossbard. Calcium and magnesium infusion for the prevention of taxane induced neuropathy in early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-12-10.

NMR crystallography of monovalent cations in inorganic matrixes: Li+ siting and the local structure of Li+ sites in ferrierites

A new approach to the determination of the Li⁺ siting and the local structure of Li⁺ sites in zeolites is reported.

The incidence of hepatocellular carcinoma is reduced in patients with chronic hepatitis B on long-term nucleos(t)ide analogue therapy

BACKGROUND

North American data are lacking on the effect of nucleos(t)ide analogues (NA) in preventing chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC).

AIM

To determine the incidence of HCC in NA-treated patients and compare this risk with that predicted without treatment based on the REACH-B model.

METHODS

In this retrospective study, the incidence of HCC was determined in CHB patients initiated on NA from 1999 to 2012. Pre-treatment data utilised in the REACH-B model were used to predict the annual HCC risk. The standardised incidence ratio (SIR) for HCC was calculated by comparing the observed to expected number of cases, and HCC risk factors determined by Cox proportional hazards regression.

RESULTS

Five hundred and forty nine initiated NA (14% lamivudine, 5% adefovir, 1.5% telbivudine, 39% entecavir, 41% tenofovir). Over a median follow-up of 3.2 years (IQR 1.9-4.6), 11 (3.2%) were diagnosed with HCC. Among 322 with data to calculate the REACH-B model, the median age at treatment initiation was 46 years (IQR 38-55), 65% were male, 32% HBeAg positive and 20% had cirrhosis. The median pre-treatment ALT was 71 U/L (IQR 41-127) and HBV DNA was 6.48 log10 copies/mL (4.95-8.04). The observed annual HCC incidence (0.9%; 95% CI 0.5-1.7) was significantly lower than predicted without treatment by the REACH-B model (SIR 0.46; 95% CI 0.23-0.82); this risk was reduced after 4 years of therapy (SIR 0.49; 95% CI 0.2-1.00).

CONCLUSIONS

In this Canadian study of nucleos(t)ide analogues-treated patients with chronic hepatitis B, the incidence of HCC was lower than expected, suggesting that NA reduce the risk of chronic hepatitis B-related HCC.