Abstract P1-09-14: Demographic, clinical/disease characteristics, and treatment of patients with germline mutated metastatic breast cancer: A CancerLinQ study

Objective: To describe the demographics, clinical/disease characteristics and treatment patterns of patients with germline BRCA mutated (gBRCAm) metastatic breast cancer (mBC) as compared to those with gBRCA wild type (wt) and those who are untested for gBRCA mutations.

Methods: The CancerlinQ Discovery Database (CLQ), launched by the American Society of Clinical Oncology (ASCO) in 2016, consists of longitudinal, demographic and geographic diverse data aggregated from oncology practice electronic health record (EHR) databases. Natural language processing and technology-enabled curation are utilized to identify records of most interest, followed by manual curation to abstract information from unstructured EHR fields. This cohort consists of 7,889 patients diagnosed with mBC between 1982 and 2018, and is enriched for patients with gBRCA testing through the curation process.

Results: Overall most patients were female (99.0%), white (55.3%), and the median age at mBC diagnosis was 63 years (yrs). The majority were not tested for gBRCA mutation (88.4%); 2.0% were gBRCAm, 9.2% were gBRCAwt, 0.4% had an undetermined test result, and 0.1% had a variant of unknown significance. Among those tested for estrogen-receptor (ER) (n=6,700) and progesterone-receptor (PR) (n=6,737) status, 76.6% were ER positive (+) and 62.2% were PR+. Among those tested for human epidermal growth factor receptor 2 (HER2) (n=6,696), 21.7% were HER2+. Among those with known results for ER, PR, and HER2 (n=6,063), 10.1% were hormone receptor (HR)+/HER2+, 10.6% were HR negative (-)/HER2+, 65.0% were HR+/HER2-, and 14.3% were HR-/HER2-. The median age at mBC diagnosis was 50 yrs for gBRCAm, 51 yrs for gBRCAwt and 64 yrs among the gBRCA untested group. A similar proportion of patients were diagnosed with metastatic disease among the gBRCAm and gBRCAwt groups (25.3% and 20.3%, respectively), while the proportion was higher among the gBRCA untested group (38.0 %). The most common site of metastasis for all groups was bone (35.1% for gBRCAm, 41.7% for gBRCAwt, and 36.5 % for gBRCA untested), followed by liver (16.2% for gBRCAm, 13.3% for gBRCAwt, and 8.5% for gBRCA untested). The most common first-line therapies for gBRCAm patients were tamoxifen (7.7%), letrozole (7.0%), cyclophosphamide+doxorubicin (6.3%), and paclitaxel (6.3%); for gBRCAwt patients they were cyclophosphamide+doxorubicin (6.6%), paclitaxel (6.4%), and tamoxifen (6.4%); and for gBRCA untested patients they were letrozole (11.1%), fulvestrant (9.3%), and tamoxifen (4.6%). The mean number of lines of therapy (including lines of chemotherapy and hormone therapy) were 3.5, 3.8, and 3.4 for the gBRCAm, gBRCAwt, and gBRCA untested groups, respectively.

Conclusions: Patients with gBRCAm were younger than the gBRCA untested group, and more patients had metastatic disease at diagnosis in the gBRCA untested group. Further analyses accounting for HR and HER2 status will be conducted and presented. This is the first example of research using curated breast cancer data from ASCO's CLQ.

Citation Format: Dalvi T, Herr I, Maclachlan S, Briceno J, Bennett J, McLaurin K, Hettle R, McCutcheon S. Demographic, clinical/disease characteristics, and treatment of patients with germline mutated metastatic breast cancer: A CancerLinQ study [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 P1-09-14.

Abstract P1-09-13: A real world evidence study of BRCA mutations and survival in HER2-negative breast cancer

Background: Limited data exist on the natural history (treated with standard of care) of metastatic breast cancer (mBC) characterized by germline breast cancer susceptibility gene mutations (gBRCAm). Real-world data examining survival for patients with gBRCAm mBC, overall and separated into gBRCA1m and gBRCA2m, compared to gBRCA wild type (wt) mBC, can help to clarify the prognostic outlook associated with the gBRCA mutation.

Methods: Adults with human epidermal growth factor receptor 2 negative (HER2-) mBC diagnosed from January 2013 – August 2017 were retrospectively selected from the Flatiron Health Oncology electronic medical record database. Patients were classified as having gBRCA1m, gBRCA2m, or gBRCAwt disease. Those who did not receive the genetic testing or who had equivocal results were classified as gBRCA unknown. Overall survival (OS) was calculated from first diagnosis of mBC, as well as from the start of first- and second-line therapy for metastatic disease. Lines of therapy included both hormonal and systemic therapies. Kaplan-Meier analyses provided median OS with 95% confidence interval (CI). Unadjusted log-rank tests compared OS between gBRCA1m and gBRCA2m, and between overall gBRCAm and gBRCAwt.

Results: Of 8,080 patients selected, mean age at first mBC diagnosis was 64 years, 98.7% were female, and 82.0% had evidence of hormone receptor positive disease. gBRCA status was known for 1,852 (22.9%) of patients, of whom 89 (4.8%) had gBRCA1m, 152 (8.2%) had gBRCA2m, and 8 (0.4%) had both gBRCA mutations. Patients with known gBRCA status were younger, with mean ages of 52 years for gBRCAm, 55 years for gBRCAwt, and 67 years for gBRCA unknown. Hormone receptor positive disease was less common among those with known gBRCA status (71.9%, 77.2%, and 83.6% for gBRCAm, gBRCAwt, and gBRCA unknown, respectively). Median (95% CI) OS from mBC diagnosis was 22 (14 - 26) months for gBRCA1m and 30 (27 - 37) months for gBRCA2m (p = 0.01), though numbers were quite small by the median timepoint. Overall gBRCAm disease was associated with median survival of 28 (25 - 32) months, compared to 32 (30 - 35) months for gBRCAwt (p = 0.07); survival was similar between groups for the first 24 months but declined thereafter in the gBRCAm group. Similar patterns were observed for OS after the start of first- and second-line therapy, although no comparisons were significant. Further analyses will present adjusted results and comparisons with outcomes for the patients with gBRCA unknown.

Conclusions: This real-world study of patients receiving care in largely community oncology clinics suggests that survival after diagnosis of mBC is reduced in patients with gBRCA1m compared to gBRCA2m disease and may be reduced in gBRCAm mBC overall. Effective treatments targeted for the gBRCAm subtypes of mBC appear to be needed.

Citation Format: Dalvi T, McLaurin K, Briceno J, Nordstrom B, Bennett J, Hettle R, Murphy B, Collins J, McCutcheon S. A real world evidence study of BRCA mutations and survival in HER2-negative breast cancer [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 P1-09-13.

Use of a new immunoassay to measure PrP Sc levels in scrapie-infected sheep brains reveals PrP genotype-specific differences

The diagnosis of prion diseases, such as scrapie and BSE, has traditionally relied upon the identification of the disease-associated form of the prion protein, PrP(Sc), based on its resistance to digestion by proteinase K (PK). A more recent development is the conformation-dependent immunoassay (CDI), which distinguishes between PrP Sc and normal PrP (PrP C) based on their differing solubility in guanidine hydrochloride rather than resistance or sensitivity to PK. We have developed a CDI-formatted sandwich immunoassay for the measurement of PrP Sc in sheep brain, which discriminates between clinically affected scrapie cases (natural or experimental) and uninfected controls of the same PrP genotype. Using this method, we have shown for the first time that, in sheep, the PrP genotype has a significant influence on the amount of PrP Sc deposited in the brains of animals experimentally infected with scrapie.

P34(cdc2) kinase is associated with cortical microtubules from higher plant protoplasts

The cell cycle regulatory enzyme p34(cdc2) kinase is known to be localized to the preprophase band, the spindle and the phragmoplast, but not to interphase cortical microtubules. This was investigated further by mechanically cleaving substrate-attached protoplasts to leave plasma membrane disks bearing microtubules freed of nuclear and cytosolic signal. Antibodies to PSTAIRE and to specific C-terminal peptides of cdc2a, were used in immunofluorescence, protein blotting and immunogold electron microscopy to demonstrate that antigen is located on the cortical microtubules of carrot, tobacco BY-2 and Arabidopsis cells.

"Caged cytoskeletons": a rapid method for the isolation of microtubule-associated proteins from synchronized plant suspension cells

In the cytoskeleton method for isolating microtubule-associated proteins MAP65, DcKRP120-1 and DcKRP120-2, carrot cells are first converted to protoplasts but this method cannot be used to isolate mitotic MAPs as mitotic synchrony is eroded during lengthy cellulase treatment. Anti-microtubule cycle blocks would also be unsuitable. We report here a method for overcoming these problems. Cellulase degradation of tobacco BY-2 cells for only several minutes allows extraction of detergent-soluble proteins, leaving synchronized "caged cytoskeletons" for depolymerization and enabling affinity purification of MAPs on neurotubules. This rapid and simple method should be of general utility: it can be bulked up, avoids anti-microtubule blocks, and is applicable to other cell suspensions. The effectiveness of the caged cytoskeleton method is demonstrated by comparing known MAPs (the 65 kDa structural MAPs and the kinesin-related protein, TKRP125) in synchronized cells taken at the mitotic peak with those in unsynchronized cells.

Development of Weather-Dependent Flow Requirements for River Temperature Control

/ Streamflow influences biological processes, habitat, and ecological integrity of streams in a number of vital ways. The establishment of weather-dependent minimum flows is essential to the protection of the aquatic environment and wildlife habitat from the adverse impacts of high water temperatures and to the effective utilization of the assimilative capacity of instream flows. In this study, weather-dependent flow requirements for summer river temperature control are derived from quantitative temperature-flow relationships. Correlation and regression of historical data and an analytical solution to the basic heat balance equation are employed to quantify the impacts of stream flow on river temperatures. Five-year continuous field measurements from the Platte River, Nebraska, USA, are used to illustrate the practical application in water-quality management. The methods and results demonstrate the feasibility of temperature control through streamflow management to meet water temperature standards and protect the aquatic biota by setting the appropriate weather-related minimum river discharges. The flow requirements are evaluated by a comparison with a critical discharge. Information provided in this paper will assist in planning streamflow regulation, design of river and reservoir operations, and application of water-quality criteria in environmental management.KEY WORDS: River discharges; Flow management; Habitat; Water quality; Weather; Wildlifehttp://link.springer-ny.com/link/service/journals/00267/bibs/24n4p529.html</HEA

Leadership 99. Interview by Terese Hudson

Cost control, customer service and collaboration among health care sectors rank as top concerns with panelists in H&HN's annual Leadership Report. Efforts to improve community health are a priority, too, but are often frustrated by financial and other constraints. The 16 panelists represent managed care, physicians, and hospitals and health systems.

Model framework and principles of emergency management

If not handled quickly and effectively, animal health emergencies can create significant problems for governments and industry. Placing strong emphasis on preventing a disease incursion in the first instance through the judicious use of quarantine and inspection measures will continue to be the major preventive strategy. However, the discovery of new and emerging diseases, some of which may already be present in a country or region, necessitates a rigorous emergency outbreak response mechanism premised on thorough preparation for an emergency. A generic approach to emergency management is the contemporary answer to preparing for, and dealing with, unpredictable events. In essence, generic emergency management plans encompass a set of core principles and key issues which are relevant to a particular industry or commodity. These principles and issues are then reflected in a model emergency management plan which guides participants through the various stages of preparing for, and responding to, an emergency situation and which forms the basis of more detailed farm/enterprise manuals and individual job cards. The authors illustrate the integrated nature of the model emergency management plan and the interrelationship with the core principles and key issues of emergency management planning.

Residents' perspectives of their first 2 weeks in a long-term care facility

This study investigated residents' perspectives of their first 2 weeks in a long-term care facility (LTCF). Twelve residents were interviewed to determine their experiences during the first 2 weeks, their needs, priorities and expectations, and their views about how relocation from home could be facilitated. The constant comparative method of qualitative analysis (Glaser & Strauss, 1967) was used. Qualitative analysis of the audiotaped interviews revealed four main categories: emotional reactions, transition activities, reflecting on their situation, and connecting with a personal philosophy. Residents' responses indicated that if they had actively participated in the decision to be admitted, the adjustments to the LTCF was easier. Connecting with a personal philosophy was also a significant factor. Nursing implications include recognition of the importance of preparing residents for admission, involving them in the decision, and listening to their perspectives throughout the relocation experience.

Effective consultation in nursing

Given the fiscal challenges within health care today, nurse administrators, whether acting in the role of client or consultant, must determine the most effective and efficient way to solve problems and achieve goals. The consultation process can be viewed from both the client's and the consultant's perspective. This article is intended to provide a practical approach to addressing the issues within the consultation process. The steps of the consultation process are reviewed. The evolution from solving problems to achieving goals is described. The importance of the use of a screening tool when interviewing prospective consultants is emphasized and an example of a generic screening tool is provided. During the interview, consultants are advised to clearly determine the problem or goal, the outcomes which the client expects, possible barriers and risks, and the philosophical fit between both parties. Nurses practise consultation skills daily and, therefore, consultation is a viable opportunity for self-employment.

Enchondromatosis with hemangiomas (Maffucci's syndrome)

Maffucci's syndrome in a 17-year-old girl is reported. Since the entity was first described in 1881 by Maffucci, 105 additional cases have been recorded. Several series have reported a small but significant percentage of cases (up to 18%) with malignant change. Our case, although not particularly unique in comparison with other cases of this syndrome, is presented because of the infrequent occurrence of this syndrome.