Abstract PS4-10: Serial MRI and pathology combined to select candidates for therapy de-escalation in the I-SPY 2 TRIAL

Background: The I-SPY 2 TRIAL, open to patients with locally advanced, molecular high-risk breast cancer, aims to bring each patient to pathologic complete response (pCR) with a minimum of toxicity. Here we test the hypothesis that imaging (MR volume predictors) combined with core biopsy may be used to accurately select candidates who show early response and provide an option of treatment de-escalation at mid-therapy (12 weeks). Methods: Of 100 I-SPY 2 patients with pathologist-assessed core biopsies at the inter-regimen time point (~12 weeks through treatment) and pCR data, 87 also had serial MR images and were considered in this study. Eleven I-SPY 2 TRIAL pathologists independently provided a digital assessment of the presence or absence of residual invasive cancer from H&E stained, and any requested ancillary IHC, images from imaging-guided core biopsies. Pathology predicts pCR if there is a consensus of no invasive residual disease. We generated predictions for all (55) unique pairs over the 11 pathologists, where pCR is predicted if both pathologists find no invasive cells. MRI pCR prediction models were previously developed on an independent dataset of ~990 I-SPY 2 patients, and applied to this cohort. Volume-based prediction models were previously optimized within each subtype and predicted probability thresholds were selected over a range of positive predictive value (PPV). In this study, MR predicts pCR (positive test) if the predicted probability is above a threshold that yields a given PPV value. For each pathologist pair, we combined pathology-based and MR-based predictors into a predictive-RCB (pre-RCB); and pre-RCB predicts a patient as pCR (RCB0) if both MR and pathology predicts pCR. Predictive performance is assessed by calculating the mean and range of PPV and sensitivity.Results: 39% (34/87) of the patients in this study achieved pCR. Over all pairs of pathologists, on average 80% of pathology-only predicted pCRs were true pCRs (mean PPV = 80% [range: 69-92%]), and 74% of patients who achieved pCR were predicted pCR by pathology alone (mean sensitivity = 74% [65-82%]). We assessed combinations with MR probability thresholds at PPV levels 50%-70%; and observed the best balance of PPV and sensitivity for the pre-RCB when MR thresholds were set at 50% PPV level. At this threshold setting, the pre-RCB achieved a PPV = 92% [83-100%], meaning on average 92% of predicted pCRs were true pCRs, and this improvement in positive predictive performance over pathology alone is achieved with a lower but still-reasonable 53% sensitivity [33-62%].

Conclusion: Pre-RCB, which predicts a patient as pCR if both MR and inter-regimen pathology predicts pCR, provides clinically actionable accuracy for treatment de-escalation for early responders (PPV>90%). Adding a final MR review at the time of early surgery may further improve performance. Resulting from data presented in this abstract, the pre-RCB algorithm, including the final MR review, has been operationalized and will be used prospectively to identify patients who are highly likely to have already achieved pCR by the inter-regimen timepoint.

Citation Format: Sara J Venters, Wen Li, Denise M Wolf, Jodi M Carter, Molly E Klein, Kamaljeet Singh, Kimmie Rabe, I Tolgay Ocal, David Newitt, Christina Yau, Natsuko Onishi, Jessica Gibbs, Sunati Sahoo, Shuko Harada, Laila Khazai, Malini Harigopal, Alexander D Borowsky, Gregor Krings, Ronald Balassanian, Yunn-Yi Chen, Kimberley Cole, Sonal Shad, Barbara LeStage, Amy Delson, Sandra Finestone, Lamorna Brown-Swigart, I-SPY 2 Imaging Working Group, I-SPY 2 TRIAL Consortium, Laura Esserman, Laura van ‘t Veer, W Fraser Symmans, Nola M Hylton. Serial MRI and pathology combined to select candidates for therapy de-escalation in the I-SPY 2 TRIAL [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-10.

Abstract P1-16-01: Susan G. Komen advocates in science (AIS): Bringing patients’ perspectives to research

Susan G. Komen® is committed to ensure the unique, valuable perspectives of breast cancer patients, survivors, and co-survivors are integrated into scientific discussions and decisions impacting Komen’s progress toward ending breast cancer. Advocates in Science (AIS) was formed to build a cadre of skilled, knowledgeable and broadly-networked breast cancer research advocates; and engage them throughout the research process. AIS members provide real-world understanding of what matters to patients and a sense of urgency to find better solutions to prevent, diagnose, treat, and cure breast cancer. AIS, led by an AIS Steering Committee, is a multi-pronged approach to research advocacy:

• A Diverse & Engaged Membership: The latest survey was sent to 230 members. 146 (65%) completed it. AIS has a wide range of research advocacy experience. This latest survey showed a shift toward more experienced advocates. AIS members with metastatic disease increased 1.5%; co-survivors (friend & family caregivers) increased 5%; and younger members increased 6.4%. AIS had a slight increase in diversity: 6.7% African American; 0.8% Asian; and 2.1% Hispanic.

• Ongoing Education & Training: Komen is committed to developing the next generation of breast cancer research advocates and strengthening the skills and knowledge of all AIS members. AIS provides opportunities for advocates to learn more about research and strengthen their research advocacy skills through a variety of educational sessions and rigorous training programs. New resources are developed based on members’ suggestions and offer varied formats: online tools, webinars, face-to-face meetings, and peer-to-peer mentoring.

• Networking & Communications: The AIS Update (email) keeps advocates current on recent scientific advances in breast cancer, Komen’s research and its impact, and upcoming education and involvement opportunities for advocates. The Voice offers member-to-member highlights from advocate activities. The AIS Facebook page offers networking and member-to-member sharing.

• Involvement in Komen’s Research Grant Strategy and Peer Review: Through AIS, Komen seeks to match advocates to Komen activities best fitting their training, experience and preference. Some advocates serve on advisory boards, providing strategic guidance and input on Komen’s research grant focus. Many others serve as research grant reviewers.

• Engagement in Komen-funded Research Projects: Advocate involvement is required in most Komen-funded grants. AIS together with researchers created a toolkit of resources to enable productive advocate researcher relationships. It includes resources and training for researchers to spur greater understanding of the value advocates can bring to their research and how to effectively engage them on their team. AIS assists researchers in identifying AIS members to work with researchers.

AIS members bring patients’ insights and wisdom to research from bench to bedside to curbside and back. Many AIS members are active in their communities, serving as bridges connecting advocates, scientists and Komen Affiliates. Their efforts foster greater understanding, excitement and support for research and its funding; build stronger researcher community connections; and energize hope for better answers and cures.

Citation Format: Anne Meyn, Wayne Dornan, Cheryl Jernigan, Marian Johnson-Thompson, Rebecca Seago-Coyle, Barbara Segarra-Vazquez, Sandra Spivey, Meryl Weinreb, Sandra Finestone. Susan G. Komen advocates in science (AIS): Bringing patients’ perspectives to research [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 P1-16-01.

Abstract P4-18-03: Measuring what is important to patients in clinical trials: Hearing the patient's voice

Patients who participate in clinical trials are important to clinical research and contribute to the advancement of medical discoveries. However, typical clinical trials do not always capture information that is important to patients: how they feel, function and survive. The only way to accurately measure how a patient feels or functions is to ask them. This can be done through the administration of health related questionnaires that are filled out by the patient without interpretation from anyone else; these are referred to as Patient Reported Outcomes (PROs). Although, PRO assessments have been used in clinical trials for the past 30 years through the collection of global quality of life (QOL) and later health related QOL (HR-QOL) measurements, the information has been too broad and has not been precise enough to use in drug approvals, descriptive drug label information or to inform other patients.

There is an effort to change the paradigm of PRO assessment to measure the information most relevant to patients in clinical trials. This includes measuring treatment toxicity, symptom burden and physical function. This is relevant information that other patients want to know about a specific treatment for a specific disease to help them in their treatment decision making. The voice of the patient is critical to assess these items, through PRO measurements. In order to ensure that PRO questionnaires are filled out during a clinical trial, there are ways to make them more acceptable to patients by involving patients in their development (what questions are asked/how many questions are asked/when they are given to patients/how they are given to patients). Patients can inform study teams on the acceptability, understandability and relevance of the questions being asked. Patients can be a key contributor to clinical trial development by identifying the questions that are most important to them and the best way to ask these questions during a clinical trial.

Patient advocacy and educational organizations like Cancer Information & Support Network (CISN) are advocating for changes in PRO collection in clinical trials. Based on information collected from many survivors, caregivers and advocates, a patient-centric clinical trial development model will be proposed. The model includes the involvement of patients as key stakeholders early in clinical trial development to incorporate PROs into clinical trials that are acceptable for patients to complete and the outcomes are meaningful and matter to future patients.

Citation Format: Spears PA, Devine P, Finestone S. Measuring what is important to patients in clinical trials: Hearing the patient's voice [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-18-03.

Abstract P5-10-02: Clinical trials: "A holistic approach"

Goal:

New and improved treatments depend on the completion of successful clinical trials. Our goal is to impact all aspects of the clinical trial process to enhance accrual and outcomes.

1) To provide patient focused feedback at the design phase of clinical trials

2) To increase health literacy about clinical trials at both the national and community level

3) To provide decision aids for individual trials

4) To provide patient focused staff communication trainings

Strategy: CISN principals are currently working with the following groups

National Clinical Trial Network

Academic Medical Centers: UCSF and Mayo

Industry: Genentech, Pfizer, Novartis, and Lilly

Nonprofit Organizations: AACR, Faster Cures, Susan G. Komen, SOCRA

CISN principals are working within the NCTN to accomplish strategies one and two. The goal is to branch out to more community venues in the future. A 2001 study by Lara et. al. reported that the consent process with its legalistic and confusing forms is itself a barrier to patient participation with 49% of eligible patients declining enrollment. We address these concerns by accomplishing strategies 3 and 4 above.

Action Taken

CISN is introducing the medical community to an array of issues affecting patients considering participation in clinical trials. They are also developing patient-centered, study specific, educational materials included as part of the informed consent process. These interventions may enhance patient literacy, improve patient satisfaction and advance public trust in the research enterprise, leading to responsible increased accrual and retention. Additionally, CISN has worked as a contractor for several biotech companies to develop patient educational materials for several studies.

Work done at the Clinical Trial Summit documented that 67% of professionals consenting patients have less than 6 hours of psychosocial training. To address that issue, CISN developed a training program for those professionals who administer consent. Two PhD psychologists where brought onboard as consultants to assist in the development of the training. To date CISN has conducted many trainings for various groups and will soon submit grants to partner with other organizations to translate the materials into Spanish and work with patient navigators to further ensure proper training in all communities.

Outcome

Interest in our methods and materials continues to grow. CISN was identified by Faster Cures as having "best practice" methods in the area of informed consent. We work closely with academic, government, other non-profits and industry researchers to help foster public awareness about the importance of medical research to daily life. CISN addresses these issues and presents various strategies that might be applied to NCI network group and industry trials so as to bridge the research gap, move research forward, and adopt the best course to serve the needs of the community, researchers and patients.

Citation Format: Spears PA, Devine P, Finestone S, Carbine N. Clinical trials: "A holistic approach". [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 P5-10-02.

Hepatitis A and Down's syndrome: lack of an association

The occurrence of hepatitis A early in pregnancy has been reported to result in increased births of children with Down's syndrome. Eleven sets of paired sera were obtained before conception and during pregnancy from women who delivered infants with Down's syndrome. These sera were tested for antibody to hepatitis A virus with use of immune electron microscopy. None of the women had seroconversions or increases in levels of antibody to hepatitis A virus. No evidence of an association between hepatitis A and Down's syndrome was found in the women studied.