Analysis of the association of HER-2 low carcinomas and PAM50 assay in hormone receptor positive early-stage breast cancer

BACKGROUND

HER2-low has emerged as a new predictive biomarker in metastatic breast cancer. However, its prognostic value in early-stage carcinomas needs to be revisited. We aimed to evaluate the association of HER2-low carcinomas with PAM50 risk groups combined with clinicopathological variables in early breast cancer.

METHODS

We conducted a retrospective analysis of 332 patients with early-stage breast cancer that underwent PAM50 signature analysis between 2015 and 2021at Hospital Universitario 12 de Octubre (Madrid, Spain). Clinical and pathological variables were collected from medical records. After adjusting for potential confounders, we estimated Odds Ratio (OR) and 95% confidence interval for high-risk PAM50 subgroup, comparing HER2-low versus HER2-zero carcinomas by multivariable logistic regression. P values below 0.05 were deemed statistically significant.

RESULTS

192 (57%) patients were classified as HER2-low carcinomas. Median follow-up was 34 months. Adjusted OR for high-risk PAM50 when comparing HER2-low versus HER2-zero carcinomas was 1.31 (95% CI: 0.75-2.30, p = 0.33). The multivariable model detected significant associations for Ki-67% (≥20% vs. <20%: OR = 4.03, 95% CI: 2.15-7.56, p < 0.001), T staging category (T2/T3 vs. T1: OR = 3.44, 95% CI: 1.96-6.04, p < 0.001), progesterone receptor (PR ≥ 20% vs. <20%: OR = 0.44, 95% CI: 0.23-0.83, p = 0.01), nodal staging category (N+ vs. N0: OR = 3.8, 95% CI: 1.89-7.62, p < 0.001) and histological grade (grade 2 vs. 1: OR = 2.41, 95% CI: 1.01-5.73, p = 0.04; grade 3 vs 1: OR = 5.40, 95%CI: 1.98-14.60, p = 0.001).

CONCLUSIONS

In this early-stage breast cancer cohort, HER2-low was not associated with a high-risk PAM50 compared to HER2-zero carcinomas. Ki-67 ≥ 20%, T2/T3, histological grade 2/3, N+ and PR<20% were significantly associated to a high-risk PAM50.

OVOL1 immunohistochemical expression is a useful tool to diagnose invasion in ocular surface squamous neoplasms

BACKGROUND AND OBJECTIVES

OVOL1 is a gene that negatively regulates mesenchymal transformation, which allows epithelial cells to invade the stroma. On the other hand, it negatively regulates c-Myc, which has a positive effect on cell proliferation. The aim of this study is to evaluate the expression of OVOL1 and c-Myc in ocular surface squamous neoplasia (OSSN).

PATIENTS AND METHODS

Cross-sectional cohort study of 36 samples including 6 squamous papillomas, 19 conjunctival intraepithelial neoplasms, 6 squamous carcinomas and 7 normal conjunctivae were evaluated using immunohistochemistry against OVOL1 and c-Myc. The expression of both markers was analysed using the H-score (intensity 1-3 multiplied by the percentage of positive cells).

RESULTS

Percentages of 98 and 100 of the OSSN, and 57 and 71% of the normal conjunctivae expressed OVOL1 and c-Myc respectively, however, the mean H-score of OVOL1 and c-Myc was higher in the OSSN than in normal conjunctivae group (P=0.0001 in both). Within the OSSN, OVOL1 demonstrated a higher H-score in the conjunctival intraepithelial neoplasms and papilloma, compared to the squamous carcinoma (P<0.01) group. c-Myc did not show differences between the OSSN groups. An H-score lower than 35 differentiates a squamous cell carcinoma from other OSSN lesions with a sensitivity of 83.3% and a specificity of 100%.

CONCLUSIONS

The expression of OVOL1 is a useful tool to differentiate between a squamous carcinoma of conjunctival intraepithelial neoplasms and papilloma. OVOL1 could play a role in the invasiveness of squamous neoplasms and places it as a potential therapeutic target.

Abstract P5-13-24: Efficacy of first line CDK4/6 inhibitors in HER2-low vs HER2-zero, hormone receptor positive, HER2 negative metastatic breast cancer

Introduction: CDK4/6 inhibitors are the standard of care in the vast majority of patients with metastatic breast cancer (MBC) in first line setting. HER2-low expression, defined as IHC score of 1+ or 2+ with negative ISH assay, has been associated with resistance to CDK4/6 inhibitors. This has not yet been explored for advanced disease in the first line setting. We aimed to analyze the efficacy of CDK4/6 inhibitors in this subset of patients compared to HER2-zero tumors. Methods: We identified patients with positive hormone receptors and HER2 negative metastatic breast cancer treated with first line CDK4/6 inhibitor (palbociclib, ribociclib or abemaciclib) and letrozole or fulvestrant between December 2017 - April 2021 in our institution (Hospital 12 de Octubre, Madrid, Spain). HER2 expression and PAM50 subtypes were analyzed in metastatic tissue samples for all patients. For the analysis, patients were classified as HER2-zero or HER2-low groups. Our main objective was to evaluate the relationship between HER2 expression and progression-free survival (PFS) with log-rank test. Multivariable Cox regression model was used to estimate the adjusted hazard ratio (HR). As secondary objectives, we analyzed this association in all CDK4/6 subgroups and described the prevalence of PAM-50 subtypes in each category (HER2-low and HER2-zero). Results: We included 82 patients in our final analysis. 57% of the patients were classified in the HER2-low category. In our sample, 49% of patients received palbociclib, 39% ribociclib and 12% abemaciclib. A high proportion of patients presented visceral disease (75% in the HER2-zero vs 60% in the HER2-low group). Only 20% of tumors were considered as hormone-resistant. The overall response rate was slightly higher in the HER2-zero category (41% vs 35% in the HER2-low). With a median follow-up of 14 months (2 - 48 months), the median PFS was 31.7 months (95%CI: 20.3 - NR months) in the HER2-zero category and 22.8 months (95%CI: 15.7 - NR months) in the HER2-low (p=0.37). In the multivariable Cox regression model, HER2-low tumors were associated with a non-significantly higher risk of progression (HR=1.62; CI 95%:0.74-3.54). In patients treated with palbociclib, the median PFS for HER2-zero vs HER2-low categories were 31.7 months and NR (p=0.79), respectively. For ribociclib, the HER2-zero had a median PFS of 38.4 months and 33.1 months in the HER2-low category (p=0.47). In patients treated with abemaciclib, median PFS was NR for HER2-zero group and 9.2 months for HER2-low (p=0.18). The interaction test between HER2 categories and CDK4/6 inhibitors was not statistically significant (p=0.48). PAM-50 subtypes information was available for 47 patients. In these patients the prevalence of PAM-50 subtypes showed a relative higher proportion of luminal subtypes in the HER2-zero category (95%) and non-luminal (HER2-enriched and normal-like subtypes) in the HER2-low category (21%). Conclusions: In our sample, HER2-low category had a shorter median PFS in first line treatment with CDK4/6 inhibitors plus endocrine treatment compared to HER2-zero group. This finding was consistent for the three CDK4/6 inhibitors analyzed, although the HER2-low group showed more relative benefit in terms of PFS with palbociclib. Our results suggest a lower benefit of CDK4/6 inhibitors in the first line treatment of HER2-low MBC, which could be partially explained by a relative higher proportion of non-luminal PAM-50 subtypes in HER2-low tumors. FundingThis project has received a research grant from “Instituto de Salud Carlos III (ISCIII), Ministerio de Economía y Competitividad” (Spain) awarded within the National Research Program with reference PI 18/01408, co-funded with European Union ERDF funds (European Regional Development Fund).

Citation Format: Rodrigo Sanchez-Bayona, Santiago Terán, Ana Sánchez De Torre, Manuel Alva, Laura Lema, Luis Manso, Estefanía Toledo, Ana Maria Roncero, Cristina Merino, Mario Martínez, Lucía Parrilla, Eva Ciruelos, Pablo Tolosa. Efficacy of first line CDK4/6 inhibitors in HER2-low vs HER2-zero, hormone receptor positive, HER2 negative metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-24.

Posttraumatic stress disorder in victims of the March 11 attacks in Madrid admitted to a hospital emergency room: 6-month follow-up

Purpose:

To determine the change in prevalence of posttraumatic stress disorder (PTSD) symptoms in victims of the March 11 attacks and their relatives, 1 and 6 months after the attacks.

Subjects and methods

Evaluation of PTSD symptoms using the Davidson Trauma Scale (DTS) and General Health Questionnaire (GHQ) in a sample of 56 patients admitted to an emergency room of a general hospital, and assessment of PTSD symptoms in relatives of the patients.

Results:

At Month 1, 41.1% of patients (31.3% of males and 54.2% of females) presented with PTSD. At Month 6, this figure was 40.9% (30.4% of males and 52.4% of females). There was a significant improvement in perception of health among females between Month 1 and Month 6. Relatives presented similar DTS scores at baseline and at 6 months.

Discussion:

We verified that rates of PTSD did not vary substantively between the two evaluations. PTSD symptoms positively correlated with psychological health involvement. This correlation points out that both PTSD symptoms and subjective general health involvement are part of the psychological response to trauma.

Conclusion:

The prevalence of PTSD symptoms was high and remained stable between Month 1 and Month 6, while subjective perception of health improved significantly.

Increased incidences of noninfectious comorbidities among aging populations living with human immunodeficiency virus in Ecuador: a multicenter retrospective analysis

Introduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador. Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador. Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs. Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.

Multiplex Phenotyping for Systems Medicine: A One-Point Optimized Practical Sampling Strategy for Simultaneous Estimation of CYP1A2, CYP2C9, CYP2C19, and CYP2D6 Activities Using a Cocktail Approach

Phenotyping of the CYP450 enzyme activities contributes to personalized medicine, but the past phenotyping approaches have followed a piecemeal strategy measuring single enzyme activities in vivo. A barrier to phenotyping of populations in rural and remote areas is the limited time and resources for sample collection. The CEIBA cocktail approach allows metabolic capacity estimation of multiple CYP450 enzymes in a single sample analysis, but the attendant sample collection schemes for applications in diverse global settings are yet to be optimized. The present study aimed to select an optimal matrix to simultaneously analyze CYP450 enzyme activities so as to simplify the sampling schemes in the phenotyping protocol to enhance its throughput and feasibility in native populations or in remote and underserviced geographies and social contexts. We evaluated 13 Ecuadorian healthy volunteers for CYP1A2, CYP2C9, CYP2C19, and CYP2D6 genotypes and their metabolic phenotypes, including CYP3A4, in plasma and urine after administering one reduced dose of caffeine, losartan, omeprazole, and dextromethorphan. Pharmacokinetic analyses were performed, and the correlation between AUC parent/AUC metabolite and the ratio between concentrations of probe drugs and their corresponding metabolites at timepoints ranging from 0 to 12 hours post-dose were analyzed. A single sampling timepoint, 4 hours post-dose in plasma, was identified as optimal to reflect the metabolic activity of the attendant CYP450 enzymes. This study optimizes the CEIBA multiplexed phenotyping approach and offers new ways forward for integrated drug metabolism analyses, in the pursuit of global personalized medicine applications in resource-limited regions, be they in developed or developing countries.

Chlamydia trachomatis infection in women: bad news, good news, and next steps in prevention

Chlamydia trachomatis causes largely asymptomatic infections that can lead to pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. Screening women routinely is critical to controlling the epidemic of this disease. Testing innovations now make diagnosis easier, and simple treatment regimens may improve compliance with medications and increase cure rates, but testing and treatment must be coupled with improved screening efforts and effective partner services. Ongoing research may point to other interventions that will increase our success in fighting chlamydial infections.