Abstract P6-14-04: Is fat mass more effective than body mass index (BMI) to predict toxicity in early breast cancer patients treated with doxorubicin and cyclophosphamide?

Patients and Methods:We performed a retrospective cohort study of 207 operated breast cancer women treated with doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) for adjuvant setting between 2007 and 2016. Patients' demographic features, toxicities, fat mass, body mass index (BMI) and body surface area (BSA) were evaluated in their charts. Patients were evaluated according to fat mass (high ≥35% vs. low <35%), BMI (obese ≥30 kg/m2 vs. nonobese <30 kg/m2), and BSA (≥1.73 vs. <1.73) levels.

Results:Median age was 46 (23-82) and 61.8% of the patients (n=128) were premenopausal. Median fat mass, BSA, and BMI level was 37 (10-55), 1.75 (1.3-2.27) and 29.4 (16-54.7), respectively. Grade ≥3 toxicity was observed in 68 patients (%32.9). Although, in univariate analyses [table 1] there are no differences in terms of grade ≥3 toxicity according to BMI (in obese and nonobese patients, 34.8% vs. 31.4%, respectively, p=0.589), and BSA (in patients with m2 ≥1.73 vs. m2 <1.73, 35.8% vs. 29.6%, respectively, p=0.344), statistically significant difference was observed according to fat mass (fat mass high and low, 39.1% vs. 25.0%, respectively, p=0.031). In multivariate analyses [table 2], fat mass [<35 vs. >35, OR (odds ratio): 2.341 %95CI:0.39-5.27, p=0.040] was affect grade ≥3 toxicity, while BMI [<30 vs. >30; OR:0.876 %95 CI=0.392-1.959, p=0.748], BSA [<1,73 vs. >1.73 m2, OR:0.956, %95CI:0.450-2.034, p=0.908], age [<50 vs. >50, OR:2.171, %95CI:0.338-13.956, P= 0.414], menopausal status [premenopausal vs. postmenopausal, OR:4.374, %95CI:0.661-28.964, p=0,126], stage [1,2 vs 3, OR:0.535, %95CI:0.279-1.024, p=0.059] and histologic subtype [ductal vs. others; OR:2.010 %95 CI=0.368-2.010, p:0.729] was not.

Grade ≥3 toxicity according to BMI, BSA, and fat massMethodGrade ≥3 toxicityP valueBMI (obese vs nonobese)34.8% vs. 31.4%0.589BSA (≥1.73 vs. m2 <1.73)35.8% vs. 29.6%0.344Fat mass (≥35% vs. <35%)39.1% vs. 25.0%0.031BMI: Body mass index, BSA: body surface area

Multivariate analayses for grade ≥ 3 tocicityParametersOdds Ratio%95 Confidence IntervalP valueFat mass (≥35% vs. 35%)2.3410.39-5.270.040BMI (≥30 vs. < 30)0.8760.392-1.9590.748BSA (<1,73 vs. >1.73)0.9560.450-2.0340.908Age (≥50 vs. <50)2.1710.338-13.9560.414Menopausal status4.3740.661-28.9640,126Stage0.5350.279-1.0240.059Histhologic type2.0100.368-2.0100.729BMI: Body mass index, BSA: Body surface area

Discussion:BSA-based dosing has been widely adopted in oncology as a means of safely administering cytotoxic drugs. In our study demonstrated that fat mass is most valuable than BSA and BMI for evaluation to grade ≥3 toxicity for breast cancer patients treated with AC in the adjuvant setting.

Citation Format: Kaplan MA, Kavak H, Urakci Z, Nas N, Oruç Z, Yerlikaya H, Akdeniz N, Isikdogan A. Is fat mass more effective than body mass index (BMI) to predict toxicity in early breast cancer patients treated with doxorubicin and cyclophosphamide? [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 P6-14-04.

Outcomes of surveillance versus adjuvant chemotherapy for patients with stage IA and IB nonseminomatous testicular germ cell tumors

BACKGROUND

Currently, it is accepted that risk assessment of clinical stage I (CS I) nonseminomatous germ cell tumors (NSGCT) patient is mainly dependent on the presence of lymphovascular invasion (LVI). Initial active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND) are acceptable treatment options for these patients, but there is no uniform consensus. The purpose of this study was to compare outcomes of active surveillance with adjuvant chemotherapy.

METHODS

A total of 201 patients with CS I NSGCT after orchiectomy were included. Outcomes of active surveillance and adjuvant chemotherapy were retrospectively analyzed. The prognostic significance of risk factors for survival and relapse was evaluated.

RESULTS

Of the 201 patients, 110 (54.7%) received adjuvant chemotherapy, while the remaining 91 patients (45.3%) underwent surveillance. Relapses were significantly higher for patients underwent surveillance compared to adjuvant chemotherapy group (18.3 vs. 1.2%, p < 0.001). The 5-year relapse-free survival (RFS) rate for patients who were treated with adjuvant chemotherapy was significantly better than those of patients underwent surveillance (97.6 vs. 80.8%, respectively; p < 0.001). Univariate analysis showed that the presence of LVI (p = 0.01) and treatment option (p < 0.001) were prognostic factors for RFS and pT stage (p = 0.004) and invasion of rete testis (p = 0.004) and the presence of relapse (p < 0.001) were significant prognostic factors for OS. Multivariate analysis revealed that the treatment strategy was an independent prognostic factor for RFS (p < 0.001, HR 0.54). A logistic regression analysis demonstrated that treatment options (p = 0.031), embryonal carcinoma (EC) >50% (p = 0.013) and tumor diameter (p = 0.016) were found to be independent factors for predicting relapse.

CONCLUSIONS

Our results indicate that adjuvant chemotherapy is associated with improved RFS compared with surveillance for CS I NSGCT patients. Moreover, the treatment strategy is an important prognostic indicator for RFS and a predictive factor for relapse. Although adjuvant chemotherapy seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still preferred management option.

Prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with advanced non-small cell lung cancer: single center experience

PURPOSE

The purpose of this retrospective single-center study was to evaluate the prognostic implication on overall survival (OS) of the F-18 FDG PET scan in locally advanced or metastatic non small cell lung cancer (NSCLC) patients.

METHODS

We retrospectively reviewed 120 locally advanced or metastatic NSCLC patients (December 2004-November 2011) treated/followed at the Dicle University, School of Medicine, Department of Medical Oncology. SUVmax and other potential prognostic variables (n=18) were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors for OS.

RESULTS

Among 18 variables of univariate analysis, 6 were identified to bear prognostic significance: sex (p=0.01), performance status (PS) (p =0.03), stage (p=0.04), bone metastases (p=0.002), serum albumin (p=0.01) and blood glucose level (p=0.03). Multivariate analysis showed that PS, bone metastases and serum albumin level were independent prognostic factors for OS (p=0.01, p=0.004, p=0.003, respectively).

CONCLUSION

PS, serum albumin levels and bone metastases were independent prognostic factors, while FDG uptake of the primary lesion was not associated with prognosis of OS in locally advanced or metastatic NSCLC patients.

Contribution of low-molecular weight heparin addition to concomitant chemoradiotherapy in the treatment of glioblastoma multiforme

PURPOSE

Glioblastoma multiforme (GBM) is the most common brain tumor in adults and has a very aggressive course. Median survival is as short as 2 years with standard treatment (chemoradiotherapy followed by adjuvant temozolomide). The purpose of this study was to determine the contribution of low molecular weight heparin (LMWH) addition to concomitant chemoradiotherapy in the treatment of GBM.

METHODS

All patients with newly diagnosed GBM between March 2004-May 2009 were evaluated. After surgical intervention (total, subtotal resection or only biopsy) all of them were treated with concomitant chemoradiotherapy (2 Gy daily, 5 days a week, 30 fractions, total tumor dose 60 Gy; and 75 mg/m² temozolomide, 7 days a week), followed by adjuvant temozolomide (6 cycles, 150-200 mg/m², 5 days every 28 days), with or without LMWH (4000 IU/day, 7 days a week, concomitant with radiotherapy) because of risk of thrombosis. The primary endpoint was the determination of progression-free survival (PFS) and overall survival (OS); secondary endpoints were 1- and 2-year OS survival.

RESULTS

30 patients (13 patients in the group non receiving LMWH (LMWH-) and 17 patients in the group receiving LMWH (LMWH+)) were included in the study. Median age was 54 years (range 24-75). Median PFS was 57 and 38 weeks in LMWH+ and LMWH- groups, respectively (p=0.068). Median OS was 69 and 44 weeks (p=0.095), 1-year OS survival 84.6 and 41.2% (p=0.016), and 2-year OS survival 38.5 and 5.9% in LMWH+ and LMWH-, respectively (p=0.061). No significant difference was noted between the two groups for grade 3-4 toxicity (p>0.05).

CONCLUSION

Better PFS, OS and 2-year OS survival were obtained in present study with the addition of LMWH to concomitant chemoradiation for GBM but without statistical significance. One-year OS survival was statistically significant favoring the LMWH group. The addition of LMWH did not increase temozolomide toxicity.

P4-17-08: Is Cranial Magnetic Resonance Imaging (MRI) Necessary for Staging of Asymptomatic HER2−Positive Breast Cancer Patients?

Background

Breast cancer one of the most common tumors of the adults. Approximately 20% to 25% of all breast cancers are HER2−positive. It can be assumed that up to 30% of HER2−positive metastatic breast cancer (MBC) patients may experience brain metastasis during the course of their disease. The aim of this study to investigate that whether cranial MR is necessary for staging in asymptomatic HER2−positive breast cancer patients.

Material and metods: HER2−positive breast cancer patients without symptoms of brain metastasis included in the study. Cranial MRI was added to the staging procedures. Subgroup analysis was performed to determine risk factors for developing brain metastasis.

Results: Seventy five patients included in the study. Of whom, 71 were women (94.7%). Median age was 42.5 (22-76). Ten of the 75 patients (13.3%) had brain metastasis. The distribution rate of brain metastasis according to breast cancer stage at diagnosis was: 0% for stage I, 9.1% for stage 2, 4.3% for stage 3 and 28.6% for stage 4 (p=0.027). There was no association between presence of brain metastasis and the site of metastasis, estrogen and progesterone receptor positivity, grade, histological subgroup, menopausal status and gender.

Discussion: Brain metastasis is an important problem for breast cancer patients. Treatment strategies may vary in the presence of brain metastasis. In our study we found brain metastasis nearly one quarter of patients with metastatic HER2−positive breast cancer. Cranial MRI imaging can be performed routinely in patient with metastatic HER2−positive breast cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-17-08.