Alberto Riccardi

Antonio Bernardo

Barbara Tagliaferri

Cristina Teragni

Federico Sottotetti

Giovanni Bernardo

M.R. Strada

Raffaella Palumbo

English

Open Access Repository

Abstracts / The Breast 20 (2011) S12–S55S46PO100A HOSPITAL-BASED STUDY OF FACTORS RELATED TO LATE STAGEDIAGNOSIS IN A SERIES OF 44,085 BREAST CANCER PATIENTS IN BRAZILLuiz Claudio Thuler 1,2, Anke Bergmann 1,3, Letícia Casado 11Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil2 Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil3Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, BrazilIntroduction: Significant advances in the prevention, diagnosis andmanagement of breast cancer have been made in recent years. However,breast cancer remains a complex disease affecting millions worldwide. InBrazil, the majority of women tend to be diagnosed at a more advancedstage of disease.Objective: The aim of this study was to examine the factors related to latestage diagnosis in a series of patients with breast cancer registered ina searchable database produced by the Brazilian National Cancer Institute(INCA).Material and Methods: The IntegradorRHC, a public-domain program,collects uniformly reported data on patient demographics, year of diag-nosis, tumor characteristics, and treatment utilization for cancers patients.Presently 145 hospital-based cancer registries, from 88 Brazilian munici-palities, participate. It comprises more than 500,000 cancer cases. A totalof 71,476 patients with breast cancer diagnosed as their first primarymalignancy between 2000 and 2009 were identified. We excluded 13,985patients who were first diagnosed and receive all of first course of therapyat another institution, or were diagnosed at autopsy or by death certificateonly (non-analytic cases) and 13,406 cases with missing information,leaving 44,085 patients in the final analyses. Data included epidemiolog-ical, socio-demographic and clinical factors. Chi-square and odds ratiowere performed to examine associations between studied factors and latestage diagnosis (stages IIB to IVB). Statistical analysis was carried out usingEpiInfo version 6.Results: The mean age was 55.68 years, with a considerable femalepreponderance in gender distribution (99.05%). Sixty percent hadadvanced disease (II B). The results suggest that being female (OR¼ 2.28;95% CI 1.87-2.79; p<0.001), age 20-49 (OR¼ 1.23; 95% CI 1.18-1.28;p<0.001), black (OR¼ 1.79; 95%CI 1.65-1.94; p<0.001) or mulatto (OR¼1.53; 95% CI 1.46-1.60; p<0.001), single/separated/divorced/ widowed(OR¼ 1.15; IC95% 1.11-1.20; p<0.001), diagnosed between 2000 and 2005(OR¼ 1.09; 95%CI 1.05-1.14; p<0.001), current smoker (OR¼ 1.12; 95%CI1.06-1.18; p<0.001), treated in a hospital located in the Northeast Region ofBrazil (OR¼ 1.33; 95%CI 1.27-1.39; p<0.001), having less than 8 years offormal education (OR¼ 1.41; 95%CI 1.34-1.47; p<0.001) or ductal infiltrantcarcinoma (OR¼ 1.69; 95%CI 1.61-1.77; p<0.001) were more likely to bediagnosed at a late stage. No relationship could be established betweenalcohol consumption (p¼ 0.87) and breast cancer stage.Conclusion: In summary, our study has identified several factors that ifaddressed could reduce the number of advanced stage breast cancer cases.The results have important implications in public policy. Targeted educa-tion and policies could reduce the burden of this disease.PO101RESPONSE TO SUBSEQUENT ENDOCRINE THERAPY IN PATIENTSTREATED WITH FULVESTRANT 500MG OR ANASTROZOLE: RESULTSFROM FIRSTJohn F.R. Robertson 1, Justin P.O. Lindemann 2, Sally Garnett 2, AntonioLlombart-Cussac 3, Janusz Rolski 4, David Feltl 5, John Dewar 6, Matthew J.Ellis 71Division of Breast Surgery, University of Nottingham, Nottingham, UK2AstraZeneca Pharmaceuticals, Macclesfield, UK3Hospital Arnau de Vilanova, Lérida, Spain4Centrum Onkologii, Instytut im M. Sklodowskiej-Curie, Krakow, Poland5 FNsP Ostrava, Radioterapeutická klinika, Ostrava-Poruba, Czech Republic6Department of Oncology, Ninewells Hospital and Medical School,Dundee, UK7Washington University School of Medicine, St Louis, USABackground: The Fulvestrant fIRst-line Study comparing endocrineTreatments (FIRST) compared fulvestrant 500mg with anastrozole as first-line endocrine therapy in postmenopausal women with hormonereceptor-positive (HR+) advanced breast cancer. Fulvestrant 500mg was atleast as effective as anastrozole in terms of clinical benefit rate (CBR;primary study endpoint) and objective response rate (ORR); however, timeto progression (TTP) was significantly longer with fulvestrant 500mg. Wepresent an analysis of response to subsequent breast cancer therapy.Methods: FIRST is a Phase II, randomised, open-label, multicentre studycomparing fulvestrant 500mg (500mg/month plus 500mg on Day 14 ofMonth 1) with anastrozole (1mg/day) as first-line endocrine therapy inpostmenopausal women with advanced breast cancer. Following with-drawal from randomised treatment, best overall response (completeresponse [CR], partial response [PR], stable disease [SD] 24 weeks, SD<24 weeks, not evaluable, or progressive disease) to first subsequentsystemic breast cancer therapy was determined by investigator opinion.ORR is the proportion of patients with a best overall response of CR or PR.CBR is defined as ORR plus SD 24 weeks.Results: In total, 205 patients received fulvestrant 500mg (n¼102) oranastrozole (n¼103). At data cut-off for the follow-up analysis for TTP, 63patients in the fulvestrant 500mg group and 79 patients in the anastrozolegroup had progressed. Median TTP was 23.4 months for fulvestrant 500mgand 13.1 months for anastrozole (hazard ratio 0.66; 95% confidenceinterval, 0.47-0.92; p¼0.01). The number of treatment failures was 76 inthe fulvestrant 500mg group and 87 in the anastrozole group.A total of 64 (62.7%) patients in the fulvestrant 500mg group and 69(67.0%) patients in the anastrozole group received subsequent systemictherapy for breast cancer (chemotherapy, endocrine therapy, novel tar-geted therapy or unknown). ORR to subsequent therapy was 23.4% (15/64patients) in the fulvestrant 500mg group and 21.7% (15/69 patients) in theanastrozole group. CBR to subsequent therapy was 43.8% (28/64 patients)and 46.4% (32/69 patients) in the fulvestrant 500mg and anastrozolegroups, respectively. Endocrine therapy was received by 34 (53.1%)patients in the fulvestrant 500mg group and 50 (72.5%) patients in theanastrozole group (most common endocrine therapies: anastrozole andletrozole in the fulvestrant 500mg group; fulvestrant and exemestane inthe anastrozole group). Of those patients who received subsequentendocrine therapy, ORR was 8.8% (3/34 patients) for fulvestrant 500mgand 14.0% (7/50 patients) for anastrozole. CBR was 41.2% (14/34 patients)for fulvestrant 500mg and 42.0% (21/50 patients) for anastrozole.Conclusion: Patients who progress on either fulvestrant 500mg or anas-trozole as first-line treatment for HR+ advanced breast cancer may expe-rience comparable CBRs to first subsequent endocrine therapy.PO102BENEFIT OF CONTINUING TRASTUZUMAB BEYOND PROGRESSION INHER2-POSITIVE METASTATIC BREAST CANCER (MBC) IS INDEPENDENTOF THE CHEMOTHERAPY PARTNER: MESSAGE FROM A SINGLE-CENTRE RETROSPECTIVE STUDY.Raffaella Palumbo, Federico Sottotetti, Antonio Bernardo, Maria RosaStrada, Alberto Riccardi, Cristina Teragni, Barbara Tagliaferri, GiovanniBernardoFondazione Maugeri-IRCCS, Pavia, ItalyBackground: The activity of trastuzumab-based chemotherapy (CT) inHER2-positive MBC is now well-established, but the question of theoptimal antineoplastic partner remains a relevant issue. We performeda retrospective comparison of the clinical outcomes associated withdifferent trastuzumab-CT combinations.Patients and methods: Patients for this analysis were selected froma monoinstitutional database containing the data of women with HER2-positive MBC (IHC3+ or FISH positive) receiving first-line trastuzumab-based CT between February 2005 and December 2008. Treatment activitywas assessed according to the WHO criteria, time to progression (TTP) andoverall survival (OS) were calculated by the Kaplan Meier method (intent-to-treat analysis).Results: A total of 147 womenwith measurable disease were evaluated: 57received trastuzumab with weekly vinorelbine (25 mg/m2 until tumorAbstracts / The Breast 20 (2011) S12–S55 S47progression), 48 trastuzumab plus docetaxel (75-100 mg/m2 every 3weeks for 6-8 cycles), 42 a triple combination of three-weekly trastuzu-mab plus oral vinorelbine (60mg/m2 days 1 and 8 q 21) and capecitabine(1000 mg/m2 bid days 1->14, every 3 weeks). Response rate (RR) was 76%in trastuzumab+vinorelbine group, 68% in the docetaxel-based regimenand 72% in the triple combination. More treatment-related grade 3-4toxicities were recorded in the docetaxel-treated population. Medianfollow-up was 41.2 months, median duration of trastuzumab-basedtherapy was 18.2 months. Following disease progression, all womencontinued trastuzumab-based CT as second-line or subsequent lines oftreatment, shifting the chemotherapeutic partner, according to our insti-tution policy: 142 as 2nd line treatment, 69 as 3rd , 48 as 4th and 16 as 5th.There was no significant difference in median TTP according to 1st-linetreatment type (14, 11 and 12 months, respectively, p¼0.62), while a slowdecline was observed throughout the successive CT lines, with almoststable values beyond the 3rd (7.5 e 7.2, respectively). Median OS from thestart of trastuzumab therapywas 36, 32 and 34months, respectively, in the3 treatment group (p¼0.48). In multivariate analysis the number of tras-tuzumab-based regimens was significantly correlated to OS (p¼0.02),while no correlation was found between the survival benefit and thedifferent type of CT.Conclusions: Our results confirm that the benefit of continuing trastu-zumab beyond progression was independent from the CT partner, alsosuggesting a benefit in overall clinical outcome for given subsequent linesof trastuzumab-based therapy at the time of disease relapse.PO103METRONOMIC ORAL COMBINATION CHEMOTHERAPY WITHCAPECITABINE AND CYCLOPHOSPHAMIDE IN PATIENTS WITHMETASTATIC BREAST CANCER: A SINGLE INSTITUTION EXPERIENCEShintaro Takao, Kaori Tane, Kouichi Hirokaga, Youko MaekawaHyogo Cancer Center, Akashi, JapanBackground: Metronomic combination chemotherapy with the oralcapecitabine (X) combined with oral cyclophosphamide (C) has showedpromising efficacy without significant toxicity in three phase II studies. Wewidely used this XC regimen for the patients with metastatic breast cancer(MBC) in our institution by two reasons. First, the patients prefer oral,home-based therapy to IV hospital-based therapy. Second, there is anestablished scientific rationale for XC regimen. Capecitabine is convertedto 5-FU in the presence of thymidine phosphorylase (TP). TP, presented atsignificantly higher concentrations in the tumor than in other tissues, isupregulated by cyclophosphamide. A synergistic effect was observed withthe XC combination.We conducted a retrospective study to evaluate an all-oral XC combination in patients with MBC in Hyogo Cancer center.Material and methods:We retrospectively evaluated 56 patients (medianage 62; range 32-82 years) with metastatic breast cancer. The patientsreceived X 828 mg/m2 with 65 mg/m2/day C, days 1–14 every 3 weeks.Results: Median cycles of XC treatment were six (range 1-32 cycles).Twenty-four patients received XC more than 8 cycles. The overall responserate (ORR) was 41.1% (95%CI: 28.1–55.0%). In a further 21.4%, disease wasstabilized for 24 weeks (LSD), resulting in a clinical benefit response rate(CBR) of 62.5% (95%CI: 48.6–75.1%). A subanalysis of efficacy accoding tonumber of prior chemotherapy regimens for MBC showed that the patientswith no prior chemotherapy presented ORR of 52.6% and CBR of 73.7%. ORRand CBR of the patients with one prior chemotherapy resulted in 35.3% and58.8%, while those with more than two prior chemotherapy and 35.0% and55.0%, respectively. Of 22 patients pretreated with capecitabine, weobserved one CR, 5PRs (ORR 27.3%) and 5 patients with LSD (CBR50%) withXC therapy. Median progression free survival (PFS) and overall survival(OS) was 7.0 months (95% CI: 6.9–11.5months) and 13.8 months (95% CI:14.1–19.6months), respectively. Subpopulation analysis demonstratedmedian PFS of 7.0 months in estrogen-receptor positive, 7.3 monthsin triple-negative disease and 6.8 months in HER2-positive disease. The1-year PFS rate and OS rate was 32.4% and 72.8%, respectively. Toxicity wasgenerally mild. Grade 3 adverse events comprised 9 leukopenia (16%),1 thrombocytopenia (2%) and 1 hand-foot syndrome (2%).Conclusions: Oral XC combination chemotherapy is an effective therapyfor MBC, demonstrating high activity in any subtype with few severe sideeffects. This metronomic chemotherapy could be beneficial for the patientswith MBC who have been treated with capecitabine, and further evalua-tion is justified.PO104STUDY OF MUTATIONS IN BRCA1 AND BRCA 2 GENE AMONG THEBREAST CANCER PATIENTS IN EASTERN INDIAN POPULATION.Abhijit Chakraborty, Deboshree Bhattacharyya (Majumdar), JayasriBasak, Ashis MukhopadhyayNetaji Subhas Chandra Bosr Cancer Research Institute, Kolkata, W.B, IndiaBackground: Breast Cancer is the most commonly diagnosed canceramong Indian women. A large number of distinct mutations in the BRCA1and BRCA2 genes have been reported worldwide, In West Bengal (India)till date no such supporting data of BRCA1 and BRCA 2 gene causingmutations are available. From our hospital record we have observed thatthere aremany breast cancer patients whosemolecular level diagnosis andfamily level survey has not yet been done.Objectives: 1. To detect BRCA1 and BRCA2mutations of patients with breastand ovarian cancer and their 1st& 2nd degree relatives in their families.2. To study BRCA1&BRCA2gene expression in normal individuals as control.3. To establish a genetic profile for the studied population.4. To study the BRCA1 & BRCA2 gene positivity as prognostic factor inBreast Cancer patients.5. Analysis of haplotype pattern linked with BRCA1 and BRCA 2 mutationsMethods: Firstly to make aware the individual and its family aboutthe familial inheritance of breast cancer. Then cases were selectedwith regards to early onset of disease (<45 yrs) and family history ofbreast and ovarian cancer. Out of 150 patients with family history (83individuals) and without family history (67 individuals) were screened.70 control subjects were used to analyze the mutation. We usedmultiplex PCR, PCR-SSCP and direct sequencing for screening. Productswith abnormal patterns in SSCP were sequenced to identify themutation.Results: Mutations were identified in 48 families (32%); 37 had BRCA1mutation and 11 had BRCA2 mutation. In case of BRCA1 and BRCA2 gene,insertion, deletion, intronic variants were identified. In most cases ofBRCA1 mutation 185delAG (14 of 37) and 5382 InsC (9 of 37) mutationswas found. Significantly fewer BRCA2 mutations (2 of 11) detected infamilies with ovarian cancer families. 1 family had male breast cancer withBRCA1 mutation.Conclusion: BRCA1 mutations were more prevalent than BRCA2 mutation.Breast Cancer diagnosis before age 50, Breast and ovarian cancer in singleindividuals are significantly more common in BRCA 1 & 2 mutation.Reference: Saxena S et al Clinico-morphological patterns of breast cancerincluding family history in a New Delhi hospital, India – a cross-sectionalstudy. World J Surg Oncol 2005, 3:67Lynch HT et al. ‘Breast cancer family history as a risk factor for early onsetbreast cancer.’ Breast Cancer Res Treat 1988;11:263–7Choi D.H, Lee M.H, et al Incidence of BRCA1 and BRCA2 Mutations in YoungKorean Breast Cancer Patients”, Journal Of Clinical Oncology, 2004 ;22 (9)Dufoth R.M, Carvalho S, etalAnalysis of BRCA1 and BRCA2 mutations inBrazilian breast cancer patients with positive family history Sao Paulo MedJ. 2005;123(4):192-7.PO105THE VERTICAL RECTUS ABDOMINIS MYOCUTANEOUS (VRAM) FLAP ISTHE PREFERRED MEANS OF POST-MASTECTOMY DEFECT COVER FORLARGE BREAST TUMOURSTse Han Loong, Yia Swam Tan, Ern Yu Tan, Juliana Chen, MarcusWong, Mun Yew Patrick ChanTan Tock Seng Hospital, Singapore, Singapore

Benefit of continuing trastuzumab beyond progression in her2-positive metastatic breast cancer (mbc) is independent of the chemotherapy partner: message from a single-centre retrospective study

https://www.openaccessrepository.it/record/83261/files/fulltext.pdf

Benefit of continuing trastuzumab beyond progression in her2-positive metastatic breast cancer (mbc) is independent of the chemotherapy partner: message from a single-centre retrospective study

Abstract

Similar works

Full text

Available Versions

Open Access Repository