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Does the Choice of First-Line Chemotherapy Influence the Outcome of ER+HER2: Metastatic Breast Cancer?
Abstracts / The Breast 36 S1 (2017) S19–S76
inflammatory breast carcinomas. It represents the most advanced stage breast cancer that is still potentially curable with surgery, radiation, and systemic therapy. Few things have been written in the literature about this stage of disease in younger age diagnosis of breast cancer patients. Methods: We present a retrospective study of 204 patients younger than 40 years, from January of 2009 to December of 2013. Of that analyses 31.6% had locally advanced breast cancer (stage III) at diagnosis and the aim of this study was to describe the clinical features and outcomes in that group of patients. Multivariate statistical analysis, was performed using the SPSS v.20 program. Results: Analyzing retrospectively these 75 women we found that the mean age at diagnosis was 35 years old (min 22 – max 39), mostly ECOG-PS 0. Histological examination of the tumors revealed that were mostly invasive ductal carcinoma and 62.7% of our sample were grade 2, 17% grade 3 and 10% grade 1. Considering the subtypes, we had 24% luminal A-like, 24% luminal B-like (HER2negative), 21.3% HER2-positive and 30.7% patients had triple negative breast cancer. Breast-conserving surgery was performed in 2.7% and 96% of patients received neoadjuvant chemotherapy with 26.4% achieving pathologic complete response ( pCR). At the end of this study progression was identified in 31.1% of the patients and 26.7% died. Conclusion: This single center study of women under 40 years old with locally advanced breast cancer confirms what is being described in the literature that LABC is an aggressive type of BC and responsible for poor prognosis, resulting in a higher mortality rate.
PR108 DOES THE CHOICE OF FIRST-LINE CHEMOTHERAPY INFLUENCE THE OUTCOME OF ER + HER2: METASTATIC BREAST CANCER? Junichiro Watanabe, Kanako Yoshitsugu Shizuoka Cancer Centre, Breast Oncology Dept., Shizuoka, Japan Background: Estrogen receptor-positive, HER2-negative metastatic breast cancer (ER + HER2-MBC) is recognized as having a good prognosis; however, the survival from the initiation of chemotherapy can be as short as two to three years. While numerous anticancer agents are available these days, the impact of the first-line chemotherapy (1stCTx) on the ultimate outcome has not been well discussed. Methods: We reviewed our medical records from 2002 to the present to assess the background characteristics, regimen and survival of ER + HER2-MBC patients who underwent 1stCTx. Statistical analyses were performed using the chi-squared test, the Kaplan-Meyer method and multivariate COX regression analysis. Results: We identified 311 ER + HER2-MBC (224 recurrent, 87 advanced) patients who received 1stCTx. The applied regimes were as follows: Anthracycline-based (A), 82 (26.4%); paclitaxel (P), 69 (22.2%); capecitabine (X), 37 (11.9%); P + bevacizumab (PB), 32 (10.3%); docetaxel, 27 (8.7%) and others, 65 (20.5%). A was significantly preferred in cases of advanced BC ( p < 0.01, chisquared) or visceral involvement ( p < 0.05); however, A was less frequently administered in patients with a history of (neo)adjuvant CTx (P < 0.01). PB was frequently applied to ‘high-risk patients,’ such as those with visceral involvement ( p < 0.05) or a history of (neo)adjuvant CTx ( p < 0.05). Patients who received A or P as 1stCTx showed a good prognosis (median survival from the initiation of CTx: 1036.0 and 1056.0 days, respectively). In contrast, those who received X or PB as 1stCTx showed a poorer prognosis (median survival from the initiation of CTx: 819.0 and 777.0 days, respectively) than those who received A or P. However, the
S61
difference was not statistically significant ( p > 0.05, log-rank). There were no specific risk factors influencing the outcome at the initiation of each 1stCTx on a multivariate analysis. However, patients who received A as 1stCTx had a significantly increased mortality risk with subsequent P use (hazard ratio 1.78, p < 0.05). Conclusions: Our realistic picture of the daily practice showed that the choice of 1stCTx did not markedly influence the survival of ER + HER2-MBC patients. A prospective, randomized study including the follow-up of the post-progression survival to determine the optimum CTx sequence is warranted.
PR109 A WOMAN WITH VON RECKLINGHAUSEN AND A RESECTABLE BRAIN METASTASIS HER2 POSITIVE Anna Andreadou Theageneio, 3rd Clinic, Thessaloniki, Greece Introduction: Neurofibromatosis type 1 (NF1) is a multi-system genetic disease, a common neurocutaneous condition with an autosomal dominant pattern of inheritance. It is characterized by cutaneous findings, most notably café-au-lait spots and axillary freckling, by skeletal dysplasias, and by the growth of both benign and malignant nervous system tumors, most notably benign neurofibromas. Women with palpable lesions do not ask for consultions, since they believe it is moles. Case report: A woman with von Recklingahausen syndrome at the age of 53 presented with breast cancer in May 2011. Due to locally advanced cancer with pathological lymph nodes a core biopsy was performed in order to start neo-adjuvant chemotherapy. The biopsy showed mucinous carcinoma. While the immuno – histochemistry expressed ER: +, PR: +, CERBb2: +3, KI – 67:25–30%. The woman started chemotherapy with the schedule of 4 cycles epirubicin – cyclophoashamide q 2 weeks., and then 4 cycles docetaxel – herceptin q3 weeks. In October 2011, a mastectomy was performed and the pathology report showed no tumor regression. T:10 cm, N:7/8 lymph nodes. With no delay, the woman continued herceptin (till 08/01/2013), received radiotherapy, and hormonal treatment with letrozole. In November 2013, a brain MRI was performed due to dizziness that showed a mass in the left parietal lobe, with diameter of 3cm. A surgery was performed in December 2013, but the mass was not completely excisized and she had cyber – knife in February 2014 for the remaining tissue. There was no other disease progression and the woman re – initiated herceptin and examestane. In August 2014, the woman was admitted in our clinic due to right pyramidic. A brain MRI showed progression of the disease and the patient started cortisol, mannitol, and radiotherapy of the brain. the neurological condition was improved, but 3 months later due to new deterioration and since there was no splanchnic progression, a new surgery was discussed and eventually was performed in November 2014. The woman continued herceptin examestane since there was no progression in other organs. The last image of the brain is disease free (03/2017) and she continues herceptin – examestane. Conclusion: There are few cases reported with women with von Recklinghausen and breast cancer. What is interesting and should be mentioned is that the gene for von Recklinghausen is located in chromosome 17q11 whether the gene of HER2 is also located in the arm 17q12. Neurofibromin, the gene product, is ubiquitously expressed at high levels in the nervous system and functions as a tumor suppressor. Loss of neurofibromin through mutation leads to an increased risk of developing benign and malignant tumors in affected individuals.
inflammatory breast carcinomas. It represents the most advanced stage breast cancer that is still potentially curable with surgery, radiation, and systemic therapy. Few things have been written in the literature about this stage of disease in younger age diagnosis of breast cancer patients. Methods: We present a retrospective study of 204 patients younger than 40 years, from January of 2009 to December of 2013. Of that analyses 31.6% had locally advanced breast cancer (stage III) at diagnosis and the aim of this study was to describe the clinical features and outcomes in that group of patients. Multivariate statistical analysis, was performed using the SPSS v.20 program. Results: Analyzing retrospectively these 75 women we found that the mean age at diagnosis was 35 years old (min 22 – max 39), mostly ECOG-PS 0. Histological examination of the tumors revealed that were mostly invasive ductal carcinoma and 62.7% of our sample were grade 2, 17% grade 3 and 10% grade 1. Considering the subtypes, we had 24% luminal A-like, 24% luminal B-like (HER2negative), 21.3% HER2-positive and 30.7% patients had triple negative breast cancer. Breast-conserving surgery was performed in 2.7% and 96% of patients received neoadjuvant chemotherapy with 26.4% achieving pathologic complete response ( pCR). At the end of this study progression was identified in 31.1% of the patients and 26.7% died. Conclusion: This single center study of women under 40 years old with locally advanced breast cancer confirms what is being described in the literature that LABC is an aggressive type of BC and responsible for poor prognosis, resulting in a higher mortality rate.
PR108 DOES THE CHOICE OF FIRST-LINE CHEMOTHERAPY INFLUENCE THE OUTCOME OF ER + HER2: METASTATIC BREAST CANCER? Junichiro Watanabe, Kanako Yoshitsugu Shizuoka Cancer Centre, Breast Oncology Dept., Shizuoka, Japan Background: Estrogen receptor-positive, HER2-negative metastatic breast cancer (ER + HER2-MBC) is recognized as having a good prognosis; however, the survival from the initiation of chemotherapy can be as short as two to three years. While numerous anticancer agents are available these days, the impact of the first-line chemotherapy (1stCTx) on the ultimate outcome has not been well discussed. Methods: We reviewed our medical records from 2002 to the present to assess the background characteristics, regimen and survival of ER + HER2-MBC patients who underwent 1stCTx. Statistical analyses were performed using the chi-squared test, the Kaplan-Meyer method and multivariate COX regression analysis. Results: We identified 311 ER + HER2-MBC (224 recurrent, 87 advanced) patients who received 1stCTx. The applied regimes were as follows: Anthracycline-based (A), 82 (26.4%); paclitaxel (P), 69 (22.2%); capecitabine (X), 37 (11.9%); P + bevacizumab (PB), 32 (10.3%); docetaxel, 27 (8.7%) and others, 65 (20.5%). A was significantly preferred in cases of advanced BC ( p < 0.01, chisquared) or visceral involvement ( p < 0.05); however, A was less frequently administered in patients with a history of (neo)adjuvant CTx (P < 0.01). PB was frequently applied to ‘high-risk patients,’ such as those with visceral involvement ( p < 0.05) or a history of (neo)adjuvant CTx ( p < 0.05). Patients who received A or P as 1stCTx showed a good prognosis (median survival from the initiation of CTx: 1036.0 and 1056.0 days, respectively). In contrast, those who received X or PB as 1stCTx showed a poorer prognosis (median survival from the initiation of CTx: 819.0 and 777.0 days, respectively) than those who received A or P. However, the
S61
difference was not statistically significant ( p > 0.05, log-rank). There were no specific risk factors influencing the outcome at the initiation of each 1stCTx on a multivariate analysis. However, patients who received A as 1stCTx had a significantly increased mortality risk with subsequent P use (hazard ratio 1.78, p < 0.05). Conclusions: Our realistic picture of the daily practice showed that the choice of 1stCTx did not markedly influence the survival of ER + HER2-MBC patients. A prospective, randomized study including the follow-up of the post-progression survival to determine the optimum CTx sequence is warranted.
PR109 A WOMAN WITH VON RECKLINGHAUSEN AND A RESECTABLE BRAIN METASTASIS HER2 POSITIVE Anna Andreadou Theageneio, 3rd Clinic, Thessaloniki, Greece Introduction: Neurofibromatosis type 1 (NF1) is a multi-system genetic disease, a common neurocutaneous condition with an autosomal dominant pattern of inheritance. It is characterized by cutaneous findings, most notably café-au-lait spots and axillary freckling, by skeletal dysplasias, and by the growth of both benign and malignant nervous system tumors, most notably benign neurofibromas. Women with palpable lesions do not ask for consultions, since they believe it is moles. Case report: A woman with von Recklingahausen syndrome at the age of 53 presented with breast cancer in May 2011. Due to locally advanced cancer with pathological lymph nodes a core biopsy was performed in order to start neo-adjuvant chemotherapy. The biopsy showed mucinous carcinoma. While the immuno – histochemistry expressed ER: +, PR: +, CERBb2: +3, KI – 67:25–30%. The woman started chemotherapy with the schedule of 4 cycles epirubicin – cyclophoashamide q 2 weeks., and then 4 cycles docetaxel – herceptin q3 weeks. In October 2011, a mastectomy was performed and the pathology report showed no tumor regression. T:10 cm, N:7/8 lymph nodes. With no delay, the woman continued herceptin (till 08/01/2013), received radiotherapy, and hormonal treatment with letrozole. In November 2013, a brain MRI was performed due to dizziness that showed a mass in the left parietal lobe, with diameter of 3cm. A surgery was performed in December 2013, but the mass was not completely excisized and she had cyber – knife in February 2014 for the remaining tissue. There was no other disease progression and the woman re – initiated herceptin and examestane. In August 2014, the woman was admitted in our clinic due to right pyramidic. A brain MRI showed progression of the disease and the patient started cortisol, mannitol, and radiotherapy of the brain. the neurological condition was improved, but 3 months later due to new deterioration and since there was no splanchnic progression, a new surgery was discussed and eventually was performed in November 2014. The woman continued herceptin examestane since there was no progression in other organs. The last image of the brain is disease free (03/2017) and she continues herceptin – examestane. Conclusion: There are few cases reported with women with von Recklinghausen and breast cancer. What is interesting and should be mentioned is that the gene for von Recklinghausen is located in chromosome 17q11 whether the gene of HER2 is also located in the arm 17q12. Neurofibromin, the gene product, is ubiquitously expressed at high levels in the nervous system and functions as a tumor suppressor. Loss of neurofibromin through mutation leads to an increased risk of developing benign and malignant tumors in affected individuals.