Geriatric assessment in latin breast cancer patient

Abstracts

Breast cancer in elderly patients P010 LKB1 — A POTENTIAL NOVEL BIOMARKER AND CLINICAL SIGNIFICANCE IN BREAST CANCER B.M. Syed1, A.R. Green2, D. Morgan3, I.O. Ellis2, P. Cheung1,⁎ 1 Breast Surgery, University of Nottingham, United Kingdom 2 Department of Pathology, University of Nottingham, United Kingdom 3 Department of Oncology, University of Nottingham, Nottingham, United Kingdom

Introduction: The role of liver kinase B1 (LKB1), a serine/threonine kinase, has been described in the development of Peutz Jagher's syndrome, where a large proportion (45%) of patients have been reported to develop breast cancer in their life time. Cell line studies have also shown a link of LKB1 with the action of oestrogen, metformin and diabetes. Objectives: This study aimed to investigate the intracellular molecular relationships of LKB1 in older women with early operable primary breast cancer and its correlation with clinical outcome. Methods: Between 1973 and 2010, a consecutive series of 1,758 older (≥70 years) women with T0-2 N0-1 M0 breast carcinoma were managed in a dedicated facility. Of these 813 patients underwent primary surgery and 575 had good quality tumour samples available for tissue microarray construction. LKB1 was assessed by indirect immunohistochemistry using Ley37D/G6-ab15095/Abcam (primary antibody) and Envision method (secondary antibody). Tumours having 30% of cells with cytoplasmic LKB1 expression were considered positive. LKB1 expression was compared with a number of pathological factors and biomarkers, and also correlated with the long-term clinical outcome. Results: Positive LKB1 expression was seen in 318 (78.1%) patients, significantly associated with high tumour grade (p = 0.01), HER2 overexpression (p = 0.003), Ki67 (p = 0.01), VEGF (p = 0.002), HER4 (p = 0.001), BRCA2 (p = 0.01), MDM2 (p b 0.001) and negative expression of CD44 (p = 0.03). However there was no significant correlation with tumour size, axillary lymph node status, ER, PgR, p53, basal or luminal cytokeratins, BCL2, Muc1, EGFR, HER3, MDM4, E-cadherin, and BRCA1. No correlation was found between LKB1 positivity and clinical outcome. However in those patients receiving endocrine therapy LKB1 positivity was significantly associated with better 5-year breast cancer specific survival (93% versus 74%, p = 0.03). Conclusion: While LKB1 positivity shows strong correlations with most biomarkers known to be associated with poor prognosis, it also appears to be associated with better clinical outcome in a selected group of patients treated with adjuvant endocrine therapy. Further research is required to explore its potential role as a therapeutic target. Disclosure of interest: None declared.

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School of Medicine, United Kingdom Nottingham Breast Institute, United Kingdom 3 Department of Oncology, Nottingham University Hospitals, Nottingham, United Kingdom 4 School of Nursing, University of Buffalo, United States 5 School of Health Sciences, Nottingham University Hospitals, Nottingham, United Kingdom 2

Introduction: Quality of life (QOL) is widely accepted to be an important factor when considering cancer treatment decision making. However, studies exploring its relevance in the older population are lacking. Objectives: This pilot study aimed to investigate quality of life in older (≥70 years) women newly diagnosed with stage I/II breast cancer. Methods: Patients as described were invited to participate. The decision of primary treatment followed consultation with the clinical team and was not guided by QOL measures. The European Organisation for Research and Treatment of Cancer (EORTC) QOL questionnaire, the QLQ-C30, and breast cancer component, QLQBR23, were completed at 6 weeks and 6 months after diagnosis, alongside Comprehensive Geriatric Assessment and semi-structured interviews, as part of a larger study. Answers were graded as to level of QOL on a scale of 1 to 4. Comparison was made between scores for each question on the QOL questionnaires and whether the patient had surgery or non-surgery using the t-test for normally distributed data or the Mann–Whitney test for data not following a normal distribution. 46 patients were available for analysis at this stage (N: surgery = 28, non-surgery = 18). Results: There were a total of 54 questions for participants to complete. Statistically significant association was found between nonsurgery (as opposed to surgery) and: – greater difficulty doing strenuous activities, like carrying a heavy shopping bag or suitcase (p = 0.042) – more trouble taking a long walk (p = 0.004) – more trouble taking a short walk outside of the house (p = 0.027) – reduced pain in arm or shoulder (p = 0.030). Conclusion: Preliminary analysis has demonstrated some associations between elements of quality of life and treatment patterns in this cohort of patients. The study is still ongoing. Disclosure of Interest: None declared. Keyword: Breast cancer doi:10.1016/j.jgo.2014.09.041

Keyword: Breast cancer

Breast cancer in elderly patients

doi:10.1016/j.jgo.2014.09.040

P012 GERIATRIC ASSESSMENT IN LATIN BREAST CANCER PATIENT M. Cruz-Ramos1,⁎, A. Acuña-Arellano1, J. García-Lara2, A. GamboaDominguez2, A. Soriano-Rodríguez2, S. Campos-Gomez3, J.R. Álvarez Guerrero1, E. León-Rodríguez4 1 Unidad Funcional de Onco-Geriatría, Centro Oncologico Estatal ISSEMyM, Toluca, Mexico 2 Medical-oncology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran., Mexico 3 Medical-oncology, Centro Oncologico Estatal, Toluca, Mexico 4 Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran, Mexico, Mexico

Breast cancer in elderly patients P011 COMPARISON OF QUALITY OF LIFE (QOL) SCORE FOLLOWING INITIAL TREATMENT OF SURGERY OR NON-SURGERY IN OLDER WOMEN WITH PRIMARY OPERABLE BREAST CANCER R.M. Parks1,⁎, L. Hall1, S.-W. Tang1, R.L.1, L. Winterbottom2, D. Morgan3, D. Porock4, K. Cox5, K.-L. Cheung1

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Abstracts

Introduction: Global population is growing older, and the prevalence of cancer is rising among the elderly. In Mexico, women’s life expectancy was 78.1 years in 2012. The diagnosis of cancer among women over 70 years of age had an incidence of 9.3%. Cancer caused 13% of the deaths in females in this age group, and was the third cause of death in women over 65 years of age. Objectives: To evaluate Geriatric Assessment (GA) impact in Latin elderly breast cancer patient. Methods: We performed a retrospective analysis of the medical records from 140 female breast cancer patients over 70 years of age treated at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, in Mexico City, between January 1st, 1990 and November 30th, 2010. Patients were divided into three groups according to their age: 70 to 75 year olds (group I), 76 to 80 year olds (group II), and age over 81 years (group III). Comorbidites (CCI) and GA were evaluated by patient group. Patient’s characteristics were obtained by descriptive analysis, inferential comparisons were performed by Pearson chi-square tests, survival was evaluated by Kaplan–Meier, subgroup comparisons were analyzed with Log-rank test and multivariate analysis of predictor’s factors by Cox proportional hazards regression analysis. Results: 140 women of 70 years or more were evaluated.The majority (97.1%) of patients had good performance status, ECOG 0–2, 50.7% in group 1, 27.9% group II, and 21.4% group III. Fifty-four (38.6%) of patients had three or more CCI, two CCI 27.1%, one CCI 25%, only 13 (9.3%) had no comorbidities; The most frequent comorbidity in the three groups was arterial hypertension (HA) in 72.1%, followed by dislipidemy in 34.3%, diabetes in 29.3% and dementia in 37.5%. GA began in 1990–2000 decade, 70% of women ≥81 years had been evaluated and 48.7% in women aged 75–80. Younger women were less evaluated in 35.2% (p b 0.05*). The median follow-up was 59 months. Fifty-two patients (37.14%) still alive at last follow-up examination, no statistical survival difference by age group (p = 0.425) or comorbidity (p = 0.697) was observed. In univariate and multivariate analysis performance geriatric assessment significative impact in survival (p = 0.002). Conclusion: Geriatric assessment positive impact in Latin elderly breast cancer patient survival. Disclosure of Interest: None declared Keywords: Basic research, Breast cancer doi:10.1016/j.jgo.2014.09.042

Breast cancer in elderly patients P013 BREAST CANCER IN A GERIATRIC POPULATION — WHAT DO WE NEED TO CHANGE? A. Nogueira1,⁎, R. Garcia1, L. Pinto1, G. Sousa1, H. Gervásio1 1 IPOC F.G E.P.E, Coimbra, Portugal

Introduction: Patients 65 years old or more are the fastest growing segment of the population in most developed countries. By 2030, this group will comprise about 20% of the total population, and among elderly persons, the percentage of patients older than 75 and 85 years old will increase. Approximately 50% of all cancers and 70% of cancer deaths occur in those over 65 years old. Nevertheless this group is significantly underrepresented in clinical trials. We know that the age is one of the risk factors for breast cancer development, and also that one third of all cases occur in women older than 70 years.

Objectives: To analyze the pathologic characteristics and treatment in a female geriatric population (age 65 years old or more) with breast cancer, and the difference between different age subsets. Methods: Data from patients diagnosed with breast cancer within a one year period was collected in an Oncology Center, regarding stage tumor, histological study, treatment and patient's personal and familial history. Results: In one year, 559 patients were diagnosed with breast cancer; 206 (36.8%) from those were geriatric patients. In the latest population the average age was 72.9 years (with a variation from 65 to 86 years). The majority of patients had localized breast cancer (stage 0 — 16.5%, stage IA — 15%, stage IIA — 21.4%, stage IIB — 24.3%, stage IIIA — 5,3%, stage IIIB — 11.6%) and only 4% had metastatic disease (stage IV). Analyzing the histological diagnosis, the most prevalent type was infiltrating ductal (N = 148, of 71.8%), followed by ductal carcinoma in situ (N = 18, 8.7%, invasive lobular (N = 14, 6.8%), invasive mucinous (N = 8, 3.9%), papillary (N = 5, 2.4%), mucinous (N = 3 1.5%), invasive papillary (N = 3 1.5%), lobular (N = 2 1%), tubular (N = 1 0.5%). In terms of tumor's aggressive potential, 72 were grade I, 90 grade II and 31 grade III; we also observed that Ki67 value was over 13% in 71% of the patients and that only 6.8% had vascular involvement. 59.7% were double positive for both progesterone and estrogen receptors. In those in which it was investigated the human epidermal growth factor receptor 2 (HER2) status, only 12% were positive. Regarding the first treatment option, surgery was used in 77.7% of the patients, hormonal therapy used as neoadjuvant in 9.2% and as palliative care in 3%, neoadjuvant chemotherapy in 5.8% and radiotherapy in 3% (in one case as palliative care). Curiously, in the group submitted to neoadjuvant therapy, we saw that, from those under hormonal therapy, 4 underwent subsequent mastectomy, 3 patients refused surgery and in 4 cases it was decided not to do the surgical intervention; from those who underwent radiotherapy, 2 of 3 patients were submitted to mastectomy and from the group that did chemotherapy all patients underwent surgical intervention. Considering the histological diagnosis, tumor aggressive potential, hormonal receptors and HER2+ status, on subsets of this population according to aged related intervals (65–69 years, 70–75 years and N75 years) there were no significant differences among them. Conclusion: The results found are according to current literature, letting us think that there is a chance of a good prognosis in the elderly population. In fact, the use of a multidimensional geriatric evaluation will led to a better selection of the best and individualized therapy for each patient. The growing number of treatment options in the elderly breast cancer patients will lead to an increase in survival and contribute to an improvement in their quality of life. Disclosure of interest: None declared. Keyword: Breast cancer doi:10.1016/j.jgo.2014.09.043

Breast cancer in elderly patients P014 FEASIBILITY OF ADJUVANT CHEMOTHERAPY IN BREAST CANCER WOMEN OVER 70 YEARS AFTER COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) E. Colomba1, M. Leheurteur1, S. Thureau1, F. Di Fiore1,2, O. Rigal1,⁎ 1 CLCC Henri Becquerel, France 2 CHU-ROUEN, Rouen, France