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ATwo-Centre Audit on Changes in Ejection Fraction (EF) following sequential anthracycline chemotherapy and Trastuzumab (T) in patients with HER2+ Early Breast Cancer (EBC)
S128
Poster Abstracts II / The Breast 32S1 (2017) S78–S132
Other P320 A Two-Centre Audit on Changes in Ejection Fraction (EF) following sequential anthracycline chemotherapy and Trastuzumab (T) in patients with HER2+ Early Breast Cancer (EBC) S. Fernando1 *, A. Conway2, H. Mitchell2, I. Sandri1, A. Wardley2, L. Okonta1, J. Mansi1. 1Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, 2The Christie NHS Foundation Trust, Manchester, United Kingdom Aims: NCRI [1] guidelines state that echocardiograms should be done on HER2+ EBC patients pre-anthracycline, pre-T and on the 6th and 12th cycles of T. The Christie NHS Foundation Trust and The Guy’s and St Thomas’ NHS Foundation Trust (GSTT) conducted a two centre audit on EF changes pre-anthracycline and pre-T, as there is evidence that there is no significant change in EF pre-anthracycline and pre-T [2]. Methods: At GSTT retrospective data was collected between May 2014 and May 2016. At The Christie retrospective data was collected from Jan – Dec 2010, Jan – June 2013 and Jan – Dec 2015. HER2+ EBC patients having adjuvant/neoadjuvant chemotherapy with an A followed by T were selected. Echocardiogram reports were retrieved pre-anthracycline and then pre-T. Results: GSTT: 69 patients were identified at GSTT. There was a decrease in EF of ≥10% pre-anthracycline and pre-T in only two patients (A and B), both under 50 years of age. On further review, the Cardiology team concluded that the initial EFs were overestimated in Patient A and B. The Christie: 342 patients’ were identified at the Christie. The 2010 and 2013 data (214 patients) did not show ≥10% drop in EF pre-anthracycline and pre-T in any of the patients. The 2015 data (128 patients) showed 3 patients (C, D and E) had a clinically significant drop in EF in the two time points by ≥10%. Patient C would have been identified as high risk according to baseline EF and would merit an echo post anthracycline. Patient D and E had cardiovascular comorbidities and did not have a significant drop in EF between baseline and after anthracycline. Conclusions: The results from The Christie and GSTT support the recommendation that most patients do not require two echocardiograms pre T. This supports a change in practice with only high risk patients having more frequent echocardiograms. Disclosure of Interest: No significant relationships. References [1] Jones AL et al. Management of cardiac health in trastuzumabtreated patients with breast cancer: updated United Kingdom National Cancer Research Institute recommendations for monitoring. Br J Cancer. 2009. 100(5):684–692. [2] Wardley A, Mitchell H, Conway AM, et al. Cardiac monitoring and cardiac events in patients receiving adjuvant trastuzumab treatment. The Christie NHS Foundation Trust. Poster session presented at: 3rd Annual UK Breast Cancer Group; 2015 Nov 20–21; London, UK.
P321 Clinical and biological factors associated with higher rates of locoregional recurrences in Egyptian patients with early breast cancer L. Kassem1,3 *, W. El Sheshtawy2,3, S. Lasheen1,3, M. Ismail4, D. El Khishin4, H. Azim1,3. 1Department of Clinical Oncology, Cairo University, Cairo, Egypt, 2Department of Clinical Oncology, El Azhar University, Cairo, Egypt, 3Clinical Oncology Department, Cairo Oncology Center (COC), Cairo, Egypt, 4Clinical Research Unit, Cairo Oncology Center (COC), Cairo, Egypt Aim: We aimed at investigating the impact of each of the classical breast cancer clinico-pathological factors on the risk and outcome of loco-regional recurrence in Egyptian women with early breast cancer. Methods: We retrospectively identified clinical records of 1637 consecutive women diagnosed with early breast cancer between January 2000 and December 2009. We explored the relationship between the clinico-pathologic factors and the incidence of local or regional recurrence, local recurrence free survival (LRFS), and overall survival (OS) following local recurrence. Results: Median follow up period for the whole cohort was 5.2 years (Range 0.8–14 years); 201 patients (12.3%) developed locoregional relapse. Chest wall nodules was the most common site of recurrence (62 cases, 30.8%) followed by tumor bed recurrence in conserved breast (50 cases, 24.9%) then nodal recurrence in 24 cases (11.9%) while 25 (12.4%) patients had multiple sites of recurrence. Among the individual clinico-pathological parameters, more than 3 positive axillary LNs ( p = 0.003), positive LN ratio >0.8 ( p < 0.001), ER negativity ( p = 0.049), PR negativity ( p = 0.049) and Breast conserving surgery ( p = 0.002) were associated with higher incidence of loco-regional recurrence. By Kaplan Meier model, factors associated with shorter LRFS included tumors larger than 2 cm (8y LRFS: 71.4% versus 81.2%; p = 0.013), more than 3 positive axillary LNs (8y LRFS: 69.6% versus 79.3%; p < 0.001), LN ratio >0.8 (8y LRFS: 52.8% versus 76.0%; p < 0.001) and breast conservative surgery (8y LRFS: 60.5% versus 79.1%; p < 0.001). The only biological subtype associated with shorter LRFS was the triple negative breast cancer (8y LRFS 71.0% versus 76.3 compared to the non-triple negative; p = 0.008). Regarding survival after local recurrence, the OS was longer in patients with no other sites of relapse (3y OS: 95.5% versus 79.0%; p = 0.012), in patients who could receive local treatment for local recurrence (3y OS: 96.5% versus 78.5%; p = 0.020) and in those relapsing >3 years after surgery (3y OS: 91.4% versus 83.7%; p = 0.09). Conclusion: Higher stage at presentation and the extent of surgery remain the most significant predictors of local recurrence with limited impact of the biological subtype on that pattern of failure. Disclosure of Interest: No significant relationships.
Table (abstract: P320). Patient/Age
Co-morbidities
Baseline EF
Pre T EF
A/48 B/42 C/62
Nil Palpitations Nil
64% 76% 52%
54% 55–65% 34%
D/77
Aortic stenosis
72%
62%
E68
Hypertension
66%
>55%
Treatment held?
No No Yes – after anthracycline Yes – after 3 cycles T Yes – after 14 cycles T
EF at holding treatment
N/A N/A 34% 51% 35–40%
Ramipril started?
Yes, Pre T No Yes, post anthracycline Patient already on Ramipril Yes, when EF 45–50% at C12 T
When treatment restarted N/A N/A 3 months later, EF >50% T discontinued after 3 cycles T discontinued after 14 cycles
T completed?
Yes Yes Yes No No
Poster Abstracts II / The Breast 32S1 (2017) S78–S132
Other P320 A Two-Centre Audit on Changes in Ejection Fraction (EF) following sequential anthracycline chemotherapy and Trastuzumab (T) in patients with HER2+ Early Breast Cancer (EBC) S. Fernando1 *, A. Conway2, H. Mitchell2, I. Sandri1, A. Wardley2, L. Okonta1, J. Mansi1. 1Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, 2The Christie NHS Foundation Trust, Manchester, United Kingdom Aims: NCRI [1] guidelines state that echocardiograms should be done on HER2+ EBC patients pre-anthracycline, pre-T and on the 6th and 12th cycles of T. The Christie NHS Foundation Trust and The Guy’s and St Thomas’ NHS Foundation Trust (GSTT) conducted a two centre audit on EF changes pre-anthracycline and pre-T, as there is evidence that there is no significant change in EF pre-anthracycline and pre-T [2]. Methods: At GSTT retrospective data was collected between May 2014 and May 2016. At The Christie retrospective data was collected from Jan – Dec 2010, Jan – June 2013 and Jan – Dec 2015. HER2+ EBC patients having adjuvant/neoadjuvant chemotherapy with an A followed by T were selected. Echocardiogram reports were retrieved pre-anthracycline and then pre-T. Results: GSTT: 69 patients were identified at GSTT. There was a decrease in EF of ≥10% pre-anthracycline and pre-T in only two patients (A and B), both under 50 years of age. On further review, the Cardiology team concluded that the initial EFs were overestimated in Patient A and B. The Christie: 342 patients’ were identified at the Christie. The 2010 and 2013 data (214 patients) did not show ≥10% drop in EF pre-anthracycline and pre-T in any of the patients. The 2015 data (128 patients) showed 3 patients (C, D and E) had a clinically significant drop in EF in the two time points by ≥10%. Patient C would have been identified as high risk according to baseline EF and would merit an echo post anthracycline. Patient D and E had cardiovascular comorbidities and did not have a significant drop in EF between baseline and after anthracycline. Conclusions: The results from The Christie and GSTT support the recommendation that most patients do not require two echocardiograms pre T. This supports a change in practice with only high risk patients having more frequent echocardiograms. Disclosure of Interest: No significant relationships. References [1] Jones AL et al. Management of cardiac health in trastuzumabtreated patients with breast cancer: updated United Kingdom National Cancer Research Institute recommendations for monitoring. Br J Cancer. 2009. 100(5):684–692. [2] Wardley A, Mitchell H, Conway AM, et al. Cardiac monitoring and cardiac events in patients receiving adjuvant trastuzumab treatment. The Christie NHS Foundation Trust. Poster session presented at: 3rd Annual UK Breast Cancer Group; 2015 Nov 20–21; London, UK.
P321 Clinical and biological factors associated with higher rates of locoregional recurrences in Egyptian patients with early breast cancer L. Kassem1,3 *, W. El Sheshtawy2,3, S. Lasheen1,3, M. Ismail4, D. El Khishin4, H. Azim1,3. 1Department of Clinical Oncology, Cairo University, Cairo, Egypt, 2Department of Clinical Oncology, El Azhar University, Cairo, Egypt, 3Clinical Oncology Department, Cairo Oncology Center (COC), Cairo, Egypt, 4Clinical Research Unit, Cairo Oncology Center (COC), Cairo, Egypt Aim: We aimed at investigating the impact of each of the classical breast cancer clinico-pathological factors on the risk and outcome of loco-regional recurrence in Egyptian women with early breast cancer. Methods: We retrospectively identified clinical records of 1637 consecutive women diagnosed with early breast cancer between January 2000 and December 2009. We explored the relationship between the clinico-pathologic factors and the incidence of local or regional recurrence, local recurrence free survival (LRFS), and overall survival (OS) following local recurrence. Results: Median follow up period for the whole cohort was 5.2 years (Range 0.8–14 years); 201 patients (12.3%) developed locoregional relapse. Chest wall nodules was the most common site of recurrence (62 cases, 30.8%) followed by tumor bed recurrence in conserved breast (50 cases, 24.9%) then nodal recurrence in 24 cases (11.9%) while 25 (12.4%) patients had multiple sites of recurrence. Among the individual clinico-pathological parameters, more than 3 positive axillary LNs ( p = 0.003), positive LN ratio >0.8 ( p < 0.001), ER negativity ( p = 0.049), PR negativity ( p = 0.049) and Breast conserving surgery ( p = 0.002) were associated with higher incidence of loco-regional recurrence. By Kaplan Meier model, factors associated with shorter LRFS included tumors larger than 2 cm (8y LRFS: 71.4% versus 81.2%; p = 0.013), more than 3 positive axillary LNs (8y LRFS: 69.6% versus 79.3%; p < 0.001), LN ratio >0.8 (8y LRFS: 52.8% versus 76.0%; p < 0.001) and breast conservative surgery (8y LRFS: 60.5% versus 79.1%; p < 0.001). The only biological subtype associated with shorter LRFS was the triple negative breast cancer (8y LRFS 71.0% versus 76.3 compared to the non-triple negative; p = 0.008). Regarding survival after local recurrence, the OS was longer in patients with no other sites of relapse (3y OS: 95.5% versus 79.0%; p = 0.012), in patients who could receive local treatment for local recurrence (3y OS: 96.5% versus 78.5%; p = 0.020) and in those relapsing >3 years after surgery (3y OS: 91.4% versus 83.7%; p = 0.09). Conclusion: Higher stage at presentation and the extent of surgery remain the most significant predictors of local recurrence with limited impact of the biological subtype on that pattern of failure. Disclosure of Interest: No significant relationships.
Table (abstract: P320). Patient/Age
Co-morbidities
Baseline EF
Pre T EF
A/48 B/42 C/62
Nil Palpitations Nil
64% 76% 52%
54% 55–65% 34%
D/77
Aortic stenosis
72%
62%
E68
Hypertension
66%
>55%
Treatment held?
No No Yes – after anthracycline Yes – after 3 cycles T Yes – after 14 cycles T
EF at holding treatment
N/A N/A 34% 51% 35–40%
Ramipril started?
Yes, Pre T No Yes, post anthracycline Patient already on Ramipril Yes, when EF 45–50% at C12 T
When treatment restarted N/A N/A 3 months later, EF >50% T discontinued after 3 cycles T discontinued after 14 cycles
T completed?
Yes Yes Yes No No