- Email: [email protected]
Cardiac monitoring among stage 0-III and stage IV breast cancer patients treated with trastuzumab
abstracts
MO2 4 2
Cardiac monitoring among stage 0-III and stage IV breast cancer patients treated with trastuzumab
MO2 4 5
ROLE OF POST MASTECTOMY RADIOTHERAPY (PMRT) IN T1,T2 LESIONS WITH 1-3 POSITIVE AXILLARY LYMPH NODES
Manish A Sadhwani1, Nikhil B Garg1, Rajen A Tankshali2, Shashank J Pandya3 Surgical Oncology department, Gujarat cancer and research institute, India, 2Head of Unit, Department of Surgical Oncology, Gujarat Cancer and Research Institute, 3 Director of Institute, Gujarat Cancer and Research Institute
1
Background: There is international consensus to recommend PMRT for patients with tumour invasion of the skin or chest wall (T4) and patients with > 4 positive lymph nodes . However, the role of PMRT for patients with T1, T2 disease with 1-3 positive LN is still controversial. Study objectives:
Taisuke Ishii1, Eriko Nakano2, Tomone Watanabe1, Takahiro Higashi1 Division of Health Services Research, National Cancer Center, 2Medical Oncology Department, St. lukes international hospital
1. Empirically explore whether it is advisable to carry out radiation when there are 1-3 nodes 2. Whether Perinodal extention is an important parameter to consider for radiotherapy.
Background: Trastuzumab has significantly improved the survival of HER2 positive breast cancer both in early stage and metastatic diseases. Cardiotoxicity is the major adverse event that limits the use of trastuzumab. Every guidelines recommend regular assessment of left ventricular ejection fraction (LVEF) at baseline and every 3 months during therapy for stage 0-III, and at baseline for stage IV. However, there are no large studies that describe current practice. Methods: We used a database that linked the National Database of the Hospital-Based Cancer Registry (HBCR) and health insurance claims data from the Diagnosis Procedure Combination (DPC) survey. We collected claims data from October 2011 to December 2016 to allow inclusion of all treatments performed for breast cancers treated with trastuzumab newly diagnosed from 2012 to 2015. The annual echocardiogram examination rate in stage 0-III and stage IV were analyzed. We also explored factors associated with the performance of echocardiogram. Results: In all, stage 0-III patients treated with trastuzumab were 18,968(12.7%) and mean age was 58(612), stage IV patients treated with trastuzumab were 1,702(21.4%) and mean age was 58(612). In stage 0-III, appropriate echocardiogram rate were increasing year by year (2012 13.4%, 2013 38.5%, 2014 40.3% and 2015 43%, p < 0.001). In stage IV, baseline LVEF assessment increased (2012 66.3%, 2013 78.2%, 2014 78.5% and 2015 76.2%, p < 0.001). In multivariate analysis, anthracycline containing regimen and older age were associated with the performance of appropriate echocardiogram both in stage 0-III and stage IV. Conclusion: Appropriate echocardiogram rate improved, however a large proportion of patients still received suboptimal cardiac monitoring especially those among stage 0III.
Methods: We collected data after approval from our institutional board review and analysed patients who were treated at our institute between 2014-2017.Of the 891 patients who underwent mastectomy and axillary lymph node dissection, 211 cases fulfilled following inclusion criteria (1) Female with unilateral breast cancer and no metastasis at initial diagnosis(2) postoperative pathology indicated T1-2 and 1-3 positive lymph nodes, at least 10 lymph nodes removed (3) complete surgical resection and negative margins (4) No neoadjuvant chemotherapy. We formulated hypotheses 1. Radiotherapy does not have any impact on recurrence post mastectomy. 2.There is no influence of Peri nodal extention on recurrence. The above hypotheses were tested using chi-square test. Results: Radiotherapy was given in 118 patients and 93 were not given .Recurrences were obtained in 18 amongst radiotherapy and without radiotherapy in 38 .When chi square was applied with 1 degree of freedom, value was highly significant at 0.006 with 99% CI.Hence our hypothesis was rejected. Also in case of PNE with recurrence and radiotherapy, 15 had PNE with radiotherapy and recurrence and 54 had no recurrence,on computation degree of freedom was 3 and p value was 0.013% hence highly significant. Conclusion: Radiotherapy should be strongly considered in patients with 1-3 nodes post mastectomy as it decreases the chances of recurrence and also if PNE is present chances of recurrence are increased, hence radiotherapy be considered.
1
MO2 4 3
Hematological Toxicity in Low Muscle Mass Breast Cancer Patient Underwent Chemotherapy: A Preliminary Study
Felix Wijovi1, Claudia Jodhinata1, Andree Kurniawan2, Wilson M. Raffaello1, Devina A. Halim1, Helenia Putri1 1 Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia, 2 Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia Background: Chemotherapy, as treatment, may responsible for undesired side effects, such as sarcopenia and chemotherapy toxicity. Based on the previous study, slow muscle mass may increase hematological toxicity and decrease response of chemotherapy effectiveness. The reported data about hematological chemotherapy toxicity and low muscle mass in Indonesian breast cancer patients is very limited thus the aim of this study to find out the prevalence and association between them. Methods: This was cross-sectional study, conducted in our general hospital at Tangerang, Indonesia. Muscle mass was measured using Bio Impedance analysis. The first step, Asian Working Group for Sarcopenia (AWGS) criteria is used to count muscle mass cut-off in Indonesian population by height-based muscle mass. AWGS recommends to define low muscle mass as below the mean minus 2 standard deviation. The second step, blood sample from breast cancer patients undergoing chemotherapy were taken consecutively. The cut-off for defining anemia is hemoglobin <12g/dL; leukopenia is leukocyte count <5.000/mm3, and thrombocytopenia is < 150.000/mm3. The Chi Square analysis was used to see the association. Results: The first step of the study included 137 young adult women. Cut off point of muscle mass in Indonesian female was 4.781 kg/m2. The second step, a total of 36 breast cancer patients with mean age 48.0869.73 were included. Anemia was found in 20 (54%) subjects, leukopenia in 2 (5.5%) subjects, thrombocytopenia in 1 (2.7%) subject. In this study, patient with low muscle mass only found in 1 of 37 patients. Conclusion: Cut-off muscle mass for Indonesian female is 4.781kg/m2, lower than AWGS standard. There is no statistically significant between low muscle mass and hematological toxicity in breast cancer patient. Further study needs to be evaluated in bigger population to confirm this result.
vi102 | Oral Session : Mini-Oral Abstracts Session
MO2 4 6
Comparison of concurrent, sequential, and sandwich chemoradiation modalities in breast cancer therapy: A Meta Analysis
Citra Aryanti, Wayan Sudarsa, Tjakra Manuaba Division of Surgical Oncology, Department of Surgery, Indonesia Background Despite of the increasing of chemoradiation modality usage in breast cancer, the optimal sequence and timing of them was not well studied. Therefore, this meta analysis aimed to pooled studies of the existing practical sequence to search whether which modality has most better survival or lower recurrence rate. Methods This is a meta analysis to compare the overall survival, recurrence, and disease free survival between concurrent vs sequential, concurrent vs sandwich, concurrent vs simultaneous, and comparing either beginning with chemotherapy or radiation. This study was done by using PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Data were collected after literature research and analyzed using Review Manager 5.3. Results In this study, author included 7 studies to be analyzed. No difference of overall survival, recurrence, and disease free survival between concurrent vs sandwich and concurrent vs simultaneous chemoradiation. Overall survival was superior in using concurrent chemoradiation than delaying RT in sequence (Survival Odds 1.31;95CI 0.513.38; p ¼ 0.004; I2 78%). This study showed that starting chemotherapy first then radiotherapy showed higher recurrence than starting radiotherapy in the beginning (Risk ratio 3.12; 95CI 0.33-29.79; p < 0.001; I2 96%). Discussion Concurrent chemoradiation without delaying or making any gap between chemotherapy and radiotherapy was recommended. Making both therapies without any gap might provide an additive interaction to tumor response. Besides that, placing radiotherapy prior to chemotherapy was still debated and left to a personalized treatment choice. After radiation, the size of tumor shrink, making chemotherpay worked optimally. Conclusion No significant difference of survival and recurrence were found in sequencing chemoradiation. However, effort of not delaying both modalities and using radiotherapy first should be considered.
Volume 30 | Supplement 6 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz338.051/5583107 by East Carolina University user on 09 December 2019
Patients with FEC-D experienced higher toxicity with hospitalization rates of 25.1% of patients needing at least one hospitalization (p value ¼ 0.005). Grade 3 and 4 febrile neutropenia was higher with FEC-D (22.5% vs. 8.4%, p value ¼ 0.001) as was the use of granulocyte colony stimulating factors (GCSF). The rates of chemotherapy interruptions and dose reductions were similar in both treatment arms. Conclusions: Our study confirmed the benefit of sequential anthracycline-taxane chemotherapy in node positive breast cancer in the real-world albeit with higher toxicity.
Annals of Oncology
MO2 4 2
Cardiac monitoring among stage 0-III and stage IV breast cancer patients treated with trastuzumab
MO2 4 5
ROLE OF POST MASTECTOMY RADIOTHERAPY (PMRT) IN T1,T2 LESIONS WITH 1-3 POSITIVE AXILLARY LYMPH NODES
Manish A Sadhwani1, Nikhil B Garg1, Rajen A Tankshali2, Shashank J Pandya3 Surgical Oncology department, Gujarat cancer and research institute, India, 2Head of Unit, Department of Surgical Oncology, Gujarat Cancer and Research Institute, 3 Director of Institute, Gujarat Cancer and Research Institute
1
Background: There is international consensus to recommend PMRT for patients with tumour invasion of the skin or chest wall (T4) and patients with > 4 positive lymph nodes . However, the role of PMRT for patients with T1, T2 disease with 1-3 positive LN is still controversial. Study objectives:
Taisuke Ishii1, Eriko Nakano2, Tomone Watanabe1, Takahiro Higashi1 Division of Health Services Research, National Cancer Center, 2Medical Oncology Department, St. lukes international hospital
1. Empirically explore whether it is advisable to carry out radiation when there are 1-3 nodes 2. Whether Perinodal extention is an important parameter to consider for radiotherapy.
Background: Trastuzumab has significantly improved the survival of HER2 positive breast cancer both in early stage and metastatic diseases. Cardiotoxicity is the major adverse event that limits the use of trastuzumab. Every guidelines recommend regular assessment of left ventricular ejection fraction (LVEF) at baseline and every 3 months during therapy for stage 0-III, and at baseline for stage IV. However, there are no large studies that describe current practice. Methods: We used a database that linked the National Database of the Hospital-Based Cancer Registry (HBCR) and health insurance claims data from the Diagnosis Procedure Combination (DPC) survey. We collected claims data from October 2011 to December 2016 to allow inclusion of all treatments performed for breast cancers treated with trastuzumab newly diagnosed from 2012 to 2015. The annual echocardiogram examination rate in stage 0-III and stage IV were analyzed. We also explored factors associated with the performance of echocardiogram. Results: In all, stage 0-III patients treated with trastuzumab were 18,968(12.7%) and mean age was 58(612), stage IV patients treated with trastuzumab were 1,702(21.4%) and mean age was 58(612). In stage 0-III, appropriate echocardiogram rate were increasing year by year (2012 13.4%, 2013 38.5%, 2014 40.3% and 2015 43%, p < 0.001). In stage IV, baseline LVEF assessment increased (2012 66.3%, 2013 78.2%, 2014 78.5% and 2015 76.2%, p < 0.001). In multivariate analysis, anthracycline containing regimen and older age were associated with the performance of appropriate echocardiogram both in stage 0-III and stage IV. Conclusion: Appropriate echocardiogram rate improved, however a large proportion of patients still received suboptimal cardiac monitoring especially those among stage 0III.
Methods: We collected data after approval from our institutional board review and analysed patients who were treated at our institute between 2014-2017.Of the 891 patients who underwent mastectomy and axillary lymph node dissection, 211 cases fulfilled following inclusion criteria (1) Female with unilateral breast cancer and no metastasis at initial diagnosis(2) postoperative pathology indicated T1-2 and 1-3 positive lymph nodes, at least 10 lymph nodes removed (3) complete surgical resection and negative margins (4) No neoadjuvant chemotherapy. We formulated hypotheses 1. Radiotherapy does not have any impact on recurrence post mastectomy. 2.There is no influence of Peri nodal extention on recurrence. The above hypotheses were tested using chi-square test. Results: Radiotherapy was given in 118 patients and 93 were not given .Recurrences were obtained in 18 amongst radiotherapy and without radiotherapy in 38 .When chi square was applied with 1 degree of freedom, value was highly significant at 0.006 with 99% CI.Hence our hypothesis was rejected. Also in case of PNE with recurrence and radiotherapy, 15 had PNE with radiotherapy and recurrence and 54 had no recurrence,on computation degree of freedom was 3 and p value was 0.013% hence highly significant. Conclusion: Radiotherapy should be strongly considered in patients with 1-3 nodes post mastectomy as it decreases the chances of recurrence and also if PNE is present chances of recurrence are increased, hence radiotherapy be considered.
1
MO2 4 3
Hematological Toxicity in Low Muscle Mass Breast Cancer Patient Underwent Chemotherapy: A Preliminary Study
Felix Wijovi1, Claudia Jodhinata1, Andree Kurniawan2, Wilson M. Raffaello1, Devina A. Halim1, Helenia Putri1 1 Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia, 2 Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia Background: Chemotherapy, as treatment, may responsible for undesired side effects, such as sarcopenia and chemotherapy toxicity. Based on the previous study, slow muscle mass may increase hematological toxicity and decrease response of chemotherapy effectiveness. The reported data about hematological chemotherapy toxicity and low muscle mass in Indonesian breast cancer patients is very limited thus the aim of this study to find out the prevalence and association between them. Methods: This was cross-sectional study, conducted in our general hospital at Tangerang, Indonesia. Muscle mass was measured using Bio Impedance analysis. The first step, Asian Working Group for Sarcopenia (AWGS) criteria is used to count muscle mass cut-off in Indonesian population by height-based muscle mass. AWGS recommends to define low muscle mass as below the mean minus 2 standard deviation. The second step, blood sample from breast cancer patients undergoing chemotherapy were taken consecutively. The cut-off for defining anemia is hemoglobin <12g/dL; leukopenia is leukocyte count <5.000/mm3, and thrombocytopenia is < 150.000/mm3. The Chi Square analysis was used to see the association. Results: The first step of the study included 137 young adult women. Cut off point of muscle mass in Indonesian female was 4.781 kg/m2. The second step, a total of 36 breast cancer patients with mean age 48.0869.73 were included. Anemia was found in 20 (54%) subjects, leukopenia in 2 (5.5%) subjects, thrombocytopenia in 1 (2.7%) subject. In this study, patient with low muscle mass only found in 1 of 37 patients. Conclusion: Cut-off muscle mass for Indonesian female is 4.781kg/m2, lower than AWGS standard. There is no statistically significant between low muscle mass and hematological toxicity in breast cancer patient. Further study needs to be evaluated in bigger population to confirm this result.
vi102 | Oral Session : Mini-Oral Abstracts Session
MO2 4 6
Comparison of concurrent, sequential, and sandwich chemoradiation modalities in breast cancer therapy: A Meta Analysis
Citra Aryanti, Wayan Sudarsa, Tjakra Manuaba Division of Surgical Oncology, Department of Surgery, Indonesia Background Despite of the increasing of chemoradiation modality usage in breast cancer, the optimal sequence and timing of them was not well studied. Therefore, this meta analysis aimed to pooled studies of the existing practical sequence to search whether which modality has most better survival or lower recurrence rate. Methods This is a meta analysis to compare the overall survival, recurrence, and disease free survival between concurrent vs sequential, concurrent vs sandwich, concurrent vs simultaneous, and comparing either beginning with chemotherapy or radiation. This study was done by using PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Data were collected after literature research and analyzed using Review Manager 5.3. Results In this study, author included 7 studies to be analyzed. No difference of overall survival, recurrence, and disease free survival between concurrent vs sandwich and concurrent vs simultaneous chemoradiation. Overall survival was superior in using concurrent chemoradiation than delaying RT in sequence (Survival Odds 1.31;95CI 0.513.38; p ¼ 0.004; I2 78%). This study showed that starting chemotherapy first then radiotherapy showed higher recurrence than starting radiotherapy in the beginning (Risk ratio 3.12; 95CI 0.33-29.79; p < 0.001; I2 96%). Discussion Concurrent chemoradiation without delaying or making any gap between chemotherapy and radiotherapy was recommended. Making both therapies without any gap might provide an additive interaction to tumor response. Besides that, placing radiotherapy prior to chemotherapy was still debated and left to a personalized treatment choice. After radiation, the size of tumor shrink, making chemotherpay worked optimally. Conclusion No significant difference of survival and recurrence were found in sequencing chemoradiation. However, effort of not delaying both modalities and using radiotherapy first should be considered.
Volume 30 | Supplement 6 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz338.051/5583107 by East Carolina University user on 09 December 2019
Patients with FEC-D experienced higher toxicity with hospitalization rates of 25.1% of patients needing at least one hospitalization (p value ¼ 0.005). Grade 3 and 4 febrile neutropenia was higher with FEC-D (22.5% vs. 8.4%, p value ¼ 0.001) as was the use of granulocyte colony stimulating factors (GCSF). The rates of chemotherapy interruptions and dose reductions were similar in both treatment arms. Conclusions: Our study confirmed the benefit of sequential anthracycline-taxane chemotherapy in node positive breast cancer in the real-world albeit with higher toxicity.
Annals of Oncology