- Email: [email protected]
Electrochemotherapy with bleomycin in the treatment of cutaneous metastases from breast cancer and resistant to standard therapies: a case report
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Abstracts / The Breast 20 (2011) S12–S55
Results: Only two in the 50 patients (4%) developed tumor recurrences after a median of 3.2 years of follow-up. Relapses occurred at 1.6 years on average. One patient had lung, bone and liver involvement, the other brain only. These two patients survived only 4 months after relapse. They were younger than the other pCR patients (44yo vs 56yo). Among pCR cases, the proportions of triple-negative and HER2-enriched disease were both 29%. Primary tumors of the two patients with metastasis were triple-negative, suggesting these basal-like types to carry a very poor prognosis. Interestingly, both patients with recurrence had achieved pCR including lymph nodes at the time of surgery, whereas the other 48 disease-free patients included 9 with remnant disease in lymph nodes. Conclusion: In our study, disease relapse after achieving pCR was actually quite rare. The two patients with metastasis were young and had triplenegative tumors.
PO71 ANALYSIS OF FACTORS PREDICTING RESPONSE TO FIRST LINE ENDOCRINE THERAPY (HT) IN MENOPAUSAL PATIENTS WITH LUMINAL-TYPE ADVANCED BREAST CANCER (ABC) Olexiy Aseyev Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine Background: Endocrine therapy as first-line treatment is the preferred option in patients with luminal-type ABC with the exception of clinically aggressive disease or if there are doubts concerning the endocrine sensitivity of the tumor. But, even in case of good clinical response to endocrine therapy, a significant percentage of tumors develop resistance, and hence, patients relapse. Aim: To determine factors predicting response to first line endocrine therapy in post menopausal patients (Pts.) with hormone receptor positive (HR+) HER2/neu-negative ABC. Methods: Complete clinical data of 80 HR+ HER2/neu-negative ABC pts. has been studied. Time to progression (TTP), overall survival (OS) and progression rate (PR) have been assessed. Minimal time of observation was 36 months. Complete follow-up pts. information has been analyzed and identified prognostic factors having significant effect on systemic therapy results. TTP and OS were estimated using the Kaplan-Meier method. Multivariate analyses (Cox proportional hazards model, multinomial logistic regression and Multilayer Perceptron Neural Network) were used in order to detect factors significantly associated with efficiency of conducted treatment. Statistical significance were established by p values <0,05. Results: The following results of HT were achieved: median TTP was 14,7 months, median OS was 27,3 months, PR during 3 years - 78% . Otherwise, significant variance of HT outcomes has been proven: range of results (difference between 25% best and 25% worst results) in OS was 15,8 months, TTP - 15,3 months, PR during 3 years - 22%. Pts. has been categorized into 3 groups: 26 pts. (32,5%) with low efficacy of assigned HT (TTP was <6 months), 31 pts. (38,75%) with relative efficacy of HT (TTP was <18 months) and 23 pts. (28,75%) with high efficacy of HT (TTP was >18 months). The next factors significantly correlated with HT efficiency have been recognized: patient's age on moment of breast cancer primary diagnosis and progression, status of hormonal receptors, summary diameter of marker lesions, period of menopause, quantity of affected lymph nodes, localization and number of metastatic lesions, ECOG status. Individual prognostic score was established to each factor and obtained scale that allows to calculate index of the forecast efficiency of endocrine therapy (IFEET). IFEET is the summary score of all factors and varies between -7 and 19. An effect of treatment considerably varies giving to different IFEET score: in pts. received HT with low IFEET (score less than 8) median OS was 15,56 months (TTP - 7,84 months, PR during 3 years - 94,26%), with high IFEET (score more than 12) - 27,73 months (TTP - 20,79 months, PR during 3 years - 37,75%). Conclusions: Obtained clinical factors based model allows to predict response to HT in postmenopausal pts. with hormone receptor positive Her2/neu-negative advanced breast cancer.
PO72 BREAST CANCER IN SURGERY IN VIETNAM Tung Dinh Nguyen Hue Central Hospital, Hue, Thua thien Hue, Viet Nam Background : Breast cancer is leading cancer in Vietnamese women. From 2001-2007, Vietnam have been performed the cancer population -based registry in the 5 provinces. We aim to estimate the breast cancer incidence and assess the situation of breast surgery in 3 main hospitals in Vietnam. Methods : This was a retrospective follow-up of 3 hospitals in Vietnam. The breast cancer registry used by the CANREG system version 4 for data entry and management. Overall and 5 years disease-free survival rates was calculated by SPSS 16.0 Results : There was 4,715 new cancer cases based on the cancer registries of 5 provinces in Vietnam .The Age Standard Rate per 100,000 habitants (ASR) is 30.2 in Hanoi, 21.0 in Hue and 19.4 in HoChiMinh City.The common age is 55-60 (128/100,000 habitants). Stage I: 10.9%, Stage II: 24.9%, Stage III& IV: 64.2% (N¼ 1071). A total of 3,684 cases was treated in HoChiMinh Cancer Hospital and Hue Central Hospital from 2004-2008. Patients who underwent mastectomy was 94.6% with 40.06% lymph node metastasis. Sentinel lymph node biopsy has the appearance rate was 97.8% in Hanoi, 88.% in Hue and 98.6% in HoChiMinh City (N¼226). Breast reconstruction for stage I and II with LD flap and TRAM flap was performed in HoChiMinh Cancer Hospital and Hue Central Hospital with aesthetic good results as 80%, local recurrence 3.6%, distant metastasis 9.1%, the 5 years overall survival rate was 95% and 5 years free-disease survival rate was 80.7% (N¼110). Conclusions: Breast cancer is common disease in Vietnam and most of patients often admitted hospital with stage III and IV. However, this study also suggest that early diagnosis and curative treatment of breast cancer patients can improve quality of life and long-term survival.
PO73 ELECTROCHEMOTHERAPY WITH BLEOMYCIN IN THE TREATMENT OF CUTANEOUS METASTASES FROM BREAST CANCER AND RESISTANT TO STANDARD THERAPIES: A CASE REPORT Riccardo Bussone, Sara Bustreo, Ada Ala, Roberto Cianci, Simona Bevilacqua, Greta Grilz, Isabella Castellano, Marinella Mistrangelo, Giuliana Ritorto, Anna Maria Vandone, Michela Donadio Breast Unit, A.O.U. San Giovanni Battista, Turin, Piemonte, Italy Introduction: Treatment of cutaneous metastases from breast cancer and resistant to standard therapies is a challenge. Clinical management of skin lesions is complex and impact on quality of life of patients is negative, because of frequent association with pain, ulceration and exudation. In this scenario, the electrochemotherapy (ECT) with bleomycin may be beneficial? ECT is a locoregional treatment modality based on the application of electrical impulses by electroporation (cell membrane permeabilization) and passage of cytotoxic drug in the cytosol of cancer cells. Case history: 54 years women, in May 2000 diagnosis of breast cancer infiltrating mucinous locally advanced underwent primary chemotherapy and subsequently left radical mastectomy with left axillary dissection and placement of prosthetis. Histological Examination pT4, pN1, G2, 65% ER, PR negative, c-erbB2 negative, Ki67 25%. After adjuvant treatment, subsequent follow-up negative. In February 2008 appearance of bilateral breast skin metastases, left parasternal, right axillary lymph node and bone involvement; for this reason patient underwent more lines of locoregional and systemic medical therapy. Despite this skin progression was evident. In May 2011 patient presented cutaneous infiltration framework of chest wall, right breast ulcerated and subverted by lesions, erythematous skin with exudation and left breast with extruded prosthetis. Patient reported clear increase in pain and need for regular daily medications. After a wash-out two weeks long, after general anesthesia the patient underwent ECT with bleomycin on skin lesions of right breast and left parasternal. At 15 mg/m2 IV bolus injection of
Abstracts / The Breast 20 (2011) S12–S55
bleomycin followed the application of needle electrodes with delivery of electrical impulses by electroporation (Cliniporator, Igea, Italy). In second day it has appeared widespread muscle pain and itching in treated areas G2 (NCI-CTC) regressed completely and spontaneously in the tenth day. A month after the seat lesions treated remitted clearly with subsequent reduction of exudate in right breast, pain and daily medications. Conclusion: After two months median follow up skin areas treated with ECT are not advanced, while progression was observed in untreated areas. As in our case in selected patients heavily pretreated, ECT with bleomycin can be an advantageous method, repeatable and well tolerated in symptomatic control of cutaneous metastases from breast cancer and resistant to standard therapies. Bibliography Clarke M, Lancet 2005; Mir LM, Eur J Cancer Suppl 2006; Campana LG, Ann Surg Oncol 2009; Gehl J, JCO Suppl 2010; Matthiessen LW, JCO Suppl 2011.
PO74 LONG-TERM CONTROL OF BRAIN METASTASES IN BREAST CANCER PATIENTS BY LAPATINIB Petra Tesarova 1, Eva Sedlackova 1, Katarina Petrakova 2, Marketa Palacova 2, Peter Grell 2 1 Department of Oncology, Charles University Hospital, Prague, Czech Republic 2 Masaryk Memorial Cancer Institute, Brno, Czech Republic Background: The incidence of central nervous system (CNS) metastatic disease in breast cancer (BC) patients depends on the stage at initial diagnosis. About 14 - 15% of patients presenting with stage IV disease are suffering from CNS metastatic disease and autopsy studies have found clinically unsuspected brain metastases in 30% of patients with advanced BC. The median time to diagnosis of metastatic CNS disease is two years after the initial diagnosis and is uncommonly the only site of metastatic disease. There is only limited information on the factors that predict the development of CNS metastases, but the most frequently reported are young age, African ethnicity, oestrogen receptor (OR) negativity, HER2 positivity, high tumor grade and BRCA phenotype. Life expectancy of patients with untreated brain metastases is only 1 month; the life expectancy increases to three to four months with radiation and ten months when radiation is combined with surgery. More than one third of HER2-positive patients present with CNS metastases at a time when the systemic disease remains either stable of responsive to trastuzumab. In addition, it seems that for monoclonal antibodies such as trastuzumab that are unable to cross the blood-brain barrier, the brain behaves as a privileged site. Lapatinib was tested in patients with brain metastases because it is a small molecule able to penetrate the blood-brain barrier. Patients and methods: Since 2007 we treated 9 patients with HER2positive breast cancer with CNS metastatic disease. All patients were pretreated with anthracyclines, taxanes and one or two lines of chemotherapy with trastuzumab. Mean age of the patients was 53.5 years. All patients also had metastases in other organs (liver, lung, bone). Combination of lapatinib with capecitabine was started after diagnosis of brain metastases and after whole brain radiation (6 patients), gamma knife surgery (1 patient), or surgery (2 patients). 7 patients continued with lapatinib monotherapy after the completion of biochemotherapy with capecitabine. Results: 4 patients achieved complete remission, 3 partial remission and 2 stabilisation of the disease. Mean time of response duration was 14 months. Treatment was provided in outpatient clinic with a preservation of a good quality of life of treated patients. Conclusions: Brain metastases in HER2-positive BC are most common terminal phase of this disease. We need potent and clear-cut tools for the assessment of the risk of the brain metastases to start treatment with lapatinib in time (p95HER2?, CTC?). In patients with BC and brain metastases lapatinib is a very effective treatment with long term control of the disease and a good quality of life.
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PO75 COMPARING LOCAL EFFECT RADIOTHERAPY AND NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER AT HASAN SADIKIN HOSPITAL Yohana Azhar, Dradjat Suardi, Monty P. Soemitro, Dimyati Achmad, Maman Abdurahman, Francisca Badudu, Pisi Lukitto Oncology, Head and Neck Surgery, Hasan Sadikin Hospital, Bandung, Indonesia The aim of this study is to compare local control effect in patients with Locally Advanced Breast Cancer (LABC) who received anthracycline based neoadjuvant chemotherapy treatment compared with primary radiotherapy in an effort to minimize local recurrent rate and improve the quality of life. This research also aims to determine the role of p53 expression in local effect to determine patients who received anthracycline based neoadjuvant chemotherapy or primary radiotherapy. Local control areas obtained from LABC patients who received radiotherapy compared to chemotherapy (87.50% vs. 40.62%). Chi-square statistical analysis conducted with continuity correction obtained p ¼ 0.024 (p <0.05, Relative Risk (RR) ¼ 3,927), therefore radiotherapy is significantly contributed to local control effect. While p53 expression was not statistically significantly related to local control effect that achieved in response to anthracycline based neoadjuvant chemotherapy and radiotherapy (p ¼ 0.150 and p ¼ 1,00). Eventhough RR local control effect achived in p53 wt in response to anthracycline based neoadjuvant chemotherapy (RR ¼ 2, 053)
PO76 COMPREHENSIVE CANCER THERAPY IN METASTATIC BREAST CANCERA PILOT PROJECT OF EARLY INTEGRATION OF PALLIATIVE MEDICINE Jan Gaertner 2, Ursula Klein 2, Dennis Rachel Wuerstlein 1, 2 2 3 Scheicht , Sebastian Frechen , Juergen Wolf , Martin Hellmich 4, Peter Mallmann 5, Raymond Voltz 2, Nadia Harbeck 1 1 University Hospital Cologne, CIO, Breast Center, Koeln,, Germany 2 University Hospital Cologne, CIO, Department of Palliative Medicine, Koeln, Germany 3 University Hospital Cologne, CIO, Department I of Internal Medicine, Koeln, Germany 4 University Hospital Cologne, Institute of Medical Statistics, Koeln, Germany 5 University Hospital Cologne, CIO, OBGYN, Koeln, Germany Background: The integration of palliative care (PC) early in the disease trajectory of life limiting diseases is explicitly recommended by the World Health Organisation (WHO). This recommendation was included in the administrative directives for principles of cancer care in our institution. The aim of this study was to assess, for patients with breast cancer (BC), (a) at what point in the disease trajectory the patients were first provided PC and (b) whether - over one year - an earlier integration of PC could be achieved. Objective: A retrospective systematic chart analysis of a two year period was performed. We assumed that seeing patients relatively early during the course of the illness would be reflected by seeing patients that would be not already (i) in a reduced performance status and (ii) experiencing symptoms that are indicators for advanced disease (e.g. dyspnoea). Therefore, the first PC consultation for every breast cancer patient seen by the PC support team (PCST) was analyzed to assess in what physical condition patients receive first PC consultation and what burdening symptoms they already experienced. Results: Many patients were already in a reduced physical state and were experiencing burdening symptoms. After a one-year period, the number of burdening symptoms identified at first PC consultation and the admissions to the in-patient PC ward decreased while non-PC physicians increasingly requested PC support for psychosocial interventions. Conclusion: Though some degree of development towards a better understanding of PC competencies and the "early integration" approach
Abstracts / The Breast 20 (2011) S12–S55
Results: Only two in the 50 patients (4%) developed tumor recurrences after a median of 3.2 years of follow-up. Relapses occurred at 1.6 years on average. One patient had lung, bone and liver involvement, the other brain only. These two patients survived only 4 months after relapse. They were younger than the other pCR patients (44yo vs 56yo). Among pCR cases, the proportions of triple-negative and HER2-enriched disease were both 29%. Primary tumors of the two patients with metastasis were triple-negative, suggesting these basal-like types to carry a very poor prognosis. Interestingly, both patients with recurrence had achieved pCR including lymph nodes at the time of surgery, whereas the other 48 disease-free patients included 9 with remnant disease in lymph nodes. Conclusion: In our study, disease relapse after achieving pCR was actually quite rare. The two patients with metastasis were young and had triplenegative tumors.
PO71 ANALYSIS OF FACTORS PREDICTING RESPONSE TO FIRST LINE ENDOCRINE THERAPY (HT) IN MENOPAUSAL PATIENTS WITH LUMINAL-TYPE ADVANCED BREAST CANCER (ABC) Olexiy Aseyev Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine Background: Endocrine therapy as first-line treatment is the preferred option in patients with luminal-type ABC with the exception of clinically aggressive disease or if there are doubts concerning the endocrine sensitivity of the tumor. But, even in case of good clinical response to endocrine therapy, a significant percentage of tumors develop resistance, and hence, patients relapse. Aim: To determine factors predicting response to first line endocrine therapy in post menopausal patients (Pts.) with hormone receptor positive (HR+) HER2/neu-negative ABC. Methods: Complete clinical data of 80 HR+ HER2/neu-negative ABC pts. has been studied. Time to progression (TTP), overall survival (OS) and progression rate (PR) have been assessed. Minimal time of observation was 36 months. Complete follow-up pts. information has been analyzed and identified prognostic factors having significant effect on systemic therapy results. TTP and OS were estimated using the Kaplan-Meier method. Multivariate analyses (Cox proportional hazards model, multinomial logistic regression and Multilayer Perceptron Neural Network) were used in order to detect factors significantly associated with efficiency of conducted treatment. Statistical significance were established by p values <0,05. Results: The following results of HT were achieved: median TTP was 14,7 months, median OS was 27,3 months, PR during 3 years - 78% . Otherwise, significant variance of HT outcomes has been proven: range of results (difference between 25% best and 25% worst results) in OS was 15,8 months, TTP - 15,3 months, PR during 3 years - 22%. Pts. has been categorized into 3 groups: 26 pts. (32,5%) with low efficacy of assigned HT (TTP was <6 months), 31 pts. (38,75%) with relative efficacy of HT (TTP was <18 months) and 23 pts. (28,75%) with high efficacy of HT (TTP was >18 months). The next factors significantly correlated with HT efficiency have been recognized: patient's age on moment of breast cancer primary diagnosis and progression, status of hormonal receptors, summary diameter of marker lesions, period of menopause, quantity of affected lymph nodes, localization and number of metastatic lesions, ECOG status. Individual prognostic score was established to each factor and obtained scale that allows to calculate index of the forecast efficiency of endocrine therapy (IFEET). IFEET is the summary score of all factors and varies between -7 and 19. An effect of treatment considerably varies giving to different IFEET score: in pts. received HT with low IFEET (score less than 8) median OS was 15,56 months (TTP - 7,84 months, PR during 3 years - 94,26%), with high IFEET (score more than 12) - 27,73 months (TTP - 20,79 months, PR during 3 years - 37,75%). Conclusions: Obtained clinical factors based model allows to predict response to HT in postmenopausal pts. with hormone receptor positive Her2/neu-negative advanced breast cancer.
PO72 BREAST CANCER IN SURGERY IN VIETNAM Tung Dinh Nguyen Hue Central Hospital, Hue, Thua thien Hue, Viet Nam Background : Breast cancer is leading cancer in Vietnamese women. From 2001-2007, Vietnam have been performed the cancer population -based registry in the 5 provinces. We aim to estimate the breast cancer incidence and assess the situation of breast surgery in 3 main hospitals in Vietnam. Methods : This was a retrospective follow-up of 3 hospitals in Vietnam. The breast cancer registry used by the CANREG system version 4 for data entry and management. Overall and 5 years disease-free survival rates was calculated by SPSS 16.0 Results : There was 4,715 new cancer cases based on the cancer registries of 5 provinces in Vietnam .The Age Standard Rate per 100,000 habitants (ASR) is 30.2 in Hanoi, 21.0 in Hue and 19.4 in HoChiMinh City.The common age is 55-60 (128/100,000 habitants). Stage I: 10.9%, Stage II: 24.9%, Stage III& IV: 64.2% (N¼ 1071). A total of 3,684 cases was treated in HoChiMinh Cancer Hospital and Hue Central Hospital from 2004-2008. Patients who underwent mastectomy was 94.6% with 40.06% lymph node metastasis. Sentinel lymph node biopsy has the appearance rate was 97.8% in Hanoi, 88.% in Hue and 98.6% in HoChiMinh City (N¼226). Breast reconstruction for stage I and II with LD flap and TRAM flap was performed in HoChiMinh Cancer Hospital and Hue Central Hospital with aesthetic good results as 80%, local recurrence 3.6%, distant metastasis 9.1%, the 5 years overall survival rate was 95% and 5 years free-disease survival rate was 80.7% (N¼110). Conclusions: Breast cancer is common disease in Vietnam and most of patients often admitted hospital with stage III and IV. However, this study also suggest that early diagnosis and curative treatment of breast cancer patients can improve quality of life and long-term survival.
PO73 ELECTROCHEMOTHERAPY WITH BLEOMYCIN IN THE TREATMENT OF CUTANEOUS METASTASES FROM BREAST CANCER AND RESISTANT TO STANDARD THERAPIES: A CASE REPORT Riccardo Bussone, Sara Bustreo, Ada Ala, Roberto Cianci, Simona Bevilacqua, Greta Grilz, Isabella Castellano, Marinella Mistrangelo, Giuliana Ritorto, Anna Maria Vandone, Michela Donadio Breast Unit, A.O.U. San Giovanni Battista, Turin, Piemonte, Italy Introduction: Treatment of cutaneous metastases from breast cancer and resistant to standard therapies is a challenge. Clinical management of skin lesions is complex and impact on quality of life of patients is negative, because of frequent association with pain, ulceration and exudation. In this scenario, the electrochemotherapy (ECT) with bleomycin may be beneficial? ECT is a locoregional treatment modality based on the application of electrical impulses by electroporation (cell membrane permeabilization) and passage of cytotoxic drug in the cytosol of cancer cells. Case history: 54 years women, in May 2000 diagnosis of breast cancer infiltrating mucinous locally advanced underwent primary chemotherapy and subsequently left radical mastectomy with left axillary dissection and placement of prosthetis. Histological Examination pT4, pN1, G2, 65% ER, PR negative, c-erbB2 negative, Ki67 25%. After adjuvant treatment, subsequent follow-up negative. In February 2008 appearance of bilateral breast skin metastases, left parasternal, right axillary lymph node and bone involvement; for this reason patient underwent more lines of locoregional and systemic medical therapy. Despite this skin progression was evident. In May 2011 patient presented cutaneous infiltration framework of chest wall, right breast ulcerated and subverted by lesions, erythematous skin with exudation and left breast with extruded prosthetis. Patient reported clear increase in pain and need for regular daily medications. After a wash-out two weeks long, after general anesthesia the patient underwent ECT with bleomycin on skin lesions of right breast and left parasternal. At 15 mg/m2 IV bolus injection of
Abstracts / The Breast 20 (2011) S12–S55
bleomycin followed the application of needle electrodes with delivery of electrical impulses by electroporation (Cliniporator, Igea, Italy). In second day it has appeared widespread muscle pain and itching in treated areas G2 (NCI-CTC) regressed completely and spontaneously in the tenth day. A month after the seat lesions treated remitted clearly with subsequent reduction of exudate in right breast, pain and daily medications. Conclusion: After two months median follow up skin areas treated with ECT are not advanced, while progression was observed in untreated areas. As in our case in selected patients heavily pretreated, ECT with bleomycin can be an advantageous method, repeatable and well tolerated in symptomatic control of cutaneous metastases from breast cancer and resistant to standard therapies. Bibliography Clarke M, Lancet 2005; Mir LM, Eur J Cancer Suppl 2006; Campana LG, Ann Surg Oncol 2009; Gehl J, JCO Suppl 2010; Matthiessen LW, JCO Suppl 2011.
PO74 LONG-TERM CONTROL OF BRAIN METASTASES IN BREAST CANCER PATIENTS BY LAPATINIB Petra Tesarova 1, Eva Sedlackova 1, Katarina Petrakova 2, Marketa Palacova 2, Peter Grell 2 1 Department of Oncology, Charles University Hospital, Prague, Czech Republic 2 Masaryk Memorial Cancer Institute, Brno, Czech Republic Background: The incidence of central nervous system (CNS) metastatic disease in breast cancer (BC) patients depends on the stage at initial diagnosis. About 14 - 15% of patients presenting with stage IV disease are suffering from CNS metastatic disease and autopsy studies have found clinically unsuspected brain metastases in 30% of patients with advanced BC. The median time to diagnosis of metastatic CNS disease is two years after the initial diagnosis and is uncommonly the only site of metastatic disease. There is only limited information on the factors that predict the development of CNS metastases, but the most frequently reported are young age, African ethnicity, oestrogen receptor (OR) negativity, HER2 positivity, high tumor grade and BRCA phenotype. Life expectancy of patients with untreated brain metastases is only 1 month; the life expectancy increases to three to four months with radiation and ten months when radiation is combined with surgery. More than one third of HER2-positive patients present with CNS metastases at a time when the systemic disease remains either stable of responsive to trastuzumab. In addition, it seems that for monoclonal antibodies such as trastuzumab that are unable to cross the blood-brain barrier, the brain behaves as a privileged site. Lapatinib was tested in patients with brain metastases because it is a small molecule able to penetrate the blood-brain barrier. Patients and methods: Since 2007 we treated 9 patients with HER2positive breast cancer with CNS metastatic disease. All patients were pretreated with anthracyclines, taxanes and one or two lines of chemotherapy with trastuzumab. Mean age of the patients was 53.5 years. All patients also had metastases in other organs (liver, lung, bone). Combination of lapatinib with capecitabine was started after diagnosis of brain metastases and after whole brain radiation (6 patients), gamma knife surgery (1 patient), or surgery (2 patients). 7 patients continued with lapatinib monotherapy after the completion of biochemotherapy with capecitabine. Results: 4 patients achieved complete remission, 3 partial remission and 2 stabilisation of the disease. Mean time of response duration was 14 months. Treatment was provided in outpatient clinic with a preservation of a good quality of life of treated patients. Conclusions: Brain metastases in HER2-positive BC are most common terminal phase of this disease. We need potent and clear-cut tools for the assessment of the risk of the brain metastases to start treatment with lapatinib in time (p95HER2?, CTC?). In patients with BC and brain metastases lapatinib is a very effective treatment with long term control of the disease and a good quality of life.
S37
PO75 COMPARING LOCAL EFFECT RADIOTHERAPY AND NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER AT HASAN SADIKIN HOSPITAL Yohana Azhar, Dradjat Suardi, Monty P. Soemitro, Dimyati Achmad, Maman Abdurahman, Francisca Badudu, Pisi Lukitto Oncology, Head and Neck Surgery, Hasan Sadikin Hospital, Bandung, Indonesia The aim of this study is to compare local control effect in patients with Locally Advanced Breast Cancer (LABC) who received anthracycline based neoadjuvant chemotherapy treatment compared with primary radiotherapy in an effort to minimize local recurrent rate and improve the quality of life. This research also aims to determine the role of p53 expression in local effect to determine patients who received anthracycline based neoadjuvant chemotherapy or primary radiotherapy. Local control areas obtained from LABC patients who received radiotherapy compared to chemotherapy (87.50% vs. 40.62%). Chi-square statistical analysis conducted with continuity correction obtained p ¼ 0.024 (p <0.05, Relative Risk (RR) ¼ 3,927), therefore radiotherapy is significantly contributed to local control effect. While p53 expression was not statistically significantly related to local control effect that achieved in response to anthracycline based neoadjuvant chemotherapy and radiotherapy (p ¼ 0.150 and p ¼ 1,00). Eventhough RR local control effect achived in p53 wt in response to anthracycline based neoadjuvant chemotherapy (RR ¼ 2, 053)
PO76 COMPREHENSIVE CANCER THERAPY IN METASTATIC BREAST CANCERA PILOT PROJECT OF EARLY INTEGRATION OF PALLIATIVE MEDICINE Jan Gaertner 2, Ursula Klein 2, Dennis Rachel Wuerstlein 1, 2 2 3 Scheicht , Sebastian Frechen , Juergen Wolf , Martin Hellmich 4, Peter Mallmann 5, Raymond Voltz 2, Nadia Harbeck 1 1 University Hospital Cologne, CIO, Breast Center, Koeln,, Germany 2 University Hospital Cologne, CIO, Department of Palliative Medicine, Koeln, Germany 3 University Hospital Cologne, CIO, Department I of Internal Medicine, Koeln, Germany 4 University Hospital Cologne, Institute of Medical Statistics, Koeln, Germany 5 University Hospital Cologne, CIO, OBGYN, Koeln, Germany Background: The integration of palliative care (PC) early in the disease trajectory of life limiting diseases is explicitly recommended by the World Health Organisation (WHO). This recommendation was included in the administrative directives for principles of cancer care in our institution. The aim of this study was to assess, for patients with breast cancer (BC), (a) at what point in the disease trajectory the patients were first provided PC and (b) whether - over one year - an earlier integration of PC could be achieved. Objective: A retrospective systematic chart analysis of a two year period was performed. We assumed that seeing patients relatively early during the course of the illness would be reflected by seeing patients that would be not already (i) in a reduced performance status and (ii) experiencing symptoms that are indicators for advanced disease (e.g. dyspnoea). Therefore, the first PC consultation for every breast cancer patient seen by the PC support team (PCST) was analyzed to assess in what physical condition patients receive first PC consultation and what burdening symptoms they already experienced. Results: Many patients were already in a reduced physical state and were experiencing burdening symptoms. After a one-year period, the number of burdening symptoms identified at first PC consultation and the admissions to the in-patient PC ward decreased while non-PC physicians increasingly requested PC support for psychosocial interventions. Conclusion: Though some degree of development towards a better understanding of PC competencies and the "early integration" approach