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Harvesting Population Data to Aid Treatment Decisions in Heavily Pre-Treated Advanced Breast Cancer
S76
Abstracts / The Breast 36 S1 (2017) S19–S76
with left breast cancer and underwent left mastectomy. One year later she developed a local recurrence and underwent radiation therapy and hormone therapy. When she became 38 years, she was eager to have a child. After discussing about possible progress disease due to stopping hormone therapy, she chose to stop it to have a baby. Afterward she delivered a full healthy normal weight baby. She died 7 years later. Conclusions: Young women with breast cancer should be given focus and a further study with a large number patients is recommended.
PO145 HARVESTING POPULATION DATA TO AID TREATMENT DECISIONS IN HEAVILY PRE-TREATED ADVANCED BREAST CANCER Sharon Hensley Alford, Ozery-Flato Michal, Goldschmidt Ya’ara IBM, Watson Health, Dearborn, USA Cancer is the leading cause of death worldwide among women. Among cancers, breast cancer is the most significant both in incidence and mortality. Cancer overall, and breast cancer specifically, is expected to increase world-wide due to the overall growth and aging of the world population. As treatments for breast cancer have improved, more women are living longer with advanced breast cancer. However, evidence to support treatment decisions in heavily treated cases is sparse. Medical record data is becoming more and more available in electronic format; therefore, the access and cost of obtaining data on large populations of patients has become feasible. In parallel, computing capabilities to handle large and complex datasets have also advanced. We are currently entering an era where near real-time analysis of large pools of patient data will be possible at the point of care to support treatment decisions. IBM Research and IBM Watson Health have been investing in the computing architecture and analytics to make point of care analytics possible. In particular, IBM has developed a tool for population comparison that allows the computation of the likelihood of a patient to respond better to a given treatment option, compared to an alternative. The tool incorporates causal inference techniques for correcting treatment biases in the data, as well as identifying causes for differential treatment response. The tool analyzes multiple dimensions in patients’ history, as well as observed treatment outcomes, and produces a prediction model for being a ‘better responder’ for the treatment. Using similarity analytics and pattern mining, the tool can identify women in the dataset having similar expected differential response to the treatments, allowing doctors to inspect and compare their treatments and outcomes. Doctors can use this tool to present a patient with her likelihood to respond better to a certain treatment, compared to the alternative (with confidence intervals also provided), so that a data driven decision can be made using the most current and pertinent information for that individual patient. We will present the patented mathematical methods, data visualization, and computing process, developed at IBM, needed for this type of precision medicine in breast cancer and map the data architecture necessary to build such a clinical decision support tool.
PR146 CLINICOPATHOLOGICAL FACTORS AND PROGNOSIS IN ELDERLY RECURRENT BREAST CANCER PATIENTS OLDER THAN 75-YEARS-OLD Mayumi Ishida, Takanobu Masuda, Hideki Ijichi, Wakako Tajiri, Chinami Koga, Junko Tanaka, Yoshiaki Nakamura, Eriko Tokunaga National Hospital Organization Kyushu Cancer Center, Department of Breast Oncology, Fukuoka, Japan Background: As for the purpose of adjuvant therapy (Adj.Tx) for elderly breast cancer patient, quality of life maintenance is important as well as prevention of recurrence. We also have to consider the individual health condition such as complications, performance states(PS) and life span when we determine the Adj. Tx. The average life span of Japanese women is 86 years. The significance of early breast cancer in Japanese women on the survival of elderly patients is still unknown. Purpose: We conducted this study to clarify the relationships between tumor subtypes and clinicopahtological factors and prognosis in elderly recurrent breast cancer patients older than 75 years old. Patients and methods: We reviewed retrospectively 200 cases older than 75 years old with Stage I-III primary breast cancer receiving surgery between 2000 and 2014. 26 cases of them recurred. We examined clinicopathological factors, overall survival (OS), and survival rate after recurrence. Results: The average age was 81 years old at recurrence. At surgery, 23 cases (46%) had T1-2 tumors, and 10 cases (38%) were node-negative, 10 cases (42%) were node-positive, 5 cases (20%) had no axillary surgery. Hormone receptor(HR) was positive in 17 cases (65%), HER2 was positive in 5 cases (20%). In terms of the tumor subtypes, 13 cases (50%) were HR+/HER2-, 1 case (4%) was HR+/HER2+, 4 cases (15%) were HR-/HER2+, 4 cases (15%) were HR-/HER2-. Lumpectomy(Bp) and mastectomy(Bt) were performed 16(62%) and 10 cases (38%), respectively. Adj. radiotherapy(RT) was performed for only 1 case of Bt patient. The number of the recurrent cases without adjuvant RT was larger compared with that of the cases who received adj. RT, although not statistically significant (5% vs.14%, p = 0.47). In HR positive patients, 8 cases (47%) were received endocrine therapy(ET). Chemotherapy was performed for only 1 case and 17 cases (65%) did not receive any adjuvant treatment. First recurrence sites were as follows; local recurrence(LR), 19 cases (73%), distant metastasis(DM) 7 cases (27%). 3-yaer OS after recurrence, was 43% and 40% in HR+ and HR( p = 0.27), was 23% and 54% in HER2+ and HER2- cases ( p = 0.25), 57% and 46% in the patients with LR and those with DM ( p = 0.57), adj. Tx cases were 64%, no treatment cases were 39% ( p = 0.26). In HR+ cases, patients with ET was 100% and those without ET was 83.3% ( p = 0.058). Conclusion: Regardless of operation method, there were a lot of cases who did not receive adj. RT. As for the prognosis after the recurrence, there were no significant differences between OS and HR and HER2 status, recurrent sites, and Adj.Tx, but no ET may have worse prognosis than ET. Our study suggests that the optimal adj. RT and ET may improve prognosis, even in the elderly breast cancer patients older than 75 years old.
Abstracts / The Breast 36 S1 (2017) S19–S76
with left breast cancer and underwent left mastectomy. One year later she developed a local recurrence and underwent radiation therapy and hormone therapy. When she became 38 years, she was eager to have a child. After discussing about possible progress disease due to stopping hormone therapy, she chose to stop it to have a baby. Afterward she delivered a full healthy normal weight baby. She died 7 years later. Conclusions: Young women with breast cancer should be given focus and a further study with a large number patients is recommended.
PO145 HARVESTING POPULATION DATA TO AID TREATMENT DECISIONS IN HEAVILY PRE-TREATED ADVANCED BREAST CANCER Sharon Hensley Alford, Ozery-Flato Michal, Goldschmidt Ya’ara IBM, Watson Health, Dearborn, USA Cancer is the leading cause of death worldwide among women. Among cancers, breast cancer is the most significant both in incidence and mortality. Cancer overall, and breast cancer specifically, is expected to increase world-wide due to the overall growth and aging of the world population. As treatments for breast cancer have improved, more women are living longer with advanced breast cancer. However, evidence to support treatment decisions in heavily treated cases is sparse. Medical record data is becoming more and more available in electronic format; therefore, the access and cost of obtaining data on large populations of patients has become feasible. In parallel, computing capabilities to handle large and complex datasets have also advanced. We are currently entering an era where near real-time analysis of large pools of patient data will be possible at the point of care to support treatment decisions. IBM Research and IBM Watson Health have been investing in the computing architecture and analytics to make point of care analytics possible. In particular, IBM has developed a tool for population comparison that allows the computation of the likelihood of a patient to respond better to a given treatment option, compared to an alternative. The tool incorporates causal inference techniques for correcting treatment biases in the data, as well as identifying causes for differential treatment response. The tool analyzes multiple dimensions in patients’ history, as well as observed treatment outcomes, and produces a prediction model for being a ‘better responder’ for the treatment. Using similarity analytics and pattern mining, the tool can identify women in the dataset having similar expected differential response to the treatments, allowing doctors to inspect and compare their treatments and outcomes. Doctors can use this tool to present a patient with her likelihood to respond better to a certain treatment, compared to the alternative (with confidence intervals also provided), so that a data driven decision can be made using the most current and pertinent information for that individual patient. We will present the patented mathematical methods, data visualization, and computing process, developed at IBM, needed for this type of precision medicine in breast cancer and map the data architecture necessary to build such a clinical decision support tool.
PR146 CLINICOPATHOLOGICAL FACTORS AND PROGNOSIS IN ELDERLY RECURRENT BREAST CANCER PATIENTS OLDER THAN 75-YEARS-OLD Mayumi Ishida, Takanobu Masuda, Hideki Ijichi, Wakako Tajiri, Chinami Koga, Junko Tanaka, Yoshiaki Nakamura, Eriko Tokunaga National Hospital Organization Kyushu Cancer Center, Department of Breast Oncology, Fukuoka, Japan Background: As for the purpose of adjuvant therapy (Adj.Tx) for elderly breast cancer patient, quality of life maintenance is important as well as prevention of recurrence. We also have to consider the individual health condition such as complications, performance states(PS) and life span when we determine the Adj. Tx. The average life span of Japanese women is 86 years. The significance of early breast cancer in Japanese women on the survival of elderly patients is still unknown. Purpose: We conducted this study to clarify the relationships between tumor subtypes and clinicopahtological factors and prognosis in elderly recurrent breast cancer patients older than 75 years old. Patients and methods: We reviewed retrospectively 200 cases older than 75 years old with Stage I-III primary breast cancer receiving surgery between 2000 and 2014. 26 cases of them recurred. We examined clinicopathological factors, overall survival (OS), and survival rate after recurrence. Results: The average age was 81 years old at recurrence. At surgery, 23 cases (46%) had T1-2 tumors, and 10 cases (38%) were node-negative, 10 cases (42%) were node-positive, 5 cases (20%) had no axillary surgery. Hormone receptor(HR) was positive in 17 cases (65%), HER2 was positive in 5 cases (20%). In terms of the tumor subtypes, 13 cases (50%) were HR+/HER2-, 1 case (4%) was HR+/HER2+, 4 cases (15%) were HR-/HER2+, 4 cases (15%) were HR-/HER2-. Lumpectomy(Bp) and mastectomy(Bt) were performed 16(62%) and 10 cases (38%), respectively. Adj. radiotherapy(RT) was performed for only 1 case of Bt patient. The number of the recurrent cases without adjuvant RT was larger compared with that of the cases who received adj. RT, although not statistically significant (5% vs.14%, p = 0.47). In HR positive patients, 8 cases (47%) were received endocrine therapy(ET). Chemotherapy was performed for only 1 case and 17 cases (65%) did not receive any adjuvant treatment. First recurrence sites were as follows; local recurrence(LR), 19 cases (73%), distant metastasis(DM) 7 cases (27%). 3-yaer OS after recurrence, was 43% and 40% in HR+ and HR( p = 0.27), was 23% and 54% in HER2+ and HER2- cases ( p = 0.25), 57% and 46% in the patients with LR and those with DM ( p = 0.57), adj. Tx cases were 64%, no treatment cases were 39% ( p = 0.26). In HR+ cases, patients with ET was 100% and those without ET was 83.3% ( p = 0.058). Conclusion: Regardless of operation method, there were a lot of cases who did not receive adj. RT. As for the prognosis after the recurrence, there were no significant differences between OS and HR and HER2 status, recurrent sites, and Adj.Tx, but no ET may have worse prognosis than ET. Our study suggests that the optimal adj. RT and ET may improve prognosis, even in the elderly breast cancer patients older than 75 years old.