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Influence of first treatment delay on survival among breast cancer subtypes
abstracts
Annals of Oncology
Cancer Stage
CPSþ EG Score
Modified Neo-Bioscore (8 points)
Pretreatment Clinical Stage (CS) I 0 IIA 0 IIB 1 IIIA 1 IIIB 2 IIIC 2 Post-treatment Pathologic Stage (PS) 0 0 I 0 IIA 1 IIB 1 IIIA 1 IIIB 1 IIIC 2 Tumor Marker ER negative 1
0 0 1 1 2 2
0 0 1 1 2 2
0 0 1 1 1 1 2
0 0 1 1 1 1 2
1
1
Honoraria (self): Medison; Honoraria (self): AstraZeneca; Honoraria (self): Novartis; Honoraria (self): Teva. M. Sarfaty: Honoraria (self): Roche; Honoraria (self): MSD; Honoraria (self): Medison; Honoraria (self): Novartis. All other authors have declared no conflicts of interest.
251P
Influence of first treatment delay on survival among breast cancer subtypes
I. Zarcos Pedrinaci1, D. Perez2, F. Rivas-Ruiz3, M. Sala4, M. Padilla-Ruiz3, J. AlcaideGarcia1, E. Perez-Ruiz2, R. Villatoro2, V. Navarro2, M. Redondo3 1 Oncology Unit, Hospital Costa del Sol, Marbella, Spain, 2Oncology Unit, Hospital Costa del Sol, Marbella, Spain, 3Research Unit, Hospital Costa del Sol, Marbella, Spain, 4 Epidemiology, Hospital del Mar, Barcelona, Spain
fied Neo-Bioscore could all stratify the DFS, DSS and OS (all P < 0.001). While in the same stratum of Neo-Bioscore score 2 and 3, the HER2-positive patients without trastuzumab therapy had much poorer DSS (P ¼ 0.013 and P values <0.01, respectively) as compared to HER2-positive patients with trastuzumab therapy and HER2-negative patients. Only the modified Neo-Bioscore had a significantly higher stratification of 5year DSS than PS (AUC 0.79 vs. 0.65, P ¼ 0.03). Conclusions: The modified Neo-Bioscore could circumvent the limitation of CPSþEG or Neo-Bioscore. The access of appropriate treatment should be incorporated into the existing staging systems for more refined prognosis prediction. Clinical trial identification: The trial protocol number: NCT03437837 Release date: February 19, 2018. Legal entity responsible for the study: Xuening Duan AND Yimin Cui. Funding: National Key Research and Development Program of China. Disclosure: All authors have declared no conflicts of interest.
250P
The concordance of treatment decision guided by oncotype and the PREDICT tool in early stage breast cancer
H. Goldvaser1, R. Yerushalmi2, T. Shochat3, M. Sarfaty1, D. Goldstein1, C. Mayer1 1 Davidoff Cencer Center, Rabin Medical Center, Peth Tikva, Israel, 2Davidoff Cencer Center, Rabin Medical Center Davidoff Cancer Centre, Beilinson Campus, Petah Tikva, Israel, 3Statistical Consulting Unit, Rabin Medical Center, Peth Tikva, Israel Background: Decision on adjuvant chemotherapy for early breast cancer can be guided by genomic assays. PREDICT is a validated free online tool that estimates the benefit from adjuvant chemotherapy using clinical and pathological data. The concordance of expected clinical decisions guided by Oncotype analysis and the PREDICT in unknown.
Volume 30 | Supplement 5 | October 2019
Background: Conflicting results on the the impact of cancer first treatment delay (FTD) on survival have been reported between several studies, and its importance has yet to be determined. We currently do not have any study in breast cancer (BC) analyzing how FTD influences the prognosis of the patients according to different inmunophenotypes. We conducted a study where we examined the relationship between survival and three periods of diagnostic-therapeutic delay, 30, 60 and 90 days. Methods: This multicentre cohort study included BC patients from screening CAMISS PROJECT, during 2000-2006 with follow-up until 2014. Cox regression analysis, crude and multivariate, was applied to estimate risk of death. The Hazard Ratio (HR) was adjusted by FTD, stage, immunophenotypes of BC and comorbidity Results: The study included 738 women aged 45-69 years. Median time of FTD was 58 days. First treatment aplied was surgery for all populations. 42% of BC presented as stage I and 34% stage II. 24% of patients had comorbidities. 21% expressed HER2, 80% estrogen receptors and 61% progresterone. There were 53% of Luminal A tumors, followed by 27% Luminal B, of which 10% also expressed HER2, 9% were HER2 overexpressing tumors, and 11% triple negative. In the crude analysis none of the three FDT cut-off points had a significant relationship with overall survival. Multivariate analysis adjusted for phenotypes, comorbidity and stage, showed worse prognosis tendency in DT30 and DT90, with a statistically significant level in DT60, hazard ratio [HR] 1,57; 95% IC (1,04-2,38). When we analyzed survival according to DT60 and BC subtypes there was more significant risk of death among HER2 subtype HR 2,91; 95% IC (1,635,21) and triple negative HR 1,90; 95% IC(1,01-3,60) comparing to Luminal A. No relationship was seen in Luminal B; Table. Conclusions: Waiting 60 days to initiate treatment was associated with a significantly worse overall survivall among triple negative and HER2 BC. We consider it of importance to offer early treatment to aggressive BC subtypes. Legal entity responsible for the study: REDISSEC-CAMISS Group-(Research Network in Health Services in Chronic Diseases). Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
doi:10.1093/annonc/mdz240 | v83
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.075/5576324 by National Science and Technology Library -Root user on 25 October 2019
Neo-Bioscore (7 points)
Methods: A retrospective single center cohort study comprising all women with estrogen receptor (ER) positive, human epidermal growth factor receptor 2 negative, node negative disease, whose tumors were sent for OncotypeDX analysis. Estimation of 10year overall survival (OS) benefit from 2nd generation chemotherapy was calculated using the PREDICT 2.1v tool. Omission of chemotherapy was expected to be advised when Oncotype recurrence score (RS) was 25 or when the estimated 10-year OS benefit by the PREDICT was <2%. The tests were considered concordant for women with RS 25 and estimated PREDICT benefit<2% or for women with RS > 25 and estimated PREDICT benefit 2%. Concordance was presented using percentages and the K coefficient. The impact on concordance of pre-specified histological features was assessed, including tumor size, intensity of ER and progesterone receptor (PR), grade, Ki67 and perineural and lymphovascular invasion. The difference between the subgroups was calculated using Chi-squared test. Results: A total of 445 women were included. Overall concordance was 75% (K ¼ 0.284), with 55 (12.5%) women with low RS but estimated PREDICT benefit 2% and 55 (12.5%) with high RS and estimated PREDICT benefit<2%. The concordance was significantly higher for grade 1 disease compared to grade 2-3 (93% vs 72%, p < 0.001), tumor 1cm compared to > 1cm (85% vs 72%, p ¼ 0.009), PR positive compared to PR negative (78% vs 58%, p < 0.001) and ki67<20% compared to 20% (82% vs 54%, p < 0.001). The intensity of ER and the presence of perineural or lymphovascular invasion had no significant impact on concordance. Conclusions: Compared to PREDICT, using Oncotype in node negative, ER positive disease is expected to change clinical decision in a quarter of patients. The concordance is influenced by pathological features. The use of Oncotype may not be necessary for clinically very low risk patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: H. Goldvaser: Honoraria (self): Roche. R. Yerushalmi: Honoraria (self): Roche;
Table: 249P Point assignment for the CPS+EG, neo-bioscore, and modified neo-bioscore staging systems
abstracts
Annals of Oncology
Table: 251P
Treatment delay (days)
Stage
Fenotipe
Comorbidity
v84 | Breast Cancer, Early Stage
<30 > ¼30 <60 > ¼60 <90 > ¼90 I InSitu II III Luminal A Luminal B Her2 Triple Negative Absence Presence
aHR60
aHR90
Ref 1,53 (0,84-2,78) R 1,57 (1,04-2,38)
Ref 0,29 (0,07-1,24) 1,40 (0,84-2,33) 4,42 (2,66-7,35) Ref 1,40 (0,85-2,31) 2,89 (1,62-5,18) 1,96 (1,01-3,66) Ref 1,63 (1,06-2,52)
Ref 0,29 (0,07-1,23) 1,38 (0,83-2,30) 4,43 (2,67-7,35) Ref 1,45 (0,88-2,40) 2,91 (1,63-5,21) 1,90 (1,01-3,60) Ref 1,61 (1,04-2,48)
Ref 1,72(1,00-2,95) Ref 1,47 (0,89-2,44) 3,01 (1,67-5,41) 1,95 (1,02-3,72) Ref 0,29 (0,07-1,22) 1,38 (0,83-2,31) 4,23 (2,56-7,01) Ref 1,59 (1,03-2,46)
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.075/5576324 by National Science and Technology Library -Root user on 25 October 2019
aHR30
Annals of Oncology
Cancer Stage
CPSþ EG Score
Modified Neo-Bioscore (8 points)
Pretreatment Clinical Stage (CS) I 0 IIA 0 IIB 1 IIIA 1 IIIB 2 IIIC 2 Post-treatment Pathologic Stage (PS) 0 0 I 0 IIA 1 IIB 1 IIIA 1 IIIB 1 IIIC 2 Tumor Marker ER negative 1
0 0 1 1 2 2
0 0 1 1 2 2
0 0 1 1 1 1 2
0 0 1 1 1 1 2
1
1
Honoraria (self): Medison; Honoraria (self): AstraZeneca; Honoraria (self): Novartis; Honoraria (self): Teva. M. Sarfaty: Honoraria (self): Roche; Honoraria (self): MSD; Honoraria (self): Medison; Honoraria (self): Novartis. All other authors have declared no conflicts of interest.
251P
Influence of first treatment delay on survival among breast cancer subtypes
I. Zarcos Pedrinaci1, D. Perez2, F. Rivas-Ruiz3, M. Sala4, M. Padilla-Ruiz3, J. AlcaideGarcia1, E. Perez-Ruiz2, R. Villatoro2, V. Navarro2, M. Redondo3 1 Oncology Unit, Hospital Costa del Sol, Marbella, Spain, 2Oncology Unit, Hospital Costa del Sol, Marbella, Spain, 3Research Unit, Hospital Costa del Sol, Marbella, Spain, 4 Epidemiology, Hospital del Mar, Barcelona, Spain
fied Neo-Bioscore could all stratify the DFS, DSS and OS (all P < 0.001). While in the same stratum of Neo-Bioscore score 2 and 3, the HER2-positive patients without trastuzumab therapy had much poorer DSS (P ¼ 0.013 and P values <0.01, respectively) as compared to HER2-positive patients with trastuzumab therapy and HER2-negative patients. Only the modified Neo-Bioscore had a significantly higher stratification of 5year DSS than PS (AUC 0.79 vs. 0.65, P ¼ 0.03). Conclusions: The modified Neo-Bioscore could circumvent the limitation of CPSþEG or Neo-Bioscore. The access of appropriate treatment should be incorporated into the existing staging systems for more refined prognosis prediction. Clinical trial identification: The trial protocol number: NCT03437837 Release date: February 19, 2018. Legal entity responsible for the study: Xuening Duan AND Yimin Cui. Funding: National Key Research and Development Program of China. Disclosure: All authors have declared no conflicts of interest.
250P
The concordance of treatment decision guided by oncotype and the PREDICT tool in early stage breast cancer
H. Goldvaser1, R. Yerushalmi2, T. Shochat3, M. Sarfaty1, D. Goldstein1, C. Mayer1 1 Davidoff Cencer Center, Rabin Medical Center, Peth Tikva, Israel, 2Davidoff Cencer Center, Rabin Medical Center Davidoff Cancer Centre, Beilinson Campus, Petah Tikva, Israel, 3Statistical Consulting Unit, Rabin Medical Center, Peth Tikva, Israel Background: Decision on adjuvant chemotherapy for early breast cancer can be guided by genomic assays. PREDICT is a validated free online tool that estimates the benefit from adjuvant chemotherapy using clinical and pathological data. The concordance of expected clinical decisions guided by Oncotype analysis and the PREDICT in unknown.
Volume 30 | Supplement 5 | October 2019
Background: Conflicting results on the the impact of cancer first treatment delay (FTD) on survival have been reported between several studies, and its importance has yet to be determined. We currently do not have any study in breast cancer (BC) analyzing how FTD influences the prognosis of the patients according to different inmunophenotypes. We conducted a study where we examined the relationship between survival and three periods of diagnostic-therapeutic delay, 30, 60 and 90 days. Methods: This multicentre cohort study included BC patients from screening CAMISS PROJECT, during 2000-2006 with follow-up until 2014. Cox regression analysis, crude and multivariate, was applied to estimate risk of death. The Hazard Ratio (HR) was adjusted by FTD, stage, immunophenotypes of BC and comorbidity Results: The study included 738 women aged 45-69 years. Median time of FTD was 58 days. First treatment aplied was surgery for all populations. 42% of BC presented as stage I and 34% stage II. 24% of patients had comorbidities. 21% expressed HER2, 80% estrogen receptors and 61% progresterone. There were 53% of Luminal A tumors, followed by 27% Luminal B, of which 10% also expressed HER2, 9% were HER2 overexpressing tumors, and 11% triple negative. In the crude analysis none of the three FDT cut-off points had a significant relationship with overall survival. Multivariate analysis adjusted for phenotypes, comorbidity and stage, showed worse prognosis tendency in DT30 and DT90, with a statistically significant level in DT60, hazard ratio [HR] 1,57; 95% IC (1,04-2,38). When we analyzed survival according to DT60 and BC subtypes there was more significant risk of death among HER2 subtype HR 2,91; 95% IC (1,635,21) and triple negative HR 1,90; 95% IC(1,01-3,60) comparing to Luminal A. No relationship was seen in Luminal B; Table. Conclusions: Waiting 60 days to initiate treatment was associated with a significantly worse overall survivall among triple negative and HER2 BC. We consider it of importance to offer early treatment to aggressive BC subtypes. Legal entity responsible for the study: REDISSEC-CAMISS Group-(Research Network in Health Services in Chronic Diseases). Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
doi:10.1093/annonc/mdz240 | v83
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.075/5576324 by National Science and Technology Library -Root user on 25 October 2019
Neo-Bioscore (7 points)
Methods: A retrospective single center cohort study comprising all women with estrogen receptor (ER) positive, human epidermal growth factor receptor 2 negative, node negative disease, whose tumors were sent for OncotypeDX analysis. Estimation of 10year overall survival (OS) benefit from 2nd generation chemotherapy was calculated using the PREDICT 2.1v tool. Omission of chemotherapy was expected to be advised when Oncotype recurrence score (RS) was 25 or when the estimated 10-year OS benefit by the PREDICT was <2%. The tests were considered concordant for women with RS 25 and estimated PREDICT benefit<2% or for women with RS > 25 and estimated PREDICT benefit 2%. Concordance was presented using percentages and the K coefficient. The impact on concordance of pre-specified histological features was assessed, including tumor size, intensity of ER and progesterone receptor (PR), grade, Ki67 and perineural and lymphovascular invasion. The difference between the subgroups was calculated using Chi-squared test. Results: A total of 445 women were included. Overall concordance was 75% (K ¼ 0.284), with 55 (12.5%) women with low RS but estimated PREDICT benefit 2% and 55 (12.5%) with high RS and estimated PREDICT benefit<2%. The concordance was significantly higher for grade 1 disease compared to grade 2-3 (93% vs 72%, p < 0.001), tumor 1cm compared to > 1cm (85% vs 72%, p ¼ 0.009), PR positive compared to PR negative (78% vs 58%, p < 0.001) and ki67<20% compared to 20% (82% vs 54%, p < 0.001). The intensity of ER and the presence of perineural or lymphovascular invasion had no significant impact on concordance. Conclusions: Compared to PREDICT, using Oncotype in node negative, ER positive disease is expected to change clinical decision in a quarter of patients. The concordance is influenced by pathological features. The use of Oncotype may not be necessary for clinically very low risk patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: H. Goldvaser: Honoraria (self): Roche. R. Yerushalmi: Honoraria (self): Roche;
Table: 249P Point assignment for the CPS+EG, neo-bioscore, and modified neo-bioscore staging systems
abstracts
Annals of Oncology
Table: 251P
Treatment delay (days)
Stage
Fenotipe
Comorbidity
v84 | Breast Cancer, Early Stage
<30 > ¼30 <60 > ¼60 <90 > ¼90 I InSitu II III Luminal A Luminal B Her2 Triple Negative Absence Presence
aHR60
aHR90
Ref 1,53 (0,84-2,78) R 1,57 (1,04-2,38)
Ref 0,29 (0,07-1,24) 1,40 (0,84-2,33) 4,42 (2,66-7,35) Ref 1,40 (0,85-2,31) 2,89 (1,62-5,18) 1,96 (1,01-3,66) Ref 1,63 (1,06-2,52)
Ref 0,29 (0,07-1,23) 1,38 (0,83-2,30) 4,43 (2,67-7,35) Ref 1,45 (0,88-2,40) 2,91 (1,63-5,21) 1,90 (1,01-3,60) Ref 1,61 (1,04-2,48)
Ref 1,72(1,00-2,95) Ref 1,47 (0,89-2,44) 3,01 (1,67-5,41) 1,95 (1,02-3,72) Ref 0,29 (0,07-1,22) 1,38 (0,83-2,31) 4,23 (2,56-7,01) Ref 1,59 (1,03-2,46)
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.075/5576324 by National Science and Technology Library -Root user on 25 October 2019
aHR30