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PO84 VISUALIZING TREATMENT AND OUTCOMES IN METASTATIC BREAST CANCER
S48
Abstracts / The Breast 22 S3 (2013) S19–S63
PO83 ASSESSING ACUTE THROMBOPHLEBITIS DUE TO INTRAVENOUS VINORELBINE CHEMOTHERAPY IN METASTATIC BREAST CANCER (MBC) PATIENTS AT THE UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE (UHNS) S. Gilani, L. Davies, M. Brunt, A. Jegannathen University Hospital of North Staffordshire, Stoke on Trent, UK Background: Treatment of MBC is becoming more complex as more drugs are approved for this indication. A high proportion of these drugs are intravenous, and sequential use can have a detrimental effect on venous access, causing distress to the patient as well as preventing treatment. In the UK vinorelbine is licensed for the treatment of MBC and NSCLC as a single agent or in combination. Vinorelbine is a vesicant and when given intravenously can cause venous irritation, which in some cases can lead to thrombophlebitis. Administration site reactions are very common, occurring in more than 10% of patients (grade 3/4: 3.7%). We compared the incidence of venous toxicity with IV vinorelbine in patients with MBC and those with NSCLC, who generally receive vinorelbine as their first chemotherapy. Method: Case notes of all patients receiving IV vinorelbine during a 3 year period (2008 to 2011) at UHNS were reviewed retrospectively for incidence of thrombophlebitis. Results: We identified 39 patients; 11 received vinorelbine IV as a single agent for MBC whilst 28 received it with platinum as adjuvant chemotherapy for NSCLC. Median age was 55 and 67 years for MBC and NSCLC patients respectively. Patients with MBC had previously received at least 2 lines of chemotherapy (maximum of 5 previous lines), including combination regimens and nearly all had been administered IV, whereas all patients with NSCLC were chemo-naïve. Almost half of the patients with MBC had prior history of venous access problems. Four required central line insertions for vinorelbine treatment. A total of 57 cycles (mean 5.1) were delivered for MBC and 93 cycles (mean 3.3) were delivered for NSCLC. Moderate to severe thrombophlebitis was recorded in 8 of the 11 patients with MBC (80%), compared to only 1 (3%) with NSCLC. A further two patients with MBC experienced mild thrombophlebitis and problems also occurred in a further four patients despite them having a central line inserted. Other side effects occurred at similar rates in both groups, apart from haematological toxicity which was slightly more pronounced in patients with NSCLC and probably related to combination treatment. Conclusions: Venous complications were frequent with intravenous administration of vinorelbine. A significantly higher incidence of thrombophlebitis was seen in patients with MBC. This was probably due vein damage from multiple lines of previous chemotherapy. We recommend consideration of oral administration of vinorelbine to reduce the need for central line insertion and to improve the patient experience and compliance.
PO84 VISUALIZING TREATMENT AND OUTCOMES IN METASTATIC BREAST CANCER Gabrielle Rocque, Murtuza Rampurwala, Mark Burkard University of Wisconsin Carbone Cancer Center, Madison, WI, USA Introduction: Multiple treatments exist for metastatic breast cancer without clear guidelines on the order of therapy. Individual oncologists vary in practice patterns, resulting in difficulty evaluating any given therapy due to differences in treatments before and after that therapy. Methods for evaluating and visualizing treatment of breast cancer in aggregate are limited. Methods: A retrospective review was conducted of all patients who received treatment for metastatic breast cancer from 2008-2012 as identified by the University of Wisconsin tumor registry. Data collected included: age, ER/PR/Her2 status, recurrent vs. de novo disease, treatment regimen, length of time on therapy, enrollment on clinical
trials, and length of life or last follow-up. This data was combined into a bar graph, which represents each unique patient’s treatment course including length of time on individual therapies. Individual patients (including age and tumor characteristics) are on the y-axis, and time is recorded on the x-axis. Each therapy is color-coded by treatment type (hormonal therapy, chemotherapy, targeted therapy, experimental therapy, off therapy). Results: A graphic analysis of 62 patients was created. Forty-one patients had ER/PR+ Her2-, 16 with triple negative, and 5 with Her2+ breast cancer. The median age of the population was 58. Twenty-four patients had recurrent breast cancer and 38 patients had de novo metastatic breast cancer. On average, survival was longer for ER/PR+ patients and shorter for HER2+ and triple negative patients. However, within these populations there was significant heterogeneity and 20% of women with ER+ breast cancer lived shorter than the average woman with metastatic TNBC. Treatment durations were often longer for hormonal therapies than for chemotherapies. Targeted therapies were used most extensively in the HER2 population, although this did not always produce long survival in this disease. Breaks between lines of therapy were common. Conclusions: Patients with metastatic breast cancer can be represented in aggregate graphically to include length of time on therapy and type of treatment. This method could be used in future clinical trials to visually represent where in a patient’s course a particular therapy occurred in the context of the disease process. The traditional table format includes line of therapy without details of the prior treatments received (ex hormones, chemotherapy, or targets agents). In additional to clarifying treatments received, this new graphic format would distinguish patients who had previous long duration on treatment, which might represent more treatment-responsive disease and higher likelihood of response to a new agent. Also, this format provides details about subsequent therapies, which could impact the overall survival of patients. Ultimately, reporting of this detailed information would assist in identifying when particular agents are most likely to benefit patients and could assist in making guidelines for management of patients with metastatic breast cancer.
PO85 CHARACTERISTICS AND PROGNOSIS OF HORMONE RECEPTOR POSITIVE AND HER2 NEGATIVE RECURRENT BREAST CANCER PATIENTS RECEIVING POSTOPERATIVE AROMATASE INHIBITOR Ishida Mayumi, Igawa Akiko, Saruwatari Akihiro, Oikawa Masahiro, Koga Chinami, Nishimura Sumiko, Koi Yumiko, Akiyoshi Sayuri, Nakamura Yoshiaki, Ohno Shinji National Kyushu Cancer Center, Fukuoka, Japan Background: Therapeutic advances have been making an impact on the survival of women with primary and recurrent breast cancer. Aromatase inhibitor (AI) is well known to improve the prognosis of patients with hormone receptor (HR) positive early breast cancer, as well as that with recurrent disease in patients who had received tamoxifen as adjuvant therapy. On the other hand, the feature and therapeutic effect for recurrent disease might be influenced by the adjuvant therapy. In Japan, the third generation aromatase inhibitor (AI) was approved for both early and recurrent breast cancer in 2001. Patients and Methods: Among 387 patients with recurrent breast cancer treated at National Kyushu Cancer center between 2001 and 2012, two hundred forty eight were HR positive and HER2 negative. Here we examined the characteristics and prognosis of Japanese women with recurrent breast cancer after the approval of AI. Results: Among 248 patients, xx had been treated with AIs as adjuvant therapy and xx with selective endocrine receptor modulator (SERM). The median survival of patients receiving postoperative AIs was 2.4 years, which was significantly worse than 5.3 years of those with SERM (p=0.005). We divided these patients into the following three groups, ‘de novo’ recurrent group (primary endocrine resistance, recurrence diagnosed within 2 years after operation), ‘acquired’ recurrent group (secondary endocrine resistance, between 2-5 years after operation),
Abstracts / The Breast 22 S3 (2013) S19–S63
PO83 ASSESSING ACUTE THROMBOPHLEBITIS DUE TO INTRAVENOUS VINORELBINE CHEMOTHERAPY IN METASTATIC BREAST CANCER (MBC) PATIENTS AT THE UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE (UHNS) S. Gilani, L. Davies, M. Brunt, A. Jegannathen University Hospital of North Staffordshire, Stoke on Trent, UK Background: Treatment of MBC is becoming more complex as more drugs are approved for this indication. A high proportion of these drugs are intravenous, and sequential use can have a detrimental effect on venous access, causing distress to the patient as well as preventing treatment. In the UK vinorelbine is licensed for the treatment of MBC and NSCLC as a single agent or in combination. Vinorelbine is a vesicant and when given intravenously can cause venous irritation, which in some cases can lead to thrombophlebitis. Administration site reactions are very common, occurring in more than 10% of patients (grade 3/4: 3.7%). We compared the incidence of venous toxicity with IV vinorelbine in patients with MBC and those with NSCLC, who generally receive vinorelbine as their first chemotherapy. Method: Case notes of all patients receiving IV vinorelbine during a 3 year period (2008 to 2011) at UHNS were reviewed retrospectively for incidence of thrombophlebitis. Results: We identified 39 patients; 11 received vinorelbine IV as a single agent for MBC whilst 28 received it with platinum as adjuvant chemotherapy for NSCLC. Median age was 55 and 67 years for MBC and NSCLC patients respectively. Patients with MBC had previously received at least 2 lines of chemotherapy (maximum of 5 previous lines), including combination regimens and nearly all had been administered IV, whereas all patients with NSCLC were chemo-naïve. Almost half of the patients with MBC had prior history of venous access problems. Four required central line insertions for vinorelbine treatment. A total of 57 cycles (mean 5.1) were delivered for MBC and 93 cycles (mean 3.3) were delivered for NSCLC. Moderate to severe thrombophlebitis was recorded in 8 of the 11 patients with MBC (80%), compared to only 1 (3%) with NSCLC. A further two patients with MBC experienced mild thrombophlebitis and problems also occurred in a further four patients despite them having a central line inserted. Other side effects occurred at similar rates in both groups, apart from haematological toxicity which was slightly more pronounced in patients with NSCLC and probably related to combination treatment. Conclusions: Venous complications were frequent with intravenous administration of vinorelbine. A significantly higher incidence of thrombophlebitis was seen in patients with MBC. This was probably due vein damage from multiple lines of previous chemotherapy. We recommend consideration of oral administration of vinorelbine to reduce the need for central line insertion and to improve the patient experience and compliance.
PO84 VISUALIZING TREATMENT AND OUTCOMES IN METASTATIC BREAST CANCER Gabrielle Rocque, Murtuza Rampurwala, Mark Burkard University of Wisconsin Carbone Cancer Center, Madison, WI, USA Introduction: Multiple treatments exist for metastatic breast cancer without clear guidelines on the order of therapy. Individual oncologists vary in practice patterns, resulting in difficulty evaluating any given therapy due to differences in treatments before and after that therapy. Methods for evaluating and visualizing treatment of breast cancer in aggregate are limited. Methods: A retrospective review was conducted of all patients who received treatment for metastatic breast cancer from 2008-2012 as identified by the University of Wisconsin tumor registry. Data collected included: age, ER/PR/Her2 status, recurrent vs. de novo disease, treatment regimen, length of time on therapy, enrollment on clinical
trials, and length of life or last follow-up. This data was combined into a bar graph, which represents each unique patient’s treatment course including length of time on individual therapies. Individual patients (including age and tumor characteristics) are on the y-axis, and time is recorded on the x-axis. Each therapy is color-coded by treatment type (hormonal therapy, chemotherapy, targeted therapy, experimental therapy, off therapy). Results: A graphic analysis of 62 patients was created. Forty-one patients had ER/PR+ Her2-, 16 with triple negative, and 5 with Her2+ breast cancer. The median age of the population was 58. Twenty-four patients had recurrent breast cancer and 38 patients had de novo metastatic breast cancer. On average, survival was longer for ER/PR+ patients and shorter for HER2+ and triple negative patients. However, within these populations there was significant heterogeneity and 20% of women with ER+ breast cancer lived shorter than the average woman with metastatic TNBC. Treatment durations were often longer for hormonal therapies than for chemotherapies. Targeted therapies were used most extensively in the HER2 population, although this did not always produce long survival in this disease. Breaks between lines of therapy were common. Conclusions: Patients with metastatic breast cancer can be represented in aggregate graphically to include length of time on therapy and type of treatment. This method could be used in future clinical trials to visually represent where in a patient’s course a particular therapy occurred in the context of the disease process. The traditional table format includes line of therapy without details of the prior treatments received (ex hormones, chemotherapy, or targets agents). In additional to clarifying treatments received, this new graphic format would distinguish patients who had previous long duration on treatment, which might represent more treatment-responsive disease and higher likelihood of response to a new agent. Also, this format provides details about subsequent therapies, which could impact the overall survival of patients. Ultimately, reporting of this detailed information would assist in identifying when particular agents are most likely to benefit patients and could assist in making guidelines for management of patients with metastatic breast cancer.
PO85 CHARACTERISTICS AND PROGNOSIS OF HORMONE RECEPTOR POSITIVE AND HER2 NEGATIVE RECURRENT BREAST CANCER PATIENTS RECEIVING POSTOPERATIVE AROMATASE INHIBITOR Ishida Mayumi, Igawa Akiko, Saruwatari Akihiro, Oikawa Masahiro, Koga Chinami, Nishimura Sumiko, Koi Yumiko, Akiyoshi Sayuri, Nakamura Yoshiaki, Ohno Shinji National Kyushu Cancer Center, Fukuoka, Japan Background: Therapeutic advances have been making an impact on the survival of women with primary and recurrent breast cancer. Aromatase inhibitor (AI) is well known to improve the prognosis of patients with hormone receptor (HR) positive early breast cancer, as well as that with recurrent disease in patients who had received tamoxifen as adjuvant therapy. On the other hand, the feature and therapeutic effect for recurrent disease might be influenced by the adjuvant therapy. In Japan, the third generation aromatase inhibitor (AI) was approved for both early and recurrent breast cancer in 2001. Patients and Methods: Among 387 patients with recurrent breast cancer treated at National Kyushu Cancer center between 2001 and 2012, two hundred forty eight were HR positive and HER2 negative. Here we examined the characteristics and prognosis of Japanese women with recurrent breast cancer after the approval of AI. Results: Among 248 patients, xx had been treated with AIs as adjuvant therapy and xx with selective endocrine receptor modulator (SERM). The median survival of patients receiving postoperative AIs was 2.4 years, which was significantly worse than 5.3 years of those with SERM (p=0.005). We divided these patients into the following three groups, ‘de novo’ recurrent group (primary endocrine resistance, recurrence diagnosed within 2 years after operation), ‘acquired’ recurrent group (secondary endocrine resistance, between 2-5 years after operation),