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Upper limb venous thromboembolism in early breast cancer patients on chemotherapy: a single centre experience
The Breast 32S1 (2017) S22–S77
Contents lists available at ScienceDirect
The Breast j o u r n a l h o m e p a g e : w w w. e l s e v i e r . c o m / b r st
Poster Abstracts I Adjuvant Systemic Therapy P001 Long term outcome of HER2-positive early breast cancer patients in the trastuzumab era: a single centre experience P. Aravind*, C. Jingree, F. Castell, A. Rigg. Kings College Hospital NHS trust, London, United Kingdom Purpose: Clinical trial outcomes for HER2 positive early breast cancer treatment have dramatically improved since trastuzumab combination with chemotherapy. To estimate this benefit in our clinical practice, we conducted a study which aimed to evaluate clinicopathological characteristics of our early stage breast cancer patients who have epidermal growth factor receptor 2 (HER2) overexpressed and their effects on survival. Methods: Retrospective study of 85 patients diagnosed to have HER2 positive breast cancer at a Tertiary centre, UK between 2006 and 2012 were identified. Median Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier methods. Results: Median age of study population was 48 years and median follow-up was 9.78 years. 71 (82.5%) received trastuzumab. 5 year median overall OS was 91% (95% CI 82–96%). Patients who received >9 cycle of trastuzumab, 5-year PFS was 97%, versus 69% in patients who received fewer than 9 cycles p = 0.003). The hormone positive subgroup, 50 patients (41.5%), had median OS 96% (95% CI 85–99%) though survival rates were significantly lower in patients with hormone receptor negative (n = 35) with OS of 85% (95% CI 68–94%) ( p = 0.285). Of 71 who received chemotherapy, 18 (20.9%) received anthracycline only, 48 (55.8%) received anthracycline–taxane combination and 6 (7.0%) received taxane based chemotherapy. Age group <70 years (n = 74) had PFS of 93% and >70 years (n = 11) had PFS 82% ( p = 0.278). Multivariate analysis showed that advanced stage at diagnosis, absence of hormonal status and no treatment with trastuzumab therapy showed a potential trend towards negative correlation with PFS. Cardiotoxicity on trastuzumab was reported in 4 patients (4.7%). Conclusion: Significant survival difference was seen between the HER2+, hormone positive and the HER2+, hormone negative groups. Cardiotoxicity was low. Our data demonstrates efficacy and safety of treatment with trastuzumab in early breast cancer comparable to data from previously conducted large trials. Disclosure of Interest: No significant relationships. P002 Upper limb venous thromboembolism in early breast cancer patients on chemotherapy: a single centre experience P. Aravind*, A. Rigg, F. Castell. Kings College Hospital NHS trust, London, United Kingdom Background: Association between cancer and venous thromboembolism (VTE) is well documented. Identification of factors causing chemotherapy related VTE could help minimise thrombosis events.
0960-9776/ $ – see front matter © 2017 Elsevier Ltd. All rights reserved.
Aim of this study was to assess incidence of upper limb VTE in early breast cancer patients during chemotherapy. Methods: A retrospective audit of 27 patients who attended the chemotherapy unit for breast cancer in a tertiary hospital, UK over a period of 5 months in 2014 were identified. Service changes was introduced with nursing education, limiting the number of attempts at cannulation during chemotherapy and timely referral for alternative routes of vascular access was introduced. We re-audited 25 patients during chemotherapy visits between August 2015 to January 2016. VTE were confirmed on venous doppler ultrasound. Results: 52 patients receiving neoadjuvant/adjuvant chemotherapy for breast cancer were included in the study. Incidence of VTE was 10.5% (n = 20) in first series and 7% in second series. In series 1 and 2 respectively, 16 and 8 patients had superficial venous thrombophlebitis (SVT) and 1 each had DVT. Incidence of thrombosis peaked at cycle 2 of chemotherapy with an incidence of 35% and 33.3% in both series. Among VTEs in first series, 6 were on epirubicin and cyclophosphamide (EC) regimen and 10 were on flurouracil, epirubicin and cyclophosphamide (FEC) regimen. In second series there was increased incidence in cycle 2 of chemotherapy with 7 (35%) patients on FEC and 3 (15%) on EC. 25% (5) of patients in first series had indwelling catheter when they developed VTE. All patients were treated with appropriate anticoagulation. Conclusion: VTE incidence was more during initial cycles of chemotherapy. Limiting number of attempts at cannulation during chemotherapy and timely referral for alternative route of vascular access could minimise incidence of VTE. Early identification of thrombophlebitis pre chemotherapy also likely to reduce incidence of chemotherapy related VTE. Disclosure of Interest: No significant relationships. P003 Clinical outcomes in South African breast cancer patients on tamoxifen: 10 years following CYP2D6 genotyping K. Baatjes*, S. Santhia, A. Peeters, M. Mccaul, M. Kotze. Stellenbosch University, Parow, South Africa Aim: Use of tamoxifen in estrogen receptor (ER)-positive breast cancer is well established. The clinical effects of metabolites are yielded by enzymatic activation of the cytochrome P450 enzyme system, mainly CYP2D6. Conflicting data on clinical outcomes of patients on tamoxifen, expressing variable enzyme activity due to polymorphic variation in the CYP2D6 gene, has partly been ascribed to use of tumour DNA instead of germline DNA in genotypephenotype association studies. This study aims to determine the clinical relevance of CYP2D6 variants (alleles *3,*4 and *5) in relation to survival outcomes in breast cancer patients with ER-positive tumours on tamoxifen, at Tygerberg Hospital Breast Clinic, Cape Town, South Africa. Methods: A retrospective cohort study was performed in 86 breast cancer patients, of whom 48 were previously subjected to full BRCA1/ 2 gene screening based on family history. Available clinical data was obtained from hospital records for up to ten years after the initial
Contents lists available at ScienceDirect
The Breast j o u r n a l h o m e p a g e : w w w. e l s e v i e r . c o m / b r st
Poster Abstracts I Adjuvant Systemic Therapy P001 Long term outcome of HER2-positive early breast cancer patients in the trastuzumab era: a single centre experience P. Aravind*, C. Jingree, F. Castell, A. Rigg. Kings College Hospital NHS trust, London, United Kingdom Purpose: Clinical trial outcomes for HER2 positive early breast cancer treatment have dramatically improved since trastuzumab combination with chemotherapy. To estimate this benefit in our clinical practice, we conducted a study which aimed to evaluate clinicopathological characteristics of our early stage breast cancer patients who have epidermal growth factor receptor 2 (HER2) overexpressed and their effects on survival. Methods: Retrospective study of 85 patients diagnosed to have HER2 positive breast cancer at a Tertiary centre, UK between 2006 and 2012 were identified. Median Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier methods. Results: Median age of study population was 48 years and median follow-up was 9.78 years. 71 (82.5%) received trastuzumab. 5 year median overall OS was 91% (95% CI 82–96%). Patients who received >9 cycle of trastuzumab, 5-year PFS was 97%, versus 69% in patients who received fewer than 9 cycles p = 0.003). The hormone positive subgroup, 50 patients (41.5%), had median OS 96% (95% CI 85–99%) though survival rates were significantly lower in patients with hormone receptor negative (n = 35) with OS of 85% (95% CI 68–94%) ( p = 0.285). Of 71 who received chemotherapy, 18 (20.9%) received anthracycline only, 48 (55.8%) received anthracycline–taxane combination and 6 (7.0%) received taxane based chemotherapy. Age group <70 years (n = 74) had PFS of 93% and >70 years (n = 11) had PFS 82% ( p = 0.278). Multivariate analysis showed that advanced stage at diagnosis, absence of hormonal status and no treatment with trastuzumab therapy showed a potential trend towards negative correlation with PFS. Cardiotoxicity on trastuzumab was reported in 4 patients (4.7%). Conclusion: Significant survival difference was seen between the HER2+, hormone positive and the HER2+, hormone negative groups. Cardiotoxicity was low. Our data demonstrates efficacy and safety of treatment with trastuzumab in early breast cancer comparable to data from previously conducted large trials. Disclosure of Interest: No significant relationships. P002 Upper limb venous thromboembolism in early breast cancer patients on chemotherapy: a single centre experience P. Aravind*, A. Rigg, F. Castell. Kings College Hospital NHS trust, London, United Kingdom Background: Association between cancer and venous thromboembolism (VTE) is well documented. Identification of factors causing chemotherapy related VTE could help minimise thrombosis events.
0960-9776/ $ – see front matter © 2017 Elsevier Ltd. All rights reserved.
Aim of this study was to assess incidence of upper limb VTE in early breast cancer patients during chemotherapy. Methods: A retrospective audit of 27 patients who attended the chemotherapy unit for breast cancer in a tertiary hospital, UK over a period of 5 months in 2014 were identified. Service changes was introduced with nursing education, limiting the number of attempts at cannulation during chemotherapy and timely referral for alternative routes of vascular access was introduced. We re-audited 25 patients during chemotherapy visits between August 2015 to January 2016. VTE were confirmed on venous doppler ultrasound. Results: 52 patients receiving neoadjuvant/adjuvant chemotherapy for breast cancer were included in the study. Incidence of VTE was 10.5% (n = 20) in first series and 7% in second series. In series 1 and 2 respectively, 16 and 8 patients had superficial venous thrombophlebitis (SVT) and 1 each had DVT. Incidence of thrombosis peaked at cycle 2 of chemotherapy with an incidence of 35% and 33.3% in both series. Among VTEs in first series, 6 were on epirubicin and cyclophosphamide (EC) regimen and 10 were on flurouracil, epirubicin and cyclophosphamide (FEC) regimen. In second series there was increased incidence in cycle 2 of chemotherapy with 7 (35%) patients on FEC and 3 (15%) on EC. 25% (5) of patients in first series had indwelling catheter when they developed VTE. All patients were treated with appropriate anticoagulation. Conclusion: VTE incidence was more during initial cycles of chemotherapy. Limiting number of attempts at cannulation during chemotherapy and timely referral for alternative route of vascular access could minimise incidence of VTE. Early identification of thrombophlebitis pre chemotherapy also likely to reduce incidence of chemotherapy related VTE. Disclosure of Interest: No significant relationships. P003 Clinical outcomes in South African breast cancer patients on tamoxifen: 10 years following CYP2D6 genotyping K. Baatjes*, S. Santhia, A. Peeters, M. Mccaul, M. Kotze. Stellenbosch University, Parow, South Africa Aim: Use of tamoxifen in estrogen receptor (ER)-positive breast cancer is well established. The clinical effects of metabolites are yielded by enzymatic activation of the cytochrome P450 enzyme system, mainly CYP2D6. Conflicting data on clinical outcomes of patients on tamoxifen, expressing variable enzyme activity due to polymorphic variation in the CYP2D6 gene, has partly been ascribed to use of tumour DNA instead of germline DNA in genotypephenotype association studies. This study aims to determine the clinical relevance of CYP2D6 variants (alleles *3,*4 and *5) in relation to survival outcomes in breast cancer patients with ER-positive tumours on tamoxifen, at Tygerberg Hospital Breast Clinic, Cape Town, South Africa. Methods: A retrospective cohort study was performed in 86 breast cancer patients, of whom 48 were previously subjected to full BRCA1/ 2 gene screening based on family history. Available clinical data was obtained from hospital records for up to ten years after the initial