Utility of the CPS+EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy

abstracts

181PD

Improved survival of older patients with advanced breast cancer due to an increase in systemic treatments – a population-based study

N. De Glas1, E. Bastiaannet2, A. de Boer3, S. Siesling4, G.-J. Liefers2, J. Portielje1 Medical Oncology, Leids Universitair Medisch Centrum (LUMC), Leiden, Netherlands, 2 Surgery, Leiden University Medical Center, Leiden, Netherlands, 3Surgery, Leids Universitair Medisch Centrum (LUMC), Leiden, Netherlands, 4Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands

1

Background: The number of older patients with breast cancer is rapidly increasing. A previous study showed that in the Netherlands, between 1990 and 2005, survival of older patients with breast cancer did not improve in contrast to younger patients. In recent years, scientific evidence in the older age group has increased and specific guidelines for older women with breast cancer have been developed. The aim of this study was to assess recent survival outcomes of older patients with breast cancer compared to younger patients. Methods: All patients with stage I-IV breast cancer between 2000 and 2017 were included from the Netherlands cancer registry. We assessed changes in treatments over time using logistic regression models. We calculated the changes in relative survival as proxy for breast cancer mortality, stratified by age and stage. Results: We included 239,992 patients. Relative survival improved over time for patients in the youngest age-group for all stages. In patients aged 65-75 years, relative survival adjusted for tumour characteristics did not improve in stage I-II but did improve in stage III (RER 0.98, 95% C.I. 0.96-1.00, p ¼ 0.046). Concurrently, was prescribed in an increasing proportion of patients aged 65-75 years (33.6% in 2000 to 52.7,

v58 | Breast Cancer, Early Stage

p < 0.001). In patients aged 75 years or older, relative survival did not improve in patients with stage I/II or stage III disease, nor did treatment strategies change. Conclusions: This study shows that over time, the relative survival of patients aged 6575 years with advanced breast cancer has improved, and concurrently, prescription of systemic treatment increased. These data suggest that older patients with advanced breast cancer do benefit from adjuvant systemic treatment. In order to further improve survival of patients >75 as well, future studies should focus on individualizing treatments based on concomitant comorbidity, geriatric parameters and the risk toxicity of treatments. Legal entity responsible for the study: Leiden University Medical Center, Department of Medical Oncology, Geriatric Oncology Research Group. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

182PD

Utility of the CPS1EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy

F. Marme´1, C. Solbach2, L. Michel3, P.A. Fasching4, A. Schneeweiss5, J.-U. Blohmer6, M. Rezai7, J. Huober8, C. Jackisch9, V. Nekljudova10, T. Link11, K. Rhiem12, C. Denkert13, C. Hanusch14, H. Tesch15, B. Lederer10, S. Loibl16, M. Untch17 1 Gynecologic Oncology, University Hospital Mannheim, Mannheim, Germany, 2Klinik fu¨r Frauenheilkunde und Geburtshilfe, Universit€ atsklinik Frankfurt, Frankfurt, Germany, 3 Frauenheilkunde und Geburtshilfe, Universit€ atsklinikum Heidelberg, Heidelberg, Germany, 4Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany, 5Gynecologic Oncology, Nationales Centrum fu¨r akologie mit Brustzentrum, Tumorerkrankungen Heidelberg, Heidelberg, Germany, 6Gyn€ aisches Brustzentrum, Charite´-Universit€ atsmedizin, Berlin, Berlin, Germany, 7Europ€ Luisenkrankenhaus, Du¨sseldorf, Germany, 8Department of Gynecology, Breast Center, Universitaetsfrauenklinik Ulm, Ulm, Germany, 9Oncology Department, Sana Klinikum, Offenbach, Germany, 10Medicine & Research, German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany, 11Frauenheilkunde und Geburtshilfe, arer Brust- und Universit€ atsklinikum Dresden, Dresden, Germany, 12Zentrum Famili€ Eierstockkrebs, Uniklinik Ko¨ln, Cologne, Germany, 13Institut fu¨r Pathologie UKGM, akologie und Geburtshilfe, Universit€ atsklinikum Marburg, Marburg, Germany, 14Gyn€ Klinikum zum Roten Kreuz Mu¨nchen, Germany, Munich, Germany, 15Centrum fu¨r H€ amatologie und Onkologie, Centrum fu¨r H€ amatologie und Onkologie Bethanien, Frankfurt, Frankfurt am Main, Germany, 16Department of Medicine and Research, German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany, 17Clinic for Gynecology, Gynecologic Oncology and Obstetrics, Helios Klinikum Berlin Buch, Berlin, Germany Background: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with superior disease free (DFS) and overall survival (OS). This association is strongest in triple-negative breast cancer (TNBC). The CPSþEG system, based on pre-treatment clinical (CS) and post-treatment pathologic stage (PS), grade and estrogen receptor status, leads to a refined estimate of prognosis after NACT in all comers and HRþ/HER2- (Marme´ et al Eur J Cancer 2016). Here we investigate if CPSþEG scoring provides a superior estimate of prognosis in TNBC after NACT to select patients (pts) for post-neoadjuvant therapy. Methods: We calculated the CPSþEG score for 1795 pts with TNBC from 9 prospective German trials. Pts with missing variables were excluded. 5-year DFS estimates were calculated using the Kaplan Meier method.

Volume 30 | Supplement 5 | October 2019

Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.008/5577910 by guest on 24 October 2019

(institution), Non-remunerated activity/ies: Sividon Diagnostics; Honoraria (institution), Nonremunerated activity/ies: TEVA Pharmaceuticals Ind Ltd; Honoraria (institution), Non-remunerated activity/ies: Novartis. P.A. Fasching: Honoraria (self), Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Biontech; Honoraria (self): Roche; Honoraria (self): Pfizer; Honoraria (self): Celgene; Honoraria (self): Daiichi-Sankyo; Honoraria (self): TEVA; Honoraria (self): AstraZeneca; Honoraria (self): Merck Sharp & Dohme; Honoraria (self): Myelo Therapeutics; Honoraria (self): Macrogenics; Honoraria (self): Eisai; Honoraria (self): PUMA; Research grant / Funding (institution): Cepheid. F. Marme´: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): Pfizer; Honoraria (self): Tesaro; Honoraria (self): Novartis; Honoraria (self): Amgen; Honoraria (self): PharmaMar; Honoraria (self): GenomicHealth; Honoraria (self): CureVac; Honoraria (self): EISAI; Honoraria (self): Clovis; Honoraria (self): Celgene. M. van Mackelenbergh: Honoraria (self): AstraZeneca; Honoraria (self): Novartis; Honoraria (self): Amgen. V. Mu¨ller: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Amgem; Honoraria (self), Speaker Bureau / Expert testimony: AstraZeneca; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Diichi-Sankyo; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Eisai; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Novartis; Honoraria (self), Speaker Bureau / Expert testimony: Pfizer; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Roche; Honoraria (self), Speaker Bureau / Expert testimony: Celgene; Honoraria (self), Speaker Bureau / Expert testimony: Teva; Honoraria (self), Speaker Bureau / Expert testimony: Janssen-Cilag; Honoraria (self), Advisory / Consultancy: Genomic Health; Honoraria (self), Advisory / Consultancy: Hexal; Honoraria (self), Advisory / Consultancy: Pierre Fabre; Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy: Lilly; Honoraria (self), Advisory / Consultancy: Tesaro; Honoraria (self), Advisory / Consultancy: Nektar; Research grant / Funding (institution): Seattle Genetics. S. Loibl: Research grant / Funding (institution): Roche; Research grant / Funding (institution): AbbVie; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Celgene; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Seattle Genetics; Research grant / Funding (institution): Teva; Research grant / Funding (institution): Vifor; Research grant / Funding (institution): PRIME; Research grant / Funding (institution): Daiichi; Licensing / Royalties: EP14153692.0 pending. All other authors have declared no conflicts of interest.

Annals of Oncology

abstracts

Annals of Oncology

Table: 182PD pathologic stage: All patients PS 5-year (N ¼ 1795) DFS rate* 0.86 0.78 0.49 0.39 0.24 0.19 0.12

0.84 0.73 0.43 0.29 0.15 0.02 0.04

0.89 0.82 0.55 0.50 0.33 0.36 0.20

N

%

CPS-EG 5-year (N ¼ 1795) DFS rate*

822 383 292 89 109 21 79

45.8 21.3 16.3 5.0 6.1 1.2 4.4

0 1 2 3 4 5 6

0.00 0.83 0.84 0.64 0.41 0.16 0.00

CPSþEG: non-pCR patients 95% CI

0.00 0.77 0.81 0.59 0.34 0.07 0.00

0.00 0.89 0.86 0.69 0.47 0.25 0.00

N

%

CPS-EG 5-year (N ¼ 973) DFS rate*

0 189 761 497 252 71 25

0 10.5 42.4 27.7 14.0 4.0 1.4

0 1 2 3 4 5 6

Results: Pts who achieved a pCR had a 5-year DFS of 86% (n ¼ 822, 45.8%), whereas pts with residual stage I had a 5-yr DFS of 77.5% (n ¼ 383; 21.3%). CPSþEG score was unable to identify non-pCR pts with a sufficiently good prognosis, to avoid post neoadjuvant therapy. The best prognostic CPSþEG groups (score 1/2) in non-pCR pts had a 5-year DFS of 77.5% and 74.4%, respectively (n ¼ 362; 37.2%). CPSþEG identified a small group (n ¼ 26; 3.2%) at high risk of recurrence despite pCR, mainly based on initial stage (CSþEG score > 3; 5-year DFS 61.4%) that might benefit from additional treatment. However, prognosis of pts with a CPSþEG score of 3 (5-year DFS: 64%), could be further discriminated by pCR (5-year DFS: 83.9% vs 49.7%). Detailed results are presented in the Table. Conclusions: pCR remains the strongest and most clinically useful prognostic factor after NACT in TNBC. The CPS-EG score does not add additional information beyond pCR and ypT/N staging in TNBC patients. Other factors than those used beyond staging might be needed in TNBC. Legal entity responsible for the study: GBG. Funding: Has not received any funding. Disclosure: F. Marme´: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self):

0.00 0.78 0.74 0.50 0.38 0.16 0.00

95% CI

0.00 0.68 0.69 0.44 0.32 0.07 0.00

0.00 0.87 0.80 0.56 0.45 0.25 0.00

CPSþEG: pCR patients N

%

CPS-EG 5-year (N ¼ 822) DFS rate*

0 88 274 289 226 71 25

0 9.0 28.2 29.7 23.2 7.3 2.6

0 1 2 3 4 5 6

0.00 0.88 0.89 0.84 0.61 0.00 0.00

95% CI

0.00 0.81 0.86 0.78 0.42 0.00 0.00

0.00 0.95 0.92 0.89 0.81 0.00 0.00

N

%

0 101 487 208 26 0 0

0 12.3 59.2 25.3 3.2 0.0 0.0

Honoraria (self), Non-remunerated activity/ies: Eisai GmbH; Honoraria (self), Non-remunerated activity/ies: Janssen Cilag; Honoraria (self), Non-remunerated activity/ies: TEVA Pharmaceuticals Ind Ltd; Honoraria (self), Non-remunerated activity/ies: Sividon Diagnostics; Honoraria (self), Nonremunerated activity/ies: Lilly; Honoraria (self), Non-remunerated activity/ies: MSD Merck; Honoraria (self), Non-remunerated activity/ies: Mundipharma; Honoraria (self), Non-remunerated activity/ies: Myriad Genetics; Honoraria (self), Non-remunerated activity/ies: Odonate; Honoraria (self), Non-remunerated activity/ies: Pfizer GmbH; Honoraria (self): PUMA Biotechnology; Honoraria (self), Non-remunerated activity/ies: Novartis; Honoraria (self), Non-remunerated activity/ies: Roche Pharma AG; Honoraria (self), Non-remunerated activity/ies: Sanofi Aventis Deutschland GmbH. All other authors have declared no conflicts of interest.

Pfizer; Honoraria (self): Tesaro; Honoraria (self): Novartis; Honoraria (self): Amgen; Honoraria (self): PharmaMar; Honoraria (self): GenomicHealth; Honoraria (self): CureVac; Honoraria (self): EISAI; Honoraria (self): Clovis; Honoraria (self): Celgene. P.A. Fasching: Research grant / Funding (institution): Novartis; Research grant / Funding (institution): BionTech; Honoraria (self): Novartis; Honoraria (self): Roche; Honoraria (self): Pfizer; Honoraria (self): Celgene; Honoraria (self): DaiichiSankyo; Honoraria (self): TEVA; Honoraria (self): AstraZeneca; Honoraria (self): Merck Sharp & Dohme; Honoraria (self): Myelo Therapeutics; Honoraria (self): Macrogenics; Honoraria (self): Eisai; Honoraria (self): Puma; Research grant / Funding (institution): Cepheid. A. Schneeweiss: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Celgene; Honoraria (self), Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Research grant / Funding (institution): AbbVie; Research grant / Funding (institution): Molecular Partner; Honoraria (self): Novartis; Honoraria (self), Speaker Bureau / Expert testimony: AstraZeneca; Honoraria (self): MSD; Honoraria (self): Tesaro; Honoraria (self): Lilly; Honoraria (self), Travel / Accommodation / Expenses: Pfizer. J. Blohmer: Honoraria (self): Amgen; Honoraria (self): AstraZeneca; Honoraria (self): Genomic Health; Honoraria (self): MSD Oncology; Honoraria (self): Myriad Genetics; Honoraria (self): Novratis/Pfizer; Honoraria (self): Pfizer; Honoraria (self): Rpche; Honoraria (self): Sonoscape. J. Huober: Honoraria (self), Travel / Accommodation / Expenses: Lilly; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Novartis; Honoraria (self), Travel / Accommodation / Expenses: Roche; Honoraria (self), Travel / Accommodation / Expenses: Pfizer; Honoraria (self): Hexal; Honoraria (self): AstraZeneca; Honoraria (self): MSD; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Celgene; Honoraria (self): Abbie. C. Jackisch: Travel / Accommodation / Expenses: Celgene; Honoraria (self): Roche. T. Link: Honoraria (self): Amgen; Non-remunerated activity/ies: AstraZeneca; Honoraria (self), Non-remunerated activity/ies: Pfizer; Non-remunerated activity/ies: PharmaMar; Non-remunerated activity/ies: Daiichi Sankyo; Honoraria (self): MSD; Honoraria (self): Novartis; Honoraria (self): Teva; Honoraria (self): Tesaro; Honoraria (self), Non-remunerated activity/ies: Roche. K. Rhiem: Honoraria (self): Tesaro; Honoraria (self): AstraZeneca; Honoraria (self): Pfizer. C. Denkert: Shareholder / Stockholder / Stock options: Sividon Diagnostics; Honoraria (self): Teva; Honoraria (self): Novartis; Honoraria (self): Pfizer; Honoraria (self): Roche; Honoraria (self), Advisory / Consultancy: Amgen; Advisory / Consultancy: MSD Oncology; Advisory / Consultancy: Daiichi Sankyo; Licensing / Royalties: VMScope digital pathology software; Licensing / Royalties: Patent application: EP18209672 - cancer immunotherapy; Licensing / Royalties: Patent application EP20150702464 - therapy response; Licensing / Royalties: Patent application EP20150702464 - therapy response. C. Hanusch: Honoraria (self): Roche; Honoraria (self): Pfizer; Honoraria (self): Novartis; Honoraria (self): Celgene; Honoraria (self): Lilly; Honoraria (self): AstraZeneca. H. Tesch: Honoraria (self): Vifor; Honoraria (self): Roche; Honoraria (self): Amgen. S. Loibl: Research grant / Funding (institution): Roche; Research grant / Funding (institution): Abbvie; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Celgene; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Seattle Genetics; Research grant / Funding (institution): Teva; Research grant / Funding (institution): Vifor; Research grant / Funding (institution): PRIME; Research grant / Funding (institution): Daiichi; Licensing / Royalties: EP14153692.0 pending. M. Untch: Honoraria (self), Non-remunerated activity/ ies: Abbvie; Honoraria (self), Non-remunerated activity/ies: Amgen GmbH; Honoraria (self), Nonremunerated activity/ies: AstraZeneca; Honoraria (self), Non-remunerated activity/ies: Celgene GmbH; Honoraria (self): BMS; Honoraria (self), Non-remunerated activity/ies: Daiji Sankyo;

Volume 30 | Supplement 5 | October 2019

doi:10.1093/annonc/mdz240 | v59

Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.008/5577910 by guest on 24 October 2019

0 I IIA IIB IIIA IIIB IIIC

95% CI

CPSþEG: All patients