Prognostic Factors for Locoregional Recurrence in Operable Breast Cancer Patients Treated with Preoperative Systemic Chemotherapy

Background: We aimed to evaluate the clinicopathologic factors affecting locoregional recurrence (LRR) in potentially operable breast cancer patients receiving preoperative systemic chemotherapy (PST).Methods: We reviewed the records of 316 breast cancer patients treated with PST (doxorubicin/cyclophosphamide, 101; docetaxel /capecitabine, 103; paclitaxel/gemcitabine, 43; doxorubicin/docetaxel, 69) followed by surgery and adjuvant radiotherapy between 2002 and 2006. The majority of patients had clinical positive axillary lymph nodes. To define the prognostic factors for LRR, age, clinical stage, hormone receptor (HR) and HER2 status, clinical and pathologic response, type of operation, pathological characteristics including tumor size, tumor grade, nodal status, number of positive axillary nodes, size of metastatic lymph node and status of resection margin and tumor multiplicity before and after PST were analyzed.Results: Overall 52 patients (16.5%) in the primary tumor and 87 patients (27.5%) in the axillary nodes achieved a pathologic complete response (pCR), and 206 patients (65.2%) underwent breast conserving surgery (BCS). With a median follow-up of 52.4 month (range: 4.7 - 89.4), total 18 (5.7%) patients developed LRR; 2 of 110 (1.8%) patients with mastectomy vs. 16 of 206 (7.7%) patients with BCS (p=0.04). Other significant factors in the univariate analysis were clinical T stage, HR status, clinical response and tumor multiplicity. A pCR in the primary tumor or node was not a prognostic factor for LRR in this study. In multivariate analysis, clinical T stage (T3/4, HR 7.8; 95% CI, 2.33-26.24; P=0.001), hormone receptor status (negative, HR 6.2; 95% CI, 1.91-20.22; P=0.002) and type of surgery (BCS, HR 9.5; 95% CI, 1.97-46.37; P=0.005) were independent prognostic factors. Among patients with BCS, advanced clinical T stage (HR 12.4; 95% CI, 3.45-44.56; P<0.001), negative hormone receptor (HR 4.74; 95% CI, 1.33-16.96; P=0.02), non-responding disease (HR 6.54; 95% CI, 1.07-40.12; P=0.04) and multiple tumors (HR 4.36; 95% CI, 1.06-17.90; P=0.04) developed more frequent LRR.Conclusions: Significantly more patients with advanced clinical T stage, negative HR status and BCS developed LRR in operable breast cancer treated with PST. Moreover, in patients with BCS after PST, clinically non-responding disease and multiple tumors showed unfavorable prognosis besides the larger tumors and negative hormone receptor.Partly supported by NCC Grant No 0610240

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1095.

Prognosis of Metaplastic Breast Cancer: Poorer Than the Rest of Triple-Negative Breast Cancer

Background: The biologic behavior of metaplastic breast cancer (MBC) has not been well elucidated due to its rarity and heterogeneity. This study was designed to assess the clinical and tumor characteristics and outcomes of MBC patients as compared with invasive ductal carcinoma (IDC) in general and the triple-negative (TN) subtype.Materials and methods: This study included 35 MBC and 2,839 IDC patients diagnosed at the National Cancer Center, Korea between 2000 and 2008. We, retrospectively, reviewed the clinicopathologic characteristics and clinical outcomes.Results: The mean age was 47.4 years for MBC group and 48.3 years for IDC group. The MBC group presented with larger tumors (≥ T2, 78.8% vs 41.0%; P<0.001), higher histologic grade (grade 3, 92.0% vs 44.6%; P<0.001), fewer ER and PgR positivity (ER+, 14.3% vs 69.0% ; P<0.001 and PgR+, 25.7% vs 66.1%; P<0.001), higher Ki-67 expression (35.5%±26.2% vs 20.6% ±19.8%; P=0.024) and more TN subtypes (48.6% vs 11.9%; P<0.001) than IDC group. Excluding de novo stage IV patients, 14 of 32 (43.7%) MBC patients and 260 of 2782 (9.4%) IDC patents developed disease recurrence with a median follow-up of 36.2 months (range, 4.9-117.8 months). MBC was a poor prognostic factor for disease recurrence in univariate and multivariate analysis (HR 5.19; 95% CI, 2.04-13.18; P=0.001). MBC patients demonstrated aggressive pathologic features and experienced more disease recurrence (HR 4.77; 95% CI, 1.99-11.44; P=0.001) even when compared with 330 patients with TN subtype.Conclusions:Patients with metaplastic breast carcinoma appeared to have inherent aggressive tumor biology with poorer clinical outcomes than those with IDC in general and TN subtype.Partly supported by NCC Grant No 0610240

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4057.

Classical aspects in above-threshold ionization with a midinfrared strong laser field

We present high resolution photoelectron energy spectra of noble gas atoms from high intensity above-threshold ionization (ATI) at midinfrared wavelengths. An unexpected structure at the very low-energy portion of the spectra, in striking contrast to the prediction of the simple-man theory, has been revealed. A semiclassical model calculation is able to reproduce the experimental feature and suggests the prominent role of the Coulomb interaction of the outgoing electron with the parent ion in producing the peculiar structure in long wavelength ATI spectra.

Biological barriers to therapy with antisense and siRNA oligonucleotides

Attaining the full therapeutic utility of antisense and siRNA oligonucleotides will require understanding of the biological barriers that stand between initial administration of these drugs and their final actions within cells. This review examines some of the key barriers that affect the biodistribution of oligonucleotides both in molecular form and when they are associated with nanocarriers. An understanding of the biological processes underlying these barriers will aid in the design of more effective delivery systems.

Phase II study of CKD602, a camptothecin analog, in combination with carboplatin for the treatment of recurrent ovarian cancer

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Background: Belotecan (Camtobell, Chong Keun Dang Corp, Seoul, Korea; CKD602) is a camptothecin derivative with anti-tumor properties recently developed. This phase II study was designed to evaluate the toxicity and efficacy of belotecan combined with carboplatin in patients with recurrent epithelial ovarian cancer (EOC). Methods: Belotecan 0.3 mg/m2/day (days 1–5) and carboplatin AUC 5 (day 5) were administered every 3 weeks for 6 cycles. Eligible patients had recurrent EOC, peritoneal serous cancer, or fallopian tube cancer. The primary objective was to determine response rate defined by Response Evaluation Criteria in Solid Tumors and CA-125 response; other end points included toxicities and progression free survival (PFS). Results: Until this preliminary analysis, sixteen patients had received the treatment and 13 patients were evaluable for response. Eight patients had platinum-sensitive disease (minimum treatment free interval≥6 months) and 6 had platinum-resistant disease (minimum treatment free interval <6 months). Overall response rate was 53.9%; there were 3 complete responses (23.1%), 4 partial responses (30.8%), 4 patients with stable disease (30.8%), and two patients with progressive disease (15.4%). Grade 3 and 4 hematologic toxicities included neutropenia (38%), thrombocytopenia (25%), and anemia (15%); there was one episode of febrile neutropenia. None of the patients experienced grades 3 and 4 gastrointestinal toxicities, including nausea, vomiting, and anorexia. Conclusions: The newly developed topoisomerase I inhibitor, belotecan (CKD-602), combined with carboplatin is a well-tolerated regimen with activity in recurrent EOC; further testing of this regimen is warranted.

No significant financial relationships to disclose.

Prediction of tumor necrosis fraction using combined volumetric and metabolic indices derived from FDG-PET/CT in osteosarcoma patients receiving neoadjuvant chemotherapy

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Background: Maximum standardized uptake values (mSUV) might not reliably reflect the chemotherapy response in osteosarcoma especially when treatment response within tumors is heterogenous. The purpose of this study was to compare the usefulnesses of various FDG PET/CT indices for predicting tumor response to neoadjuvant chemotherapy and to identify the most appropriate one in osteosarcoma. Methods: Thirteen patients with primary osteosarcoma (age 14±2.9 yrs, ranged 10–19 yrs) that had undergone FDG PET/CT scans before and after neoadjuvant chemotherapy were enrolled. The authors measured mSUV, metabolic tumor volumes (MTV), and total lesion glycolysis (TLG) in each PET/CT scan. MTVs were calculated by summing voxels with SUV greater than 1.5, 2, 2.5 and 3.0, and with % mSUV greater than 20%, 25%, 30% and 35%. Histopathologic necrosis fractions were compared with the above-mentioned PET/CT parameters and their pre- to post-treatment ratios (MTV ratio, rMTV; mSUV ratio, rSUV; TLG ratio, rTLG). Results: Histopathologic necrosis fractions ranged from 3% to 99% (62.2%±37.7%). rMTV and rTLG values were found to be correlated with histopathologic necrosis fractions (R2=0.45–0.65, p<0.05), whereas, mSUV and MR image volumes (MRV), both before and after treatment, rSUV values, and rMRV values were not. With regard to rMTV and rTLG values obtained using various MTV criteria, the highest correlation was observed for a rTLG value of 2.5 mg/ml (R2=0.65, p=0.001). Five patients were classified as responders and 8 as poor-responders to neoadjuvant chemotherapy defined as those with chemotherapy-induced necrosis fractions of ≥90% and <90%, respectively. The rSUVs of responders and poor-responders were not different, but rMTV and rTLG values showed a trend toward difference, although statistically not significant (p=0.110 and 0.106, respectively). The sensitivity and specificity of rTLG were 100% and 62.5%, respectively, at an SUV cut-off of 0.13. Conclusions: In our osteosarcoma patient population, TLG and MTV, which represent combined metabolic and volumetric indices, were found to predict tumor response better than pre- or post-treatment mSUV or rSUV.

No significant financial relationships to disclose.

Correlation of tumor size on preoperative breast MRI and pathologic tumor size in Asian patients

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Background: As many Asian patients want breast conserving therapy (BCT), use of magnetic resonance imaging (MRI) increase in preoperative diagnosis for breast cancer. But the impact of MRI on these patients has not been unclear. Methods: From January 2008 to July 2008, 423 patients underwent breast cancer surgery in National Cancer Center, Korea. We enrolled 357 patients consecutively in this retrospective study; 290 patients (non-MRI group) with preoperative mammography (MMG) and ultrasonography (US) vs. 66 patients (MRI group) with additional MRI to MMG, US and excluded 67 patients (42 patients with preoperative chemotherapy, 8 patients with ipsilateral recurrence, 17 patients whose MRI showed no residual lesion after excisional biopsy). We examined MRI effect on mastectomy rate, intraoperative conversion from BCT to mastectomy, positive margin rate in frozen specimen in both group. In MRI group, we evaluated the correlation between tumor size on US, MRI and pathologic tumor size. Results: Mean age of this study was 48.89 years (Non-MRI group: 50.70 years vs. MRI group: 46.33 years, p=0.001). The rate of mastectomy wasn’t different in both groups (Non-MRI group: 13.7% vs. MRI group: 19.4%, p=0.252). Intraoperative conversion to mastectomy was performed frequently in MRI group. (Non-MRI group: 1.7% vs. MRI group: 7.5%, p=0.023). But positive margin rate in frozen specimen was similar in both groups (Non-MRI group: 23.2% vs. MRI group: 34.0%, p=0.111). In MRI group, mean tumor size on MRI, US was 3.07cm, 1.98cm respectively. Mean pathologic tumor size was 2.67cm. The tumor size on MRI correlated strongly with the pathologic tumor size. The correlation coefficient was 0.732 (p=0.0001). But the tumor size on US didn’t correlate with the pathologic tumor size (p=0.066). In twenty nine patients whose MMG showed suspicious microcalcification, tumor size on MRI also correlated strongly with pathologic tumor size. The correlation coefficient was 0.693 (p=0.0001). But US didn’t show the correlation with the pathologic tumor size in these patients. Conclusions: Preoperative breast MRI didn’t give the impact on breast cancer surgery in Asian patients and could overestimate the size of tumor. But it could strongly correlate with the pathologic tumor size in Asian patients.

No significant financial relationships to disclose.