Recovery of renal function in patients with lupus nephritis and reduced renal function: the beneficial effect of hydroxychloroquine

Background

Reduced renal function is associated with worse renal outcome in patients with lupus nephritis (LN). However, there is insufficient knowledge regarding renal function recovery in patients with LN with reduced baseline renal function. Therefore, the present study aimed to investigate renal function recovery and related factors in patients with reduced baseline renal function.

Methods

The present retrospective longitudinal cohort study included patients with LN and reduced renal function. Reduced renal function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Recovery of renal function was determined by an eGFR of >60 mL/min/1.73 m2 at six months after baseline, and factors associated with it were evaluated using logistic regression analysis.

Results

We included 90 patients with LN, with a mean eGFR value of 37.2 ± 13.9 mL/min/1.73 m2. Forty-six (51.1%) patients recovered their renal function after six months. On multivariate analysis, hydroxychloroquine use (odds ratio (OR) = 3.891, 95% confidence interval (CI) 1.196–12.653, p = 0.024), prolonged LN (OR = 0.926, 95% CI 0.874–0.981, p = 0.009) and high-grade tubular atrophy (OR = 0.451, 95% CI 0.208–0.829, p = 0.013) were associated with renal function recovery. During follow up, 25 patients were on end-stage renal disease (ESRD). Kaplan–Meier analysis revealed that renal function recovery after six months and lower probability of ESRD are associated.

Conclusions

In patients with LN and reduced renal function, renal function recovery at six months was associated with use of hydroxychloroquine and inversely related to longer duration of LN and higher grade of tubular atrophy.

Relationship between airway obstruction and C-reactive protein levels in a community-based population of Korea

OBJECTIVE: To examine the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and lung function in a community-based cohort of South Korea.DESIGN: The Ansung-Ansan cohort database (an ongoing prospective study of a community-based population) was used in the analysis. We defined airway obstruction as the ratio between forced expiratory volume in 1 sec:forced vital capacity ratio (FEV1:FVC) of <95% of the predicted value for a healthy person. We also used the serum level of hs-CRP as a marker of inflammation. Multivariate analysis was performed with adjustment for the clinical characteristics of the participants.RESULTS: A total of 5528 individuals were eligible for the study. The average age was 55.1 years, and 47.8% were males. The prevalence of airway obstruction was 9.0%, and the mean hs-CRP level was 1.51 mg/dl. Serum hs-CRP levels increased with the severity of airway obstruction, and the latter worsened with an increase in the hs-CRP level. In multivariate analysis, as the hs-CRP level increased, FEV1 and FVC decreased. A higher FEV1:FVC ratio was associated with lower hs-CRP levels in males.CONCLUSION: Higher hs-CRP levels were associated with decreased FEV1 and FVC in a general population of Korea. The FEV1:FVC ratio decreased with an increase in the hs-CRP level in males.

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Objectives

Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN.

Methods

We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD).

Results

The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064).

Conclusion

Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.

Correction: Expanding analytical tools for characterizing ultrasmall silica-based nanoparticles

Correction for ‘Expanding analytical tools for characterizing ultrasmall silica-based nanoparticles’ by B. Yoo et al., RSC Adv., 2017, 7, 16861–16865.

Effect of docetaxel duration on clinical outcomes: exploratory analysis of CLEOPATRA, a phase III randomized controlled trial

Background

Combination pertuzumab, trastuzumab, and docetaxel (D) is considered standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. This post hoc, exploratory analysis of CLEOPATRA study data evaluated the clinical effects of D treatment duration within this regimen. The clinical benefits of pertuzumab and trastuzumab by different durations of D treatment were also evaluated.

Patients and methods

Patients with HER2-positive metastatic breast cancer received trastuzumab and D plus pertuzumab or placebo. Clinical outcomes were analyzed by the number of D cycles that patients received (<6D, 6D, or >6D). Progression-free survival (PFS) and overall survival (OS) for each treatment arm within each D cycle group were estimated using the Kaplan-Meier approach. Time-dependent, multivariate Cox regression was applied to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HER2-targeted therapy and D cycle groups.

Results

Overall, 804 patients received <6D (n = 119), 6D (n = 210), or >6D (n = 475) cycles. After adjusting for pertuzumab benefits versus placebo (PFS HR = 0.61, 95% CI 0.51-0.74, P < 0.0001; OS HR = 0.60, 95% CI, 0.49-0.74, P < 0.0001), >6D versus 6D cycles was not associated with statistically significant improvements in PFS (HR = 0.80, 95% CI 0.63-1.01, P = 0.0640) or OS (HR = 0.88, 95% CI 0.69-1.12, P = 0.3073). Consistent improvements in PFS and OS were observed with pertuzumab versus placebo, irrespective of D duration. The HRs for PFS were 0.395, 0.615, and 0.633 for <6D, 6D, and >6D cycles, respectively (P < 0.05 for all D cycle groups). Corresponding HRs for OS were 0.577, 0.700, and 0.612, respectively (P < 0.05 for <6D and >6D).

Conclusions

After accounting for pertuzumab benefits, more than six cycles of D treatment was not associated with significant improvements in either PFS or OS compared with six cycles. The addition of pertuzumab to trastuzumab improved clinical outcomes versus trastuzumab plus placebo, regardless of D treatment duration.

ClinicalTrials.gov identifier

NCT00567190.

Incidence and management of diarrhea in patients with HER2-positive breast cancer treated with pertuzumab

Background

Pertuzumab disrupts heterodimerization between human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR), HER3, and HER4. Thus, pertuzumab could result in adverse events similar to those observed with EGFR antagonists, such as diarrhea. We report the incidence and severity of diarrhea observed with pertuzumab in the CLEOPATRA, NeoSphere, and TRYPHAENA studies.

Patients and methods

Patients (n = 1443) had metastatic [CLEOPATRA (n = 804)] or early-stage breast cancer [NeoSphere (n = 416) and TRYPHAENA (n = 223)]. The incidence and severity of diarrhea were analyzed by treatment received. The incidence of febrile neutropenia concurrent with diarrhea and the effect of pre-existing gastrointestinal comorbidities were also evaluated. Subgroup analyses were carried out using CLEOPATRA data.

Results

The incidence of all-grade diarrhea across studies was generally greater for pertuzumab-based treatment, ranging from 28% to 72% (grade 1, 21%-54%; grade 2, 8%-37%; grade 3, 0%-12%; grade 4, 0%). Incidence was highest during the first pertuzumab-containing cycle, decreasing with subsequent cycles. Dose delays or discontinuations due to diarrhea were infrequent, ranging from 0% to 8%. Among pertuzumab-treated patients with diarrhea, 47%-67% received pharmacological intervention, most commonly with loperamide. Overlap between diarrhea and febrile neutropenia was uncommon, ranging from 0% to 11%. No relationship was observed between pre-existing gastrointestinal comorbidities and diarrhea. In CLEOPATRA, patients ≥65 years treated with pertuzumab had a higher incidence of grade 3 diarrhea than patients <65 years (19% versus 8%). All-grade diarrhea occurred at greater frequency among pertuzumab-treated Asian versus white patients with metastatic breast cancer (74% versus 63%); the corresponding rates in the control arm were 53% and 45%, respectively.

Conclusions

In both the metastatic and early-stage breast cancer settings, diarrhea was common but manageable for all pertuzumab-containing regimens. Diarrheal episodes were mainly low grade and occurred most often during the first treatment cycle. Diarrheal-related drug delays or discontinuations were uncommon.

ClinicalTrials.gov identifiers

NCT00567190 (CLEOPATRA), NCT00545688 (NeoSphere), NCT00976989 (TRYPHAENA).

Expanding Analytical Tools for Characterizing Ultrasmall Silica-based Nanoparticles

C' dots are fluorescent inorganic-organic hybrid nanoparticles synthesized in water comprised of a silica core with a covalently embedded near infrared dye, and a polyethylene glycol (PEG) outer layer. C' dots containing the integrin specific ligand, cycloRGDyC, are the first of their kind particles approved for human clinical trials. In the continued clinical development of these nanoparticles, high-resolution analytical approaches are needed. Here we investigate the use of reversed phase high performance liquid chromatography (RP-HPLC) to analyze cycloRGDyC-Cy5-C' dots. Given the stability and protein-like size, we reasoned that these nanoparticles would be compatible under RP-HPLC conditions typically used to characterize peptides and proteins. Our results show that RP-HPLC provides excellent resolution, showing significant heterogeneity of these nanoparticles. C' dots also exhibit unusual peak profiles where RP-HPLC chromatogram peak shapes change from run to run, possibly due to the conformational heterogeneity or charge distribution of the particle surface due to the PEG groups. In addition we describe a novel thiol-mediated release of C' dot ligands to directly estimate cycloRGDyC by exposing the particles to organic thiols. Ligand release is presumably afforded by a reverse Michael reaction mechanism.

Abstract P5-08-27: Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry

Introduction In 2010, the cutoff for HR positivity in breast cancer was established as ≥1% of cells staining HR+, previously having varied from 1% to 10%. The impact of this change on treatment patterns and outcomes is poorly understood. SystHERs is a prospective, observational cohort registry of patients (pts) with HER2+ metastatic breast cancer (MBC) that commenced enrollment in 2012. To our knowledge, SystHERs is the largest registry to collect and analyze data for the HER2+ subgroup. We report baseline characteristics, treatment patterns, and early outcomes by %HR+ (1–9% vs 10–100%).

Methods SystHERs enrolled pts aged ≥18 years and within 6 months of HER2+ MBC diagnosis. For pts with locally-determined HR+ disease, defined as HR+ in primary or metastatic tissue, %HR+ is the highest percentage of ER+ or PR+ tissue in early breast cancer or MBC. The percentage of ER+ or PR+ cells was not reported for pts considered HR– by the investigator. Median overall survival (OS; Kaplan–Meier) and hazard ratios (Cox regression) were estimated.

Results As of Feb 1, 2016, data were available for 872 eligible pts with known HR status, of whom 608 (70%) had HR+ disease. Of the 608 pts, 53 (9%) had 1–9%HR+ and 496 (82%) had 10–100%HR+; %HR+ was not reported for 59 pts. Baseline characteristics were similar between %HR+ subgroups (Table 1).

As shown in Table 2, the 1–9%HR+ subgroup was less likely to receive first-line hormonal therapy (26%) than the 10–100%HR+ subgroup (56%). 87% and 79% of pts received chemotherapy, respectively.

Median time from MBC diagnosis was 16.5 months (range, 0.4–49.4 months). Median OS was not reached at the data cutoff. The number of deaths was 13 (25%) in the 1–9%HR+ subgroup, and 68 (14%) in the 10–100%HR+ subgroup (log-rank P=0.025). The OS hazard ratio (0.514, 95% CI 0.283–0.931) favored the 10–100%HR+ subgroup. OS did not differ significantly between pts with 1–9%HR+ vs HR– disease (log-rank P=0.582, hazard ratio 1.185, 95% CI 0.647–2.169).

Table 1. Baseline characteristics 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)Age at MBC diagnosis, median yrs (range)54 (30–86)57 (21–86)55 (28–88)Race, %   White838372Black151320Premenopausal, %282522ECOG performance status, %   04654441463942≥2878MBC diagnosis type, %   De novo404958Recurrent605142Visceral, %*686275*Non-hepatic abdominal, ascites, CNS, liver, lung, or pleural effusion sites of metastasis

Table 2. First-line treatment 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)HER2-targeted therapy, %969391Chemotherapy, %877989Hormonal therapy, %26564

Conclusions These preliminary observational data suggest potential differences in treatment patterns and survival outcomes in low vs moderate/high HR+ expressers, with the former being less likely to receive hormonal therapy (26% vs 56%). Furthermore, low HR positivity was associated with poorer OS and was similar to OS observed in pts with HR– disease.

Citation Format: Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-27.

Abstract P5-08-24: How do real-world treatment patterns compare to guideline recommendations for first-line metastatic breast cancer patients in US community clinics?

Background:

Treatment (txt) guidelines are based on trial data from a small minority of patients (pts). Linked electronic health records (EHRs) are a novel approach to examine txt patterns and outcomes in larger and more generalizable populations. Given the increasing importance of real world data and real world outcomes, we utilized linked EHRs from a network of US community clinics to examine how real world txt patterns compare to metastatic breast cancer (mBC) txt guideline recommendations.

Methods:

The Flatiron database provides real world clinical data collected from EHRs used by US cancer care providers. The Flatiron network comprises ~15% of US cancer pts and is geographically and demographically diverse.

Using EHR from Jan 2016 mBC database, we evaluated first-line (1L) txt patterns in mBC by molecular subtype. Pts were selected if they received mBC txt within 60 days of mBC diagnosis between 01Jan2011-31Dec2015, had ≥2 visits within the Flatiron Network on or after 01Jan2013, and were ≥18 years (yrs). Analyses were conducted to describe pt and clinical characteristics and 1L txt by HER2 and/or hormone receptor (HR) status.

Results:

Among 2509 mBC pts identified, 58.9% were HR+/HER2-, 17.7% HER2+, 11.6% HR-/HER2- (triple negative, TNBC), 7.4% HER2 equivocal, and 4.3% 'not done/unknown HER2 status'. Txt patterns in the latter two groups were not analyzed. Selected pt and disease characteristics by subtype are shown in Table 1. Median follow-up since mBC diagnosis was 1.1 yrs (range 0-5 yrs). The 1L mBC txts by subtype are shown in Table 2. Pts with HR+/HER2- subtype were treated primarily with hormonal therapy (68%) and/or chemotherapy (chemo) (35%). Among HER2+ pts, the 1L mBC txt patterns include trastuzumab+pertuzumab with chemo (31%), trastuzumab with chemo (22%), trastuzumab with hormonal therapy (9%), ado-trastuzumab (4%), lapatinib with chemo (3%), and lapatinib with hormonal therapy (1%). For TNBC, the majority received chemo (95%), such as paclitaxel (21%), nab-paclitaxel (13%) and docetaxel (12%).

Conclusion:

This study advances our current understanding of real world 1L patterns of care by molecular subtype among mBC pts and how these compare to guideline recommendations. While the majority of pts are receiving therapy per guidelines, up to 22% of HER2+ of pts are not receiving targeted therapy in 1L mBC

Table 1. Patient and disease characteristics by subtypeN (%)HR+/HER2- (N=1479)HER2+ (N=445)TNBC (N=291)Age at mBC diagnosis (yrs), median (range)66 (24-85)60 (27-85)60 (33-85)Sex   Female1459 (99)441 (99)289 (99)Race   White995 (67)274 (62)168 (58)Black112 (8)44 (10)42 (14)Asian19 (1)14 (3)5 (2)Other179 (12)50 (11)36 (12)Missing173 (12)63 (14)40 (14)MBC type   De novo418 (28)172 (39)94 (32)Recurrent881 (60)225 (51)178 (61)Unknown180 (12)48 (11)19 (7)HR Status   Positive1479 (100)300 (67)--Negative--145 (33)291 (100)

Table 2. 1L mBC treatments by subtypeN (%)HR+/HER2- (N=1479)HER2+ (N=445)TNBC (N=291)Any Targeted Therapy*77 (5)346 (78)12 (4)Any Chemotherapy521 (35)283 (64)276 (95)Any Hormonal Therapy1010 (68)115 (26)16 (6)*Targeted therapy includes trastuzumab, pertuzumab, ado-trastuzumab emtansine, lapatinib and bevacizumab

Citation Format: Chu L, Yoo B, Carrigan G, Lai C, Beattie M, Reyes C. How do real-world treatment patterns compare to guideline recommendations for first-line metastatic breast cancer patients in US community clinics? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-24.

Beneficial effect of a nitric oxide donor in an ex vivo model of pig-to-human pulmonary xenotransplantation

BACKGROUND

Nitric oxide (NO) can reduce platelet adhesion and vascular resistance. Tempol can scavenge the reactive oxygen species (ROS) that induce tissue injury. As xenograft rejection attenuates endogenous NO production and generates ROS, we evaluated the potential effect of an NO donor (SIN-1, 3-morpholinosydnonimine) and tempol on hyperacute xenograft dysfunction using an ex vivo porcine lung perfusion model.

METHODS

For the evaluation of von Willebrand factor (vWF) secretion, human endothelial cells were stimulated with thrombin. Porcine lungs were perfused with either fresh human whole blood (unmodified control group [n = 4]), SIN-1 (n = 4), or SIN and tempol (n = 4).

RESULTS

SIN-1 and tempol significantly inhibited vWF secretion from endothelial cells in vitro. However, they did not suppress xenogeneic complement activation. In an ex vivo pulmonary perfusion model, SIN-1 improved pulmonary xenograft function by reducing pulmonary vascular resistance (PVR), inhibiting complement activation, and inhibiting thrombin generation. Combined treatment with tempol and SIN-1 potentiated PVR reduction, but slightly enhanced complement activation.

CONCLUSIONS

An NO donor is expected to improve pulmonary xenograft function through inhibition of vWF secretion, vasoconstriction, thrombin generation, and indirectly through inhibition of complement activation. The additional effects of tempol on an NO donor were not considered significant in an ex vivo xenograft system.

Abstract P4-14-27: Effect of docetaxel duration on clinical outcomes: Results from the phase III trial CLEOPATRA

Introduction:

In the CLEOPATRA study, pertuzumab (P) plus trastuzumab (T) and docetaxel (D) significantly improved median progression-free survival (PFS) and overall survival (OS) compared with placebo (Pla) plus T and D in pts with HER2-positive metastatic breast cancer. Study treatment was given every 3 weeks until disease progression (PD) or unacceptable toxicity. D starting dose was 75 mg/m2 and could be escalated or reduced per protocol. A minimum of 6 cycles of D was recommended. If D was discontinued, patients could continue P+T or Pla+T. To evaluate the potential association between D duration and clinical outcomes, we conducted post hoc exploratory analyses of the CLEOPATRA study.

Methods:

As of 11 Feb 2014 data cutoff, the safety population analyzed included 804 pts (396 Pla+T+D; 408 P+T+D) who received at least one dose of any study medication. Exposure and clinical outcomes of study treatment groups are presented by dichotomized subgroup of pts who received &lt;6 cycles of D and those who received more than 6 cycles. Median PFS and OS were estimated using Kaplan-Meier methods. Cox regression analyses were used to estimate hazard ratios (HRs).

Results:

The median number of D cycles received was 8 for both arms. Forty-one % of pts received &lt;6 (14% &lt;6; 27% exactly 6) and 59% received &gt;6 cycles.

Docetaxel Duration and Clinical Outcomes D &lt;6 cycles (n=329, 41%)D &gt;6 cycles (n=475, 59%) Pla+T+D (n=159)aP+T+D (n=170)aPla+T+D (n=237)P+T+D (n=238)Treatment Exposure#D Cycle, median (range)6 (1,6)6 (1,6)10 (7,42)10 (7,52)# Study Treatment Cycle, median (range)7 (1,78)14 (1,90)19 (7,92)28 (7,96)Duration of Study Treatment in month, median (range)6 (1,54)10 (1,63)14 (5,67)19 (5,68)Clinical OutcomesPFS in month, median (range)8.2 (6.2,9.0)12.5 (10.5,20.7)14.5 (12.6,17.2)22.8 (17.7,N/A)95% CIHR=0.59 (0.44,0.79)HR=0.65 (0.50,0.84)OS in month, median (range)29.8 (22.2,39.2)48.9 (36.8,N/A)46.7 (39.4,53.0)N/A (56.4,N/A)95% CIHR=0.67 (0.45,0.90)HR=0.62 (0.47,0.81)N/A=not available aTwo pts in each group had missing D cycle

Treatment Discontinuation Summary D &lt;6 cyclesD &gt;6 cycles Pla+T+D (n=159)P+T+D (n=170)Pla+T+D (n=237)P+T+D (n=238)D discontinuation before stopping anti-HER2 agents (n,%)90 (57)118 (69)180 (76)196 (82)Reason (n,%)    AE/intercurrent illness34 (38)27 (23)60 (33)72 (37)Patient reasonb3 (3)5 (4)5 (3)8 (4)Standard practice36 (40)59 (50)65 (36)41 (21)Adequate therapy12 (13)22 (19)36 (20)59 (30)Other1 (1)1 (1)9 (5)11 (6)Missing4 (4)4 (3)5 (3)5 (3)Discontinuation of all study treatment (T+D+Pla or P), n159170237238Reason (n,%)    AE/intercurrent illness15 (9)22 (13)25 (11)32 (13)Death10 (6)5 (3)4 (2)2 (1)Disease progression111 (70)110 (65)182 (77)154 (65)Patient reasonb17 (11)16 (9)12 (5)14 (6)Other6 (4)16 (9)12 (5)35 (15)Missing0 (0)1 (1)2 (1)1 (1)bIncluded failure to return, refused treatment, withdrawal, protocol violation

Conclusions:

Consistent with the overall study results, addition of P to T+D showed significant improvement in clinical outcomes regardless of whether &lt;6 or &gt;6 cycles of D were received. In the poster, three subgroup (&lt;6, 6 and &gt;6 D cycles) analyses and time-dependent Cox regression analysis to capture the dynamic variations in D exposure will be presented.

Citation Format: Miles D, Fung A, Yoo B, Knott A, Heeson S, Portera C, Swain S. Effect of docetaxel duration on clinical outcomes: Results from the phase III trial CLEOPATRA. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-27.

Abstract P4-14-13: Pertuzumab (P) use in first-line HER2-positive metastatic breast cancer (mBC) in US community oncology practices: Treatment patterns and outcomes

Background: Pertuzumab was FDA-approved in 6/2012 for use in first-line in combination with trastuzumab (H) and docetaxel for patients (pts) with HER2-positive mBC. This retrospective study investigated the clinical characteristics, treatment patterns, safety, and outcomes for pts with HER2-positive mBC who received a P-containing regimen in first-line in US community oncology practices.

Methods: This study utilized iKnowMed electronic health records, Claims Data Warehouse, and Social Security Death Index. Pts with HER2-positive mBC, who received a P-containing regimen between 6/2012 and 6/2014 and were followed through 12/2014, had ≥2 visits within the McKesson Specialty Health/US Oncology Network, and were not on clinical trials during the study period, were eligible.

Results: Of the 322 pts who received a P-containing regimen in the first-line setting, 25% were ≥65 years of age, 63% were post-menopausal, 61% had hormone receptor-positive mBC, 84% had a performance status of 0 or 1, and 76% had a Charlson Comorbidities Index of 0. Twenty-one percent of pts had 1 site of metastasis noted, 32% had 2 sites, and 47% had 3 or more sites. Pts with de novo mBC made up 40% of this cohort. Of the pts with recurrent mBC, over 60% received H in the early-stage BC setting. In the first-line mBC setting, 93% of the 322 pts received H+P+taxane, and 7% received H+P with other chemotherapy agent(s). Common adverse events reported included: fatigue (49%), diarrhea (44%), nausea (33%), peripheral neuropathy (33%), neutropenia (24%), and rash (22%). Further analyses including outcomes of these 322 pts will be presented.

Conclusions: First-line P was given in combination with H and chemotherapy agent(s) (93% taxane). No new safety signals were observed. More details on the clinical characteristics, specific treatment patterns, and safety will be presented, along with the progression-free survival of these pts receiving first-line P-containing therapy in a real-world setting.

Citation Format: Robert N, Goertz H-P, Asmar L, Tseng W-Y, Jiao X, Portera C, Yoo B, Patt D, Antao V. Pertuzumab (P) use in first-line HER2-positive metastatic breast cancer (mBC) in US community oncology practices: Treatment patterns and outcomes. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-13.