Abstract P3-04-09: Genomic analysis to evaluate response to neoadjuvant anastrozole and fulvestrant in post-menopausal ER-positive HER2-negative breast cancer patients included in the UCBG CARMINA02 trial

Background: CARMINA02 is a non-comparative multicenter phase II randomized trial evaluating the clinical response rate after up to 6 months of neoadjuvant endocrine therapy (NET) in HR+/HER2- patients with 1 mg anastrozole (Arm A) or 500 mg fulvestrant (Arm B). Secondary objectives included predictive markers of response and outcome. Between 2007 and 2011, 116 women with operable infiltrating breast adenocarcinoma T2-T4 N0-N3 M0 were randomized. Clinical response rates at 6 months (RECIST criteria) were 52.6% [95%CI 41-64%] in Arm A and 36.8% [95%CI 25-49%] in Arm B (Cancer 2016, in press). We aimed to identify the molecular predictive markers of resistance or sensitivity common to both treatments.

Methods: Ninety tumor RNA from clinical responder (n=34) and resistant patients (n=23) treated in arms A or B have been sequenced with Illumina Hiseq2500 technology leading to 2x100-nt paired-end RNA-seq reads. These samples are from pre-treatment (29 in arm A, 28 in arm B) and post-treatment tumors (6 months after, 17 in arm A and 16 in arm B). Alignment was performed with Tophat_2.0.6. Differential gene expression was analyzed with the Differential Expression analysis for Sequence count data package. Gene fusion was detected with ChimeraScan, TophatFusion and DeFuse tools. Variant calling including variations, insertions and deletions was processed following GATK recommendations for RNAseq datas. Quantitative RT-PCR experiments were done to confirm RNA-seq expression results in patient samples not selected for RNA-seq analysis (validation cohort).

Results: We first analyzed differentially expressed genes (DEGs) between responders and non-responders in pre-treatment or post-treatment samples to select potential predictive markers of response. We identified 51 DEGs before treatment common to anastrozole and fulvestrant. Among these 51 genes, SGK2 was the only gene more intensely expressed in responders than in non-responders. Then we compared DEGs between pre and post-treatment samples for responders or non-reponders for both treatment arms. SGK2 expression remains stable after treatment. Furthermore we identified 7 DEGs specific to responders and 11 DEGs specific to non-responders. Concerning genes fusion detection predicted by at least 2 tools, none was specific to a response type. We noted a higher number of fusions in non-responders samples. Variants detected by RNA-Seq are being confirmed by DNA-Seq using a home-made next-generation sequencing panel including 95 genes frequently mutated in breast cancers (analysis ongoing).

Conclusion:High expression of SGK2, encoding a kinase induced in response to signals that activate PI3kinase, may represent a predictive marker of sensitivity to NET. DEGs associated with NET response or resistance belong to cell cycle, DNA replication and repair, cell death and drug metabolism. Ongoing DNA-seq datas will complete this genomic analysis. This research was conducted with support from AstraZeneca and Institut Curie.

Citation Format: Callens C, Bessoltane N, Ngo C, Chemlali W, Becette V, Bernard V, Delattre O, Lemonnier J, Mouret-Reynier M-A, Andre F, Bieche I, Lerebours F. Genomic analysis to evaluate response to neoadjuvant anastrozole and fulvestrant in post-menopausal ER-positive HER2-negative breast cancer patients included in the UCBG CARMINA02 trial [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 P3-04-09.

Prediction of axillary lymph node status in male breast carcinoma

BACKGROUND

To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC.

PATIENTS AND METHODS

From January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie (IC). We analysed the calibration and discrimination performance of two nomograms [IC, Memorian Sloan-Kettering Cancer Center (MSKCC)] originally designed to predict axillary lymph node metastases in female BC.

RESULTS

About 55% and 24% of the tumours were pT1 and pT4, respectively. Nearly 46% demonstrated axillary lymph node metastasis. About 99% were oestrogen receptor positive and 94% HER2 negative. Lymph node status was the only significant prognostic factor of overall survival (P = 0.012). The area under curve (AUC) of IC and MSKCC nomograms were 0.66 (95% CI 0.54-0.79) and 0.64 (95% CI 0.52-0.76), respectively. The calibration of these two models was inadequate.

CONCLUSIONS

Multi-variate models designed to predict axillary lymph node metastases for female BC were not effective in our male BC series. Our results may be explained by (i) small sample size (ii) different biological determinants influencing axillary metastasis in male BC compared with female BC.

Meeting the challenge of interpreting high-resolution single nucleotide polymorphism array data in prenatal diagnosis: does increased diagnostic power outweigh the dilemma of rare variants?

OBJECTIVE

Several studies have already shown the superiority of chromosomal microarray analysis (CMA) compared with conventional karyotyping for prenatal investigation of fetal ultrasound abnormality. This study used very high-resolution single nucleotide polymorphism (SNP) arrays to determine the impact on detection rates of all clinical categories of copy number variations (CNVs), and address the issue of interpreting and communicating findings of uncertain or unknown clinical significance, which are to be expected at higher frequency when using very high-resolution CMA.

DESIGN

Prospective validation study.

SETTING

Tertiary clinical genetics centre.

POPULATION

Women referred for further investigation of fetal ultrasound anomaly.

METHODS

We prospectively tested 104 prenatal samples using both conventional karyotyping and high-resolution arrays.

MAIN OUTCOME MEASURES

The detection rates for each clinical category of CNV.

RESULTS

Unequivocal pathogenic CNVs were found in six cases, including one with uniparental disomy (paternal UPD 14). A further four cases had a 'likely pathogenic' finding. Overall, CMA improved the detection of 'pathogenic' and 'likely pathogenic' abnormalities from 2.9% (3/104) to 9.6% (10/104). CNVs of 'unknown' clinical significance that presented interpretational difficulties beyond results from parental investigations were detected in 6.7% (7/104) of samples.

CONCLUSIONS

Increased detection sensitivity appears to be the main benefit of high-resolution CMA. Despite this, in this cohort there was no significant benefit in terms of improving detection of small pathogenic CNVs. A potential disadvantage is the high detection rate of CNVs of 'unknown' clinical significance. These findings emphasise the importance of establishing an evidence-based policy for the interpretation and reporting of CNVs, and the need to provide appropriate pre- and post-test counselling.

Abstract P1-01-19: Prediction of axillary lymph node status in male breast carcinoma

Background: To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC.

Patients and methods: From January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie. We analysed the calibration and discrimination performance of two nomograms (Institut Curie (IC), Memorian Sloan-Kettering Cancer Center (MSKCC)) originally designed to predict axillary lymph node metastases in female BC.

Results: 55% and 24% of the tumours were pT1 and pT4 respectively. 46% demonstrated axillary lymph node metastasis. 99% were estrogen receptor positive and 94% HER2 negative. Lymph node status was the only significant prognostic factor of overall survival (p = 0.012). The area under curve (AUC) of IC and MSKCC nomograms were 0.66 (95%CI, 0.54–0.79) and 0.64 (95% CI, 0.52–0.76) respectively. The calibration of these two models was inadequate (Table 1).

Effects of hyperglycemia and effects of ketosis on cerebral perfusion, cerebral water distribution, and cerebral metabolism

Diabetic ketoacidosis (DKA) may cause brain injuries in children. The mechanisms responsible are difficult to elucidate because DKA involves multiple metabolic derangements. We aimed to determine the independent effects of hyperglycemia and ketosis on cerebral metabolism, blood flow, and water distribution. We used magnetic resonance spectroscopy to measure ratios of cerebral metabolites (ATP to inorganic phosphate [Pi], phosphocreatine [PCr] to Pi, N-acetyl aspartate [NAA] to creatine [Cr], and lactate to Cr) and diffusion-weighted imaging and perfusion-weighted imaging to assess cerebral water distribution (apparent diffusion coefficient [ADC] values) and cerebral blood flow (CBF) in three groups of juvenile rats (hyperglycemic, ketotic, and normal control). ATP-to-Pi ratio was reduced in both hyperglycemic and ketotic rats in comparison with controls. PCr-to-Pi ratio was reduced in the ketotic group, and there was a trend toward reduction in the hyperglycemic group. No significant differences were observed in NAA-to-Cr or lactate-to-Cr ratio. Cortical ADC was reduced in both groups (indicating brain cell swelling). Cortical CBF was also reduced in both groups. We conclude that both hyperglycemia and ketosis independently cause reductions in cerebral high-energy phosphates, CBF, and cortical ADC values. These effects may play a role in the pathophysiology of DKA-related brain injury.

Interim report of a randomized cross-over study comparing clinical performance of novice trainee endoscopists using conventional air insufflation versus warm water infusion colonoscopy

BACKGROUND

The applicability of water method colonoscopy in trainee education is not known.

AIM

To compare the water method vs. usual air method in teaching novice trainee colonoscopy.

METHOD

An IRB approved prospective randomized cross-over study (NCT01482546) in a university setting with diverse patient population.

DESIGN

Three first year GI fellows consented to participate in the study. Trainees were randomized to learn with either usual air method or the water method in performing colonoscopy with a dedicated endoscopy attending during their weekly outpatient endoscopy clinics for the initial six months of training and then cross-over to the other method for the remaining six months.

PATIENTS

Patients undergoing screening, surveillance or diagnostic colonoscopy.

RESULTS

The interim data revealed no significant difference in age, gender, and body mass index (BMI). Trainees rated the water method colonoscopy as significantly easier to learn compared to the air method (p=0.007).

CONCLUSIONS

The interim data demonstrate positive effects of using the water method in training novice endoscopists who reported a significant ease of learning colonoscopy using this method. Training programs could consider joining us in evaluating the use of warm water infusion in colonoscopy education.

Indigocarmine added to the water exchange method enhances adenoma detection - a RCT

PURPOSE

Chromoendoscopy with dye spray and the water method both increase adenoma detection.

HYPOTHESIS

Adding indigocarmine to the water method will enhance further the effectiveness of the latter in adenoma detection.

METHODS

Screening colonoscopy was performed with the water method (control) or with 0.008% indigocarmine added (study) by two endoscopists. Randomization was based on computer-generated codes contained in blocks of pre-arranged opaque sealed envelopes. High resolution colonoscopes were used. Upon insertion into the rectum, air was suctioned. With the air pump turned off, water was infused using a blunt needle adaptor connected to the scope channel and a foot pump to facilitate scope insertion until the cecum was reached. Residual stool causing cloudiness was suctioned followed by infusion of clear or colored water (water exchange) to facilitate scope passage with minimal distention of the colonic lumen. Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal.

STATISTICS

Sample size calculation revealed 168 patients (84/group) needed to be randomized. Study was IRB-approved and registered (NCT01383265).

RESULTS

There were no significant differences in mean age, gender distribution, BMI, and family history of colon cancer. Cecal intubation success rate was 100% in both groups. The overall adenoma detection rate was 44% (water only) versus 62% (water with indigocarmine), respectively (p=0.03). One cancer was detected in each group.

CONCLUSION

In a RCT, indigocarmine at 0.008% concentration, added to the water method, significantly enhanced further the effectiveness of the latter in detecting adenomas.

Comparison of measurements of time outdoors and light levels as risk factors for myopia in young Singapore children

AIMS

To compare methods to measure time outdoor and light levels, two possible predictors of myopia, in Singapore children.

METHODS

Outdoor time from a diary and portable light meter over a 1-week period was compared in 117 Singapore children aged 6-12 years with and without myopia. All children wore a (HOBO Pendant temp/light Part # UA-002-64) light meter for 1 week and the parents filled the 7-day outdoor diary to track the outdoor activity.

RESULTS

Mean outdoor time from diary and time with light levels was 5.44 hours per week and 7.91 hours per week, respectively, during school term and school holidays. Time spent with light levels of >1000 Lux from the light meter were 7.08 h per week and 9.81 h per week, respectively, during school term and school holidays. The intraclass correlation coefficients were 0.21 and 0.28 for outdoor time from the diary and light meter (1000 Lux cut-off) during the school term and holidays, respectively. The correlation coefficient was 0.34 (95% CI 0.05, 0.58) for a weekday during school holidays, 0.17 (-0.14, 0.45) for a weekday during school term, 0.07 (-0.16, 0.29) for a weekday during school term, and 0.25 (0.02, 0.46) for a weekend during school term.

CONCLUSIONS

The agreement between the light meter and 1-week diary was poor to fair. Both instruments measure different parameters, time outdoors and light intensity, and could therefore capture different aspects of risk in future myopia studies.

Head-to-head comparison of practice with endoscopic retrograde cholangiopancreatography computer and mechanical simulators by experienced endoscopists and trainees

BACKGROUND AND AIM

  The endoscopic retrograde cholangiopancreatography (ERCP) mechanical simulator (EMS) and computer simulator (ECS) are described herein. No direct hands-on comparison has been reported to reflect the perception of trainers and trainees regarding the efficacy of each model for trainee ERCP education. We compared the trainers' and trainees' assessments of the EMS and ECS for trainee education.

METHODS

  Eighteen gastrointestinal trainees and 16 trainers with varying ERCP experience completed a questionnaire survey before and after practice with each simulator at hands-on ERCP practice workshops. They carried out scope insertion, selective bile duct cannulation, guidewire negotiation of a bile duct stricture, biliary papillotomy and insertion of a single biliary stent using both simulators. Main outcome measurement was respondents' assessments of comparative efficacy of EMS and ECS practice for trainee education.

RESULTS

  Compared to pre-practice evaluation, both EMS and ECS received higher scores after hands-on practice. Both trainers and trainees showed significantly greater increases in scores for EMS when compared with ECS in facilitating understanding of ERCP procedure, enhancing confidence in carrying out ERCP and the simulator as a credible option for supplementing clinical ERCP training (P < 0.05). Participants also scored EMS significantly higher in realism and usefulness as an instructional tool.

CONCLUSIONS

  Both computer and mechanical simulators are accepted modalities for ERCP training. The current data (based on a head-to-head comparison of hands-on practice experience) indicate EMS practice is rated higher than ECS practice in supplementing clinical ERCP training. EMS offers the additional advantage of coordinated practice with real equipment and accessories.

Retrospective analysis showing the water method increased adenoma detection rate - a hypothesis generating observation

BACKGROUND: A water method developed to attenuate discomfort during colonoscopy enhanced cecal intubation in unsedated patients. Serendipitously a numerically increased adenoma detection rate (ADR) was noted. OBJECTIVE: To explore databases of sedated patients examined by the air and water methods to identify hypothesis-generating findings. DESIGN: Retrospective analysis. SETTING: VA endoscopy center. PATIENTS: creening colonoscopy. INTERVENTIONS: From 1/2000-6/2006 the air method was used - judicious air insufflation to permit visualization of the lumen to aid colonoscope insertion and water spray for washing mucosal surfaces. From 6/2006-11/2009 the water method was adopted - warm water infusion in lieu of air insufflation and suction removal of residual air to aid colonoscope insertion. During colonoscope withdrawal adequate air was insufflated to distend the colonic lumen for inspection, biopsy and polypectomy in a similar fashion in both periods. Main outcome measurements: ADR. RESULTS: The air (n=683) vs. water (n=495) method comparisons revealed significant differences in overall ADR 26.8% (183 of 683) vs. 34.9% (173 of 495) and ADR of adenomas >9 mm, 7.2% vs. 13.7%, respectively (both P<0.05, Fisher's exact test). LIMITATIONS: Non-randomized data susceptible to bias by unmeasured parameters unrelated to the methods. CONCLUSION: Confirmation of the serendipitous observation of an impact of the water method on ADR provides impetus to call for randomized controlled trials to test hypotheses related to the water method as an approach to improving adenoma detection. Because of recent concerns over missed lesions during colonoscopy, the provocative hypothesis-generating observations warrant presentation.

Heterogeneous Amplification of HER2 Is a Rare but Clinically Significant Event in Invasive Ductal Carcinoma

BackgroundWe have recently shown that pT1ab HER2 positive tumors carry a poor prognosis, which may be alleviated by trastuzumab (T) based therapy (Rodrigues et al, ASCO 2009). We had also reported that heterogeneous expression of HER2 (hetHER2) may be associated with a poor outcome depending on the HER2 overexpressing subclone (Cottu et al, Ann Oncol 2007). Meanwhile, ASCO/CAP guidelines have questioned the minimum valid score for HER2 expression (Moeder et al, J Clin Oncol 2007; Wolff et al, J Clin Oncol 2007). We describe here the characteristics and outcome of a series of patients with hetHER2 disease.Patients and methodsHER2 status is routinely assessed in our institution in advanced breast cancer patients since 1999, and in early patients since 2002. Out of 1300 HER2 positive cases, we have been able to identify 12 pts with heterogeneous expression of HER2 in the primary tumor (&lt;1%). HetHER2 was defined as more than 5% and less than 59% of infiltrating cells overexpressing HER2 with an intense and complete membrane staining, and /or with a FISH ratio ≥ 2.2. Confirmation was obtained by FISH in 8 patients. Detailed pathological analysis, clinical characteristics and outcome were obtained.ResultsMedian age at diagnosis was 45 years (31-64). All pts received adequate locoregional therapy according to institutional guidelines. Pathological characteristics of the primary tumors are depicted in the table.Pathological Characteristics pT1pT2pT3Tumor Size (n)633 n/ n evaluable%ER+11/1292PR+5/1242HER2 FISH+8/1080vascular emboli5/862.5 pN0pNmi/i+pN+pN (n)624 I / lowII / intermediateIII / highGrade (Elston Ellis)255Mitotic Index327 All patients had infiltrating ductal carcinoma, two of them bearing also a ductal carcinoma in situ component. Most ER+ tumors had a faint staining, observed in less than 50% of tumor cells. In 1 pt with a node-positive tumor, the same pattern of heterogeneous overexpression of EHR2 was observed in the primary tumor and in the lymph nodes. Chemotherapy was given to 9 patients (75%), hormonal treatment to 6 pts (50%) and T was added to chemotherapy in 3 pts. With a median follow-up of 69 months (0-200), 6 pts have relapsed, none of them having received T based therapy. Median time to relapse was 46 mths (14-151). Initial sites of relapses were axillary lymph nodes (1), mediastinal lymph nodes (1), skin (1), liver (2) and ipsilateral relapse (1). No brain metastases were recorded. HER2 status was obtained in four relapses and was considered either negative (Skin), or highly overexpressed (liver) or heterogeneous (ipsilateral and axillary lymph node relapses). None of the 3 T treated pts has relapsed so far, but their follow up is still under 6 months.ConclusionsMore than half of the tumors exhibited at least 1 poor prognosis feature beyond HER2 overexpression. In the line of the recent reanalysis of the NCCTG9831 adjuvant T trial which has suggested that T may be beneficial to hetHER2 patients (Sukov et al, ASCO 2009), our data support the evidence of a poor prognosis of hetHER2 disease, which may be similar to the prognosis of the “real” HER2 3+ and amplified disease. Prospective evaluation of anti HER2 based therapy in this subset of patients is clearly warranted.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6034.

Rapid gynogenetic mapping of Xenopus tropicalis mutations to chromosomes

Pilot forward genetic screens in Xenopus tropicalis have isolated over 60 recessive mutations. Here we present a simple method for mapping mutations to chromosomes using gynogenesis and centromeric markers. When coupled with available genomic resources, gross mapping facilitates evaluation of candidate genes as well as higher resolution linkage studies. Using gynogenesis, we have mapped the genetic locations of the 10 X. tropicalis centromeres, and performed fluorescence in situ hybridization to validate these locations cytologically. We demonstrate the use of this very small set of centromeric markers to map mutations efficiently to specific chromosomes. Developmental Dynamics 238:1398-1406, 2009. (c) 2009 Wiley-Liss, Inc.