[Male breast cancer: prognostic factors, diagnosis and treatment: a multi-institutional survey of 95 cases]

OBJECTIVES

The optimal treatment for male breast cancer is not known because male breast cancer is a rare disease. It represents as little as 0.6% of all breast cancers and less than 1% of human cancers. The aim was to analyze the clinical, histological and therapeutic characteristics of 95 men cared for breast cancer between 2000 and 2010 in four hospitals, and determine predictors of poor prognosis to improve care of male breast cancer.

METHODS

This study is a multi-institutional survey, retrospective, involving four French institutions: Cancer Institute of the West (ICO), Reunion Island South hospital group, the hospital group of Dax, and the Bergonié Institute. All carcinomas in situ or invasive breast occurred in male patients were included. An analysis of clinical, histological and therapeutic features was performed. Statistical analysis of our study focused on the overall survival of patients and specific method of Kaplan-Meier, enabling search for predictors of poor prognosis.

RESULTS

The mean age was 65 years. Thirty-seven percent of patients were overweight or obese. It was in 88% of cases of palpable tumor whose average size was 26.29mm. Ninety patients, none had a lesion palpable T0, 44% T1 tumors, 38% T2 tumors, 3% had a T3 tumors, and finally 10% T4 tumors. The histological type was the most common invasive ductal carcinoma (87%). He found a similar proportion of patients with or without lymph node involvement. N+ patients, capsular rupture was observed in 29% of cases. Receptor positivity was found, estrogen in 95% of cases and progesterone in 83% of cases. Additional irradiation was performed in 75% of patients and chemotherapy in 37% of patients. Overall survival was 79.2% at five years and 70.8% at ten years. Age, tumor size and histological capsular rupture are factors that significantly influence the overall survival and specific.

CONCLUSION

Male breast cancer is a different pathology of breast cancer in women. The majority of recommendations suggest treating men who are diagnosed with breast cancer, using the guidelines applied to postmenopausal women treatments. There is no study based on male population that has evaluated these treatment modalities in terms of impact on survival. The diagnosis is usually made at later stages, and tumor size is often greater. Histological characteristics also differ. However, the treatment is almost identical.

Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas (Observatoire dédié au Cancer Bretagne / Pays de la Loire)

BACKGROUND

In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer.

METHODS/RESULTS

A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks.

CONCLUSION

Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.

[Sexual functions after treatment for rectal cancer: impact of doses in autonomic pelvic nerves]

PURPOSE

Prospective evaluation of sexual function after treatment of rectal cancer and identification of predictive factors.

PATIENTS AND METHODS

Thirty-three patients were treated with curative intent by chemoradiation and surgery for localized rectal adenocarcinoma. Sexual toxicity was assessed four times (before treatment and at 2, 6 and 12 months) using validated questionnaires: QLQ C30 and EORTC CR38 for all, simplified IIEF for men and FSFI for women. A correlation was sought between the toxicity and clinical and dosimetric parameters by Fisher and Mann-Whitney tests.

RESULTS

In men, erections and sexual satisfaction decreased significantly from the acute phase and then stabilized (respective scores of 84.5 and 86/100 in the initial phase, 66 and 70.4 at the end of radiotherapy, 70 and 70 at 6 months and 68.5 and 70 at 12 months). For women, the changes were not significant. This study confirms some risk factors for sexual toxicity already mentioned (original function, age, tumor volume) and highlights new (dose to the seminal vesicles and above all, doses to pelvic autonomic plexus).

CONCLUSION

Sexual effects of combined treatment of rectal cancer have only recently been described but remain undervalued and poorly understood. The impact of the autonomic pelvic plexus doses is a completely new data that could be extended in the development of intensity-modulated radiotherapy.

Single cells from human primary colorectal tumors exhibit polyfunctional heterogeneity in secretions of ELR+ CXC chemokines

Cancer is an inflammatory disease of tissue that is largely influenced by the interactions between multiple cell types, secreted factors, and signal transduction pathways. While single-cell sequencing continues to refine our understanding of the clonotypic heterogeneity within tumors, the complex interplay between genetic variations and non-genetic factors ultimately affects therapeutic outcome. Much has been learned through bulk studies of secreted factors in the tumor microenvironment, but the secretory behavior of single cells has been largely uncharacterized. Here we directly profiled the secretions of ELR+ CXC chemokines from thousands of single colorectal tumor and stromal cells, using an array of subnanoliter wells and a technique called microengraving to characterize both the rates of secretion of several factors at once and the numbers of cells secreting each chemokine. The ELR+ CXC chemokines are highly redundant, pro-angiogenic cytokines that signal via the CXCR1 and CXCR2 receptors, influencing tumor growth and progression. We find that human primary colorectal tumor and stromal cells exhibit polyfunctional heterogeneity in the combinations and magnitudes of secretions for these chemokines. In cell lines, we observe similar variance: phenotypes observed in bulk can be largely absent among the majority of single cells, and discordances exist between secretory states measured and gene expression for these chemokines among single cells. Together, these measures suggest secretory states among tumor cells are complex and can evolve dynamically. Most importantly, this study reveals new insight into the intratumoral phenotypic heterogeneity of human primary tumors.

Candidemia in intensive care unit: a nationwide prospective observational survey (GISIA-3 study) and review of the European literature from 2000 through 2013

BACKGROUND

Candida bloodstream infections (BSI) represent an important problem in Intensive Care Units (ICUs). The epidemiology of candidemia is changing with an increase in the proportion of Candida (C.) non-albicans.

OBJECTIVES

An Italian 2-year observational survey on ICU was conducted to evaluate the species distribution and possible differences between BSI caused by C. albicans and C. non-albicans. For comparative purposes, we performed a European literature-based review to evaluate distribution and frequency of Candida spp. causing ICU candidemia, during the period 2000-2013.

MATERIALS AND METHODS

This laboratory-based survey involved 15 microbiology centers (GISIA-3 study). All candidemia episodes in adult patients were considered. Data were prospectively collected from 2007 to 2008. PubMed was searched for peer-reviewed articles.

RESULTS

In total, 462 candidemia episodes were collected. C. albicans accounted for 49.4% of the isolates, followed by C. parapsilosis (26.2%) and C. glabrata (10.4%). Mortality was higher in patients with C. non-albicans than C. albicans (47.3% vs. 32.4 %, p > 0.05). Among risk factors, parenteral nutrition was more common (p = 0.02) in non-albicans candidemia, while surgery was more frequent (p = 0.02) in C. albicans candidemia. Twenty-four relevant articles were identified. C. albicans was the predominant species in almost all studies (range 37.9% -76.3%). C. glabrata was commonly isolated in the German-speaking countries, France, UK and North Europe; C. parapsilosis in Turkey, Greece and Spain.

CONCLUSIONS

Although C. non-albicans BSI is increasing, our study shows that C. albicans is still the predominant species in ICU candidemia. There are differences in the epidemiology of Candida BSI among European countries, with a prevalence of C. glabrata and C. parapsilosis in Northern and Southern countries, respectively.

[Helical tomotherapy in the treatment of malignant pleural mesothelioma: The impact of low doses on pulmonary and oesophageal toxicity]

PURPOSE

To evaluate the adjuvant treatment of malignant pleural mesothelioma by helical tomotherapy and the impact of low doses on esophageal and pulmonary toxicity.

PATIENTS AND METHODS

Between June 2007 and May 2011, 29 patients diagnosed with malignant pleural mesothelioma received adjuvant radiotherapy by helical tomotherapy. The median age was 63 years (34-72). Histologically, 83 % of patients had epithelioid malignant pleural mesothelioma. Clinically, 45 % of patients were T3 and 55 % N0. Eighty six percent of the patients were treated by extrapleural pneumonectomy and 35 % received neoadjuvant chemotherapy with platinum and pemetrexed. The median dose in the pneumonectomy cavity was 50Gy at 2Gy/fraction.

RESULTS

The mean follow-up was 2.3 years after diagnosis. Overall survival at 1 and 2 years was 65 and 36 % respectively. The median survival from diagnosis was 18 months. Median lung volumes receiving 2, 5, 10, 13, 15 and 20Gy (V2, V5, V10, V13, V15 and V20) were 100, 98, 52, 36, 19 and 5 %. The median of the mean remaining lung dose was 11Gy. Two patients died of pulmonary complications, three patients had grade 3 lung toxicity, while esophageal grade 3-4 toxicity was observed in three other patients. No significant impact of clinical characteristics and dosimetric parameters were found on pulmonary toxicity, however a V10≥50 %, a V15≥15 % and mean lung dose of 10Gy or more had a tendency to be predictive of pulmonary toxicity (P<0.1). Moreover, in our analysis, the mean lung dose seems to have a significant impact on esophageal toxicity (P=0.03) as well as low doses to the controlateral lung: V5, V10 and V13 (P<0.05).

CONCLUSION

Helical tomotherapy is a promising technique in the multimodality treatment of malignant pleural mesothelioma. Low doses received by the contralateral lung appear to be the limiting factor. A dosimetric comparison with volumetric modulated arctherapy techniques would be interesting in this setting.

Abstract B269: Effects of blocking aberrantly expressed CSF-1R in Hodgkin lymphoma

The human genome contains a large number of repetitive elements that have been suspected to play a role in human diseases. Recent literature has shown that aberrant activation of one of these repetitive elements, a long terminal repeat (LTR), leads to lineage inappropriate expression of the CSF-1 receptor (CSF-1R) transcript in Hodgkin's lymphoma (HL) clinical samples and cell lines. CSF1-R, also known as Feline McDonough Sarcoma (FMS), is the receptor for CSF-1 and IL-34, and under normal circumstances it plays an important role in monocyte survival, proliferation, and differentiation as well as osteoclast generation. Aberrant expression of CSF-1R has been shown previously to support proliferation and survival in HL cells. To confirm the role of CSF-1R in HL, we determined that 17 of 17 HL clinical samples and 7 of 7 HL cell lines were positive for the aberrant CSF-1R transcript by TaqMan and traditional PCR, while non-HL cell lines were negative for the aberrant CSF-1R transcript. The HL lines were further characterized for surface expression of CSF-1R by flow cytometry and CSF-1 secretion by ELISA. L-1236 cells expressed the highest levels of CSF-1R and CSF-1. Treatment of the HL cell lines with CSF-1R-Fc, resulted in reduced viability in four of the five lines, consistent with the hypothesis that HL cell lines are sensitive to CSF-1 as a growth factor. Additionally, it was found that treating the L-1236 HL cell line with the CSF-1R small molecule inhibitor JNJ-40646527 had a significant effect on viability of the HL cell line L-1236, with an IC50 of 264 nM at 72 hrs. JNJ-40646527 did not have a significant effect on the viability of several other HL cell lines. These results indicate that aberrant LTR driven CSF-1R expression may play a role in the pathogenesis of Hodgkin's lymphoma (HL) and could be a potential target for Hodgkin's lymphoma therapy.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B269.

Citation Format: Liam Campion, Nikki Deangelis, Catherine Ferrante, Raluca Verona, Shobha Seetharam, Carl Manthey, Linda Snyder. Effects of blocking aberrantly expressed CSF-1R in Hodgkin lymphoma. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B269.

[Diagnostic laparoscopy in gynecological cancer, prophylactic oophorectomy: feasibility study on 22 cases]

OBJECTIVES

The purpose of our study was to assess the feasibility of outpatient laparoscopy in a cohort of 22 patients admitted for bilateral oophorectomy (n=11) and preoperative diagnostic laparoscopy (n=11).

PATIENTS AND METHODS

Between December 2012 and May 2013, we included 22 patients in our study. All selected patients received a questionnaire the day before surgery. The questionnaire consisted of chapters on intraoperatively, and the postoperative assessments of patients regarding a possible return home on the evening of surgery. The ability to output was measured with the score of Chung at the evening of surgery and in the morning before leaving.

RESULTS

The mean age of patients was 60 years. The average length of stay was 1.2 days. Postoperative pain tends to be higher in the morning in the bilateral oophorectomy group (P=0.06), nausea and vomiting are the same in both groups. In the bilateral oophorectomy group, six patients were able to go out and five wished it; in the diagnostic laparoscopy group nine patients were able to go out and two wished it, this difference was significant (P=0.041).

DISCUSSION

The outpatient hospital is the norm for many surgeries. In our study, 47% of patients able to go out wishing that output. This difference is important when comparing the two groups. There are more patients wishing an output in the oophorectomy group. This reduction in length of stay must be compensated by a medical and paramedical supervision at home.

CONCLUSION

A large number of surgical procedure are performed on an outpatient basis. Patients who underwent diagnostic laparoscopy are more fragile, they should receive active postoperative support to enable an outpatient hospital.

[Multicentric evaluation of a self-screening questionnaire for occupational bladder cancer]

OBJECTIVE

Evaluate a self-screening questionnaire for bladder cancer of occupational origin and analyse an influence of exposure to a carcinogen bladder tumor on prognosis.

PATIENTS AND METHODS

Five hundred and thirty-one patients followed, between 2005 and 2010, for bladder cancer in two university centers have received a self-screening questionnaire derived from questionnaire KVP 08. Patients who responded positively to at least one of the items were considered to have a self-screening questionnaire "positive". Patients were finally invited to take an appointment for consultation in occupational pathology.

RESULTS

The response rate to self-screening questionnaire was 39.9% (212/531). It was "positive" in 82 cases (38.7%). Among the 82 patients with a self-screening questionnaire "positive", 46 patients consulted in occupational pathology (56%). Occupational exposure to a bladder carcinogen was documented in 91.3% of cases. Among the 22 patients who consulted in occupational pathology with a self-screening questionnaire "negative", an occupational exposure to a bladder carcinogen was documented in 13.6% of cases. The sensibility of the self-screening questionnaire was 91.3%, the specificity 86.4% and the accuracy 89.7%. The relative risk to have an occupational exposure if the self-screening questionnaire was "positive" was 6.69. The analysis of groups "positive" versus "negative" does not reveal any statistically significant difference in terms of tumor aggressiveness and disease-free survival.

CONCLUSION

The self-screening questionnaire was considered relevant with good reliability for detection of occupational exposure to a bladder carcinogen.

PD08-10: High Frequency of Triple Negative Mammary Carcinomas in the Dog as Model of Human Breast Cancer

Background Information: Relevant animal models of human breast cancer are currently lacking, especially regarding the triple-negative breast cancer (TNBC) subtype, for which efficient therapies are needed. Recent studies indicate that spontaneous canine mammary carcinomas (CMCs) (which are common in France due to absence of early neutering) resemble human breast cancers, by pathology, tumor genetics, and biological behavior. However, the current molecular classification of human breast cancer has not been evaluated in canine samples yet.

Objective: To establish the prognostic value of the human immunophenotypic classification in dogs To evaluate CMCs as a model of human breast cancer including TNBC.

Methods: 350 CMCs treated by surgery alone were obtained from the Nantes Atlantic College of Veterinary Medicine, Food Science and Engineering (France) from 2005 to 2008. Recorded clinical data included breed, neutering, age at diagnosis, presence of metastases, cause and time to death. Histological records included the subtype of carcinoma, Elston & Ellis grade, presence of emboli and lymph node metastasis. By immunohistochemistry (IHC) using ER, PR, Her2 (Herceptest and Pathway® Her2), CK5/6, EGF-R and KI67, CMCs were classified into the subtypes of human breast cancer according to Nielsen et al. IHC analyses were independently reviewed by four pathologists.

Results: The preliminary data in this abstract are based on 200 cases. The mean age at diagnosis was 10.8±2.1 years. 72,7% of dogs were intact female (27,3% of late neutering). 41% of dogs died due to cancer progression (metastasis rate of 30%). The most common histologic subtype was simple tubulopapillary CMC (53%), then solid CMC (32%). The most common grades were grade II (49%) and III (43%). 53% of the tumours showed lymphatic emboli. 4 immunophenotypes were defined: luminal A (11.9%), luminal B (5.1%), basal-like (59.3%) and non basal-like (23.7%) triple negative CMCs. 8.8% of the CMCs were scored Her2 2+ but none were considered Her2-overexpressing as defined by a 3+ score, despite appropriate staining with the two well established methods. Predictive factors for specific survival were: dog weight (p=0.01), histologic subtype (p=0.001), presence of emboli (p&lt;0.0001) or lymph node metastasis (p=0.02), Ki67 index (p=0.03). Triple-negative carcinomas showed a significantly shorter specific survival (median=224 days) when compared to luminal A CMCs (median=641 days) (MannWhitney, p=0.016).

Conclusion: The molecular classification of human breast cancer identifies 4 subtypes of invasive CMCs with different prognoses. In dogs, a low rate of luminal tumors are observed, and no Her2-overexpressing tumors are found (defined by a score of 3+ by Her2 immunohistochemistry). 83% of CMCs were of the triple-negative subtype, associated with a shorter survival, as reported in human breast cancer. Infiltrative mammary cancer in dogs could be an interesting model for preclinical investigations. Final data based on 350 animals will be presented at the meeting.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD08-10.

Abstract 555: CCL2 promotes pancreatic tumor growth and is upregulated in tumor-stroma models

CCL2 (C-C chemokine ligand 2; also known as MCP-1) is a pleiotropic chemokine overexpressed by many types of tumors. CCL2 is believed to promote tumor growth by increasing macrophage infiltration, angiogenesis, tumor proliferation/survival, and metastasis. The purpose of these studies was to assess potential mechanisms of action associated with the efficacy of neutralizing CCL2 in human pancreatic xenograft models.

Cell lines included BxPC-3, PANC-1 and AsPC-1 human pancreatic carcinoma, all of which are p53mut/krasmut, but each differentially expresses CCL2 and its receptor, CCR2. The three tumor cell lines were implanted subcutaneously in immunocompromised mice. When tumors reached ∼50-100 mm3, a cocktail of neutralizing antibodies to human CCL2, mouse MCP-1 and mouse MCP-5 (termed CCL2 blockade) was administered i.p. at 10 mg/kg each, twice a week for the study duration, either alone or in combination with gemcitabine i.p. at 120 mg/kg q3dx4. CCL2 blockade alone significantly inhibited primary tumor growth for BxPC-3 (66-78% tumor growth inhibition (TGI); P&lt;0.001) or prolonged survival for PANC-1 (by seven days; P&lt;0.004). CCL2 in combination with gemcitabine significantly inhibited AsPC-1 tumor growth compared to either therapy alone (55% TGI; P&lt;0.034). By IHC analysis, macrophage infiltration in AsPC-1 tumors was reduced significantly by CCL2 blockade (P=0.049).

In vitro studies were conducted to further understand the mechanism of action. Recombinant huCCL2 had no effect on pancreatic tumor cell proliferation in vitro, suggesting that the in vivo anti-tumor effect by CCL2 blockade may be through CCL2 neutralization within the host stroma. Co-culture studies to mimic the tumor-stroma interaction were conducted, using pancreatic tumor cells and normal human lung fibroblasts (NHLF). Secretion of CCL2, as well as IL-5, IL-6, IL-6R, IL-8 and GRO, was significantly enhanced 2-10-fold during co-culture of BxPC3 with NHLF (P&lt;0.001), while only CCL2 was enhanced 2-fold during PANC-1/NHLF co-culture (P&lt;0.001).

Furthermore, cell-cell contact was not required for cytokine induction for both BxPC-3 and PANC-1 with NHLF. Tumor cell conditioned medium (CM) stimulated NHLF to produce cytokines, not vice versa, suggesting that a factor(s) in tumor CM is responsible for cytokine induction. Neutralizing antibodies to either CCL2 or IL-6 did not abolish induction of other cytokines in the BxPC-3/NHLF model. The inducers of chemokines/cytokines as well as in vitro migration and in vivo gene profiling studies are underway to better understand the impact of CCL2 blockade on pancreatic tumor growth. These results demonstrate the significant effect of CCL2 blockade on pancreatic tumor growth in vivo, and suggest that the tumor cell/fibroblast interaction may be an important source of CCL2 at the tumor site.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 555.

Neutralizing CCL2 Inhibits Breast Tumor Growth Via Impact on the Tumor/Stroma Microenvironment

CCL2, (CC-chemokine ligand 2 or monocyte chemoattractant protein-1 (MCP-1)), is overexpressed in many human tumors and is believed to exert pro-tumor effects by recruiting monocytes to the tumor, where these cells become tumor associated macrophages (TAMs). TAMs secrete growth factors that stimulate angiogenesis and tumor growth, as well as proteases to promote tumor invasion and metastasis. CCL2 expression levels in primary breast tumors have been correlated with macrophage infiltration and blood vessel density, which in turn is correlated with disease stage and prognosis. These correlations indicate that CCL2 is a key player in tumor macrophage infiltration and/or tumor growth/invasion, and suggest that neutralizing CCL2 could be an effective form of therapy for breast cancer patients.The objective of these studies was to investigate whether CCL2 blockade could inhibit tumor growth in mice bearing human breast tumors. The human breast tumor cell lines MDA-MB-231 (ER-, PR-, Her2-) and MDA-MB-361 (ER+, PR+, Her2+) were implanted orthotopically in immunocompromised mice, and in both models the primary tumors metastasized to lungs and brain. Neutralizing antibodies to human CCL2 (CNTO 888) and to the mouse orthologs, MCP-1 and MCP-5, were administered therapeutically, either as a cocktail (termed CCL2 blockade) or individually to study the relative roles of host vs tumor derived CCL2 in promoting tumor growth.In both tumor models, CCL2 blockade significantly inhibited the growth of established primary tumors in the mammary fat pad. In addition, CCL2 blockade inhibited metastasis to distant sites. As measured by Taqman, visual inspection and immunohistochemistry, mice with MDA-MB-361 tumors treated with CCL2 blockade showed significantly reduced metastasis to lungs and brain, while mice bearing MDA-MB-231 tumors showed significantly reduced metastasis to lungs.To define the relative roles of human tumor-derived CCL2 vs mouse host-derived MCP-1/MCP-5, in vivo monotherapy tumor studies were conducted using the individual neutralizing antibodies. These studies included the mammary fat pad model and a tail vein metastasis model. In both cases, only the treatment with the anti-mouse MCP-1 antibody significantly inhibited primary tumor growth and distant metastasis, indistinguishable from the effect of CCL2 blockade treatment. In the tail vein metastasis model, the antibody treatment resulted in significantly fewer detectable lesions with these lesions showing a significant reduction in both tumor size and growth fraction, suggesting antibody treatment inhibits tumor seeding and growth. Mechanistic studies are in progress to further understand the basis of the anti-tumor effect mediated by the antibody treatment. These results demonstrate that host-derived MCP-1, produced from the tumor microenvironment, plays the critical role in tumor growth and metastasis in these models of human breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6095.