Effect of early administration of alendronate after surgery for distal radial fragility fracture on radiological fracture healing time

This multicentre prospective clinical trial aimed to determine whether early administration of alendronate (ALN) delays fracture healing after surgical treatment of fractures of the distal radius. The study population comprised 80 patients (four men and 76 women) with a mean age of 70 years (52 to 86) with acute fragility fractures of the distal radius requiring open reduction and internal fixation with a volar locking plate and screws. Two groups of 40 patients each were randomly allocated either to receive once weekly oral ALN administration (35 mg) within a few days after surgery and continued for six months, or oral ALN administration delayed until four months after surgery. Postero-anterior and lateral radiographs of the affected wrist were taken monthly for six months after surgery. No differences between groups was observed with regard to gender (p = 1.0), age (p = 0.916), fracture classification (p = 0.274) or bone mineral density measured at the spine (p = 0.714). The radiographs were assessed by three independent assessors. There were no significant differences in the mean time to complete cortical bridging observed between the ALN group (3.5 months (SE 0.16)) and the no-ALN group (3.1 months (SE 0.15)) (p = 0.068). All the fractures healed in the both groups by the last follow-up. Improvement of the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, grip strength, wrist range of movement, and tenderness over the fracture site did not differ between the groups over the six-month period. Based on our results, early administration of ALN after surgery for distal radius fracture did not appear to delay fracture healing times either radiologically or clinically.

Abstract P2-19-06: Breast conserving surgery using volume replacement with oxidized regenerated cellulose: A cosmetic outcome analysis

Background: Breast conserving surgery (BCS) is a standard procedure for patients with early stage breast cancer. However, as the objective of BCS is to obtain both local control and a cosmetic outcome, it may lead to unsatisfying cosmetic results when the volume of resected tissue is large in order to secure an adequate oncological safety margin. Autologous flaps or artifact implants are commonly used when performing a replacement for a defect in the breast during BCS. Oxidized regenerated cellulose (ORC) is composed primarily of vegetable nitrocellulose and was originally developed as a styptic for surgery. We expected that the ORC would help induce granulation and fibrous tissue with reactive tissue fluid, and finally ORC would prevent adhesion between skin and pectoralis major muscle. In this study, we focused on short-term cosmetic outcomes after volume replacement with ORC after BCS.

Materials and Methods: Inclusion criteria of this study were the patients with early breast cancer indicated BCS that did not required breast reconstruction, or the patients who did not wish to undergo breast reconstruction with autologous flaps after BCS. We evaluated the cosmetic outcome of volume replacement with ORC after BCS, and also examined factors that may have influenced the results. The cosmetic outcomes of these patients were evaluated using scores based on the criteria of the Japan Breast Cancer Society.

Results: Ninety-four patients who underwent this procedure between January 2010 and August 2012 were reviewed. We evaluated cosmetic scores with regards to several clinical factors and the occurrence of complications after this procedure. The mean score of the cosmetic outcome of all patients was 9.5 points out of 12 points. Thirty-seven patients were categorized as “Excellent”, 34 were “Good”, 22 were “Fair”, and 1 was “Poor”. Patient age, body mass index, weight of the specimen, and ORC amount were not significantly different between patients with favorable cosmetic scores and those without.

Table 1. Univariate analyses of clinical factors according to the cosmetic outcome E/G* (n = 71)F/P# (n = 23)P valueAge52.5±12.656.0±10.30.23Body mass index22.0±3.723.3±4.10.15Specimen weight54.0±23.961.4±39.10.27ORC amount$3.2±1.23.2±1.20.95Values are expressed as the mean±SD. *Categorized as “Excellent” and “Good”. #Categorized as “Fair” and “Poor”. $ORC amount used for volume replacement.

However, the weight of the removed specimen was slightly higher in patients with an unfavorable cosmetic score. Although acute dermatitis and eczema was observed in 15% and 3% of patients, all of them were improved with conservative treatment. Cosmetic scores were significantly higher in patients without complications than in patients with complications.

Table 2. Cosmetic scores between patients with and without acute complications Cosmetic scores (mean±SD)P valusWithout9.8±2.00.003With8.0±2.4 

Conclusions: ORC replacement after BCS is a simple and reliable procedure. The selection of indication and prevention of complications are important for obtaining a better cosmetic outcome. To our knowledge, this is the first report to cosmetically evaluate a relatively large number of patients that have undergone ORC replacement after BCS.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-06.

Abstract P6-06-20: Predictive factors for pathologic complete response and disease-free survival after neoadjuvant chemotherapy with trastuzumab: A multicenter retrospective observational study in patients with HER2-positive primary breast cancer (JBCRG-C03 study)

BACKGROUND:

Addition of trastuzumab to neoadjuvant chemotherapy (NAC) improved pathologic complete response (pCR) rate in HER2-positive breast cancer. Although recent trials have shown favorable prognosis with NAC plus trastuzumab, clinicopathological factors to predict the outcome have not been fully understood. The aim of this study was to investigate the survival after NAC with trastuzumab and to explore the predictive factors.

PATIENTS AND METHODS:

This is a multicenter retrospective observational study. Patients with HER2-positive primary breast cancer treated with NAC plus trastuzumab from 2001 to 2010 were identified from the institutional database. Primary end point was disease-free survival (DFS). pCR was defined as ypT0/is+ypN0. Kaplan-Meier method was used to estimate DFS. Logistic regression and proportional hazard analysis were used to identify clinicopathological factors to predict pCR and DFS, respectively.

RESULTS:

733 patients were included in the analysis (whole dataset). 425 were ER/PgR-negative (HR- dataset) and 306 were ER/PgR-positive (HR+ dataset). Radiation therapy was performed in 90% of lumpectomy and 31% of mastectomy. Hormonal therapy was performed in 84% of HR+ dataset. pCR rate was 45% in whole dataset, 60% in HR- dataset, and 34% in HR+ dataset. Table 1 showed the result of multivariate analysis for pCR in whole dataset. When HR+ and HR- dataset were analyzed separately, no definitive predictors for pCR were identified in multivariate analysis. Although the patients with pCR showed a significantly favorable prognosis than those without pCR at 3 years DFS, in whole dataset (93% vs 83%, p<0.0001) and HR- dataset (94% vs 80%, p<0.0001), there was no significant difference in HR+ dataset (89% vs 86%, p = 0.10). Different predictors were selected for DFS when multivariate analysis was conducted separately between HR- and HR+ dataset (Table 2).

CONCLUSIONS:

In this observational study, we clarified predictors for pCR and DFS in HER2-positive patients treated with neoadjuvant trastuzumab containing therapy based on tumor subtype. Our results may help us to predict the prognosis more precisely and to simulate the disease course.

Table 1) Multivariate logistic regression analysis for pCR in whole datasetFactorsOR95%CIp-valuePost- vs Pre-menopause1.50(1.05-2.15)0.026*cT1-2 vs cT3-41.72(1.16-2.59)0.008*ER/PgR-negative vs ER/PgR-positive3.32(2.30-4.82)<0.0001*Grade 3 vs 1-21.28(0.89-1.84)0.183

Table 2) Multivariate proportional hazard analysis for DFSFactors†HR95%CIp-valueWhole dataset   Pre- vs Post-menopause1.61(1.04-2.52)0.033*cN2-3 vs cN03.06(1.58-6.24)0.001*cN1 vs cN02.26(1.23-4.41)0.007*Grade 3 vs 1-21.87(1.20-2.97)0.006*non-pCR vs pCR1.90(1.18-3.13)0.008*HR- dataset   Pre- vs Post-menopause1.70(1.01-2.85)0.046*cT3-4 vs cT1-21.86(1.09-3.17)0.024*non-pCR vs pCR3.28(1.90-5.87)<0.0001*HR+ dataset   cN2-3 vs cN05.01(1.79-16.19)0.002*cN1 vs cN03.50(1.40-10.61)0.006*Grade 3 vs 1-22.95(1.52-5.87)0.001*†Only factors with statistical significance

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-20.

Abstract P2-18-03: Feasibility of sentinel node biopsy following neoadjuvant chemotherapy in cytology-proven node positive breast cancer before chemotherapy

BACKGROUND: Sentinel node biopsy (SNB) for the node negative breast cancer is standard treatment as an accurate assessment of axillary lymph node status; however, axillary node dissection is a standard procedure for the node positive breast cancer. Neoadjuvant chemotherapy (NAC) has become the standard of care for patients with locally advanced breast cancer. It is reported that 40% of node positive disease convert to node negative after NAC. It remains controversial whether SLB could be applied to patients who present with node-positive disease before neoadjuvant chemotherapy. In this study, we evaluated the accuracy of SNB following NAC in breast cancer patients presenting with cytology-proven axillary node metastasis before chemotherapy.

METHODS: A multicenter prospective study was performed from September 2011 to April 2013 in 101 breast cancer patients with positive axillary nodes, proven by ultrasound-guided fine-needle aspiration at initial diagnosis (T1-3, N1, M0). After the confirmation of patients as clinically node-negative by preoperative imaging following NAC, all patients underwent breast surgery, with SNB and complete axillary lymph node dissection. The sentinel nodes were examined by hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA).The false negative rate and detection rate were analyzed.

RESULTS: Among the 101 patients analyzed, all cases presented with invasive ductal carcinoma. with a mean tumor size of 3.4cm. Thirty-six cases were hormone receptor (HR) positive and HER2 negative (Lum), 14 cases were HR positive and HER2 positive (Triple-Positive), 27 cases were positive for HER2 (HER2-enriched), and 24 cases were Triple-Negative. After neoadjuvant chemotherapy, a complete clinical response in the primary tumor was seen in 24.8%(25/101), a partial response in 66.3%(67/101), and no response in 7.9%(8/101). Pathological complete response of primary tumor was 39.6%. The pathological complete nodal response rate was 42.2%. The sentinel lymph node could be identified in 91 of 101 cases (90.1%); 88.9% (32/36) of patients with Lum, 100%(14/14)of those with Triple-Positive, 85.2% (23/27) of those with HER2-enriched, and 91.7% (22/24)% of those with Triple-Negative breast cancer subtype. The false negative rate was 12.7%; 35.7 (5/14) for Lum, 0% (0/8) for Triple-Positive, 5.0% (1/20) for HER2-enriched, and 7.7% (1/13) for Triple-Negative subtype (P = 0.03).

CONCLUSION: SNB following NAC in patients with node-positive breast cancer was found to be technically feasible, but is not recommended for the Lum subtype. However, it might be safely considered in selected patients, those with Triple-Positive, HER2-enrich and Triple-Negative subtype breast cancers.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-03.

Abstract P3-14-05: Randomized phase II study of preoperative docetaxel and cyclophosphamide-containing chemotherapy for luminal-type breast cancer

Background: We compared and evaluated three 6-cycle, docetaxel and cyclophosphamide (TC)-containing chemotherapy regimens in a multicenter randomized phase II study. The main aim was to investigate whether anthracyclines are needed or can be omitted, and whether the order of chemotherapy is important, for treating luminal-type breast cancer.

Methods: We recruited patients (pts) with ER-positive, HER2-negative breast cancer aged 20–70 years, and histo-pathologically invasive breast cancer (T1c-3, N0-1, M0), T≤7cm. Pts were randomized to 3 groups for the following treatments: 6 cycles of TC; 3 cycles of 5-FU/epirubicin/cyclophosphamide (FEC) followed by 3 cycles of TC (FEC-TC); and 3 cycles of TC followed by 3 cycles of FEC (TC-FEC). TC treatment consisted of administration of docetaxel at 75 mg/m2 and cyclophosphamide at 600 mg/m2 once every 3 weeks. FEC treatment consisted of administration of 5-FU at 500 mg/m2, epirubicin at 100 mg/m2, and cyclophosphamide at 500 mg/m2 once every 3 weeks. We aimed to enroll 65 pts per group based on an expected pCR rate among regimens of adding 10% at a threshold of 9%. The primary endpoint was pathological complete response (pCR) rate. Secondary endpoints were overall response rate (ORR), breast conservation rate and safety.

Results: A total of 195 pts (median age, 49.5 years (range, 26–69); median tumor size, 32.8 mm (range, 9–82); 91 pts with N(+) (51%)) were enrolled and randomized as follows: FEC-TC (n = 65), TC-FEC (n = 63), and TC group (n = 67). There were no differences in backgrounds among groups. Both the intention-to-treat population and the safety analysis set included 65, 63 and 65 pts in these groups, respectively. The 6-cycle treatment completion rates were 96.9%, 96.8% and 84.6%, respectively. pCR, defined as yT0/isyN0, was achieved by 9.2% of pts in the FEC-TC group, 8.1% in the TC-FEC group, and 15.9% in the TC group (p = 0.321). A quasi pCR in breast (yT0/is and near pCR) was achieved by 13.9%, 14.5%, and 17.5%, respectively. These responses did not differ among the 3 groups. ORRs, assessed by MRI or CT, were 75.8% (CR: 12.9%), 75% (CR: 5%), and 82.2% (CR: 17.9%) in the FEC-TC, TC-FEC and TC groups, respectively. Breast conservation rates were 50.8%, 45.2%, and 73.0%, respectively.Adverse events of Grade≥3 were observed in 20.0%, 27.0%, and 20.3% of pts in the FEC-TC, TC-FEC, and TC groups, respectively, with no significant differences. Febrile neutropenia was observed in 17.2%, 21.0%, and 11.3%, respectively, but in most cases it was managed sufficiently on an outpatient basis. Of 28, 27 and 23 pts in these groups in whom mastectomy was planned, 9 (32%), 5 (19%), and 10 (44%) were successfully converted to undergo breast-conserving surgery. Of 37, 35 and 40 pts in the FEC-TC, TC-FEC and TC groups in whom breast-conserving surgery was planned, 13 (35%), 12 (34%), and 4 (10%) underwent mastectomy.

Conclusion: Six cycles of TC had therapeutic effects and safety equivalent to FEC-TC and TC-FEC. The 3 treatment groups showed similar pCR rates, although the breast conservation rate was significantly higher in the TC group than in the other 2 groups. It may be possible to conduct preoperative chemotherapy for pts with ER-positive breast cancer without using an anthracycline.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-05.

A randomized phase III trial of postoperative adjuvant therapy for completely resected stage IA-IIIA lung cancer using an anti‑angiogenetic agent: irsogladine maleate

AIM

Although angiogenesis plays an important role in the invasion and metastasis of solid tumors, very few anti-angiogenetic drugs have been developed. Reexamining the anti-angiogenetic effects of existing drugs such as Thalidomide is another possible strategy for drug discovery. Irsogladine maleate (IM) is a drug invented to treat gastric ulcers; however, several reports have shown that IM also exerts anti-angiogenetic effects in vitro, in vivo and in humans. In order to elucidate whether treatment with IM would improve the prognoses of patients with resected lung cancer, we conducted a randomized trial.

METHODS

In the control group, uracil-tegafur (250 mg/m2/day) was administered for two years to patients with resected stage IB - IIIA lung cancer, and no adjuvant therapy was administered to those with stage IA disease. In the study group, IM (4 mg/body/day) was additionally administered for two years.

RESULTS

No significant differences were observed in the major prognostic factors among 305 eligible patients between the study and control groups. Adverse effects were minimal. The overall survival of the patients in the study and control groups were not statistically different. When the analysis was stratified by regimen, among the patients with resected stage IA disease, disease-specific survival in the study group was slightly higher than that in the control group; however, the difference was not significant (p=0.07).

CONCLUSION

Although it could not be proven that IM improves the prognoses of resected lung cancer patients, IM might have some effect on resected stage IA disease, and another trial should be conducted.

New paradigm for intrinsic function of heat shock proteins as endogenous ligands in inflammation and innate immunity

Recently, growing evidences that extracellular heat shock protein (HSP) functions as endogenous immunomodulator for innate and adaptive immune responses have been demonstrated. Because HSPs inherently act as chaperones within the cells, passive release such as cell necrosis and active release including secretion in the form of exosome have been suggested for HSP release into extracellular milieu. Such extracellular HSPs have been shown to be activators for innate immune responses through Toll-like receptors (TLRs). However, it has also been suggested that HSPs augmented the ability of associated innate ligands such as LPS to stimulate cytokine production and dendritic cell (DC) maturation. More interestingly, recent study demonstrated that innate immune responses elicited by both endogenous and exogenous danger signals were spatially and temporally regulated and this can be manipulated using Hsp90 or oxygen-regulated protein 150 (ORP150), thereby controlling the immune responses. We will discuss how spatiotemporal regulation of HSP-chaperoned molecules within antigen-presenting cells affects the antigen cross-presentation and innate immune responses. Precise analysis of HSP biology can lead us to establish outstanding HSPbased immunotherapy.

Preferential expression of cancer/testis genes in cancer stem-like cells: proposal of a novel sub-category, cancer/testis/stem gene

Cancer/testis (CT) antigens encoded by CT genes are immunogenic antigens, and the expression of CT gene is strictly restricted to only the testis among mature organs. Therefore, CT antigens are promising candidates for cancer immunotherapy. In a previous study, we identified a novel CT antigen, DNAJB8. DNAJB8 was found to be preferentially expressed in cancer stem-like cells (CSCs)/cancer-initiating cells (CICs), and it is thus a novel CSC antigen. In this study, we hypothesized that CT genes are preferentially expressed in CSCs/CICs rather than in non-CSCs/-CICs and we examined the expression of CT genes in CSCs/CICs. The expression of 74 CT genes was evaluated in side population (SP) cells (=CSC) and main population (MP) cells (=non-CSC) derived from LHK2 lung adenocarcinoma cells, SW480 colon adenocarcinoma cells and MCF7 breast adenocarcinoma cells by RT-PCR and real-time PCR. Eighteen genes (MAGEA2, MAGEA3, MAGEA4, MAGEA6, MAGEA12, MAGEB2, GAGE1, GAGE8, SPANXA1, SPANXB1, SPANXC, XAGE2, SPA17, BORIS, PLU-1, SGY-1, TEX15 and CT45A1) showed higher expression levels in SP cells than in MP cells, whereas 10 genes (BAGE1, BAGE2, BAGE4, BAGE5, XAGE1, LIP1, D40, HCA661, TDRD1 and TPTE) showed similar expression levels in SP cells and MP cells. Thus, considerable numbers of CT genes showed preferential expression in CSCs/CICs. We therefore propose a novel sub-category of CT genes in this report: cancer/testis/stem (CTS) genes.

A comparison between intraductal papillary neoplasms of the biliary tract (BT-IPMNs) and intraductal papillary mucinous neoplasms of the pancreas (P-IPMNs) reveals distinct clinical manifestations and outcomes

BACKGROUND

Intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) has been increasingly recognized as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas (P-IPMN). However, there is limited information regarding whether BT-IPMNs and P-IPMNs behave in a similar fashion.

METHODS

We retrospectively compared clinicopathological variables between 9 patients with BT-IPMN and 44 patients with P-IPMN.

RESULTS

There was no significant difference in age between patients with BT-IPMN and those with P-IPMN. The male/female ratio was significantly higher in patients with P-IPMN than in those with BT-IPMN (P = 0.012). Clinical presentation with jaundice was more common in patients with BT-IPMN (67%) than in those with P-IPMN (4.5%, P = 0.002). In addition, serum levels of CEA and CA19-9 were higher in patients with BT-IPMN than in those with P-IPMN (P = 0.019 and P = 0.002, respectively). The pathological diagnosis of malignancy was significantly more common in patients with BT-IPMN (89%) than in those with P-IPMN (23%, P = 0.002). The association with invasive carcinoma was significantly more frequent in patients with BT-IPMN (44.4%) than in those with P-IPMN (6.8%, P = 0.008). Furthermore, survival time after surgical resection was significantly shorter in patients with BT-IPMN than in those with P-IPMN (P = 0.002).

CONCLUSION

These findings reveal differences in clinicopathological features and prognosis between BT-IPMN and P-IPMN, thereby suggesting distinct biological pathways underlying the pathogenesis of these neoplasms.

Abstract P1-12-01: Evaluation on efficacy and safety of capecitabine plus docetaxel versus docetaxel monotherapy in metastatic breast cancer patients pretreated with anthracycline: Results from a randomized phase III study (JO21095)

Introduction: A previous large-scale phase III study demonstrated that, compared with docetaxel (T) alone, capecitabine (X) and T in combination (XT) offered significantly superior progression free survival (PFS) and overall survival (OS) in metastatic breast cancer (MBC). However, XT increased Grade 3/4 adverse events (AEs) which led to more frequent dose reductions than with T alone. Optimal dose of XT in Japanese was examined in a phase Ib study. Based on the background, we conducted a phase III randomized study in Japanese HER2 negative MBC patients pre-treated with anthracycline to compare efficacy and safety of XT therapy and T therapy.

Methods: Eligible pts were HER2-negative MBC pts with anthracycline-pretreatment, a measurable tumor, and ECOG performance status of 0 or 1. Pts were randomly assigned to the XT group or the T→X group. The XT group received concurrent therapy of X (1650 mg/m2/day from day 1 to 14) and T (60 mg/m2) in 3-week cycle. The T→X group received sequential therapy of T (70 mg/m2) in 3-week cycle followed at disease progression by X (2500 mg/m2/day from day 1 to 14 followed by 1-week rest). Primary endpoint was PFS. Secondary endpoints were OS, overall response rate (ORR), time to treatment failure (TTF), safety, and quality of life. The XT group and the T phase of the T→X group (T group) were compared in our evaluation.

Results: Of 163 pts enrolled, 156 were eligible. Baseline characteristics of all pts in each group were well balanced. The median delivered dose was 79.0% and 95.1% of the planned dose respectively for X and T in the XT group, and it was 97.2% in the T group. Median PFS in the XT group was 10.5 months compared to 9.8 months in the T group (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.40–0.97). The ORR was 70% and 61%; the median TTF was 9.6 months and 7.0 months in the XT group and the T group, respectively. Median OS has not been reached yet. Subgroup analysis showed PFS was longer in pts with liver metastasis (HR, 0.39; 95% CI, 0.19–0.84) and in pts with lung metastasis (HR, 0.43; 95% CI, 0.21–0.90) in the XT group. Incidence of treatment related AEs (TR-AEs) ≥Grade 3 was 74.4% (61 pts) in the XT group and 76.3% (61 pts) in the T group. Frequently reported TR-AEs ≥Grade 3 were; decrease in neutrophil count (XT, 57.3%; T, 60.0%), neutropenia (XT, 8.5%; T, 12.5%) and febrile neutropenia (XT, 6.1%; T, 10.0%). TR-AE ≥Grade 3 in the XT group with incidence at least 5% higher than the T group was hand-foot syndrome (XT, 7.3%; T, 0%). On the other hand, TR-AEs ≥Grade 3 in the T group with incidence at least 5% higher than the XT group were fatigue (XT, 2.4%; T, 8.8%) and peripheral edema (XT, 1.2%; T, 6.3%).

Conclusion: The concurrent therapy of XT demonstrated significant improvement of PFS compared with T alone. Superior efficacy of XT therapy was reported as same as the previously reported study on XT versus T although the dose was lower in our study. Considering the efficacy and tolerability, we consider concurrent Japanease dose XT therapy is a preferable treatment for MBC pts with liver or lung metastasis.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-12-01.

Abstract P1-14-02: Preoperative docetaxel (T) with or without capecitabine (X) following epirubicin, 5-fluorouracil and cyclophosphamide (FEC) in patients with operable breast cancer (OOTR N003): Results of comparative study and predictive marker analysis

Objective: This preoperative study aimed to evaluate the efficacy of 4 cycles of TX compared with 4 cycles of T, following 4 cycles of FEC in operable breast cancer patients.

Methods: Women with operable breast cancer (T1C-3N0M0/T1-3N1M0) were randomly assigned to receive either T (75 mg/m2, q3) plus X (825 mg/m2 bid, days 1 to 14) or T alone (75 mg/m2, q3) after completion of FEC (5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2, q3). Patients who had disease progression on FEC were excluded from randomization. The primary endpoint was pathological complete response (pCR). Predictive factor analysis was conducted using clinicopathological markers such as hormone receptors, Ki67 labeling index (Ki67LI) and thymidine phosphorylase (TP).

Results: From November 2005 to October 2009, 504 patients were enrolled and 239 and 238 patients were assigned to TX and T group, respectively (median age 49 years, median tumor size 3.5 cm and node positive rate 56%). Treatment discontinuation was observed in 22% of TX group and 5% in T group (p < 0.0001). The major reasons for discontinuation were toxicity, refusal/ consent withdrawal and several others. No significant difference in pCR rate was shown between the two groups (TX 23% and T 24%, p = 0.748). Neither clinical response nor surgical outcome differed between TX and T. The pCR rate in patients who had therapy discontinuation or dose-reduction on TX was 23%, whereas pCR rate in those on T was 11%. A subpopulation treatment effect pattern plots method indicated a trend that TX may improve the pCR rate in patients having a middle range of pretreatment Ki67LI, such as 10%–20%. In the median follow-up time of 3.7 years, disease-free survival (DFS) was not different between TX and T (3-year DFS: 92% in TX and 91% in T; hazard ratio 0.907, 95%CI 0.528–1.557, p = 0.723). The frequency of major grade 3 or greater adverse events of TX and T were leukopenia, 36% and 34%, febrile neutropenia 8% and 5%, and hand-foot syndrome 15% and 2%, respectively.

According to the analysis for evaluating predictive values of biomarkers, a multivariate logistic regression analysis showed that HER2 (+/−: odds ratio 4.107, p < 0.0001), Ki67LI (continuous variables: 1.029, p = 0.003), hormone receptor status (+/−: 0.457, p = 0.009), stroma TP status (0.523, p = 0.02) and grade (1/3: 0.387, 2/3: 0.532, p = 0.047) had statistical significant values for predicting pCR. A multiple Cox model in landmark analysis showed that tumor size (p < 0.0001), cancer cell TP status (p = 0.005), pCR and posttreatment Ki67LI (p = 0.016), and age (p = 0.049) were associated with DFS significantly.

Conclusions: Addition of X to T showed no superiority to T alone following FEC in neoadjuvant treatment of these patients with operable breast cancer. Treatment discontinuation rate was significantly higher in TX than T group, however the pCR rate in patients in TX group who required treatment discontinuation or dose-reduction was similar to that in patients who completed as scheduled, which was different from T group. Determination of pre-/ post-treatment Ki67LI looks useful for predicting pCR and DFS.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-02.

Abstract P3-02-02: Use of contrast-enhanced computed tomography in clinical staging of asymptomatic breast cancer patients to detect asymptomatic distant metastases

Objective: The use of computed tomography (CT) with regards to the clinical staging of breast cancer (BC) patients has been on the increase in clinical practice. However, NCCN guidelines recommended the use of imaginng only in cases with locally advanced disease or signs of distant metastases (DM), and the benefits of routine CT have yet to be fully clarified. This study investigated the value of employing contrast-enhanced CT (CECT) to screen for DM in patients with asymptomatic BC.

Methods: The clinical records of 483 patients with asymptomatic BC who underwent CECT, also in order to detect BC spread, between April 2006 and January 2011 were reviewed. The CECT results were classified into normal, true-positive (metastases) or false-positive findings.

Results: Abnormal CECT findings, including true- and false-positive results, were detected in 65 patients (13.5%). Of these, 26 patients (5.4%) showed confirmed true metastatic disease, including 18 lung metastases, 11 liver metastases and 13 bone metastases. Upstaging to stage IV due to the results of the CECT was significantly associated with only larger tumos size (odds ratio, 33.4; 95% CI 12.1–92.5; P < 0.0001) and lymph node status (odds ratio, 37.1; 95% CI 14.2–96.8; P < 0.0001.)

Abstract P6-07-16: Evaluation of circulating tumor cell as a marker of prognosis and efficacy in a randomized phase III study in HER2 negative metastatic breast cancer patients treated with capecitabine and docetaxel: JO21095 study

Introduction: Circulating tumor cell (CTC) has been reported as a predictive marker of prognosis and treatment response in metastatic breast cancer by comparing CTC count prior to and after treatment. However, most of previous reports were based on retrospective studies and still controversial. We prospectively evaluated CTC as a marker of prognosis and treatment efficacy in a randomized multi-center phase III study in HER2 negative metastatic breast cancer patients (pts) in Japan.

Methods: Pts were randomized into two groups to receive either the concurrent therapy of capecitabine plus docetaxel in 3-week cycle (XT group) or the sequential therapy of docetaxel followed by capecitabine at progression of disease in 3-week cycle (T→X group). Primary endpoint was progression free survival (PFS). Secondary endpoints were overall survival (OS), overall response rate (ORR) and safety. The number of CTC in 7.5 mL of blood sample was measured at the time of screening, after cycle 1, after cycle 2 and at progression of disease (PD) in both groups. Measurement of CTC was conducted by CellSearch System of Veridex. Our evaluation on CTC count was conducted in the XT group and the docetaxel phase of the T→X group.

Results: Of the total 163 pts enrolled in the study, CTC count was evaluated in 158 pts. The number of pts with <2 CTCs was 88 (55.7%) and ≥2 CTCs were 70 (44.3%) at screening. The CTC count was higher in patients with liver or bone metastasis. In pts with ≥2 CTCs, liver metastasis was reported in 47 pts (64%) and bone metastasis in 53 pts (64%) while metastases were less in pts with <2 CTCs. Between the XT group and the docetaxel phase of the T→X group, the median PFS was 10.5 months and 9.8 months (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.40–0.97) and ORR was 70% and 61%. Analysis of the OS data is under examination. Subgroup analysis showed PFS was longer in pts with liver metastasis (HR = 0.39; 95% CI = 0.19–0.84) or lung metastasis (HR = 0.43; 95% CI, 0.21–0.90) in the XT group. As a result of our exploratory analysis on CTC count, the median PFS was 10.7 months in pts with <2 CTCs and 8.2 months in pts with ≥2 CTCs (HR, 0.65; 95% CI, 0.42–0.99) at screening. The median PFS of pts with ≥2 CTCs at screening and decreased to <2 CTCs after receiving one cycle of study treatment was 8.3 months and that of pts remained ≥2 CTCs was 8.2 months (HR, 0.79; 95% CI, 0.43–1.46). Between the XT group and the T→X group, the respective median PFS was 10.7 months and 12.1 months (HR, 0.83; 95% CI, 0.46–1.49) in pts with <2 CTCs while it was 10.4 months and 7.1 months in patients with ≥2 CTCs (HR, 0.53; 95% CI, 0.28–0.99). No major safety issues of concern were reported.

Conclusion: Results from our study suggested the CTC count at screening could serve as a marker of prognosis and during treatment as a marker of treatment efficacy. The median PFS in the XT group was longer than the T→X group in pts with liver metastasis or ≥2 CTCs. Aggressive treatment with the concurrent therapy of capecitabine and docetaxel could be a preferable treatment option for HER2 negative metastatic breast cancer patients with ≥2 CTCs in the future.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-16.

Abstract P1-14-08: A prospective multicenter randomized phase II neo-adjuvant study of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) followed by docetaxel, cyclophosphamide and trastuzumab (TCH) versus TCH followed by FEC versus TCH alone, in patients (pts) with operable HER2 positive breast cancer: JBCRG-10 study

Background: The current standard treatment of primary systemic therapy (PST) in HER2 positive breast cancer is anthracyclines (A) and/or taxanes combined with trastuzumab (H) which demonstrates high pathological complete response (pCR). The pCR is considered as a predictive marker of prognosis although results are slightly different depending on the hormone receptor status. We conducted a randomized phase II study to examine sequence of treatments and necessity of A in the treatments using TCH to improve outcome and reduce cardiac toxicity in Japanese HER2 positive pts.

Methods: Pts were treated with FEC (5FU 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2) and/or TCH (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2, H 6 mg/kg, loading by 8 mg) in 3 groups: 4 cycles of FEC followed by 4 cycles of TCH (A-TCH); 4 cycles of TCH followed by 4 cycles of FEC (TCH-A) or 6 cycles of TCH. An unplanned interim analysis was conducted due to one death by interstitial lung disease (ILD) in the A-TCH after completion of 8 cycles. The pCR results suggested A containing regimens did not exceed benefit from the current standard regimen. The study was continued by limiting allocation only to the TCH group considering efficacy and safety. The primary endpoint was pCR and secondary endpoints were overall response rate (ORR) and safety.

Results: A total of 103 pts were enrolled between Sep. 2009 and Sep. 2011; 21 pts in the A-TCH, 22 pts in the TCH-A and 60 pts in the TCH including pts enrolled after termination of random allocation. Characteristics of the 103 pts were; median age of 54 (range, 33–70), median tumor size of 35 mm (range, 12–80), 42 pts with N(+) (40.8%) and 62 ER positive pts (60.2%). Characteristics of pts in the TCH were; median age of 54.5 (range, 33–67), median tumor size of 35.5 mm (range, 12–80), 25 pts with N(+) (41.7%) and 34 ER positive pts (56.7%). No major difference was reported between groups treated with or without A. Per protocol population was 59 pts in the TCH and its pCR rate was 45.8% (95% CI, 32.2–59.3: ER negative, 61.5%; ER positive, 33.3%). ORR was 86.4% assessed by MRI or CT. Although it is an exploratory analysis, the pCR rate of A containing regimens was 39.0% (ER negative, 57.1%; ER positive, 29.6%). Adverse events ≥grade 3 were reported in 50 pts (48.5%). Reported ILD was in 5 pts (A-TCH, 1; TCH-A, 1; TCH, 3). The mean left ventricular ejection fraction (LVEF) decreased from 70.0% to 69.0% after treatment (A-TCH, 65.9%; TCH-A, 70.4%; TCH, 69.0%). Decrease of LVEF in the A-TCH was significant (p < 0.01).

Conclusion: The pCR rate of the TCH group was similar to previous reports on A including regimens. Although ILD had been occurred during the treatment containing the TCH, no other new safety issues were reported. We were not able to conclude preferable sequence of A and T since statistical power was not sufficient. However, the result of LVEF suggested TCH followed by A or TCH were preferable. Six cycles of TCH could be one of treatment options as a PST in HER2 positive breast cancer to exclude A. (UMIN000002365)

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-08.

Clinical evaluation of the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome: a prospective, randomized, multicenter study

PURPOSE

To assess the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome.

METHODS

This study evaluated 64 eyes of 32 patients (age: 62.6±12.8 years (mean±SD)) in whom treatment with 0.1% sodium hyaluronate was insufficiently responsive. The eyes were randomly assigned to one of the two regimens in each patient: topical administration of sodium hyaluronate and diquafosol tetrasodium in one eye, and that of sodium hyaluronate in the other. Before treatment, and 2 and 4 weeks after treatment, we determined tear volume, tear film break-up time (BUT), fluorescein and rose bengal vital staining scores, subjective symptoms, and adverse events.

RESULTS

We found a significant improvement in BUT (P=0.049, Dunnett test), fluorescein and rose bengal staining scores (P=0.02), and in subjective symptoms (P=0.004 for dry eye sensation, P=0.02 for pain, and P=0.02 for foreign body sensation) 4 weeks after treatment in the diquafosol eyes. On the other hand, we found no significant change in these parameters after treatment in the control eyes.

CONCLUSIONS

In dry eyes, where sodium hyaluronate monotherapy was insufficient, diquafosol tetrasodium was effective in improving objective and subjective symptoms, suggesting its viability as an option for the additive treatment of such eyes.

Postoperative transient reduced diffusion in the ipsilateral striatum and thalamus

BACKGROUND AND PURPOSE

Restriction of diffusion has been reported in the early phase of secondary neuronal degeneration, such as wallerian degeneration. The purpose of this study was to investigate postoperative transient reduced diffusion in the ipsilateral striatum and thalamus as a remote effect of surgery.

MATERIALS AND METHODS

Six hundred two postoperative MR imaging examinations in 125 patients after cerebral surgery were retrospectively reviewed, focusing on the presence of reduced diffusion in the striatum and/or thalamus. The distribution of reduced diffusion in the striatum was classified into 3 groups: anterior, central, and posterior. Reduced diffusion in the thalamus was also classified on the basis of the anatomic locations of the thalamic nuclei. Further follow-up MRI was available in all patients with postoperative reduced diffusion, and acute infarctions were excluded. The patient medical records were reviewed to evaluate neurologic status.

RESULTS

Restriction of diffusion was observed in the striatum and/or thalamus ipsilateral to the surgical site in 17 patients (13.6%). The distribution of signal abnormality correlated with the location of the operation, in concordance with the architecture of the striatocortical and thalamocortical connections. Reduced diffusion was observed from days 7 to 46 after the operation, especially during days 8-21. The signal abnormalities completely resolved on follow-up examinations. The median follow-up period was 202 days (interquartile range, 76-487 days).

CONCLUSIONS

Postoperative transient reduced diffusion in the ipsilateral striatum and/or thalamus likely represents an early phase of secondary neuronal degeneration based on its characteristic distribution and time course. Clinically, this reduced diffusion should not be mistaken for postoperative ischemic injury.

Clinical evaluation of the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome: a prospective, randomized, multicenter study

PURPOSE

To assess the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome.

METHODS

This study evaluated 64 eyes of 32 patients (age: 62.6±12.8 years (mean±SD)) in whom treatment with 0.1% sodium hyaluronate was insufficiently responsive. The eyes were randomly assigned to one of the two regimens in each patient: topical administration of sodium hyaluronate and diquafosol tetrasodium in one eye, and that of sodium hyaluronate in the other. Before treatment, and 2 and 4 weeks after treatment, we determined tear volume, tear film break-up time (BUT), fluorescein and rose bengal vital staining scores, subjective symptoms, and adverse events.

RESULTS

We found a significant improvement in BUT (P=0.049, Dunnett test), fluorescein and rose bengal staining scores (P=0.02), and in subjective symptoms (P=0.004 for dry eye sensation, P=0.02 for pain, and P=0.02 for foreign body sensation) 4 weeks after treatment in the diquafosol eyes. On the other hand, we found no significant change in these parameters after treatment in the control eyes.

CONCLUSIONS

In dry eyes, where sodium hyaluronate monotherapy was insufficient, diquafosol tetrasodium was effective in improving objective and subjective symptoms, suggesting its viability as an option for the additive treatment of such eyes.

Glutamatergic changes in the cerebral white matter associated with schizophrenic exacerbation

OBJECTIVE

Glutamatergic dysfunction in the brain has been implicated in the pathophysiology of schizophrenia. This study was aimed to examine several brain chemical mediators, including Glx (glutamate + glutamine), using (1)H magnetic resonance spectroscopy (MRS) in medicated patients with schizophrenia, with and without psychotic exacerbation.

METHOD

(1)H MRS was acquired in 24 patients with schizophrenia, with psychotic exacerbation; 22 patients without exacerbation; and 27 age- and sex-matched healthy volunteers. The levels of metabolites were measured in the left frontal and inferior parietal white matter and compared across the three groups.

RESULTS

The Glx level was significantly elevated in the left inferior parietal white matter in the patients with psychotic exacerbation in comparison with that in the healthy volunteers and the patients without exacerbation (P < 0.05). We also detected that there was a significant correlation between Positive and Negative Syndrome Scale-positive scale and Glx level in the left parietal white matter (r = 0.51, P < 0.001).

CONCLUSION

Higher than normal Glx levels indicate glutamatergic overactivity in the left inferior parietal white matter with schizophrenic exacerbation, a finding that is in accordance with the glutamatergic hypothesis in schizophrenia. The Glx level measured by (1)H MRS could be a biomarker for exacerbation in schizophrenia.

Predictions of the pathological response to neoadjuvant chemotherapy in patients with primary breast cancer using a data mining technique

Nomogram, a standard technique that utilizes multiple characteristics to predict efficacy of treatment and likelihood of a specific status of an individual patient, has been used for prediction of response to neoadjuvant chemotherapy (NAC) in breast cancer patients. The aim of this study was to develop a novel computational technique to predict the pathological complete response (pCR) to NAC in primary breast cancer patients. A mathematical model using alternating decision trees, an epigone of decision tree, was developed using 28 clinicopathological variables that were retrospectively collected from patients treated with NAC (n = 150), and validated using an independent dataset from a randomized controlled trial (n = 173). The model selected 15 variables to predict the pCR with yielding area under the receiver operating characteristics curve (AUC) values of 0.766 [95 % confidence interval (CI)], 0.671-0.861, P value < 0.0001) in cross-validation using training dataset and 0.787 (95 % CI 0.716-0.858, P value < 0.0001) in the validation dataset. Among three subtypes of breast cancer, the luminal subgroup showed the best discrimination (AUC = 0.779, 95 % CI 0.641-0.917, P value = 0.0059). The developed model (AUC = 0.805, 95 % CI 0.716-0.894, P value < 0.0001) outperformed multivariate logistic regression (AUC = 0.754, 95 % CI 0.651-0.858, P value = 0.00019) of validation datasets without missing values (n = 127). Several analyses, e.g. bootstrap analysis, revealed that the developed model was insensitive to missing values and also tolerant to distribution bias among the datasets. Our model based on clinicopathological variables showed high predictive ability for pCR. This model might improve the prediction of the response to NAC in primary breast cancer patients.

Automatic voxel-based morphometry of structural MRI by SPM8 plus diffeomorphic anatomic registration through exponentiated lie algebra improves the diagnosis of probable Alzheimer Disease

BACKGROUND AND PURPOSE

The necessity for structural MRI is greater than ever to both diagnose AD in its early stage and objectively evaluate its progression. We propose a new VBM-based software program for automatic detection of early specific atrophy in AD.

MATERIALS AND METHODS

A target VOI was determined by group comparison of 30 patients with very mild AD and 40 age-matched healthy controls by using SPM. Then this target VOI was incorporated into a newly developed automated software program independently running on a Windows PC for VBM by using SPM8 plus DARTEL. ROC analysis was performed for discrimination of 116 other patients with AD with very mild stage (n = 45), mild stage (n = 30) and moderate-to-advanced stages (n = 41) from 40 other age-matched healthy controls by using a z score map in the target VOI.

RESULTS

Medial temporal structures involving the entire region of the entorhinal cortex, hippocampus, and amygdala showed significant atrophy in the patients with very mild AD and were determined as a target VOI. When we used the severity score of atrophy in this target VOI, 91.6%, 95.8%, and 98.2% accuracies were obtained in the very mild AD, mild AD, and moderate-to-severe AD groups, respectively. In the very mild AD group, a high specificity of 97.5% with a sensitivity of 86.4% was obtained, and age at onset of AD did not influence this accuracy.

CONCLUSIONS

This software program with application of SPM8 plus DARTEL to VBM provides a high performance for AD diagnosis by using MRI.

The effects of a novel histamine-3 receptor inverse agonist on essential tremor in comparison to stable levels of alcohol

Essential tremor (ET) is a common movement disorder. Animal studies show that histaminergic modulation may affect the pathological processes involved in the generation of ET. Histamine-3 receptor inverse agonists (H3RIA) have demonstrated attenuating effects on ET in the harmaline rat model. In this double-blind, three-way cross-over, single-dose, double-dummy study the effects of 25 mg of a novel H3RIA (MK-0249) and a stable alcohol level (0.6 g L(-1)) were compared with placebo, in 18 patients with ET. Tremor was evaluated using laboratory tremorography, portable tremorography and a clinical rating scale. The Leeds Sleep Evaluation Questionnaire (LSEQ) and a choice reaction time (CRT) test were performed to evaluate potential effects on sleep and attention, respectively. A steady state of alcohol significantly diminished tremor as assessed by laboratory tremorography, portable tremorography and clinical ratings compared with placebo. A high single MK-0249 dose was not effective in reducing tremor, but caused significant effects on the LSEQ and the CRT test. These results suggest that treatment with a single dose of MK-0249 does not improve tremor in alcohol-responsive patients with ET, whereas stable levels of alcohol as a positive control reproduced the commonly reported tremor-diminishing effects of alcohol.

P2-15-04: Clinical Significance of Resection with Curative Intent for Isolated Pulmonary Metastases from Breast Cancer. Multi-Institutional Study in Japan

OBJECTIVE: Although resection of isolated pulmonary metastases is a common treatment in other primaries such as colon cancer, the role of lung metastasectomy of breast cancer is still unclear. The objective of the present study was to investigate the clinical outcome of our operated patients with isolated pulmonary breast cancer metastases and discuss the clinical implication of resection with curative intent for them.

METHODS: We retrospectively analyzed 86 female patients with histologically proven isolated pulmonary metastases from breast cancer who were treated with surgery of curative intent between January 1980 and September 2010 at 7 Japanese hospitals. The mean age of them was 50 years, the median disease free interval (DFI) from the definitive surgery for the primary breast cancer was 4.6 years (range: 0.5−20.4 years) and the median follow-up after lung metastasectomy was 4.1 years (range: 0.3−30.9 years).

RESULTS: Lung metastasectomy was performed by thoracotomy in 22 patients and by video-assisted thoracoscopic surgical resection in 64 patients. The number of metastatic foci resected was one for 79 patients, two for 6, and unknown for 1. Lymph node resection was performed for 12 patients, was not done for 69, and unknown for 5. Five-year survival rates after lung metastasectomy were 68% in the patients. The main prognostic factor was the DFI. Five-year survival rates for patients with DFI of longer than 2 years (n = 72) and those with DFI of shorter than 2 years (n=14) were 74.5% and 33.8%, respectively (p = 0.0006). Five-year survival rates after lung metastasectomy were 68% in patients without macroscopic residual pulmonary tumor after lung metastasectomy (n = 69) and 34% in those with macroscopic residual tumor (n = 12) (p = 0.023). Five-year disease free survival after lung metastasectomy for patients without macroscopic residual tumor was 51 %. Five-year survival rates were 78% in patient with endocrine hormonal therapy following lung metastasectomy (n = 51) and 53% in those without endocrine hormonal therapy (n = 35) (p = 0.045). No prognostic influence could be demonstrated for age, number of initial axillary node metastases, primary tumor size.

CONCLUSION: The prognosis of the breast cancer patients with isolated pulmonary metastases who underwent metastasectomy with curative intent was good. It was affected by the biological aspects of the primary tumor, “curativity” of the resection, and systemic treatments after lung resection. It may be expected that some of those patients will be cured by surgery with curative intent.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-04.

P1-06-21: Relationship between Body Mass Index and Preoperative Treatment Response to Aromatase Inhibitor Exemestane in Postmenopausal Patients with Primary Breast Cancer

Background: Some studies have shown that high body mass index (BMI) is associated with inferior outcome after adjuvant therapy with non-steroidal aromatase inhibitor, anastrozole in breast cancer patients. We aimed to investigate predictive effect of BMI on clinical response to neoadjuvant therapy with steroidal aromatase inhibitor, exemestane in postmenopausal patients with primary breast cancer.

Patients and methods: The study group consisted of 109 patients from the JFMC 34-0601 neoadjuvant endocrine therapy trial in which postmenopausal patients with estrogen receptor (ER)-positive primary breast cancer were administered exemestane (25 mg/day) for 24 weeks before surgery. Patients were categorized into three groups according to BMI: low (BMI &lt; 22 kg/m2), intermediate (22 ≤ BMI &lt; 25 kg/m2) and high (BMI ≥ 25 kg/m2). Statistical analyses were performed to explore the predictive effect of BMI on clinical response using a multivariable logistic regression model.

Results: Higher BMI correlated with positive progesterone receptor status (p &lt; 0.01) and low Ki-67 index (p = 0.03). Objective response rates (ORR) were 21.7% in low BMI, 56.0% in intermediate BMI and 60.6% in high BMI, respectively (p = 0.01). In a multivariate analysis, only low BMI was an independent negative predictor of clinical response.

Conclusion: Low BMI was associated with a decreased ORR to neoadjuvant endocrine therapy with exemestane. Our results may suggest that the predictive effect of BMI varies according to the type of aromatase inhibitor and objective outcome.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-06-21.

P3-12-03: A Prognostic Index of Ipsilateral Breast Tumor Recurrence in Patients Treated with Breast-Conserving Surgery after Preoperative Chemotherapy: Validation of M.D. Anderson Prognostic Index

Background: Preoperative chemotherapy (PCT) is widely used to increase the possibility of breast-conserving treatment (BCT). However, the appropriate indication for BCT after PCT is controversial, because the rates of ipsilateral breast tumor recurrence (IBTR) may be higher than those reported for BCT when surgery is used first. We performed a multicenter retrospective study to evaluate factors that were associated with IBTR in patients with BCT after PCT, and validated M. D. Anderson Prognostic Index (MDAPI) (Cancer 2005;103:689–95) using our data set.

Patients and Methods: From eight Japanese hospitals, data were extracted on a total of 381 patients with invasive breast cancer (BC) who were treated with ≥3 cycles of PCT followed by breast-conserving surgery and irradiation. The rates of IBTR were evaluated by MDAPI including clinical N2 or N3 disease, pathologic residual tumor &gt;2 cm, multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. Kaplan-Meier method was used to estimate cumulative recurrence rates. Log-rank test and Cox's proportional hazard model were used for statistical analyses.

Results: Median age at diagnosis of the primary tumor was 48 years; median size of the primary tumor at diagnosis was 4.0 cm. One hundred and forty-six patients received postoperative chemotherapy and 211 received postoperative endocrine therapy. At a median follow-up period of 50 months, 18 of 381 patients developed IBTR, which resulted in 5-year IBTR-free rate of 94.1%. Univariate analyses revealed that estrogen receptor (ER) status both before and after PCT (positive vs. negative), pathological nodal status after PCT (≥4 vs. 0–3 positive nodes), and pathologically residual invasive tumor (≥1.8 vs. ≤1.7 cm) were significantly associated with IBTR (all P &lt; 0.05). Pathological margin status did not affect IBTR rate (P=0.88). Multivariate analysis revealed that significant independent predictors of IBTR included ER status after PCT (Hazard Ratio [HR], 0.10; P&lt;0.01), size of residual invasive tumor (HR, 5.29; P=0.03), and pathological nodal status after PCT (HR, 3.59; P=0.02). The rates of IBTR of patients with MDAPI 0–3 were 1.3%, 2.9%, 16.0%, and 3.6%, respectively. Based on the data of our multivariate analysis, ER status after PCT (ER positive;0 and ER negative; 1 was added to MDAPI. Total scores of the prognostic index including MDAPI and ER status after PCT ranged between 0 and 5. The rates of IBTR correlated well with this prognostic index. The 5-year IBTR-free survival rates were 0% for 23 patients in score 0, 3.4% for 89 in score 1, 3.9% for 51 in score 2, 21.2% for 33 in score 3, and 16.7% for 6 in score 4 (P &lt; 0.01).

Conclusion: Our prognostic index (MDAPI plus ER status) would be useful for clinical decision making according to surgical procedures after PCT. BCT is an appropriate treatment option for patients with the low prognostic index (0 to 2). The high risk population with the high prognostic index (3 to 5) may benefit from mastectomy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-12-03.

Temporal association of serum progesterone concentrations and vaginal cytology in walruses (Odobenus rosmarus)

Concentrations of serum estradiol-17β and progesterone were monitored in six female walruses using an enzyme immunoassay. Progesterone concentrations increased from March to May in females aged 6 y or older, and subsequently declined (October). No significant elevation of estradiol-17β concentration was detected before an elevation of progesterone concentration. Vaginal smears from four females were examined with Papanicolaou staining. In all females, most epithelial cells were basophilic intermediate-superficial cells; no color change from basophilic to eosinophilic of the cells was detected. Meanwhile, the percentage of anucleate cells in vaginal smears reached its highest value before the elevation of progesterone concentration, followed by an increase in the percentage of leukocytes. We inferred that the change in populations of anucleate cells and leukocytes in vaginal smears reflected ovarian status and CL formation in female walruses.