Abstract P5-01-02: Role of FDG-PET/CT in Metastatic Staging of Newly Diagnosed Primary Breast Cancer

Background

FDG positron emission tomography/computed tomography (PET/CT) may accurately detect distant metastases during staging of primary breast cancer. However, the evidence is very limited. We retrospectively compared the sensitivity and specificity of PET/CT and conventional imaging (CT, ultrasonography, radiography, and skeletal scintigraphy) for the detection of distant metastases in patients with primary breast cancer. We also retrospectively tested the hypothesis that stage III disease detected by conventional imaging + PET/CT has a better prognosis than that detected by conventional imaging only.

Methods

To determine sensitivity and specificity, we used a database of 225 patients with primary breast cancer (2000-2009) for which PET/CT data existed. The presence or absence of distant metastases was determined based on histopathologic findings, subsequent imaging findings, or clinical follow-up. To determine prognosis, we studied 935 patients newly diagnosed with stage III breast cancer (2000-2009). In 82 of these patients, stage III disease was detected by conventional imaging + PET/CT. We studied 171 IBC patients newly diagnosed with stage III breast cancer. In 51 of these patients, stage III disease was detected by conventional imaging + PET/CT; we compared their relapse-free survival (RFS) and overall survival (OS) rates with those for 853 patients diagnosed using conventional imaging only. Univariate and multivariate Cox Proportional Hazard regression models were used to assess PEC/CT.

Results

Among 225 pts with primary breast cancer, the sensitivity and specificity for PET/CT in the detection of distant metastases were 97.4% and 91.2%, respectively; This was significantly higher (p=0.009 and P<0.001) than the sensitivity and specificity rates for conventional imaging only (85.9% and 67.3%, respectively). Eleven patients of distant metastases detected by PET/CT were clinically occult and not evident on conventional imaging. Among patients with stage III disease, RFS (hazard ratio [HR]=1.10, p=0.7) and OS (HR=1.14, p=0.673) did not significantly differ based on whether PET/CT was used. RFS also did not show significant difference in multivariate analysis (HR=0.70, p=0.213). However, in inflammatory breast cancer (IBC), patients diagnosed with conventional imaging + PET/CT had longer RFS than patients diagnosed with conventional imaging only in both univariate (HR=0.43, p=0.014) and multivariate analysis (HR=0.33, p=0.004). There was a trend for OS improvement among patients who had PET/CT (HR=0.55, p=0.122). Conclusion

PET/CT had higher sensitivity and specificity than conventional imaging in the detection of distant metastases of breast cancer. Among patients with stage III disease, there was no difference in OS or RFS between patients diagnosed with conventional imaging + PET/CT and patients diagnosed with conventional imaging only. IBC patients staged with conventional imaging + PET/CT had better prognosis than those staged with conventional imaging only. Based on our results, the use of PET/CT as a staging tool to detect metastasis is not justified in stage III non-IBC. Conversely, the use of conventional imaging + PET/CT in patients with IBC appears promising, but needs prospective confirmation.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-02.

Abstract P6-08-02: Comparative Analysis between Primary and Secondary in Breast Tumors by Polymorphysim of Androgen Receptor Gene and Mitochondria D-Loop Somatic Mutation

Background: It has not been fully understood how we can differentiate a new primary breast cancer from a recurrent tumor, when second tumor arises in ipsilateral breast after the surgery for primary breast cancer. To address this research question, we estimate the usefulness of a method analyzing polymorphism of androgen receptor gene and mitochondrial D-loop somatic mutation.

Materials and methods: 1) Select patients: Among the 558 patients who received the breast conservative surgery in Tokai University Hospital (1991∼2004), 9 ipsilateral breast tumors and 11 contralateral breast tumors were submitted for the analysis. 2) Formalin-fixed paraffin-embedded (FFPE) sections of non-neoplastic lymph node were examined whether polymorphism of AR gene present or not. 3) When polymorphism of AR gene in non-neoplastic lymphoid tissue were demonstrated, ipsilateral and contralateral breast cancers were further examined. 4) When AR gene in breast cancers on same allele in primary and secondary tumors, FFPE sections were further analyzed by mutaion analysis of mitochondrial D-loop region.

Results: 1) Polymorphism of AR was demonstrated in 8/9 (88.9%) and 9/11 (81.8%) non-neoplastic lymph nodes obtained from the patients who had ipsilateral and contralateral breast tumor, respectively. 2) Only 2 of 8 ipsilateral breast cancers demonstrated AR polymorphism different from primary cancer. In contrast, 6 of 9 contralateral breast cancers had different polymorphism for AR from primary breast cancers. 3) Analysis of mitochondrial D-loop mutation showed that 8 seconary ipsilateral cancers had different mutation in 3/8 (37.5%), identical mutation in 3/8 (37.5%), and no mutation in 2/8 (25.0%).

Results of analysis for ipsilateral secondary breast cancers

Conclusion: Half of the ipsilateral in breast secondary tumors were estimated as new primary lesions by molecular estimation. Combination analyses of AR gene polymorphism and mitochondrial D-loop somatic mutation unable us to distinguish between true recurrent or new primary cancers.

Quantitative analyses of oxidation states for cubic SrMnO(3) and orthorhombic SrMnO(2.5) with electron energy loss spectroscopy

The oxidation state of Mn in cubic SrMnO(3) and orthorhombic SrMnO(2.5) was investigated by electron energy loss (EEL) spectroscopy. Change in the oxidation state of Mn produced some spectral changes in the O-K edge as well as in the Mn-L(2,3) edge EEL spectra. This study demonstrated that the oxidation state of Mn and the amount of oxygen vacancies in cubic SrMnO(3) and orthorhombic SrMnO(2.5) could be quantified by analyzing the features of the O-K edge spectrum and the Mn L(3)∕L(2) ratio in the Mn-L(2,3) edge spectrum. Our quantitative analysis showed that the spectral changes in the Mn-L(2,3) edge were mainly caused by the oxidation state of Mn, whereas those in the O-K edge could be sensitive to both the oxidation state of Mn and to lattice distortions.

Lapatinib monotherapy in patients with relapsed, advanced, or metastatic breast cancer: efficacy, safety, and biomarker results from Japanese patients phase II studies

Background:

HER2-positive metastatic breast cancer (MBC) relapsing after trastuzumab-based therapy may require continued HER2 receptor inhibition to control the disease and preserve the patients' quality-of-life. Efficacy and safety of lapatinib monotherapy was evaluated in Japanese breast cancer patients after trastuzumab-based therapies.

Methods:

In studies, EGF100642 and EGF104911 evaluated the efficacy and safety of oral lapatinib given 1500 mg once daily in patients with advanced or MBC. All patients progressed on anthracyclines and taxanes; HER2-positive patients had also progressed on trastuzumab.

Results:

For HER2-positive tumours (n=100), objective response rate was 19.0% (95% confidence interval (CI): 11.8–28.1) and clinical benefit rate (CBR) was 25.0% (95% CI: 16.9–34.7). One out of 22 HER2-negative tumour was documented as complete response (n=22). The median time-to-progression (TTP) in the HER2-positive and HER2-negative groups was 13.0 and 8.0 weeks (P=0.007); median overall survival was 58.3 and 40.0 weeks, respectively. The most frequent adverse event was diarrhoea. TTP and CBR were significantly associated with HER2 expression. Patients with tumours harbouring an H1047R PIK3CA mutation or low expression of PTEN derived clinical benefit from lapatinib.

Conclusion:

Lapatinib monotherapy had shown anti-tumour activity in Japanese patients with HER2-positive MBC that relapsed after trastuzumab-based therapy, including those with brain metastases. Patients benefiting from lapatinib may have biomarker profiles differing from that reported for trastuzumab.

PDA usage by Japanese resident physicians is low: a cross-sectional survey

OBJECTIVES

Personal digital assistants (PDAs) are in widespread use by resident physicians in many countries, reaching as high as 95% in some reports. Uses are varied and include clinical decision support and support of evidence-based practice. Utilization by resident doctors in Japan has not been characterized. This study was conducted to determine practice patterns of PDA use by Japanese resident physicians.

METHODS

A nationwide cohort survey study was distributed to all 1070 residency teaching programs in Japan. The survey included questions pertaining to use of PDAs in clinical practice.

RESULTS

1124 surveys were returned (response rate of approximately 75%). 297 (30.7%) respondents reported currently using PDAs, while 971 (86.4%) reported having used a PDA in the past. PDA users were more likely to be male (p <0.05), but no other significant differences were found when examining the following variables: age, training site (university hospital versus community teaching hospital), satisfaction with existing information technology access.

CONCLUSIONS

Use of PDAs among Japanese resident physicians is much lower than their counterparts in other countries. In light of this, further research on patient outcomes in Japan and the impact of PDA usage on patient outcomes is urgently needed. If demonstrated to improve outcomes, barriers to adoption need to be identified and overcome.

Assessment of uterus, bone, serum lipids, and hormones in postmenopausal breast cancer patients treated with TAS-108, a novel steroidal antiestrogen: Results of a randomized phase II study

1120

Background: TAS-108, a novel steroidal antiestrogen, has demonstrated a favorable safety profile, including lower agonistic activity on uterus than tamoxifen and supportive effect on bone in preclinical studies. The potential tissue-specific effect of TAS-108 was investigated in postmenopausal breast cancer patients included in a randomized phase II study. (The clinical efficacy and safety results were presented at the 31st San Antonio Breast Cancer Symposium). Methods: Postmenopausal women aged 20–80 years with hormone receptor-positive metastatic breast cancer were eligible for this study and treated with oral TAS-108 (40, 80, or 120 mg/day) once a day. Endometrial thickness (ET) was measured by ultrasonography. The change in Bone Mineral Density (BMD) at lumber spine was assessed by dual energy X-ray absorptiometry. Hormone levels, bone metabolism markers, and serum lipid parameters were also measured at regular intervals. Wilcoxon signed-rank test was used to assess the significance of changes or percentage changes from baseline. Results: Ninety one patients with a median age of 62 years (range 44–80) were included in the analysis population. TAS-108 did not cause significant endometrial thickening (median baseline ET 3.3 mm, last point ET 3.6 mm; n = 36). In particular, after at least 1 year of treatment in 13 cases, no clinically significant increase in ET was found. No change was observed in median BMD (+0.74%; n = 20). Serum carboxy-terminal telopeptide of type I collagen (I CTP) levels remained unchanged although the decrease in osteocalcin levels was significant (p = 0.019; n = 49) in patients without bone metastasis. Median triglyceride levels significantly decreased from 104.0 to 85.0 mg/dl (p = 0.000) after 4 weeks of treatment, while there were no changes in other lipid parameters. An increase in sex hormone-binding globulin and testosterone levels were observed. Conclusions: TAS-108 may have no harmful effects within these parameters and could be used safely. However, further study in a greater number of cases is needed to identify the effect of the long-term use of TAS-108 on the uterus and bone.

[Table: see text]

Randomized phase II study of neoadjuvant chemotherapy and trastuzumab for operable breast cancer with overexpression of HER2

565

Background: Achievement of pathological complete response (pCR) by primary systemic therapy (PST) correlates with improved survival in operable breast cancer patients. Based on data of the higher pCR rate with concomitant chemotherapy and trastuzumab (H) reported by some clinical trials, we performed a multi-center, prospective randomized phase II study to evaluate the efficacy of adding H to standard chemotherapy and to determine more effective agent which will show higher pCR by the comparison between weekly paclitaxel (P) and tri-weekly docetaxel (D) in neo-adjuvant setting for HER-2+ pts. Methods: Generally, the concomitant combination with anthracycline and H is not recommended because of the increasing cardiac toxicity. PST regimen was scheduled as the sequential chemotherapy with 4 cycles of CEF (cyclophosphamide, epirubicin 100 mg/m2, 5FU) followed by 4 cycles of q3w H with qw P 80 mg/m2 (HP) or q3w D 75 mg/m2 (HD). The primary objective was designed to evaluate the pCR, defined as no evidence of residual invasive cancer in axilla and breast. The inclusion criteria was pts with Stage II or IIIA, HER-2 overexpression, under 65-yo, adequate cardiac function (EF>=60%) and a written informed consent. The sample size was estimated to detect the difference of pCR rate >=10% from 30% baseline, as at least 100 pts. The pathological response was evaluated by central review. Results: From March 2007 to June 2008, 102 pts were enrolled and randomized as well balance in the same number, median age (51yo), and the same distribution of clinical stage. 88 pts (86%) was successful on complete treatment course. Pre-matured data was available for 60 pts whom central review had been completed: there was no significantly difference in pCR rate between two groups, 53% (95%CI: 35.4–71.1%) on HP and 47% (28.8–64.5%) on HD. Out of 30 pts with pCR, 13 pts had component of DCIS. Serious adverse events were reported on 13 cases; mainly febrile neutropenia was experienced on 6 pts. One after the HP course had experienced the cardiac failure to fall in LVEF to 39%. Conclusions: In HER-2+ pts, PST with CEF followed by HP or HD might be equally active and achieving high pCR without significant toxicity. The final reviewed results will be established until May 2009, and presented at the ASCO meeting.

No significant financial relationships to disclose.

Overexpression of E2F-5 correlates with a pathological basal phenotype and a worse clinical outcome

The purpose of the present study is to identify genes that contribute to cell proliferation or differentiation of breast cancers independent of signalling through the oestrogen receptor (ER) or human epidermal growth factor receptor 2 (HER2). An oligonucleotide microarray assayed 40 tumour samples from ER(+)/HER2(−), ER(+)/HER2(+), ER(−)/HER2(+), and ER(−)/HER2(−) breast cancer tissues. Quantitative reverse transcriptase PCR detected overexpression of a cell cycle-related transcription factor, E2F-5, in ER-negative breast cancers, and fluorescence in situ hybridisation detected gene amplification of E2F-5 in 5 out of 57 (8.8%) breast cancer samples. No point mutations were found in the DNA-binding or DNA-dimerisation domain of E2F-5. Immunohistochemically, E2F-5-positive cancers correlated with a higher Ki-67 labelling index (59.5%, P=0.001) and higher histological grades (P=0.049). E2F-5-positive cancers were found more frequently in ER(−)/progesterone receptor (PgR)(−)/HER2(−) cancer samples (51.9%, P=0.0049) and in breast cancer samples exhibiting a basal phenotype (56.0%, P=0.0012). Disease-free survival in node-negative patients with E2F-5-positive cancers was shorter than for patients with E2F-5-negative cancers. In conclusion, we identify, for the first time, a population of breast cancer cells that overexpress the cell cycle-related transcription factor, E2F-5. This E2F-5-positive breast cancer subtype was associated with an ER(−)/PgR(−)/HER2(−) status, a basal phenotype, and a worse clinical outcome.

The influence of meteorological factors on the occurrence of trauma and motor vehicle collisions in Tokyo

BACKGROUND

Previous studies have suggested a possible association between meteorological factors and the occurrence of trauma, but with conflicting results. This study investigated the relation of the occurrence of trauma with meteorological factors, including barometric pressure, ambient temperature, relative humidity and rainfall.

METHODS

Hourly data were collected on traumatic injuries through ambulance transport records of the Tokyo Fire Department from 1 January to 31 December 2005. Hourly meteorological data for Tokyo were also collected from the Japan Meteorological Agency during the same period. A time-series analysis was performed using an autoregressive integrated moving average (ARIMA) model to control for autocorrelations in time-series data.

RESULTS

Of a total of 643,849 patients who were transported to hospitals by ambulance, there were 226,339 trauma patients, including 94,916 patients from motor vehicle collisions (42% of all trauma patients). Based on the ARIMA model, higher temperature (p<0.001), greater rainfall (p<0.05) and holidays (p<0.001) were significantly associated with the occurrence of trauma. These factors were also significantly associated with the occurrence of motor vehicle collisions. Barometric pressure and humidity were not associated with the occurrence of trauma.

CONCLUSIONS

This population-based study shows that, in addition to high temperature, rainfall and holidays are associated with the occurrence of trauma including motor vehicle collisions.

Integrated analysis of efficacy and safety of palonosetron (PALO) 0.75 mg IV for preventing chemotherapy-induced nausea and vomiting (CINV) in anthracycline and cyclophosphamide (AC/EC) combination chemotherapy in Japan: PALO Japanese breast cancer cooperative study group

Abstract #4099

Background: In the treatment of breast cancer, combination chemotherapy of AC/EC has been widely used for neoadjuvant, adjuvant chemotherapy or standard treatment of metastatic breast cancer. AC/EC frequently induces severe nausea and vomiting, that it is important to adequately prevent and control. PALO is the first novel serotonine antagonist approved for prevention of delayed nausea and vomiting in moderately emetogenic chemotherapy in US and other countries. Integrated analysis was done on the data from phase 2 and 3 trials that have been completed in Japan. The purpose of this analysis was to assess efficacy and safety of PALO for preventing CINV induced by AC/EC regimens.&#x2028; Methods: Three Japanese studies with single/repeated IV dose of PALO in pts receiving AC/EC were used. In all these studies, PALO 0.75 mg IV was administrated 30 min prior to AC/EC. Dexamethasone was administrated before AC/EC on day 1, and also on days 2-3 for the phase 3 trial. This integrated analysis assessed the efficacy and safety by difference in regimens (AC or EC), assessed the efficacy by difference in FEC (EC with 5-FU) or EC regimen and by difference in epirubicin (E) dosage in EC. Apart from the integrated analysis, efficacy of PALO in repeated cycles of chemotherapy was assessed by different regimens (AC or EC).&#x2028; Results: Total of 266 pts administrated AC/EC were evaluated for efficacy in single dose. Overall CR(CR = no emesis or rescue medication)% for PALO in acute phase was 70.7%. Overall CR% in delayed phase was 61.3%. CR% in acute and delayed phase for (a) AC (n=76) vs EC (n=190), (b) FEC (n=141) vs EC (n=49), (c) low (n=109) vs high (n=81) dosage of E (&lt;=90, &gt;90 mg/m2) in EC were as follows; (a) acute: 80.3 vs 66.8, delayed: 68.4 vs 58.4, (b) acute: 61.7 vs 81.6, delayed: 56.7 vs 63.3, (c) acute: 72.5 vs 59.3, delayed: 61.5 vs 54.3. Total of 155 pts administrated AC/EC were evaluated for efficacy of PALO in repeated cycles of chemotherapy, and similar efficacy between AC and EC was confirmed. Total of 474 pts administered AC/EC were evaluated for safety in all Japanese studies. There was no significant difference in the incidence of adverse drug reactions between AC and EC.&#x2028; Conclusion: This integrated analysis suggested that high antiemetic activity of PALO in CINV was shown for breast cancer pts receiving either AC or EC. In addition, in the FEC regimen and high dosage of E, all showed CR rate of more than 50% in both acute and delayed phases in the efficacy analysis, revealing a long lasting antiemetic activity of palonosetron.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4099.

Phasic characteristics of inspiratory crackles of bacterial and atypical pneumonia

BACKGROUND

No known physical findings are available to differentiate between bacterial pneumonia (BP) and atypical pneumonia (AP) in patients with community-acquired pneumonia (CAP).

OBJECTIVE

To evaluate the possible differences in phasic characteristics of inspiratory crackles between BP and AP in patients with CAP.

METHODS

Retrospective chart reviews were conducted to obtain phasic characteristics of inspiratory crackles (early, early-to-mid, late and pan-inspiratory crackles) in AP and BP groups in a community teaching hospital in Japan (n = 183).

RESULTS

100 patients with BP and 83 patients with AP were evaluated. Patients with BP were significantly more likely to present with pan-inspiratory crackles (49 (49.0) vs 5 (6.0); p<0.0001), whereas patients with AP were more likely to present with late inspiratory crackles (28 (33.7) vs 9 (9.0); p<0.0001) (mean (SD)). Among pneumonia patients with audible crackles, the sensitivity and specificity of pan-inspiratory crackles for BP were 83.1% and 85.7%, respectively, and the sensitivity and specificity of late inspiratory crackles for AP were 80.0% and 84.7%, respectively.

DISCUSSION

In patients with CAP and audible crackles, phasic characteristics of inspiratory crackles may be used to distinguish AP from BP. Prospective studies are needed to confirm these findings.

Dysmenorrhea among Japanese women

OBJECTIVE

To investigate the epidemiology of dysmenorrhea in Japanese women of menstrual age.

METHODS

A prospective cohort study was conducted using a health diary in a sample representative of Japanese women. Information on health care use was also collected.

RESULTS

Among 823 enrolled participants (age range, 18-51 years), dysmenorrhea (mean duration 1.75 days; range 1-5 days) was reported in 15.8% (95% CI, 13.3-18.3) during the 1-month study period. Common associated symptoms included headache (10.77%), back pain (6.92%), and fatigue (5.38%). No participant with dysmenorrhea visited a physician, while 51.5% of the women used self-medication, and 7.7% used complementary/alternative medicine.

CONCLUSION

Dysmenorrhea is common in Japanese women. In our study, about half used self-medication, while some preferred complementary/alternative medicine. Dysmenorrhea is significantly associated with younger age and employment status.