Open-label randomized clinical trial of standard neoadjuvant chemotherapy with paclitaxel followed by FEC versus the combination of paclitaxel and everolimus followed by FEC in women with triple receptor-negative breast cancer†

BACKGROUND

Everolimus synergistically enhances taxane-induced cytotoxicity in breast cancer cells in vitro and in vivo in addition to demonstrating a direct antiproliferative activity. We aim to determine pharmacodynamics changes and response of adding everolimus to standard neoadjuvant chemotherapy in triple-negative breast cancer (TNBC).

PATIENTS AND METHODS

Phase II study in patients with primary TNBC randomized to T-FEC (paclitaxel 80 mg/m(2) i.v. weekly for 12 weeks, followed by 5-fluorouracil 500 mg/m(2), epirubicin 100 mg/m(2), and cyclophosphamide 500 mg/m(2) every 3 weeks for four cycles) versus TR-FEC (paclitaxel 80 mg/m(2) i.v. and everolimus 30 mg PO weekly for 12 weeks, followed by FEC). Tumor samples were collected to assess molecular changes in the PI3K/AKT/mTOR pathway, at baseline, 48 h, 12 weeks, and at surgery by reverse phase protein arrays (RPPA). Clinical end points included 12-week clinical response rate (12-week RR), pathological complete response (pCR), and toxicity.

RESULTS

Sixty-two patients were registered, and 50 were randomized, 27 received T-FEC, and 23 received TR-FEC. Median age was 48 (range 31-75). There was downregulation of the mTOR pathway at 48 h in the TR-FEC arm. Twelve-week RR by ultrasound were 29.6% versus 47.8%, (P = 0.075), and pCR were 25.9% versus 30.4% (P = 0.76) for T-FEC and TR-FEC, respectively. mTOR downregulation at 48 h did not correlate with 12-week RR in the TR-FEC group (P = 0.58). Main NCI grade 3/4 toxicities included anemia, neutropenia, rash/desquamation, and vomiting in both arms. There was one case of grade 3 pneumonitis in the TR-FEC arm. No grade 3/4 stomatitis occurred.

CONCLUSION

The addition of everolimus to paclitaxel was well tolerated. Everolimus downregulated mTOR signaling but downregulation of mTOR at 48 h did not correlate with 12-week RR in the TR-FEC group.

CLINICAL TRIAL NUMBER

NCT00499603.

Concordance of genomic alterations between primary and recurrent breast cancer

There is growing interest in delivering genomically informed cancer therapy. Our aim was to determine the concordance of genomic alterations between primary and recurrent breast cancer. Targeted next-generation sequencing was performed on formalin-fixed paraffin-embedded (FFPE) samples, profiling 3,320 exons of 182 cancer-related genes plus 37 introns from 14 genes often rearranged in cancer. Point mutations, indels, copy-number alterations (CNA), and select rearrangements were assessed in 74 tumors from 43 patients (36 primary and 38 recurrence/metastases). Alterations potentially targetable with established or investigational therapeutics were considered "actionable." Alterations were detected in 55 genes (mean 3.95 alterations/sample, range 1-12), including mutations in PIK3CA, TP53, ARID1A, PTEN, AKT1, NF1, FBXW7, and FGFR3 and amplifications in MCL1, CCND1, FGFR1, MYC, IGF1R, MDM2, MDM4, AKT3, CDK4, and AKT2. In 33 matched primary and recurrent tumors, 97 of 112 (86.6%) somatic mutations were concordant. Of identified CNAs, 136 of 159 (85.5%) were concordant: 37 (23.3%) were concordant, but below the reporting threshold in one of the matched samples, and 23 (14.5%) discordant. There was an increased frequency of CDK4/MDM2 amplifications in recurrences, as well as gains and losses of other actionable alterations. Forty of 43 (93%) patients had actionable alterations that could inform targeted treatment options. In conclusion, deep genomic profiling of cancer-related genes reveals potentially actionable alterations in most patients with breast cancer. Overall there was high concordance between primary and recurrent tumors. Analysis of recurrent tumors before treatment may provide additional insights, as both gains and losses of targets are observed.

Prevalence of sleep disturbance in chronic pain

OBJECTIVE

Sleep is a vital function for human beings, which can be affected by several factors. Chronic pain is one of these factors where it is the most frequent cause for seeking medical care in combination with insomnia. The aim of this study is to examine the prevalence and relationship between sleep disturbance and chronic pain.

PATIENTS AND METHODS

After approval, a total of 85 Family Medicine Units from over 170 in Tokat were randomly selected using a 50% sampling. A sample of 2635 subjects, over the age of 19 years, who were registered with the selected Family Medicine Units, were assessed due to gender, age group, and the urban/rural population size of Tokat using the stratified sampling method. The sample size distribution was calculated as 1515 urban subjects, 1120 rural subjects; 1345 female subjects, 1290 male subjects; 1123 subjects between 20-39 years of age, 1103 subjects between the ages of 40-64, and 409 subjects over 64 years of age. After sampling, subjects were invited to participate in the study via an invitation letter, and agreeing individuals were taken to the Family Medicine Unit for face-to-face meetings. Written, informed consent was obtained, along with demographic data. The presence of chronic pain was recorded. According to the presence of chronic pain, all subjects were separated into two groups as Group Chronic Pain and Group Non-Chronic Pain. The visual analog scale for pain intensity, and Pittsburgh Sleep Quality Index for sleep quality, were performed with all subjects. A multiple linear regression model was used to assess the predictors of sleep quality. Analyses were conducted using the Statistical Package for Social Sciences program (SPSS Inc., Chicago, IL, USA), version 20.0. The statistical significance for all analyses was set at p < 0.05.

RESULTS

The mean global Pittsburgh Sleep Quality Index score of Group Chronic Pain (5.30 ± 4.29) was significantly higher than in Group Non-Chronic Pain (3.22 ± 3.30; p < 0.01). The mean Pittsburgh Sleep Quality Index scores of females (5.69 ± 4.40) were significantly higher than males (4.54 ± 3.96) in Group Chronic Pain (p = 0.000045). A total of 40.7% of patients in Group Chronic Pain, and 21.9% in Group Non-Chronic Pain demonstrated poorer sleep quality according to the Pittsburgh Sleep Quality Index scores, with a cut-off level > 5. A moderate positive correlation was found between the global Pittsburgh Sleep Quality Index and Visual Analog Scale scores (r = 0.310, p < 0.01). A multiple linear regression analysis showed that age, gender, income, Visual Analog Scale, and presence of depression were the significant predictors for Pittsburgh Sleep Quality Index score.

CONCLUSIONS

The current study revealed that chronic pain and pain intensity are important predictors of sleep quality.

Increased expression of CYP24A1 correlates with advanced stages of prostate cancer and can cause resistance to vitamin D3-based therapies

A major limitation of exogenous vitamin D3 administration for the treatment of prostate cancer is the marginal, if any, clinical efficacy. We dissected the basis for the resistance to the vitamin D3 antitumor properties and specifically examined the effect of its major catabolic enzyme, CYP24A1, in prostate cancer. Local CYP24A1 expression levels and the effect of selective modulation were analyzed using tissue microarrays from needle core biopsy specimens and xenograft-bearing mouse models. CYP24A1 mRNA was elevated in malignant human prostate tissues compared to benign lesions. High CYP24A1 protein levels were seen in poorly differentiated and highly advanced stages of prostate cancer and correlated with parallel increase in the tumor proliferation rate. The use of CYP24A1 RNAi enhanced the cytostatic effects of vitamin D3 in human prostate cancer cells. Remarkably, subcutaneous and orthotopic xenografts of prostate cancer cells harboring CYP24A1 shRNA resulted in a drastic reduction in tumor volume when mice were subjected to vitamin D3 supplementation. CYP24A1 may be a predictive marker of vitamin D3 clinical efficacy in patients with advanced prostate cancer. For those with up-regulated CYP24A1, combination therapy with RNAi targeting CYP24A1 could be considered to improve clinical responsiveness to vitamin D3.

Malaria epidemiology in mersin province, Turkey from 2002 to 2011

BACKGROUND

Malaria is an infectious disease caused by Plasmodium spp. with high morbidity and mortality in human in tropical and subtropical regions. In recent years, number of malaria cases has been significantly reduced because of fight with the disease in Turkey. This study intended to investigate the malaria epidemiology in Mersin Province from 2002 to 2011 using data from the provincial Public Health Directorate.

METHODS

Over ten years, 303573 blood samples were taken from the people by active and passive surveillance methods and blood smears were prepared. Smears were stained with Giemsa and examined under the microscope.

RESULTS

Totally, 73 people including 44 male and 29 female were positive in terms of Plasmodium spp. It was determined that P. vivax observed in 67 cases while P. falciparum in 6 cases. Cases were mainly observed in 15 to 44 years old range, showed an increase between June-September periods and a significant decrease after 2006. Out of the 73 malaria cases, 54 cases were from Mersin Province and 13 cases were imported from another province of Turkey. Six cases were transmitted from abroad.

CONCLUSION

These results provide information about malaria epidemiology in an endemic area in Turkey and contribute its prevention in Mersin Province.

Abstract P1-07-06: Effect of biospecimen variables on proteomic biomarker assessment in breast cancer

Background: PI3K/Akt/mTOR signaling is being actively pursued as a therapeutic target. We sought to determine how tumor heterogeneity and biospecimen variables affect assessment of PI3K/Akt/mTOR pathway activation.

Methods: Intraoperative image-guided core-needle biopsies (CNB) of primary breast tumors were prospectively collected in 53 patients with invasive breast cancer. After surgery, specimens were collected from the center and periphery of the excised tumor. CNB, central and peripheral surgical specimens were assessed with reverse phase proteomic arrays (RPPA), H&E and immunohistochemistry (IHC).

Results: The expression of standard of care markers ER, PR, and HER2 by RPPA correlated well between biospecimen types. Overall, there was a significant correlation between the expression of 132 (86%) of 154 different markers in the center and periphery; the correlation was significantly higher for smaller tumors, and with shorter cold ischemia time. Expression of many investigational prognostic markers and druggable targets on CNB correlated with expression in the surgical specimen (average of center and periphery), while others, such as EGFR and c-MET, had a weak correlation. Of 154 RPPA markers, 132 (86%) were not statistically different between the center and periphery, and 97 (67%) were not different between the CNB and the surgical specimen. On analysis of the PI3K/AKT/mTOR pathway, pAkt S473 and PTEN had a significant correlation between central and peripheral specimens, and between CNB and surgical specimens. However, pAkt S473, pS6 S235/236 and pS6 240/244 levels were higher in CNB than the central specimens both by RPPA and by IHC. When patients were classified by RPPA PI3K pathway activation score, there was a moderate agreement between classification on the CNB and central specimens (Cohen's Kappa 0.539). However 9 of 20 tumors classified as having PI3K activation on CNB were classified as not having pathway activation on central specimens.

Conclusions: There is remarkable homogeneity in expression of biomarkers within a tumor. However, proteomic markers are differentially expressed by biospecimen type and other preanalytic variables. PI3K pathway activation is greater in CNB compared to surgical samples.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-07-06.

Functional proteomics characterization of residual breast cancer after neoadjuvant systemic chemotherapy

BACKGROUND

The purpose of this study was to determine the functional proteomic characteristics of residual breast cancer and hormone receptor (HR)-positive breast cancer after neoadjuvant systemic chemotherapy, and their relationship with patient outcomes.

METHODS

Reverse phase protein arrays of 76 proteins were carried out. A boosting approach in conjunction with a Cox proportional hazard model defined relapse predictors. A risk score (RS) was calculated with the sum of the coefficients from the final model. Survival outcomes and associations of the RS with relapse were estimated. An independent test set was used to validate the results.

RESULTS

Test (n = 99) and validation sets (n = 79) were comparable. CoxBoost revealed a three-biomarker (CHK1pS345, Caveolin1, and RAB25) and a two-biomarker (CD31 and Cyclin E1) model that correlated with recurrence-free survival (RFS) in all residual breast cancers and in HR-positive disease, respectively. Unsupervised clustering split patients into high- and low risk of relapse groups with different 3-year RFS (P ≤ 0.001 both). RS was a substantial predictor of RFS (P = 0.0008 and 0.0083) after adjustment for other substantial characteristics. Similar results were found in validation sets.

CONCLUSIONS

We found models that independently predicted RFS in all residual breast cancer and in residual HR-positive disease that may represent potential targets of therapy in this resistant disease.

Abstract B84: The association between germline genetic variants in the PI3K pathway and PI3K mutations in breast tumors

Background: Gene mutations in the PI3K pathway in breast tumors are associated with resistance to tamoxifen and poorer prognosis. Differences in host susceptibility to developing breast cancers with PI3K pathway mutations may explain the heterogeneity in response to tamoxifen for chemoprevention and breast cancer outcomes. The objective of the study was to evaluate the association between host germline single nucleotide polymorphisms (SNPs) and activation of the PI3K pathway in breast tumors.

Methods: We extracted tumor and germline DNA from 386 women with stages I-II breast cancer treated at the MD Anderson Cancer Center. Nine PI3K mutation sites were evaluated using the Sequenom assay and 57 tagging single nucleotide polymorphisms (SNPs) of candidate genes in the PI3K pathway were genotyped using the Illumina Golden Gate Platform.

Results: 36 patients (10%) had at least one mutation in the PI3K pathway. There was no association between PI3K mutation status by age at diagnosis or ethnicity. In univariate analysis, there was a statistically significant association between PI3K gene mutation status and 3 tagging SNPs in the genes, PTEN (rs123421, rs1234213) and IGF-1 (rs2033178).

Conclusion: PI3K mutations are rare in breast tumors but represent a druggable target for prevention and treatment. Host genetics may play a role in contributing to tumor biology and serve to identify individuals at risk for tumors with PI3K pathway activation and tamoxifen resistance.

Citation Format: Abenaa M. Brewster, Melissa Bondy, Kim-anh Do, Aysegul Sahin, Katherine Hale, Caimiao Wei, Gordon Mills, Patricia Thompson. The association between germline genetic variants in the PI3K pathway and PI3K mutations in breast tumors. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B84.

Carbapenem resistance due to Bla(OXA-48) among ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates in a univesity hospital, Turkey

Bacterial isolates producing Class D OXA-48 carbapenemase may be missed in routine laboratory testing, allowing them to spread undetected. The purpose of the present study was to detect bla(OXA-48) among ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates collected from a university hospital, Turkey. Ninety-two ESBL-producing isolates (66 E. coli, 26 K. pneumoniae) were obtained in 2010. Antibiotic susceptibility tests were performed using the disc diffusion method and VITEK 2 system. Carbapenemase activity was screened using modified Hodge test. Beta-lactamase genes were detected by PCR and bla(OXA-48)-positive amplicons were sequenced. Genetic relatedness among K. pneumoniae isolates was investigated by pulsed-field gel-electrophoresis (PFGE). Carbapenemase activity was detected in 1 E. coli and 9 K. pneumoniae isolates and 8 of the K. pneumoniae plus the E. coli isolates were resistant to ertapenem. Three K. pneumoniae and 1 E. coli isolates were resistant to imipenem. All 10 isolates were susceptible to meropenem. bla(OXA-48) was present in all 10 isolates. Additionally, 9 isolates contained at least one beta-lactamase gene, including bla(SHV') bla(CTX-M) and bla(VEB) type. PFGE revealed different karyotypes among 9 K. pneumoniae isolates suggesting that the dissemination of bla(OXA-48) gene was not spread by a single K. pneumoniae clone. Thus OXA-48-producing isolates found in carbapenem-susceptible strains according to CLSI guidelines.

Abstract LB-193: Ganglioside GD2 identifies cancer stem cells and inhibition of GD2 biosynthesis by targeting GD3 synthase exerts antitumor effects

Currently, only very few markers either as single or in combination are available to identify cancer stem cells (CSCs). In this report, we identified that the ganglioside GD2, a marker known to express on mesenchymal stromal cells (MSCs) is expressed on a small fraction (5.5% ± 3.4%) of transformed human mammary epithelial cells (HMLER) and breast cancer patient tumors. FACS sorted GD2+ cells appear spindle shaped and proliferate 5 fold slower compared to GD2- cells in-vitro. Analysis of breast cancer cell lines (n=12) indicated that GD2 expression varies and that the basal breast cancer cell lines have a higher percentage of GD2+ cells (median 9%, range 1.2-17%, n=6), as compared to their luminal counterparts (median 0.2%, range 0-3%, n=6, p&lt;0.001). Functional analysis revealed that GD2+ HMLER and MDA-MB-231 cells produced 2-5 fold more mammospheres in-vitro (p&lt;0.003) and tumors in-vivo than GD2- cells (p&lt;0.04). Recent reports suggest that breast tumor cells with CD44highCD24low phenotype exhibit CSCs characteristics. Interestingly, the majority (94% ± 3.5%) of GD2+ cells were characterized by the CD44highCD24low phenotype in HMLER cells. Analysis of primary breast cancer samples (n=10) revealed that GD2 is variably expressed in these samples (median 4.35%, range 0.5%-35.8%) and 95.5% ± 2.7% of GD2+ cells co-segregated with CD44highCD24lowCD45- phenotype. In contrast, only 2.4%± 0.4% of GD2- cells displayed this phenotype. Gene-chip and quantitative RT-PCR analysis revealed that GD3 synthase (GD3S), the enzyme responsible for synthesis of GD3, the precursor of GD2, was expressed 10-fold higher in GD2+ cells compared to GD2- HMLER and MDA-MB-231 cells. Analysis of GD2 expression in HMLER cells induced to undergo EMT revealed that the percentage of GD2+ cells increased 6-7 fold and the expression of GD3S &gt; 10 fold. Moreover, we observed spontaneous generation of GD2+ from GD2- cells and vice versa in both in-vitro and in-vivo, suggesting a role of EMT in this process. Stable knock-down of GD3S in MDA-MB-231 cells using shRNA impaired in-vitro matrigel invasion by more than 10-fold and completely abolished tumor growth in-vivo. Importantly, Triptolide, an anti-inflammatory and anti-cancer drug, which was recently shown to inhibit GD3S expression in melanoma cells, also inhibited GD3S expression in MDA-MB-231 and SUM159 cells by &gt;95% in a dose dependent manner and thereby inhibited growth of GD2+ cells in a time dependent manner. Intra-peritoneal administration of Triptolide (0.15mg/Kg/day) in NOD/SCID mice bearing MDA-MB-231 breast tumors completely eliminated tumors in 50% and reduced the tumor volume 7- to 8-fold in 25% of the mice. In conclusion, we identified GD2 as a new CSC specific cell surface marker and GD3 synthase as a potential therapeutic target for CSCs, with the potential of improving survival and cure rates of patients with breast cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-193. doi:1538-7445.AM2012-LB-193

Abstract 1912: Jab1/Csn5 as a novel driver for therapeutic resistance in HER2-positive breast cancer

Her2-positive (Her2+) breast cancer has the second worst prognosis of the five subtypes of breast cancer. The most successful targeted therapy for Her2+ breast cancer to date is trastuzumab (Herceptin)-based. However, the median duration of response to trastuzumab is shorter than 1 year, and about 75% of patients who initially responsed, has experienced resistance to the therapy after a year. Thus, better treatment strategies for Her2+ subtype are urgently needed. We and other researchers previously demonstrated that c-Jun activation domain-binding protein 1 (Jab1) negatively regulates p27, mediates p27 nuclear-to-cytoplasmic export and degradation and contributes to the loss of p27 that is seen in &gt;50% of breast tumors and that correlates with poor clinical outcome in breast cancer cells. Thus, implicates the potential role of Jab1 in interfering with trastuzumab. We identified Jab1/Csn5 as a novel oncogene. Jab1 is amplified and overexpressed in elevated in 50% of primary and 90% of metastatic breast tumors, but is low or absent in normal adult breast tissue. In addition, high Jab1 expression is associated with short progression-free survival durations in breast cancer patients. Our preliminary data showed that inactivation of Jab1/Csn5 in trastuzumab-resistant breast cancer cells sensitized the cells to trastuzumab in a dose- and time-dependent manners. However, the ways in which Jab1 expression is up-regulated in Her2+ breast cancer cells and how this up-regulation drives trastuzumab resistance remain largely unclear. In this study, we will seek to analyze the cross-talk between Src/Stat3 or Akt signaling and Jab1 activation in breast carcinoma. We have found that Stat3 is a novel positive regulator of Jab1 expression in breast cancer cells and that Jab1 overexpression driven by the Src/Stat3 pathway compensates for trastuzumab's inhibition of Her2 signaling in Her2+ breast cancer cells. This suggests that activated Stat3, by up-regulating Jab1 expression, inhibits trastuzumab-induced cell-cycle arrest. In general, our proposed study elucidates Jab1 as a novel contributor to trastuzumab resistance and determine its potential as a prognostic and predictive marker as well as an important therapeutic target. The successful completion of our study would benefit breast cancer patients in three ways. 1) Because Jab1 is rarely expressed in mammary epithelial cells, targeting Jab1 would be less toxic to normal epithelial cells, compared to other agents. 2) Combining Jab1 with trastuzumab would interfere with both Src/Stat3 and Akt pathway. This would significantly benefit patients with Her2+ breast cancer refractory to this therapy due to PTEN loss or activating mutant Stat3. 3) Because Jab1 expression is higher in trastuzumab-resistant cells than in trastuzumab-sensitive cells, Jab1 could be used as a marker of tumor response to trastuzumab.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1912. doi:1538-7445.AM2012-1912

Estimates of phenotypic and genetic parameters for birth weight of Brown Swiss calves in Turkey using an animal model

A study was conducted to assess the influence of genetic and environmental factors on Brown Swiss calf birth weight, and to estimate variance components, genetic parameters, and breeding values. Data were collected on 1,761 Brown Swiss calves born from 1990 to 2005 in the Konuklar State Farm in Turkey. Mean birth weight for all calves was 39.3 ± 0.09 kg. Least squares mean birth weights for male and female Brown Swiss calves were 40.3 ± 0.02 and 39.0 ± 0.02 kg, respectively. Variance components, genetic parameters, and breeding values for birth weight in Brown Swiss calves were estimated by restricted error maximum likelihood (REML)-best linear unbiased prediction(BLUP) procedures using an MTDFREML (multiple trait derivative free restricted maximum likelihood) program employing an animal model. Direct heritability (h(d)(2)), maternal heritability (h(m)(2)), total heritability (h(T)(2)), r(am) and c(am) estimates were 0.12, 0.09, 0.23, -0.58, and -0.06, respectively. The estimated maternal permanent environmental variance expressed as a proportion of the phenotypic variance (c(2)) was 0.05. Breeding values were estimated for the trait and used to evaluate genetic trends across the time period investigated. The genetic trend linear regression was not different from zero. No genetic trend for birth weight was expected, since there had been no direct selection pressure on the trait. Absence of a trend confirms that there was no change due to selection pressure on correlated traits. Genetic and environmental parameter estimates were similar to literature values indicating that effective selection methods used in more developed improvement programs would be effective in Turkey as well.

P5-03-01: Cytoplasmic Cyclin E and P-CDK2 Expression in Triple Negative Breast Carcinomas Measured by Immunohistochemistry Correlates with Poor Outcome

Background: Triple negative breast carcinomas (TNBCs) are aggressive malignancies that lack effective therapeutic targets but express low molecular isoforms of cyclin E (LMW-E). These LMW-E, generated primarily from NH2-terminal elastase cleavage of full length cyclin E (EL), preferentially accumulate in the cytoplasm of cancer cells. Using a transgenic mouse model system, our laboratory has recently shown that cyclin-dependent kinase 2 (CDK2) is required for LMW-E-mediated mammary tumorigenesis. These results lead us to hypothesize that immunohistochemical cytoplasmic detection of LMW-E and phospho-CDK2 in TNBC provides a valuable screening tool for those patients most likely to have a poor prognosis who could then be treated with anti-CDK2 therapy currently clinically available. Material and Methods: Tissue micro-arrays from 168 TNBC patients were IHC stained for cyclin E and p-CDK2. Cyclin E staining intensity and percentage of positivity were evaluated both in the nucleus and cytoplasm of cancer cells and four different phenotypes of cyclin E were distinguished with respect to predominant nuclear or cytoplasmic localization of staining: cyclin E negative, predominantly nuclear, both nuclear and cytoplasmic and predominantly cytoplasmic. p-CDK2 IHC was achived using an antibody, which recognizes phospho-threonine 160 on CDK2. Immunoreactive scores were determined by multiplying the intensity with the extent of staining of nuclei and cytoplasm. We sought correlations between different cyclin E and p-CDK2 expression patterns and disease-free survival (DFS). Results: Cytoplasmic cyclin E accumulation on IHC of TNBCs correlated with poor outcome. Within the median follow up of 7.3 years tumors with both nuclear and cytoplasmic cyclin E expression demonstrated higher recurrence rate compared to entirely negative for cyclin E (p=0.0117). In contrast patients with exclusively nuclear cyclin E showed only a trend toward decreased DFS compared to patients with cyclin E negative tumors (p=0.0896). Furthermore we identified the new phenotype of cyclin E immunoreactivity, which is characterized by negative nucleus and positive cytoplasmic staining. This phenotype was the most significantly associated with poor DFS compared to cyclin E negative phenotype (p=0.0026) and as the only one distinguished at high risk of early recurrence among TNBC patient without axillary nodes involvement (p=0.0105). The expression of p-CDK2 was significantly higher in this phenotype than the cytoplasmic cyclin E.negative tumors. High p-CDK2 tumors were also correlated to worse DFS then p-CDK2 low tumors (P=0.019). Lastly, our analyses revealed that tumors positive for both cytoplasmic cyclin E and p-CDK2 had higher recurrence rate compared to negative for both or positive for one of them (p=0.003).

Discussion: Cytoplasmic cyclin E may help to predict recurrence, especially in early stage, node negative TNBCs. We present a new concept in assessing cyclin E expression. Poor outcome due to TNBCs overexpressing LMW-E provide a rationale to investigate the treatment strategies that could specifically target high LMW-E tumors. These patients could particularly benefit from treatment with CDK2 inhibitors.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-03-01.

Why do we use drains in some inguinal hernia repairs?

BACKGROUND AND AIMS

There is no consensus among surgeons on the indication of putting drains for in groin hernias. In this study we aimed to investigate the factors that are associated with drain usage by comparing the clinical characteristics of patients who had drains with the patients without drains in the repair of groin hernias.

MATERIAL AND METHODS

The data of all groin hernia repairs from January 2006 till February 2010 in Ankara Diskapi Research Hospital were collected prospectively. The type of presentation, age, gender, presence of coexisting diseases, type of hernia, American Society of Anesthesiologists (ASA) class, type of anesthesia, postoperative general complications, local wound complications, duration of operation, and length of hospitalization, recurrence and mortality were compared between the groups of patients with drains versus without drains.

RESULTS

The drains were used in 66 (8.3%) of 795 open mesh repairs of inguinal hernias. The patients who had drains were older, had cardiovascular disease, higher ASA class, received anticoagulant regimens more often, had indirect type hernia more often, more recurrent hernias, more commonly had emergency operations, had complicated presentations such as incarceration and strangulation, therefore had resections more often, pulmonary complications, had local complications such as hematoma, had longer duration of the operations and stayed longer in the hospital when compared with the patients without drains (p < 0.05). Anticoagulant use, duration of the operation, recurrent hernias and ASA class were statistically significant independent variables predicting drain use in inguinal hernias (p < 0.05). When femoral hernia repairs (n = 35) were analysed; drains were associated with male gender and long operation time (p < 0.05).

CONCLUSIONS

Drains are more commonly used in patients on anticoagulants, who had long duration of the operation, recurrent hernias and high ASA class. Drain use in selected patients seems to not increase infection risk but are associated with longer hospital stay.

Phase III randomized trial of dose intensive neoadjuvant chemotherapy with or without G-CSF in locally advanced breast cancer: long-term results

OBJECTIVE

To compare the pathologic complete response (pCR) rate of patients treated with 5-fluorouracil (5-FU), doxorubicin, and cyclophosphamide (FAC) versus dose-intense FAC plus G-CSF in the neoadjuvant setting and to compare the delivered dose intensity, disease-free survival (DFS) and overall survival (OS) times, and toxicity between treatment arms in patients with breast cancer.

METHODS

Patients were randomized to receive preoperative FAC (5-FU, 500 mg/m(2); doxorubicin, 50 mg/m(2); cyclophosphamide, 500 mg/m(2)) every 21 days for four cycles or dose-intense FAC (5-FU, 600 mg/m(2); doxorubicin, 60 mg/m(2); cyclophosphamide, 1,000 mg/m(2)) plus G-CSF every 18 days for four cycles.

RESULTS

Two hundred two patients were randomly assigned. The median follow-up was 7.5 years. Patients randomized to FAC plus G-CSF had a higher pCR rate as well as clinical complete response rate; however, these differences were not statistically different from those with the FAC arm. Patients in the FAC + G-CSF arm had a higher delivered dose intensity of doxorubicin in the neoadjuvant and adjuvant settings than those in the standard FAC arm. DFS and OS times were not significantly different between the two groups. However, the OS and DFS rates were significantly higher for patients who achieved a pCR than for those who did not. Thrombocytopenia, febrile neutropenia, and infection rates were higher in the FAC + G-CSF arm.

CONCLUSIONS

A higher delivered dose intensity of doxorubicin with the FAC + G-CSF regimen did not result in a statistically significant higher pCR rate. However, patients who achieved a pCR experienced longer DFS and OS times.