Abstract OT1-12-06: Neoadjuvant pyrotinib versus pertuzumab in combination with trastuzumab and nab-Paclitaxel for patients with HER2-positive early or locally advanced breast cancer (Pyramid): A randomized, multicenter, open-label, phase 2 trial

Background: Pyrotinib is an irreversible pan-ErbB receptor tyrosine kinase inhibitor targeting human epidermal growth factor receptor 1 (HER1), HER2, and HER4. Exploratory studies of neoadjuvant pyrotinib combined with trastuzumab-based standard chemotherapy for HER2-positive (HER2+) early or locally advanced breast cancer (BC) showed promising pathological complete response (pCR) rates of 51.6%-71%, with a manageable toxicity profile. We are to further investigate this combination strategy versus standard therapy in a randomized trial. Trial design: Pyramid is a randomized, multicenter, open-label, two-stage adaptive enrichment phase 2 trial to evaluate the efficacy and safety of pyrotinib plus trastuzumab and nab-Paclitaxel versus pertuzumab plus trastuzumab and nab-Paclitaxel as neoadjuvant treatment in patients with HER2+ early or locally advanced BC (NCT04900311). Eligible patients will be randomized 1:1 to receive four 21-day cycles of pyrotinib (400 mg, po, qd) or pertuzumab (840 mg loading dose, 420 mg maintenance doses, i.v., day 1) with trastuzumab (8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., day 1) and nab-Paclitaxel (260 mg/m2, day 1 or 125 mg/m2, i.v., day 1/8/15). After completion of neoadjuvant treatment, patients will undergo surgery, followed by standard EC regime for 4 cycles. Subsequent adjuvant therapy will be decided by investigators. Randomization was stratified by hormone receptor (HR) status (ER and/or PR positive vs. negative) and primary tumor size (2<T≤5 cm vs. T>5 cm). There will be two stage of this trial, and population may be enriched to HR-positive based on the results of interim analysis at Stage I. Eligibility criteria: Key inclusion criteria include female, treatment-naïve, histologically confirmed HER2+ invasive BC (cT2-4/cN0-3/cM0), the diameter of primary tumor > 2 cm, known HR status (ER and PR). Specific aims: Primary endpoint is total pathologic complete response (tpCR) rate per central review assessment. Secondary endpoints include invasive disease-free survival, event-free survival, objective response rate, breast-conserving surgery rate, safety. Exploratory endpoint is to investigate the possible predictive biomarkers of efficacy. Statistical methods: A sample size of 220 patients per arm is calculated to provide a power of 80% with a significance level of 0.1 (one-sided) to detect an estimated increase in the tpCR rate from 39% in the pertuzumab group to 49% in the pyrotinib group. Considering a dropout rate of 10%, 490 patients (245 per arm) will be required to be enrolled. A two-stage adaptive enrichment design will be used. The trial will enroll 186 patients at Stage I and an interim analysis will be conducted by an independent data monitoring committee (IDMC) when the pathologic response has been evaluated in at least 132 patients (including at least 66 HR-positive patients) at Stage I. Then, one of five options might be adapted at Stage II depending on the results, including: i. Continue study as planned in whole population; ii. Re-estimate sample size in whole population; iii. Enrich to HR-positive population with pre-defined sample size; iv. Enrich to HR-positive population and re-estimate sample size; v. Early termination. The Clopper-Pearson method will be used to calculate a 95% confidence interval (CI) for the tpCR rate. The CMH chi-square test will be used to compare the tpCR rate between groups and 95% CIs for the difference will be estimated using the Miettinen-Nurminen method. Present accrual and target accrual: Target enrollment will be 490 patients at approximately 20 sites in China. As of June 24, 2021, 4 patients have been enrolled. Contact information: Jin Zhang, MD, Email: zhangjin@tjmuch.com.

Citation Format: Jin Zhang, Qiang Liu, Hongchuan Jiang, Jianguo Zhang, Jianghua Ou, Dedian Chen, Fuguo Tian, Yongqing Li, Xiaoming Cheng, Zhong Ouyang. Neoadjuvant pyrotinib versus pertuzumab in combination with trastuzumab and nab-Paclitaxel for patients with HER2-positive early or locally advanced breast cancer (Pyramid): A randomized, multicenter, open-label, phase 2 trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-12-06.

A Comprehensive Roof Bolter Drilling Control Algorithm for Enhancing Energy Efficiency and Reducing Respirable Dust

In underground coal mines, the drilling process in roof bolting operation could generate excessive amount of respirable coal and quartz dusts. Improper drilling control might also pose safety hazard and interrupt production. Therefore, an automated, high-efficiency drilling control system with safety features can be beneficial to the bolter personnel. In this research, a comprehensive drilling control algorithm has been developed to reduce the generation of respirable dust and to increase the drilling energy efficiency based on laboratory drilling test results and safety considerations. Specific energy is used to evaluate the energy efficiency. In addition, the ratio between specific energy and rock uniaxial compressive strength can be used as a basis for determining the rational drilling bite depth-typically a determined high one permissible by the driller power and drill steel. The test results show that to achieve and maintain a desired drilling bite depth for good drilling performance, a combination of relatively low rotational rate and a rationally high penetration is preferred. By monitoring the drilling rate, the system is able to evaluate the bit wear condition and improve drilling safety. In this paper, the developed drilling control algorithm for achieving a rational drilling bite depth is demonstrated. By adapting this drilling control algorithm, the drilling efficiency and bit condition can be monitored in real time, so the system can maintain a relatively high energy efficiency, generate less respirable dust, and avoid drilling failure.

[Lifelong nutrition and the control of noninfectious chronic diseases]

During a person's entire life, nutrition is essential for growth, development, maintenance, reproduction, disease control and health. Based on a brief review of existing research on lifelong nutrition, this article focuses on the relationship between early life nutrition and noninfectious chronic diseases (NCDs) in adulthood. It points out that early life is the most important stage, with the rapid growth and development of the body and strong requirements for energy and nutrients. Due to the "metabolic memory", insufficient or imbalanced nutrition at this stage affects not only the growth and development of the body, but also leads to increased risks of NCDs in adulthood. In addition to early life, the reasonable intake of nutrients in throughout life plays an important role in meeting the basic requirements of the body and the control of NCDs.

[Progress in research of HIV transmission network analysis methods and metrics]

HIV transmission network analysis plays a significant role in the precise prevention and control of AIDS. The current studies inferred the HIV transmission networks mainly based on the social network methods and molecular network methods and interpret the structural characteristics using individual-level and network-level metrics. To provide references for further researches, we summarized the principles, advantages or disadvantages, and application of HIV transmission network analysis methods and metrics in this paper.

Effectiveness and safety of pegylated liposomal doxorubicin versus epirubicin as neoadjuvant or adjuvant chemotherapy for breast cancer: a real-world study

BACKGROUND

Pegylated liposomal doxorubicin (PLD) is an improved formulation of doxorubicin with comparable effectiveness but significantly lower cardiotoxicity than conventional anthracycline. This study aimed to evaluate the real-world effectiveness and safety of PLD versus epirubicin as neoadjuvant or adjuvant treatment for breast cancer.

METHODS

Clinical data of invasive breast cancer patients who received neoadjuvant or adjuvant chemotherapy with PLD or epirubicin were retrospectively collected. Propensity score matching (PSM) was performed to reduce the risk of selection bias. The molecular typing of these patients included Luminal A, Luminal B, HER2-positive, and basal-like/triple-negative. The primary outcome was pathological complete response (pCR) rate for neoadjuvant chemotherapy and 3-year disease-free survival (DFS) rate for adjuvant chemotherapy. Noninferiority was suggested if the lower limit of the 95% CI for the 3-year DFS rate difference was greater than - 10%. The secondary outcome was adverse reactions.

RESULTS

A total of 1213 patients were included (neoadjuvant, n = 274; adjuvant, n = 939). pCR (ypT0/Tis ypN0) rates of patients who received neoadjuvant chemotherapy were 11.6% for the PLD group and 7.0% for the epirubicin group, but the difference was not statistically significant (P = 0.4578). The 3-year DFS rate of patients who received adjuvant chemotherapy was 94.9% [95%CI, 91.1-98.6%] for the PLD group and 95.4% [95%CI, 93.0-97.9%] for the epirubicin group (P = 0.5684). Rate difference between the two groups and its 95% CI was - 0.55 [- 5.02, 3.92]. The lower limit of the 95% CI was - 5.0% > - 10.0%, suggesting that PLD is not be inferior to epirubicin in adjuvant chemotherapy for breast cancer. The incidences of myelosuppression, decreased appetite, alopecia, gastrointestinal reactions, and cardiotoxicity were lower in the PLD group than in the epirubicin group, while the incidence of nausea was higher in the PLD group.

CONCLUSIONS

In the neoadjuvant and adjuvant treatment of breast cancer, effectiveness is similar but toxicities are different between the PLD-containing regimen and epirubicin-containing regimen. Therefore, further study is warranted to explore PLD-based neoadjuvant and adjuvant chemotherapy for breast cancer.

Diagnostic accuracy and prognostic value of three-dimensional electrical impedance tomography imaging in patients with breast cancer

Background

Three-dimensional electrical impedance tomography (3D EIT) is a novel, non-invasive, radiation-free imaging technology for breast cancer screening. This study aimed to identify characteristics and classification of 3D EIT breast cancer imaging that could provide diagnostic accuracy and prognostic value for breast cancer patients.

Methods

A total of 645 suspicious breast lesions [Breast Imaging Reporting and Data System (BI-RADS) III, IV, V] identified by mammography or ultrasound were examined with 3D EIT (MEIK, SIM-Technika, Yaroslavl, Russia). Breast tissue conductivity was quantified using MEIK 5.6 software. Diagnostic performance of visually interpreted 3D EIT was assessed using histology (surgical excision or vacuum core biopsy) and clinical follow-up. Kaplan-Meier analysis was used to calculate progression-free survival (PFS) and overall survival (OS) rates. Hazard ratio (HR) with a 95% confidence interval (95% CI) for various clinicopathological variables were determined using univariate and multivariate Cox regression models.

Results

Breast cancer was confirmed in 272 of 645 patients by histopathology and other diagnostic imaging modalities. Among the confirmed cases, 218 patients had positive 3D EIT findings. The sensitivity, specificity, accuracy, positive likelihood, and negative likelihood ratios of 3D EIT were 80.1%, 75.1%, 77.2%, 70.1%, and 83.8%. There were no significant differences in the diagnostic accuracy, sensitivity, or specificity between 3D EIT and mammography, ultrasound, or combined mammography and ultrasound. 3D EIT breast cancer images were classified into 3 different types, including Ia [non-complicated breast cancer (NCBC), 62 cases], Ib [complicated breast cancer (CBC), 131 cases], and Ic [edematous-infiltrative breast cancer (EIBC), 25 cases], which were associated with tumor size (P<0.001), TNM stage (P<0.001), and lymph node metastasis (P=0.012). At 5-year follow-up, multivariate analysis demonstrated that breast cancer 3D EIT imaging classification was an independent predictor for decreased OS (HR: 2.399, 95% CI: 1.035, 5.564, P=0.041) and PFS (HR: 2.836, 95% CI: 1.555, 5.172, P=0.012) in patients with breast cancer.

Conclusions

3D EIT breast cancer images were classified into 3 types based on different image characteristics. 3D EIT appeared to be useful in clinical diagnostic performance and prognostic evaluation in patients with breast cancer.

The expression profile of miR-222b-5p/MAPK10 in spleens of SPF chickens infected with REV-SNV at 28-42 dpi

Reticuloendotheliosis virus (REV) is an avian oncogenic retrovirus that causes atrophy of immune organs, such as the spleen, thymus, and bursa of Fabricius, leading to severe immunosuppression. However, there is limited information describing the genes or microRNAs (miRNAs) that play a role in replicating REV-spleen necrosis virus (SNV). Our previous miRNA and RNA sequencing data showed that the expression of gga-miR-222b-5p was significantly upregulated in REV-SNV-infected chicken spleens of 7, 14, and 21 dpi compared to non-infected chicken spleens, but mitogen-activated protein kinase 10 (MAPK10), which is related to innate immunity, had the opposite expression pattern. To understand chicken cellular miRNA function in the virus-host interactions during REV infection, we used quantitative reverse transcription PCR (qRT-PCR) to determine whether the expression of gga-miR-222b-5p and MAPK10 in the spleen of specific-pathogen-free chickens at 28, 35, and 42 dpi was consistent with the first 3 time points, and dual-luciferase reporter assay was used to determine the targeting relationship between gga-miR-222b-5p and MAPK10. Results show that MAPK10 was downregulated at all 3 time points; however, significant difference (p⟨0.01) was noted only at 35 dpi. Moreover, the expression of gga-miR-222b-5p was upregulated; however, significant difference (p⟨0.01) was observed only at 28 and 35 dpi. A dual-luciferase reporter assay showed that MAPK10 is a direct target of gga-miR-222b-5p. This study suggests that gga-miR-222b-5p may target MAPK10 to promote the REV-SNV-induced tumorigenesis via the RLRs signaling pathway.

Predicting Axillary Lymph Node Metastasis in Early Breast Cancer Using Deep Learning on Primary Tumor Biopsy Slides

Objectives

To develop and validate a deep learning (DL)-based primary tumor biopsy signature for predicting axillary lymph node (ALN) metastasis preoperatively in early breast cancer (EBC) patients with clinically negative ALN.

Methods

A total of 1,058 EBC patients with pathologically confirmed ALN status were enrolled from May 2010 to August 2020. A DL core-needle biopsy (DL-CNB) model was built on the attention-based multiple instance-learning (AMIL) framework to predict ALN status utilizing the DL features, which were extracted from the cancer areas of digitized whole-slide images (WSIs) of breast CNB specimens annotated by two pathologists. Accuracy, sensitivity, specificity, receiver operating characteristic (ROC) curves, and areas under the ROC curve (AUCs) were analyzed to evaluate our model.

Results

The best-performing DL-CNB model with VGG16_BN as the feature extractor achieved an AUC of 0.816 (95% confidence interval (CI): 0.758, 0.865) in predicting positive ALN metastasis in the independent test cohort. Furthermore, our model incorporating the clinical data, which was called DL-CNB+C, yielded the best accuracy of 0.831 (95%CI: 0.775, 0.878), especially for patients younger than 50 years (AUC: 0.918, 95%CI: 0.825, 0.971). The interpretation of DL-CNB model showed that the top signatures most predictive of ALN metastasis were characterized by the nucleus features including density (p = 0.015), circumference (p = 0.009), circularity (p = 0.010), and orientation (p = 0.012).

Conclusion

Our study provides a novel DL-based biomarker on primary tumor CNB slides to predict the metastatic status of ALN preoperatively for patients with EBC.

[Study on the relationship between non-alcoholic fatty liver disease and sarcopenia in type 2 diabetes mellitus]

Objective: To explore the relationship between non-alcoholic fatty liver disease and sarcopenia in patients with type 2 diabetes mellitus. Methods: 792 cases with type 2 diabetes mellitus who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from June 2013 to December 2015 were enrolled in this cross-sectional study. Liver ultrasound examination and dual-energy X-ray absorptiometry (DXA) were used to examine the body composition. Patients were grouped according to gender and whether or not they had combined NAFLD, and indicators such as age, duration of diabetes, body mass index (BMI), waist circumference, biochemical indicators, skeletal muscle mass index (SMI), prevalence of sarcopenia, and medication status were collected. An independent-sample t-test, two-sample Kolmogorov-Smirnov test or χ (2) test were performed on the data. Logistic regression model was used to analyze the correlation between NAFLD, sarcopenia and SMI in diabetic patients of different genders. Results: The average age of 792 cases were (64.54 ± 9.61) years, and there were 301 (38%) patients with NAFLD. The prevalence of sarcopenia in male and female NAFLD patients was significantly higher than non-NAFLD patients (male 20.2% and 9.9%, χ(2) = 9.67, P = 0.002; female 12.2% and 5.1%, χ(2) = 5.64, P = 0.018). Male SMI (30.92 ± 2.31 and 31.81 ± 2.17, P < 0.001) and female SMI (25.48 ± 2.14 and 26.34 ± 2.28, P < 0.001) in NAFLD patients were significantly lower than non-NAFLD patients. Multivariate logistic regression analysis showed that sarcopenia was an independent risk factor for NAFLD in male patients with type 2 diabetes mellitus (OR = 2.006, 95% CI: 1.012 ~ 3.976, P = 0.046). There was no correlation between sarcopenia and NAFLD in female patients after adjusting for clinical risk factors. Conclusion: There is an independent correlation between sarcopenia and NAFLD in male patients with type 2 diabetes, and sarcopenia may be an independent risk factor for male patients with NAFLD.

Sulforaphane overcomes T790M-mediated gefitinib resistance in vitro through epithelial-mesenchymal transition

The purpose of the present study was to investigate the effects of sulforaphane (SFN) on gefitinib-resistant cell lines with a T790 mutation (PC-9/AB11). The PC-9 and PC-9/AB11 cells were stained with H&E and visualized with a light microscope. The CCK-8 assay method was used to evaluate the antiproliferative activity of gefitinib and SFN on the cells. Cell cycle arrest and apoptosis were analyzed via flow cytometry. The cytotoxic interaction between the two drugs was evaluated in vitro using the combination index method, and epithelial-mesenchymal transition (EMT)-related proteins and alterations in the signaling pathways were determined by Western blot analysis. Compared to the PC-9 cells, the gefitinib-resistant PC-9/AB11 cells acquired a T790M mutation and had characteristics in accordance with EMT. The combination of gefitinib and SFN induced dose-dependent antiproliferative effects in the PC-9 and PC-9/AB11 cells, while both induced cell cycle arrest and cell apoptosis only in the PC-9/AB11 cells. The synergistic effect in the PC-9/AB11 cells was associated with this drug combination, as it caused an expression change of the epithelial (E-cadherin, claudin-1) and matrix proteins (vimentin, N-cadherin) in the cells, related to the reversal of EMT, as well as an expression change of the epidermal growth factor receptor (EGFR), p-EGFR, p-AKT, and p-ERK proteins. In this study, SFN overcame T790M-mediated gefitinib resistance in vitro through EMT. Thus, a combination of gefitinib and SFN may be a beneficial treatment strategy for lung cancer patients with acquired resistance due to T790M mutation.

Mucin-type sialyl-Tn antigen is associated with PD-L1 expression and predicts poor clinical prognosis in breast cancer

Background

A recent study showed that mucin-type sialylated O-linked glycans could induce the increased expression of PD-L1 via binding to Siglec receptors. However, the relationship between the expression of the mucin-type sialyl-Tn antigen (sTn) and PD-L1 remains unclear in breast cancer (BC). Therefore, we investigate the clinicopathological and prognostic effects of sTn expression and its relationship with PD-L1 expression in BC tissues.

Methods

We retrospectively analyzed the clinical data of 380 invasive BC patients between January 2011 and January 2014. The last follow-up time was January 31, 2019 with a median follow-up of 62 months. The expression of the sTn antigen and PD-L1 in 380 tumor specimens was assessed by immunohistochemistry. Correlations between sTn/PD-L1 expression and clinicopathological features and prognoses were analyzed.

Results

In BC tissues, the positive expression rate of PD-L1 (20.5%) was much lower than that of sTn (41.8%). Pearson's contingency analysis showed that sTn and PD-L1 expression in tumor tissues demonstrated a high correlation (P<0.001). High sTn expression was associated with negative ER expression (P<0.001), positive HER-2 status (P<0.001), advanced tumor stage (P<0.001), high density of CD8+ tumor-infiltrating lymphocytes (TILs) (P=0.028), and positive lymph node metastasis (P=0.002). Moreover, patients with concomitant high expression of both markers had the highest risk of relapse (P<0.001) and mortality (P<0.001). The multivariate Cox regression model revealed that positive sTn expression (HRos: 1.941, 95% CI: 1.168, 3.223, Pos=0.028; HRpfs: 1.739, 95% CI: 1.063, 2.847, Ppfs=0.010) and positive PD-L1 expression (HRos: 1.912, 95% CI: 1.138, 3.212, Pos=0.017; HRpfs: 1.863, 95% CI: 1.116, 3.110, Ppfs=0.014) were independent indicators for poor overall survival (OS) and progression-free survival (PFS), respectively.

Conclusions

BC patients who expressed both sTn and PD-L1 had poorer survival. Therefore, combinational therapy with dual blockade might benefit BC patients with sTn(+)/PD-L1(+) expression, which requires further examination in future clinical trials.