P867Detecting cholesterol crystals in coronary artery disease

Background

Cholesterol crystals (CCs) have been recognized as only ghost images. Recently, free monolayer and multilayer CCs besides atheromatous materials from aortic ruptured plaque, obtained using nonobstructive angioscopy, were demonstrated using polarized light microscopy.

Purpose

The aim of the study was to detect free CCs from coronary slow flow.

Methods

A total of 86 patients with coronary artery disease underwent angioscopy with coronary artery sampling. Blood in the coronary artery with and without temporary slow flow was sampled. The blood sample was spread onto a filter paper, and the filter paper was rinsed with distilled water (filter paper-rinse method). The rinse water was scanned using polarized light microscopy, and CCs were detected. The dimensions of CCs from the coronary artery and aortic ruptured plaques were measured for 100 randomly selected samples. The lengths and widths of the CCs were measured.

Results

CCs were obtained in 31 of 86 patients (36.0%). CCs were detected in 38.4% of patients with acute coronary syndrome and in 31.9% of patients with stable angina. CCs were detected 47.1% with slow flow and in 25% without slow flow.

Cholesterol Crystals in Coronary Artery

Conclusions

CCs from the coronary artery can be successfully obtained by using our original method. CCs were detected in patients with clinically stable angina and in those without coronary artery slow flow.

P6524The comparison of radial artery occlusion rate after distal radial artery puncture between hemodialysis and non-hemodialysis patients

Background

In recent years it has been attempted to use a distal radial artery (DRA) as a puncture site for cardiac catheterization and intervention. A patency of radial artery is important in hemodialysis patients because the radial artery is source as an arteriovenous shunt. However, the incidence of radial artery occlusion (RAO) is not known after DRA puncture.

Purpose

To compare RAO rates after DRA puncture between dialysis and non-dialysis patients.

Method

This was retrospective, observational and single center study. All consecutive 1,533 patients undergoing DRA puncture were analyzed. The primary endpoint is RAO rates. The secondary endpoint is composite bleeding adverse event rates. These endpoints were evaluated by a vascular echocardiography several hours or the next day after the procedure.

Result

Among 1,533 patients, 26 were dialysis patients and 1,504 were non-dialysis patients. 1,386 people (90.5%) succeeded in puncture. Radial artery occlusion occurred in 7 patients (0.4%), all of whom were non-dialysis patients. There was no significant difference of RAO rate in dialysis patients and non-dialysis patients.

Conclusion

When performing DRA puncture, the probability of radial artery occlusion is not higher in dialysis patients than non-dialysis patients. The DRA puncture may be one of the option as puncture site even in dialysis patients.

P1830The Relationship between Spontaneous Ruptured Aortic Plaques/Injuries and Cardiovascular

Background

Non-obstructive general angioscopy has enabled to demonstrate high incidence of various types of spontaneous ruptured aortic plaques/injuries (SRAPIs).

Purpose

The aim of the study is to clarify the relationship between SRAPI and cardiovascular risk factors.

Methods

A total of 439 consecutive patients who had or suspected coronary artery disease were performed angioscopy and were screened SRAPI from ascending aorta to iliac artery. The incidence and the number of SRAPI were analyzed. Association between the total number of total SRAP and patients' characteristics were analyzed.

Results

The total number of SRAPI detected was 2211, 10 [4,22](median [IQR]) per patient.

The numbers of high incidence of representative SRAPI, such as erosion, intramural bleeding, puff-chandelier rupture, puff rupture, fissure, flap, bleeding from fissure, and subintimal bleeding were 327, 313, 268, 262, 224, 167, 120, and 91, respectively. Stepwise multiple linear regression analysis indicated that age, smoking, HbA1c, and coronary heart disease significantly affected the numbers of overall SRAPI (Table).

Conclusions

SRAPIs were associated with cardiovascular risk factors.

Single-cell DNA replication profiling identifies spatiotemporal developmental dynamics of chromosome organization

In mammalian cells, chromosomes are partitioned into megabase-sized topologically associating domains (TADs). TADs can be in either A (active) or B (inactive) subnuclear compartments, which exhibit early and late replication timing (RT), respectively. Here, we show that A/B compartments change coordinately with RT changes genome wide during mouse embryonic stem cell (mESC) differentiation. While A to B compartment changes and early to late RT changes were temporally inseparable, B to A changes clearly preceded late to early RT changes and transcriptional activation. Compartments changed primarily by boundary shifting, altering the compartmentalization of TADs facing the A/B compartment interface, which was conserved during reprogramming and confirmed in individual cells by single-cell Repli-seq. Differentiating mESCs altered single-cell Repli-seq profiles gradually but uniformly, transiently resembling RT profiles of epiblast-derived stem cells (EpiSCs), suggesting that A/B compartments might also change gradually but uniformly toward a primed pluripotent state. These results provide insights into how megabase-scale chromosome organization changes in individual cells during differentiation.

Simplifying the Chemical Structure of Cationic Lipids for siRNA-Lipid Nanoparticles

We report a potent cationic lipid, SST-02 ((3-hydroxylpropyl)dilinoleylamine), which possesses a simple chemical structure and is synthesized just in one step. Cationic lipids are key components of siRNA-lipid nanoparticles (LNP), which may serve as potential therapeutic agents for various diseases. For a decade, chemists have given enhanced potency and new functions to cationic lipids along with structural complexity. In this study, we conducted a medicinal chemistry campaign pursuing chemical simplicity and found that even dilinoleylmethylamine (SST-01) and methylpalmitoleylamine could be used for the in vitro and in vivo siRNA delivery. Further optimization revealed that a hydroxyl group boosted potency, and SST-02 showed an ID₅₀ of 0.02 mg/kg in the factor VII (FVII) model. Rats administered with 3 mg/kg of SST-02 LNP did not show changes in body weight, blood chemistry, or hematological parameters, while the AST level decreased at a dose of 5 mg/kg. The use of SST-02 avoids a lengthy synthetic route and may thus decrease the future cost of nucleic acid therapeutics.

[Does the Relationship between Home and Palliative Care Wards Change-The Influence of the Revision of Medical Compensation]

Home care and at-home-based palliative care for cancer patients are being improved bythrough a basic law on cancer control and subsequent institutional reforms in 2007. However, in the revision of the medical treatment fee in 2018, it is a big feature that the facilitystandard for the waiting days and the home return rate was built in the palliative care ward. The number of inpatients in our palliative care department was 3,835 in the 5 years from 2013 to 2018. It consists of 2,414 in general wards and 1,421 in the palliative care ward, regarding the home return rate, the total was 27.5%, but there were 891 from the general ward and 163 from the palliative care ward. In the future, the role of palliative care wards is expected to change, shorting the number of waiting days, and providing a much greater degree of flexibilityin the wayof promoting home care. The important thing is to establish a system to be able to choose the place of recuperation quickly depending on the patient, familysituation, and their hope. Hence, we aim to strengthen the home-visit system by emphasizing the continuityof medical treatment while maintaining the relationship of mutual trust among the local cooperative clinics.

Seasonal gaps in measles vaccination coverage in Madagascar

INTRODUCTION

Measles elimination depends on the successful deployment of measles containing vaccine. Vaccination programs often depend on a combination of routine and non-routine services, including supplementary immunization activities (SIAs) and vaccination weeks (VWs), that both aim to vaccinate all eligible children regardless of vaccination history or natural infection. Madagascar has used a combination of these activities to improve measles coverage. However, ongoing massive measles outbreak suggests that the country was in a "honeymoon" period and that coverage achieved needs to be re-evaluated. Although healthcare access is expected to vary seasonally in low resources settings, little evidence exists to quantify temporal fluctuations in routine vaccination, and interactions with other immunization activities.

METHODS

We used three data sources: national administrative data on measles vaccine delivery from 2013 to 2016, digitized vaccination cards from 49 health centers in 6 health districts, and a survey of health workers. Data were analyzed using linear regressions, analysis of variance, and t-tests.

FINDINGS

From 2013 to 2016, the footprint of SIAs and VWs is apparent, with more doses distributed during the relevant timeframes. Routine vaccination decreases in subsequent months, suggesting that additional activities may be interfering with routine services. The majority of missed vaccination opportunities occur during the rainy season. Health facility organization and shortage of vaccine contributed to vaccination gaps. Children born in June were the least likely to be vaccinated on time.

DISCUSSION

Evidence that routine vaccination coverage varies over the year and is diminished by other activities suggests that maintaining routine vaccination during SIAs and VWs is a key direction for strengthening immunization programs, ensuring population immunity and avoiding future outbreaks.

FUNDING

Wellcome Trust Fund, Burroughs Wellcome Fund, Gates Foundation, National Institutes of Health.

S-1 and irinotecan plus bevacizumab versus mFOLFOX6 or CapeOX plus bevacizumab as first-line treatment in patients with metastatic colorectal cancer (TRICOLORE): a randomized, open-label, phase III, noninferiority trial

Background

Combination therapy with oral fluoropyrimidine and irinotecan has not yet been established as first-line treatment of metastatic colorectal cancer (mCRC). We carried out a randomized, open-label, phase III trial to determine whether S-1 and irinotecan plus bevacizumab is noninferior to mFOLFOX6 or CapeOX plus bevacizumab in terms of progression-free survival (PFS).

Patients and methods

Patients from 53 institutions who had previously untreated mCRC were randomly assigned (1 : 1) to receive either mFOLFOX6 or CapeOX plus bevacizumab (control group) or S-1 and irinotecan plus bevacizumab (experimental group; a 3-week regimen: intravenous infusions of irinotecan 150 mg/m2 and bevacizumab 7.5 mg/kg on day 1, oral S-1 80 mg/m2 twice daily for 2 weeks, followed by a 1-week rest; or a 4-week regimen: irinotecan 100 mg/m2 and bevacizumab 5 mg/kg on days 1 and 15, S-1 80 mg/m2 twice daily for 2 weeks, followed by a 2-week rest). The primary end point was PFS. The noninferiority margin was 1.25; noninferiority would be established if the upper limit of the 95% confidence interval (CI) for the hazard ratio (HR) of the control group versus the experimental group was less than this margin.

Result

Between June 2012 and September 2014, 487 patients underwent randomization. Two hundred and forty-three patients assigned to the control group and 241 assigned to the experimental group were included in the primary analysis. Median PFS was 10.8 months (95% CI 9.6-11.6) in the control group and 14.0 months (95% CI 12.4-15.5) in the experimental group (HR 0.84, 95% CI 0.70-1.02; P < 0.0001 for noninferiority, P = 0.0815 for superiority). One hundred and fifty-seven patients (64.9%) in the control group and 140 (58.6%) in the experimental group had adverse events of grade 3 or higher.

Conclusion

S-1 and irinotecan plus bevacizumab is noninferior to mFOLFOX6 or CapeOX plus bevacizumab with respect to PFS as first-line treatment of mCRC and could be a new standard treatment.

Clinical trials number

UMIN000007834.

DNA Replication Timing Enters the Single-Cell Era

In mammalian cells, DNA replication timing is controlled at the level of megabase (Mb)-sized chromosomal domains and correlates well with transcription, chromatin structure, and three-dimensional (3D) genome organization. Because of these properties, DNA replication timing is an excellent entry point to explore genome regulation at various levels and a variety of studies have been carried out over the years. However, DNA replication timing studies traditionally required at least tens of thousands of cells, and it was unclear whether the replication domains detected by cell population analyses were preserved at the single-cell level. Recently, single-cell DNA replication profiling methods became available, which revealed that the Mb-sized replication domains detected by cell population analyses were actually well preserved in individual cells. In this article, we provide a brief overview of our current knowledge on DNA replication timing regulation in mammals based on cell population studies, outline the findings from single-cell DNA replication profiling, and discuss future directions and challenges.

Abstract P2-08-37: The prognostic impact of synaptojanin 2 expression in estrogen receptor α-positive breast cancer patients

Background: Synaptojanin 2 (SYNJ2) was reported to be a druggable mediator of metastasis. It is overexpressed and amplified in breast cancer, particularly estrogen receptor α (ERα)-positive breast cancer. SYNJ2 was also shown to promote cell migration and invasion in breast cancer xenograft cultures and lung metastasis in mice. Here, we investigated SYNJ2 mRNA expression in breast cancer patients during long-term follow-up.

Materials and methods: A total of 434 invasive breast cancer tissues were analyzed for SYNJ2mRNA expression using TaqMan PCR, and the correlation of this expression with patient clinicopathological factors was determined. We also examined the expression of markers associated with tumor-initiating capacity, such as SNAI1, SNAI2, and VIM. Survival curves were analyzed using the Kaplan–Meier method. Cox proportional hazards regression analysis was used for univariate and multivariate analyses of prognostic values.

Results: The median follow-up period was 10.7 years. We found positive correlations between high expression of SYNJ2 mRNA and shorter disease-free survival in breast cancer patients (P=0.049), which was limited to ERα-positive patients (P=0.020) and not seen in ERα-negative patients (P=0.863). High SYNJ2 mRNA levels were positively correlated with high tumor grade, ERα negativity, and node positivity. Multivariate analysis indicated that high SYNJ2 mRNA expression was an independent factor for poor disease-free survival in breast cancer patients.

Multivariate analysis of poor disease-free survival   DFS    Mutivariate   All patientsp valueHR (95%CI)Tumor size2cm and fewer1540.43151 (Reference) more than 2cm280 1.19 (0.78-1.85)Lymph node metastasisNegative2190.0001 and fewer1 (Reference) Positive184 5.61 (3.59-9.05) Unknown31 2.40 (0.89-5.48)Grade1,22330.38471 (Reference) 3195 1.20 (0.79-1.81) Unknown6 0.17 (1.78-3.49)ER statusPositive3370.02621 (Reference) Negative97 2.06 (1.87-4.07)PgR statusPositive2930.39511 (Reference) Negative141 1.30 (0.70-2.28)SYNJ2 mRNA expressionlow2170.02251 (Reference) high217 1.57 (1.07-2.34)

Conclusion:High SYNJ2 expression was shown to be an independent predictive factor of poor prognosis in ERα-positive breast cancer patients. SYNJ2 could therefore be used as a candidate biomarker and therapeutic target in breast cancer.

Citation Format: Nishikawa S, Kondo N, Wanifuchi-Endo Y, Hisada T, Uemoto Y, Katagiri Y, Dong Y, Kato H, Takahashi S, Toyama T. The prognostic impact of synaptojanin 2 expression in estrogen receptor α-positive breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-37.

Abstract P4-08-29: Lymphatic invasion is an independent risk factor in patients with small node-negative luminal breast cancer

[Background]

In patients with node-negative (N0), hormone receptor-positive, human epidermal growth factor receptor (HER2) -negative (luminal) breast cancer, the impact of lymphatic invasion (ly) on the prognosis remains to be clarified.

[Methods]

Among 3,158 patients with primary breast cancers who underwent surgery in our institute from January 2007 to December 2009, we analyzed 1027 N0 luminal invasive breast cancers without preoperative systemic therapy. The luminal breast cancer was defined as hormone receptor-positive (ER of ≥ 10% or PgR of ≥ 10%) and HER2-negative (immunohistochemistry: 0, 1+ or FISH: ratio &lt; 2.0) cancer in the postoperative pathological specimen. ly was defined as positive when cancer cell nests were detected within the lymph duct in the whole specimen. N0 was confirmed pathologically by the sentinel lymph node biopsy in all the patients. The Fisher's exact test was used for comparison between different categories. The distant recurrence rate (DRR) was analyzed using the Kaplan-Meier method and the log-rank test. For multivariate analysis, Cox's regression analysis was performed.

[Results]

The median follow-up period was 103.8 months (range: 5.6-128.8). Recurrence with distant metastasis occurred in 26 patients (2.5%). There were 5 (0.7%) deaths related to breast cancer. ly was detected in 240 patients (23.4%). In the ly-positive group, the tumor size was larger (p = 0.007), and the nuclear grade (NG) was higher (p &lt; 0.001) than in the ly-negative group. Postoperative endocrine therapy (p &lt; 0.001) and postoperative chemotherapy (p &lt; 0.001) were more frequently employed for patients with ly-positive tumor. The univariate analysis showed that ly positivity (p &lt; 0.001), large tumor size (p &lt; 0.001), high NG (p &lt; 0.001), PgR negativity (p = 0.002) and the history of adjuvant chemotherapy (p &lt; 0.001) were associated with high DRR. In the multivariate analysis, large tumor size (p = 0.007) and PgR negativity (p = 0.015) remained significant. Although positive ly had a risk ratio of 2.2, it was not an independent risk factor.When restricted to T1 tumor (n = 899), the aforementioned factors still showed prognostic value in the univariate analysis, among which ly positivity (p = 0.004)remained significant together with PgR negativity (p = 0.047)in themultivariate analysis.The 8-year DRR was very favorable (0.8%) in patients with ly-negative T1N0 tumor while it was modest (6.6%) in patients with ly-positive T1N0 tumor (p &lt; 0.001). Only 1.3% of the patients had received adjuvant chemotherapy in the ly-negative group while 27% of the patients had in the ly-positive group.

[Conclusion]

Lymphatic invasion was associated with higher DRR although it was not independent in the multivariate analysis among patients with N0 luminal breast cancer. When restricted to patients with T1N0 luminal breast cancer, the presence of ly was independently associated with higher risk of distant recurrence. It suggests that the assessment of ly is clinically more relevant when considering treatment options for small luminal breast cancer.

Citation Format: Abe T, Ito Y, Fukada I, Shibayama T, Ono M, Kobayashi T, Kobayashi K, Takahashi S, Horii R, Akiyama F, Iwase T, Ueno T, Ohno S. Lymphatic invasion is an independent risk factor in patients with small node-negative luminal breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-29.

Abstract PD1-08: Phase 1/1b study of novel oral selective estrogen receptor degrader (SERD) LSZ102 for estrogen receptor-positive (ER+) advanced breast cancer (ABC) with progression on endocrine therapy (ET)

Background: LSZ102 is an orally bioavailable SERD that inhibits ER gene transcription, induces receptor degradation, and blocks ER-dependent cell growth in preclinical models. This study is evaluating LSZ102 as a single agent and in combination with the CDK 4/6 inhibitor ribociclib (LEE011) or the PI3K inhibitor alpelisib (BYL719) in patients (pts) with ER+ ABC. The LSZ102 single agent data are presented below; combination data are not discussed.

Methods: In the dose-escalation phase evaluating single-agent LSZ102 (Arm A), pts (age ≥18 years; ECOG PS 0-1) with histologically confirmed ER+ ABC and progression on endocrine therapy (ET) received LSZ102. The starting dose was 200 mg once daily. The primary objective of Arm A was to characterize the safety and tolerability of LSZ102 and identify a recommended dose for expansion (RDE). Secondary objectives included preliminary antitumor activity and pharmacokinetics (PK).

Results: As of January 22, 2018, 57 pts were enrolled to Arm A (LSZ102 200 mg, n=4; 400 mg, n=6; 450 mg fasted, n=15; 450 mg with food, n=6; 600 mg, n=20; 900 mg, n=6). Median age was 60 years, 75% (n=43) of pts had an ECOG PS of 0, 56% (n=32) had received prior fulvestrant, and 58% (n=33) had received prior CDK4/6 inhibitors; median number of prior lines of therapy (all settings) was 6. At data cut-off, 48 pts had discontinued treatment, most (n=45, 94%) due to disease progression. Dose-limiting toxicities across treatment groups included diarrhea (2 pts in the 900-mg group), vomiting (1 pt in the 600-mg group), and AST and ALT elevation (1 pt in the 450-mg with food group). The most common treatment-related adverse events (AEs) in the treatment period were diarrhea (60%), nausea (56%), and vomiting (30%). In the treatment period, treatment-related grade 3 AEs (12%) were infrequent, and there were no such grade 4 events. Six pts (11%) required dose reduction due to AEs (nausea, vomiting or diarrhea); 4/6 of the dose reductions occurred at 900 mg. Preliminary PK assessment showed rapid absorption and dose-proportional increases in LSZ102 exposure; trough concentrations were above the predicted tumorostatic concentrations at doses of ≥400 mg. Based on PK results for the 450-mg fasted and fed cohorts, LSZ102 exposure does not appear to be affected by dosing with a regular meal. Evidence of ER modulation by immunohistochemistry was observed in paired baseline and on-treatment biopsies. 18F-fluoroestradiol positron emission tomography (FES-PET) analysis (n=6) demonstrated abrogation of FES-PET signal for pts in the 450-mg and 600-mg dose groups. Seventeen pts (29.8%) had a best response of stable disease, and 1 pt, who happened to be in the 600-mg group, achieved a partial response.

Conclusion: In heavily pretreated pts, LSZ102 was well tolerated, demonstrated antitumor activity, and achieved effective exposure levels based on PK and pharmacodynamics. Food intake did not appear to significantly alter the PK profile of LSZ102. Dose escalation for LSZ102 in combination with ribociclib or alpelisib is ongoing and will be reported in a future analysis. An update on the recommended single agent dose and schedule will be presented.

Citation Format: Jhaveri K, Curigliano G, Yap Y-S, Cresta S, Duhoux FP, Terret C, Takahashi S, Ulaner GA, Kundamal N, Baldoni D, Liao S, Crystal A, Juric D. Phase 1/1b study of novel oral selective estrogen receptor degrader (SERD) LSZ102 for estrogen receptor-positive (ER+) advanced breast cancer (ABC) with progression on endocrine therapy (ET) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD1-08.

Abstract P3-03-34: Sentinel lymph node biopsy is unnecessary in ductal carcinoma in situ patients diagnosed by biopsy

Background: Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer 2018 state that sentinel lymph node (SN) biopsy is unnecessary for patients treated with breast-conserving therapy (BCT) and with an expected final pathological diagnosis of ductal carcinoma in situ (DCIS). Regardless of whether they were diagnosed with DCIS by biopsy before surgery, 78% of patients currently undergo axial procedures in Japan because invasive lesions may be detected in surgical specimens. This study examined whether SN biopsy can be omitted in DCIS patients diagnosed by biopsy and which factors are associated with invasion.

Methods: Patients who underwent definitive surgery for DCIS diagnosed by preoperative biopsy at our institution from May 2004 to January 2018 were investigated retrospectively. The factors associated with upstaging to invasive cancer from DCIS were examined with Fisher's exact test and the t-test. (Age, Tumor size, Operation (Mastectomy or BCT), Biopsy method (Core Needle Biopsy or Vaccume-Assisted Biopsy), Mammography (ditected or not-detected), Ultrasound (ditected or not-detected, mass or non-mass), Comedo, ER, PgR, HER2)

Results: A total of 311 patients were enrolled in this study, of whom 277 (89.1%) underwent SN; six of these (2.2%) had SN metastasis. All six cases were upstaging to invasive cancer: five (1.8%) had micrometastasis and one had macrometastasis (0.4%). From a surgical viewpoint, SN metastasis were detected in 3/161 (1.9%) cases treated with mastectomy and 3/150 (2.4%) cases treated with BCT. Although all three cases treated with BCT had micrometastasis, one case treated with mastectomy had macrometastasis (the other two cases had micrometatastasis). A total of 80/311 cases (25.7%) upstaged to invasive cancer and the only predictor of invasion was tumor size on images (p=0.0002). We could not determine the effective cut-off for tumor size because the area under the receiver operating characteristic curve was 0.63&lt;0.70.

Tabule 1.Tumor size on images was the only predictor of invasion. Upstaging (N=80)DCIS (N=231)P valueTumor size: mm (95% Confidence Interval)47.5 (41.9-53.2)33.9 (30.5-37.3)0.0002

Conclusion: Tumor size was found to be the only predictor of invasion. Only 2.2% of DCIS patients had SN metastasis despite the fact that 25.7% patients were upstaged to invasive cancer. We conclude that SN biopsy is not necessary for DCIS patients diagnosed by biopsy.

Citation Format: Uemoto Y, Kondo N, Wanifuchi-Endo Y, Hisada T, Nishikawa S, Katagiri Y, Kato H, Takahashi S, Toyama T. Sentinel lymph node biopsy is unnecessary in ductal carcinoma in situ patients diagnosed by biopsy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-34.

Abstract P6-17-06: Characterization, monitoring and management of interstitial lung disease in patients with metastatic breast cancer: Analysis of data available from multiple studies of DS-8201a, a HER2-targeted antibody drug conjugate with a topoisomerase I inhibitor payload

Background: Several classes of anti-cancer agents including certain immunotherapies, systemic chemotherapies, and targeted therapies including trastuzumab and T-DM1 increase the risk of interstitial lung disease (ILD) and fatal cases have been reported. For DS-8201a, interim efficacy and safety analyses of available data established a final recommended dose of 5.4 mg/kg IV q3wk in advanced HER2-positive breast cancer (BC). Based on preliminary clinical results, ILD was identified as an important risk for DS-8201a. A robust monitoring and management plan was established across all studies and an international, independent ILD adjudication committee (AC) reviews the cases reported as ILD on an ongoing basis.

Methods: All subjects (sbj) who received ≥1 dose of DS-8201a across 7 ongoing studies were included in this analysis. Reported ILD (standardized MedDRA Query terms) included the terms ILD, pneumonitis, and organizing pneumonia. ILD frequencies were calculated based on investigator's assessment and after adjudication. The analysis of potential risk factors associated with ILD is ongoing.

Results: As of 21 June 2018, 448 sbj received ≥1 dose of DS-8201a across multiple tumor types, including BC. Of the 321 sbj with BC, 173 (53.9%) were from Japan, 103 (32.1%) from the US, and 45 (14.0%) from 6 other countries (Spain, South Korea, Taiwan, Belgium, France, and Italy). These sbj received 1 of 7 doses of DS-8201a (0.8 mg/kg: 3 sbjs, 1.6 mg/kg: 1 sbj, 3.2 mg/kg: 3 sbjs, 5.4 mg/kg: 111 sbjs, 6.4 mg/kg: 178 sbj, 7.4 mg/kg: 20 sbj, 8.0 mg/kg: 5 sbj). Overall, 44 cases of potential ILD were reported by the investigators across all tumor types (44/448, 9.8%; Grade ≥3 10/448, 2.2%). In sbj with BC who received 5.4 mg/kg, any grade and Grade ≥3 investigator-reported ILD were 7.2% (8/111) and 0.9% (1/111), respectively. The ILD AC assessed 30 of 44 cases; 22 were considered drug-related ILD, 4 were ILD but not drug-related, and 4 were found not to be ILD. For adjudicated drug-related ILD cases, the median time to onset was 159 (range; 46-591) days from the time of first dose.

  Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 All Grades All tumors, All doses (N=448)      Investigator-reported20 (4.5)14 (3.1)4 (0.9)1 (0.2)5 (1.1)44 (9.8)Cases adjudicated13840530Adjudicated as drug-related ILD9 (2.0)6 (1.3)3 (0.7)04 (0.9)22 (4.9) BC, All doses (N=321)      Investigator-reported17 (5.3)11 (3.4)3 (0.9)1 (0.3)4 (1.2)36 (11.2)Cases adjudicated11830426Adjudicated as drug-related ILD8 (2.5)6 (1.9)3 (0.9)04 (1.2)21 (6.5) BC, 5.4 mg/kg (N=111)      Investigator-reported4 (3.6)3 (2.7)001 (0.9)8 (7.2)Cases adjudicated120014Adjudicated as drug-related ILD00001 (0.9)1 (0.9)n (%), except where noted

Conclusions: These analyses confirm that ILD is an important identified risk for DS-8201a. Further analyses are ongoing to better understand the potential risk factors associated with the incidence of on-treatment ILD. When ILD is suspected, early diagnosis through appropriate imaging, laboratory tests, and pulmonary consultation as well as prompt management with steroids are recommended.

Citation Format: Powell CA, Camidge DR, Gemma A, Kusumoto M, Baba T, Kuwano K, Bankier A, Kiura K, Tamura K, Modi S, Tsurutani J, Doi T, Iwata H, Krop IE, Zhang L, Jasmeet S, Saito K, Shahidi J, Yver A, Takahashi S. Characterization, monitoring and management of interstitial lung disease in patients with metastatic breast cancer: Analysis of data available from multiple studies of DS-8201a, a HER2-targeted antibody drug conjugate with a topoisomerase I inhibitor payload [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-06.

Abstract OT1-03-01: Phase 1/1b study of novel oral selective estrogen receptor degrader (SERD) LSZ102 in combination with alpelisib (BYL719) in estrogen receptor-positive (ER+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC) with progression on endocrine therapy (ET)

Background: Although ET remains the basis of therapy for ER+, HER2– ABC, treatment resistance frequently occurs. Novel strategies to target the receptor and/or alternative pathways to overcome therapeutic resistance are under investigation. LSZ102 is a novel, orally bioavailable, nonsteroidal SERD. Preclinically, LSZ102 inhibits ER gene transcription, induces receptor degradation, blocks ER-dependent cell growth, and has synergistic activity with the phosphoinositide 3-kinase (PI3K)-alpha inhibitor alpelisib (BYL719). The present study is evaluating the safety and tolerability of LSZ102 plus alpelisib in patients with ER+, HER2– ABC with progression on ET.

Trial Design: This phase 1/1b, open-label study is enrolling ˜18-30 patients (men and women of any menopausal status) in Arm C of the dose-escalation part of the study, which investigates the combination of LSZ102 and alpelisib; additional study arms will investigate LSZ102 as a single agent or in combination with ribociclib. Enrollment in Arm C started after identification of a safe and tolerable single-agent dose for LSZ102. Alpelisib dosing began at 200 mg/day and will not be escalated beyond the maximum tolerated dose (MTD) determined in the alpelisib single-agent arm of study CBYL719X2101 (400 mg/day). Dose escalation of alpelisib in combination with LSZ102 is guided by BLRM and integrates Cycle 1 DLT rates, lower grade and later cycle AE, PK, PD and preliminary activity to identify a recommended dose for expansion (RDE). Patients will receive treatment until disease progression, unacceptable toxicity, or withdrawal of consent. For inclusion in the study, patients must have histologically confirmed ER+, HER2– ABC and disease progression after ET for ABC or recurrence on/within 12 months of completion of adjuvant ET. In the escalation part of the study, patients are eligible regardless of PIK3CA status. Premenopausal women must receive concomitant treatment with a gonadotropin-releasing hormone agonist. Eligible patients must have adequate bone marrow and organ function, Eastern Cooperative Oncology Group performance status of 0 or 1, and have completed and recovered from acute toxicities of radiotherapy and/or prior anticancer therapy. Exclusion criteria include symptomatic central nervous system metastases, clinically significant cardiac disease or impaired cardiac function (including a QT interval corrected for heart rate using Fridericia's formula [QTcF] &gt;460 ms in women or &gt;450 ms in men), uncontrolled diabetes mellitus type II (or type I), and prior treatment with a PI3K inhibitor. The primary objectives are characterization of safety and tolerability for the combination and identification of a recommended dose. Secondary objectives include characterization of pharmacokinetic properties and pharmacodynamic effects. Recruitment for Arm C is ongoing. NCT02734615

Citation Format: Curigliano G, Cresta S, Yap Y-S, Juric D, Duhoux FP, Terret C, Takahashi S, Layman RM, Kundamal N, Baldoni D, Liao S, Crystal A, Jhaveri K. Phase 1/1b study of novel oral selective estrogen receptor degrader (SERD) LSZ102 in combination with alpelisib (BYL719) in estrogen receptor-positive (ER+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC) with progression on endocrine therapy (ET) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-03-01.