Abstract GS4-06: Cancer risks and response to targeted therapy associated with BRCA2 variants of uncertain significance

Background: Germline genetic testing of individuals with a diagnosis of triple negative breast cancer, young age at diagnosis, or a family history of breast and/or ovarian cancer has led to the identification of many unique BRCA2 missense variants of uncertain significance (VUS). VUS in BRCA2 are predominantly missense mutations that have unclear relevance to breast, ovarian, and other cancers. Thus, patients found to have a germline BRCA2 VUS do not know if the variant is associated with high risks of these cancers similar to truncating mutations, intermediate risks more similar to CHEK2 mutations, or low risks of no clinical significance. Furthermore, it is unclear if germline BRCA2 VUS, or somatic VUS identified by tumor sequencing, are associated with hypersensitivity to selected DNA damaging and cross-linking agents.

Methods: We have used a homology directed repair (HDR) cell-based assay to characterize missense variants in the DNA binding domain (DBD) of BRCA2. The method has been validated using known pathogenic and known non-pathogenic BRCA2 missense variants and has 100% sensitivity (95% confidence interval (CI): 75.3%–100%) and 100% specificity (95% CI: 81.5%–100%) for pathogenic BRCA2 variants. A classifier of variant pathogenicity based on the mean and variances of the distributions of the HDR results of the known pathogenic and neutral variants has been established. We have also developed PARP inhibitor and cisplatin drug response assays for BRCA2 missense variants.

Results: Assessment of 207 BRCA2 missense variants, identified in public databases such as BRCA exchange and ClinVar, by the HDR assay identified 71 deleterious variants with >99% probability of pathogenicity, 116 neutral variants with >99% probability of neutrality, and 20 with hypomorphic activity and potentially intermediate risk. A combination of the functional data and sequence-based predictors of protein activity in a Bayesian prediction model resulted in classification of the deleterious variants as pathogenic cancer predisposing variants and the neutral variants as non-pathogenic with low clinical significance. The influence of the deleterious/pathogenic variants on PARPi and cisplatin response was also assessed.

Conclusion: The HDR assay is effective for characterization of BRCA2 VUS. The combination of functional data and in silico prediction models provides a robust tool for clinical annotation of BRCA2 VUS. HDR function of BRCA2 missense variants is strongly correlated with response to targeted therapy.

Citation Format: Couch FJ, Shimelis H, Hart SN, Moore RM, Thomas A, Lipton GB, Iversen E. Cancer risks and response to targeted therapy associated with BRCA2 variants of uncertain significance [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS4-06.

Significant Changes in Circulating Plasma Levels of IGF1 and IGFBP3 after Conventional or Dose-Intensified Adjuvant Treatment of Breast Cancer Patients with one to three Positive Lymph Nodes

The insulin-like growth factor 1 (IGF1) and its binding protein IGFBP3 (insulin-like growth factor binding protein 3) play a pivotal role during the growth and development of tissues. The purpose of this study was to evaluate the influence of anthracycline- and taxane-containing adjuvant chemotherapy in breast cancer patients on the circulating plasma levels of IGF1 and its main binding protein, IGFBP3. This investigation was part of a prospective randomized phase III study in which breast cancer patients were treated with either conventional or dose-intensified adjuvant chemotherapy. The factors were quantified in the plasma of 151 patients with a commercially available sandwich enzyme immunoassay. Before therapy, both parameters were within the normal range in most patients (n=145 and n=144). After therapy, both factors had increased significantly by 29% (IGF1) and 19% (IGFBP3), with the highest increase being observed in the dose-intensified group. Correlations with patient and tumor characteristics revealed a relatively higher increase in both parameters in premenopausal patients, patients with lower-grade tumors, more positive lymph nodes, larger tumor volume, and positive hormone receptor status. No correlation was found with the HER2 expression of the tumors.

Staff perception on reduction of medication in patients with chronic schizophrenia

This exploratory study assessed staff perceptions to the reduction of maintenance neuroleptic medication in patients with chronic schizophrenia living in a long-stay hospital. Ten in-patients were assessed at regular times over six months. In addition to the Brief Psychiatric Rating Scale (BPRS), data were obtained from nursing staff on patients' ward behaviour (Ward Behaviour Interview Schedule, WBIS), clinical global opinion (CGI) and staff reaction (SR) to the reduction of medication plan. The average decrease of BPRS and WBIS was not related to keyworker's clinical global impression. The SR increased against the reduction of medication over the study period (P<0.05). Staff perceptions in the treatment of patients with chronic schizophrenia and their possible influence on prescribed closes should be taken into consideration in addition to psychopathology and clinical symptoms.

Effects of olive-cake supplementation on fatty acid composition, antioxidant status and lipid and meat-colour stability of Barbarine lambs reared on improved rangeland plus concentrates or indoors with oat hay plus concentrates

The effects of feeding system (indoor vs rangeland) and olive-cake (OC) supplementation (control vs supplemented) on fatty acid (FA) composition, lipid oxidation status and meat-colour stability were studied. Lambs were fed indoor with hay (OH) or reared on improved rangeland (RL). All lambs received concentrate at a rate of 400 g/head.day. Twenty-four 6-month-old Barbarine lambs with an average weight of 24.3 ± 1.1 kg were assigned into the following four groups: OH without OC, OH with OC, RL without OC and RL with OC. Supplemented groups received 280 g/day of OC. Lambs were reared for ~3 months and then slaughtered at 33 kg. Feeding lambs on rangeland increased proportions of polyunsaturated fatty acids (PUFA, P < 0.05), n-3 PUFA (P < 0.01) and long-chain n-3 PUFA (P < 0.01) and decreased those of C16:0 and monounsaturated fatty acids (P = 0.052). Higher PUFA : saturated FA (SFA) (P < 0.001) and lower n-6 : n-3 PUFA (P < 0.01) ratios were found for RL lambs. The peroxidisability index was higher (P = 0.024) for RL lambs. Whereas, a lower malondialdehyde concentration (P < 0.001) was found for meat of RL group after 5-day storage, because of a higher vitamin E concentration (P < 0.001) and catalase activity (P = 0.002). Moreover, colour was more stable for meat of RL lamb. OC supplementation reduced only superoxide dismutase activity (P = 0.033) and did not have any effect on lipid peroxidation and colour stability. No interactions were noted between the feeding system and olive-cake supplementation. Meat lambs produced on rangeland had a healthier fatty acid composition. Lipids were more stable to oxidation than was meat produced indoor with hay and concentrate.

A novel fibrinogen γ chain frameshift deletion (c.637delT) in a patient with hypodysfibrinogenemia associated with thrombosis

Inherited fibrinogen (FG) disorders are rare and result in quantitative or/and qualitative FG deficiency. While the majority of patients with clinically relevant FG deficiencies demonstrate a bleeding phenotype, a subset of patients are at increased risk of thrombosis.

We report a 54-years old man presenting with a thrombophilic phenotype characterized by two episodes of unprovoked venous thrombosis and a deep vein thrombosis several weeks after myocardial infarction. Recently, he developed A. carotis communis thrombosis and died. Coagulation tests were done using standard procedures. FG genes were screened using direct sequencing. Effect on fibrin clot structure was analyzed by scanning electron microscopy (SEM) and FG chain polymerization was analysed using SDS-PAGE.

While thrombophilia testing was negative, we found a decreased concentration of clottable FG (126-148 mg/dl) compared to FG antigen (182-194 mg/dl of normal). The thrombin time was slightly prolonged, while aPTT and reptilase time were within the normal range. A novel deletion in FGG gene (c.637delT) resulting in a frameshift and the premature termination of the γ chain at amino acid position p.228 was identified. SDS-PAGE showed a time-shift in γ-γ and α-α cross linking. SEM showed no statistically significant differences between the patient´s and a healthy control´s fibrin clot structure.

In addition to the reduction of FG concentration expected by the nature of the mutation also a functional defect (hypodysfibrinogenemia) was found. Moreover this mutation seems to increase the risk of thrombosis warranting long term anticoagulation possibly in a combination with antiplatelet drugs.

Associations of blood glucose dynamics with antihyperglycemic treatment and glycemic variability in type 1 and type 2 diabetes

AIMS

The dynamical structure of glucose fluctuation has largely been disregarded in the contemporary management of diabetes.

METHODS

In a retrospective study of patients with diabetes, we evaluated the relationship between glucose dynamics, antihyperglycemic therapy, glucose variability, and glucose exposure, while taking into account potential determinants of the complexity index. We used multiscale entropy (MSE) analysis of continuous glucose monitoring data from 131 subjects with type 1 (n = 18), type 2 diabetes (n = 102), and 11 nondiabetic control subjects. We compared the MSE complexity index derived from the glucose time series among the treatment groups, after adjusting for sex, age, diabetes duration, body mass index, and carbohydrate intake.

RESULTS

In type 2 diabetic patients who were on a diet or insulin regimen with/without oral agents, the MSE index was significantly lower than in nondiabetic subjects but was lowest in the type 1 diabetes group (p < 0.001). The decline in the MSE complexity across the treatment groups correlated with increasing glucose variability and glucose exposure. Statistically, significant correlations existed between higher MSE complexity indices and better glycemic control. In multivariate regression analysis, the antidiabetic therapy was the most powerful predictor of the MSE (β = -0.940 ± 0.242, R ² = 0.306, p < 0.001), whereas the potential confounders failed to contribute.

CONCLUSIONS

The loss of dynamical complexity in glucose homeostasis correlates more closely with therapy modalities and glucose variability than with clinical measures of glycemia. Thus, targeting the glucoregulatory system by adequate therapeutic interventions may protect against progressive worsening of diabetes control.

Pilot study of MRI/ultrasound fusion imaging in postpartum assessment of Cesarean section scar

OBJECTIVE

To evaluate prospectively the uterine scar after Cesarean section (CS) and the corresponding uterine region after vaginal delivery (VD) at 6 weeks postpartum using transabdominal (TAS) and transvaginal (TVS) sonography with magnetic resonance imaging (MRI) fusion to investigate whether fusion imaging allows standardized and reproducible identification of the scar location and measurement of uterine wall thickness compared with high-resolution MRI alone.

METHODS

Pelvic MRI was performed 6 weeks after delivery in 30 women (10 with planned CS (PCS), 10 with emergency CS (ECS) and 10 with VD). After transfer of MRI-DICOM datasets to the ultrasound system, the scar region after CS and the corresponding uterine region after VD were examined by TAS (5 MHz) and TVS (10 MHz) using smart fusion with MRI to guide visualization of the region in the corresponding sectional planes for both modalities. Vascularization of the scar region was determined as a percentage area using power Doppler ultrasound. Anterior (AW) and posterior (PW) uterine wall thickness was measured using TAS and TVS with fusion imaging and using MRI alone.

RESULTS

TVS with fusion imaging was applied successfully for uterine assessment at the end of the postpartum period in all women. TAS failed to identify the scar area in three women. Imaging techniques were similar in the evaluation of AW and PW thickness following VD. MRI and MRI/TVS fusion showed significant differences in AW thickness or scar area, in terms of the difference relative to PW thickness, in women with PCS and ECS (MRI: PCS, 4.3 mm; ECS, 4.2 mm; VD, 0.8 mm; P = 0.034; MRI/TVS fusion: PCS, 2.0 mm; ECS, 3.3 mm; VD, 0.0 mm; P = 0.01). The degree of vascularization in the scar region measured by power Doppler ultrasound was lower after PCS (13.1 ± 9.4%/area) and ECS (17.0 ± 8.2%/area) than after VD (34.6 ± 8.5%/area; P = 0.0017).

CONCLUSION

MRI/ultrasound fusion imaging can be performed in a reproducible manner for examination of the postpartum uterus. MRI/TVS fusion enables standardized identification of the CS scar location and vascularization is reduced in this area. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Mental health status of workers in selected tea estates, Tamil Nadu, India

Introduction: The prevalence of mental illnesses among industrial workers ranged between 14% - 51%, which is more than that of the general population. Individual’s psychosocial functioning has an impact on the work efficiency and hence the current study was undertaken to screen workers in tea plantations.Objective: To document the prevalence of probable mental illness and its associated factors among workers in selected tea estates in South India.Methodology: A cross sectional study was done in two tea estates in Tamil Nadu from March to May 2012.  The General Health Questionnaire (GHQ) 28 was used to screen for mental health status. Socio-demographic details, work profile and associated risk factors were also documented.Results: Among the 400 subjects interviewed, 75.5% were females. The mean age was 43.21 (±7.47) years and the mean work experience was 21.38 (±9.31) years. In this study 12.8% subjects screened positive for probable mental illness and 1%, 1%, 0.2% and 1.5% screened positive for the domains of somatic symptoms, anxiety/insomnia, social dysfunction and severe depression respectively. Workers who screened positive for probable mental illness had availed significantly greater duration of leave in the previous year. There was no significant association of mental illness with age, gender, marital status, substance abuse, designation, co-morbidity and stressful life events.Conclusion: The prevalence of probable mental illness was similar to other occupational settings. Management of the associated risk factors may improve one’s work efficiency and productivity. 

Study of η and η' Photoproduction at MAMI

The reactions γp→ηp and γp→η^{'}p are measured from their thresholds up to the center-of-mass energy W=1.96  GeV with the tagged-photon facilities at the Mainz Microtron, MAMI. Differential cross sections are obtained with unprecedented statistical accuracy, providing fine energy binning and full production-angle coverage. A strong cusp is observed in the total cross section for η photoproduction at the energies in the vicinity of the η^{'} threshold, W=1896  MeV (E_{γ}=1447  MeV). Within the framework of a revised ηMAID isobar model, the cusp, in connection with a steep rise of the η^{'} total cross section from its threshold, can only be explained by a strong coupling of the poorly known N(1895)1/2^{-} state to both ηp and η^{'}p. Including the new high-accuracy results in the ηMAID fit to available η and η^{'} photoproduction data allows the determination of the N(1895)1/2^{-} properties.

Combined effect of toe out gait and high tibial osteotomy on knee adduction moment in patients with varus knee deformity

BACKGROUND

Gait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear. This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored.

METHODS

Three-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls.

FINDINGS

Pre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls.

INTERPRETATION

Increasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.

Spreading of Thelazia callipaeda in Greece

Thelazia callipaeda (Spirurida, Thelaziidae), the so-called oriental eyeworm, has been increasingly reported as an agent of infection in animals and humans from many European countries. Clinical signs range from subclinical to moderate or severe ocular disorders (e.g., epiphora, photophobia, conjunctivitis, keratitis, ulcers). The disease has been also diagnosed in animals from countries of the Balkan area (e.g., Croatia, Bosnia and Herzegovina and Serbia), but only a single case of canine thelaziosis, presumably autochthonous, was reported in Northern Greece. In this study, we provide robust information of the occurrence of thelaziosis in Greece by reporting autochthonous cases of thelaziosis in dogs (n = 46), cats (n = 3) and in one rabbit (Oryctolagus cuniculus) living in Northern and Central regions of Greece. The occurrence of a single haplotype of the cytochrome oxidase subunit 1 gene confirms that the same zoonotic haplotype of the parasite circulating in Europe is also spreading in Greece. The increased awareness of this parasitosis is crucial to limit the risk of further infections in both humans and animals in European countries.

Abstract P6-09-24: Vitamin D level impacts odds of pathologic complete response following neoadjuvant therapy in operable breast cancer

Introduction:

Pathologic complete response (pCR) following neoadjuvant systemic chemotherapy (NAC) serves as a measure of tumor responsiveness and is a recognized surrogate for improved long-term outcomes. Some, but not all, studies have found a positive association between vitamin D (VD) and disease-free survival. We investigated if VD at diagnosis or during chemotherapy impacts pCR following neoadjuvant chemotherapy for operable breast cancer.

Methods:

Patients from Iowa were eligible if they were enrolled in one of two Iowa registries and had serum from before or during NAC tested for VD. French patients enrolled in a previous study of the impact of NAC on vitamin D and bone metabolism were considered for this study. VD deficiency was defined as &lt;20 ng/ml. pCR was defined as no residual invasive disease in breast and lymph nodes. Firth-penalized logistic regression multivariable model was used.

Results:

The final cohort included 144 women. 84.7% of VD levels were obtained before initiation of chemotherapy. There was no difference between the French and Iowa cohorts with regard to age (p=0.20), clinical stage (p=0.22), disease receptor status (HER2+ [Hormone receptor (HR)+ or HR-], HR+/HER2-, and Triple Negative) (p=0.32) and rate of pCR (p=0.34). French women had lower body mass index (mean 24.8 vs 28.8, p&lt;0.01), lower VD levels (mean 21.5 vs 27.5, p&lt;0.01) and underwent lumpectomy instead of mastectomy more frequently (75.3% vs 47.8%, p&lt;0.01) than Iowa women. Only pCR differed between the VD sufficient and deficient groups (Table 1). In multivariate analysis, after adjusting for the effects of cohort, clinical stage, and disease type by receptor status, VD deficiency put a woman at 2.68 times increased odds of not attaining a pCR (95%CI: 1.12-6.41, p=0.03) (Table 2). This variable remained significant with VD deficiency defined as &lt;30 ng/ml and when considering this variable continuously.

Conclusion:

In this retrospective cohort, VD level before or during NAC was associated with pCR. Prospective trials could elucidate if maintaining VD levels during NAC, a highly modifiable variable, can be utilized to improve cancer outcomes in addition to benefiting other established health outcomes.

Table 1: VD Deficient and Sufficient Groups  Vitamin D (ng/ml)   Deficient (&lt; 20)Sufficient (≥ 20)pN 5391 BMIUnderweight-Normal27 (50.9)47 (51.6)0.93 Overweight-Obese26 (49.1)44 (48.4) VD LevelBefore Chemotherapy45 (84.9)77 (84.6)0.96 During Chemotherapy8 (15.1)14 (15.4) GradeG1-224 (47.1)41 (46.1)0.91 G327 (52.9)48 (53.9) Clinical StageI-II37 (69.8)61 (67)0.73 III16 (30.2)30 (33) Receptor StatusHER2+ (HR+ or HR-)12 (22.6)29 (32.2)0.20 HR+/HER2-30 (56.6)37 (41.1)  Triple Negative11 (20.8)24 (26.7) SurgeryBreast Conserving32 (60.4)58 (63.7)0.69 Mastectomy21 (39.6)33 (36.3) pCRNo43 (81.1)53 (58.2)&lt;.01 Yes10 (18.9)38 (41.8) AgeMean (SD)48 (10.9)51 (10.3)0.15

Table 2: Odds of Not Attaining a pCR: Multivariable Results  NOdds Ratio95% CIp-valueCohortIowa661.170.522.630.71 France77Ref   Vitamin D (&lt;20)Deficient532.681.126.410.03 Sufficient90Ref   Clinical StageI-II97Ref    III463.251.308.110.01Receptor StatusHER2+ (HR+ or HR-)411.060.402.810.91 HR+/HER2-675.502.0414.85&lt;0.01 Triple Negative35Ref   

Citation Format: Thomas A, Thezenas S, Mott SL, Raman R, Viala M, Pouderoux S, Schroeder MC, Lamy P-J, Jacot W. Vitamin D level impacts odds of pathologic complete response following neoadjuvant therapy in operable breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-24.

Abstract P3-17-10: The impact of the presence of ductal carcinoma in situ in patients with invasive ductal carcinoma

Background: Ductal carcinoma in situ (DCIS) is considered to be a precancerous lesion that shares many genetic similarities with invasive ductal carcinoma (IDC). However, it remains unclear how DCIS might develop into IDC and whether the coexistence of DCIS has any clinical significance.There is limited data on whether coexisting DCIS in patients with IDC (IDC-DCIS) has any impact on patients' clinical presentation, tumor characteristics, prognosis and treatment selection. We aim to investigate differences in patients with pure IDC versus patients with IDC-DCIS.

Methods: We reviewed clinicopathologic data from the Breast Molecular Epidemiological Resource (BMER) database, which is a prospectively maintained breast cancer database from the University of Iowa. Missing information was supplemented by Iowa Cancer Registry database. Patients with a diagnosis of pure IDC and IDC-DCIS from 2009 to 2014 who underwent surgical resection of their breast cancer were included. We excluded patients with stage IV disease at diagnosis and those who underwent neoadjuvant therapy. Patients who had more than one tumor were only analyzed once using parameters of the largest tumor. Patient and tumor characteristics and treatment selection were compared between the IDC and IDC-DCIS groups. Student's t test was used for continuous variables and chi squared test for categorical variables.

Results: We observed that women with IDC-DCIS (n=226) had higher incidence of Her-2 positive cancers than those with pure IDC (n=95) (p=0.04). The IDC-DCIS group was more likely to be ER + and PR +, though these differences were not statistically significant. Another distinguishing characteristic between the two groups was that the IDC group contained more current smokers than the IDC-DCIS group (18.9% vs 10.6%, p&lt;0.01). Patients with IDC-DCIS were more likely, than patients with pure IDC, to be under-staged based on clinical information. Clinical stage distribution in IDC-DCIS group was: 4% stage 0, 61.9% stage I, 28.3% stage II and 5.8% stage III. In contrast, the percentages of pathologic stage I, II and III were 54.5%, 35.4% and 10.2%, respectively (p=0.002). Similar analysis for patients with pure IDC showed no significant overall change from clinical to pathologic stage. Patients with IDC-DCIS tended to have higher total mastectomy rates than patients with IDC (37.2% vs 31.6%, p=0.34). Management of patients in either group were not significantly different in terms of radiation, chemotherapy, or hormonal therapy. There were 4 deaths (4.2%) in the IDC group and 12 deaths (5.3%) in the IDC-DCIS group (p=0.68).

Conclusions: Our study showed that active smoking may be a risk factor for the development of IDC without pre-existing DCIS. Patients with IDC-DCIS had higher rates of Her-2 positivity and significant differences between clinical and pathologic stages. Management and survival of both groups were similar.

Citation Format: Xu L, Monga V, Thomas A, Leone JP. The impact of the presence of ductal carcinoma in situ in patients with invasive ductal carcinoma [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-17-10.

Abstract P5-10-02: African Americans have more aggressive invasive lobular carcinoma subtypes and inferior early outcomes: SEER 2010-2013

Introduction:

African Americans (AA) present more frequently with triple negative breast cancer (TN) and other aggressive breast cancer subtypes. Invasive lobular (ILC) breast cancer most commonly presents as estrogen receptor (ER)+, progesterone receptor (PR)+ and HER2-, though less frequently the more aggressive ER- or PR- luminal, TN or HER2+ subtypes occur. For women presenting with ILC 2010-2013, we report by race, differences in disease subtype, grade and stage at presentation and 2-year outcomes.

Methods:

We conducted a retrospective cohort analysis using Surveillance, Epidemiology and End Results Program. Women diagnosed with first primary malignant lobular breast cancer from 2010-2013 were included. Subtypes were categorized into four exclusive groups: ER+ and PR+ HER2-, ER+ or PR+ HER2-, TN and HER2+. Two-year survival was compared across race, and a multivariate cox model assessed overall survival.

Results:

ILC occurred less frequently in non-whites (Table 1). AA and other non-whites were younger at diagnosis than whites (p&lt;0.001). AAs and other non-whites were less likely to have ER+ and PR+ HER2- disease (OR 0.85, p= 0.019 and OR 0.79, p=0.003 respectively). AAs had ILC of significantly higher grade and presented with more advanced stage disease than other race categories (p&lt;0.001 for both). On multivariate analysis, survival was inferior for AA relative to whites (HR 1.32, p&lt;0.010). Other non-whites had better survival than whites (HR 0.58, p=0.008). For AAs 2-year survival by disease subtype was: ER+ and PR+ HER2- (91.3%), ER+ or PR+ HER2- (90.5%), TN (59.5%), HER2+ (84.0%). For these subtypes, the proportion of women presenting with Stage IV ILC was 8.1%, 10.8%, 22.6% and 15.9% respectively.

Conclusion:

In this large, recent ILC cohort there were significant racial disparities in disease biology at presentation, with non-whites having more aggressive ILC subtypes, but only AAs having higher grade ILC. Short-term survival outcomes were inferior for AAs. Whether AAs presenting with advanced stage disease more frequently is due to biology or access to care is unknown. Further study of disease biology and healthcare delivery disparities could offer improved outcomes for AAs with ILC.

Table 1: ILC Characteristics by Race WhiteAA  Other non-white  N13,5571,445  957  ILC - % diagnoses per race category9.67.2  5.8  Rate of ILC (per 100,000 women of that race)10.56.4  4.4  Median Age6461  60   %%OR*p%OR*pSubtype       ER+ and PR+ HER2-80.978.30.850.01977.00.790.003ER+ or PR+ HER2-12.914.41.140.10615.31.220.036TN1.52.11.440.0642.11.400.158HER2+4.75.11.090.4735.61.210.186Stage       I40.536.4  39.0 &lt;0.001II36.534.5  40.4  III17.019.9  14.9  IV6.09.2  5.6  Grade (Differentiation)       Well or Moderate91.287.5  89.5 &lt;0.001Poor or Undifferentiated8.812.5  10.5  2-year survival93.9%90.0%  96.3%  *compared to white (reference group)

Table 2: Multivariate Cox Model for 2-year Survival HRp95% CIRace    Whiteref   AA1.320.0101.071.64Other non-white0.580.0080.380.87Subtype    ER+ and PR+ HER2-ref   ER+ or PR+ HER2-1.80&lt;0.0011.512.16TN2.89&lt;0.0012.074.03HER2+0.970.8670.691.37Stage    Iref   II1.91&lt;0.0011.512.42III3.44&lt;0.0012.714.37IV22.34&lt;0.00117.7828.07Grade (Differentiation)    Well or Moderateref   Poor or Undifferentiated1.400.0011.141.71

Citation Format: Thomas A, Altekruse S, Avery TP, Melin SA, Howard-McNatt MM, Schroeder MC. African Americans have more aggressive invasive lobular carcinoma subtypes and inferior early outcomes: SEER 2010-2013 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-02.

Abstract P3-10-04: Disparities in human epidermal growth factor receptor 2 testing completion: A population-based retrospective cohort study, 2010-2013

Introduction: Human epidermal growth factor receptor 2 (HER2) is an established biomarker predictive for response to HER2-targeted therapies. Testing breast cancer specimens for HER2 protein overexpression or gene amplification is the standard of care. Earlier work showed inconsistent delivery of HER2 testing to some patient groups. We sought to understand current imbalances in HER2 testing.

Methods: Our retrospective cohort analysis of Surveillance, Epidemiology and End Results Program data included women diagnosed with microscopically confirmed, first primary malignant breast cancer from 2010-2013. Women were categorized by race, stage, age, and whether they received HER2 testing. Those with unknown information in any of these variables were excluded. Descriptive analyses and multivariate logistic regression assessed the effect of these factors on the likelihood of not receiving HER2 testing.

Results: The full cohort included 182,032 women, of which 3,551 (2.0%) did not undergo testing for HER2 (Table 1). The portion of HER2 untested tumors was higher for African American women (2.3%) and other non-white women (2.2%), women over age 70 (2.3%) and women with Stage I (2.3%) or Stage IV disease (5.0%). Within the African American cohort similar patterns were seen: age &gt;70 (2.8%), Stage I (2.8%) and Stage IV (5.4%). The portion of women with untested tumors decreased from 2010 to 2013: 2.6% to 1.6% (p&lt;0.001) for the full cohort, and 2.9% to 1.9% (p&lt;0.001) for African Americans. On multivariate analysis, odds of not undergoing testing were highest for African American women (OR=1.27, p&lt;0.001), women of age &gt;70 (OR=1.26, p&lt;0.001), and women with Stage IV disease (OR=4.07, p&lt;0.001) (Table 2). Odds of not undergoing HER2 testing decreased over time (OR=0.60 for 2013 vs 2010, p&lt;0.001).

Conclusion: Persistent, and significant, disparities in completion of HER2 testing suggest that reasons for not testing extend beyond technical issues. While proportionally small, given the prevalence of breast cancer, addressing these disparities in HER2 testing may offer an opportunity to deliver life-prolonging, often well tolerated, therapy to significant numbers of patients. The improvements in delivery of HER2 testing seen over time are reassuring.

Table 1. Portion of women not having HER2 testing.  Full Cohort African Americans   N%p-valueN%p-valueN3,5512.0 4702.3 Race       White2,7081.9&lt;0.001    African American4702.3 4702.3  Other3732.2    Age at diagnosis       &lt;507081.7&lt;0.0011051.90.024 50-598921.9 1302.3  60-698941.9 1202.4  70+1,0572.3 1152.8 Stage       I2,0692.3&lt;0.0012232.8&lt;0.001 II7621.3 1111.4  III2211.0 441.4  IV4495.0 925.4 Year of diagnosis       20101,0662.6&lt;0.0011322.9&lt;0.001 20119432.1 1442.8  20128011.7 931.7  20137411.6 1011.9 

Table 2. Multivariate logistic regression for odds of not having HER2 testing.  OR*p-valueRace   Whiteref  African American1.27&lt;0.001 Other1.24&lt;0.001Age at diagnosis   &lt;50ref  50-591.080.128 60-691.010.795 70+1.26&lt;0.001Stage   Iref  II1.87&lt;0.001 III0.81&lt;0.001 IV4.07&lt;0.001Year of diagnosis   2010ref  20110.80&lt;0.001 20120.66&lt;0.001 20130.60&lt;0.001* Odds of group not being tested vs being tested, compared to the reference group and controlling for all other factors.

Citation Format: Schroeder MC, Neuner JM, Xia C, Thomas A. Disparities in human epidermal growth factor receptor 2 testing completion: A population-based retrospective cohort study, 2010-2013 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-04.

Abstract P1-01-14: Nuclease-activated oligonucleotide probes for detection of breast cancer circulating tumor cells (CTCs): Early clinical results

Introduction:

A challenge for CTC-based diagnostic tests has been the development of methods with sufficient sensitivity to detect low levels of CTCs. Expense, accuracy and complexity have also limited clinical uptake of CTCs. To overcome these limitations we explored detecting CTCs by measuring their nuclease activity with nuclease-activated probes. We present the development of a rapid and highly-sensitive CTC detection assay based on probes that are selectively digested (activated) by target nucleases expressed in breast cancer cells.

Methods:

Nuclease activity in samples from women with Stage IV breast cancer and healthy donors was determined and correlated with clinical data. Patients seen at University of Iowa Clincis were eligible for this IRB-approved study. Blood samples were processed using microfilter (ScreenCell) units for CTC enrichment and converted into cell lysates that were examined by means of three different chemically-optimized oligonucleotide probes. CTC-derived nuclease activity was quantified using a fluorometer. The presence of CTCs was confirmed using established CTC detection methods (e.g. RT-PCR, immunohistostaining).

Results:

Sensitivity of the probe assay was 5 cancer cells in buffer solution and ~200 cancer cells in 1 mL of healthy donor blood. The final study cohort included 28 breast cancer patients and 10 healthy donors. The averaged signal intensities from patient samples were significantly higher compared to the healthy donor control group, presumably arising from CTCs in the blood. Statistical analysis further reveald short incubations in the assay (&lt;20 min) to be optimal. From an ROC analysis we obtained AUC values of 0.8821, 0.8103 and 0.9356 for the three different probes. The oligonucleotide probe being the best predictor of disease yielded 100% sensitivity in the patient samples with a specificity of 70%. The dsDNA 20 minute probe was correlated negatively with tumors being ER+/PR+ (p=0.03). The 2'f-RNA 0 minute probe correlated significantly with HER2- tumors (p=0.04). In this smaller series other trends were also suggested.

Conclusion:

We describe a novel diagnostic for the detection of CTCs that could overcome limitations of CTC detection assays and could provide a robust diagnostic tool for breast cancer. Future clinical assays derived from this technology could require minimal training and infrastructure and might be developed into a point-of-care testing format.

Citation Format: Giangrande PH, Kruspe S, Dickey DD, Kamboj S, Clark KC, Urak K, Burghardt E, Smith B, Thomas A, McNamara JO. Nuclease-activated oligonucleotide probes for detection of breast cancer circulating tumor cells (CTCs): Early clinical results [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-14.

Relation between plasma trough concentration of abiraterone and prostate-specific antigen response in metastatic castration-resistant prostate cancer patients

BACKGROUND

Abiraterone (ABI) is a major oral agent for the treatment of metastatic castration-resistant prostate cancer (mCRPC) patients but its systemic exposure is subject to a large inter-individual variability. We aimed to explore the relationship between ABI trough plasma concentration and prostate-specific antigen (PSA) response in mCRPC patients and to identify the critical determinants for its activity.

PATIENTS AND METHODS

This is a monocentric prospective observational study in mCRPC patients treated with ABI. The plasmatic concentration of ABI at steady state was measured using liquid chromatography with fluorescence detection. The primary objective was to study the relationship between mean ABI plasma exposure (ABI C_min) and 3-month PSA response.

RESULTS

From 2012 to 2016, 61 mCRPC patients were eligible for pharmacokinetic/pharmacodynamic assessment. Thirty-eight patients experienced PSA response (62%, [confidence interval {CI} 95% 50-78]). In univariate analysis, ABI C_min was 1.5-fold higher in responders: 12.0 ng/mL (CI 95% 9.4-15.6) versus 8.0 ng/mL (CI 95% 5.8-11.6; P = 0.0015). In multivariate analysis, only ABI C_min was independently associated with PSA response (odds ratio = 1.12 [CI 95% 1.01-1.25], P = 0.004). By receiver operating characteristic analysis, the optimal threshold for ABI C_min was 8.4 ng/mL. Progression-free survival (PFS) was significantly higher in patients with ABI C_min above 8.4 ng/mL (hazard ratio 0.55, [CI 95% 0.31-0.99], 12.2 [CI 95% 9.2-19.5] versus 7.4 [CI 95% 5.5-14.7] months otherwise, P = 0.044).

CONCLUSIONS

We showed that ABI trough concentration correlates with PSA response and PFS. Moreover, we could determine a cut-off value of plasmatic concentration for PSA response. Altogether, ABI concentration monitoring appears as a new approach to improve clinical outcome in mCPRC patients.

Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study

BACKGROUND AND PURPOSE

The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid embolic agent, in the treatment of patients with cranial dural arteriovenous fistulas. The primary end point was the rate of complete occlusion of dural arteriovenous fistulas. Secondary end points included the incidence of adverse events and clinical status at 3-month follow-up.

MATERIALS AND METHODS

This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started in August 2014 and ended in September 2015.

RESULTS

Twenty-two (85%) patients were treated with PHIL only, with 3 patients treated with both PHIL and Onyx, and 1, with both PHIL and coils. Immediate complete angiographic occlusion was achieved in 20 (77%) patients. Of the 6 patients with residual fistulas, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein.

CONCLUSIONS

PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous fistulas. Short-term angiographic and clinical results are comparable with those of Onyx, with the added advantage of easier preparation and improved homogeneous cast visualization. The use of iodine as a radio-opacifier also produces considerably less artifacts on CT compared with tantalum-based embolic materials.

[Highflow priapism : diagnostic evaluation, contribution of ultrasound and recommendations]

The high flow priapism (HFP) is a very rare pathology. It must be distinguished from the low flow which is a real urologic emergency. The diagnosis of HFP (most often post-trauma) remains clinical, but penile color Doppler ultrasound can confirm, identify and track the evolution of the lesion. Conservative treatment is effective and remains the first line treatment. However the different therapeutic modalities (selective embolisation, surgery) should be explained to the patient and be considered case by case.

Using Next-Generation Sequencing to Develop Molecular Diagnostics for Pseudoperonospora cubensis, the Cucurbit Downy Mildew Pathogen

Advances in next-generation sequencing (NGS) allow for rapid development of genomics resources needed to generate molecular diagnostics assays for infectious agents. NGS approaches are particularly helpful for organisms that cannot be cultured, such as the downy mildew pathogens, a group of biotrophic obligate oomycetes that infect crops of economic importance. Unlike most downy mildew pathogens that are highly host-specific, Pseudoperonospora cubensis causes disease on a broad range of crops belonging to the family Cucurbitaceae. In this study, we identified candidate diagnostic markers for P. cubensis by comparing NGS data from a diverse panel of P. cubensis and P. humuli isolates, two very closely related oomycete species. P. cubensis isolates from diverse hosts and geographical regions in the United States were selected for sequencing to ensure that candidates were conserved in P. cubensis isolates infecting different cucurbit hosts. Genomic regions unique to and conserved in P. cubensis isolates were identified through bioinformatics. These candidate regions were then validated using PCR against a larger collection of isolates from P. cubensis, P. humuli, and other oomycetes. Overall seven diagnostic markers were found to be specific to P. cubensis. These markers could be used for pathogen diagnostics on infected tissue, or adapted for monitoring airborne inoculum with real-time PCR and spore traps.