Abstract PD6-06: Oncologic outcome of pregnancy associated breast cancer: A case-control study

Introduction and Aims

Pregnancy-associated breast cancer (PABC) is defined as the diagnosis of invasive breast cancer during the gestational period, within one year of pregnancy or any time during lactation. A diagnosis of PABC has traditionally been attributed a poor prognosis. The aim of this study was to assess the long-term outcome of patients diagnosed with PABC compared to a cohort of age-matched control patients.

Methods

A single-institution retrospective chart review was performed in 188 patients with PABC treated between the years of 1992 and 2015.Non-PABC controls were selected to match based on age and year of diagnosis. Clinicopathologic features, surgical and adjuvant treatments received, and clinical outcomes were assessed. Patients who were stage IV at diagnosis were excluded. Overall survival was estimated using Kaplan-Meier methods and compared between cases and controls using a log-rank test stratified on matched pair.

Results

Out of 188 patients with PABC, 63 (34%) were pregnant at the time of diagnosis and 125 diagnosed within 1 year of pregnancy (average: 6 months post partum). The characteristics of the PABC and case-matched controls are listed in Table 1 . Important pathological differences were evident with PABC patients compared to the non-PABC controls. PABC cases were more likely to be high grade (p<.001), node positive (p=.039) and less likely to be estrogen or progesterone receptor positive (p=.003). The majority of both cases and controls received chemotherapy (18% neoadjuvant). In the patients who were pregnant at time of diagnosis, 19 received chemotherapy during their pregnancy, with the most common combination being AC followed by paclitaxel in the post-partum period. Five year overall survival was similar for both groups, 88% for PABC patients and 95% for non-PABC case controls (p=.746) with a median follow up of 5.1 years.

Table 1: Demographics, treatment, and outcome of PABC and non-PABC case-matched controlsPABC n=188Non PABC n=188p-valueDemographicsAge (mean)35.7yrs35.9yrs0.633BRCA1/2 carrier22%12%0.072SurgeryBreast Conservation22%38%0.001Immediate reconstruction post mastectomy81%84%0.544PathologyGrade 388%70%<0.001ER and/or PR positive56%72%0.003HER2 positive27%22%0.283Triple negative27%20%0.145Node positive27%47%0.039Clinical StageI-II67%79%0.010III33%21%Adjuvant treatmentsChemotherapy99%21%<0.001Neoadjuvant18%17%0.849Anthracycline84%81%0.393Taxane82%75%0.148Anti-HER220%15%0.238Anti-estrogen53%68%0.003Radiotherapy57%62%0.4005-year OS88%95%0.746Figures are reported as percentages for categorical variables. OS: Overall survival

Conclusion

Diagnostic and therapeutic advances have improved the oncological outcome for breast cancer patients, but not all of these have been adapted for pregnant patients. The consistent finding of higher-stage tumors in these patients reinforces the importance of utilizing developments in systemic treatments, potentially through case registries, to evaluate outcomes. PABC is associated with more adverse features than non-PABC controls matched for age and year of diagnosis. However, PABC is not in itself an adverse prognostic factor for survival after correcting for pathologic features.

Citation Format: McCartan D, Kamer S, Eaton A, Seidman A, Murphy C, Gemignani M, Goldfarb S. Oncologic outcome of pregnancy associated breast cancer: A case-control study [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 PD6-06.

Abstract OT3-04-03: The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor (ER) positive, lymph node positive early stage breast cancer in Ireland

BACKGROUND

For Estrogen Receptor (ER) positive, early stage breast cancer, the 21 gene Recurrence Score (RS) has clinical use both as a prognostic tool and to predict chemotherapy benefit. The availability of this tool in Ireland has led to a reduction in the use of adjuvant chemotherapy for women with lymph node (LN) negative disease. However, the RS is not routinely funded for patients with LN positive (LN+) breast cancer in Ireland. In addition, there are limited international data on the use of this tool in the preoperative setting. In this prospective observational study, we are investigating whether access to the 21 gene RS leads to a reduction in the receipt of chemotherapy for patients with ER+, LN+ breast cancer, and to correlate the 21 gene RS with response to preoperative systemic therapy.

TRIAL DESIGN

This is a national, multi-site, prospective, observational study that will examine the impact of the 21 gene RS on chemotherapy recommendations in both the neoadjuvant and adjuvant setting. Prior to and following tumor testing with the 21 gene RS, Physicians will complete a questionnaire which details type and strength of systemic therapy recommendations.

ELIGIBILITY

Cohort 1 (postoperative) will include patients with ER+ tumors of any size with involvement of 1-3 lymph nodes (N1 including micrometastases). Cohort 2 (preoperative) will include patients with ER+, T2-T4 tumors with biopsy proven nodal metastases. Both cohorts will have ECOG PS 0 or 1 and be fit for consideration of chemotherapy as determined by the Investigator.

SPECIFIC AIMS

The primary endpoint is the percentage reduction in the number of patients for whom treating physicians recommend chemotherapy after testing with 21 gene RS. Secondary endpoints include the correlation between the 21 gene RS and residual cancer burden score, as well as pathological, clinical and radiological response rates. The economic impact of the 21 gene RS in ER+, LN+ will also be assessed.

STATISTICAL METHODS

The sample size is based on similar decision impact studies conducted in other countries. Physician recommendations for chemotherapy pre 21-gene RS and recommendations post 21-gene RS testing will be compared and percentage change estimated with 95% confidence intervals. For secondary endpoints, the Pearson correlation coefficient (rho) will be used to examine the strength of the correlation between the 21 gene RS category and response. A budget impact model will be used to estimate the cost reduction in adjuvant chemotherapy as a result of 21-gene RS testing.

PRESENT ACCRUAL AND TARGET ACCRUAL

Target accrual is 75 in each of the neoadjuvant and adjuvant cohorts to total 150 patients.

Supported by Genomic Health.

Citation Format: Keegan NM, Milewski M, Kelly CM, Murphy V, Chao C, Walsh J, Kennedy MJ, O'Connor M, Murphy C, O'Reilly S, Keane M, Duffy K, Hennessy B, Morris PG. The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor (ER) positive, lymph node positive early stage breast cancer in Ireland [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 OT3-04-03.

The effect of dietary supplementation of algae rich in docosahexaenoic acid on boar fertility

The objective of this study was to assess the effects of dietary supplementation of a commercial algal product rich in docosahexaenoic acid (DHA) on boar fertility as assessed in vitro and in vivo. Boars were fed one of three experimental diets for 19 weeks: (i) Control (Ctl) diet (n = 31), (ii) Ctl diet plus 75g All-G-Rich per day (n = 31) or (iii) Ctl diet plus 150g All-G-Rich per day (n = 30). Parameters assessed were (i) raw semen quality; volume, sperm concentration, total motility and morphology (ii) liquid semen quality; progressive motility, viability, hypotonic resistance and acrosomal integrity (iii) frozen-thawed semen quality; motility, thermal stress, viability, membrane fluidity and mitochondrial activity (iv) sperm and seminal plasma (SP) fatty acid composition (FAC) (v) total antioxidant capacity (TAC) of SP and (vi) farrowing rates and litter sizes of sows (n = 1158) inseminated with liquid semen. Boars consuming 75g All-G-Rich had a larger semen volume (P < 0.05) and a higher total sperm number (P < 0.01) than the Ctl treatment, however, there was no effect of treatment on any other semen quality parameter (P > 0.05). There was no effect of dietary treatment on the FAC and TAC of SP or on farrowing rate and litter size (P > 0.05). There was an effect of dietary treatment on the FAC of sperm, represented by an 1.72 and 1.60 fold increase in the DHA content for 75 and 150g treatments, respectively, compared to the Ctl treatment. In conclusion, a significant increase in semen volume and total sperm number in boars supplemented 75g All-G-Rich daily, resulted in an increase in production of 3 to 4 more doses per ejaculate, thus, indicating that the feeding regime described within this study has the potential for increasing the output of boar studs.

Relationship between in vitro sperm functional assessments, seminal plasma composition, and field fertility after AI with either non-sorted or sex-sorted bull semen

The hypothesis of this study was that different in vitro parameters are required to predict the in vivo fertility of non-sorted (NS) and sex-sorted (SS) semen. Thus, the aim was to correlate in vitro bull sperm functional parameters (experiment 1) and seminal plasma composition (experiment 2) with pregnancy rates using 2 cohorts of bulls (NS and SS). Experiment 1: ejaculates from each bull (n = 3 ejaculates per bull; n = 6 bulls for both NS and SS) were assessed for motility, thermal stress tolerance and morphology using microscopy, and viability, osmotic resistance, mitochondrial membrane potential, and acrosome integrity using flow cytometry. Fertilizing ability was assessed using IVF. Experiment 2: ejaculates (n = 3 per bull; n = 8 and 6 bulls for NS and SS, respectively) were collected, seminal plasma harvested and frozen and later analyzed for amino acid and fatty acid composition using gas chromatography mass spectrometry. In the NS cohort of bulls, there was no correlation between pregnancy rate and any of the sperm functional parameters assessed. However, within the SS cohort, motility and viability were correlated with pregnancy rate (r = 0.84 and 0.80, respectively; P < 0.05). There was no correlation between IVF outcome and pregnancy rate in either the SS or NS cohort of bulls. In the NS cohort of bulls, concentrations of the amino acid isoleucine and the fatty acid tricosylic acid (C23:0) were correlated with pregnancy rate (r = 0.80 and 0.74, respectively; P < 0.05). Within the SS cohort of bulls, the amino acid glutamic acid and the fatty acid arachidic acid (C20:0) were correlated with pregnancy rate (r = 0.84 and 0.82, respectively; P < 0.05). In conclusion, this study suggests that different in vitro markers of fertility are required to predict the fertility of NS and SS sperm.

Relationship Between Cortical Gyrification, White Matter Connectivity, and Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, which is accompanied by differences in gray matter neuroanatomy and white matter connectivity. However, it is unknown whether these differences are linked or reflect independent aetiologies. Using a multimodal neuroimaging approach, we therefore examined 51 male adults with ASD and 48 neurotypical controls to investigate the relationship between gray matter local gyrification (lGI) and white matter diffusivity in associated fiber tracts. First, ASD individuals had a significant increase in gyrification around the left pre- and post-central gyrus. Second, white matter fiber tracts originating and/or terminating in the cluster of increased lGI had a significant increase in axial diffusivity. This increase in diffusivity was predominantly observed in tracts in close proximity to the cortical sheet. Last, we demonstrate that the increase in lGI was significantly correlated with increased diffusivity of short tracts. This relationship was not significantly modulated by a main effect of group (i.e., ASD), which was more closely associated with gray matter gyrification than white matter diffusivity. Our findings suggest that differences in gray matter neuroanatomy and white matter connectivity are closely linked, and may reflect common rather than distinct aetiological pathways.

Expanding the dairy herd in pasture-based systems: The role of sexed semen within alternative breeding strategies

A simulation model was developed to determine the effects of sexed semen use in heifers and lactating cows on replacement heifer numbers and rate of herd expansion in a seasonal dairy production system. Five separate artificial insemination (AI) protocols were established according to the type of semen used: (1) conventional frozen-thawed semen (CONV); (2) sexed semen in heifers and conventional semen used in cows (SS-HEIFER); (3) sexed semen in heifers and a targeted group of cows (body condition score ≥3 and calved ≥63 d), with conventional semen used in the remainder of cows (SS-CONV); (4) sexed semen in heifers and a targeted group of cows, with conventional semen in the remainder of cows for the first AI and conventional beef semen used for the second AI (SS-BEEF); or (5) sexed semen in heifers and a targeted group of cows, with conventional semen in the remainder of cows for the first AI and short gestation length semen used for the second AI (SS-SGL). Each AI protocol was assessed under 3 scenarios of sexed semen conception rate (SS-CR): 100, 94, and 87% relative to that of conventional semen. Artificial insemination was used on heifers for the first 3 wk and on cows for the first 6 wk of the 12-wk breeding season. The initial herd size was 100 cows, and all available replacement heifers were retained to facilitate herd expansion, up to a maximum herd size of 300 cows. Once maximum herd size was reached, all excess heifer calves were sold at 1 mo old. All capital expenditure associated with expansion was financed with a 15-yr loan. Each AI protocol was evaluated in terms of annual farm profit, annual cash flow, and total discounted net profit. The SS-CONV protocol generated more replacement heifers than all other AI protocols, facilitating faster expansion, and reached maximum herd size in yr 9, 9, and 10 for 100, 94, and 87% SS-CR, respectively. All AI protocols, except SS-BEEF and SS-SGL at 87% SS-CR, reached maximum herd size within the 15-yr period. Negative profit margins were experienced for SS-CONV in the first 5, 4, and 3 yr of expansion for 100, 94, and 87% SS-CR, respectively. Total discounted net profit was greater in all sexed semen AI protocols compared with CONV. This study demonstrated that, for each SS-CR, the greatest rate of expansion is achieved when using sexed and conventional semen (SS-CONV). The combined use of sexed semen and beef (SS-BEEF) or SGL (SS-SGL) semen resulted in greater discounted net profit at 100, 94, and 87% SS-CR compared with CONV, but a similar net worth change at 87% SS-CR due to a lower inventory change because SS-BEEF and SS-SGL reached maximum herd size within 15 yr.

Odontogenic myxoma of the maxilla: surgical management and case report

BACKGROUND

Odontogenic myxoma is a benign odontogenic tumour of the jaw [1]. This tumour often presents as an asymptomatic expansile lesion without sensory nerve changes [2]. It is thought to arise from mesenchymal origin with cells of microscopic similarity to dental pulp and follicle [3]. Radiographically it presents most often as a multiloculated radiolucency [2]. It is a locally aggressive lesion which may require extensive treatment to prevent recurrence.

METHOD

The authors present the case of a 13-year-old boy with an extensive lesion in the maxilla.

CONCLUSION

We discuss various treatment approaches for management of this tumour.

Diagnostic yield of molecular autopsy in patients with sudden arrhythmic death syndrome using targeted exome sequencing

AIMS

The targeted genetic screening of Sudden Arrhythmic Death Syndrome (SADS) probands in a molecular autopsy has a diagnostic yield of up to 35%. Exome sequencing has the potential to improve this yield. The primary aim of this study is to examine the feasibility and diagnostic utility of targeted exome screening in SADS victims, utilizing familial clinical screening whenever possible.

METHODS AND RESULTS

To determine the feasibility and diagnostic yield of targeted exome sequencing deoxyribonucleic acid (DNA) was isolated from 59 SADS victims (mean age 25 years, range 1-51 years). Targeted exome sequencing of 135 genes associated with cardiomyopathies and ion channelopathies was performed on the Illumina HiSeq2000 platform. Non-synonymous, loss-of-function, and splice-site variants with a minor allele frequency <0.02% in the NHLBI exome sequencing project and an internal set of control exomes were prioritized for analysis followed by <0.5% frequency threshold secondary analysis. First-degree relatives were offered clinical screening for inherited cardiac conditions. Seven probands (12%) carried very rare (<0.02%) or novel non-sense candidate mutations and 10 probands (17%) had previously published rare (0.02-0.5%) candidate mutations-a total yield of 29%. Co-segregation fully confirmed two private SCN5A Na channel mutations. Variants of unknown significance were detected in a further 34% of probands.

CONCLUSION

Molecular autopsy using targeted exome sequencing has a relatively low diagnostic yield of very rare potentially disease causing mutations. Candidate pathogenic variants with a higher frequency in control populations are relatively common and should be interpreted with caution.