Abstract P6-11-02: Patient characteristics and outcomes for patients with HER2-overexpressing breast cancer with brain metastases undergoing radiation therapy in the pre- and post adjuvant trastuzumab era

Background: Trastuzumab (H) has improved outcomes for patients with HER2 overexpressing (HER2+) breast cancer (BC) and thus increased the at-risk period for development of brain metastases (BM). In this study we describe the characteristics and outcomes of patients with HER2+BCBM who underwent stereotactic radiosurgery (SRS) or whole brain radiation (WBRT) as initial BM treatment (tx) in the pre- and the post adjuvant (adj) H era at MSKCC.

Methods: 100 consecutive pts with HER2+ BCBM who received SRS or WBRT from January 2001 to December 2011 were identified. Clinical, pathologic and tx information were obtained by retrospective review. Pt characteristics at the time of BM diagnosis (dx) and their associations with time from BM to death were evaluated by Kaplan-Meier (KM) curves, log-rank tests, and Cox proportional hazard models.

Results: The median age at BM dx was 54 yrs (range 26-79). 31% and 69% of pts received SRS and WBRT respectively. After the BM dx, 97% continued to receive systemic tx consisting of chemotherapy and/or anti-HER2 tx. 97% of pts received H for MBC and 17% received H in the adj setting (all after 2005). Patient characteristics were compared between pre-adj H (2001-2005) and post-adj H (2006-2011) cohorts. The only significant differences noted between the cohorts in univariate analysis were extra-CNS disease control and use of anti-HER2 therapy after BM dx: pre-adj H era pts had a higher likelihood of extra-CNS disease control (79.5% vs. 52%, p = 0.004) at BM dx and less use of anti-HER2 tx after BM dx (70% vs. 87.5%. p = 0.05). For all pts, the median follow-up for survivors was 33.5 mos (range 18-103). There were 79 deaths. The median survival from BM dx was 19.4 mos (95%CI: 15.5, 26.6). KM curves and log-rank tests showed significantly better survival from BM for pts with higher KPS, single BM, extra-CNS disease control, lack of neurologic sx at BM dx, initial presentation without LMD, use of lapatinib (ever), SRS as initial RT, and use of any anti-HER2 tx after BM dx. Multivariate analysis showed that higher KPS [HR 0.21 (0.09,0.53)], extra-CNS disease control [HR 2.89 (1.67, 5.00)], single BM [HR 4.73 (2.11,10.60)], use of anti-HER2 tx after BM dx [HR 0.30 (0.17,0.53)], asymptomatic status at BM dx [HR 3.69 (1.69,8.07)] were associated with improved survival from BM. Lack of neurologic sx at BM dx was significantly associated with longer survival from BM even after adjustment for other potentially confounding prognostic factors.

Conclusion: These data are mostly consistent with prior reports regarding prognostic factors and inform contemporary clinical trial design. In pts with HER2+BCBM where the majority were subsequently exposed to anti-HER2 and other systemic tx, presence of neurologic sx at BM dx was significantly associated with worse survival after BM dx. Prospective evaluation of screening brain MRI allowing for earlier detection, leading to more careful monitoring or pre-emptive tx of asymptomatic BM may be warranted. The observation of better extra-CNS disease control at BM dx among pts in the pre- adj H era was unexpected, is hypothesis generating, and requires independent confirmation.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-02.

Nasal in-situ gels for delivery of rasagiline mesylate: improvement in bioavailability and brain localization

Intranasal thermosensitive gel for rasagiline mesylate (RM) was developed for effective treatment of Parkinson's disease. Intranasal gels were prepared by combination of poloxamer 407 and poloxamer 188 (1:1) with mucoadhesive polymers (carbopol 934 P and chitosan). The formulations were evaluated for sol-gel transition temperature, in-vitro drug release and in-vivo mucociliary transit time. Further, optimal intranasal gel formulations were tested for in-vivo pharmacokinetic behavior, nasal toxicity studies and brain uptake studies. It was found that optimal formulations had acceptable gelation temperature (28-33 °C) and adequate in-vitro drug release profile. Pharmacokinetic study in rabbits showed significant (p < 0.05) improvement in bioavailability (four- to six-folds) of the drug from intranasal gels than oral solution. Chronic exposure studies in Wistar rats showed that these intranasal gels were non-irritant and non-toxic to rat nasal mucosa. Estimation of RM in rat brain tissue showed significant (p < 0.01) improvement in uptake of RM form intranasal gel formulations than nasal solution.

Interplay of Dirac fermions and heavy quasiparticles in solids

Many-body interactions in crystalline solids can be conveniently described in terms of quasiparticles with strongly renormalized masses as compared with those of non-interacting particles. Examples of extreme mass renormalization are on the one hand graphene, where the charge carriers obey the linear dispersion relation of massless Dirac fermions, and on the other hand heavy-fermion materials where the effective electron mass approaches the mass of a proton. Here we show that both extremes, Dirac fermions, like they are found in graphene and extremely heavy quasiparticles characteristic for Kondo materials, may not only coexist in a solid but can also undergo strong mutual interactions. Using the example of EuRh₂Si₂, we explicitly demonstrate that these interactions can take place at the surface and in the bulk. The presence of the linear dispersion is imposed solely by the crystal symmetry, whereas the existence of heavy quasiparticles is caused by the localized nature of the 4f states.

The unexpected absence of Kondo resonance in the photoemission spectrum of CeAl2

We study the temperature dependent Ce 4f spectral evolution of a well known Kondo system, CeAl2, for a range extending beyond 2 eV below the Fermi level, using photoemission spectroscopy. Interestingly, the spectral evolution is inconsistent with the predictions of the many-body spectral function calculations corresponding to the Kondo resonance interpretation of the screened Ce 4f photoemission features. In order to explain our spectral evolution we propose the phenomenon of collapse of the Kondo singlet wavefunction upon photoelectron kinetic energy measurement. Our proposal suggests that the screened final states in photoemission spectroscopy are not quantum states.

Distinct set of kinases induced after retrieval of spatial memory discriminate memory modulation processes in the mouse hippocampus

Protein phosphorylation and dephosphorylation events play a key role in memory formation and various protein kinases and phosphatases have been firmly associated with memory performance. Here, we determined expression changes of protein kinases and phosphatases following retrieval of spatial memory in CD1 mice in a Morris Water Maze task, using antibody microarrays and confirmatory Western blot. Comparing changes following single and consecutive retrieval, we identified stably and differentially expressed kinases, some of which have never been implicated before in memory functions. On the basis of these findings we define a small signaling network associated with spatial memory retrieval. Moreover, we describe differential regulation and correlation of expression levels with behavioral performance of polo-like kinase 1. Together with its recently observed genetic association to autism-spectrum disorders our data suggest a role of this kinase in balancing preservation and flexibility of learned behavior.

Dissolved methane in Indian freshwater reservoirs

Emission of methane (CH4), a potent greenhouse gas, from tropical reservoirs is of interest because such reservoirs experience conducive conditions for CH4 production through anaerobic microbial activities. It has been suggested that Indian reservoirs have the potential to emit as much as 33.5 MT of CH4 per annum to the atmosphere. However, this estimate is based on assumptions rather than actual measurements. We present here the first data on dissolved CH4 concentrations from eight freshwater reservoirs in India, most of which experience seasonal anaerobic conditions and CH4 buildup in the hypolimnia. However, strong stratification prevents the CH4-rich subsurface layers to ventilate CH4 directly to the atmosphere, and surface water CH4 concentrations in these reservoirs are generally quite low (0.0028-0.305 μM). Moreover, only in two small reservoirs substantial CH4 accumulation occurred at depths shallower than the level where water is used for power generation and irrigation, and in the only case where measurements were made in the outflowing water, CH4 concentrations were quite low. In conjunction with short periods of CH4 accumulation and generally lower concentrations than previously assumed, our study implies that CH4 emission from Indian reservoirs has been greatly overestimated.

Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis

This report describes our experience of arteriovenous fistula (AVF) creation as vascular access for hemodialysis (HD). Study has been carried out in Deenanath Mangeshkar Hospital, Pune from January 2004 to December 2009. A total of 271 AVFs were created in 249 patients. Maximum follow up was 7 years and minimum was 1 year. In this study of 271 cases of AVFs, there were 196 (72.3%) successful cases and 75 (27.7%) failures. Basilic vein was used in 77 (28.4%) cases, cephalic vein in 186 (68.6%), and antecubital vein in 8 (3%) cases. End (vein) to side (artery) anastomosis was done in 170 (63%) cases. Side to side anastomosis was done in 100 (37%) cases. On table bruit was present in 244 (90%) and thrill in 232 (85.6%) cases. During dialysis, flow rate >250 ml/min was obtained in 136 (50.4%) cases. In complications, 16 (5.9%) patients developed distal edema, 32 (11.8%) developed steal phenomenon. Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. During proximal side to side fistula between antecubital/basilic vein and brachial artery, breaking of first valve toward wrist helps to develop distal veins in forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in arm.

The expression of laminin-5 in severe dysplasia/carcinoma in situ and early invasive squamous cell carcinoma: an immunohistochemical study

AIM

The objective of the present study was to detect the immunohistochemical localization of laminin-5 in the subepithelial basement membrane and to investigate the integrity of the basement membrane in cases of severe dysplasia/carcinoma in situ and early invasive squamous cell carcinoma.

METHODS

Tissue samples of 55 filed (25-early invasive squamous cell carcinoma; 25-severe dysplasia/carcinoma in situ;5-normal buccal mucosa as controls) cases were collected from the archives of Oral Pathology Department. Routine staining and Immunostaining for laminin-5 (Biogenex) was carried out on the sections. The immunohistochemical localization and integrity of the basement membrane protein isoform laminin-5 was studied in formalin fixed paraffin embedded sections of severe dysplasia/CIS and early invasive squamous cell carcinoma (EISCC). Chi square test was used for statistical analysis. P values <0.05 were considered statistically significant.

RESULTS

The immunostaining of laminin-5 as observed under light microscope ranged from continuous to complete absence. The laminin-5 staining pattern was more often continuous in severe dysplasia/CIS and discontinuous or absent in EISCC. A statistical comparison between different scores of laminin-5 staining in severe dysplasia/CIS and early invasive squamous cell carcinoma showed a highly significant 'P' value (0.0001).

CONCLUSION

The status of basal lamina, laminin-5 may provide additional and relevant information about invasive potential of dysplasias. Hence the study of laminin-5 immunohistologically can be regarded as an adjunct to distinguish severe dysplastic lesions from early oral invasive carcinoma.

Interactions between Dyes and Cetyl-trimethyl Ammonium Bromide

Surfactants have been widely used as auxiliaries in many areas of textile finishing. The nature of the interactions between dyes and surfactants is one of the basic piece of information for understanding the process of dyeing and finishing of textile material. The role of attractive interactions between the hydrocarbon tails and repulsive interactions between the surfactant head groups on the micellar association process have been studied. The presented work is oriented on the determination of the critical micelle concentration and molar conductance, in aqueous solution of cationic surfactant cetyltrimethyl ammonium bromide by using the electric conductivity method. From conductivity data parameters for dyes – surfactant interaction such as micellar ionization degree α, counter ion binding and free energy of micellization have been calculated. On the basis of results it is clear that critical micelle concentration depends on the nature of ionic group and concentration of counter ion in solution.

Study of Glycerol and Sweet Water as a Carbon Source for Production of Rhamnolipids by Naturally Occurring Strains of Pseudomonas aeruginosa (ATCC 10145 and ATCC 9027)

The interest in biosurfactant has increased considerably due to their large potential for industrial applications. Rhamnolipid is a simplest class of biosurfactants with well defined structure. The main obstacle in commercialization of biosurfactant especially rhamnolipids is the higher cost of the production. Glycerol is readily available from commercial fat-splitting process in the form of sweet water (up to 20% w/v) at very low cost. Two natural strains of Pseudomonas aeruginosa (ATCC 10145 and ATCC 9027) were compared for rhamnolipid production. The neotype strain of Pseudomonas aeruginosa (ATCC 10145) was found to produce more amounts of rhamnolipids than Pseudomonas aeruginosa (ATCC 9027) on glucose and glycerol as carbon source. The microbial growth (0.94 g/L) and formation of rhamnolipids (2.75 g/L) was maximum at 5% (w/v) glycerol concentration by Pseudomonas aeruginosa (ATCC 10145). The fermentation was monitored for 8 days on shake flask and magnetically stirred batch culture. In magnetically stirred batch culture, microbial growth was 0.69 g/L and 2.73 g/L of rhamnolipid was formed. Sweet water was also used as a source of glycerol.

Dose indices in dental cone beam CT and correlation with dose-area product

OBJECTIVES

In the 2011 project "Safety and efficacy of a new and emerging dental X-ray modality (SEDENTEXCT)", it was suggested that dose index (DI) and dose-area product (DAP) could be easily measured and used as diagnostic reference levels (DRLs), which would help in the management of radiation doses to patients in optimum exposure settings. Such indices could be directly related to effective dose. The purposes of this study, therefore, were to measure and calculate the DI and DAP in cone beam CT (CBCT) machines and to evaluate the correlation between the two.

METHODS

Dose measurements were performed on three-dimensional cone beam CT (3D-CBCT) machines [3D Accuitomo (J. Morita Mfg. Corp., Kyoto, Japan), Veraviewepocs (J. Morita Mfg. Corp.) and CS9300 (Carestream, New York, NY)] by exposing a cylindrical poly-methyl methacrylate (PMMA) phantom using a CT ionization chamber. These dose measurements were used for the calculation of Dose Indices 1 and 2, according to the methodology suggested by SEDENTEXCT. The DAP was measured using a DAP meter that was attached to the detector to cover the entire irradiated area.

RESULTS

The DI1 ranged from 53.6 mR to 216.6 mR, the DI2 ranged from 77.1 mR to 325.0 mR and the DAP ranged from 101.1 mGy cm(2) to 457.9 mGy cm(2), depending on the machines and exposure settings. Index 2 had a better correlation with the DAP than Index 1.

CONCLUSIONS

The DIs and DAP proposed by SEDENTEXCT may be useful for establishing DRLs for dental CBCT machines; however, further studies are necessary to determine which of these indices provide accurate dose estimates proportionally relating to the effective dose.

Abstract P2-11-05: Work status and financial stability during treatment for early breast cancer: a pilot study of an ethnically diverse sample

Background: Black and Latina women have lower rates of return to work than non-Latina whites (NLW) after breast cancer treatment. We recently showed that stopping work during chemotherapy is associated with not returning to work for 5 years after treatment. Little is known about the impact of breast cancer on employment outcomes in other low-English proficiency (LEP) immigrant or minority groups. The ongoing longitudinal Breast Cancer and the Workforce study measures work status in LEP immigrants and ethnic minorities undergoing breast cancer treatment with curative intent. For this pilot, we assessed work status and financial stability during treatment.

Methods: Women aged 18–64, undergoing treatment for stage I-III breast cancer, employed at diagnosis, and able to consent in English, Korean, Mandarin, or Spanish were recruited at 3 community oncology clinics and an NCI-designated cancer center. Participants enrolled any time prior to completing their last treatment (chemo, XRT, or surgery) and self-administered web surveys with in-person assistance, as needed, in their preferred language. Demographic, financial, and pre- and post-diagnosis employment characteristics were analyzed using descriptive statistics.

Results: The sample (n = 61) median age was 48 years. 20 (33%) were black, 14 (23%) NLW, 11 (18%) Latina, 8 (13%) Korean, 7 (12%) Chinese, and 1 (2%) other. 37 (61%) were foreign born, 35 (58%) had &lt;college education, 30 (49%) had annual household income &lt;$50,000. 41 (69%) had private insurance, 14 (24%) Medicaid or Emergency Medicaid, and 2 (3%) Medicare/VA. Before diagnosis, 47 (78%) worked full time and 13 (22%) part time. 36 (60%) had white collar jobs (37% manager/professional, 2% arts/media, 22% sales/admin. support); 24 (40%) had blue collar jobs (5% fabricators/laborers; 35% service). 32 (52%) had paid sick leave available at work; 33 (57%) had disability pay. Most were undergoing active therapy: 44 (75%) receiving chemotherapy (7% neo-adjuvant), 3 (5%) post-surgery awaiting adjuvant therapy, 7 (11%) receiving XRT and 5 (8%) awaiting surgery.

When surveyed, 25 (41%) were working full time, 11 (18%) part time and 25 (41%) not working (13% on disability, 16% on paid sick leave, 12% other). 31 (51%) changed work status – stopped working or reduced hours. Of pre-diagnosis full-time workers (n = 47), 23 (49%) changed work status – 4 (9%) to part-time, 8 (17%) sick leave, 7 (15%) disability and 4 (9%) stopped working. Of pre-diagnosis part-time workers (n = 13), 6 (46%) changed status – 2 (16%) sick leave, 1 (8%) disability and 3 (23%) stopped working. Overall, 26 (43%) had less money to spend on food since starting treatment; 31 (53%) did not have enough money to cover their needs.

Discussion: In this pilot, 51% of women changed work status during breast cancer treatment. 41% stopped working, of whom almost a third did not have sick leave or disability. 43% experienced food insecurity during treatment, and 53% said they did not have enough money to cover their needs. Additional research is needed to understand the factors that disrupt work during or soon after treatment, how these factors vary for low-income and minority groups, and to better define the impact of change in work status on financial stability.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-05.

Abstract P6-05-02: Endocrine biomarkers in response to AR-inhibition with bicalutamide for the treatment of AR(+), ER/PR(−) metastatic breast cancer (MBC) (TBCRC011)

Background: Our group and others have identified a subset of ER/PR(−) breast cancers characterized by expression of the androgen receptor (AR) and androgen-dependent growth (Doane 2006). We conducted a proof-of-concept multicenter phase II study to test the efficacy of the AR-antagonist, bicalutamide for the treatment of AR(+) ER/PR(−) MBC (NCT00468715). Results of the primary endpoint, clinical benefit rate (CBR), were presented at ASCO (Gucalp 2012). Data for the impact of bicalutamide on circulating hormone levels in women are limited. Elevations in serum testosterone (T) and estradiol (E) have been observed for men treated with bicalutamide. We hypothesized comparable patterns of change in circulating endocrine markers in response to bicalutamide for women with MBC.

Methods: Patients (pts) with AR(+) (IHC ≥10%), ER/PR(−) (IHC &lt;10%) MBC were eligible for treatment (tx) if ECOG performance status ≤2 and normal organ function regardless of menopausal status. There was no limit to prior tx except prior trastuzumab required if HER2(+). Tx consisted of bicalutamide 150mg orally daily in 28-day cycles (C). Toxicity assessed q4 weeks, response q12wks. Primary endpoint was CBR. Peripheral blood was collected for total and free T, E and sex hormone binding globulin (SHBG) at baseline, start of C2 (C2) and at end of study (EOS). Standard institutional assays were used. A Wilcoxon signed-rank test was done to compare baseline to C2 and EOS values.

Results: 26 patients with AR(+) ER/PR(−) MBC were treated on study. Evaluable number (n) of pts at baseline, C2 and EOS are 26, 26 and 19 respectively. Two pts remain on study. Menopausal status: pre=2, post=24. Baseline median total and free T and estradiol were consistent with expected norms, however a wide range was observed (Table). There were no significant differences observed for median free T, total T, E or SHBG between baseline and C2 or baseline and EOS. Changes in hormone levels could not be stratified by menopausal status or response to bicalutamide given small sample size. Given the wide range of baseline values, we examined the percent change for each endocrine biomarker from baseline to C2 and EOS. As shown in the Table, there was no difference in median percent change observed across time points for each biomarker.

Abstract P2-08-01: PIK3CA mutations associate with decreased Ki67 in early stage breast cancer (BC) and better outcomes in patients even among those with low Ki67 tumors

Background: In studies of over 450 BC patients (pts) with &gt; 10 years follow-up, pts with PIK3CA-mutated primary tumors had improved clinical outcome (Kalinsky et al 2009, Cizkova et al 2012). PIK3CA mutations associated with favorable clinicopathologic features: lower grade, smaller size, lymph node negativity (−), ER positivity (+), HER2−. In BC, several studies have suggested that PIK3CA mutations do not associate with PI3K/mTOR pathway activation (Loi et al 2010, Stemke-Hale et al 2008). To gain additional insight into the favorable biology imparted by a PIK3CA mutation in early stage BC and to identify predictive biomarkers, we performed immunohistochemistry (IHC) on tissue microarrays (TMA) constructed from 590 primary BCs.

Methods: TMAs derived from FFPE tumors previously genotyped for PIK3CA mutations (rate of 32.5%, 192/590) were stained for ER, HER2 and AR (Kalinsky et al 2009). Here, we performed additional stains for MIB1 (Ki67 proliferation index, Ki67), p53 and markers of PI3K pathway activation (pS6, PTEN). Slides were scanned with Aperio ScanScope XT and segmented using TMALab (Aperio). Images were analyzed with the Aperio algorithm based on staining pattern (nuclear, cytoplasmic, membrane) and scored for % + and intensity. Manual review was performed for tumors with less than 3 cores or discordant results. PTEN was scored manually: 0 (no tumor staining, PTEN loss), 1 (tumor &lt; stroma), or 2 (tumor ≥ stroma). P values were based on the log-rank test for comparison of Kaplan-Meier curves for disease free survival (DFS), Chi-square test for categorical variables and t-test for continuous variables.

Results: On average, 66 cases (11%) were non-informative for each IHC stain, due to missing cores or insufficient tumor cells. In a binary analysis of Ki67 using a cutoff of ≥10% + cells, PIK3CA mutated tumors demonstrated significantly lower proliferation index with only 9.4% of tumors (16/170) having high Ki67 as compared to 23.6% of wild-type PIK3CA tumors (82/347) (P = .001). Ki67 was also highly associated with PIK3CA genotype when analyzed with a cutoff of ≥13.25% + cells or as a continuous variable. Importantly, DFS was significantly different when analyzed by PIK3CA genotype and Ki67 (P = .01). Among pts with low Ki67 tumors (n = 419), PIK3CA mutation associated with longer DFS (10yr 79%, CI 69–85) as compared to wild-type PIK3CA (10yr 71%, CI 64–77). When PI3K pathway interactions were analyzed, PTEN loss associated with wild-type PIK3CA (P&lt;.001), although PTEN loss occurred with mutated PIK3CA in 11 hormone receptor (HR)+ tumors. In analysis of pS6 with a binary cutoff of ≥20% + cells, high pS6 associated with HER2+ (P&lt;.001), HR- (P&lt;.001) and high tumor grade (P = 0.003), but did not associate with PIK3CA genotype (P = .13). PIK3CA mutation was associated with lower pS6 when pS6 % + cells was analyzed as a continuous variable (P = .01).

Conclusions: PIK3CA mutation associates with lower Ki67 in early stage BC. Even among pts with low Ki67 tumors, PIK3CA mutation associates with improved clinical oucome. pS6 is not increased in PIK3CA-mutated tumors which likely indicates that mTORC1 signaling is not activated as a result of PIK3CA mutation in early stage ER+ BC.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-08-01.

Q-TWiST analysis to estimate overall benefit for patients with metastatic renal cell carcinoma treated in a phase III trial of sunitinib vs interferon-α

Background:

In a randomised phase III trial of treatment-naive patients with metastatic renal cell carcinoma, sunitinib showed significant improvement in progression-free survival (PFS) compared with interferon (IFN)-α. We assessed between-treatment differences in overall benefit using a quality-adjusted Time Without Symptoms of disease progression or Toxicity of treatment (TWiST; Gelber and Goldhirsch) analysis.

Methods:

In this analysis, in which only grade 3/4 treatment-related toxicities were included, overall survival was partitioned into three health states: toxicity (time with toxicity after randomisation and before progression), time without symptoms of disease progression or toxicity, and time from progression until death. Between-treatment differences in the mean duration of each state were calculated. A threshold utility analysis was used to assess quality-adjusted TWiST (Q-TWiST) outcomes.

Results:

Q-TWiST scores showed that quality-adjusted survival time was greater with sunitinib than with IFN-α, even though certain grade 3/4 toxicities occurred more frequently with sunitinib. For both treatments, the mean number of days with toxicity was small compared with PFS. This effect was more pronounced with sunitinib in which time spent without progression or toxicity was 151 days greater than with IFN-α.

Conclusion:

Patients randomised to sunitinib had longer clinical benefit, defined as Q-TWiST scores, than patients randomised to IFN-α.

Oral mucoceles - review of the literature

Oral mucoceles are mucin filled cavities and lined by ductal epithelium or covered by granulation tissue in retention or extravasation type respectively. The extra-vasation type is very common in the minor salivary glands (particularly in the labial glands), but very infrequent in the major salivary glands, whilst most of the retention cyst affect the major salivary glands. Partial obstruction of duct and spillage of mucin following trauma are the chief etiological factors. Though the two lesions are clinically indistinguishable, the patients are typically older than in the case of extra-vasation type. The case history along with heedful clinical examination of the lesion is crucial for diagnosing mucoceles correctly, but to avoid recurrences histopathological examination is mandatory. The surgical approach to mucoceles is the most common mode of treatment amongst various other techniques including cryosurgery, laser and so on.

P4-02-04: Androgen Receptor (AR) Expression in a Cohort of Patients (pts) with Triple Negative Breast Cancer (TNBC)

Background

TNBC, defined by the absence of ER, PR, and HER2, is associated with higher risk of recurrence and BC-related mortality, earlier age at diagnosis, menarche, and 1st pregnancy, increased parity, higher BMI, and African-American/Hispanic race. TNBC is a heterogeneous group. Using gene expression analysis, our group described a subset of AR+ ER/PR- BC that exhibits androgen-dependent growth. In vitro studies confirmed the functional role of AR and showed that growth could be abrogated by antiandrogens.(Doane et al 2006) We translated this work into a phase II trial of bicalutamide in pts with AR+ ER/PR- metastatic BC (MBC). (NCT00468715) We now describe the prevalence and clinicopathological characteristics of AR+TNBC in primary disease in a single-institution retrospective cohort.

Methods: We identified 1,032 pts with resectable, TNBC (ER/PR&lt;1%; HER2&lt;2+/FISH&lt;2.2) who had surgery at MSKCC from 1998–2006. Exclusion criteria: neoadjuvant chemotherapy, prior radiation, inflammatory/MBC. IRB approval was obtained. We constructed tissue microarrays (TMA) from 210 primary tumors (&gt; 1 cm) with each tumor represented by three 0.6mm cores. AR was tested with DAKO antibody (Clone AR441; dilution 1:500). TMAs were digitized with a Mirax scanner. MetaMorph image analysis software was used to quantify the ratio of DAB staining to hematoxylin signal. A ratio &gt;1 SD above mean was defined as AR+. AR+ cores were manually reviewed; false positives due to core artifact were excluded. To evaluate clinicopathological variables and differences in recurrence-free survival (RFS) and overall survival (OS) by AR status we used chi-square/t-tests and Kaplan-Meier methods/log-rank test, respectively.

Results: 169 pts had adequate cores for image analysis/quantification of AR. 10% of pts tested AR+ (17/169). Median (med) followup: AR+=6 years (yr), AR-=5.6yr. Demographic/clinicopathological variables: Table 1 (ages in med yr). Overall med age=54yr (29-84). Adjuvant chemotherapy received: AR+ 82%, AR- 87%, p =0.40; 77% received anthracycline/taxane-based therapy. Med time to distant metastasis (DM)=2.1yr (0.2−6.2yr). We were unable to demonstrate a difference in 5yr RFS (69% vs. 77%; p=0.37) or OS (68% vs. 84%; p=0.25) between AR+ and AR- TNBC.

PD04-03: Sexual Dysfunction in Premenopausal Women with Breast Cancer: Prevalence and Severity

Background: Sexual dysfunction is reported after chemotherapy and endocrine therapies. However, the prevalence and severity of sexual dysfunction in premenopausal women undergoing therapy for both local and metastatic disease is not well defined. This study was performed in order to understand the impact of contemporary breast cancer treatment on the prevalence and severity of sexual health in premenopausal women.

Methods: We developed a survey that includes a previously validated questionnaire, the Female Sexual Function Index (FSFI), as well as an established measure of health-related quality of life (the EuroQol EQ-5D), and disease-specific items to characterize sexual dysfunction and its causes based on literature review and expert consultations. Anonymous administration of the surveys was conducted in outpatient clinic waiting areas of the Breast Cancer Center at Memorial Sloan-Kettering Cancer Center (MSKCC), under an IRB waiver of consent.

Results: 372 consecutively approached premenopausal women with breast cancer of any stage, undergoing treatment were each queried once. The mean age was 47. 87% reported current or past hormonal treatment, and 86% reported current or past chemotherapy (76% adjuvant; 24% for metastatic disease). Sexual dysfunction attributed to breast cancer or its treatment, defined as an FSFI score &lt;26, was reported by 75% of respondents with a mean score of 16.3. Among these women, 79% of patients considered their sexual symptoms to be bothersome, with 51% noting moderate or severe levels of bother (score &gt;=5/10). In a multivariate analysis, metastatic disease, development of amenorrhea from cancer treatment, antidepressant use and poorer overall health were each significantly associated with worse FSFI scores. Lower FSFI scores were also significantly associated with worse health-related quality of life.

Conclusion: Sexual dysfunction is prevalent in premenopausal women treated for breast cancer and should be discussed with patients as a potential adverse effect of therapy. Assessment of sexual symptoms throughout treatment and beyond may facilitate the use of potential interventions such as lubricants, dilators, treatment modification and counseling.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-03.

PD06-09: Early Predictors of Prolonged Unemployment after a Diagnosis of Breast Cancer

Introduction: Low-income women may be more vulnerable to job loss and prolonged work absence after a diagnosis of breast cancer than their higher-income counterparts. This can have important adverse financial consequences on breast cancer survivors. The identification of early risk factors for long-term unemployment could inform interventions to help patients avoid this outcome. Methods: A consecutive sample of 921 low-income, underinsured or uninsured, English and/or Spanish-speaking women treated for breast cancer through the California Breast and Cervical Cancer Treatment Program was recruited and surveyed 6 months after a diagnosis of breast cancer. Participants completed follow-up telephone surveys at 18, 36, and 60 months post-diagnosis; 539 remained in the cohort at 60 months. This analysis includes only the 315 (58%) women who were employed before diagnosis. Our primary study outcome was prolonged unemployment, defined as being unemployed at every survey. Baseline characteristics (measured in the 6-month survey) were compared between women with prolonged unemployment and those who were working 60 months after diagnosis. Results: The median age of the study sample was 50, and 98% had a baseline annual household income &lt; $40,000. Eighty-five of 315 (27%) women who were employed before diagnosis had prolonged unemployment after diagnosis. In contrast, 168 (53%) were working at 60 months. Baseline predictors of prolonged unemployment after diagnosis include lower household income (p=0.003), inadequacy of financial resources to cover needs (40% vs. 23%, for inadequate vs. adequate, p=0.006), lower education (43%, 30%, and 23% among those who did not complete high school, had a high school diploma, and had a college diploma, respectively, p=0.04), higher comorbidity burden (p=0.006), higher cancer stage at diagnosis (p=0.001), and receipt of chemotherapy (p=0.008). Variables found not to be associated with prolonged unemployment include age, ethnicity, acculturation, marital status, children in the home, social support, job type, type of breast surgery, type of axillary surgery, endocrine therapy, and radiation therapy. In a multivariable analysis that included ethnicity, education, income, chemotherapy, and comorbidity, the latter three variables remained statistically significant predictors of prolonged unemployment, but education and ethnicity were not significantly associated with the outcome. Discussion: More than a quarter of women treated for breast cancer never returned to work during the five years after their diagnosis. In this low-income sample, those with the lowest income appeared to be especially vulnerable to prolonged unemployment, even when controlling for education. It is possible that the income provided by a low-paying job provides a marginal benefit, if any, over disability income, and additional research is needed to better understand this relationship and its financial and psychosocial consequences. Clinical variables also were important predictors of prolonged unemployment. Women with a higher comorbidity burden and those treated with chemotherapy appear to be most vulnerable to prolonged unemployment. This may have clinical implications for informed decision-making between oncologists and their patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD06-09.