Abstract P3-13-06: A prospective phase II trial of vinorelbine plus oxaliplatin in second- or third-line metastatic triple-negative breast cancer

Purpose: Patients with metastatic triple-negative breast cancer (mTNBC) typically have a poor prognosis and limited treatment options. Previous study showed biweekly combination of vinorelbine and oxaliplatin (NVBOX) at doses of 30 mg/m2 and 90 mg/m2, respectively, is highly active and well tolerated as first-line treatment for patients with metastatic breast cancer. The purpose of this study (NCT 01528826) was to prospectively evaluate the efficacy and toxicity of NVBOX in second- or third-line mTNBC.

Methods: Eligible patients were female with 18–70 years old and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1, and had mTNBC that had progressed after 1or 2 prior chemotherapy regimens in the metastatic setting. A period of 4 weeks (NVBOX twice) was considered as one treatment cycle and the maximum cycles were 6. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR), and safety.

Results: Between Dec 2011 and Nov 2012, forty-four patients were recruited [median age 47; 77.3% with viceral metastasis, 100% had been exposed to anthracyclines and/or taxanes; 56.8% cis/carbo-platin pretreated for MBC; 38.6% with time to progression (TTP) of 1-2 previous regimens before recruitment ≤ 3 months]. The overall response rate was 31.6% (1 complete response, 11 partial responses) and 10 achieved stable diseases (7 lasting more than 6 months) in 38 evaluable patients. After a median follow-up of 12.8 months, the median PFS and OS were 4.3 (95% CI, 3.6–5.0) months and 12.6 (95% CI, 8.1–17.0) months, respectively. PFS was significantly shorter in patients with disease free interval (DFI) ≤ 1year (HR = 2.10; 95% CI, 1.05–4.21; P = 0.037) and TTP of 1-2 previous regimens before recruitment ≤ 3 months (HR = 3.39; 95% CI, 1.66–6.89; P < 0.001). Also, these two factors were two independent predictors for the poor OS (HR = 5.45; 95% CI, 2.08–14.32; P < 0.001 and HR = 4.09; 95% CI, 1.73–9.68; P < 0.001). For 34 second line patients, prior platinum in the first line was a factor significantly compromise the PFS (HR = 2.29; 95% CI, 1.03–5.10; P = 0.043). Dose adjustment happened in 14 patients (31.8%) due to adverse events (AEs). Grade 3/4 hematologic toxicities were neutropenia (70.5%), thrombocytopenia (27.3%) and anemia (15.9%). Four patients experienced febrile neutropenia. The most frequent grade 3/4 non-hematologic toxicities were constipation (20.5%) and vomiting (11.4%). Two patients developed grade 3 NVBOX-related peripheral neurotoxicity. There were no treatment-related deaths.

Conclusion: We conclude that biweekly NVBOX regimen is effective with a good safety profile in the second- or third-line mTNBC, which warrants further investigation in a phase III study.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-13-06.

Abstract P1-01-13: Intraoperative evaluation of sentinel lymph nodes using touch imprint cytology in patients with early-stage breast cancer: A series of 4367 procedures

Background: As the screening for breast cancer becomes common in China, an increasing number of early-stage breast cancer has been detected. For those patients, especially the ones with cliniaclly negetive lymph nodes, sentinel lymph node biopsy (SLNB) plays an important role in the assessment of the axillary status, while minimizing the mobidity of axillary lymph node dissection(ALND). Accurate intraoperative assessment of SLN metastases enables the selection of patients for ALND during the same operation. Touch imprint cytology (TIC) serves as a main intraoperative evaluation of SLNs in our institute since Feb-2005. The purpose of this study is to evaluate its clinical value.

Methods: Early-stage breast cancer patients treated in our institute between Feb-2005 and Apr-2013 enrolled in this study. To avoid breast tissue contamination, all patients had an intraoperative SLNB performed before undergoing lumpectomy or mastectomy. The fresh SLNs were sectioned into 1.5-3.0mm pieces along the short axis, TIC was performed on both surfaces of each piece, its result was correlated with the histological assessments with Hematoxylin-Eosin (H&E) staining, which considered as the gold standard.

Results: A total of 4,367 early-stage breast cancer patients enrolled in the study, and 14,112 SLNs were successfully harvested. Among those, 917 (21.0%) patients were confirmed to have at least one SLN positive for metastases, and 1343 (9.5%) positive SLNs were removed. Based on the final H&E report, the sensitivity, specificity and overall accuracy of TIC was 71.4%, 99.2% and 93.6%, respectively on a per patient basis, and 69.6%, 99.5% and 96.6%, respectively on a per node basis. The sensitivity for macrometastasis and micrometastasis was 74.8% and 26.5%, respectively on a per patient basis, and 78.9% and 25.2%, respectively on a per node basis. To discuss the influence of error results on the surgery procedure, we further reviewed the detail medical records of the patients enrolled in the recent 3 years. Of all the 3290 patiens treated between Jun-2010 and Apr-2013, 207(6.5%) patients needed a second opereation to have the ALN dissected. Meanwhile, 20(0.6%) patients had undergone extra ALND because of the false positive results of TIC.

Conclusion: The sensitivity of TIC seems a little lower then the ones reported previously, but the overall accuracy still remains acceptable. In addition, only 7.1% patients were influenced by the error results of TIC, along with the advantages, such as the shorter preparation time and the less cost of cytological specimens, we consider TIC a feasible method, and believe it can serve well in the intraoperative evaluation of SLNs for early-stage breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-13.

Abstract P2-19-07: Current trends of breast reconstruction after mastectomy for breast cancer patients in China

Background: To ascertain the current trends of breast reconstruction (BR) for breast cancer patients in China, we conducted a retrospective study in Committee of Breast Cancer Society, Chinese Anti-Cancer Association.

Methods: We designed a questionnaire for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy (RT) or chemotherapy, complication, oncoplastic surgery, fat grafting, physician and patient satisfaction, etc. All data were collected until 2012. Questionnaires were sent to 52 members of Committee of Breast Cancer Society by e-mail. By Jun-2013, 30 questionnaires (response rate 57.7%) had been returned. Among all, 3 were excluded for not performing BR. Finally, 27 respondents were included.

Results: All but one of these 27 hospitals were Class Three Grade A hospitals in China. A total of 402 surgeons worked in the general surgery or oncological surgery department, among them, only 84 (20.9%) were able to perform BR. Surgeons from 10 hospitals would also choose to cooperate with the plastic department to finish the complicated reconstructive procedure. In 2012, 21026 mastectomies were performed; among them, 679 (3.2%) received immediate BR, 102 (0.5%) received delayed BR while 192 (0.9%) received delayed-immediate one. At the same time, 414 (2.0%) had their breast reconstructed by implant while 393 (1.9%) chose the autologous ones, the choices of reconstructive type were not recorded for other 166 (0.8%) cases. According to these 27 respondents, 88.9% predominantly performed prosthetic (1265 cases in all) or latissimus dorsi myocutaneous flap (LDMF) with or without an implant (1571 cases in all) BR from the time of their first BR operation to the end of 2012. During the same period, 327 pedicled transverse rectus abdominis myocutaneous (TRAM) BR were performed in 20 hospitals, while 169 free TRAM BR, which requiring technique of microsurgery, were carried out in 9 hospitals (68.6% were performed by a single surgeon from Nov-2006). The overall complication rate of BR was 12.4%. As RT had low to medium effect on increasing the operational difficulties and influencing the esthetic outcomes of BR, about 75% surgeons would choose delayed autologous BR in patients who had previous RT. Autologous flaps were also recommended for patients who need postoperative RT, but the timing still remained controversial. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

Conclusion: With the growing number of breast cancer patients who need to undergo mastectomy, more and more BR are needed to improve the quality of life for them, but the ratio is still low in China, partially because of the lack of qualified plastic surgeons. As free flap BR requiring microsurgical techniques seems still complicated for most surgeons, implant and LDMF BR are the most common choices for patients nowadays in China. In addition, the effect of radiotherapy will be an important consideration when deciding the type and timing of BR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-07.

Abstract P4-07-11: Dual characteristics of microRNA-484 modulated cytidine deaminase (CDA) axis in breast cancer: Chemo-resistance and regulating cell proliferation

Acquired resistance to chemotherapy is a major clinical obstacle to achieve successful treatment in breast cancer. Cancer cells could evolve a complicated sensory network to develop resistance to chemo treatment. Recently, microRNAs modulated chemo-resistance is investigated as a new paradigm in cancer biology and some acquired mis-expression of miRs confer cancer cells to escape chemotherapy. However, it is important to address whether these miRs also play various intrinsic roles in carcinogenesis. Here, our study demonstrated that miR-484 could modulate cytidine deaminase (CDA) axis, playing various roles in chemo-resistance and cell proliferation.

We have generated a chemo-resistant breast cancer cell line (MDA-MB-231 Gem) which has 10 fold higher IC50 value than MDA-MB-231 cells in response to gemcitabine (dFdC) treatment through molecular evolution. Gene ontology analysis showed that cytidine degradation pathway was activated in the resistant cells, and qPCR array confirmed that cytidine deaminase (CDA), which converts dFdC to dFdU, was significantly upregulated. Interestingly, microRNA array analysis implicated that miR-484, which might target the 3’UTR region of CDA gene was down-regulated in these resistant cells. Furthermore, 3’UTR luciferase reporter assay and western blot revealed that miR-484 directly regulates CDA gene expression. Over-expression of miR-484 can sensibilize the resistant cells to dFdC treatment. Remarkably, restoration of CDA gene strongly converts miR-484–mediated dFdC sensibilization. These results implicated that miR-484/CDA axis play a pivotal role in chemo-resistance. Unexpectedly, further studies implicated that miR-484/CDA axis could also regulate cell proliferation due to disrupting cell cycle. We found that the chemo-resistant cells had deficiency in cell cycle progression at the S-phase transition, and miR-484 could significantly promote cell growth and overcome cell cycle arrest with CDA down-regulation. Moreover, reintroduction of CDA gene could abrogate miR-484-induced effects on cell proliferation via reactivating S-phase checkpoint. Importantly, the Kaplan-Meier survival analysis supported that higher expression of CDA in breast cancer patients indicates better outcome in DFS model.

In summary, this study uncovers for a previously unknown axis that cytidine deaminase was a direct downstream target for miR-484. The miR484/CDA axis could modulate cells into stagnant status for promoting cellular resistance to DNA damage agents in chemotherapy. On the other hand, as CDA gene participates in cell cycle S-phase arrest, miR484/CDA axis could also contribute to cell proliferation. Taken together, our findings provided new evidences that miR-484/CDA axis has various functions in cell proliferation and chemo-resistance and might be considered as a candidate therapeutic target in breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-11.

GATA1s induces hyperproliferation of eosinophil precursors in Down syndrome transient leukemia

Transient leukemia (TL) is evident in 5–10% of all neonates with Down syndrome (DS) and associated with N-terminal truncating GATA1-mutations (GATA1s). Here we report that TL cell clones generate abundant eosinophils in a substantial fraction of patients. Sorted eosinophils from patients with TL and eosinophilia carried the same GATA1s-mutation as sorted TL-blasts, consistent with their clonal origin. TL-blasts exhibited a genetic program characteristic of eosinophils and differentiated along the eosinophil lineage in vitro. Similarly, ectopic expression of Gata1s, but not Gata1, in wild-type CD34⁺-hematopoietic stem and progenitor cells induced hyperproliferation of eosinophil promyelocytes in vitro. While GATA1s retained the function of GATA1 to induce eosinophil genes by occupying their promoter regions, GATA1s was impaired in its ability to repress oncogenic MYC and the pro-proliferative E2F transcription network. ChIP-seq indicated reduced GATA1s occupancy at the MYC promoter. Knockdown of MYC, or the obligate E2F-cooperation partner DP1, rescued the GATA1s-induced hyperproliferative phenotype. In agreement, terminal eosinophil maturation was blocked in Gata1^Δe2 knockin mice, exclusively expressing Gata1s, leading to accumulation of eosinophil precursors in blood and bone marrow. These data suggest a direct relationship between the N-terminal truncating mutations of GATA1 and clonal eosinophilia in DS patients.

Maternal immunization promotes the immune response of neonates towards hepatitis B vaccine

Infants infected with hepatitis B virus (HBV) face the risk of developing severe complications. Unfortunately, in spite of universal vaccination programmes, 5% or more of vaccinated newborns still do not achieve protective levels of anti-hepatitis B virus surface antigen titres (anti-HBs). The aim of this study was to use animal experiments and population-based research to determine whether maternal vaccination against HBV affects the outcome of neonatal vaccination. Six sows and 53 newborn piglets were used for this study and randomly assigned to the vaccination group (three 20 μg doses of recombinant HBV vaccine). All the piglets were followed up to 10 weeks of age, and peripheral blood was withdrawn for measurement of anti-HBs. A cross-sectional study was also conducted on 449 mothers with infants. A structured questionnaire was used to collect demographic, medical and maternal data, and their peripheral blood was collected for measurement of anti-HBs. The results of animal experiments demonstrated that nonvaccinated piglets born to vaccinated sows and nonvaccinated piglets born to nonvaccinated sows were negative for anti-HBs. Repeated measures analysis of variance showed that the titres of anti-HBs in vaccinated piglets born to vaccinated sows were significantly higher than in vaccinated piglets born to nonvaccinated sows (P < 0.05). In a population-based study, a cumulative logistic regression analysis showed that the strongest influences on neonatal anti-HBs titres were delay of the first vaccination dose [OR = 3.02(95% CI: 1.72-5.30)] and maternal anti-HBs titres [OR = 2.48(95% CI: 2.03-3.04)]. In conclusion, high maternal anti-HBs titres can enhance the response to HBV vaccination in infants.

A causal role for circulating miR-34b in osteosarcoma

PURPOSE

To investigate the associations between plasma miR-34b/c expression levels and osteosarcoma (OS).

SUBJECTS AND METHODS

A case-control study was conducted in 133 patients with OS and 133 controls. MiR-34b/c levels were detected by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assays. Genotyping of SNP rs4938723 was done using the TaqMan assay. The causal association was examined by mendelian randomization analysis.

RESULTS

Plasma miR-34b level was significantly lower in OS patients than in controls (P = 0.001). Expression levels of miR-34b in OS tissues decreased (P = 3.22 × 10(-4)) and was significantly related with its expression in plasma (r = 0.21, P = 0.004). Compared with wild-type TT genotype, the variant genotypes of rs4938723 TC/CC were significantly associated with increased OS risk (TC vs. TT: OR, 1.97 [95% CI: 1.40-2.55], P = 0.021; CC vs. TT: OR, 2.76 [95% CI: 2.00-3.53], P = 0.009; TC + CC vs. TT: OR, 2.16 [95% CI: 1.61-2.70], P = 0.006), consistent with its decreased effect on plasma miR-34b (TC vs. TT: -0.32 (-0.43, -0.21), P < 0.001; CC vs. TT: -0.70 (-0.84, -0.56), P < 0.001; TC + CC vs. TT: -0.42 (-0.53, -0.32), P < 0.001). Adjustment for miR-34b completely abolished the association between SNP rs4938723 and OS risk (P > 0.05). In addition, plasma expression levels of miR-34b were significantly decreased in the metastatic patients compared with that in the non-metastatic ones (P = 0.004).

CONCLUSION

Plasma miR-34b was causally associated with OS risk and related with its metastatic status, suggesting that plasma miR-34b might be a novel biomarker and a potential treatment target for OS.

A DR6/p75(NTR) complex is responsible for β-amyloid-induced cortical neuron death

The p75 neurotrophin receptor (p75(NTR)) is a known mediator of β-amyloid (Aβ)-induced neurotoxicity implicated in Alzheimer's disease (AD). Here, we demonstrate that death receptor 6 (DR6) binds to p75(NTR) and is a component of the p75(NTR) signaling complex responsible for Aβ-induced cortical neuron death. Cortical neurons isolated from either DR6 or p75(NTR) null mice are resistant to Aβ-induced neurotoxicity. Blocking DR6 function in cortical neurons by anti-DR6 antibodies that block the binding of DR6 to p75(NTR) receptor complex or by a dominant negative DR6 construct lacking the cytoplasmic signaling death domain attenuates Aβ-induced caspase 3 activation and cell death. DR6 expression is upregulated in AD cortex and correlates with elevated neuronal death. Targeting the disruption of the DR6/p75(NTR) complex to prevent Aβ cytotoxicity represents a new approach for the treatment of neurodegenerative disorders such as AD.

Abstract P6-04-26: Tamoxifen may block estrogen induced secretion of certain cytokines to interrupt tumor associated macrophage infiltration in breast cancer

The role of tumor microenvironment during the initiation and progression of breast cancer is now realized to be of critical importance, both for understanding of the fundamental cancer biology and exploiting relatively new mechanism for breast cancer metastasis. Macrophage is a one of the most common components in the breast cancer microenvironment. Normally, the macrophage in tumor microenvironment is referred to tumor associated macrophage (TAM), which shares some attributes of alternatively activated macrophage. Many pre-clinical and clinical studies demonstrate an inverse correlation between TAM infiltration and patients' prognosis indicating a macrophage supporting role for tumor progression. It is well documented that selective patients with breast cancer can benefit from anti-estrogen therapy. However, the mechanisms involved are still not fully elucidated. Our previous study indicates that highly tumorigenic breast cancer cell line MDA-MB-231 can educate monocyte differentiation into alternatively activated macrophage, while weakly tumorigenic cell line MCF-7 (without estrogen supplementation) can not. In the present study, we explored the effects of estrogen and tamoxifen on the secreting of certain cytokines, which are required for monocyte chemotaxis and differentiation. Breast cancer cell lines with different estrogen receptor status were applied to estimate the level of cytokines (IL4, IL6, M-CSF, GM-CSF, and MCP-1) before and after cultured with 17β-estradiol, tamoxifen or both. We found that weakly invasive breast cancer cell lines (MCF-7, T47D, MDA-MB-468, and SKBR3) generally expressed lower levels of such cytokines compared with highly invasive breast cancer cell lines (MDA-MB-231, MDA-MB-231-BO, MDA-MB-231 HM, Bcap 37, BT549, and Hs578T) at baseline. However, the discrepancies could be compensated partially by exposure to 10nM 17β-estradiol in estrogen receptor (ER) positive cell lines (MCF-7 and T47D). Moreover, the compensation was substantially blocked by 2μM tamoxifen. On the contrary, tamoxifen, alone, didn't affect the secretion of such cytokines mentioned above in vitro. Based on these findings, we tentatively concluded that some patients with ER positive breast cancers benefiting from anti-estrogen therapy may partially attributes to blocking monocyte differentiation into TAM, which destroyed the tumor microenvironment. These findings suggest the future possibility of using TAM as a novel therapeutic target in patients with anti-estrogen resistance and primary triple-negative breast cancers (TNBC) with no effectively therapeutic measures nowadays, which are defined by lack of estrogen receptor, progesterone receptor and ERBB2 gene amplification, representing approximately 16% of all breast cancers.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-04-26.

P2-12-18: A Prognostic Model Based on Node Status, Cathpesin-D and Ki-67 Predict the Outcome of Patients Failing To Achieve Pathological Complete Response after Anthracycline-Based Neoadjuvant Chemotherapy for Breast Cancer

Background

Aim of this study was to evaluate factors which could possibly affect the outcome of patients failing to achieve pathological complete response (pCR) after anthracycline-based neoadjuvant chemotherapy (NCT) for breast cancer, and built a prognostic model to predict disease free survival (DFS) and overall survival (OS).

Material and Methods: We retrospectively collected data of 199 stage II-III breast cancer patients who had failed to achieve pathological complete response after neoadjuvant chemotherapy in Shanghai Cancer Hospital. The NCT regimens were NE (navelbine 25mg/m2, day 1, 8 and epirubicin 60mg/m2, day 1; every three weeks) or CEF (cyclophosphamide 600 mg/m2, day 1; epirubicin 60 mg/m2, day 1 and 5-fluorouracil 600 mg/m2, day 1; every three weeks) for a median treatment course of 3 cycles. To develop the prognostic model, variables at baseline(age, menopausal status, tumor size, node status, ER, PR, and HER-2) and at surgery(tumor size, grade, histotype, node status, vascular invasion, ER, PR, HER-2, Cathpesin-D, P53, Topo-IIα, Nm-23, Bcl-2, BAX, MDR, GSTn, PS2, P27, Cyclin D1 and Ki-67) were investigated. Multivariate Cox regression model and Kaplan-Meier method was used to build the model, and show the discrimination of DFS and OS in different risk groups.

Results: By multivariate analysis, ≥4 lymph node metastasis (HR=1.9, P=0.009), Cath-D positive (HR=2.5, P=0.006), and Ki-67 index≥20% (HR=1.9, P=0.001) at surgery were independent predictors for lower DFS and OS rate among non-pCR responders. We built a prognostic scoring model on the basis of these variables, in which ≥4+ nodes, Cath-D + or Ki-67 index≥20% would contribute 1 point separately to the risk score. The 5-year DFS rates in low(0 point), intermediate-low(1 point), intermediate-high(2 points) and high risk groups(3 points) were 94%, 65%, 43%, and 28%, respectively (Log-rank teat p&lt;0.001). The 5-year OS rates in these four groups were 94%, 84%, 66% and 34%, respectively (Log-rank test p&lt;0.001).

Conclusion: Post-NCT node status, Cathpesin-D and Ki-67 were used to develop a prognostic model which could simply discriminate patients with poor prognosis among non-pCR responders after anthracycline-based neoadjuvant chemotherapy, and might help to tailor further individualized treatment strategies.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-18.

P1-09-08: Association of Hypoxia-Inducible Factor-1 with Breast Cancer Risk: A Meta-Analysis of Published Studies

Background: Hypoxia-inducible factor-1 (HIF-1) plays an important role in the development and progression of breast cancer. However, conflicting results have been yielded for the association between HIF-1 polymorphisms and breast cancer risk. Therefore, we carried out a meta-analysis to assess the association of HIF-1 1772 C/T and 1790 G/A polymorphisms with breast cancer.

Material and methods: Computerized and manual searches were performed to identify eligible studies comparing allelic and genotypic frequency between cases and controls in breast cancer. Odds ratios (ORs) were used to estimate the association between HIF-1 polymorphisms and breast cancer risk. The fixed-effects or random-effects model was used to combine data. Subgroup analyses by ethnicity were also performed.

Results: This meta-analysis for 1772 C/T polymorphism included 1934 breast cancer cases and 1848 controls, and for 1790 G/A polymorphism included 602 breast cancer cases and 479 controls. We found that 1772C/T polymorphism increased the risk of breast cancer in the recessive model (OR = 2.273, 95% CI: 1.061−4.872, P = 0.035), whereas similar effect failed to be observed in the dominant model (OR = 1.075, 95% CI: 0.717−1.613, P = 0.725). There was a significant increase in breast cancer risk among Asian women (OR = 4.162, 95% CI: 1.508−11.484, P = 0.006) but not Turkish patients in the recessive model. For the 1790G/A polymorphism, we found that it had no exact effect on the decreased risk of breast cancer in both recessive and dominant model.

Discussion: This meta-analysis indicates that the polymorphism of HIF-1 1772C/T rather than 1790G/A polymorphism might be one of the high risk factors for breast cancer. The effect of the 1772C/T polymorphism on breast cancer risk is completely generated by the Asian women.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-09-08.

P5-13-13: The Role of Topoisomerase IIa in Predicting Sensitivity to Anthracyclines in Breast Cancer Patients: A Meta-Analysis of Published Literatures

Topoisomerase IIα is not only a proliferation marker of tumor cells but also a target for anthracycline-based chemotherapy. Both in vitro and in vivo studies have shown that there was a relationship between topo IIα and chemosensitivity to anthracyclines, but the predictive role of topo IIα is still controversial in breast cancer patients. A meta-analysis based on published studies was performed with the aim of obtaining an accurate evaluation of the association between topo IIα and sensitivity to anthracycline-based chemotherapy. A total of 13 eligible studies including 2,633 cases and 2,118 controls were identified. Topo IIα was associated with sensitivity to anthracyclines in locally advanced breast cancer patients who received neoadjuvant chemotherapy (RR = 1.93, 95%CI: 1.27−2.94, P=0.002; RR =1.98, 95%CI: 1.37−2.86, P&lt;0.001). In early breast cancer patients who received anthracycline-based adjuvant chemotherapy compared with non-taxane-based polychemotherapy, amplification(HR = 0.64, 95%CI: 0.49−0.83, P=0.001; HR = 0.59, 95% CI: 0.35−1.01, P=0.056) or deletion (HR = 0.82, 95%CI: 0.67−1.00, P=0.051; HR =0.58, 95%CI: 0.35−0.97, P=0.036) of topo IIα was significantly associated with better RFS and OS. The subgroup analysis in the early breast cancer patients indicated that taxane could be an interference for evaluation of the predictive role of topo IIα. In summary, the present meta-analysis suggests that topo IIα is a predictive factor for breast cancer patients who received anthracycline-based chemotherapy. Larger and well-designed prospective studies are required to further evaluate the predictive role of topo IIα in clinical practice.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-13.

P3-16-10: The Efficacy of Zoledronic Acid in Breast Cancer Adjuvant Therapy: A Meta-Analysis of Randomized Controlled Trials

Background: The effect of zoledronic acid in breast cancer adjuvant therapy concerning improvement of patient survival has yet to be confirmed. We performed a meta-analysis of published and unpublished randomized controlled trials with the aim of accurate evaluation between clinical outcome and the association of the addition of zoledronic acid to adjuvant therapy.

Methods: We searched Pubmed (from 1966 to present) and online abstracts from the proceeding Annual Meetings of the American Society of Clinical Oncology (ASCO) (years 1992–2010) and online abstracts from San Antonio Breast Cancer Symposium (years 2004–2010). A total of five eligible studies including 3676 subjects and 3678 controls met our search criteria and were evaluated. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. The primary study endpoints were the DFS. Secondary endpoints were OS, distant or loco-regional recurrence free survival and bone metastasis free survival.

Results: Compared with the control arm, adjuvant breast cancer treatment with zoledronic acid did not significantly improve overall survival (OS), disease free survival (DFS), bone metastasis free survival, distant and locoregional recurrence free survival. However, in the postmenopausal subgroup, the addition of zoledronic acid to standard therapy could significantly improve DFS (RR=0.763, 95%CI 0.658−0.884, p&lt;0.001) and reduce the risk of distant (RR=0.744, 95% CI 0.611−0.906, p=0.003) and locoregional recurrence (RR=0.508, 95% CI 0.340−0.760, p=0.001).

Discussion: Adjuvant zoledronic acid may potentially improve the prognosis of postmenopausal patients. Additional studies are needed to evaluate the value of adjuvant treatment of zoledronic acid in premenopausal couterparts, differing disease stages, and various pathological types of breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-16-10.

CT-guided percutaneous injection of fibrin glue for the therapy of symptomatic arachnoid cysts

BACKGROUND AND PURPOSE

Although often asymptomatic, enlarging sacral arachnoid cysts can also cause significant discomfort. These symptomatic sacral arachnoid cysts require specific treatments to facilitate local decompression. The main drawback of the surgical managements is the high risk of recurrence and complications. To decrease risks, we had been attempting to seek a simple and safe method to manage the symptomatic sacral arachnoid cysts. CT-guided percutaneous fibrin glue therapy is a new nonsurgical alternative. To evaluate the efficacy of the novel nonsurgical approach, we conducted this retrospective study of 38 patients.

MATERIALS AND METHODS

Thirty-eight patients with symptomatic sacral arachnoid cysts underwent fibrin glue therapy in our hospital between June 2006 and May 2009. The clinical results of improvement in pain and neurologic function were evaluated after an average of 25 months of follow-up, and changes on the imaging findings were evaluated. Preoperative and postoperative pain severity was assessed according to a 10-cm VAS. Moreover, we also analyzed the postoperative complications.

RESULTS

Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Twenty-one patients (55.3%) reported excellent recovery, 12 (31.5%) reported good recovery, 4 (10.5%) reported fair recovery, and 1 (2.6%) reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 86.8%. No serious postoperative complications were discovered.

CONCLUSIONS

CT-guided percutaneous injection of fibrin glue therapy is simple, safe, and effective for the management of symptomatic sacral arachnoid cysts.

Diffusion-Weighted MRI in Predicting the Efficacy of Neoadjuvant Chemotherapy of Breast Cancer

Objective: To approach the apparent diffusion coefficient(ADC) obtained on diffusion weighted imaging (DWI) in predicting the response of breast cancer to neoadjuvant chemotherapy.Methods: 53 locally advanced breast cancer patients participated in this prospective study on neoadjuvant chemotherapy. All patients were treated with weekly neoadjuvant paclitaxel plus carboplatin for 4 cycles. DWI and ADC value were examined before chemotherapy(the first time point), after the first and the forth cycle of chemotherapy(the second and the third time point). Patients were categorized as high responders if their ADC at the second time point were higher by 2 times the standard deviation than the mean pre-chemotherapy ADC, and otherwise the patients were considered as low responders. Logistic regression was conducted to examine the independent factors predictive of clinical complete response(CR) and pathologic complete response(pCR).Results: CR was documented in 13 patients (24.5%); partial response in 36 patients (67.9%); stable disease in 4 patients (7.5%) and no patient had progressive disease. 11 patients(20.8%) have achieved pCR. There was a strong positive correlation between the percentage changes in ADC value at the third time points and the degree of the tumor reduction. A significant increase in ADC value was observed at the second time point compared with the first time point (1.104±0.117×10-3mm2/s, 1.220±0.158×10-3mm2/s, P&lt;0.001), while the decrease of the longest diameter of the tumors measured by physical examination, ultrasound or MRI or the tumor volumn measured by MRI were not (P&gt;0.05). Logistic regression revealed that percentage changes of ADC value at the second time point were significantly associated with CR(P=0.022, hazard ratio[HR] =1.08, 95% confidence interval[CI]: 1.01∼1.16) and pCR(P=0.022, HR =1.11, 95%CI: 1.02∼1.21). The AUC value of the receiver operating characteristic curve were 0.721(95%CI: 0.512∼0.931, P=0.017) and 0.775(95%CI: 0.598∼0.952, P=0.005) in the two diagnostic tests for CR and pCR, and the sensitivity and specificity were 76.9%, 63.6% and 77.5%, 90.5%, respectively. According to categorizing system described above, 10 patients(18.9%) were considered as high responders and 43 patients(81.1%) low responders. 7 patients(70%) of the high responders have achieved clinical CR and pCR while for the low responders there were only 6 patients(14.0%) and 4 patients (9.3%) proven to have CR and pCR. The difference have both reached statistical significance(P=0.001, P&lt;0.001). Logistic regression confirmed that the categorizing system was independently predictive of CR(P=0.006, HR=42.26, 95%CI: 2.86∼624.08) and pCR(P=0.013, HR=25.19, 95%CI: 2.00∼318.91). Taking this categorizing system as a dignostic test, the sensitivity and specificity were 53.8% and 92.5% for CR and 63.6% and 92.9% for pCR, respectively.Conclusions: The change of ADC value obtained on DWI after the first cycle of neoadjuvant chemotherapy occured prior to the morphologic changes of the tumor and at this time ADC value could to some extent predict the efficacy of neoadjuvant chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4025.