Abstract P1-05-26: A blood-based lipid panel for personalized risk assessment of breast cancer

Background: The metabolic syndrome characterized in part by obesity, hyperinsulinemia, and insulin resistance is associated with increased risk of breast cancer. However there remains a need to establish a circulating biomarker metabolic profile indicative of increased risk of breast cancer. In the current study, we performed a comprehensive metabolomics screen to identify biomarkers indicative of increased risk of breast cancer. Methods: Unbiased metabolomics profiling was conducted on an initial Development Set of plasmas collected from 353 newly-diagnosed breast cancer cases and 141 controls. A deep learning neural network with 3 layers each containing 32 nodes based on 11 individual lipids corresponding to discrete lipid subclasses was built for risk prediction of breast cancer. The model was validated in an independent Test Set consisting of 79 breast cancer cases and 163 controls. Using a nested case:control matched design, we evaluated the performance of the model among body mass index (BMI) strata (≥ 30 or < 30kg/m2). Results: An 11-marker lipid biomarker panel encompassing lipid subclasses with known pro-inflammatory and tumor promoting roles yielded an AUC of 0.75 (95% CI: 0.70-0.79) for distinguishing breast cancer cases from controls in the Development Set. Predictive performance of the lipid panel was comparable when stratifying cases into hormone-receptor (HR) positive, HER2-positive/HR negative, and triple-negative breast cancer subtypes. The biomarker panel had an AUC of 0.74 (95% CI: 0.68-0.81) in the independent Test Set. The predictive performance of the panel was most pronounced among obese subjects (BMI ≥ 30) with an AUC of 0.81 (95% CI: 0.71-0.91) in the Test Set. Conclusions: The lipid-based biomarker panel has utility for identifying women with ‘metabolic obesity’ who are at increased risk of breast cancer and would benefit from tailored screening.

Citation Format: Johannes Fahrmann, Ehsan Irajizad, Jody Vykoukal, Angelica Gutierrez Barrera, Jennifer Dennison, Ranran Wu, Banu K. Arun, Abenaa Brewster, Samir Hanash. A blood-based lipid panel for personalized risk assessment of breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-26.

Abstract P077: A blood-based lipid biomarker panel for personalized risk assessment of breast cancer

Background: The metabolic syndrome characterized in part by obesity, hyperinsulinemia, and insulin resistance is associated with increased risk of breast cancer. However there remains a need to establish a circulating biomarker metabolic profile indicative of increased risk of breast cancer. In the current study, we performed a comprehensive metabolomics screen to identify biomarkers indicative of increased risk of breast cancer. Methods: Unbiased metabolomics profiling was conducted on an initial Development Set of plasmas collected from 353 newly diagnosed breast cancer cases and 141 controls. A deep learning neural network with 3 layers each containing 32 nodes based on 11 individual lipids corresponding to discrete lipid subclasses was built for risk prediction of breast cancer. The model was validated in an independent Test Set consisting of 79 breast cancer cases and 163 controls. Using a nested case: control matched design, we evaluated the performance of the model among body mass index (BMI) strata (≥ 30 or <30kg/m2). Results: An 11-marker lipid biomarker panel encompassing lipid subclasses with known pro-inflammatory and tumor promoting roles yielded an AUC of 0.75 (95% CI: 0.70-0.79) for distinguishing breast cancer cases from controls in the Development Set. Predictive performance of the lipid panel was comparable when stratifying cases into hormone-receptor (HR) positive, HER2-positive/HR negative, and triple-negative breast cancer subtypes. The biomarker panel had an AUC of 0.74 (95% CI: 0.68-0.81) in the independent Test Set. The predictive performance of the panel was most pronounced among obese subjects (BMI ≥ 30) with an AUC of 0.81 (95% CI: 0.71-0.91) in the Test Set. Conclusions: The lipid-based biomarker panel has utility for identifying women with ‘metabolic obesity’ who are at increased risk of breast cancer and would benefit from tailored screening.

Citation Format: Johannes F. Fahrmann, Ehsan Irajizad, Jody Vykoukal, Angelica Gutierrez Barrera, Jennifer B. Dennison, Ranran Wu, Banu Arun, Abenaa Brewster, Samir Hanash. A blood-based lipid biomarker panel for personalized risk assessment of breast cancer. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P077.

Application of Artificial Intelligence to Plasma Metabolomics Profiles to Predict Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

There is a need to identify biomarkers predictive of response to neoadjuvant chemotherapy (NACT) in triple-negative breast cancer (TNBC). We previously obtained evidence that a polyamine signature in the blood is associated with TNBC development and progression. In this study, we evaluated whether plasma polyamines and other metabolites may identify TNBC patients who are less likely to respond to NACT. Pre-treatment plasma levels of acetylated polyamines were elevated in TNBC patients that had moderate to extensive tumor burden (RCB-II/III) following NACT compared to those that achieved a complete pathological response (pCR/RCB-0) or had minimal residual disease (RCB-I). We further applied artificial intelligence to comprehensive metabolic profiles to identify additional metabolites associated with treatment response. Using a deep learning model (DLM), a metabolite panel consisting of two polyamines as well as nine additional metabolites was developed for improved prediction of RCB-II/III. The DLM has potential clinical value for identifying TNBC patients who are unlikely to respond to NACT and who may benefit from other treatment modalities.

The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design

Background

Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity.

Objective

The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes.

Methods

This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes.

Results

The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53).

Conclusions

Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.

Acceptance- and mindfulness-based techniques for physical activity promotion in breast cancer survivors: a qualitative study

Purpose

The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors.

Methods

The acceptance- and mindfulness-based physical activity intervention was delivered to participants electronically over the course of 4–8 weeks. It consisted of didactic videos, experiential exercises, and workbook-type activities that targeted principles from acceptance and commitment therapy (ACT). We conducted semi-structured, in-depth interviews with participants after they completed the intervention. Three coders conducted qualitative data analysis on interview transcripts to identify overarching themes and subthemes.

Results

We recruited 30 participants. Of those, 16 engaged in an individual interview. The mean age of the sample was 58.4 years (SD = 13.8). The sample was relatively well educated (50.0% college graduates) and mostly overweight or obese (58.8%). We identified two overarching themes from interviews. They were centered on (1) internal and external barriers to physical activity adherence and (2) the utility of targeting core ACT processes (acceptance and defusion, mindfulness, and values clarification) for physical activity promotion.

Conclusion

Intervention content was perceived to be acceptable, relevant, and to fulfill important needs related to healthy living. Findings suggest that this approach to physical activity promotion can be delivered effectively online. Electronically delivered acceptance- and mindfulness-based approaches hold promise for helping insufficiently active breast cancer survivors increase physical activity.

Abstract PS7-12: Impact of race/ethnicity on triple negative breast cancer molecular features, treatment response and clinical outcomes in patients receiving neoadjuvant therapy

Background: Triple negative breast cancer (TNBC) disproportionally impacts Black and Hispanic women and is suggested to be partly responsible for disparities observed in breast cancer mortality. We sought to evaluate the impact of race/ethnicity on TNBC molecular subtype, immune profile, pathologic complete response (pCR) and recurrence free survival (RFS).

Methods: The ARTEMIS trial (NCT02276443) uses imaging response and molecular profiling to personalize neoadjuvant chemotherapy in early stage TNBC. After 4 cycles of AC, patients with chemo-sensitive disease receive standard taxane-based therapy, while those with chemo-resistant disease are offered therapeutic trials based upon molecular profiling. Pathologic response was assessed at surgery. Patients self-reported race/ethnicity was categorized as Asian, Black/African-American, Hispanic/Latino and White (non-Hispanic). Patients were excluded if no race or ethnicity was reported. Clinical and pathologic factors were recorded and compared. Gene expression profiling was performed by RNAseq to determine Vanderbilt signature. PD-L1 and Androgen Receptor (AR) were determined by immunohistochemistry. Frequencies at which various factors were observed by race/ethnicity were calculated and Fisher’s exact test performed to determine statistical significance. Kaplan-Meier analysis was used to estimate survival stratified by pCR status and race/ethnicity.

Results: Among 321 women enrolled in ARTEMIS, 26 (8.1%) were classified as Asian, 50 (15.6%) as Black, 59 (18.4%) as Hispanic and 186 (57.9%) as White. Demographic and clinical features were similar, except Black women were more likely to have BMI ≥30 (70.0%, p<0.001). Comparing by race/ethnicity, there was no statistically significant difference in tumor histology, tumor size, nodal status, clinical stage, chemo-resistant disease, type of surgery or receipt of radiation. A trend toward higher proportion of N3 disease was observed in Black women (24.0%) compared to other groups (p=0.054). Tumor profiling results are listed in Table 1. No statistically significant difference was observed by race/ethnicity in Vanderbilt signature, presence of PD-L1 or stromal tumor infiltrating lymphocytes (sTIL) status. More AR-positive tumors were identified in Asian women (64%, p=0.007). pCR and RCB status did not significantly vary by race/ethnicity however, higher proportion of RCB-III disease was identified in Black (14%) and Hispanic women (16.9%) as compared to Asian (3.8%) and White (8.6%) women (p=0.164). At median follow up of 23.8 months (range 3.4-51.1), there was no statistically significant difference in RFS by race/ethnicity.

Conclusion: Among this population of patients with TNBC treated with neoadjuvant chemotherapy there was no statistically significant difference observed in TNBC Vanderbilt signature, PD-L1 staining, sTIL, pCR or RFS by race/ethnicity. Asian women were found to have a higher incidence of AR-positive subtype. Numerically higher rates of N3 stage in Black women and RCB-III classification in Black and Hispanic women were identified, however not statistically significant. Larger cohorts of patients are needed to further investigate these findings.

Table 1. TNBC profiling compared by race/ethnicity.Total n (%)Asian n (%)Black n (%)Hispanic/Latino n (%)White n (%)p valueVanderbilt signature n (%) Basal like (BL1) Basal like 2 (BL2) Immunomodulatory (IM) Luminal androgen receptor (LAR) Mesenchymal (M) Mesenchymal stem-like (MSL) Unstable (UNS)231 50 (21.6) 25 (10.8) 42 (18.2) 22 (9.5) 48 (20.8) 14 (6.0) 30 (13.0)21 (9.1) 0 (0.0) 4 (19.0) 5 (23.8) 3 (14.3) 5 (23.8) 1 (4.8) 3 (14.3)35 (15.2) 9 (25.7) 5 (14.3) 6 (17.1) 2 (5.7) 7 (20.0) 1 (2.9) 5 (14.3)43 (18.6) 14 (32.5) 3 (7.0) 10 (23.2) 5 (11.6) 6 (14.0) 2 (4.7) 3 (7.0)132 (57.1) 27 (20.5) 13 (9.8) 21 (15.9) 12 (9.1) 30 (22.7) 10 (7.6) 19 (14.4)NSAndrogen Receptor n (%) Positive (>=10%) Negative (<10%)311 109 (35.0) 202 (65.0)25 (8.0) 16 (64.0) 9 (36.0)49 (15.8) 11 (22.4) 38 (77.6)57 (18.3) 19 (33.3) 38 (66.7)180 (57.9) 63 (35.0) 117 (65.0)0.007PD-L1 n (%) None >1298 212 (71.1) 86 (28.9)24 (8.1) 15 (62.5) 9 (37.5)47 (15.8) 33 (70.2) 14 (29.8)57 (19.1) 40 (70.2) 17 (29.8)170 (57.0) 124 (72.9) 46 (27.1)NSStromal tumor infiltrating lymphocytes (sTIL) n (%) High (>=20%) Low (<20%)319 107 (33.5) 212 (66.5)26 (8.1) 12 (46.2) 14 (53.8)50 (15.7) 13 (26.0) 37 (74.0)58 (18.2) 21 (36.2) 37 (63.8)185 (58.0) 61 (33.0) 124 (67.0)NS

Citation Format: Mediget Teshome, Ryan Sun, Elizabeth E. Ravenberg, Abenaa Brewster, Mariana Chavez-MacGregor, Jason B. White, Stacy Moulder. Impact of race/ethnicity on triple negative breast cancer molecular features, treatment response and clinical outcomes in patients receiving neoadjuvant therapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-12.

Abstract P4-10-02: Impact of raloxifene adherence in breast cancer risk

BACKGROUND: Raloxifene is a selective estrogen receptor modulator that has demonstrated to reduce breast cancer risk and reduce the incidence of vertebral fractures. Based on these effects, raloxifene is used as a risk reduction agent and to prevent osteoporosis in postmenopausal women. Little is known about the raloxifene adherence rates or the relationship between adherence and breast cancer incidence.

METHODS: Women 60 years or older without a breast cancer history were identified in the MarketScan database (2008-2015). We identified women who received raloxifene by searching for prescription claims. Proportion of days covered (PDC) were calculated, adherence was defined as a PDC >80% in the first year after initial prescription claim. We identified factors associated with adherence. ICD-9 codes were used to identify incident cases of invasive breast cancer and cumulative incidence rates were calculated. A multivariable Cox model with propensity score method (matching variables included year of claim, age, comorbidities and family history of breast cancer) was used to evaluate the association between raloxifene adherence and breast cancer risk. All statistical tests were two-sided.

RESULTS: A total of 16,179 women were included in the analysis. We identified that during the first year of treatment 6,716 (40.2%) women had a PDC >80% and thus were considered to be adherent. Factors associated with increased adherence included the use of generic drug, mail order of 90 days supply and family history of breast cancer (all p<0.001). Using propensity score matching, the 5 year-cumulative incidence of invasive breast cancer was 1.5% among those not adherent and 0.9% among those adherent to raloxifene (p=0.01). Similarly, the 9 year-cumulative rates were 3.6% and 1.9% respectively (p=0.01). After adjusting for potential confounders, patients that were adherent to raloxifene during the first year of treatment had a lower risk of invasive breast cancer compared to those that were non-adherent (HR=0.64; 95%CI 0.04-0.9).

CONCLUSIONS: Among women 60 years of age or older receiving raloxifene, adherence to therapy was associated with lower risk of invasive breast cancer. Efforts to ensure adherence and compliance are crucial so patients can receive full benefit from this therapy.

Citation Format: Chavez-MacGregor M, Lei X, Zhao H, Bevers TB, Brewster A, Giordano SH. Impact of raloxifene adherence in breast cancer risk [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-02.

Abstract P2-07-06: Cumulative copy number imbalances after neoadjuvant chemotherapy residual breast tumor is an independent predictor of relapse

Background: Identifying breast cancer patients after neoadjuvant chemotherapy (NAC) at greatest risk of recurrence would enhance selection of patients who may benefit from novel adjuvant treatments.

Patients. 243 stage I-III breast cancer patients who underwent NAC with ≥10% residual tumor cellularity were identified from the MD Anderson Cancer Center and Ben Taub General Hospital, Harris County hospital. Tumor DNA was isolated for DNA copy number using OncoScan CNV FFPE, Affymetrix. Median follow-up was 67.8 months. Continuous residual cancer burden (RCB) scores with CNI data were available for 152 cases. To test if CNIs covering large regions were associated with recurrence after adjusting for prognostic variables and study site, data were summed to a chromosome-arm level. Eleven chromosome arms with false discovery rate <0.05 for breast cancer recurrence were identified. A stepwise multivariable model including age at diagnosis, tumor subtype, histologic grade, pre- and post-treatment stage, study site, and the 11 chromosomal arms were used to fit a parsimonious multivariate model for recurrence. Minimizing the Akaike Information Criterion yielded a final model with post-stage and a 5-arm CNI (5A-CNI) indicator including 2q, 3q, 4q, 10p, and 18p. Tumors were classified on 5A-CNI as 0 [no CNI], 1 [1- 2] and 2 [> 2].

Results. The study population included 76 non-Hispanic White, 89 Hispanic, and 68 African American patients with a mean age of 49.1 years. 105 patients were classified as 5A-CNI-0, 97 as 5A-CNI-1 and 41 as 5A-CNI-2. A higher 5A-CNI score was associated with tumor grade, ER-negative tumors (p<0.002) and tumor subtype (p=0.014). For 5A-CNI scores of 0, 1 and 2, recurrence rates of 14%, 34% and 58.5% were observed, respectively. In the final multivariable model adjusted for post-stage, RCB and study site, when compared to 5A-CNI-0, the hazard of recurrence was elevated for 5A-CNI-1 (HR= 2.27 [95% CI, 1.01-5.1]) and 5A-CNI-2 tumors (HR=7.43 [95% CI, 2.85-19.39]). Further, while the sample size is limiting, of 10 patients who were RCB3 and 5A-CNI-2, 9 relapsed (90%) during follow-up compared to only 6 of 43 (14%) of RCB3 patients with 5A-CNI-0 (p<10-6). For patients with RCB1 or 2, relapse did not differ by 5A-CNI score. Neither race nor ethnicity were found to be independently associated with recurrence or tumor subtype. However, African American, followed by Hispanic patients, were more likely than non-Hispanic White patients to be classified as 5A-CNI-2 (p=0.013).

Table 1.Significant difference in distribution of 5 arm CNI classifier by Race/Ethnicity in Study Sample (p =0.013).5A-CNI012Non-Hispanic Whiten=44; 57.9%n=25; 32.9%n=7; 9.2%Hispanicn=32; 36%n=42; 47.2%n=15; 16.9%African Americann=28; 41.2%n=23; 33.8%n=17; 25%

Conclusion. The 5A-CNI score in post NAC tumor identifies a patient population with very poor prognosis independent of current clinical prognostic factors including RCB. Validation of these findings may lead to a post NAC genomic test that identifies patients who would benefit from additional treatment Further investigation of the nature of the association between the 5A-CNI score and race/ethnicity, which appears independent of tumor subtype, is warranted.

Citation Format: Thompson PA, Brewster A, Tsavachidis S, Armstrong G, Do K-A, Ha M-J, Gutierrez C, Symmans F, Bondy M. Cumulative copy number imbalances after neoadjuvant chemotherapy residual breast tumor is an independent predictor of relapse [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-06.

Abstract P4-03-14: Stem cell and macrophage markers are enriched in normal tissue adjacent to inflammatory breast cancer

Introduction: We hypothesized that normal breast tissue in inflammatory breast cancer (IBC) patients contains intrinsic differences, including increased mammary stem cells and macrophage infiltration, which may promote the IBC phenotype.

Materials and Methods: Normal breast tissue at least 5cm away from primary tumors were obtained from mastectomy specimens. This included an initial cohort of 8 IBC patients and 60 non-IBC patients followed by a validation cohort of 19 IBC patients and 25 non-IBC patients. Samples were immunostained for either CD44+CD49f+CD133/2+ stem cell markers or the CD68 macrophage marker and correlated with IBC status. Automated quantitation of positive cells was employed for the validation cohort. We also examined the association between IBC status and previously published tumorigenic stem cell and IBC tumor signatures in the validation cohort samples.

Results: 8 of 8 IBC normal tissue samples expressed CD44+CD49f+CD133/2+ stem cell markers in the initial cohort as opposed to 0/60 non-IBC normal tissue samples (p=0.001). Similarly, the median number of CD44+CD49f+CD133/2+ cells was 25.7 in the IBC validation cohort as opposed to 14.2 in the non-IBC validation cohort (p=0.007). 7 of 8 IBC samples expressed CD68+ macrophages in initial cohort as opposed to 12/48 non-IBC samples (p=0.001). In the validation cohort the median number of CD68+ cells was 3.7 in the IBC cohort vs 1.0 in the non-IBC cohort (p=0.06). Normal tissue of IBC patients was positively associated with a tumorigenic stem cell signature (p=0.02) and with a 79-gene IBC gene signature (p<0.001).

Conclusions: Normal tissue from IBC patients is enriched for both mammary stem cells and macrophages. Further, normal tissue of IBC patients has higher association with both a tumorigenic stem cell signature and IBC-specific tumor signature. Collectively, these data suggest that normal tissue from IBC patients is distinct from non-IBC normal tissue and may support the hypothesis that a primed normal breast contributes to the development of IBC symptoms upon oncogenic insult. Validation of these results in additional normal tissue in cancer-free women would better determine causality.

Citation Format: Reddy JP, Atkinson RL, Larson RA, Burks JK, Smith D, Debeb BG, Ruffell B, Creighton C, Reuben JM, Krishnamurthy S, Symmans WF, Brewster A, Van Laere SJ. Stem cell and macrophage markers are enriched in normal tissue adjacent to inflammatory 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 P4-03-14.

Abstract 2574: Outcomes of contralateral prophylactic mastectomy in relation to familial history: a decision analysis

Purpose

Family history of breast cancer is associated with an increased risk of contralateral breast cancer (CBC) even in the absence of mutations in the breast cancer susceptibility genes BRCA1/2. We compared quality-adjusted survival outcomes after contralateral prophylactic mastectomy (CPM) with surveillance only (no CPM) among women with breast cancer in relation to degree of family history.

Methods

We created a microsimulation model for women with a first-degree, second-degree and no family history treated for a stage I, II, or III estrogen receptor (ER)-positive or -negative breast cancer at the ages of 40, 50, 60, and 70 years. The model incorporated a 10-year post-treatment period for risk of developing CBC and/or dying of the primary cancer or CBC. For each patient profile, we used 100,000 microsimulation trials to estimate the quality-adjusted life expectancy for two clinical strategies: CPM and no CPM.

Results

CPM had a minimal improvement on quality-adjusted life expectancy among women age 50 to 60 with no or a unilateral first or second-degree family history (range -.06 to 0.31) and was unfavorable for the majority of women age 70 with stage III breast cancer regardless of degree of family history (range -.08 to -.02). Sensitivity analysis showed the highest predicted benefit of CPM with 95% risk reduction was 0.57 QALY for a 40-year-old woman with stage I breast cancer who had a first-degree relative with bilateral breast cancer.

Conclusion

Women age 40 years with stage I breast cancer and a first-degree relative with bilateral breast cancer have a QALY benefit from CPM similar to that reported for BRCA1/2 mutation carriers. For the majority of women, having a family history does not improve the minimal effect of CPM on quality-adjusted life expectancy.

Citation Format: Kalatu R. Davies, Abenaa Brewster, Isabelle Bedrosian, Patricia Parker, Melissa A. Crosby, Susan K. Peterson, Yu Shen, Robert Volk, Scott B. Cantor. Outcomes of contralateral prophylactic mastectomy in relation to familial history: a decision analysis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2574.

Abstract P4-14-22: A single-center, open-label phase 1b study of entinostat, and lapatinib alone, and in combination with and trastuzumab in patients with HER2+ metastatic breast cancer after progression on trastuzumab

Background: Our in vitro and in vivo preclinical data showed that entinostat enhances the efficacy of lapatinib in HER2 positive (HER2+) breast cancer cells via FOXO3-mediated Bim1 expression, which resulted in enhanced apoptosis in HER2 targeted therapy (lapatinib and trastuzumab)-resistant breast cancer (IBC and non-IBC) cells [Lee et al.]. Based on these findings, we conducted a phase 1b trial of entinostat to determine the maximal tolerated dose (MTD) in combination with lapatinib alone and in combination with lapatinib and trastuzumab for metastatic HER2+ breast cancer patients (pts), who progressed on trastuzumab.

Method: This was a single-center, open-label phase 1b study to evaluate the dose limiting toxicity (DLT) and determine MTD. 3+3 dose escalation schedule was used for Cohorts 1 and 2. Pts received lapatinib and entinostat (Cohort 1) or entinostat, lapatinib, and trastuzumab (Cohort 2). Initial dose of lapatinib 1250mg in Cohort 1 and 1000mg for Cohort 2 to match standard dose in combination with trastuzumab dose. In Cohort 1, entinostat was given PO on day 1 and 15 every 28 days cycle at dose levels 10 mg (level 0), 12 mg (level 1), or 15 mg (level 2). The dose levels for Cohort 2 were 12 mg (co-level 0) or 15 mg (co-level 1) on day 1 and 15 every 28 days cycle. While lapatinib and entinostat were given 28 days cycle due to entinostat dosing, the dosing of trastuzumab followed approved schedule every 21 days starting at 8mg/kg loading followed by 6mg/kg q 3 wks in Cohort 2 and 3. After the MTD of entinostat in cohort 2 was determined at 12mg, an expansion cohort of 10 pts (cohort 3) was conducted.

Results: Median age was 52 (26-69 yrs). Median number of prior trastuzumab-based regimens was 2 (1-6), 8 pts had lapatinib containing treatment prior to the trial, including 5 pts who had clinical benefit. 16 had ER+ and 13 ER negative, and 9 had IBC. Clinical efficacy and toxicity of treatment is summarized in table 1. Out of 14 pts who had clinical benefit (CR, PR, SD), 6 had IBC. Three pts are still on therapy (1CR, 1PR, 1SD).

Table 1. Clinical Efficacy, Toxicity of combination Receptor StatusResponseGrade 3 toxicityGrade 4 toxicityCohort 1HER2+/ER- (N=8) HER2+/ER+ (N=7)CR (N=1; 8M), SD (N=4;1,2,4M)Lapatinib dose reduction: 3 pts Rash (2) Abdominal pain + dyspnea (1)Entinostat dose reduction: 2pts Neutropenia (1 at 12mg, 1 at 15mg)Cohort 2/3HER2+/ER- (N=8) HER2+/ER+ (N=6)CR (N=2; 3,6M), PR (N=2;4,5M) SD (N=5;1,2,4,6M)Lapatinib dose reduction: 2 pts Diarrhea (N=1 at 12mg N=1 at 10mg) Entinostat dose reduction: 5 pts Neutropenia (N=2 at 12 mg) Leukopenia (N=1 at 12mg) Anemia (N=1 at 12mg)Entinostat dose reduction: 2pts Hypokalemia (N=1 at 12mg) Thrombocytopenia (N=1 at 15mg)CR: complete response, PR: partial response, SD: stable disease, N=number of pts, M=months

Conclusion: MTD was reached at 12mg q 2wkly entinostat, lapatinib 1000 mg daily and trastuzumab 8 mg/kg followed by 6mg/kg q 3 wks. This combination was safe and had promising clinical efficacy in patients with trastuzumab-resistant metastatic HER2+ breast cancer including IBC, warranting further study.

Citation Format: Lim B, Jackson S, Alvarez RH, Ibrahim NK, Willey JS, Murthy RK, Booser DJ, Giordano SH, Barcenas CH, Brewster A, Walters RS, Brown PH, Tripathy D, Valero V, Ueno NT. A single-center, open-label phase 1b study of entinostat, and lapatinib alone, and in combination with and trastuzumab in patients with HER2+ metastatic breast cancer after progression on trastuzumab. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-22.

Abstract B17: Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women

Background: A family history of breast cancer in a first-degree relative is an established risk factor for breast cancer; however, little is known about the profile of breast and ovarian family history in Hispanic/Latina women. Importance of this relates to recent reports showing a high prevalence of BRCA mutations in Hispanic/Latina women and a pattern of multiple recurrent mutations. In addition, less is known about the association of family history and tumor subtype in this growing ethnic group in the U.S.

Methods: Study participants included breast cancer patients of Mexican descent enrolled in the Ella Binational Breast Cancer Study. We first assessed the self-reported breast and ovarian family history profile in 1,150 women. Second, we compared differences in family history of breast and ovarian cancer prevalence between triple negative breast cancer (TNBC) and non-TNBC in 914 patients with available tumor subtype data. Logistic regression was conducted to compare odds of TNBC to non-TNBC according to family history of breast and ovarian cancer.

Results: Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively. A history of breast or ovarian cancer in first-degree relatives was reported in 14.9% of the women. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC compared to non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC was 1.93 (95% CI, 1.26–2.97) for women with first-degree relatives with breast or ovarian cancer. There was a suggestion of stronger associations between family history and TNBC among women diagnosed at age <50 compared to those >50 years for breast cancer history in first-degree (P-interaction=0.14) and first- or second-degree relatives (P-interaction=0.07).

Conclusion: Findings suggest that familial cancers are associated with triple negative subtype, possibly related to the prevalence of BRCA mutations in Hispanic women, which are strongly associated with TNBC. Improvement in collection of family history through new tools and instruments targeting English- and Spanish-speaking Hispanic women should be a priority for future research. Identification of a strong family history can ultimately affect treatment plans, screening practices, and prevention options both for patients and their relatives.

Citation Format: Maria Elena Martinez, Kristin Anderson, Patricia Thompson, Betsy C. Wertheim, Lorena Martin, Ian Komenaka, Melissa Bondy, Adrian Daneri-Navarro, Maria Mercedes Meza-Montenegro, Luis Enrique Gutierrez-Millan, Abenaa Brewster, Lisa Madlensky, Malaika Tobias, Loki Natarajan. Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B17.

Abstract B09: Acculturation, behavioral factors, and family history of breast cancer among Mexican and Mexican-American women

Introduction: Incidence rates for breast cancer are higher among Mexican-American (MA) women in the US than women living in Mexico. Studies have shown higher prevalence of breast cancer risk factors in higher vs. lower acculturated Hispanic/Latina women in the US. We compared the prevalence for behavioral risk factors and family history of breast cancer by level of acculturation and country of residence in women of Mexican descent.

Methods: Data were collected from 1,201 recently diagnosed breast cancer patients living in Mexico (n=581) and MAs in the US (n=620). MA participants were categorized into three acculturation groups (Spanish dominant, bilingual and English dominant) according to responses to an 8-item language acculturation scale, while women living in Mexico were used as the reference group. Prevalence of behavioral risk factors and family history of breast cancer were compared among the acculturation groups adjusting for age at diagnosis and education level.

Results: In the final adjusted models, bilingual and English-dominant MAs were significantly more likely to have a body mass index > 30 kg/m2, consume more than one alcoholic beverage a week, and report having a family history of breast cancer when compared to women living in Mexico. All three US acculturation groups were significantly more likely to have low total energy expenditure (<533 kcal/day) than women in Mexico. English-dominant women were significantly less likely to smoke cigarettes than the Mexican comparison group.

Conclusions: Our findings on acculturation and distributions of behavioral risk factors and family history of breast cancer add to the growing body of evidence suggesting acculturation has both positive and negative impacts on health behavior in Hispanic/Latino populations living in the US. Interventions and public health policies may benefit from considering these relationships when targeting health programs and campaigns to Mexican-American and Mexican women.

Citation Format: Jesse Nodora, Renee Cooper, Maria Elena Martinez, Gregory Talavera, Patricia Thompson, Ian Komenaka, Melissa Bondy, Abenaa Brewster, Adrian Daneri-Navarro, Maria Mercedes Meza-Montenegro, Luis Enrique Gutierrez-Millan. Acculturation, behavioral factors, and family history of breast cancer among Mexican and Mexican-American women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B09.

Abstract B05: Randomized pilot study of Project BALANCE: a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy

Background: Weight gain is a common problem after breast cancer diagnosis and treatment, particularly for women who receive chemotherapy. The weight gain has negative effects on quality of life, increases risk for chronic disease, and may increase risk of breast cancer recurrence. This pilot study tested a behavioral weight gain prevention intervention on weight, waist circumference, and biomarkers related to breast cancer prognosis (sex hormone binding globulin [SHBG], adiponectin, and leptin).

Methods: Thirty-eight breast cancer patients receiving neoadjuvant chemotherapy were randomized to the weight gain prevention intervention or usual care. The intervention focused on exercise (resistance training, aerobic) and eating a low energy dense diet. Participants received 20 sessions during chemotherapy (14 in person, 6 by telephone) and 9 sessions after surgery (3 in person, 6 by telephone). They completed assessments of weight and waist circumference at baseline (T0), mid-chemotherapy (T1), post-chemotherapy (T2), post surgical recovery (T3), after the post-surgical intervention (T4). Serum was collected at T0, T2, and T3 and SHBG, adiponectin, and leptin was assayed by ELISA. Differences between participants in the intervention and usual care groups for weight, waist circumference, and biomarkers were assessed using linear mixed models. All analyses were controlled for baseline values. Missing observations were imputed by worst observation carried forward. We conducted both an intent-to-treat (all participants) and a per protocol analysis where intervention group participants were included if they completed at least 50% of the intervention sessions.

Results: In the intent to treat analysis, the intervention group participants weighed less at T1-T4 (mean difference = 1.12 kg, p = .2225). In the per protocol analysis the mean difference of 1.6 kg was statistically significant (p=.0499). Waist circumference was lower at T1-T4 in the intervention group in both the intent-to-treat analysis (mean difference = 2.8 cm, p=.0354) and the per protocol analysis (mean difference = 3.7 cm, p=.0122). Levels of natural log transformed SHBG were higher for the intervention group at T2-T3; the difference neared significance (intent-to-treat: p=.0914; per protocol analysis: p=.0506), but there was no significant difference between the groups in adiponectin or leptin levels. However, all three biomarkers were significantly correlated with weight, BMI and waist circumference in the expected direction at T0, T2, and T3, with the exception of SHBG at T3, which was significantly correlated with weight only.

Conclusion: A diet and exercise intervention delivered during and after chemotherapy can promote weight loss in breast cancer patients. Given the associations between body composition and prognostic biomarkers, the Project BALANCE intervention could be investigated for its effects on prognosis.

Citation Format: Karen Basen-Engquist, James L. Murray, III, Abenaa Brewster, Susan M. Schembre, Jaejoon Song, Angelica Gutierrez-Barrera, Banu Arun. Randomized pilot study of Project BALANCE: a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B05.

Acculturation, Behavioral Factors, and Family History of Breast Cancer among Mexican and Mexican-American Women

BACKGROUND

Incidence rates for breast cancer are higher among Mexican-American (MA) women in the United States than women living in Mexico. Studies have shown higher prevalence of breast cancer risk factors in more acculturated than less acculturated Hispanic/Latinas in the United States. We compared the prevalence of behavioral risk factors and family history of breast cancer by level of acculturation and country of residence in women of Mexican descent.

METHODS

Data were collected from 1,201 newly diagnosed breast cancer patients living in Mexico (n = 581) and MAs in the United States (n = 620). MA participants were categorized into three acculturation groups (Spanish dominant, bilingual, and English dominant); women living in Mexico were used as the referent group. The prevalence of behavioral risk factors and family history of breast cancer were assessed according to acculturation level, adjusting for age at diagnosis and education.

RESULTS

In the adjusted models, bilingual and English-dominant MAs were significantly more likely to have a body mass index of 30 kg/m(2) or greater, consume more than one alcoholic beverage a week, and report having a family history of breast cancer than women living in Mexico. All three U.S. acculturation groups were significantly more likely to have lower total energy expenditure (≤533 kcal/d) than women in Mexico. English-dominant women were significantly less likely to ever smoke cigarettes than the Mexican group.

CONCLUSIONS

Our findings add to the limited scientific literature on the relationships among acculturation, health behavior, and family history of breast cancer in Mexican and MA women.

Abstract LB-193: Prediagnostic breast cancer metabolites in Mexican Americans: a nested case control study

Breast cancer (BrCa) is the most common invasive cancer in Hispanic women. Although at decreased risk, Hispanic women are diagnosed at younger ages and with more aggressive disease than non-Hispanic Whites. Early detection is key in BrCa survival; however, there are no pre-diagnostic circulating biomarkers for early detection. This pilot nested case-control study based on our Mexican-American Cohort (MAC) study evaluates the role of global metabolic expression in predicting BrCa risk. MAC includes ∼23,000 participants in the Houston area with baseline blood specimens and epidemiological data. Using mass spectrometry-based global protein expression, 435 plasma metabolites were analyzed by Metabolon in 30 invasive BrCa cases (14 pre- (preM) and 16 post-menopausal (postM)) diagnosed 1-5 years after enrollment and 40 healthy controls (matched to cases on age, menopausal status) and length of follow-up). Mean age of preM women was 37.6 years (range 32-43) compared to 63.4 for postM (range 50-81). Using principal component analysis, we evaluated differences by disease and menopausal status. We found 76 metabolites that differed significantly (P<0.05) between cases and controls among postM women compared to only 13 metabolites in preM women. Using a pathway-based approach, we found that the majority of case-control differences were in metabolites related to hormone, lipid and energy metabolism. The specific metabolites differed by menopausal status. In postM cases, levels of steroid hormones epiandrosterone sulfate, androsterone sulfate, and 5-alpha-androstan-3beta,17beta-diol disulfate were higher than in controls; among preM cases, steroid hormones 5-alpha-pregnan-3beta,20alpha-diol disulfate and 5-alpha-pregnan-3alpha,20beta-diol disulfate 1 levels were higher. PostM cases had significantly (P<0.05) lower levels in fatty acids valerylcarnitine and butyrylcarnitine and higher levels of monoacylglycerols and glycerol 3-phosphate (G3P) than controls; there were no significant differences in these metabolites in preM cases and controls. The statistically significant (P<0.05) decreases in 3-phosphoglycerate, pyruvate, sarcosine (N-methylglycine), citrate, and malate which are all associated with glycolysis and the tricarboxylic acid cycle found in cases compared to controls irrespective of menopausal status, suggest energy metabolism may be associated with BrCa risk. In summary, our findings suggest: (1) case-control differences in plasma levels of specific metabolites associated with key functional pathways; (2) the specific metabolites and number of relevant metabolites differs by menopausal status; and (3) these differences are detectable years prior to diagnosis. Future studies exploring these associations with tumor hormone receptor status, dietary intake and anthropometric measurements will aid in further identifying key pre-diagnostic plasma markers for BrCa.

Citation Format: Sara S. Strom, Hua Zhao, Abenaa Brewster, Yuko Yamamura. Prediagnostic breast cancer metabolites in Mexican Americans: a nested case control study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-193. doi:10.1158/1538-7445.AM2015-LB-193

Association of Body Mass Index Changes during Neoadjuvant Chemotherapy with Pathologic Complete Response and Clinical Outcomes in Patients with Locally Advanced Breast Cancer

The purpose of this study was to determine the association between body mass index (BMI) measurements (baseline BMI and changes in BMI during neoadjuvant systemic treatment [NST]) and clinical efficacy (pathologic complete response [pCR] rate and survival outcomes) in locally advanced breast cancer (LABC). We hypothesized that high baseline BMI and increases in BMI during NST are associated with lower pCR rates and poorer clinical outcomes in LABC.

We retrospectively reviewed the medical records of 1002 patients, 204 with primary inflammatory breast cancer (IBC) and 798 with stage III non-IBC, who underwent standard NST and definitive surgery between November 1, 2006, and December 31, 2012.

The median follow-up time for the survivors was 19.6 months (0.4 - 67.8 months). The pCR rates of patients whose BMI increased or decreased were 23.2% and 18.1%, respectively, (p=0.048). The unadjusted overall survival (OS) was significantly better in the group with increased BMI (p=0.006). However, increased BMI was not an independent predictor of pCR and clinical outcomes (recurrence-free survival and OS) after adjusting for other clinical variables. In subset analyses, increased BMI as a continuous variable was an independent predictor of higher pCR rates in the normal BMI/underweight group (odds ratio [OR]=1.35, 95% confidence interval [CI]: 1.06-0.71, p=0.015). Increased BMI (BMI change ≥0 vs. <0) was also an independent predictor of pCR (OR=1.65, 95% CI: 1.00-2.72, p=0.049) in the postmenopausal group.

Our results show that increasing BMI shows improved clinical outcome in terms of better pCR rates in normal BMI/underweight group and in the postmenopausal group. These results contradict previously reported findings on the association between high BMI and poor clinical efficacy regarding pCR rate and survival outcomes in early-stage breast cancer. Thus, the role of BMI in breast cancer may depend on patients' clinical characteristics such as advanced stage.

Family history of breast and ovarian cancer and triple negative subtype in hispanic/latina women

Familial breast and ovarian cancer prevalence was assessed among 1150 women of Mexican descent enrolled in a case-only, binational breast cancer study. Logistic regression was conducted to compare odds of triple negative breast cancer (TNBC) to non-TNBC according to family history of breast and breast or ovarian cancer among 914 of these women. Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively; that for breast or ovarian cancer in a first-degree relative was 14.9%. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC than non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC were 1.93 (95% CI, 1.26-2.97) for women with a first-degree relative with breast or ovarian cancer. There were non-significant stronger associations between family history and TNBC among women diagnosed at age <50 compared to ≥50 years for breast cancer in a first-degree relative (P-interaction = 0.14) and a first- or second-degree relative (P-interaction = 0.07). Findings suggest that familial breast cancers are associated with triple negative subtype, possibly related to BRCA mutations in Hispanic/Latina women, which are strongly associated with TNBC. Family history is an important tool to identify Hispanic/Latina women who may be at increased risk of TNBC, and could benefit from prevention and early detection strategies.

Abstract 3271: The association between germline genetic variants in the PI3K-AKT-mTOR pathway and breast cancer disease free survival

Background: PI3K-AKT-mTOR pathway activation in breast tumors is associated with poorer breast cancer disease-free survival and decreased responsiveness to tamoxifen and trastuzumab. However, the role of germline variation in this pathway and breast cancer outcomes has not been previously evaluated. We hypothesized that single nucleotide polymorphisms (SNPs) in candidate genes affecting the PI3K-AKT-mTOR signaling pathway may act as genetic modifiers of breast cancer specific outcomes in patients diagnosed with early stage disease.

Methods: We genotyped 106 SNPs in 13 genes (ADIPOQ, IGF1, INS, IRS1, LEP, LEPR, LEPROT, PIK3CA, PIK3R5, PTEN, TSC1, TSC2, and AKT1) in the P13K-AKT-mTOR pathway in a sample of 1020 women with stages I-II breast cancer treated at the MD Anderson Cancer Center between 1985 and 1999 and for whom long term follow-up on recurrence and death were available. The relationship between SNPs and breast cancer disease free survival (DFS) was assessed using Cox regression analysis. After correcting for false discovery rate (0.10) SNPs significantly associated with DFS in any genetic model (additive, dominant or recessive) were included in multivariable analysis.

Results: After adjusting for race, age at diagnosis, tumor stage and treatment, rs1063539 in ADIPOQ (Hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.19 - 0.86), rs11585329 in LEPROT (HR 0.72, 95% CI 0.53 - 0.98), and rs2519757 in TSC1 (HR 0.29, 95% CI 0.09 - 0.91) were associated with improved DFS and rs1520220 in IGF1 (HR 1.56, 95% CI 1.21 - 2.00) and rs2677760 in PIK3CA (HR 1.43, 95% CI 1.70 - 1.92) were associated with worse DFS. The associations were not modified by type of systemic treatment received. The SNPs were not associated with tumor characteristics such as tumor size, lymph node status, nuclear grade, or hormone receptor status.

Conclusion: In this study, germline allelic variation inthe PI3K-AKT-mTOR pathway appears to modify breast cancer patient outcomes. Future studies are needed to replicate our results and to evaluate the relationship between these polymorphisms and activation of the PI3K-AKT-mTOR pathway in breast tumors.

Citation Format: Mala Pande, Melissa Bondy, Kim-Anh Do, Aysegul A. Sahin, Jun Ying, Gordon B. Mills, Patricia Thompson, Abenaa Brewster. The association between germline genetic variants in the PI3K-AKT-mTOR pathway and breast cancer disease free survival. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3271. doi:10.1158/1538-7445.AM2014-3271

Loss of LRIG1 locus increases risk of early and late relapse of stage I/II breast cancer

Gains and losses at chromosome 3p12-21 are common in breast tumors and associated with patient outcomes. We hypothesized that the LRIG1 gene at 3p14.1, whose product functions in ErbB-family member degradation, is a critical tumor modifier at this locus. We analyzed 971 stage I/II breast tumors using Affymetrix Oncoscan molecular inversion probe arrays that include 12 probes located within LRIG1. Copy number results were validated against gene expression data available in the public database. By partitioning the LRIG1 probes nearest exon 12/13, we confirm a breakpoint in the gene and show that gains and losses in the subregions differ by tumor and patient characteristics including race/ethnicity. In analyses adjusted for known prognostic factors, loss of LRIG1 was independently associated with risk of any relapse (HR, 1.90; 95% CI, 1.32-2.73), relapse≥5 years (HR, 2.39; 95% CI, 1.31-4.36), and death (HR, 1.55; 95% CI, 1.11-2.16). Analyses of copy number across chromosome 3, as well as expression data from pooled, publicly available datasets, corroborated the hypothesis of an elevated and persistent risk among cases with loss of or low LRIG1. We concluded that loss/low expression of LRIG1 is an independent risk factor for breast cancer metastasis and death in stage I/II patients. Increased hazard in patients with loss/low LRIG1 persists years after diagnosis, suggesting that LRIG1 is acting as a critical suppressor of tumor metastasis and is an early clinical indicator of risk for late recurrences in otherwise low-risk patients.

Sexual problems during the first 2 years of adjuvant treatment with aromatase inhibitors

INTRODUCTION

Sexual dysfunction has only recently been recognized as a highly prevalent side effect of adjuvant aromatase inhibitor (AI) therapy for breast cancer.

AIMS

A cross-sectional survey using standardized measures of female sexual function was designed to provide a detailed view of sexual problems during the first 2 years of adjuvant AI therapy and secondarily to examine whether sexual dysfunction leads to nonadherence to this therapy.

METHODS

Questionnaires were mailed to all 296 women in a breast oncology registry who had been prescribed a first-time AI for localized breast cancer 18-24 months previously.

MAIN OUTCOME MEASURES

Items assessed medication adherence, demographic, and medical information. Scales included the Female Sexual Function Index, the Menopausal Sexual Interest Questionnaire, the Female Sexual Distress Scale-Revised, the Breast Cancer Prevention Trial Eight Symptom Scale to assess menopausal symptoms, and the Merck Adherence Estimator(®) .

RESULTS

Questionnaires were returned by 129 of 296 eligible women (43.6%). Respondents were 81% non-Hispanic white with a mean age of 63 and 48% had at least a college degree. Only 15.5% were nonadherent. Ninety-three percent of women scored as dysfunctional on the Female Sexual Function Index, and 75% of dysfunctional women were distressed about sexual problems. Although only 52% of women were sexually active when starting their AI, 79% of this group developed a new sexual problem. Fifty-two percent took action to resolve it, including 24% who stopped partner sex, 13% who changed hormone therapies, and 6% who began a vaginal estrogen. Scores on the Adherence Estimator (beliefs about efficacy, value, and cost of medication) were significantly associated with adherence (P = 0.0301) but sexual function was not.

CONCLUSIONS

The great majority of women taking AIs have sexual dysfunction that is distressing and difficult to resolve. Most continue their AI therapy, but a large minority cease sexual activity.

Reproductive and hormonal risk profile according to language acculturation and country of residence in the Ella Binational Breast Cancer Study

BACKGROUND

We compared the distribution of breast cancer reproductive and hormonal risk factors by level of acculturation and country of residence in women of Mexican descent.

METHODS

To compare the distribution of breast cancer reproductive and hormonal risk factors by level of acculturation and country of residence in women of Mexican descent, taking into account level of education, we analyzed data on 581 Mexican and 620 Mexican American (MA) women with a history of invasive breast cancer from the Ella Binational Breast Cancer Study. An eight-item language-based acculturation measure was used to classify MA women. Multivariate logistic regression was used to test associations between language acculturation, country of residence, and reproductive and hormonal risk factors.

RESULTS

After adjustment for age and education, compared to women residing in Mexico, English-dominant MAs were significantly more likely to have an earlier age at menarche (<12 years; odds ratio [OR]=2.08; 95% confidence interval [CI], 1.30-3.34), less likely to have a late age at first birth (≥30 years; OR=0.49; 95% CI, 0.25-0.97), and less likely to ever breastfeed (OR=0.13; 95% CI, 0.08-0.21).

CONCLUSIONS

Differences in reproductive and hormonal risk profile according to language acculturation and country of residence are evident; some of these were explained by education. Results support continued efforts to educate Mexican and MA women on screening and early detection of breast cancer along with promotion of modifiable factors, such as breastfeeding.

Association between parity and obesity in Mexican and Mexican-American women: findings from the Ella binational breast cancer study

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m(2), waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m(2)) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.

Abstract B17: The evaluation of breast cancer chemoprevention uptake in a high-risk cohort

Background: Population-based estimates in the United States indicate that uptake of breast cancer chemoprevention has remained low despite more than a decade of scientific evidence demonstrating clinical benefit. The objective of our study was to evaluate the uptake of breast cancer chemoprevention in a high-risk clinical setting. Methods: We evaluated the uptake of chemoprevention (tamoxifen, raloxifene or exemestane) 2007 to 2011 among 1,151 healthy women at high risk of breast cancer who were seen at the MD Anderson Cancer Center and enrolled in a high-risk breast cancer cohort. We used stepwise multivariable logistic regression to determine patient-related factors associated with use of chemoprevention. Results: Mean age of the cohort was 60 years; 85% of the women were white, 6% black and 9% of other ethnicities. Chemoprevention use was reported among 29% of women (n=340) (22% tamoxifen, 7% raloxifene). Among women with a history of lobular carcinoma in situ (LCIS), a proliferative breast lesion or Gail 5-year risk ≥1.66%, the uptake of chemoprevention was 52%, 42% and 14%, respectively. In multivariable analysis, history of osteoporosis (p=0.0034), prior use of hormone replacement therapy (p=0.0002) and elevated Gail model 5 year risk &gt;3.0% (p=0.003) were positively associated with uptake of chemoprevention. Conclusion: Women seen in a high-risk clinical setting may be more motivated to use chemoprevention and uptake was highest among women with a history of LCIS or a proliferative breast lesion. Individualized strategies are needed to improve breast cancer chemoprevention uptake among different subsets of high-risk patients.

Citation Format: Scott Nimmons, Arvind Bambhroliya, Bevers Teresa, Jun Ying, Powel Brown, Elise Cook, Lonzetta Newman, Abenaa Brewster. The evaluation of breast cancer chemoprevention uptake in a high-risk cohort. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B17.

Abstract B119: Presence of etiologic heterogeneity by breast tumor subtypes in Hispanic women with unique reproductive risk factor patterns

Background: Published data support the presence of etiologic heterogeneity by breast tumor subtype, but few studies have assessed this in Hispanic populations. Methods: We assessed tumor subtype prevalence and associations between reproductive factors and tumor subtypes in 1041 women of Mexican descent (559 U.S. and 482 Mexico) who participated in the Ella Binational Breast Cancer Study. Multinomial logistic regression comparing human epidermal growth factor receptor 2 positive tumors (HER2+, regardless of ER or PR status) and triple negative breast cancer (TNBC) to hormone receptor positive (HR+) tumors was conducted. Results: A higher proportion of ER- tumors was shown for women in Mexico (40.5%) vs. those in the U.S. (27.2%) and slightly higher proportions of HR+ (61.2% vs. 57.9%) and HER2+ (23.8% vs. 20.3%) tumors were observed in the U.S. compared to Mexico. Prevalence of TNBC was 16.7% overall; the percentage was higher for Mexican vs. U.S. women (19.5% vs. 14.5%). After adjustment for age and country of residence, compared to women with HR+ tumors, those with a later age at first pregnancy were significantly less likely to have TNBC (odds ratio [OR]=0.61; 95% confidence interval [CI]=0.39-0.95), whereas those with ≥ 3 full-term pregnancies were significantly more likely to have TNBC (OR=1.68; 95% CI=1.10-2.55). Patients who reported breastfeeding for &gt;12 months were over twice as likely to have TNBC than HR+ tumors (OR=2.14; 95% CI=1.24–3.68). A lower odds of TNBC was shown for longer menstruation duration, whether prior to first pregnancy (OR=0.78; 95% CI= 0.65–0.93 per 10 years) or prior to menopause (OR=0.79; 95% CI, 0.69–0.91 per 10 years). Associations comparing HER2+ to HR+ tumors were weak or non-existent except for the interval between last full-term pregnancy and breast cancer diagnosis. Conclusions: Findings show etiologic heterogeneity by tumor subtype in a population of Hispanic women with a unique reproductive profile. Given that Hispanic women have higher risk of breast cancer-specific mortality than non-Hispanic whites, our findings add to growing evidence of opposing effects of reproductive factors on breast tumor subtypes, which may partly explain disparities in outcomes.

Citation Format: Maria Elena Martinez, Betsy Wertheim, Loki Natarajan, Richard Schwab, Melissa Bondy, Adrian Daneri-Navarro, Maria Mercedes Meza-Montenegro, Luis Enrique Gutierrez-Millan, Abenaa Brewster, Ian K. Komenaka, Patricia A. Thompson. Presence of etiologic heterogeneity by breast tumor subtypes in Hispanic women with unique reproductive risk factor patterns. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research: Genetics, Biology, and Clinical Applications; Oct 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2013;11(10 Suppl):Abstract nr B119.

Reproductive factors, heterogeneity, and breast tumor subtypes in women of mexican descent

BACKGROUND

Published data support the presence of etiologic heterogeneity by breast tumor subtype, but few studies have assessed this in Hispanic populations.

METHODS

We assessed tumor subtype prevalence and associations between reproductive factors and tumor subtypes in 1,041 women of Mexican descent enrolled in a case-only, binational breast cancer study. Multinomial logistic regression comparing HER2(+) tumors and triple-negative breast cancer (TNBC) to luminal A tumors was conducted.

RESULTS

Compared with women with luminal A tumors, those with a later age at first pregnancy were less likely to have TNBC [OR, 0.61; 95% confidence interval (CI), 0.39-0.95], whereas those with three or more full-term pregnancies were more likely to have TNBC (OR, 1.68; 95% CI, 1.10-2.55). A lower odds of TNBC was shown for longer menstruation duration, whether before first pregnancy (OR, 0.78; 95% CI, 0.65-0.93 per 10 years) or menopause (OR, 0.79; 95% CI, 0.69-0.91 per 10 years). Patients who reported breastfeeding for more than 12 months were over twice as likely to have TNBC than luminal A tumors (OR, 2.14; 95% CI, 1.24-3.68). Associations comparing HER2(+) with luminal A tumors were weak or nonexistent except for the interval between last full-term pregnancy and breast cancer diagnosis.

CONCLUSIONS

Findings show etiologic heterogeneity by tumor subtype in a population of Hispanic women with unique reproductive profiles.

IMPACT

Identification of etiologically distinct breast tumor subtypes can further improve our understanding of the disease and help provide personalized prevention and treatment regimens.

Changes in body mass index and alcohol and tobacco consumption among breast cancer survivors and cancer-free women: a prospective study in the Danish Diet, Cancer and Health Cohort

BACKGROUND

A breast cancer diagnosis has been suggested as a teachable moment when a woman is more open to making healthier lifestyle changes. Little is known about the health behaviour changes women with breast cancer initiate compared to those made by other women.

MATERIAL AND METHODS

We examined changes in body mass index (BMI) and tobacco and alcohol consumption among women with a diagnosis of breast cancer and among cancer-free women. We used data from 23 420 women aged 50-64 years who participated in the Diet, Cancer and Health cohort, of whom 449 were diagnosed with breast cancer between baseline (1993-1997) and follow-up (2000-2002), and 22 971 remained cancer-free. We used multiple linear regression analysis to examine differences in BMI and alcohol and tobacco consumption between the two groups and to examine whether demographic and prognostic factors were associated with behavioural changes in women with breast cancer.

RESULTS

There were no significant differences in changes in BMI, alcohol and tobacco consumption between the two groups. Only in sub-analyses among women who lost weight between baseline and follow-up, women with breast cancer lost more weight than cancer-free women (β = 0.2; CI 0.1; 0.4), but residual confounding from stage cannot be excluded. Among the women with breast cancer we found no significant changes in BMI, alcohol and tobacco consumption by level of education, marital status, chemotherapy, hormone therapy or radiation.

CONCLUSION

Women with breast cancer did not reduce their BMI, or modify their alcohol use or tobacco consumption compared with cancer-free women. This study indicates that guidelines and interventions to change health behaviour are needed after a cancer diagnosis.

Hypothesized role of pregnancy hormones on HER2+ breast tumor development

Breast cancer incidence rates have declined among older but not younger women; the latter are more likely to be diagnosed with breast cancers carrying a poor prognosis. Epidemiological evidence supports an increase in breast cancer incidence following pregnancy with risk elevated as much as 10 years post-partum. We investigated the association between years since last full-term pregnancy at the time of diagnosis (≤10 or >10 years) and breast tumor subtype in a case series of premenopausal Hispanic women (n = 627). Participants were recruited in the United States, Mexico, and Spain. Cases with known estrogen receptor (ER), progesterone receptor (PR), and HER2 status, with one or more full-term pregnancies ≥1 year prior to diagnosis were eligible for this analysis. Cases were classified into three tumor subtypes according to hormone receptor (HR+ = ER+ and/or PR+; HR- = ER- and PR-) expression and HER2 status: HR+/HER2-, HER2+ (regardless of HR), and triple negative breast cancer. Case-only odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for HER2+ tumors in reference to HR+/HER2- tumors. Participants were pooled in a mixed-effects logistic regression model with years since pregnancy as a fixed effect and study site as a random effect. When compared to HR+/HER2- cases, women with HER2+ tumors were more likely be diagnosed in the post-partum period of ≤10 years (OR = 1.68; 95 % CI, 1.12-2.52). The effect was present across all source populations and independent of the HR status of the HER2+ tumor. Adjusting for age at diagnosis (≤45 or >45 years) did not materially alter our results (OR = 1.78; 95 % CI, 1.08-2.93). These findings support the novel hypothesis that factors associated with the post-partum breast, possibly hormonal, are involved in the development of HER2+ tumors.

The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer

INTRODUCTION

Overweight women diagnosed with breast cancer have greater recurrence and mortality risks. Recent studies in advanced cancer showed that the combination of sarcopenia and an overweight or obese body mass index (BMI) is associated with poor clinical outcomes.

OBJECTIVES

To compare pathological complete response (pCR) cases with controls and evaluate associations among a pCR, survival outcome, and sarcopenia as well as the combination of both sarcopenia and a BMI ≥25 kg/m(2).

METHODS

Sixty-seven breast cancer patients with a pCR to neoadjuvant chemotherapy (NC) were matched with controls who did not have a pCR to NC. Patients were matched by age, Black's nuclear grading system, clinical cancer stage, and estrogen receptor and progesterone receptor status. Body composition was analyzed using computed tomography images taken prior to NC.

RESULTS

BMI was associated with pCR. Among normal weight patients, the pCR rate was higher in sarcopenic patients and the progression-free survival (PFS) interval was significantly longer than in overweight or obese BMI patients. The death hazard was 2% higher for each unit higher skeletal muscle index and 0.6% higher for each unit higher visceral adipose tissue.

CONCLUSIONS

Overweight patients treated with NC had a lower pCR rate and shorter PFS time. Among patients with a normal BMI, the pCR rate was better in sarcopenic patients. More research is required to evaluate the negative impact of sarcopenic obesity on prognosis and the contributors to better response rates in operable, normal weight breast cancer patients with sarcopenia.

Implications of constructed biologic subtype and its relationship to locoregional recurrence following mastectomy

Introduction

We examined the prognostic value of biologic subtype on locoregional recurrence (LRR) after mastectomy in a cohort of low risk women who did not receive adjuvant radiation therapy.

Methods

A total of 819 patients with invasive breast cancer underwent mastectomy from January 2000 through December 2005. No patient received preoperative chemotherapy. Estrogen receptor (ER) receptor, progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status were used to construct the following 4 subtypes: i) ER+ or PR+ and HER2- (HR+/HER2-), ii) ER+ or PR+ and HER2+ (HR+/HER2+), iii) ER- and PR- and HER2+ (HR-/HER2+)and iv) ER- and PR- and HER2- (HR-/HER2-). LRR-free survival was estimated by the Kaplan-Meier method. Cox proportional hazard models were used to evaluate the association between time-to-event outcomes and patient prognostic factors.

Results

At a median follow-up of 58 months, five-year cumulative incidence of LRR for the entire cohort was 2.5%. Subtype specific LRR rates were 1% for HR+/HER2-, 6.5% in HR+/HER2+, 2% for HR-/HER2+ and 10.9% for HR-/HER2- (P < 0.01). In HER-2+ patients (irrespective of ER/PR status), trastuzumab therapy was not associated with LRR-free survival. On multivariate analysis, one to three positive lymph nodes (HR 4.75 (confidence interval (CI) 1.75 to 12.88, P < 0.01), ≥ 4 positive lymph nodes (HR23.4 (CI 4.64 to 117.94, P < 0.01), HR+/HER2+ (HR 4.26 (CI 1.05 to 17.33), P = 0.04), and HR-/HER2- phenotype (HR 13.87 (CI 4.96 to 38.80), P < 0.01) were associated with shorter LRR-free survival whereas age > 50 at diagnosis (HR 0.31 (CI 0.12 to 0.80), P = 0.02) was associated with improved LRR-free survival. Among the HR-/HER2- subtypes, five-year LRR incidence was 23.4% in patients with positive lymph nodes compared to 7.8% for lymph node negative patients (P = 0.01), although this association did not reach significance when the analysis was limited to HR-/HER2- women with only one to three positive lymph nodes (15.6% versus 7.8%, P = 0.11).

Conclusions

Constructed subtype is a prognostic factor for LRR after mastectomy among low risk women not receiving adjuvant radiation therapy, although rates of LRR remain low across subtypes. Patients with node positive, HR-/HER2- type tumors were more likely to experience LRR following mastectomy alone. Prospective studies to further investigate the potential benefit of adjuvant radiation therapy in these women are warranted.

Abstract 2607: Genetic variants in the vitamin D pathway and breast cancer disease free survival

Objective. Vitamin D deficiency has been associated with poor outcomes in patients with breast cancer. The objective of this study was to investigate the association between single nucleotide polymorphisms (SNPs) in 7 Vitamin D-related genes and disease free survival (DFS). We hypothesized that vitamin D-related genes may modify breast cancer DFS. Methods. A total of 102 SNPs in Vitamin D pathway genes were explored as predictors of DFS among 1030 stage I/II breast cancer patients treated at MD Anderson Cancer Center between 1985 and 2000. Genotyping was performed using the Illumina GoldenGate array. We applied recursive partitioning tree analysis (RPART) to explore interactions of variables predictive of DFS including vitamin D-related SNPs, age at diagnosis, race, stage, nuclear grade, estrogen (ER) and progesterone (PR) receptor status, chemotherapy, hormone therapy and BMI. Results. Results from partitioning identified chemotherapy as the optimum first split for DFS where patients receiving chemotherapy experienced longer DFS. In patients receiving chemotherapy (n=540), SNP rs1118569 (RXRA) followed by rs10881583 (RXRA) were associated with greater DFS. Patients with two major alleles of rs1118569 had the best outcome, whereas those with two minor alleles of rs10881583 and one or two minor rs1118569 alleles had poorer DFS. In patients who did not receive chemotherapy (n=482), stage I patients had longer DFS than stage II. Further, stage I patients who were homozygous for any allele of rs2248098 (VDR) had longer DFS. Among the stage II patients, those with ER/PR negative tumors had poorer DFS with heterozygous carriers of rs344781 in PLAUR having the worst DFS. Conclusion. While exploratory, we show that chemotherapy, stage, ER and PR status and vitamin D-related pathway polymorphisms but not race/ethnicity modified disease free survival in early stage breast cancer patients. Validation of vitamin D-related pathway genes as genetic determinants of patient outcomes would offer insights on alternative approaches for the secondary prevention of breast cancer recurrence considering clinical pathological and treatment characteristics of the patient population.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2607. doi:1538-7445.AM2012-2607

Short-term biomarker modulation prevention study of anastrozole in women at increased risk for second primary breast cancer

The selective estrogen receptor modulators (SERM), Tamoxifen and raloxifen reduce risk breast cancer. Patient acceptance of SERMs for breast cancer prevention is low due to toxicities. New agents with a better toxicity profile are needed. Aromatase inhibitors (AI) reduce the risk of contralateral breast cancer and risk of new breast cancer in high risk women. However, the mechanism by which AIs reduce breast risk is not known. Surrogate biomarkers are needed to evaluate the effect of preventive agents. The objective of this prospective short-term prevention study was to evaluate the effect of anastrozole on biomarkers in breast tissue and serum of women at increased risk for developing a contralateral breast cancer. Women with a history of stage I, II breast cancer who started anastrozole for standard adjuvant treatment were eligible. Patients underwent baseline fine needle aspiration of the unaffected breast and serum collection for biomarker analysis before starting anastrozole at 1 mg per oral/day and again at 6 months. Biomarkers included changes in cytology, insulin-like growth factor 1 (IGF-1), IGF-binding protein 1 (IGFBP-1), and IGFBP-3. Thirty-seven patients were enrolled. There was a significant modulation in serum IGFBP-1 levels between pre- and postsamples (P = 0.02). No change was observed in IGF-1, IGFBP-3, and breast cytology.We showed a significant modulation of IGFBP-1 levels with six months anastrozole. Anastrozole is currently being studied as a prevention agent in a large phase III trial and our results provide support for continued evaluation of IGFBP-1 as a surrogate endpoint biomarker in prospective breast chemoprevention studies.

Factors that influence mammography use and breast cancer detection among Mexican-American and African-American women

OBJECTIVE

This study examined factors that influence mammography use and breast cancer detection, including education, health insurance, and acculturation, among Mexican-American (MA) and African-American (AA) women.

METHODS

The study included 670 breast cancer cases (388 MAs and 282 AAs), aged 40-86 years at diagnosis. Data on mammography use, detection, and delay in seeking care were collected via questionnaires and medical records. Using a language-based bidimensional acculturation measure, MAs were classified as English-dominant (n = 67), bilingual (n = 173), and Spanish-dominant (n = 148). Mammography prior to diagnosis was assessed by racial/ethnic acculturation subgroup using logistic regression.

RESULTS

In age-adjusted models, mammography use was non-significantly lower among English-dominant (OR = 0.84; 95% CI: 0.45-1.59) and bilingual (OR = 0.86; 95% CI: 0.55-1.35) MAs and significantly lower among Spanish-dominant MAs (OR = 0.53; 95% CI: 0.34-0.83) than among AA women. After adjustment for education or insurance, there was no difference in mammography use by race/ethnicity and acculturation subgroup. Despite high self-reported mammography use (75%), a large proportion of cases reported self-detection (59%) and delay in seeking care >90 days (17%).

CONCLUSIONS

These findings favor promoting culturally appropriate messaging about the benefits and limitations of mammography, education about breast awareness, and prompt reporting of findings to a health professional.

Capecitabine in operable triple receptor–negative breast cancer: A subgroup analysis of a randomized phase III trial

292

Background: Recent data suggest that patients with operable triple negative breast cancer (TNBC) may derive greater benefit from the addition of capecitabine to anthracycline-taxane regimens.

Methods: We examined pathological complete response (pCR), relapse-free survival (RFS) and overall survival (OS) in patients with TNBC randomized to paclitaxel 80mg/m2 weekly (WP) x 12 followed by fluorouracil (500mg/m2), epirubicin (100mg/m2), cyclophosphamide (500mg/m2) every 3 weeks x 4 cycles (FEC) vs. docetaxel (75mg/m2) 3 weekly and capecitabine D1-14 (1500mg/m2 daily; DX) followed by FEC. Patients were stratified by timing of chemotherapy (preoperative vs. adjuvant).

Results: 149 patients with TNBC comprising 25% of all patients randomized (N=601). Median age; 49 years (IQR; 41 to 55). The number and proportion of patients by stage were; I (n=32: 21.5%), IIA (n=72: 48.3%), IIB (n=34: 22.8%), IIIA (n=9: 6.0%) and IIIC (n=2; 1.3%). Preoperative therapy was administered to 58 patients (39%) and adjuvant to 91 (61%). There were 17 events (21%) in the DX arm and 10 events (15%) in the WP arm (P=0.36) including 11 distant recurrences in the DX arm and 9 in the WP arm (P=0.99). We observed a pCR in 11 patients (37%) and 10 (36%) in the DX and WP arms respectively (P=0.94). The odds ratio for pCR for patients with TNBC given DX vs. WP was 0.98 (95% CI; 0.33 to 2.80: P=0.94). At 50-months median follow-up the RFS and OS in patients with TNBC randomized to DX or WP was 77% (66 to 86%) and 83% (73 to 92%) (P=0.41) and 78% (67 to 87%) and 87% (77 to 95%) (P=0.16) respectively. RFS and OS for WP vs. DX for non-TNBC was 93% (87 to 95%) and 92% (88 to 96%) (p=0.91) and 96% (92 to 98%) and 97% (94 to 99%) for WP and DX respectively (P=0.39).

Conclusions: In this unplanned subgroup analysis there was no difference in pCR, RFS or OS in patients with operable TNBC randomized to WP or DX however, power is limited and should be considered when interpreting these data.