Abstract P4-22-17: Safety of the combination of everolimus plus exemestane in the Italian cohort of patients enrolled in the expanded access “BALLET” study

Background:The expanded access “BALLET” study has been designed toevaluate the safety of EVE plus EXE combination in hormone receptor-positive (HR+), human epidermal growth factor-receptor-2-negative (HER2-) metastatic Breast Cancer (mBC). The Italian population was predominantly enrolled in trial.

Patients and methods: Patients has been included according to the inclusion and exclusion criteria provided previously in the BALLET study. The aim of our analysis was the safety everolimus and exemestane analysed in two sets of population: a subpopulation including only patients who never received chemotherapy in metastatic setting (416 patients – 36.1% of the safety population) and a subpopulation including only patients who received at least one chemotherapy in metastatic setting, whatever the line of treatment (735 patients – 63.9%).

Results:One thousand two hundred seventy nine (1279) Italian female patients were screened, 1153 (90.1% of the screened set) out of these were included in the analysis and 1151 (90.0% of the screened set) were included in the safety population. 1116 (97.0% of the safety population) prematurely discontinued the study drug and the main reasons reported were disease progression (39.1%), local reimbursement of everolimus (31.1%) and adverse event(s) (16.1%). The mean duration of study treatment exposure was 158.3±106.79 days (median 139.5) for exemestane and 153.9±108.48 days (median 135.0) for everolimus with a treatment compliance (higher than 90%) of 94.4% and 58.6% and (lower than 60%) of 0.1% and 15.1% for exemestane and everolimus, respectively. 92.5% of patients of the safety population (91.1% and . 93.3% patients without and with chemotherapy respectively) experienced at least one adverse event: gastrointestinal disorders” (67.3% vs. 64.6% in without and with chemo group); general disorders (48.6% vs. 48.3%); metabolism and nutrition disorders (35.6% vs. 37.4%) and skin and subcutaneous tissue disorders (32.2% vs. 27.5%). The incidence of everolimus related adverse events was higher (83.9%) when compared to those which occurred with exemestane. The most commonly reported adverse event was stomatitis (51.3% of patients) with 22.5% Grade 1; 18.2% Grade 2; 10.5% Grade 3; 0.2% Grade 4. The 49.7% of the patients experienced at least one stomatitis related to everolimus. No relevant difference was observed between the two groups of patients without and with chemo in metastatic setting.

Conclusions: The administration of chemotherapy before starting EVE plus EXE combination did not affect the safety profile of EXE/EVE in the treatment of mBC. The stomatitis is the most frequent and relevant adverse event to be clinically focused on.

Citation Format: Generali D, Bordonaro R, Febbraro A, Madoffa A, Romito S, Michelotti A, Savastano C, Mariani G, Tondini C, Piovano P, Iona MT, Bighin C, Roviello G, Ascione G, Goffredo F, Sartori D, Frassoldati A, Simoncini E. Safety of the combination of everolimus plus exemestane in the Italian cohort of patients enrolled in the expanded access “BALLET” study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-17.

Abstract P1-09-06: Imaging Tests in Staging and Surveillance of Early Breast Cancer (EBC) — Changes in Routine Clinical Practice and Cost Implications

Background. New imaging tests such as computed tomography [CT], [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning and magnetic resonance imaging (MRI) are not recommended for staging or follow up of asymptomatic patients with EBC according to current guidelines. However, frequently these tests are requested even in the absence of a clinical indication. Variations in practice patterns have significant cost implications and no clear impact on cancer outcomes. Aim. In the present study we analyzed how the availability of novel and more expensive imaging technique has changed staging and follow-up modalities in EBC patients and if these changes affect costs. Methods. Two thousand and five patients with EBC diagnosed between January 2005 and December 2008 were identified using clinical computerized medical records from 639 general practitioners assisting 915,689 inhabitants of the Campania, a southern region of Italy. For each year EBC incidence, the mean number of diagnostic tests per patient (N/Pt) done during the first year after the initial diagnosis and the mean costs per each year were evaluated and compared by Anova test. Results. We identified 576, 489, 474 and 497 newly diagnosed cases of EBC in 2005, 2006, 2007 and 2008 respectively.

Table 1

Table 1 describes changes in the mean number of different imaging tests requested per patient in these years. Overall, there was a significant increase of the mean number of imaging tests done per patient from 2005 to 2008 (P<0.0001). No change of the mean number of mammograms, bone scan and chest X ray requested per patient was observed. However, importantly, the mean number of TC scan, PET scan and MRI requested per patient almost doubled from 2005 to 2008. Accordingly, the mean costs for staging and surveillance per patient also significantly increased (355 € in 2005, 378 € in 2006, 391 € in 2007 and 547 € in 2008; <0.0001).

Conclusions. TC scan, PET scan and MRI employment for patient with EBC in daily clinical practice has been steadily growing over the past four years. However, there are no data to support their role in routine breast cancer staging or surveillance in asymptomatic patients. More studies are needed to characterize which subset of patients deserve more intensive staging and follow up procedures as costs related to these imaging test prescriptions are relevant.

Pananemia 2008 multicenter observational study on erythropoietin beta treatment in patients with cancer: Efficacy, patient satisfaction, and impact on psychological distress

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Background: Cancer-related anemia, results in both a need for transfusions and a decreased functional capacity and quality of life. Treating anemia associated with chemotherapy and many cancers is often necessary. However, patient satisfaction with anemia treatment, and the possible correlation between anemia and psychological distress frequently present in these patients is limited by the lack of validated instruments. Methods: Between January 2008 and December 2008, 591 cancer patients in treatment with erythropoietin beta for anemia were targeted to complete the Psychological Distress Inventory (PDI), a 13-item self-administered questionnaire, and the Patient Satisfaction Questionnaire ( PSQ) at 4 week intervals, a 10-item, self-administered questionnaire. Data from weeks 5 and 9 were analyzed. Patients were required to receive at least four weekly injections of Epo, expecting to receive ≥ 8 additional weeks of chemotherapy, and able to complete questionnaires. Results: Among patients fulfilling eligibility criteria and having received at least four Epo Beta administrations, most (57.5%) of them were female, with a median age of 66 (52.4 - 76.5), and a median KPS of 85 (range: 50–100). 399 patients had a stage IV cancers. Hemoglobin values increased from mean baseline levels of 9.55 g/dL, to attain levels 10.31 at week 5, and 11.05 after 8 weeks of therapy; 247 (42%) patients received iron supplementation. For PDI, the overall response rate was 93 % (548/591) at baseline, 100 % (517/517) at week 5, and 99% (491/492) at week 9. The percentage of patients with psychological difficulties decreased during the treatment. For PSQ, the overall response rate was 100% (517/517) at week 5, and 100 % (492/492) at week 9. The PSQ questionnaires showed that a conspicuous group of patients (124/517) marked troubles to accept the treatment. Conclusions: Our results suggest that in anemic cancer patients psychological distress and anemia were related. PSQ reflect the burden of injection anemia treatment on cancer patients. Final data analysis will be presented.

No significant financial relationships to disclose.

[The anthropomorphic proportions of the face: an evaluation of the response to orthodontic surgical treatment of Angle class III]

The purpose of this investigation was: to examine the anthropometric facial presurgical and postsurgical indices of patients having a dento-skeletal class III malocclusion and who were treated with the orthodontic-surgical procedure. To evaluate the postsurgical response of the soft tissues, according to the type of approach: mandibular surgery or maxillo-mandibular surgery. To recognize, if it is possible, what indices are to be considered more involved in the esthetic change. Ninety pre and postoperative frontal photographs of 45 subjects were studied. The subjects were 32 females and 15 males who had a dento-skeletal class III malocclusion and who had undergone the orthodontic-surgical treatment (21 had sagittal bilateral mandibular osteotomy, 24 had sagittal bilateral mandibular osteotomy + Le Fort I). The photographs were taken with lips in repose, relaxed soft tissue and centric occlusion. The mean age of the patients was 23 years (ranging 16-35). The post-treatment follow-up went from 1 to 3 years. 11 frontal landmarks: n = nasion, sn = subnasale, sto = stomion, sl = sublabiale, gn = gnathion, go = gonion (bilateral), zy = zygoma (bilateral), ch = cheilion (bilateral) were recognized and 3 horizontal and 5 vertical measurements were taken: zygomatic width (zy-zy), mouth width (ch-ch), gonial width (go-go); face height (n-gn), lower face height (sn-gn), upper face height (n-sto), height of lower third of the face (sto-gn), medial vertical chin height (sl-gn). 11 pre and post-treatment facial indices were obtained from the ratio per cent of the measurements previously mentioned using the method of Farkas: Facial (n-gn-zy-zy), Mandible-face width (go-go/zy-zy), Upper face (n-sto/zy-zy), Mandible width-face height (go-go/n-gn), Mandibular (sto-gn/go-go), Mouth face width (ch-ch/zy-zy), Lower face-face height (sn-gn/n-gn), Mandible face height (sto-gn/n-gn), Mandible-upper face height (sto-gn/n-sto), Mandible-lower face height (sto-gn/sn-gn), Chin-face height (sl-gn/sn-gn). In each patient the mean values, with their standard deviations, were calculated according to the sex for each index. A different group of average values was calculated according to the sex and to the type of surgical approach; 17 females and 4 males underwent a mandibular setback osteotomy and 15 females and 9 males underwent a sagittal bilateral mandibular osteotomy + Le Fort I osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS)

[Inclination of the temporomandibular eminence and craniomandibular disorders]

The articular eminence angle of 30 patients with TMJ dysfunctions was measured on cephalometric X-ray and compared with the joints of 30 patients without TMJ disorders. The inclination of the posterior slope of the articular eminence was 52.9 degrees with a mean difference compared to the control group of 1.7 degrees. The vertical parameters appeared of less importance than the antero-posterior to produce TMJ dysfunction. In the skeletal class II group a steeper inclination, with a mean difference compared to the control group of 8.6 degrees, was seen in the symptomatic patients. The study of this angle could have a diagnostic and prognostic utility in the treatment of dysfunctional class II malocclusions.