Abstract P6-17-31: Real world evidence of neoadjuvant treatment based on dual blockade with pertuzumab plus trastuzumab for early HER2+ breast cancer: The NeoPETRA study

Background: Evidence from clinical trials supports the neoadjuvant use of pertuzumab and trastuzumab with chemotherapy to improve the pathologic complete response (pCR) in early HER2+ breast cancer (BC), but information on the efficacy of this combination in the clinical practice setting is still limited. In order to widen its real-world data (RWD), we conducted an observational study to determine the pCR rate obtained in routine clinical practice.

Methods: This was a multicenter, retrospective, observational study in patients (pts) with early HER2+ BC who received neoadjuvant therapy based on dual blockade with pertuzumab and trastuzumab. All data were retrospectively collected from pts medical charts. The primary study objective was the total pCR rate (ypT0/is ypN0). Secondary objectives included patient characteristics, neoadjuvant treatment patterns with the dual blockade, surgery types, breast pCR rate (ypT0is), and neoadjuvant safety profile.

Results: Two hundred and forty-three evaluable pts treated in Spain between November 2013 and September 2017 were enrolled between October 2017 and February 2018 (median age [range] 51.7 [44.7-60.2] years; postmenopausal 47.7%; ECOG 0/1 88.9/10.6%; stage II/III tumors 54.3/28.7%; hormone receptor-positive 62.4%). The most common neoadjuvant chemotherapies used were taxanes+anthracyclines (n=180, 74.1%), platinum-based chemotherapies (n=35, 14.4%), and taxanes (n=27, 11.1%). Response rates (radiologic/clinical assessments) before surgery were: complete response 62.1% (n=151), partial response 33.3% (n=81), stable disease 4.1% (n=10), and non-evaluable 0.4% (n=1). Breast-conserving surgery (tumorectomy/lumpectomy and quadrantectomy) was performed in 57.8% (n=133) pts and not conserving (simple, radical and modified radical mastectomy) in 42.2% (n=97). The total pCR was 66.4% and breast pCR was 67.6%. Total pCR in the breast was achieved by 80.7% (n=67) hormone receptor-negative and 56.3% (n=76) hormone receptor-positive pts (statistically significant differences; p<0.001). According to neoadjuvant treatment, total pCR in the breast was achieved by 71.0% (n=120) taxanes+anthracyclines, 48.6% (n=17) platinum-based chemotherapies, and 59.3% (n=16) taxanes users (statistically significant differences; p=0.028). Sixty-three (35.0%) pts experienced at least one adverse reaction (AR) to pertuzumab/trastuzumab+taxanes+anthracyclines (grade 3 ARs: asthenia 0.6%, diarrhea 2.2%, febrile neutropenia 1.1%, and neutropenia 1.1%; grade 4 AR: neutropenia 0.6%), 3 (8.6%) to pertuzumab/trastuzumab+platinum-based chemotherapies, and 22 (11.1%) to pertuzumab/trastuzumab+taxanes (grade 3 AR: diarrhea 3.7%).

Conclusions: This is the first, to the best of our knowledge, multicenter observational study to determine the pCR rate obtained in routine clinical practice in Spain. Results obtained from it have been remarkable: neoadjuvant therapy based on dual blockade with pertuzumab and trastuzumab for HER2+ BC in the routine clinical practice setting enabled the achievement of total pCR rates over 66%, which are even higher than those obtained in previous clinical trials. In addition, this therapy has showed an acceptable safety profile, in line with previous assessments.

Citation Format: Chacón JI, Saura C, Ciruelos E, Alonso JI, de la Morena P, Santisteban Eslava M, Gallegos I, de Luna A, Dalmau E, González-Santiago S. Real world evidence of neoadjuvant treatment based on dual blockade with pertuzumab plus trastuzumab for early HER2+ breast cancer: The NeoPETRA study [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 P6-17-31.

Adipocyte accumulation in corpus cavernosum: First clinical evidence and pathophysiological implications in erectile dysfunction

OBJECTIVES

Animal models have shown that erectile dysfunction is associated with adipocyte accumulation under tunica albugínea, which could be involved in venous leakage and loss of penile rigidity. In the current sudy, we compared the histology of the penile sub-albuginean region of drug-refractory erectile dysfunction patients undergoing penile prosthesis implantation with potent patients with Peyronie's disease undergoing curvature correction procedures.

MATERIALS AND METHODS

Seventeen refractory erectile dysfunction patients and fourteen potent patients with Peyronie's disease were recruited. Sub-albuginean tissue samples were taken in each surgery. An expert uropathologist analysed each section. A bivariate analysis was performed. Multivariate logistic regression was used to calculate adjusted odds ratios; P value<.05 was considered significant.

RESULTS

Eleven patients (11/17) in the case group presented cavernous fat cell accumulation, while only one patient (1/14) in the control group presented this finding (P<.05). Adjusted odds ratio for erectile dysfunction was 40.72; 95% CI 2.28-727.29 (P=.012).

CONCLUSIONS

Different studies have shown that androgen disruption could be involved in penile structural changes, leading to trabecular smooth muscle apoptosis and trans or de-differentiation into adipocytes. This is the first prospective study in humans to report an association between erectile dysfunction and sub-albuginean adipocyte accumulation. Venous leakage secondary to this phenomenon could be a factor in the pathophysiology of erectile dysfunction, especially in patients that do not respond to medical therapy.

Merkel cell carcinoma of the eyelid. A series of 5 cases and review of the literature

OBJECTIVE

Presentation of 5 clinical cases of Merkel cell carcinoma of the eyelid, highlighting the clinical, histopathological, management, and monitoring features. Review of related literature.

METHODS

Retrospective review of clinical records and telephone interview of the 5 patients treated for Merkel cell carcinoma between 2006 and 2013, in the Orbit and Oculoplastic Department, Clinical Hospital of the University of Chile.

RESULTS

Five patients (2 men, 3 women); 79.2 years (range 64-94 years), with a mean onset of 10 weeks (range 5-16 weeks), tumour size reaching a mean of 2.5×2×2.1cm at the time of surgery. Described as a nodular mass, exophytic, solid, reddish coloured. With no infiltrated lymph nodes or metastases in the first match. Staging as T2N0M0, after the first surgery with oncological criteria. Two lymph node recurrences detected during monitoring. Distant metastasis was found in one patient. The histopathological diagnosis was confirmed by immunohistochemical study of the biopsy. The surgical strategy was full excision, control of surgical margins in the intraoperative period, and eyelid reconstruction with Hughes flap, Cutler/Beard flap or primary closure, depending on the case.

CONCLUSIONS

Early diagnosis, wide excision of the tumour with intraoperative control of clear margins with conventional or Mohs surgery, and proper eyelid reconstruction are adequate for a good survival in elderly patients with this eyelid tumour. The study of sentinel lymph node biopsy in primary intervention is recommended; with subsequent radiotherapy to decrease the recurrence and increase survival.

Systemic vasculitis associated withFasciola hepaticainfection

We report the case of a 50-year-old man who presented with systemic vasculitis associated with Fasciola hepatica infection. The patient presented with severe skin, kidney, spleen, ophthalmic, and neurological compromise. An immunological examination for primary vasculitis was negative and other infections were discounted by microbiological and serological analyses. The patient was treated with steroids without clinical response. The Fasciola hepatica infection was confirmed by the presence of specific immunoglobulin G (IgG) serum antibodies detected by a quantitative enzyme-linked immunosorbent assay (ELISA) with an optical density (OD) of 0.483 OD units (normal value<0.170 OD units) and a high-titre complement fixation (1/80 dilution). The patient received treatment with triclabendazole and all symptoms and systemic manifestations resolved within weeks. Hence, this previously unreported vasculitis-associated infection, if identified opportunely, can be treated and cured.

Efficacy of sublingual nifedipine in the acute treatment of systemic hypertension

The effects of sublingual nifedipine, a calcium antagonist vasodilator, were assessed in 43 patients with moderate to severe hypertension in an emergency room setting. Following a no-response placebo treatment period, the patients with supine diastolic blood pressure of less than 110 mm Hg (group A, n equals 17) received 10 mg of sublingual nifedipine, and the patients with supine diastolic blood pressure of much greater than or equal to 110 mm Hg (group B, n equals 26) received a 20-mg sublingual dose. In group A, systolic blood pressure decreased from 172.4 plus or minus 18.6 mm Hg to 140.0 plus or minus 14.6 mm Hg; diastolic pressure from 108.8 plus or minus 3.3 mm Hg to 87.6 plus or minus 9.9 mm Hg (P less than 0.001)., In group B, systolic blood pressure decreased from 203.8 plus or minus 22.1 mm Hg to 160.0 plus or minus 23.6 mm Hg; diastolic pressure from 127.7 plus or minus 11.3 mm Hg to 96.7 plus or minus 14.1 mm Hg (P less than 0.001). Heart rate increased significantly only in the 20-mg dose group, from 76 plus or minus 2 to 89 plus or minus 6 beats/min (P less than 0.005). Th effects of sublingual nifedipine were seen in one to five minutes, and the maximal effect in 20 to 30 minutes, with return to placebo baseline in four to five hours. Adverse reactions were minimal in both treatment groups. Nifedipine is an effective and safe hypotensive drug in the rapid management of moderate to severe hypertension and seems to be an effective nonparenteral agent for treatment of hypertensive emergencies.