Abstract P1-15-03: Association between exercise, pathological complete response, and treatment tolerability in patients receiving neoadjuvant chemotherapy for operable breast cancer: Results from the CANTO study

Background: Randomized trials, although not all, suggest exercise therapy improves treatment completion rates / relative dose intensity in patients with early-stage breast cancer receiving adjuvant chemotherapy (CT). In addition, preclinical studies show that exercise therapy adds to the antitumor activity of standard CT in murine models of breast cancer. We evaluated the association between exercise and pathologic complete response (pCR) rate (i.e., ypT0ypN0) in patients receiving neoadjuvant CT for operable breast cancer.

Methods: Using a prospective design, patients with stage I-III breast cancer receiving anthracycline-taxane (± trastuzumab) neoadjuvant CT participating in a multicenter, national cohort study in France (CANTO, NCT01993498) completed questionnaire assessing self-reported exercise behavior (GPAQ 16). Multivariate logistic models were performed to determine the relationship between pre-CT exercise exposure (total MET-h/wk categorized into the proportion of patients meeting WHO exercise guidelines, the equivalent of ≥10 MET-h/wk), pCR rates, CT± trastuzumab dose reductions, delays, treatment completion or interruptions for the overall cohort and on the basis of clinical subtype.

Results: Between March, 2012 to December, 2014, a total of 989 patients participating in CANTO received neoadjuvant CT and completed GPAQ 16. Here we present interim analyses on 608 patients. Fifty-four percent of patients engaged on of ≥10 MET-h/wk prior to CT administration. In multivariable analysis for the overall cohort, exercise exposure was not associated with higher pCR (p=0.69). The pCR rate was 27.7% for patients reporting <10 MET h/wkcompared with 28.0% for those reporting ≥ 10 MET-h/wk (OR, 1.02; 95% CI, 0.71-1.45). Stratification analyses indicated no differences on the basis of clinical subtype for hormone receptor (HR) positive/HER2 negative (<10 MET h/wk: 15.1% vs. ≥ 10 MET h/wk: 16.5%; OR, 0.95, 0.41-2.16); HER2 positive (<10 MET h/wk: 38.1% vs. ≥ 10 MET h/wk: 32.5%; OR, 0.62, 0.28-1.35); or triple-negative disease (<10 MET h/wk: 33.3% vs. ≥ 10 MET h/wk: 36.7%; OR, 1.04, 0.52-2.10). Rates of CT dose reductions (<10 MET h/wk: 16.1% vs. ≥ 10 MET h/wk: 18.3%), CT dose delays (<10 MET h/wk: 19.9% vs. ≥ 10 MET h/wk: 19.8%), CT completion (<10 MET h/wk: 12.03% vs. ≥ 10 MET h/wk: 11.45%) trastuzumab interruptions (<10 MET h/wk: 9.01% vs. ≥ 10 MET h/wk: 7.95%) were also not different on the basis of exercise exposure.

Conclusion: On the basis of interim analyses, higher pretreatment exercise exposure is not associated with higher clinical response or treatment tolerability in breast cancer patients receiving uniform conventional neoadjuvant CT. Full results will be presented at the meeting.

Citation Format: Baker JL, Di Meglio A, El Mouhebb M, Iyengar NM, Michiels S, Cottu P, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Jouannaud C, Levy C, Everhard S, Martin A-L, Arveux P, Fabrice A, Vaz Luis I, Jones LW. Association between exercise, pathological complete response, and treatment tolerability in patients receiving neoadjuvant chemotherapy for operable breast cancer: Results from the CANTO 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 P1-15-03.

Abstract P6-12-18: CANTOCHEM: Analysis of chemotherapy practice and early side effects in the 6090 first patients from the prospective CANTO cohort

Background

There is no large prospective trial assessing mid-term adverse effects of adjuvant chemotherapy. In order to address this question, we developed CANTO (CANcer TOxicities - NCT01993498 - http://etudecanto.org/), a prospective trial dedicated to the quantification of side effects after treatment for patients with early breast cancer and to develop predictors of such toxicities. The aim of this presentation is to assess chemotherapy (CT) practice and to report toxicities that persist 3-6 months after CT.

Methods

CANTO is a prospective study enrolling newly diagnosed invasive cT0-cT3, cN0-3, M0 breast cancer patients (pts) of 26 French comprehensive cancer centers. The study has included 10 500 patients at the time of submission. Pts are assessed at diagnosis, 3-6, 12, 36, 48 and 60 months after treatment completion. CANTO collects >100 items related to toxicities. In the current study, we focus on the first set of data available from the trial (1st database lock, n=6090). We here assess CT practice and toxicities at 3 months.

Results

Information about (neo)adjuvant CT (NACT/ACT) is available in 5805 pts (96%). Median age at diagnosis was 57y (22-93). Pts had HR+/HER2-, HER2+ or triple negative (TN) tumors in 74%, 15% and 11% of cases. Ki67 was assessed in 70%, and genomic tests in 1% of pts, respectively.

Overall, 3074 pts (53%) received CT, either adjuvant (ACT: 76%) or neoadjuvant (NACT: 24%). ACT/NACT pts (84%) received a sequential anthracyclines–taxanes based 6 courses CT schedule. CT was administered in 44.7%, 87.2% and 92.3% of HR+/HER2+/TN tumors, respectively. ACT was administered in 73.2% of pT2+ pts (vs 36.0% in pT0-1 – p<.001)) and in 74.7% in pN1+pts (vs 36.7% in pN0 – p<.001)). After NACT, pts had yPT0 (32.3%) and/or ypN0 (64.6%) for an overall 28.9% pCR rate.

We focus here on clinically most relevant patient reported symptoms at 3 m (any grade).

side effects at 3m no CT (%)CT (%)p valuePain76.682.1<.001Neurological symptom4768.7<.001GI symptom34.342.1<.001CV sympton8.110.20.011

Pain complaint was recorded in 3596 pts (97.2% of pts with available data), with a median value of 4 on the VAS (range 1-10). In ACT/NACT pts, muscle and joint pain were predominant. Neurological symptoms were seen in 3024 pts (59%), the most frequent pertaining to cognitive disorder (attention trouble, CT: 61.2% vs noCT: 56% - p=.06) and peripheral neuropathy (overall 31%). Paresthesias and sensory neuropathy were much more frequent in CT vs noCT pts: respectively 37.3% vs 20.3% and 25.7% vs 12.8% (both p<.001). Of note, pts receiving paclitaxel had more peripheral neuropathy (92.3% vs 69% in docetaxel pts – p=.07). Diarrhea was the most frequent GI symptom post CT: 44.5% vs 33.2%, p< 0.001. CV symptoms (NOS) were slightly more frequent after CT.

Conclusions

In this real life, prospective cohort, CT is frequently prescribed and appears in good compliance with current guidelines. Overall, symptoms burden at treatment completion is strikingly high, and much higher in pts receiving CT. A special attention should be given to pain and neurological symptoms. Dedicated questionnaires and sub-studies will explore in depth these side effects. Extended analyses of CT practice and toxicities will be presented.

Citation Format: Cottu PH, Amar Y, Pistilli B, Bonsang-Kitzis H, Lesur A, Lerebours F, Vanlemmens L, Tredan O, Levy C, Jouannaud C, Fournier M, Soulie P, Rigal O, Giacchetti S, Arnaud A, Arsene O, Savignoni A, Mesleard C, Andre F, Arveux P. CANTOCHEM: Analysis of chemotherapy practice and early side effects in the 6090 first patients from the prospective CANTO cohort [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-18.

Abstract PD7-06: MAAT: Menses after adjuvant treatment. Prediction of menses recovery after chemotherapy for early breast cancer (BC) by using a nomogram model in UNICANCER PACS04 and PACS05 trials

Purpose:The likelihood of menses recovery (MR) is largely variable in premenopausal patients (pts) receiving adjuvant chemotherapy for BC. Quantifying this probability for each single patient could impact discussion of chemotherapy side effects and better individualize fertility counseling.We performed a pooled analysis from PACS04 and PACS05 randomized trials aiming to develop a nomogram to estimate the probability of menses recovery at 6 and 18 months (mos) after the end of adjuvant chemotherapy (CT) for premenopausal pts with early BC.

Patients and Methods: The analyzed population consisted of 1683 pts who were premenopausal and ≤ 50 (out of 4524 enrolled in both trials). In PACS05 node-negative BC pts were randomized to 4 or 6 cycles of FE100C (standard arm); in PACS04 node-positive pts were randomized to 6 cycles of FE100C or 6 cycles of Epirubicin 75mg/m2 and Docetaxel 75 mg/m2 (ED75). Endocrine therapy (ET) (Tamoxifen) x 5 years was mandatory for ER+ BC. Variables significantly associated with MR in the univariate analysis (P<0.20) were included in the multivariate analysis. Using this data set, a logistic regression-based nomogram was developed to predict MR at 6 and 18 mos.

Results: Pts' characteristics were: median age 43 (22-50), median body mass index (BMI) at baseline 22.6 (15.6-54.7), at the end of chemotherapy 22.8 (15.8-58.6). ED75 was administrated to 517 (30.7%), while 802 (47.7%) received 6FE100C, 364 (21.6) 4FE100C. Trastuzumab was given to 122 (7.2%), ET to 1229 (73%) pts. CT-induced amenorrhea was observed in 1407 (83.6%) pts. Factors associated to MR were assessed on 1210 pts (excluding pts who recovered menses during CT or of whom date of recovery was not specified). At a median follow-up of 90 mos, 28.2% (342/1210) of pts had recovered menstrual cycles: 11% (133/1210) at 6 mos and 24.3% (294/1210) at 18 mos. Multivariate analysis showed that younger age, higher BMI at the end of CT, non-alkylating agents and absence of ET were independently associated to MR.

Table 1 Multivariate Cox regression analysis of menses recoveryVariablesHR (95%CI)P valueAge1.49 (1.16-1.93)< 0.002Age2*0.99 [0.98-0.99]<0.0001BMI after CT1.02 (0.99-1.04)0.07Alkylating agents0.72 (0.57-0.90)0.004Endocrine Therapy0.50 (0.40-0.62)<0.001* The quadratic term in the age variable accounts for the non-linearity of the relation between the age and the probability of recovering menses. Overall this probability tend to decrease when age increase with a greater decrease for the older patients.

Nomogram concordance-index was 0.749 and 0.750 for predicting MR at 6 and 18 mos respectively. A better calibration was observed at 18 mos, comparing nomogram predictions with the actual probability of MR in the 1210 women.

Conclusion:Our analysis confirmed the possibility of developing a user-friendly nomogram for predicting menses recovery after adjuvant chemotherapy. As next step, we will externally validate our nomogram on CANTO premenopausal population, one of the biggest national cohorts aiming to assess the long-term impact of cancer treatments toxicities (UNICANCER NCT01993498 - http://etudecanto.org/).

Citation Format: Pistilli B, Mazouni C, Zingarello A, Faron M, Saghatchian M, Grynberg M, Spielmann M, Kerbrat P, Roché H, Lorgis V, Bachelot T, Campone M, Levy C, Goncalves A, Lesur A, Veyrat C, Vanlemmens L, Lemonnier J, Delaloge S. MAAT: Menses after adjuvant treatment. Prediction of menses recovery after chemotherapy for early breast cancer (BC) by using a nomogram model in UNICANCER PACS04 and PACS05 trials [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-06.

Abstract P5-20-03: Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcome in 2863 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program

Background: The management of HER2+ BC has changed dramatically with the introduction and widespread use of HER2-targeted therapies, especially in the adjuvant setting. However, there is relatively limited real-world information on the impact of adjuvant Trastuzumab (aT) on patterns of recurrence and outcome of HER2+ MBC.

Methods: In 2014, the 18 French Cancer Centers launched the Epidemiological Strategy and Medical Economics (ESME) program to provide real-world data on MBC patients (pts). All pts who started a 1st-line treatment for MBC between 01-Jan-2008 and 31-Dec-2014 were included. We examined clinical characteristics and outcomes (overall survival [OS] and time to next treatment [TNT]) in patients with HER2+ MBC pretreated with trastuzumab in the adjuvant setting (aT) compared with trastuzumab-naïve patients (nT) and patients with de novo HER2+ MBC (dn). Multivariate analyses adjusted for baseline demographic, prognostic factors and year of diagnosis (prior or after 2005, when aT was approved and widely administered in France for early HER2+ breast cancer).

Results: Among the 15170 pts of the ESME database, 2863 (19%) were HER2+: 1093 pts (38%) had de novo and 1765 pts (62%) recurrent MBC; 63% were Hormone Receptor (HR) +; 54%, 25% and 21% had respectively 1, 2, or > 2 metastatic sites (68% visceral and 12% brain). Median time to 1st metastasis was 43.4 months (m) (95% CI: 24.6-84.4): 54 m in HR+ and 30 m in HR-. Among pts with recurrent MBC, 55% (995) had received aT. As 1st-line therapy for MBC, 90 % of pts received HER2-targeted agents (73% T-based). With a median follow-up of 46 m, median OS is 45 m (95% CI: 42.5-48). OS is significantly higher in de novo compared to recurrent MBC: 54 m (95% CI: 50.2-60.4) vs. 38.4 m (95% CI: 36.7-41.9), (p < 0.0001). Among pts with recurrent cancers, median OS is inferior in pts who had received aT, as compared to those who had not: 33.4 m (95% CI: 29.6-36.7) vs. 49.5 m (95% CI: 44.3-56.8), (p < 0.0001). Statistically significant differences persist after adjustment for age at MBC, disease-free interval, metastatic sites and RH status in the multivariate model (HR=1.45, 95% CI: 1.26-1.67) but not after adjustment for year of diagnosis (prior or after 2005) (HR=0.90, 95% CI: 0.70-1.15).

Conclusions: These large-scale real-world data in patients with HER2+ MBC provide evidence that the survival outcome remain similar in patients with failure of adjuvant trastuzumab compared with trastuzumab-naïve patients after adjustment for year of diagnosis. De novo HER2+ MBC pts have the best outcomes. Data on clinical characteristics of metastasis and time to next treatment for the three subgroups will be presented at the meeting.

Citation Format: Saghatchian M, Carton M, Piot I, Pérol D, Pistilli B, Brain E, Ghouadni A, Ricci F, Vanlemmens L, Loeb A, Levy C, Goncalves A, Dalenc F, Lefeuvre-Plesse C, Campone M, Jaffre A, Gourgou S, Cailliot C, Robain M, Dieras V. Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcome in 2863 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-03.

Final efficacy and updated safety results of the randomized phase III BEATRICE trial evaluating adjuvant bevacizumab-containing therapy in triple-negative early breast cancer

Background

The purpose of this analysis was to assess the long-term impact of adding bevacizumab to adjuvant chemotherapy for early triple-negative breast cancer (TNBC).

Methods

Patients eligible for the open-label randomized phase III BEATRICE trial had centrally confirmed triple-negative operable primary invasive breast cancer (pT1a-pT3). Investigators selected anthracycline- and/or taxane-based chemotherapy for each patient. After definitive surgery, patients were randomized 1:1 to receive ≥4 cycles of chemotherapy alone or with 1 year of bevacizumab (5 mg/kg/week equivalent). Stratification factors were nodal status, selected chemotherapy, hormone receptor status, and type of surgery. The primary end point was invasive disease-free survival (IDFS; previously reported). Secondary outcome measures included overall survival (OS) and safety.

Results

After 56 months' median follow-up, 293 of 2591 randomized patients had died. There was no statistically significant difference in OS between treatment arms in either the total population (hazard ratio 0.93, 95% confidence interval [CI] 0.74-1.17; P = 0.52) or pre-specified subgroups. The 5-year OS rate was 88% (95% CI 86-90%) in both treatment arms. Updated IDFS results were consistent with the primary IDFS analysis. Five-year IDFS rates were 77% (95% CI 75-79%) with chemotherapy alone versus 80% (95% CI 77-82%) with bevacizumab. From 18 months after first study dose to study end, new grade ≥3 adverse events occurred in 4.6% and 4.5% of patients in the two arms, respectively.

Conclusion

Final OS results showed no significant benefit from bevacizumab therapy for early TNBC. Late-onset toxicities were rare in both groups. Five-year OS and IDFS rates suggest that the prognosis for patients with TNBC is better than previously thought.

ClinicalTrials.gov

NCT00528567.

Paclitaxel plus bevacizumab or paclitaxel as first-line treatment for HER2-negative metastatic breast cancer in a multicenter national observational study

BACKGROUND

Bevacizumab combined with paclitaxel as first-line chemotherapy for patients with HER2-negative metastatic breast cancer (MBC) has led to mixed results in randomized trials, with an improvement in progression-free survival (PFS) but no statistically significant overall survival (OS) benefit. Real-life data could help in assessing the value of this combination.

PATIENTS AND METHODS

This study aimed to describe the outcome following first-line paclitaxel with or without bevacizumab in the French Epidemiological Strategy and Medical Economics (ESME) database of MBC patients, established in 2014 by Unicancer. The primary and secondary end points were OS and PFS, respectively.

RESULTS

From 2008 to 2013, 14 014 MBC patient files were identified, including 10 605 patients with a HER2-negative status. Of these, 3426 received paclitaxel and bevacizumab (2127) or paclitaxel (1299) as first-line chemotherapy. OS adjusted for major prognostic factors was significantly longer in the paclitaxel and bevacizumab group compared with paclitaxel [hazard ratio (HR) 0.672, 95% confidence interval (CI) 0.601-0.752; median survival time 27.7 versus 19.8 months]. Results were consistent in all supportive analyses (using a propensity score for adjustment and as a matching factor for nested case-control analyses) and sensitivity analyses. Similar results were observed for the adjusted PFS, favoring the combination (HR 0.739, 95% CI 0.672-0.813; 8.1 versus 6.4 months).

CONCLUSIONS

In this large-scale, real-life setting, patients with HER2-negative MBC who received paclitaxel plus bevacizumab as first-line chemotherapy had a significantly better OS and PFS than those receiving paclitaxel. Despite robust methodology, real-life data are exposed to important potential biases, and therefore, results need to be treated with caution. Our data cannot therefore support extension of current use of bevacizumab in MBC.

Abstract P1-07-02: 5-year overall survival of early breast cancer during pregnancy: A multicenter French case control study

Background: Breast cancer (BC) during pregnancy (BCP) is a rare situation that requires collaboration between oncologists, surgeons and obstetricians. The main objectives of this study were to compare the overall survival (OS) and disease free survival (DFS) of a multicenter cohort of pregnant patients (pts) with those of matched control pts.

Methods: Patients from 27 centers and diagnosed between 2000 and 2006 with histological confirmed M0 invasive BC were included in this retrospective study. For the cohort of BCP, pts whose pregnancy was interrupted were not eligible. Controls were matched to BCP pts on 5 criteria: clinical T (of TNM), hormonal receptor (HR) status, HER2 status, administration of neo-adjuvant chemotherapy and pathological nodal status in the absence of neo-adjuvant chemotherapy. Survival times were estimated from the date of diagnosis using Kaplan-Meier method. OS was calculated until death from every cause, DFS was calculated until relapse or death from every cause; patients alive were censored at the date of last news.

Results: 100 BCP pts were identified. Their clinical and pathological characteristics were described on a previous presentation (SABCS 2013 P6-06-07). Matched controls could not be found for 12 BCP pts. 88 BCP pts were matched with 204 controls. The only differences between the 2 populations in terms of characteristics or treatment were more radical mastectomy (p=0.036) and fewer taxane administrations in the BCP group (p=0.06). The median duration of follow-up was 8.2 years for cases and 7.7 years for controls. There were no differences between BCP pts and controls in 5-year OS: 83.4%, IC 95% (73.5-89.8) vs 83.8%, IC 95% (77.9-88.3) nor 7-year OS: 76.5% (65.5-84.4) vs 78.1% (71.5-83.3) (p=0.52). The 5-year DFS was 58.6% IC 95% (47.3-68.3) vs 67.2% IC 95% (60.2-73.2) (p= 0.16). However, 5-year DFS was lower in HR+ BCP pts subgroup than in HR+ control group (56.7% IC 95% (40.7-69.8) vs 70.9% IC 95% (61.4-78.5) (p=0.023).

Conclusion: This multicenter French large study confirmed that there are no differences on OS and DFS between pregnant and no pregnant pts, though this might not be true for HR subgroup.

Citation Format: Vanlemmens L, Ploquin A, Delaloge S, Rouzier R, Lesur A, Frenel J-S, Loustalot C, Bachelot T, Provansal M, Ferrero J-M, Coussy F, Debled M, Kerbrat P, Vinceneux A, Djelila A, Baron M, Jebert S, Decoupigny E, Tresch E, Bonneterre J. 5-year overall survival of early breast cancer during pregnancy: A multicenter French case control study. [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 P1-07-02.

The subjective experience of young women with non-metastatic breast cancer: the Young Women with Breast Cancer Inventory

BACKGROUND

The subjective experience of young women with breast cancer has some particular features linked to the impact of the disease and its treatment on their age-related issues (e.g. desire for a child, couple relationship, career management). Despite these specific concerns, no questionnaire currently targets the young breast cancer patient's quality of life, subjective experience or common problems when facing cancer. This study presents the psychometric validation of an inventory that aimed to measure the impact of breast cancer on the quality of life of young women (<45 years of age) with non-metastatic disease.

METHODS

546 women aged <45 years when diagnosed with a non-metastatic breast cancer were recruited in 27 French cancer research and treatment centers. They answered a self-reported questionnaire created from verbatim collected by non-directive interviews carried out with 69 patients in a first qualitative study. Exploratory and confirmatory analyses were conducted in order to obtain the final structure of the scale. Internal consistency, test-retest reliability and concurrent validity with quality of life questionnaires currently used (QLQ-C30 and the QLQ-BR23 module) were then assessed.

RESULTS

The YW-BCI36 contains 36 items and highlights 8 factors: 1) feeling of couple cohesion, 2) negative affectivity and apprehension about the future, 3) management of child(ren) and of everyday life, 4) sharing with close relatives, 5) body image and sexuality, 6) financial difficulties, 7) deterioration of relationships with close relatives, and 8) career management. Psychometric analyses indicated good internal consistency (Cronbach's alpha values ranging from 0.76 to 0.91) and temporal reliability (Bravais-Pearson correlations ranging from 0.66 to 0.85). As expected, there were quite strong correlations between the YW-BCI36 and the QLQ-C30 and QLQ-BR23 scores (r ranging from 0.20 to -0.66), indicating adequate concurrent validity.

CONCLUSIONS

The YW-BCI36 was confirmed as a valid scale for evaluating the subjective experience of breast cancer in young women. This instrument could help to identify the problems of these women more precisely, in order to respond to them better by an optimal care management. This scale may improve the medical, psychological and social care of breast cancer patients.

Multicentric neoadjuvant phase II study of panitumumab combined with an anthracycline/taxane-based chemotherapy in operable triple-negative breast cancer: identification of biologically defined signatures predicting treatment impact

BACKGROUND

Triple-negative breast cancer (TNBC) is a heterogeneous group of tumors for some of which the epithelial growth factor receptor (EGFR) pathway may play an important role. We investigated the efficacy and toxicity of an anti-EGFR antibody (panitumumab) combined with a standard neoadjuvant anthracycline-taxane-based chemotherapy in patients with operable, stage II-III, TNBC.

PATIENTS AND METHODS

Treatment in this multicentric neoadjuvant pilot study consisted of panitumumab (9 mg/kg) for eight cycles q.3 weeks combined with four cycles of 5-fluorouracil, epidoxorubicin and cyclophosphamide (FEC100: 500/100/500 mg/m(2)) q.3 weeks, followed by four cycles of docetaxel (T: 100 mg/m(2)) q.3 weeks. Following therapy, all patients underwent surgical resection. Pathologic complete response (pCR) in assessable patients was the main end point while clinical response, toxicity and ancillary studies were secondary end points. Paraffin-embedded and frozen tumor samples were systematically collected with the aim to identify predictive biomarkers of efficacy and resistance in order to select biologically defined subpopulations for potential further clinical development of the anti-EGFR antibody.

RESULTS

Sixty patients were included with 47 assessable for pathologic response. The pCR rates were 46.8% [95% confidence interval (CI): 32.5% to 61.1%] and 55.3% [95% CI: 41.1% to 69.5%] according, respectively, to Chevallier and Sataloff classifications. The complete clinical response (cCR) rate was 37.5%. Conservative surgery was carried out in 87% of cases. Toxicity was manageable. The association of high EGFR and low cytokeratin 8/18 expression in tumor cells on one hand and high density of CD8+ tumor-infiltrating lymphocytes on the other hand were significantly predictive of pCR.

CONCLUSIONS

Panitumumab in combination with FEC100 followed by docetaxel appears efficacious, with acceptable toxicity, as neoadjuvant therapy of operable TNBC. Several biomarkers could help define large subsets of patients with a high probability of pCR, suggesting a potential interest to further develop this combination in biologically defined subgroups of patients with TNBC.

CLINICAL TRIAL NUMBER

NCT00933517.

Abstract P3-14-13: eIF4E/4EBP1 axis and response to neoadjuvant trastuzumab-based treatment in HER2+ breast cancer – Results of a multicentre French retrospective cohort

Background

Despite a growing number of studies exploring the underlying mechanisms, resistance to trastuzumab (TTZ) in HER2+ breast cancer (BC) remains elusive and an important issue in clinical practice. Among the proposed mechanisms, involvement of the PI3K/Akt/mTOR pathway is one of the best characterized. In a previous preclinical and clinical study (n = 54) (Bergé Y et al, SABCS 2009 and [1]), we have shown a significant correlation between eIF4E (a downstream effector of the PI3K/Akt/mTOR pathway) expression level as determined by immunohistochemistry (IHC) on initial tumor biopsy and pathological complete response (pCR) in patients with HER2+ BC treated with a neoadjuvant TTZ-containing regimen. The aim of this study was to validate these findings on an independent and larger cohort of HER2+ BC treated in neoadjuvant setting.

Method

In this multicenter (n = 9) study, 274 patients (pts) with HER2+ BC treated were included. All pts received neoadjuvant chemotherapy regimen containing TTZ, consisting mostly of 3-4 cycles of FEC (5FU, Epirubicin, Cyclophosphamid) followed by 3-4 cycles of TTZ–Docetaxel (n = 116). 74 pts received 6 cycles of TTZ–Docetaxel, 18 received 6 cycles of TTZ–Docetaxel-Cyclophosphamid, 12 received 6 cycles of TTZ–Docetaxel-carbolpatine, and the remaining 54 pts received other regimens. Pathological response was assessed according to Sataloff and Chevallier criteria. Unstained slides from the initial tumor biopsy were centrally collected for biomarkers analysis. Expression levels of eIF4E, p-4EBP1 and pS6 were determined by IHC. An immunoreactive score (IRS) combining the percentage of stained tumor cells and staining intensity was assessed by two pathologists.

Results

Median age at diagnosis was 50 years [range 22–84]. Most pts presented with T2 (52.6%), N1 (53.9%) stage, with a median tumor size of 40mm [range 0-150mm] as determined on clinical examination. Tumors were mainly invasive ductal of no special type (93.8%), of histological grade III (50%) and II (45%), ER+ (54.4%). Breast conserving surgery with free margins was achieved in 50.9% of pts. pCR (breast Sataloff TA) was observed in 53% of pts, and in 47.6% when considering both breast and lymph node response. Out of the 274 pts, 257 had sufficient tumor on the initial biopsy for biomarker analysis. Preliminary results showed a median eIF4E IRS of 6 [range 1-12], with 52.1% of cases displaying a low eIF4E expression level (IRS£6). The agreement for inter-observer assessment of eIF4E status was good (k = 0.618, 95% CI [0.523-0.713]). Scoring of p-4EBP1 and pS6 are ongoing and correlations of pCR with eIF4E/4EBP1 axis will be presented.

Conclusion

In this large multicentre retrospective study, the rate of pCR obtained in neoadjuvant setting of HER2+ BC is similar to those described in the literature. Thorough tumor collection allows biomarkers analysis, which has been specifically focused on downstream effectors of the PI3K/Akt/mTOR pathway.

Reference[1] Zindy P, Bergé Y, Allal B et al. Formation of the eIF4F translation-initiation complex determines sensitivity to anticancer drugs targeting the EGFR and HER2 receptors. Cancer Res. 2011;71(12):4068-73.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-13.

Abstract P6-06-07: 5-year disease free-survival results of aggressively-treated breast cancer during pregnancy: Results from a French multicenter study

Background: Breast cancer (BC) during pregnancy (BCP) is a rare situation that requires multi-disciplinary management. The objectives of this study were to assess the tumor characteristics, clinical course and outcome of such patients (pts).

Methods: French hospitals were invited to collect retrospective clinical, treatment and follow-up data of BCP managed between 2000 and 2006. Pts with histologically confirmed M0, invasive BC and pregnant at diagnosis were included. Pts whose pregnancy was interrupted were not eligible. Survival times were calculated from the date of diagnosis.

Results: 100 BCP pts were identified. Median age was 32 years (24-42). Median gestational age at diagnosis was 25 weeks (3-38). 84% and 13% had palpable breast axillary mass respectively. Clinical stages were 1T0, 21T1, 39T2, 28T3, 6 T4A-C, 2 T4D, 3 TX, 56 N0, 39 N1, 5 NX. Histological analysis identified 85 ductal carcinomas, 4 lobular, 11 others. The histopathological grades was G1 in 4,3%, G2 in 29%, and G3 in 66,7%. Tumor subtype was luminal A in 3%, luminal B in 37% (24HER2-, 13HER2+), luminal undetermined in 6%, triple-negative in 45,9%, Her2 + in 21,3%, and not classified in 2% (HR -, HER 2 unknown). Median time interval between first observation and biopsy was 31 days (0-337), respectively 40 days (0-337) and 15 days (0-172) when the first observation was made by patients or physicians. Median time interval between pathologic diagnosis and treatment was 18 days (0-295). Treatment was initiated after pregnancy for 42 pts, with median time of 18 days after delivery. 97 pts received chemotherapy with a median number of 6 cycles (4-11), 92 with anthracyclin, 44 with taxanes. 53 chemotherapy were administered in neo adjuvant setting among which 25 during pregnancy), and 44 in adjuvant setting (23 during pregnancy). 98 pts underwent surgery (34 during pregnancy), with 57 conservations and 41 mastectomies, 93 pts received radiotherapy and 43 hormone therapy after pregnancy. 10 pts received Trastuzumab. The mean gestational age at delivery was 35 weeks (22-45). All children were alive, with a median weight of 2735 g at birth (550-3740). The 5-year Overall Survival rate is 83% (95%CI 74-89), while Disease Free Survival is 53% (95%CI 43-63). First recurrence site was metastasis in 28, locoregional in 13, controlateral in 9 and other cancers in 2.

Conclusion: Biopsy and treatment intervals remain long among this population. In this large series BCP, there is an excess of triple-negative breast cancer. The 5-year OS rate is higher than previously reported but with DFS is lower. BCP remains an aggressive entity despite adapted treatment. Multivariate analysis will be presented. A comparison of this BCP population to matched controls is ongoing.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-07.

A retrospective case series of 103 consecutive patients with leptomeningeal metastasis and breast cancer

Approximately 2-5 % of patients with breast cancer (BC) develop leptomeningeal metastasis (LM). 103 consecutive patients with BC were diagnosed with LM and initially treated with intra-CSF liposomal cytarabine from 2007 to 2011 at a single institution. Correlations were determined with respect to patient characteristics and BC subtype with regard to overall survival (OS). At LM diagnosis, 61 % of patients had a 0-2 performance status (PS), the remaining 39 % were severely neurologically impaired. Regardless of PS, all patients received intra-cerebrospinal fluid (CSF) liposomal cytarabine as first-line treatment. Systemic treatment and radiotherapy were also given in 58 and 17 % of patients respectively as clinically appropriate. Second- (intra-CSF thiotepa) and third-line (intra-CSF methotrexate) treatment was administered in 24 and 6 patients respectively. Median OS was 3.8 months (range 1 day-2.8 years). In multivariate analysis, an initial combined treatment, a second-line treatment with intra-CSF thiotepa, an initial clinical response, and a non-'ER/PR/HER2 negative' BC were significantly associated with a better OS. Median OS in this heterogeneous retrospective case series was similar to that of previously observed BC patients treated with intra-CSF methotrexate suggesting intra-CSF liposomal cytarabine is a reasonable first choice therapy of BC-related LM.

Abstract P2-13-10: Prospective randomized and multicentric evaluation of cognition in menopausal breast cancer patients receiving adjuvant hormonotherapy: a phase III study (Preliminary results)

Background: Cognitive impairment has been considered to be a possible adverse effect of aromatase inhibitors (AI). The aim of the study was to compare the impact of tamoxifen or AI on verbal memory (Rey auditory-verbal learning test) and other cognitive functions (memory, executive and attentional functions) after 6 months of treatment.

Methods: In this randomized, open-label phase III study, menopausal patients treated with adjuvant hormonotherapy for early breast cancer were enrolled at the end of the radiotherapy. Patients over 70 years, with a history of cognitive disorder or with prior chemotherapy were excluded. Detailed neuropsychological assessments and quality of life evaluations were performed before the 1st administration of hormonotherapy and then 6 months later. Considering the usual norms of the auditivo-verbal Rey test, an alpha risk of 5% and a 95% power, 27 patients per arm had to be included. Statistical analyses included Chi2 test and Student tests when appropriate.

Results: 62 consecutive evaluable patients were randomized in 2 arms between March 2009 and April 2011. Patients received tamoxifen in arm A (n = 31) and AI in arm B (letrozole n=17; anastrozole n=12; exemestane n= 2). Median age at inclusion was 61.4 years. The median time since menopause was 10 years. Characteristics of the breast tumor and initial neuropsychological evaluations did not differ significantly between the 2 arms. After 6 months, we observed a significant decline of the performance at the episodic memory test (immediate recall of the Rey auditory verbal learning test) (p = 0.0015) in arm A only and a significant improvement on executive measures (Trail Making Test and Stroop test) (respectively p = 0.03/p = 0.002) in arm B. Quality of life didn't differ after 6 months of treatment.

Conclusions: These preliminary results do not support that AI have a worse adverse effect on cognitive functions than tamoxifen after 6 months of treatment. A confirmation is planned after one year of treatment.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-13-10.

Abstract P3-06-20: Is it possible to predict the efficacy of a combination of Panitumumab plus FEC 100 followed by docetaxel (T) for patients with triple negative breast cancer (TNBC)? Final biomarker results from a phase II neoadjuvant trial

Background: TNBC is an heterogeneous group of tumors for some of which the Epithelial Growth Factor Receptor pathway (EGFR) may play an important role. We evaluated the efficacy and toxicity of an anti-EGFR antibody (panitumumab) combined with a standard neoadjuvant chemotherapy in order to identify predictive biomarkers of efficacy and target biologically defined subpopulations for potential further development.

Methods: Sixty patients with stage II-IIIA disease were prospectively included in this multicentre neoadjuvant study. Systemic therapy (ST) consisted of panitumumab (9 mg/kg q.3 weeks x8) combined with FEC 100 (500/100/500 mg/m2q.3 weeks x4) followed by 4 cycles of T (100 mg/m2 q.3weeks x4). All patients underwent surgery at completion of ST.

Paraffin-embedded and frozen samples were systematically collected before and after ST for biologic studies.

Patients characteristics are as follows: mean age 50 [27–72]; median tumor size: 40 mm [20–120]; invasive ductal carcinoma: 96.7%; Scarff-Bloom-Richardson Grade III: 71.7%, grade II: 28.3%.

Complete pathological response (pCR) rate was 52.3% [95% IC: 37.3–67.5] (Sataloff's classification) and 46.7% [95% IC: 31.6–61.4](Chevallier's classification). Conservative surgery was performed in 88% of cases.

Skin toxicity was the main side-effect: Cutaneous toxicity grade IV: 5%, grade III: 30%, grade II: 20%. Neutropenia grade IV: 27%; febrile neutropenia: 5%. Infection: 0%. Hand-foot syndrome grade III: 3.3%. Ungueal toxicity grade III: 1.6%, grade II: 20%.

Results: We performed a ROC curve to identify the best cut-off value for KI-67, EGFR, cytokeratin 5–6 and p53 in order to predict a pCR.

Tumors with more than 40% of positive cells for KI-67 and tumors with a score for EGFR greater than 70 tend to be associated with pCR according to Chevallier's classification (p = 0.06). No predictive value was identified for Cytokeratin 5–6 and p53 (p = 0.61 and p = 0.27, respectively).

Immunohistochemistry results show that two thirds of tumors have more than 40% of positive cells for KI-67 and that two thirds of tumors present a score for EGFR greater than 70.

About half of the tumors express cytokeratin 5–6 and p53 (cut off: 1%).

Chi-squared tests were performed to assess relations between cutaneous toxicities and pCR.

The cutaneous toxicities were not predictive of pCR (p = 0.94) and no correlations were found with KI-67, EGFR, Cytokeratin 5–6 and p53.

In terms of BRCA1 and BRCA2 status, 35 tumors were analysed so far: BRCA1: 6 mutations (17%); BRCA2 (30 patients): 1 mutation (3.3%).

Conclusions: These results suggest the possibility to identify a subpopulation with high probability of pCR (KI-67 &gt; 40%, EGFR score &gt; 70).

Further biological studies are ongoing and will be presented at the meeting, including EGFR polymorphisms, C-met, ALDH1, pCadherine and PTEN.

This will help us further define subpopulations of TNBC patients, potential targets for antiEGFR development.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-20.

Objective measure of patients’ understanding of their role in a randomized trial: A multicenter case-control study

e17500

Background: Informed consent process is the key-element of the ethical considerations of clinical trials. Several reports have shown that even having been through this process, enrolled patients misunderstand the modalities and goals of randomized clinical trials (RCT). The purpose of this study is to compare individuals’ objective understanding about RCT between patients already included (cases) and patients treated under standard care who have never received information about clinical trials (controls). Methods: We submitted a standardized questionnaire to both populations to explore the objective understanding of RCT. This questionnaire includes 10 ended-questions (q) exploring: understanding of underlying legislation (3 q), understanding of conditions of study withdrawal (3 q), understanding of randomization (2 q) and understanding of uncertainty (2 q). Results: 75 cases and 107 controls were included in the present study. Three questions are associated with a rate of good responses close to 70% in both populations: anonymity of collected data (66% in controls vs 81% in cases), existence of legislation protecting patients (73% vs 76%) and right to withdraw in case of toxicity (73% vs 82%). Understanding of cases is statistically better (p < 0.05) for 6 other questions: physicians duty to tell everything about the trial (44% vs 68%), right to withdraw from the study without giving any reason (38% vs 73%), withdrawing does not jeopardies the quality of further care (40% vs 71%), all the patients do not receive the same treatment (56% vs 73%), allocation at random (12% vs 52%) and uncertainty about benefits (20% vs 38%). At last, the rate of correct responses is similar and very low for the question exploring the uncertainty about toxicity (43% vs 44%). Conclusions: Informed consent actually improves enrolled patients’ understanding of RCT. Nevertheless, additional efforts should be made to increase the quality of the transmission of information about randomization and uncertainty.

[Table: see text]

Familial transmission of information dealing with BRCA1/2 mutations in hereditary breast and ovarian cancer

Abstract #1104

Background: A mutation of the BRCA1/2 genes is implicated in 5 to 10% of the breast and ovarian cancer cases. In France, when such a genetic mutation is discovered in a family, the consulting persons are expected to transmit themselves this medical information to their relatives. Indeed, for legal reasons, physicians are not allowed to contact them personally. An important gap has been observed however between the number of persons who are potentially concerned by this genetic information and the number of persons actually consulting. We then wondered about (1) the actual transmission of genetic information to relatives, (2) possible reasons for the non-transmission of this information, (3) the rate of concerned consulting relatives and (4) presumed reasons for not consulting when informed.&#x2028; Methods: This sample includes 31 target consultants (index cases) of mutated families who received the result of the genetic test between January 2003 and June 2005. Data were gathered in two successive steps: some were first referring to consultants' medical files, then we called these target consultants asking them standardized questions about their relatives. Final analyses concern 264 relatives complying with our selection criteria.&#x2028; Results: According to information gathered thanks to medical files and calls to target consultants, most of the relatives (73.1 %) are informed that a deleterious mutation is present in the family. Women are more often informed (80.7 %) than men (63.2 %). The non-informational motives are on the one hand mainly social and emotional distance and, on the other hand, the stressful content of this information. It would be disclosed through family by the women who are alive and carry the mutation. Moreover, a minority of the presumed informed women (39.7 %) have attended the oncogenetic consultation. This rate represents 32 % of all concerned women. Almost no man has consulted. We can just assume the motives for short-term absence of consultation. They seem to be especially linked to relatives' disinterest towards genetic information. The studied characteristics just allow us to point out the closeness with a mutated relative as a determinant factor of consultation.&#x2028; Discussion: This study brings two main results linked to relatives' information and consultation when a breast and ovarian cancer genetic risk has been identified in the family. On the first hand, it confirms that familial transmission of the medical information is pretty good. On the other hand, despite the good communication among family members, the rate of consultation remains low in informed women. According to these findings, efforts have to be made to give better explanations about the goals of oncogenetic consultation as well as enhancing the quality of information transmission in mutated families. These improvements could raise consultation rates and then increase the efficiency of screening and preventive measures.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1104.

Correlation between clinical response according to WHO criteria and pathological response according to Chevallier and Sataloff in inflammatory breast cancer (IBC)

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Introduction: IBC has a very poor prognosis ; the first treatment is first primary chemotherapy, followed by surgery and radiotherapy. It has been shown that patients experiencing a complete pathological response haved a longer survival . The pathological response has thus to be carefully assessed. Material and Methods: The aim of this retrospective study was to determine whether there islook for a correlation between clinical response with (WHO criteria) and pathological response using Chevallier’s and Sataloff’s classifications. 56 successive patients received an anthracycline- based chemotherapy regimen for IBC before surgery; for all of these patients a pathological analysis had beenwas performed before chemotherapytreatment and after surgery. Alll the specimens werehave been reviewed by the same pathologist. Results: There is a very good correlation between the 2 pathological classifications fAmong the 56 patients, there were 3 complete clinical responses, which were also pathological complete responses according to both classifications.or the complete responders only. In all the other cases, no correlation wascould be found between the 3 classifications . It was particularly striking for all the 41 patients tumours classified grade 3 according to Chevallier who could be classified clinically (with WHO) or pathologically (with Sataloff) in either of the 4 groups from complete responseders to progressive disease . Overall , in this our series , 3 patients according to Chevallier and 11 according to Sataloff were complete pathological responders. Discussion: The lack of correlation between clinical and pathological classifications could be explained , at least in part, by the fibrosis often observed after primary chemotherapy. The differences observed between the 2 pathological classifications highlight the fact that there is no standard and that further research is neede in that perspective.

[Table: see text]

No significant financial relationships to disclose.

Pathological response to neoadjuvant chemotherapy for inflammatory breast cancer (IBC). Critical evaluation of Chevallier’s and Sataloff’s classifications

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Background: The aim of this study was to compare the two most frequently used pathological classifications to assess the response to chemotherapy (CT) in IBC. Methods: The pathological characteristics of 85 inflammatory breast cancers were reviewed. 52 patients (pts) had a post-CT mastectomy , 49 a tumor biopsy before CT and 16 both. Tumor types, grade, hormonal and Her status were evaluated before and after CT, when available. Results: Among 49 pts with initial biopsy, 1 had a high grade intraductular carcinoma and 48 an invasive carcinoma (42 ductular, 5 lobular, 1 mucinous). 27 (56%) invasive tumors were grade 3 and 21 (44%) grade 2, none was grade 1. Median value of mitotic index (Ki 67) was 23%. Hormone receptors (HR) were evaluable for 46 pts; 28 (61%) were negative. 13 (29%) out of 45 evaluable pts were Her2 3+. The pathological response was evaluated according to the Chevallier et Sataloff classifications in the 52 pts with post CT- mastectomy. According to Chevallier there were no grade 1(no microscopic invasive or in situ carcinoma) or 2 (microscopic in situ carcinoma without invasive carcinoma or axillary lymph node metastases), 44 (85%) were grade 3 (invasive carcinoma with fibrosis or sclerosis) and 8 grade 4 (no modification of initial tumor). There was no pathological complete response. According to Sataloff there were 4 grade TA (complete or nearly complete response), 15 (29%) TB (therapeutic response over 50%), 23 (44%) TC (therapeutic response above 50%), 10 TD (no evident therapeutic effect). There were 4 pathological complete responses out of 52 ( 8%). 16 pts had initial biopsy and post chemotherapy mastectomy. According to the OMS clinical classification there were 5 CR, 37 PR, 10 ST. Among the 4 pathological CR according to Sataloff (TA), 2 were CR and 2 PR. Conclusions: In our experience, there was a very poor correlation between the two pathological classifications and between pathological and clinical classifications. A clinical residual tumor can be due to fibrosis only. The classification used for the determination of the pathological response should always be given in clinical studies.

No significant financial relationships to disclose.

Pre-operative systemic (neo-adjuvant) therapy with trastuzumab and docetaxel for HER2-overexpressing stage II or III breast cancer: results of a multicenter phase II trial

BACKGROUND

Trastuzumab plus chemotherapy has become the standard of care for women with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. Trastuzumab-based pre-operative systemic (neo-adjuvant) therapy (PST) also appears promising, warranting further investigation.

PATIENTS AND METHODS

Patients with HER2-positive, stage II/III non-inflammatory, operable breast cancer requiring a mastectomy (but who wished to conserve the breast) received weekly trastuzumab and 3-weekly docetaxel for six cycles before surgery. The primary end point was pathological complete response (pCR) rate, determined from surgical specimens.

RESULTS

Thirty-three patients were enrolled. The majority (79%) had T2 tumors, with 42% being N1/2. Twenty-nine patients completed six cycles of therapy and one patient withdrew prematurely due to progressive disease. A complete or partial objective clinical response was seen in 96% (73% and 23%, respectively) of patients. Surgery was performed in 30 patients, breast conserving in 23 (77%). In an intention-to-treat analysis, tumor and nodal pCR was seen in 14 (47%) patients. Treatment was generally well tolerated. Grade 3/4 neutropenia occurred in 85% of patients while febrile neutropenia was encountered in 18%. Only three patients withdrew prematurely due to toxicity. No symptomatic cardiac dysfunction was reported.

CONCLUSIONS

PST with trastuzumab plus docetaxel achieved promising efficacy, with a high pCR rate and good tolerability, in women with stage II or III HER2-positive breast cancer.

Age as a prognostic factor in breast cancer

We retrospectively analysed data from 1751 patients with non-metastatic and non-inflammatory breast cancer treated in our institution between 1977 and 1989, in order to evaluate the link between age and prognosis in breast cancer. We chose three age groups (1): < or = 33 (n = 67), 34-40 ( n = 155), > 40 years (n = 1529). There were no significant differences in the distribution of clinical tumor size (T), histological node status (N), histology of the primary-tumor and progesterone receptor levels (PR). Younger patients had a higher proportion of SBR III (p < 0.0001), and of Estradiol Receptor negative tumors (EP). There was a significant difference between the three groups in terms of overall survival (p < 0.035), breast cancer specific survival (p < 0.0001) and relapse-free survival (p < 0.0002). Younger patients had a significantly poorer prognosis (survival and relapse) than older ones. Multivariate analysis of specific survival demonstrated that young age at diagnosis was a poor independent prognostic factor.

Prognostic value of p53 and urokinase-type plasminogen activator in node-negative human breast cancers

We measured the levels of p53 and urokinase-type plasminogen activator (uPA) in 634 tumor tissues from 634 different node-negative primary breast cancer patients who underwent locoregional surgery in the Center Oscar Lambret between July 1989 and September 1994. p53 and uPA were assayed using commercially available kits in cytosols prepared for estradiol receptor (ER) and progesterone receptor (PgR) assays. The optimum clinical thresholds were chosen for prognostic studies: 4 ng/ml for p53 and 0.5 ng/ml for uPA. p53 was elevated in 13.7% of the tumors, and uPA was elevated in 27.5% of the tumors; they were negatively related (chi 2 test) to ER and PgR and positively related to histoprognostic grading (HPG) and tumor diameter. uPA was negatively correlated to ER and PgR, and p53 and uPA were positively correlated to each other (P = 0.0001; Spearman test). In the prognostic studies, the 316 patients who did not receive adjuvant chemotherapy were included to avoid treatment interference; this number corresponds to all of the patients operated on between 1989 and 1992. The mean duration of follow-up of living patients was 4 years. In overall survival studies, Cox univariate analyses demonstrated a prognostic value of p53 (P = 0.011; risk ratio, 1.59), uPA (P = 0.038; risk ratio, 2.32), PgR, HPG, and tumor diameter. In Cox multivariate analyses, only HPG had a statistically significant prognostic value. In relapse-free survival studies, univariate analyses demonstrated prognostic values of uPA (P = 0.0011) and of age, and both parameters retained their prognostic value in multivariate analyses (uPA: P = 0.0004). This study demonstrates not only that p53 and uPA have prognostic value but also that these two parameters are linked to other classical clinical, histological, or biological prognostic parameters, as well as to each other. Moreover, because uPA is of prognostic value in multivariate relapse-free survival studies, uPA is an important prognostic factor in node-negative breast cancer patients.

Ineffectiveness of sequential high dose methotrexate and 5-fluorouracil combined with epirubicin (FEMTX regimen) as a salvage therapy in advanced colorectal cancers and other gastrointestinal tumors

The combination of sequential high dose methotrexate and 5-fluorouracil (FU) combined with epirubicin (FEMTX regimen) has shown some clinical efficiency as a first line therapy in advanced gastric cancer. We evaluated the therapeutic activity of this combination in advanced colorectal cancer patients who failed the FU + folinic acid regimen, and in advanced gastrointestinal cancer situation where no standard regimen is available. Twelve patients with measurable metastatic colorectal cancer refractory to first line (n = 6) or second line (n = 6) chemotherapy, as well as 9 patients with advanced gastrointestinal cancer, entered this pragmatic pilot study. Eighty-six per cent and 38% of the patients experienced severe haematological or non-haematological toxicities, respectively. Four patients were not evaluable for response due to their early departure from the scheme due to acute toxic events (n = 3) or toxic death (n = 1). No objective response was observed, but 9 stabilisations and 8 progressive diseases were noted. The FEMTX regimen is not of clinical value as a salvage therapy in colorectal and gastrointestinal cancer, because of its toxicity and its lack of efficacy.

Does induction chemotherapy with a mitoxantrone/vinorelbine regimen allow a breast-conservative treatment in patients with operable locoregional breast cancer? A French Northern Oncology Group trial in 105 patients. French Northern Oncology Group

BACKGROUND

In recent years, induction chemotherapy has been tested by several investigators in the management of operable breast cancer.

PATIENTS AND METHODS

Our current study was aimed to evaluate, pragmatically, in patients (74 stage II and 30 stage III) whose treatment would have been mastectomy, the percentage of them in whom a conservative treatment can be performed if primarily treated with a mitoxantrone/vinorelbine regimen.

RESULTS

67/104 patients (64%; 95% CI: 55-74%) had a conservative treatment (lumpectomy: 54, radiation therapy: 12, radiation therapy then lumpectomy: 1) Neutropenia was the major dose-limiting side effect, with grade 3 or 4 neutropenia registered in 83% of patients and 53.3% of the 442 cycles. Overall, a grade 3 or 4 non hematologic side effect occurred in 19.8% of patients and in 9.1% of cycles. One toxic death was observed after 2 cycles in a patient with aplasia who developped septicemia. Seventy one per cent of the patients experienced nausea and vomiting but grade 3 were observed in only 12% of the patients. Other side effects, including stomatitis, asthenia, alopecia, and constipation, were generally mild and uncommon.

CONCLUSIONS

This mitoxantrone/vinorelbine regimen is an efficient induction treatment with only neutropenia as a noticeable side effect. It allows 64% of conservative treatment in patients whose treatment would have been mastectomy.