Abstract P5-22-07: Upgrade to high risk lesions, in situ and invasive cancer among women with benign papillary lesions diagnosed on image-guided core needle biopsy (IGCNB)

Background: Currently there is no consensus regarding the management of benign papillary breast lesions diagnosed on IGCNB. Recommendations vary as to whether all IGCNB papillary lesions require surgical excision or if IGCNB alone is adequate to confirm a benign diagnosis and patients can be followed with imaging.

Aims: To estimate percentage of patients with benign papilloma on IGNB who on surgical excision are upgraded to high risk lesion, in situ or invasive cancer and to identify patient, imaging, and/or pathologic features that are predictive of upgrade.

Methods: We conducted a study of 407 patients within Kaiser Permanente Northern California (KPNC) diagnosed with benign papillary breast lesions on IGCNB in 2012 and 2013. KPNC is a large integrated health care delivery system, racially and ethnically diverse, and representative of the underlying population. Patients were excluded from study if they were < 18 years, had atypia on IGCNB, had a prior history of breast cancer or high risk lesion, had a hereditary risk for developing breast cancer, or were noted to have papillomatosis or an incidental papilloma, or the target lesion was calcifications. Patients who did not have surgical excision of the IGCNB papilloma were followed for at least 2 years. Outcomes included in situ/invasive cancer and high risk lesions (atypical ductal or lobular hyperplasia, lobular carcinoma in-situ or papilloma with atypia). Outcomes were evaluated by review of medical records, including radiology, pathology, and surgical reports. The KPNC cancer registry and record review was used to exclude patients with a history of cancer.

Results: Among patients with benign papillary lesions, the average age was 56.4 years (range 20-93). Approximately 60% of lesions were 1 cm or less and 50% were centrally located (within 2 cm of nipple). There were 327 patients (80%) with surgical excision within 10 months of IGCNB, 61 patients (15%) with no surgical excision but follow-up imaging, and 19 patients (5%) with no surgery or follow-up imaging. Patients with and without surgical excision generally had similar age, breast density, and lesion location. However, surgical excision was more common among women with larger lesions. Among women with surgical excision, 9.5% (95% CI 6.3-12.7%) had a high risk lesion, 3.4% (95% CI 1.4-5.3-%) had an in situ lesion and 2.4% (95% CI 0.8-4.1%) had invasive cancer (all node negative). Less than 3% of women under 50 years, presenting with nipple discharge or with lesions less than 1 cm had invasive cancer on surgical excision. In contrast, over 10% of women with lesions greater than 1 cm, a palpable mass, or with lesions 5 or more cm from the nipple had invasive cancer on surgical excision. There were no cancers diagnosed among the 61 women followed by imaging; although 1 woman was upgraded to a high risk lesion.

Conclusions: In this large cohort of patients with benign papillary lesions on IGCNB, less than 3% had an invasive cancer on surgical excision. Upgrade was most common among patients with larger lesions, a palpable mass or lesions distant from the nipple and least common among women less than 50 years, with small lesions or presenting with nipple discharge.

Citation Format: Kuehner G, Darbinian JA, Butler S, Chang S, Fehrenbacher L, Chen R, Habel LA, Axelsson K. Upgrade to high risk lesions, in situ and invasive cancer among women with benign papillary lesions diagnosed on image-guided core needle biopsy (IGCNB) [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 P5-22-07.

Abstract S5-06: Randomized, placebo-controlled trial of duloxetine for aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS) in early stage breast cancer (SWOG S1202)

Background: Adherence to AI therapy for adjuvant treatment of hormone receptor-positive breast cancer is poor, primarily because of AIMSS. Premature discontinuation of AI therapy can lead to increased likelihood of breast cancer recurrence. Duloxetine (dulox) is a serotonin norepinephrine reuptake inhibitor that is FDA-approved for treatment of multiple chronic pain disorders. Phase II data from an open label trial of dulox for treatment of AIMSS demonstrated a 61% improvement in pain. We hypothesized that treatment of AIMSS with dulox would improve average joint pain compared to placebo (plac).

Methods: Postmenopausal women with stage I-III breast cancer who had been taking AI therapy for between 3 wks and 36 mo were enrolled. To be eligible, patients were required to have average pain of ≥4/10 using the Brief Pain Inventory (BPI) that developed or worsened since AI therapy initiation, and not have any contraindications to dulox therapy. Patients were randomized 1:1 to dulox 30 mg daily for 7 d then 60 mg daily for 11 wks then 30 mg daily for 7 d, or to matching plac, stratified by baseline pain (4-6 vs 7-10) and prior taxane use (yes vs no). Pain, depression, and quality of life (QoL) were assessed after 2, 6, and 12 wks of therapy, as well as at the 24 wk time point. The primary analysis used linear mixed models to examine average pain through 12 wks by arm, adjusting for the stratification factors and assessment time. Clinically significant change in average pain was defined as a ≥2-point decrease from baseline.

Results: 299 patients were randomized between June 2013 and October 2015, 10 of whom were ineligible. 127 dulox-treated and 128 plac-treated patients were evaluable for the primary analysis. No sizeable imbalances in baseline factors were noted by arm. Seventeen pts reported grade 3 adverse events (AEs) (dulox: 12/138 (8.7%), plac: 5/141 (3.5%)), and 40 pts discontinued treatment because of AEs (dulox: 21 (52.5%), plac: 19 (47.5%)). Mean observed average pain, the proportion of pts experiencing clinically significant change in average pain from baseline, and percent reduction in average pain all indicated greater improvement for dulox compared with plac through 12 wks, but were similar by arm at wk 24 (12 wks after completion of intervention; see Table). In multivariable linear mixed model analysis, the BPI average pain was reduced on average by 0.82 points more on dulox compared to plac over the first 12 wks (95% CI -1.24 to -0.40, p=0.0002). Similar patterns were observed for worst pain, pain interference, joint pain, stiffness, and functioning, and QoL.

Table: Observed Average Pain Scores by Assessment TimeTime PointBaseline2 weeks6 weeks12 weeks24 weeksduloxplacduloxplacduloxplacduloxplacduloxplacAverage pain5.445.493.514.412.953.962.913.453.373.42Percent reduction--34%20%46%28%46%36%37%37%Patients with clinically significant change--54%44%69%49%69%60%60%59%

Conclusions: Treatment with duloxetine was superior to placebo for the treatment of AIMSS among women with early stage breast cancer, was well tolerated, and was associated with improvements in QoL.

Clinicaltrials.gov NCT01598298.

Citation Format: Henry NL, Unger JM, Schott AF, Fehrenbacher L, Flynn PJ, Prow D, Sharer CW, Lew DL, Moseley A, Fisch MJ, Moinpour C, Hershman DL, Wade III JL. Randomized, placebo-controlled trial of duloxetine for aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS) in early stage breast cancer (SWOG S1202) [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 S5-06.

Abstract S6-04: Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy

Background

The clinical results of NSABP B-35, phase III trial comparing 1 mg/day A to 20 mg/day tam, each given for 5 years, were reported at ASCO 2015. B-35 demonstrated a statistically significant benefit in breast cancer free interval for women assigned to A, primarily in women <60 years. A secondary endpoint of B-35 was quality of life (QOL) and symptom (SX) outcomes in the two treatment groups. The primary hypotheses of the PRO study were that there would be no differences in QOL between the two treatments, and that patients receiving A would report higher rates of hot flashes compared to patients receiving tam. Other SX comparisons were secondary endpoints.

Methods

QOL and SX were assessed at baseline (prior to randomization), and every 6 months thereafter for 5 years of treatment and in the following 12 months. QOL was measured with the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS). SX were measured with selected scales from the BCPT symptom-checklist, and other standardized instruments. Stratification was by age (<60 v ≥60) as in the main trial. Study hypotheses and endpoints were examined by comparing PROs in the two treatment arms using a mixed model for repeated measures analysis with adjustment for the baseline scores, time point and age category, using an intention-to-treat principle and including only patients who completed the baseline and at least one follow-up questionnaire. Patients with protocol events were censored. Only data through 60 months are reported here. The accrual goal for the sub-study was 1,150 consecutive patients.

Results

Between January 6, 2003 and June 15, 2006, a total of 3,104 patients were entered and randomly assigned to NSABP Protocol B-35. Accrual to the PRO study of B-35 closed on December 28, 2004, at which time 1,275 patients were entered, with 1,193 patients included in this analysis. There were no medical or demographic differences between patients assigned to A or tam in the PRO sub-study, and they reflected the characteristics of the parent trial. Adherence to data collection across the 60 months was 87%. There were no significant differences in QOL outcomes by treatment for the PCS (p=0.16) or the MCS (p=0.38). SX subscales: hot flash scale was greater in tam group and this difference varied over time (p=0.001); musculoskeletal pain was significantly greater in A group for time points 6-24 months (all p<.001); vaginal problems were greater in A group (p=0.03). Hot flash and vaginal problems were significantly worse in women <60 years. Additional SX outcomes (depression, fatigue, sexual function) will be reported at presentation.

Conclusion

In this large, double-blind, placebo-controlled trial comparing A to tam in patients with DCIS, there was no significant difference in QOL between the two treatments. However, there were important treatment differences in SX outcomes, which should be considered as part of treatment decision-making discussions, along with the clinical breast cancer outcome results.

Support: CA-180868, 180822, 189867, 196067, 114732; AstraZeneca Pharmaceuticals LP.

Citation Format: Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. [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 S6-04.

Abstract P1-15-01: Adjuvant trastuzumab +/- anthracycline and cardiotoxicity in a community cohort of 962 HER2+ breast cancers from 2005-2011: Comparison of incidence by risk factors and by diagnostic codes vs clinical chart review

Background: Prospective clinical trials using clinical criteria and observational studies using diagnostic codes from electronic health records have reported seemingly contradictory cardiotoxicity risk for adjuvant trastuzumab (T). Accurate estimates of individualized patient specific cardiotoxicity risk are essential for treatment decisions in early HER2+ breast cancer (BC).

Methods: 1,109 consecutive non-metastatic HER2+ invasive BC's diagnosed 5/1/2005 to 12/31/2011 at Kaiser Permanente Northern California receiving adjuvant T were reviewed for symptomatic congestive heart failure (SxCHF), baseline and post-T cardiac ejection fraction (EF), anthracycline (A) use, and CHF risk factors (RF) including age, race, hypertension (HTN), diabetes (DM), obesity, smoking. Records of patients with CHF ICD9 codes or an EF drop to <50% were reviewed by a RN, a cardiologist, and an oncologist. Primary outcomes were SxCHF (NYHA Class II or higher), EF fall to <50%, and < 38 weeks of T (75% of prescribed).

Results: Median age of 962 eligible patients was 54 years (range 24-95). 305 (31.7%) were > 60 years old. During a median follow-up of 4.1 years, 4.6% of patients had CHF ICD9 codes, but only 2.5% had SxCHF or cardiac death confirmed by clinical review. At 1 year, cumulative incidence of an EF fall to <50% was 5.7% with T alone and 17.7% with T+ A. A total of 15.3% finished <38 weeks of T, 9.4% with T alone and 20.6% with T+A. The overall 2- and 5-year cumulative incidence of SxCHF/cardiac death was low: 1.3% and 2.7% with T alone and 2.2% and 3.1% with T + A. These rates were lower than reports based solely on diagnostic or billing codes, and varied substantially by RF (see table). The rates were similar to those predicted by the NSABP B-31 Cardiac Risk Score. Clinical heart failure based on diagnostic codes was not confirmed at chart review 48% of the time. Results from multivariable analyses will be presented.

Predictors of Trastuzumab Cardiotoxicity  Cumulative Incidence (%)PredictorsNFall EF to<50%Symptomatic CHF  1-year2-year5-yearAll96212.01.82.8Anthracycline50517.72.23.1Non-anthracycline4575.71.32.7Age<6065711.71.11.1Age 60-6922212.61.43.8Age 70-797112.77.111.0Baseline EF 50-55%9230.78.88.8HTN dx39212.63.44.7BMI 30+31516.32.64.5DM Dx10315.55.06.9Smoking (ever)33314.23.76.1HTN and BMI 30+18215.53.96.0HTN, BMI 30+, DM5016.08.212.2Age<50, BMI<30, No HTN/DM2197.30.00.0Age>60, 2+ RF(HTN, DM, BMI 30+)10114.95.08.9

Conclusions: Risk of clinically confirmed CHF/cardiac death was substantially lower than risk based on ICD codes alone. Risk was consistent with prior clinical trials and differed substantially by age, baseline EF, use of A, and other CHF risk factors. Greatest risk was with age of 70+, borderline baseline EF, and comorbidities known to increase CHF risk. Quite low risk (1.1% at 5 years) was seen in patients under 60 years old.

Citation Format: Fehrenbacher L, Capra A, Krishnaswami A, Quesenberry C, Habel L. Adjuvant trastuzumab +/- anthracycline and cardiotoxicity in a community cohort of 962 HER2+ breast cancers from 2005-2011: Comparison of incidence by risk factors and by diagnostic codes vs clinical chart review. [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 P1-15-01.

Abstract OT1-03-15: The METRIC trial: A randomized international study of the antibody-drug conjugate glembatumumab vedotin (GV or CDX-011) in patients with metastatic gpNMB-overexpressing triple-negative breast cancer (TNBC)

Background

Glycoprotein NMB (gpNMB) is an internalizable transmembrane protein overexpressed in approximately 20% of breast cancer (BC), including approximately 40% of TNBC. gpNMB is a poor prognostic marker in BC (Rose CCR 2010) and preclinically has been implicated in tumor invasion, metastasis, and angiogenesis. GV is a novel antibody-drug conjugate targeting the potent cytotoxin monomethylauristatin E (MMAE) to gpNMB overexpressing cancer cells.

In a Phase I/II study and the Phase II "EMERGE" study, GV demonstrated promising activity with TNBC patients (pts) deriving the greatest benefit and exhibiting the highest degree of gpNMB overexpression. GV was well-tolerated with the most frequent treatment-related toxicities consisting of rash, neutropenia, and neuropathy. In subset analyses of the EMERGE trial, objective response rate (ORR) was 30% (7/23) for GV vs. 9% (1/11) for investigator's choice in tumors with gpNMB overexpression (>25% of tumor epithelium); 18% (5/28) vs. 0% (0/11) in TNBC; and 40% (4/10) vs. 0% (0/6) in gpNMB-overexpressing TNBC for GV and IC respectively, with apparent improvements in progression-free survival (PFS; hazard ratio (HR) = 0.11) and overall survival (OS; HR = 0.14).

Trial design

The METRIC Trial (NCT#01997333) is an international (USA, CA, Aus), two-arm phase II study. Pts are randomized 2:1 to GV (1.88 mg/kg IV q 21 days) or capecitabine, a current standard of care for this population (2,500 mg/m2 daily for d1-14, q21 days) until progression or intolerance. Crossover is not permitted.

Eligibility criteria

Key eligibility criteria include: >25% of tumor epithelium gpNMB+ by central immunohistochemistry (IHC) screening of archival tissue; estrogen receptor and progesterone receptor <10% and HER2 negative [0-1+ IHC, or ISH copy number <4.0/ratio <2.0] by local assessment; ECOG 0-1; taxane resistance; anthracycline exposure (if indicated); <2 chemotherapy regimens for advanced BC; measurable disease; no persistent Grade >2 toxicity.

Specific aims

The primary endpoint is PFS per independent, blinded central review committee according to RECIST 1.1. Secondary endpoints are ORR, duration of response, OS, safety, pharmacokinetics and pharmacodynamics. Exploratory endpoints are quality of life and/or cancer-related pain.

Statistical methods and target accrual

The trial has 85% power to detect a PFS HR of 0.64 with two sided α = 0.05. The hypothesized median PFS is 4.0 months for capecitabine and 6.25 months for GV. Target accrual is open for 300 pts.

Citation Format: Melisko M, Yardley DA, Blackwell K, Forero A, Ma C, Montero A, Daniel BR, Wright G, Fehrenbacher L, Chew H, Ferrario C, Nanda R, Seiler Jr M, Guthrie T, Vance K, Ouellette G, He Y, Bagley RG, Zhang J, Vahdat LT. The METRIC trial: A randomized international study of the antibody-drug conjugate glembatumumab vedotin (GV or CDX-011) in patients with metastatic gpNMB-overexpressing triple-negative breast cancer (TNBC). [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 OT1-03-15.

A phase II/III randomized study to compare the efficacy and safety of rigosertib plus gemcitabine versus gemcitabine alone in patients with previously untreated metastatic pancreatic cancer

BACKGROUND

Rigosertib (ON 01910.Na), a first-in-class Ras mimetic and small-molecule inhibitor of multiple signaling pathways including polo-like kinase 1 (PLK1) and phosphoinositide 3-kinase (PI3K), has shown efficacy in preclinical pancreatic cancer models. In this study, rigosertib was assessed in combination with gemcitabine in patients with treatment-naïve metastatic pancreatic adenocarcinoma.

MATERIALS AND METHODS

Patients with metastatic pancreatic adenocarcinoma were randomized in a 2:1 fashion to gemcitabine 1000 mg/m(2) weekly for 3 weeks of a 4-week cycle plus rigosertib 1800 mg/m(2) via 2-h continuous IV infusions given twice weekly for 3 weeks of a 4-week cycle (RIG + GEM) versus gemcitabine 1000 mg/m(2) weekly for 3 weeks in a 4-week cycle (GEM).

RESULTS

A total of 160 patients were enrolled globally and randomly assigned to RIG + GEM (106 patients) or GEM (54). The most common grade 3 or higher adverse events were neutropenia (8% in the RIG + GEM group versus 6% in the GEM group), hyponatremia (17% versus 4%), and anemia (8% versus 4%). The median overall survival was 6.1 months for RIG + GEM versus 6.4 months for GEM [hazard ratio (HR), 1.24; 95% confidence interval (CI) 0.85-1.81]. The median progression-free survival was 3.4 months for both groups (HR = 0.96; 95% CI 0.68-1.36). The partial response rate was 19% versus 13% for RIG + GEM versus GEM, respectively. Of 64 tumor samples sent for molecular analysis, 47 were adequate for multiplex genetic testing and 41 were positive for mutations. The majority of cases had KRAS gene mutations (40 cases). Other mutations detected included TP53 (13 cases) and PIK3CA (1 case). No correlation between mutational status and efficacy was detected.

CONCLUSIONS

The combination of RIG + GEM failed to demonstrate an improvement in survival or response compared with GEM in patients with metastatic pancreatic adenocarcinoma. Rigosertib showed a similar safety profile to that seen in previous trials using the IV formulation.

Abstract P2-11-08: IHC 2+ FISH (-) breast cancer (BC): Patient characteristics and outcomes: A comparison to HER2 IHC 0, 1+ and HER2 + BC diagnosed 2000-2006

Background: HER2 IHC 2+ results are equivocal and lead to FISH testing. FISH(+) results lead to HER2(+) treatment often with trastuzumab. FISH(-) results lead to treatment without trastuzumab. We examined the characteristics and breast cancer-specific mortality of HER2 2+ FISH (-) BC in consecutive patients in a large health care delivery system. Methods: Using the KPNC cancer registry and electronic medical record, we identified 13,845 consecutive stage I-III BC patients diagnosed between 1/2000 and 12/2006 not treated with adjuvant trastuzumab. Patient demographics, disease stage, IHC and FISH results, and breast cancer mortality were obtained. IHC and FISH testing were performed in a single central laboratory. Results: After excluding any adjuvant trastuzumab, 10,760 (78%) patients had HER2 IHC scores of 0,1+, 1,533 (11%) were IHC2+/FISH (-), and 1,552 (11%) were IHC3+ or FISH (+). Compared to patients with IHC 0,1+ tumors, those with IHC2+FISH (-) tumors were younger (mean age 61 vs 62 years, p = 0.03) and more often node+ (36% vs 30%, p = <0.0001); their tumors were more often poorly differentiated (29% vs 22%, p = <0.0001),) and T2 vs T1 (31% vs 24%, p = <0.0001), and less frequently T1ab (20% vs 29%, p = <0.0001), ER+ (81% vs 85%, p = 0.0003), or PR+ (70% vs 74%, p = <0.0002). Among the ER+ patients, the 10-year BC-specific mortality was higher for those with IHC2+/FISH (-) than IHC 0, 1+ tumors (11.4% vs 8.9%, p = 0.0014). Within disease stages, there were trends but no statistical difference in BC-specific mortality. IHC3+/FISH (+) ER+ patients had greater differences in the above characteristics and significant increased mortality among middle, and higher stages. In multivariable analysis adjusting for age, tumor size, differentiation, hormonal therapy and chemotherapy, risk of BC death among ER+ patients was similar for IHC2+FISH (-) and IHC 0,1+ disease; but risk was higher for IHC3+/FISH (+) disease. Table 1: 10-year breast cancer (BC) survival of women with stage I-III ER-positive BC by HER2 subtype, 2000-2006.

10-year BC survival of stage I-III ER+ patients by IHC FISH statusHER2 SubtypeNo of PatientsBC Deathsat Risk%BC Survival95% CILogRank P-valueIHC 0,1+9,1616212,45491.190.4-91.8-IHC2+FISH(-)1,24811222388.686.3-90.60.0014IHC3+ and/or FISH(+)93512523783.680.6-86.2<0.0001

Conclusions: In ER+ patients, those with IHC2+FISH (-) tumors have prognostic characteristics that are intermediate between those with IHC 0,1+ and IHC3+/FISH(+) tumors. Compared to IHC 0,1+ disease, they are at increased risk of BC mortality overall but not within stages.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-11-08.

OT1-02-07: NSABP B-47: A Randomized Phase III Trial of Adjuvant Therapy Comparing Chemotherapy Alone (Six Cycles of Docetaxel Plus Cyclophosphamide or Four Cycles of Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel) to Chemotherapy Plus Trastuzumab in Women with Node-Positive or High-Risk Node-Negative HER2−Low Invasive Breast Cancer

Adjuvant studies utilizing trastuzumab in early HER2+ breast cancer demonstrated a large reduction in recurrence and death. Post-enrollment central testing showed HER2 non-amplified participants derived similar benefit. Among HER2−amplified patients, multiple studies showed no effect on benefit by degree of amplification. Extensive testing including blinded external review confirmed the non-amplified nature of the HER2 normal group. Detailed relevant background and confirmatory studies will be provided. As a result of these findings, NSABP study B-47, sponsored by the NCI, was activated January 2011. The study is NCI central IRB approved, open in the CTSU, and endorsed by SWOG as of April 2011.

Study: Selection of one of the two chemotherapy regimens is by physician choice: The non-anthracycline regimen is TC (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2) administered IV every 3 weeks for 6 cycles; the anthracycline regimen is AC followed by WP (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 administered IV either every 3 weeks or every 2 weeks [per investigator discretion] for 4 cycles followed by paclitaxel 80 mg/m2 IV weekly for 12 doses). Patients will be randomly assigned to receive chemotherapy with or without trastuzumab therapy. For patients receiving the TC chemotherapy regimen, trastuzumab will be given every 3 weeks during and following chemotherapy until 1 year after the first trastuzumab dose (8 mg/kg loading dose; 6 mg/kg for the remaining doses). For patients receiving the AC followed by WP chemotherapy regimen, trastuzumab will begin with the first dose of weekly paclitaxel and will be given weekly for 12 doses (4 mg/kg loading dose; 2 mg/kg for the remaining weekly doses). Following completion of WP, trastuzumab therapy will continue with 6 mg/kg doses given every 3 weeks for a total of 1 year. Patients will also receive adjuvant radiation therapy and endocrine therapy, as clinically indicated.

Detailed menstrual history, concurrent medications, weight changes, and biomarkers (estrogen, stress, inflammation status) will be collected throughout the study. Collection of circulating tumor cells as an ancillary study is planned.

Eligibility: Eligibility includes: node positive or high risk node negative female breast cancer patients; HER2 IHC 1+ or 2+ scores, but non amplified by FISH; normal cardiac, renal, and liver function. Detailed eligibility will be provided.

Statistical: The primary aim is to determine whether the addition of trastuzumab to chemotherapy improves invasive disease-free survival (IDFS). 3260 patients will be enrolled to provide statistical power of 0.9 to detect a 33% reduction in the hazard rate of IDFS using a one-sided alpha level of 0.025. Projected accrual time is approximately 3 years.

Progress: Protocol was activated in January 2011. First patient was entered in February 2011. As of June 16, 2011, 115 of 3260 patients have been enrolled. Supported by NCI U10-12027, -37377, 69651, 69974, and Genentech, Inc.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-02-07.

P5-18-05: Incidence of Febrile Neutropenia in Patients Treated with Docetaxel and Cyclophosphamide (TC) for Adjuvant Breast Cancer

Background: Adjuvant docetaxel with cyclophosphamide (TC) chemotherapy use in the community is common based on its improved disease outcomes compared to doxorubicin with cyclophosphamide (AC) treatment, lack of cardiac toxicity associated with anthracyclines, and perceived low incidence of febrile neutropenia (FN). In the pivotal trial of AC versus TC, the incidence of FN in breast cancer patients who received TC treatment was 4% in patients under 65 years and 8% in patients greater than 65 years. Growth factors (CSF) were not used in the trial, but antibiotics were used significantly. FN rates of 11.6% to 50% have been reported in multiple small studies, prompting warnings that primary prophylaxis with growth factor should be used. The true incidence of FN in community based patients may be higher than in the original clinical trial population as non-trial patients may have risk factors known to increase the risk for chemotherapy-induced FN, including increased age or other comorbid conditions. We wanted to know the incidence of FN in patients receiving TC chemotherapy who were not given primary prophylaxis with CSF.

Methods: Using our electronic medical record system, a retrospective review of patients starting TC for breast cancer in 2010 at Kaiser Permanente Northern California was included. Patients had started a four or six cycle regimen of docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 every 21 days. Patients were stratified into two groups: (1) CSF primary prophylaxis given with the first cycle versus (2) no CSF primary prophylaxis given with the first cycle. CSF prophylaxis was given by physician choice. FN episodes were defined with a clinical diagnosis code for FN from emergency department visits or hospitalizations. The primary outcome was the incidence of TC-induced FN in patients who did not receive CSF primary prophylaxis with the first cycle of treatment.

Results: 332 patients with a mean age of 57.9 years (range 30.5 to 83.6 years) were included. Of these, 204 (61.4%) did not receive primary CSF prophylaxis (mean age 57.4 years, range 30.5 to 83.6 years), and 128 (38.6%) received primary CSF prophylaxis (mean age 58.5 years, range 36.6 to 82.4 years). The incidence of FN during any cycle was 24.5% (50/204) in those who did not receive primary CSF prophylaxis and 8.6% (11/128) in those who did (p=0.0003). Patients were hospitalized for FN for a total of 174 days (mean 3.2 days, range 1 to 13 days). Mean days hospitalized were 3.2 in each group. We will present risk factors associated with the development of FN. Conclusion: In the largest population based report to date, we report the incidence of febrile neutropenia to be 24.5% in patients not receiving primary CSF prophylaxis. The rate is higher than originally reported for TC. Primary prophylaxis with CSF should be considered when treating this patient population with TC chemotherapy. Further analysis, including risk factor assessment, will be presented.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-18-05.

The effect on pCR of bevacizumab and/or antimetabolites added to standard neoadjuvant chemotherapy: NSABP protocol B-40

LBA1005

Background: The addition of capecitabine (X), gemcitabine (G), and bevacizumab (B) to taxanes have each improved PFS in metastatic breast cancer. The primary aims of this trial were to determine if adding X or G to docetaxel (T) → AC will increase breast pathologic complete response (pCR) rates in operable, HER2-negative breast cancer and if adding B to T-based regimens →AC will increase pCR rates. Secondary aims included assessment of clinical complete response (cCR) rates. Methods: Pts received one of 3 T-based regimens, with or without B, 15mg/kg, q3wks x 4: T 100 mg/m2 day 1; T 75 mg/m2 day 1 and X 825 mg/m2 BID days 1-14; or T 75 mg/m2 day 1 and G 1000 mg/m2 days 1 and 8. Pts then received preoperative AC x 4, with or without B for the initial 2 cycles of AC. Pts randomized to B resumed B for 10 postop doses. The primary endpoint was pCR in the breast. The maximum of the standardized pairwise differences between pCR rate for the T → AC regimen and for the other 2 T-based regimens was used as the test statistic to adjust for multiple comparisons. Fisher’s exact test was used to compare the arms with and without B. Results: The groups were balanced, with 47% clinically node+, 56% poorly differentiated, and 59% HR+. Assessments for pCR were available from 1180 of 1206 randomized patients. pCR for TX and TG were 29.7% and 32% vs. 32.7% for T. Neither TX nor TG increased cCR rates relative to T (58.3% and 60.4% vs. 61.5%). TX and TG increased toxicity. Addition of B increased the pCR rate (28.4 vs. 34.5%, p=0.027) and the cCR rate (55.8 vs. 64.3%, p=0.007). The effect of B was predominantly in the HR+ subset (15.2 vs. 23.3%, p=0.008) with minimal effect in the HR- subset (47.3% vs. 51.3%, p=0.44). Grades 2/3/4 toxicities increased with B were HTN (1/<1/0% vs. 13/9/<1%), HFS (11/7/0% vs. 15/11/0%), and mucositis (10/3/0% vs. 20/5/0%). Conclusions: The addition of B to neoadjuvant chemotherapy improved pCR and cCR rates, but the addition of X or G to T did not improve outcomes. Follow-up for wound healing issues and DFS will help define the role of B in the treatment of early breast cancer. Funded by NCI PHS grants U10-CA-37377, U10-CA-69974, U10-CA-12027, U10-CA-69651, and U10-CA-44066, and F. Hoffmann La-Roche, Ltd., Genentech, USA, and Eli Lilly.

Incidence and Demographic and Tumor Characteristics of HER2-Positive Invasive Breast Cancer in a Large, Unselected Population, 2000-2006

BACKGROUND: Most HER2 data have been generated from populations of invasive breast cancer (IBC) patients with selected patient and tumor characteristics (clinical trials, referral centers). The average age of women in US adjuvant trastuzumab trials was 49. Pre 2000, clinical trials of adjuvant chemotherapy included 25-40% HER2+ cases. We used an unselected population of women with IBC to estimate the age-specific incidence rates of HER2+ IBC and compare patient and tumor characteristics of HER2+ and HER2- disease.METHODS: Among female members of Kaiser Permanente Northern California (KPNC) 20 years or older (n=1.22 million), we identified all those diagnosed with a new primary IBC in 2000-2006 (n=16,975). During this period, all IBCs were routinely tested for HER2 by KPNC's regional IHC laboratory (center of excellence for HercepTest, CLIA licensed and CAP certified) and those that were IHC 2+ were sent for FISH testing; IHC 3+ or IHC 2+/FISH+ (ratio ≥ 2.0) were considered HER2+. Demographic and tumor characteristics were derived from the KPNC tumor registry. *Complete HER2 testing available for 94% of IBCs.RESULTS: Incidence of HER2+ IBC increased less dramatically with age and peaked 20 years earlier than incidence of all IBC (Table 1). Among those with IBC, the percent that were HER2+ decreased with age. Of all HER2+ IBCs, 69% were ≥50 years old and 42% were ≥60 years old.Incidence of all IBC and incidence of HER2+ diseaseAge GroupPerson-YrsNo. of IBCsIBC rate/100KHER2+ IBCs*%HER2+HER2+IBC rate/100K20-39288153371024.6416424.75.6940-4917402132680154.0049819.728.6250-5915535284354280.2759914.538.5660-699677624280442.2649412.351.0570-796676013318497.002718.740.5980+3666531633445.381429.638.73ALL817729016975207.59216813.626.51 The percent of tumors that were HER2+ increased with stage (local=11%, regional=18%, distant =25%), tumor differentiation (well =2%, moderate =12%, poor=26%, undifferentiated=30%), and generally with size (&lt;0.5cm=17%, 0.5-0.9cm=7%, 1-1.9 cm=10%, 2-4.9 cm=17%, &gt;5 cm=20%). ER- and PR- tumors were more likely to be HER2+ (of all ER- tumors, 29% were HER2+; of all PR- tumors, 25% were HER2+; of all ER+ tumors, 10% were HER2+; of all PR+ tumors, 9% were HER2+). Among all IBC patients, percent of disease that was HER2+ was highest for Asians (20%) and lowest for Caucasians (12%).CONCLUSION: In a large, unselected, population of invasive breast cancer patients, the incidence of HER2+ disease was highest among women aged 60-69 years. Among breast cancer patients, HER2+ disease was highest in Asians. The percent HER2+ was 13.6% for all breast cancer patients in this population based cohort and highest (24.7%) in the 20-39 year age group.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3058.

Phase II trial of nab-paclitaxel as first-line therapy of hormone refractory metastatic prostate cancer (HRPC)

5152

Background: Many patients with hormone refractory prostate cancer have poor tolerance to treatment. Docetaxel chemotherapy was shown to improve survival but has substantial toxicity, requires steroid administration, may cause poorly reversible neuropathy and requires long infusion times, all limiting its use. Nab-paclitaxel, an albumin-bound nanopaticle form of paclitaxel, delivers paclitaxel without steroids, requires only 30 minutes infusion time and has favorable toxicity profile that may be more tolerable but effective in patients with prostate cancer. The goal of this study was to evaluate the efficacy and toxicity of nab-paclitaxel in first line chemotherapy of men with castration resistant prostate cancer. Methods: nab-paclitaxel was given iv100 mg/m2 weekly x 3 of 4 weeks cycles. Main eligibility criteria include: hormone refractory metastatic prostate cancer, no prior chemotherapy, performance status 0–2. Primary endpoint was efficacy based on prostate-specific antigen (PSA) response. PSA response was PSA decrease of >50%, progressive disease (PD) was PSA increase of >25%, stable disease (SD) was <25% PSA increase or <50% decrease sustained longer that 8 weeks. Results: There are 38 patients enrolled, 35 were evaluable for response. Median age was 71 years old (range 57–86). One patient discontinued the treatment after 1 infusion due to toxicity (elevated ALT). PSA response was seen in 9 (25%) patients and SD in 15 patients (43%), with an overall response rate of 25% and clinical benefit of 68%. Seven patients received treatment for ≥ 6 months with minimal toxicity (range 6–10 months). Grade 3 related hematologic toxicity was reported in 7 (18%) patients (4 anemia, 4 neutropenia), grade 3 related non-hematologic toxicity was reported in 6 patients (1 hypokalemia, 1 muscle weakness, 2 fatigue, 1 fever, 1 neuropathy, 1 ALT elevation). Conclusions: Nab-paclitaxel has activity in patients with metastatic hormone refractory prostate cancer. This regimen was well tolerated, and may be useful in patients who are not suitable candidates for docetaxel based therapy.

[Table: see text]

Phase II trial of bevacizumab in combination with temozolomide and regional radiation therapy for up-front treatment of patients with newly diagnosed glioblastoma multiforme

2000

Background: Bevacizumab (BV) is a humanized monoclonal antibody directed against the vascular endothelial growth factor (VEGF). Based on the promising activity of BV in the treatment of recurrent glioblastoma, we are conducting a phase II trial to determine whether up-front treatment of newly diagnosed GBM with BV may be more advantageous than withholding BV until recurrence. In this trial, we evaluate the safety and efficacy of BV combined with standard of care radiation (RT) and temozolomide (TMZ) and radiation (RT) for newly-diagnosed GBM. Methods: This is a phase II trial with a 10-patient pilot and 60-patient expansion phases. Newly-diagnosed GBM patients with no prior treatments are eligible. Primary outcome measure is overall survival; the secondary outcome measure is TTP and 12-month survival. Therapy began between 3–5 weeks of surgery with BV (10 mg/kg every 2 weeks), TMZ (75 mg/m2 daily), and external beam RT (30 x 200 Gy) on the same day. After completion of radiation, patients are then placed on a maintenance phase of BV (10mg/kg every 2 weeks) and TMZ (150–200 mg/m2 5 out of every 28 days) until progression or 24 months in which patients are then maintained on BV only. Results: 70 of 70 projected GBM patients have been enrolled between August 2006 and November 2008 at UCLA and Kaiser Permanente (KP) (Northern and Southern California). All patients had resections to ensure that frozen tissue (>200mg) was collected. The median age was 57.4 years (range 31–75). MGMT methylation analysis has been performed on 52/70 patients with ∼40% showing methylation. Severe adverse events to date have included ischemic stroke, pulmonary embolus, wound breakdown, GI bleeding/perforation, and renal dysfunction. Isolated cases of retinal detachment and optic neuropathy have also been observed. As of now, 35/70 patients are off study (26 due to progression and 9 due to SAE). Preliminary TTP by Kaplan-Meier analysis is promising compared to that of a UCLA/KP control group of patients that received the conventional RT/TMZ regimen. Conclusions: Addition of BV to the standard regimen of TMZ and RT for newly-diagnosed GBM is well-tolerated and shows promising efficacy. More detailed analysis of safety and efficacy will presented.

[Table: see text]

Routine preventive care and cancer surveillance in long-term survivors (LTS) of colorectal cancer: Results from NSABP Protocol LTS-01

6500

Background: Little is known about the use of routine preventive care and cancer surveillance in long-term colorectal cancer survivors. NSABP LTS-01 is a study that examines the use of such services in long-term colorectal cancer survivors previously treated in NSABP adjuvant trials. Methods: Long-term colorectal cancer survivors (≥ 5 years) were recruited from five completed NSABP treatment trials (Protocols C-05, C-06, C-07, R-02, R-03) at 65 study sites. A survey battery for long-term survivors of colorectal cancer (LTS-01) was developed. A 1:4 comparison cohort case-matched by age, gender, race, and education was created from the 2005 National Health Interview Survey. Contingency tables and multivariate models were used to compare cohorts and determine predictors of preventive care and cancer surveillance. Results: 649 LTS-01 patients (625 colon, 24 rectal) completed the interview; 57% male, mean age 66.1yr (SD 10.5), median survival 8 yrs. LTS-01 patients were more likely to have a usual source of healthcare than the NHIS cohort (98% vs. 93%, p < 0.0001). The number of ER visits in the previous 12 months was not significantly different between the two groups. LTS-01 patients were more likely to have received a flu shot in the past 12 months (68% vs. 42%, p < 0.0001) and were also more likely to have undergone cancer screening by Pap smear (67% vs. 54%, p < 0.001), mammogram (85% vs. 71%, p < 0.001), and PSA test (84% vs. 75%, p < 0.001). For CRC surveillance, 3% did not have a colonoscopy, 13% had not had a CEA test, and 34% did not have a CT scan in the last 5 years. The best predictor of the receipt of these cancer screening tests was the presence of health insurance (OR 2.6–4.5). No factor was uniformly associated with colorectal cancer surveillance. Conclusions: Long-term survivors of colorectal cancer achieve better routine preventive care including cancer screening than the general population. However in these stage II and stage III cancer patients cancer surveillance is variably performed.

No significant financial relationships to disclose.

Randomized clinical trial eligibility rates for chemotherapy (CT) and antiangiogenic therapy (AAT) in a population-based cohort of newly diagnosed non-small cell lung cancer (NSCLC) patients

6538

Background: NSCLC leads the US in cancer deaths, but randomized clinical trials (RCT) of CT with/without antiangiogenic therapy (AAT) are relatively slow to accrue. Treatment guidelines for NSCLC are based on RCTs that enroll patients with a mean age of 62–64 without serious comorbidities. SEER mean age of NSCLC diagnosis in the US is 70. Methods: 326 consecutively diagnosed (from January 1, 2006) NSCLC patients from a large prepaid health care delivery system (Kaiser Permanente Northern California-KPNC), were retrospectively evaluated by manual chart and electronic medical record review for eligibility criteria (EC) to enter treatment defining RCTs, i.e. E4599, S0023. The KPNC members are representative of the regional population. Ineligibility, the main endpoint, was determined on imaging and laboratory tests and history in the medical record. This may overestimate eligibility. Results: Age at diagnosis:<60years-18%, <65–28%, <70–50%, >75–34%, >80–18%; mean (SD)age- 69.3 (10.6). Male:Female 51:49%. Adeno-49%; Squamous-22%; LargeCell-2.5%; NSC NOS-27%. Current/former smokers-90%. Staging: IA-14%; IB-13%; IIA+B-4%; IIIA-17%; IIIB+IV-52%. Surgical resection-26%. When standard RCT eligibility criteria were applied to the entire cohort, 34% (CI 29%-39%) were eligible. Only 23% (CI 19%-28%) were both eligible and <75yo. stage IIIB+IV patients were 29% (CI 24%-36%) eligible at all ages, 20% (15%-26%) were both eligible and <75yo. When AAT EC were added, 21% (17%-26%) were eligible for all ages, 14% (CI 10%-18%) eligible and <75yo., and 9%(CI 6%-13%) eligible and <70yo. Conclusions: Treatment guidelines for NSCLC are based on RCTs enrolling the healthiest quartile of the youngest half of patients. The majority of NSCLC patients are excluded by trial eligibility criteria or subjective age criteria from entering CT and/or AAT RCTs. Toxicities in these older and more comorbid NSCLC patients likely alter the risk:benefit ratio. RCTs specific for the 70+yo and comorbid NSCLC patients are needed to help define the best therapy for this understudied majority of lung cancer patients.

No significant financial relationships to disclose.

NSABP B-30: definitive analysis of quality of life (QOL) and menstrual history (MH) outcomes from a randomized trial evaluating different schedules and combinations of adjuvant therapy containing doxorubicin, docetaxel and cyclophosphamide in women with operable, node-positive breast cancer

Abstract #76

Background: QOL and MH outcomes were integrated into the NSABP B-30 trial as secondary outcomes to the efficacy analyses which are being presented separately. Explicit secondary aims of the NSABP B-30 study were 1) to compare toxicities among the regimens, 2) to compare QOL, and 3) to examine differences in amenorrhea and its relationship to symptoms, QOL, and efficacy. Here we examine the secondary aims of the study as a companion to the efficacy results that are presented separately.&#x2028; Materials and Methods: 5351 pts with cT1-3, N0-1, M0 were enrolled from 3/1/99 to 3/31/2004. 2170 were enrolled on the QOL study, and 2449 were enrolled on the MH study and were randomized to one of three treatment groups: Group 1 [doxorubicin (A) 60 mg/m2 and C 600 mg/m2 q 3 weeks (wks) x 4 followed by docetaxel (T) 100 mg/m2 q 3 wks x 4; Group 2 [A 50 mg/m2 and T 75 mg/m2 q 3 wks x 4]; Group 3 [A 50 mg/m2 T 75 mg/m2 and cyclophosphamide (C) 500 mg/m2 q 3 wks x 4]. All patients with ER-positive tumors received hormonal therapy after completing chemotherapy. Preliminary results from Group 1 have been reported previously (Swain, et al. Breast Cancer Res Treat, 2008).&#x2028; Results: The protocol specifies that 800 deaths are required for the definitive analysis of treatment, QOL, and MH outcomes, which are expected to occur by fall 2008. For this final report, results from a comparison of the three arms will be analyzed and presented.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 76.

Phase II trial of paclitaxel in front-line therapy of hormone refractory metastatic prostate cancer

15628

Hormone refractory prostate cancer patients have poor prognosis with median survival of only 16 months. They are frequently elderly men with many co-morbid conditions unable to tolerate treatments with substantial toxicity. Docetaxel, the only drug shown to prolong survival causes significant toxicities, requires steroids administration, may cause poorly reversible neuropathy and requires long infusion times, all limiting its use in elderly men that are mostly affected by hormone refractory prostate cancer. Abraxane is a novel agent delivering paclitaxel without steroids, requires only 30 minutes infusion times and low toxicity potential that may be effective and more tolerable in patients with prostate cancer. The goal of our study is to evaluate the effectiveness and toxicity of Abraxane in first line chemotherapy of men with hormone refractory prostate cancer. Considering the favorable toxicity profile of Abraxane and in an effort to make our results applicable to the majority of prostate cancer patients we are including men with performance status of 2. Main eligibility criteria are: hormone refractory metastatic prostate cancer documented by PSA progression, no prior chemotherapy, PSA >5 and performance status 0–2. Primary endpoint is efficacy based on PSA response. Secondary endpoints are time to PSA progression, overall survival, and toxicities. The clinical trial has been opened at Kaiser Permanente Northern California since September 2005. There are 15 patients enrolled. All have been evaluable for toxicity and the drug is very well tolerated so far by this population of patients. Out of 15 patients 12 are evaluable for response. Two patients have recently started the protocol therapy and have not met the time point for disease assessment. One patient discontinued the treatment after one infusion due to toxicity (elevated LFTs). One patient completed 11 cycles of Abraxane, while maintaining stable disease on bone scan and achieved a PR by PSA. Ten patients have come off study due to progressive disease based on clinical presentation, rising PSA or signs of radiological progression. There are currently 4 patients actively receiving therapy. Updated results will be presented at the time of ASCO 2007 meeting.

No significant financial relationships to disclose.

DN101–004: A multicenter, open label, dose ranging study of DN-101 and docetaxel in patients with stage IIIB or IV non-small cell lung cancer (NSCLC) after platinum-based chemotherapy

7685

Background: DN-101 is a high-dose oral formulation of calcitriol, the most potent natural ligand of vitamin D receptor. Calcitriol has various anti-neoplastic effects on malignant cells and increases activity of cytotoxic agents, including taxanes. DN-101 in combination with docetaxel was associated with improved survival in a phase II study in androgen-independent prostate cancer and ASCENT 2, a phase III confirmatory study is underway. The objective of the study was to determine the maximum tolerated dose, response rate (ORR), progression-free survival (PFS), and overall survival (OS) of DN-101 in combination with docetaxel in advanced NSCLC patients (pts). Methods: Eligible pts had Stage IIIB or IV NSCLC that progressed on or after platinum-based chemotherapy, ECOG = 1, and measurable disease by RECIST criteria. DN-101 was administered on day 1 in doses of 45 (n=5), 75 (n=4), 135 (n=3), or 180 μg (n=53) in the q21d group, or 180 μg on day 1, followed by 45 (n=5), 90 (n=4), or 180 μg (n=12) on days 8 and 15 in the q7d group. Docetaxel (75 mg/m2 BSA) was given on day 2 q21d for all pts. Results: A total of 86 pts were treated. No unexpected toxicities were reported with DN-101. Grade 3/4 (G3/4) toxicities and fatal adverse events (AEs) were consistent with the reported toxicity of docetaxel alone. Stomatitis (0% in q7d, 9% in q21d) and G3/4 asthenia and fatigue (5% in q7d, 14% in q21d) were less frequent on DN-101 compared to published reports on docetaxel. No pt on DN-101 q21d developed hypercalcemia while 2 pt on DN-101 q7d (180 μg cohort) developed G3/4 hypercalcemia. Three fatal AEs included 2 on DN-101 q21d (1 lung infiltration, 1 pneumonitis) and 1 on DN-101 q7d (intestinal perforation). The ORR was 5.9% (CI 0.1%, 28.7%) and 6.6% (1.8%, 15.9%), median PFS 14.1 (6.0, 20.0) and 11.6 (8.4, 17.4) weeks, median OS 8.8 (7.1, NA) and 6.9 (5.5, 9.7) months, and 1 year survival rate 40% (15.2%, 64.8%) and 31% (18.9%, 42.2%) for the q7d and q21d group, respectively. Conclusions: DN-101 in combination with docetaxel is well-tolerated in advanced NSCLC. The observation of improved PFS, OS, and 1 year survival with weekly DN-101 administration supports further investigation.

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Automated data base screening of a population-based cohort of stage 1 colon cancer patients for eligibility in NSABP P-3, a polyp prevention study with celecoxib at Kaiser Permanente Northern California (KPNC)

1021

Background: Adjuvant/Prevention approaches should be designed to have broad applicability for maximum effectiveness. Celecoxib had generated interest as a polyp/colon cancer (CC) preventive agent. We used KPNC electronic data bases to identify consecutive Stage I CC patients and determine their eligibility for NSABP P-3, a polyp prevention study utilizing celecoxib in resected stage I CC. Methods: After IRB approval of both the P-3 study and use of KP data bases for recruitment, we prospectively screened all newly diagnosed CC patients within KPNC (1120 new patients a year) for stage I CC and P-3 eligibility. We identified 121 Stage I CC patients from 9/1/04 to 8/1/05 and using electronic data we screened these patients for 10-year life expectancy and other eligibility criteria. We confirmed each pathology diagnosis and stage by direct review. Results: Without chart review or patient history and exam, we found 65% of the patients were ineligible (IE) for any or multiple reasons. The average patient age was 68.9 years. 133 IE criteria were met by the 121 patients. 32% of patients were IE by age, though for only 11% was age the only criteria met. Other IE included 11% prior invasive CA, 19% coronary disease, 11% sulfa allergy, 8% coumadin usage, 7% prior CVA/TIA, 22% other GI or thrombotic criteria. It is likely that in-person history and examination would increase these IE numbers and reveal other barriers. Conclusions: Population-based automated eligibility analysis may be helpful in evaluating feasibility of chemoprevention and adjuvant trials and more importantly in determining their applicability to the whole population at risk.

No significant financial relationships to disclose.

The study of tamoxifen and raloxifene (STAR): Initial findings from the NSABP P-2 breast cancer prevention study

LBA5

Background: The STAR trial was designed to compare raloxifene to tamoxifen in terms of relative effect on invasive breast cancer risk and on other beneficial and detrimental outcomes associated with the use of tamoxifen. Methods: The trial opened on 7-1-1999, and accrual was completed November 4, 2004, with 19,747 women enrolled. To be eligible, a woman had to be postmenopausal with a 5-year predicted breast cancer risk of 1.66% as determined by the modified Gail model. Women were randomized and treated in a double-blinded fashion to receive 5 yr of therapy with either 20 mg per day of tamoxifen or 60 mg per day of raloxifene. The protocol-defined monitoring plan called for a final analysis and release of findings when 327 invasive breast cancer cases had been diagnosed in the total population. The mean age of the population at the time of entry into this trial was 58 yr, and the mean 5-yr risk of breast cancer was 4.04%. 93.5% of the women were white; 51.5% had a hysterectomy before entry into the study; 9.2% had a history of LCIS; 71.1% had at least one first-degree relative with a history of breast cancer. The average time on the study is 47 months. Results: There was no difference between the treatment groups in terms of effect on invasive breast cancer: 163 cases in women assigned to tamoxifen and 167 in women assigned to raloxifene (RR = 1.02, 95% CI = 0.82–1.27). The risk of invasive uterine malignancies was 40% less in the raloxifene group (36 in women assigned tamoxifen and 23 in women assigned raloxifene [RR = 0.62, 95% CI = 0.35–1.08]). The risk of non invasive breast cancer was less in the tamoxifen group (57 cases in those assigned to tamoxifen and 81 in those assigned to raloxifene [RR = 1.41, 95% CI = 1.00–2.02]). There were no significant differences between the treatment groups for any of the other invasive cancer sites or for cardiac events, osteoporotic fractures, or deaths. There were fewer thromboembolic events in women taking raloxifene than in those taking tamoxifen. Conclusions: Raloxifene is an effective alternative to tamoxifen for reducing the incidence of invasive breast cancer in postmenopausal women at increased risk of developing the disease and is associated with fewer endometrial cancers, deep vein thromboses, and pulmonary emboli.

[Table: see text]

A phase II, multicenter, randomized clinical trial to evaluate the efficacy and safety of bevacizumab in combination with either chemotherapy (docetaxel or pemetrexed) or erlotinib hydrochloride compared with chemotherapy alone for treatment of recurrent or refractory non-small cell lung cancer

7062

Background: Bevacizumab is a recombinant, humanized anti-VEGF MAb. Erlotinib is a potent, reversible, highly selective and orally available EGFR tyrosine-kinase inhibitor. Both compounds have demonstrated a survival benefit in the treatment of NSCLC: bevacizumab when added to chemotherapy in the first line setting, and erlotinib when given alone in the 2nd/3rd line. In addition, a single arm phase I/II study of the combination of bevacizumab and erlotinib has shown encouraging survival and response rate data, with a favorable safety profile (Sandler et al, PASCO 2004). Methods: A multicenter, randomized phase II trial was conducted to evaluate the safety of combining bevacizumab with chemotherapy (docetaxel or pemetrexed), or with erlotinib; and to make a preliminary assessment of the efficacy of combining bevacizumab with chemotherapy or erlotinib relative to chemotherapy alone, as measured by progression-free survival. All patients had histologically confirmed non-squamous NSCLC and had experienced disease progression (clinical or radiological) during or following one platinum-based regimen for advanced stage disease. Randomization was on a 1:1:1 basis to docetaxel or pemetrexed plus placebo (arm 1) v docetaxel or pemetrexed plus bevacizumab (arm 2) v bevacizumab plus erlotinib (arm 3). Patients remained in the treatment phase of the study until documented radiographic or clinical disease progression or through 52 weeks of study treatment. Results: Between August 2004 and November 2005, 120 patients were randomized and treated. To date, there have been 68/85 required PFS events; arms 1 and 2 therefore remain blinded. Demographics from the first 85 patients for arms 1 & 2 v 3 are as follows: median age 65 v 68;% male/female 64/36 v 44/56; ethnicity % white/black/asian/other 83/12/2/3 v 74/15/4/7; % ECOG PS 0/1/2 46/52/2 v 50/50/0; % adenocarcinoma/BAC&BAC-like/Other 67/7/26 v 69/8/23; % current/previous/never-smoker 15/71/14 v 11/74/15. Conclusions: Efficacy and safety results will be presented at the meeting.

[Table: see text]