Fatigue visual analogue scale score correlates with quality of life in cancer patients receiving epoetin alfa (Sandoz) for chemotherapy-induced anaemia: The CIROCO study

PURPOSE

Available tools to measure fatigue and health-related quality of life (HRQoL) in cancer patients are often difficult to use in clinical practice. The fatigue visual analogue scale (VAS) provides a simple method to assess fatigue. This study evaluated the correlation between HRQoL and fatigue perceived by cancer patients undergoing chemotherapy.

METHODS

This was a non-interventional prospective study of adult cancer patients in France presenting with chemotherapy-induced anaemia (CIA) treated with epoetin alfa (Sandoz). Data were collected using an electronic case report form at study inclusion (T0), after 2-3 chemotherapy cycles (T1) and after 4-6 cycles (T2).

RESULTS

The study included 982 patients from September 2015 to October 2017. Overall, there was a negative correlation between fatigue VAS and HRQoL. The overall haemoglobin (Hb) change between T0 and T2 was +17.8 % (± 18.1 %). Fatigue assessed by both patients and physicians showed a clinically significant improvement during the study. Global HRQoL also increased.

CONCLUSION

Treatment of CIA with epoetin alfa (Sandoz) improved Hb levels, fatigue, and HRQoL, with a correlation observed between fatigue VAS score and HRQoL. Fatigue VAS could act as a simple alternative to more complex methods to measure HRQoL; however, further analyses are required to confirm this association.

Single-dose NEPA versus an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy

INTRODUCTION

Non-inferiority of NEPA (fixed combination of NK1 receptor antagonist (RA), netupitant, and 5-HT3 RA, palonosetron) versus an aprepitant regimen was previously shown in a pragmatic study in patients receiving anthracycline cyclophosphamide (AC) and non-AC moderately emetogenic chemotherapy (MEC). In the MEC group a numerically higher complete response (CR: no emesis, no rescue) rate was seen for NEPA during the overall 0-120 h phase (NEPA 76.1% vs. 63.1% aprepitant). As NEPA exhibits long-lasting efficacy, this study evaluated a prolonged period up to 144 h, beyond the traditional 120 h post-chemotherapy. In this post-hoc analysis we explore the comparative efficacy of NEPA versus the aprepitant regimen in the MEC group up to 144 h, while also assessing the impact of risk factors on CINV prevention.

METHODS

This was a pragmatic, multicenter, randomized, prospective study. Oral NEPA was administered as a single dose on day 1, while aprepitant was given on days 1-3 + ondansetron on day 1; all patients were to receive dexamethasone on days 1-4. Patients were chemotherapy-naïve and receiving MEC, with a subset evaluation of those with a risk factor for developing CINV (i.e., female, male <60 years, male ≥60 years who received carboplatin, or male ≥60 years with anxiety). CR rates were compared during the extended overall (0-144 h) phase.

RESULTS

The MEC group included 211 patients; of these 181 were in the risk factor subset. Significantly higher CR rates were seen for NEPA than aprepitant during the extended overall phase for the total MEC group (NEPA 77.1%, aprepitant 57.8%, p = 0.003) and also in the subset of patients with CINV risk factors (NEPA 73.9%, aprepitant 56.2%, p = 0.012).

CONCLUSION

A single dose of NEPA, administered on day 1 only, was more effective than a 3-day aprepitant regimen in preventing CINV for an extended duration in patients receiving MEC and in those with emetic risk factors.

Abstract P2-06-03: Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort

Background: Acrylamide is classified as a probable human carcinogen by the IARC but epidemiological evidence on the carcinogenicity of acrylamide from dietary sources is limited. This study aimed to investigate the associations between dietary acrylamide and breast cancer risk in the NutriNet-Santé cohort. Methods: This prospective cohort study included 80,597 French women (mean [SD] age at baseline: 40.8 [14] years) during a mean (SD) follow-up of 8.8 (2.3) years. Acrylamide intake was evaluated using repeated 24h dietary records (n= 5.5 [SD 3.0]), linked to a comprehensive food composition database. Associations between acrylamide intake and breast cancer risk (overall, premenopausal and post-menopausal) were assessed by Cox hazard models adjusted for known risk factors. Results: The mean (SD) dietary acrylamide intake was 30.1 (21.9) µg/d (main contributors: coffee, potato fries and chips, pastries and cakes, and bread). During follow-up, 1016 first incident breast cancer cases were diagnosed (431 premenopausal, 585 postmenopausal). A borderline significant positive association was observed between acrylamide intake and breast cancer risk overall (HRQ4 vs Q1= 1.21 [95% CI: 1.00-1.47]) and a positive association was observed with premenopausal cancer (HRQ4 vs Q1= 1.40 [95% CI: 1.04-1.88]). Restricted cubic spline analyses suggested evidence for non-linearity of these associations, with higher HR for intermediate (Q2) and high (Q4) exposures. Receptor-specific analyses revealed a positive association with estrogen receptor-positive breast cancer, which represented 86% of total cancer cases. Acrylamide intake was not associated with post-menopausal breast cancer. Conclusions: Results from this large prospective cohort study suggest the potential deleterious role of dietary acrylamide in breast cancer etiology, especially in premenopausal women, and provide new insights that should encourage further mitigation strategies to reduce the content of acrylamide in food.

Citation Format: Alice Bellicha, Gaëlle Wendeu-Foyet, Xavier Coumoul, Meriem Koual, Fabrice Pierre, Françoise Guéraud, Laurent Zelek, Charlotte Debras, Bernard Srour, Laury Sellem, Emmanuelle Kesse-Guyot, Chantal Julia, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier. Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-06-03.

Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort

BACKGROUND

Acrylamide is classified as a probable human carcinogen by the International Agency for Research on Cancer but epidemiologic evidence on the carcinogenicity of acrylamide from dietary sources is limited.

OBJECTIVES

This study aimed to investigate the associations between dietary acrylamide and breast cancer risk in the NutriNet-Santé cohort, accounting for menopausal and hormone receptor status.

METHODS

This prospective cohort study included 80,597 French females (mean ± SD age at baseline: 40.8 ± 14 y) during a mean ± SD follow-up of 8.8 ± 2.3 y. Acrylamide intake was evaluated using repeated 24-h dietary records (n ± SD = 5.5 ± 3.0), linked to a comprehensive food composition database. Associations between acrylamide intake and breast cancer risk (overall, premenopausal, and postmenopausal) were assessed by Cox hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors).

RESULTS

The mean ± SD dietary acrylamide intake was 30.1 ± 21.9 µg/d (main contributors: coffee, potato fries and chips, pastries, cakes, bread). During follow-up, 1016 first incident breast cancer cases were diagnosed (431 premenopausal, 585 postmenopausal). A borderline significant positive association was observed between dietary acrylamide exposure and breast cancer risk overall (HR for quartile 4 compared with 1: 1.21; 95% CI: 1.00, 1.47) and a positive association was observed with premenopausal cancer (HRQ4vs.Q1: 1.40; 95% CI: 1.04, 1.88). Restricted cubic spline analyses suggested evidence for nonlinearity of these associations, with higher HRs for intermediate (quartile 2) and high (quartile 4) exposures. Receptor-specific analyses revealed positive associations with estrogen receptor-positive breast cancer (total and premenopausal). Acrylamide intake was not associated with postmenopausal breast cancer.

CONCLUSIONS

Results from this large prospective cohort study suggest a positive association between dietary acrylamide and breast cancer risk, especially in premenopausal females, and provide new insights that support continued mitigation strategies to reduce the content of acrylamide in food.This trial was registered at clinicaltrials.gov as NCT03335644.

Influence of the SARS-CoV-2 outbreak on management and prognosis of new lung cancer cases, a retrospective multicenter real-life cohort study

Introduction

The SARS-CoV-2 pandemic has impacted the care of cancer patients. This study sought to assess the pandemic’s impact on the clinical presentations and outcomes of newly referred patients with lung cancer from the Greater Paris area.

Methods

We retrospectively retrieved the electronic health records and administrative data of 11.4 million patients pertaining to Greater Paris University Hospital (AP-HP). We compared indicators for the 2018–2019 period to those of 2020 in regard to newly referred lung cancer cases. We assessed the initial tumour stage, the delay between the first multidisciplinary tumour board (MTB) and anticancer treatment initiation, and 6-month overall survival (OS) rates depending on the anticancer treatment, including surgery, palliative systemic treatment, and best supportive care (BSC).

Result

Among 6240 patients with lung cancer, 2179 (35%) underwent tumour resection, 2069 (33%) systemic anticancer therapy, 775 (12%) BSC, whereas 1217 (20%) did not receive any treatment. During the first lockdown, the rate of new diagnoses decreased by 32% compared with that recorded in 2018–2019. Initial tumour stage, repartition of patients among treatment categories, and MTB-related delays remained unchanged. The 6-month OS rates of patients diagnosed in 2018–2019 who underwent tumour resection were 98% versus 97% (HR = 1.2; 95% CI: 0.7–2.0) for those diagnosed in 2020; the respective rates for patients who underwent systemic anticancer therapy were 78% versus 79% (HR = 1.0; 95% CI: 0.8–1.2); these rates were 20% versus 13% (HR = 1.3; 95% CI: 1.1–1.6) for those who received BSC. COVID-19 was associated with poorer OS rates (HR = 2.1; 95% CI: 1.6–3.0) for patients who received systemic anticancer therapy.

Conclusions

The SARS-CoV-2 pandemic has not exerted any deleterious impact on 6-month OS of new lung cancer patients that underwent active anticancer therapy in Greater Paris University hospitals.

Abstract P1-09-01: Breast and prostate cancer risk associated with nitrites and nitrates from food additives: Results from the NutriNet-Santé cohort

Background Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives in processed meats to increase shelf life and to avoid bacterial growth. These compounds could have a role in the carcinogenicity of processed meat. Objective To investigate the relationship between nitrate and nitrite intakes (distinguishing between natural food, water and food additive sources) and the risk of cancer in a large prospective cohort with detailed and up to date dietary assessment. Design Population based prospective cohort study. Setting Overall, 101,056 adults from the French NutriNet-Santé cohort study (2009-ongoing) were included. Consumption of nitrites and nitrates was evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products. Main outcome measures Associations between nitrite and nitrate exposures and the risk of cancer (overall and by main cancer sites) were assessed by Cox hazard models adjusted for known risk factors. Results During follow-up, 3311 first incident cancer cases were diagnosed (among which 966 breast and 400 prostate cancers). Compared with non-consumers, higher consumers of nitrates from food additives had higher risk of breast cancer (HR=1.24 (1.03-1.48), P=0.02); this was more specifically observed for potassium nitrate (e252, HR=1.25 (1.04-1.50), P=0.01). Higher consumers of nitrites from food additives had higher risk of prostate cancer (HR=1.58 (1.14-2.18), P=0.008), specifically for sodium nitrite (e250, HR=1.62 (1.17-2.25), P=0.004). No significant association was observed for nitrates and nitrites from natural sources. Conclusions In this large prospective cohort, food additive nitrates were positively associated with breast cancer risk and food additive nitrites were positively associated with prostate cancer risk. While these results need confirmation in other large-scale prospective studies, they provide new insights in a context of lively debate around the ban of nitrite additives in the food industry. Study registration The NutriNet-Santé cohort is registered at clinicaltrials.gov (NCT03335644).

Citation Format: Eloi Chazelas, Fabrice Pierre, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agaesse, Alexandre De Sa, Rebecca Lutchia, Stéphane Gigandet, Bernard Srour, Charlotte Debras, Inge Huybrechts, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Laurent Zelek, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier. Breast and prostate cancer risk associated with nitrites and nitrates from food additives: Results from the NutriNet-Santé cohort [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-09-01.

Abstract P3-12-35: Industrial and ruminant trans fatty acid intakes and cancer risk: Results from the NutriNet-Santé cohort

Background Dietary trans fatty acids (TFAs) are either natural (from ruminant sources) or generated through industrial processes by partial hydrogenation of vegetable oils. Extended evidence demonstrated their role as cardiovascular risk factors. In contrast, their involvement in cancer etiology is suspected, but epidemiological evidence remains limited. Objectives Our objective was to investigate associations between TFA intake of different types (total, rumninant [rTFAs], industrial [iTFAs], and corresponding specific isomers) and the risk of cancer (overall and main cancer sites) in the NutriNet-Santé prospective cohort (2009-2020). Methods Overall, 104,909 participants were included. Usual TFA intake was estimated from validated repeated 24-h dietary records matched with detailed composition table. Associations between sex-specific quartiles of TFA intake and cancer risk were assessed using multi-adjusted Cox proportional hazard models. Results A total of 3,374 incident cancer cases occured during follow-up (among which 982 breast and 405 prostate cancers). Dietary intake of total TFAs was associated with higher prostate cancer risk (HRfor quartile 4 versus 1: 1.27, 1.11-1.77 Ptrend=0.005). rTFAs were associated with increased overall cancer risk (1.16, 1.02-1.32 Ptrend=0.07), in particular the conjugated linoleic acid isomers (CLA) (1.19, 1.04-1.36 Ptrend=0.04). These associations were specifically observed for breast cancer (rTFAs: 1.35, 1.06-1.72 Ptrend=0.01; CLA: 1.29, 1.00-1.66 Ptrend=0.048), in particular before menopause (rTFAs: 1.68, 1.06-2.67 Ptrend=0.02; CLA: 2.013, 1.25-3.23 Ptrend=0.003). Several iTFAs were associated with overall (1.18, 1.06-1.31 Ptrend=0.02 for transdocosenoic acid), breast (isomer 18:2t: 1.30, 1.06-1.58 Ptrend=0.01; hexadecenoic acid: 1.28, 1.05-1.56 Ptrend=0.02) and prostate (transdocosenoic acid: 1.52, 1.09-2.12 Ptrend=0.07) cancer risks. Conclusion In this large prospective study, several types of TFAs were associated with increased overall, breast and prostate cancer risks. Although further studies are needed to better understand underlying mechanisms, these results support the WHO's goal of achieving industrially produced TFAs elimination from food supplies. Meanwhile, the consumption of food products containing partially-hydrogenated oils should be avoided.

Citation Format: Gaëlle Wendeu-Foyet, Véronique Chajes, Inge Huybrechts, Jean-Marie Bard, Charlotte Debras, Eloi Chazelas, Bernard Srour, Laurent Zelek, Chantal Julia, Emmanuelle Kesse-Guyot, Cédric Agaësse, Nathalie Druesne-Pecollo, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier. Industrial and ruminant trans fatty acid intakes and cancer risk: Results from the NutriNet-Santé cohort [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-35.

Abstract P1-09-02: Risk of breast and other cancers associated with the consumption of artificial sweeteners: Results from the prospective NutriNet-Santé cohort

Background: Added sugars’ deleterious effects have been established for several chronic diseases, leading food industries to use artificial sweeteners as alternatives in a wide range of foods and beverages. Their safety is debated and findings remain contrasted regarding their role in the etiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies but robust epidemiological evidence is lacking. Objective: The objective was to investigate the associations between sweetener intakes (total from all dietary sources, and most frequently consumed ones: aspartame e951, acesulfame-K e950 and sucralose e955) and cancer risk (overall and by sites: breast, prostate and obesity-related cancers). Design: Population based prospective cohort study. Setting and Participants: Overall, 102,046 adults from the French NutriNet-Santé prospective cohort (2009-2021) were included. Consumption of sweeteners was obtained by repeated 24h-dietary records including brands and commercial names of industrial products. Associations between sweeteners and cancer incidence were assessed by multi-adjusted Cox hazard models. Main outcome measures: Association between sweetener intakes and cancer risk were assessed by Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). Results: Compared to non-consumers, higher consumers of total sweeteners (i.e. above the median exposure in consumers) had higher risk of overall cancer (n=2,527 cases, hazard ratio=1.12, 95% confidence interval=1.00-1.25, P-trend=0.005). In particular, aspartame (HR=1.20 [1.05-1.38] P=0.001) and acesulfame-K (HR=1.18 [1.04-1.34] P=0.003) were associated with increased cancer risk. Similarly, higher risks were observed for breast (n=723 cases, HR=1.25 [1.02-1.53] P=0.01 for total sweeteners, HR=1.33 [1.05-1.69] P=0.007 for aspartame and HR=1.39 [1.11-1.74] P=0.003, for acesulfame-K) and obesity-related cancers. (n=1,509 cases, HR=1.16 [1.00-1.33] P=0.02 for total sweeteners, HR=1.22 [1.02-1.45] P=0.01 for aspartame and HR=1.23 [1.04-1.45] P=0.01, for acesulfame-K). Conclusion: In this large prospective cohort, artificial sweeteners (especially aspartame and acesulfame-K), which are found in &gt;10,000 foods and beverage references worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally.

Citation Format: Charlotte Debras, Eloi Chazelas, Bernard Srour, Nathalie Druesne-Pecollo, Younes Essedik, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Rebecca Lutchia, Stéphane Gigandet, Inge Huybrechts, Chantal Julia, Emmanuelle Kesse-Guyot, Laurent Zelek, Benjamin Allès, Valentina A. Andreeva, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier. Risk of breast and other cancers associated with the consumption of artificial sweeteners: Results from the prospective NutriNet-Santé cohort [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-09-02.

Dose-Intense Cisplatin-Based Neoadjuvant Chemotherapy Increases Survival in Advanced Cervical Cancer: An Up-to-Date Meta-Analysis

Simple Summary

Although neoadjuvant chemotherapy has become standard care for many locally advanced cancer sites, the benefit of neoadjuvant chemotherapy remains unclear for the treatment of locally advanced cervical cancer. With this meta-analysis, we set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Dose-intense cisplatin-based neoadjuvant chemotherapy followed by local therapy was significantly associated with a survival benefit in the treatment of locally advanced cervical carcinoma. Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting.

Abstract

Purpose: We set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Methods: We searched through MEDLINE and Cochrane Library databases up to May 2021 to identify randomized clinical trials comparing the benefit of using cisplatin-based neoadjuvant chemotherapy followed by local treatment with local treatment alone for the treatment of locally advanced cervical cancer. The PRISMA statement was applied. Results: Twenty-two randomized clinical trials were retrieved between 1991 and 2019, corresponding to 3632 women with FIGO stages IB2-IVA cervical cancer. More than 50% of the randomized clinical trials were assessed as having a low risk of bias. There was no benefit of neoadjuvant chemotherapy on overall survival, but there was significant heterogeneity across studies (I² = 45%, p = 0.01). In contrast, dose-intense cisplatin at over 72.5 mg/m²/3 weeks was significantly associated with increased overall survival (RR = 0.87, p < 0.05) with no heterogeneity across the pooled studies (I² = 36%, p = 0.11). The survival benefit was even greater when cisplatin was administered at a dose over 105 mg/m²/3 weeks (RR = 0.79, p < 0.05). Conclusion: Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting. Neoadjuvant chemotherapy could be proposed when surgery is local treatment instead of standard chemoradiotherapy for the treatment of locally advanced cervical cancer.

Glycaemic index, glycaemic load and cancer risk: results from the prospective NutriNet-Santé cohort

BACKGROUND

Evidence is accumulating that high dietary glycaemic index (GI) and glycaemic load (GL) are potential risk factors for several metabolic disorders (e.g. type-2 diabetes, cardiovascular diseases), but remains limited concerning cancer risk. Although, mechanistic data suggest that consuming high-GI foods may contribute to carcinogenesis through elevated blood glucose levels, insulin resistance or obesity-related mechanisms. Our objective was to study the associations between dietary GI/GL and cancer.

METHODS

In total, 103 020 French adults (median age = 40.2 years) from the NutriNet-Santé cohort (2009-2020) with no cancer or diabetes at baseline were included (705 137 person-years, median follow-up time = 7.7 years). Repeated 24-h dietary records linked with a detailed food-composition table (>3500 food/beverage items). We computed the average dietary GI and GL at the individual level. Associations between GI, GL, contribution of low- and medium/high-GI foods to energy and carbohydrate intake and cancer risk (overall, breast, prostate and colorectal) were assessed using multivariable Cox proportional-hazard models.

RESULTS

Higher dietary GL was associated with higher overall cancer risk [n = 3131 cases, hazard ratios (HRs) for sex-specific quintile 5 vs 1 = 1.25, 95% confidence interval (CI) = 1.03-1.52; Ptrend = 0.008] and specifically postmenopausal breast cancer (n = 924, HRQ5vs.Q1 = 1.64, 95% CI = 1.06-2.55; Ptrend = 0.03). A higher contribution of low-GI food/beverages to energy intake was associated with lower cancer risk whereas a higher contribution of medium/high-GI items to energy intake was positively associated with higher risk of overall, breast and postmenopausal breast cancers (Ptrend ≤ 0.02).

CONCLUSIONS

These results support a possible impact of GI/GL on cancer risk. If confirmed in other populations and settings, dietary GI/GL could be considered as modifiable risk factors for primary cancer prevention.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT03335644.

A Pragmatic Study Evaluating NEPA Versus Aprepitant for Prevention of Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Moderately Emetogenic Chemotherapy

BACKGROUND

Neurokinin (NK) 1 receptor antagonists (RAs), administered in combination with a 5-hydroxytryptamine-3 (5-HT₃ ) RA and dexamethasone (DEX), have demonstrated clear improvements in chemotherapy-induced nausea and vomiting (CINV) prevention over a 5-HT₃ RA plus DEX. However, studies comparing the NK₁ RAs in the class are lacking. A fixed combination of a highly selective NK₁ RA, netupitant, and the 5-HT₃ RA, palonosetron (NEPA), simultaneously targets two critical antiemetic pathways, thereby offering a simple convenient antiemetic with long-lasting protection from CINV. This study is the first head-to-head NK₁ RA comparative study in patients receiving anthracycline cyclophosphamide (AC) and non-AC moderately emetogenic chemotherapy (MEC).

MATERIALS AND METHODS

This was a pragmatic, multicenter, randomized, single-cycle, open-label, prospective study designed to demonstrate noninferiority of single-dose NEPA to a 3-day aprepitant regimen in preventing CINV in chemotherapy-naive patients receiving AC/non-AC MEC in a real-life setting. The primary efficacy endpoint was complete response (no emesis/no rescue) during the overall (0-120 hour) phase. Noninferiority was achieved if the lower limit of the 95% confidence interval (CI) of the difference between NEPA and the aprepitant group was greater than the noninferiority margin set at -10%.

RESULTS

Noninferiority of NEPA versus aprepitant was demonstrated (risk difference 9.2%; 95% CI, -2.3% to 20.7%); the overall complete response rate was numerically higher for NEPA (64.9%) than aprepitant (54.1%). Secondary endpoints also revealed numerically higher rates for NEPA than aprepitant.

CONCLUSION

This pragmatic study in patients with cancer receiving AC and non-AC MEC revealed that a single dose of oral NEPA plus DEX was at least as effective as a 3-day aprepitant regimen, with indication of a potential efficacy benefit for NEPA.

IMPLICATIONS FOR PRACTICE

In the absence of comparative neurokinin 1 (NK₁ ) receptor antagonist (RA) studies, guideline committees and clinicians consider NK₁ RA agents to be interchangeable and equivalent. This is the first head-to-head study comparing one NK₁ RA (oral netupitant/palonosetron [NEPA]) versus another (aprepitant) in patients receiving anthracycline cyclophosphamide (AC) and non-AC moderately emetogenic chemotherapy. Noninferiority of NEPA versus the aprepitant regimen was demonstrated; the overall complete response (no emesis and no rescue use) rate was numerically higher for NEPA (65%) than aprepitant (54%). As a single-dose combination antiemetic, NEPA not only simplifies dosing but may offer a potential efficacy benefit over the current standard-of-care.

Endobronchial Seeding of Squamous Lung Carcinoma with Mediastinal Lymph Involvement Node after EBUS: A Case Report

In locally advanced non-small-cell lung cancer (NSCLC), mediastinal staging is the cornerstone of the therapeutic decision and echoendoscopy is the most practiced exam to assess the lymph node involvement. We describe a rare case of endobronchial involvement by cells originating from a metastatic lymph node after endobronchial ultrasound (EBUS). A 64-year-old man was diagnosed with a squamous cell lung cancer with mediastinal nodal involvement proven by EBUS. The patient received neoadjuvant chemotherapy with partial response and was scheduled for a lobectomy. Before surgery, a fibroscopy was performed which demonstrated a 1-cm polypoid lesion settled on the internal face of the main right bronchus corresponding to the EBUS puncture site. The histological analysis confirmed tumoral cell in this lesion. The patient was rejected for surgery and undergo chemoradiation. This case highlights the need for a careful endoscopic control before surgical resection in case of prior positive EBUS followed by an interval of time.

Abstract PD11-01: Adherence to the new WCRF cancer prevention recommendations associates with a decreased breast cancer risk

Background: Breast cancer remains the leading cancer in women. In 2018, following its summary report, the World Cancer Research Fund (WCRF) issued its recommendations for cancer prevention based on the nutritional risk factors with a sufficient level of evidence, several of which being related to breast cancer. Our objective was to study whether adherence to these new recommendations was actually associated with reduced risk of breast cancer.

Methods: A total of 62,546 women from the NutriNet-Santé population-based cohort study (2009-2019) were included in our analyses. Adherence to the 2018 WCRF recommendations was assessed using the operationalized score on a 7-point scale, proposed by Shams-White et al (Nutrients 2019), including: weight, physical activity, fruit and vegetables, dietary fibers, ultra-processed foods, red and processed meat, sugary drinks and alcohol. Usual dietary intakes were assessed using repeated 24h-dietary records and physical activity level using the IPAQ questionnaire. Cox proportional hazard models were computed with adjustment for the following potential confounders: educational level, height, smoking status, number of 24h dietary records, family history of cancer, number of biological children, age at menarche, age at parity, menopausal status, use of oral contraception or hormonal treatment for menopause.

Results: During a median follow-up of 7.3 years, 745 women were diagnosed with a first incident breast cancer. The median WCRF 2018 adherence score was 3.75 (IQR: 3.25-4.50). An increase of 1-point increment in the score was associated with a decreased risk of breast cancer (HR=0.92; 95%CI 0.85-1.00; P=0.05), and especially of breast cancer post-menopause (n=456 cases, HR=0.88; 0.79-0.98; P=0.02). No association was observed for breast cancer pre-menopause (n=289, HR=0.99; 0.87-1.12; P=0.8). Sugary drink, alcohol and weight components of the score particularly contributed to the observed association.

Conclusions: Our results suggest that a higher adherence to the WCRF 2018 recommendations for cancer prevention is associated to a decreased risk of breast cancer. Considering that the WCRF cancer recommendations are consistent with overall food-based dietary guidelines, such recommendations should be promoted to the general public and transposed as public health actions to contribute to decrease the burden of cancer.

Citation Format: Mélanie Deschasaux, Laurent Bourhis, Laurent Zelek, Eloi Chazelas, Charlotte Debras, Serge Hercberg, Paule Latino-Martel, Chantal Julia, Emmanuelle Kesse-Guyot, Bernard Srour, Mathilde Touvier. Adherence to the new WCRF cancer prevention recommendations associates with a decreased breast cancer risk [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD11-01.

Budget Impact Analysis of Fixed Dose Versus Weight-Based Dosing Regimen of Nivolumab and Pembrolizumab in the Treatment of Non-Small Cell Lung Cancer

In 2018, dosing regimens of the two most prescribed immune check point inhibitors (ICI), nivolumab (Opdivo®) and pembrolizumab (Keytruda®), in the treatment of lung cancer were changed from weight-based dosing to fixed dosing. The aim of this study was to compare the economic impact of this change in our university hospital group and then across Ile-de-France, the most inhabited French region. A budget impact analysis (BIA) has been performed on the French public health insurance data. The duration of treatment and the weight of the patients were calculated using data from the patients treated at our health facility and from clinical studies. The cost of treatment was calculated at the local level of our health facility and then for Ile-de-France. Our model demonstrates an additional cost of €550,115 in our hospital and €9,704,778 in Ile-de-France for a fixed dose prescription in 2018. In 2019, the BIA concluded an additional cost, according to the respective low and high assumptions, of €556,969 and €756,544 locally and € 10,201,027 to €14,486,141 for Ile-de-France for an equivalent efficacy between the two different drug dosing regimens of nivolumab and pembrolizumab. The adoption of the fixed dose regimen would lead, according to the least expensive hypothesis, to an additional cost of 26% for the ICI. These results encourage reflection on the strict adoption of this dosage modification. The option of maintaining the free choice between a prescription adapted to weight or in a fixed dose seems a relevant option and should be considered.

Total and added sugar intakes, sugar types, and cancer risk: results from the prospective NutriNet-Santé cohort

BACKGROUND

Excessive sugar intake is now recognized as a key risk factor for obesity, type 2 diabetes, and cardiovascular diseases. In contrast, evidence on the sugar-cancer link is less consistent. Experimental data suggest that sugars could play a role in cancer etiology through obesity but also through inflammatory and oxidative mechanisms and insulin resistance, even in the absence of weight gain.

OBJECTIVE

The objective was to study the associations between total and added sugar intake and cancer risk (overall, breast, and prostate), taking into account sugar types and sources.

METHODS

In total, 101,279 participants aged >18 y (median age, 40.8 y) from the French NutriNet-Santé prospective cohort study (2009-2019) were included (median follow-up time, 5.9 y). Sugar intake was assessed using repeated and validated 24-h dietary records, designed to register participants' usual consumption for >3500 food and beverage items. Associations between sugar intake and cancer risk were assessed by Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors).

RESULTS

Total sugar intake was associated with higher overall cancer risk (n = 2503 cases; HR for quartile 4 compared with quartile 1: 1.17; 95% CI: 1.00, 1.37; Ptrend = 0.02). Breast cancer risks were increased (n = 783 cases; HRQ4vs.Q1 = 1.51; 95% CI: 1.14, 2.00; Ptrend = 0.0007). Results remained significant when weight gain during follow-up was adjusted for. In addition, significant associations with cancer risk were also observed for added sugars, free sugars, sucrose, sugars from milk-based desserts, dairy products, and sugary drinks (Ptrend ≤ 0.01).

CONCLUSIONS

These results suggest that sugars may represent a modifiable risk factor for cancer prevention (breast in particular), contributing to the current debate on the implementation of sugar taxation, marketing regulation, and other sugar-related policies. This trial was registered at clinicaltrials.gov as NCT03335644.

[Nomadism of patients treated by radiotherapy in Île-de-France: Does our health system have as much money to waste?]

PURPOSE

Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home.

MATERIALS AND METHODS

Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes.

RESULTS

In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros.

CONCLUSION

Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.

Comparison of Mobility Indices for Predicting Early Death in Older Patients With Cancer: The Physical Frailty in Elderly Cancer Cohort Study

BACKGROUND

To assess and compare the ability of five mobility indices to predict 6-month mortality in older patients with cancer.

METHODS

All consecutive ambulatory older patients with cancer referred for a geriatric assessment before a cancer treatment decision were included in a prospective two-center cohort study (Physical Frailty in Elderly Cancer) between 2013 and 2017. The mobility indices compared were the short physical performance battery, gait speed, hand grip strength, the one-leg stance balance test, and repeated falls. The primary endpoint was 6-month overall mortality. The adjusted hazard ratio (95% confidence interval [CI]) for each mobility index was estimated using a multivariate Cox proportional hazard model adjusted for sex, the Cumulative Illness Rating Scale for Geriatrics, the body mass index, cancer site/extension, and the provision of supportive care alone. The models' predictive performances were assessed in terms of Harrell's C index, net reclassification improvement, and the standardized net benefit.

RESULTS

A total of 603 patients included (mean age: 81.2 ± 6.1 years; women: 54%; metastatic cancer: 45%). In multivariate analyses, an impairment in any of the mobility indices (with the exception of repeated falls) was independently associated with 6-month mortality following a geriatric assessment; the adjusted hazard ratio [95% CI] ranged from 2.35 [1.34-4.13] for the one-leg stance balance (C index: 0.74) to 3.03 [1.93-4.76] for the short physical performance battery (C index: 0.77). For each mobility index, inclusion in the multivariate model improved significantly the latter's prediction of 6-month mortality.

CONCLUSIONS

Among mobility tests, short physical performance battery had the best discriminative value for predicting 6-month mortality in older patients with cancer.

Expression of angiopoietin-like 4 fibrinogen-like domain (cANGPTL4) increases risk of brain metastases in women with breast cancer

Background: Brain metastases challenge daily clinical practice, and the mechanisms by which cancer cells cross the blood-brain barrier remain largely undeciphered. Angiopoietin-like 4 (ANGPTL4) proteolytic fragments have controversial biological effects on endothelium permeability. Here, we studied the link between ANGPTL4 and the risk of brain metastasis in cancer patients.

Materials and Methods: From June 2015 to June 2016, serum samples from 113 cancer patients were prospectively collected, and ANGPTL4 concentrations were assessed. Using a murine model of brain metastases, we investigated the roles of nANGPTL4 and cANGPTL4, the two cleaved fragments of ANGPTL4, in the occurrence of brain metastases.

Results: An ANGPTL4 serum concentration over 0.1 ng/mL was associated with decreased overall-survival. Multivariate analyses found that only breast cancer brain metastases were significantly associated with elevated ANGPTL4 serum concentrations.

4T1 murine breast cancer cells were transfected with either nANGPTL4- or cANGPTL4-encoding cDNAs. Compared to mice injected with wild-type 4T1 cells, mice injected with nANGPTL4 cells had shorter median survival (p < 0.05), while mice injected with cANGPTL4 had longer survival (p < 0.01). On tissue sections, compared to wild-type mice, mice injected with nANGPTL4 cells had significantly larger surface areas of lung metastases (p < 0.01), and mice injected with cANGPTL4 had significantly larger surface areas of brain metastases (p < 0.01).

Conclusions: In this study, we showed that a higher expression of Angiopoietin-like 4 Fibrinogen-Like Domain (cANGPTL4) was associated with an increased risk of brain metastases in women with breast cancer.

Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE

Background: To develop, validate, and assess the clinical impact of a clinical score to predict a 6-month mortality risk among older cancer patients.

Results: The mean age was 81.2 ± 6.1 years (women: 54%, various cancers, metastatic cancer: 45%). The score, namely the GRADE, included two geriatric variables (unintentional weight loss, impaired mobility), two oncological variables (cancer site, cancer extension), and exclusively supportive care. Up to a 14% risk of early death, the decision curves suggest that cancer treatment should be instated.

Conclusion: We have developed and validated a simple score, easy to implement in daily oncological practice, to predict early death among older cancer patients which could guide oncologists in their treatment decisions.

Methods: 603 outpatients prospectively included in the Physical Frailty in Elderly Cancer patients cohort study. We created a multivariate prediction model by evaluating the strength of the individual components of the Geriatric Assessment regarding risk of death at 6 months. Each component was evaluated by univariate analysis and the significant variables (P ≤ 0.20) were carried on as covariates in the multivariate cox proportion hazard analysis. The beta coefficients from the model were used to build a point-based scoring system. Clinical impact was assessed using decision curves.

Abstract P5-08-09: Sugar consumption and breast cancer risk: Results from NutriNet-Santé prospective cohort

Background: The impact of sugar consumption on diabetes and cardiovascular disease risks is well established. In contrast, the level of evidence regarding the role of sugar in cancer onset is still very limited. However, simple sugars could have a deleterious effect on cancer risk via different mechanisms, such as weight gain, but also through inflammation or insulin resistance. We recently showed that an increased consumption of sugary drinks was associated with cancer incidence, in particular, with breast cancer in the NutriNet-Santé cohort (Chazelas BMJ 2019).

Objective: Our objective was to expand this research to all sugary products and to prospectively investigate the association between the consumption of sugar (simple sugar, added sugar, sugar from different food sources) and risk of breast cancer (overall, premenopausal and postmenopausal) in a large cohort of French adults.

Design: Population based prospective cohort study.

Setting and participants: 79,742 female participants aged ≥ 18y (mean age: 41.0±14.0y) from the French NutriNet-Santé cohort (2009- 2019) were included. Consumption of sugar were assessed using repeated 24h-dietary records, designed to register participants’ usual consumption for more than 3,500 different food and beverages items.

Main outcome measures: Prospective associations between sugar consumption and risk of breast (premenopausal, postmenopausal and both) cancer were assessed by multivariable Cox proportional hazard models adjusted for known risk factors.

Results: The consumption of sugar was significantly associated with higher breast cancer risk (n=783 cases, HRfor a 10g/d increase=1.05, 95% confidence interval 1.01 to 1.09, P for trend=0.02), so was the consumption of added sugar (n=783 cases, HRfor a 10g/d increase=1.07, 95% confidence interval 1.02 to 1.12, P for trend=0.01) and more specifically with postmenopausal breast cancer (n=459 cases, HRfor a 10g/d increase=1.08, 95% confidence interval 1.01 to 1.16, P for trend=0.02). The consumption of sugar from sugary drinks was significantly associated with breast cancer (n=783 cases, HRfor a 10g/d increase=1.09, 95% confidence interval 1.01 to 1.17, P for trend=0.03). The overall consumption of sugar from sugary food and beverages (excluding fruits) was significantly associated with breast cancer risk (n=783 cases, HRfor a 10g/d increase=1.07, 95% confidence interval 1.02 to 1.11, P for trend=0.003).

Conclusion In this large prospective study, a greater consumption of sugar, added sugars, sugary food and beverages was associated with an increased risk of breast cancer, especially after menopause. These results need replication in other large-scale prospective studies. They suggest that sugar and sugary foods, whose consumption is increasing in Western countries, may potentially represent a modifiable risk factor for breast cancer prevention.

Citation Format: Charlotte Debras, Eloi Chazelas, Bernard Srour, Laurent Zelek, Emmanuelle Kesse-Guyot, Chantal Julia, Nathalie Druesne-Pecollo, Pilar Galan, Serge Hercberg, Paule Latino-Martel, Mélanie Deschasaux, Mathilde Touvier. Sugar consumption and breast cancer risk: Results from NutriNet-Santé prospective cohort [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-09.

Abstract P6-10-01: Consumption of sugar-containing beverages and cancer risk: Results from the NutriNet-Santé prospective cohort

OBJECTIVE

To assess the associations between the consumption of sugar-containing and artificially sweetened beverages and cancer risk.

DESIGN

Population based prospective cohort study.

SETTING AND PARTICIPANTS

Overall, 101 257 participants aged ≥18y (mean age: 42.2±14.4y) from the French NutriNet-Santé cohort (2009-2017) were included. Consumptions of sugar-containing and artificially sweetened beverages were assessed using repeated 24h-dietary records, designed to register participants' usual consumption for 3300 different food and beverage items.

MAIN OUTCOME MEASURES

Associations between beverage consumption and overall, breast, prostate and colorectal cancer risk were assessed by multivariable Cox Proportional Hazard models adjusted for known risk factors.

RESULTS

A 100mL increase in the consumption of sugar-containing beverages was significantly associated with an increased risk of overall cancer (HR=1.08, 95% confidence interval 1.04 to 1.12, P&lt;.0001) and breast cancer (HR=1.11, 95% confidence interval 1.04 to 1.19, P&lt;0.002). The consumption of artificially sweetened beverages was not associated with cancer risk. In sub-analyses, a 100 mL increase in the consumption of 100% fruit juice was significantly associated with an increased risk of overall cancers (HR=1.08, 95% confidence interval 1.02 to 1.15, P=0.01). These associations were strongly mediated by the sugar contained in these beverages. In contrast, weight gain during follow-up did not appear as a strong mediator. Besides, results were similar in overweight and non-overweight participants.

CONCLUSIONS

In this large prospective study, a 100mL increase in the consumption of sugar-containing beverages in the diet was associated with an 8% significant increase in overall cancer risk and an 11% significant increase in breast cancer risk. 100% fruit juices were also associated with an 8% increased risk of overall cancers. Given the massive consumption of sugar-containing beverages in Western countries, these results suggest that they may represent a key modifiable risk factor for cancer prevention.

Citation Format: Chazelas E, Srour B, Desmetz E, Kesse-Guyot E, Julia C, Druesne-Pecollo N, Galan P, Zelek L, Hercberg S, Latino-Martel P, Deschasaux M, Touvier M. Consumption of sugar-containing beverages and cancer risk: Results from the NutriNet-Santé prospective cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-10-01.

Monitoring anti-PD-1-based immunotherapy in non-small cell lung cancer with FDG PET: introduction of iPERCIST

Background

Immunotherapy represents a new therapeutic approach in non-small cell lung carcinoma (NSCLC) with the potential for prolonged benefits. Because of the systemic nature and heterogeneity of tumoral diseases, as well as the immune restoration process induced by immunotherapy, the assessment of therapeutic efficacy is challenging, and the role of FDG PET is not well established. We evaluated the potential of FDG PET to monitor NSCLC patients treated with a checkpoint inhibitor.

Results

This was a retrospective analysis of 28 NSCLC patients treated with nivolumab, a programmed cell death 1 (PD-1) blocker. All patients underwent a PET scan before treatment (SCAN-1) and another scan 2 months later (SCAN-2). Disease progression was assessed by immune PET Response Criteria in Solid Tumors (iPERCIST), which was adapted from PERCIST; and the immune Response Evaluation Criteria in Solid Tumors (iRECIST). iPERCIST is a dual-time-point evaluation of “unconfirmed progressive metabolic disease” (UPMD) status at SCAN-2. UPMD at SCAN-2 was re-evaluated after 4 weeks with SCAN-3 to confirm PMD. Patients with complete/partial metabolic response (CMR or PMR) or stable metabolic disease (SMD) at SCAN-2 or -3 were considered responders. Patients with UPMD confirmed at SCAN-3 were considered non-responders. The Kaplan-Meier method was used to estimate survival. At SCAN-2, we found 9/28 cases of PMR, 4/28 cases of SMD, 2/28 cases of CMR, and 13/28 cases of UPMD. Four of the 13 UPMD patients were classified as responders at SCAN-3 (PMR n = 1, SMD n = 3). The remaining nine UPMD patients were classified as non-responders due to clinical degradation, and treatment was stopped. The median follow-up was 16.7 months [3.6–32.2]. Responders continued treatment for a mean of 10.7 months [3.8–26.3]. Overall survival was longer for responders than that for non-responders (19.9 vs. 3.6 months, log rank p = 0.0003). The 1-year survival rates were 94% for responders and 11% for non-responders. A comparison with iRECIST showed reclassification in 39% (11/28) of patients with relevant additional prognostic information.

Conclusions

iPERCIST dual-time-point evaluation might be a powerful tool for evaluating anti-PD-1-based immunotherapy, with the ability to identify patients who can benefit most from treatment. The prognostic value of iPERCIST criteria should be confirmed in large prospective multicentric studies.

Electronic supplementary material

The online version of this article (10.1186/s13550-019-0473-1) contains supplementary material, which is available to authorized users.

A successful compartmental approach for the treatment of breast cancer brain metastases

BACKGROUND

Brain metastases are challenging daily practice in oncology and remain a compartmental problem since most anti-cancer drugs do not cross the blood-brain barrier at relevant pharmacological concentrations.

METHODS

In a young woman with HER2-overexpressing breast cancer resistant to standard treatments, at the time of brain metastases progression, a ventricular reservoir was implanted for intrathecal drug injections and detailed pharmacokinetic studies.

RESULTS

A first association of intrathecal trastuzumab with intravenous cisplatin was offered to the patient. For trastuzumab, the mean cerebrospinal fluid trough concentration of 53.4 mg/L reached relevant levels, enabling the stabilization of the metastases. Adding intravenous cisplatin was not beneficial, since the cerebrospinal fluid exposure was almost undetectable under 0.08 mg/L. We then offered the patient an intrathecal combination of trastuzumab and methotrexate, because of their in vitro synergic cytotoxicity. The cerebrospinal fluid peak of methotrexate was 1037 µmol/L at 2 h, and the concentrations remained above the theoretical therapeutic concentration. After 2 months of this drug combination, we obtained an excellent response on the brain metastases.

CONCLUSION

Our preliminary study supports the interest of a compartmental approach through a direct administration of drugs into the cerebrospinal fluid for the treatment of breast cancer brain metastases.

Immunotherapy for LELC: Case Report and a Focused Review

Lymphoepithelioma-like carcinoma of the lung (LELC) is a rare, Epstein-Barr virus-associated tumor. LELC occurs mostly in young, Asian nonsmokers. A few hundred cases have been reported, mostly from retrospective Asian studies. Optimal treatment has not been clearly established. Treatment options are based on surgery for early stage and on cisplatin-based chemotherapy as first-line therapy for metastatic disease. Prognosis may seem better than for other types of non-small-cell lung cancer, but it remains poor in advanced disease, with a median survival of 24 months, and new treatments options are still warranted. Immunotherapies are now key players in the treatment of non-small-cell lung cancer. However, few data are available for this rare histologic subgroup. We have reviewed the available data on LELC with a focus on the first few cases reported with a response to a programmed cell death 1 inhibitor.

Impact of the addition of bevacizumab, oxaliplatin, or irinotecan to fluoropyrimidin in the first-line treatment of metastatic colorectal cancer in elderly patients

INTRODUCTION

The clinical benefit of double-front-line therapy (including oxaliplatin or irinotecan or bevacizumab plus 5-fluorouracil (5FU) or capecitabine) compared to monotherapy (5FU or capecitabine) in elderly (> 70 years) patients with metastatic colorectal cancer (MCRC) is controversial. We performed a meta-analysis of published randomized studies.

MATERIALS AND METHODS

The selection of the studies was carried out using PubMed with the following keywords: "metastatic colorectal cancer," "elderly," "oxaliplatin," "irinotecan," "bevacizumab," "survival." The efficacy endpoints were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) with their 95% confidence intervals (CIs) were collected from the studies and pooled. By convention, an HR < 1 was a result in favor of biotherapy.

RESULTS

This meta-analysis (MA) included ten studies: three assessing irinotecan (FFCD 2001-02, CAIRO, and an already published MA by Folprecht), three assessing oxaliplatin (FOCUS2, FFCD 2000-05, and a published study by De Gramont), and four assessing bevacizumab (PRODIGE-20, AVEX, AGITG-MAX, and "AVF2192g" by Kabbinavar). Our MA included 1652 patients (62% of men). Concerning age, we chose a cut-off of 70 years or a cut-off of 75 years, corresponding to the available data for each study. The performance index (PS) was 0-1 for about 90% of patients, with the exception of FFCD 2001-02 and FOCUS2 which included 30% of patients with PS2. Overall, the addition of bevacizumab to fluoropyrimidin statistically improves both OS and PFS (HR = 0.78; CI 0.63-0.96 and HR = 0.55; CI 0.44-0.67, respectively). The addition of oxaliplatin did not statistically improve OS (= 0.99; CI 0.85-1.17) but improves PFS (HR = 0.81; CI 0.67-0.97) as well as the addition of irinotecan (HR = 1.01; CI 0.84-1.22 and HR = 0.82; CI 0.68-1.00, respectively).

CONCLUSION

In previously untreated elderly patients with MCRC, the addition of bevacizumab to fluoropyrimidin appears more effective in terms of OS or PFS than the addition of oxaliplatin or irinotecan.

Micromolecular methods for diagnosis and therapeutic strategy: a case study

An intraductal carcinoma, 55 mm across, was diagnosed on a total mastectomy in a 45-year-old woman. The 2 micro-invasive areas found were too small for reliable immunostainings for estrogen, progesterone, and HER2 receptors. In the sentinel lymph-node, a subcapsular tumor embole of about 50 cancer cells was identified on the extemporaneous cryo-cut section, but not on further sections after paraffin-embedding of the sample.

Considering this tumor metastatic potential, we decided to assess HER2 status on the metastatic embole using pathological and molecular micro-methods. We laser-microdissected the tumor cells, extracted their DNA, and performed droplet-digital-PCR (ddPCR) for HER2 gene copy number variation. The HER2/RNaseP allele ratio was 5.2 in the laser-microdissected tumor cells, similar to the 5.3 ratio in the HER2-overexpressing breast cancer cell line BT-474.

We thus optimized the adjuvant treatment of our patient and she received a trastuzumab-based adjuvant chemotherapy.

Abstract P5-12-02: B-vitamin intake from diet and supplements and breast cancer risk in middle-aged women: Results from the prospective NutriNet-Santé cohort

Experimental studies suggest a protective effect of B-vitamins on breast cancer risk, potentially modulated by alcohol intake. However, epidemiological studies are limited, especially regarding non-folate B-vitamins. Furthermore, few of them included quantitative assessment of supplemental intake. This prospective study aimed at investigating the associations between intakes of B-vitamins (dietary, supplemental, total) and breast cancer risk. 27,853 women aged ≥45y from the NutriNet-Santé cohort (2009-2016) were included, with a median follow-up time of 4.2 years. Dietary data were collected using repeated 24h records. A specific questionnaire assessed dietary supplement use over a 12-month period. A composition database of 8000 supplements was developed. Associations were characterized by multivariable Cox models. 462 incident breast cancers were diagnosed. Dietary (HRQ4vs.Q1=0.74(0.55,0.99), P-trend=0.05), supplemental (HRQ4vs.Q1=0.61(0.38,0.98), P-trend=0.05) and total (HRQ4vs.Q1=0.67(0.50,0.91), P-trend=0.01) pyridoxine intakes were inversely associated with breast cancer risk. Total thiamin intake was borderline inversely associated with breast cancer risk (HRper 1-unit increment=0.78(0.61,1.00), P=0.05). Statistically significant interactions between alcohol consumption and B-vitamin (thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, folate, and cobalamin) supplemental intake were observed, the latter being inversely associated with breast cancer risk in non-to-low alcohol drinkers but not in higher drinkers. This large prospective study, including quantitative assessment of supplemental intake, suggests a potential protective effect of pyridoxine and thiamin on breast cancer risk in middle-aged women.

Citation Format: Egnell M, Fassier P, Lécuyer L, Zelek L, Vasson M-P, Hercberg S, Latino-Martel P, Galan P, Deschasaux M, Touvier M. B-vitamin intake from diet and supplements and breast cancer risk in middle-aged women: Results from the prospective NutriNet-Santé 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 P5-12-02.

Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review

BACKGROUND & AIMS

To assess the prevalence of sarcopenia before cancer treatment and its predictive value during the treatment.

METHODS

We searched MEDLINE via PubMed for articles published from 2008 to 2016 that reported prospective observational or interventional studies of the prevalence of pre-therapeutic sarcopenia and its consequences in adults with cancer who were 18 years or older. Two independent reviewers selected articles based on titles and/or abstracts before a complete review. Sarcopenia had to be measured before cancer treatment. Methods recommended by consensuses (CT scan, MRI, dual X-ray absorptiometry or bio-impedancemetry) to assess sarcopenia were considered. Characteristics of the studies included the prevalence of pre-therapeutic sarcopenia and the prognostic value for outcomes during the cancer treatment.

RESULTS

We selected 35 articles involving 6894 participants (in/out patients, clinical trials). The mean age ranged from 53 to 69.6 years. Pre-therapeutic sarcopenia was found in 38.6% of patients [95% CI 37.4-39.8]. Oesophageal and small-cell lung cancers showed the highest prevalence of pre-therapeutic sarcopenia. Pre-therapeutic sarcopenia was significantly and independently associated with post-operative complications, chemotherapy-induced toxicity and poor survival in cancer patients.

CONCLUSIONS

Pre-therapeutic sarcopenia is highly prevalent in cancer patients and has severe consequences for outcomes of cancer patients.

FDG-PET in the assessment of metabolic response in patients with NSCLC treated with nivolumab: Preliminary results

e20554

Background: Immunotherapy becomes a standard treatment in non-small-cell lung carcinoma (NSCLC), locally advanced or metastatic, after prior chemotherapy. Because of systemic involvement and heterogeneity of the tumoral disease, methods of assessment are complex and the role of PET-FDG is not well established. The objective of the present study is to describe the results of FDG-PET in the evaluation of patients with NSCLC treated with checkpoint inhibitor (OPDIVO®, Nivolumab) in our academic center. Methods: A retrospective analysis of FDG-PET’s data was performed in 16 patients (performance status: 1), with NSCLC (13 adenocarcinoma, 2 squamous cell carcinoma and 1 large cell neuroendocrine carcinoma) and progression after at least one line of treatment, and treated with Nivolumab. All patients had an FDG-PET before and at 2 months (M2) of treatment. Patients showing progression at M2 had a third PET at M3 to confirm disease progression. Disease responses were assessed according to PERCIST criteria. Patients were considered as responders to Nivolumab treatment, if the treatment was pursued at least 6 months, or as non-responders if the treatment was pursued less than 6 months. Pseudoprogression was defined as a disease progression at M2, which was not confirmed on FDG-PET control at M3. Results: Assessment by FDG-PET after 2 months of treatment showed 8/16 partial metabolic responses (PMR), 6/16 progressive diseases (PD), 1/16 stable disease (SD) and 1/16 complete metabolic response (CMR). Among the patients with PMR, SD or CMR at M2 (n = 10), 90% (9/10) were considered as responders and 10% (1/10) as non-responder. Nivolumab was discontinued in patients with PD. One patient showed a pseudo progression at M2 (PMR at M3), and was eventually classified as non-responder. Conclusions: These results show an association between the metabolic response at M2 and the continuation of the treatment with Nivolumab in NSCLC patients. 90% of patients with early metabolic response showed a sustained response with Nivolumab. FDG-PET could be helpful in the therapeutic strategy of these patients and deserves to be assessed in prospective trials including a cost/benefit evaluation.

Modifications in dietary and alcohol intakes between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort

Postdiagnosis diet and alcohol consumption may be associated with cancer prognosis, recurrence and mortality. Our aim was to investigate food, nutrient and alcohol intake variations between before and after cancer diagnosis and their determinants in a prospective cohort. Subjects (n = 696) were incident cancer cases diagnosed in the NutriNet‐Santé cohort between 2009 and 2016. Food, nutrient and alcohol intakes were prospectively collected using repeated nonconsecutive 24‐hr dietary records since subjects' inclusion (i.e. an average of 2 y before diagnosis). Mean number of dietary records per subject was 5.9 before and 8.1 after diagnosis. All dietary data before and after diagnosis were compared by mixed models. Factors associated with the main dietary changes observed were also investigated using multivariable logistic regressions. We observed a decrease in intakes of vegetables (mean decrease in intake in patients who decreased their intake=‐102.4 ± 79.8 g/d), dairy products (–93.9 ± 82.8 g/d), meat/offal (–35.5 ± 27.8/d), soy products (–85.8 ± 104.1 g/d), sweetened soft drinks (–77.9 ± 95.4 g/d), and alcoholic drinks (–92.9 ± 119.9 g/d), and an increase in broths (42.1 ± 34.9 g/d) and fats/sauces (18.0 ± 13.4 g/d). We observed a decrease in energy intake (–377.2 ± 243.5 kcal/d) and in intakes of alcohol (–7.6 ± 9.4 g/d) proteins (–17.4 ± 12.5 g/d), and several vitamins (p < 0.05) and micronutrients (p < 0.05). Conversely, lipid (19.4 ± 14.6 g/d), SFA (9.3 ± 7.0 g/d), MUFA (8.3 ± 6.3 g/d) and vitamin E (3.9 ± 3.3 mg/d) intakes increased after diagnosis. This large prospective study suggests that cancer diagnosis is a key period for nutritional changes. It highlights some healthy behaviors such as a decrease in alcohol and sweetened drink consumption, but also less favorable trends, such as a decrease in vegetable consumption and in many vitamin and mineral intakes. These results provide insights to identify and target recommendations to put forward for better nutritional care of cancer survivors.

What's new?

Postdiagnosis diet and alcohol consumption may be associated with cancer prognosis, recurrence and mortality. In this study, the authors analyzed the socio‐demographic, economic, lifestyle and clinical factors associated with these dietary changes. They found that, while there was a decrease in alcohol consumption, there were a number of less favorable trends, such as decreased vegetable consumption and nutrient intake. These results offer insights to identify and target dietary recommendations to improve prognosis and quality of life for cancer patients.

B-Vitamin Intake from Diet and Supplements and Breast Cancer Risk in Middle-Aged Women: Results from the Prospective NutriNet-Santé Cohort

Experimental studies suggest a protective effect of B-vitamins on breast cancer risk, potentially modulated by alcohol intake. However, epidemiological studies are limited, especially regarding non-folate B-vitamins. Furthermore, few studies included quantitative assessment of supplemental intake. This prospective study aimed to investigate the associations between intakes of B-vitamins (dietary, supplemental, total) and breast cancer risk. 27,853 women aged ≥45 years from the NutriNet-Santé cohort (2009–2016) were included, with a median follow-up time of 4.2 years. Dietary data were collected using repeated 24 h records. A specific questionnaire assessed dietary supplement use over a 12-month period. A composition database of 8000 supplements was developed. Associations were characterized by multivariable Cox models, and 462 incident breast cancers were diagnosed. Dietary (HR_Q4vs.Q1 = 0.74 (0.55, 0.99), P-trend = 0.05), supplemental (HR_Q4vs.Q1 = 0.61 (0.38, 0.98), P-trend = 0.05), and total (HR_Q4vs.Q1 = 0.67 (0.50, 0.91), P-trend = 0.01) pyridoxine intakes were inversely associated with breast cancer risk. Total thiamin intake was borderline inversely associated with breast cancer risk (HR_{per 1-unit increment} = 0.78 (0.61, 1.00), P = 0.05). Statistically significant interactions between alcohol consumption and B-vitamin (thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, folate, and cobalamin) supplemental intake were observed, the latter being inversely associated with breast cancer risk in non-to-low alcohol drinkers but not in higher drinkers. This large prospective study, including quantitative assessment of supplemental intake, suggests a potential protective effect of pyridoxine and thiamin on breast cancer risk in middle-aged women.

Sociodemographic and economic factors are associated with weight gain between before and after cancer diagnosis: results from the prospective population-based NutriNet-Santé cohort

Purpose

While many cancer patients are affected by weight loss, others tend to gain weight, which may impact prognosis and risk of recurrence and of second cancer. The aim of this prospective study was to investigate weight variation between before and after cancer diagnosis and socio-demographic, economic, lifestyle and clinical factors associated with moderate-to-severe weight gain.

Methods

1051 incident cases of first primary cancer were diagnosed in the NutriNet-Santé cohort between 2009 and 2015. Weight was prospectively collected every 6 months since subjects’ inclusion (i.e. an average of 2y before diagnosis). Mean weights before and after cancer diagnosis were compared with paired Student's t-test. Factors associated with moderate-to-severe weight gain (≥5% of initial weight) were investigated by age and sex-adjusted logistic regression.

Results

Weight loss was observed in men (-3.54±4.39kg in those who lost weight, p=0.0002) and in colorectal cancer patients (-3.94±4.40kg, p=0.001). Weight gain was observed in breast and skin cancers (2.83±3.21kg, p=0.04, and 2.96±2.75kg, p=0.04 respectively). Women (OR=1.75[1.06-2.87],p=0.03), younger patients (2.44[1.51-3.70],p<0.0001), those with lower income (OR=1.30[1.01-1.72],p-trend=0.007), lower education (OR=1.32[1.03-2.70],p-trend=0.03), excess weight before diagnosis (OR=1.64[1.12-2.42],p=0.01), lower physical activity (OR=1.28[1.01-1.64],p=0.04) and those who stopped smoking (OR=4.31[1.99-9.35],p=0.005]) were more likely to gain weight. In breast cancer patients, induced menopause was associated with weight gain (OR=4.12[1.76-9.67]), but no association was detected for tumor characteristics or treatments.

Conclusion

This large prospective cohort provided original results on weight variation between before and after cancer diagnosis, highlighting different weight trajectories. Socio-demographic and economic factors appeared to influence the risk of weight gain, illustrating social inequalities in health.

Abstract P5-13-13: Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community

BACKGROUND: To enhance compliance with national nutrition recommendations in breast cancer survivors (BCS), a 3-year program granted by the Regional Health Authority began in 2013 in an area (Seine-Saint-Denis, SSD) which is among the poorest in France.

PATIENTS AND METHODS: Ac'Santé 93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using an 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score &gt;30 and considered as severe when &gt;40. Given the high level of poverty in the area and the incidence of financial difficulties in cancer survivors, a particular attention was paid to comparing the costs of different foods in order to promote affordable dietary changes. Between March 2013 and December 2015, 109 BCS were enrolled in a 3-month education program including 3 sessions of a professionally led support group (with dieticians and social workers).

RESULTS: Ten BCS were lost for follow-up before the end of the program; 54 BCS attended all the sessions. Mean age was 52. Median vulnerability score was 51.8 (0-93.48) and 59% of patients had a score &gt;30. Dietary intakes were assessed at baseline, and 1 and 6 mos. after the last session. At 1 mo. 65% BCS had knowledge of healthy dietary choices and 63% were ready to translate it into practice. Of note, 47% BCS decided to enroll in a tailored 1-year physical activity program or planned to do it, although it was not the aim of the study. At 6 mos. 52% of BCS still had knowledge of healthy diet and 49% of turned it into practice. However, only 12% were still practicing physical activity. Barriers were reported in 67% BCS and included asthenia or other treatment side effects (40%), anxiety or depression (27%), reluctance of relatives (20%), social isolation (20%) or cost (18%). Semi-directive interviews revealed unexpected benefits from this program such as empowerment, socialization or improvement of body image.

CONCLUSION: A short-term dietary intervention is feasible in vulnerable BCS living in an underserved area and improves adherence to higher quality diet in a meaningful number of patients. In spite of the attention paid to the affordability of dietary modifications, numerous barriers still exist in this population, the main one being treatment related side effects, including fatigue. Furthermore, compliance to a tailored physical activity program spontaneously decreases over time.

Citation Format: Zelek L, Festa A, Bodere C, Morello S. Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community [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 P5-13-13.

Abstract P5-13-01: Sociodemographic and economic factors are essential determinants of weight gain between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort

Background: While many cancer patients are affected by weight loss, others tend to gain weight, which may impact prognosis and risk of recurrence and of second cancer. The aim of this prospective study was to investigate weight variation between before and after cancer diagnosis and socio-demographic, economic, lifestyle and clinical factors associated with moderate-to-severe weight gain.

Methods: 1051 incident cases of first primary cancer were diagnosed in the NutriNet-Santé cohort between 2009 and 2015. Weight was prospectively collected every 6 months since subjects' inclusion (i.e. an average of 2y before diagnosis). Mean weights before and after cancer diagnosis were compared with paired Student's t-test. Factors associated with moderate-to-severe weight gain (≥5% of initial weight) were investigated by multivariable logistic regression.

Results: Weight loss was observed in men (-3.54kg in those who lost weight, p=0.0002) and in colorectal cancer patients (-3.94kg, p=0.0012). Weight gain was observed in breast and skin cancers (2.83kg, p=0.047, and 2.96kg, p=0.03 respectively). Women (OR=1.99[1.18-3.35]), younger patients (OR=1.78[1.05-3.03]), those with lower education (OR=2.17[1.07-4.37]), those with excess weight before diagnosis (OR=1.53[1.02-2.30]) and those who stopped smoking after diagnosis (OR=4.60[2.06-10.25]) were more likely to experience moderate-to-severe weight gain. In breast cancer patients, induced menopause was associated with weight gain (OR=4.12[1.76-9.67]), but no association was detected for tumor characteristics or treatments.

Conclusion: This large prospective cohort provided original results on weight variation between before and after cancer diagnosis, highlighting different weight trajectories. Socio-demographic and economic factors appeared to strongly influence the risk of weight gain, illustrating social inequalities in health.

Citation Format: Fassier P, Zelek L, Partula V, Lecuyer L, Srour B, Bachmann P, Touillaud M, Druesne-Pecollo N, Galan P, Hercberg S, Cohen P, Hoarau H, Latino-Martel P, Gonzalez R, Deschasaux M, Touvier M. Sociodemographic and economic factors are essential determinants of weight gain between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort [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 P5-13-01.

Abstract P5-03-07: The measurement of gait speed: An easy way to select older patients with breast cancer for an adapted therapeutic decision making

Background: Despite recommendations about the adaptation of therapeutic decision making by the International Society of Geriatric Oncology, there is no guidelines concerning breast cancer in older patients for whom a therapeutic decision making should be adapted. Currently, the G8 index ≤ 14/17 is recommended for patients aged 70 and over before a therapeutic decision making to select patients with a potential frailty. Moreover, gait speed (GS) at the threshold of 1 m/s has been reported in a recent review to identify complications associated with frailty in older outpatients. Indeed, these patients could experience poor outcomes with cancer treatments. For these patients, it is expected that they could not have a standardized decision. We aimed to assess the geriatric profil of older patients with breast cancer for whom a therapeutic decision making was adapted.

Methods: 64 outpatients with breast cancer aged 65 and over were prospectively and consecutively included between November 2013 and April 2016, in two teaching hospitals in a Paris suburb (France). All patients had a G8 index, measurement of gait speed over a short distance (4m) and a multidimensional geriatric assessment before therapeutic decision making. An adapted therapeutic decision making was defined if it not followed treatment recommendations based on tumor characteristics (pTNM, grade, status of hormonal receptors, HER2 status, Ki67 index). A univariate and multivariate analysis by using a logistic regression with a stepwise procedure were performed in all patients with an adapted therapeutic decision. Two models were created to assess the value of G8 index and GS. All variables with P &lt; 0.20 were included in both multivariate models. All tests were two sided significant at 0.05. Informed consent was obtained from studied patients prior inclusion. This study was approved by a local committee ethic.

Results: 67% (n=43) of patients had an adapted treatment with a mean age of 82.6 +/- 5.7 years (67-95). Of these patients, 33 had an invasive ductal carcinoma, 23 lymph nod extension, 11 metastatic disease. The mean tumor size was 30.4 +/- 15.4mm. 37 patients had a SBR ≥ 2, 39 positive hormonal receptors, 5 positive HER2 status. The mean KI67 index was 24.2 +/- 20%. 37 received hormonotherapy, 18 surgery, 16 radiotherapy, 5 chemotherapy. Most of these patients (53.5%) had ECOG-PS ≤ 1, 39 G8 index ≤ 14 and 36 GS &lt; 1 m/s. In the first model, GS &lt; 1 m/s was the only variable significantly and independently associated with adapted treatment (aOR=5.65, 95%CI: 1.78-19.31, P=0.003). In the second model, at least one severe comorbidity (CIRSG grade III, aOR=4.52, 95%CI: 1.30-17.84, P=0.02) and cognitive impairment (MMSE&lt;24/30, aOR=4.60, 95%CI: 1.32-17.97, P=0.01) were the only variables significantly and independently associated with adapted treatment. In the two models, G8 index was not significantly associated with adapted treatment.

Conclusion: A slow gait speed &lt; 1 m/s could be used as a screening test to select older patients with breast cancer for an adapted therapeutic decision making.

Citation Format: Pamoukdjian F, Bricou A, Boudabous H, Sebbane G, Zelek L. The measurement of gait speed: An easy way to select older patients with breast cancer for an adapted therapeutic decision making [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 P5-03-07.

Slow Gait Speed Is an Independent Predictor of Early Death in Older Cancer Outpatients: Results from a Prospective Cohort Study

OBJECTIVE

To assess the predictive value of gait speed for early death in older outpatients with cancer.

DESIGN

Prospective bicentric observational cohort study.

SETTING

The Physical Frailty in Elder Cancer patients (PF-EC) study (France).

PARTICIPANTS

One hundred and ninety outpatients with cancer during the first 6 months of follow up in the PF-EC study.

MEASUREMENTS

The association between usual gait speed over 4 m alone (GS) or included in the short physical performance battery (SPPB) and overall survival within 6 months following a comprehensive geriatric assessment (CGA). A Cox proportional-hazard regression model was performed in non-survivors for clinical factors from the CGA, along with c reactive protein (CRP). Two models were created to assess GS alone and from inclusion in the SPPB.

RESULTS

The mean age was 80.6 years, and 50.5% of the participants were men. Death occurred in 11% (n=22) of the participants within the 6 month follow up period. Of these participants, 98% had solid cancers, and 33% had a metastatic disease. A GS < 0.8 m/s (HR=5.6, 95%CI=1.6-19.7, p=0.007), a SPPB < 9 (HR=5.8, 95%CI=1.6-20.9, p=0.007) and a CRP of 50 mg/l or greater (p<0.0001) were significantly associated with early death in the two multivariate analyses. Cancer site and extension were not significantly associated with early death.

CONCLUSION

Walking tests are associated with early death within the 6 month follow up period after a CGA independent of cancer site and cancer extension. GS alone < 0.8 m/s is at least as efficacious as the SPPB in predicting this outcome. GS alone could be used routinely as a marker of early death to adapt oncologic therapeutics. Further studies are needed to validate these preliminary data.

Variations of physical activity and sedentary behavior between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort

Physical activity (PA) but also reduced sedentary behavior may be associated with better prognosis and lower risk of recurrence in cancer patients. Our aim was to quantify the variations in PA and time spent sedentary between before and after diagnosis, relying on prospective data in French adults. We also investigated sociodemographic and lifestyle factors associated with these variations.Subjects (n = 942) were incident cancer cases diagnosed in the NutriNet-Santé cohort between 2009 and 2015. PA and sedentary behavior were prospectively collected with the 7-day short version of the IPAQ questionnaire every year since subjects' inclusion (i.e., an average of 2 year before diagnosis). All PA and sitting time points before and after diagnosis was compared by mixed model. Factors associated with decrease in PA and increase in sitting time were investigated using logistic regressions.Overall and vigorous PA decreased after diagnosis (P = 0.006, -32.8 ± 36.8 MET-hour/week on average, in those who decreased their overall PA and P = 0.005, -21.1 ± 36.8 MET-hour/week for vigorous PA, respectively), especially in prostate (-39.5 ± 36.3 MET-hour/week) and skin (-35.9 ± 38 MET-hour/week) cancers, in men (-40.8 ± 46.3MET-hour/week), and in those professionally inactive (-34.2 ± 37.1 MET-hour/week) (all P < 0.05). Patients with higher PA level before diagnosis were more likely to decrease their PA (odds ratio [OR]: 4.67 [3.21-6.81], P < 0.0001). Overweight patients more likely to decrease moderate PA (OR: 1.45 [1.11-1.89], P = 0.006) and walking (OR: 1.30 [1.10-1.70], P = 0.04). Sitting time increased (P = 0.02, +2.44 ± 2.43 hour/day on average, in those who increased their sitting time), especially in women (+2.48 ± 2.48 hour/day), older patients (+2.48 ± 2.57 hour/day), and those professionally inactive (2.41 ± 2.40 hour/day) (all P < 0.05). Patients less sedentary before diagnosis were more likely to increase their sitting time (OR: 3.29 [2.45-4.42], P < 0.0001).This large prospective study suggests that cancer diagnosis is a key period for change in PA and sedentary behavior. It provides insights to target the subgroups of patients who are at higher risk of decreasing PA and increasing sedentary behavior after cancer diagnosis.