Abstract P6-11-02: Reduced sedentary time intervention for breast cancer survivors: objectively-measured outcomes for activity and metabolism

Physical activity (PA) promotion and sedentary behavior reduction among cancer survivors is a national priority and the number of PA-based behavioral interventions has expanded considerably in recent years. However, due in part to past limitations related to precise quantitative measurement of sedentary behaviors, there have been relatively few trials focused on reduction of sedentary time among cancer survivors. Additionally, many PA interventions rely on clinic-based coaching, which is both time-intensive and unrealistic for many clinics. The purpose of this study was to investigate the effects of a home-based 6-week reduced sedentary time intervention (RSTI) in breast cancer survivors who had completed primary treatment. Questionnaires, anthropometric measures, fasting blood glucose, lipid profiles and other cancer-relevant biomarkers, and an oral glucose tolerance test to assess dynamic insulin were completed at baseline and post-intervention. Participants wore ActivPALs (on right thigh) for 7 days at baseline and post-intervention. The mailed RSTI included tailored feedback on PA and sedentary habits and provision of personalized visual displays generated from baseline ActivPal data, with specific tips for how to reduce sedentarism through environmental modifications to home and work spaces (example: moving your printer from next to your desk to down the hall). Eligibility criteria included: females ages 20-80; not meeting national exercise guidelines (150 minutes per week); diagnosis of Stage I-III breast cancer treated >6 months and <5 years prior; overweight or obese (BMI >25); no history of diabetes. Sixteen enrolled and 13 completed the study. Average BMI at baseline was 31.9 and all participants' daily step counts were significantly below national recommendations (mean=6190 steps/d, SD: 2086 steps/d). Post-intervention changes from baseline were analyzed using non-parametric statistics. No statistically significant changes in daily bouts of sedentarism, energy expenditure, or total steps were detected, although participants' mean daily steps post-intervention were 6326/d (SD: 2788/d), still well below recommended guidelines. Leptin levels also showed a significant reduction pre/post (p<0.01). Results indicate that similar home-based RSTIs are safe, acceptable to survivors, and feasible to implement by cancer center staff. Further research with larger samples is required to establish efficacy and effect sizes for the intervention. A larger intervention dose may be required to see clinically-meaningful changes in sedentarism, daily activity, and metabolism.

Citation Format: Walker RK, Viskochil R, Barham R, Moraitis A, Gagliarducci J, Makari-Judson G. Reduced sedentary time intervention for breast cancer survivors: objectively-measured outcomes for activity and metabolism [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 P6-11-02.

Micronutrient status in Jordan: 2002 and 2010

BACKGROUND/OBJECTIVES

Two national surveys were conducted in Jordan in 2002 and 2010 to investigate the micronutrient status in women and children. To determine the prevalence of anemia, iron and folate deficiency among women and children in 2010 and compare with the prevalence of anemia and iron deficiency in 2002.

SUBJECTS/METHODS

A nationally representative survey was conducted in 2002 (1023 women, 15-49 years of age; 1059 children, 12-59 months of age) and a second survey in 2010 (2035 women; 940 children). Venous blood samples were used to measure hemoglobin, ferritin and red blood cell folate (the latter on a subsample of 393 women).

RESULTS

Among women in 2010, the prevalence of folate deficiency and insufficiency was 13.6% and 82.9%, respectively. Geometric mean serum ferritin was higher in 2010 compared with 2002 (21.3 ng/ml vs 18.3, P=0.01); there was no significant change in the prevalence of iron deficiency (35.1% vs 38.7%, P=0.17), iron deficiency anemia (19.1% vs 20.0%, P=0.61) or anemia (29.2% vs 29.3%, P=0.96). Among children, a significantly lower prevalence was observed in 2010 compared with 2002 for iron deficiency (13.7% vs 26.2% P<0.001) and iron deficiency anemia (4.8% vs 10.1%, P<0.001); a nonsignificant lower prevalence was observed for anemia (16.6% vs 20.2%, P=0.09).

CONCLUSIONS

In 2010, approximately one of seven women was folate deficient and six out of seven were folate insufficient for the prevention of neural tube defects. Between 2002 and 2010, significant improvement was observed in the prevalence of iron deficiency in children, but not in women.

Abstract P2-06-13: Pathway Profiling of Signal Transduction Proteins in Paired Tumor and Adjacent Normal Tissues Obtained from Breast Cancer Patients

Background: Targeted therapeutic strategies are currently limited to patients with hormone receptors and/or HER2 positive disease in breast cancer (BCA) treatment. However, patients often develop resistance to these therapies. The ability to functionally profile a whole spectrum of pathway proteins (and their variants) in tumor may provide valuable information about the potential mechanism for drug resistance and evidence for rational selection of suitable targeted therapies. Here we report a comprehensive profile of HER1, HER2, p95HER2, HER3, cMET, IGF1R, PI3K, Shc, AKT and other signal transduction pathway proteins in BCA tissues and their matched adjacent normal tissues (ANTs). Methods: A multiplexed Collaborative Proximity ImmunoAssay (COPIA), antibody-microarray platform requiring co-localization of 2 detector antibodies on captured biomarker proteins has been used for comprehensive pathway analysis. Channeling events between 2 detector enzymes (glucose oxidase & horse radish peroxidase) in proximity enabled the profiling of the target biomarkers with extreme sensitivity and specificity, and a direct comparison to electrochemiluminescence based immunoassay platform (MSD) was performed for pathway proteins in tumor vs. ANTs for their expression and activation in samples collected from 20 BCA patients. Results: Three dilutions of lysate (10ug, 1ug, 0.1ug) were analyzed for quantitative differential pathway modulation for COPIA.

- Substantially higher cytokeratin (CK) levels were found in 16/20 tumor samples when compared to paired-ANT; 3/20 samples showed high levels of CK in ANTs. Substantial levels of HER3 and IGF1R expression was detected in 9 and 5 tumor samples respectively.

- Over-expression of HER2 with high degree of activation was found in 2 patients. In one of the HER2-overexpressing patients, HER3 was also highly expressed and moderately phosphorylated. Co-expression of cMET and IGF1R was evident as well.

- A significant degree of HER2 phosphorylation was found in many patients with low level HER2 expression; this may be due to co-expression of high level of HER3 and other RTKs with trans-activational potential. Evidence of activated PI3K complex will be reported.

- In direct comparison to MSD, COPIA detected activated pathway proteins in samples that were not detectable with MSD. MSD was sensitive enough to detect the very extreme cases. COPIA appeared to be a more desirable method for detection of protein expression and activation for samples with limited availability. The distinct pathway modulation in each patient (detected by COPIA) will be reported.

Discussion: COPIA was used to detect the differential expression and phosphorylation of HER2, other RTKs and pathway proteins in 20 paired tumor and matched ANTs. As this platform requires magnitudes lower amounts of specimen, it can be used to profile tumors at different metastatic sites and could provide comprehensive metastatic profiles. The comprehensive functional pathway profiling of tumor specimen may provide insightful information for potential drug-resistant mechanisms and may guide appropriate selection of targeted drug-combinations or drug-sequencing.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-06-13.

Therapeutic Implications of Detection of Amplification and Activation of HER2 and Other Receptor Tyrosine Kinases (RTKs) in Circulating Tumor Cells (CTCs) in Recurrent Breast Cancer

Background: HER2 is one of four trans-membrane RTKs in epidermal growth factor receptor family, and HER2-positive phenotype has been associated with aggressive subtype of breast cancer with HER2 gene amplification. Approximately 15-20% of breast cancers are considered HER2-positive by IHC or FISH analysis. Recently, changes in HER2 expression status between primary tumor and CTCs found in recurrent metastatic disease have been reported to occur at a significant frequency. Methods for detecting HER2 expression and phosphorylation in serially collected CTCs may provide valuable insight into the overall disease profile shift, and therefore lead to better selection of therapy for each patient.Methods: A triple-antibody-enzyme-channeling multiplexed protein microarray platform has been developed to detect the phosphorylation on target molecules. Extremely high assay specificity was achieved by immuno-complex formation via co-localization of two detector enzyme-conjugated-antibodies once target proteins are captured on the microarray-surface. The channeling events between two detector enzymes in proximity enabled profiling of the RTKs with a single-cell level sensitivity. In order to validate the method on clinical samples, CTCs from 77 breast cancer patients on different therapy regimens were analyzed at various time points along their course of therapy.Results: Whole blood of 77 metastatic cancer patients and 60 healthy volunteers were analyzed for CTC-HER2 expression and activation. We observed significant HER2 status conversion with recurrent disease. 29% of patients with negative HER2 expression in the primary tumor showed HER2-amplification in isolated CTCs. Phosphorylated HER2 receptors were found in 52% of patients with primary HER2 negative disease. The enhancement of assay sensitivity and specificity using proximity mediated immuno-assay made the detection of HER2 activation (even without amplification) possible when isolated CTCs were stimulated with ligands to other RTKs with transactivation potential.Discussion: The multiplexed-proximity mediated immunoassay successfully detected the expression of HER2 RTKs and their degree of activation in CTCs isolated from recurrent breast cancer patients. As we hypothesize that CTCs found in metastatic stage represent the most aggressive and invasive cell population, serial CTC-profiling can lead to better therapy selection/adjustment and disease/treatment monitoring as there are available options to choose appropriate kinase inhibitors for RTK-targeted therapies. While significant number of patients acquired HER2-amplification in their CTCs, substantially higher rate of CTC-HER2 activation was found in relapsed metastatic disease. The unique triple-antibody mediated immuno-microarray analysis allowed a single cell level profiling of the CTC-HER2. The ability to profile serially collected CTCs will provide valuable information on changes occurring in tumor cells as a function of time and treatment. This method can provide guidance, not only for initial selection of targeted therapeutics, but also in subsequent monitoring for rapidly 'evolving' disease in individual patient.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3010.

Profiling of receptor tyrosine kinases (RTK) activation in circulating tumor cells (CTCs) in metastatic tumors using proximity mediated microarray immunoassay

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Background: The abnormal activation of HER1 and HER2 has been linked to various types of cancer progression, and the changes in their expression status between primary tumor and CTCs have been reported to occur at a significant frequency. Methods for detecting HER1/HER2 phosphorylation in serially collected CTCs may provide valuable insight into the overall disease profile shift, and therefore lead to better selection of therapy combination for individual patient. Methods: A triple-antibody-enzyme-channeling multiplexed protein microarray platform has been developed to detect the phosphorylation on target molecules. It utilizes a unique immuno-complex formation via co-localization of two detector enzyme-conjugated-antibodies once target proteins are captured on the microarray-surface. The channeling events between two detector enzymes in proximity enabled profiling of the RTKs with a single-cell level sensitivity. The simultaneous binding of three different types of target specific antibodies for signal amplification results in extremely high assay specificity. In order to validate the method on clinical samples, CTCs from 75 cancer patients (stage 3/4) on various therapy regimens were analyzed. Results: We identified 6 patients (8%) with activated HER1, 6 patients (8%) with activated HER2 and 14 (18.5%) patients with dual RTK activation in their CTCs from various types of metastatic cancer. 25 samples from normal subjects showed no detectable HER1/HER2 activation. We also observed discrepancies between HER2 activation status in CTCs and their corresponding primary HER2-IHC status among breast cancer patients. CTCs with activated-HER2 were found in 6 out of 16 (38%) patients with HER2-negative primary breast cancer. In addition, 2 out of 5 HER2-positive breast cancer patients had CTCs with no apparent HER2-activation. Conclusions: The multiplexed-proximity mediated immunoassay successfully detected the activation of RTKs in CTCs isolated from various cancer patients. As CTCs found in metastatic stage represent the most aggressive invading cell population, serial CTC-profiling can lead to better therapy selection/adjustment and disease/treatment monitoring as there are available options to choose appropriate kinase inhibitors for RTK-targeted therapies.

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Eye movements during anagram tasks

5-letter anagram problems were presented to field-independent and field-dependent Ss and their corneally reflected EMs were examined concomitantly. The data suggest that field-independent Ss are apt to spend less initial time examining specific letters than field-dependent Ss and that males are more deliberate in their visual search than females. The results are discussed in terms of two factors reflecting analytical perception, number of shifts between letters and mean latency to first 5 looks.

Eye movements during embedded figure tasks

Corneally reflected EMs of 16 field-independent and 16 field-dependent Ss were examined concomitantly with individually administered hidden figure items. The data suggested that field-independent Ss make more shifts between target and alternatives than do field-dependent Ss and that males are more deliberate in their visual search than females. The results were discussed in terms of two factors reflecting analytical perception, number of shifts, and mean length of time on target.