Adjuvant nivolumab, capecitabine or the combination in patients with residual triple-negative breast cancer: the OXEL randomized phase II study

Chemotherapy and immune checkpoint inhibitors have a role in the post-neoadjuvant setting in patients with triple-negative breast cancer (TNBC). However, the effects of nivolumab, a checkpoint inhibitor, capecitabine, or the combination in changing peripheral immunoscore (PIS) remains unclear. This open-label randomized phase II OXEL study (NCT03487666) aimed to assess the immunologic effects of nivolumab, capecitabine, or the combination in terms of the change in PIS (primary endpoint). Secondary endpoints included the presence of ctDNA, toxicity, clinical outcomes at 2-years and association of ctDNA and PIS with clinical outcomes. Forty-five women with TNBC and residual invasive disease after standard neoadjuvant chemotherapy were randomized to nivolumab, capecitabine, or the combination. Here we show that a combination of nivolumab plus capecitabine leads to a greater increase in PIS from baseline to week 6 (91%) compared with nivolumab (47%) or capecitabine (53%) alone (log-rank p = 0.08), meeting the pre-specified primary endpoint. In addition, the presence of circulating tumor DNA (ctDNA) is associated with disease recurrence, with no new safety signals in the combination arm. Our results provide efficacy and safety data on this combination in TNBC and support further development of PIS and ctDNA analyses to identify patients at high risk of recurrence.

Adjuvant nivolumab, capecitabine or the combination in patients with residual triple-negative breast cancer: the OXEL randomized phase II study

Chemotherapy and immune checkpoint inhibitors have a role in the post-neoadjuvant setting in patients with triple-negative breast cancer (TNBC). However, the effects of nivolumab, a checkpoint inhibitor, capecitabine, or the combination in changing peripheral immunoscore (PIS) remains unclear. This open-label randomized phase II OXEL study (NCT03487666) aimed to assess the immunologic effects of nivolumab, capecitabine, or the combination in terms of the change in PIS (primary endpoint). Secondary endpoints include the presence of ctDNA, toxicity, clinical outcomes at 2-years and association of ctDNA and PIS with clinical outcomes. Forty-five women with TNBC and residual invasive disease after standard neoadjuvant chemotherapy were randomized to nivolumab, capecitabine, or the combination. Here we show that a combination of nivolumab plus capecitabine leads to a greater increase in PIS from baseline to week 6 (91%) compared with nivolumab (47%) or capecitabine (53%) alone (log-rank p = 0.08), meeting the pre-specified primary endpoint. In addition, the presence of circulating tumor DNA (ctDNA) was associated with disease recurrence, with no new safety signals in the combination arm. Our results provide efficacy and safety data on this combination in TNBC and support further development of PIS and ctDNA analyses to identify patients at high risk of recurrence.

Feasibility of Symptom Monitoring During the First Year of Endocrine Therapy for Early Breast Cancer Using Patient-Reported Outcomes Collected via Smartphone App

PURPOSE

Treatment-associated symptoms drive early discontinuation of adjuvant endocrine therapy (ET) for breast cancer. We hypothesized that symptom monitoring with electronic patient-reported outcomes (ePROs) during adjuvant ET will enhance symptom detection, symptom management, and persistence.

METHODS

Eligible patients were initiating ET for stage 0-III breast cancer. Participants completed ePRO surveys via smartphone at baseline and 1, 3, 6, and 12 months. Measures included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Fatigue, and Vaginal Discomfort; plus Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events items assessing joint pain, hot flashes, vaginal dryness, concentration problems, and memory problems. Scores surpassing prespecified thresholds triggered alerts, and recommended symptom management pathways were provided to clinicians. The primary objective was to evaluate feasibility, assessed by survey completion rates, with targets of >65% for the baseline survey and ≥1 follow-up survey during the first 6 months. Secondary objectives included 12-month ET discontinuation rate (target: ≤15%), describing symptoms and evaluating pathway implementation.

RESULTS

Among 250 participants, 73.2% completed the baseline survey and 69.6% completed ≥1 follow-up survey during the first 6 months. Thirty-one percent of participants had ≥1 symptom alert at baseline and 74% had ≥1 symptom alert during follow-up. The proportions of participants for whom pathway-concordant symptom management was documented at each time point ranged from 12.8% to 36.6%. Twenty-eight participants (11.2%) discontinued ET by 12 months.

CONCLUSION

Symptom monitoring with ePROs during adjuvant ET is feasible. Despite infrequent documentation of pathway-concordant symptom management after symptom alerts, ePROs were associated with favorable short-term ET persistence.

The applicability of the "surprise question" as a prognostic tool in patients with severe chronic comorbidities in a university teaching outpatient setting

BACKGROUND

Life expectancy in recent decades has increased the prevalence of chronic diseases in the population, requiring an approach to new health topics, such as discussions on quality of life and expectations about death and dying. The concept of advance directives (ADs) gives individuals the opportunity to make known their decisions about the treatments they would like to receive at the end of life. Despite the recognition of relevance in clinical practice, the applicability of the concept presents challenges, including establishing the appropriate prognosis for each patient and the ideal time to approach the patient. Some prognostic tools were developed, such as the surprise question (SQ): "Would you be surprised if your patient died in 12 months?", which is used in some clinical settings to predict patient deaths and to make decisions regarding ADs. The main objective of the present study was to evaluate the behavior of second-year resident physicians (PGY-2) when the SQ was applied.

METHOD

In our observational study, from July 1, 2016, to February 28, 2017, (PGY-2) in the Internal Medicine Residency Program (IMRP) applied SQ to all patients with multiple and varied chronic no communicable comorbidities, who were followed up at the general medicine outpatient clinic (GMOC) of a tertiary university hospital in São Paulo- Brazil. The frequency of the outcome (death or non-death within 12 months) was analyzed by correlating it with the clinical data (impact of the studied variables).

RESULTS

Eight hundred forty patients entered the study. Fitfty-two of them (6.2%) died within one year. PGY-2 predicted that two hundred and fourteen patients (25.5% of total) would die within a year (answer No to SQ), of which, 32 (14.9%) did so. The correct residents' prognosis for the subgroup of 626 patients (answer "Yes" to SQ) was NPV = 96.8% (CI = 95.4%-98.2%) and PPV = 14.9% (CI 10.1%-19, 6%). Answering "Yes" to SQ correlated negatively to addressing AD while the outcomes death and the answer No to SQ were positively correlated, according to the number of comorbidities.

CONCLUSION

The SQ, in addition to care, contributed to health education, communication and care planning shared by the doctor and patient.

Adjuvant treatment decisions among women age > 65 with early-stage, hormone-receptor breast cancer seen in multidisciplinary clinic versus standard consultation

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Background: Randomized studies and national guidelines support de-escalation of adjuvant therapy for a target population of woman >65 years with Stage I, ER positive breast cancer after breast conserving surgery. We sought to evaluate the impact of a multidisciplinary clinic (MDC) in this population by comparing treatment patterns and patient perceptions of adjuvant radiation therapy (RT) and hormone therapy (HT) between patients seen in MDC vs. standard consultation. Methods: Medical records were retrospectively reviewed for women in the above target population who underwent surgery between 8/2020- 5/2022at our institution. Two cohorts were included: (1) patients seen in MDC, and 2) patients seen in standard clinic separately by medical and radiation oncology (non-MDC cohort). The non-MDC patients declined, could not attend, and/or were not referred to the MDC. Patients in the MDC cohort were prospectively administered validated questionnaires to evaluate patient reported data including the Decision Autonomy Preference Scale (DAPS), e-Prognosis, and Medical Maximizing-Minimizing Scale (MMS). Chi square, t-tests, and non-parametric equivalents compared demographics and logistic and linear regression evaluated RT and HT use and survey score outcomes between cohorts. Results: A total of 128 patients met inclusion criteria, with 33 MDC and 94 non-MDC patients. There was no difference between the cohorts in age, margin status, histology, grade, or focality. In the MDC cohort there were significantly fewer sentinel lymph node biopsies (42.4% vs. 71.3%, p = 0.003) and mean tumor size was smaller (0.69 vs. 0.96 cm, p < 0.003). There was no significant difference in receipt of RT (65% MDC vs 77% standard; OR = 0.55, p = 0.189, HT (78% MDC vs 72% standard; OR = 1.36, p = 0.534), or both (65% MDC vs 77% standard; OR = 0.7, p = 0.430). The MDC cohort was significantly more likely to undergo accelerated (vs. standard hypofractionated) RT (70% vs 39%; OR = 3.60, p = 0.020). In MDC patients with completed questionnaires (n = 33), by DAPS, all “mostly patient (n = 8)” chose RT while all “mostly doctor (n = 1)” chose no RT (p = 0.063). Based on e-Prognosis, there were lower odds of RT for increasing Schonberg score/ higher 10yr mortality risk (OR 0.600, p = 0.048). MIMS score > 40 (“maximizer”) was strongly correlated with the use of RT (OR 18.57, p = 0.011). Conclusions: For women > 65 years with early stage, ER positive breast cancer, MDC participation was not associated with lower use of adjuvant RT or HT versus standard consultation but was significantly associated with shorter RT courses. DAPS and MMS results indicate that patient treatment preference may be predictable, highlighting an opportunity to tailor consultation discussions and recommendations based on intrinsic patient preferences and individual goals.

Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL

Background

Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19.

Methods

This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting.

Results

A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017–1.109 and OR = 2.438, 95%CI 1.023–5.813, respectively).

Conclusions

Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.

Integrating Immunotherapy in Early-Stage Triple-Negative Breast Cancer: Practical Evidence-Based Considerations

The KEYNOTE-522 study is a practice-changing phase III randomized study that demonstrated that the addition of pembrolizumab to polychemotherapy improves outcomes in patients with high-risk early-stage triple-negative breast cancer (TNBC). This regimen is highly efficacious with unprecedented pathologic complete response (pCR) rates, and clinically meaningful improvements in event-free survival (EFS). However, the combination is also associated with significant high-grade treatment-related toxicity. The backbone regimen deviated from common practice, including the addition of carboplatin, lack of dose dense anthracyclines, and adjuvant capecitabine for residual disease, thus brining important questions regarding real-world translation of these results. This brief report practically addresses some of the most relevant questions physicians and patients face in optimizing care using the best available evidence.

AB0437 MONTELUKAST AS A TREATMENT FOR REFRACTORY CUTANEOUS LUPUS ERYTHEMATOSUS: A CASE SERIES AND PROOF-OF-CONCEPT STUDY

Background

Treatment of cutaneous lupus relies mostly in avoidance of exposure to sunlight, steroids and hydroxychloroquine. A diverse array of cytokines and chemokines released by resident and migrating inflammatory cells have been implicated in the pathogenesis of skin damage in patients with systemic lupus erythematosus (SLE). Leukotrienes are potent lipid mediators involved in hypersensitivity reactions but very few data exist on their involvement in SLE.

Objectives

Our aim is to report a case series of SLE patients with refractory skin lesions that were successfully treated with sodium montelukast (MLK), a cysteinyl-leukotriene antagonist.

Methods

We present 4 consecutive female SLE patients with refractory skin lesions that were treated with MLK (10mg/d). Skin lesions were scored using CLASI criteria. Peripheral blood mononuclear cells (PBMC) from those 4 SLE patients and 4 healthy age-matched female controls were collected and the relative expression of the 5-lipoxigenase (ALOX5) and 15-lipoxigenase (15LOX1R) genes against a reference gene (GAPDH) was assessed using a quantitative polymerase change reaction (qPCR) protocol.

Results

All four patients experienced improvement of skin lesions 2-4 weeks following initiation of MLK with over 50% reduction in severity using CLASI score. The response was sustained for at least 3 months follow-up and no adverse events were recorded. All but one of the patients relapsed following MLK withdrawal but response was recovered after restart of MLK. Expression of the ALOX5, but not of 15LOX1R, was significantly (p<0.001) increased in PBMC from SLE patients as compared to controls.

Conclusion

This is the first report of a fast and sustained successful response of cutaneous SLE to MLK. There were no safety issues. PBMC from SLE patients showed increased expression of the ALOX5gene. This case series suggests the involvement of MLK in cutaneous lupus and encourage designing a randomized trial.

Disclosure of Interests

None declared

AB0051 EVIDENCE OF VERY EARLY CARTILAGE DAMAGE IN EXPERIMENTAL OSTEOARTHRITIS USING SCANNING ELECTRON MICROSCOPY

Background

Early, reproducible, sensitive imaging biomarkers are an unmet need in experimental osteoarthritis (OA) evaluation. Electron microscopy may reveal joint changes prior to soluble biomarkers.

Objectives

This study describes very early, quantitative, articular cartilage surface damage in posttraumatic experimental OA models allowing determination of disease severity.

Methods

Mice (5/group) were subjected to anterior cruciate ligament transection (ACLT), ACLT plus meniscectomy (MNCT), as OA models, or sham surgery and sacrificed 3, 7 or 14 days later. Articular cartilage was collected and processed for optical (H&E; Safranin O staining) or scanning electron microscopy (SEM) analysis. Histology was graded using Osteoarthritis Research Society International (OARSI) parameters whereas cartilage thickness, roughness and damage index were evaluated under SEM.

Results

Optical microscopy did not reveal significantly relevant cartilage changes in OA models vs controls. Femoral and tibial cartilage thickness were significantly reduced in mice subjected to ACLT or MNCT at 7 and 14 days postsurgery (P<0.05). Cartilage roughness was significantly increased in MNCT agroup as early as 3 days postsurgery, as compared to sham and ACLT groups, being sustained up to 14 days in both femoral and tibial extremities. Articular damage index using SEM was more severe at 14 days postsurgery in ACLT and MNCT vs control groups (P<0.05).

Conclusion

Posttraumatic experimental OA display quantitative cartilage changes at SEM with increased roughness and thickness as early as 3 days post induction. In addition to unravel very early ultrastructural cartilage damage, these changes may be used as early surrogates for joint damage in experimental OA.

Disclosure of Interests

None declared

Profile of Margetuximab: Evidence to Date in the Targeted Treatment of Metastatic HER2-positive Breast Cancer

Human epidermal growth factor receptor 2 (HER2) positive breast cancer accounts for about 20% of all breast cancers and this subtype has been historically associated with worse prognosis. Margetuximab is a chimeric and Fc-engineered monoclonal antibody directed to HER2 that can enhance the activation of the innate and adaptive immune responses while maintaining trastuzumab’s antiproliferative effects. Margetuximab in combination with chemotherapy was approved by the US FDA in December 2020 for patients with metastatic HER2+ breast cancer who have received two or more HER2-targeted regimens. This approval was based on the results of the SOPHIA trial that showed a modest improvement in progression-free survival with margetuximab and chemotherapy compared to trastuzumab and chemotherapy. Ongoing studies are assessing the role of margetuximab in other settings and diseases such as early stage breast cancer and gastrointestinal malignancies. Here we review the rationale for the development of margetuximab, previous and ongoing clinical trials and current role in clinical practice.

Association of treatment-emergent symptoms identified by patient-reported outcomes with adjuvant endocrine therapy discontinuation

Many patients discontinue endocrine therapy for breast cancer due to intolerance. Identification of patients at risk for discontinuation is challenging. The minimal important difference (MID) is the smallest change in a score on a patient-reported outcome (PRO) that is clinically significant. We evaluated the association between treatment-emergent symptoms detected by worsening PRO scores in units equal to the MID with discontinuation. We enrolled females with stage 0-III breast cancer initiating endocrine therapy in a prospective cohort. Participants completed PROs at baseline, 3, 6, 12, 24, 36, 48, and 60 months. Measures included PROMIS pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance; Endocrine Subscale of the FACT-ES; and MOS-Sexual Problems (MOS-SP). We evaluated associations between continuous PRO scores in units corresponding to MIDs (PROMIS: 4-points; FACT-ES: 5-points; MOS-SP: 8-points) with time to endocrine therapy discontinuation using Cox proportional hazards models. Among 321 participants, 140 (43.6%) initiated tamoxifen and 181 (56.4%) initiated aromatase inhibitor (AI). The cumulative probability of discontinuation was 23% (95% CI 18-27%) at 48 months. For every 5- and 4-point worsening in endocrine symptoms and sleep disturbance respectively, participants were 13 and 14% more likely to discontinue endocrine therapy respectively (endocrine symptoms HR 1.13, 95% CI 1.02-1.25, p = 0.02; sleep disturbance HR 1.14, 95% CI 1.01-1.29, p = 0.03). AI treatment was associated with greater likelihood of discontinuation than tamoxifen. Treatment-emergent endocrine symptoms and sleep disturbance are associated with endocrine therapy discontinuation. Monitoring for worsening scores meeting or exceeding the MID on PROs may identify patients at risk for discontinuation.

Abstract P2-08-15: Clinical, pathologic, and molecular associations of tumor mutational burden in metastatic breast cancer

Background: Tumor mutational burden (TMB) is a biomarker approved to predict response to immune checkpoint blockade (ICB) in solid tumors irrespective of their tissue of origin. However, there are limited data in patients with breast cancer and high TMB to support the use of ICB. The goal of this analysis is to describe clinical, pathological and molecular associations with TMB within a cohort of patients with metastatic breast cancer. Methods: We included patients enrolled onto an ongoing prospective study titled Individualized Molecular Analyses Guide Efforts (IMAGE)-II. Patients eligible for IMAGE-II have metastatic breast cancer of any subtype that had progressed on at least one standard-of-care therapy. Genetic profiling of tumor tissue was performed at the discretion of the treating team using one of several commercially available next generation sequencing platforms. For purposes of this analysis, only patients who underwent tissue-based Foundation Medicine analysis are included as TMB assessments are different across different platforms. Data are summarized by descriptive statistics. Linear and logistic regression analyses are conducted to evaluate the association between TMB and other clinical, pathological and molecular factors. We will present data on associations with specific mutations (i.e. ESR1, ERBB2, DNA repair, Pi3K signaling, TP53) and ctDNA TMB at a later time. Results:Of 117 patients in the IMAGE-II database, median age was 57 (range 23-86), 65% were White, 29% Black, and 6% Other. TMB data were available on 62 patients. Of those with both TMB and subtype information, 35 (70%) had ER+HER2- tumors, and 15 (30%) had ER-HER2- tumors. Median TMB was 4 mutations/megabase and ranged from 0 to 27. We did not observe significant differences in TMB in patients with ER+HER2- and those with ER-HER2- tumors (median TMB of 4 [0-27] and 5 [1-25], respectively), nor between White versus Black patients (median TMB of 4 [0-27] and 5 [0-12], respectively). However, we did observe that age was positively associated with higher TMB (p-value = 0.02). Additionally, we observed that the time between metastatic diagnosis and TMB measurement was positively associated with TMB (p-value &lt; 0.01); this significant association was also observed in ER+HER2- patients (p-value &lt; 0.01) but not in ER-HER2- patients. Median time to obtaining TMB since metastatic diagnosis was 1.1 (range -0.8 - 12.8) years. More lines of chemotherapy prior to TMB assessment was not observed to be associated with higher TMB. Conclusions: We observed that TMB was higher in patients who have had a longer disease course. Further research is required to understand changes in TMB over time, and how TMB is correlated with. other genomic and tumor microenvironment characteristics. A deeper understanding of TMB may help refine it as a predictive biomarker for ICB.

Citation Format: Mohamed A Mohamed, Chenghuang Wang, Morgan Buckley, Jennifer Lehman, Jenna Canzoniero, Christopher D Gocke, Raquel Nunes, Ben Ho Park, Karen L Smith, Jessica Tao, Hanna Tukachinsky, Mary Wilkinson, Antonio C Wolff, Vered Stearns, Cesar A Santa-Maria. Clinical, pathologic, and molecular associations of tumor mutational burden in metastatic breast cancer [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 P2-08-15.

Abstract PD9-02: Peripheral immune subsets and circulating tumor DNA (ctDNA) in patients (pts) with residual triple negative breast cancer (TNBC) treated with adjuvant immunotherapy and/or chemotherapy (chemo): The OXEL study

Background: Poor clinical outcomes are noted in pts with TNBC who do not achieve a pathologic complete response (pCR). We characterized peripheral immune subsets and the role of minimal residual disease (MRD) detection via ctDNA in pts who participated in the OXEL study. Methods: OXEL (Opdivo® -XELoda ®) is a recently completed phase II open-label 3-arm randomized study of nivolumab (nivo), capecitabine (cape) or the combination as adjuvant therapy (tx) for pts with residual TNBC after appropriate neoadjuvant chemo. Residual disease was defined as ≥ 1.0 cm of primary tumor and/or nodal involvement. Eligible pts had completed definitive local tx. Pts were randomly assigned to nivo 360 mg iv q3wks x 6 (arm A); cape 1250mg/m2 po bid D1-D14 q3 wks x 6 (arm B); nivo 360mg iv q3wks + cape 1250mg/m2 po bid D1-D14 q3 wks x 6 (arm C). Peripheral blood mononuclear cells (PBMCs) and ctDNA were assessed at baseline (D1 of cycle 1), 6, and 12 wks and at time of recurrence, if applicable. PBMCs were stained with 30 markers and analyzed by flow cytometry to identify changes in 158 immune cell subsets at 6 wks, as a percent of total PBMCs. RaDaRTM, a deep sequencing based, tumor-informed personalized assay was utilized to detect the presence of ctDNA in plasma. Distant disease-free survival (DDFS) and overall survival (OS) were analyzed by the Kaplan-Meier method and Log-Rank test was used to compare DDFS and OS according to baseline MRD results. All pts will be followed for distant recurrence and survival for 3 yrs. Here we report the translational endpoints of the OXEL study. Clinical endpoints according to treatment received will be reported in a future analysis. Results: 45 pts were enrolled between 8/2018 and 6/2021. 29 (64%) were Caucasian and 14 (31%) were African American. Mean age at enrollment was 51 [+/- 12]. 93% of pts received a taxane-anthracycline containing neoadjuvant tx. 15 pts were randomized to each arm. DDFS probability at 1-yr and 2-yrs was 0.71 (+/- 0.07) and 0.66 (+/- 0.08) respectively. At 12 mos of median follow up, 13/45 pts (29%) experienced distant recurrence, none had local recurrence. 43 pts were evaluated for PBMC subsets. Changes in PBMC subsets at 6 wks were different amongst the arms; in arm A, reductions in NK subsets, including a 33% reduction in CD56dimCD16- cells, were observed, while in arm B, increases in naïve CD4+ T cells (+45%) and CD73+CD8+ T cells (+12%) and reductions in ki67+CD8+ T cells (-48%) were noted. In arm C, increases were observed in conventional dendritic cells (+36%), effector memory ki67+CD4+ T cells (+46%), and CD56dimCD16- NK cells (+29%). 33 pts underwent successful MRD analysis. 12/33 (36%) pts were MRD+ at baseline. 2/12 pts MRD+ at baseline subsequently cleared MRD, with undetectable ctDNA on future time points; neither patient has had recurrence to date. The remaining 10/12 MRD+ pts (83%) have experienced distance recurrence. 21/33 (64%) pts were ctDNA negative at baseline; 20/33 remained negative for all follow up timepoints. 10/11 pts experiencing distant recurrence were MRD+ at baseline, compared to 1/11 pt who became MRD+ at wk 6 post initiation of tx. At 12 mos of median follow-up, baseline MRD+ testing was significantly associated with an inferior DDFS ( p&lt;0.0001 Log-rank test, median DDFS 4.0 mos vs. not reached) and OS (p=0.02 Log-rank test, median OS not reached for both groups). Results will be updated at the time of abstract presentation. Conclusions: Changes in PBMC subsets were associated with receipt of chemo and/or immunotherapy. Our results suggest that baseline MRD+ in pts without pCR is a poor prognostic factor. Future trials aiming to optimize adjuvant treatment with chemo and/or immunotherapy in residual TNBC should consider incorporating ctDNA as a selection marker of pts at higher risk of recurrence.

Citation Format: Filipa Lynce, Candace Mainor, Xue Geng, Greg Jones, Ilana Schlam, Hongkun Wang, Ute Feger, Renee Donahue, Nicole Toney, Caroline Jochems, Jeffrey Schlom, Christopher Gallagher, Rita Nanda, Deena Graham, Erica M Stringer-Reasor, Neelima Denduluri, Julie Collins, Asma A Dilawari, Ami Chitalia, Shruti Tiwari, Raquel Nunes, Rebecca Kaltman, Katia Khoury, Margaret Gatti-Mays, Sandra M Swain, Heather A. Parsons, Paula Pohlmann, Claudine Isaacs. Peripheral immune subsets and circulating tumor DNA (ctDNA) in patients (pts) with residual triple negative breast cancer (TNBC) treated with adjuvant immunotherapy and/or chemotherapy (chemo): The OXEL study [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 PD9-02.

Prognostic Utility of Breast Cancer Index to Stratify Distant Recurrence Risk in Invasive Lobular Carcinoma

PURPOSE

The prognostic utility of Breast Cancer Index (BCI) for risk assessment of overall (0-10 years), early (0-5 years), and late (5-10 years) distant recurrence (DR) in hormone receptor-positive (HR+) invasive lobular carcinoma (ILC) was evaluated.

EXPERIMENTAL DESIGN

BCI gene expression analysis was performed blinded to clinical outcome utilizing tumor specimens from patients with HR+ ILC from a multi-institutional cohort. The primary endpoint was time to DR. Kaplan-Meier analyses of overall, early, and late DR risk were performed, and statistical significance was evaluated by log-rank test and Cox proportional hazards regression. The prognostic contribution of BCI in addition to clinicopathologic factors was evaluated by likelihood ratio analysis.

RESULTS

Analysis of 307 patients (99% ER+, 53% T1, 42% N+, 70% grade II) showed significant differences in DR over 10 years based on BCI risk categories. BCI low- and intermediate-risk patients demonstrated similar DR rates of 7.6% and 8.0%, respectively, compared with 27.0% for BCI high-risk patients. BCI was a significant independent prognostic factor for overall 10-year DR [HR = 4.09; 95% confidence interval (CI), 2.00-8.34; P = 0.0001] as well as for both early (HR = 8.19; 95% CI, 1.85-36.30; P = 0.0042) and late (HR = 3.04; 95% CI, 1.32-7.00; P = 0.0224) DR. In multivariate analysis, BCI remained the only statistically significant prognostic factor for DR (HR = 3.49; 95% CI, 1.28-9.54; P = 0.0150).

CONCLUSIONS

BCI is an independent prognostic factor for ILC and significantly stratified patients for cumulative risk of 10-year, early, and late DR. BCI added prognostic value beyond clinicopathologic characteristics in this distinct subtype of breast cancer.

Patient-reported outcomes to assess symptoms in patients with metastatic breast cancer: Pilot implementation project

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Background: Use of patient-reported outcomes (PRO) to evaluate symptoms improves clinical outcomes. Best practices for implementing PROs into routine care may vary according to clinical scenario, site-specific resources and programmatic goals. Patients with metastatic breast cancer (MBC) often experience a variety of symptoms. Methods: As a quality improvement project, we are pilot testing incorporation of a battery of PRO measures into routine care for patients with MBC at Johns Hopkins in order to gain experience that will guide future broader implementation of PROs across our program. Participants complete the PROs on paper at baseline (BL), 3, and 6 months (mo). Measures include NCCN Distress Thermometer (BL only), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), PRO-CTCAE Insomnia questions and a modified version of the revised Edmonton Symptom Assessment System (r-ESAS) questionnaire with 3 extra symptom domains. Project team members alert clinicians by email of scores that exceed severity thresholds as follows – Distress: ≥4, PHQ-8: ≥8, GAD-7: ≥10, any item on r-ESAS: ≥4 and PRO-CTCAE Insomnia: severe/very severe or quite a bit/very much. Results: From May 29, 2020 and April 5, 2021, 67 patients were approached for participation, and 40 (59.7%) completed the BL PROs. Median age was 64 (range 36-85). Most participants were White (70%), non-Hispanic (90%) and had hormone receptor-positive (93%) MBC. At BL, 22 (55%) had visceral disease and most were receiving endocrine-based regimens [21 (53%)] or chemotherapy [16 (40%)]. 27 (68%) participants had ≥1 BL alert. The most common BL alerts were for symptoms on the r-ESAS [23 participants (58%)]. The most frequent items on the r-ESAS for which participants had BL alerts were pain, tiredness, well-being, tingling/numbness and rash. Other BL alerts were: Distress [9 participants (23%)], PRO-CTCAE Insomnia [5 participants (13%)], PHQ-8 [4 participants (10%)] and GAD-7 [2 participants (5%)]. To date, 24 of 35 (69%) and 15 of 28 (54%) participants who have reached the 3 and 6 mo time points have completed the respective follow-up (FU) PROs. Most common FU alerts to date are on the r-ESAS [3 mo: 14 participants (58%), 6 mo: 9 participants (60%)]. The project team has successfully notified providers of all alerts to date. Clinical actions (phone calls, provider visits and/or referrals) have been taken within 30 days of notification for > 75% of alerts. Conclusions: Implementation of a PRO battery for patients receiving routine care for MBC led to detection of a range of symptoms, the majority of which were clinically actionable. Restrictions on in-person interactions during the COVID-19 pandemic may have contributed to low rates of PRO completion in this pilot project. Prior to broader implementation, we will consider strategies such as an electronic platform and a shorter battery to enhance patient engagement.

Role of Platinums in Triple-Negative Breast Cancer

PURPOSE OF REVIEW

Platinum compounds are used in the treatment of various types of cancer. Here, we review the current role of cisplatin and carboplatin in the treatment of early stage and advanced triple-negative breast cancer (TNBC), and the use of biomarkers in predicting response to platinum therapy.

RECENT FINDINGS

Addition of carboplatin to a neoadjuvant chemotherapy regimen can result in improvement in the pathological complete response rates. The long-term benefit of the addition of carboplatin to standard chemotherapy regimens remains unproven. Single-agent platinum is an option in the treatment of advanced breast cancer. BRCA1/2 mutations predicted benefit from platinums in advanced, but not early stage breast cancer. There are yet no biomarkers to predict response to platinum in sporadic TNBC. Platinum compounds are an option in the treatment of TNBC. Identification of biomarkers to select tumors most likely to derive benefit from these agents is still needed. Ongoing trials are exploring the role of platinum in the adjuvant setting and in combination with other agents, including immune checkpoint inhibitors.

Abstract PS9-14: Feasibility of monitoring symptoms during endocrine therapy with patient reported outcomes collected via smart phone app

Background: Despite known benefits in reducing breast cancer (BC) recurrence and death, up to 50% of patients discontinue endocrine therapy (ET) early. Symptoms are often cited as a reason for early ET discontinuation (DC). The symptom burden during ET captured by patient reported outcomes (PRO) exceeds that captured by clinicians. Methods: We initiated a single arm pilot trial evaluating symptom monitoring during ET with PRO collected via smart phone app. Eligible patients are women starting ET for stage 0-III BC. Participants receive text message reminders to complete surveys at baseline (BL), 1, 3, 6 and 12 months (mo). Participants who do not complete 2 sequential surveys may opt out of further surveys. Surveys include PROMIS measures for anxiety, depression, fatigue and the vaginal discomfort domain of sexual function plus PRO-CTCAE measures for concentration, memory, hot flashes, joint pain and vaginal dryness. PROMIS measures are scored by T-score look up tables. PRO-CTCAE responses are reported on a 5 point scale (0-4). Severe or worsening scores trigger email alerts to clinicians as follows: T-scores ≥70 or ≥5 points worse than BL for anxiety, depression, and fatigue; T-score ≥65 or ≥5 points worse than BL for sexual function; scores ≥3 or ≥2 points worse than BL on PRO-CTCAE measures. Recommended management pathways are provided to clinicians upon alert acknowledgement. The primary endpoint is feasibility, with success defined as ≥65% of participants completing the BL survey and ≥65% of participants completing ≥1 follow-up (FU) survey during the first 6 mo of ET. Secondary endpoints include patient-reported symptoms and pathway-concordant symptom management based on chart review. We report here descriptive statistics of the observed data to date and multivariate logistic regression analysis of factors associated with BL survey completion. Results: From Feb 2019 to May 2020, 213 of 250 planned participants enrolled. Median FU is 5.7 mo. Mean age is 58.3 years (SD 11.7). 154 (72.3%) participants are white (W) and 32 (15%) are black (B). 189 (88.7%) participants have stage I-II BC. Prior to initiating ET, 82 (39%) had mastectomy, 75 (35.2%) had chemotherapy and 135 (63.4%) had radiation. 138 (64.8%) initiated an aromatase inhibitor and 72 (33.8%) initiated tamoxifen. BL survey completion rate is 73.7% (95% confidence interval (CI) 67.3-79.5%). To date, 69.3% (95% CI 60.5-77.2%) of participants completed ≥1 FU survey during the first 6 mo of ET. 25.2% of participants opted out of participation within 6 mo. On multivariate analysis, race was associated with BL survey completion. By race, BL survey completion rate was: 77.9% (W) and 62.5% (B). Mean scores on PROMIS depression, anxiety, fatigue, and sexual function measures at BL, 1 mo, and 3 mo were +/- 0.5 SD of population means. Compared to BL, mean PRO-CTCAE scores for joint pain severity and hot flash frequency worsened at 1 and 3 mo and mean PRO-CTCAE score for vaginal dryness severity worsened at 3 mo (p&lt;0.05). 28% of participants had alerts at BL. Most common BL alerts were joint pain and hot flashes. To date, 79.7% of participants had ≥1 alert on a FU survey. Most common FU alerts were joint pain, hot flashes and fatigue. Median number of alerts per participant per FU survey is 1 (range 0-5). To date, clinicians acknowledged 29.8% of alerts within 7 days and made pathway-concordant management recommendations within 30 days for 39.4% of alerts. Conclusion: Monitoring symptoms during ET using PRO collected via smart phone app is feasible. Symptoms are common during ET. Updated data, including factors associated with survey completion, clinician response to alerts and the association between PRO scores and early ET DC, will be reported at the conference. These data will be used to design a randomized trial to evaluate symptom monitoring via smart phone app to reduce early ET DC.

Citation Format: Karen L Smith, Chenguang Wang, David Lim, Amanda Montanari, Raquel Nunes, Mary J. Wilkinson, Jennifer Y. Sheng, Rima Couzi, John Fetting, Carol Riley, Antonio C. Wolff, Cesar A. Santa-Maria, Katie Papathakis, Lauren Collins-Chase, Christie Hilton, Claire Snyder, Elissa Thorner, Dara Z. Ikejiani, Molly Steimer, Vered Stearns. Feasibility of monitoring symptoms during endocrine therapy with patient reported outcomes collected via smart phone app [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 PS9-14.

Abstract PS7-68: Racial disparities within basal-type breast cancer: Clinical and molecular features of African American and Caucasian obese patients

Background: African American breast cancer patients (AA) are diagnosed at a younger age and present more frequently with triple-negative/Basal tumors than Caucasian American patients (CA). High prevalence of obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome in AA may confound attempts to evaluate the influence of race on gene expression. Previously we showed that differentially expressed genes (DEGs) between AA and CA within the Basal subtype were related to metabolism, translation, and cell signaling pathways (Nunes et al. 2019). However, AA had higher obesity and T2DM rates than CA, and we were unable to distinguish between the influence of metabolic factors and race. In the current analysis, we aim to dissect these factors by comparing clinical and molecular features of Basal-type breast tumors in obese AA and CA.

Methods: The prospective, observational FLEX Registry (NCT03053193) includes stage I-III breast cancer patients who receive 70-gene signature (MammaPrint, MP)/80-gene signature (BluePrint, BP) testing and consent to full transcriptome and clinical data collection. This interim substudy included 50 AA and 96 CA (n=146), enrolled from 2017 to present, all obese by body mass index (BMI, ≥30) and whose tumors were MP High Risk and BP Basal subtype. AA were significantly younger (mean, 55 years) than CA (mean, 60 years, p=0.02); thus, an age distribution-matched subset (n=49 AA, n=49 CA) was added for comparison. Gene expression data were quantile normalized using R limma package; DEGs were compared between groups in the following: (1) all AA (n=50) and CA (n=96), (2) AA and 3 random selections of CA (n=50 pairs), and (3) age-matched AA and CA (n=49 pairs).

Results: Clinical factors, including tumor stage, nodal stage, and T2DM status were similar between AA and CA, regardless of age-matching. Most tumors were T1/2 (83% AA, 88% CA) and negative for nodal involvement (77% AA, 68% CA). 94% of tumors from AA and 74% of tumors from CA were grade 3 (p=0.17). Notably, 32% of tumors from AA and 46% of tumors from CA were ER+ by immunohistochemistry. Age-matched AA and CA had a 20% rate of T2DM. 152 DEGs were significant (adjusted p&lt;0.05) in at least one comparison, with 115 genes more highly expressed in AA and 37 genes more highly expressed in CA. Across all comparisons, 6 genes were consistently more highly expressed in AA: PSPH, NOTCH2NL, POLR1A, AC069240.1, ORAI1, and RPS26P10. Except ORAI1, these genes were also found in the previous comparison between Basal-type AA and CA, and the current analysis confirmed 11/16 DEGs previously reported (Nunes et al. 2019). Genes more highly expressed in AA are associated with transcription, angiogenesis, and Notch signaling pathways, as well as breast cancer aggressiveness and treatment resistance.

Conclusions: Higher prevalence of obesity/T2DM in AA has been proposed as a key factor to explain racial disparities in breast cancer incidence and prognosis, but the current results suggest that race may influence DEGs more than differences in tumor subtype, age, or metabolic factors. This comparison also emphasizes the importance of matched clinical features for DEG analysis and suggests disparities in AA beyond those attributable to clinical differences within the population. DEGs in AA suggest upregulation of Notch-associated aggressiveness, which may be particularly relevant under hypoxic conditions (e.g., obesity), and pathways associated with stemness, metastasis, and chemotherapy resistance. Notch pathway also interacts with key oncogenic pathways, and future studies will reveal the molecular networks underlying racial disparity in AA and CA breast cancer patients.

Citation Format: Dipali Sharma, Lisa E. Blumencranz, Heather M. Kling, Sahra Uygun, Sarah Untch, William Audeh, Jennifer A. Crozier, Mehran Habibi, Raquel Nunes. Racial disparities within basal-type breast cancer: Clinical and molecular features of African American and Caucasian obese patients [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 PS7-68.

Long-term follow-up assessment of cardiac safety in SAFE-HEaRt, a clinical trial evaluating the use of HER2-targeted therapies in patients with breast cancer and compromised heart function

PURPOSE

HER2-targeted therapies are associated with cardiotoxicity which is usually asymptomatic and reversible. We report the updated cardiac safety assessment of patients with compromised heart function receiving HER2-targeted therapy for breast cancer, enrolled in the SAFE-HEaRt trial, at a median follow-up of 3.5 years.

METHODS

Thirty patients with stage I-IV HER2-positive breast cancer receiving trastuzumab with or without pertuzumab, or ado-trastuzumab emtansine (T-DM1), with asymptomatic LVEF (left ventricular ejection fraction) 40-49%, were started on cardioprotective medications, with the primary endpoint being completion of HER2-targeted therapy without cardiac events (CE) or protocol-defined asymptomatic worsening of LVEF. IRB-approved follow-up assessment included 23 patients.

RESULTS

Median follow-up as of June 2020 is 42 months. The study met its primary endpoint with 27 patients (90%) completing their HER2-targeted therapies without cardiac issues. Of the 23 evaluable patients at long-term f/u, 14 had early stage breast cancer, and 9 had metastatic disease, 8 of whom remained on HER2-targeted therapies. One patient developed symptomatic heart failure with no change in LVEF. There were no cardiac deaths. The mean LVEF improved to 52.1% from 44.9% at study baseline, including patients who remained on HER2-targeted therapy, and those who received prior anthracyclines.

CONCLUSIONS

Long-term follow-up of the SAFE-HEaRt study continues to provide safety data of HER2-targeted therapy use in patients with compromised heart function. The late development of cardiac dysfunction is uncommon and continued multi-disciplinary oncologic and cardiac care of patients is vital for improved patient outcomes.

Portuguese adaptation of the S3-non-invasive ventilation (S3-NIV) questionnaire for home mechanically ventilated patients

Short, valid and easy to use tools are needed to monitor non-invasive ventilation in clinical practice and for organization of home mechanical ventilation services. The aim of this study was to develop a professional translation and cultural adaptation of the Portuguese S³ non-invasive ventilation questionnaire. 234 stable patients (128 male patients, 53.8%) with a mean age of 69.3 years under long-term home non-invasive ventilation were recruited from a single-center outpatient clinic. The most frequent diagnostic groups were obesity hypoventilation syndrome, chronic obstructive pulmonary disease and restrictive chest wall disorders. The Portuguese version of the questionnaire was obtained using translation back-translation process with two professional translators. Internal consistency for the total score was good (Cronbach's α coefficient of 0.76) as well as for the "respiratory symptoms" and the "sleep and side effects" domains (Cronbach's α coefficient=0.68 and Cronbach's α coefficient=0.72, respectively). An exploratory factor analysis was performed leading to an explained variance of 54.6%, and resulted in 3 components. The Portuguese version of the S3-NIV questionnaire is a simple and valid tool for the routine clinical assessment of patients receiving home NIV.

Patients and Health Professional's Perspective of Functional Mobility in Parkinson's Disease

Background: Functional mobility (FM) is the person's ability to move to accomplish daily living tasks and activities. FM limitations are common in Parkinson's disease, increase with disease progression, and can be highly disabling. Although several studies in Parkinson's disease (PD) field use this concept, only recently, a formal definition has been proposed.

Objective: We aimed to explore patient's and health professional's perspectives of FM in PD.

Methods: A focus group methodology has been used. Four focus groups, with a total of 10 patients and 10 health professionals, were performed. Six patients were early stage and four advanced stage. The health professional's group was composed of five neurologists and five physiotherapists. The suitability of the new concept, the impact of FM limitations in PD patient's daily routine, and the potential benefit of walking aids have been discussed.

Results: All participants were able to provide a spontaneous definition of FM, matching with the proposed concept. All agreed that PD affects patient's FM, increasing the limitations with disease progression, and with the existence of a serious prejudice with walking aids that hinders its use. Early-stage patient's perspective seems to be more in line with neurologist's perspective, while the views of advanced-stage patients were closer to physiotherapist's views.

Conclusion: FM concept was considered as intuitive and useful. FM limitations have an important physical and social impact in the advanced stage of the disease. Although patients and health professionals acknowledge walking aid's benefit improving patient's FM, the prejudice associated with this type of tools limits its recommendation and use.

Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Guideline Update

PURPOSE

The aim of this work is to update key recommendations of the ASCO guideline adaptation of the Cancer Care Ontario guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for breast cancer.

METHODS

An Expert Panel conducted a targeted systematic literature review guided by a signals approach to identify new, potentially practice-changing data that might translate into revised guideline recommendations.

RESULTS

The Expert Panel reviewed abstracts from the literature review and identified one article for inclusion that reported results of the phase III, open-label KATHERINE trial. In the KATHERINE trial, patients with stage I to III human epidermal growth factor receptor 2 (HER2)-positive breast cancer with residual invasive disease in the breast or axilla after completing neoadjuvant chemotherapy and HER2-targeted therapy were allocated to adjuvant trastuzumab emtansine (T-DM1; n = 743) or to trastuzumab (n = 743). Invasive disease-free survival was significantly higher in the T-DM1 group than in the trastuzumab arm (hazard ratio, 0.50; 95% CI, 0.39 to 0.64; P < .001), and risk of distant recurrence was lower in patients who received T-DM1 than in patients who received trastuzumab (hazard ratio, 0.60; 95% CI, 0.45 to 0.79). Grade 3 or higher adverse events occurred in 190 patients (25.7%) who received T-DM1 and in 111 patients (15.4%) who received trastuzumab.

RECOMMENDATIONS

Patients with HER2-positive breast cancer with pathologic invasive residual disease at surgery after standard preoperative chemotherapy and HER2-targeted therapy should be offered 14 cycles of adjuvant T-DM1, unless there is disease recurrence or unmanageable toxicity. Clinicians may offer any of the available and approved formulations of trastuzumab, including trastuzumab, trastuzumab and hyaluronidase-oysk, and available biosimilars.Additional information can be found at www.asco.org/breast-cancer-guidelines.

Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach

The COVID-19 pandemic has rapidly changed delivery of cancer care. Many nonurgent surgeries are delayed to preserve hospital resources, and patient visits to health care settings are limited to reduce exposure to SARS-CoV-2. Providers must carefully weigh risks and benefits of delivering immunosuppressive therapy during the pandemic. For breast cancer, a key difference is increased use of neoadjuvant systemic therapy due to deferral of many breast surgeries during the pandemic. In some cases, this necessitates increased use of genomic tumor profiling on core biopsy specimens to guide neoadjuvant therapy decisions. Breast cancer treatment during the pandemic requires multidisciplinary input and varies according to stage, tumor biology, comorbidities, age, patient preferences, and available hospital resources. We present here the Johns Hopkins Women's Malignancies Program approach to breast cancer management during the COVID-19 pandemic. We include algorithms based on tumor biology and extent of disease that guide management decisions during the pandemic. These algorithms emphasize medical oncology treatment decisions and demonstrate how we have operationalized the general treatment recommendations during the pandemic proposed by national groups, such as the COVID-19 Pandemic Breast Cancer Consortium. Our recommendations can be adapted by other institutions and medical oncology practices in accordance with local conditions and resources. Guidelines such as these will be important as we continue to balance treatment of breast cancer against risk of SARS-CoV-2 exposure and infection until approval of a vaccine.

AB0968 DIAGNOSIS OF INFLAMMATORY BACK PAIN (IBP) IN A LOW-INCOME POPULATION USING ASAS IBP DEFINITION

Background:

Inflammatory back pain (IBP) is an important entry criterion for identifying patients with axial spondyloarthritis. Due to the very frequent prevalence of chronic non-inflammatory back pain (CBP), IBP is difficult to differentiate and recognize in many clinical practices. CBP is a frequent diagnosis in populations with low socioeconomic status.

Objectives:

To investigate whether IBP ASAS definition help discriminate from CBP in a low-income population.

Methods:

A total of 202 consecutive individuals were directly interviewed in Fortaleza/Brazil, for the prevalence of IBP (ASAS definition), monthly family income (US$), school education [>/≤ 8 school-years(SY)], and smoking habit (present/absent). People from all social levels were included.

Results:

Mean age was 38.9±12.9 years, 100 (49.5%) were male and 36 (17.8%) were smokers; 135 (66.8%) declared less than 730US$ family earnings per month and 71 (35.1%) had less than 8 SY. Although 122 (60.3%) declared lumbar pain, in comparison, 29 (14.3%), 22 (10.9%) and 59 (29.2%) fulfilled ASAS, Berlin, and Calin’s IBP criteria, respectively. There were 39 (58.02%) vs. 83 (61.5%) with vs. without CBP and 9 (13.4%) vs. 20 (14.8%) fulfilling vs. not fulfilling the ASAS IBP definition among those with more or less than 730US$ earnings (P>0.05), respectively.

Conclusion:

This is the first report on the prevalence of IBP in a very low-income population. Over one-third had less than 8SY, revealing very low literacy. Smoking prevalence was also low if compared to 28% smoking prevalence WHO estimates across Europe*. These IBP prevalence data are similar to those reported in wealthier populations, living in higher latitude. Data suggest that ASAS IBP definition may be used to discriminate patients with IBP from those with CBP, regardless of income and literacy.

References:

This is the first report on the prevalence of IBP in a very low-income population. Over one-third had less than 8SY, revealing very low literacy. Smoking prevalence (17.8%) was also low if compared to 28% smoking prevalence WHO estimates across Europe*. These IBP prevalence data are similar to those reported in wealthier populations, living in higher latitude. Data suggest that ASAS IBP definition may be used to discriminate patients with IBP from those with CBP, regardless of income and literacy.

Disclosure of Interests:

Jobson Oliveira: None declared, Rodolfo Nunes: None declared, Guilherme da Silva: None declared, Igor Nogueira: None declared, Artur Azevedo: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Airton Rocha Speakers bureau: Not related to the present work

1024 Associations Of Low Back Pain And Sleep Among Nursing Staff

Introduction

Nursing is one of the top occupations suffering musculoskeletal disorders, especially low back pain (LBP). Nursing staff also experience short and disturbed sleep. Although there is a known relationship between pain and sleep, the specific associations between different aspects of LBP (e.g., duration, frequency, intensity) and sleep have not been studied. The objective of this study is to examine different aspects of LBP and their cross-sectional associations with sleep among nursing staff.

Methods

Online Qualtrics surveys were distributed among nurses and nursing assistants at a community hospital in the northeast U.S. LBP was assessed in terms of duration, frequency, intensity, and intensity change from before to after the work shift. Sleep duration and disturbances were assessed with validated scales.

Results

Among the 541 participants (94% female; age 43±13y), more than a third reported short sleep duration (≤6hrs/day; 38%) or sleep disturbances (38%), and more than half (60%) reported LBP in the past 6 months. Among those with LBP, 82% had ongoing pain for at least 6 months; 44% had ongoing pain for at least half the days in the past 6 months; 39% had LBP intensity ≥4 out of 10; and 79% reported post-shift LBP intensity increased of at least 1 level. Short sleep duration was associated with ongoing LBP for at least half the days in the past 6 months, intensity ≥4, and post-shift LBP intensity increase. Sleep disturbances were associated with prevalent LBP and intensity ≥4.

Conclusion

Nursing staff reported a high prevalence of LBP as well as short and disturbed sleep. Overall, poor sleep was associated with higher LBP prevalence, frequency, intensity, and post-shift increase. Future longitudinal studies are needed to clarify the causal directions of these relationships. Workplace interventions should address the widespread problems of LBP and sleep deficiency of nursing staff.

Support

Drs. Yuan Zhang and Jeanne F. Duffy were supported by NIH grant R01 AG044416.

Long-term follow-up assessment of cardiac safety in SAFE-HEaRt, a clinical trial evaluating the use of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function

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Background: HER2-targeted therapies are associated with cardiotoxicity, mostly asymptomatic and reversible. The impact of withholding these therapies on breast cancer outcomes is unknown. SAFE-HEaRt trial was the first study to evaluate the safety of HER2-targeted agents in patients with reduced left ventricular ejection fraction (LVEF) receiving concomitant cardioprotective medications and close cardiac monitoring. We report the 3-year follow-up (f/u) results. Methods: Thirty patients with stage I-IV HER2-positive breast cancer receiving trastuzumab, pertuzumab or ado-trastuzumab emtansine (TDM-1), with asymptomatic LVEF 40-49%, were started on beta blockers (ß-blockers) and/or ACE inhibitors/ARBs, with the primary endpoint being completion of HER2-targeted therapy without cardiac events (CE) or protocol-defined asymptomatic worsening of LVEF. Results: Patients were accrued from 10/2013 to 12/2017 and median f/u as of 2/7/20 is 37 months. The study met its primary endpoint with 27 patients (90%) completing their HER2-targeted therapies without cardiac issues. 24 patients were reconsented for long-term f/u. There were 23 evaluable patients (1 lost for f/u). Off study, 2 patients continued treatment with trastuzumab, 3 with trastuzumab and pertuzumab, and 3 with TDM-1 for metastatic disease. 1 of the 2 patients who had developed a CE with symptomatic heart failure (HF) died of progressive oncological disease, and the second had LVEF recovery on cardiac medications after completion of adjuvant HER2-targeted therapy. Almost 5 years later, she had an asymptomatic decline in her LVEF to 35% after deciding to stop her ß-blocker and ARB. Of the remaining 21 patients, 15 had recovery of their LVEF to ≥50%, 9 of whom remain on cardiac medications. 5 patients had stable LVEF 40-49% and remain asymptomatic on cardiac medications. Only 1 patient had symptoms suggestive of HF, with last documented LVEF stable at 45-50%, but she has not sought medical care for the last 15 months since relocating to another country. There were no new CE and no cardiac deaths. Mean LVEF was 45% at baseline, 46% at end of treatment, and 51.5% at long term f/u. Conclusions: Long-term f/u of the SAFE-HEaRt study continues to provide safety data of HER2-targeted therapy use in patients with compromised heart function. The late development of cardiac dysfunction is uncommon and continued multi-disciplinary oncologic and cardiac care of patients is essential for improved patient outcomes. Clinical trial information: NCT04143594 .

Abstract P3-08-03: Breast cancer index and prognostic performance in invasive lobular breast cancer

Background: Invasive lobular carcinoma (ILC) has distinct clinical, histologic, molecular, and biological characteristics. Dyscohesive cells infiltrating the mammary stroma, lack of E-cadherin expression, mutations in the PIK3CA pathway and lower incidence of GATA3 mutations are hallmarks of these tumors. As a result of these molecular features, tumor biology is of key importance in determining prognosis and treatment approaches for ILC. The Breast Cancer Index (BCI) is a gene expression signature validated as a significant and independent prognostic factor both for risk of overall (0-10 years) and late (5-10 years post-diagnosis) distant recurrence, and is predictive of extended endocrine benefit in patients with early-stage, HR+ breast cancer. The objective of the current study is to examine BCI prognostic risk stratification and potential clinical utility specifically in ILC. Methods: In this multi-institutional, prospectively defined retrospective study, FFPE tumor samples from 356 HR+ stage I-III N0 and N+ ILC patients diagnosed between 1997-2011 were collected. Genomic risk stratification was performed using BCI-prognostic models (N0: gene expression alone; N+: gene expression plus tumor size and grade) using previously validated assay cut-points. Prognostic performance for 10-year and late DR risk was estimated using Kaplan-Meier analysis and the difference was evaluated by log-rank test and Cox proportional hazards regression. Results: Results were generated on 311 evaluable patients (99% ER+, T1 52%, 42% N+, 66% grade II) with 10 years of median follow-up. BCI significantly stratified ILC patients into three prognostic risk groups based on 10-year risk of DR (p &lt; 0.0001). Notably, BCI low and intermediate risk patients demonstrated similar patterns and rates of distant recurrence, with limited risk in early DR (0-5 years) and increasing risk of late DR (5-10 years), constituting a single risk group in lobular cancer. Analysis combining the low and intermediate risk groups resulted in 53% and 47% of patients classified as BCI low/int and high risk, respectively. In well and moderately differentiated N0 tumors, 18% of patients were classified by BCI as high risk. The overall 10-year risk of DR was significantly different (hazard ratio [HR] =4.67, 95% confidence interval [CI]: 2.24 - 9.74; p &lt; 0.0001) between BCI low/int (6.9%, 95% CI: 2.4% - 11.2%) and high (27.9%, 95% CI: 19.3% - 35.5%). The risk was also significantly different for both early (0-5 years; p = 0.001) and late DR (5-10 years; p = 0.02). For early DR, the risk was 1.4% (0.0% - 3.3%) and 11.8 (6.2% - 17.1%) for the low/int and high risk groups, respectively; while for late DR, the risk was 5.6% (1.4% - 9.5%) and 18.2% (10.1% - 25.6%), respectively. Conclusion: BCI was a significant prognostic factor in risk stratification of ILC and identified a substantial proportion of ILC, which is generally associated with indolent characteristics, that were associated with a high 10-year risk of DR and late DR. In addition, BCI reclassified a considerable proportion of clinically low and moderate grade tumors as high genomic risk. These results support a role for genomic classification with BCI to define distinct prognostic subtypes based on tumor biology towards more individualized treatment strategies for patients with ILC.

Citation Format: Tal Sella, Raquel Nunes, Kai Treuner, Jennifer Atkinson, Jenna Wong, Yi Zhang, Pedro Exman, David Dabbs, Andrea Richardson, Catherine Schnabel, Dennis Sgroi, Steffi Oesterreich, Ashley Cimino-Mathews, Otto Metzger. Breast cancer index and prognostic performance in invasive lobular breast cancer [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 P3-08-03.

Abstract P2-10-08: Racial disparities in breast cancer: Identifying predisposing clinical and molecular features associated with African American patients

Background: Breast cancer (BC) mortality is higher in African-American women (AA) than in Caucasian women (CA). AA are also diagnosed at a younger age, have more aggressive subtypes and greater incidence of metabolic dysfunction such as obesity and diabetes. These disparities have been attributed to a confluence of socioeconomic, genetic and epigenetic factors. However, the distinctive tumor biology of AA BC is not yet fully elucidated, as AA remain underrepresented in breast cancer studies and databases. Here, we compared clinical and molecular BC features of AA and CA patients for insights into mechanisms associated with these racial disparities.

Methods: The FLEX Registry Trial (NCT03053193) is a prospective study evaluating tissue collected from patients with stage I-III BC who have consented to receive MammaPrint(MP)/BluePrint(BP) and clinically annotated full genome (FG) data. FLEX subset analyses investigate new gene associations that may be relevant to BC biology. This sub-study includes 160 AA and 199 CA patients (n=359) enrolled since April 2017. Clinical characteristics used in the analysis include menopausal status, metabolic factors, stage, grade and IHC results. A comprehensive publication search (PubMed) was conducted to validate candidate genes involved in BC in AA, BC genes associated with epigenetic regulation and genes associated with metabolic syndrome. Hierarchical clustering was performed on FG microarray (Agilent) intensity data focusing on the candidate genes (50 probes targeting 37 unique genes). Gene expression was compared between race and MP/BP risk groups.

Results: AA were predominately MP High Risk (HR) 67.5%, BP Luminal B 40.2%, BP Basal 22.6%. Interestingly, 40.0% of AA BP Basal were classified by IHC as ER+. CA were MP Low Risk (LR) 54.8%, BP Luminal A 54.8%. Clinically, there were no differences in histology, tumor size, nodal or menopausal status between AA and CA patients. AA had higher grade tumors, higher rates of type 2 diabetes and obesity. Three comparisons were performed: 1) AA and CA, irrespective of MP result, 2) AA and CA HR MP only, and 3) AA only, irrespective of MP result. In comparison 1) 15 unique genes showed significant differences (p&lt;0.05) in gene intensities between AA and CA patients. A heatmap showed four major clusters; cluster 1 included mainly (72.3%) AA patients, and these were predominantly MP HR and BP Basal. In comparison 2) 9 unique genes had significant differences (p&lt;0.05) in gene intensities, 6 of which were common to the first comparison. This showed three major clusters and a significant cluster among AA patients. Finally, comparison 3) found 20 unique genes with significant differences (p&lt;0.05) in gene intensities, 10 of which were common to the previous comparisons. This showed two major clusters with one significant cluster among AA MP HR, BP Basal patients. In total, 11 unique genes showed significant differences in intensities in AA or AA with HR MP including CYP4F8, TWIST1/2, CCND2, FOXA1 and GSTP1. These genes have known functions regulating metabolism and cell cycle.

Conclusions: Here we show AA patients were enriched for genes associated with metabolic syndrome and epigenetic regulation of metabolic syndrome. The aberrant function of these genes has been implicated in tumorigenesis, dysregulation of metabolism and drug resistance. Further validation is warranted to fully understand the association of these genes with the unique biology of breast cancer in AA.

Citation Format: Raquel Nunes, Lisa E. Blumencranz, Heather M Kling, Sahra Uygun, Sarah Untch, Erin B Yoder, Jennifer A Crozier, William Audeh. Racial disparities in breast cancer: Identifying predisposing clinical and molecular features associated with African American patients [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 P2-10-08.

Intervoice: Um Projeto Photovoice Intergeracional

Este artigo descreve um Projeto Intergeracional Photovoice implementado numa Estrutura Residencial para Pessoas Idosas (ERPI), em Portugal, em que participaram quatro idosos e quatro estudantes universitários. O Projeto consistiu em solicitar a idosos e as pares intergeracionais que fotografassem a realidade envolvente. A análise do seu impacto, a cada participante em termos de efeitos muito proveitosos, sugere que esta pode ser uma estratégia bem-sucedida para melhorar as relações interpessoais, intergeracionais e o bem-estar físico e psicológico de idosos especialmente os institucionalizados. 

Race and response to neoadjuvant chemotherapy according to MammaPrint risk

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Background: African-American (AA) women with breast cancer have a less favorable prognosis, likely due to differences in tumor biology. This is not only driven by the higher rate of triple negative/basal tumors in patients with AA ancestry, as worse outcome has also been seen in patients with luminal tumors. The Neoadjuvant BReast Cancer Symphony Trial (NBRST, NCT01479101) was a prospective trial that has shown an association of MammaPrint/BluePrint (MP/BP) with a rate of pathologic Complete Response (pCR) of 2% in Luminal A with 95% Distant Metastasis Free Interval at 3 years. Here, we determine the MP/BP risk distribution, response to therapy, and outcome in African American (AA) and Caucasian (Cau) patients. Methods: NBRST enrolled 1,072 breast cancer patients (pts) in the US (June 2011 and December 2014), median follow-up 34.9 months. The current unplanned analysis compared clinicopathological characteristics, molecular risk assignment and outcome with neoadjuvant chemotherapy (NACT) in AA and Cau pts. Molecular subtyping groups were assessed by MP/BP as follows: Luminal A (MammaPrint Low Risk), Luminal B (MammaPrint High Risk), HER2 and Basal types. Results: Out of 1,072 pts, 157 (15%) were AA, and 780 (73%) were Cau. AA patients were younger at diagnosis (52 vs 54 yrs; p = 0.016), had a higher likelihood of having higher grade (gr 3, 65% vs 53%; p = 0.005), ER-negative (45% vs 33%; p = 0.005) and lymph node positive tumors (71% vs 51; p < 0.001). MP/BP classified more AA patients as Basal type, 45% compared to 33% of Cau patients (p = 0.004). Fewer AA patients were classified as Luminal A (15%) compared to Cau pts (33%; p = 0.004). In multivariate analysis race was a significant factor for higher pCR rates to NACT in AA compared to Cau pts, together with PR, HER2, T-stage and Grade (HR = 1.679, 95% CI = (1.057, 2.67), p = 0.028). The pCR rate to NACT in patients with Basal tumors was 38% and similar in AA and Cau patients. In patients with hormone receptor positive and HER2 negative tumors, patients classified by MP/BP as Luminal A had lower pCR (2%) compared to non-luminal A (13%) (p = 0.0015). MP low risk patients had higher 3 yr DMFS (97%) than MP high risk patients (86%; p = 0.010). DMFS for AA MP Low Risk patients was 100%. Conclusions: In this study, MP was able to identify patients with hormone receptor positive tumors with low sensitivity to chemotherapy and good outcome, irrespective of race, suggesting that this test can be helpful to characterize the tumor’s biology and select patients who will not benefit from chemotherapy independently of their ancestry. Clinical trial information: NCT01479101.

Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study

Purpose

HER2-targeted therapies have substantially improved the outcome of patients with breast cancer, however, they can be associated with cardiac toxicity. Guidelines recommend holding HER2-targeted therapies until resolution of cardiac dysfunction. SAFE-HEaRt is the first trial that prospectively tests whether these therapies can be safely administered without interruptions in patients with cardiac dysfunction.

Methods

Patients with stage I–IV HER2-positive breast cancer candidates for trastuzumab, pertuzumab or ado-trastuzumab emtansine (TDM-1), with left ventricular ejection fraction (LVEF) 40–49% and no symptoms of heart failure (HF) were enrolled. All patients underwent cardiology visits, serial echocardiograms and received beta blockers and ACE inhibitors unless contraindicated. The primary endpoint was completion of the planned HER2-targeted therapies without developing either a cardiac event (CE) defined as HF, myocardial infarction, arrhythmia or cardiac death or significant asymptomatic worsening of LVEF. The study was considered successful if planned oncology therapy completion rate was at least 30%.

Results

Of 31 enrolled patients, 30 were evaluable. Fifteen patients were treated with trastuzumab, 14 with trastuzumab and pertuzumab, and 2 with TDM-1. Mean LVEF was 45% at baseline and 46% at the end of treatment. Twenty-seven patients (90%) completed the planned HER2-targeted therapies. Two patients experienced a CE and 1 had an asymptomatic worsening of LVEF to ≤ 35%.

Conclusion

This study provides safety data of HER2-targeted therapies in patients with breast cancer and reduced LVEF while receiving cardioprotective medications and close cardiac monitoring. Our results demonstrate the importance of collaboration between cardiology and oncology providers to allow for delivery of optimal oncologic care to this unique population.

Electronic supplementary material

The online version of this article (10.1007/s10549-019-05191-2) contains supplementary material, which is available to authorized users.

Abstract P3-12-02: Predictors of adherence to adjuvant endocrine therapy (ET) for early breast cancer (BC) in a prospective clinic-based cohort

Background: Adjuvant ET is associated with improved survival in women with hormone receptor-positive early BC. Nonetheless, more than a quarter of women are non-adherent or discontinue therapy early. We aimed to identify whether baseline characteristics and changes in weight and patient-reported outcomes (PRO) early during the course of ET are associated with medication adherence behavior (MAB) in a prospective cohort.

Methods: We enrolled women initiating or switching adjuvant ET for stage 0-III BC in a prospective clinic-based cohort. Participants completed PRO questionnaires at baseline, and 3, 6, and 12 months (mo) after initiating ET. PRO questionnaires included FACT-ES, the NIH PROMIS measures for pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance, and the MOS Sexual Functioning Scale. MAB was assessed by the Medication Adherence Questionnaire (MAQ). MAB was defined as high (MAQ score=0), or medium/low (MAQ score&gt;0). Questionnaires were administered through the PatientViewpoint web-based interface. We tested changes in mean PRO scores from baseline to follow-up time points with paired t-tests. We explored associations between baseline characteristics, and changes in weight and PRO at 6 mo with MAB at 12 mo using Fisher's exact test, Wilcoxan rank sum tests and t-tests. P-values &lt;0.05 were considered significant.

Results: From March 2012 to December 2016, 336 women enrolled in the cohort. Mean age was 60 (range 26-90), 84% were Caucasian, and 67% were post-menopausal. Overall, 57% received an aromatase inhibitor, 43% received tamoxifen, and 28% received prior taxane chemotherapy. Median follow-up was 12 mo. At baseline, 61% were overweight/obese, and 21% gained &gt;5% of baseline weight by 12 mo. Mean baseline and follow-up scores at 3, 6 and 12 mo were within 1 standard deviation of reference population means for all PRO measures. Compared to baseline, endocrine symptoms were increased at 3, 6 and 12 mo (p&lt;0.05), while sexual function and depression did not differ between baseline and any follow-up time point (p&gt;0.05). At 6 mo, anxiety was reduced, physical function was improved and pain impact was reduced compared to baseline (p&lt;0.05). MAB was high for 71% of participants at 12 mo. Preliminary data demonstrate that, compared to those with high MAB at 12 mo, women with medium/low MAB at 12 mo took fewer concomitant medications at baseline, and had more improvement in anxiety and sexual function at 6 mo. MAB at 12 mo did not differ according to race, type of ET, baseline weight or PRO measures, or 6 mo change in weight or other PRO measures.

Conclusions: Early changes in anxiety and sexual function during the course of adjuvant ET and the number of baseline concomitant medications may separate women with subsequent high versus medium/low MAB risk. Weight loss interventions and symptom management are needed for women receiving adjuvant ET during the first year of treatment. Our data will be used to create a model to predict MAB for validation studies and as the basis to devise interventions to improve adherence to adjuvant ET.

Citation Format: Smith KL, Yeruva SLH, Blackford A, Huang C-Y, Westbrook KE, Harding BA, Smith A, Fetting J, Wolff AC, Jelovac D, Miller RS, Connolly R, Armstrong D, Nunes R, Visvanathan K, Stearns V. Predictors of adherence to adjuvant endocrine therapy (ET) for early breast cancer (BC) in a prospective clinic-based 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 P3-12-02.

Neurogenic stuttering: a review of the literature

INTRODUCTION

Neurogenic stuttering is a disorder of neurologic origin in the rhythm of speech during which the patient knows exactly what he wants to say but is unable to because of an involuntary prolongation, cessation or repetition of a sound.

AIM

To assemble new insights regarding the epidemiology, pathophysiology, diagnosis, evaluation and treatment of neurogenic stuttering.

DEVELOPMENT

A review of all PubMed and Scopus published articles between January 2000 and September 2016 was performed. Thirty-three publications were analyzed. Neurogenic stuttering is a rare entity whose epidemiological incidence is yet not fully established. It is correlated with several neurological diseases and with several possible localizations within the nervous system. Notwithstanding the recent advances in the understanding of the underlying mechanism, it is not yet possible to establish a single pathophysiological mechanism of neurogenic stuttering. The differential diagnosis is complex and requires the detailed knowledge of other language disorders. The treatment is currently based on specific speech language therapy strategies.

CONCLUSION

Neurogenic stuttering is a complex disorder which is not fully understood. Additional studies might help to better explain the underlying pathophysiological mechanism and to open doors to novel therapeutic methods.

Video intervention increases participation of black breast cancer patients in therapeutic trials

There is a striking racial and ethnic disparity in incidence and mortality of cancer yet minorities remain markedly underrepresented in clinical trials. This pilot study set out to determine the impact of a 15-min culturally tailored educational video on three outcomes relating to clinical trials: likely participation, attitudes (assessed based on six barriers), and actual enrollment. Breast cancer patients with Stage I-III, if diagnosed within previous 6 months, or metastatic disease who self-identified as black or African American were invited to participate. The primary outcome measure was the decision to participate in a therapeutic clinical trial after the intervention. Patients’ intention to enroll on a therapeutic clinical trial and the change in attitudes toward clinical trials were measured by the previously developed Attitudes and Intention to Enroll in Therapeutic Clinical Trials (AIET) questionnaire. Of the 200 patients that participated, 39 (19.5%) patients signed consent to participate in a therapeutic clinical trial; 27 (13.5%) patients enrolled, resulting in a 7.5% increase from our baseline comparison of 6% clinical trial enrollment rate in black cancer patients (p < .001). Pre-test versus post-test assessment demonstrated the proportion of patients expressing likelihood to enroll in a therapeutic trial following the intervention increased by 14% (p < .001). Among 31 AIET items, 25 (81%) showed statistically significant and positive change post-intervention. The findings suggest the promising utility of a culturally tailored video intervention for improving black patients’ attitudes regarding clinical trial participation and resultant enrollment. Future efforts should continue to target facilitators of population-specific recruitment, enrollment, and retention in therapeutic and non-therapeutic clinical trials.

A culturally tailored educational video can boost participation among black patients in clinical trials of new breast cancer treatments. A US team led by Sandra Swain from Georgetown University Medical Center in Washington, DC, created a 15-min video designed to address six of the concerns commonly cited by blacks about human subjects research. The researchers showed the video to 200 black patients, and saw a large bump in the number of women willing to sign up for a therapeutic trial. On average, only 6% of black cancer patients typically enroll in clinical trials. But in the video intervention study, 19.5% agreed to participate and then 13.5% went ahead with a trial. Video watchers also reported a positive change in their attitude toward clinical research. The study points to the need for population-specific recruitment efforts.