Real-world treatment patterns and outcomes of abemaciclib for the treatment of HR + , HER2- metastatic breast cancer patients in Japan

INTRODUCTION

This study described, in routine clinical practice in Japan, the patient characteristics, treatment patterns, and outcomes of female patients with HR + /HER2- metastatic breast cancer (MBC) who started abemaciclib treatment.

METHODS

Clinical charts were reviewed for patients starting abemaciclib in 12/2018-08/2021 with a minimum of 3 months follow-up data post-abemaciclib initiation regardless of abemaciclib discontinuation. Patient characteristics, treatment patterns, and tumor response were descriptively summarized. Kaplan-Meier curves estimated progression-free survival (PFS).

RESULTS

200 patients from 14 institutions were included. At abemaciclib initiation, median age was 59 years, and the Eastern Cooperative Oncology Group performance status score was 0/1/2 for 102/68/5 patients (58.3/38.9/2.9%), respectively. Most had an abemaciclib starting dose of 150 mg (92.5%). The percentage of patients receiving abemaciclib as 1st, 2nd, or 3rd line treatment was 31.5%, 25.8%, and 25.2%, respectively. The most frequent endocrine therapy drugs used with abemaciclib were fulvestrant (59%) and aromatase inhibitors (40%). Evaluation of tumor response was available for 171 patients, 30.4% of whom had complete/partial response. Median PFS was 13.0 months (95% CI 10.1-15.8 months).

CONCLUSIONS

In a routine clinical practice setting in Japan, patients with HR + , HER2- MBC appear to benefit from abemaciclib treatment in terms of treatment response and median PFS, with the results broadly reflecting the evidence demonstrated in clinical trials.

POS1415 A MACHINE LEARNING ANALYSIS OF FACTORS PREDICTING ORGAN DAMAGE PROGRESSION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS USING THE SPANISH SOCIETY OF RHEUMATOLOGY LUPUS REGISTRY (RELESSER)

Background

Evidence shows that around half of the patients with systemic lupus erythematosus (SLE) develop irreversible organ damage due to the disease itself or to other factors (e.g., steroid treatment). It is essential to have a comprehensive understanding of factors that predict organ damage progression to identify at-risk patients and inform clinical decision making.

Objectives

To develop an algorithm, using machine learning (ML) methodology, that predicts organ damage progression in SLE patients.

Methods

The Spanish Society of Rheumatology Lupus Registry (RELESSER) with patient records from 45 Rheumatology Units across Spain was used. RELESSER data were collected from 2011 to 2021 and captured demographic and comprehensive clinical information. In this analysis, a sample of 2,676 patients was used. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to measure organ damage progression between 2015 (start of the prospective data collection in RELESSER) and 2020.To predict the risk of an increase in the SDI, 102 variables were identified as potential predictors. A ML model (gradient boosting trees) was developed and validated by a simple logistic regression (LG) model. The area under the receiver operating characteristic curve (AUCROC) was used to quantify the improvement over random chance (an AUCROC of 0.5). Shapley Additive Explanation (SHAP) values were used in the ML model to identify predictors and their contribution to damage progression.

Results

Of all patients, 13% experienced organ damage progression, with 2-year patient follow-up. The ML algorithm was better at identifying these patients (AUCROC 0.68) than the LG model (AUCROC 0.63) (Figure 1). ML model performance can be contextualized using a random sample of 100 SLE patients of whom 13 suffered organ damage progression, the model would successfully identify 12. However, 66 additional patients would be incorrectly identified (True Positive 90%; False Positive 79%). The top 5 predictors of damage progression, across all patients, were patient age >49 years,

Figure 1.

ROC AUC plot

Creatinine > 0.9 mg/dl, cardiovascular-related disease complications (> 3 complications), low hematocrit level recorded recently (<41.9 months ago), and triglycerides > 81.5 mg/dl. At the patient level, the 5 patients with the highest predicted risk had strong predictors of progression, with key predictors being patient age at study entry >49 years, age at diagnosis >40 years, cardiovascular-related disease complications, and increased creatinine >0.9 mg/dl. The 5 patients with the lowest predicted risk had strong predictors of no change with key predictors being not having a low hematocrit level recorded recently, triglycerides <81.5 mg/dl and patient age at study entry <49 years.

Conclusion

We developed a machine learning model, using an exhaustive set of variables in RELESSER which successfully predicted short-term organ damage progression in SLE patients, and outperformed a standard regression model. If the model were to be used as a clinical tool, only light-touch interventions should be carried out due to high false positive rate. Further model optimizations, including exposing the model to longer follow-up data and testing it in non-Spanish patients is needed.

Disclosure of Interests

Jose M Pego-Reigosa Speakers bureau: Eli Lilly, GSK, Consultant of: AstraZeneca, GSK, MSD, Eli Lilly, Grant/research support from: The RELESSER registry was funded by grants from GSK, UCB, Roche and Novartis, WALID FAKHOURI Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Silvia Díaz-Cerezo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Aidan Cooper Consultant of: Salaried employee of IQVIA while conducting the analyses for this study, Anne-Marie Saunders Consultant of: Salaried employee of IQVIA while conducting the analyses for this study, Grace Segall Consultant of: Salaried employee of IQVIA throughout conceptualization, design and execution of analysis for this study, Employee of: Eli Lilly and Company throughout finalization of analysis and abstract development for this study, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Sebastian Moyano Employee of: Eli Lilly and Company, Iñigo Rua-Figueroa Grant/research support from: The RELESSER registry was funded by grants from GSK, UCB, Roche and Novartis

AB0261 A MULTINATIONAL, PROSPECTIVE, OBSERVATIONAL STUDY IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING BARICITINIB, TARGETED SYNTHETIC OR BIOLOGIC DISEASE-MODIFYING THERAPIES (RA-BE-REAL) – STUDY DESIGN AND BASELINE CHARACTERISTICS

Background:

Baricitinib (BARI) is a JAK1-2 inhibitor approved for the treatment of adults with moderately to severely active rheumatoid arthritis (RA). RA-BE-REAL is a 3-year, prospective, observational study of adult RA patients (pts) evaluating adherence to treatment in clinical practice.

Objectives:

To describe pt and disease characteristics of pts enrolling into RA-BE-REAL in 5 European countries.

Methods:

The primary endpoint of RA-BE-REAL is time until discontinuation of initial treatment for all causes (excluding sustained clinical response) over a 24-month (M) period. Secondary endpoints include clinical and pt reported outcomes, healthcare resource utilization and treatment patterns over a 36M period. Two pt cohorts are assessed: cohort A, started treatment with BARI (2-mg or 4-mg), and cohort B, any other targeted synthetic (ts)DMARDs or biologic (b)DMARD (Fig. 1). Treatment initiation and changes are at the discretion of the pt and physician. Data is collected at baseline and at routine visits (~3M, 6M, 12M, 18M, 24M and 36M). Summaries are presented with t-test and chi-square test of independence.

Results:

Between October 2018 and March 2020, 1074 adult RA pts were enrolled from France, Germany, Italy, Spain, and UK. In cohort A, 88.2% of pts are treated with BARI 4-mg. At time of enrolment pts in cohort A are more likely to commence treatment as a monotherapy as compared to pts in cohort B who are more likely to commence treatment in combination with csDMARDs (p<0.001). Cohort A are more likely to be older (59.2 vs 57.0, mean years p=0.009) and have higher Health Assessment Questionnaire-Disability Index (HAQ-DI) scores (1.4 vs 1.3, p=0.03). A greater percentage of cohort A pts have received prior treatment with either 1 b/tsDMARD (15.3 vs 11.0%), 2 b/tsDMARD (20.2 vs 14.7%) or >2 b/tsDMARD (15.9 vs 12.9%), while cohort B are more likely to be treatment naïve (61.4 vs 48.5%). There are no significant differences in other baseline characteristics shown in Table 1.

Conclusion:

There are few but potentially clinically important differences between cohorts. Pts in cohort A are more likely to be older, have a longer disease duration, have received prior b/tsDMARD treatment, and are more likely to receive treatment as a monotherapy as compared to pts in cohort B.

Figure 1.

Study Design. Participants entered cohort A or B based on their treatment decision for BARI or another b/tsDMARD, pts in each cohort were with/without concomitant csDMARDs.

Table 1.

Patient disposition and baseline characteristics.

Cohort ABaricitinib(n=509)Cohort BOverall(n=1074)TNFi(n=338)non-TNFi(n=161)tsDMARD(n=66)Combination Therapywith any csDMARD238 (46.8)231 (40.9)110 (19.5)38 (6.7)617 (57.4)monotherapy271 (53.2)107 (18.9)51 (9.0)28 (5.0)457 (42.6)Values represent n (%)Cohort ACohort Bp-valueOverall (n=1074)(n=509)(n=565)Age in years59.2 (13.2)57.0 (13.9)0.00958.0 (13.6)Disease duration in years10.3 (9.2)9.1 (9.8)0.059.7 (9.5)CDAI24.1 (11.7)23.9 (12.4)0.7524.0 (12.1)Swollen joint count5.2 (4.8)4.7 (4.9)0.184.9 (4.8)Tender joint count7.3 (6.1)7.8 (6.5)0.197.6 (6.3)PhGA5.6 (2.0)5.5 (2.1)0.395.6 (2.0)PGA5.9 (2.3)5.8 (2.4)0.495.9 (2.4)Pain VAS59.0 (23.1)56.4 (24.3)0.0857.6 (23.8)HAQ-DI1.4 (0.7)1.3 (0.7)0.031.4 (0.7)b/tsDMARDs treatment any time before enrolment; n (%)<0.001* Naïve247 (48.5)347 (61.4)594 (55.3) 1 b/tsDMARD78 (15.3)62 (11.0)140 (13.0) 2 b/tsDMARDs103 (20.2)83 (14.7)186 (17.3) >2 b/tsDMARDs81 (15.9)73 (12.9)154 (14.3)

Values represent mean (SD), unless otherwise stated.

b/tsDMARD, biologic/targeted synthetic disease-modifying antirheumatic drug; CDAI, Clinical Disease Activity Index; HAQ-DI, Healthy Assessment Questionnaire-Disability Index; P(h)GA, Patient’s (Physician’s) global assessment of disease activity; VAS, Visual analogue scale. *chi-square test of independence for comparison of b/tsDMARD treatment received before enrolment.

Acknowledgements:

The authors would like to acknowledge Luke Healy for medical writing support.

Disclosure of Interests:

Rieke Alten Speakers bureau: Janssen Pharmaceuticals, Eli Lilly and Company, Pfizer Inc., and Galapagos, and Gilead Sciences, Consultant of: Eli Lilly and Company, Pfizer Inc., Galapagos NV, and Gilead Sciences, Grant/research support from: Bristol-Myers Squibb, Eli Lilly and Company, Pfizer Inc., Galapagos NV, and Gilead Sciences, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Gilead Sciences, Eli Lilly and Company, and Pfizer Inc., Consultant of: AbbVie, Gilead Sciences, Eli Lilly and Company, and Pfizer Inc., Marco Matucci-Cerinic Speakers bureau: Actelion, Janssen Pharmaceuticals, MSD, Eli Lilly and Company, Biogen Inc., Grant/research support from: MSD, Actelion., Jean-Hugues Salmon: None declared, Pedro López-Romero Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, WALID FAKHOURI Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Inmaculada De La Torre Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Anja Gentzel-Jorczyk Employee of: Eli Lilly and Company, Thorsten Holzkaemper Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Bruno Fautrel Consultant of: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Janssen Pharmaceuticals, Eli Lilly and Company, Medac, MSD, NORDIC Pharma, Novartis, Pfizer Inc., Roche, Sanofi-Aventis, SOBI, UCB, Grant/research support from: AbbVie, MSD, Pfizer Inc.

THU0212 FIRST LINE TREATMENT WITH CONVENTIONAL SYNTHETIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATOID ARTHRITIS: A MULTINATIONAL POPULATION-BASED COHORT FROM 14 REAL WORLD HEALTHCARE DATABASES AND 9 COUNTRIES - REALITY VERSUS GUIDELINES

Background:

Treatment guidelines recommend early initiation of csDMARDs following diagnosis of rheumatoid arthritis (RA), with methotrexate (MTX) as first-line therapy. Scarce evidence exists on adherence to this guidance

Objectives:

To characterize first-line csDMARD treatment during the first year following an RA diagnosis.

Methods:

14 real world databases (3 Primary care, 6 primary/secondary care records, 5 claims) from 9 countries were included, all mapped to the OMOP common data model.

Patients were included on the earliest event of: 1st diagnosis of RA or 1st DMARD prescription with an RA diagnosis within 30 days. Patients were >18 years-old, required 1+ year pre-index data, and at least 1-year follow-up. Study period covered 2000-2018. Previous users of DMARDs or non-RA inflammatory arthritis history were excluded. Only MTX, Hydroxychloroquine (HCQ), Sulfasalazine (SSZ) and Leflunomide (LEF) were available in all databases.

Results:

We identified 323,547 eligible participants. Large variation was observed internationally (Figure 1). MTX as first-line monotherapy ranged from 33.3% to 74.5%, and in combination with HCQ from 2.1% to 6.7%. Three additional csDMARDs were used as first-line: HCQ in 10.1% to 30.2%, SSZ in 0.9% to 28.7%, and LEF in 1.8% to 15.2%.

Figure 1.

First line csDMARD treatment during 1yr from first observed RA diagnosis

Conclusion:

We report wide heterogeneity of first-line csDMARDs regimens internationally. Despite recommendations for MTX to be first line therapy, data suggest that a large proportion of patients receive alternative csDMARD.

Disclosure of Interests: :

Anthony G Sena Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Full-time employment salary from Janssen, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, Denis Granados: None declared, Nigel Hughes Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, WALID FAKHOURI Shareholder of: E Lilly Shares, Employee of: Eli Lilly and Company, Antje Hottgenroth Shareholder of: Eli Lilly shares, Employee of: Lilly Deutschland GmbH, Raivo Kolde: None declared, Sulev Reisberg: None declared, Carmen Olga Torre: None declared, Talita Duarte-Salles: None declared, Yesika Díaz: None declared, Jose Felipe Golib-Dzib Grant/research support from: Full-time employment salary from Janssen, Employee of: Yes, Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Emily S. Brouwer Shareholder of: J&J shares, Takeda shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Edward Burn: None declared, Jennifer Lane: None declared, David Vizcaya Employee of: Bayer, Sara Bruce Wirta Employee of: Janssen-Cilag Sweden AB, Marcel de Wilde: None declared, Katia Verhamme: None declared, Peter Rijnbeek: None declared, Elke Theander Employee of: Janssen-Cilag Sweden AB, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Patrick Ryan: None declared

Isolation and identification of N-mercapto-4-formylcarbostyril, an antibiotic produced by Pseudomonas fluorescens

Pseudomonas fluorescens strain G308 isolated from barley leaves produces a novel antibiotic substance that was purified by preparative TLC and HPLC and identified as N-mercapto-4-formylcarbostyril (Cbs) by LC/DAD, IR, LC-ES(+)/MS, LC-ES(-)/MS, GC-EI/MS, LC-HRES(+)/MS, mass isotope ratios analysis, 1H NMR and 13C NMR analysis. The purified new antibiotic compound is effective against many phytopathogenic fungi in vitro. The compound inhibited at 25 ppm spore germination and germ tube growth of the following fungi; Fusarium oxysporum f. sp. lycopersici, Fusarium culmorum, Cladosporium cucumerinum and Colletotrichum lagenarium. At concentrations up to 125 ppm, the compound did not interfere with release of zoospores from sporangia and germination of encysted zoospores of Phytophthora infestans.