Abstract P4-13-14: “Real world” characteristics, treatment patterns and outcomes of patients with hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (MBC)

OBJECTIVES: Outcomes for patients with MBC vary according to disease phenotype and treatment history. We present UK real-world patient characteristics, treatment patterns and outcomes for patients with HR+/HER2- BC treated at a single cancer center.

METHODS: A retrospective review of health records including coded data, unstructured text and clinical review of patients treated from January 2012 to March 2018 identified females ≥ 18 years with metastatic or locally advanced HR+/HER2- BC. Those enrolled in clinical trials, with operable local recurrence as only disease site, incomplete treatment records or significant secondary malignancy were excluded. Patient characteristics, systemic, local (radiotherapy/surgery) and supportive treatments, health care resource use (HRU) and overall survival (OS) are presented. OS was estimated using the Kaplan-Meier method, censoring patients alive at study end.

RESULTS: 253 patients meeting study inclusion criteria were identified (median age 67, IQR 56,76; 84% post-menopausal), of whom 47 (19%) had locally advanced disease (T4 and/or N3), 75 (30%) had MBC at initial presentation and 131 (52%) had metastatic disease at first recurrence. Among patients with MBC at initial presentation, all received systemic treatment following diagnosis, including chemotherapy (35%), endocrine (93%) and targeted therapy (i.e. everolimus 7%). Among those recurring with MBC, 97% subsequently received systemic treatment, including chemotherapy (50%), endocrine (93%) and targeted therapy (27%). For patients recurring with MBC, the most common first line therapies (LoT) were letrozole (20%), exemestane (single agent, 15%), anastrozole (14%), everolimus (with exemestane, 11%) and paclitaxel (9%). For patients diagnosed with MBC, the most common first LoT were letrozole (47%), anastrozole (23%) and EC (11%). At second LoT, the most commonly used regimen for patients recurring with MBC was fulvestrant (13%) and for patients with MBC at initial diagnosis, it was exemestane (19%). Median OS for patients recurring with MBC was estimated to be 2.11 years (IQR 1.80,3.05), compared with 2.65 years (IQR 2.24,2.95) for those with metastatic disease at initial diagnosis. Median available follow-up time for the whole cohort was 2.85 years (IQR 1.42,4.82).

CONCLUSIONS: Patients with overt metastatic disease at presentation comprise a substantial proportion of those treated for MBC. With the follow-up time available, estimated median OS for patients with metastatic disease at initial presentation appears somewhat better than for those recurring with metastatic disease. Real world analysis demonstrates diverse treatment pathways for patients with HR+, HER2- MBC, reflecting the individualized care they receive.

Citation Format: Twelves C, Cheeseman S, Thompson M, Riaz M, Perren T, Ahat-Donker N, Sopwith W, Myland M, Lee A, Turner S, Hall G. “Real world” characteristics, treatment patterns and outcomes of patients with hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-14.

The changing epidemiology of cryptosporidiosis in North West England

Between 1996 and 2000, rates of cryptosporidiosis in North West England were significantly higher than overall in England and Wales, particularly during the first half of each year. In addition, during the second quarter of each year in this period, up to 40% of all cases recorded in England and Wales were from the North West Region. In 2001, cryptosporidiosis dramatically decreased throughout the United Kingdom and the springtime excess of cases formerly seen in the North West was no longer apparent. This changed epidemiology was due to a decline in cases of Cryptosporidium parvum (formerly genotype 2), associated with zoonotic transmission. Although the initial loss of a spring peak of infection corresponded with the outbreak of foot-and-mouth disease throughout the United Kingdom, its continued absence relates to major structural changes in the North West public water supply. This study highlights the far-reaching public health benefit of local working relationships in addressing re-occurring disease issues.

Behind the mask. Journey through an epidemic: some observations of contrasting public health responses to SARS

SARS has been called the first global epidemic of the 21st century and has been the cause of a massive and varied public health response in many countries of the world. This report describes observations made by two authors on a journey from Manchester in the United Kingdom to Chiang Mai in Thailand during the peak of global transmission. The public response to SARS, particularly characterised by the wearing of face masks, seemed to outstrip official guidance. Though of uncertain protective benefit, the wearing of masks may have contributed to the awareness of the collective and personal responsibility in combating infectious disease. Active and empowered involvement of the general public in implementing and cooperating with public health control measures supported by national and international authorities has clearly helped to bring SARS under control. The public health significance of such potent symbols as the face mask may be considered in strategies to tackle other emerging infections.

An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester

BACKGROUND

In the past few years, increased diagnoses of syphilis have been reported in cities around Britain and Europe. Enhanced surveillance of cases began in 1999 to identify the epidemiology of this increase in Greater Manchester.

METHODS

Information was collected on all cases of syphilis newly diagnosed in genitourinary medicine (GUM) clinics in Greater Manchester between January 1999 and November 2002. The data collected included demographic information and information about other sexually transmitted infections, sexual behaviour, perception of risk of infection, and awareness of syphilis transmission.

RESULTS

The majority of cases identified were white homosexual men resident in Greater Manchester. Of the 414 cases diagnosed, 74% had either a primary or secondary stage of syphilis infection and 37% of cases were HIV positive. High numbers of individuals practised unprotected oral sex despite good awareness of the risk of infection with syphilis. There is evidence that the way people are meeting sexual contacts is changing, with increasing numbers meeting most of their partners through the internet.

CONCLUSIONS

These findings have implications for targeting interventions. The provision of rapid diagnostic and treatment services is likely to be key for the control of syphilis and potentially of subsequent increases in HIV in the region.

Enhanced surveillance of campylobacter infection in the North West of England 1997-1999

OBJECTIVES

To identify sources and routes of infection for sporadic cases of campylobacter infection in the North West of England.

METHODS

Standard, structured questionnaires were used to gather epidemiological information from cases of campylobacter infection in the North West Region of England between 1997 and 1999. The strains of campylobacter isolated from these cases were identified and typed using serotyping and phage typing methods. Analysis of combined serotype and epidemiological data is presented.

RESULTS AND CONCLUSIONS

Human campylobacter infection in the North West is seasonal and a new observation was a peak in cases in March each year. Drinking bird-pecked milk was a highly seasonal exposure that might be an indicator of environmental contamination with campylobacter. A possible environmental basis for seasonality of infection is discussed. Frequencies of risk exposures related to serotypes of cases are described and a potential association was demonstrated between Campylobacter jejuni HS6 and consumption of bird-pecked milk. Also, Campylobacter coli infections were more commonly associated with travel abroad than C. jejuni and a decreased proportion of C. jejuni HS2 and C. jejuni HS11 reported consumption of meat and unpasteurised milk (respectively). Contact with a sick animal may be a significant risk exposure in younger age groups and in those who do not consume poultry or meat. It is clear from this and other studies that the sources and vehicles of human campylobacter infection are numerous and interventions that target a single risk factor are unlikely to impact significantly on the overall burden of disease.

Surveillance of influenza in the North-West Region of England 2001-02

A local sentinel network of general practitioners has been established in the north west of England for the surveillance of influenza. In the 2001-02 winter, consultation rates for influenza-like-illness (ILI) were low but the surveillance network was able to demonstrate sub-regional variations in the timing of peak influenza activity, and the infection of different age groups. This suggests the network can contribute to better planning to winter pressures on the North West health service.