Use of Endpoints in Phase III Randomized Controlled Trials for Hematopoietic Stem Cell Transplantation Over the Last 15 Years: A Systematic Review

This systematic review aimed to evaluate the proportion of primary and secondary endpoints in hematopoietic stem cell transplant (HSCT) phase III randomized clinical trials (RCTs) and analyze their trends in time and study sponsorship status. The Chi-square test and logistic regression analyses were performed using SPSS version 28. A total of 147 HSCT phase III RCTs from 2006 to 2021 reported 197 primary and 600 secondary endpoints. Overall survival (OS, 17 %), progression-free survival (PFS, 15 %), graft versus host disease (GVHD, 8 %), event-free survival (EFS, 8 %), and organ function (8 %) were the most common primary endpoints. GVHD (12.3 %, n = 74), safety/toxicity/adverse events (11.8 %, n = 71), OS (11.5 %, n = 69), PFS (9.3 %, n = 56), and relapse rate (RR; 7.5 %, n = 45) were the most common secondary endpoints during 2006-2021. After 2013, an increase was noted in the use of PFS as a primary endpoint (12 %-18 %, p = 0.196), while the use of OS as a primary endpoint declined (20 %-13 %, p = 0.170). An increase was observed in using the secondary endpoints RR (5 %-10 %, p = 0.047) and NRM (3 %-6 %, p = 0.047). EFS was used more (14 % vs. 4 %, p = 0.012) than ORR (11 % vs. 2 %, p = 0.003) as a primary endpoint in pharmaceutical-compared to non-pharmaceutical-sponsored studies. As secondary endpoints, the use of EFS (4 % vs. 1 %, p = 0.013) and ORR (4 % vs. 1 %, p = 0.028) was higher, whereas that of organ systems/functions (1.5 % vs. 5.5 %, p = 0.022) and GVHD (6.5 % vs. 15 %, p = 0.002) was lower in pharmaceutical-compared to non-pharmaceutical sponsored studies. GVHD-free relapse-free survival was reported as a primary endpoint in 2 % of studies, while only 5 % reported quality of life as a secondary endpoint. We described commonly used endpoints in HSCT phase III RCTs and patterns in their use over time by funding source and study intervention category.

A retrospective analysis of the frequency of heparin-induced thrombocytopenia in the intensive care unit at a tertiary care center in Riyadh, Saudi Arabia

BACKGROUND

Heparin-induced thrombocytopenia (HIT) is an extremely serious and potentially fatal condition that can develop in patients taking heparin-based medications, such as unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). The incidence and risk factors for HIT in critically ill patients, however, are not well defined.

METHODS

We retrospectively collected data on HIT test results, route of heparin administration, age, sex, heparin type (UFH or LMWH), and date of illness from patients admitted to the intensive care unit (ICU) and regular nursing floor (non-ICU) at our hospital between January 2011 and December 2014. We screened patients for HIT using the 4T score and confirmed the diagnosis through laboratory testing (direct enzyme immunoassay immunoglobulin G [IgG] or a platelet-activating antibody).

RESULTS

We screened a total of 946 patients, 56 (5.9%) of whom were positive for HIT. Among 776 patients receiving UFH and 180 receiving LMWH, 2.8 and 6.6% developed HIT, respectively (P = 0.051). We then classified our patients into two groups: ICU, and non-ICU. In the non-ICU group (n = 317), 4 (2.7%) patients receiving LMWH and 25 (5.1%) receiving UFH were positive for HIT (P = 0.221). In the ICU group (n = 639), 1 (3.1%) patient receiving LMWH and 26 (9.1%) receiving UFH were positive for HIT (P = 0.249). The ICU group, therefore, had a higher cumulative incidence rate of HIT than the non-ICU group (8.5 vs. 4.5%).

CONCLUSION

HIT was more common in ICU patients than non-ICU patients and in more patients receiving UFH than LMWH, although the differences were not statistically significant. Early diagnosis and appropriate treatment are essential to prevent adverse outcomes in patients with HIT.

An Unexpected Diagnosis of Second Primary Malignancy in a Breast Cancer Survivor: A Case Report

BACKGROUND

Breast cancer survival rates are increasing more than ever with the development of better diagnostic and therapeutic techniques. Survivors of breast cancer have an increased risk of developing second primary malignancies, which may be mistaken for breast cancer recurrence and lead to delayed diagnosis and poor prognosis.

CASE REPORT

We report a case of a 62-year-old female who presented with shortness of breath and bone pain. She had a history of left triple-positive invasive ductal carcinoma (T1N0M0) treated with bilateral skin-sparing mastectomy, adjuvant Taxotere, and trastuzumab-based therapy and then continued on trastuzumab and letrozole. She underwent imaging to explore the source of her symptoms at which new pulmonary nodules were discovered. During workup, she was found to have elevated tumor markers. They were initially suspected to be breast cancer recurrence metastases based on elevated tumor markers; however, further investigations confirmed that the nodules were a second primary lung adenocarcinoma with a different molecular profile. The patient had disease progression despite chemotherapy and eventually succumbed to her disease.

CONCLUSION

This case highlights the importance of considering second primary malignancies in breast cancer survivors and utilizing advanced diagnostic modalities to efficiently diagnose such cases.

Abstract P2-14-13: Single institute data to assess timing of surgery post neoadjuvant in breast cancer patients

Background: This study aims to analyze the impact of the time taken from the completion of neoadjuvant chemotherapy to surgery on patients' outcomes in terms of pathological response, overall survival and disease-free survival. There is no specific guideline for timing of the surgery. This study presents the experience of our institute's unique and large data of locally advanced breast cancer patients who received neoadjuvant systemic therapy.

Methods: This retrospective study evaluated patients diagnosed with Stage II and III breast cancer patients who received neoadjuvant chemotherapy, which was FEC and Taxotere +/-Herceptin depending on Her2 status of disease. Evaluation of the treatment outcome was based on the time interval between completion of neoadjuvant chemotherapy and surgery. Patients were selected from the time frame of January 2004 to December 2014. The effect of time interval was studied using two types of stratification. First stratification included time interval less than 4 weeks, 4-6 weeks and more than 6 weeks. Second stratification included patients with time interval <4 weeks, 4-7 weeks, and ≥8 weeks. Patients were also evaluated on the basis of receptor status ER, PR and Her2, and their outcomes.

Results: A total of 611 patients were identified. The patients were divided into two cohorts for better analysis. The first cohort showed 94 patients (15.4%) who had surgery within 4 weeks of their last dose of neoadjuvant chemotherapy, 378 (61.9%) within 4-6 weeks, and 139 (22.7%) ≥6 weeks. For the second cohort 94 patients (15.4%) had surgery within 4 weeks, 424 (69.4%) within 4-7 weeks, and 93 (15.2%) ≥ 8 weeks. Median OS and median DFS is not reached. OS at 5 years was 89.6% and DFS at 5 years was 74%. In both cohorts, OS and DFS were not significant when stratified to timing of surgery but the trend of DFS, although not statistically significant, was poor when patients had surgery more than 6 and 8 weeks. When patients were assessed on pathologic response stratified with timing of surgery, about 15% of patients had surgery ≥8 weeks, only 12.9% of those had complete pathological response compare to patients whose surgery was 6-7 weeks and complete pathologic response was 26% (p=0.02). In terms of receptor status, (ER-/HER-2+) patients had a statistically significant decrease in complete pathologic response if surgery was ≥8 weeks. However, ER+/HER-2-, (ER+/HER-2+), ER-/HER-2- had no difference in complete pathological response.

Conclusion: The above data indicates that our patients showed improved complete pathologic response if the surgery was performed within 8-weeks, especially for (ER-/HER-2+) patients. All patients post neoadjuvant had better OS and DFS trends if the surgery was performed between 4-6 weeks. The data suggests that early surgery helps complete pathologic response, and the necessary measures must be taken to identify any obstacles leading to delay in surgery and eliminating these obstacles.

Citation Format: Suleman K, Haque E, Mushtaq AH, Badran A, Alsayed A, Ajarim D, Twegieri T, Almalik O, Jastaniyah NT, Elhassan T, Alkhayal W. Single institute data to assess timing of surgery post neoadjuvant in breast cancer patients [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 P2-14-13.