First-line therapy with palbociclib in patients with advanced HR+/HER2- breast cancer: The real-life study PALBOSPAIN

PURPOSE

To evaluate the efficacy and safety of first-line therapy with palbociclib in a Spanish cohort treated after palbociclib approval.

METHODS

PALBOSPAIN is an observational, retrospective, multicenter study evaluating real-world patterns and outcomes with 1 L palbociclib in men and women (any menopausal status) with advanced HR+/HER2- BC diagnosed between November 2017 and November 2019. The primary endpoint was real-world progression-free survival (rw-PFS). Secondary endpoints included overall survival (OS), the real-world response rate (rw-RR), the clinical benefit rate, palbociclib dose reduction, and safety.

RESULTS

A total of 762 patients were included. The median rw-PFS and OS were 24 months (95% CI 21-27) and 42 months (40-not estimable [NE]) in the whole population, respectively. By cohort, the median rw-PFS and OS were as follows: 28 (95% CI 23-39) and 44 (95% CI 38-NE) months in patients with de novo metastatic disease, 13 (95% CI 11-17) and 36 months (95% CI 31-41) in patients who experienced relapse < 12 months after the end of ET, and 31 months (95% CI 26-37) and not reached (NR) in patients who experienced relapse > 12 months after the end of ET. rw-PFS and OS were longer in patients with oligometastasis and only one metastatic site and those with non-visceral disease. The most frequent hematologic toxicity was neutropenia (72%; grade ≥ 3: 52.5%), and the most common non-hematologic adverse event was asthenia (38%).

CONCLUSION

These findings, consistent with those from clinical trials, support use of palbociclib plus ET as 1 L for advanced BC in the real-world setting, including pre-menopausal women and men.

TRIAL REGISTRATION NUMBER

NCT04874025 (PALBOSPAIN). Date of registration: 04/30/2021 retrospectively registered.

Abstract P6-07-21: High reduction of circulating tumour cells in HER2-negative locally advanced or metastatic breast cancer (LAMBC) patients treated with eribulin as third line chemotherapy (ONSITE study)

Background Circulating tumour cells (CTC) may be a good biomarker to guide the management of patients with LAMBC (Cristofanilli, NEJM 2004). Detection of CTCs in peripheral blood is a simple procedure. Eribulin monotherapy has shown improved survival in patients with LAMBC that has progressed after 2 or 3 chemotherapy regimens (EMBRACE study). The aims of this study were to evaluate the kinetics of CTCs before and after eribulin treatment, and its correlation with clinical outcomes.

Methods Patients received eribulin (1.23 mg/m2 on days 1 and 8 of every 21-day cycle) as third-line therapy until progression, unacceptable toxicity or withdrawal. CTCs were measured in 7.5ml of blood at baseline and after the second cycle of treatment. Cell counting was performed using the CellSearch System, Veridex. Cox proportional hazards regression modeling was used to identify independent prognostic factors for survival endpoints.

Results Out of 59 eligible women (mean age 57.7 years), 58 (98.3%) had received previous taxanes and/or anthracyclines. Nearly all (98.3%) had HER2-negative tumors, 72% were positive for estrogens, 21% were triple-negative; 64.4% had liver metastasis and 57.6% bone metastasis. The mean number of administered cycles was 6.9 ± 5.4. Follow-up was performed in 54 patients, with 18.5% (n=10) partial response, 42.6% (n=23) stable disease, and 38.9% (n=21) progressive disease. Clinical benefit was achieved in 33 patients (61.1%). Median progression-free survival (PFS) was 5.13 months (95% CI 3.23, 8.90) and median overall survival (OS) was 13.6 months (95% CI 11.8, not reached). CTC levels were measured in 50 patients. The mean number of CTCs at baseline was 16.8 (IQR 0-21) and on cycle 2, 5.4 (IQR 0-8.5), p&lt;0.001. In patients with CTC ≥ 5 at baseline, 52.4% reduced their levels to CTC &lt; 5 on cycle 2 (p=0.043). No significant differences (p=0.066) were found in PFS when baseline CTC levels were &lt; 5 or ≥ 5 cells/ml. Statistical differences were, however, found in OS (p= 0.0083). On cycle 2, significant differences were observed for both PFS (p=0.045) and OS (p=0.0129) with CTC levels &lt;5 or ≥ 5 cells/ml. No correlation could be found between CTC levels and the objective response at baseline or on cycle 2.

Conclusions Our study suggests there is a significant correlation between levels of CTCs and disease prognosis. Eribulin monotherapy was related to a significant reduction in CTCs.

(EudraCT number 2013-001416-30).

Keywords eribulin, metastatic, breast cancer, circulating tumour cells.

Citation Format: Manso Sánchez L, Moreno Antón F, Izarzugaza Perón Y, Delgado Mingorance I, Borrega García P, Echarri González MJ, Martínez Jáñez N, López González A, Olier Garate C, Ballesteros García A, Chacón López-Muñiz I, Ciruelos Gil EM, García Sáenz JA, Paz-Ares Rodríguez L. High reduction of circulating tumour cells in HER2-negative locally advanced or metastatic breast cancer (LAMBC) patients treated with eribulin as third line chemotherapy (ONSITE study) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-07-21.

Brain metastasis and carcinomatous meningitis from vulvar squamous cell carcinoma: case report

BACKGROUND

Brain metastasis and carcinomatous meningitis from gynecological tumors are an uncommon event, usually related to choriocarcinoma, ovarian and cervical cancer.

CASE

A 74-year-old woman was diagnosed with locally advanced vulvar squamous carcinoma. Initial therapy consisted of multiagent chemotherapy and vulvar, pelvis and groin irradiation. The patient subsequently developed widely spread metastatic disease including brain and meningeal metastases.

CONCLUSION

The rising incidence of central nervous system metastasis in the last two decades is probably associated with treatment-related improvement in life expectancy. To our knowledge, this is the first case reported of brain metastases and meningeal carcinomatosis associated with vulvar squamous cell carcinoma.

Cardiac metastasis from uterine leiomyosarcoma

Cardiac metastases are more frequent than primary heart neoplasias. Nearly any malignant tumour may metastasize to the heart, but the most common are carcinomas rather than sarcomas. We report the case of a patient who presented with heart metastasis 6 years after resection of an uterine leiomyosarcoma. The patient died thirty months after surgical resection without evidence of cardiac recurrence. Although cardiac metastases from uterine leiomyosarcoma are exceptional, they should be suspected in the presence of suggestive symptoms, since they can be associated with long survival after surgical treatment.

[Obstructive jaundice after cholecystectomy]

In this article we present the case of a 72 year-old woman who three years after laparoscopic cholecystectomy develops obstructive jaundice. An MRI of the liver and biliary system revealed an hiliar mass that caused dilatation of the biliary tree. The patient underwent hepatic duct resection and reconstruction via hepaticojejunostomy. The histological examination of the surgical specimen identified an intramural biliary neuroma with no evidence of malignancy.

Sex differences in uric acid metabolism in adults: evidence for a lack of influence of estradiol-17 beta (E2) on the renal handling of urate

The serum urate concentration of adult women, which is lower than in men of a similar age, is thought to be related to a higher renal clearance of urate in women, possibly due to their higher plasma estrogen levels. Intersexual differences in the renal handling of uric acid was assessed in 9 normal adult women and 9 normal age-matched men. Women showed a significantly lower serum urate concentration as compared to men (3.5 +/- 0.3 v 4.9 +/- 0.7 mg/dL, P less than 0.001), higher fractional excretion of urate (9.8 +/- 1.0 v 7.3 +/- 0.8%, P less than 0.001), and significantly lower tubular urate postsecretory reabsorption (67.2 +/- 1.6 v 76.6 +/- 1.4% of secreted urate, P less than 0.01). To test whether plasma E2 has a uricosuric effect we administered estradiol valerate and estradiol benzoate to either oophorectomized or adult women. Plasma E2 levels and urinary total estrogen excretion increased significantly in both groups but the treatment failed to significantly modify serum urate or the fractional excretion of uric acid. Furthermore, in 4 normal adult women, the tubular phases that modulate the renal excretion of urate were not significantly influenced by increased plasma E2 levels. We conclude that in comparison to men of a similar age, the lower tubular urate postsecretory reabsorption of adult women is in accordance with the intersexual differences in uric acid metabolism. Plasma E2 does not influence renal handling of uric acid or serum urate levels.

Complete proximal tubular acidosis (Type 2, RTA) in chronic active hepatitis

Fifteen patients with chronic active hepatitis (CAH) were tested in order to ascertain the site of tubular dysfunction in renal tubular acidosis (RTA) associated with CAH. Renal plasma flow and GFR were reduced in the patients compared to controls (P < 0.005). Underbasal and acidification conditions, twelve patients showed normal acid-base balance and net acid excretion, while three patients had basal hyperchloremic metabolic acidosis while passing alkaline urine and showing bicarbonaturia. A sustained acidification test showed adequate urinary acidification in these three patients. Bicarbonate loading carried out in two of the three patients showed a proximal tubular acidifying defect (Type 2 RTA), Distal RTA (Type 1 RTA) complicating CAH is widely known, but these data suggest that CAH can also involve the proximal convoluted tubule in isolation.