Influence of Height on Risk and Outcome of Patients with Early Breast Cancer: A Pooled Analysis of 4,925 Patients from 5 Randomized Trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG)

<b><i>Background:</i></b> Associations between height, cancer risk and worse outcome have been reported for several cancers including breast cancer. We hypothesized that in breast cancer clinical trials, tall women should be overrepresented and might have worse prognosis. <b><i>Methods:</i></b> Data of 4,935 women, included from 1990 to 2010 in 5 trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG), were analyzed retrospectively. The primary objective was to determine differences in height distribution between the ABCSG cohort and the Austrian female population according to a cross-sectional health survey conducted by the Austrian Statistic Center in 2006 and 2007. Secondary endpoints were disease-free survival (DFS) and overall survival (OS) in different height classes and differences of body mass index (BMI) distribution. <b><i>Results:</i></b> Breast cancer patients in the ABCSG cohort were only slightly but statistically significantly smaller compared to unselected Austrian adult females (mean 164.3 vs. 164.8 cm; <i>p</i> &#x3c; 0.0001) and significantly more patients were seen in the lower body height class (50 vs. 46%; <i>p</i> &#x3c; 0.0001) when using the median as a cutoff. However, after adjustment for age, the difference in body height between the two cohorts was no longer significant (<i>p</i> = 0.089). DFS and OS in the two upper height groups (≥170 cm) compared to the two lowest height groups (&#x3c;160 cm) was not significantly different (5-year DFS: 84.7 vs. 83.0%; HR 0.91, 95% CI 0.73–1.13, <i>p</i> = 0.379; 5-year OS: 94.8 vs. 91.7%; HR 0.74, 95% CI 0.55–1.00, <i>p</i> = 0.051). The BMI of ABCSG patients was significantly higher than in the reference population (mean BMI 24.64 vs. 23.96; <i>p</i> &#x3c; 0.0001). <b><i>Conclusions:</i></b> Our results do not confirm previous findings that greater body height is associated with a higher breast cancer risk and worse outcome.

Response to Vemurafenib in Metastatic Triple-Negative Breast Cancer Harbouring a BRAF V600E Mutation: A Case Report and Electronically Captured Patient-Reported Outcome

Effective treatment options are still scarce for metastatic triple-negative breast cancers. An increasing interest in the mutational landscape of this disease will facilitate novel therapeutic strategies in a variety of cancers. Here we report the case of a 38-year-old female patient who developed multiple lung metastasis of a triple-negative breast cancer 2 years after the completion of local therapy. When she progressed after two palliative chemotherapy lines and local electroporation, a next-generation sequencing revealed a BRAF V600E mutation for which we initiated therapy with the BRAF inhibitor vemurafenib. Radiological improvement was already evident after 3 months and has been ongoing for 19 months so far with very few side effects, as is demonstrated by electronically captured patient-reported outcomes. To our knowledge, this is the first published case where a BRAF V600E-mutated advanced triple-negative breast cancer was successfully treated with vemurafenib.

Mixed response and mechanisms of resistance to larotrectinib in metastatic carcinoma ex pleomorphic adenoma of the parotid harboring an NTRK2 fusion: A case report

INTRODUCTION

Standardized systemic treatment options are lacking for carcinoma ex pleomorphic adenoma, which is a rare and aggressive tumor primarily found in salivary glands.Here we report the case of a 63-year-old male with carcinoma ex pleomorphic adenoma of the left parotid and parapharyngeal space harboring a neurotrophic receptor tyrosine kinase (NTRK) 2 fusion who was treated with a small molecule inhibitor that targets the tropomyosin receptor kinase (TRK) proteins. To the best of our knowledge, no similar case has been described in the literature so far.

PATIENT CONCERNS

After multiple surgical resections and radiotherapy for localized cancer disease over several years, our patient again developed an increasing swelling and pain around the left ear and numbness of the left half of the face.

DIAGNOSIS

Magnetic resonance imaging and positron emission tomography/computed tomography scans showed tumor recurrence in the left parotid, below the left ear, and in the parapharyngeal space, as well as metastases of the lungs and cervical lymph nodes. As data on the efficacy of systemic therapies for inoperable carcinoma ex pleomorphic adenoma are scarce, we performed a next-generation sequencing that revealed the presence of a hitherto unknown NTRK2 fusion.

INTERVENTIONS

Treatment with the TRK inhibitor larotrectinib was initiated, which induced rapid symptom improvement. However, part of the tumor had to be removed shortly afterwards due to local progression. Molecular testing did not demonstrate any alterations accounting for resistance to larotrectinib, with maintenance of the NTRK2 fusion.

OUTCOMES

Three months later, imaging confirmed mixed response. While the reason for this remains unknown, the patient is in good condition and continues to receive larotrectinib.

CONCLUSION

It remains unclear why our patient showed mixed response to larotrectinib and further studies are needed to explore other possible mechanisms of resistance.

Aberrant Lck Signal via CD28 Costimulation Augments Antigen-Specific Functionality and Tumor Control by Redirected T Cells with PD-1 Blockade in Humanized Mice

Purpose: Combination therapy of adoptively transferred redirected T cells and checkpoint inhibitors aims for higher response rates in tumors poorly responsive to immunotherapy like malignant pleural mesothelioma (MPM). Only most recently the issue of an optimally active chimeric antigen receptor (CAR) and the combination with checkpoint inhibitors is starting to be addressed.Experimental Design: Fibroblast activation protein (FAP)-specific CARs with different costimulatory domains, including CD28, Δ-CD28 (lacking lck binding moiety), or 4-1BB were established. CAR-T cells were characterized in vitro and antitumor efficacy was tested in vivo in a humanized mouse model in combination with PD-1 blockade. Finally, the Δ-CD28 CAR was tested clinically in a patient with MPM.Results: All the three CARs demonstrated FAP-specific functionality in vitro Gene expression data indicated a distinct activity profile for the Δ-CD28 CAR, including higher expression of genes involved in cell division, glycolysis, fatty acid oxidation, and oxidative phosphorylation. In vivo, only T cells expressing the Δ-CD28 CAR in combination with PD-1 blockade controlled tumor growth. When injected into the pleural effusion of a patient with MPM, the Δ-CD28 CAR could be detected for up to 21 days and showed functionality.Conclusions: Overall, anti-FAP-Δ-CD28/CD3ζ CAR T cells revealed superior in vitro functionality, better tumor control in combination with PD-1 blockade in humanized mice, and persistence up to 21 days in a patient with MPM. Therefore, further clinical investigation of this optimized CAR is warranted. Clin Cancer Res; 24(16); 3981-93. ©2018 AACR.

Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients - "En route for eradication"?

OBJECTIVES

Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients.

METHODS

All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection.

RESULTS

Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR.

CONCLUSIONS

HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.

Lapatinib-plus-pegylated liposomal doxorubicin in advanced HER2-positive breast cancer following trastuzumab: a phase II trial

BACKGROUND

Trastuzumab, one important treatment option for HER2-positive metastatic breast cancer (MBC) is limited by its cardiotoxic potential. Lapatinib and pegylated liposomal doxorubicin (PLD) represent a cardiosparing alternative that can cross the blood brain barrier. This is important, because one third of breast cancer patients develop brain metastases.

PATIENTS AND METHODS

We included 24 patients with HER2-positive MBC progressing under trastuzumab. They received 1,250 mg lapatinib daily until progression plus PLD (40 mg/m(2)) every 4 weeks for maximal 6 cycles. The primary end-point was the overall response rate (ORR). Secondary end-points were progression-free survival (PFS), overall survival (OS), 1-year PFS and 1-year OS rates.

RESULTS

ORR was 54%. Median PFS was 5.8 and median OS 23.3 months. The one-year PFS rate was 27% and 1-year OS rate 76%.

CONCLUSION

Lapatinib-plus-PLD is active and safe in HER2-positive MBC, especially suitable for patients with cardiological risk or brain metastases.

Three-beam Doppler optical coherence tomography using a facet prism telescope and MEMS mirror for improved transversal resolution

An improved three-beam Doppler optical coherence tomography system was developed. It utilizes a custom-made three-facet prism telescope to improve the transversal resolution at the sample. Furthermore, a two-axis gimbal-less MEMS mirror is used to minimize off-pivot beam movement at the pupil of the eye, enabling circular scanning for in vivo retinal measurements. We demonstrate the system's abilities for in vitro circular scanning to measure absolute flow and to reconstruct the full velocity vector on a bifurcation flow phantom. Moreover, in vivo retinal measurements using circular scanning around vessel bifurcations of healthy human volunteers were performed. Measurements of the absolute mean flow and its orientation are in good agreement with the expected values for in vitro measurements. For in vivo measurements, the in- and outflow of blood for retinal vessel bifurcations show an excellent agreement, demonstrating the reliability of the technique.

Hypertension as a predictive marker for bevacizumab in metastatic breast cancer: results from a retrospective matched-pair analysis

BACKGROUND

Several phase-III studies have shown improvements in terms of progression-free survival (PFS) with bevacizumab when added to chemotherapy in advanced breast cancer. However, the extent of improvement varied and none of the trials showed benefit in terms of overall survival (OS).

PATIENTS AND METHODS

All patients with metastatic breast cancer treated with bevacizumab at our Institution between 2005 and 2011 were retrospectively analyzed. A control group was matched according to the following variables: receptor status, treatment line, type of chemotherapy, presence of visceral disease and age.

RESULTS

All 212 patients were evaluable for toxicity, and 198 for response; 430 controls allowed a complete matching for 85 bevacizumab-treated patients. The addition of bevacizumab to chemotherapy significantly prolonged PFS (9.3 vs. 7.6 months, hazard ratio [HR]=0.70, 95% confidence interval [CI]=0.51-0.97, p=0.031) and OS (28.9 vs. 22.6 months, HR=0.67, 95% CI=0.45-0.99, p=0.043). Clinical benefit rate (overall response rate + stable disease for at least six months) was significantly better in the bevacizumab group (75% vs. 59%, p=0.002), while ORR did not differ significantly (48% vs. 35%, p=0.21). Patients developing hypertension during treatment had a more favourable outcome (PFS 13.7 vs. 6.6 months, HR=0.34, 95% CI=0.23-0.49 p<0.001; 2-year OS 78% vs. 30%, HR=0.20, 95% CI=0.12-0.35, p<0.001).

CONCLUSION

Bevacizumab in addition to chemotherapy prolonged PFS and OS in a non-selected, partly intensively pre-treated breast cancer population. Hypertension induced by bevacizumab predicted therapy efficacy.

Abstract P5-20-11: Bevacizumab in metastatic breast cancer: a retrospective matched-pair analysis

Background: In November 2011 the FDA withdrew accelerated approval of the breast cancer indication for bevacizumab, because “the drug has not been shown to be safe and effective for this use” (FDA Commissioner M. A. Hamburg, MD). The objective of this analysis was to evaluate efficacy and safety of bevacizumab in non-selected patients with stage IV breast cancer.

Patients and methods: All patients with metastatic breast cancer treated with bevacizumab in combination with chemotherapy in our institution between 2005 and 2011 were retrospectively analysed. At least 1 cycle of bevacizumab was required for safety analysis, 3 applications for efficacy evaluation. A control group was matched according to the following criteria: receptor status, line of treatment, chemotherapy backbone, visceral or non-visceral disease and age.

Results: A total of 213 patients fulfilled the inclusion criteria. All of them were evaluable for toxicity, 199 for response. 503 potential controls allowed a complete matching for 103 patients. Fifty-eight percent of patients received first-line, 15% second-line and 27% of patients beyond second-line treatment. Visceral metastases were present in 69% of patients in both groups. The most common chemotherapy backbones were paclitaxel, capecitabine and docetaxel with 44%, 32% and 19%, respectively.

Temporal changes of human cone photoreceptors observed in vivo with SLO/OCT

In this study we use our previously introduced scanning laser ophthalmoscope (SLO) / transverse scanning optical coherence tomography (TS-OCT) instrument to investigate long term changes in cone photoreceptors. The instrument is capable to provide 3D information of the human cone photoreceptors with negligible eye motion artifacts due to an implemented 3D motion correction on a cellular level. This allows for an in vivo investigation of exactly the same location on the retina with cellular resolution over several days. Temporal changes in the backscattered intensity are observed and quantified within the junction between inner and outer segments of cone photoreceptors, the cone outer segments, the end tips of cone photoreceptors and the retinal pigment epithelium. Furthermore, the length of individual cone outer segments is measured and observed over time. We show, to the best of our knowledge for the first time, that bright reflection spots which are located within the outer segment of cone photoreceptors change their position when observed over extended time periods. The average measured bright reflection spot motion speed corresponds well to the expected cone growth speed. We believe that this observation can be associated with the first direct in vivo imaging of the cone renewal process.

Retinal nerve fiber layer birefringence evaluated with polarization sensitive spectral domain OCT and scanning laser polarimetry: a comparison

A polarization-sensitive spectral domain optical coherence tomography (PS-SD-OCT) system is used to measure phase retardation and birefringence of the human retinal nerve fiber layer (RNFL) in vivo. The instrument records three parameters simultaneously: intensity, phase retardation and optic-axis orientation. 3D data sets are recorded in the optic nerve-head area of a healthy and a glaucomatous eye, and the results are presented in various ways: En-face phase-retardation maps of the RNFL are generated from the recorded 3D data and results are compared with scanning laser polarimetry (SLP). The depth information provided by OCT is used to segment the RNFL in the intensity image and measure the RNFL thickness. From the retardation and thickness data, 2D birefringence maps of the RNFL are derived. Circumpapillary plots of RNFL retardation and thickness obtained by PS-SD-OCT are quantitatively compared with those obtained by SLP.

Value of polarisation-sensitive optical coherence tomography in diseases affecting the retinal pigment epithelium

OBJECTIVES

To evaluate pathological changes of retinal pigment epithelium (RPE) by polarisation-sensitive optical coherence tomography (PS-OCT).

METHODS

Forty-four eyes (22 patients) with significant pathologies of the RPE were evaluated using PS-OCT. A transversal scanning time domain OCT system was used for two-dimensional cross-sectional imaging of retinal polarisation properties.

RESULTS

The RPE scrambles the polarisation state of backscattered light (ie, acts as a depolarising layer), while the polarisation state of transmitted light is maintained. In patients with RPE pathologies irregularity, elevation, thickening or absence of the RPE is readily visualised by exploiting the depolarisation information. Polarisation scrambling in the sensory retina can be found in cases with advanced dry age-related macular degeneration. Sclera and fibrosis show characteristic birefringence in PS-OCT.

CONCLUSION

PS-OCT allows tissue identification based on polarisation scrambling and birefringence, providing additional information on RPE pathologies. It is a promising new tool for diagnosis, disease follow-up and evaluation of new treatment strategies.

Simultaneous imaging of human cone mosaic with adaptive optics enhanced scanning laser ophthalmoscopy and high-speed transversal scanning optical coherence tomography

We describe a novel instrument capable of acquiring, simultaneously, adaptive optics enhanced scanning laser ophthalmoscopy and optical coherence tomography (OCT) images of the human cone mosaic in vivo. The OCT system is based on transversal scanning of the sample with a line scan rate of 14 kHz, approximately 20 times faster than a previously reported instrument. We demonstrate the capability of this instrument with the measurement of the human cone spacing in perifoveal retina.

Dynamic focus in optical coherence tomography for retinal imaging

Imaging the human retina still represents the main field of application of optical coherence tomography (OCT). A major advantage of OCT is the decoupling of depth resolution (given by the coherence length of the light source) and transverse resolution (given by the focal spot size). This enables images of the retina with high depth resolution. On the other hand, in most OCT systems, a limited transverse resolution has been accepted to provide a sufficiently large (approximately 1 mm) depth of focus. However, to obtain images with high transverse resolution throughout the whole depth of the retina (especially in the nerve head region) a tracking of coherence gate and focus position (dynamic focus) is essential. This study realizes a dynamic focus in a time domain transversal (en face) scanning system for retinal imaging. We show that maintenance of a transverse resolution of approximately 4.4 microm can be achieved over an optical depth of 1 mm in a model eye and apply our method to imaging the human retina in vivo.

Transversal ultrahigh-resolution polarizationsensitive optical coherence tomography for strain mapping in materials

Optical coherence tomography (OCT) and its extension, polarization-sensitive (PS-)OCT, are techniques for contactless and nondestructive imaging of internal structures. In this work, we apply PS-OCT for material characterization. We use a transversal scanning, ultra-high resolution (UHR-)PS-OCT setup providing cross-sectional as well as inplane information about the internal microstructure, the birefringence and the orientation of the optical axis within the material. We perform structural analysis and strain-mapping for different samples: we show the necessity of UHR imaging for a highly strained elastomer sample, and we discuss the effect of large birefringence on the PS-OCT images. Furthermore, we investigate high-aspect ratio photoresist moulds for the production of microelectromechanical parts (MEMS), demonstrating that transversal UHR-PSOCT is a promising tool for non-destructive strain-mapping.

Birefringence properties of the human cornea measured with polarization sensitive optical coherence tomography

We map the three-dimensional distribution of birefringence of the normal human cornea and provide insight into structures and mechanisms causing corneal birefringence, establishing standard patterns of 3D birefringence distribution. A polarization sensitive optical coherence tomography (PS-OCT) system was developed that allows measurement and imaging of three tissue parameters simultaneously: reflectivity, retardation, and slow optic axis orientation. This instrument was used to obtain 3D PS-OCT data sets of normal human corneas in vitro. From the 3D data sets, conventional cross sectional, as well as en face images of reflectivity, retardation, and optic axis orientation were derived. Preliminary results from a healthy cornea in vivo and a keratoconus cornea in vitro are also presented. In transversal direction the retardation distribution of the normal cornea has a radially symmetric shape; retardation is lowest at the center of the cornea and increases towards the periphery. At peripheral regions, retardation also increases with depth. The distribution of the optic axis is not constant with the parallel illumination scheme used. Optic axis orientation is an approximately linear function of azimuth angle, however, if averaged over the entire cornea, a preferential optic axis orientation is observed. In a keratoconus cornea, the normal birefringence pattern is heavily distorted. The results provide additional insight into corneal birefringence as compared to published work where corneal birefringence is usually averaged over a larger area. The results can be explained by a birefringence model based on stacked collagen fibril lamellae of different orientations. The observed birefringence patterns in normal corneas might be used as standard patterns for comparisons with pathologic changes.

Measurement and imaging of birefringence and optic axis orientation by phase resolved polarization sensitive optical coherence tomography

We present an improved method of polarization sensitive optical coherence tomography that enables measurement and imaging of backscattered intensity, birefringence, and fast optic axis orientation simultaneously with only one single A-scan per transverse measurement location. While intensity and birefringence data are obtained in a conventional way, the optic axis orientation is determined from the phase difference recorded in two orthogonal polarization channels. We report on accuracy and precision of the method by measuring birefringence and optic axis orientation of well defined polarization states in a technical object and present maps of birefringence and, what we believe for the first time, of optic axis orientation in biological tissue.