Role of palliative care intervention in patients with vulvar cancer: a retrospective study

OBJECTIVE

To describe the experience of a Mexican cancer centre in vulvar cancer and the opportunity to incorporate palliative care (PC) during treatment.

PATIENTS AND METHODS

A retrospective study of clinical and sociodemographic characteristics of women with vulvar cancer referred to the PC service (PCS) between 2010 and 2021 is reported. Frequencies were estimated, as well as medians and IQRs, accordingly. Referral time and overall survival were estimated using the Kaplan-Meier method.

RESULTS

125 women with vulvar cancer were seen between 2010 and 2021, but only 42% were seen at PCS, mostly polysymptomatic, after several visits to the emergency room. 89% of the patients seen at PCS died at home.

CONCLUSIONS

Vulvar cancer is a rare type of cancer, while squamous cell carcinoma is the most frequent type. At the time of referral, almost half of the patients had severe pain, bleeding, malodor, infection and urinary incontinence. Most of these patients lived in poverty, were poorly educated and had multiple surgeries. PC may play an important role in the care of patients with advanced vulvar cancer, relieving the physical and psychological symptoms, avoiding unnecessary hospitalisation and favouring death at home without pain and other symptoms.

Mortality Prognosis Factors in Patients with Active Cancer Under Treatment, and Severe COVID-19

BACKGROUND

COVID-19 is associated with systemic inflammation. This inflammatory response is further deregulated by oncological treatments increasing mortality in this population. However, there is conflicting information regarding the clinical factors that increase mortality in patients with severe COVID-19.

OBJECTIVE

The aim of this study was to identify prognostic factors associated with mortality during severe COVID-19 in patients with active cancer. In addition, the correlation between oncologic codes and mortality related to severe COVID-19 was evaluated.

PATIENTS AND METHODS

We analyzed a cohort of Mexican patients with active cancer and severe COVID-19 between March 2020 and February 2021. We collected information on patient demographic characteristics, COVID-19 symptoms, clinical and laboratory data, and treatments. Patients were classified according to oncologic code. We defined the oncological code based on clinical stage, treatment intention, performance status before COVID-19, and median overall survival with palliative treatment. A log-rank test was performed to determine survival. A multivariate logistic regression model was used to adjust for potential confounders.

RESULTS

One hundred fifty-two patients with severe COVID-19 were analyzed. The red oncologic code was associated with an increased risk of mortality OR 22.8 (CI 95% 5.0-105.1, p <0.001), low oxygen saturation OR 5.4 (CI 95% 1.7-17.4, p = 0.005), chronic corticosteriod use OR 4.3 (CI 95% 1.0-18.1, p = 0.050) and high D-dimer level OR 3.2 (CI 95% 1.2-8.2, p = 0.019).

CONCLUSIONS

The survival of patients with active cancer and severe COVID-19 was possible to identify, at the time of admission, specific oncological characteristics. Based on this code, decreased oxygen saturation, increased D-dimer levels, and chronic corticosteroid use were the main predictive factors related to mortality.

Breast cancer survival in Mexico between 2007 and 2016 in women without social security: a retrospective cohort study

Background

Essential indicators of health system performance for breast cancer are lacking in Mexico. We estimated survival and clinical stage distribution for women without social insurance who were treated under a health financing scheme that covered 60% of the Mexican population.

Methods

We conducted a retrospective cohort study cross-linking reimbursement claims for 56,847 women treated for breast cancer between 2007 and 2016 to a mortality registry. We estimated overall- and clinical stage-specific survival and breast cancer survival according to patient age, state of residence, marginalization, type of treatment facility, and patient volume of the treatment facility. We also explored the distribution of clinical stage according to age, year of treatment initiation, and state where the woman was treated. We used log-rank tests and estimated 95% CIs to compare differences between patient groups.

Findings

Median age was 52 years (interquartile range [IQR] 45, 61) (Sixty five percent patients (36,731/56,847) had advanced disease at treatment initiation. Five-year overall survival was 72.2% (95% CI 71.7, 72.6). For early disease (excluding stage 0), 5-year overall survival was 89.0% (95% CI 88.4, 89.5), for locally advanced disease 69.9% (95% CI 69.0, 70.2) and for metastatic 36.9% (95% CI 35.4, 38.4). Clinical stage at treatment initiation and breast cancer survival remained unchanged in the period analyzed. Clinical stage and survival differed across age groups, state of residence, and type of facility where women received treatment.

Interpretation

In the absence of population-based cancer registries, medical claims data may be efficiently leveraged to estimate essential cancer-related performance indicators.

Funding

The authors received no financial support for this research.

A comprehensive health effects assessment of the use of sanitizers and disinfectants during COVID-19 pandemic: a global survey

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87-2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74-1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90-2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused.

The Clinical Utility of lncRNAs and Their Application as Molecular Biomarkers in Breast Cancer

Given their tumor-specific and stage-specific gene expression, long non-coding RNAs (lncRNAs) have demonstrated to be potential molecular biomarkers for diagnosis, prognosis, and treatment response. Particularly, the lncRNAs DSCAM-AS1 and GATA3-AS1 serve as examples of this because of their high subtype-specific expression profile in luminal B-like breast cancer. This makes them candidates to use as molecular biomarkers in clinical practice. However, lncRNA studies in breast cancer are limited in sample size and are restricted to the determination of their biological function, which represents an obstacle for its inclusion as molecular biomarkers of clinical utility. Nevertheless, due to their expression specificity among diseases, such as cancer, and their stability in body fluids, lncRNAs are promising molecular biomarkers that could improve the reliability, sensitivity, and specificity of molecular techniques used in clinical diagnosis. The development of lncRNA-based diagnostics and lncRNA-based therapeutics will be useful in routine medical practice to improve patient clinical management and quality of life.

Abstract P5-08-13: Frequency of low bone mineral density in young women with breast cancer and associated factors

Background: Young women with breast cancer (YWBC) may experience bone mineral density (BMD) loss due to the effects of cancer treatment on estrogen levels. Studies assessing BMD in breast cancer (BC) patients have had a limited representation of young women. This study aimed to analyze the frequency of low BMD and its associated factors in this specific age group.

Methods: This retrospective, multicenter study included women ≤40 years diagnosed with stage 0-III BC, treated with chemotherapy (CT) and/or endocrine therapy (ET) between 2010-2020, and with no documented bone metastases during follow-up. The protocol was conducted in 5 BC referral centers in Mexico. Demographic, clinical and treatment data were collected, as well as bone dual-energy X-ray absorptiometry (DEXA) results. Low BMD was defined as T-score &lt;-1.0 or Z-score ≤-2.0 at the lumbar spine (L1-L4) or femoral neck.

The frequency of low BMD was analyzed with descriptive statistics. Binary logistic regression using complete case analysis was conducted to calculate odds ratios (OR) and 95% confidence intervals (95%CI) of experiencing low BMD according to demographic, clinical and therapeutic factors.

Results: In total, 716 YWBC met inclusion criteria. Median age at BC diagnosis was 36 years (21-40); 708 (99%) women were premenopausal at diagnosis. Most were married (355; 50%), had higher education (381; 53%), were unemployed (433; 61%), and were non-smokers (552; 77%). Body mass index (BMI) was &lt; 18.5 kg/m2 (underweight) and ≥25.0 kg/m2 (overweight/obese) in 14 (2%) and 392 (58%) cases, respectively. The most common BC subtype was hormone receptor (HR) positive/HER2 negative (371; 52%), followed by triple negative (168; 24%), HR positive/HER2 positive (122; 17%) and HR negative/HER2 positive (55; 8%). Patients were mostly diagnosed with stage II (346; 48%) or III (276; 39%) disease. As for treatment, CT in 667 (93%), ET in 468 (65%), anti-HER2 therapy in 168 (24%), and radiotherapy was administered in 562 (79%) cases.

DEXA scans were documented in 213/716 (30%) patients. In total, 286 DEXA results were available. The time elapsed from the start of the first systemic treatment to the DEXA result was 0-12 months in 42 cases (15%); 13-36 months in 103 (36%); 37-60 months in 72 (25%); and &gt;60 months in 69 (24%). Overall, 133/213 patients (62%; 95%CI 56-69%) had at least one low BMD report after the start of CT or ET. T-scores and Z-scores in each period are detailed in the Table. No fractures were recorded in any case after BC diagnosis. The only variable associated with at least one low BMD result was BMI ≥25.0 kg/m2 (OR, 1.88; 95%CI, 1.04-3.40). The described demographic, clinical and treatment factors were not significantly associated with low BMD.

Conclusion: This study showed a suboptimal frequency of bone DEXA monitoring in YWBC. A considerable proportion of YWBC experienced low BMD after initiation of CT and/or ET; and a significant association was found between obesity/overweight at BC diagnosis and subsequent low BMD. These data reflect the importance of requesting DEXA scans in young patients on a regular basis and promoting the maintenance of an adequate body weight, in line with international recommendations. Further studies evaluating the degree of BMD loss and its determinants would contribute to establish the optimal periodicity to monitor BMD in relation to BC therapy, allow timely offering of interventions to reduce bone morbidity, as well as improve the quality and life and survivorship of this young group of patients.

Table. DEXA T-scores and Z-scores.

Citation Format: Fernanda Mesa-Chavez, Yanin Chavarri-Guerra, Sandy Ruiz-Cruz, Paula Cabrera-Galeana, Christopher Jesus del Rio-Martinez, Carmen Guadalupe Bermudez-Barrientos, Brizio Moreno-Jaime, Abigail Samayoa-Mateos, David Vega-Morales, Cynthia Villarreal-Garza. Frequency of low bone mineral density in young women with breast cancer and associated factors [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-08-13.

The Evolution of Clinically Aggressive Triple-Negative Breast Cancer Shows a Large Mutational Diversity and Early Metastasis to Lymph Nodes

In triple-negative breast cancer (TNBC), only 30% of patients treated with neoadjuvant chemotherapy achieve a pathological complete response after treatment and more than 90% die due to metastasis formation. The diverse clinical responses and metastatic developments are attributed to extensive intrapatient genetic heterogeneity and tumor evolution acting on this neoplasm. In this work, we aimed to evaluate genomic alterations and tumor evolution in TNBC patients with aggressive disease. We sequenced the whole exome of 16 lesions from four patients who did not respond to therapy, and took several follow-up samples, including samples from tumors before and after treatment, as well as from the lymph nodes and skin metastases. We found substantial intrapatient genetic heterogeneity, with a variable tumor mutational composition. Early truncal events were MCL1 amplifications. Metastatic lesions had deletions in RB1 and PTEN, along with TERT, AKT2, and CCNE1 amplifications. Mutational signatures 06 and 12 were mainly detected in skin metastases and lymph nodes. According to phylogenetic analysis, the lymph node metastases occurred at an early stage of TNBC development. Finally, each patient had three to eight candidate driving mutations for targeted treatments. This study delves into the genomic complexity and the phylogenetic and evolutionary development of aggressive TNBC, supporting early metastatic development, and identifies specific genetic alterations associated with a response to targeted therapies.

Adjuvant endocrine therapy for premenopausal women with breast cancer: Patient adherence and physician prescribing practices in Mexico

BACKGROUND

In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians' prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice.

METHODS

Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1-5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians' adherence to standard-of-care prescription.

RESULTS

In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying (p = 0.042), worrying about long-term ET use (p = 0.031), and experiencing >7 ET-related symptoms (p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy.

CONCLUSIONS

Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians' knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes.

Prognosis of breast cancer diagnosed during pregnancy and early postpartum according to immunohistochemical subtype: A matched case-control study

PURPOSE

Pregnancy-associated breast cancer (PABC) poses a clinical challenge and its prognosis remains controversial. During the pregnancy and postpartum periods, the breast undergoes biological events that may uniquely influence disease behavior and treatment response. This study aimed to assess if a PABC diagnosis influences survival compared to non-PABC.

METHODS

A single-center record review was performed to identify PABC patients diagnosed from January 2007 through June 2018. Two controls were matched to each PABC case by stage, immunohistochemical (IHC) subtype, age (± 3) and year of diagnosis (± 2). Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was used to assess the impact of PABC on outcomes.

RESULTS

125 PABC patients (pregnant: 62; postpartum: 63) and 250 controls were included. Median follow-up was 67.7 and 73.4 months, respectively. 4-year DFS was 62% in pregnant vs 78% in controls (p = 0.010), and 63% in postpartum vs 83% in controls (p = 0.034). Subanalysis by IHC subtype revealed a significantly inferior DFS in PABC with hormone receptor-positive/HER2-negative (p = 0.032) and HER2-positive disease (p = 0.005) compared to corresponding non-PABC patients. 4-year OS was similar between case groups and controls. Multivariate analysis supported the independent impact of pregnant and postpartum status on DFS (p < 0.05).

CONCLUSION

Patients diagnosed during pregnancy and early postpartum are at high risk of recurrence. Further research is warranted to better characterize PABC tumor biology and enable the identification of novel therapeutic interventions to improve treatment outcomes.

Joven y Fuerte (J&F): Multidisciplinary distance care program in Mexico for young women with breast cancer (YWBC) during the COVID-19 pandemic

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Background: The COVID-19 Pandemic represents unprecedented new challenges for healthcare systems, care programs and especially for vulnerable populations like oncologic patients. The J&F Program, developed at the National Cancer Institute (INCan) in Mexico City, provides multidisciplinary care and navigation support for YWBC patients. During the first months of 2020, the whole mexican healthcare system, including the INCan and programs like J&F had to undergo structural adjustments to offer distance care attention (DCA) and face the Pandemic challenges. Methods: From March to September 2020, 196 patients received DCA (phone and video calls, text messages and virtual workshops), which addressed navigation, unmet psychological needs, psychoeducation, oncology and sexual support provided by different healthcare professionals (oncologists, psychologists, sexual specialists). Seventy agreed to participate in this study (intervention group, IG). Forty-three recently diagnosed breast cancer patients could not be contacted by the Program (control group, CG). The patients from the IG completed the emotional distress thermometer and were interviewed about stressors, coping strategies during the Pandemic, and satisfaction with the multidisciplinary support given by the J&F Program. We compared thestandard care given within the institutional facilities and the multidisciplinary support provided virtually by J&F Program for YWBC during the COVID-19 Pandemic regarding their perceived stressors and emotional distress. Results: The CG had more concerns about oncology treatments and their side effects (nausea p = 0.031, fever p = 0.007, anorexia p = 0.006) than the IG. Emotional distress was present in 77% and 86% in the IG and the CG respectively. The IG received significant navigation guidance and multidisciplinary support with the J&F Program’s DCA strategy during the Pandemic than the CG (p < 0.01 and p = 0.019). The J&F Program's psychological care significantly helped YWBC manage their distress (p = 0.001); 70% of the IG patients considered that the support given by the J&F Program dealt with the COVID-19 Pandemic challenges successfully (p < 0.01). Conclusions: DCA by theJ&F Program showed feasibility and benefit in the COVID-19 Pandemic context for YWBC. These findings suggest that multidisciplinary care could be preserved by combining care provision physically and virtually depending on patients' resources or unmet needs.

Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system

Although breast conserving surgery is the standard of care for patients with localized breast cancer in high-income countries, little is known about its use in developing countries, where disparities in access to treatment may lead to an increased use of mastectomy. We examined the use of breast conserving surgery at a Mexican cancer center after the implementation of a public insurance program aimed at providing coverage for previously uninsured patients. Between 2006 and 2016, 4519 women received surgical treatment for breast cancer, of which 39% had early-stage disease. The proportion of patients treated with breast conserving surgery increased from 10% in the 2006-2009 period to 33% in the 2013-2016 period, with most of this increase occurring among women with early-stage disease (17-52%). Improving access to care and reducing the financial burden of breast cancer in developing countries may lead to an increased use of breast conserving surgery.

Abstract PS1-05: Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system

Introduction Although temporal trends in breast conserving surgery (BCS) have been described for developed countries like the United States (US), there is a lack of information regarding the uptake of breast conservation in developing regions of the world. In developing countries, the implementation of breast conservation might be hindered by the availability of radiation therapy, lack of training among surgeons, or concerns regarding compliance with follow-up care and surveillance. In 2006, the Mexican government created Seguro Popular, which provided coverage for breast cancer care for all Mexican women, thus potentially mitigating the difficulties with obtaining care after BCS and improving access to multidisciplinary care. We undertook an overview of ten years of breast cancer surgery at our Mexican cancer center following the implementation of Seguro Popular, and explored changes in surgical technique over time. Methods A retrospective cohort analysis was conducted using the National Cancer Institute of Mexico (INCAN) database from 2006 to 2016. All patients with a diagnosis of breast cancer seen during that period were included. Patients who received surgery for breast cancer where then grouped together based on the type of surgery (mastectomy versus BCS). The effect of the year of diagnosis and of clinical stage at the time of presentation was evaluated. Logistic regression was used to model temporal trends in use of BCS over mastectomy for three 3-year periods (2006-2009, 2010-2012, and 2013-2016). Results The patient cohort consisted of 5289 women from the INCAN database, of which 4519 received some form of local surgical treatment. Sixty-one percent (n = 2764) had locally advanced disease (stages IIB-IIIC) at the time of presentation, and a quarter (n = 1156) had ≥60 days between diagnosis and receipt of surgical treatment. Eighty percent of the patients in the entire cohort (n = 3611) were treated with mastectomy, while 20% (n = 908) received BCS. For the 2006-2009 period, out of 1596 total surgeries, 9.9% were BCS (n = 158). The proportion of BCS increased for each of the other two studied periods, being 18.5% for the 2010-2012 period (n = 276/1490), and 33.1% for the 2013-2016 period (n = 474/1433) (p&lt;0.01 for trend). While the increase in BCS was significant for all stages, it was most pronounced for women with early-stage disease (Stages I-IIA), going from 17% in 2006-2009 to 52% in 2013-2016 (p&lt;0.01), than in those with locally-advanced disease (6.5 to 18%, p&lt;0.01). Conclusions In the ten years after the start of the Seguro Popular public insurance program, the proportion of BCS at a Mexican cancer center increased significantly, particularly for women with early-stage disease. The rates seen at INCAN for the period between 2013-2106 resemble those reported by the US National Cancer Database, in which approximately 61% of women with stage I-II breast cancer and 20% of women with stage III disease receive BCS. Potential reasons for the increase in the uptake of BCS include improved access to adjuvant radiation therapy, improved access to systemic treatment, and higher adherence to follow-up care after the start of Seguro Popular, as well as improvements in surgical training. In addition, changes in BCS may also be related to improvements in the implementation of multidisciplinary teams over time, which may lead to a more homogeneous and comprehensive care. Our results show that improving access to care for patients living in developing countries positively impacts the uptake of BCS for women with breast cancer.

Citation Format: Enrique Bargalló-Rocha, Nancy Reynoso-Noveron, Jaime Corona, Nereida Esparza-Arias, María Teresa Ramírez-Ugalde, Caros Daniel Robles-Vidal, Robin Shaw-Dulin, Armen Stankov, Rafael Vazquez-Romo, Patricia Villarreal-Colin, Sergio Aguilar-Villanueva, Jaime Hidalgo-Bahena, Milagros Perez-Quintanilla, Fernando U Lara-Medina, Juan Alejandro Torres, Enrique Soto-Perez-de-Celis, Paula Cabrera-Galeana, Alejandro Mohar, Abelardo Meneses-García. Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-05.

Validation of an instrument to assess health care quality (FACIT-TS-PS) in cancer patients

Introduction

Cancer patient satisfaction with the healthcare team is of great relevance for assessing the quality of the care provided by the health system. In Mexico, no valid and reliable tool is available to assess this construct.

Objective

To validate the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction (FACIT-TS-PS) instrument, version 4, in cancer patients.

Method

Cross-sectional design, non-probability convenience sampling. The sample consisted of 200 cancer-diagnosed patients, with mean age of 45.86 ± 15.01 years. Exploratory and confirmatory factor analyses were conducted.

Results

The exploratory factor analysis identified four factors, with a Cronbach alpha of 0.945, and an explained variance of 68.15 %. The confirmatory factor analysis indicated that the proposed theoretical model adjusts to the data with an error close to zero and, in addition, it is balanced and carefully measures overall patient satisfaction with the treatment.

Conclusion

FACIT-TS-PS was shown to be a valid and reliable instrument for use in clinical care and research in Mexican cancer patients. Its use is recommended in the evaluation of oncology multidisciplinary healthcare teams in Mexico.

Comprehensive Genomic Profile of Heterogeneous Long Follow-Up Triple-Negative Breast Cancer and Its Clinical Characteristics Shows DNA Repair Deficiency Has Better Prognostic

Triple-negative breast cancer (TNBC) presents a marked diversity at the molecular level, which promotes a clinical heterogeneity that further complicates treatment. We performed a detailed whole exome sequencing profile of 29 Mexican patients with long follow-up TNBC to identify genomic alterations associated with overall survival (OS), disease-free survival (DFS), and pathologic complete response (PCR), with the aim to define their role as molecular predictive factors of treatment response and prognosis. We detected 31 driver genes with pathogenic mutations in TP53 (53%), BRCA1/2 (27%), CDKN1B (9%), PIK3CA (9%), and PTEN (9%), and 16 operative mutational signatures. Moreover, tumors with mutations in BRCA1/2 showed a trend of sensitivity to platinum salts. We found an association between deficiency in DNA repair and surveillance genes and DFS. Across all analyzed tumors we consistently found a heterogeneous molecular complexity in terms of allelic composition and operative mutational processes, which hampered the definition of molecular traits with clinical utility. This work contributes to the elucidation of the global molecular alterations of TNBC by providing accurate genomic data that may help forthcoming studies to improve treatment and survival. This is the first study that integrates genomic alterations with a long follow-up of clinical variables in a Latin American population that is an underrepresented ethnicity in most of the genomic studies.

Endocrine therapy adherence of premenopausal Mexican breast cancer patients

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Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.

Abstract P2-13-08: Biopsychosocial changes since diagnosis and the time taking endocrine therapy in Mexican patients with breast cancer

Background: The increasing of breast cancer survivors (BCS) as the result of treatment success involves patients demanding cares related to the adverse events of cancer treatment. Furthermore, the study of the course of the disease process and treatment over time has been a yielding perspective to understand cancer patients. Few studies have attempted to analyze changes over time since diagnosis (TSD) in women who remain disease free and are taking endocrine therapy (TET). It is known that some BCS reported high levels of quality of life (QoL), no changes in social support (SS) and that survivors without chemotherapy as adjuvant treatment had better QoL that those who had received it. However, the changes over time in terms of unmet needs (UN), QoL, and perceived SS outcomes in Mexican BCS have no examined, which is fundamental to identify convenient goals, better times of integrated interventions and optimize our human resources according to the trajectory of cancer treatment. Objective: Identify changes over TSD, and the time TET in terms of UN, SS perception and QoL on Mexican BCS. Method: 368 patients with BC and TET were enrolled in a cross-sectional and comparative design, were assessed using QoL (EORTC-30 and BR-23), UN (SCNS-SF32), SS (MOS-SSS14), validated and standardized instruments in a Mexican cancer population. Premenopausal patients with ovarian function suppression were excluded. Patients were divided into four groups according to TSD and time TET, both in ≤1year and &gt;1year. Parametric and non-parametric analyses were used: t Student and U Mann Whitney. Results: Patients mean age was 54 (SD=10.6) years; mean of TSD was 38 (SD=24) months, and they had 30 months on average (SD= 19) TET. The level of global QoL was high (78%) as well as the level of SS (73%), the UN were low (28%). Cognitive function was the most rated concern in terms of QoL for all groups. “Help with daily shores" was the type of SS, which all groups perceived the lowest support. "Fear about cancer spreading" and “Concern about worries of those close to you” were the first and second rated UN in all groups. Additionally, we found that patients with ≤1year of TSD had more significantly insomnia, financial difficulties, psychological and global UN (p=.02; p=.01; p=.0005; p=.01, respectively) than patients with &gt;1 year of TSD. Moreover, the results showed that after one year of time TET: psychological and global needs, besides tangible and global SS, diminished significantly (p=.002; p=.009; p=.01; p=.03, respectively), nevertheless, the future perspective of health increases significantly (p=.01). Discussion and conclusions: Our findings are consistent with previous studies in terms of QoL. These results indicate that not only BCS patients improve physically, but also psychosocially over time: they are more independent, also have a better perspective of their health even though the fear persists. In conclusion, all biopsychosocial aspects evaluated improve over time. These data suggest that the most optimal effort might be provided to newly diagnosed patients, which is fundamental information for a country as Mexico with a lack of human resources. For instance, health staff could be focused on providing tools to deal with fears, social concerns, and physical/cognitive symptoms as a priority in this vulnerable group.

Citation Format: Lizette Gálvez-Hernández, V Neri-Flores, I Paéz-Gerardo, E López-Muñiz, I Monroy-Ortiz, A Mohar-Betancourt, Enrique Bargallo-Rocha, Cynthia Villarreal-Garza, Paula Cabrera-Galeana. Biopsychosocial changes since diagnosis and the time taking endocrine therapy in Mexican patients with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-08.

Abstract P2-14-16: Optimal timing to initiate adjuvant chemotherapy in Mexican women with high risk luminal breast cancer

Background: It is well known that the interval time (IT) to begin adjuvant chemotherapy (ADYCT) after surgical treatment, it is important to achieve better outcomes in breast cancer (BC), patients. After an IT of more than 91 days, the benefit of systemic treatment in breast cancer-specific overall survival (OS) decreases. Particularly in breast cancer patients with high proliferation tumors as a triple-negative subtype. There is a concern in low/middle-income countries as Mexico where early detection continues a challenge and the number of premenopausal women is high if this conventionally IT could be different in hormone-receptor-positive BC patients. Objective: Identify the optimal interval time between a curative surgical procedure and the adjuvant chemotherapy in high-risk luminal breast cancer patients to avoid a decrease in the overall survival benefit. Methods: We analyzed 749 patients with hormone-receptor-positive (HR+)/HER2 negative breast cancer that received ADYCT during 2006 and 2015 at the National Cancer Institute. HR-positive was defined using ASCO-CAP guidelines. ADYCT was based on anthracyclines and taxanes. Interval time was defined as the period in days between the date of surgical procedure and the date of the first dose of adjuvant chemotherapy. A ROC curve analysis was performed to identify the IT value that correlates with a decrease in OS. OS was calculated by the Kaplan-Meier method. We evaluated differences between survival curves with the log-rank test and used Cox’s proportional hazards model for the multivariate analysis. For statistical analysis, we used SPSS version 23.0. Results: The median follow up was 64.8 months. The median age was 52 years, 365 (48.7%) were premenopausal patients. The mean tumor size was 3 cm, 475 (63.4%) of patients had positive nodes, 80 (10.7%) had pN3, a high nuclear grade was reported in 327(43.7%) cases and 399 (53.3%) patients had Ki67 more than 20%. Mastectomy was performed in 565 (75.5%) and conservative surgery in 184 (24.6%) patients. Our cut-off value for IT was 42 days. Overall survival for patients with an IT less than 42 days was 115.2 months vs 108.8 months for those that initiated ADYCT in more than 43 days (p=0.002). In the univariate analysis for OS, we found significant stage IIB/III (p=0.003), IT more than 43 days (p=0.045), presence of positive nodes (p=0.001) and high nuclear grade (p=0.033). Finally, factors that influence negative OS in the multivariate analysis were positive nodes (HR 1.89, 95%CI 1.72-2.06; p&lt;0.001) and the IT more than 43 days (HR 1.57, 95%CI 1.38-1.77; p=0.049). Conclusions: It is important to recognize that IT time still matters in luminal breast cancer patients. So delays in ADYCT it's not recommended in a high-risk population with hormone-receptor-positive tumors. IT of 42 days seems to be the goal in our country to initiate ADYCT in the meantime early detection programs move forward.

Citation Format: Paula Cabrera-Galeana, Leticia Mendoza-Oliva, Wendy Muñoz, Cynthia Villarreal-Garza, Rafael Vázquez-Romo, Alberto Alvarado, Fernando Lara, Diana Flores, Juan Matus, Enrique Bargallo. Optimal timing to initiate adjuvant chemotherapy in Mexican women with high risk luminal breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-16.

Abstract P3-07-10: Prognostic value of neutrophil-lymphocyte ratio in early breast cancer patients with ER+/Her2 negative and its association with 21 gen recurrence score

Background: Breast cancer (BC) is a heterogeneous disease, around 70% of these tumors are hormone receptor (HR) positive. The 21 gene recurrence score (RS) is a prognosis tool to define disease-free-survival in patients with early-stage HR+/HER2- BC with negative and positive lymph nodes also because its predictive value is used to decide the kind of adjuvant systemic treatment. The ability of malignant cells to progress and subsequently metastasize is not entirely dependent on their own intrinsic cellular signaling pathways but also of complex interactions with the tumor microenvironment and the innate and specific immune system. A high neutrophil to lymphocyte ratio (NLR) has been associated with lower overall survival (OS), disease-free survival (DFS) and distant disease-free survival (DDFS). Because both tools have evidence to evaluate prognosis. We propose that NLR would be a faster and cheaper alternative to achieved prognosis in low/middle-income countries. Objective: 1)Evaluated the association between NLR and RS to predict disease-free survival and distant disease-free survival in patients with early-stage HR+/HER2- BC. 2)Define the prognosis value to DFS and DDFS of NLR in patients with HR+/HER2- BC. Methods: We collected data from 208 patients with HR+/HER2- early BC treated with surgery upfront and RS has done. The recorded variable used were tumor size, nuclear grade, lymph node status. Regarding HR status, estrogen receptor (ER) positive was mandatory and progesterone receptor (PR) was exploratory. Complete blood count (CBC) test was obtained after BC diagnosis and prior to breast surgery. NLR was calculated as absolute neutrophil count divided by absolute lymphocyte count. The cut-off value used was 2.5. RS of each patient was categorized into a low-risk (≤ 25) or high-risk (&gt; 26). Disease-specific survival curves were calculated according to the Kaplan-Meier method and comparison was done with the log-rank test, the correlation between NLR and RS was assessed using Spearman’s rank correlation coefficient. Statistical analysis was performed by SPSS software v 23.0. Results: The median age was 61.1 years old (33-97), median tumor size 2,3 (0.5-5) cm, 92.8% were PR-positive, 71.5% had lymph node metastases (1-3), 159 (76%) patients had NLR &lt; 2.5. There was no difference in DFS 91.8 months vs 93.7 months p=0.44 neither in DDFS 92.9 months vs 94.6 months p=0.30 between groups by NLR. NLR did not correlate significantly with RS (Spearman’s r= 0.08, p=0.23). Correlation among NLR a PR, lymph node status, nuclear grade, and tumor size, was not significant. Low RS was associated with a DFS of 96% vs 87.8% in high RS (p=0.049) Conclusions: We failed to demonstrate the prognostic value of NLR for DFS in HR+/HER2- early breast cancer. NLR does not correlate with RS so, RS remains to be the most useful prognostic factor in this population.

Citation Format: Ivan Maldonado-Noboa, Paula Cabrera-Galeana, Claudia Arce-Salinas, María Elena Lara, Gerardo Cuamani-Mitznahuatl, Diego Ladron De Guevara, Adan Ordoñez, Enrique Bargallo-Rocha. Prognostic value of neutrophil-lymphocyte ratio in early breast cancer patients with ER+/Her2 negative and its association with 21 gen recurrence score [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-10.

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio in Different Phenotypes of Locally Advanced Breast Cancer During Neoadjuvant Systemic Treatment

PURPOSE

Neutrophils are among the key cellular players in the inflammatory milieu produced in patients with breast cancer (BC), and strong evidence exists in terms of the prognostic value of assessing the neutrophil-to-lymphocyte ratio (NLR) in patients with BC. In this study we sought to determine whether the baseline NLR correlates with pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS) in patients with locally advanced BC in the neoadjuvant chemotherapy (NAC) setting.

METHODS

We analyzed the pretreatment NLR from the first blood count of patients treated from 2007 to 2015 in terms of pCR, DFS, and OS in patients with locally advanced BC. Patients received standard medical care based on national guidelines.

RESULTS

A total of 1519 patients were included in the study. Median age was 49 years (22-88). The cutoff point for NLR was 2.0. NLR was not associated with pCR or DFS. However, patients with high NLR had worse OS in the presence of triple-negative BC (105.9 months; 95% confidence interval [CI], 100.2-111.5] vs. 98.7 months; 95% CI, 91.1-106.3; P = .029), Her2 overexpression (114.0 months; 95% CI, 110.5-118.0 vs. 100.8 months; 95% CI 95.7-105.9; P = .019), and residual disease after NAC for both phenotypes. Multivariate analysis showed that NLR was independently associated with OS (hazard ratio, 1.4; 95% CI, 1.02-1.95; P = .037).

CONCLUSIONS

Pretreatment NLR in patients with locally advanced BC correlates with OS as an independent prognostic factor. This influence depends on phenotype and residual disease. Routine assessment of this parameter could be an easy and affordable tool for defining prognosis.

Abstract 5256: Molecular signatures associated with obesity-related tumor growth in breast cancer women

Obesity has been widely associated with chronic diseases, including cancer. Obesity increases the risk of developing several types of cancer, both in women and men, especially breast cancer in postmenopausal women. However, the role of obesity after tumors is established and its potential mechanisms are unknown. Our study aims to determine the molecular signatures associated with obesity-related tumor growth in a cohort of breast cancer patients from a country with an obesity epidemic. We evaluated a cohort of patients with breast cancer (n=151) at diagnosis, including patients in all clinical stages and 78% of them showed overweight or obesity. We determined the role of body mass index (BMI) on clinical characteristics and, using RNA-seq analyses in biopsy samples at diagnosis, we determined potential genes associated. We found a positive correlation between BMI and tumor size at diagnosis (r = 0.147, p-value = 0.006) and age (r=0.116, p-value=0.03). Lower BMI was observed when the number of positive nodes increased (p-value = 0.015). In a random subset from these patients (n=12) and using robust linear models, we determined that 10 genes (GPRC5B, SLITRK6, KRT23, VTCN1, TNFRSF12, PTP4A2, BACE2, EPH8, CYP21A1P, and TMEM52) were positively associated with BMI. CSTA and IGKV1-16 showed a negative association with BMI. Gene ontology analyses revealed that VTCN1 and PTP4A3 were linked to increased proliferation and tumor progression. CSTA, a protease inhibitor, was also associated with poor prognosis. Our study suggested a deleterious effect of obesity on breast cancer patients, which could be caused by changes in cell expression on key genes in tumor cells.

Citation Format: Diddier Prada, Cristian Arriaga-Canon, Jose Diaz-Chavez, Carlo Cortes, Marco Andonegui-Elguera, Pedro Perez-Collado, Rodolfo Muniz, David Cantu-de-Leon, Paula Cabrera-Galeana, Enrique Bargallo, Luis Herrera, Fernando Penaloza. Molecular signatures associated with obesity-related tumor growth in breast cancer women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5256.

Impact of invasive lobular carcinoma on long-term outcomes in Mexican breast cancer patients

PURPOSE

The aim of this study was to compare the difference in disease-free survival (DFS) and overall survival (OS) between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) in our Hispanic population with breast cancer (BC).

METHODS

We retrospectively analyzed a database of 4533 non-metastatic BC patients treated for BC at the National Cancer Institute in Mexico (INCan) between 2006 and 2016. We compared clinical characteristics, treatment and survival between women with invasive ductal and invasive lobular BC. We evaluated differences between survival curves with the log-rank test and used Cox's proportional hazards model for the multivariate analysis.

RESULTS

Median follow-up time was 42.13 months (IQ₂₅ 25.2-IQ₇₅ 72.06). The median age was 50.9 years (IQ₂₅ 43.5-IQ₇₅ 59.8). DFS at 5 years was 80.8% for IDC versus 76.2% for ILC. 5 years OS was 88.7% for IDC versus 84.3% for ILC. Multivariate analysis showed that factors that negatively affected the 5-year DFS include: clinical stage III [hazard ratio (HR) 4.2, 95% CI 3.36-5.35; p < 0.001], triple negative phenotype (HR 1.4, 95% CI 1.08-1.81; p = 0.009), Ki67 ≥ 18 (HR 1.6, 95% CI 1.28-2.11; p < 0.001), and lobular histological type (HR 1.6, 95% CI 1.09-2.49; p = 0.017). Factors associated with a negative impact on OS were: clinical stage III (HR 4.5, 95% CI 3.15-6.54; p < 0.001), triple negative phenotype (HR 2.4, 95% CI 1.69-3.48; p < 0.001), and Ki67 ≥ 18% (HR 1.9, 95% CI 1.27-2.92; p = 0.02).

CONCLUSION

Our results highlight the different biology of ILC and show that long-term prognosis in terms of DFS is not as favorable as previously reported.

Abstract P2-07-13: OncoproMex®: An intelligent decision support system for Mexican breast cancer patients

Background: Breast cancer in Mexico is the first cause of mortality due to malignant tumors among women. The five-year overall survival among Mexican breast cancer patients (MexBCP)treated at governmental facilities is about 75-80% as a result of an increased access to oncology treatments (WHO 20thmodel list essential medicines) in the Public Health Insurance called "Seguro Popular". Expert systems are computer programs that are derived from a branch of computer Science research called Artificial Intelligence (AI). We do not have a system based on artificial intelligence for MexBCP prognostic and predictive evaluation. The aim was develop an expert system that generates a model based on data mining techniques, which allowed predict the MexBCP survival

Patients and Methods:

This study was carried out by the methodology currently used in the processes of Knowledge Discovery from Databases (KDD), supported by the WEKA free distribution tool for the modeling of data mining techniques. The breast cancer data of 4,773 were provided by INCAN cohort of 4300 patients diagnosed from 2006 to 2013 with a median follow-up of 40.5 months and by INCMNSZ cohort of 473 patients from 2011 to may 2018 with a median follow-up of 39 months. The clinical and pathologic variables were: age, TNMc stage, hormonal status (pre or perimenopause or postmenopause), ER, PR, HER2, Ki67, nuclear grade. Date of histological diagnosis, date of recurrence or last medical consultation, date of death, date of death, specific cancer were used for Survival analysis.

Results: The knowledge base for the expert system was based on the rules generated by the different data mining techniques. The rules used were generated by the Prism classification algorithm, which classify with a 97% percentage of instances correctly and a Kappa statistic of 0.9208. These rules obtained characteristics in each of the attributes, as well as the percentage of certainty of each of those rules. In addition to determining the average life of the group of patients that was classified in each of the generated rules. Finally, the basic elements that formed part of the architecture of the expert system carried out were the knowledge base, the inference engine, the database and the interface with the user. An on-line expert system was created, which allows users to interact and thus allow decision-making based on the results presented.

Conclusion:

As far as we know this is the first expert system that allows calculate prognosis according to clinical-pathological variables. It is of great relevance know the survival of a Mexican patient with breast cancer in the public health system with access to essential treatment. The applications of the system can be multiple in the usual clinical practice, education and in the taking of public policies for breast cancer in Mexico. We are currently working on a predictive model of oncological treatment benefit based also on an expert system.

Citation Format: Armengol-Alonso A, Villalobos-Castaldi FM, Cabrera-Galeana P, Bargallo-Rocha E, Reynoso-Noverón N, Mohar A, Melo-Morin JP. OncoproMex®: An intelligent decision support system for Mexican 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 P2-07-13.

Abstract P6-16-07: The BREAST-Q: Translation and validation for Mexican population

BACKGROUND: BREAST-Q is a patient-reported outcome (PRO) that has been designed to evaluate perception outcomes among women undergoing different types of breast surgery, the modules include evaluation for mastectomy, breast reconstruction, augmentation, reduction/mastopexy and breast-conserving therapy.

OBJECTIVES: Generate a translated version that is conceptually equivalent to the original version and to validate for Mexican population.

METHODS: A linguistic and psychometric validation was performed in 494 women. We carry out pre and postoperative test. Reliability and internal consistency were performed by Cronbach's alpha and intraclass correlation coefficient (ICC).

RESULTS: The results of patient testing, number of participants, acceptability and reliability are shown in table 1. The average scores were in all cases &gt;0.80.

Summary of BREAST-Q validation analysisN =494Module=nMean age(range)Time to completion Test(minutes) average(range)Time to completion Retest(minutes) average(range)Number of itemsNumber of missing itemsCronbach's Alpha min-max*Test-Retest ICC min-max*Mastectomy=160Pre=6248(26-76)7.8(2-20)6.4(3-20)3700.81-0.940.72-0.94Post=9852(32-78)13(4-40)11(4-28)6310.87-0.970.87-0.96Breast Conserving Therapy=153Pre=8150(21-78)7(2-17)5.2(2-13)3220.88-0.950.82-0.95Post=7255(37-73)18.7(5-44)15.4(6-29)8720.92-0.980.92-0.98Reconstruction=181Pre=6544(23-64)7.9(3-22)6.4(2-20)4220.90-0.970.90-0.97Post=9246(24-74)18.5(8-41)15.7(5-42)11610.86-0.990.85-0.99Lattisimus Dorsi=2445(33-74)5(1-18)4(2-10)1910.95-0.960.96-0.96We report the low and the high value between all sub scales, per questionnaires

The internal consistency and reproducibility support the reliability of the instrument; all of the scores were acceptable.

DISCUSSION: The importance of measurements quality of life in patient whit cancer, become an essential end-point, we need validated tools that help us improve our performance in different methods of treatments.

Is the first validation study of an instrument that measures the impact of surgical treatment on the quality of life of breast cancer patients in Mexico, our results support the equivalent Spanish version for Mexican population. Breast-Q will provide valuable metrics for a surgeon team to document and measure their clinical performance and improve quality of healthcare in our Hispanic patients.

CONCLUSIONS: The Mexican Spanish version of tree Modules of Breast-Q is reliable and easy to implement in the population with breast cancer in different scenarios in México with the advantage to measure the quality of life and satisfaction on our population with a locally advanced stage that will help to improve quality of healthcare.

The high acceptability of the questionnaire demonstrate that the version is well accepted for our population so we will include a significant number of patient in our country; therefore, more hospital centers will be invited to participate for further studies that allow us to evaluate the population in Latin America and thus compare our results.

Citation Format: Bargalló-Rocha J, Gutiérrez-Zacarías L, Gallargo-Alvarado L, Maciel-Miranda J, Shaw-Dulin R, Esparza-Arias N, Figueroa-Padilla J, Vazquez-Romo R, Robles-Vidal C, Drucker-Zertuche M, Cabrera-Galeana P, Cantu-De Leon D. The BREAST-Q: Translation and validation for Mexican population [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 P6-16-07.

Abstract P1-19-07: Real-world characteristics, treatment patterns, and overall survival in patients with metastatic breast cancer (mBC) and CNS metastases

Background:

CNS metastases are reported in about 10 to 15%. Knowledge about the management of these patients are limited because they are excluded from clinical trials due to its poor prognosis and morbidity. In these study, we aim to describe characteristics, treatment patterns, and overall survival (OS) of patients of mBC with CNS metastases at Instituto Nacional de Cancerología de Mexico (INCan) from january 2007 to december 2015.

Methods:

We include patients with histological diagnosis of mBC and tumoral activity in the CNS (at diagnosis or during de follow-up). mBC subtype was defined using HER2 and hormone receptor (HR) status by immunohistochemistry; systemic treatment, and mortality data were used to characterize mBC with CNS involment.

Results:

During the study period, we found 1272 patients diagnosed with metastatic disease, of whom 408 had CNS disease (novo/recurrence) the median follow up was 52 months. Table 1 describes the percentage of CNS metastases by subtype, clinical characteristics at diagnosis and median OS. Almost all patients (85.6%) were candidate to holocranial radiotherapy; after that, systemic treatment varied according to the subtype of mBC; 69.1% of TN received CT (26% based on platinum); 75.3% of HER2+ received systemic treatment, all included antiher2 therapy; luminal subtype, no one were treated with endocrine therapy.

Table 1.- characteristics and Overall suvival by subtype of mBC all mBC 1272 n(%)her2 positive 339 (26.6) n (%)triple negative 298 (23.4) n(%)luminal 636 (50) n(%)CNS metastasis at dianosis44 (3.5)12 (3.5)13 (4.4)19 (2.9)CNS mets after prog to systemic tx205(16.1)63(18.6)50(16.7)92(14.5)CNS as first place of recurrence159(12.5)75(22.2)34(11.4)50(7.8)prevalence on CNS mets408(10.7)150(14.7)97(10.8)161(8.4)median age at diagnosis of CNS mets50(28-84)50(29-84)48(28-80)51(28-80)median OS after CNS mets (months)14.927.29.3316.3

Conclusions:

HER2 positive breast cancer patients have the highest prevalence of CNS metastases, whereas luminal has the lowest. Patients with HER2+ and CNS metastases commonly receive treatment based on anti-HER2 therapy, maybe this target treatment contribute to the better survival achieved than patients with luminal or TN subtype. mBC with CNS metastases continues in the real world to be an unmet medical need.

Citation Format: Alvarado-Miranda A, Cabrera-Galeana P, Muñoz-Montaño WR, Lara-Medina F, Bargallo-Rocha E, Arrieta-Rodriguez O, Perez M, Porras-Reyes F, Mohar-Betancourt A, Gamboa C. Real-world characteristics, treatment patterns, and overall survival in patients with metastatic breast cancer (mBC) and CNS metastases [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 P1-19-07.

Abstract P2-13-05: Prevalence of trastuzumab-induced cardiotoxicity in a real-world setting

Background: Trastuzumab treatment plus adjuvant or neoadjuvant chemotherapy is the standard of care for women with HER2 positive breast cancer. Despite relative low rates of cardiotoxicity observed in randomized clinical trials, trastuzumab interruption driven by LVEF reduction is a major concern in current clinical practice.

Patients and methods: We retrospectively identified women with stage I-III HER2 positive breast cancer who received 12 months of trastuzumab treatment after adjuvant or neoadjuvant chemotherapy at Instituto Nacional de Cancerología (INCan, Mexico City), between 2006 and 2018. Patients were eligible if a pre-therapy MUGA scan and ≥2 subsequent follow-up scans were available. Cardiotoxicity was defined as a ≥10% LVEF reduction to a value &lt; 50%, associated with trastuzumab interruption.

Results: 910 patients were included, with a median age at diagnosis of 50 (24-85) years and a median follow up of 7 (2-11 ) years. Among the whole cohort, 10.3% of patients had diabetes, 15.4% had hypertension, 78% were obese/overweight, and 40% had positive estrogen and/or progesterone receptor status. Anthracycline-based therapy was used in 819 (90%) patients, with a median (doxorubicin equivalent) cumulative dose of 200 mg/m2 (IQR 180-240). The median baseline LVEF was 61.8% (50-88.9). In total, 94 (10.3%) patients developed cardiotoxicity, but symptomatic heart failure was observed in only 31 (3.4%) individuals. In univariable analyses, the development of cardiotoxicity was not associated significantly with cardiovascular risk factors.

Conclusions: In this large single-center cohort, cardiotoxicity rates remain high, thus, interventions to minimize the risk of cardiotoxicity and trastuzumab treatment interruption should be considered.

Citation Format: Calvillo-Argüelles O, Flores-Diaz D, Gonzalez-Serrano J-P, López-Rojas A, Mendoza-Galindo L, Matus-Santos J-A, Reynoso-Noverón N, Cabrera-Galeana P, Bargalló-Rocha E, Arce-Salinas C. Prevalence of trastuzumab-induced cardiotoxicity in a real-world setting [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 P2-13-05.

Abstract P4-11-04: Palliative care and older women with advanced breast cancer in Mexico

Background: Mexico is an upper-middle income country, as other developing regions, there is an accelerated aging of the population that will double the absolute number of new breast cancer (BC) cases by 2035. Unfortunately, the incidence of stage III and IV in women older than 65 years old represented 45% of new cases (higher than high-income regions); also, 21% had diabetes, 41.1% hypertension and 71% overweight/obese. These factors make our older adults patients with BC a high-risk population of recurrence and dead from disease.

Objective: Describe the characteristics of older women with BC that received palliative care in a multidisciplinary setting.

Patients and Methods:A cross-sectional, retrospective, descriptive of 178 patients with advanced breast cancer, older than 65 years from our data based, that were referred to palliative service during 2010-2016 at National Cancer Institute, Mexico. Statistical analysis was done with STATA V12.0. We described clinical, pathological and sociodemographic characteristics of this older women with advanced BC and analyzed the risk factors that influence dead. Approval from IRB was obtained.

Results:The median age was 75 years old (range 69-82), 71(41%) was widows, 51(29%) had none education, 93(52%) had elementary school. Highlights that 93 (52%) of the patients evaluated had any income source. Diabetes was present in 43(24%), hypertension in 81 (46%) and cardiopathy in 17(10%) of cases. ECOG-2 were 58 (33%) patients, ECOG-3 was in 47 (26%)patients and ECOG-4 was reported in 19 (11%). None patient had geriatric assessment. Affected metastasis sites were bone 90 (51%), lung 66 (37%), central nervous system 31 (17%), liver 27 (15%). 69 (62%) patients had hormonal receptor positive, 17 (15%) triple negative, 12 (11%) HER2positive and 13(12%) of the cases were triple positive, 41 (74%) patients had Ki-67 higher than 50%. Polypharmacy was identified in 77 (43%) of the patients. The median survival after the admission in the palliative service was 2 months (IQR 0-10). After a logistic regression univariate Ki-67&gt;20% (OR 10.25), triple negative (OR 1.5), HER2 positive (OR 2.3), influence negative survival.

Conclusions: Management of BC in the elderly is complex. Our data show that we have highly vulnerable population. Additionally, we found an unfortunate late reference to palliative care services that limited the impact of the multidisciplinary approach. We need to identify the barriers that influence this delay. Health care provides have a challenge in early reference of older women with advanced breast cancer patients to the palliative care and need to think in integrate to the multidisciplinary team a geriatrician with oncology perspective.

Citation Format: Cabrera-Galeana P, Sánchez N, Verastegui E, Rodriguez C, Bargallo E, Monreal E, Allende S. Palliative care and older women with advanced breast cancer in Mexico [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 P4-11-04.

Abstract P5-14-08: Not presented

This abstract was not presented at the conference.

Citation Format: Galindo-Vázquez O, Baragalló-Rocha E, Cabrera-Galeana P, Costas-Muñiz R, Lerma A, Esparza-Arias N. Not presented [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 P5-14-08.

Ki67 Changes Identify Worse Outcomes in Residual Breast Cancer Tumors After Neoadjuvant Chemotherapy

BACKGROUND

Several breast cancer (BC) trials have adopted pathological complete response (pCR) as a surrogate marker of long-term treatment efficacy. In patients with luminal subtype, pCR seems less important for outcome prediction. BC is a heterogeneous disease, which is evident in residual tumors after neoadjuvant-chemotherapy (NAC). This study evaluates changes in Ki67 in relation to disease-free survival (DFS) and overall survival (OS) in patients without pCR.

SUBJECTS, MATERIALS, AND METHODS

Four hundred thirty-five patients with stage IIA-IIIC BC without pCR after standard NAC with anthracycline and paclitaxel were analyzed. We analyzed the decrease or lack of decrease in the percentage of Ki67-positive cells between core biopsy samples and surgical specimens and correlated this value with outcome.

RESULTS

Twenty-five percent of patients presented with luminal A-like tumors, 45% had luminal B-like tumors, 14% had triple-negative BC, 5% had HER2-positive BC, and 11% had triple-positive BC. Patients were predominantly diagnosed with stage III disease (52%) and high-grade tumors (46%). Median Ki67 level was 20% before NAC, which decreased to a median of 10% after NAC. Fifty-seven percent of patients had a decrease in Ki67 percentage. Ki67 decrease significantly correlated with better DFS and OS compared with no decrease, particularly in the luminal B subgroup. Multivariate analysis showed that nonreduction of Ki67 significantly increased the hazard ratio of recurrence and death by 3.39 (95% confidence interval [CI] 1.8-6.37) and 7.03 (95% CI 2.6-18.7), respectively.

CONCLUSION

Patients without a decrease in Ki67 in residual tumors after NAC have poor prognosis. This warrants the introduction of new therapeutic strategies in this setting.

IMPLICATIONS FOR PRACTICE

This study evaluates the change in Ki67 percentage before and after neoadjuvant chemotherapy (NAC) and its relationship with survival outcomes in patients with breast cancer who did not achieve complete pathological response (pCR). These patients, a heterogeneous group with diverse prognoses that cannot be treated using a single algorithm, pose a challenge to clinicians. This study identified a subgroup of these patients with a poor prognosis, those with luminal B-like tumors without a Ki67 decrease after NAC, thus justifying the introduction of new therapeutic strategies for patients who already present a favorable prognosis (luminal B-like with Ki67 decrease).

Abstract P6-12-23: Not presented

This abstract was not presented at the symposium.

Differential association of 5-hydroxymethylcytosine levels with clinical and histopathological characteristics in breast cancer tumors

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Background: Breast cancer is one of the top causes of cancer death worldwide. In Mexico, locally advanced breast cancer (LABC) comprises the majority of the breast cancer stages at diagnosis. Recent studies have suggested that 5-hydroxymethylcytosine (5hmC), could be a prognostic marker in breast cancer. However, the role of 5hmC on clinical and histopathologic characteristics in LABC has not been explored. Methods: From a cohort of locally advanced and advanced breast cancer patients treated at the National Cancer Institute in Mexico City with a 3-year follow-up, we measured 5hmC levels by immunodetection from fresh frozen tissue samples taken from the initial biopsy (N = 193). We determined the association between 5hmC levels and the most relevant clinical and histopathological characteristics. Results: From the full cohort analyzed; 42% were luminal A (n = 82), 33% were luminal B (N = 63), 9% were HER2-positive (N = 18), and 15% were triple-negative tumors. We found higher levels of global 5hmC in HER2 positive tumors vs. all other subtypes (p = 0.028, Kruskal-Wallis test). In luminal B tumors, 5hmC levels were associated with Ki67 (β = -0.04, 95%CI: -0.08, -0.01, p = 0.01 from multivariable model) but not in luminal A. Furthermore, we found that low 5hmC levels were associated with higher histological grade in HER2-positive tumors (p = 0.03, Kruskal-Wallis test). In subgroup analysis of LABC patients, we found higher 5hmC levels in non-ductal vs. ductal invasive tumors (β = 1.38, 95%CI: 0.049, 2.911, p = 0.043 from multivariable model). Also, lower 5hmC levels were associated with Ki67 (β = -2.53, 95%CI: -4.32, -0.74; p = 0.009 from multivariable model) and with histological type (p = 0.028, Kruskal-Wallis test) in LABC luminal B tumors. A borderline association with OS (p = 0.07, log-rank test) and RFS (p = 0.071, log-rank test) was observed in luminal A tumors in the LABC group. Conclusions: Our findings suggest that 5hmC levels are differentially associated with distinct clinical and histopathological characteristics in breast cancer, especially those linked to aggressiveness, including Ki67, histological type, and grade.

Clinical and Epidemiological Profile of Breast Cancer in Mexico: Results of the Seguro Popular

Purpose

One half of the Mexican population lacks comprehensive health care coverage. In 2003, a reform to the General Health Law was approved that led to the creation of the System of Social Protection in Health and made universal health coverage mandatory. The main innovation of this reform was Seguro Popular, which provided coverage for breast cancer. Here we report the outcomes of women with breast cancer treated at a cancer center in Mexico under Seguro Popular.

Materials and Methods

This was a retrospective cohort study that included all patients with breast cancer treated in the Instituto Nacional de Cancerología in Mexico City between January 2007 and December 2013 with Seguro Popular coverage. Demographic and clinical information were collected and survival outcomes were analyzed.

Results

A total of 4,300 women with breast cancer were included in this analysis. Most patients had locally advanced disease at diagnosis (53%, n = 2,293), and 13% (n = 558) presented with stage IV disease. Neoadjuvant chemotherapy was administered to 1,834 patients (52%), with a pathologic complete response in 25.1% (n = 460). Median follow-up was 40.5 months. Five-year survival for the entire cohort was 82% (95% CI, 81% to 84%). Five-year survival was 97% for early-stage disease (95% CI, 95% to 98%), 82% for locally advanced disease (95% CI, 80% to 84%), and 36% for metastatic disease (95% CI, 30% to 42%).

Conclusion

This represents the first description of a cohort of patients with breast cancer treated in Mexico under Seguro Popular. Seguro Popular has allowed our institution, and other Mexican centers, to establish efficient standardized mechanisms to treat patients with breast cancer.

Safety and efficacy of sunitinib in patients from Latin America: subanalysis of an expanded access trial in metastatic renal cell carcinoma

BACKGROUND

Sunitinib is an approved treatment for metastatic renal cell carcinoma (mRCC). The safety profile and efficacy of sunitinib were confirmed in a global expanded access trial (ClinicalTrials.gov identifier: NCT00130897). This report presents a subanalysis of the final trial data from patients in Latin America.

METHODS

Treatment-naïve or previously treated mRCC patients aged ≥18 years received oral sunitinib at a starting dose of 50 mg/day on a 4-weeks-on/2-weeks-off schedule. Treatment continued until disease progression, unacceptable toxicity, or withdrawal of consent. Safety was assessed regularly, and tumor measurements were scheduled per local practice (using Response Evaluation Criteria in Solid Tumors).

RESULTS

In total, 348 patients from Latin America received sunitinib. Overall, 75% of patients had two or more sites of metastatic disease, 28% were aged ≥65 years, 14% had an Eastern Cooperative Oncology Group performance status ≥2, 9% had brain metastases, 9% had no prior nephrectomy, and 5% had non-clear cell RCC. Median treatment duration was 8 months, and median follow-up was 15.1 months. In total, 326 patients (94%) discontinued treatment, primarily due to death (41%) or lack of efficacy (22%). Most treatment-related adverse events were of mild to moderate severity (grade 1/2). Mucosal inflammation (reported in 54% of patients), diarrhea (53%), and asthenia (41%) were the most common any-grade treatment-related adverse events. Asthenia (12%), neutropenia (10%), and fatigue and thrombocytopenia (both 9%) were the most common grade 3/4 treatment-related adverse events. In total, 311 patients were included for tumor response, of whom eight (3%) had a complete response and 46 (15%) a partial response, yielding an objective response rate of 17%. Median duration of response, progression-free survival, and overall survival were 26.7, 12.1, and 16.9 months, respectively.

CONCLUSION

The efficacy and safety profile of sunitinib in patients with mRCC from Latin America was comparable to that in the entire cohort of the global expanded access trial.