Cardiac dysfunction and their determinants in patients treated for breast cancer and lymphoma: A cardio-oncology center experience

OBJECTIVE

Cancer and cardiovascular diseases both have adverse effects on each other. We aim in the current study to investigate cardiac dysfunction including its prevalence, and associated factors in patients treated for breast cancer and lymphoma in a unique cardiac oncology center.

METHODS

A single-center retrospective study included 180 patients with cancer breast and lymphoma who presented and were treated at our oncology center from January 2019 to February 2022.

RESULT

Out of 180 consecutive patients, 155 patients (86 %) were diagnosed with cancer breast and 25 patients (14 %) were diagnosed with lymphoma. Patients with lymphoma were older age, less obese, and showed more prevalence of diabetes mellitus (DM) (P = 0.026, 0.05, and 0.04 respectively). They also showed more post-therapy left ventricular (LV) dilatation and lower values of global longitudinal strain (GLS); however, they did not develop more LV dysfunction compared to cancer breast patients. Moreover, lymphoma patients showed poor in-hospital outcomes (P = 0.04, 0.001, and 0.015 for infection, pericardial effusion, and mortality respectively). Cancer therapy-related cardiac dysfunction (CTRCD) was observed in 41 patients (23 %) of our population. The independent predictors of CTRCD in the current study were DM, low body mass index (BMI), and the use of trastuzumab.

CONCLUSIONS

Some patients treated for breast cancer and lymphoma develop LV dysfunction. Lymphoma patients showed more subclinical LV dysfunction and poor in-hospital outcomes compared to patients with cancer breast. DM, low body mass index (BMI), and the use of trastuzumab were the independent predictors of cardiac dysfunction among our patients.

Abstract P4-07-30: Residual lymphovascular invasion: Predicts the outcome of neoadjuvant chemotherapy in locally advanced breast cancer

Background: Lymphovascular invasion (LVI) is known to be associated with a poor outcome in breast cancer patients. It indicates a highly proliferative cancer. Few studies examined the value of LVI as a predictor for outcome after neoadjuvant chemotherapy (NAC). The aim of this study to look for an association between survival outcomes and clinicopathological features in locally advanced breast cancer patients treated with NAC and to identify the predictors of nodal pathologic complete response (PCR). Methods:This study is a retrospective analysis of 224 women with locally advanced breast cancer who underwent NAC between 2011-2020. Kaplan-Meier analyses were used to assess the associations between disease-free survival (DFS) and overall survival (OS) and all clinicopathological variables including LVI in breast surgical specimens following NAC. Associations between nodal PCR and all clinicopathologic variables were assessed Results:Median follow-up was 29.9 months. Absence of nodal PCR (p.000), positive family history (p .027), clinical T4 (p.049), pathological TNM staging (p.016), high tumor grade (p .020),triple negative disease(p .016) and absence of tumor PCR (p.001) were associated with worse disease free survival. Absence of nodal PCR (p.002), high BMI (p.039), multicentric disease (p.026), high tumor grade, triple negative disease (p.018), and absence of tumor PCR (p.005) were associated with worse overall survival. LVI was found in 53 of surgical specimens (23.7%). It was associated with worse DFS (HR) (2.967) 95% CI (1.7-4.9), p.000 and overall survival (HR) (3.05) 95% CI (1.525-6.09), p.002). Nodal PCR significantly correlated with T stage (p .013), LVI (p.000), ER status (p.004), PR status (p.003), Her2neu status and IHC score (p.000), tumor subtype (p.000), tumor PCR (p.000), DFS (p.000), and OS (p.000). Conclusion:LVI is significantly associated with worse DFS and OS in locally advanced breast cancer patients treated with NAC. This data confirmed the previously published recommendation to add LVI to the pathological staging system. LVI may be further explored as a guide for adjuvant treatment options in clinical trials. Nodal PCR is another significant predictor of outcome and is associated significantly with tumor PCR and LVI. Both tumor PCR and LVI can be used as criteria for axillary surgery omission in future trials.

Citation Format: Omima Elemam, Khaled Elnaghi, Ziad Emarah, Hossam Alghanami, Seham Abdelkhalek. Residual lymphovascular invasion: Predicts the outcome of neoadjuvant chemotherapy in locally advanced breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-07-30.

Emergency oncology admissions during COVID-19 pandemic: a major institution experience from Saudi Arabia

BACKGROUND

The WHO has declared the coronavirus disease 2019 (COVID-19) pandemic in March 2020. Cancer patients are considered a highly susceptible group. The effect of this pandemic on cancer mortality is still unknown.

AIM

Our aim is to know whether or not we need to postpone cancer treatment during viral pandemics in the future.

MATERIALS AND METHODS

A retrospective observational study from March 1, 2020 to June 1, 2020, included cancer patients on active treatment, who have been admitted to our oncology center through the emergency unit, and patients who received oncology treatment in the outpatient treatment unit. COVID-19 positive cases were identified based on polymerase chain reaction testing of nasopharyngeal swab.

RESULTS

A total of 1300 patients was included in the study, 1096 patients attended the outpatient clinics, 204 patients were admitted to our oncology floor for emergency care. The cancer diagnosis was mainly breast cancer, followed by colon cancer. The main cause of emergency room visit was mainly fever followed by pain. Admission diagnosis was mainly disease progression followed by symptom control, COVID-19 infection, and febrile neutropenia. 1288 cycles of anticancer therapy were provided to 513 patients in the outpatient treatment unit. Three out of the nineteen patients who had a confirmed COVID-19 infection (16%) died not only due to infection, but also disease progression.

CONCLUSION

Cancer treatment is not a risk factor for COVID-19 infection or its complications. Cancer treatment should not be interrupted during viral pandemics and every effort should be made to give cancer patients the standard of care.

Multiple Primary Tumours, How Frequent we can Offer Curative Therapy?

Background: Patients with Multiple-primary Malignancies are usually excluded from clinical trials. Clinical information re-distribution, associations, response to treatment and prognosis are scared. Collecting information will help us to expect the impact of prior therapies and to teach us how to best treat them. This study aims to report cases in our society and to see if we have a special predilection of certain Multiple-primary Malignancies in our region based on different geographic and environmental risk factors. Our retrospective study aims to collect these cases and follow their prognosis and treatment response as well as looking for any relation to cancer therapy. Methods: A retrospective study included patients who have two or more histologically diverse primary malignancy, either as synchronous or metachronous malignancy. The study was conducted in King Abdullah Medical City, Saudi Arabia over 7 years period from 2012 to 2019. We collected all patient’s clinicopathological information, treatment, and modalities. Results: We collected 53 cases of multiple primary malignancies 26were synchronous (48%) and 27 were metachronous (52%). Out of 53 patients, 29 (60 %) were females and 14 (40 %) were males. The most common sites for synchronous are breast and endometrial cancer. Curative treatment could be offered in 19 patients (73%). For metachronous tumours, the most common primary tumour was breast cancer, while the most common second malignancy was colorectal cancer. Curative treatment could be offered in 15 patients (53%). Conclusion: Multiple primary malignancies represent a small proportion of our cases, with no special predilection in our society. Multiple primary malignancies did not signify a poor prognosis; besides nonmetastatic cases showed a good response to therapy. We should not forget the possibility of a second primary tumour as these cases can be reasonably treated with curative intent.   

Sequential Chemoradiotherapy Compared to Radiotherapy in Endometrial Carcinoma

Background:

The role of combined modality in the adjuvant treatment of Endometrial Cancer has not been established. This study aims to assess the benefits of Sequential Chemoradiotherapy (SCRT) compared to Radiotherapy (RT) alone in the treatment of patients with Endometrial Cancer.

Methods:

Retrospective analysis of patients with Endometrial Cancer stage I to stage III C at King Abdullah Medical city, Makkah. Each group of patients was assigned to receive External pelvic RT, brachytherapy or both. While a second group received SCRT consisting of six cycles of Carboplatin (AUC 5) and Paclitaxel 175 mg/m² followed by radiotherapy.

Results:

Fifty-six women were treated of which 26 received SCRT and 30 received RT. The two groups had a median age of 58 years old ranging from 34 – 84 years old with no other statistically significant difference. Patients who received SCRT had poorer prognostic tumor characteris-tics. Median follow-up was 29.6 months (95% CI: 19.6-39.5 months). All deaths (n=5) were exclusively in the RT group. The 2 and 4-year OS rates were 100% and 100% in SCRT group versus 87.3% and 64.9% in RT group (hazard ratio [HR] 0.018 [95% CI: 0-24.4; p= 0.038); The 2- and 4-year DFS were 100% and 100% in SCRT group versus 78.1% and 43.9% in RT group (HR 0.102 [95% CI: 0.103-0.805; p= 0.008).

Conclusion:

Adjuvant chemotherapy given before radiotherapy for Endometrial Cancer may lessen the effect of high-risk features on the DFS and OS. Randomized clinical trials are needed to determine the benefits of early Systemic Therapy.