Eastern Spanish experience with nivolumab in metastatic renal cell carcinoma

BACKGROUND (OR PURPOSE)

Nivolumab has been shown to be effective for the treatment of second-line mRCC. The present study has investigated the effectiveness and safety of nivolumab in real-world Eastern Spanish patients with advanced mRCC at TKI progression.

PATIENTS AND METHODS

A retrospective review of mRCC patients treated with nivolumab as a second-line treatment was performed. Analyzed variables included age, sex, ECOG (quality of life scale designed by the Eastern Cooperative Oncology Group), histology, nephrectomy, location of metastases, number of metastasis locations, previous treatments, analytical data from the standard blood count and biochemistry, and response to treatment.

RESULTS

98 patients from 18 sites in Spain were retrospectively reviewed. The majority of patients were male (75%), had ECOG 0-1 (90.6%), had no brain metastasis (91.4%), had undergone one prior systemic regimen (94.3%), and were current/former smokers (97.1%). Fourteen patients (13.1%) had non-clear cell histology, seven (7.1%) had poor-IMDC prognostic group characteristics, 13 patients (13.1%) had liver metastasis and 35 (35.7%) had bone lesions. All patients received prior systemic therapy (63.3% sunitinib, 34.7% pazopanib). During the study, a median of eight doses of nivolumab was given (range 2-62) and 11 patients received more than 12 doses. Eleven patients (11.2%) received nivolumab as a third or fourth line of treatment. Median duration of therapy was 3.6 months (range 0.5-29.3). Confirmed response rate was 25%. Median progression free survival was 7.8 months (range 1.2-12.1). Median overall survival was 16.3 months (range 1.7-29.3). After discontinuation of treatment, 27.58% of the patients received subsequent systemic cancer therapy. Side effects were mostly grade 1-2 (7.2% had hypothyroidism and 6.2% liver toxicity, 4% had nephritis and 2% hypophysitis). Two cases of grade 3-4 adverse events (2%) were reported.

CONCLUSION

Benefit/risk profile of nivolumab in Eastern-Spanish real-world population with mRCC after tyrosine-kinase inhibitors was consistent with prior real-life studies reported as well as pivotal study.

Skipping Breakfast Is Associated with an Atherogenic Lipid Profile in Overweight and Obese Prepubertal Children

BACKGROUND

Skipping breakfast has been associated with a higher risk of obesity and cardiovascular (CV) risk factors. However, it is not known if skipping breakfast is also correlated with CV risk factors independently from obesity. The mechanisms explaining the role of skipping breakfast on promoting fat accumulation as well as CV risk are not known. Hormones, in particular, insulin-like growth factor-1 (IGF-1), may potentially play a role in the metabolic profile of breakfast skippers.

AIM

This cross-sectional study aims to test, in a sample of overweight/obese children, the hypotheses that skipping breakfast is associated with a worse metabolic profile and that IGF-1 levels are associated with this unfavorable metabolic profile.

METHODS AND RESULTS

We enrolled 112 overweight/obese prepubertal children (3-12 years). Anthropometric characteristics (height SDS, weight SDS, and body mass index (BMI) z-score) were measured. Blood samples were collected to evaluate glucose and lipid metabolisms and hormone profile (growth hormone (GH), IGF-1, insulin, and cortisol). The triglycerides/high-density lipoprotein (HDL) cholesterol ratio was calculated as a predictor of cardiovascular risk. Children were divided into two groups according to breakfast habits: consumers (≥5 weekly; N = 76) and skippers (≤4 weekly; N = 36). Glycaemia, total and low-density lipoprotein (LDL) cholesterol, triglycerides (p < 0.05), and triglycerides/HDL cholesterol ratio (p < 0.001) were higher, while HDL cholesterol was lower (p < 0.01) in skippers as compared to consumers. IGF-1 concentrations were inversely correlated with LDL cholesterol (r = -0.279, p=0.013) and directly correlated with HDL cholesterol (r = 0.226, p=0.047). IGF-1 correlated positively with HDL cholesterol (r = 0.266, p=0.045) in consumers and correlated negatively with LDL cholesterol (r = -0.442, p=0.024) in skippers. Breakfast consumption among prepubertal overweight/obese children showed a better lipid profile in comparison with those who skipped breakfast [OR: 0.165 (95% CI: 0.053-0.518), p=0.001]; these latter odds of the increased triglycerides/HDL cholesterol ratio was 6.1-fold higher.

CONCLUSIONS

Breakfast skippers show a worse lipid profile when compared to breakfast consumers. IGF-1 might play a role as an independent modulator of lipid metabolism.

Abstract P4-12-04: Initial treatment and survival among elderly breast cancer patients by receipt of human epidermal growth factor receptor 2-targeted therapy: An analysis of US national data 2006-2009

BACKGROUND: There are few studies of initial treatment and survival among elderly, newly diagnosed breast cancer (BC) patients stratified by receipt of human epidermal growth factor receptor 2- (HER2-) targeted therapy.

METHODS: Using linked Surveillance, Epidemiology, and End Results (SEER) and Medicare claims and enrollment data from 2006-2009, women aged 65+ years with an incident diagnosis of BC (index date) in 2007 and no prior history of any other cancer were identified and followed to evaluate initial treatment and survival. Study patients were required to have continuous enrollment from 1 year before index (baseline period) through the end of the data window, disenrollment or death, whichever came first. Patients were classified as having received HER2-targeted therapy if they had any claim indicating trastuzumab or lapatinib following diagnosis. Demographics, initial treatment (within 4 months of diagnosis), and survival (proportion of patients who died during the study period) were evaluated by receipt of HER2-targeted therapy (and by age and stage among those who received HER2-targeted therapy). Kaplan-Meier (KM) survival curves and survival at 36 months were estimated by stage. Treatment included surgery, radiation, chemotherapy, biologic, and hormone therapy, and was evaluated among patients with &gt; 2 months of follow-up.

RESULTS: Among 11,238 female BC patients, 510 received HER2-targeted therapy (99.8% trastuzumab, 2.5% lapatinib) and 10,728 did not. Those who received HER2-targeted therapy were slightly younger at diagnosis (mean age 73 vs. 76, P&lt;0.01) and less likely to have positive estrogen receptor (ER+; 52.7 vs. 85.1%, P&lt;0.01) and progesterone receptor (PR+; 37.8 vs. 72.6%, P&lt;0.01) status. They were also more likely to be diagnosed at later stages (Stage III: 23.3 vs. 7.4%; Stage IV: 10.6 vs. 4.9%; P&lt;0.01). Patients with HER2-targeted therapy were less likely to receive surgery (87.5 vs. 91.9%; P = 0.06), radiation (39.0 vs. 43.2%; P&lt;0.01), or hormone therapy (6.9 vs. 16.8%, P&lt;0.01), but more likely to receive chemotherapy (69.8 vs. 12.6%, P&lt;0.01). Mortality was similar between the two groups (15.3% for HER2-targeted therapy vs. 16.1% for non HER2-targeted therapy, P = 0.71). Among patients receiving HER2-targeted therapy, increased age (P&lt;0.01) and later stage (P&lt;0.01) were associated with higher mortality. Older patients were more likely to receive hormone therapy (P = 0.02) and less likely to receive chemotherapy (P = 0.02) and surgery (P = 0.08). Patients in later stages were less likely to receive surgery (P&lt;0.01) or radiation (P&lt;0.01) and more likely to receive chemotherapy (P = 0.01) or hormone therapy (P = 0.05).

CONCLUSIONS: Elderly, newly diagnosed BC patients who received HER2-targeted therapy were younger than those who did not received HER2-targeted therapy. Initial treatment patterns varied between the two groups, but survival outcomes were similar. Among patients in the HER2-targeted therapy group, treatment characteristics also differed by disease stage and age.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-04.

Abstract P3-06-10: All-cause resource use among elderly breast cancer patients by receipt of human epidermal growth factor receptor 2-targeted therapy: An analysis of US national data 2006-2009

BACKGROUND: There are few recent studies of all-cause resource use among elderly, newly diagnosed breast cancer (BC) patients by receipt of human epidermal growth factor receptor 2- (HER2-) targeted therapy.

METHODS: Using linked Surveillance, Epidemiology, and End Results (SEER) and Medicare claims and enrollment data from 2006-2009, women aged 65+ years with an incident diagnosis of BC (index date) in 2007 and no prior history of any other cancer were identified and followed to evaluate all-cause resource use. Study patients were required to have continuous enrollment from 1 year before index (baseline period) through the end of the data window, disenrollment or death, whichever came first. Patients were classified as having received HER2-targeted therapy if they had any claim indicating trastuzumab or lapatinib following diagnosis. Demographics and all-cause resource use (hospitalizations, hospital days, outpatient visits, physician/provider services, prescription drug use, skilled nursing facility [SNF] care, home health care, hospice care, and durable medical equipment) were evaluated by receipt of HER2-targeted therapy (and by stage and age among those treated with HER2-targeted therapy).

RESULTS: Among 11,238 female BC patients, 510 received HER2-targeted therapy (99.8% trastuzumab, 2.5% lapatinib) and 10,728 did not. Duration of follow-up was longer for the HER2- targeted therapy group (mean: 28.0 vs. 27.2 months, P = 0.06). Patients receiving HER2-targeted therapy were more likely to be hospitalized during follow-up (72.4% vs. 57.8%, P&lt;0.01), though they had fewer mean per-patient-per-month (PPPM) hospital days (0.38 vs. 0.49, P&lt;0.01). Almost all patients had an outpatient visit (100.0% and 97.3%, P&lt;0.01) and a physician/provider visit (100.0% and 99.6%, P = 0.42) during follow-up, though patients receiving HER2-targeted therapy experienced greater PPPM service use (mean outpatient visits 1.08 vs. 0.69, P&lt;0.01; mean physician/provider services 3.91 vs. 2.79, P&lt;0.01). Similar proportions of patients had prescription drug (61.2% vs. 57.7%, P = 0.12), SNF care (14.3% vs. 14.5%, P = 0.95), and hospice care (both 8.2%, P = 1.00) use. Among patients treated with HER2-targeted therapy, those with later stage cancer were more likely to receive SNF (8.6% [Stage I], 11.8% [Stage II], 16.8% [Stage III], 27.8% [Stage IV]; P&lt;0.01), home health (20.7%, 39.6%, 50.4%, 50.0%; P&lt;0.01), and hospice care (0.0%, 0.5%, 15.1%, 31.5%; P&lt;0.01), and had higher mean PPPM hospital days (0.23, 0.32, 0.47, 0.73; P&lt;0.01). Patients treated with HER2-targeted therapy aged 75+ were more likely to be hospitalized (64.7% [65-69], 73.3% [70-74], 79.4% [75+]; P = 0.01) and to receive SNF (12.4%, 10.0%, 21.3%; P = 0.01), home health (31.2%, 35.6%, 51.9%; P&lt;0.01), and hospice care (5.3%, 4.4%, 15.6%; P&lt;0.01).

CONCLUSIONS: Patients receiving HER2-targeted therapy were more likely to be hospitalized than those not receiving HER2-targeted therapy, although with fewer mean PPPM hospital days. Outpatient and physician visits also were more frequent in the HER2-targeted therapy group. Among those receiving HER2-targeted therapy, resource use was higher among those diagnosed at later stages and advanced ages.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-10.

Abstract P3-07-07: Incidence and survival among breast cancer patients in the United States by race and stage diagnosis: an analysis of national registry data 2000–2009

BACKGROUND: This study evaluated incidence and survival among breast cancer (BC) patients in the United States during 2000–2009, by race and stage at diagnosis.

METHODS: The Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database was used for this analysis. SEER is an epidemiologic surveillance system consisting of population-based tumor registries designed to track cancer incidence and survival in the US. The registries routinely collect information on incident cancer cases in areas that represent approximately 25% of the US population. We evaluated age-adjusted (to the 2000 US standard population) incidence (number of cases per 100,000 population), and 1- and 5-year survival among newly diagnosed female breast cancer patients during 2000–2009, by cancer stage (localized, regional, distant and unknown/unstaged) and race (White, Black, Other [American Indians/Alaska Natives or Asians/Pacific Islanders]).

RESULTS: A total of 543,539 cases of female BC were reported to SEER during 2000–2009, with 452,047 cases among Whites (W), 54,310 cases among Blacks (B), and 37,182 among other races (O). The overall incidence was highest for Whites (130.2 per 100,000 population), followed by Blacks (120.1) and other races (59.6–93.2). Similarly, incidence of localized BC was highest among Whites (81.1), followed by Blacks (63.0) and other races (35.4–58.7). Blacks had the highest incidence of regional (43.6 vs. 18.8–40.1), distant (9.7 vs. 3.7–6.0), and unknown stage of BC (3.8 vs. 1.6–3.0) compared to Whites and other races. Incidence of localized BC decreased slightly for Whites (average annual change −0.4%) during 2000–2009; however it increased for all other groups (1.4–1.8%). Incidence of distant BC increased for all races (W: 1.0%, B: 2.3%, O: 3.1–3.8%). Blacks had the lowest one-year and five-year survival for localized, regional and distant BC.

Abstract P3-07-14: Initial treatment and survival among elderly breast cancer patients in the United States by estrogen receptor status and cancer stage at diagnosis: an analysis of national registry data 2000–2009

BACKGROUND: There are few recent studies of initial treatment and survival among elderly, newly diagnosed breast cancer (BC) patients by estrogen receptor (ER) status and cancer stage at diagnosis.

METHODS: The linked Surveillance and Epidemiology End Results-Medicare (SEER-Medicare) database was used for this analysis. SEER is an epidemiologic surveillance system consisting of population-based tumor registries designed to track cancer incidence and survival in geographically defined areas that represent approximately 25% of the US population. The SEER registry file (available through 2007) is linked to Medicare claims and enrollment data available through 2009. We identified female patients newly diagnosed with Stage I, II, III, or IV breast cancer in a SEER registry between January 2002 and December 2007. Study patients were required to be aged 66+ years with no prior history of any other (non-breast) cancer. Patients were followed from the date of breast cancer diagnosis through death or December 31, 2009. Patients were identified as ER+ (ER−) if the ER assay was reported to SEER as positive/elevated (negative/normal). Demographics, initial treatment (surgery or radiation within 4 months of diagnosis), and survival (proportion of patients who died during the study period, survival at 96 months and median survival) were evaluated by ER status and cancer stage. Kaplan-Meier (KM) survival curves were estimated by ER status and stage.

RESULTS: 70,845 female BC patients (59,243 ER+, and 11,602 ER−) were identified. Age at diagnosis was similar for ER+ and ER− patients (mean [SD]: 75–77 [7] years; median: 74–76 years) across all stages. More ER+ patients were White (86% vs. 80% for ER−), and diagnosed at Stage I (56% vs. 39%). Fewer ER+ than ER− patients were diagnosed at Stage II (32% vs. 39%), Stage III (8% vs. 15%) and Stage IV (4% vs. 7%). Most patients had surgery in the first 4 months following diagnosis (96% ER+; 94% ER−), with Stage IV patients least likely (41% ER+ vs. 47% ER−). ER+ patients were more likely to receive initial radiation than ER− patients (48% vs. 42%), with a similar trend by stage (Stage I: 54% vs. 50%; Stage II: 40% vs. 35%; Stage III: 46% vs. 44%; Stage IV: 30% vs. 29%). Fewer ER+ patients died during follow-up (23% vs. 36% of ER− patients). KM survival analyses suggest that survival rates were higher for ER+ than ER− patients for the entire study period, overall (survival at 96 months: 64% vs. 52%), and by stage (Stage I: 73% vs. 70%; Stage II: 60% vs. 50%; Stage III: 38% [median survival 72 months] vs. 27% [median survival 41 months]; Stage IV: 12% [median survival 23 months] vs. 8% [median survival 9 months]).

CONCLUSIONS: Among elderly patients diagnosed with BC, those with ER+ status were diagnosed at earlier stages and had better survival outcomes. Further study of treatment patterns and outcomes by ER status is warranted.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-07-14.

Abstract P3-07-06: Initial treatment and survival among elderly breast cancer patients with positive estrogen receptor status by progesterone receptor status and stage: an analysis of US national registry data 2000–2009

BACKGROUND: There are few recent studies of initial treatment and survival among elderly, newly diagnosed breast cancer (BC) patients with positive estrogen receptor (ER) status, by progesterone receptor (PR) status and cancer stage at diagnosis.

METHODS: The linked Surveillance and Epidemiology End Results-Medicare (SEER-Medicare) database was used for this analysis. SEER is an epidemiologic surveillance system consisting of population-based tumor registries designed to track cancer incidence and survival in geographically defined areas that represent approximately 25% of the US population. The SEER registry file (available through 2007) is linked to Medicare claims and enrollment data available through 2009. We identified female patients newly diagnosed with ER positive (ER assay reported to SEER as positive/elevated) Stage I, II, III, or IV breast cancer in a SEER registry between January 2002 and December 2007. Study patients were required to be aged 66+ years with no prior history of any other (non-breast) cancer. Patients were followed from the date of breast cancer diagnosis through death or December 31, 2009. PR status was collected in the breast cancer site-specific factor variable, with patients identified as PR+ (PR−) if the PR assay was reported to SEER as positive/elevated (negative/normal). Demographics, initial treatment (surgery or radiation within 4 months of diagnosis), and survival (proportion of patients who died during the study period, survival at 96 months and median survival) were evaluated, by PR status and cancer stage. Kaplan-Meier (KM) survival curves were estimated by PR status and stage.

RESULTS: 57,571 female ER+ BC patients (47,385 PR+, and 10,186 PR−) were identified. Age at diagnosis was similar for PR+ and PR- BC patients (mean [SD] 75–77 [7]; median 75–77 years) across all stages. Compared to PR- patients, those with PR+ status were more likely to be diagnosed at Stage I (56.6% vs. 50.7%), and slightly less likely to be diagnosed at other stages (Stage II: 31.7% PR+ vs. 33.2% PR−; Stage III: 7.7% vs. 10.4%; Stage IV: 4.0% vs. 5.7%). Most patients had surgery in the first 4 months following diagnosis (96% PR+; 94% PR−), with Stage IV patients least likely (42% for both PR+ and PR−). Similar proportions of PR+ and PR- patients received initial radiation (49% vs. 46%), with minor variation across stages. Overall, fewer PR+ patients died during the evaluation period (22% vs. 28% PR−). KM survival analyses suggest that survival rates were higher for PR+ than PR- patients overall (survival at 96 months: 64% vs. 59%), and, with the exception of Stage I (73% for both), by stage (Stage II: 61% vs. 55%; Stage III: 40% [median survival 76 months] vs. 31% [median 58 months]; Stage IV: 14% [median 25 months] vs. 9% [median 19 months]).

CONCLUSIONS: Among elderly, newly diagnosed ER+ BC patients, those with PR+ status were diagnosed at earlier stages and had better survival outcomes. Further studies of treatment patterns and outcomes in the ER+ BC population are warranted.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-07-06.

Lenalidomide, melphalan, prednisone and thalidomide (RMPT) for relapsed/refractory multiple myeloma

This multicenter, open-label, non-comparative phase II trial evaluated the safety and efficacy of salvage therapy with lenalidomide, melphalan, prednisone and thalidomide (RMPT) in patients with relapsed/refractory multiple myeloma (MM). Oral lenalidomide (10 mg/day) was administered on days 1-21, and oral melphalan (0.18 mg/kg) and oral prednisone (2 mg/kg) on days 1-4 of each 28-day cycle. Thalidomide was administered at 50 mg/day or 100 mg/day on days 1-28; six cycles were administered in total. Maintenance included lenalidomide 10 mg/day on days 1-21, until unacceptable adverse events or disease progression. Aspirin (100 mg/day) was given as thromboprophylaxis. A total of 44 patients with relapsed/refractory MM were enrolled and 75% achieved at least a partial response (PR), including 32% very good PR (VGPR) and 2% complete response (CR). The 1-year progression-free survival (PFS) was 51% and the 1-year overall survival (OS) from study entry was 72%. Grade 4 hematologic adverse events included neutropenia (18%), thrombocytopenia (7%) and anemia (2%). Grade 3 non-hematologic adverse events were infections (14%), neurological toxicity (4.5%) and fatigue (7%). No grade 3/4 thromboembolic events or peripheral neuropathy were reported. In conclusion, RMPT is an active salvage therapy with good efficacy and manageable side effects. This study represents the basis for larger phase III randomized trials.

Superior vena cava bypass

A case of superior vena cava obstruction due to carcinoma of unknown origin is reported. A superior vena cava bypass with polytetrafluoroethylene was performed by suturing the prosthesis to the left innominate vein and the right atrium, respectively. Long-term satisfactory results were achieved.