Download the ESMO 2012 Abstract Book - Oxford Journals

Annals of Oncology
dexamethasone in the prevention and treatment of malignant bowel obstruction has
been initiated.
Conclusion: Overall survival in patients with malignant bowel obstruction is poor
with no significant improvement over the last decade. Bowel obstruction in patients
with chemonaïve disease represents an aggressive phenotype with poor prognosis.
Judicious selection of patients for surgery and/or chemotherapy can significantly
increase survival.1. ESMO Congress 2010, Milan. Poster 987P.
Disclosure: All authors have declared no conflicts of interest.
993P FROM A WEBSITE TO A NATIONAL AND REGIONAL
REFERENCE CENTRE NETWORK: THE FRENCH EXPERIENCE
FOR RARE OVARIAN TUMORS
I. Ray-Coquard 1 , P. Pautier 2 , J. Alexandre 3 , M. Vacher-Lavenu 4 , M. Fabbro 5 ,
A. Floquet 6 , F. Selle 7 , G. Ferron 8 , N. Chiannilkulchai 9 , E. Pujade-Lauraine 3
1 Oncology, Centre Leon Berard, Lyon, FRANCE, 2 Medical Oncology, Institut de
Cancerologie Gustave Roussy, Villejuif, FRANCE, 3 Oncologie Médicale, Hôpital
Hôtel Dieu, Paris, FRANCE, 4 Service D’anatomie et Cytologie Pathologiques,
Hôpital Cochin, Paris, FRANCE, 5 Médecine B2, CRLC Val d’Aurelle, Montpellier,
FRANCE, 6 Oncologie, Institut Bergonié, Bordeaux, FRANCE, 7 Medical Oncology,
Hôpital Tenon, Paris, FRANCE, 8 Médecine - Oncologie, Institut Claudius
Regaud, Toulouse, FRANCE, 9 Hôpital Hôtel Dieu, Arcagy, Paris, FRANCE
Background: Rare ovarian tumors (ROT) represent more than 20% of all ovarian
cancers. Difficulties in histological diagnosis, absence of prognostic factors, evidence is
not available for medical decision. In 2002, the GINECO group organized a dedicated
website for sex cords (SCT) and germ cell (GCT) management. At the end of 2010,
supported by the French NCI, a national network for all ROT was organized with 3
national and 21 regional expert centers (REC). The objectives are to monitor the
management of ROT and give equal access to expertise (systematic second opinion for
histological diagnosis) and innovative treatments to all patients with ROT.
Methods: The expected incidence of ROT in France is near 1000 new cases per year,
including mostly SCT, GCT, mucinous (MC), clear cell (CCC), carcinosarcoma (CS),
small cell carcinoma and borderline with invasive implants (BLT). A website collecting
all files discussed in the REC was generated (www.ovaire-rare.org). The prospective
collection of clinical data, dedicated multidisciplinary staff decision (MS), central
pathological review and patient follow-up were implemented in the national database.
Results: In 2011, 712 patients benefited of second opinion & were included by expert
pathologists, representing 71% of expected incident cases. Major discordances
concern 8% of patients. 294 patients gave informed consent & were included in the
database before initial treatment in 229, (78 % of cases) or at the time of the first
relapse in 65 (22%) : 85 (29 %) had SCT, 57 GCT, 61 BLT, 26 MC, 20 CCC, 45
other. 280 (96%) patients cases were discussed in dedicated MS. 18 patients entered a
clinical trial. Virtual tumor banking is on going to develop molecular diagnosis (as
FOXL2 for SCT).
Conclusion: This web-based tool supported by a national network including national
and regional expert centers seems to be an efficient tool for the organisation of the
management of rare ovarian cancer. The present project is under consideration for
an EU project in 5 other countries interesting to duplicate such organisation.
Disclosure: All authors have declared no conflicts of interest.
994P MALIGNANT OVARIAN GERM CELL TUMORS (MOGCT) AT A
TERTIARY CARE SETTING IN PAKISTAN
A. Hannan 1 , N. Siddiqui 2 , F. Badar 2
1 Mediacal Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore,
PAKISTAN, 2 Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and
Reserch Centre (SKM), Lahore, PAKISTAN
Introduction: Malignant ovarian germ cell tumors (MOGCT) are rare neoplasms.
Little is known about their behavior in the South East Asian populations. Aim of our
study was to evaluate MOGCT patients treated at Shaukat Khanum Memorial Cancer
Hospital and Research Centre, Lahore, Pakistan.
Patients and methods: Of 638 females identified with ovarian cancer at our hospital
from 1994 to 2007, 66 presenting with MOGCT were reviewed retrospectively.
Histology was based on WHO classification. Tumors were staged according to FIGO
system. Data was collected on presenting age, histopathology, stage, alpha-feto
protein (AFP), B-human chorionic gonadotropins (B-hCG) levels, treatment, time to
recurrence (TTR) and overall survival (OS). OS was the interval between the dates of
diagnosis and last visit / death and TTR was between the dates of diagnosis and first
recurrence. OS was determined by the Kaplan Meier method. Seven patients were
not included in survival analysis as they were lost to follow up.
Results: Mean presenting age: 18.1 years (6-45). Stage wise distribution (n): Stage 1
(19), II (8), III (21), IV (18). Histology (n): Dysgerminoma (22), malignant teratoma
(16), yolk sac tumor (15), Mixed germ cell (12) and embryonic carcinoma in 1
patient only. AFP levels (n): elevated (29), normal (25) while unknown in 12
patients. B-hCG levels (n): elevated n = 15, normal n = 42 and unknown in 9. Median
follow up time was 48 months (0.2-183). All patients underwent initial surgery, with
20 patients undergoing second look surgeries. Fertility sparing procedures were
performed in 57 % of patients. Thirty four patients (57 %) achieved a complete
remission at the end of treatment; while 18 (27.2%) patients did not show a response
to any chemotherapy and had progressive disease. Seven patients relapsed, all within
the first 3 years. The TTR was 11.2-32.5 months. Cumulative overall survival: 60
months. 16 (88 %) of stage 1 patients while only 4 (26.6 %) of stage IV patients were
alive at median follow up.
Conclusions: The prognosis of MOGCT appears to be good and results are similar
to what has been seen in the west. Fertility sparing surgery was possible in majority
of cases and its feasibility should be explored in this young population of patients.
Disclosure: All authors have declared no conflicts of interest.
995P DOES PACLITAXEL PLUS CARBOPLATIN (TC) SUBSTITUTE
FOR PACLITAXEL PLUS CISPLATIN (TP) IN CERVICAL
CANCER WITHOUT PRIOR PLATINUM TREATMENT? (SUBSET
ANALYSIS OF JAPAN CLINICAL ONCOLOGY GROUP TRIAL
(JCOG 0505))
H. Tanabe 1 , R. Kitagawa 2 , T. Shibata 3 , M. Saito 1 , S. Takakura 1 , A. Okamoto 1 ,
H. Sasaki 1 , K. Ochiai 1 , H. Yoshikawa 4 , T. Kamura 5
1 Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, JAPAN,
2 Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, JAPAN,
3 Regulatory Science Section Multi-institutional Clinical Trial Support Center,
National Cancer Center Hospital, Tokyo, JAPAN, 4 Obstetrics and Gynecology,
Tsukuba University, Ibaraki, JAPAN, 5 Obstetrics and Gynecology, Kurume
University School of Medicine, Kurume, JAPAN
Objective: TP is the standard regimen for advanced or recurrent cervical cancer.
However, JCOG0505 presented statistically significant non-inferiority of TC to TP in
terms of overall survival (OS), for stage IVB or recurrent cervical cancer in ASCO ‘12
annual meeting. By subset analyses of JCOG0505, we investigated whether the
treatment effect of TP or TC is different among some specific subgroups including
the one by prior platinum status.
Methods: Patients (Pts) with stage IVB or recurrent cervical cancer; not amenable to
curative therapy; 0-1 prior platinum; no prior taxanes; were randomized with
minimization method to either TP (T 135 mg/m 2 24h d1 + P 50 mg/m 2 2h d2) or TC
(T 175 mg/m 2 3h d1 + C AUC5 1h d1), both for maximum 6 cycles every 21 days.
We estimated the hazard ratios and 95% confidence intervals in OS among
subgroups (including prior platinum status) for the eligible patients, comparing TC
and TP. Each hazard ratio (HR) was estimated by an unstratified Cox regression.
Results: Total 253 pts were enrolled. Median follow-up of all randomized patients is
17.4 months (mo). As was reported before, it was demonstrated that TC was not
inferior to TP for OS (17.5 mo in TC and 18.3 mo in TP, HR 0.99 (non-inferiority
p = 0.032 with a non-inferiority margin 1.29)). Both arms were comparable with
respect to toxicity except for grade 4 neutropenia (45% in TC vs. 75% in TP). In a
subset analysis (n = 244), TP was superior to TC for OS in non-prior platinum group
(n = 117) (13.0 mo in TC and 23.2 mo in TP, HR 1.57 (95% CI:1.06-2.32)). Contrary,
TC tended to show better survival than TP for OS in prior platinum group (n = 127)
(19.0 mo in TC and 16.3 mo in TP, HR 0.69 (95% CI:0.47-1.02)). Furthermore, TP
tended to be superior to TC for OS in stage IVB (n = 51) (14.8 mo in TC and 25.4
mo in TP, HR 1.50 (95% CI:0.84-2.67)).
Conclusion: Non-inferiority of TC to TP was demonstrated in the whole population
of JCOG0505. By the subset analyses, however, TP may be still the first choice for
patients without prior cisplatin-based treatment such as those with primary stage
IVB cervical cancer.
Disclosure: All authors have declared no conflicts of interest.
996P SHORTER SURVIVAL IN CERVICAL CANCER ASSOCIATION
WITH HIGH EXPRESSION OF NOTCH-1
N.G. Yousif 1 , J. Kamiran 2 , M.G. Yousif 3 , S. Anderson 2 , J. Albaghdadi 2
1 Department of Medicine and Surgery, Box C-320, University of Colorado
Cancer Center Anschutz Cancer Pavilion, Aurora, CO, UNITED STATES OF
AMERICA, 2 Surgery, Colorado University, Aurora, CO, UNITED STATES OF
AMERICA, 3 Biology, Al-Qadysia, IRAQ
Background: Notch1 signaling has been shown to play a key role in carcinogenesis
and progression of various human malignancies. Recent studies have implicated
aberrant Notch signaling in cervical cancers. But, relatively little is known about the
relation between expression of the Notch1 and survival rate in cervical cancer. In this
study, we investigated the expression of Notch1 in cervical cancer to determine
whether they could serve as prognostic predictors.
Materials and methods: The expression of Notch1 was detected in 81 cases of
cervical cancer; immunohistochemistry and Western blot were used to assay the
expression level of Notch1. The predictive value of this expression for prognosis was
investigated by Kaplan-Meier curves in a multivariate model.
Results: Notch1 factor were intensively stained in cervical cancer
immunohistochemically and expression was significantly increased with age and not
Volume 23 | Supplement 9 | September 2012 doi:10.1093/annonc/mds401 | ix327