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Annual Meeting Proceedings Part 1 - American Society of Clinical ...

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104s Cancer Prevention/Epidemiology<br />

1575 General Poster Session (Board #6A), Sat, 1:15 PM-5:15 PM<br />

Hepatitis B reactivation risk in patients with solid tumors receiving<br />

single-agent capecitabine versus doxorubicin-based chemotherapy. Presenting<br />

Author: Winnie Hui Yee Ling, National University Cancer Institute,<br />

Singapore<br />

Background: Reactivation <strong>of</strong> hepatitis B virus (HBV) in cancer patients on<br />

chemotherapy is a challenge especially in Asia where HBV infection is<br />

endemic. Risk <strong>of</strong> HBV reactivation differs according to cancer type,<br />

chemotherapy regimen, and concomitant use <strong>of</strong> steroids. The United<br />

States Centre for Disease Control and Prevention recommends universal<br />

screening for chronic HBV infection for all patients before chemotherapy<br />

although screening for low-risk chemotherapy regimens may not be cost<br />

effective. Methods: We sought to assess and compare HBV reactivation risk<br />

and effectiveness <strong>of</strong> prophylactic anti-viral therapy in preventing HBV<br />

reactivation in patients receiving a ‘high-risk’ (doxorubicin-based) chemotherapy<br />

regimen for which prophylactic anti-viral therapy for hepatitis B<br />

carriers is generally accepted versus a ‘low-risk’ (single agent capecitabine)<br />

chemotherapy regimen for solid tumours at a tertiary cancer centre. The<br />

electronic medical records <strong>of</strong> eligible patients were reviewed between<br />

January 2007 and December 2010. Results: A total <strong>of</strong> 708 patients were<br />

identified, including 434 and 274 who received doxorubicin-based chemotherapy<br />

and single agent capecitabine respectively. HBV screening rate was<br />

42.6% (51% for doxorubicin-based chemotherapy, 30% for single agent<br />

capecitabine, p�0.0001). 15/302 (5%) screened patients were found to<br />

be hepatitis B carriers (6 on doxorubicin, 9 on capecitabine). Overall,<br />

3/708 patients (0.4%) developed HBV reactivation (all from the unscreened<br />

doxorubicin group, 3/214 (1.4%) compared to 0/192 (0%)<br />

unscreened patients in the capecitabine group, p�0.0001). All 15<br />

identified hepatitis B carriers received prophylactic anti-viral therapy (14<br />

received lamuvidine, 1 had entacavir) and none had HBV reactivation.<br />

Conclusions: Not all chemotherapy regimens are associated with risk <strong>of</strong> HBV<br />

reactivation. Routine hepatitis B screening and prophylaxis for low-risk<br />

chemotherapy regimens such as single agent capecitabine may add<br />

morbidity and may not be cost effective.<br />

1577 General Poster Session (Board #6C), Sat, 1:15 PM-5:15 PM<br />

Assessing a prognostic model for predicting VTE occurrence in cancer<br />

patients. Presenting Author: Deesha Sarma, Princeton University, Princeton,<br />

NJ<br />

Background: Venous thromboembolism (VTE) poses a significant health risk<br />

to cancer patients and is one <strong>of</strong> the leading causes <strong>of</strong> death among this<br />

population. The most effective way to prevent VTE and reduce its<br />

prominence as a public health burden is by identifying high-risk patients<br />

and administering prophylactic measures. In 2008, Khorana et al. developed<br />

a model that classified patients by risk based on clinical factors.<br />

Methods: We conducted a retrospective study to test this model’s efficacy,<br />

on 150 patients with cancer receiving chemotherapy at an outpatient<br />

oncology clinic between January 1 and August 1, 2011. We aggregated<br />

data and assigned points based on the five factors in the Khorana model:<br />

site <strong>of</strong> cancer with 2 points for very high-risk site and 1 point for high-risk<br />

site, 1 point each for leukocyte counts more than 11 x 109 /L, platelet<br />

counts greater than 350 X 109 /L, hemoglobin levels less than 100 g/L<br />

and/or the use <strong>of</strong> erythropoiesis-stimulating agents, and BMI greater than<br />

35 kg/m2 (Khorana et al., Blood 2008). Based on this scoring system,<br />

patients with 0 points were grouped into the low-risk category, those with<br />

1-2 points were considered intermediate-risk, and those with 3-4 points<br />

were classified as high-risk. Results: As shown in the table, VTE incidence<br />

for the low-risk group was 1.9%, intermediate-risk group was 3.9%, and<br />

high-risk group was 9.1%. Conclusions: High-risk patients were about 4.5<br />

times more likely to develop a VTE than low risk patients. These results<br />

provide valuable insight in determining which patients might benefit from<br />

prophylaxis and in motivating the design <strong>of</strong> prospective clinical trials that<br />

assess the VTE predictive model in various ambulatory cancer settings.<br />

Risk level<br />

Number <strong>of</strong><br />

patients<br />

Number <strong>of</strong><br />

patients with VTE<br />

VTE incidence<br />

(%)<br />

Low risk (score�0) 52 1 1.9<br />

Intermediate risk (score�1-2) 76 3 3.9<br />

High risk (score�3�) 22 2 9.1<br />

Total: 150 6 4<br />

1576 General Poster Session (Board #6B), Sat, 1:15 PM-5:15 PM<br />

Predictors <strong>of</strong> pediatric and adult fibrosarcoma survival: Analyses <strong>of</strong> the<br />

Surveillance, Epidemiology, and End Results (SEER) program, 1973-<br />

2008. Presenting Author: Simona Ognjanovic, Biothera, Eagan, MN<br />

Background: Fibrosarcoma (FS) is the second most common group <strong>of</strong> s<strong>of</strong>t<br />

tissue sarcomas in children, however, most FS are diagnosed in adults. The<br />

goal <strong>of</strong> this study was to compare clinical features and outcomes <strong>of</strong> children<br />

and adults diagnosed with FS and identify predictors <strong>of</strong> survival. Methods:<br />

We have analyzed data from 569 children (� 19 years) and 5,508 adults<br />

(�19 years) diagnosed between 1973 and 2008 with FS (ICCC category<br />

IXb) available in the SEER database. Survival estimates were determined<br />

using survival time with end point death from any cause. Results: Comparison<br />

<strong>of</strong> two diagnostic periods, 1973-1989 vs. 1990-2008 showed that<br />

5-year survival rates have improved in adults (48.4% vs 60.9%, P�0.0001),<br />

but not in children (72.3% vs. 73.9%, P�0.16). Children with FS had<br />

significantly better outcome compared to adults (5-year survival rates were<br />

73.4% � 2%, and 56.7% � 0.7%, respectively, P�0.0001). Sites with<br />

survival rates higher than the median 5-year survival were grouped as<br />

favorable (extremities, head and neck, and genitourinary site); trunk,<br />

abdomen, and other sites were grouped as unfavorable. Cox proportional<br />

hazard regression model identified diagnosis in childhood, fibromyxosarcoma<br />

histologic subtype (ICD-O3 code 8811/3), favorable site, and<br />

localized stage as positive predictors <strong>of</strong> survival. Compared to fibromyxosarcoma,<br />

other histologic types had hazard ratio (HR) <strong>of</strong> 11.6 (95% CI�<br />

1.6-83.2, P�0.01) in children, and HR <strong>of</strong> 1.8 (95%CI�1.5-2.1,<br />

P�0.0001) in adults. Diagnosis at unfavorable site was associated with<br />

HR�1.9 (95%CI�1.4-2.6) in children and HR�1.4 (95%CI�1.3-1.5) in<br />

adults. Compared to localized, distant disease had HR�4.2 in children and<br />

HR�5.1 in adults, both highly significant (P�0.0001). Conclusions:<br />

Adults diagnosed with FS had worse survival than children. Predictors <strong>of</strong><br />

good outcome, including histiologic subtype, primary site, and stage, were<br />

valid in both children and adults.<br />

1579 General Poster Session (Board #6E), Sat, 1:15 PM-5:15 PM<br />

Incidence <strong>of</strong> bone metastases among children with cancer in Denmark. Presenting<br />

Author: Rohini Khorana Hernandez, Center for Observational Research,<br />

Amgen Inc, Thousand Oaks, CA<br />

Background: There are no published population-based studies on the incidence<br />

<strong>of</strong> bone metastases (BM) among children with cancer. The current literature is<br />

limited to small case series or case reports. Methods: We used the Danish Cancer<br />

Registry (DCR) to identify children �18 years old diagnosed with cancer<br />

between 1/1/1994 and 12/31/2009. Patients were followed from cancer<br />

diagnosis to BM, emigration, death, or end <strong>of</strong> study (1/1/2011). DCR data were<br />

linked to (1) Danish Civil Registration System to obtain information on death and<br />

emigration, and (2) Danish National Registry <strong>of</strong> Patients to identify ICD-10<br />

codes for BM. We estimated incidence rates (IRs) <strong>of</strong> BM and mortality rates<br />

overall and stratified by gender, calendar year, age, and primary tumor type.<br />

Results: During the study period, 2,652 children were identified with a first-time<br />

diagnosis <strong>of</strong> cancer, <strong>of</strong> whom 35 (1.3%) developed BM (mean follow-up <strong>of</strong> 7.0<br />

years). The IR <strong>of</strong> BM was 1.9 per 1,000 person-years (95% CI: 1.4 – 2.6); the<br />

highest rates occurred in children aged 12 – 17 years and among those with<br />

osteosarcoma (Table). Twenty-one (60%) children with BM died during followup,<br />

yielding a mortality rate <strong>of</strong> 192 per 1,000 person-years (95% CI: 125 –<br />

295). The median time from cancer diagnosis to BM was 221 days and from BM<br />

to death was 283 days. Conclusions: This study represents the first comprehensive<br />

examination <strong>of</strong> BM in children and reveals that BM is a rare event, with<br />

median survival <strong>of</strong> less than one year from diagnosis.<br />

IR <strong>of</strong> BM among children 0-17 years diagnosed with cancer in Denmark,<br />

1994-2009.<br />

Characteristic N<br />

N<br />

with BM<br />

IR <strong>of</strong> BM<br />

per 1,000 person-years<br />

(95% CI)<br />

Overall<br />

Gender<br />

Female<br />

Male<br />

Age at cancer diagnosis<br />

0–27days<br />

28 days – 23 months<br />

2 – 11 years<br />

12 – 17 years<br />

Calendar year <strong>of</strong> cancer diagnosis<br />

1994 – 1997<br />

1998 – 2001<br />

2002 – 2005<br />

2006 – 2009<br />

Tumor type<br />

Leukemia<br />

Lymphoma<br />

Brain / other CNS tumors<br />

Neuroblastoma<br />

Nephroblastoma<br />

Osteosarcoma<br />

Other tumors<br />

NA � Not Applicable.<br />

2,652<br />

1,163<br />

1,489<br />

38<br />

392<br />

1,314<br />

908<br />

642<br />

649<br />

691<br />

670<br />

827<br />

156<br />

378<br />

20<br />

115<br />

154<br />

1,002<br />

35<br />

14<br />

21<br />

0<br />

1<br />

18<br />

16<br />

3<br />

13<br />

8<br />

11<br />

1<br />

0<br />

1<br />

1<br />

1<br />

12<br />

19<br />

1.9 (1.4 - 2.6)<br />

1.7 (1.0 - 2.9)<br />

2.0 (1.3 - 3.1)<br />

NA<br />

0.37 (0.05 - 2.6)<br />

1.9 (1.2 - 3.1)<br />

2.6 (1.6 - 4.2)<br />

0.43 (0.14 - 1.3)<br />

2.3 (1.3 - 4.0)<br />

2.0 (1.0 - 4.0)<br />

6.0 (3.3 - 11)<br />

0.17 (0.02 - 1.2)<br />

NA<br />

0.45 (0.06 - 3.2)<br />

8.7 (1.2 - 62)<br />

1.0 (0.15 - 7.4)<br />

14 (8.0 - 25)<br />

2.4 (1.5 - 3.8)<br />

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