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