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

104s Cancer Prevention/Epidemiology
1575 General Poster Session (Board #6A), Sat, 1:15 PM-5:15 PM
Hepatitis B reactivation risk in patients with solid tumors receiving
single-agent capecitabine versus doxorubicin-based chemotherapy. Presenting
Author: Winnie Hui Yee Ling, National University Cancer Institute,
Singapore
Background: Reactivation of hepatitis B virus (HBV) in cancer patients on
chemotherapy is a challenge especially in Asia where HBV infection is
endemic. Risk of HBV reactivation differs according to cancer type,
chemotherapy regimen, and concomitant use of steroids. The United
States Centre for Disease Control and Prevention recommends universal
screening for chronic HBV infection for all patients before chemotherapy
although screening for low-risk chemotherapy regimens may not be cost
effective. Methods: We sought to assess and compare HBV reactivation risk
and effectiveness of prophylactic anti-viral therapy in preventing HBV
reactivation in patients receiving a ‘high-risk’ (doxorubicin-based) chemotherapy
regimen for which prophylactic anti-viral therapy for hepatitis B
carriers is generally accepted versus a ‘low-risk’ (single agent capecitabine)
chemotherapy regimen for solid tumours at a tertiary cancer centre. The
electronic medical records of eligible patients were reviewed between
January 2007 and December 2010. Results: A total of 708 patients were
identified, including 434 and 274 who received doxorubicin-based chemotherapy
and single agent capecitabine respectively. HBV screening rate was
42.6% (51% for doxorubicin-based chemotherapy, 30% for single agent
capecitabine, p�0.0001). 15/302 (5%) screened patients were found to
be hepatitis B carriers (6 on doxorubicin, 9 on capecitabine). Overall,
3/708 patients (0.4%) developed HBV reactivation (all from the unscreened
doxorubicin group, 3/214 (1.4%) compared to 0/192 (0%)
unscreened patients in the capecitabine group, p�0.0001). All 15
identified hepatitis B carriers received prophylactic anti-viral therapy (14
received lamuvidine, 1 had entacavir) and none had HBV reactivation.
Conclusions: Not all chemotherapy regimens are associated with risk of HBV
reactivation. Routine hepatitis B screening and prophylaxis for low-risk
chemotherapy regimens such as single agent capecitabine may add
morbidity and may not be cost effective.
1577 General Poster Session (Board #6C), Sat, 1:15 PM-5:15 PM
Assessing a prognostic model for predicting VTE occurrence in cancer
patients. Presenting Author: Deesha Sarma, Princeton University, Princeton,
NJ
Background: Venous thromboembolism (VTE) poses a significant health risk
to cancer patients and is one of the leading causes of death among this
population. The most effective way to prevent VTE and reduce its
prominence as a public health burden is by identifying high-risk patients
and administering prophylactic measures. In 2008, Khorana et al. developed
a model that classified patients by risk based on clinical factors.
Methods: We conducted a retrospective study to test this model’s efficacy,
on 150 patients with cancer receiving chemotherapy at an outpatient
oncology clinic between January 1 and August 1, 2011. We aggregated
data and assigned points based on the five factors in the Khorana model:
site of cancer with 2 points for very high-risk site and 1 point for high-risk
site, 1 point each for leukocyte counts more than 11 x 109 /L, platelet
counts greater than 350 X 109 /L, hemoglobin levels less than 100 g/L
and/or the use of erythropoiesis-stimulating agents, and BMI greater than
35 kg/m2 (Khorana et al., Blood 2008). Based on this scoring system,
patients with 0 points were grouped into the low-risk category, those with
1-2 points were considered intermediate-risk, and those with 3-4 points
were classified as high-risk. Results: As shown in the table, VTE incidence
for the low-risk group was 1.9%, intermediate-risk group was 3.9%, and
high-risk group was 9.1%. Conclusions: High-risk patients were about 4.5
times more likely to develop a VTE than low risk patients. These results
provide valuable insight in determining which patients might benefit from
prophylaxis and in motivating the design of prospective clinical trials that
assess the VTE predictive model in various ambulatory cancer settings.
Risk level
Number of
patients
Number of
patients with VTE
VTE incidence
(%)
Low risk (score�0) 52 1 1.9
Intermediate risk (score�1-2) 76 3 3.9
High risk (score�3�) 22 2 9.1
Total: 150 6 4
1576 General Poster Session (Board #6B), Sat, 1:15 PM-5:15 PM
Predictors of pediatric and adult fibrosarcoma survival: Analyses of the
Surveillance, Epidemiology, and End Results (SEER) program, 1973-
2008. Presenting Author: Simona Ognjanovic, Biothera, Eagan, MN
Background: Fibrosarcoma (FS) is the second most common group of soft
tissue sarcomas in children, however, most FS are diagnosed in adults. The
goal of this study was to compare clinical features and outcomes of children
and adults diagnosed with FS and identify predictors of survival. Methods:
We have analyzed data from 569 children (� 19 years) and 5,508 adults
(�19 years) diagnosed between 1973 and 2008 with FS (ICCC category
IXb) available in the SEER database. Survival estimates were determined
using survival time with end point death from any cause. Results: Comparison
of two diagnostic periods, 1973-1989 vs. 1990-2008 showed that
5-year survival rates have improved in adults (48.4% vs 60.9%, P�0.0001),
but not in children (72.3% vs. 73.9%, P�0.16). Children with FS had
significantly better outcome compared to adults (5-year survival rates were
73.4% � 2%, and 56.7% � 0.7%, respectively, P�0.0001). Sites with
survival rates higher than the median 5-year survival were grouped as
favorable (extremities, head and neck, and genitourinary site); trunk,
abdomen, and other sites were grouped as unfavorable. Cox proportional
hazard regression model identified diagnosis in childhood, fibromyxosarcoma
histologic subtype (ICD-O3 code 8811/3), favorable site, and
localized stage as positive predictors of survival. Compared to fibromyxosarcoma,
other histologic types had hazard ratio (HR) of 11.6 (95% CI�
1.6-83.2, P�0.01) in children, and HR of 1.8 (95%CI�1.5-2.1,
P�0.0001) in adults. Diagnosis at unfavorable site was associated with
HR�1.9 (95%CI�1.4-2.6) in children and HR�1.4 (95%CI�1.3-1.5) in
adults. Compared to localized, distant disease had HR�4.2 in children and
HR�5.1 in adults, both highly significant (P�0.0001). Conclusions:
Adults diagnosed with FS had worse survival than children. Predictors of
good outcome, including histiologic subtype, primary site, and stage, were
valid in both children and adults.
1579 General Poster Session (Board #6E), Sat, 1:15 PM-5:15 PM
Incidence of bone metastases among children with cancer in Denmark. Presenting
Author: Rohini Khorana Hernandez, Center for Observational Research,
Amgen Inc, Thousand Oaks, CA
Background: There are no published population-based studies on the incidence
of bone metastases (BM) among children with cancer. The current literature is
limited to small case series or case reports. Methods: We used the Danish Cancer
Registry (DCR) to identify children �18 years old diagnosed with cancer
between 1/1/1994 and 12/31/2009. Patients were followed from cancer
diagnosis to BM, emigration, death, or end of study (1/1/2011). DCR data were
linked to (1) Danish Civil Registration System to obtain information on death and
emigration, and (2) Danish National Registry of Patients to identify ICD-10
codes for BM. We estimated incidence rates (IRs) of BM and mortality rates
overall and stratified by gender, calendar year, age, and primary tumor type.
Results: During the study period, 2,652 children were identified with a first-time
diagnosis of cancer, of whom 35 (1.3%) developed BM (mean follow-up of 7.0
years). The IR of BM was 1.9 per 1,000 person-years (95% CI: 1.4 – 2.6); the
highest rates occurred in children aged 12 – 17 years and among those with
osteosarcoma (Table). Twenty-one (60%) children with BM died during followup,
yielding a mortality rate of 192 per 1,000 person-years (95% CI: 125 –
295). The median time from cancer diagnosis to BM was 221 days and from BM
to death was 283 days. Conclusions: This study represents the first comprehensive
examination of BM in children and reveals that BM is a rare event, with
median survival of less than one year from diagnosis.
IR of BM among children 0-17 years diagnosed with cancer in Denmark,
1994-2009.
Characteristic N
N
with BM
IR of BM
per 1,000 person-years
(95% CI)
Overall
Gender
Female
Male
Age at cancer diagnosis
0–27days
28 days – 23 months
2 – 11 years
12 – 17 years
Calendar year of cancer diagnosis
1994 – 1997
1998 – 2001
2002 – 2005
2006 – 2009
Tumor type
Leukemia
Lymphoma
Brain / other CNS tumors
Neuroblastoma
Nephroblastoma
Osteosarcoma
Other tumors
NA � Not Applicable.
2,652
1,163
1,489
38
392
1,314
908
642
649
691
670
827
156
378
20
115
154
1,002
35
14
21
0
1
18
16
3
13
8
11
1
0
1
1
1
12
19
1.9 (1.4 - 2.6)
1.7 (1.0 - 2.9)
2.0 (1.3 - 3.1)
NA
0.37 (0.05 - 2.6)
1.9 (1.2 - 3.1)
2.6 (1.6 - 4.2)
0.43 (0.14 - 1.3)
2.3 (1.3 - 4.0)
2.0 (1.0 - 4.0)
6.0 (3.3 - 11)
0.17 (0.02 - 1.2)
NA
0.45 (0.06 - 3.2)
8.7 (1.2 - 62)
1.0 (0.15 - 7.4)
14 (8.0 - 25)
2.4 (1.5 - 3.8)
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