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

1580 General Poster Session (Board #6F), Sat, 1:15 PM-5:15 PM
Compliance of recommendations with French clinical practice in the management
of thromboembolism in patients with cancer: The CARMEN study.
Presenting Author: Marie-Antoinette Sevestre, Service de Medecine Vasculaire,
Amiens, France
Background: Long-term treatment with low-molecular-weight heparin (LMWH) is
recommended for treatment of venous thromboembolism (VTE) in cancer
patients. Few data are available on compliance in this population. Our study
measured whether the management of VTE in patients with cancer was
consistent with French recommendations. Methods: Compliance with recommendations
(CR�) was analysed according to malignancy and VTE from a 500patient
cross-sectional observational study run between May and October 2010.
CR� was defined as the compliance to initial 10-day treatment followed by
long-term LMWH for at least 3 months, avoiding LMWH in patients with renal
insufficiency (SRI). All inpatients with a diagnosis of cancer and VTE of less than
6 months were included in the study. Results: Of 500 patients included in 47
centers, 242 (49%) were male, 81 (18%) had local (T�), 83 (18%) had
loco-regional (N�) and 287 (64%) had metastatic malignancies. Malignancies
were gastro-intestinal (25%), gynaecologic (23%), pulmonary (21%), haematological
(14%), urologic (10%) or other (8%). Twelve patients had SRI. Overall,
treatment was CR� in 289/500 patients (58% [95% CI 53%-62%]). Out of 12
patients with SRI only 3 (25%) were treated long-term with vitamin K
antagonists (VKA), as usually recommended. Tumour site influenced CR�
(p�0.02). Treatment for haematological malignancy was poorly compliant with
recommendations (32%) while patients with lung malignancy had the best
compliance (68%). TNM stage and VTE location had no influence on treatment
compliance. Conclusions: In French practice, treatment of cancer-related VTE is
CR� in 58% of cases. TNM stage and VTE location do not influence compliance
which remains insufficient, especially in patients with haematological malignancy.
Characteristics N (%) CR� (%)*
Primary tumor Gastrointestinal 92 (18) 56
Gynaecologic 52 (10) 65
Haematological 67 (13) 37
Pancreas 32 (6) 50
Lung 106 (21) 68
Breast 63 (13) 57
Urologic 48 (10) 65
Other 40 (8) 72
TNM stage T� 81 (18) 63
N� 83 (18) 59
M� 287 (64) 61
VTE Pulmonary embolism 149 (30) 60
Deep vein thrombosis 315 (63) 61
Superficial thrombosis 16 (3) 25
Other 18 (4) NA
*Rate of compliance with recommendations.
1582 General Poster Session (Board #6H), Sat, 1:15 PM-5:15 PM
Age, race/ethnicity, and the ER/PR/HER2 subtypes in breast cancer.
Presenting Author: Carol Parise, Sutter Institute for Medical Research,
Sacramento, CA
Background: The association of age and ER/PR/HER2 subtype in African-
American (AA) and Hispanic women with breast cancer has been reported.
This study examines the association of age and subtype among 12
self-reported race/ethnicity categories. Methods: Using the California Cancer
Registry 2000-2010, we examined 136,175 cases of first primary
female invasive breast cancer. Race/ethnicity was stratified into 12
categories. The distribution of age and race/ethnicity among the 8
ER/PR/HER2 subtypes was examined. Age was stratified into �40, 40-69,
and 70� years. For each age strata, odds ratios (OR) and 95% confidence
intervals (CI) were computed to assess the association of race/ethnicity with
ER-/PR-/HER2�, ER-/PR-/HER2- (TN), and ER�/PR�/HER2� (TP) when
compared with the ER�/PR�/HER2- subtype. Results: The % of each race
was: White 66.8; AA 6.0; Hispanic 15.9; Pacific Islander (PI) 0.3;
Southeast Asian (SEA) 2.5; Indian Continent (IC) 0.7; American Indian;
0.2; Chinese 2.5; Japanese 1.2; Filipino 3.1; Korean 0.7; Hispanic/nonwhite
0.3. All AA women had increased ORs of the ER-/PR-/HER2�, TN
and TP. Hispanic women mimicked the AA population except for young
women with TP. Chinese (OR�0.53; 95%CI�0.37-0.76) Japanese
(OR�0.51; 95%CI�0.28-0.96), and Filipino (OR�0.45; 95%CI�0.31-
0.67) women �40 were less likely to have TN subtype. For women 40-69,
SEA, Chinese, Filipino, and Korean women had increased ORs for TP, and
ER-/PR-/HER2�. The Japanese had increased ORs for the TP (OR�1.23;
95%CI�1.00-1.49) but decreased odds for the TN (OR�0.72;
95%CI�0.57-0.90). IC women had increased odds for the TN (OR�1.38;
95%CI�1.10-1.72). Korean women 70� were more likely to have the TP
and ER-/PR-/HER2�. SEA had increased ORs for ER-/PR-/HER2� and TN,
IC only had increased ORs for TN (OR�2.03; 95%CI�1.26-3.27).
Chinese and Filipino women only had increased ORs for the ER-/PR-/
HER2�. Conclusions: AA and Hispanic women of all ages are at increased
risk of the TN, and ER-/PR-/HER2� subtypes. AA women of all ages and
Hispanic women over age 40 are at increased risk of the TP subtype. The
diversity of Asian women with regard to breast cancer necessitates
accurately defining this population.
Cancer Prevention/Epidemiology
105s
1581 General Poster Session (Board #6G), Sat, 1:15 PM-5:15 PM
Castration resistance and high-risk disease among nonmetastatic (M0)
prostate cancer (PC) patients on androgen deprivation therapy (ADT).
Presenting Author: Melissa Pirolli, SDI Health, Plymouth Meeting, PA
Background: Prostate-specific antigen (PSA) is a well-known PC biomarker.
In the M0 setting, rising PSAs despite ADT is an indication of the
development of castration-resistant prostate cancer (CRPC). In this disease
state, men are at risk for developing bone metastasis (BM), which is
associated with significant morbidity and may negatively affect survival.
Using real-world data, we explored PSA-based criteria to identify patients
who develop CRPC while on ADT and the subsets that may be at increased
risk of BM. Methods: We used the Oncology Services Comprehensive
Electronic Records (OSCER) database, which includes electronic medical
record (EMR) data on cancer patients from 328 urology and oncology
clinics in the US. Eligible patients were adult men with M0 PC with �1 PSA
recorded between 3/1/2010 and 2/28/2011 and currently receiving ADT
(gonadotropin-releasing hormone agonists or bilateral orchiectomy) for �6
months (mos). We defined CRPC as two sequential PSA rises while on ADT
and high risk for BM as any PSA �8 ng/mL or PSA doubling time (DT) �10
mos, as described by Smith MR et al, Lancet 2012. We explored subsets of
CRPC patients who may be at even higher risk of BM using PSA thresholds
(�8 ng/mL and �20 ng/mL) and DT (�4, 6, 8, and 10 mos). Results: Of
1,818 men with M0 PC receiving ADT �6 mos, 36% (N�646) met the
CRPC definition, of whom 80% (N�517) had PSA �8 ng/mL and/or PSA
DT �10 mos (high risk). PSA DT alone explained 63% (44% / 70%) to
93% (65% / 70%) of subgroup eligibility (Table), and emerged as a main
driver in defining increased risk of BM for CRPC subsets. Conclusions: In
this analysis of EMR data, over one-third of men with M0 PC on ADT met
criteria for CRPC, and most CRPC patients (80%) may be considered at
high risk for BM. Requiring �3 PSAs to define CRPC may be a limitation;
however, because PSAs are closely monitored in patients on ADT, these
definitions of CRPC and high risk may be useful in practice. These data
suggest that PSA DT may be a more clinically meaningful measure of
defining CRPC subsets than absolute PSA thresholds.
CRPC subsets PSA >8 ng/mL PSA >20 ng/mL No PSA threshold (PSA < 8 ng/mL)
DT