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

24s Breast Cancer—HER2/ER
569 General Poster Session (Board #5D), Sat, 8:00 AM-12:00 PM
Evaluation of Oncotype DX testing and subsequent patterns of care in
patients (pts) with early-stage breast cancer (ESBC). Presenting Author:
Meghan Fitzgerald, Cardinal Health, Specialty Solutions, Dublin, OH
Background: Cardinal Health Specialty Solutions (CHSS) partners with
payers to manage clinical care pathways in oncology and rheumatology.
Observations from one such pathway with CareFirst BlueCross BlueShield
revealed that pts with estrogen receptor-positive ESBC who underwent
Oncotype DX testing and were found to have high-risk Recurrence Scores
(RS) received less chemotherapy than expected. To better understand
physician behavior as it relates to Oncotype DX testing, CHSS examined
patterns of Oncotype DX use in a large private practice oncology group with
a robust electronic medical record (EMR), Georgia Cancer Specialists
(GCS). We aimed to determine the RS risk distribution among pts who
received Oncotype DX testing and assess the patterns of care that followed.
Methods: Using GCS EMR data from 2009 to 2011, the number of pts who
were eligible to undergo Oncotype DX testing was compared to the number
of pts who underwent testing. Pts were considered eligible for testing if they
had node-negative, estrogen receptor-positive, HER2-negative ESBC. We
determined the number of pts with a RS value in the low- (RS �18),
intermediate- (RS 18-30), and high-risk (RS �31) groups along with the
number of pts who subsequently received chemotherapy in each category.
Results: Of the 1908 patients identified with ESBC, 788 were eligible for
Oncotype DX testing and 288 (37%) underwent testing. Fifty percent of pts
were in the low-, 34% in intermediate-, and 16% in the high-risk groups.
Six percent of low-, 41% of intermediate-, and 83% of high-risk pts
received chemotherapy. Seventeen percent of pts in the high-risk group did
not receive chemotherapy. Conclusions: The use of chemotherapy in the
low- and intermediate-risk groups was as expected based on adjuvant
chemotherapy guidelines; however, an under utilization of chemotherapy
was found in high-risk pts. There also appears to be a noteworthy underuse
of Oncotype DX testing in eligible pts. Further data analysis is needed to
understand the low use of Oncotype DX testing in eligible pts and to explain
the lower than expected use of chemotherapy in high-risk pts.
571 General Poster Session (Board #5F), Sat, 8:00 AM-12:00 PM
Evaluation of variables that may impact chemotherapy (CT) administration
after determination of Oncotype DX (ODX) recurrence score (RS). Presenting
Author: Kristina E. Bowen, Georgia Cancer Specialists PC, Atlanta, GA
Background: Cardinal Health Specialty Solutions (CHSS) partners with
payers to manage clinical care pathways in oncology and rheumatology.
Observations from one such pathway with CareFirst BlueCross Blue Shield
revealed lower than expected use of CT in patients (pts) with estrogen
receptor-positive early-stage breast cancer (ESBC) at high-risk for recurrence
by ODX RS. To better understand physician behavior, CHSS examined
patterns of care in a large private practice oncology group with a robust
EMR, Georgia Cancer Specialists (GCS). Pt characteristics and physicianprescribing
patterns were analyzed to determine variables that most
impacted the physician’s decision to treat high-risk pts with CT. Methods:
Using the GCS EMR from 2009 to 2011, we retrospectively identified pts
with ESBC (stage I-II, node-negative, estrogen receptor-positive, HER2negative)
who underwent ODX testing. We determined the number of pts
with a RS value in the low- (RS �18), intermediate- (RS 18-30), and
high-risk (RS �31) groups along with the number of pts who subsequently
received CT in each category. The use of CT in high-risk pts was analyzed by
pt age, tumor size, tumor grade, and physician prescribing patterns.
Results: Of the 1908 pts identified with ESBC, 788 were eligible for ODX
testing and 288 (37%) underwent testing. Fifty percent of pts were in the
low-, 34% in intermediate-, and 16% in the high-risk groups. Six percent of
low-, 41% of intermediate-, and 83% of high-risk pts received CT. In
high-risk pts analyzed by age, CT was used in 100% of pts � 45 years (y),
86% in pts 46-55 y, 86% in pts 56-65 y, and 25% in pts �66 y. CT use in
high-risk pts was 82% and 86% in pts with tumor sizes �2 cm and 2-5 cm,
respectively; and, 100%, 60%, and 91% in pts with grade 1, 2, or 3
tumors, respectively. Of the 41 physicians who were evaluated, 10 (24%)
used ODX �15% of the time, 13 (32%) used ODX 15-40%, 10 used (24%)
used ODX 41-60%, and 8 (20%) used ODX � 60% of the time. There were
no significant differences in patterns of CT use. Conclusions: The less than
expected use of CT in high-risk patients appears to be related to physician
preference and pt age. Tumor size and grade did not appear to influence
choice of therapy.
570 General Poster Session (Board #5E), Sat, 8:00 AM-12:00 PM
Treatment pattern by hormone receptors and HER2 status in patients with
metastatic breast cancer in the United Kingdom, Germany, France, Spain,
and Italy (EU-5): Results from a physician survey. Presenting Author: Mitch
DeKoven, IMS Health, Alexandria, VA
Background: The differences in country-specific treatment patterns across
Europe for Stage IV metastatic breast cancer (mBC) patients have not been
extensively studied. This study compared treatment choices, by biomarker
status, between various lines of therapy (LOT) in clinical practice in the
EU-5 countries among newly diagnosed stage IV mBC patients. Methods:
The IMS LifeLink Oncology Analyzer (OA) database, based upon practicing
oncologist surveys, was used to identify mBC patients aged �21 and
surveyed between July 2008 – June 2010. The database encompasses over
100,000 unique patients per year, treated by nearly 3,000 physicians,
including nearly 60,000 patients and 800 physicians in the EU5. Results:
A total of 152,311 mBC patients were included in the study. In Italy,
30.8% of HER2�/HR� patients received chemotherapy following mBC
diagnosis, as compared to only 8.6% in France. The majority of these
patients in France received chemotherapy plus a HER2 targeted therapy
(58.2%) as their first treatment. For HER2�/ HR- patients, chemotherapy
plus a HER2 targeted therapy was provided to the majority of the patients in
France (70.8%), with the UK providing this regimen to the fewest patients
with this biomarker status (44.9%). Monotherapy hormonal regimens were
given as a first LOT for HER2-/HR� patients (UK 64.7%, Spain 52.8%).
Triple negative patients received chemotherapy (UK 84.1% as compared to
France 57.3%) or chemotherapy plus bevacizumab (France 36.6% as
compared to UK 0.9%) as a first treatment. Conclusions: Thisstudy
confirmed that chemotherapy combined with HER2-targeted therapy was
the most frequent initial treatment option for HER2� patients, while the
vast majority of ER/PR� patients were initially treated by hormonal
therapy, suggesting that a personalized medicine approach has been
accepted in the EU-5. However, the use of HER2-targeted therapy and
bevacizumab greatly varied; while they were most frequently used in
France, they were least frequently opted for in the UK. Also, fewer
treatment options existed for triple negative patients and patients with
HER2� disease following trastuzumab treatment.
572 General Poster Session (Board #5G), Sat, 8:00 AM-12:00 PM
Synchronous bilateral breast cancer (SBBC): Concordance of receptor
status between right and left breast. Presenting Author: Palak Desai, Rush
University Medical Center, Chicago, IL
Background: This analysis was prompted by a patient who presented with
SBBC who had and ER�, HER2- cancer in one breast and an ER-, HER2�
cancer in the other. Since both breasts have the same genetic background
and environmental exposures, concordance should be virtually identical
unless other factors are at play. Methods: SBBC was defined as bilateral
cancer diagnosed concurrently or within 6 months of each other. Cases
were identified retrospectively from patients seen at Rush University
Medical Center. This analysis was limited to invasive SBCC (ISBBC).
Estrogen receptor (ER) and Her2/neu (HER2) status were assessed according
current ASCO/CAP guidelines. Correlation between ER and HER2
status was determined using � statistic. Results: From January 1998 to
December 2012, 33 cases of ISBBC were diagnosed. In 65% of cases
synchronous disease was diagnosed concurrently. The average age at
diagnosis was 56. The majority were multiparous and 79% post menopausal.
About half of the patients (55%) had at least one first degree
relative with a history of breast or ovarian cancer and 9% of the cohort had a
deleterious mutation in BRCA1 or BRCA2. Infiltrating ductal was most
common (74%) followed by infiltrating lobular (21%). 53% of breasts
specimens also contained ductal carcinoma in situ. 68% of tumors were ER
positive and 8% were HER2 positive. Concordance in ER status was seen in
73% of cases (kappa coefficient 0.14) and in HER2 status was 64%
(Kappa coefficient 0.35). Conclusions: Despite identical hereditary and
environmental exposure, some patients develop ISBBC cancers with
discordant receptor status. While this is the exception, it suggests that
other factors influence important tumor characteristics.
R breast � (n) R breast – (n) Total
ER status
L breast � 22 4 26
L breast - 5 2 7
Total 27 6 33
HER2 status
L breast � 1 2 3
L breast - 1 28 29
Total 2 30 32
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