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

5098 General Poster Session (Board #25B), Sun, 8:00 AM-12:00 PM
Clinicopathologic characteristics of endometrial cancer in Lynch syndrome.
Presenting Author: Fabrice Lecuru, European Hospital George
Pompidou, Paris, France
Background: Poor data exist on clinico-pathological description of endometrial
cancer (EC) in Lynch syndrome (LS) compared with sporadic ones. To
evaluate the clinico-pathological findings of Lynch-related EC to establish
histological criteria to discriminate familial and sporadic EC and to decide
the optimal management of patients. Methods: Retrospective study of
prospective cohort of patients with LS in our institution from 1999 to
2011. We identified and described all cases of endometrial cancers.
Management and follow-up were detailed. Results: Of a cohort of 126
patients with LS, 10 women developed endometrial carcinoma. The
median age at diagnosis was 51 years (41-58). Five patients had an
identified mutation (2 hMLH1, 2 hMSH2 and 1 hMSH6). In 9 cases, EC
was the first Lynch-related tumor to occur. No patient developed ovarian
cancer. All, except 2 patients (1 serous carcinoma and 1 clear cell
carcinoma), had endometrioid adenocarcinoma (80%). Tumor grade was
grade 1 in 3 patients, grade 2 in 5 and grade 3 in 2 patients. Forty per cent
of patients had lymphovascular space involvement (LVSI). The FIGO stages
were as follows: stage IA (n�7), stage IB (n�2) and stage IIIC (n�1). Four
in ten patients had tumor located in the lower uterine segment. With a
median follow-up of 14 months (range9–40months), recurrence occurred
in one patient with a stage IB grade 2 endometrioid adenocarcinoma with
LVSI. Conclusions: EC in LS is characterized by early age at onset,
localization in lower uterine segment, and high rate of LVSI. Other data on
histology and survival do not differ from sporadic cancers. These results
suggest that we can consider conservative treatment in patients with good
prognosis tumors. Further studies are required.
5100 General Poster Session (Board #26A), Sun, 8:00 AM-12:00 PM
The effects of age on treatment and outcomes in women with stage IB-IIB
cervical cancer. Presenting Author: Dario R. Roque, Women and Infants
Hospital, Providence, RI
Background: Advanced age may affect the treatment choice and subsequent
outcome in elderly patients with cervical cancer. Given the potential
for cure with either surgery or chemoradiation in early stage disease, we
aimed to determine whether a patient’s age influenced the treatment
received and the outcome. Methods: Our retrospective cohort identified a
total of 303 patients diagnosed with Stage IB1 through IIB cervical
carcinoma who were treated at our institution between 2000 and 2010.
The eligible patients were divided into two groups based on age at the time
of diagnosis: �65 and � 65 years. Adjusted odd ratios were calculated to
determine variables associated with treatment received (chemoradiation or
surgery). Single and multivariate Cox proportional hazards modeling were
used to estimate hazard ratios for variables associated with disease specific
survival. Results: Of the patients meeting inclusion criteria, 253 were �65
years and 50 were � 65 years. The distribution of tumor histology, stage
and grade was not different between the two groups. After adjusting for
histology, stage and a validated comorbidity score, the odds ratio of
receiving chemoradiation vs. surgery for the cohort � 65 years was 1.69
(OR 95% CI: 0.68-4.17). There was no significant difference in the type of
primary treatment received between the two groups (P � 0.16). Persistent
disease was seen in 46 (18%) of the younger patients and in 19 (38%) of
the older patients (P � 0.02). In the elderly cohort the treatment received
did not influence disease-specific or all-cause mortality. However, compared
to women under 65, older women treated surgically had increased
disease specific (HR 3.18, 95% CI: 0.98-10.3) and all-cause mortality
(HR 6.53, 95% CI: 2.57-16.6). Conclusions: Age does not appear to be a
factor influencing the treatment received by patients with Stage IB1-IIB
cervical cancer. The type of treatment received does not seem to affect
disease-specific mortality among older versus younger women. However,
surgery was associated with a 6.5-fold increased risk of all cause mortality
among older women when compared to women under 65 years.
Gynecologic Cancer
351s
5099 General Poster Session (Board #25C), Sun, 8:00 AM-12:00 PM
Prognostic factors and treatment-related outcomes in patients with uterine
serous cancer (USC). Presenting Author: Maria deLeon, Yale University,
New Haven, CT
Background: USC an uncommon (10%) but aggressive form of uterine
cancer, causes 50% of uterine cancer deaths. The purpose of this study is
to report a large single-institution experience with USC investigating the
effects of clinicopathological parameters and treatment on overall (OS) and
disease-free survival (DFS). Methods: Records from our institution were
reviewed from 1987-2009. All 334 USC patients (pts) identified were
surgically staged. Postoperative treatments used were: (1) observation
(OBS, n�33); (2) platinum-based chemotherapy (PCH, n�78); (3) whole
pelvis radiation therapy (WPRT, n�16); (4) PCH and vaginal apex brachytherapy
(PCHR, n�165); (5) vaginal apex brachytherapy (VAB, n�35). The
cancer stages were 121 pts IA (36.2%), 36 IB (10.8%), 27 II (8.1%), 39
IIIA (11.7%), 2 IIIB (0.6%), 32 IIIC1 (9.6%), 9 IIIC2 (2.7%), 28 IVA
(8.4%) and 40 IVB (12%). Results: The 5-year OS for stage IA/IB, II,
IIIA/IIIB, IIIC1/IIIC2, IVA/IVB were 82%, 70%, 64%, 36%, and 9%,
respectively. The 5-year DFS for stage IA/IB, II, IIIA/IIIB, IIIC1/IIIC2,
IVA/IVB were 82%, 68%, 56%, 24%, 6%, respectively. Advanced stage
was associated with significantly shorter OS and DFS (p �0.01). The 5-year
OS for stage IA/IB disease was 94% for pts who received PCHR, 90% for
OBS, 75% for PCH, 65% for VAB and 0% for WPRT. The 5-year DFS for
PCHR, OBS, PCH, VAB and WPRT for Stage IA/IB were 89%, 82%, 86%,
72% and 0% respectively. For stage II-IVB pts, the 5-year OS was 51% for
PCHR, 0% for OBS, 23% for PCH and 20% for WPRT. The 5-year DFS for
stage II-IVB with PCHR, OBS, PCH and WPRT were 42%, 0%, 17% and
13% respectively. Older age pts had worse survival, (p�0.01). Race and
BMI did not impact survival. Incomplete surgical debulking (p�0.01),
depth of myometrial invasion �50% (p�0.01) and lymph node metastasis
(p�0.01) were all associated with worse prognosis. Conclusions: PCHR
overall exhibited better OS and DFS regardless of disease stage. Age,
incomplete surgical debulking, depth of myometrial invasion and lymph
node involvement were independent prognostic factors in USC patients in
this study.
5101 General Poster Session (Board #26B), Sun, 8:00 AM-12:00 PM
Phase II trial of topotecan, cisplatin, and bevacizumab for recurrent or
persistent cervical cancer. Presenting Author: Israel Zighelboim, Washington
University School of Medicine and Siteman Cancer Center, St. Louis,
MO
Background: The prognosis associated with recurrent or persistent cervical
cancer is exceedingly poor. GOG-179 demonstrated a survival benefit with
the combination of cisplatin and topotecan compared to single-agent
cisplatin, with the former showing median PFS of 4.6 months, median OS
of 9.4 months, and a 27% objective response rate. The role of angiogenesis
in cervical carcinogenesis and progression has been well documented. We
evaluated the activity and safety of the combination of topotecan, cisplatin
and bevacizumab in patients with incurable carcinoma of the cervix.
Methods: Patients with histologically proven measurable recurrent or
persistent cervical carcinoma not amenable to curative intent treatment
were eligible. No prior chemotherapy for recurrence was allowed. Cisplatin
50 mg/m2 day 1, topotecan 0.75 mg/m2 days 1, 2 and 3 and bevacizumab
15 mg/kg day 1 were prescribed in a 21-day cycle. Cytokine support was
allowed at physician discretion. The primary endpoint was 6-month PFS.
Additionally, objective clinical response and toxicity were evaluated.
Accrual goal (N�27) was based on a 50% improvement goal in 6-month
PFS in relation to GOG-179 (40% to 60%), with a one-sided 0.10
significance and 80% power. Results: 27 eligible patients received a
median of 3 treatment cycles (range, 1-19). All patients received radiotherapy
as part of their first line treatment. Median follow-up was 8.5
months (1.2-32.9). The 6-month PFS was 59% (95%CI: 38.0-74.7).
Among 26 RECIST-evaluable patients, objective response rates were (%;
95%CI): 1 CR (4%; 1-19.6), 7 PR (27%; 11.6-47.8), 11 SD (42%;
23.4-63.1) and 7 PD (27%; 11.6-47.8). Median OS was 9.8 months
(95%CI: 7.7-20.6) and median PFS was 7.1 months (95%CI: 2.0-12.1).
Grade 3-4 hematologic toxicity occurred in 96% of patients (thrombocytopenia
93% leukopenia 70%, anemia 70%, neutropenia 59%). Other grade
3-4 toxicities were also common (metabolic 48%, pain 37%, genitourinary
30%, constitutional 22% and gastrointestinal 19%). Conclusions: The
addition of bevacizumab totopotecan and cisplatin results in a highly active
but toxic regimen. Future efforts should focus on identification of predictive
biomarkers and treatment modifications to minimize toxicity.
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