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

9512 Oral Abstract Session, Mon, 8:00 AM-11:00 AM
Evaluation of the effect of care at NCI comprehensive cancer centers
(NCICCCs) on disparities in outcome within adolescents and young adults
(AYAs) with cancer. Presenting Author: Julie Anna Wolfson, City of Hope,
Duarte, CA
Background: AYAs (15-39y at diagnosis) with cancer have not seen the
survival improvement evidenced by younger and older age groups with
similar diagnoses, leaving an AYA Gap. While treatment on pediatric
protocols is associated with superior survival in 15-21 year-olds, the
impact of site of care on survival for vulnerable AYA subpopulations (age at
diagnosis or race/ ethnicity) between 22-and 39y at diagnosis remains
unstudied. Methods: We constructed a cohort of 10,727 patients newly
diagnosed between the ages of 22- and 39y with lymphoma, leukemia,
brain tumors, melanoma, thyroid and GU cancers, and reported to the LA
County cancer registry between 1998 and 2008. Multivariable Cox
regression analysis was conducted, and included race/ethnicity, age at
diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis
year in the model; the analysis was stratified by site of care (NCICCC vs.
non-NCICCC). Results: A total of 928 (9%) patients received treatment at
the 3 NCICCCs (City of Hope, Jonsson Cancer Center and Norris Cancer
Center) in LA County, and 9,799 received care elsewhere. Five-year overall
survival (5y OS) was significantly worse for patients treated at non-NCICCC
(87%) when compared with those treated at NCICCC (84%, p�0.02). In
addition, 5y OS was worse for African Americans (71%) vs. non-Hispanic
whites (89%, p�0.0001) and for older patients (31-39yo: 84%, vs.
22-30yo: 86%, p�0.0004). Multivariable analysis adjusting for SES,
insurance status, diagnosis and diagnosis year revealed that African
Americans (HR�1.4, p�0.0002) and older AYAs (31-39y: HR�1.24,
p�0.0001) were at an increased risk of death. Among patients treated at
NCICCC, the difference in risk of death due to race (African Americans:
HR�0.8, p�0.7) and age (31-39yo: HR�1.1, p�0.6) was abrogated. On
the other hand, among patients treated at non-NCICCC, these differences
in outcome persisted (African Americans: HR�1.45, p �0.0002; 31-
39yo: HR�1.25, p�.0001). Conclusions: Population-based data reveal
that receipt of care at an NCICCC abrogates the effects of race and older
age on mortality in AYAs with cancer. Barriers to accessing care at NCICCCs
are being explored.
9514 Oral Abstract Session, Mon, 8:00 AM-11:00 AM
Increasing risk of chronic health conditions in aging survivors of childhood
cancer: A report from the Childhood Cancer Survivor Study. Presenting
Author: Gregory T. Armstrong, St. Jude Children’s Research Hospital,
Memphis, TN
Background: Survivors of childhood cancer are at an increased risk for
treatment-related chronic health conditions during early adulthood. However,
the incidence, severity, and spectrum of chronic health conditions in
the fourth and fifth decades of life have not been well studied. Methods:
Analyses included 14,358 � 5 yr survivors of childhood cancer (median
age at last follow-up 32.3 yrs, range 8.0-58.0; 21.4% � 40 years) and a
sibling comparison group (n � 4,031). Self-reported health conditions
were classified using NCI CTCAE 4.0 grading system. Analyses focused on
two primary outcomes: severe/life-threatening/fatal conditions (grades
3-5), and multiple (� 2) conditions. Cumulative incidence of a new chronic
health condition was calculated from age 26 yrs. Cox proportional hazards
models adjusted for gender and race, were evaluated using age as the time
scale. Results: Among survivors with no previous health conditions through
age 25, the cumulative incidence for a new grade 3-5 condition by age 50
compared to siblings was 45.9% (95% CI 45.9-45.9) vs. 13.9%, (95% CI
13.9-14.0) and for new onset of � 2 conditions 33.0% (95% CI
33.0-33.1) vs. 24.9% (95% CI 24.8-24.9) . Survivors � 40 yrs of age had
a 5.8-fold (95% CI 5.3 – 6.5) increased risk of a grade 3-5 condition
compared to same age siblings, in contrast to those � 40 years of age (HR
2.7, 95% CI 2.5-3.0). A similar magnitude of difference was present for
risk of �2 conditions (HR 2.7 vs. 1.2). In comparison to siblings, survivors
� 40 years of age had a significantly increased risk for: congestive heart
failure (HR 15.7, 95% CI 9.2-26.7), myocardial infarction (HR 8.8, 95%
CI 6.0-12.9), stroke (HR 8.6, 95% CI 5.6-13.2),joint replacement (HR
6.8, 95% CI 4.1-11.4), renal failure (HR 5.1, 95% CI 2.2-11.9) among
other serious conditions. Conclusions: As they age, adult survivors of
childhood cancer continue to develop new and serious health conditions at
substantially higher rates than siblings. These data emphasize the importance
of placing a greater focus on investigations of premature aging and
organ senescence in this high risk population.
Pediatric Oncology
609s
CRA9513 Oral Abstract Session, Mon, 8:00 AM-11:00 AM
New insights into the risk of breast cancer in childhood cancer survivors
treated with chest radiation: A report from the Childhood Cancer Survivor
Study (CCSS) and the Women’s Environmental Cancer and Radiation
Epidemiology (WECARE) Study. Presenting Author: Chaya S. Moskowitz,
Memorial Sloan-Kettering Cancer Center, New York, NY
The full, final text of this abstract will be available at
abstract.asco.org at 12:01 AM (EDT) on Monday, June 4,
2012, and in the Annual Meeting Proceedings online
supplement to the June 20, 2012, issue of Journal of
Clinical Oncology. Onsite at the Meeting, this abstract will
be printed in the Monday edition of ASCO Daily News.
9515 Oral Abstract Session, Mon, 8:00 AM-11:00 AM
A large prospective trial of children with unilateral retinoblastoma with and
without histopathologic high-risk features and the role of adjuvant chemotherapy:
A Children’s Oncology Group (COG) study. Presenting Author:
Murali M. Chintagumpala, Baylor College of Medicine, Houston, TX
Background: The definition of histopathologic high-risk features (HRF) in
enucleated eyes of children with unilateral retinoblastoma and their
contribution to metastases is controversial. The COG completed a large,
prospective international study to determine the prevalence of strictly
defined histopathologic HRF that are predictors of recurrence and the role
of chemotherapy to prevent recurrences. Methods: All patients who underwent
enucleation for unilateral retinoblastoma were eligible for the study.
Pathology slides were submitted for central review within 21 days of
enucleation. Patients with evidence of one or more high-risk features
(posterior uveal invasion grades IIC and D, concurrent optic nerve and
choroid involvement and post-lamina optic nerve involvement) as determined
by central review, received 6 cycles of chemotherapy consisting of
carboplatin, vincristine and etoposide. All others were observed. All
patients were followed for extraocular recurrences. Results: Patients were
enrolled from February of 2005 until May 2010. As of July 2011, the
median follow-up from enrollment was 1.9 years (max�5.3 years). Of 312
patients with central histopathology review, 49 patients had their risk
classification changed (13% with no HRF had HRF, 24% with HRF had no
HRF). Two patients developed extraocular disease and one patient died of
unknown cause. The death and one of the extraocular relapses occurred
among the 93 (2/93�2.2%, upper 95% CI 3.4%) patients assigned by the
central review to receive chemotherapy, while one patient experienced
extraocular relapse among the 209 (1/209�0.5%, upper 95% CI 0.6%)
assigned to observation only. There is no evidence of a difference in the
EFS and OS in these two groups. Conclusions: Preliminary results strongly
suggest that a central review of pathology can spare a significant number of
patients from exposure to chemotherapy. Chemotherapy may have contributed
to fewer relapses in patients with high-risk features as defined in this
study. The preliminary results from this study indicate an excellent
outcome with this approach.
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