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

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1032 Poster Discussion Session (Board #24), Mon, 1:15 PM-5:15 PM and<br />

4:45 PM-5:45 PM<br />

Impact <strong>of</strong> surgery and radiation <strong>of</strong> the primary among women with de novo<br />

stage IV breast cancer. Presenting Author: Shaheenah S. Dawood, Dubai<br />

Hospital, Dubai, United Arab Emirates<br />

Background: The aim <strong>of</strong> this retrospective study was to determine the<br />

impact <strong>of</strong> surgery(S) and radiation(R) therapy to the primary tumor among<br />

patients (pts) with stage IV denovo breast cancer. Methods: The SEER<br />

registry was used to identify pts with denovo stageIV breast cancer<br />

diagnosed between 1988 and 2008. Pts were divided into 4 groups based<br />

on type <strong>of</strong> treatment to primary tumor: both S�R, S alone, R alone, or no<br />

treatment <strong>of</strong> primary (no S/R). Breast cancer specific survival (BCS) was<br />

calculated from the date <strong>of</strong> diagnosis <strong>of</strong> breast cancer to the date <strong>of</strong> death<br />

from breast cancer or last follow up. Survival outcomes were estimated by<br />

the Kaplan-Meier method, and Cox models were fit to determine the<br />

association between treatment <strong>of</strong> primary and survival after adjusting for<br />

potential confounders (e.g age, grade, hormone receptor and race). Results:<br />

25903 pts were identified; 4640 (17.9%) S�R, 6556 (25.3%) S, 4467<br />

(17.2%) R, and 10240 (39.5%) no S/R. 1183 (4.6%) had surgery to sites<br />

other than the primary. Median age was 63 years. Median follow-up was 14<br />

months. Median BCS was 23 months. Median BCS among pts who<br />

underwent S�R, S, R and no S/R was 36 months, 31 months, 18 months<br />

and 15 months respectively (p�0.0001). Among pts who underwent S�R,<br />

median BCS among pts who did and did not have surgery to sites other than<br />

primary was 50 months and 41 months respectively (p�0.029). Of the pts<br />

treated with S�R 10-year BCS was 18%. In the multivariable model<br />

compared to women who were in the no S/R group those who underwent S<br />

(HR� 0.59, 95%CI 0.55- 0.62,p�0.0001) and S�R (HR�0.51, 95%CI<br />

0.47-0.55,p�0.0001) had decreased risk <strong>of</strong> death from breast cancer and<br />

those who underwent R (HR�1.13, 95% CI 1.04-1.21, p�0.002) had an<br />

increased risk <strong>of</strong> death from breast cancer. Pts who had surgery to sites<br />

other than the primary tumor had decreased risk <strong>of</strong> death from breast<br />

cancer compared to those who did not (HR�0.80, 95%CI 0.72-<br />

0.89,p�0.0001). Conclusions: Our results indicate that S�R <strong>of</strong> the<br />

primary breast tumor among pts with denovo stage IV breast cancer maybe<br />

associated with a decreased risk <strong>of</strong> death from breast cancer. A select<br />

subgroup <strong>of</strong> pts who undergo S�R may also benefit from surgery to sites<br />

other than the primary which may afford them maximum survival advantage.<br />

1034 General Poster Session (Board #19A), Sat, 8:00 AM-12:00 PM<br />

Impact <strong>of</strong> adjuvant chemotherapy on recurrence-free survival in patients<br />

with pT1a/b hormone-negative and HER2-positive breast cancer. Presenting<br />

Author: Yazan Migdady, Memorial Hospital <strong>of</strong> Rhode Island, Pawtucket,<br />

RI<br />

Background: T1ab triple-negative (TN) or Her-2-positive (H2�) breast<br />

cancers are reported to pose relatively high risk <strong>of</strong> relapse, but benefits <strong>of</strong><br />

adjuvant chemotherapy are uncertain. We studied the impact <strong>of</strong> chemotherapy<br />

on recurrence-free survival in this group. Methods: Records <strong>of</strong> all<br />

consecutive cases diagnosed in Brown-affiliated centers in 2000 - 2010<br />

were reviewed. Factors influencing chemotherapy decision were studied<br />

with logistic regression, and recurrence-free interval (RFI) with a Cox<br />

proportional hazard model and Kaplan-Meier estimator. Results: Among<br />

1415 screened T1a/b N0 cases, 161 were eligible (57 TN; 104 HER2�),<br />

with a median age <strong>of</strong> 57 years; 66% tumors were T1b. 20% <strong>of</strong> patients<br />

underwent mastectomy, 76% received radiation and 30% hormonal<br />

therapy. Adjuvant chemotherapy was recommended in 53% <strong>of</strong> cases.<br />

Younger age (p�10-6 ), stage T1b (p�10-5 ), high grade (p�0.001),<br />

HER2�/ERPR- status (p�0.017) and diagnosis after 2006 (p�0.007)<br />

were significantly predictive <strong>of</strong> the medical oncology recommendation.<br />

There was a significant trend with decrease in anthracycline (p�0.001)<br />

and increase in taxane use (p�0.001). With a median follow up <strong>of</strong> 46<br />

months, the 5-year rate <strong>of</strong> relapse was 6.1% (95%CI 2.7-13.9%),<br />

somewhat higher in T1b tumors (8.1%) and without detectable difference<br />

in TN/HER2� subgroups. In a univariate analysis chemotherapy did not<br />

significantly impact the recurrence-free interval (HR�0.45; 95%CI 0.09-<br />

2.34; p�0.32), however there was a detectable benefit (p�0.02) for T1b<br />

tumors in a multivariable Cox model including age (p�0.02) and LVI<br />

(p�0.01). The histology, type <strong>of</strong> surgery and year <strong>of</strong> diagnosis were not<br />

significant. There were no relapses among ER/PR� patients who received<br />

hormonal therapy or HER2� patients who received trastuzumab.<br />

Conclusions: The risk <strong>of</strong> relapse in biologically aggressive T1ab breast<br />

cancers is very low with judicious use <strong>of</strong> adjuvant therapy. The benefit <strong>of</strong><br />

chemotherapy is likely restricted to the highest-risk patients with T1b<br />

tumors, lymphovascular invasion and younger age.<br />

Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy<br />

57s<br />

1033 Poster Discussion Session (Board #25), Mon, 1:15 PM-5:15 PM and<br />

4:45 PM-5:45 PM<br />

Utilization <strong>of</strong> post-lumpectomy radiation therapy in women 70 years <strong>of</strong> age<br />

or older: A report from the National Cancer Data Base. Presenting Author:<br />

Katharine Yao, NorthShore University HealthSystem, Evanston, IL<br />

Background: The Cancer and Leukemia Group B (CALGB) 9343 trial<br />

published in 2004 showed no overall survival benefit from radiation in<br />

patients �70 years old with estrogen receptor (ER) positive, pT1 tumors<br />

with the use <strong>of</strong> tamoxifen. We tested the hypothesis that the use <strong>of</strong><br />

radiotherapy decreased in this group <strong>of</strong> patients following publication <strong>of</strong> the<br />

trial, utilizing the National Cancer Data Base. Methods: 34,853 breast<br />

cancer patients 70 years or older with pT1N0/NX, ER positive tumors who<br />

underwent a lumpectomy between 2004 and 2007 were studied. Chisquare<br />

tests and logistic regression models were used to determine trends<br />

and factors related to the use <strong>of</strong> radiation. Results: The use <strong>of</strong> radiation<br />

decreased from 70.6% in 2004 to 66.4% in 2005, 66.6% in 2006, and<br />

67.2% in 2007 (p�0.001). The use <strong>of</strong> standard external beam radiation<br />

decreased from 58.8% in 2004 to 45.8% in 2007 while the use <strong>of</strong><br />

accelerated partial breast radiation using brachytherapy (APBI) increased<br />

from 4.5% to 10.0%, IMRT radiation from 3.1% to 5.3%, and 3D<br />

conformal radiation from 3.7% to 5.7% (p�0.001). Patients between the<br />

ages <strong>of</strong> 86� years old were less likely to undergo radiation than patients<br />

70-75 years old (OR�0.12, 95% CI: 0.11-0.13). Asian Pacific Islanders<br />

were more likely to undergo radiation than whites (OR�1.39, 95% CI:<br />

1.13-1.70). In community cancer programs, 67% patients received<br />

radiation, compared to 69.1% in comprehensive community programs and<br />

65.5% in academic programs (p�0.001). The use <strong>of</strong> radiation varied by<br />

facility location; 73.5% <strong>of</strong> facilities located in the Midwest radiated these<br />

patients as opposed to 62.6% in the South. In patients who had no nodes<br />

examined, 37% underwent radiation as opposed to 74% who did have<br />

nodes examined (p�0.001). Likewise, 79.4% <strong>of</strong> patients who received<br />

hormone therapy underwent radiation as opposed to 54.6% <strong>of</strong> patients who<br />

did not receive hormonal therapy (p�0.001). Conclusions: The use <strong>of</strong><br />

radiation therapy decreased only slightly and remained high in women with<br />

ER� stage I breast cancer over the age <strong>of</strong> 70, despite findings from the<br />

CALGB 9343 study. However, there was a large shift in radiation modality<br />

over the study period in the older patients.<br />

1035 General Poster Session (Board #19B), Sat, 8:00 AM-12:00 PM<br />

Pathologic complete response rates observed in women with locally<br />

advanced and inflammatory breast cancer receiving neoadjuvant carboplatin<br />

and paclitaxel. Presenting Author: Arvind Manohar Shinde, City <strong>of</strong><br />

Hope, Duarte, CA<br />

Background: Pathologic complete response (pCR) following neoadjuvant<br />

chemotherapy (NCT) is predictive <strong>of</strong> outcome in patients with locally<br />

advanced breast cancer (LABC). A non-anthracycline containing NCT<br />

regimen (Sikov et al. JCO 10/09) may reduce the risk <strong>of</strong> associated<br />

secondary hematologic malignancies and cardiac toxicity while yielding<br />

comparable pCR rates. Methods: A retrospective review <strong>of</strong> all LABC and<br />

inflammatory breast cancer (IBC) cases treated from 4/09 to 12/11 with a<br />

NCT regimen <strong>of</strong> carboplatin (AUC <strong>of</strong> 6, administered on day 1) and<br />

paclitaxel 80 mg/m2 (given weekly on a 21-28 day cycle) was conducted at<br />

the City <strong>of</strong> Hope Cancer Center (COHCC). Pts with HER2� (HER�) tumors<br />

received trastuzumab during the NCT treatment. All pCRs (pCR <strong>of</strong> primary<br />

only – �pCR1°�; pCR <strong>of</strong> primary and lymph nodes – �pCR-All�) were<br />

determined by a COHCC pathologist based on final surgical specimens.<br />

Results: 38 pts were identified, with 39 breast primaries; 18% had IBC,<br />

62% <strong>of</strong> LABCs/IBCs were hormone receptor positive (HR�), 46% <strong>of</strong> tumors<br />

were HER2�, and 26% were triple negative. Median age was 51 [27-63].<br />

All pts completed the planned number <strong>of</strong> cycles. Four pts required<br />

carboplatin dose reductions, 4 pts required dose reductions in paclitaxel, 3<br />

pts had paclitaxel changed to nab-paclitaxel, and 17 pts required G-CSF to<br />

complete their planned treatment. One pt receiving trastuzumab experienced<br />

asymptomatic LVEF decline below normal limits. Conclusions: A<br />

non-anthracycline-containing NCT regimen <strong>of</strong> carboplatin/paclitaxel was<br />

well tolerated and resulted in high pCRs when given to triple negative<br />

(HER2-/HR-) pts, and HER2� pts, especially with HER2�HR- subtypes.<br />

The findings warrant further studies <strong>of</strong> this regimen in a prospective<br />

randomized setting.<br />

HER2 status N pCR1° (%) pCR-All (%) HR status N pCR1° (%) pCR-All (%)<br />

HER2� BC 18 56 44 HR� 13 38 31<br />

HR- 5 100 80<br />

HER2- BC 21 38 29 HR� 11 9 0<br />

HR- 10 70 60<br />

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